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CHILD SITUATION ANALYSIS FOR ETHIOPIA

May 2004

TABLE OF CONTENTS
Part 1 Part 2 Part 3 Part 4 Introduction Country Context The Legal Foundation Status of Child Rights - Survival - Development - Protection - HIV/AIDS - Participation Conclusions Bibliography P3 P4 P 17 P 22 P 28 P 43 P 55 P 57 P 59 P 65

Part 5

Part 1 - Introduction
This Child Situation Analysis is a snap shot of the situation of children in Ethiopia in May 2004. This is designed to be an iterative document which can be updated at any time. Although this has been compiled by Save the Children UK, many sections are based word for word on the Child Situation Analysis prepared by Save the Children Sweden in 2001. SC UK gratefully acknowledges the permission of SC Sweden to use their document. Contributions have also been provided by the other Save the Childrens operational in Ethiopia Save the Children Denmark, Norway and U.S. Thanks also go to input from individuals who made the effort, in particular Amanda Harding, our Child Rights Programming consultant, for extensive comments, Felleke Tadelle, Beruk Habtamu, Tayech Yimer, and Judith Sandford of SC UK in Ethiopia. While the comments and information from organizations and individuals is gratefully acknowledged, the mistakes and inadequacies are entirely my responsibility. This document unapologetically makes use of Save the Children studies as major sources. A flurry of recent studies on nutrition, livelihoods, emergencies, health, and education by Save the Children helps provide a strong basis for this CSA. The CSA also provides a good opportunity to pull together the conclusions of the various studies in one document. Inevitably, although this is a national analysis, the information is biased to the areas in which the studies have taken place. There is great scope for further information and analysis within each sector and for different geographic areas of the country. However, the line must be drawn somewhere, and this is the result. It is hoped that this document will provide the basis for a common Child Situation Analysis for the Save the Children Alliance in Ethiopia, for the Common Framework of Operations under preparation for 2005-07.

John Graham Programme Director, Ethiopia Save the Children UK

Part 2: Country Context


Ethiopia is an ancient country situated on the crossroads of Africa and the Middle East. This gives Ethiopia its' unique ethnic mix, with Middle Eastern influenced Semitic speakers in the north and Kushitic speaking people in the south. The 3,000 year history of Ethiopia gives it a unique position in Sub Saharan Africa, with the pride, culture and traditions which accompany it. Ethiopia is the dominant country in the Horn of Africa, with 70 million people and a powerful presence. Relations with neighbouring countries varies from hostility with Eritrea and Somalia to more friendly relations with Sudan, Somaliland and Kenya.

2.1. Ethiopia
The Federal Democratic Republic of Ethiopia (FDRE) covers an area of approximately 1.13 million sq. km, which is equivalent to the combined area of France and England. The Central Statistical Authority estimated the population of Ethiopia at 70 million as of 2004, making it the third-largest country on the African continent behind Nigeria and Egypt. The overwhelming majority of the population lives in rural areas (about 85%), though growth in urban areas (5.6% annually) is outstripping that in rural areas.

As a multi-ethnic and multi-lingual country, Ethiopia is made up of 260 ethnic groups or subgroups, speaking over 210 languages or dialects. Amharic, Tigrigna and Oromiffa are the most common, spoken by roughly two-thirds of the population. Although the total number of languages is vast, fourteen are spoken by 93% of the population. Amharic and English remain de facto languages of state. Of Ethiopia's population of about 70 million, two-thirds are under the age of 25 years and about a third (34%) are between the ages of 10 and 24. This accounts for the high fertility rate of 5.9 per women per year. Youth, defined here as the population between the ages of 10 and 24, is estimated to be 20 million which is expected to increase to 24 million by 2010 and 29 million by 2015 (A. Bekele). The overall population density, at 45 people per square kilometer, is not high Kenya has a density of over 60 per sq km More than 85% of the population is concentrated in barely 45% of the total territory.

2.1.1. Demography and reproductive health


Ethiopia is characterized by very rapid population growth fuelled primarily by high levels of fertility. The population grew by 2.6 percent during 1970-1990, and by 2.7 percent during 19901998, extremely high by world standards but roughly equal to the average growth in Sub-Saharan Africa over the same periods.

The rapid population growth poses a major challenge to Ethiopia's ability to ensure that the rights of children are realised., particularly in relation to expanding education, health care and other basic services(currently only half of children have access to health services, and little more than half attend even basic education). It creates further stress on the economy, demanding higher economic growth rates and changes in areas of economic activity . Pressures of large family sizes and high child dependency rates strain limited family resources, contributing to environmental degradation and food insecurity (UNICEF (2001). In Ethiopia, evidence from various studies indicates that sexual activity occurs early, and that this activity is usually outside marriage. The 2000 DHS found that 27% of women age 20-29 have had sexual intercourse by the age of 15, 64% by the age of 18 and 88% by the age of 25. The median age for first intercourse for women of this age group was 16.4 years, which is also the median age at first marriage. First sexual activity occurs later for men, with the median age of first intercourse being 20.3 years for men between 25 and 59 and 23.3 years for marriage. Other smaller studies, however, reported a more realistic lower mean age for first sexual experience ranging from 14 to 18, with a substantial segment of young women experiencing first sex prior to marriage, while young men are found to initiate sexual activity earlier than young women. These studies also indicated the presence of a significant difference between urban and rural youth; and the literate and illiterate where median ages were higher for urban and literate youth for both sexes. Findings from the literature confirm that young people are sexually active before marriage, exposing themselves to the risks of STDs, HIV/AIDS , unintended pregnancy and abortion. According to the 2000 DHS, 16% of women age 15-19 were already mothers or were pregnant at the time of the survey. This was found to be more common in rural areas (18%) compared to urban (9%); and more in those with no education (21 %) compared to those with primary education (9%) and secondary education (10%). Out of marriage pregnancy is common both in in-school and out of school young women as reported by various studies (8-10). Many of the unintended pregnancies in young women end in abortion. Adolescent pregnancy, particularly if the girl is very young, is a serious health risk to both the mother and the baby. An added risk of pregnancy in young women, especially if unmarried, is illegal and unsafe abortion. Abortion is currently a topic of considerable discussion in Ethiopia. According to the 2000 DHS, 16% of women age 15-19 were already mothers or were pregnant at the time of the survey. This was found to be more common in rural areas (18%) compared to urban (9%); and more in those with no education (21 %) compared to those with primary education (9%) and secondary education (10%). Unwanted pregnancy is common both in inschool and out of school young women as reported by various studies (8-10). Many of the unintended pregnancies in young women end in abortion. The 2000 DHS found that in general knowledge of contraceptive methods is high for both men and women, and married and unmarried groups with a relatively lower knowledge among the younger age groups of 1519 for both men and women. However, despite the high level of knowledge, use of contraceptive methods was found to be very low both in men and women. The rate of ever using contraceptive methods was lower than 5% and 15% for those between 1519 and 20-24 respectively (A.Bekele, 2002). By almost any measure, Ethiopia is a country that suffers from severe and widespread poverty. Per capita income is estimated by the World Bank and UNICEF at US$100-110, less than one third of the average for sub-Saharan Africa and six lowest in the world. Most of the population must struggle to make do with less than US$ 1 per day.

Poverty may also be defined in social terms as a lack of options and possibilities to affect your own life situation. In Ethiopia children are the hardest hit by poverty. It affects the ability of society at all levels to fulfill its obligations to children. Almost all of the manifestations of unmet child rights in Ethiopia, e.g. such as high infant and child mortality, widespread malnutrition, high incidence of communicable disease, low school enrolment, high number of children in situations of special risk, have poverty as a key underlying root. The effects of poverty cause life long damage to children's minds and bodies, making it more likely that they pass on poverty to their own children, thereby perpetuating the poverty cycle. Ethiopian is largely an agrarian society characterized by over 85% of the population living in rural areas, under conditions of extreme poverty. Agriculture accounted for 44 percent of gross domestic product (GDP) in 1998/99, and accounts for 85 percent of total employment and more than two-thirds of total earnings from exports. The remainder of the GDP originates from services (44%) and industry (12%). The country is frequently affected by drought and this often turns to disaster because of the high level of vulnerability among the population. This is no surprise given that such a large percent of the population is engaged in subsistence agriculture. In response to the problem, the government has made reforms to enhance agricultural productivity and the economy. The government has in theory embraced a market-oriented economic policy of which the key features are removal of price and market controls, reduction and removal of subsidies and tariffs, and holding a weekly foreign exchange auction that allows licensed investors to bid for the amount of foreign exchange they need. Despite the successful implementation of some of these reforms, movement remains slow on privatization of state owned businesses, and much of the new private sector is dominated by government or party related businesses. The Government has stated its aim of addressing poverty by doubling per capita income by 2010. However, in order to achieve the aim the economy will have to sustain an average annual growth rate of 7 to 8 percent per year. Despite some impressive figures in recent years, rising to above 6% in the good years from 1995-98, bad weather in 2000 and 2003 resulted in stagnation.

2.2 The Economic Policy Environment


The following is a recent unpublished analysis of the Ethiopian government economic policy, which presents an interesting critique of current economic policy: Summary of Ethiopian Economic Policy Despite the Marxist ideological background of the EPRDF, the post-Soviet context in which they came to power in 1991 helped dictate the adoption of a market oriented economic policy framework. While there was popular removal of some of the more egregious forms of the control economy under the Communist Derg regime, such as the state monopoly on grain trade, the current government has at best been ambivalent about embracing a market economy. Private sector development has been allowed, but sometimes viewed with suspicion. The debates within the ruling party which erupted publicly in 2001 with a major ideological split, which revealed the thinking within the party. The explanations by the Prime Minister of the government policy of revolutionary democracy also explained the government thinking on the private sector. A combination of the imprisonment of a large number of party related

businessmen in 2001 with the depiction of businesses as either productive or parasitic rent seekers, undermined the confidence of the fledgling private sector (Revolutionary Democracy, EPRDF, 2001). The solution to accommodate the ambivalence over the market reforms when the EPRDF came to power was to adopt a form of crony capitalism, loosely similar to the Indonesian model of the time. Each of the major regional party affiliates of the ruling EPRDF set up a business wing, which became involved in a variety of new or existing enterprises. The largest of these, EFFORT, was Tigray based, and has a wide range of interests in the transport and industrial sector. This provided the ruling party with direct involvement and control over a large and critical portion of the private sector. The degree to which this represented suspicion of having a truly independent private sector, and the degree to which it represented an effort by the party to jump start economic development is a matter of speculation. The independent private sector is lead by the Chamber of Commerce, which has been an outspoken advocate for business. While the private sector voice is an essential part of civil society in a country such as Ethiopia, the business community is small and inward looking. Much of their effort has been directed at providing protection against competition, further weakening international business links. While the Chamber of Commerce appeared to be an accepted voice by the government, the recent abrupt detention of the President of the Chamber on questionable tax related charges, has raised concern that the mild criticisms by the Chamber of government policy are no longer tolerated. The Chamber President posted bail and fled the country. The role of foreign investment in improving the economic conditions of the poor and therefore improving childrens rights situation is controversial. On the one hand, providing economic opportunities and diversification from subsistence agriculture is essential for Ethiopia. Foreign investment, often linked with domestic investment, has arguably been a key ingredient in lifting similar economies from chronic food insecurity. However, foreign investment is often associated with sweat-shop conditions and extraction of surplus rather than contribution to an economy. Because of restrictive practices by the government in Ethiopia, foreign investment still may have little prospect of growing quickly. This may be changing, with UNCTAD and the WTO declaring that Ethiopia offered the second most improved business environment in the world (The Reporter, April 14, 2004). Up until recently, the formal and informal restrictions and high level of suspicion of foreign investors makes the investment climate unattractive. The exception of Sheikh Al-Amoudi, a Yemeni Ethiopian raised in Ethiopia, helps prove the rule. Because of his close relationship with Ethiopia, he has used his fortune developed overseas to invest in both practical and prestige projects which make him by far the dominant external investor in the country. One of the most interesting parts of the private sector is the private press. There is an active and quite large private press in Addis Ababa, in English but primarily Amharic. Many of these papers take an active and daily line of harsh criticism of the government. While the reporting is often amateurish and alarmist, the existence of a healthy opposition media is a good sign for Ethiopian democracy. Although tolerated by the government, there are occasional raids on newspapers which are accused of promoting armed uprising against the government. As well, new legislation on the media has been criticized for putting new restrictions on the private media. Promised legislation to allow private radio stations, which would potentially reach a much wider population, has been repeatedly delayed. The overall situation is mixed at best.

Economic policy in the rural sector is defined by the core policy of Agriculture Development Lead Industrialization (ADLI), which posits that emphasis must be on the rural sector where the majority live and toil. Through development of surplus in the agricultural sector, the raw materials for developing the industrial sector will be developed. This approach is the core of a flurry of rural economic policies, including the Rural Development Strategy, Food Security Policy, New Coalition for Food Security and even the Social Development and Poverty Reduction Program. The application of this approach can resemble the Great Leap Forward of Maoist China. Mobilizing the peasants for development through massive social engineering schemes has been discredited elsewhere, but remains popular with the Ethiopian goverenment. Recent examples are the resettlement programme, which set out too ambitiously and has been problematic in implementation at best, and water harvesting, in which peasants were mobilized without sufficient technical assistance, are instructive. While both programmes could provide part of the solution to food security in Ethiopia, hasty and unplanned implementation with inadequate capacity creates as many problems as it solves. A growing critique of economic policy in Ethiopia, put forward by the Ethiopia Economic Association and Forum for Social Studies, criticizes both the social engineering approach and the focus on subsistence agriculture (EEA and FSS, various publications and forums). Building on growth potential areas, such as small towns and urban centres, with the emphasis on artisanship and industrialization, is increasingly cited as the alternative. While the government maintains that this fits with the ADLI (PM Meles Zenawi, New Coalition on Food Security, consultative meeting, Sept., 2003), critics point out that ADLI inevitably puts the emphasis on the wrong area agricultural development rather than industrial. Whether a change in policy emphasis to small towns and urban areas is forthcoming remains to be seen. Problems with the emphasis on agricultural development are obvious. A bust-bust cycle prevails in grain production. In a good rain year, there is no market for the surplus so the prices collapse, harming the producer. In a bad rain year, production is limited, harming the producer. An additional advantage cited for the emphasis on urbanization is the provision of a more rapidly growing market for local agricultural production. Unpublished document, April 2004

2.2.1 MACROECONOMIC POLICY IMPACT ON CHILD WELFARE AND THEPOVERTY REDUCTION STRATEGIC PLAN
Given that 45.5% of Ethiopians live in absolute poverty (Welfare Monitoring Unit, 2000), eliminating poverty should presumably be the highest priority for government, donors and NGOs. However, there are worrying elements in both the impact of macro-economic policies and the programmes to confront poverty. Macroeconomic policy has a worrying impact on childrens welfare and therefore rights. A recent study by SC UK The Impact of Macro Economic Policy Reforms on the Well Being of Children: The Micro-Macro Linkage (2003) attempts to draw these links.

Some examples of the negative impact of Macro-economic policies on children include: Exchange rate of the Ethiopian Birr declining against International Currencies (from 2.07/$1 in 1993 to 8.8/$1 in early 2004) has caused huge local price increases in various essentials, including drugs for human and animal health, and essential agricultural inputs such as fertilizer. Privatisation of state enterprises and other liberalization policies have resulted in the loss of an estimated 32,000 jobs, and therefore the livelihoods of about 160,000 people (96,000 children). Although there have been increases in the expenditures in social sectors such as health and education, the emphasis on capital expenditures have contributed to a decline in quality of service.

While overall liberalization of the government is a desirable alternative to the current structures, and has been accepted in principle by the government, these impacts of liberalization also need to be considered and ameliorated. Process of PRSP development ticking a box? In 2000-02 the Ethiopian government went through the process of developing a PRSP and Social Development Poverty Reduction Program (SDPRP) according to the World Bank format. This has been enormously successful in obtaining World Bank support and encouraging many donors to move to direct budget support for the Ethiopian government. Part of the PRSP format requires that governments have a consultative process with the population, civil society and specifically NGOs. NGOs participated enthusiastically with a process led by the NGO umbrella group, CRDA. Save the Children participated strategically, in particular assisting with writing the education and food security sections of the NGO input. While the government encouraged this process and welcomed the input from NGOs, most of the NGO recommendations for changes were not taken up in the final document. In addition, while NGOs were encouraged to participate in the general consultation on the PRSP at the woreda level, woreda officials generally refused to allow NGO representatives to speak at these sessions. This eliminated the opportunity for NGOs to be involved in the dialogue, and reduced the involvement to a written submission. Naturally, all of this can lead to the conclusion that the Ethiopian government was ticking a box, meeting a requirement of the World Bank format without taking it seriously. Clearly the objective of the government is to have a process which delivers resources directly to the government itself. The government seems mainly to see NGOs as competitors for resources rather than partners in development. Although the resulting PRSP and SDPRP are filled with good intentions and a compilation of positive plans there are some glaring omissions or problems. These include the exclusion of all but cursory attention to emergencies, despite the critical and huge impact of emergencies on Ethiopias poor. It also lacks an analysis of child poverty, and outside of the education component there is virtually no mention of children at all in the documents. This reflects an underlying invisibility of children in the process, which is very dangerous given that child poverty is a time bomb which perpetuates itself in future generations.

