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The 2021 Situation Analysis of the Statusand Well-Being of Children in ZambiaOctober 2021

The Government of Zambia and UNICEF thanks the Centre for International Development and Training (CIDT),University of Wolverhampton and the Zambia Council for Social Development Data for their support in theproduction of this Situation Analysis.Cover photo UNICEF/Zambia/2021/Siakachoma

FOREWORDThis 2021 Situation Analysis of the Status and Well-being of Children in Zambia is the culmination ofa joint effort by the Government of the Republic of Zambia and the United Nations Children’s Fund(UNICEF) to take stock of the progress that has been made towards improving the welfare of childrenin Zambia, to better understand the vulnerabilities they still face, and the reasons and drivers behindthe deprivations faced by many children which consequently impede the full enjoyment of theirrights.This analysis comes at an opportune time as Zambia develops its Eighth National Development Plan;as the United Nations in Zambia develops its next five-year Sustainable Development CooperationFramework; and as UNICEF develops its five-year programme of cooperation with the Government.The common thread that runs through all these plans and frameworks is the shared commitmentto promote the rights and well-being of Zambia’s children, who make up over half of Zambia’spopulation.The following pages present an important snapshot and record of the status of child developmentand respect for child rights in Zambia. Behind each statistic is the story of Zambia’s children, andthe opportunities and obstacles they face through their life course. This report, therefore, providesinsights into areas where the situation of children has improved, and where significant challengesremain.This report is intended to inspire action towards stepping up efforts where evidence has presentedpoor outcomes for children, while also building upon the good lessons and doing more and betterfor Zambia’s children, and in doing so – secure the future of Zambia by achieving the ambitioustargets the country has set for itself.Permanent SecretaryMinistry of Finance and National PlanningMr. Trevor KaundaRepresentativeUNICEF ZambiaMs. Noala Skinner

Table of ContentsABBREVIATIONS . 6EXECUTIVE SUMMARY . 8CHAPTER 1. INTRODUCTION TO THE SITUATION ANALYSIS.191.1Purpose of the 2021 situation analysis .191.2Methodological framework of the situation analysis .191.3Issues and limitations .20CHAPTER 2. COUNTRY OVERVIEW .212.1Zambia’s progress towards sustainable development goals .212.2International, regional, and national legal and policy framework .232.3Demographic profile.242.4Political economy and governance .252.5The macroeconomic context .252.6The poverty context .262.7Gender profile .28CHAPTER 3. EARLY CHILDHOOD DEVELOPMENT .343.1Introduction .343.2Legal and policy framework.353.3Levels, trends and differentials in key indicators .373.4Challenges, shortfalls and inequities .413.5Stakeholder landscape and initiatives .423.6Sector specific recommendations .45CHAPTER 4. EDUCATION .474.1Introduction .474.2Legal and policy framework.474.3Levels, trends and differentials in key indicators .504.4Challenges, shortfalls and inequities .554.5Stakeholders, initiatives and opportunities .564.6Sector specific recommendations .57CHAPTER 5. HEALTH.585.1Introduction .585.2Legal and policy framework.585.3Levels, trends and differentials in key indicators .582

5.4Challenges, shortfalls and inequities .695.5Stakeholders, initiatives and opportunities .725.6Sector specific recommendations .74CHAPTER 6. NUTRITION .786.1Introduction .786.2Legal and policy framework.796.3Levels, trends and differentials in key indicators .806.4Challenges, shortfalls and inequities .836.5Stakeholder landscapes and initiatives .846.6Sector specific recommendations .85CHAPTER 7. WATER, SANITATION AND HYGIENE.877.1Introduction .877.2Legal and policy framework.877.3Levels, trends and differentials in key indicators .897.4Challenges, shortfalls and inequities .957.5Stakeholder landscape and initiatives .987.6.Sector specific recommendations .99CHAPTER 8. ADOLESCENCE. 1018.1Introduction . 1018.2Legal and policy framework. 1018.3Levels, trends and differentials in key indicators . 1028.4Challenges, shortfalls and inequities . 1108.5Stakeholder landscape and initiatives . 1128.6Sector specific recommendations . 112Chapter 9. CHILDREN AND PARTICIPATION . 1149.1Introduction . 1149.2Legal and policy framework. 1159.3Levels, trends and differentials in key indicators . 1169.4Challenges, shortfalls and inequities . 1189.5Stakeholder landscape and initiatives . 1199.6Sector specific recommendations . 120CHAPTER 10. DISABILITY . 12010.1Introduction . 1203

