Save the Children s Input to the Future Programming in Afghanistan. Save the Children EU Office / Afghanistan August 2012

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1 Save the Children s Input to the Future Programming in Afghanistan Save the Children EU Office / Afghanistan August 2012 Save the Children is the world s leading independent organisation for children. We work in 120 countries. We save children s lives; we fight for their rights; we help them fulfill their potential. We work together, with our partners, to inspire breakthroughs in the way the world treats children and to achieve immediate and lasting change in their lives. We have over two million supporters worldwide and raised 1.6 billion dollars last year to reach more children than ever before, through programmes in health, nutrition, education, protection and child rights, also in times of humanitarian crises. We work with and towards the EU through our representation in Brussels, our member organisations in the Member States, and through our Country Offices internationally. In 2011 we received some EUR 49 million from ECHO, and EUR 12 million from EuropeAId. In total our on-going projects funded by EuropeAid amount to approximately EUR 112 million. A. Introduction The European Union (EU) has started negotiations with the Afghan Government on a new partnership framework, Cooperation Agreement for Partnership and Development (CAPD). The European Commission (EC) has also begun programming for the period of The programming design process is an opportunity to take stock on what has been achieved with EU support in Afghanistan so far, and which sectors need support in the future. Being one of the largest donors in Afghanistan, the EU has considerable advantage in reaching economies of scale in building the public administration system, mechanisms and structures to ensure citizen s access to services. With 57% of Afghanistan s population being under 18 1, more resources need to be made available to basic services that ensure this generation has the opportunity to grow up healthy and well educated. Afghanistan s future economic development and stability is dependent of having a healthy well-educated workforce. Save the Children welcomes the agreement between the EU and Member States to focus EU aid on sectors where the EU can show the best added value in Afghanistan. However, no sector operates in isolation and interventions must be complementary and inter-linked. Improving service delivery in basic social sectors requires efficient social protection mechanisms that ensure access to services. Furthermore, support to basic social services must be enhanced through strengthening of governance and rule of law to ensure that the people of Afghanistan are aware of and able to claim their rights to adequate living standards MDG report: Documents/MDG-2005-vision2020.pdf (accessed September 22, 2011) cited in Save the Children, Afghanistan in Transition: Putting Children at the Heart of Development. (Save the Children: Washington D.C. 2011) 1

2 This paper outlines our key recommendations for the next programming and budget cycle (Multiannual Financial Framework, MFF ) in Afghanistan. B. Building on achievements: Health Currently 18-21% of the EU development assistance is channeled to health and social protection, meeting the EC s global target of 20% allocation of development cooperation to basic health and education. The EU has committed to long-term and sustainable cooperation with Afghanistan, as reinforced by the External Action Service (EEAS) and the European Council in the Council Conclusions on 14 May More specifically, the EU has committed to continued support to social and productive sectors 2. In Tokyo, Commissioner Piebalgs reaffirmed the commitment, stating that the EU will focus on health, education and governance. 3 Health is a sector where the EC has a comparative advantage and expertise in Afghanistan.The EC has been one of three key funders of Basic Package of Health Services (BPHS) 4. Building on the development plans of the government and ensuring sound coordination of action between EU, World Bank and USAID is a good practice model that has shown tangible results. The BPHS, which is based on partnership between donors, the Afghan government and NGOs is considered to be one of the more successful models of service delivery in Afghanistan. One of the main factors behind the success of the BPHS is its community based approach. Some 15,000 community health committees have been formed, and more than 23,000 voluntary community-based health workers recruited and trained. Roughly 50% are women, making health services more accessible for women and girls. Also key to success is that the BPHS is free at the point of delivery (as required by the constitution), and is implemented in districts where 85% of the population live. Because BPHS has a particular focus on mothers and children, antenatal care more than tripled between 2003 and Similarly, the number of births being assisted by a skilled birth attendant more than doubled in the same period. 5 The past decade has seen impressive progress in health indicators thanks in large part to the BPHS. The Afghanistan Mortality Survey 2010 shows that the number of children dying before the age of five has fallen from one in four to one in ten; the maternal mortality rate has fallen from one death in 62 live births to one in 300; and for women, the lifetime risk of dying from pregnancy-related complications has fallen from one in 11 to one in 50. The proportion of children vaccinated against diphtheria, tetanus and whooping cough has increased from 31% to 83%. 6 The 2008 Millennium Development Goal (MDG) Annual Progress Report assessed Afghanistan s status against MDGs 4 and 5 as on track and achievable, respectively. There has been significant progress in the health sector, yet progress needs to be sustained and built upon. Maternal, child and infant mortality statistics remain among the lowest in the world. Nationally, most deaths among children under-five years of age in Afghanistan result from infectious causes, with diarrhoea, acute respiratory infections and vaccine-preventable illnesses accounting for nearly 60% of deaths. 7 While the BPHS is implemented in districts where 85% of the population live, 2 3 Andris Piebalgs, Intervention at the Tokyo Conference. 8 July Speech/12/532 4 The EU supports BPHS in 10 provinces. In these provinces for instance deliveries were assisted and babies vaccinated in European Union, Afghanistan State of Play September Agency Coordinating Body for Afghan Relief, previously cited: remove this citation and make cross-reference. 6 Mark Bailey, 'Afghanistan in Transition: Putting Children at the Heart of Development' (Save the Children, 2011)

