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Core Commitments

for Children

are the core UNICEF policy and framework for humanitarian action

HEALTH

 

Key Considerations

Advocacy

  • Advocate with national and local authorities (and in conflict-affected contexts with all parties to conflict), donors, partners and caregivers for every child and woman’s right to health[48], using global and national commitments around ensuring healthy lives and promoting well-being for all at all ages, including SDG 3 on health[49], the CRC and the Astana Commitment.

  • Advocate for greater and timely investments to ensure timely access to life-saving care and to quality maternal, neonatal, child and adolescent health services.

  • Advocate for the protection of health workers, health care users, health facilities, supplies and ambulances, with reference to IHL and relevant Security Council resolutions, including  Resolution 2286.[50]

  • In conflict affected contexts, establish a dialogue with all parties to conflict around access to health services and in line with IHL.

Coordination and Partnerships 

  • Clarify the responsibilities of UNICEF, national and local authorities and partners in response plans as early as possible.

  • Ensure that the rights and needs of newborns, children, adolescents and women are adequately captured in interagency and health sector assessments, strategies and programming.

  • Identify and address any gaps or bottlenecks in coordination mechanisms in collaboration with governments, the World Health Organisation (WHO) and other partners.

  • Ensure coordination with mental health actors and psycho-social support services as per IASC Guidelines on Mental Health and Psycho-social Support.

 

Quality Programming and Standards

  • Foster an integrated multi-sectoral response: collaborate closely with other sectors (especially Nutrition, WASH, Education, Protection and Community Engagement for Behaviour and Social Change) for an integrated response to displacement, disease outbreaks, natural disasters and other situations that require multi-sectoral and integrated approaches. 

  • Focus on the most deprived and hard-to-reach: newborns, children, adolescents and women, especially in remote rural areas, urban slums and poorest and hard-to-reach communities who are often dis-proportionally affected by humanitarian crises.

  • In the case of a mass casualty event, when governments or partners call for UNICEF’s support, ensure affected populations, especially newborns, children, adolescents and women, have access to first aid, emergency and trauma care and that health authorities are supported to launch and implement a comprehensive response, including psycho-social support.  In areas at risk of such events, UNICEF and its partners, especially the health cluster/sector lead agency, should ensure preparedness for response.  

  • Healthcare facilities must be safe and child-friendly in line with early childhood development principles, as per the Framework on Nurturing Care, in terms of design, information provided and access.

  • Rights and needs of children with disabilities and their caregivers must be considered during needs assessments, humanitarian needs overview exercises, response and recovery efforts.

  • Work with GBV actors and coordination mechanisms to reduce risks of GBV and ensure provision of care for survivors of GBV. Equip and train health personnel with up-to-date information on available GBV response services and referral procedures to support GBV survivors. If there are no GBV actors available, train health staff on the GBV Pocket Guide.

  • Systematically engage affected communities and local authorities in preparedness and preventive action at community level, and in the design, planning and monitoring of health programmes.

  • Using safe and confidential feedback and reporting mechanisms based on affected populations’ preferred methods of communication, systematically use their views to review, inform and correct health interventions.

  • Ensure that children, adolescents, caregivers and communities participate in decisions that affect their lives and have access to safe and confidential complaints mechanisms.

 

Linking Humanitarian and Development

  • Preventing health system and service collapse is of utmost importance soon after the initial shock to ensure ability to deliver all other programme commitments and reduce efforts and resources needed for early recovery. UNICEF should provide critical inputs towards re-establishment of routine services, e.g. cold chain for resumption of Expanded Programme on Immunisation services.

  • Support the decentralisation and strengthening of primary health care in areas most subjected to natural disaster and conflict.

  • Ensure front-line health workers are mobilised and supported by their local communities, authorities and CSOs, including local women’s and children’s organisations/groups, and mechanisms are in place for rapid expansion of integrated community services when needed.

  • Identify and strengthen the capacity of existing community structures to respond to shock and contribute to the reconstruction of systems as soon as the context allows for recovery interventions to reduce needs, vulnerabilities and risks of affected populations.

