Unicef Uganda: Fast Facts Geosheets 2009

FAST FACTS 2009

SUB-REGIONAL OVERVIEWS OF UGANDA THE KARAMOJA SUB-REGION The Complex Developmental Challenge with an Acute Child Survival Crisis The semi-arid sub-region of Karamoja is topographically, climatically and culturally distinct from the rest of Uganda. It is also the poorest and most marginalized. Over 80% of the semi-pastoral population lives below the poverty line and at present, over 70% are food-insecure. Humanitarian interventions are addressing excess mortality due to malnutrition—but a long-term developmental approach for capacity building of governments and communities is key.

THE ACHOLI SUB-REGION Facilitating Return and Recovery for the Conflict-Affected and Internally Displaced While the majority of communities displaced by the 20-year conflict have returned to their original homesteads, close to 800,000 persons continue to reside in camps and temporary transit sites, due mainly to the stark lack of infrastructure and basic social services in return areas.

THE WESTERN SUB-REGION The Forgotten Children, in Danger of Behind Left Behind Being far from the LRA insurgency, the western “Rwenzori” sub-region is in danger of missing out on the significant recovery and development investments designated for forty districts in the north — but the western region also suffered a violent insurgency and remains significantly below national averages for human development and child survival indicators as a result.

THE LANGO AND TESO SUB-REGIONS Transition to Sustainable Development The Lango and Teso sub-regions are both recovering from the destruction, displacement and marginalization caused by armed conflict. With almost all the internally displaced communities returning to their original homesteads, these sub-regions are transitioning to sustainable development.

All photos © UNICEF Uganda/Chulho Hyun

FAST FACTS 2009 KARAMOJA SUB-REGION OF UGANDA REGIONAL OVERVIEW The semi-arid sub-region of Karamoja is topographically, climatically and culturally distinct from the rest of Uganda. It is also the poorest and most marginalized sub-region, as defined by both income per capita and key human development indicators. Over 80% of the semi-pastoral population lives below the poverty line and at present, over 70% are deemed critically food insecure. A serious dearth of basic social services and infrastructure leaves the population extremely vulnerable to a variety of political, social and climactic shocks. In the past 3-5 years for example, a series of disasters has affected both the agricultural and pastoral components of community livelihoods. Dry spells, flooding, and crop fungus severely damaged agricultural production 2007/8. Meanwhile, violent, and often commercialized, cattle raiding continues to reduce cattle herds. Finally, diseases such as PPR and CBPP infected up to 40% of the livestock in 2008, decimating the population of small ruminants and cattle. These factors culminated to produce an acute child survival crisis in 2008, with alarming levels of severe acute malnutrition. A series of concentrated emergency interventions, combined with the arrival of rains, brought malnutrition rates back below emergency thresholds to approximately 9.5% for global acute malnutrition and 1.5% for severe acute malnutrition – however, this is still high and a sufficient caseload. Longer-term developmental programmes that enhance the capacity of district local governments and communities to build peace, extend basic social services and sustainable livelihoods are a essential to preparing families for the next hungry season and beyond.

Map of Uganda Karamoja Sub-region

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Abim Moroto

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Karamoja: The Complex Developmental Crisis

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Karamoja’s pervasive insecurity and lawlessness however, pose serious challenges to programming. Reaching the most vulnerable in remote regions often requires a higher level of operation support costs than other areas, due to the need for armed escorts and other security precautions.

REGIONAL RANKING

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• Under-five mortality in Karamoja is the highest in the country at 174 deaths per 1000 births (national average is 137/1000). Maternal Mortality is 750 deaths per 100,000 live births versus the national average of 403/100,000. • Access to health services in Moroto District is estimated at 24% compared to a national average of 72%. Only 15% of pregnant women attend 4 antenatal visits. • ANC sentinel surveillance indicates HIV prevalence rates among pregnant women have risen from 1.7%

