edr suriname en by iPv3vS9

VIEWS: 0 PAGES: 42

									National Report on Follow-up to
the World Summit for Children
           Suriname




            April, 2001
Table of contents


A.   Introduction and Background ....................................................................................... 3
B.   Process established for the End-Decade Review ............................................................ 5
C.   Actions at the National and International Level under paragraphs 34 and 35 of the
     World Summit Plan of Action ........................................................................................ .6
D.   Specific Actions for Child Survival, Protection and Development ................................. 7
     I.       Ratification, dissemination, promotion, implementation and monitoring
              of the Convention on the Rights of the Child .................................................... 7
     II.      Combat childhood diseases through low-cost remedies and strengthening of
              primary health care and basic health services; prioritising of prevention and
              treatment of HIV/AIDS; provide universal access to drinking water and
              sanitary excreta disposal; control of water-borne diseases. ................................ 8
     III.     Overcome malnutrition, including ensuring household food security, increase
              employment and income-generating opportunities; dissemination of
              knowledge; support increased food production and distribution. .................... 12
     IV.      Enhance the status of girls and women and ensure full access to health,
              nutrition, education, training, credit, extension, family planning, prenatal
              delivery, referral and other basic services ........................................................ 13
     V.       Ensure support for parents and caregivers in nurturing and caring for
              children; prevent separation of children from their families and ensure
              appropriate alternative family care or institutional placement. ........................ 16
     VI.      Ensure priority for early childhood development; universal access to basic
              education; reduction of adult literacy; vocational training and preparation
              for work; increased acquisition of knowledge, skills and values through
              all available channels. ...................................................................................... 18
     VII.     To ensure special attention to children living under especially difficult
              circumstances; including by ending their exploitation through labour;
              and by combating drugs, tobacco and alcohol abuse among young people ..... 19
     VIII.    To ensure special protection of children in armed conflict and to build a
              foundation for a peaceful world by promoting the values of peace,
              tolerance, understanding and dialogue .............................................................. 20
     IX.      To prevent degradation of the environment by pursuing the World Summit
              Goals, by inculcating respect for the natural environment, and by changing
              wasteful consumption patterns. ......................................................................... 21
     X.       To address poverty and debt; mobilize development finance; halt the net transfer
              of resources from developing to developed countries; establish an equitable
              trading system; and ensure children are given priority in economic and social
              development.            ...................................................................................... 22

E.               Lessons Learnt .................................................................................................. 26

F.               Future Action .................................................................................................. 27

G.               Appendix: Statistical Report on Individual Goals ............................................ 29

                                                               2
A.             Introduction and Background


Suriname delegation to the World Summit for Children
In 1990, Suriname participated on the highest level in the World Summit for Children.
The delegation was led by the President of Suriname, Mr. Ramsewak Shankar.

Follow up action after WSC
Two efforts have been undertaken to prepare a National Plan of Action:
 The National Child Rights Committee prepared a draft framework for a National Plan of
   Action in 1997;
 The Steering Committee on Children, established in 1998, drafted a National Youth Policy
   (2000) in close collaboration with sector Ministries, NGO’s and the National Youth
   Council. This policy is considered the basis for finalization of a comprehensive National
   Plan of Action.

Up till now, strategies and programs to enhance the well-being of children have been
incorporated in the sectoral policies of the various Ministries- with their own budget -, which
focus on this target group e.g. Justice & Police, Social Affairs & Housing, Education and
Community Development, Health, and Labor. It has been acknowledged that in order to have
an effective policy on children, it is necessary to integrate all the priority areas and have one
integrated national policy document. This awareness led to the drafting of the afore-mentioned
Plans of Action. The intention is to finalize the comprehensive National Plan of Action in 2001.

Periodic review of progress
For most of the decade Suriname did not have mechanisms in place for periodic review of
progress, neither did Suriname participate in the Mid-Decade review process. In 1998 Suriname
entered into a five-year Programme of Cooperation with UNICEF. After signing the Master
Plan of Operations of the Programme of Cooperation UNICEF – Government of Suriname,
1998 – 2002, plans of action have been prepared every year and different activities have been
implemented. At the end of every year annual reviews on progress have been prepared.

In 2000, a comprehensive mid-term review of the Programme of Cooperation was held, which
included a review of national programmes for children and progress towards the goals.
Principal findings were that progress has been made in:
-    the creation and strengthening of mechanisms for implementation and monitoring of child
     survival
-    development and protection, including child rights promotion, e.g. establishment of the
     Steering Committee on Children, National Youth Institute; current preparations for a
     Child Rights Bureau and the appointment of inter-sectoral District Teams in two rural
     districts for planning of child development.

Significant progress was noted in the areas of capacity building and institutional strengthening
of key stakeholders with regard to the monitoring of child development. Enhanced advocacy
and actions for change and elimination of gaps in relevant policies, programs, legislation and

                                               3
school curricula e.g. draft legislation on regulation of child care facilities have been presented
to the Ministry of Social Affairs and Housing. Other highlights are:
-     Approval of the bill to eliminate discrepancies in inheritance law between legitimate and
      children born out of wedlock
-     Development and modification of the learning program of the Teachers Training College
-     Development of curricula for pre-school education
-     Promotion of Basic Life Skills education at pre -, primary and secondary school
-     Implementation of an effective child rights promotion campaign in the past 3 years.

It was however recommended that, in order to strengthen programmatic planning, the focus
should be on development of a framework based on broad consensus and consisting of jointly
determined set of priorities, instead of individual proposals. It was also recommended to use
successful models and experiences as examples for strengthening of less successful
experiences, to introduce village-based development plans and to create village councils to
accommodate and ensure full participation of the community.

Report under article 44 of the CRC
Suriname has ratified the Convention on the Rights of the Child in March 1993, and submitted
the Initial Report of Suriname on February 13th, 1998. In May 2000, written replies were
submitted with regard to the List of Issues related to the consideration of the Initial Report. On
May 29th, 2000 the Initial Report of Suriname was examined by the International CRC
Committee in Geneva. Currently the second CRC Country Report is being finalized.

Positive aspects noted by the Committee were:
1. enactment of new legislation in January 2000, which eliminates discrimination against
    children born out of wedlock, including their inheritance rights;
2. establishment of a Steering Committee on Youth in 1998;
3. installation of the National Youth Council in November 1999;
4. initiatives undertaken by the state party in 1999 to improve data collection, including a
    national women and children survey (MICS) and the establishment of a Child Indicators
    Monitoring System (CIMS).

In their concluding observations, the Committee made several recommendations, including:
1. implement appropriate measures to ensure that State party laws conform fully with the
    principles and provisions of the convention;
2. intensify efforts to establish a central registry for data collection and introduce a
    comprehensive system of data collection which incorporates all the areas covered by the
    Convention;
3. set up an independent child-friendly mechanism accessible for children, to deal with
    complaints of violations of their rights and to provide remedies for such violations;
4. prioritize budgetary allocations to ensure implementation of the economic, social and
    cultural rights of children;
5. provide adequate and systematic training and/or sensitization of professional groups
    working with and for children;
6. reinforce efforts to implement alternatives for institutionalization of children with
    disabilities and special education programs.

                                                4
B.      Process established for the End-Decade Review

The existing Inter-Ministerial working group (Lima Working Group) under leadership of the
Ministry of Social Affairs & Housing and further consisting of representatives of the Ministries
of Education and Community Development, Home Affairs, Regional Development, Health,
Justice & Police and Natural Resources, was mandated to draft the report. Since the
Government was aware of the persisting problem of lack of reliable data, a Multiple Indicators
Cluster Survey (MICS) was prepared and implemented during September 1999 - January 2001
with UNICEF support. The MICS provided most of the data for the End-Decade Report.
In addition, routine surveillance data, epidemiology data and several studies/surveys conducted
by government organizations and NGO’s were utilized. For analytical input, several key
documents, including the Mid-Term Report of the Government of Suriname - UNICEF
Programme of Cooperation, in which over 60 agencies, including NGO’s and youth agencies
participated, Suriname's Initial CRC Report (1998), and Suriname's response to the List of
Issues of the CRC Committee (1999) have been used.

In a regional initiative, a preliminary report was prepared and submitted to the Vth Inter-
Ministerial Meeting in Kingston, Jamaica (October 2000). Prior to submission, the draft report
was submitted to the Council of Ministers for review and approval. A final draft report was
completed in January 2001 and consequently submitted to the Ministers of Health, Education
and Community Development, Social Affairs & Housing and Regional Development for
review and approval, after which it was finalized.

Principal data sources:

     1. Annual Report 1999. Medical Mission (1999).
     2. Annual Report of the Chief Medical Officer - for 1996. Ministry of Health (1997).
         Paramaribo, Suriname.
     3. Case Management of Diarrhea in the Home. Bureau of Public Health, Ministry of
         Health. (1991).
     4. Epidemiology data 1995-1999. Ministry of Health (2000)
     5. Health Conditions in Suriname 1996. Bakker, W.J. (1996). Paramaribo, Suriname.
     6. Infant Feeding Practices in Suriname. Bureau of Public Health, Ministry of Health.
         (1992).
     7. MICS 2000 Report. Ministry of Social Affairs and Housing. (2000).
     8. MICS Draft Report. Ministry of Social Affairs and Public Housing. (2000)
     9. Mortality in Suriname 1992 - 1994. Ministry of Health (1996).
     10. Mortality in Suriname 1996 - 1996. Ministry of Health (1999)
     11. Mortality in Suriname 1997 – 1999. Ministry of Health (2000)
     12. Perinatal Mortality 1995 – 1999. Bureau of Public Health, Ministry of Health. (2000).;
         Hospital Survey. Paramaribo, Suriname. Draft Report.
     13. Review of EPI Cold Chain, Safety of Injections & Programme Performance.
         PAHO/WHO. (1999). Paramaribo, Suriname.
     14. Safe Motherhood - Confidential enquiries into Maternal Deaths in Suriname.
         Dissertation. Mungra, A. (1999). Pasmans Publications, The Hague.

                                               5
     15. Situation Analysis of Women in Suriname. Period 1983 - 1998. Ketwaru, S. for
         UNIFEM. (1999) Draft Report.
     16. Status of Children in Suriname - World Summit Goals, Indicators and Definitions.
         Consultancy report for the Ministry of Social Affairs. Krishnadath, I. (1999).
     17. Suriname EFA Report. Ministry of Education and Community Development. (1999)



C.      Actions at the national and international level under
        paragraphs 34 and 35 of the World Summit Plan of Action


National and international action taken by Suriname during the 1990's should be reviewed
against the background of the social, political and economic crisis that has been going on since
the mid-1980’s. During 1980 – 1987, Suriname was ruled by a military regime. During this
period international relations and aid were reduced to a minimum. In the mid 80’s a civil war
with rebel groups from Maroon and Amerindian origin led to a deterioration of the living
situation in the interior.
In 1987 democracy was restored through election of a new democratic government, however in
1990 the army again took control. In 1991 elections were held and a civil government was
installed. This government was confronted with a difficult socio-economic situation and a
structural adjustment program was incorporated in their policy. The government negotiated
with the rebel groups for a peace accord, which then was signed.
In 1996, elections were held again, but social instability during 1998-1999 led to the
breakdown of the functioning of the parliament. As a result, elections were held again in May
2000.

