DRAFT – 08-10-2010PD-HATIS
Programme Lessons from Tsunami Evaluations 2009 – Country and Thematic Syntheses
Table of Contents
PROGRAMMES
WASH
Partnerships
Sector Coordination
Programme/Strategy
Recovery/Transition
Planning
Communication for Development
NCD
HEALTH
National Capacity Development
Recovery and Transition
CHILD PROTECTION
Programming/Strategy
Needs Assessment/FTR
Information Management
National Capacity Development
EDUCATION
Decentralization
Recovery Programming/Strategy
CFS
Context/Programme Adaptation
“Building Back Better”
CONFLICT AND POST-CONFLICT ENVIRONMENTS
Natural Disaster
PROGRAMMES
WASH
Partnerships
Partnering with the housing sector can be critical for in providing and improving household sanitation.During UNICEF’s response in Indonesia and Sri Lanka, the housing sector the most significant driver of change, in improving household access to improved sanitation, especially in areas with high ownership of toilets. UNICEF contributed to these achievements by directly building facilities, and more importantly, providing the housing sector with guidelines and standards, and advocating for houses to be built with sanitation facilities. In partnership, improved sanitation was achieved for many households. (UNICEF, 2009, Indonesia, p.19, p.25; UNICEF, 2009, Sri Lanka, p.24)
For complex construction projects, it is important to engage with experienced partners and have clear roles and responsibilities. Arising from the Maldives tsunami response was the lesson that for complex construction projects, it is important to engage with experienced partners and have clear roles and responsibilities. This is especially the case for sanitation systems; in this developmental intervention the key partners are those who use, monitor, regulate and sustain the facility – the community and government. In addition, the actual construction would normally, in a developmental context, be undertaken with a contractor and an engineering consultancy firm. The choice of UNOPS playing all these roles in countries where internal capacity does not exist was fraught with problems. Future choice of partners needs careful consideration. (UNICEF, 2009, Maldives – WASH, p.47)
Sector Coordination
The role of sector coordinator provides an opportunity to address systemic challenges, especially when aligned with government structures.Following the tsunami in Indonesia, UNICEF played a significant role as sector coordinator in both providing government with key information, as well as being a platform to solve problems and identify gaps. UNICEF aided in the setting of standards, coordination and establishing guidelines for the WASH sector and its working groups, including for the housing sector. The establishment of the nationally supported WASH Task Forces at the provincial and district levels was facilitated by UNICEF to help ensure effective coordination among relevant government departments. UNICEF also supported BRR (government rehabilitation and reconstruction agency) and BAPPEDA (planning board) to monitor water and sanitation in both temporary living shelters and new housing developments. UNICEF also chose to have a wide geographic spread in its response, reducing the inequalities between easily accessible populations and more remote communities. These actions, undertaken alongside government agencies, have driven further government effort to address systemic weakness in the WASH sector. (UNICEF, 2009, Indonesia, p.19, p.22, p.27)
It can be more important for UNICEF as sector/cluster coordinator to identify and address gaps during (heavily funded) emergencies than direct interventions, especially where partners have large funds. In Indonesia and Maldives following the tsunami, there was an armada of heavily funded NGOs and agencies that were active in the WASH sector. As the lead agency, UNICEF was able to effectively identify and prioritise needs and influence major actors through its coordination meetings and discussions with NGOs and the government. UNICEF had the potential to have a greater impact on the sector by investing in sector leadership rather than in funding partners Opportunities exist to use this role in similar emergencies to support and assist implementing agencies in programmes and retain funds to address longer-term challenges. (UNICEF, 2009, Indonesia, p.22; UNICEF, 2009, Indonesia - WASH, p.58; UNICEF, 2009, Maldives - WASH, p.48)
Programme/Strategy
There is a need for more appropriate balance between capacity building and investments in infrastructure, as well as careful planning to ensure that WASH systems are suitable.During the tsunami response in Maldives, UNICEF’s choice to invest in capital-intensive programming was not balanced with appropriate national capacity development. Water supply systems were over-resourced, and there was heavy investment in infrastructure without the necessary analysis and planning prior to response activity – for example there was little evidence that actors understood the limitations of small islands to sustain even non-potable groundwater supply. The need for government and community capacity building, as well as long-term sustainability, was overlooked and under-resourced. This lack of capacity within the Maldives reduced UNICEF’s capacity to lead the sector, resulting in missed opportunities in the sector and sub-optimal implementation strategies.(UNICEF, 2009, Maldives, p.28)
There is a need to better leverage large-scale investments in infrastructure. In Sri Lanka, following the tsunami, although large investments in equipment and infrastructure would normally have been funded by the World Bank, and included detailed Bank-led assessments, socioeconomic analysis, stakeholder involvement and planning, it was the WASH sector and UNICEF which invested in large-scale water treatment and distribution infrastructure. Sustainability and acceptance of these investments are well ensured as the infrastructure is part of an evolved developmental framework. However, opportunities existed to leverage these investments for disparity reduction, and a greater alignment with developmental actors such as the Water Sanitation Programme (WSP) and World Bank could have increased the impact of these investments. Similarly, if UNICEF invests at the end-user side of the distribution mechanisms, it can gain more leverage to address issues. (UNICEF, 2009, Sri Lanka, p.26)