Perhaps more importantly, the opportunity for NGOs to participate in the monitoring and evaluation of the implementation of the SDPRP has been almost non-existent. The Ethiopian government includes donors in the development of the monitoring framework and review of sector programmes such as health and education, and has recently set up a process for monitoring of the New Coalition on Food Security. NGOs have been reduced to attempting to provide input through sympathetic donors. One positive development was the invitation of about 20 NGOs to the first annual review of the SDPRP in December 2003. Some NGOs took advantage of this opportunity to make basic points about the content of the PRSP. Save the Children joined with UNICEF to point out the inadequacy of the coverage of childrens poverty in the programme. There has been some interest shown by the Ethiopian government in including NGO research in the monitoring and evaluation framework. The SC UK study on Destitution in the Northeast Highlands is the only study cited in the annual review of the SDPRP. But the integration of this study, the findings of the Young Lives research following 2000 children born in the year 2000, and other SC research has yet to be institutionalized.

2.3 Democracy and Governance


The health of a countrys democracy, and therefore the context for child rights, is measured by the state of contested elections, the role of the media, and the strength and activity of civil society amongst other factors. Electoral democracy has been making progress in Ethiopia. Timid experiments with electoral democracy under Emperor Haile Selassie were swept away by the dictatorial Derg regime. While democratic reforms have been introduced under the current government, the official government policy remains revolutionary democracy. Elections are held, and in particular the Federal Election of May 2000 introduced a level of multi-party democracy and public debate never before reached in Ethiopia. The state remains set up on one party lines however, and the recent local elections have been marred by intimidation and manipulation. There is a lively private press in both Amharic and English which brings a welcome level of diversity to public information. Despite the amateurish beginnings, there is steady progress in the professionalism of the independent press. The government has tolerated the often outrageous claims in the Amharic press, although there are worries that new legislation on the media will be used to restrict the press. Private access to radio broadcasting, although promised, has not materialized. State dominance in the print media is still strong, and in local television it is complete. The role of civil society is discussed below. Again, while there is considerable progress in the enabling environment and development of civil society, there is still some way to go. The government move to de-centralization may be considered a strengthening of democracy. While the weakening of the highly centralized dictatorship under the Derg is a very positive development, de-centralization may or may not be a sign of greater democracy. The design of the de-centralization, has initially devolved accountability rather than responsibility. The capacity of local levels of government at the woreda level and below to exercise genuine responsibility, and to be accountable to local populations, has yet to be realized.

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Since its inception, the Government has vigorously pursued a program of decentralization of authority to the regions and lower tiers of government, with the overall aims of achieving greater equity, a higher level of popular participation, and better governance. Concerns about the degree to which the program is de-centralization of authority rather than just responsibility have been raised, as well as concerns about the disruption resulting from devolution of responsibility to levels without the capacity to handle them. The regional planning process is complex, varies considerably from region to region, and in many regions is still evolving. As power has decentralized, capacity building at the local level has become increasingly important to the effective delivery of local services. Recent experience, such as remote woreda's studied by SC UK in South and North Wollo, indicates that the proportion of local government staff recruited frequently remains at below 25%. Moreover, partly due to the difficulties of relocating personnel from the capital to the regions, and zones to woredas, gaps have emerged in the skill levels among the various levels of administrations. Tigray is relatively well endowed with skilled manpower, and already has functioning administrative systems, while other regions are continuing to experience difficulty in filling their skills gaps. The regional planning process is complex, varies considerably from region to region, and in many regions is still evolving Although still moderate by the standards of many African countries, during the last years Ethiopia has suffered from corruption within the government. An Anti-Corruption Commission has been set up by government.

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2.3.1 Government and administrative institutional structures


Political structure Official name: Form of state: Legal system: Federal Democratic Republic of Ethiopia Federal Republic The federal constitution was promulgated by the transnational Authorities in December 1994. In May 1995 representatives were elected to the institutions of the new republic, which formally came into being in August 1995.

National Legislature: The federal assembly consists of the Council of Peoples' Representatives (lower house; 548 members) and the Council of the Federation (upper house; 108 members). The nine regional state councils have limited powers, including that of selecting members of the Council of Federation. National elections: Head of State: National Gov't: National elections: May 2000 (federal and regional); next elections due in May 2005. President, currently Girma Wolde Giorgis, who has a largely ceremonial role and is appointed by the Council of Peoples' Representatives. The Prime Minister and his cabinet (Council of Ministers), appointed in August 1995.

Main political parties: The Ethiopian Peoples' Revolutionary Democratic Front (EPRDF) evolved from the coalition of armed groups that seized power in May 1991. It includes the Tigray People's Liberation Front and the Amhara National Democratic Movement, formerly the Ethiopian Peoples' Democratic movement. The Oromo Liberation Front withdrew from the transitional government in July 1992 and was subsequently banned. It was replaced by the Oromo Peoples Democratic Organization (OPDO). Several small opposition parties exist. Having boycotted the 1995 elections, some participated in the 2000 poll, but gained only a handful of seats, with the main body of 13 opposition members from the Southern Peoples Region. Ethiopia is governed by a Federal structure and the country is divided into nine National Regional States and two city administrations. The nine regions are Tigrai, Afar, Amhara, Oromia, Somali, Benishangul Gumuz, Gambella, Harari and the Southern Nations, Nationalities and Peoples (SNNP). The regions Afar, Benishangul Gumuz, Gambella and Somali are categorized as "emerging" because they were neglected by the 'previous political systems and "under-served" by economic and social services (EIU, 2001) Administration at the regional level is divided into zones, woreda and kebele. The constitution endorses the principles of democracy and multiparty elections are held every five years federal and state levels. The regions are purposely demarcated along ethnic and linguistic lines, and thus vary greatly in terms of total land area and population size. The national regional states and the administrative councils are further divided into a total of 62 zones, over 550 Woredas and about 10,000 Kebeles.
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Since its inception, the Government has vigorously pursued a program of decentralization of authority to the regions and lower tiers of government, with the overall aims of achieving greater equity, a higher level of popular participation, and better governance. Concerns about the degree to which the program is de-centralization of authority rather than just responsibility have been raised, as well as concerns about the chaos resulting from devolution of responsibility to levels without the capacity to handle them. The regional planning process is complex, varies considerably from region to region, and in many regions is still evolving. As power has decentralized, capacity building at the local level has become increasingly important to the effective delivery of local services. A 1996 study found that less than one-quarter of total civil servants had training (i.e. an education degree ranging from a Diploma to PhD), and decentralization has exacerbated this lack of skilled personnel in the country. Moreover, partly due to the difficulties of relocating personnel from the capital to the regions, gaps have emerged in the skill levels among the various regional administrations. Tigray is relatively well endowed with skilled manpower, and already has functioning administrative systems, while other regions are continuing to experience difficulty in f1lling their skills gaps. Amhara region, for example, is functioning with less than half of its total manpower needs. The regional planning process is complex, varies considerably from region to region, and in many regions is still evolving

2.4 Civil Society and Empowerment


Thirteen years into Ethiopia's uneven but continuing move towards representative democracy, the country's non-governmental sector struggles for definition, operating space and enhanced institutional capacity. Civil society, traditionally weak in Ethiopia (with the possible exception of churches). remains underdeveloped and somewhat misunderstood in the current era of relative political liberalization. The historical centralization of power in Ethiopia, and the impulse to extend strict and, at times, arbitrary authority over various civil society actors made it very difficult for civil society to develop - despite a decidedly nonpartisan orientation by the vast majority (World Bank, 2000). By any measurement, the progress realized since 1991 is impressive. Civil society is increasingly vibrant and relevant to the nation's political and economical revitalization. The private business sector is growing, academic freedom is returning to the universities, the media is slowly gaining credibility, and professional associations are again forming. Local NGOs continue to grow at an impressive rate, with the best available count of registered NGOs now being over 600. Further there has been notable progress in the ability of the national NGOs to strategically target and design activities, credibly deliver critical services, and provide accountability on programming and expenditure of funds. The overall operating climate for NGOs is improving. Relations with the central and regional governments are better, if still uneven. The emergence of a coherent NGO sector is now more apparent. Measurable improvements in the capacity of its members are manifest. The shift in emphasis from relief to long-term development on the part of NGOs has according to some sources, increased their relevance and acceptance by the government (World Bank, 2000). According to a recent report by Oxfam GB and the CRDA, the local NGO sector remains weak and a bit directionless. Public and government attitude to NGOs remains quite negative.

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Many local NGOs are accused of being the vehicle of a single person, or a form of consultancy organization, a MONGO (My Own NGO). A great deal of experience and capacity building is needed for the development of the NGO sector. The weak and incipient nature of the NGO sector can be used as an excuse to avoid strengthening the enabling environment for NGOs. Government requirements for new NGOs are quite extreme from the outset, with guaranteed sources of funds and a detailed workplan required as part of the initial submission. This is particularly difficult for rural based NGOs, contributing to the large proportion of urban NGOs. In the major regions of Tigray, Amhara and Oromo there are government/party organized NGOs, which are actively promoted by the government. What is needed is an enabling environment which promotes the establishment of large numbers of local NGOs, and provides the time and opportunity for good NGOs to develop (and bad ones to fall by the wayside). As the space for NGOs to operate expands, the concept of public policy advocates is now slowly advancing as well. Several factors have contributed to this: the NGO initiated Code of Conduct for NGOs and a new NGO-legislation is on its way to hopefully strengthen the interaction between the civil society and the government, generally improved press coverage of NGOs and their work, expanded institutional capacity within the sector, and support from the diplomatic community. However, the increase in communication and collaboration between government and NGO officials has not been unproblematic. During 2001, a very strong advocacy organization, the Ethiopia Women's Lawyers Association, was suspended due to their public criticism of the police and government handling of a girl, who was abused and raped. The government claimed that the organization was involved in political affairs and hence suspended their license After court proceedings, the organization eventually got back its license, but the message from the government scared many NGOs off from taking public positions. Although most NGOs, both local and international, shun any criticism of government and therefore constrain their advocacy agenda to statements of good intentions at best. A small group of local advocacy organizations has developed in the last few years, including the Womens Lawyers Association mentioned above, the Ethiopian Economics Association, and the Forum for Social Studies. They have brought a refreshing frankness, even boldness to the public domain, often based on solid research. Key donors have supported these organizations and offer them a measure of protection. International NGOs have generally been quite reticent to take public stands. Over the last year this has begun to shift, in particular with strong stands taken by INGOs on the handling of the famine in 2003 and the New Coalition on Food Security initiated by the government. The Save the Children Alliance has played a leading role in this effort and continues to move forward in developing strong advocacy stances.

2.5. Cultural Values


People derive values from their membership in a group - a family, a community, an organization, a racial, religious or ethnic group that can provide a cultural identity and a reassuring set of values. Such groups also offer practical support. The extended family system, for example, offers protection to its weaker members, and many tribal societies work on the principle that heads of households are entitled to enough land to support their families - so land is distributed accordingly.

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But traditional communities can also perpetuate oppressive practices such as employing bonded labor and slaves and treating women and children particularly harshly. In Ethiopia thousands of girls suffer genital mutilation each year because of the traditional practice of female circumcision. Some of these traditional practices are breaking down under the steady process of modernization. On the other hand, many oppressive practices still need to be fought by people's organizations and through legal action. Traditional communities, particularly ethnic groups, can also come under much more direct attack from each other. Ethiopia is made up of 260 ethnic groups of which many face discrimination. In Ethiopia, ethnic tensions are on the rise, often over limited access to opportunities and resources. While there are clearly regional/ethnic variations in Ethiopia, this North Wollo study is a good start on understanding attitudes to Children. Further studies will probably reveal variations in attitudes to children in different ethnic contexts.

2.5.1. Perception of child hood


In a recent study on local perceptions of children's needs and rights in North Wollo in northern Ethiopia, it was revealed that parents and children define a child in the same way in all study areas of the region (SC Denmark, 2001). Aeymerow yal leye" are children between 0 - 5 years and they are called "muchikila/mucha" or sometimes "madego" this mean a developing child with an unclear mind, who does not know him/her self, or whether other likes or hates him/her (Ibid, p. 13) It could have been " a child who needs intensive parental care or guidance" "Nefis Aweke" is used to define a child between 5-7 years and means "a child who knows him/herself and is expected to render services to parents". They are expected to participate in domestic activities with the supervision of older siblings or adults. There is a significant age difference between boys and girls when entering into the "no more a child stage". Married girls of 8-12 years could be categorized as adult women, boys of the same age or older are not labeled adults unless they are married, which usually does not happen until they are in their 20s. Even though there are regional differences in the perception of children, the report suggests that some similarities can be found allover the country. There is also a gender difference in the roles a child assumes after the age of six or seven. The girl: A girl between 7 and 12 can look after a calf; can take care of younger siblings at home. After 10 years, the girl child can substitute her mother in doing chores. She can even get married if she is from a wealthy family, and she will not be considered a child afterwards. The boy: A boy between 7 and 15 can look after the cattle. A boy in this age range is usually considered as a young child. After 15 years of age he is called older child or youth. Usually males get married in their twenties.

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A boy between 15 and 18 years, can plough with his father. After 18 years, a boy can plough independently (Ibid)

Parent/child perceptions In the SC Denmark et al study (2001) from North Wollo it was clear that parents decide major issues such as engagement, marriage, education and medication without the involvement of children. Children usually discuss with their parents on the basic necessities of food and clothing. They also discuss on domestic services that they should render to their parents. Children try to involve but do not decide. Normal illustrative sayings from adults regarding children include: "Wolaj Yazezewun Lij Aikolifewum, meaning "what a parent decides and orders, a child never contradicts" "Ke Lij Fiit Ainagerum Waza, meaning, "does not talk in front of a child though it may be a joke" or "you do not need to talk confidential or serious matters in the presence of a child" "Ye Lij Aeymerow Abatu Naw meaning, "the mind of a child is in the head of his/her father" or "the father is the model of his child " Lij Yabokaw Ie Erat Aibekam meaning, "what a child plans is not achievable" (Ibid, p 14)

Parent/Child Relationship In North Wollo parents talk to their children about domestic issues. The parents have the leading role while children take the orders and act accordingly. The discussion is not initiated to involve the child in the issue but they are involved because they have to listen and obey orders. Children are not given the chance to express their views. The local saying is that "a child does not know its limits and has to be restricted from communicating with adults." However, sons, after the age of 15 years can share ideas with parents although only to some degree. Girls may also express their views after they get married. Children request their parents to fulfill basic needs as food and clothing. Other issues are not seriously discussed with children. Another saying goes: "you do not talk in front of a child for it discloses secrets". Whenever there is a discussion children are not involved; parents alone discuss issues in private. The right to be heard and freedom of expression are also affected by perceived importance of a child. Parents acknowledge that boys and girls make their own contributions to their home. For the parents it is difficult to prefer one child to the other. This is conveyed in the local saying "there is no unworthy child". However, according to the research in North Wollo, if it was possible to choose, the family would prefer more males than females.

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PART 3: UN CRC - The Legal Foundation


The UN Convention on the Rights of the Child was adopted unanimously without modifications by the General Assembly of the United Nations on 20 November 1989. It entered into force as international human rights law on 2 September 1990, after it was ratified by the 20 required states. To date, 191 countries have ratified the Convention including Ethiopia in 1992, making it the fastest and most universally accepted human rights accord in history. By ratifying or acceding to the Convention, states declare themselves party to the Convention and bound to observe its provisions, and become answerable to the international community if they fail to comply with them. The Twenty-sixth Session of the Assembly of Heads of State and Government of the OAU, in Addis Ababa, Ethiopia, July 1990, adopted the African Charter on the Rights and Welfare of the Child. The Charter came into force on July 2001, after its ratification by the required 15 states. Ethiopia has not yet ratified it. The Convention on the Rights of the Child and the African Charter constitute in their essence "bills of rights" for all children, a code of binding obligations for governments, and a minimum standard of responsible conduct for communities and families with respect to the young. They set standards which address the neglect and abuse that children face in all countries (to varying degrees) every day, and recognize every child's right to develop physically, mentally and socially. The Convention and the African Charter stress that the "best interest of the child" be a primary consideration in all actions and decisions affecting the children.

3.1. What Does the UN Convention Say?


The 54 articles of the Convention can be divided into three main parts: key principles, specific rights and ways in which the Convention will be monitored. The Right to Right to Life, Survival and Development (Art. 6): "States Parties shall ensure to the maximum extent possible the survival and development of the child." The Right to Respect For the Best Interest of the Child (Art.3): "In all actions concerning children, whether undertaken by public or private social welfare institutions, courts of law, administrative authorities or legislative bodies, the "best interest of the child shall be a primary consideration". The Right of the Child to Express Their Views freely on All Matters Affecting Them (Art.12): "States Parties shall assure to the child who is capable of forming his or her own views the right to express those views freely in all matters affecting the child, the views of the child being given due weight in accordance with the age and maturity of the child." The Right of All Children to Enjoy All the Rights of the Convention without Discrimination of Any Kind. (Art. 2): "States Parties shall respect and ensure the rights set forth in the present Convention to each child within their jurisdiction without discrimination of any kind, irrespective of the child's or his or her parent's or legal guardians race color, sex, language, religion, political or other opinion, national, ethnic or social origin, property, disability, birth or other status."