Against this background the Surinamese Government participated on the highest level at events
with regard to the World Summit. During 1991 - 1992 the Government commissioned a
thorough review of the Surinamese legislative and social context in relation to the Convention,
after which the Convention was ratified unconditionally in March 1993.
In 1995 a National Committee on the Rights of the Child was appointed for a period of 3 years.
The appointment was not renewed, and in 1998, a National Steering Committee on Children
was appointed by the President. As mentioned in section A, each of these bodies have produced
frameworks for a National Plan of Action.
In general it can be stated that through the 1990s, increasingly children were placed at the
center of Government effort and policy. Significant increase in mobilization and awareness of
NGO’s and civil society can also be noted.

Since 1998 the Government of Suriname has been allocating 25% of the national budget for the
social sector in total, which mainly benefits mothers and children. Since then, the Government
has been working on the development of effective distribution models of these funds between
the sub-sectors (Ministry of Social Affairs and Housing, Education, Health and Labour).

The Government also supports the 20/20 concept, which stipulates that 20% of Government
spending and 20% of international support should be dedicated directly to children. In this

                                               6
context, the Director of the General Bureau for Statistics participated in a regional workshop
presenting budget analysis models and skills. Since 1998 the Government is preparing to
conduct an in-depth 20/20 country analysis. Social and economic instability and lack of
manpower have contributed to delays. A request has been made to UNICEF to support the
20/20 country analysis this year.


D.     Specific Actions            for     Child      Survival,       Protection        and
       Development


I.     Ratification, dissemination, promotion, implementation and monitoring of the
       Convention on the Rights of the Child

Progress achieved

Suriname ratified the Convention on the Rights of the Child (CRC) in 1993 and published it in
the State Gazette in November 1999. The Ministry of Social Affairs & Housing has been
mandated to coordinate implementation and monitoring of the CRC and the Lima Accord.
Towards this end the Ministry has established an Inter-ministerial Working Group with
representatives from the Ministry of Social Affairs & Housing, Health, Education and
Community Development, Regional Development, Home Affairs and Justice & Police. The
Working Group meets regularly to report on progress and discuss future action.

During 1998 - 2000 the Ministry of Social Affairs & Housing conducted several community
education activities to increase awareness of the CRC, including media campaigns, seminars
and workshops, and production of promotion material. In 1995 the National Committee on the
Rights of the Child was appointed with a 3-year mandate. Between 1995 and 1997 the National
Committee prepared Suriname's first report to the Committee on the Rights of the Child and a
framework for a National Plan of Action. In 1998 the Government appointed a Steering
Committee on Children with the tri-fold task to:
    1. prepare a national children and youth policy based on the CRC
    2. guide the process of conforming the national legislation with the CRC
    3. establish a National Youth Council to enable structural participation of children in
        policy development.
The National Youth Council was appointed in November 20, 1999, composing of 21 members
within the age-group 12 - 17 years, for a period of 2 years. The members were chosen by their
peers through regional elections held in all 10 districts.
On August 8, 2000 the Steering Committee presented a National Youth Policy document to the
President. The National policy which was developed based on broad consultations with
relevant sectors, focuses on four major areas:
a.      survival
b.      development
c.      protection and
d.      participation.

                                              7
II.    Combat childhood diseases through low-cost remedies and strengthening of primary
       health care and basic health services; prioritizing of prevention and treatment of
       HIV/AIDS; provide universal access to drinking water and sanitary excreta disposal;
       control of water-borne diseases.

Progress achieved

Immunization
The Expanded Program on Immunization (EPI) started in 1976 in Suriname with vaccination
of children age 0-12 months against diptheria, pertussis, tetanus and poliomyelitis. In 1981
measles was included in the routine immunization schedule. Since 1993 the combined MMR
vaccine is administered to children at 12 months.
Between 1980 - 1985 Suriname had a high immunization coverage of over 90%.

During and after the civil war and ensuing destruction of infrastructure between 1986 -1990,
immunization coverage significantly dropped. In 1990 DPT3 and OPV3 coverage was 83%,
while Measles coverage was 57.4%. In 1992 the vaccination coverage fell to very low levels. In
the coastal area coverage was 53.6%, with even lower coverage in the interior.
Intensive efforts from the Ministry of Health resulted in some improvement in immunization
coverage during 1996- 1999. MICS data reports OPV3 and DPT3 coverage over 80% and
Measles coverage over 60% nationally for children 12-23 months.

The last case of confirmed poliomyelitis was recorded in 1982. During the past decade, annual
numbers of polio and measles reached 0. The last 2 reported cases of neonatal tetanus were in
1996.

Diarrhea.
This is the second leading cause of death under children age 0-11 months, and the first for
children age 1-4 years. Between 1992 – 1994, 110 children 0-4, and between 1997 – 1999, 71
children died due to gastroenteritis.
In 1989 the epidemiology surveillance of the Ministry of Health recorded 1200 cases of child
diarrhea. It was estimated at that time that 25% of all physician consultations for children were
due to diarrhea. In the MICS study 11% of the urban children, 10% of the rural children and
25% of the children in the interior had had diarrhea in the last two weeks.

The death rate of children under five due to acute respiratory infections was 42.9 per 100,000
children in 1995. According to the MICS survey, 4.2% of the under-five children had had acute
respiratory infection in the last two weeks. The incidence was the highest in the interior (5.0%),
followed by the rural children (4.4%). The lowest incidence was seen in the urban population
(3.7%). The incidence was slightly higher among males (4.7%) compared to females (3.8%).
Out of the total number of children with ARI, 60% had been seen by a provider.

Breastfeeding
There is a lack of quantitative data with regard to breastfeeding practices. A qualitative study
conducted by the Ministry of Health in 1991 found that breastfeeding was widely practiced,
while complementary foods were generally introduced between 0-3 months. The MICS data

                                                8
reports that currently in Suriname the situation has apparently not changed much. Breastfeeding
is practiced widely, but complementary foods are introduced at early age. Almost 13% of all
children are exclusively breastfed at 0-3 months. Between 6-9 months 60% of children receive
breast milk and complementary foods. Between 12- 15 months 50% of the children still receive
breast milk, with a drop to 35% after 15 months. Between 20 - 23 months 11% of the children
still receive breast milk. The Baby Friendly Hospital Initiative (BFHI) was introduced in
Suriname in 1992, bur there are no designated baby-friendly facilities in Suriname yet. In this
same year four of the five major hospitals and the two major primary health care organizations
signed a protocol for implementation of BFHI. Implementation has been slow but continues.

Child growth
Consistent national data regarding child growth is lacking. In the 1989-1990 school year a
survey conducted by the Ministry of Health recorded that among first graders age 5 - 8 from 33
primary schools (out of 113) in the capital city, 13.5% had a weight-for-height below P3. MICS
recorded a percentage of over 10% of children with a weight-for-height below P2, with 17.5%
in the interior. There were no significant differences between boys and girls.

Integrated Management of Childhood illnesses
In the MICS national sample the caretakers from the interior scored highest (32.2% of all
caretakers from the interior), followed by the rural population (18.3%) and the urban
population (11.6%). The most frequently mentioned sign was "develops a fever" (74.5%),
followed by "becomes sicker" (14.2%). “Has difficulty breathing” was the third most
mentioned by 12.6% of all caretakers.

HIV/AIDS and Sexually Transmitted Diseases
A 1993 KAP study among school youth (12 – 20) conducted by the National AIDS Programme
(Ministry of Health) reported that 91% knew that HIV can be transmitted by sex; 94% knew
that HIV can be transmitted vertically; 93.3% knew that HIV is contagious. Over 90% of all
women included in MICS had heard of AIDS, 43.9% of urban, 31.5% rural and 16.4% of
women in the interior knew 3 ways to prevent HIV transmission. A total of 46.1% of urban
women, 28.5% rural and 13.2% of women in the interior correctly identified 3 misconceptions
about HIV.

Safe drinking water
In 1990 national access to safe drinking water was estimated at 89%. The urban population had
95% access while the rural population (including interior) had 70% access to safe drinking
water. According to MICS data, national access to safe water is currently over 90% for the
urban population, around 70% for rural, and around 20% for the interior population. According
to PAHO observations, the UNICEF and national definitions of safe drinking water applied to
these figures should be considered with caution, since they don't necessarily reflect the actual
quality of the water when it reaches the user. For instance sabotaged and leaking pipe systems
in some areas, seasonal influences on water streams and lakes (drying up, etc.), gold mining
and other environmental pollution of streams and rivers potentially contribute to a lower
percentage of the population with access to safe drinking water.

Excreta disposal

                                               9
In 1992-1995, 63% of the urban population and 34 % of the rural population had access to
sanitary facility for human excreta disposal in or around the dwelling. MICS reported 99.1 % of
urban population, 98.3% of rural population and 30.5% of the population of the interior having
access to adequate means for human excreta disposal.

Strategies and policies followed

1. Rehabilitation project for improvement of the infrastructure of the National Water
    Company.
2. Sectoral analysis of drinking water supply and sanitation in Suriname in 1998.
3. Extension of the piped water system to include the Brokopondo District
4. Community health education to improve hygienic and sanitation practices
5. Support to villages in the interior to build pit latrines.
6. Comprehensive social mobilization campaigns to involve parents and communities in
    vaccinations which included posters, folders, TV and radio spots and targeted community
    education activities in the interior.
7. Mass immunization campaigns for measles and rubella in 1992, 1997 and 2000
8. Cold chain assessment in 1999.
9. Rehabilitation and improvement of the cold chain in strategic locations in the interior.
10. Improvement of EPI data management and surveillance through staff training and provision
    of necessary supplies and equipment, including computers.
11. Legislation mandating complete immunization status as a requirement for enrollment in
    primary school.
12. Training of health workers to improve monitoring and preventive actions for child health.
13. Perinatal Mortality Assessment 1995 - 1998.
14. Development and introduction of national protocols for uniform reporting of perinatal
    mortality.
15. Establishment of a working group in 1999, consisting of the Ministry of Health, the Central
    Bureau for Statistics, and the Civil Registry to reach consensus and develop effective
    protocols regarding collection and processing of vital statistics.
16. Establishment of a working group in 1999, consisting of representatives of the Association
    of Pediatricians, Association of Gynecologists, Association of Dietitians, Planning Division
    of the Ministry of Health, and the Bureau of Public Health to develop national protocols for
    maternal and child health care.
17. Community education through mass media to improve knowledge, attitude and practices
    with regard to infant and child health issues.
18. In 1990 ORS was taken out of the formulary and made available for over-the-counter
    purchase through pharmacies at a minimum price. This action was accompanied by an
    intensive community education campaign through mass media, health centers and
    physicians. A 1990 survey conducted by the Ministry of Health reported that exclusively
    ORT was administered in 67.9% of child hospitalization due to diarrhea. In this survey with
    a limited population of parents of children with diarrhea, 43.8% of the children received
    increased fluids during the diarrhea episode.
19. The Baby Friendly Hospital Initiative was introduced in Suriname in 1992. In that same
    year four of the five major hospitals and the two agencies providing primary health care in
    Suriname signed a protocol, committing themselves to implement the ten steps in their

                                              10
    facilities. An informal assessment by an external consultant, conducted in 2000, indicated
    that all facilities have made progress in implementation of the ten steps. Currently two
    hospitals are considered close to realizing full implementation.
20. The Bureau of Public Health regularly implements community awareness and education
    campaign through radio and TV, containing relevant child health messages, including
    messages regarding child growth, hygiene and sanitation, immunization, breastfeeding, and
    child development.
21. A Surinamese version of "Facts for Life" was developed and printed in10,000 copies. The
    booklet was widely distributed in the community to further increase knowledge regarding
    child health and wellness issues.
22. The Bureau of Public Health developed and is currently implementing training programmes
    for primary health workers to improve knowledge and skills regarding child health, growth
    and development monitoring, screening and early detection.
23. The Bureau of Public Health developed and is currently operationalizing a check-list for
    upgrading and monitoring of care provided in day care centers. Day care center staff has
    been trained to implement the checklist.
24. Establishment of a National AIDS Programme at the Bureau of Public Health which was
    merged in 1997 with the National STD programme.
25. Provision of free and confidential HIV testing.
26. Intensive community education activities to promote safe sex and condom use
27. Support for NGOs active in HIV/AIDS prevention outreach.