Where there are significant investments in WASH facilities in schools, dedicated budgets are necessary to sustain and maintain them. In Indonesia, UNICEF made a large investment in building schools and providing WASH facilities, but only about one quarter of schools allocated a budget to maintaining sanitation facilities. Children were found to bring their own water, and did not make full use of the facilities. There was a need at provincial and district levels for systems to ensure the management and sustainability of existing WASH facilities in schools, including clarity on budget responsibilities. (UNICEF, 2009, Indonesia, p.77; UNICEF, 2009, Sri Lanka, p.23)
UNICEF spread the programme too thinly both geographically and programmatically. This led to a challenges in terms of quality control, transitioning and bring key aspects of the programme to scale. UNICEF spread the programme too thinly and had problems going to scale on key activities. In addition, this led to challenges in providing oversight and quality control. The programme was active in all sub-sectors, which required higher calibre staff to provide quality assurance. Transitioning the programme or bringing key initiatives to scale is more difficult in a complex and diverse programme. The evaluation notes that real or perceived pressure to spend and commit funds early drove many decisions. In addition, available staff and partner capacity limited programmatic choices. (UNICEF, 2009, Indonesia – WASH,p.57)
Recovery/Transition
Lack of analysis for and investmentin transitional programmes can diminish opportunity. Following the tsunami in Indonesia, Maldives and Sri Lanka, UNICEF did not invest enough in planning and programme design based on appropriate levels of analysisand field teams did not have the time and space to lead a programme development process during emergencies and early recovery. In Sri Lanka, in part due to movements of people to camps the sector and UNICEF lost key opportunities for change in groundwater quality improvement, options for treatment of effluent, household water treatment, establishment of improved hand washing technology in new houses, water tariffs and WASH in schools.
The lesson is that UNICEF needs to provide considerable sustained support to both planning a transition programme, analytical development-framed decision-making and providing change management support. UNICEF should use a sustainable development process and timeframe to ensure impact and invest in planning and assessment. Rather than the emphasis being on scaling up the initial response UNICEF must enhance the sector’s leadership role in providing a basis for and supporting transitional programming. If UNICEF does not envision a sustainable development impact, then emphasis should be placed on exit strategies. (UNICEF, 2009, Indonesia, p.81; UNICEF, 2009, Sri Lanka, p.21-22; UNICEF, 2009, Sri Lanka - WASH, p.38; UNICEF, 2009, Maldives – WASH, p.52)
Transitioning is most effective when aligned with existing developmental initiatives and systems and the developmental framework to manage and sustain these systems already exists. In Maldives, UNICEF promoted and accelerated the pre-existing and functioning strategy of household and community rainwater harvesting systems to near complete coverage. The acceptance and competence of households and communities to manage these investments is high because UNICEF undertook interventions within a pre-existing developmental framework. As a result, transitioning the programme from replacing destroyed rainwater harvesting units to increasing the national harvesting capacity was a natural progression. The sanitation programme highlights a contrasting situation: UNICEF built four of the thirty new atoll sanitation systems, demanding a change from household managed sanitation to communal. The developmental framework to manage and sustain these systems does not exist. The programme was based upon clear needs and agreements from the government but the systems built were not based upon previous evidence and learning, which included the failure of all previous attempts at communal sanitation systems. (UNICEF, 2009, Maldives, p.36-7)
Planning
Pressure to act and spend can detract from planning and the development of effective programming; allowing projects to develop in an appropriate (developmental) framework and timeframe can be effective.During the tsunami response in Indonesia, UNICEF managed and conceived the programme on a project-by-project basis. This resulted in a lack of focus and did not allow essential components of the programme to be brought to their appropriate scale. Important information from surveys and studies, as well as good example projects like the CLTS, had high impact in a small area. UNICEF was able to concentrate on direct, output level interventions although it was not able to direct its focus on effective and sustainable solutions. For capacity to increase, to go to scale and have a sustained impact, comprehensive programmes need to be undertaken. For example, UNICEF provided a shortened course in PHAST to a relatively small number of sanitarians. This had a limited impact, as opposed to building government capacity to improve participatory methodology within their system through a training-of-trainers programme. (UNICEF, 2009, Indonesia - WASH, p.55, p.59)
Communication for Development
It is critical to provide timely and appropriate hygiene messages linked with the provision of sufficient sanitation facilities and materials.During the tsunami response in Indonesia, practices relating to the messages all showed negative trends for specific reasons. The number of households boiling water was lower after the tsunami than before. The messages were appropriate. However, to be effective promoters needed to link them with water testing and to raise awareness that refill water contained contaminants and needed treatment. Similarly, hand washing practices in the IDP situation were more dependent on the availability and convenient location of water and soap. Anecdotes indicate that practices relating to hand washing showed a negative trend. These indications also link hand washing practices to the convenient availability of hand washing technology, especially the availability of water and soap in appropriate places like latrines and places of food preparation and consumption. (UNICEF, 2009, Indonesia - WASH, p.32)