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in 2000 to 3.5%. However only 3% of the HIV positive pregnant women in 2007 received ARVs for prevention of HIV transmission, compared to 29% nationally. Malnutrition rates frequently exceed emergency thresholds of 15% global acute malnutrition for children under-five, on a seasonal basis. Coverage of safe water sources rests at only 30% (versus the national average of 68%) and latrine coverage rests at an abysmal 2% (versus the national average of 52 %). There are approximately 76 pupils for every latrine stance in Abim. Illiteracy remains high (at 89% for women) and primary school attendance is still low (only 43% of children in school versus 87% nationally). Completion rates range between 6-10% for primary. Local district governments are stretched with service delivery in the complex environment and meeting statutory obligations for social welfare of children has not been a priority. Preventative and remedial services which address violence, abuse and exploitation are rudimentary and lacking. Coverage of community child protection systems is only 3.6%. Some 56% of sub-counties have a Community Development Officer on staff. In response to the dire situation, there is a marked out-migration of women and children to urban centres, which has increased their risk of exposure to a variety of protection threats. Some 15,000 Karamajong children and women are living on the streets of Kampala. The majority of Karamajong are cut off from developmental communications that can increase service uptake and enhance life-skills. Radio listener-ship (at 23.2%) is lower than in the rest of Uganda due to limited programming in the local language(s) and low levels of radio ownership.

FAST FACTS 2009 ACHOLI SUB-REGION OF UGANDA REGIONAL OVERVIEW

Map of Uganda Acholi Sub-region Kitgum

Northern Uganda is in a critical and historic period of transition. The conflict between the Uganda People’s Defense Forces and the Lord’s Resistance Army (LRA), which locked the communities of Acholi, Lango and Teso sub-regions in a complex and protracted humanitarian situation for more than two decades, appears to be coming to a close. In response to the increasingly secure environment camp-based communities have begun the landmark journey home. By the end of 2008, almost three quarters (73%) of the 1.8 million displaced persons throughout the north had entered the return process. In the Acholi sub-region, however, the pace of returns in slower and uneven, due largely to the deep-seated trauma evident in the majority of the population (who bore the brunt of the violence and abduction) and the stark conditions in return areas that were destroyed, damaged or neglected during the conflict. Overall, only 24% of the original IDP population in Acholi are estimated to be living in their villages of origin. Most households continue to use camps as the central point for basic schooling, health care delivery and general food and non-food items distribution, thereby retaining one foot in both worlds, hedging bets on which location provides the greater degree of safety and opportunity. An unfortunate consequence of this divided state is the temporary separation/abandonment of extremely vulnerable individuals (the disabled, the elderly and chronically ill, and children), left behind in camps as stronger and older family members journey ahead to the return areas. Not only does the separation exacerbate the risk of abuse and exploitation, it threatens to further concentrate poverty and despair in camps. The only way to facilitate safe, voluntary and dignified return, which can lead to sustainable development of northern Uganda– is to expand the capacity of government and communities to rehabilitate and maintain infrastructure and basic social services in return areas. With revitalization or rural areas, there will be a stronger “pull” away from camps to original homesteads.

REGIONAL RANKING

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Acholi Sub-Region: Facilitating Return in 2009

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• While the national averages for under-five and infant mortality rates are 137 and 76 (deaths per 1000 live births) respectively, the IDP populations of northern Uganda had a rate of 200 and 123, respectively, in 2006, the worst in Uganda. • Access to a safe water source stands at approximately 72% in Acholi but is as low as 53% in Pader. Coverage in the rural areas of return is significantly