Major constraints faced and lessons learnt

   1. In Suriname, the Government is responsible for provision of funding for procurement of
      vaccine. Although there is a dedicated budget line in the Government budget for
      procurement of vaccine, delays in release of the funds result in shortages of vaccine.
      Consequently the country experienced shortages of vaccine several times during the
      past decade.
   2. The internal war and the socio-economic crisis contributed to accelerated deterioration
      of the public transport system and infrastructure. The continuing brain drain and limited
      Government funds further compromised the ability of the Government to provide
      adequate services. Targeted Government effort and donor support contributed to some
      improvement. However, in order to consolidate this improvement and to achieve the
      90% goal, there is a need for structural and strategic planning for:
          a) maintenance of adequate infrastructure including cold chain, in particular for the
              hard-to-reach areas in the interior
          b) availability of trained health personnel and
          c) maintenance and further development of EPI surveillance, (public) health data
              management systems, and preventive services.




                                             11
III.      Overcome malnutrition, including ensuring household food security, increase
          employment and income-generating opportunities; dissemination of knowledge;
          support increased food production and distribution.

Progress achieved

Child malnutrition
During the civil war in the 1980’s and in the early 1990’s, malnutrition among children was on
the rise. A 1994 study among former refugees in one district showed that 17% of 278 children
were malnourished. Another 1994 study found 10% of the children with a weight-for-age
below the third percentile. Hospitalization of 1-5's due to malnutrition sharply increased from
33 in 1988 to 64 in 1989, 123 in 1990, 114 in 1991, and further rose to 185 in 1994. Around
50% of the hospitalized children were in the age group 0-1. During 1992-1994 29 boys and 15
girls died due to malnutrition and in 1997-1999 6 boys and 4 girls.

Table 1: Hospitalization due to malnutrition in the four hospitals in Paramaribo

Age of child                      1995              1996              1997        1998   1999
< 28 days                         7                 3                 3           2      1
28 days - 11 months               85                72                70          67     45
1-4 years                         73                53                64          62     69
5-9 years                         2                 4                 1           2      6
10 years +                        1                 2                 1           0      0
Total                             168               134               139         133    121
(Source: Epidemiology Department – Bureau of Public Health, Ministry of Health)

Currently there is some evidence that acute malnutrition is slowly decreasing. In 1996
hospitalization was 134 and in 1998 133. However, there is evidence that chronic malnutrition
remains a public health problem in Suriname. In the MICS national sample, 13% of the under-
five children had a weight-for-age below P2 and 2.1% below P3.

Household Food security
There is no national data regarding household food security. Based on food basket and income
estimates, the General Bureau for Statistics estimates that the income of around 50% of
households lies below the level which is necessary to procure the food basket.

Micro-nutrients - Iodine Deficiency Disorders and Vitamin A.
There is no evidence in Suriname of a public health problem for either iodine deficiency or
vitamin A. The Government of Suriname notes some progress in the reduction of chronic and
acute malnutrition among children. The accelerated deterioration of the Surinamese economy
over the past decade diminished real and relative family income, which negatively impacted the
nutritional status of the population, including children.




                                                                 12
Strategies and policies followed

1. Community education regarding breastfeeding, appropriate weaning foods and food
   pyramid.
2. Growth monitoring and nutritional counseling at under-five clinics.
3. Emergency school and day care center lunch programmes during the depth of the economic
   crisis mid-nineties.
4. Provision of milk and other food products to displaced people and other qualifying families
   during the depth of the economic crisis.
5. Encouragement and support for community and home gardening to grow food stuff.
6. Support for small-scale community-based income generating and production raising
   projects and initiatives, as specified in section C of this report.

Major constraints faced and lessons learnt

      1. The lack of Government resources to provide adequate support for the most vulnerable
         groups.
      2. The inter-related nature of the economic crisis, which impacted all aspects of family life
         and priorities. The Government learned that interference in only one aspect will be less
         successful when not supported by a structural improvement in the economy.



IV.      Enhance the status of girls and women and ensure full access to health, nutrition,
         education, training, credit, extension, family planning, prenatal delivery, referral and
         other basic services.

Progress achieved

Legislation and policy
Suriname ratified the CEDAW in 1993. The Belem do Para Convention on Violence Against
Women has been introduced in Suriname, and is currently being reviewed by relevant agencies,
including the Gender Bureau of the Ministry of Home Affairs, and the Ministry of Justice and
Police. The Convention has been send to the Council of State and has yet to be sent to the
National Assembly for approval for ratification.

The Constitution does not allow any form of discrimination. However, there is no specific
legislation addressing gender discrimination. In 1993 legislation was drafted to make gender
discrimination punishable. In May 1993 the draft legislation was approved by the Council of
Ministers. Approval by the legislature is still pending.

In 1998 the National Gender Bureau was established at the Ministry of Home Affairs. This
Bureau serves as the national institute to promote and monitor gender equality in Suriname.
One main task of the National Gender Bureau is to implement capacity building and training
activities for women. During 1998-1999 the Gender Bureau conducted the following:



                                                 13
    Volunteers and employees of the private Foundation “Stop Violence Against Women”
     were trained to adequately respond to telephone calls (hot-line) with regard to domestic
     violence.
    A regional workshop on elimination of violence against women was held. Experiences
     and expertise were exchanged.
    A poster competition ”A life free of violence, it’s our right” was organized by UNIFEM
     and coordinated by the Bureau. The purpose of the competition was to increase
     awareness among the youth with regard to violence against women, non- violence and
     respect of human rights.
    The process of gender mainstreaming within government offices has been set in motion
     through training of staff members of the various ministries.

Maternal Mortality
In 1990 the registered Maternal Mortality rate was 38 per 100,000 live births, 45.9 for 1995,
31.9 for 1996 and 108.4 for 1999. The Ministry of Health considered these rates unreliable, due
to suspected underreporting. A review of all deaths of women aged 10-50 between 1990 -1993
revealed an MMR of 226 per 100,000. Currently the Ministry of Health is working towards a
national plan for improvement of Prenatal Care, assistance at Childbirth, and providing better
care at obstetric emergencies.

Prenatal care
Traditionally prenatal care attendance and obstetric assistance at childbirth are high. Over 90%
of all women are, during pregnancy at least once attended by trained health personnel and over
80% of all births are attended by trained health personnel. A total of 15 facilities provide
essential obstetric care throughout the country.

Family planning
The 1992 national Contraceptive Prevalence Study reported that 50% of the urban women and
20% of the rural women (including the interior) aged 15-44 used some contraceptive method.
In the MICS sample contraceptive use was 51% for urban women, 45% for rural women and
7% for women in the interior.

Assistance to poor women
About 30–50% of the households in Suriname are headed by women. Most of these households
classified as poor are supported by the government.
The Ministry for Social Affairs and Housing is the main agency providing assistance to these
poor families. Qualifying families receive medical care, monthly financial support, child
support, social-safety net (1993) and subject subsidy (1994). In addition, the Government
collaborates with UNIFEM and UNICEF to initiate economic empowerment and sustainable
livelihood activities predominantly in the districts and in the interior of Suriname. Most of
these activities are still small-scale and in pilot phase.

Violence against women
The first quantitative study regarding violence against women was, executed in 1993 by the
Emergency Division of the Academic Hospital in collaboration with the police. The study
revealed that 1 of 5 incidences of violent acts regarded violence against women perpetrated by

                                              14
the spouse or partner. The same study revealed that in 1993, 94% of all police reports on
violence, regarded violence against women perpetrated by a spouse or partner. In 1994 a study
was commissioned by CAFRA (Caribbean Association for Feminists Research and Action),
which indicated that 69% of the 264 female respondents had been victim of violence.

The penal code provides regulation for punishment of violent acts, regardless of gender.
However, the Government recognized the need for development of specific legislation with
regard to violence against women. In March 1999 the Government appointed the National
Committee “Legislation on Violence Against Women”. The committee consists of
representatives of the Ministry of Home Affairs, Justice and Police, Regional Development,
Labour, and Social Affairs and Housing.

The “National Steering Committee Women’s Workers Rights” consisting of Governmental and
Non Governmental organizations, the private sector and union organizations, became active in
1998. That year the Steering Group commissioned assessments of sexual harassment in the
workplace. The assessment revealed that over 50% of the interviewed female workers had
experienced some form of sexual harassment and one-third sexual molest. Based on the
assessments, information folders and leaflets were developed for community awareness and
information.

Strategies and Policies Followed

1. Research to establish the true nature of maternal mortality in Suriname.
2. Development and introduction of national registration and reporting mechanisms to
   generate reliable maternal mortality and morbidity data.
3. Establishment of facilities providing essential obstetric care in strategic locations.
4. Provision of iron supplements to qualifying pregnant women free of charge.
5. Training of the police force and other relevant professional groups.
6. Gender training for policy makers of all ministries.
7. In 1998 the National Gender Bureau (NBG) was established as a department of the Ministry
   of Home Affairs. The NBG also must gather data on gender issue, and update this
   information. This bureau is very important for the future development of gender policy.
8. In May 1999 a “Commission for Legislation on Violence Against Women“ was appointed
   by the Ministry of Home Affairs.

Major constraints faced and lessons learned

Due to the absence of reliable baseline data, the Government is not able to assess progress
regarding the Safe Motherhood indicators. However, progress is noted in the establishment of
mechanisms for improved recording and monitoring of these indicators. Suriname also notes
progress in the area of awareness and policy development with regard to promotion of gender
equity and full access of girls and women to services. However, much work remains to be done
in most of these areas.




                                             15
V.     Ensure support for parents and caregivers in nurturing and caring for children;
       prevent separation of children from their families and ensure appropriate alternative
       family care or institutional placement.