  • Strengthen resilience of communities and health infrastructure to withstand disaster-related   hazards such as floods, hurricanes or earthquakes as determined by the risk assessment. 

Strategic Result

Children, adolescents and women have access to life-saving, high-impact and quality health services

Commitment

Benchmarks

UNICEF actively contributes to the interagency and intersectoral coordination mechanisms

1: Leadership and coordination

 

Effective leadership and coordination are established and functional

See 2.1.2 Coordination

  • At least 90% of pregnant women and adolescent girls receive scheduled antenatal care[37] (ANC) in line with coverage of 4+ ANC visits

  • At least 90% of pregnant women and adolescent girls receive skilled attendance at birth including essential newborn care, with desired quality[38],[39]

  • At least 80% of mothers and newborns receive early routine postnatal care within two days following birth

  • At least 80% of small and sick newborns have access to inpatient level 2[40]  special newborn care within two hours of travel time

2: Maternal and neonatal health

 

Women, adolescent girls and newborns safely and equitably access quality life-saving and high-impact[35], [36] maternal and neonatal health services

  • At least 80% of the targeted children and women receive routine vaccinations, including in hard-to-reach areas[41]

  • At least 95% of the targeted population are reached during vaccination campaigns conducted to reduce risk of epidemic-prone outbreaks[42]

3: Immunization

 

Children and women receive routine and supplemental vaccinations

  • Children and adolescents have safe and uninterrupted access to health services through functional health facilities, school and community-based activities and at the household level

  • Children and adolescents receive quality, age- and gender-appropriate prevention, diagnosis and treatment for common causes of illness and death

  • Children, adolescents and caregivers have access to psychosocial support

4: Child and adolescent health

 

Children and adolescents safely and equitably access quality life-saving and high-impact child health services

  • At least 70% of UNICEF supported facilities have adequate cohort of staff appropriately trained for providing basic health services[43]

  • At least 70% of UNICEF supported facilities apply Quality of Care (QoC)[44] or clinical audit standards for reproductive, maternal, newborn, child and adolescent health and nutrition care (RMNCAHN)[45] 

  • At least 70% of UNICEF supported facilities and/or frontline workers submit data in real time for the health management information system (HMIS), reproductive, maternal, newborn, child and adolescent health and nutrition care (RMNCAHN) service mapping and for meeting the International Health Regulations (IHR) guidelines[46]

  • All subnational storage points report no stock outs of the key health products[47]

5:  Strengthening of health systems and services

 

Primary health care continues to be provided through health facilities and community-based service delivery mechanisms 

 

See 2.2.4 Linking humanitarian and development

  • Children, their caregivers and communities are aware of available health services and how and where to access them

  • Children, their caregivers and communities are engaged through participatory behaviour change interventions

  • Adolescents have access to information on health, including sexual, reproductive and mental health

6: Community engagement for behaviour and social change

 

At-risk and affected populations have timely access to culturally appropriate, gender- and age-sensitive information and interventions, to improve preventive and curative health care practices

 

See 2.2.7 Community engagement for behaviour and social change

Footnotes

[35] 16 high impact lifesaving interventions: Darmstadt GL, Bhutta ZA, Cousens S, Adam T, Walker N, de Bernis L, Lancet Neonatal Survival Steering Team: NSS, Evidence-based, cost-effective interventions: how many newborn babies can we save? Lancet. 2005, 365 (9463): 977-988. 10.1016/S0140-6736(05)71088-6.

[36] Preconception: (1) Folic acid supplementation; Antenatal (2) Tetanus toxoid immunization, (3) Syphilis screening and treatment, (4) Pre-eclampsia and eclampsia: prevention (calcium supplementation), (5) Intermittent presumptive treatment for malaria, (6) Detection and treatment of asymptomatic bacteriuria; Intrapartum (7) Antibiotics for preterm premature rupture of membranes, (8) Corticosteroids for preterm labour, (9) Detection and management of breech (caesarian section), (10) Labour surveillance (including partograph) for early diagnosis of complications, (11) Clean delivery practices; Postnatal: (12) Resuscitation of newborn baby, (13) Breastfeeding, (14) Prevention and management of hypothermia, (15) Kangaroo mother care (low birthweight infants in health facilities), and (16)  Community-based pneumonia case management.