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lower than the levels of access in camps, due to the humanitarian intervention. Access to sanitation is low throughout the subregion, with an average of only 33% of persons accessing a latrine. In Pader there are approximately 74 students for every latrine stance. The outbreak of Hepatitis E in 2008 (which infected over 8,000 persons) evidenced the critical gaps in both the hardware (schemes and facilities) and software (health and hygiene knowledge and practices) in this subregion. HIV sero-prevalence in the Northern districts stands at 8.3%, far above the national average of 6.4%. Some 22% of all new HIV infections in Uganda are due to Mother to Child Transmission (MTCT) of HIV. However, Prevention of MTCT services are currently available in 66.3% of health facilities with ANC in Acholi sub region. In Kitgum and Pader, only 49% of expected pregnant women attending ANC are tested for HIV. Approximately 41% of all primary schools were displaced by conflict in November 2007. In 2008 however, only 2% of schools remain in camps, meaning that over 200 primary schools successfully relocated to traditional homesteads. However, due to the damage experienced during the conflict, serious gaps in the infrastructure, staffing and functionality of return schools remain. Primary school attendance amongst IDP populations is estimated to be around 83%– however, Primary School Completion rates range from 30% in Pader to 52% in Gulu in 2008. Over 3,000 children and women continue to be associated with the LRA meaning that for many, the conflict is not yet over. Over 90% of children in the Acholi sub-region are considered conflict-affected. Coverage of child protection systems stands at 60% of sub-counties.

FAST FACTS 2009 WESTERN REGION OF UGANDA REGIONAL OVERVIEW Being far from the LRA conflict-affected region of the north, this region is often overlooked by the international assistance community. However, in the late 1990s, the region also experienced a rebel insurgency (with remnants still reported) which provoked significant internal displacement and relative marginalization of large sections of the population.

Map of Uganda Western Rwenzori Sub-region

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Relative underdevelopment persists today, as coverage of basic social services is markedly below national averages, earning most districts the lowest. As a result, early childhood mortality rates are notably higher, even now, over a decade after the conflict. For example, while approximately 137 children out of every 1000 die before their fifth birthday in Uganda, in the Rwenzori region, 145 die before reaching the same age.

Kabarole Ky enjojo Kamwenge Kasese

Western Region: In Danger of Being Left Behind

In addition to child survival concerns, two of the districts, Bundibugyo and Kasese, often host refugees fleeing unrest in DR Congo, making it a region which requires a robust emergency response capacity. The region is also prone to epidemic outbreaks of disease, having experienced both cholera and Ebola crises in 2007-2008. The region has a combined population of over 2 million persons, of which 56% children under 18 years old. Complicating service provision, the population growth rate in this region is higher than the national average leading to exponential increases in the demand for social services. However, high population density also offers the opportunity for significant returns on programmatic investment. The application of a series of high-impact, cost-effective interventions could make the critical contribution towards reducing the national child mortality rate, for attainment of MDG4 (reducing child mortality by two thirds).

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REGIONAL RANKING According to the Uganda National Demographic and Health Survey 2006 and other government sources: • The western region has the highest level of immunization coverage for children for all antigens (51%). However, this coverage is grossly inadequate to protect children from outbreaks of disease in the fluid border area. • Malaria is the number one killer of children under five – but the western region has one of the lowest levels of mosquito net ownership and usage (only 10.6% of households in the western region have at least 1 ITN and only 5.7% of children under-five actually sleep under them). • Caregivers also display lower than average levels of knowledge and use of basic home-based treat-

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ments of childhood illnesses. Only 74% of mothers (compared to 86% nationally) know to treat diarrhea with ORS packets and only 32% actually used ORS or a home mixture with the last episode (compared to 43% nationally). Only 26% of children aged 2-23 months are fed according to basic Infant and Young Child Feeding Practices. Approximately 73% of persons are estimated to have access to a safe water source—but field monitoring reveals an extraordinarily high level of non-functional systems. Similarly, sanitation coverage appears high at 76% but there is concern for the functionality of latrine facilitates and inter-district disparities. Latrine coverage is only 57% in Bundibugyo. Only 27% of primary schools in the western region (including southwestern districts) have sanitation facilities that are segregated by gender and 69% of schools have no hand-washing facilities. There are approximately 54 students per latrine stance – high above the recommended 40:1 ratio. The HIV/AIDS prevalence rate is higher than the national average (7.4% versus 6%) but awareness and availability of PMTCT is lower. Some 59% of women and 57% of men in the Western Region know that risk of MTCT can be reduced by taking special drugs (national average 65%) but PMTCT is only available in 51% of facilities that offer ANC. While net primary school attendance ratios are in the low 80% for this sub-region, primary school completion rates range between 29% in Bundibugyo and 41% in Kasesse and Kabarole. The conflict contributed to the breakdown of community support structures and an increase in the number of women and child-headed households. Approximately 80.2% of Orphans and Vulnerable Children in the west reported receiving no free external support (medical, emotional, social or school related assistance).