Progress achieved

Birth registration
According to Surinamese law, the birth of a child must be entered in the Registers of Birth within
3 days, not including Sundays and holidays. For the districts this notification term has been
determined at 16 days after birth. The child’s father must make the notification of birth. If the
father is unknown or if he is absent or prevented, notification of birth will be made by the
physician, midwife or other person present at the birth and, if the mother gave birth at another
place than her home, by one of the above-mentioned persons or the person at whose home the
child was born. Notification of birth is made to the registrar of the place where the child is born.
The information to be provided includes date of birth, place of birth, time of birth, the personalia
of the parent(s) and the child's name.

With the exception of the interior of Suriname, the obligation of notification of birth is complied
with reasonably well, although there are many cases of late notification, requiring permission from
the Prosecutor General. As a consequence of the war in the interior of Suriname between 1986 and
1991, the branch-offices of the Civil Registry Office became inoperational. Since then, notification
of birth is done through the Medical Mission. Currently, the government of Suriname has
reactivated the branch-offices of Civil Registry Office (CBB) in the interior.

Identity - The Surinamese Civil Code states that every individual has one last name and one or
more first names. Legitimate and acknowledged children born out of wedlock who bear the name
of the father/person, who has acknowledged them, while, non-acknowledged children born out of
wedlock bear the mother's name. The first name given to the child may not be offensive or go
against good morals.

Nationality – The Surinamese nationality is based on the principle of descent. Pursuant to the
Nationality and Residence Act (Bulletin of Acts and Decrees 1975, no. 171) the following persons
shall have Surinamese nationality by birth:
- a legitimate, legitimized or a child born out of wedlock who has been acknowledged by the
    father who held the Surinamese nationality at the time of the child's birth;
- a legitimate child of a Surinamese national who has died before the child was born;
- child born out of wedlock in Suriname, who has not been acknowledged by the father, unless
    it appears that this child holds the nationality of another state.

Nurturing and caring for children
Caretakers /parents are obliged to take care of and educate their children (articles 157 and 351 of
the Civil Code). Furthermore, the father of a non-acknowledged child born out of wedlock is
obliged to provide for the upbringing and education of his child in accordance with his means
(article 342 of the Civil Code). If the child, after attaining the age of majority, is unable to take
care of him/herself because of a physical and/or mental disability, the father shall remain obliged
to provide for the child. The mother and father of an acknowledged child born out of wedlock are

                                                 16
obliged to maintain and educate the child as long as he/she has not attained the age of majority
(article 358 of the Civil Code). As previously mentioned, the Government provides support to
low-income families in the areas of affordable housing, child allowance and specific support
such as procurement of school uniforms. The Government has increasingly been undertaking
efforts to enhance parenting skills through the Basic Life Skills Programme, better parenting
programmes, and encouragement of parental involvement in school (PTA).

Separation from family
Since years there is an informal foster care system in Suriname. This means that parents who
are in a social economic deprived situation can give up their child to another couple into
custody to bring up or care for. There is no need for a family relationship between the
biological parents and the adopting couple. The important factor is that the couple, who will
have custody of this child is able to provide in the needs of the child. Furthermore, there is also
the possibility that minors can be given to a family relation e.g. an aunt; grandparents.
These are cases where the custodians don’t have the formal custody over these children.

In 1981 a draft Decree was formulated regarding Foster Children, through which everyone who
has the care over children, without having formal custody over these children, are compelled to
register this at the Bureau of Family Law of the Ministry of Justice and Police. This Decree
however has never taken effect. Since 1972, Suriname has an Adoption Law.

Alternative care
In Suriname, the government and NGOs are engaged in child care facilities and activities.
Government day care centers and a number of private childcare institutions are associated with
the Government Foundation "Supervision and Exploitation of Childcare Institutions" and
receive government subventions. However, over the past decade, there has been a significant
growth in types and numbers of formal and informal childcare facilities.
Through the Ministry of Social Affairs and Housing, a draft bill was prepared with regard to
the introduction of a permit system for the exploitation or establishment of a care-providing
institution. This bill introduces the obligation to obtain a permit through the Ministry of Social
Affairs and Housing. There are certain conditions incorporated in it to guarantee the quality of
provisions, of services and protection of the children.

In 1996 legislation was drafted to regulate all types of childcare facilities, including day care
centers, children's homes and alternative care institutions. This draft legislation was the result
of NGO-Government consultations. Key issues in this legislation include:
a) the establishment of an interdisciplinary committee to review requests for permits and to
    monitor child care agencies;
b) training and qualifications of staff;
b) the development and enforcement of specific issues such as size, occupancy rate, number of
    staff, nutrition, and activities.
While the draft has not passed the National Assembly yet, the spirit and contents are already
being included in government-supported training programmes for child care staff.
The government also reorganizes the government day care center programme accordingly. The
Government recognizes the need to pass and enforce this legislation and to develop appropriate
legislation further defining a code of standards for childcare facilities.

                                                17
Major constraint faced and lessons learnt

-     Lack of uniformity with regard to birth registration between Civil Registry Office and
      Public Health Bureau (BOG). There is need for improvement
-     In the case of teenage mothers, there is a need to also notify the Bureau for Family Law
      Affairs within the Ministry of Justice and Police.



VI.      Ensure priority for early childhood development; universal access to basic education;
         reduction of adult literacy; vocational training and preparation for work; increased
         acquisition of knowledge, skills and values through all available channels.

Progress achieved

Early Childhood Development
The General Bureau for Statistics reported in 1995/1996 that 81.3% of children in Suriname
had participated in learning activities prior to starting formal schooling. The 1999 EFA report
of the Ministry of Education estimated that close to 100% of the children enrolling in formal
education have participated in some form of organized preschool learning activity. In the MICS
sample 61% of the 4-5 yrs and 14% of the children aged 3 years were participating in organized
preschool learning activities.

Literacy
During 1991 - 1994 adult literacy rates in Suriname were estimated by the Ministry of
Education and Community Development to be over 90%. The General Bureau for Statistics
reported adult literacy rates for males 95% and females 91% in 1997, for Paramaribo and
Wanica (80% of the population).
In the national MICS sample, the national literacy rate was 80.2% (urban 92.9%, rural 87%,
and in the interior 51%).

Primary education
According to the Ministry of Education and Community Development, the proportion of
children reaching grade 5 was 74.4% in 1990 and 71.8% in 1998. In the MICS national sample
83.8% reached grade 5 among which 92.8% of the urban, 82.5% of the rural, and 64.5% of the
interior population.

Adolescent mothers and education
17% Of the annual number of births are out of teenage mothers. Even though the Ministry of
Education and Community Development never had an official rule or policy to restrict pregnant
girls from visiting school, in practice, school administrators, teachers and parents discouraged
pregnant girls or teenage mothers to continue with school. However, dropping out of school
because of pregnancy has reduced over the past years. A number of junior and senior secondary
schools now allow pregnant teenagers and teenage mothers to continue with school, in
particular when students are in exam classes.



                                               18
Strategies and Policies Followed.

1.     Development of new primary school curricula over recent years.
2.     Training of teachers in new teaching and classroom skills.
3.     Fostering of community and parental involvement in the classroom
4.     Studies on several key issues in education, including the mother tongue approach,
       emotional intelligence, corporal punishment, and Basic Life Skills Education
5.     Development of a national policy on early childhood development
6.     The Youth Department of the Ministry of Education Community Development started a
       teenage-mother project in 1989 to create conditions for teenage mothers to finish their
       education, learn job-skills and parenting skills. The program includes reproductive health
       education and building self-esteem of teenage mothers. The program is being
       implemented in collaboration with the Young Women’s Network. Currently, the full
       program is only available in the coastal area of Suriname. There is a need to develop
       appropriate and comprehensive programs for teenage mothers in the rural areas and
       interior of Suriname.
7.     Establishment of day care centers with appropriate playgrounds in 4 villages in the
       interior and in two populous peri-urban neighborhoods.
8.     Development of a new work and play plan for the 4 and 5 years old children.
9.     Training of teachers in the interior.
10.    Strengthen the data management system of the Ministry of Education.
11.    Strengthen the several units of the Ministry of Education with manpower and material.
12.    Reduce the number of repeaters at the primary level.
13.    To establish rules and regulations/policy for the group of 0-3 years old in cooperation
       with the ministers of Health, Social Affairs and Housing and Regional Development.
14.    Evaluation of the teacher training colleges and review of the curriculum.
15.    Establishment of “new” style teacher training colleges.

Progress Achieved, Constraints Faced, and Lessons Learned.

The Government is not satisfied with the current crisis in the education system of Suriname.
Key constraints are lack of motivated teachers, lack of resources for renewal and replacement
of teaching material, deterioration of school buildings and premises, and political instability
leading to multiple replacements of key officials at the Ministry of Education and Community
Development during the past years.



VII.    To ensure special attention to children living under especially difficult circumstances;
        including by ending their exploitation through labour; and by combating drugs,
        tobacco and alcohol abuse among young people

Data
In Suriname there are about a hundred institutions which deal with children in need of special
protection (CNSP). The main categories are: children in institutions, children in conflict with
the law, children with disabilities and child victims of abuse and neglect. Most of these

                                               19
institutions are subsidized or run by the Government (Ministry of Social Affairs and Housing).
Until recently, these institutions provided only minimal data about their client population with
the result that the Government had insufficient data to develop proper policy and monitoring
mechanisms. In order to improve record keeping and availability of data in this area, the
development of a CNSP monitoring system was initiated in May 1999 by the Ministry of Social
Affairs and Housing with technical support from UNICEF. In this initiative uniform data
registry forms are introduced and institutions are supported to develop adequate administrative
and intake procedures. The periodic collection of all generated forms will facilitate the
production of periodic reports in this area. A pilot phase with 12 institutions has been
completed and currently national implementation is being prepared.

Child labour
A child labour survey conducted by the Ministry of Labour in 1998 reported that 3.2% of the
children in the sample had ever been involved in child labour. Current involvement in child
labour activities was 2%. The most prevalent activity was helping in the field (agriculture),
followed by caring for younger siblings. Around 80% of the children reported doing this "to
help the mother/family".

Substance abuse
The Bureau for Alcohol and Drugs (BAD) of the Ministry of Health provides ambulant
substance abuse prevention and treatment services to the community. This agency implements
specific activities in schools and through the media and community centers aimed at educating
and sensitizing youth regarding substance abuse. In the past years effective peer education
programs have been implemented in several districts. The Basic Life Skills Program also
addresses substance abuse and other health-risk issues, and aims to equip young people with
the skills necessary to make healthy choices.

The use of children in the production and/or trafficking of illicit drugs is an offense. Deliberate
provocation to commit an offense has been made punishable according to Article 72 Subsection
2 of the Penal Code. Thus, the person who uses a child in the production and/or trafficking of
illicit drugs is punishable by law. A special article dealing with provocation of children has not
been included in the Law. This has not been included as an aggravation of penalty.



VIII. To ensure special protection of children in armed conflict and to build a
      foundation for a peaceful world by promoting the values of peace, tolerance,
      understanding and dialogue Children in armed conflict.

During the previously mentioned years of internal war in the 1980's-early 1990's, the interior of
Suriname was the primary battleground. As a result, the interior suffered most of the casualties.
Some thousands of inhabitants from the interior fled to the capital and predominantly occupied
two unfinished Government housing projects in Sophia's Lust and Pontbuiten. In the early years
after the war, some Government and NGO initiatives were taken to provide support for these
groups. However, no comprehensive Government programme was developed.