NCD
Beware response activities undermining government and community systems, including voluntary community work.Responses to the tsunami and strategies employed by some NGOs have undermined some government and community systems. This manifested itself in tsunami areas where transient NGOs are now the main trusted source of hygiene information, replacing the role traditionally held by local health centres and workers. In the same vein, although UNICEF supported government and community systems, like most other actors in this complex environment, its strategies have undermined the pre-existing systems of voluntary community work that are often employed in the maintenance of water supply systems and solid waste management. These strategies did not well engage or utilize this community spirit, and this may have a negative impact on long-term development. (UNICEF, 2009, Indonesia - WASH, p.58)
HEALTH
National Capacity Development
Building national capacity, through strengthening planning and management ability, is critical, alongside engaging in programmatic activity.Especially in the recovery stage of UNICEF’s tsunami response international staff were very engaged in programmatic activity; this preoccupation precluded more effective and extensive attention to capacity development in the health sector. In addition, there were also limitations imposed by system weaknesses. In retrospect, it is clear that ambitious program goals could not be achieved due to these limitations, and a revised strategy that focused increasingly on capacity development for management of the health system and policy advocacy with provincial and district authorities would have been necessary to more adequately utilize the opportunities presented under reconstruction. Strengthening national and district medium- and longer-term planning skills would have assisted to further advance programmes and integrate them into normal country programmes when tsunami-related funding was to end. In addition, developing health information systems, setting better provincial health policies, or training for management and supervision of the health system were essential needs. Focusing on capacity development as well as programming is critical to realising desired increases in coverage and effectiveness and strengthening future capacity.(UNICEF, 2009, Maldives Synthesis, p.51; UNICEF, 2009, Indonesia Synthesis, p.58-59; UNICEF, 2009, Indonesia Health and Nutrition, p.38)
Recruiting expatriate professionals can fill a short-term gap, but it is critical for health system strengthening and sustainability to invest in technical capacity development.During UNICEF’s tsunami response in Maldives, in both the government and private sector, the gap between emerging requirements and the availability of skilled manpower was filled by recruiting expatriate health professionals and there was a lack of investment in building the technical capacity within the health system. This increased costs to the health system, which also caused frustration that Maldivian health workers, trained for community health promotion, were not able to practice in their health system. While it would have been possible to fill many positions with an increased training of Maldivian personnel, it was easier, with limited training and management capacity in the health system, to hire foreign workers. In Sri Lanka, too, despite a demonstrated high level of capacity among national staff and institutions in responding to the tsunami, NGOs and agencies frequently flew in far more costly and less experienced volunteers from Europe and the US who did not speak local languages. (UNICEF, 2009, Maldives Synthesis, p.53; UNICEF, 2009, Sri Lanka Synthesis, p.55)
This short-term strategy, while effective for filling response needs is now problematic for the health system, with rising costs and consumer expectations. It is therefore important to address the pressing demand for trained health care workers.This implies appropriate development and management of human resources for health occupations, as well as improved in-country training facilities. UNICEF has an opportunity, with its historical role as promoter of primary care and community participation, to help countries develop a health strategy that more fully utilises its own main development resource, its largely female health workforce, and training cadre. (UNICEF, 2009, Maldives Synthesis, p.53; UNICEF, 2009, Indonesia Synthesis, p.92
Health training should be focused on contextual needs and key epidemiologic priorities for the country, looking at both short and long term requirements.During UNICEF’s tsunami response, health training was at times lacking in focus, and undirected by the epidemiologic needs evident in the country. In Sri Lanka, in-service training activities were too often carried out without strategic consideration for the key programmatic needs in local areas. These trainings needed to be prioritised on the basis of the evolving epidemiologic conditions and programmatic needs of the country. (UNICEF, 2009, Sri Lanka Synthesis, p. 54, P.78)
In Indonesia, the relevance of programmatic focus on the training of health workers outside of epidemiologic monitoring for long-term recovery was poor. An example related to maternal death reports from health centers: these showed that 60% of deaths occurred prior to reaching health facilities. Two important delays were found to exist: seeking care from a midwife in the case of a perceived obstetric emergency, and being moved to a hospital for definitive care in the case of a true emergency. Improved coverage, improved transport, and quality of care could potentially reduce mortality by half. These epidemiologic data should drive the health system. Yet the training and coordination of midwifery and surgical services are not among the topics of major focus in training or supervision in the health system. More coherence in planning would have involved interim capacity development activities for health systems leaders, more investment in supervision and management, and the use of a small number of key indicators for administrative management rather than the design of comprehensive systems. (UNICEF, 2009, Indonesia Synthesis, p.57; UNICEF, 2009, Indonesia Health and Nutrition, p.23)