FAST FACTS 2009

LANGO & TESO SUB-REGIONS OF UGANDA REGIONAL OVERVIEW Northern Uganda is finally emerging from two decades of conflict and instability. However, the pace of recovery and return of camp-based communities to their villages of origin is uneven. While the Acholi subregion continues to have significant numbers of displaced, 100% of Lango’s originally displaced have returned to their original homesteads and the recovery process has begun in earnest.

Map of Uganda Lango and Teso Sub-regions

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vulnerable to natural hazards such as drought and flooding. Some 300,000 people affected by the flooding and water-logging in 2007 continue to need livelihood support and various forms of recovery assistance in 2009.

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Lango & Teso: Meaningful Recovery with Emergency Response Capacity

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REGIONAL RANKING • There are approximately 1 million children under 18 in the Lango Sub-region and 650,000 children under 18 in the Teso sub-region. • While the national averages for under-five and infant mortality rates are 137 and 76 (deaths per 1000 live births) respectively, the IDP populations of northern Uganda had a rate of 200 and 123 in 2006, the worst in Uganda. While this is expected to have improved, these areas likely remain below national averages. • Malaria is the number one killer of children in Uganda and Apac District in Lango sub-region has the highest transmission rate for Malaria in the world – but in the northern districts as a whole, only 18% of children under-five sleep under an insecticide treated net. • Access to a safe water source in Teso averages 80% and ranges between 71% (in Katakwi) and 92% (in Kabermaido) – however, functionality of

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However, it has not been without challenges. A spike in malnutrition rates above emergency thresholds in late 2007 provided a clear warning concerning the dangers of rapid population movements to rural areas with insufficient infrastructure and social services. Rehabilitation and construction of water, sanitation, education and health infrastructure must be combined with revitalization of software systems and structures to make essential life-saving services functional and sustainable. In the Teso sub-region, aggressive Karamojong incursions prevent some displaced communities from returning to their homes, but the majority of the 110,000 IDPs in camps at the start of the year have returned to their villages of origin. There are 18 camps in two districts (Amuria and Katakwi) and all are expected to phase-out in 2009. While the rehabilitation needs are less dramatic in Teso, the sub-region is particularly

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schemes and systems is a problem. Access to safe water in Lango region averages 60% and ranges between 52% (in Amolatar and Oyam) and 82% (in Dokolo), meaning that expansion of services in return areas is still required. Latrine coverage is 52% in Teso sub-region with a pupil to latrine stance ratio in primary school as high as 53:1 in Soroti. In the Lango sub-region, sanitation coverage is lower at 49% with a pupil to latrine stance ratio as high as 63:1 in Oyam. HIV sero-prevalence in the Northern districts stands at 8.3%, far above the national average of 6.4%. Some 22% of all new HIV infections in Uganda are due to Mother to Child Transmission (MTCT) of HIV. However, only 47% of expected pregnant women attending ANC in Teso are actually tested for HIV (64% in Lango) and only 44% of HIV positive pregnant women given ARVs for PMTCT in Teso (59% in Lango). Primary School completion rates in Teso range between 22% (in Amuria) and 42% (in Soroti). Completion rates in Lango range between 36% (in Oyam ) and 52% (in Amolatar). In the conflict-affected districts of Apac, Lira and Oyam, 54% of sub-counties have functional child protection (CP) systems which can identify, refer and support vulnerable children. Approximately 74% have a Community Development Officer (CDO) which can lead and coordinate activities in the sector. In the conflict-affected districts of Amuria and Katakwi, only 11.5% of sub-counties have a functional CP system and only 5% have a CDO.