                                                20
Currently the Government is undertaking efforts to support these groups to legalize the
occupation of the houses and finish construction. Furthermore these two areas and some other
neighbourhoods with high percentages of ex-refugees are included as high priority areas in the
Government of Suriname-UNICEF Programme of Cooperation.

Promoting the values of peace, tolerance, understanding and dialogue
The principles of the earlier mentioned Basic Life Skills Programme from the Ministry of
Education and Community Development include the promotion of relationship-building, family
life, friendship, effective communication and non-discrimination as necessary life skills.
Through media awareness activities, training of educators and policy makers from the health
and social sectors, this programme aims to incorporate these values and teaching of effective
skills in all sectors.


IX.    To prevent degradation of the environment by pursuing the World Summit Goals, by
       inculcating respect for the natural environment, and by changing wasteful
       consumption patterns.

Suriname has ratified the following treaties
 United Nations Convention on Biological Diversity (UNCBD) (1996)
 United Nations Framework Convention on Climate Change (1997)
 United Nations Vienna Convention for the Protection of the Ozone layer (1997)
 United Nations Convention to combat Diversification and Drought (2000)

In order to establish an environmental management structure, Suriname benefited from both
regional structures and national consultations resulting in an innovative yet promising structure for
environmental management. The National Council for the Environment (Nationale Milieuraad) is
a policy and advisory body, at the highest possible level: the Cabinet of the President of Suriname.
The National Institute for Environment and Development in Suriname (NIMOS, by its acronym in
Dutch: “Nationaal Instituut voor Milieu en Ontwikkeling in Suriname”) is the executive and
research arm of the council with legal personality as a foundation. These bodies will work in close
cooperation with line ministries dealing with environment and development, through the to-be-
established Inter-Ministerial Advisory Commission (IMAC). The proposal to establish this
structure circulated widely among various governmental and non-governmental bodies and was
unanimously endorsed in a special seminar titled “Op Weg naar een Duurzaam Milieubeleid”,
(On the Way to a Sustainable Environmental Policy) on 17 November 1997.

The National Council for the Environment
The National Council for the Environment (NCE) was established by Presidential decree on June
1997. Its mandate is to support the Government of the Republic of Suriname by means of advises
concerning the preparation of environmental policy at the national level and the exercising of
control in the implementation thereof. The Council, according to the Presidential decree,
implements its activities through NIMOS, while for the actual control and sanctions to be taken, if
any, and arising there from, the President can charge the ministries most suited and/or NIMOS to
do so. The President of Suriname appoints the members of the council for a period of two years.
The NCE envisions its tasks within columns: human well-being, ecology, energy and natural

                                                 21
resources, and conflict resolution. For each of these columns corresponding experts have been
appointed in the council. In the near future it will be expanded to ten members, adding
representatives of the interior (indigenous peoples and maroons), private sector, labor unions and
consumers. Among the environmental concern in Suriname, three have been identified as most
pressing priorities, namely small scale gold mining, forestry and logging, and waste management.

The National Institute for Environment and Development in Suriname (NIMOS)
NIMOS was established as a foundation with legal personality on 16 November 1998. Its
objectives are:
-    advise the government of Suriname on the implementation of environmental policies
-    realize national environmental legislation
-    prepare and realize regulations regarding environmental protection
-    coordinate and monitor compliance with those rules and regulation.



X.      To address poverty and debt; mobilize development finance; halt the net transfer of
        resources from developing to developed countries; establish an equitable trading
        system; and ensure children are given priority in economic and social development.

Several initiatives have been undertaken in the nineties with a special focus on poverty
eradication e.g.:
 To alleviate the economic crisis in which Suriname found itself in the early nineties, a
    Structural Adjustment Programme (SAP) was announced in 1993. To mitigate the negative
    effects of the mainly monetary-economic measures, a Social Safety Net was put into place,
    which had to provide short, medium and long term strategies to protect vulnerable groups,
    including children, and to increase the development potential of the population. On short
    term it was decided to restructure and expand the existing facilities and services of the
    Ministry of Social Affairs and Housing and to distribute a basic food package.

    The policy document 1997-1999 of the Ministry of Social Affairs and Housing indicates
     that elderly people, people with a handicap, young people (0-18) and women are the most
     important target groups at which the policy is aimed. Apart from social and categorical
     social work (elderly, youth and disabled persons) the Ministry also provides in the
     following material support benefiting children:
·        General Child Allowance for persons who do not receive child allowance from
         government - or private employment.
·        Free Medical Care for minima households category A (SG 40,000.-) and B (between
         SG 40,000.- and SG 80,000.-).
·        Subsidy on school uniforms, shoes and learning material for minima households
         category A and B. In 1999, this concerned 18,334 children (from 4,692 eligible
         households)
·        Subsidy to social institutions, based on exploitation costs and individual
         subsidy of inhabitants: In 1995 this concerned 33 children's homes/boarding
         schools with an occupation of 1064 children in total and 9 private old people's
         homes with an occupation of 465 elderly in total.

                                               22
   On a monthly basis, the Ministry of Social Affairs and Housing estimates subsistence
    minimum levels, to keep the social services effective in relation to the costs of living. If
    necessary, allowances are adjusted accordingly.

   In 1997, the Government started the implementation of a public house-building programme.
    Furthermore, by Government’s decision, there is a possibility for low-and middle income
    groups who are in rental public houses to buy these houses for a reduced rate. In co-
    operation with the IDB, a “Low Income Shelter program” has been initiated. The target of
    this program is to improve the living conditions of the people. This program aims at new
    housing development, with an emphasis on personal initiatives. In this project, community
    based organisations and NGO’s have a crucial role.

   Fund for Development of the Interior 1994.
    This Fund is for the reconstruction and development of the interior (where circumstances
    have deteriorated even more due to the civil war in the interior (1986-1992), and for small-
    scale projects identified by the target groups themselves. In 1995, 141 projects were
    submitted, of which 10 were completed, 8 are in progress, 9 are committed, 21 approved
    and 93 in preparation.

   Suriname Integrated Area-Based Programme
    In 1998 the government, in co-operation with UNICEF, developed an area based
    programme, which aims to anticipate on the fast deteriorating situation of women and
    children in the interior. The programme incorporates different components of the
    UNICEF Country Programme in small-scale community projects, in which
    strengthening skills and development potential of the community on one hand, and
    facilitating cooperation between different government departments, levels and NGO’s
    on the other hand are integrated objectives. Projects within this programme vary
    from building sanitary and potable water facilities (preventive healthcare) to courses
    in early childhood development. At this moment technical assistance is given by
    UNIFEM in the framework of the sustainable livelihoods approach. An innovative
    project for economic emancipation of women is being prepared as a joint effort in the
    district of Brokopondo.

   The NGO Fund started in 1995 with a budget of NG 5 million (Dutch Florins), and an
    additional NG 1 million for projects in food production for the domestic market. Focus was
    laid on the financing of small-scale activities. From March 1996 to March 1999, 18 of the
    39 submitted projects were approved in several sectors such as primary health care, micro
    entrepreneurs, education and community facilities. Continuation of the programme was
    approved in the second half of 1999.

   The Micro Projects Programme, financed by the European Union, was implemented from
    1994-1998, and had the same focus as the NGO Fund. In total 82 projects were approved,
    of which 41 urban and 41 rural. After external evaluation, a second programme for five
    years was approved.


                                               23
     The Community Development Fund Suriname (CDFS) is a further realisation of the pursuit
      for self-development from a regional approach, and fits in the Strategic Framework for
      Social Development and Poverty Reduction. Therefore, the Ministry of Regional
      Development, in cooperation with the IDB, has developed the CDFS, which is accessible
      for NGO's and local authorities, including traditional authorities. The Fund has a duration
      time of 4 years with a benefaction from the Japan Special Fund of the IDB. The pilot phase
      started in July 1999. Twelve demonstration projects have been initiated in 1999, at least one
      in each of the ten districts. The Fund also tries to attract additional investments for the
      social sector in order to enhance the capacity of government- and non-government
      organisations to implement and administrate small-scale community projects.

     In 1999 the Surinamese government (in co-operation with the Inter-American Development
      Bank, the IDB) assigned a consultant to comprise a Strategic Framework and Action Plan
      for Social Development and Poverty Reduction in Suriname. The reduction of poverty as an
      important part of the strategic framework has to be placed within a holistic view of
      development; in this concept the intention is to achieve macro-economic stability, economic
      growth and capital generating policy measures at the same time. This report was presented
      at a workshop in January 2000 to stakeholders.

     To guarantee the right to education for as many children as possible, investments have
      been made for the decentralization of secondary schools to several districts.
      Furthermore, there are two boarding schools especially for children from districts come to
      the city to get education at a higher level than basic level. The Ministry of Education and
      Community Development has installed evaluation committees for the different learning
      levels. Besides this, a committee has been installed for the preparation of a national
      congress, at which the contents of the education process will be scrutinized.
      Main topics will be:
      -    objectives of different educational levels
      -    curricula, language issues, methods and techniques
      -    the measuring of learning performance
      -    norms for promotion and
      -    evaluation of examinations.
      A sub-seminar “Education in the Interior” has already been held, of which the results will
      be taken into account at the national congress. Also, a committee has been established for
      evaluation of the pedagogical institutes1.

     Within the Government, the Ministry of Social Affairs and Housing is responsible for social
      youth protection measures. There is a division within the Ministry, which provides
      assistance for children and their family who are in a socially deprived situation. There are
      two shelters under supervision of the Ministry, one for boys and one for girls.

     The Ministry of Education and Community Development provides learning experiences for
      over 1800 children with disabilities, in collaboration with the private sector, on the levels of
      Basic Special Education, Secondary Special Education, and vocational training.

1
    National Report of the Republic of Suriname on the World Summit for Social Development (June 2000)

                                                       24
       The Youth Department of the Ministry of Education and Community Development started a
       teenage-mother project in 1989 to create conditions for teenage mothers to finish their
       education, learn job-skills and parenting skills. The program includes reproductive health
       education and building self-esteem of teenage mothers.
       The program has grown and evolved into an independent program implemented in
       collaboration with the Young Women’s Network. Currently, the full program is only
       available in the coastal area of Suriname.

      The Medical Pedagogical Bureau (MOB) at the Ministry of Health with a staff of
       physicians, psychologists and social workers provides services for assessment and
       placement of children in special schools and services, guidance, screening, early detection
       and care for children2.

Major events concerning national social policy/legislative reforms favoring children

      Installation of a National Committee on the Rights of the Child by the Minister of Social
       Affairs and Housing in January1995, responsible for coordination of the implementation
       and monitoring of the Convention on the Rights of the Child. During their term the
       National Commission has prepared a draft framework for a National Plan of Action and the
       initial country report.

      Approval by the Council of Ministers in February 1996 of a bill on further amendment of
       the Surinamese Civil Code, in particular with respect to the elimination of the differences
       between legitimate and born out of wedlock children in the inheritance laws.


      Signing of the Master Plan of Operations of the Programme of Cooperation 1998 – 2002
       (UNICEF – Government of Suriname).