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The Convention incorporates the whole spectrum of human rights - civil, political, economic, social and cultural - and sets out the specific ways in which these should be made available to children. The definition of children as all persons less than 18 years of age, unless the legal age of majority in a country is lower (Art. 1) Civil rights and freedoms, including the right to a name and nationality, To freedom of expression, thought and association, to access to information and to the right not to be subjected to torture (Art. 7, 8, 13-16 and 37) Family environment and alternative care, including the right to live with parents, to be reunited with parents if separated from them and the provision of appropriate alternative care where necessary (Art: 5, 7, 9-11. and 25) Basic health and welfare, including the rights of disabled children, the right to health and health-care, social security, child care services and an adequate standard of living (Art. 18, 24, 26, and 27) Education, leisure and cultural activities, including the right to education, the aims of education and the rights to play, leisure and participation in cultural life and the arts. (Art. 2831) Special measures of protection covering the rights of refugee children, those caught up in armed conflicts, children in the juvenile justice system, children deprived of their liberty and children suffering economic, sexual or other exploitation. (Art. 22, 23, 30, and 32-40)

The last 13 articles of the Convention establish the ways in which the implementation of the Convention will be monitored. These include the setting up of a Committee of the Rights of the Child, which receives initial reports from governments two years after they have ratified the Convention and every five years thereafter. UN agencies and NGOs are invited to submit relevant information to the Committee in order to support their work. In ensuring the realization of these rights, the Convention recognizes the primary role and responsibility of the family as the first and ideally the last line of protection and care for the child. States Parties are also expected to provide support to families when necessary, particularly in the areas of nutrition, shelter and clothing.

African Charter on the Rights and Welfare of the Child and Differences with the UN
CRC In 1990, the Heads of State and government of the OAU (now AU) unanimously adopted the African Charter on the Rights and Welfare of the Child. The aim was to put an African perspective on the concept of children's rights, thereby complementing the UNCRC. The Charter was implemented at the end of 1999. In its preamble, the GAU Charter emphasizes the principles of the Rights and Welfare of the Child as defined in the UNCRC. Consequently, three principal objectives are found in both treaties: firstly, children's basic needs for survival and development must be secured; secondly, children's physical, moral and spiritual integrity must be protected from different forms of harmful treatment; and thirdly, opportunities for children to participate in social, political and economic processes should be improved.

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However, some ideological and conceptual differences do exist between the treaties: The African Charter focuses on children as a group while the UNCRC focuses on the child as an individual Child Rights are counterbalanced by duties in the African Charter, article 31, NO such duties are mentioned in the UNCRC According to the African Charter, the minimum age for recruitment into armed forces is 18 years (in January 2000, a text for an additional protocol to the UNCRC was agreed. This raises the age of recruitment from 15 to 18. The text was adopted the General Assembly of the United Nations in May 2000). Greater stress is put on the role of the family in the African Charter. The family is expected to produce, develop and defend African traditional and cultural values. Preservation of positive African morals, traditional and cultural heritage in the education process is highlighted in the African Charter.

Despite the differences, the African Charter is viewed as an important complement to the United Nations Convention on the Rights of the Child. The relevant articles are similar to those highlighted in the UNCRC but the African Charter provides better protection for children as referred to above.

3.2 Application of Legal Framework for Child Rights in Ethiopia


Traditionally, Ethiopian culture does not give rights to children as understood in the CRC. However, at the national level, within the limitations that exist, Ethiopia has always taken the welfare of its children seriously. For various reasons, ideology amongst them, the socialist regime did not ratify the UN CRC, but it established an autonomous Children's Commission that facilitated the care and support for orphans and poor children. Unfortunately, political indoctrination was also part and parcel of the care and support at that time. The Government of Ethiopia ratified the UN CRC in 1992. One of the first tasks was to harmonize national laws and policies with the provisions of the convention. While an initial government assessment found that the major Ethiopian laws and policies were largely sufficient to Implement the CRC; a committee was set up to iron out the "minor differences". A subsequent action resulted in corporal punishment in schools being forbidden immediately through the Ministry of Education. The State of Ethiopia adopted a new Constitution in December 1995, which improved in many ways the legal protection of children. Article 36 of the Constitution pertains specifically to the rights of children, and was drafted taking the provisions of the CRC into account (UNICEF, 2001). Article 36 of the Ethiopian Constitution: Every child has the following rights: The right to life The right to obtain name and nationality The right to know and be cared for by his parents or legal guardians (UNICEF, 2001)

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The right to be protected from labor exploitation and not to be forced to undertake work that may harm his/her education, health and wellbeing The right to be free from harsh or inhuman punishments that may be inflicted on his body, in schools or child care institution (UNICEF, 2001)

In the Ethiopian Constitution there are articles that protect children and women; The rights of women against physical and mental brutality The rights of people to education, health care, employment, to participate in policy development and implementation Women's right to choose her own partner The right of the child from physical and mental abuse

In addition to the UN CRC and the Convention on the Elimination on all forms of Discrimination against Women, there are policies in Ethiopia on social security, health population, and education. At the same time progress has been made since 1991 to set up democratic institutions in the country. A new Constitution has been adopted, which incorporates international standards in the field of human rights; including, in its article 36, a specific reference to some of the rights enshrined in the Convention on the Rights of the Child. In addition, the Convention on the Rights of the Child, as well as other international treaties dealing with human rights, is incorporated into domestic law. The Government of Ethiopia has expressed political commitment to improve the situation of children, notably through setting up an Inter-ministerial Legal Committee to review national legislation and its compatibility with the provisions of the Convention, and through the establishment of committees on the rights of the child at the national, regional, zonal and woreda levels. The Government has also adopted a National Plan of Action for children and established a ministerial committee to monitor its implementation. The House of Peoples' representatives endorsed a bill establishing a Human Rights Commission and a human rights ombudsman's office in July 2000. Although the initial draft bills did not include specific women's and children's rights in subsequent public hearings and consultations children's and women's rights were explicitly added to the mandates of the two offices. Five newly designed alternative childcare guidelines have been introduced by Ministry of Labor and Social Affairs (MOLSA). These are guidelines for adoption, foster care, institutional care, reintegration, reunification and community based child support programs. In every guideline CRC articles are incorporated to create awareness among persons working with children (Ibid) Combined efforts has been undertaken by the Government and NGOs to protect and promote children's rights, in particular in the field of information on HIV / AIDS and information campaigns on harmful traditional practices affecting children. With regard to the latter, a National Committee on Traditional Practices to develop information and sensitization campaigns on all forms of harmful traditional practices affecting the health of women and children. with a particular emphasis on female genital mutilation has been established. Primary education has been made free. although it regrets that it has not yet been made compulsory.

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Almost a decade after the ratification of the CRC. it is widely recognized that much more must be done, particularly in terms of implementation and advocacy in order to improve the situation of children's rights in Ethiopia. Existing criminal and civil laws are not compatible with the CRC, particularly in the case of child offenders who are subject to the adult justice system. On a positive note. exposure and punishment of child rights abusers (molesters, rapists. and kidnappers) has been increasing since the CRC ratification. This has also raised public awareness about child rights to the extent that many are angry and ashamed by such crimes against children in a society that regards itself decent and has strong religious underpinnings. There remains a fundamental assumption that children are safe in schools and homes. But it is reported that some of the worst cases of child abuse and neglect actually takes place within families and school compounds. Furthermore, there has been little progress in changing attitudes related to the elimination of harmful traditional practices such as female circumcision. Child labor is another area that presents difficulties for advocacy and awareness raising given that it is largely accepted and not understood as a violation of children's rights. Finally. those children with disabilities are largely denied their rights, associated with access to service and programs to meet their specific needs (Ibid) In a revision of the Civil Code. the Penal Code and the Criminal Code made by UNICEF in 2001 revealed the following gaps and areas of incompatibility with the CRC: The provision in the Penal Code for the possibility to sentence children to light corporal punishment at the sole discretion of the judge; The provision in the Civil Code for "light bodily punishment" as an educative measure within the family; The provision stating that children are only able to lodge complaints through their parents or legal guardians, meaning that children's right to adequate resources and complaint procedures in cases of abuse, neglect or ill treatment with families is not fully secured; The absence of a provision making primary education compulsory; The absence of provisions in the systems for national and inter-country adoptions consistent with the principles of the best interest of the child and respect for his or her views; The provisions in the Criminal Code setting the age of criminal responsibility at nine years and stating that children should be treated as adults from 15 years of age onwards; The absence of provisions dealing with the illicit transfer of non-return of children abroad; and The absence of a provision calling for the periodic review of child placements (UNICEF 2001)

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PART 4 - STATUS OF CHILDREN AND THEIR FAMILIES ACCORDING TO CHILD RIGHTS


PART 4.1 SURVIVAL (The right to life, survival and development, Article 6 of the Child Rights Convention)

4.1.1 Endangerment of Children Recurring Famines in Ethiopia


Already in the short period of the 21st century, Ethiopia has experienced two famines. This comes on top of a historical tendency to famines which dates as far back as records of Ethiopia. In the twentieth century Ethiopia experienced a regular cycle of famines. The most memorable are the 1972-74 and 1984-85 famines, which captured international attention and response. 1984-85 claimed the most lives, an estimated 1 million, and burned an impression of Ethiopia as a drought and famine stricken country in the minds of a generation around the world. Children are always severely affected by famine. In famine conditions where starving families are forced to migrate long distances in search of food, mortality amongst children under 2 runs up to 100%. In famine camps, the mortality amongst the arrivals under 5 can run to 30% or more. This is accompanied by the unimaginable suffering of even those who survive, and the long term impacts on the severely malnourished and those orphaned. Famine remains the most haunting specter for children in Ethiopia today. Despite progress since the large famine of 1984-85, averting famines remains a challenging business in Ethiopia with its deadly impact alone for the period 1999-2003 likely to be counted in terms of hundreds of thousands of lives. The famine of 1999-2000, particularly in the Somali Region, did however provide lessons which were sufficiently learned to improve the response in the 2002-2003 famine, reducing the impact of the crisis and saving lives. Much remains to be done, however. Sufficient capacity to respond and deliver food aid still does not exist, despite the concentration on improving food systems over the last 30 years. In other sectors the situation is much worse. Nutritional supplementary feeding and therapeutic feeding for the most affected children remains heavily dependent on NGOs, which dont have the support to scale up to meet the needs in a large emergency. In 2003, the estimated need for therapeutic feeding, especially in the South where the food delivery system failed, was 600 centres the total number established was 46 (UNICEF Lessons Learned document). Tens of thousands of children paid with their lives. Other aspects of the emergency health, HIV/AIDs, water, animal health, and education - are even more neglected. The lack of a well functioning health system makes children weakened by malnutrition vulnerable to health problems for which there is no help. Emergency inoculation campaigns must substitute for good regular EPI coverage. The special nutritional needs of persons with AIDS are not met, and are beyond contemplation for most areas due to capacity limitations. Instead of becoming venues for HIV awareness raising, food distribution points become another opportunity for the virus to spread. Lack of water for people and livestock carries off more lives, and preventable livestock diseases destroy the herds that the people rely on. Emergencies can be an opportunity to extend education to displaced or gathered populations, but in Ethiopia they become another barrier to education.

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4.1.2 Famines of 1999-2000 and 2002-03


Despite indications that the situation in Somali Region was going to be severe from early 1999 onwards, the shortage of concrete information and the conflicting analysis of conditions delayed major response. Although there were concerns from USAID, some NGOs and the Ethiopian government, the severity of the crisis was hotly contested, in particular by detractors who generally insisted that it wasnt that bad by comparing it to previous famines, or those operational United Nation agencies and donors who were simply driven by personalities less focused on meeting humanitarian needs. The pressure to respond remained timid through late 1999 and early 2000 in the face of obstinate opposition from some donor groups. This was finally changed in February 2000 by a combination of an announcement by Save the Children/US in New York that a famine event was imminent, BBC television coverage of the severity of the situation in Gode in Somali Region, and by action by the U.S. Agency for International Development (USAID) and the World Food Program (WFP) which led other donors in responding. Once again it was TV images of starving babies which notified the world of the situation in Ethiopia and led to the major response. The assistance response of the humanitarian community after the BBC coverage and program of February 28, 2000 was massive, sufficient to meet the needs of over 10 million affected people, including those suffering from a rain failure in Northern Ethiopia. It was too late, however, to save the lives of at least tens of thousands of malnourished Somali children, mostly swept away by a preventable measles epidemic Save the Children UK, which had tried to alert donors and mobilize support for the famine victims as early as October 1999, was another organization which learned and took action. The major organizational lessons remembered as famine erupted again in late 2002 were that the alarm needed to be raised early and aggressively, and that health problems such as measles were the major killers in the famine. Both of these lessons proved critical, and changed the behavior and actions of the Save the Children Alliance and those who followed their lead. More immediately, the lack of an effective and legitimate early warning system in Somali Region had to be addressed. Save the Children UK took the lead in working with the Ethiopian government on identifying the best system for the huge and frequently insecure pastoral areas of Somali Region, and then methodically putting it in place. In cooperation with the other major aid actors in the region, including NGOs and UN organizations, and with the support of USAID, the EU and Canada (through Save the Children Canada), a new Early Warning system was put in place. By the time of the emerging crisis in late 2002 the system was working well, with probably the best information in the country for identifying and responding to crises. Early response was organized for the region, with initial and strong support from DFID (which had also changed), and a major famine was averted in the region. A major measles vaccination campaign was also organized in the most affected parts of Somali region by Save the Children UK and US, which ensured there was no repeat of the massive measles epidemic of 2000. The famine of the year 1999-2000, which claimed an estimated figure of 75,000 childrens lives in Somali Region alone, resulted from late identification of the severity of the drought of 1999 and the process of famine that was well underway since 1997 and an even later and inadequate technical response. The result of the lessons learned of the 1999-2000 famine was a much improved and legitimate early warning system established in the Somali Region, and perhaps more importantly institutional learning Again, while a national famine was averted, famine in Ethiopia in 2002-

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2003 was not. Many lessons were learned but many more need to be learned and deployed for 2004 and beyond. The year 2002 saw the worst drought in Ethiopia since 1984 with the failure of the main rains. Over 15 million Ethiopians were seriously affected, 13.2 million requiring food assistance before the end of 2003. This compares with an official number of 8 million affected by the drought of 1984-85. The difference was that an estimated 1 million people died in 1984-1985, while the systems and organizations in place in 2003 were there to ensure that this level of death was avoided. Although overall preparedness and response to the drought of 2002 was better than in previous large droughts, it was still far from perfect. From June 2002 the deteriorating situation in the Afar region was recognized, and by November the Prime Minister announced to the international media that up to 15 million people were affected by the drought. Assistance was slow to start in the food sector, and much slower in other sectors. Because of food shortages, the government maintained a ration of only 12.5 kg of food grain per beneficiary, far below minimum international standards. Under pressure from a group of NGOs lead by the SC Alliance, donors agreed to provide the resources for a full food basket (15 kg of grain, plus 1.5 kg of pulses and a liter of oil). This was officially adopted in September 2003. The effect of the inadequate rations, combined with the spreading of the resources available to too many beneficiaries, resulted in a drastic decline in child nutrition in the most affected areas. In areas where the food assessment and delivery systems were well established, such as Amhara and Tigray, nutrition levels were kept to normal levels. In parts of Oromo and the Southern Peoples Region, inadequate food systems resulted in a drastic decline in child nutrition and many deaths. Somali region had a much improved assessment due to the SC and Government Early Warning system, but there were isolated cases where nutrition fell to crisis levels. In the Southern Peoples Region, the situation of child nutrition got out of hand in a number of areas. According to a UNICEF Lessons Learned paper on the 2002-03 famine, over 600 therapeutic feeding centres were required for severely malnourished children. Only 46 were opened. If nutritional assessments were correct, then 10s of thousands of children died from malnutrition, the bulk in the Southern Peoples Region. Strengthening the capacity to predict and respond to disasters in the South is a high priority. The non-food response was also highly inadequate in the drought, in the areas of health, water provision, and animal health in particular. Better coordination initiatives have been set up. As noted above, Save the Children applied the lessons learned in Somali Region in the 2000 drought, and pressed for and mobilized measles campaigns in Fik and Shinille Zones with the support of UNICEF and the WHO. No major measles outbreak occurred in the Region, unlike the 2000-01 outbreak which killed tens of thousands of children. Save the Children has advocated a position of walking on three legs following the drought of 2003 improve the systems to predict and respond to disasters; assist people with recovery from the crisis; and improve long term programs to reduce vulnerability to shocks. Lessons learned from the famine of 2003 include the need for better Early Warning through Household Economy Analysis, improved food aid targeting, tackling pastoralist issues, dealing better with nutrition, and better non-food response.