10.2Legal and policy framework. 12110.3Levels, trends and differentials in key indicators . 12210.4Challenges, shortfalls and inequities . 12410.5Stakeholder landscape and initiatives . 12610.6Sector specific recommendations . 126CHAPTER 11. CHILD PROTECTION . 12711.1Introduction . 12711.2Legal and policy landscape . 12711.3Levels, trends and differentials in key indicators . 13211.4Challenges, shortfalls and inequities . 14011.5Stakeholder landscape and initiatives . 14311.6Sector specific recommendations . 144CHAPTER 12. SOCIAL PROTECTION . 14812.1Introduction . 14812.2Legal and policy framework. 14912.3Levels, trends and differentials in key indicators . 15112.4Challenges, shortfalls and inequities . 15512.5Stakeholder landscape and initiatives . 15712.6Sector specific recommendations . 1584

Figures and TablesFigure 1: Proportion of out-of-school children and adolescents in Zambia (weighted) . 53Figure 2: New HIV infections among children due to gaps in PMTCT . 65Figure 3: Trends in nutritional status . 80Figure 4: Healthcare facilities’ access to services . 92Figure 5: WASH services in healthcare facilities . 93Figure 6: Percentage distribution of households by source of drinking water . 94Figure 7: A trends analysis of budget allocation to WASH . 97Figure 8: Percentage of women aged 15–19 years who have begun childbearing by residence . 103Figure 9: Trends in age-specific and total fertility rates per 1,000 births for 15- to 19-year-olds (ZDHS2018) . 104Figure 10: National Operational Plan 2017–2021: Six priority areas and delivery modalities for promotionof adolescent health and well-being. . 105Figure 11: Progress towards 90:90:90 targets in 2016 in percentages . 107Figure 12: Birth registration by province. 132Figure 13: Trends in allocation of SCT 2015–2021 . 152Table 1: Sexual violence experienced by women (percentage) by residence and wealth quintile . 32Table 2: Supply of primary and secondary schools 2009–2018 . 48Table 3: Supply of primary and secondary schools by location. 49Table 4: Out-of-school children from 2014–2018 . 52Table 5: Status of school-going children . 52Table 6: Transition rate by gender and province . 53Table 7: Comparison of mortality in children under one year and children between ages one and fiveyears . 60Table 8: Newborn deaths over a ten-year period . 61Table 9: Factors associated with newborn deaths . 61Table 10: Newborn deaths and mothers' characteristics . 63Table 11: Downward trend of RMNCH services . 70Table 12: Health facilities’ access to WASH. 92Table 13: Population of adolescents by gender . 102Table 14: Current social protection by pillar . 148Table 15: 2021 budget allocation to MCDSS . 1525

ABBREVIATIONS7NDPSeventh National Development PlanAFDBAfrican Development BankAIDSAcquired Immune Deficiency SyndromeANCAntenatal CareARTAntiretroviral TherapyCMRChild Mortality RatioCRCConvention on the Rights of the ChildCSOCivil Society OrganisationCSRHEComprehensive Sexual and Reproductive Health EducationDHSDemographic and Health SurveyECDEarly Childhood DevelopmentECEEarly Childhood EducationFAOFood and Agriculture Organization (of the United Nations)FGDFocus Group DiscussionFISPFarmer Input Support ProgrammeFSPFood Security PackGDPGross Domestic ProductGEIGender Equality IndexGEWELGirl Education Women Empowerment and LivelihoodsGIIGender Inequality IndexHDIHuman Development IndexHIVHuman Immunodeficiency VirusICCMIntegrated Community Case ManagementILOInternational Labour OrganizationIMCIIntegrated Management of Childhood IllnessesIMFInternational Monetary FundIYCFInfant and Young Child FeedingJMPJoint Monitoring ProgrammeKGSKeeping Girls in SchoolsKIIKey informant interviewLCMSLiving Conditions Monitoring SurveyM&EMonitoring and EvaluationMCDPFirst 1,000 Most Critical Days Programme6

MCDSSMinistry of Community Development and Social ServicesMHMMenstrual Hygiene ManagementMLSSMinistry of Labour and Social ServicesMMRMaternal Mortality RatioMNPDMinistry of National Planning and DevelopmentMoAMinistry of AgricultureMODAMultiple Overlapping Deprivation AnalysisMoGEMinistry of General EducationMPIMultidimensional Poverty IndexMTCTMother to Child TransmissionMYSCDMinistry of Youth, Sport and Child DevelopmentNGONon-Governmental OrganisationNMRNewborn Mortality RateNPFNational Planning FrameworkNSPPNational Social Protection PolicyPHCPrimary Health CarePWASPublic Welfare Assistance SchemeRMNCHReproductive, Maternal, Newborn and Child HealthSCTsSocial Cash TransfersSDGsSustainable Development GoalsSRHRSexual Reproductive Health RightsSUNScaling-Up NutritionU5MRUnder-five Mortality RateUHCUniversal Health CoverageUNICEFUnited Nations Children’s FundUNJPSPUnited Nations Joint Programme on Social ProtectionVNRVoluntary National ReviewWASHWater, Sanitation and HygieneWBWorld BankWHOWorld Health OrganizationZamStatsZambia Statistics AgencyZDHSZambia Demographic and Health Survey7