3 in reality basic health services are only available to around 60% 8 of the population. There are disparities between urban and rural areas with infant and child mortality rates around 20% higher in rural than in urban areas. 9 Despite a significant decrease in rates of children dying under the age of five, there has been less progress in the rates of children dying in their first month of life. 40% of children under 5 that die, do so in their first month of life. Greater attention must be paid to tackling the causes of newborn deaths. There is a widespread lack of knowledge about referral systems among both community health workers and professional Ministry of Public Health (MoPH) staff; there is a lack of awareness about pregnancy-related health issues; and a critical shortage of skilled health workers, particularly in rural areas. In addition, while there has been significant progress in outcome indicators for health, there has been little progress in addressing and reducing chronic malnutrition in Afghanistan. It is estimated that 2 3% of the national income of a country can be lost to malnutrition 10 and that tackling malnutrition lowers the cost of healthcare well-nourished children and adults are less prone to disease and illness. Stunting affects 59% of children in Afghanistan, the highest rate in the world, and 33% of children are underweight 11. Two-thirds of children are stunted and a third are underweight. Nutrition elements of BPHS are not yet being fully implemented. In its next programming EC support to health should focus on: Expanding the BPHS to reach the most remote and insecure areas. Central to this is the need to build human resources for health, particularly community-based health workers in rural areas. At least 7,000 more community health workers (CHWs) and 3,500 midwives are required to meet the objective of providing community-based healthcare services to 90% of the population by Health workers require continued support, supervision and training including in new areas, such as the provision of community-based newborn care in order to better tackle the causes of newborn mortality. Improving the quality of service delivery, while maintaining progress towards national coverage. Now that the base for service delivery has been built, emphasis should be placed on quality, focusing on outcomes and impact. There should be a continued prioritisation on maternal and child health, with a particular focus on newborns. Tackle malnutrition. Support for the health sector should include: supporting the full implementation of nutrition components of the BPHS, a scaling up of direct nutrition interventions; support for capacity development in the Ministry of Public Health and BPHS implementers with a view to enabling government and BPHS staff to effectively design and execute effective nutrition policies and programs. C. Continued support: social protection For the period of the EC has allocated some EUR 49 million for support to social protection. We believe that maintaining this relatively small amount of funding can bring substantial changes if interventions are well designed. We propose that the EC continues support to social 8 Government of the Islamic Republic of Afghanistan: Strategic plan for the Ministry of Public Health (2011) and Save the Children, Afghanistan in Transition: Putting Children at the Heart of Development World Health Organization (2011) Tuberculosis: 2010/11 global facts 11 WHO World Health Statistics Agency Coordinating Body for Afghan Relief, previously cited: remove this citation and make cross-reference. 3