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4.1.3 Root Causes: The Normal Situation of Child Survival in Ethiopia


Even outside of the recurrent famines in Ethiopia, the conditions of child survival are appalling almost beyond imagination. According to the State of the Worlds Children 2004 report by UNICEF, 504,000 children under 5 die per year in Ethiopia the 6th highest number in the world, and second highest as a proportion of population. This is the equivalent of the famine in 1984-85 over 2 years. Apart from the large number of child deaths, UNICEF also reports that 52% of Ethiopian children suffer from stunting and 11% wasting, resulting from the long term effects of malnutrition. The Save the Children UK report Wealth, Health and Knowledge undertaken in Gubulafto Woreda in North Wollo researched the causes behind the bad nutritional conditions of children. This research was undertaken to help determine the most cost effective approach to reducing child malnutrition. The proposed World Bank/GFDRE nutritional component of the Food Security Programme is based on the assumption that education of mothers is the main programme needed to improve nutrition. The study was designed to see if ignorance of mothers was the main reason for child malnutrition. The main finding of the study was that child nutrition remained fairly stable up until the age of 5 months. After that, the nutritional conditions deteriorated, with 40% of children malnourished before the age of 2 years. Through various correlation techniques, the impact of knowledge and other factors, such as poverty and educational levels, on the level of child malnutrition was tested. The conclusions were clear. Poverty was the main cause of malnutrition. The main problem was that mothers from poorer households needed to go back to work in the fields or in gathering firewood or dung after the children were 5 months old. Better off mothers could stay in the household for longer, therefore not interrupting breast feeding. Once the poorer mothers had to leave the household for long periods during the day or take their baby to the field. Either way, the health of the 5 month old deteriorated rapidly, as measured in the nutrition declines. Mothers generally had the knowledge that breast feeding and good weaning foods were needed, but those in greater poverty were not able to practice what they knew. Although crude extrapolation of these findings to all parts of Ethiopia would be wrong, similar conditions of life exist through the populous and vulnerable highlands which cover much of Amhara and Tigray regions, and stretch into Oromo. Further study planned by Save the Children in the pastoralist and semi-pastoralist areas of Somali Region will provide some geographic balance to the findings in the highland agricultural areas of Gubulafto. This research provides the foundation for tackling child malnutrition in a longer term way in Ethiopia. These results are planned to feed in through an established technical committee into the nutrition programme of the Ministry of Rural Development/World Bank. (See further analysis in the Nutrition and Health sections below)

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4.1.4 Destitution and Long Term Food Insecurity


The underlying causes of the poverty and recurring famine which affects the children of Ethiopia so drastically are a matter of ongoing discussion, but insufficient action. Although there is enormous variation in the country in agro-ecological or food economy zones, all parts of Ethiopia suffer from poverty. Urban areas have generally higher levels of income, and generally much better access to services, but an enormous underclass of slum dwellers and indigent street children. Rural areas, with 85% of the population, vary in their conditions, but all suffer from a high level of poverty. The debate, discussed below, is over the causes of the poverty and the solutions. Most of the areas of the highlands which have a high level of fertility have a commensurately high level of population. Where production is high, the size of plots is small, so that farmers continue to live on a small surplus in a good year, which turns to a serious deficit in a shock year. The classic example is Wolayta in the Southern Highlands, where green famine is common (Save the Children UK, NSP). Plots are so small that farmers are dependent on a complex set of production, including yams, maize and enset (false banana). A failure of one of these sources of food precipitates famine conditions, even though the area remains green and lush-looking. Cash crops can provide a good income for families on small plots of land, but this is unreliable. The collapse of the price of Ethiopias largest cash crop, coffee, in 2002, cut incomes of affected farmers by up to 80% (Oxfam, 2003). Coffee plants were uprooted in vast numbers, often to be replaced by the mild narcotic chat, with obvious social consequences. Although there has been much talk of alternative cash crops, and there is limited success for farmers with fruit and sugar, there have been more failures from diversification than successes. Pastoralist areas are filled with peoples with great self reliance and a lifestyle not characterized by destitution, but they are extremely vulnerable (Devereux, 2004}. Drought and livestock price declines can quickly push pastoralist populations into famine conditions. A combination of both in the period since 1999 in Somali and Afar areas pushed millions of pastoralists into desperate conditions. Although pastoralist livelihoods are based on a boom and bust cycle, recovery from the extreme conditions of recent years will be difficult. Tens if not hundreds of thousands of pastoralists have lost their livestock, and traditional methods of re-stocking are over-stretched (SC UK, HEA baseline, 2002). Those left in shanty towns with no means of support constitute a new class of destitute in pastoralist communities. It is the children who suffer the most. The classic areas of poverty and destitution in Ethiopia are the Northeast Highlands, the epicenter for the famines of 1973-74 and 1984-85, and chronically food insecure to this day. There was a brief period of optimism in the 1990s, where the newly established EPRDF government launched a massive agricultural inputs programme designed to increase production and create self sufficiency in Ethiopia. With good rains and therefore harvests in 1995 and 1996, great optimism prevailed. Former US President Jimmy Carter arrived in Ethiopia and declared the biggest problem Ethiopia will have is finding enough storage for all the surplus grain. This proved optimistic. Unfortunately the increased production at the macro level did not mean household self sufficiency in the deficit areas. Even with a very good rainy season in 1996, over 3.5 million people remained dependent on food assistance in 1997 (DPPC, Annual appeal, Jan. 1997). They did not have the money to buy the surplus produced in other areas, and no mechanism existed for purchasing the surplus and providing it to deficit areas (although local purchase for food

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relief helped). Farmers in the surplus areas saw the price of grain collapse, reducing their returns to less than the cost of their inputs in many cases. The agricultural inputs policy, even when undertaken in a participatory way with farmers, did not solve the underlying reality of destitution and poverty. Save the Children was unconvinced by the optimistic reports of the late 1990s, and in 2001 began planning a major study on destitution and livelihoods in the Northeast Highlands to challenge the notion that rural poverty was in decline. This Destitution Study was undertaken with the Institute of Development Studies of the University of Sussex, and provided a statistically firm analysis on the trends in destitution vs. sustainable livelihoods. Destitution had been increasing steadily during the 1990s, leaving children and their families ever more vulnerable to malnutrition and famine . The main findings on trends in destitution are reported below. The Destitution Study was a statistically valid analysis of the population of Wollo and Wag Hamra, about 4 million people in one of the poorest parts of the country. EXCERPT FROM DESTITUTION IN ETHIOPIAS NORTHEASTERN HIGHLANDS (AMHARA NATIONAL REGIONAL STATE), SC UK, AND INSTITUTE OF DEVELOPMENT STUDIES (APRIL 2003) TRENDS IN DESTITUTION OVER TIME
Table 4.1. Self-assessed levels of destitution and vulnerability over time

Classification Destitute Vulnerable Viable Sustainable Total households

10 years ago 2 years ago 85 [5.5%] 333 [16.4%] 932 [45.8%] 672 [33.1%] 96 [4.7%] 2,023 [100%]

1 year ago 307 [14.6%] 1,119 [53.3%] 605 [28.8%] 70 [3.3%] 2,101 [100%]

Today 310 [14.6%] 1,167 [54.9%] 585 [27.5%] 65 [3.1%] 2,127 [100%]

10 years time [projected] 617 [21.8%] 1,504 [53.1%] 647 [22.9%] 63 [2.2%] 2,831 [100%]

267 [17.4%] 691 [45.0%] 494 [32.1%] 1,537 [100%]

Note: The total of 1,537 households [72.3% of the sample] ten years ago comprises those households that were formed before the start of the recall period. The remaining 27.7% were formed within the last ten years. e transition probability matrix. Figure 4.1 shows the percentage of households in each category of the self-assessment over time. The projections for 10 years in the future are obtained through a Markov chain process, i.e. by multiplying the vector of categories today by the transition probability matrix. Figure 4.1. Trends in self-assessed destitution and vulnerability in the study area Trend analysis highlighted the fact that the proportion of destitute households has increased dramatically in recent years, and will inevitably continue to rise in coming years. Qualitative work at the community level confirmed that these processes of destitution are affecting entire communities. New categories of extremely poor households have emerged in six out of nine qualitative research sites, and this has been accompanied by a simultaneous shrinking or disappearance of those better-off households who previously provided access to productive resources to the poor, as well as assistance in times of need. This community-wide slide towards destitution greatly exacerbates the vulnerability of those already at the bottom end of the scale.

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60.0

50.0

Rich Middle Poor Destitute

Percent of households

40.0

30.0

20.0

10.0

0.0 10 years ago 2 years ago 1 year ago This year 10 years time

4.1.5 Conclusion of Child Survival Clearly the underlying issues of destitution and unsustainable livelihoods create the conditions under which childhood survival is threatened. The recurrent cycle of drought and famine, as well as the chronic poverty and malnutrition from which children suffer is based on the fragile livelihoods and destitution of most of the population. Sufficient analysis of this background in different geographic areas of Ethiopia is essential to properly tackle the development challenges as well as the survival challenges of children. HIV/AIDS and Child Survival will be covered under a separate HIV/AIDS section, with recognition that HIV/AIDS has drastic implications for child survival and development, as well as protection.

4.2 DEVELOPMENT
(Right to Basic Health and Welfare, Education, and Survival and Development Articles 6, 18,24,26,27,28-31 of the Child Rights Convention) 4.2.1 Livelihoods As discussed above, addressing childrens right to development requires an understanding of the underlying poverty and unsustainable livelihoods which afflict children in Ethiopia. Livelihoods in Ethiopia vary widely. Save the Children has identified up to 160 livelihood zones in Ethiopia, each with different characteristics to the household economy. In Somali Region alone, which has been thoroughly surveyed, there are 13 Food Economy or Livelihood Zones. Detailed understanding of all the Livelihoods will help Save the Children and others to plan and implement programmes more suitable to work in those areas. Even without this detail, there is sufficient knowledge to provide sufficient analysis of the situation of children to identify ways to go forward. As discussed above under Survival, the reality for children and their families everywhere in Ethiopia is that poverty affects a large proportion. Livelihoods are overwhelmingly based on subsistence agriculture and pastoralism. Although the complexity of the survival and development strategies in Ethiopia are revealed by Household Economy Analysis, their

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vulnerability is also revealed. As with other traditional societies, as long as Ethiopians are overwhelmingly dependent on subsistence activities, they will be vulnerable to the recurring cycle of drought and famine, and highly vulnerable to other shocks. It is in the best interest of the child to support their families to have more sustainable livelihoods. Livelihood diversification programmes have been underway in Ethiopia for some time, but have had limited success. In the meantime, population growth and therefore pressure on the land continues to grow, and overwhelms all efforts. As in other societies, the process of urbanization and industrialization in Ethiopia is probably the only answer. Assisting farmers to make better use of their scarce resources can help to sustain or even improve the livelihoods for them and their families. In the long run, alternative off farm employment will allow for less population dependent on subsistence activities, and will provide the market which will provide those remaining on the land to make a better living. Priorities for efforts in supporting livelihoods of the poor include long term commitments of food assistance to preserve assets, substitution of cash for food assistance as it becomes possible, and efforts to improve the positive economic cycle between the rural economy and small towns and urban areas. As demonstrated in the study Economic Alternatives in North Wollo (Rahmato and Holt, 1998), limits are soon reached to the potential for economic development in rural areas alone. Household Economy Analysis (HEA) provides an analytical basis not only for Early Warning but also to help design pilots and programmes to assist livelihood development. 4.2.3 Child Nutrition As shown above, the statistics on child nutrition in Ethiopia are appalling. What are the reasons for the high rate of stunting (52%) and wasting (11%) which reflects the poor state of child nutrition? How can malnutrition be reduced so that new generations of children dont start life with the huge physical and mental challenges of malnutrition? Understanding child malnutrition is essential for Save the Children to devise programmes of support which can tackle this monumental problem. The commitment of the Government of Ethiopia to tackling child malnutrition is questionable. There are no major programmes for tackling malnutrition, the departmental responsibility is unclear (Ministry of Health or Rural Development), and the agenda for child nutrition seems to be set by the World Bank rather than the government. The major proposed programme in the nutritional component of the Food Security Programme, a World Bank supported programme under the Ministry of Rural Development. This project is mainly based on the assumption that mother ignorance is the main underlying cause of child mortality. Using a methodology of growth monitoring, this approach has been discredited in studies by Save the Children UK (Thin on the Ground, 2002) and others. To understand more fully the underlying causes of child malnutrition, SC UK undertook a study, Wealth, Health, and Knowledge (2002), to test the causes in one area. The main conclusion, that poverty is the major cause of child malnutrition, is summarized below. This study is very important in developing programmes to test the most effective means of confronting child malnutrition. Five interventions were identified to be tested - payment of poor lactating mothers in food or cash until babies are 6 months old, improved water and sanitation, access to free drugs for children under 2, as well as mothers education on nutrition.

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Testing of these alternatives in the northern highlands, will be complemented by study and testing of alternatives in other parts of the country in particular pastoralist areas to provide a more balanced approach to the diversity of Ethiopia. These programmes will be used to help inform Save the Children programmes, but also to assist the government and the World Bank and other donors to use the most cost effective means of combating child malnutrition. Wealth, Health and Knowledge: Determinants of malnutrition in North Wollo, Ethiopia, SC(UK) Ethiopia, June 2002 Study conclusions
For children under six months, the most important factor associated with malnutrition is breastfeeding pattern. The ability to exclusively breastfeed depends on whether or not a mother can spend sufficient time with her child as well as the knowledge that exclusive breastfeeding is best for children aged 0-6 months. Women who spend more than two hours away from their children aged less than six months are significantly less likely to exclusively breastfeed than other mothers are.
Figure 3: The prevalence of malnurition by age
50 45 40 35 30 25 20 15 10 5 0 0-1 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-23 Age (months)

Malnutrition increases very rapidly between 5-10 months in this population. This is partly explained by the introduction of inappropriate weaning foods. Up to 20% of women delay introducing weaning foods until the child is 10 months old. Diarrhoea is highly associated with malnutrition at this age.
Figure 4: T he rate of exclusive breastfeeding by child's age
Proportion of children 100 80 60 40 20 0 0-1 1-2 2-3 3-4 M onths 4-5 5-6 6-7

Above the age of 10 months, household wealth, maternal education and nutritional status, and childs illness status in the 24 hours prior to interview are all significantly and independently associated with childrens nutritional status.

Prevalence of malnutrition

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Figure 5: T he pre v ale nce of malnutrition by we alth group


50 Prevalence of malnutrition 45 40 35 30 25 20 Better-off M edium P oor

Household wealth affects many of the underlying causes of malnutrition including childrens illness, feeding and hygiene practices in the household. These associations can be explained by the fact that women living in better-off households have increased access to food, higher cash incomes to spend on health, education and hygiene and more time to spend caring for their child.
Figure 6: The prevalence of malnutrition according to mother's school attendance
Prevalence of malnutrition 50 45 40 35 30 25 20 Did not attend school Attended school

Mothers educational status is associated with vaccination status as well as hygiene practices in the household. These associations can be explained by the fact that educated women are likely to be betterinformed about caring practices than uneducated women. Educated women may also have more decision making power in the household than uneducated women. Poor mothers Better-off mothers Community leaders Food 1 4 3 Health care 2 1 1 Family planning 3 3 5 Health education 4 2 4 Safe water 5 2 Money 6 DDT spray 5 6 Vaccination 6 Poor mothers from Gubalafto prioritised food as the most important intervention to improve their childrens nutritional status. Improved healthcare, family planning services, health education and access to clean water were the next most important priorities for this group. Better-off women prioritised healthcare and family planning over food as interventions.

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4.2.4 Health The status of child health in Ethiopia remains extremely poor despite increased investment by the government in the health sector. Despite an increase to 1.3% of GDP in spending in the 1990s from 1% in the 1980s, child mortality has actually increased in the same period (Young Lives, 2003). Apart from the imbalance of capital expenditures versus recurrent expenditures, which has put more emphasis on health structures rather than the personnel to manage them, further analysing the success and failures of the current health system is critical. Based on many years of experience working with the Ministry of Health on building capacity in two very different areas in Amhara and Oromo, SC UK undertook a study with the MOH to look at the issues affecting utilization of health services by the poor in Ethiopia. Unlike most or virtually all other African countries, rural health facilities, where they exist, are generally underutilized in Ethiopia. There are no crowds of people waiting for service at most rural health clinics, but rather a trickle of use. Why is this the case? The excerpt from the Too Poor to be Sick (SC UK, 2002) study below, provides an analysis of barriers to the poor of the health care system in a particular area, the findings are useful in understanding problems with the health system in Ethiopia as a whole. The overwhelming role of poverty in excluding Ethiopians from use of the health system, in particular the high costs and availability of drugs, are documented in the study. In other parts of the country, in particular the highly under-served pastoralist areas, further study can add to the understanding of improvements needed in the health system.