EXECUTIVE SUMMARYThis report examines the current national context and Zambia’s progress in safeguarding the rights andimproving the welfare of children and adolescents. It also identifies causes of shortfalls and inequities todirectly address issues through risk-informed, equity-focused efforts. Findings and insights presented inthe report are based on nationally endorsed data sources, such as the Zambia Demographic and HealthSurvey (ZDHS), Living Conditions Monitoring Survey, National Census, Vision 2030, the Seventh NationalDevelopment Plan (7NDP), budget analyses, published scientific and grey literature, and sector-specificanalyses and administrative data (e.g., the Health Management Information System and EducationManagement Information System). Furthermore, to investigate trends in the situation of children andadolescents in Zambia on the ground, field research was conducted across six provinces in Zambia:Luapula, Copperbelt, Southern, Western, Eastern and Central.The national contextZambia has one of the world’s fastest growing populations. The United Nations projects that thepopulation will almost triple by 2050. If this is the case, then any economic growth under 2.7 per centper annum (and thus below population growth) will lead to lower income per capita, and thus thecountry would end up being poorer by 2050. The economy needs to grow by significantly higherproportions and include the poorer strata of society to reduce poverty. While approximately 59 per centof the population resides in rural areas, the trend is being reversed as urban population growth outstripsrural growth. With three quarters of its population estimated to be living on less than US 1.90 per day,this lower-middle-income country has high levels of inequity in income distribution. About 54 per centof the population lives below the poverty line. Inequality remains high and Zambia recorded a Ginicoefficient of 49.50 in 2018: this points to significant room for wealth redistribution in addition todriving an agenda of inclusive growth for poverty reduction. Poverty in its multiple dimensions is alsoaddressed by public social policies. However, increasing public debt together with inadequate budgetallocations to social sectors have created constraints for social spending. Nearly three-quarters ofZambia’s tax revenues go toward debt service. In 2019, Zambia had a budget deficit of 10.9 per cent ofgross domestic product (GDP).Zambia has a legal framework that guarantees equality between men and women. The extent towhich these legislations have translated into outcomes for women can be deciphered through certaintrends and data. The number of women who reported to have experienced physical violence hasdeclined from 43.3 per cent in 2014 to 36 per cent in 2018. The proportion of seats held by women inthe Parliament has remained low at 19 per cent since 2016. On a positive note, the proportion of localgovernment seats held by women rose from 10 per cent in 2016 to 38 per cent in 2019. Challenges intranslating policy and regulation to action include lack of gender-disaggregated data for planning,monitoring, and evaluation (M&E); difficulties in enforcing statutory law in a traditional setting andpersistent low representation of women in leadership.Early childhood developmentThe crucial structural foundation for human and social development is laid in the first 1,000 days of achild’s life. These early years represent a critical development phase of the parts of the brain that areresponsible for physical and motor activities, thought, memory, social and emotional behaviours,perceptual and sensory faculties, and language. Holistic and integrated early childhood development(ECD) interventions in life—in health, nutrition, nurturing care, water and sanitation, early learning, andprotection, therefore set a trajectory for lifelong good health and well-being.8