4 protection as a support action for better results to improve service delivery for health. A Social Protection Strategy is included in the Afghanistan National Development Strategy. Social protection plays a significant role in reducing inequality and discrimination in Afghanistan, and social protection initiatives can be the key to increasing food security and children s nutrition needs. Resources should be allocated to specific schemes reaching children under two, adolescent girls, pregnant women and breastfeeding mothers. In short, the EU could cover social protection by designing following support action to BPHS 13 : Promote access to government programmes, and social assistance mechanisms within them. These may include support to regular and predictable transfers in cash, such as allowances and pensions, combined with employment generation schemes. At the community level initiatives to establish such mechanisms, and secure access to them, should be supported. A particular challenge of the cash transfer schemes thus far has been unpredictability of the schemes, and dependency on short term assistance. Hence, there is a need to ensure that cash transfer schemes are regular and long-term. In addition, specific employment generation schemes could be planned in collaboration with the private sector with a view to secure job opportunities for the poorest and most marginalized. Support to the government of Afghanistan (GIRoA) to establish social insurance systems, including health insurances, and support access to such systems. At the community level, microinsurance systems should be supported. These types of action should also target orphaned children and Internally Displaced Persons (IDPs) as well as returnee populations. Access to basic services and employment opportunities are particularly limited for the latter group, therefore there is a need to develop specific strategies and action targeted to returnees. Focus on strengthening legislation and implementation of laws that protect the individual s rights to protection and welfare. For social protection initiatives there must be targeted action supporting labour standards, protecting employees, combating worst forms of child labour, enforcing minimum pay rates, supporting paid maternity leave and ensuring that health and safety in general standards are met. Support is also needed to creating awareness of the rights to social services. D. A base for change: governance and public sector reform A significant proportion of the current EC assistance to Afghanistan is allocated to governance and rule of law (around 35-40%). The assistance focuses on strengthening the justice system and increasing access to justice through several initiatives targeting provision of legal aid, justice service delivery and awareness raising. Additional resources have also been allocated to public administration reform and capacity building of the government officials. We support continuation of these efforts in the future. We are particularly concerned about the child rights violations in Afghanistan, where access to justice, the rule of law and implementation of the laws continue to be weak. Afghanistan has ratified the UN Convention on the Rights of the Child (UNCRC), and is a party of a number of other international treaties. The statutory laws for children are, however, not adequate to respond to child rights violations, which include wide-spread abuse and denied access to basic services. Moreover, the 13 Child Sensitive Social Protection. A key strategy to combat child poverty. Save the Children Finland

5 justice system is not effectively focusing on prevention of child rights violations. Both aspects are equally important parts of a functioning social sector 14. In general, the government structures and the decision-making processes remain weak and there are legitimate concerns regarding moving greater proportions of funding to the government budget 15, i.e. budget support. More support is needed to ensure that the government is fully capable of running the structures in the future. There is also a serious need to both promote and strengthen community-driven administration and management from budgeting to implementation in all sectors. The EC should ensure targeted support to the following areas: Efficient administration practices, budgeting and financial flows from central administration (Ministries) to Provincial Governors aligned with the broader de-centralisation process. Currently only a tiny fraction of the government s total Operations and Maintenance budget goes outside of the line ministries in Kabul. 16 Far more responsibility for planning, budgeting and monitoring needs to be delegated to the provincial and district levels of line ministries. Furthermore, there is a need to clarify the structure, roles, responsibilities and reporting lines of all layers of subnational governance bodies, particularly from the district level and below, and between elected and appointed offices. Clarifying roles and responsibilities is particularly important in the case of transitioning CDCs to village councils and district councils. Full clarification would require political consensus, policy clarification and legislative processes. This is a major reform process, where the EC could play a major facilitation role. Coordination mechanisms between different Ministries, such as Ministry of Public Health, Ministry of Finance, Ministry of Women s Affairs, Ministry of Education, and other relevant ministries need to be enhanced. In addition, many Afghan technical experts are employed within the MoPH, MRRD and MoE, with their salaries paid from other than public sources. It is essential that the phasing out of this 2 nd civil service is conducted in a cautious, gradual manner and that further efforts are made to ensure they transfer their capacity to colleagues. Awareness raising on children s rights, child protection and children s special needs across sectors; and awareness raising and building of partnerships between the government officials and the civil society in order to build systems for service provision with maximum outreach. There is also a need for capacity building of legal professionals and government officials, especially in Ministries of Health and Justice, and Ministry of Labour, Social Affairs, Martyrs and Disabled in child-friendly approaches and inclusion, women s and children s participation and transparency, in order to set the stage for the future. Plan for the fiscal sustainability of subnational governance structures, clarifying future sources of predictable, annual budgets. Such plan must include measures to fight corruption and promote accountability and transparency mechanisms. Currently the government s own quality control and monitoring mechanisms for both public services and service implementation provided by NGOs vary considerably 17. In addition, the EC should promote systems of minimum pricing in requests for proposals to ensure that lowest bids are not accepted over technical expertise and experience 18.To this end, the EU must promote and ensure regular policy dialogues between the EU, the government and other stakeholders such as the civil society. 14 Child Rights Situation Analysis (CRSA) in Afghanistan Nordic Consulting Group 15 Adam Smith Institute, Education Sector Analysis: Afghanistan 16 World Bank, Transition in Afghanistan: Looking Beyond Interview with MoPh representative, 4 th April, 2012 & MoE representative, 14 th April, NGO representative, MoPH representative, ACBAR, Health and Education in Afghanistan 5