[37] Antenatal care (ANC) is provided by skilled health-care professionals to pregnant women and adolescent girls in order to ensure the best

health conditions for both mother and baby during pregnancy. The components of ANC include risk identification; prevention and management

of pregnancy-related or concurrent diseases; health education and health promotion.                    

For details see WHO recommendations on Antenatal care for a positive pregnancy experience.

[38] Operational definitions for the characteristics of Quality of Care for maternal and newborn health: (1) Safe—delivering health care which minimises risks and harm to service users, including avoiding preventable injuries and reducing medical errors, (2) Effective—providing services based on scientific knowledge and evidence-based guidelines, (3) Timely—reducing delays in providing/receiving health care, (4) Efficient—delivering health care in a manner which maximises resource use and avoids wastage, (5) Equitable—delivering health care which does not vary in quality because of personal characteristics such as gender, race, ethnicity, geographical location or socioeconomic status, and (6) People-centred—providing care which takes into account the preferences and aspirations of individual service users and the cultures of their communities.

[39] For details of quality of care standards, result statements and measures, refer to WHO Standards for improving quality of maternal and newborn care in health facilities, 2016

[40] Key inpatient care (24/7) practices for small and sick newborns, including (but not exclusively): provision of warmth; support for feeding and breathing; treatment of jaundice; prevention and treatment of infection. Special newborn care does not include the provision of intermittent positive-pressure therapy. Special newborn care can only be provided in a health facility

See WHO and UNICEF, Survive and Thrive: Transforming care for every small and sick newborn, 2019. p.60 and 130.

[41] Routine vaccination schedules are determined by national standards. Coverage levels should be scrutinised at sub-national level (3rd administrative level) to ensure equitable coverage. Refer to targets in Global Vaccine Action Plan 2011-2020 and the soon to be released Global Vaccine Action Plan 2021-2030.

[42] As defined in the  Global Vaccine Action Plan 2011-2020 and the soon to be released Global Vaccine Action Plan 2021-2030 and based on decision- making framework for vaccination in acute humanitarian emergencies.

[43] This benchmark is specific to health facilities; however, an equivalent benchmark will be used for community-based service delivery through a community-based cadre of health workers, for countries/ contexts with community health systems in place.

[44] Quality of care (QoC) is defined as “the extent to which health care services provided to individuals and patient populations improve desired health outcomes. In order to achieve this, health care must be safe, effective, timely, efficient, equitable and people-centred.” See WHO, What is the Quality of Care Network?

[45] See UNICEF, The UNICEF Health Systems Strengthening Approach, 2016.

[46] See WHO, About IHR.

[47] The United Nations Commission on Life-Saving Commodities for Women and Children aims to increase access to life-saving medicines and health supplies for the world's most vulnerable people by championing efforts to reduce barriers that block access to essential health commodities. These 13 commodities are Oxytocin, Misoprostol, Magnesium sulphate, Injectable antibiotics, Antenatal corticosteroids, Chlorhexidine, Resuscitation devices, Amoxicillin, Oral rehydration salts, Zinc, Female condoms, Contraceptive implants and emergency contraceptives.

[48] The WHO Constitution (1946): “…the highest attainable standard of health as a fundamental right of every human being.”

[49] See UNICEF and the SDGs.

[50] “Strongly condemns acts of violence, attacks and threats against the wounded and sick, medical personnel and humanitarian personnel exclusively engaged in medical duties, their means of transport and equipment, as well as hospitals and other medical facilities…” (op para 1) and “Demands that all parties to armed conflicts fully comply with their obligations under international law to ensure the respect and protection of all medical personnel and humanitarian personnel exclusively engaged in medical duties….” (op para 2).

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