The current situation analysis found the quality of early childhood education (ECE) to be wanting inZambia: 40 per cent of teachers are untrained and those who are trained are not necessarily trained inappropriate pedagogy for early years education. Currently only 35 per cent of children have access toearly learning,1 especially in rural and hard-to-reach areas and this is widening the equity gap. The 2017–2021 Education Sector Plan identifies ECE as a key strategic priority with several strategies outlined toaccelerate access to ECE and improve quality, equity, efficiency, and effectiveness. Parents in Zambiahave limited knowledge about the importance of early stimulation and playful parenting and tend tofocus on practical and physical care of young children, rather than the socioemotional care, earlylearning and development.2In 2017, the Government launched the 2016 Early Childhood Development Lancet Series in Zambia, andthereafter adapted the Child’s Healthy Growth and Development package to train frontline workers inkey family and community care practices to promote family well-being and optimal child development.Following this, in 2018 the Government adopted the Nurturing Care Framework (NCF) for ECD andcommitted to scaling up Nurturing Care for ECD and Care for Child Development (CCD). Publicinformation about ECD, particularly responsive caregiving and playful parenting, is still permeatingZambian society since the launch of the playful parenting campaign.The different government line ministries have no one, unified policy or framework under which theycan frame and align ECD interventions. While the current policy environment in which ECDprogramming is being delivered is aligned to international commitments and national policies,guidelines and strategic service delivery platforms, there is currently no national multisectoral ECDpolicy that guides delivery of nurturing care to children. This hinders progress towards the country’svision for accomplishing developmental goals for young children. There is also limited capacity amongmultisectoral structures at the national, provincial and district levels. National platforms like the ZambiaECD Action Network (ZECDAN) and the National ECD Technical Committee are promoting themultisectoral ECD agenda, but these structures currently need greater capacity to perform theirfunctions. It is therefore recommended that an overarching National Multisectoral ECD PolicyFramework is developed which will serve to improve ECD workforce capacity and intersectoralcollaboration, strengthen data, indicators, and assessment of progress, and agree on a consistent,national definition of ECD.EducationThe education sector in Zambia is guided by the Zambia National Education Policy 1996, the Educationand Skills Sector Plan 2017–2021, and the National Higher Education Policy 2019. These policies arealigned with the 7NDP, which emphasises the development of quality human capital, includinginvestment in quality education and skills development. A striking achievement of the education andskills sector is the attainment of gender parity in enrolment at primary school level. In 2016, 89 per centof eligible girls and 90 per cent of eligible boys were enrolled in primary school. In 2019, enrolmentdeclined slightly, but there were still more girls (89 per cent) enrolled than boys (85 per cent). In 2018,the national average dropout rate from Grade 1 to 7 was 1.7 per cent, compared to 1.2 per cent fromGrade 8 to 12. ZDHS 2018 data shows that, in general, more boys than girls attend school in uppersecondary than in primary and lower levels. Girls are more likely to drop out of upper secondary school:in fact, while less than a fifth of girls are out-of-school at primary-level, nearly half will have dropped out12Ministry of General Education (2018) Education Statistics.ECD KAP survey, 2020 by M&C SAATCHI, UNICEF Zambia.9

of school by the upper secondary level. The official school entrance age into Grade 1 is seven years, andin 2018 the primary school net intake rate (NIR) was reported as being just 54.5 per cent of the totalpopulation of eligible children—the remaining children mostly began at an older age. This late schoolstart and the insufficient access to ECE results in Zambian children losing age-appropriate education.A major challenge that the education sector faces is the extremely low levels of attainment, especially inliteracy and numeracy. The situation is possibly worse than the data suggests because many children,who are failing in school, may have dropped out before taking exams. Improving the quality of teachingis crucial, and both pre- and in-service teacher training at primary level needs to have a strong focus onappropriate pedagogy for the relevant age group, with an emphasis on teaching literacy and numeracy.It is recommended that the education sector prioritises education in budget allocation, strengthensfocus on age-appropriate pedagogy, expands and develops flexible Alternative and Distance Education,reviews and strengthens the Grade 1 entry process, provides all 6-year-old children with at least oneyear of ECE, and focuses on and prioritises children and schools in the most disadvantaged and hardestto reach areas.Health and HIVMaternal mortality has continued to decline from 591 deaths per 100,000 live births in 2007 to 398deaths per 100,000 live births in 2013/2014 and 278 deaths per 100,000 live births in 2018. However, arecent analysis of Maternal and Perinatal Death Surveillance and Response (MPDSR) data for 674maternal deaths at public health facilities in Zambia in 2018–2019 by Zambia National Public HealthInstitute highlights that Zambia is not on track to achieve the Sustainable Development Goal (SDG) 3target for maternal mortality rate (MMR).3There have been steady progresses in the reduction of under-five mortality rate (U5MR) and infantmortality rate (IMR). As per ZDHS 2018, the U5MR reduced from 75 in 2013-14 to 61.7 in 2018 and theIMR reduced from 45 in 2013-14 to 42 in 2018 per 1000 live births. However, it is of great concern thatnewborn mortality rate (NMR, the probability of dying within the first 28 days of life) increased from 24deaths per 1,000 live births in 2013–14 to 27 deaths per 1,000 live births in 2018. The main causes ofnewborn deaths are reported as asphyxia, neo-natal sepsis, and prematurity. Mitigating all three, butespecially asphyxia, depends on the technical skill of the birth attendant. According to the ZDHS, therehas been an increase in the proportion of women whose delivery was attended by a skilled healthworker from 64 per cent in 2015 to 80 per cent in 2018. The uptake of antenatal services also saw asurge, with the majority of women (97 per cent) aged 15–49 years had a live birth in the five years

MMR Maternal Mortality Ratio MNPD Ministry of National Planning and Development MoA Ministry of Agriculture MODA Multiple Overlapping Deprivation Analysis MoGE Ministry of General Education MPI Multidimensional Poverty Index MTCT Mother to Child Transmission MYSCD Ministry of Youth, Sport and Child Development

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