      Installation of the Steering Committee in October 1998; The Steering Committee has not
       officially replaced the National Commission on the Rights of the Child which was installed
       in 1995. After it’s mandate of 2 years no reappointment took place. In it’s evaluation the
       Committee indicated that it was not able to function adequately, partly due to the heavy
       workload and multiple commitments of Committee members. The Steering Committee has
       drafted a National Youth Policy, in close collaboration with sector Ministries, NGO’s and
       the National Youth Council. This draft will serve as the basis for the finalization of a
       comprehensive National Plan of Action.

      The National Youth Council was installed on November 20th 1999, composing of 21
       members within the age group 12 – 17 years, for a period of 2 years. The members were
       chosen by elections held in all 10 districts. In all these 10 districts youth congresses were
       organized with the focus on Child Rights, and participating children held presentations on
       the various rights. The Steering Committee has established a National Youth Institute,


2
    List of issues in connection with the consideration of the Initial CRC report of Suriname (May 2000)

                                                          25
     through which the Youth Council operates. The task of the Youth Council is to advise the
     Government on child related issues and youth policy.

    Approval of the Bill on elimination of the differences between legitimate and born out of
     wedlock children in inheritance laws: adopted by the National Assembly, which has taken
     immediate effect since February 2000 (published in State Gazette of February 18th, 2000).

    The first comprehensive analytical comparison of the national legislation with the CRC
     took place prior to Suriname's ratification of the CRC in 1993. The preparation of the
     Initial Report has been elaborated on this analysis. Several thematic analyses have been
     conducted since, including legislation with regard to child-care, and the recently completed
     Juvenile Justice assessment.

    The Government of Suriname actively participated in regional activities regarding children,
     including the regional Inter-Ministerial Meetings. Suriname co-signed the Santiago Accord
     and the Lima Accord, and is also party to the Caricom HFLE initiative aimed at
     improvement of adolescent health and life skills.



E.      Lessons learnt


Factors that have limited progress and the lessons learned about how to deal with them are the
following:

1. The internal war and the socio-economic crisis contributed to accelerated deterioration of the
   public transport system and roads. The continuing brain drain and limited Government funds
   further compromised the ability of the Government to provide adequate services. Targeted
   Government effort and donor support contributed to some improvement. However, in order
   to achieve sustainable and structural improvement of the child health indicators, there is a
   need for long-term, strategic commitment of efforts and resources, embedded in a context of
   national development.

2. It can be concluded that the Government of Suriname did not achieve the health related
   goals. However, considering the internal war, the continuing socio-economic crisis and the
   incapacitating brain drain, the Government of Suriname is satisfied with some of the
   progress made. The Government was able to halt the dropping immunization coverage and
   achieve some progress in particular during the second half of the decade.

    The Government of Suriname has reached the goals of elimination of new cases of polio,
    measles and neonatal tetanus. While there has been progress in the immunization coverage
    against diphtheria, pertussis, tetanus, measles, poliomyelitis, and tuberculosis, the 90% goal
    has not been reached.



                                                26
     Some progress was made in the implementation of the baby-friendly hospital initiative and
     the promotion of breastfeeding. There has been progress in the awareness and knowledge
     regarding HIV/AIDS.
     Overall there has been good progress in the development of data systems for future
     monitoring and planning for improvement of child health indicators.

3. In spite of the efforts, the Government recognizes that access to services and goods is not
    equal, and that the population of the interior remains underserved. It is therefore very
    important, prior to implementation, for every initiative and/or programme to make an
    assessment of the impact this will have on the most vulnerable groups, which usually are the
    women and children. In addition, the Government intends to step up efforts to
   reach the vulnerable and underserved groups.



F.       Future Actions

The future actions on national level are officially incorporated in the government document
2000 – 2005. The immediate actions based on the GOS – UNICEF program of cooperation are
being implemented.

Immediate Actions

        Select qualitative and quantitative data regarding the situation of children in Suriname
         through several surveys at such as MICS, CIMS, CNSP, Child Labour Survey.
        Training & Technical Assistance for strengthening of national capacity for improved
         planning, implementation and monitoring for Child Survival, Development &
         Protection (CSDP).
        Strengthening of linkages for integration of child-focused research, policy, development
         and program development.
        Increase awareness and knowledge regarding the Convention on the Rights of the Child
         through dissemination of the Convention, CRC education through media, celebration of
         National Child Rights Day.
        Support participation of children in policy and program development through training in
         public speaking, leadership, planning and organization of meetings.
        Support legislation reform to harmonize local laws with the CRC.
        Support development of programs for personal and job skills development for out of
         school youth with disabilities, juvenile delinquents and teenage mothers.
        Provide children with pre school education, especially those who are socio-
         economically disadvantaged.
        Assess and improve pre-primary school curriculum in line with prevailing socio-
         economic reality.
        Formation of a sound policy and legal framework on early childhood education.



                                                27
      Promote parents’ participation in basic education in order to improve quality of
       education.
      Improve basic life skills with the emphasis on health and family life education.
      Achieve and maintain 80% immunization coverage.
      Reduce the prevalence of chronic and acute malnutrition.
      Improved prevention, detection and treatment of vertical HIV transmission.
      Improve community knowledge and skills towards improvement of child care and
       disease prevention.

Medium-term plans 2001-2005 as specified in the Government multi-year plan 2001-2005

1. Reorganization of the Civil Service, including training and targeted institutional
    strengthening with the aim to increase capacity, efficiency and effective functioning of the
    Civil Service sector.
2. Improvement of the civil registry system to ensure that every citizen is adequately
    registered and documented.
3. Gender mainstreaming to ensure full participation of females in the community process.
4. Economic stabilization and increase of national productivity through intensive mobilization
    of human potential and responsible exploitation of natural resources.
5. Strive for macro-economic equilibrium through attraction of foreign capital (investments),
    monetary discipline and poverty reduction.
6. Support for agricultural sector for increased productivity for local food supply and export
    purposes.
7. Rehabilitation of the education sector, targeted restructuring and reorganization of the
    education system to ensure a coherent and relevant education system, and equal
    participation of boys and girls.
8. Strengthening of primary health care services to guarantee high quality basic services for all
    and to reduce the threats of malaria, dengue and other epidemics.
9. Improve accessibility of primary care services for women, children and remote populations.
10. Design an effective and rational social policy emphasizing survival and protection of the
    most vulnerable groups and creation of conditions for sustainable improvement of living
    conditions.
11. Safeguard the needs of children, people with disabilities and other vulnerable populations to
    ensure a humane and equitable living standard.

International Action

1. Continue regional support and action toward implementation and monitoring of child
   rights:
   a) Regional Inter-Ministerial meetings
   b) Regional initiatives, i.e. Health and Family Life Education Initiative
   c) Regional Accords, i.e. Santiago Accord, Lima Accord, Kingston Consensus
   d) Regional studies, i.e. Juvenile Justice Study, Disability Study




                                               28
G. Appendix

Statistical Report on Individual Goals


Goal 1:        Between 1990 and the year 2000, reduction of infant and under-five mortality
               rate by one-third or to 50 and 70 per 1,000 live births respectively, whichever is
               less.

Indicator                     1990         Source of data               1999       Source of data
Under-five mortality rate         21       1996 Ministry of Health                 MICS II
                                           Mortality & morbidity data
Infant mortality rate               21.1   1990 Ministry of Health         16.8    1999 MOH mortality
                                           Mortality & morbidity data              data

Discussion
In 1990 the Government recorded an infant Mortality Rate of 21. Infant mortality rates
remained between 22-23 per 1,000 live births between 1990 and 1994 and dropped to 15.4 in
1995 and 16.4 in 1996. The recorded under-five mortality rate was 21 in 1996. The Ministry of
Health considered these figures unreliable, due to evidence of underreporting. For this reason
the Epidemiology Division conducted a retrospective perinatal mortality assessment over 1995-
1999. The study results indicated underreporting of 25 %. According to survey results, the
perinatal mortality rate for 1995 was 26.8 per 1000 and 32.5 per 1000 in 1999. This adjustment
in perinatal mortality rate suggests that the total infant mortality rate and under-five mortality
rate is higher than the reported 22-23 per 1000.



Goal 2:        Between 1990 and the year 2000, reduction of maternal mortality rate by half.

Indicator                   1990      Source of data                        1999           Source of data
Maternal mortality ratio      226     1991-1993 corrected MMR after                108.4   1995-1999 MOH
                                      MM survey by Ministry of Health                      MM survey
The proportion of births     Over     Ministry of Health Statistics     National: 90.6%    MICS II
attended by skilled          80%                                           Urban: 90%
health personnel                                                           Rural: 87.5%
                                                                        Interior: 93.9%

Discussion
In 1990 the registered Maternal Mortality rate was 92 per 100,000 live births, and 55 for 1996.
The Ministry of Health considered these rates unreliable, due to suspected underreporting. A
review of all deaths of women aged 10-50 between 1991 -1993 revealed an MMR of 226 and
108.4 for 1995-1999. Currently the Ministry of Health has made good progress towards
improvement of maternal mortality reporting.




                                                         29
Goal 3:       Between 1990 and the year 2000, reduction of severe and moderate
              malnutrition among under-five children by half

Indicator                1990                Source of data   2000               Source of data
Underweight prevalence   No data available                    -2 SD:             MICS II
                                                              National - 13.3%
                                                              Urban - 10.7%
                                                              Rural - 13..8%
                                                              Interior - 17.5%
                                                              -3SD:
                                                              National - 2.1%
                                                              Urban - 1.5%
                                                              Rural - 1.9%
                                                              Interior – 3.4%
Stunting prevalence      No data available                    -2SD               MICS II
                                                              National -9.9%
                                                              Urban - 6.3%
                                                              Rural - 8.0%
                                                              Interior- 18.4%
                                                              -3SD
                                                              National -2.7%
                                                              Urban - 1.3%
                                                              Rural - 2.0%
                                                              Interior - 5.0%
Wasting prevalence       No data available                    -2SD               MICS II
                                                              National -6.5%
                                                              Urban -6.5%
                                                              Rural - 7.7%
                                                              Interior - 5.0%
                                                              -3SD
                                                              National -1.5%
                                                              Urban - 1.2%
                                                              Rural - 1.7%
                                                              Interior - 1.6%

Discussion
During the civil war in the 1980s and in the early 1990s malnutrition among children was on
the rise. A 1994 study among former refugees in one district showed that 17% of 278 children
were malnourished. Another 1994 study found 10% of the children with a weight-for-age
below the third percentile. Hospitalization of 1-5's due to malnutrition, sharply increased from
33 in 1988 to 64 in 1989, 123 in 1990, 114 in 1991, and further rose to 185 in 1994. Around
50% of the hospitalized children were in the age group 0-1. During 1992-1994, 29 boys and 15
girls died due to malnutrition.