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Summary "TOO POOR TO BE SICK" (SC UK, 2002) Illness costs and their implications for poor households ability to pay for healthcare, and childrens access to health services in Ethiopia
A Study by Save the Children UK
Too Poor to be Sick reveals how despite a decade of health sector reform the needs of most Ethiopians have not been addressed. It demonstrates that the major barrier to healthcare for the majority of rural Ethiopians is the high cost of drugs. It also raises worries about the institution to improve the availability and affordability of drugs, the Special Pharmacies (SPs), which potentially excludes the majority of potential users. It calls on both the government and its partners to work at making healthcare really available for the poor majority, through making cost recovery more equitable and urgently exploring alternatives for affordable treatment. It challenges the conventional wisdom that cost recovery on drugs must be a condition for sustainable healthcare, as in the context of poverty in Ethiopia most people cannot afford to pay for drugs. The result is a public health care system that effectively excludes half of the population. Overall, the Ethiopian Government is demonstrating support for a good healthcare system by honouring its commitment to spend 20 per cent of its national budget on basic services1 but the international community is lagging far behind. Main findings of the study: Most people do not use the public healthcare system. Only a minority of people in the study area who were ill sought treatment at public facilities, with lack of money being the main factor deterring treatment. These financial barriers were linked largely to drug shortages at public facilities, which meant people had to buy drugs from private pharmacies. For those who did seek treatment, it was a difficult choice to make: roughly one third of households had to sacrifice other essential spending; and, another third had to adopt a cost management strategy such as borrowing, selling assets or mortgaging a crop. Evidence also suggests that these risky strategies are contributing to indebtedness and asset depletion. In most places existing exemption mechanisms are weak or not working and therefore do not protect the poor from the high costs of healthcare. Special Pharmacies potential to generate additional resources and increase relative affordability may be overstated. The majority is unable to pay because people lack cash to meet even basic food requirements. Slightly cheaper drugs will not change the financial cost barriers for most households. SPs may actually exacerbate geographical inequity: they will improve drug availability at facilities in urban centres and cashrich areas, but these benefits are unlikely to reach people in rural and more marginal areas who live great distances from health centres and hospitals.

The government spent 19 per cent of its budget in 2000/01 on health and education alone (World Bank 2001).

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Main recommendations:

Increase levels of public funding through donor support.


The evidence shows that policy-makers need to be cautious and realistic about the contribution user fees and SPs can make. Donors and the government should continue to increase public funding for healthcare, and donors must add considerable support to this funding if any significant progress is to be made towards reaching the minimum funding requirements recommended by the World Bank or WHO. To meet the WHOs target of US$30-40 per capita, the Ethiopian Government would have to spend 100133 per cent of its total budget on health2. The government could likely increase the share of the budget it spends on health, but certainly not to the levels recommended by the WHO. These figures reflect the poverty of Ethiopia and the drastic need for additional external resources.

Invest more heavily in alternative sources of funding through a range of risk pooling and health insurance initiatives. To date, very little has been done regarding health insurance in Ethiopia and the

private sector sees very little opportunity here. While the Essential Services for Health in Ethiopia (ESHE) project has started by surveying existing health insurance schemes in the country, further study and pilot schemes should be given high priority. Particularly, the feasibility of community health insurance schemes, possible linked to local savings societies, eders, should be examined.

Strengthen equity priorities within a national user fee policy. User fees are an established source of

additional funding for facilities and health managers, and given this reality fees are likely to be sustained. The strengthening of policy should focus on making fees more equitable or pro-poor. The main focus for more equitable user fee policy should lie with the exemption system, or a system of differential charging. Targeting in Ethiopia is currently done using an income threshold, but this is notoriously difficult to implement in practice, especially where many peoples livelihoods are semi-subsistence and their incomes are highly seasonal. More attention should be given to alternative exemption targeting procedures. One possibility that needs further examination is to use livelihood groups when assessing ability to pay and the potential burden of treatment costs. This could involve a relatively simple methodology similar to Save the Childrens Household Economy Approach. Note on methodology: The broad aims of the research were to evaluate the implications that financial and time costs have for peoples treatment-seeking behaviour and ability to pay for healthcare, and to use these findings to inform health policy debates in Ethiopia, particularly with respect to Special Pharmacies and user fee policy. The specific research objectives were to evaluate: peoples treatment-seeking behaviour and the factors influencing treatment strategies; the financial and time costs of seeking treatment; the availability of cash resources within the household to pay for treatment; and the strategies households adopted to pay for treatment. A mixed method approach using quantitative and qualitative techniques was used. Data was collected at community level through a household survey, focus group discussions and interviews with key informants. The research was located in three woredas in East Hararghe, purposefully selected on the basis of distance from the zonal capital Harar: Alemaya (relatively close), Meta (medium distance) and Grawa (distant). In each woreda two kebeles were purposefully selected one relatively cash rich (highland) and one relatively cash poor (lowland) to enable comparisons of treatment-seeking behaviour, health spending and cash availability between these different livelihood zones. The study was carried out in an area of above average prosperity and results are therefore likely to be valid for large parts of Ethiopia The household survey covered 643 households (3,642 individuals). It distinguished between acute and chronic illness, the latter defined as an illness that had persisted for more than a month. The survey used a two-week recall period to elicit information about acute illness, and treatment and treatment costs for both chronic and acute illness.

Total government expenditure on health for 2000/01 was EB794m or US$94m (World Bank 2001).

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Follow-up Save the Children has followed up on the study by: pressing donors, particularly DFID, to increase their support to Health and other Basic Services, and working with the Amhara Region Bureau of Health to design and implement a pilot on exemption systems for the poor on health care in Debre Sina Woreda. The overall state of child health and survival has been well documented by the Ministry of Health and UNICEF for a high level conference on Child Survival in April 2004. A summary of the material is below: EXCERPT FROM "CHILD HEALTH IN ETHIOPIA", Background Document for the National Child Survival Conference, MOH and UNICEF, April 24-26, 2004

When does malnutrition begin? Almost immediately. Despite the fact that virtually all mothers breastfeed their newborns (see below), 11 % of infants less than six months of age are already stunted. Malnutrition rates continue to rise to 12-23 months of age, resulting in stunting in nearly 60% of children and wasting in about 20%. From that period onwards about 60% of children remain stunted and about 10% of children remain wasted. 41 %. This decrease may have been in part due to population dislocations resulting from the famine there at the time.

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A health facility survey of child health services conducted in SNNPR in 2001 found that 79% of facilities had all the necessary EPI equipment and supplies and of the 88% of facilities with a functioning refrigerator, only 59% reported safe vaccine temperatures (2-8 C). All vaccines were present in 89% of facilities and 6-month stock-outs were as follows: BCG 16%, OPV 7%, DPT 14%, Measles 9%, TT 5%. Outreach was conducted by 98% of facilities, for an average of 7.6 times/month to 8.4 communities. In addition to the routine EPI system, Ethiopia has continued to employ National Immunization Days (NIDs), sub-NIDs (SNIDs) and supplemental immunization activities (SlAs) for tetanus, and measles. Polio eradication efforts have been ongoing and the country has been polio-free for the past three years. GA VI has been working at the national level for nearly ten years, but recently Immunization Coordination Committees (ICCs) have been established at the regional level. Even more recently, Ethiopia has adopted the Reaching Every District (RED) initiative, which by report has succeeded in bringing together administrators, managers and providers at the regional level to jointly budget and plan immunization activities.

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"Health Facility Survey of Child Health Services: SNNPR"; ESHE Project, March 2002.

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Ratios of population to private drug outlet are about one factor lower, but significant variation still exists across regions. In both analyses, Somali stands out as having especially poor access to drug outlets.

There are also significant regional discrepancies in human resources, particularly when it comes to program managers and health providers. In Oromia, for example, a region larger than most countries in Africa, staffing for program management is extraordinarily limited: there is only one staff for nutrition, one for IMCI, one for maternal health, one for family planning, two for HIV / AIDS, 3 for BPI and a team of about 10 for malaria. The staffing pattern for each region is different, but no region has the staff it needs to scale up interventions to anything approaching universal coverage.

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Health provider staffing is also extremely limited and highly variable. Overall, there is about one nurse per 4,882 population (the WHO "standard" is 1 :5000), but recruitment and retentionparticularly in the more remote and larger regions - is consistently difficult.

The number of pediatricians is even more limited. Overall, there are a total of 1,280 physicians in the country, but only about 82 pediatricians. Most of these pediatricians are in the urban centers, leaving only a handful for the remainder of the country. Harari, even though it has one of the country's highest ratios, has only one pediatrician for its population of 178,000. The three largest regions (accounting for about 56 million people, or 80% of the country) together have only 10 pediatricians.

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Pastoralist communities, which represent about 10% of the population and are mobile and seasonally change their residence, are especially difficult to reach with traditional facility-based health services. Estimated health service coverage and utilization by region (2000-2001) Region Population Potential health Outpatient visits per service coverage (%) capita per year Tigray 3,797,000 66.24 0.80 Afar 1,243,000 52.70 0.23 Amhara 16,748,000 43.50 0.15 Oromia 23,023,000 46.91 0.28 Somali 3,797,000 30.55 0.04 Ben-Gumuz 551,000 86.21 0.76 SNNPR 12,903,000 55.06 0.20 Gambella 216,000 87.96 0.80 Haran 166,000 114.46 0.79 Addis Ababa 1,570,000 93.39 0.55 Dire Dawa 330,000 51.52 0.28 National 65,344,000 51.24 Source: FMOH (2000), Health and Health- Related Indicators. 0.27

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Identification of these priority areas of child health, and the context and capacity of the health response, has been accepted by the government, major donors, and relevant NGO's. The action programme to deal with these issues continues to develop.

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4.2.5 Education By law primary education in Ethiopia is free, and Ethiopia is committed to the Education for All (EFA) goals of universal primary education by 2015 and gender equity by 2005. However, despite efforts by the Government to increase the number of schools, there are not enough schools to accommodate the country's youth. The Government uses a two shift system in many primary and secondary schools, particularly in towns and larger villages, to maximize the utilization of classrooms and to provide an opportunity for working children to attend school. Nation-wide the total enrollment of children who are of primary school age is about 64.4 percent. 74.6 percent of male primary age children and 53.8 percent of female primary age children attend school. In general secondary education (grade 9-10), the total enrolment rate is 19.3%; 24% for boys and only 14.3% for girls (Education Statistics Annual Abstract 2002/03, Ministry of Education). The Government adopted the New Education and Training Policy and Strategy in 1994, focusing on the expansion of equitable access to primary and vocational education, restructuring the education system, changing the curriculum to increase the relevance of education to communities and improving the quality of education throughout the system. The planning and management of primary and secondary education has been decentralized to the regional level, opening up for increased relevance through adapting to the realities in the various regions. The first Education Sector Development Program (ESDP I) was adopted in 1997, covering the school years 1997/98 to 2001/2002. ESDP II covers 2002/2003 to 2004/2005, focusing in particular on vocational training and on methods to strengthen pupil centered education. The development of ESDP III is currently underway. Within the space of 4 years, the official primary school enrolment figure has increased from around 5.7 million to almost 8.6 million children. Despite this achievement, several problems remain. The average pupil/teacher ratio at the primary level (1-8) increased from 51 in 1998/99 to 64 in 2002/03. Moreover, the gender gap has widened - although more boys and girls are enrolled, the number of boys is increasing faster than the number of girls. For example, from 2000/2001 to 2002/2003, boys enrolment increased with 7.3 percentage points while girls enrolment increased by 6.8 percentage points. At secondary level, in 2000/01 14.8 % of boys and 10.9 % of girls of secondary school age were enrolled. In 2002/2003, those figures had risen to 24 % for boys and 14.3 % for girls. That is, enrolment increased with 9.2 percentage points for boys but only by 3.4 percentage points for girls. The dropout rates are still high. Almost 30% of pupils enrolled in Grade 1 in 1998/99 left school before reaching grade 2. Grade by grade analysis shows that the repetition rate at Grade 1 is about 10%. There is an acute shortage of schools, especially in rural areas. Increased enrolment in the first cycle of primary education (1-4 grade) has put pressure on a limited number of fullcycle primary schools (1-8 grade). Access to secondary school is even more limited, and at the tertiary level there is an acute shortage of higher learning institutions. Equitable distribution is a considerable challenge in Ethiopia. There 'are significant discrepancies regarding children's participation between urban-rural locations, between gender (male/female) and between/within Regional States. The education system does not give enough consideration to disadvantaged groups such as working children, street children, children with disabilities, rural children, girls, etc. In addition early marriage, and household responsibility present important barriers to education for girls and young women (CRC report, 2001) The educational system is characterized by inadequate facilities such as lack of basic education materials, insufficient training of staff, large classes with large age differences among pupils, weak institutional capacity and limited community involvement in the management of schools. The
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curriculum is not appropriate to the interests, needs and life challenges of the children and their families. The school schedule conflicts with the work schedules of many children and their families and education is too expensive for communities with very low economic status. This clearly reveals the need for a flexible, low cost and relevant curriculum. The current curriculum revision is an opportunity for improvement in this area. Factors such as distance to school and harmful traditional practices such as early marriage and abduction make parents feel that priority for educational opportunities should be given to boys, as they are less vulnerable. The girl in most traditional societies is also a source of wealth, as the parents of the girl child get a considerable amount of money, material and cattle from the family of a person marrying her. Thus, parents prefer to keep the girl child within the home yard, while sending the boy to school, and this widens the participation gap between girls and boys in school. Even though the Education and Training Policy of Ethiopia states that the education program shall enable both the disabled and the gifted to learn in accordance with their potential and needs, only very insignificant numbers of children with difficulties benefit from the education program of the country, although nation-wide information on these group of children is not available.. In general, parents don't give equal chances for children with disabilities to education. Schools don't have welcoming environments for children living with disabilities and teachers are not prepared to teach them. For example, a recent survey in Alefa Takussa and Chilga Woredas in North Gonder Zone identified 413 children with mental disabilities. Of these, only 24 were enrolled in school. Only 5 of a total of 383 deaf children and 4 of a total of 52 blind children attended school. Special provision is limited and reaches only a small percentage of children with disabilities in larger towns. In South Wollo SC UK has been working on access of disabled children to school for the past 7 years. Stigma against children with disabilities has resulted in marginalization, to the point where children with disabilities are considered a source of shame by their families. As a result, disabled children are usually locked away from any connection with the community. Through a prolonged process of community workers discussing with the families and setting up cross disability support and action groups, the disabled children were gradually released into the community. A programme for integrating disabled children has helped over 200 to become integrated into the school system, but this was very involved and labour intensive work. The possibility of replicating this work in other areas is very limited, and requires enormous changes in the government capacity and approach. There are strong attitudinal barriers, which should be tackled through advocacy and awareness raising campaigns. The UN Committee on the Rights of the Child recommends that the State party pursue its efforts to increase enrolment, to build additional schools, supply better school equipment, to improve teacher training and to recruit more teachers towards ensuring improvements in the quality of education, giving particular attention to those regions most in need of such assistance. 4.2. 5.1 Alternative basic education Models of alternative basic education provide flexible and cost effective solutions to the shortage of education provision in Ethiopia. For example, the Alternative Basic Education for Children out of School (ABECS) program covers the formal school requirement of the first cycle of primary education. The content is considered relevant to the lives and needs of children in
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Cultural practices

Ethiopia and it covers subjects such as children's rights, health with a special focus on HIV/AIDS, and agriculture (Hestad & Focas Licht (2002). It also prepares the pupils for the second cycle of primary education. This system has been tested and implemented by Save the Children in various parts of the country, and has now been accepted by the government as part of the education policy and practice. After children complete the curriculum, usually within three or four years, they can take the entrance test for the fifth grade. In areas where ABECS has been implemented, enrollment has increased from very low rates, i.e. 8-10 percent, to the highest education rates in the region, i.e. 45% ( Hestad & Focas Licht, 2002) The non-formal basic education alternative is an innovative achievement for the most vulnerable children: poor working children, particularly girls, in remote rural areas. With this new model, children can combine duties at home with school. More children become literate, including children who would never have the opportunity to continue the formal school. The alternative model is sorely needed in this nation where the adult illiteracy rate is estimated at 64,5%. Innovation is imperative in order to reach the millions of children who currently have no access to education.( Hestad & Focas Licht 2002

4.3 - PROTECTION
4.3.1 Key CRC Principles - The right to life, survival and development (Art6), the right to
non-discrimination (Art2) and the best interest of the child (Art 3)

The right to non-discrimination, life, survival and development, and respect for the views of the child in the exercise of civil rights, political, or property rights are claimed to be guaranteed by the Ethiopian Constitution, the Civil Code and the Penal Code (CRC, 2000). Ensuring these rights is in practice hampered by economic underdevelopment, widespread poverty and inadequacy of basic social infrastructure. One important measure taken .by the Ethiopian government to improve the implementation of these rights is the increased budgetary allocation for primary health care (PHC) and basic education (CRC, 2000). Under the Ethiopian Civil and Penal laws the child's right to life is protected in three ways. One is by threatening penal sanctions against those who commit, attempt or incite murder or other acts likely to lead to death, including aiding suicide and committing genocide. This sanction may even go to the extent of protecting the life of the unborn child (CRC, 2000). The other means of protecting the right to life is more lenient than the one already discussed. It is taken by way of giving the survivors of the deceased person the right to sue for damages (Mulugeta, 1996). The third protection is unique to children. Under the Ethiopian Penal Law it is strictly prohibited to impose death sentences on persons below the age of eighteen, however grave the offence may be. This by itself constitutes one of the mechanisms of ensuring that the child is exercising his right to life (Ibid, p. 29) The protection of the child's right to life is not. however, restricted to the legal measures taken by the State. It also involves various other additional measures. For example, it involves the provision of adequate health services and treatment to keep alive those children who would be likely to die if not treated (Ibid, p. 30). It also obviously includes the obligation of the state to intervene in emergencies to preserve life, a role acknowledged by the Ethiopian Government in the National Policy of Disaster Prevention and Management. The right also extends to the

