230. Under the National Referral Protocol for Victims of Sexual and Gender Based Violence, the Ministry of Health and Sanitation is responsible for the provision of free treatment for child victims of sexual abuse and violence. An initial assessment is provided by the primary care Peripheral Health Units (PHUs) who refer children in need of additional medical care to hospitals with forensic facilities. However, there are a number of districts where free health services are not provided. 231. Despite the fairly well-developed legislative framework governing child protection in Sierra Leone, many children continue to experience abuse, neglect and exploitation, and the resultant demand for child protection services remains largely unmet because of severe financial and human resources, capacity and infrastructure constraints. 232. 32 percent of children receive inadequate care in their early childhood. 82 percent of children aged 2-14 years are subjected to at least one form of psychological or physical punishment. 50 percent of children aged 5-14 are involved in child labour. The persistent problem of early marriage violates child rights and contributes to the high rate of teenage pregnancy (38.1 per cent) with health and socio-economic problems. 16 percent of girls aged 15-19 years are married before 15, and 50 per cent before 18 years. Nine out of ten women (88 percent) have Female Genital Mutilation and Cutting (FGM/C) (Statistics Sierra Leone and UNICEF, 2011) (Statistics Sierra Leone, 2014). Although reliable figures are lacking, indications are very strong that sexual abuse of girls is widespread. 234. High levels of abuse, neglect and exploitation in Sierra Leone are driven by social and economic deprivation of families in Sierra Leone, including chronic poverty and food insecurity which fuel family stress and violence. The existing poverty levels are aggravated by high levels of disease and long-term illness such as HIV and AIDS which leaves children without adequate parental care and protection, reduces family income and diminishes the physical and emotional capacity of parents to care for their children. In addition, resilient abuse-tolerant customary attitudes and practices contribute to wide-spread disregard of governing statutes and responsibilities by many people at a community level. These factors drive the need for protection services. Severe resources and capacity constraints within the MSWGCA’s and other partners and at a local level severely limit the adequacy of the scale and quality of response services for affected children. 235. The MSWGCA’s budget for fulfillment of its responsibilities is low. It has been allocated a recurring 0,8 percent of the overall national budget for the past number of years. Whilst the actual amount allocated has increased in accordance with the increasing size of the national budget; it has not increased as a proportionate share of the budget. The groundwork is however being laid for increased investments in child protection given the prioritization of child protection as a developmental priority within the Agenda for Prosperity and concomitant commitments to ensure sufficient public funds to realize the plans priority objectives and outcomes. 236. The MSWGCA is working to improve capacity at a local level, and is in the process (as previously described in Part 2 on General Measures of Implementation) of developing a national training institute for the child protection sector as well as the development of curricula for the standardised improvement of capacity of all social workers. 6. Family Environment and Alternative Care  63