                                                       30
Goal 4:          Universal access to safe drinking water

Indicator                     1990           Source of data   2000               Source of data
1) piped water to household   Urban - 95%    1996 MOH CMO     National -70.1%    MICS II
                              Rural - 70%    Report           Urban - 90.6%
                              Interior-12%                    Rural - 64.5%
                                                              Interior - 15.3%
(2) public standpipe/tap      No data                         National-0.9%      MICS II
                              available                       Urban - 0.5%
                                                              Rural - 0.6%
                                                              Interior - 2.7%
(3) borehole/pump             No data                         National-0.6%      MICS II
                              available                       Urban - 0.6%
                                                              Rural- 0.2%
                                                              Interior- 1.4%
(4) protected well            No data                         National-0.1%      MICS II
                              available                       Urban - 0.2%
                                                              Rural - 0.1%
                                                              Interior - 0%
(5) protected spring          No data                         National-0.7%      MICS II
                              available                       Urban - 0.7%
                                                              Rural - 1.0%
                                                              Interior - 0.5%
(6) rain water                No data                         National - 13.4%   MICS II
                              available                       Urban - 5.5%
                                                              Rural - 23.4%
                                                              Interior - 18.3%

Discussion
In 1990, national access to safe drinking water was 89% according to Government estimates.
The urban population had 95% access while the rural population (including interior) had 70%
access to safe drinking water. MICS data suggests a current access to safe drinking water of
over 80%. According to PAHO observations, the UNICEF and national definitions of safe
drinking water applied to these figures should be considered with caution, since they don't
necessarily reflect the actual quality of the water when it reaches the user. For instance
sabotaged and leaking pipe systems in some areas, seasonal influences on water streams and
lakes (drying up, etc.); gold mining and other environmental pollution of streams and rivers
potentially contribute to a lower percentage of the population with access to safe drinking
water.




                                                      31
Goal 5:          Universal access to sanitary means of excreta disposal

Indicator                        1990                 Source of data   2000                        Source of data
(1) toilet connected to sewage   No data available*                    National-65.6%              MICS II
system or septic tank;                                                 Urban - 84.3%
                                                                       Rural - 65.6%
                                                                       Interior - 5.0%
(2) pour-flush latrine           No data available*                    National-21.5%              MICS II
                                                                       Urban - 14.6%
                                                                       Rural - 30.9%
                                                                       Interior - 24.9%
(3) improved pit latrine         No data available*                    National-0.3%               MICS II
                                                                       Urban - 0.9%
                                                                       Rural- 0.9%
                                                                       Interior - 0%
(4) traditional pit latrine      No data available*                    National-0.4%               MICS II
                                                                       Urban - 0%
                                                                       Rural - 0.9%
                                                                       Interior - 0.6%

Discussion
According to MOH estimates, in 1992-1995, 63% of the urban population and 34 % of the rural
population had access to sanitary facility for human excreta disposal in or around the dwelling.
MICS reported that currently from the population in the interior, 24.2% uses the river and
43.4% reported no facilities/bush/field as main means of excreta disposal.


Goal 6:          Universal access to basic education and achievement of primary education by
                 at least 80 per cent of primary school-age children through formal schooling or
                 non-formal education of comparable learning standard, with emphasis on
                 reducing the current disparities between boys and girls

Indicator                                1990                 Source of data   2000                   Source of data
Children reaching grade 5                74.4%                Ministry of      National - :83.8%      MICS II
                                                              Education data   Urban - 92.8%
                                                                               Rural - 82.5%
                                                                               Interior - 64.5%
Net primary school enrolment ratio       No data available                     No data available
Net primary school attendance rate       No data available                     National - 77.5%       MICS II
                                                                               Urban - 81.6%
                                                                               Rural - 81.9%
                                                                               Interior - 61.2%

Discussion
The General Bureau for Statistics reported in 1995/1996 that 81.3% of children in Suriname
participated in learning activities prior to starting formal schooling. Suriname's 1999 EFA
report estimated that close to 100% of the children enrolling in formal education have
participated in some form of organized preschool learning activity. In the MICS sample, 61%
of the 4-5 yrs and 14% of the children aged 3-4 years were participating in organized preschool
learning activities.

                                                             32
Goal 7:         Reduction of the adult illiteracy rate (the appropriate age group to be
                determined in each country) to at least half its 1990 level, with emphasis on
                female literacy

Indicator                       1990                Source of data            2000               Source of data
Literacy rate                   Over 90%            Ministry of Education     National - 86.2%   MICS II
                                                    estimate                  Urban - 92.9%
                                                                              Rural - 87.0%
                                                                              Interior - 51.1%
Literacy rate by gender         No data available                             Male - 90.2%       MICS II
                                                                              Female - 82.3%

Discussion
During 1991 – 1994, adult literacy rates in Suriname were estimated by the Ministry of
Education and Community Development to be over 90%. The Bureau for Statistics reported
adult literacy rates for males 95%, females 91% in 1997, for Paramaribo and Wanica (80% of
the population).


Goal 8:         Provide improved protection of children in especially difficult circumstances
                and tackle the root causes leading to such situations

Indicator                     1990                  Source of data            2000        Source of data
Total child disability rate   No data available                               1.3%        Regional disability
                                                                                          Situation Analysis -
                                                                                          January 2000

Discussion
In January 2000, a situation analysis of children with disabilities was conducted in the
Caribbean by UNICEF. In Suriname, the study covered the urban and rural areas of Suriname
(80% of total population) and surveyed 3095 people between the age group of 0 – 18. The
number of children identified with disabilities was 39 (1,3 %). The major disability was
difficulty in learning (36 %) followed by difficulty with speech and hearing (21 %). Gender of
children identified with a disability: male – 25 (64,1%) and female – 14 (35,9 %).


Goal 9:         Special attention to the health and nutrition of the female child and to pregnant
                and lactating women

Indicator                            1990                Source of data     2000                 Source of data
Under-Five mortality rate –          No data available                      No data available
female/male
Underweight prevalence               No data available                      Female - 2.3%        MICS II
female/male                                                                 Male – 14.3%
Antenatal care                       Over 90%            MOH estimates      Urban - 90%          MICS II
                                                                            Rural - 87.5%
                                                                            Interior - 93.9%
HIV prevalence female/male           No data available                      No data available
Anemia                               No data available                      No data available



                                                           33
Discussion
Iron Deficiency Anemia: There is no national data available regarding iron deficiency anemia.
Some small-scale studies indicate that there might be a public health concern regarding anemia
in the general population. A small 1992 study found almost half of the women anemic (hb
<7mmol). A study conducted by the Medical Mission in the interior in 1999 found 23.3% of the
population with hb levels of 5-6.8 mmol, 43% with 4-5 mmol, 0.8% <4 mmol. Based on these
findings and the endemic nature of malaria in the interior, the Medical Mission prescribes iron
supplements to all pregnant women in the interior.

Antenatal Care; assistance at Childbirth; Obstetric Emergencies: Traditionally, prenatal care
attendance and obstetric assistance at childbirth are high. Over 90% of all women are at least
once during pregnancy attended by trained health personnel and over 80% of all births are
attended by trained health personnel.



Goal 10: Access by all couples to information and services to prevent pregnancies that
         are too early, too closely spaced, too late or too many.

Indicator                           1990                Source of data       2000                Source of data
Contraceptive prevalence            Urban - 50%         National             National - 42,1%    MICS II
                                    Rural (including    Contraceptive        Urban - 51.2%
                                    interior) – 20%     Prevalence Survey,   Rural - 45.1%
                                                        1992 (Lobi           Interior - 7.1%
                                                        Foundation)
Fertility rate for women 15 to 19   No data available                        No data available
Total fertility rate (15-44)        2.7                 1990-1995 rate
                                                        MOH 1996 CMO
                                                        Report




Goal 11: Access by all pregnant women to pre-natal care, trained attendants during
         childbirth and referral facilities for high-risk pregnancies and obstetric
         emergencies.

Indicator                           1990                Source of data       2000                Source of data
Antenatal care                      Over 90%            MOH estimates        National - 90.6%    MICS II
                                                                             Urban - 90%
                                                                             Rural - 87.5%
                                                                             Interior - 93.9%
Childbirth care                     Over 80%            MOH estimates        National - 84.5%    MICS II
                                                                             Urban - 92.6%
                                                                             Rural - 90.0%
                                                                             Interior - 68.4%
Comprehensive Obstetric care        5                   Ministry of Health   5                   Ministry of
per 500,000                                                                                      Health
Basic essential obstetric care      15                  Ministry of Health   15                  Ministry of
per 500,000                                                                                      Health



                                                           34
Goal 12: Reduction of the low birth weight (less than 2.5 kg) rate to less than 10 per cent

Indicator                     1990                     Source of data       2000                                  Source of data
Birth weight below 2.5 kg     No data available                             National-11.4% of 77.3%               MICS II
                                                                            weighed at birth
                                                                            Urban 11.7% of 87.4%
                                                                            weighed at birth
                                                                            Rural - 12.5% of 80.8%
                                                                            weighed at birth
                                                                            Interior - 9.9% of 60.2%
                                                                            weighed at birth


Goal 13: Reduction of iron deficiency anemia in women by one third of the 1990 levels

Indicator                     1990                     Source of data       2000                                  Source of data
Anemia                        No data available                             No data available

There is no national data available regarding iron deficiency anemia. Some small-scale studies
indicate that there might be a public health concern regarding anemia in the general population.
A small 1992 study found almost half of the women anemic (hb <7mmol). A study conducted
by the Medical Mission in the interior in 1999 found 23.3% of the population with hb levels of
5-6.8 mmol, 43% with 4-5 mmol and 0.8% <4 mmol. Based on these findings and the endemic
nature of malaria in the interior, the Medical Mission prescribes iron supplements to all
pregnant women in the interior.



Goal 14: Virtual elimination of iodine deficiency disorders

Indicator                     1990                            Source of data        2000                         Source of data
Iodized salt consumption      No data available                                     No data available
Low urinary iodine            No data available                                     No data available

No systematic iodization of salt in Suriname. No evidence of a public health problem with iodine deficiency in Suriname.




Goal 15: Virtual elimination of vitamin A deficiency and its consequences, including
         blindness

Indicator                            1990                     Source of data        2000                         Source of data
Children receiving Vitamin           No data available                              No data available
A supplements
Mothers receiving Vitamin            No data available                              No data available
A supplements
Low vitamin A                        No data available                              No data available
Discussion
No Vitamin A supplement programme in Suriname. No evidence of a public health problem with Vitamin A
deficiency in Suriname.


                                                                 35
Goal 16: Empowerment of all women to breast-feed their children exclusively for four to
         six months and to continue breastfeeding, with complementary food, well into
         the second year

Indicator              1990                Source of data   2000                 Source of data
Exclusive breast-      No data available                    National - 12.8%     MICS II
feeding rate                                                Urban - 12.3%
                                                            Rural - 9.5%
                                                            Interior - 15.8%
Timely complementary   No data available                    National - 24.5%     MICS II
feeding rate                                                Urban - 25.0%
                                                            Rural - 34.1%
                                                            Interior - 13.0%
Continued breast-      No data available                    12 – 15 months       MICS II
feeding rate                                                National - 42.9% -
                                                            Urban - 31.7%
                                                            Rural - 26.8%
                                                            Interior - 68.6%
                                                            20 - 23 months
                                                            National-11.1%
                                                            Urban - 17.0%
                                                            Rural - 9.4%
                                                            Interior - 4.3%
Number of baby-        0                   Ministry of      0                    Ministry of
friendly facilities                        Health                                Health

Discussion
There is a lack of quantitative data with regard to breastfeeding practices. A qualitative study
conducted by the Ministry of Health in 1991 found that breastfeeding was widely practiced,
while complementary foods were generally introduced between 0-3 months. The MICS data
reports that currently in Suriname the situation has apparently not changed much. Breast
feeding is practiced widely, but complementary foods are introduced at early age.