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The right to life is also interpreted as being a right to a certain quality of life. This raises issues of survival and development of the child stated under Article 6 (2) of the UN CRC. Children and families in Ethiopia who are members of ethnic groups which are in a minority in a particular region, or which are not in control of the regions administration, face discrimination.37 Girls and children with disabilities face extensive discrimination, inter alia in terms of their access to education. Societal discrimination against women and adults with disabilities limits the opportunities for girls and children with disabilities to have their rights protected and respected. In a recommendation form the Committee on the Rights of the Child, Ethiopia should make additional effort to strengthen the implementation of the non-discrimination provisions of the national constitution (CRC, 2001). The Committee recommended that particular attention to the situations of children from ethnic groups, which are a minority within a particular province, to girls, to children with disabilities and to discrimination against women. Regarding life, survival and development, the Committee recommended Ethiopia to continue to make every effort to achieve respect for children's right to life, survival and development including through improved economic development, strengthening of social infrastructure and efforts to alleviate poverty. Special attention should be given to children living in rural areas and to refugee and internally displaced children. In matters pertaining to the child's welfare "the best interests of the child" as a general principle is incorporated in the Civil Code. Articles 681 (1) and 304 is particularly mentioned in relation to the appointment of guardians and tutors for the child, placing him in custody in the event of dissolution of marriage, conditions for approval of adoption and other similar issues pertaining to the child's welfare. In addition, a new family law was approved in July 2000 improving issues such as marriage, divorce and child custody even further. It was developed on the basis of broad consultations with NGOs, government Judicial and women's affairs groups, traditional leaders and other members of the society. 4.3.1.1 Definition of the child (Art. 1) The Ethiopian Civil Code of 1960 defines the word "child" as a "minor of either sex who has not attained the full age of 18 years" (i.e. attains the age of majority). This definition is compatible with that provided in the Convention. The general principle is however, subject to exceptions; that is when the age of minority comes to an end through emancipation. Emancipation in turn takes place either through marriage or upon approval of the family council. The application for emancipation because of marriage is restricted to female minors because it is only them that are allowed by the law to conclude marriage contract while they are between 15 and 18 years old. Conclusion of marriage implies that, she has attained the age of majority age even if she is less than eighteen. Once a female girl has been emancipated through marriage and attained majority, she looses the special protection afforded to children under law. Apart from marriage, the family council may, for good cause, authorize the emancipation of a minor provided he has reached the age of fifteen years and the application for emancipation has been made by the child him/her self or one of his ascendants or his guardian or his tutor. Under the 1957 Ethiopian Penal Code it is stated that the minimum age of criminal responsibility is 9 years and that as from the age of 15 years, children are treated as adults (Article 56: 1). In this

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regard it is not clear, whether the latter means that children above 15 years of age may be sentenced to life imprisonment or detained together with adults. Ethiopian Labor Law states that there are two categories of minors: Persons under 14 years of age and "young workers", (persons who have attained the age of 14 years but are not over 18 years of age) (Ibid). The first category of minors is totally prohibited from contracts of employment. In the case of the second category of minors, they can sign employment contracts for work and apprenticeship. This Labor Law goes against Article 313 in the Civil Code, which forbids young workers to undertake professional contractual relationships with an employer. Finally, the Labor Law treats a person as an adult worker only when he is over eighteen years of age; otherwise he is a minor or a child (Ibid, p. 40) The right to nationality The UN CRC recognize the child's right to acquire a nationality and, obliges the State to undertake to respect the right of the child to preserve his or her nationality. According to the Nationality Act of 22 July 1930 (Article 1), children born to Ethiopian subjects are Ethiopian nationals, whether born in Ethiopia or abroad. If the father is an Ethiopian subject, the child automatically acquires Ethiopian nationality. But, if only the mother is an Ethiopian national, the child must affirmatively elect to become an Ethiopian national by living in Ethiopia and giving up his foreign nationality. If, in this case, a child born in Ethiopia to an Ethiopian mother lives in his father's country and if his father's country adopts the principle where citizenship is determined by its parents citizenship, this child will remain stateless (Ibid) If a child adopted by an Ethiopian national loses his former nationality under his national law, he also becomes stateless (Ibid, p. 23) The question of children born in Ethiopia by refugee parents is also another problem of the Ethiopian National Law. The Eritrean children have become stateless in Ethiopia since the national law of Eritrea follows the principle of citizenship based on the place of birth, whereas the Ethiopian law follows the principle of citizenship based on a child's parents' citizenship. 4.3.2 The right to birth registration and name According to Article 37 of the Ethiopian Civil Code, the birth of a child has to be declared and registered with the commune where the child was born within 90 days following his/her birth. However. insufficient steps have been taken to ensure the registration of children after birth. The State registration procedure is hampered in practice by the lack of registration desks, especially in rural areas. It is also evident that there is a lack of adequate means for the registration of refugee children (CRC, 2001) The Civil Code addresses situations when children are abandoned by their parents. The record of birth shall be drawn up for every new born child in the locality, whose identity is unknown. This record will state the day and the place where the child has been found. his/her apparent age, sex, and the family name and first names given to him/her. Failure to perform the obligation of registering the birth of a child entails penalty under the Penal Code of Ethiopia. The Ethiopian Civil Code has elaborate provision on naming as well. It obliges that a child should have a family name, one or more than one first name. In order to preserve the identity of origin or family group of the child, the Civil Code requires that the family name of the father

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should remain the family name of the child. However, if the father is not known, the child has been disowned, or the paternity of the child has not been judicially declared, the child will have the family name of his/her mother. If both the father and the mother are not known, the child's right to a family name is still respected. (Article 39, Civil Code) 4.3.3 The Right to family environment and alternative care (Art 5, 7, 9-", and 25) In spite of the Ethiopian government's ongoing poverty alleviation efforts, many families are under pressure as a result of population displacement. armed conflict, drought, poverty and illness. In addition, ensuring the right to family environment and alternative care is hampered by traditional and cultural values. The child has a right to know and be cared for by his parents. The Civil Code of Ethiopia tries to make indirect realization of the child's right to know his/her parents by devoting a chapter on the means by which the existence of legal parenthood can be determined and the means by which on proves such legal parenthood when the need arises. In the Ethiopian Civil Code it says, Once the parents of the child are ascertained, these parents have the obligation to care for their child because (the child has the right to be cared for by his parents (Article 7 (1) UN CRC). In addition the Ethiopian Civil Code states that the primary responsibility of caring of children rests on parents. The father and mother of the child are responsible for their upbringing (Article 647 of the Civil Code). The obligation of parents to care for their children is also addressed in Article 808 of the Civil Code in the form of the obligation to supply maintenance, i.e. to feed. Lodge, clothe and care for a child a childs health in a decent manner. Failure to perform these obligations is punishable under the Penal Code. Article 625. If children receive proper care from their parents, there is no reason to separate children from their parents. Children have the right not to be separated from his parents against his will, except when competent authorities subject to judicial review determine, in accordance with the applicable laws and procedures that such separation is necessary for the best interest of the child (Article 9 (1) UN CRC). The Civil Code reflects the intention of the Convention by acknowledging the childs right not to be separated from his parents or guardians. However, pursuant to Article 231. The court has the authority to remove the guardian of the minor if it has good reason to believe that the minor does not receive proper care, sound education and supervision. 4.3.4 Adoption The provision in the Civil Code regarding adoption and consent of parents to adoption and the advantages of adoption for the adopted child, the conditions for approval of adoption by the court in the best interests of the child, etc. are in conformity with article 21 of the Convention. Furthermore, the Government has issued a guideline on adoption, which ensures the appropriate implementation of the provisions contained in the Convention and national law. However, children being adopted are always vulnerable to abuses of their rights. The legal protection of these children must be followed by implementation procedures in order to be effective. The CRC Committee, therefore recommends the state of Ethiopia to adhere to the Hague Convention on Protection of Children and Co-operation in Respect of Inter-Country Adoption of 1993 (Ibid)

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Separation of parents - child custody and child maintenance payments The new Family Code and establishes fathers and mothers on a more equal legal base in the context of family separation than was previously the case. However, there are still traditional and discriminatory practices hampering its implementation. For example child maintenance payments are not paid to children. The population does not know the provision of the new Family Code, nor is it respected and implemented in practice. This is a problem that needs to be further addressed in order to improve the situation for children. The CRC Committee recommends the state of Ethiopia to ensure that structures are in place to raise awareness of the Family Code, implement it and to empower parents (Ibid) Alternative care The predominant use of institutional responses to provide assistance to children in difficulty and that children are who are cared for in institutions for many years and until age 18 years are not given the educational and vocational skills necessary for them to make an independent living once they leave the institution, is a major concern to Save the Children Sweden. Institutionalisation of children should be avoided as a form of alternative care. In a comment by the CRC Committee the state of Ethiopia was urged to ensure that children cared for by the state or private institutions are given all the assistance they need towards establishing a life for themselves after leaving the institution including. inter-alia. the provision of an education and suitable vocational training.54 Children living with disability Under paragraph one of Article 23 of the UN CRC State Parties recognize the rights of a disabled child to a full and decent life should not be regarded simply as a vulnerable category of children, they should be considered as a specific category of children, who need special protection. In Ethiopia, the financing of projects that provides the necessary services for these children has been poor. Children with disabilities suffer from social exclusion and stigma and as a result they are discriminated against. Children with disabilities do not take part in an inclusive way, in the every day activities in their communities. Little is being done to promote the rights of children with disabilities in schools, sport clubs, etc. The fight for the rights of children with disabilities is not only hampered by a lack of resources, it is just as much a result of cultural practices and harmful attitudes. The CRC Committee in Geneva recommends that the Ethiopia urgently gather disaggregated data on the numbers and situation of children with disabilities in the State party, and that greater efforts be made to ensure respect for their rights. In view of this fact, the Committee recommends that the State party strengthen its efforts to ensure that children's right to be heard is respected. The Committee recommends, in addition, that the State party make every effort to ensure that the right of children and adolescents to express opinions, including through peaceful demonstrations, is respected and that appropriate follow-up is given to recommendations of the Children's Forum. Save the Children UK undertook extensive work with disabled children in South Wollo in cooperation with local partner the Ethiopian Federation of Disabled People. The extent of marginalization and stigma against children with disability was astounding. Because disability is seen as a curse from God (or Allah), children with disability are treated as shameful, and are often hidden away from the community and other children. This extreme abuse of child rights

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can be successfully challenged, as the programme in South Wollo demonstrated. Community development workers were able to persuade parents to allow their children out, to play and interact with other children, and to be integrated in the school system. 4.3.5 Right to special measures of protection (Art 22, 23, 30, and 32-40) Introduction Border disputes between Eritrea and Ethiopia erupted into armed conflict on the Badme region in May 1998 and turned into a full-scale war by 1999, resulting in an estimated 100,000 deaths and almost 316,000 displaced people. In June 2000 Ethiopia and Eritrea signed a ceasefire agreement and a UN Peace keeping mission (UNMEE) was deployed. After signing a peace accord on 12 December 2000, Ethiopia and Eritrea began to withdraw troops, however, in response to remaining tensions over the disputed buffer zone the UN announced the extension of its mandate to 2003, since extended again.. Ethiopia is also confronted by internal armed opposition groups, i.e. the Oromo Liberation Front (OLF created in 1973), the Ogaden National Liberation Front (ONLF) in the Somali region, and Al-Itihad, a fundamentalist Islamist group. At the end of 1999 some 10, 000 suspected opposition supporters were in detention, some of whom had been held for several years without charge or trial (Child Soldiers Global Report, 2001) Child Soldiers It is the policy of the ministry of Defense not to permit persons under the age of 18 years to join the armed forces, and the Government made efforts to enforce this policy, but it has not yet been codified. Article 4 of the Defense Force Proclamation No. 27/1996 states that "(the) Ministry of Defense may, in accordance criteria issued by it from time to time, recruit persons fit and willing for military purposes'. There were reports that some children under the age of 18 years were recruited into the military in 199976, and military officers have admitted that underage applicants some times were enlisted during the armed conflict. However, the problem of under-age soldiers is very small compared to other neighboring countries in Africa. Ethiopia has an all volunteer military; however, scarce birth certificates, poor educational opportunities, patriotism, and pervasive poverty conspired to entice under-age applicants to try to circumvent restrictions on under-age soldiers. If young boys are found to be under 18, they are normally prohibited from doing military service; however, in rural areas children often do not have birth certificates. There is evidence that children as young as 14 were permitted to join local militia units in an effort to keep them close to home and prevent them from attempting to join the regular army. Refugees During the last years, Ethiopia has in addition sheltered and cared for 300,000 - 400,000 refugees from neighboring Sudan and Somalia. In 2002 Ethiopia hosted about 175,000 refugees (UNHCR, 2002), although the number has declined since. The administration for Refugee Returnee Affairs in collaboration with UNHCR provides essential services to refugees such as food, shelter and health services. In the case of school age child and youth refugees, the Administration has arranged for their education at various levels including attendance at higher educational institutions and vocational training centers.78 Accordingly, for the period 1993/94-1997/98 a total of 16,150 refugee children attended school, i.e. 2,800 at kindergarten, 13,000 at elementary and 350 at secondary levep9

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Country of Origin Somalia Sudan Eritrea Djibouti Other Total

Number of refugees 86,114 83,614 4,164 1,560 430 175,882

Camp location East of Ethiopia West of Ethiopia North of Ethiopia North East and Addis Addis Ababa

UNHCR: 2001-2002 According to demographic figures from the refugee camps, approximately 22 percent of the population is between 0-4 years and 38 percent is between 5-17 years. In a recommendation from the CRC Committee, it was stated that Ethiopia must ensure that the recent peace agreement leads to a lasting peace and that children are protected from the effects of armed conflicts. They also stressed the importance of taking relevant children's rights concerns into consideration in peace related deliberations and other activities, and that de-mining efforts be continued. Recent developments include the continued repatriation of refugees from the Somali Region, numbers are now under 50,000. Ethnic violence which has erupted in the Gambella Region has resulted in a major outflow of refugees from the area to Sudan. The Federal Democratic Republic of Ethiopia has signed but not ratified the 1951 Convention on the status of Refugees, and its 1967 Protocol, nor the Ottawa Convention to Ban Landmines. Internally displaced children The war with Eritrea since May 1998 has resulted in the death of children and civilians in two major urban centers of Tigrai Regional State, the death and injury of hundreds of civilians at the three border sites invaded or attacked by the Eritrean Government Armed Forces, and the displacement of thousands of families along the long border between the two countries. The Government of the FDRE, international and local NGOs and the whole society at large are mobilized and have continued to offer much needed assistance in the form of food, shelter and medical services to thy displaced and injured children and their families. A national committee has been formed to coordinate and oversee the implementation of the contributions of the general public for the assistance and rehabilitation of those displaced by the war (CRC, 2000) It is estimated that between one and two million people have died as a result of famine during the past five decades. In general, children are not given any specific attention during emergencies (whether drought or conflict) and their psychosocial needs are rarely addressed neither by communities, authorities or agencies. The difficult situation faced by internally displaced children and their families in Ethiopia, including in terms of their access to education and health services and in terms of family reunification has to be further addressed. In a comment from the CRC Committee Ethiopia it

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was recommended that Ethiopia to strengthens its efforts to provide assistance to refugee and internally displaced children and their families. The main reasons for displacement of the 450,000 IDP's are conflict among ethnic groups and famine. Approximately 40 percent of the population is under 18 years (DPPC, 2001)
Number of IDPs 300,000 46,000 14,000 4,164 75,000 3,500 16,000 458,564
UNHCR 2001-2002

Location North of Ethiopia (Tigray) North of Ethiopia (Amhara, Afar) West of Ethiopia (Gambella) North of Ethiopia East of Ethiopia (Somali) Addis Ababa (from Eritrea Oromya

Harmful traditional practices (HTP) Ethnic cultures in Ethiopia are interwoven with history, myths, and superstitions. As a result, there are traditional practices in almost all ethnic groups of the country, which adversely affect the health of the people, goals of equality, political and social rights and the process of economic development. In addition to early marriage, children and women suffer the effect from traditional practices such as nutritional taboos, genital mutilation and marriage by abduction (NCTPE, 1998) Research from Ethiopia reveals that harmful traditional practices, like milk-teeth extraction (89% of the children), Unvulectomy (84%) and Female Genital Mutilation (FGM, 73-90%), appear to be widely distributed in the country. Children are subjected to six major harmful traditional practices with FGM ranking number one, followed by Uvulectomy, soiling the stump of the umbilical cord, milk-teeth extraction and incision. Other types of HTPs are marriage by abduction, tonsillectomy, keeping children out of the sun, preventing food and fluids from children with diarrhea and feeding infants with fresh butter (Ibid) A new family law adopted in 2000 defines the age of consent as 18 for both females and males. Pregnancy at an early age often leads to obsteric fistulae and permanent incontinence. Treatment is available at only 1 hospital in Addis Ababa that performs over 1,000 fistula operations a year. It estimates that for every successful operation performed, 10 other young women need the treatment. The maternal mortality rate is extremely high due, in part, to food taboos for pregnant women, poverty, early marriage, and birth complications related to FGM, especially infibulations (Ibid). The experience of SC UK in Somali Refugee camps with FGM is instructive. Here FGM is normally performed on young girls usually under 7 years old. The practice is common throughout the region (95% or higher rate), and usually involves the most radical form of mutilation. It is not considered against the law. Experience has shown that the practice can be

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successfully challenged, in particular with the support of religious authorities. Local Imams can preach that FGM has nothing to do with Islam, and encourage the practice to stop. Women can testify to the drastic impact on health and childbirth, and men can be convinced that the expense of healthcare for their mutilated wives is too high! Ironically, even with the success of anti-FGM activities in the refugee camps, the practice is continuing to be practiced to serve the parents who have moved overseas, but want their girls mutilated. Sexual, social and economic exploitation In Ethiopia prostitution has been practiced in the "traditional" manner whereby male customers seek the service of sexual gratification from female prostitutes. As is the case with prostitution, child commercial sex work is evident throughout the country, though highly pronounced in major towns where state, administrative, military, and commercial activities are centered, the most notable place being Addis Ababa. Accurate statistics are difficult to obtain, but estimates from a 1996 study claimed that child prostitutes (under 18) make up to 15-18,000 or 20%, of the total prostitute population of 90,000 in Ethiopia. Research reveals that child prostitution and the enticement of schoolgirls for sexual purposes is on the rise. Additional research also reveals that there are several kinds of child prostitutes, some prostitutes work on the streets, while others are employed in bars/brothels and hotels who operates for very little money. Children are' sometimes known as independent prostitutes comprising street children, those working from small boothes in slum areas, streetwalkers and those who hang out at the night spots and high profile hotels. The practice of enticing young girls from their home, through promises of rewarding jobs, in order to send the abroad or bring them to urban areas is common in Ethiopia. There are no laws that criminalize child prostitution or prostitution in general. However, several task groups have been established to look into the situation. The Children, Youth and Family Affairs Department of the Ministry of Labor and Social Affairs chair the National Steering Committee Against Sexual Exploitation of Children (Mulugeta, 1996) Factors aggravating the problem of child prostitution are pervasive poverty, migration to urban centers, early marriage, HIV / Aids and sexually transmitted diseases, and limited educational and job opportunities. In recent years, owing to the sensitization campaigns undertaken by government institutions and NGOs, some cases of child abuse are being reported to the police, to MOLSA, to ANPPCAN and to the Ethiopian Women Lawyers' Association. In addition, courts are now giving priority attention to such cases and gave speedy decisions and quite stiff penalties compared to previous years and satisfactory coverage was given to such crimes by the mass media, especially by the police newspaper and radio program as well as through Radio Ethiopia and the Television Enterprise. Traffic in children The State is under the obligation of taking measures that prevent sales of or traffic in children and abduction of children (Article 35 UN CRC). The Ethiopian Penal Code punishes any person, including a parent and guardian who engages for gain in the trafficking of children under the age of 15 years, whether by seducing, enticing, procuring them or inducing them to engage in prostitution. This punishment is aggravated where the victims are under 15 years of age, or are entrusted to the care of the offender who has taken advantage of his/her position, or used

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trickery, fraud, violence and intimidation (Penal Code, Article 606). Anyone who facilitates or organizes traffic in infants or young persons, are also punishable with imprisonment (Penal Code, Article 607) (Mulugeta, 1996). Abduction is also a serious offence under the Ethiopian Penal Code. Anyone who abducts or improperly detains an infant or a young person is punishable with imprisonment not exceeding five years. Where the motive off/the offence is for gain involving exploitation, debauchery and cruelty, the punishment can go up to twenty years of imprisonment (penal Code, Article 561) (SC D, 2001). While the legal framework is fairly clear, the on the ground reality is not. While Ethiopia had a long history of slavery and slave trading, which continued even into the 1960's, there are currently no formal accusations of child trafficking leveled against Ethiopia. The practice of young maids recruited mostly to Middle Eastern countries has come under scrutiny lately, and further research may reveal children are included in this activity. Corporal punishment According to a definition on physical maltreatment used by Riddle & Apponte, (1999) physical maltreatment and corporal punishment include behaviors in which a care giver or some one else conduct an "act of commission with an aggressive component involving actual physical contact of a non-sexual nature". Research in Ethiopia on corporal punishment reveals that the major tool for disciplining a child is physical punishment. Parents and teachers perceive that they "shape" the behavior of their children through corporal punishment. When a child misbehaves there is a local insult saying that: "the child has never been punished and as a result has become spoiled." The value of punishment can be understood from the locals saying that when a child is punished he/she will be stronger, alert and active. (Balcha,1998). A study in Jimma shows that many parents use pinching (75%), whipping (72,5%), hitting with bare hands (43,5%), beating with sticks (17,6%), and exposure to fumes of burnt red pepper (3,1%) on their own children as forms of corporal punishment (ANNPCAN, 2001). The same study in Jimma revealed that child deprivation of food was considered as a disciplinary tool by 15% of the parents and 9,4% of them in practice (Ibid) The provision in the Penal Code (Art. 172) stressing the possibility to sentence children to corporal punishment at the sole discretion of the judge, and the provision in the Civil Code for "light bodily punishment" as an educative measure within the family are unsatisfactory and worrying. The CRC Committee expressed a concern that violence against women and children in the context of the family remains widespread in Ethiopia, and continues to have a negative impact on children. The Committee is concerned in particular, that domestic violence against women may lead to child abuse in the family and recommends that further efforts are made to address and condemn violence against women and children, including in the context of the family. Ethiopia should also take steps to monitor and address any incidence of violence and sexual, or other abuse, against children (CRC, 2001).

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Juvenile justice Research reveals that the extent of juvenile delinquency is on the rise (FSC, 1998). It is not only the increasing size of juvenile delinquency that should be of concern, but also the seriousness of the offenses, and the proportion of offenses committed by young people, as compared to the crimes committed by adults. In Ethiopia, in 1996, 222,109 individuals were reported to the police for committing various offenses, out of which 1,3% were in the age group 915 years, while 9,06 percent were in the age group 16-18 years and 12% were in the age group 19-21 years. As a result the figures reveal that young people, up to the age of 21 years, contributed to close to a quarter (22,4 percent) of the total crime rate in the country (FSC, 1998). Over 90 percent of the reported offenders were males, whereas only ten percent were females. The problem with juvenile offenders is mainly urban. Research reveals that almost 70 percent of the juvenile offenders are migrants from the rural areas where various social amenities were lacking. The children mostly migrate in search of educational opportunities, employment possibilities and in search of families or relatives who migrated to the cities earlier. Some of the boys claimed to have run away from cruel parents or due to lack of proper care by parents (Ibid) Family disruption causes young people to run from their homes. Another contributing factor to the causes of juvenile delinquency is the high rate of school dropouts and school-leavers. Poverty is another factor that contributes to the delinquency of children. When parents are not able to provide the minimum level of subsistence children try their luck on the streets, either by doing odd jobs like hawking small items or begging, or committing crimes. For purposes of criminal liability, the Penal Code of 1957 classifies child offenders into three distinct age groups and prescribes distinct measures for their reform and rehabilitation. The first group, called "infants", is totally exonerated from application of the penal law on ground of responsibility. According to article 52 of the Penal Code infants not having attained the age of 9 years are not criminally responsible for their acts. The second group, addressed as "young persons" in the Penal Code, is children between the ages of 9 and 15 years inclusive. For them, the Penal Code provides special punishments and measures upon conviction. They are not subject to the ordinary penalties applicable to adults nor shall they be kept in custody with adult offenders (art. 53). The third group is comprised of young persons between the ages of 15 and 18 years and they are treated under the ordinary provisions of the Penal Code as having the full prima facie liability of persons aged 18 and above (art. 56 (4)). However, the Penal Code provides that mitigation of the penalty is always permitted, the death penalty may never be imposed and, under certain conditions, the measures of the penalty scheme for young offenders be applied in toto (arts. 56 (2), 118 and 182); The penalty of imprisonment may be imposed when a young offender has committed a serious offence. Existing criminal and civil laws are not compatible with the CRC definition of the child, particularly in the case of child offenders who are subject to the adult justice system. The present legal age of criminal responsibility is very low - 9 years. Children aged 15 to 18 years are effectively considered to bear the same criminal responsibility as adults, albeit with the application of lesser penalties than those applied to adults.

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While these issues are currently unresolved in Ethiopia, they have been brought to the attention of the relevant Parliamentary Committee, and there is an ongoing effort by the Save the Children Alliance to secure the necessary changes in legislation. Street children In a US State Department report on Human Rights in Ethiopia (2001) it was stated that there are approximately 200, 000 street children in the Ethiopian urban areas, of which 150,000 reside in Addis Ababa. However, the figures are difficult to estimate, and observers believe the problems are growing. Previous research has revealed that the number of street children in the country is 500,000, and that 1,000,000 children are on the verge of joining the street life (FSC, 1998). However, according to an Ethiopian NGO, the FORUM on Street Children, this estimation takes into account only the number of children out of schools in the urban centers and do not take into account children migrating from the rural areas. Many of the street children are children of the urban poor and not migrates from the rural areas, says FORUM. These children beg, sometimes as part of a gang, or work in the informal sector. Government and privately run orphanages are unable to handle a number of street children, and older children often abuse younger children. Due to severe resource constraints, abandoned infants often are overlooked or neglected at hospitals and orphanages. There are few credible reports that children are maimed or blinded by their "handlers" in order to raise their earning" from begging (US, 2001). 70% of the street children are living with their families in slum areas of the major cities. The rest are living on the streets, small hotels in groups when they have money. The street girls are trying to get money to spend the nights in small hotels to avoid rape and sexual harassment (FSC, 2001) Many of the street children in Ethiopia are out on the streets alone by the age of 7. However, before this age they are out on the street with their families and elder brothers/sister. This assumption is not taking into consideration children living in plastic? houses on the side of the road. Children from these types of families are already living on the street from birth and home for these children is the street (Ibid) Many of the street children are going to government schools. These children are working half day and going to school the rest of the time. Many of them are living with their families and work on the street to support them. However, they under-perform in school. Because they do not have time to study nor do they have a conducive place for study. Many of these children drop out due to the rigid formal school system (Ibid) The street children are engaged in different informal sector activities to earn an income. The children are mostly engaged in shoe shining, carrying goods for customers, watching and washing cars, selling cigarettes, lottery, and chewing gum while the girls are selling food items in the markets, selling roasted bean in the bars at night etc (Ibid) While working on the street children are subject to abuse from many sides and the police chase them from one place to another. Adults will often not pay them for their work, while the girls are exposed to sexual harassment.

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SC UK experience with working with children in Harar confirms the findings of the above studies. Social disintegration in the politically reduced Amhara community is a particular contribution to the street children problem in the city. Lives of street children can be improved through support for free health care, access to education, better relations with police and local officials, HIV protection, and improved job skills. Child Labor In order to protect the child against economic exploitation, the 1993 Labor Proclamation has substantial provisions. The law forbids the employment of a child under the age of 14 years. However, those children who are between 14-18 years of age are categorized by the law as "young workers" (Ibid) Under the law, young workers can directly undertake employment or enter into contract of apprenticeship. The law, however, forbids requiring young workers to work overtime and to carry out work after 10.00 p.m. and to work more then seven hours a day. The employer is also prohibited not to engage young workers in dangerous trade. (MOLSA, 1996) Since the Ethiopian economy is mainly agrarian (85-90% of the population) and labor intensive, this fact has lead to many children used in the agricultural sector to supplement the family income. Children are usually found to work in their families small farms or businesses under the guidance of their parents or found to help them performing domestic tasks. Apart from this, there are circumstances, when children are working for people outside the family structure for small salaries. According to a survey done by the Ministry of Labor and Social Affairs on agricultural wage it was found that among the workers engaged in the agricultural sector in the country, about 64% of them are children below the age of 14 years.

4.4 HIV/AIDS
4.4.1 Children living with HIV / Aids
UNAIDS estimates that 2.1 million persons, 230 000 of them children aged 0-15 years, were living with HIV/Aids in Ethiopia at the end of 2001 - one of the largest infected populations in the world (UNAIDS website). According to the Ethiopian National Aids Council Ethiopia has the 16th highest HIV / Aids prevalence in the world and it has the third largest number of people living with HIV / Aids. One of every 11 people living with HIV / Aids today is an Ethiopian. The HIV / AIDS epidemic is an integral part of the development crises facing Ethiopia. The epidemic is systematically undermining the country's effort to reduce poverty, especially its investments in health, education, and rural development. Beyond its vast toll in suffering and death, Aids may also be costing Ethiopia significantly in its economic growth every year, further reducing the scope for poverty alleviation. HIV / Aids now poses the foremost threat to' Ethiopia's development, says the National HIV / Aids Counci1. Available statistics indicate that the problem is worse in urban areas (23 per cent) than rural areas (6 per cent) although these must be seen as estimates. AIDS patients occupy an estimated 60 per cent of hospital beds, up from 23 per cent in 1997.

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HV/AIDS orphans By the end of 2001, an estimated 990,000 children have already been orphaned due to AIDS (UNAIDS Website). In ten years time it is estimated that 3.8 - 5 million children will become orphans due to Aids. Discrimination and stigmatization of children affected by HIV is very high. Children and orphans from HIV infected families also face discrimination such as being shunned by the community and not allowed to attend schools. HIV / AIDS orphans also risk losing the property that should be theirs, making them even more vulnerable to poverty and discrimination. The problems that affect HIV / Aids orphans include: Suffering from exclusion, stigma and discrimination Lack of adequate nutrition Lack of education Inadequate or lack of health services - preventive and curative. Lack of clothing and shelter Lack of life-skills and guidance Lack of means of livelihood Lack of protection against physical and sexual abuse Lack of legal assistance for protection of their rights Lack of psychosocial support (World Bank, 2002)

National guiding principles - government's HIV / AIDS policy The objectives of the policy are to guide the implementation of successful programs to prevent the spread of HIV / AIDS, decrease vulnerability of individuals and communities to HIV / AIDS, to care for those living with the disease and to reduce the adverse socio-economic consequences of the epidemic (World Bank, 2002) Constitutional articles reinforcing the HIV / AIDS policy Although the Ethiopian law protects the rights of individuals including people living with AIDS, the laws have to be reviewed and amended, and new laws have to be enacted to better reduce the negative socioeconomic impact of HIV / AIDS on children and the community members. Major areas that need legislative review include: Requirement for informed consent with pre and post test counseling, Legislation authorizing health care workers to notify sexual partners of their patients' HIV status Review and reform criminal laws to ensure that they are consist ant with international human right obligations and are not misused in the context of HIV/AIDS or against vulnerable groups Enact and strengthen anti-discrimination and laws that protect vulnerable groups, people living with HIV /AIDS and orphans, in areas of health care, employment, education and training, play and sport, association and club, accommodations and property right. Ensure special legal requirements on privacy and confidentiality. This will minimize discrimination from the society, ensure confidentiality and ethics in research in collecting information including informed consent to see individual records Protection from discrimination at work places and in schools on bias of HIV status or for being affected children. Prohibiting screening for employment, dismissal, promotion or training

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Helping Children Affected by HIV/Aids Apart from the legal framework of protection for children affected by HIV/Aids, there are other protection methods which can be implemented. Save the Children has pioneered youth peer education initiatives, which are being implemented by Alliance members across a wide swath of Ethiopia. Seeking to look deeper into behaviour change, SC UK has also used the Stepping Stone methodology, which looks specifically at strengthening the ability of women and girls to say no to unsafe sex. Orphans and Vulnerable Children need a wide range of protection and support, and this area has to date been neglected. An Alliance initiative, led by SC US, is beginning to address the particular problems of OVC, using a successful model developed in Malawi. The overall situation of HIV/Aids in Ethiopia continues to be a huge problem with very little in the way of effective response. Although rhetoric from government and agencies has become very strong on the issue over the last five years, bureaucracy continues to slow response. Ineffective campaigns in which people fight HIV infection by going to boring meetings seem to be the main response to date. Effective behaviour change must be tackled if the disease is not to spiral out of control.