Goal 17: Growth promotion and its regular monitoring to be institutionalized in all
         countries by the end of the 1990s

     Reporting – No specific indicator has been identified to monitor this goal. In reporting
      on progress, a description of the growth monitoring systems in the country should be
      provided. This should include information on whether the country has a national growth
      chart; what proportion of children are regularly weighted, and whether a national policy
      on growth monitoring exists.

The country has a national growth chart which is being used by all under-five clinics. Under-
five care, including growth monitoring, is provided throughout the country by two primary care
organizations. In the interior under-five care is provided free of charge by the Medical Mission
and in the Coastal area under-five care is provided by the Regional Health Services.



                                                   36
Goal 18: Dissemination of knowledge and supporting services to increase food
         production to ensure household food security

      Reporting – No specific indicator has been selected to monitor this goal. Countries
       should describe the overall situation with respect to food security and how it has changed
       throughout the decade.


Goal 19: Global eradication of poliomyelitis by the year 2000

Indicator                1990            Source of data         2000      Source of data
Polio cases              0               Ministry of Health     0         Ministry of Health

The last case of confirmed poliomyelitis was recorded in 1982. During the past decade, annual
number of confirmed polio reached 0.
In total the Government of Suriname has reached the goals of elimination of new cases of
polio, measles and neonatal tetanus.


Goal 20: Elimination of neonatal tetanus by 1995

Indicator                1990            Source of data         2000      Source of data
Neonatal tetanus cases   0               Ministry of Health     0         Ministry of Health

The last 2 reported cases of neonatal tetanus were seen in 1996.



Goal 21: Reduction by 95 per cent in measles deaths and reduction by 90 per cent of
         measles cases compared to pre-immunization levels by 1995, as a major step to
         the global eradication of measles in the longer run

Indicator                        1990    Source of data         2000      Source of data
Under-five deaths from measles                                  0         Ministry of Health
Measles cases                                                   0         Ministry of Health




                                                37
Goal 22: Maintenance of a high level of immunization coverage (at least 90 per cent
             of children under one year of age by the year 2000) against diphtheria,
             pertussis, tetanus, measles, poliomyelitis, tuberculosis and against tetanus
             for women of child-bearing age


Indicator                       1990               Source of data   2000               Source of data
DPT immunization coverage       83%                Ministry of      National-79.1%     MICS II
                                                   Health           Urban 82.7%
                                                                    Rural - 84.3%
                                                                    Interior - 88.4%
Measles immunization coverage   57%                Ministry of      National-60.2%     MICS II
                                                   Health           Urban 63.1%
                                                                    Rural - 56.6%
                                                                    Interior - 59.3%
Polio immunization coverage     83%                Ministry of      National-78.5%     MICS II
                                                   Health           Urban 83.9%
                                                                    Rural - 81.7%
                                                                    Interior - 68.6%
Tuberculosis immunization       Not administered   Ministry of      Not administered
coverage                                           Health
Children protected against      Not administered   Ministry of      Not administered
neonatal tetanus                                   Health

Discussion
The Expanded Program on Immunization (EPI) started in 1976 in Suriname with vaccination
of children age 0-12 months against diphtheria, pertussis, tetanus and poliomyelitis. In 1981
measles was included in the routine immunization schedule. Since 1993 the combined MMR
vaccine is administered to children at 12 months.
Between 1980 – 1985, Suriname had a high immunization coverage of over 90%. During and
after the internal war and ensuing destruction of infrastructure between 1986 -1990,
immunization coverage significantly dropped. In 1990 DPT3 and OPV3 coverage was 83%,
measles 57.4%. In 1992 the vaccination coverage fell to very low levels. In the coastal area
coverage was 53.6%, with even lower coverage in the interior.
Intensive effort from the Ministry of Health resulted in some improvement in immunization
coverage during 1996- 1999.




                                                   38
Goal 23: Reduction by 50 per cent in the deaths due to diarrhoea in children under the
         age of five years and 25 per cent reduction in the diarrhoea incidence rate

Indicator                1990                  Source of data        2000                Source of data
Under five deaths        Between 1989 – 1991   Ministry of Health    Between 1997-1999   Ministry of Health
from diarrhea            130 children                                71 children
Diarrhea cases           3143                  Ministry of Health,   National - 14.8%    MICS II
                                               1995 surveillance     Urban - 11.2%
                                                                     Rural - 10.4%
                                                                     Interior - 25.6%
ORT use                  No data available                           National - 35.5%    MICS II
                                                                     Urban - 35.0%
                                                                     Rural - 24.2%
                                                                     Interior - 40.9%
Home management          No data available                           National - 24.2%    MICS II
of diarrhea                                                          Urban - 30.0%
                                                                     Rural - 18.2%
                                                                     Interior - 22.6%

Diarrhea is the second leading cause of death for children age 0-11 months, and the first for
children age 1-4 years. Between 1992 – 1994, 110 children 0-4 died due to gastroenteritis. In
1989 the epidemiology surveillance of the Ministry of Health recorded 3,143 cases of child
diarrhea. It was estimated at that time that 25% of all physician consultations for children were
due to diarrhea.

Goal 24: Reduction by one third in the deaths due to acute respiratory infections in
         children under five years

Indicator                  1990                 Source of data       2000                Source of data
Under-five deaths          Between 1989-1991    Ministry of Health   Between 1997-1999   Ministry of Health
from acute respiratory     40 children                               28 children
infections
Care seeking for           No data available                         National-35.4%      MICS II
acute respiratory                                                    Urban - 39.4%
infections                                                           Rural - 60.7%
                                                                     Interior - 5.6%

The death rate of children under five due to acute respiratory infections was 42.9 per 100,000
children in 1995.


Goal 25: Elimination of guinea-worm (dracunculiasis) by the year 2000

Dracunculiasis cases             Annual number of cases of dracunculiasis (guinea-worm) in the total
                                 population

No cases recorded in Suriname




                                                       39
Goal 26: Expansion of early childhood development activities, including appropriate
         low-cost family and community-based interventions

Indicator                1990                Source of data   2000                  Source of data
Preschool development    No data available                    36-47 months: 14.1%   MICS II
                                                              48-59 months: 61.4%
Underweight prevalence   No data available                    -2 SD:                MICS II
                                                              National - 13.3%
                                                              Urban - 10.7%
                                                              Rural - 13..8%
                                                              Interior - 17.5%
                                                              -3SD:
                                                              National - 2.1%
                                                              Urban - 1.5%
                                                              Rural - 1.9%
                                                              Interior - 3.4%

The General Bureau for Statistics reported in 1995/1996 that 81.3% of children in Suriname
participated in learning activities prior to starting formal schooling. Suriname's 1999 EFA
report estimated that close to 100% of the children enrolling in formal education have
participated in some form of organized preschool learning activity. In the MICS sample, 61%
of the 4-5 yrs and 14% of the children aged 3-4 years were participating in organized preschool
learning activities.



Goal 27: Increased acquisition by individuals and families of the knowledge, skills and
         values required for better living, made available through all educational
         channels, including the mass media, other forms of modern and traditional
         communication and social action, with effectiveness measure in terms of
         behavioral change

   Reporting – No specific indicator has been selected to monitor this goal.




                                                    40
Additional indicators for monitoring children’s rights.

Indicator              1990                Source of data   2000                        Source of data
Birth registration                                          National - 94.9%            MICS II
                                                            Urban -93.9%
                                                            Rural - 93.8%
                                                            Interior - 97.5%
Children living with   No data available                    National - 62.2%            MICS II
both parents                                                Urban - 64.2%
                                                            Rural - 71.0%
                                                            Interior - 45.6%
Children not living    No data available                    National- 7.8%              MICS II
with a biological                                           Urban - 6.5%
parent                                                      Rural- 6.4%
                                                            Interior - 12.1%
Child labour           No data available                    3.2% - ever involved        1998 Child Labour
                                                            2.0% - currently involved   Survey, Ministry of
                                                                                        Labour


Additional indicators for monitoring the Integrated Management of Child Illness (IMCI)
and malaria.

Indicator              1990                Source of data   2000                        Source of data
Home management of     No data available                    National - 15.3%            MICS II
illness                                                     Urban - 18.0%
                                                            Rural - 13.3%
                                                            Interior - 13.7%
Care seeking           No data available                    National - 19.0% Urban-     MICS II
knowledge                                                   11.6%
                                                            Rural - 18.3%
                                                            Interior - 32.2%
Bednets                No data available                    Interior only               MICS II
                                                            Bednet- 72.2%
                                                            Impregnated bednet - 4.6%
Malaria treatment      No data available                    No data available

Discussion
In the MICS national sample, around 19% of caretakers knew at least two signs for seeking
care immediately. The caretakers from the interior scored highest (32.2% of all caretakers from
the interior), followed by the rural population (18.3%) and the urban population (11.6%). The
most frequently mentioned sign was "develops a fever" (74.5%), followed by "becomes sicker"
(14.2%). “Has difficulty breathing”was the third most mentioned by 12.6% of all caretakers.




                                                    41
Indicators for monitoring HIV/AIDS

Indicator                      1990                Source of data   2000               Source of data
Knowledge of preventing        No data available                    National -35.6%    MICS II
HIV/AIDS                                                            Urban - 43.9%
                                                                    Rural - 31.5%
                                                                    Interior - 16.4%
Knowledge of                   No data available                    National -35.3%    MICS II
misconceptions of HIV/AIDS                                          Urban - 46.1%
                                                                    Rural - 28.5%
                                                                    Interior - 13.2%
Knowledge of mother to child   No data available                    National -31.3%    MICS II
transmission of HIV                                                 Urban - 31.6
                                                                    Rural - 33.1
                                                                    Interior - 26.6
Attitude to people with        No data available                    National -49.3%    MICS II
HIV/AIDS                                                            Urban - 59.9%
                                                                    Rural - 41.7%
                                                                    Interior - 30.0%
Women who know where to        No data available                    National -56.1%    MICS II
be tested for HIV                                                   Urban - 66.4%
                                                                    Rural - 51.0%
                                                                    Interior - 32.3%
Women who have been tested     No data available                    National -10.3%    MICS II
for HIV                                                             Urban - 12.0%
                                                                    Rural - 8.7%
                                                                    Interior - 7.6%

Discussion
A 1993 KAP study among school youth (12-20 years) conducted by the National AIDS
Programme (Ministry of Health) reported that 91% knew that HIV can be transmitted by sex;
94% know that HIV can be transmitted vertically; 93.3% knew that HIV is contagious.
Between 1995 and September 2000, 1,100 new HIV cases were registered by the National
AIDS Programme. Most infections occur in the age groups 15- 29 and 30-44 yrs. Gender
distribution of HIV+ cases is 1,285 female and 893 male, indicating that females are more
heavily affected by HIV.




                                                   42

								
To top