4.5

Child Participation

Children's participation in crucial issues that affect/concern them can be learned from the following sayings: "What a parent decides and orders, a child never contradicts" "Do not talk in front of a child" "What a child plans is not achievable " (ANPPCAN)

As a result, parents alone decide on such major issues as engagement, marriage, education and medication without the involvement of children. When a child is assertive and argues for participation on issues that affect him/her, the parental reaction is negative. Assertive children are considered undisciplined. Few school going children are assertive and start opposing issues like early marriage, harmful traditional practices, and pressure on children to drop out of school (CRC, 2001)

4.5.1 The views of Ethiopian Children


During 2000 and 2001, Save the Children and others were heavily involved in the process of collecting childrens views on serious issues facing Ethiopian children today and in the future. After consultations with more than 1,500 children all over Ethiopia, ten major issues were identified and ranked according to priority. The appeal was presented in NY on May 8, 2002 during the UN Special Session on Children. The children were also consulted on how their inclusion in the follow-up process after the Special Session, and their participation in the implementation process of the out come document, in particular in the process of establishing a new 10-year-plan of action for children should be considered.

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The priority list identified the following issues in priority order: 1. Street children should be given proper care and not be discriminated against. 2. Sexual harassment inflicted on girls should be avoided and strict measures taken on persons committing such acts. 3. Basic needs of children (food, health. shelter. clothing and education) should be fulfilled. 4. Disciplinary measures that are physically and psychologically abusing should be avoided. 5. Proper care should be given to orphans and vulnerable children 6. Raise awareness with families on family planning and child rights. 7. Children should be given the chance to fully participate in matters concerning them. 8. Children with disabilities should be given care and support. 9. Harmful traditional practices on children such as female genital mutilation. early marriage. etc, should be avoided. 10. War should be stopped for it affects children. and children who have become refugees as a result of war should be provided with appropriate education and care.

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PART 5 - Summary and Conclusions


So What Does this Mean for Save the Children?
There are clearly many huge challenges which face the children of Ethiopia and by extension organizations which seek to support their rights. This situation analysis provides a basis for understanding the priorities which Save the Children should follow. Legal Framework Although a legal framework for child rights exists in Ethiopia, it requires strengthening both in terms of the legal protections and the implementation of the laws in place. In the areas of juvenile justice and protection of childrens rights through the offices of the Human Rights Commission and Ombudsman amongst others there is still work to be done. These issues need to pursued through Parliament and bureaucratic structures. The Save the Children Alliance continues to pursue these issues through the Common Framework of Operations, with the Child Rights and Participation working group under the lead of Save the Children Sweden. Right to Survival Unlike many countries, Ethiopia still is far from being able to guarantee the right to child survival. Arguably more than any other country in the world, Ethiopia has been a focus for international attention and support for child survival in emergencies. For the foreseeable future, as long as Ethiopian children are threatened with suffering and death, supporting children and their families in emergencies must remain a priority for Save the Children. This not only includes direct support for relief, health, nutrition, water, animal health and other direct emergency interventions, it also means building the capacity of relevant institutions to predict and respond to emergency needs in an effective and timely way. Recent famines in the years 2000 and 2003 have reinforced the need to continue to build emergency response capacity. Save the Children is uniquely placed to assist with response and capacity building on emergencies. Through the Emergency Liaison Team, the Alliance coordinates work on emergencies under the lead of Save the Children UK. The Alliance coordinated the largest NGO response to the famine of 2002-03 (over $80 million), as well as taking a lead on key advocacy issues, such as providing a full food basket. Maintaining a capacity to respond to emergencies directly is critical for the foreseeable future. Save the Children has also taken the lead in building capacity for emergencies, in particular through the Save the Children Canada and UK Institutional Support Project for the DPPC. SC UK has also built capacity of the Ethiopian government in food aid targeting, early warning systems, and in nutrition along with Save the Children US. Learning from the lessons of 2003, Save the Children is pursuing further improvements in the Early Warning systems, food aid targeting, emergency nutrition support and in testing the cash alternative to food assistance. SC UK learned a hard lesson in the famine of 1984-85, when the early response was limited to support for emergency child nutrition in camps such as Korem. From late 1982, the numbers of children in need continued to escalate, to the point where 30,000 needed assistance when the BBC revealed the Ethiopian famine to the world in October 1984. Many children were saved by the nutritional intervention, but without addressing the underlying shortage of food the numbers of children in need continued to expand. From this experience Save the Children learned that we needed to address the food shortages of children and their families directly, rather than just

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the nutritional consequences for children without food. The famines of 2000 and 2003 also reinforced the need to address non-food needs, including emergency health, water and other needs. Poverty and Livelihoods Overwhelming poverty remains the underlying cause of the violation of childrens right to survival and development. With over 45% of the population of Ethiopia living in absolute poverty according to official statistics, combating poverty remains the top priority. Extreme poverty leaves the population vulnerable to drought or other shocks, for unless production conditions are optimum millions of farmers cannot produce enough to support themselves. Other millions are chronically food insecure even in good years. Poverty also leaves children vulnerable to opportunistic diseases that claim the lives of over 500,000 children each year. Through direct work against poverty on the ground as a basis for advocacy for implementation of a better policy framework for fighting poverty, Save the Children can most effectively challenge this scourge. Fighting poverty on the ground implies coming to grips with the underlying causes. For many years Save the Children has worked in rural areas to help farmers to diversify livelihoods and increase cost effective production. These efforts have made some differences, but overall have been overwhelmed by forces increasing the trend to poverty. Through the Destitution in the Northeast Highlands of Amhara study, SC UK has demonstrated the increase in destitution over the last 10 years, as well as practical and policy alternatives. Investment in long term economic alternatives was very limited by donors in the 1990s, who concentrated on short term emergency responses. This situation is shifting, as donors begin to recognize the need to pilot and implement serious efforts to turn around the trend to greater destitution. SC UK has come to grips with this challenge, and has taken the lead in two major pilots, with multi year commitment to livelihoods in two woredas with food and additional support and to cash as a substitute to food in another woreda. Both of these efforts are integrated into policy development by the respective donors and through them to the highest levels of government. Increasingly there is recognition that the solution to rural poverty is not to be found in the rural economy alone, but also in the interaction of the rural and urban economies. Alternative employment in urban areas provides an outlet for the growing rural population, so that more and more people dont have to try to scrape a livelihood from decreasing patches of land. As well, the growing urban population provides a market for the agricultural produce of the surrounding rural areas. Working on the rural-urban economic dynamic will be an increasing role for Save the Children, particularly in small towns. As well, Save the Children is attempting to tackle the underlying poverty and vulnerability of the largest pastoralist community in Ethiopia, in Somali Region. Both SC UK and SC US are undertaking programmes to tackle poverty in this region, providing a balance between work with settled agricultural communities in Amhara and pastoralists in Somali to provide a broad base of knowledge and experience to influence national policies. The policy framework for combating poverty is contained in the PRSP, and related policies on food security and other sectors. Save the Children has the opportunity to come to grips with the policy and its implementation, through on-the-ground experience of research, especially Household Economy Analysis. Despite reluctance on the part of the national level of

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government to engage with NGOs as partners, the strength of SC UKs regional relationships in Amhara and Somali regions, and relations with influential donors, provides an opportunity to influence policy and practice. Nutrition Although very experienced in emergency nutrition responses, Save the Children recognizes that tackling long term malnutrition is now also critical. Through the studies Thin on the Ground and Wealth, Health, and Knowledge, SC UK has developed a base for challenging and improving policy and practice. Child nutrition is too low a priority in Ethiopia, and the Alliance must work with UNICEF and other allies to work on this challenge. Nutrition caring practice pilots which can help to identify the most cost effective methods for reducing child malnutrition have already been started by Save the Children. These are various alternatives to be tested to document the best. This has already been initiated in settled agricultural areas in Amhara, and there are plans to undertake similar work under the different conditions of pastoralists. These findings are designed to feed into an advocacy strategy to help the Ethiopian government and other agencies to follow the most cost effective approach to reducing child malnutrition. The current World Bank funded nutrition programme with the Ethiopian government has been strongly criticized by SC UK and a technical committee has been formed to monitor the results of the programme with SC involvement. SC will continue to push for the best alternatives for tackling child malnutrition. Education The low enrollment rates and quality of education in Ethiopia poses a serious threat to the future of children. Despite the commitment of the Ethiopian government to universal primary education, the funds and capacity to accomplish this are limited. Gains made in enrollment appear to have come at the cost of quality. As well, enrollment rates vary widely, with higher rates for urban areas, and the lowest rates for pastoralist areas. Special attention is also required for girls education, which lags further behind boys enrollment even as overall enrollment increases. Official expenditure in education includes a heavy emphasis on high cost capital inputs. Over the last few years Save the Children has been experimenting with Alternate Basic Education in various parts of the country. This was a community based, cost effective approach to basic education which relied on community input to the building of schools and training of local teachers. While there was initial resistance from government to this alternative, after extensive lobbying from Save the Children and others the approach has been accepted. Peer review of the approach to ABE was undertaken amongst the Alliance members. The document produced has become the basis for the model of ABE promoted by the Alliance, although further discussion on learning from the variations in approach is still needed. With all the Save the Childrens in Ethiopia involved in ABE, the potential for shared experience and advocacy is high. Each SC works in their own operational areas on ABE, and the combined experience has been used to influence the government at the national level. This work will continue as the need for extending basic education is still enormous.

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Health Although the commitment of the government to extending health care is high, both the direction and quantity of spending is still inadequate. Only about 50% of the population have access to formal healthcare, with the poor and those in remote areas being left out. The implications of inadequate healthcare are felt in the lives of poor children, with high infant and under 5 mortality rates even by African standards. While Save the Children has been pressing for greater spending by donors on health care, we have also looked more deeply into the effectiveness of current spending. There are concerns that the emphasis on capital expenditures have resulted in health centres which are understaffed, both in numbers and qualifications. As well, the access of the poor to healthcare needs more attention. Evidence that the almost a billion birr of annual expenditure essentially subsidizes the richest 50% of the population was gathered in the Save the Children report Too Poor to be Sick. The main barriers to access of the poor was the cost of drugs, of transport and user fees. While the policy of SC UK is that user fees should be abolished, based on experience in Africa and elsewhere, the Ethiopian government is not ready to accept that recommendation. Current emphasis of SC UK in health is to work with the Ministry of Health to test alternative exemption systems for health costs for the poor. Currently a pilot exemption system is being tested with the Bureau of Health in Amhara Region, with a view to taking successes up to the regional and national level. The wider context of overall child health and survival has been well documented in this report. The role of Save the Children in tackling child survival issues continues to be defined. Save the Children US is tackling the issue of Newborn Health and Survival, in coordination with UNICEF and other organizations. In Ethiopia, the main responsibility for contending with the major threats to child survival remains with the Ministry of Health. Save the Children can provide support where there is the need for capacity building, where Save the Children has the ability to provide the support. In the case of immunization campaigns, this has generally occurred only in an emergency context. Given the seriousness of the child health situation, particularly in remote areas such as Somali, Save the Children must look at means and ways of tackling this serious issue. HIV/AIDS The growing HIV/AIDS pandemic in Ethiopia has now infected more than 2.1 million people and left at least 990,000 children orphans. Although Save the Children UK began work on HIV more than 13 years ago, there was very little attention paid to the disease until 1999-2000 in Ethiopia. With increased attention, the World Bank and Ethiopian government made a high profile announcement of a $60 million programme to combat HIV/AIDS in 2000. This large programme proved disastrous, as it discouraged other donors from committing significant funds, but even after 4 years very little has been accomplished by the funds. SC UK continued to undertake small scale work on HIV/AIDS, funded mainly by unrestricted fund. An excellent study on HIV/AIDS was undertaken in the Harar area, and followed by the preparation of IEC materials focused on youth peer education. Programmes were undertaken, in particular with the formation of anti-AIDS clubs, for which SC UK was supporting 150 by 2004.

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With the growing realization by donors that the government based anti-AIDS programme was not operating well, further support has become available through NGOs. SC UK is attempting to confront AIDS in all operational areas and cross sectorally. Apart from supporting antiAIDS clubs, reviewing the qualities that make some anti-AIDS clubs effective and others not is a top priority. SC UK has also linked HIV/AIDS to emergencies by delivering messages at food distribution sites. Concern about the impact of awareness raising on the spread of HIV/AIDS lead SC UK to work on a deeper behaviour change methodology developed in other parts of Africa. Stepping Stones is an approach which looks at strengthening the position of women to say no to unsafe sex. A major review of this programme is now underway with a view to looking at replicability in other parts of the country. Save the Children has also been tackling the issue of Orphans and Vulnerable Children. Under the lead of SC US, the Alliance has begun a programme covering different operational areas to study and strengthen the ability of communities to cope with the rising level of HIV/AIDS, particularly the ability to absorb orphans. Based on a successful programme in Malawi, this programme is now in the early stages of implementation. Marginalized Children Protection and support for especially marginalized children is important even in a country where poverty already marginalizes most children. Children in special circumstances include disabled children, street children, and refugee children amongst others. Through the direct work of SC UK with disabled children, the magnitude of the challenge in this area became clear. Disability is generally seen as a curse from God, and therefore something to be ashamed of.. Disabled children are hidden away in rural areas, and not allowed to go out and play, let alone attend school. Tackling this problem is a huge task. The fundamental principle of supporting disabled children to get health care and education is being integrated into the basic services thematic work. The number of street children has been rising sharply, especially with the high incidence of AIDS. SC UK undertook extensive studies on street children in Harar, which showed the problems in their lives. Harassment by police, sexual exploitation and prostitution of the girls, and lack of access to health care and education were all major issues. Partners in Child Rights The main stakeholder and partner on child rights for Save the Children in Ethiopia remains the Ethiopian government. Generally the policies of the government support the range of childrens rights, but there are severe weaknesses in capacity and funding. Save the Children works with the Ethiopian government, both to influence government policy and practice and to assist with capacity to implement childrens rights. Chief partners include the Parliament, Ministry of Labour and Social Affairs, Ministry of Health, Ministry of Education, Disaster Prevention and Preparedness Commission, and Ministry of Agriculture and Rural Development, at National, Regional, Zonal and Woreda level. The Save the Children Alliance works together in promoting child rights in Ethiopia. A Common Framework of Operations spells out cooperation in the areas of Emergencies, Education, HIV/AIDS, and Child Rights and Participation, focusing on joint research, training

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and advocacy. From modest beginnings the Alliance cooperation is growing, while focusing on practical areas with recognized value added. The Alliance also works with UNICEF, with quarterly coordination meetings at the directors level. Cooperation has moved forward from rhetoric to reality, with a cooperative effort on HIV/AIDS, Emergencies, and plans for joint work on Education. The Alliance has also worked with other child focused NGOs, both international and local. Plan International and World Vision participated in joint work to prepare for the UN Special Session on Children. Further activities on awareness and promotion of child rights should be encouraged. Local child focused NGOs include ANNPCAN, which undertake awareness raising but are not strong and vocal advocates on controversial issues. While there are 30 identified local NGOs working on childrens issues, they remain generally weak and highly urban based. However, the need to build local civil society in general and child focused organizations in particular is urgent, and cooperation and capacity building must be further developed.

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Ministry Of Health, Ethiopia, and UNICEF, "CHILD HEALTH IN ETHIOPIA", Background Document for the National Child Survival Conference, , April 24-26, 2004
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The Reporter, "UNCTAD and WTO Give Reasons to Invest in Ethiopia", newspaper article, Page 1, April 14, 2004 Save the Children Alliance, Alternative Basic Education, Peer Review, 2001. Save the Children Alliance, Ethiopia Common Framework of Operations, 2002-04 Save the Children Denmark, Country Context, Ethiopia, 2002. Save the Children Sweden, Situation Analysis, Ethiopia, 2001 Save the Children UK (1999) Economic Alternatives in North Wollo, Desalegn Rahmato and Julien Holt. Save the Children UK (2002). Food Security and Malnutrition in Ethiopia,:. Addis Ababa, Ethiopia Save the Children UK (2002) Health Care for all The Challenge in Ethiopia. Addis Ababa, Ethiopia Save the Children UK (2002) Health, Wealth, and Knowledge Causes of Malnutrition in Gubulafto, North Wollo Save the Children UK, Household Economy Baselines, Somali and Amhara Region, 2001-2003. Save the Children UK and Institute of Development Studies, University of Sussex (2003) Destitution in the Northeast Amhara Highlands

SC UK Young Lives Project, The Impact of Macro-Economic Policy on the Well Being of Children: the Macro-Micro Linkage, 2003
Save the Children UK (2003), Tanzania Child Situation Analysis Save the Children UK (2002) Too Poor to be Sick Study of Access to Health Care in East Hararghe State Party Report to the CRC Committee, 26th Session (2000) List of issues to be taken up in connection with the consideration of the second periodic report of Ethiopia (CRC/C/70/Add/7). Strategic Framework for the National Response to HIV/ADIDS in Ethiopia in 2001-2005. UNAIDS, Ethiopia, Epidemiological Fact Sheets, Website - www.UNAIDS.org UN- Habitat, Local Democracy and Decentralization in Ethiopia, AAU, 2002 UNHCR, Refugee statistics, 31 March, 2002, UNHCR BO Ethiopia. UNICEF (2001) Situation of Ethiopian Children and Women: A Rights Based Analysis.

UNICEF (2004) State of the Worlds Children


US State Department report on Human Rights Practices in Ethiopia 2001. World Bank, (2002) Civil Society, NGOs and Development in Ethiopia. Washington. World Bank, 2002, Ethiopia Orphans and other vulnerable Children, Ethiopia.

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