6 E. Horizontal issues; the next programme cycle Maintaining poverty reduction as the overall goal of the development cooperation Development aid should be geared towards one overall goal, poverty reduction as outlined in the European Consensus for Development and Agenda for Change. In recent years the boundaries between humanitarian and military interventions in Afghanistan have been blurred, re-defining the core purpose of development cooperation, and sometimes increasing personal risks of humanitarian and development workers. The EC should tackle the problem efficiently by: Ensuring highest quality of development cooperation that is geared towards poverty reduction, as defined by OECD/DAC; and Promoting such cooperation instead of cooperation based on strategic military objectives, or implemented by the military. Mainstreaming of children s rights across the future cooperation in Afghanistan The Commission s commitment to mainstream children s rights across its work has been well articulated in several policy documents, providing a basis for development of the future programme in Afghanistan. Afghanistan is also obliged to implement the UNCRC, further underscoring the need to fully include children in its development strategies and planning. We also stress the need to adopt and promote human rights based programming in Afghanistan to meet the commitments that the EU has made in promoting and supporting democracy and good governance 19. To this end the next programming should consider: A combination of activities from service delivery to strengthening law and policy, and awareness raising on children s rights of the Afghan population at large. Throughout this paper we provide more detailed recommendations on how children s rights may be mainstreamed in specific action. In addition, we encourage the EC to support awareness raising campaigns and training on children s through both geographic and thematic instruments, such as the European Instrument for Democracy and Human Rights (EIDHR). Aid effectiveness and donor coordination The European Parliament has estimated that as little as 20% of EU aid has reached the Afghan people, arguing that most of this money is not due to the corruption of the Afghan government, but is due to waste, duplication, over-invoicing, excessive and unnecessary expenses for consultancies and security. 20 Moreover, the development interventions by different actors continue to be geographically uneven, and the aid by sector continues to be skewed 21. Afghanistan needs SMART development: it needs to be Afghan-driven, impartial, sustainable, predictable and independent from political priorities. The need for enhanced donor coordination and harmonisation has been stressed at numerous occasions, and the need for mechanisms to secure aligned and simplified mechanisms for donor coordination at political and at implementation level must be further explored. As a concrete example of the current challenges, a lack of capacity in 19 Human rights based programming requires considering the impact of action on the realisation of human rights. In short, rights based programming entails 1) realization of human rights as set forth in the international treaties and national legislation through direct action on rights violations and filling the gaps, 2) ensuring highest standards to deliver these rights; and 3) equip the duty bearers and stakeholders with adequate capacity in delivering these obligations (policy, practice and legislation) Afghanistan in Transition: Putting children at the heart of development. Save the Children

7 ministries to manage the contracting and procurement processes is one factor leading to delays in contracting and releasing payments to the implementing partners. 22 We believe that more results are achieved through enhanced donor coordination. Furthermore, tailor-made aid, making use of several different aid modalities, will increase the impact of EU aid on the lives of the most marginalised parts of the population. Within its programming the EC needs to ensure enough operational flexibility, timely planning, transparency and simplification of procedures. Revision of the EC s financial regulations in the context of the MFF negotiations will be followed by an opportunity to critically assess the current implementation of the Multiannual Indicative Programmes. We urge the EC to: Ensure that the international donor commitments including the commitments made in the recent international conferences translate into practical level coordination between the actors in Afghanistan and outside with a view of ensuring balanced geographic and sectoral support. More efforts are needed for sound coordination from procurement, contracting and reporting to monitoring and evaluation practices 23. Ensure complementarity and consistency (with a view of moving towards joint programming) of the EU and Member State action in Afghanistan. Ensure a careful assessment of the EC s own procedures for enhanced delivery of results. Such an assessment must consider the work flows at large from planning to execution, allowing the beneficiaries to plan ahead in order to ensure quality proposals (especially when launching calls for proposals for civil society actors) for sustainable action. Linking Relief, Rehabilitation and Development (LRRD): programming should be a joint effort with humanitarian actors In the framework of the MFF negotiations the need for specific programmes /instruments to support LRRD is still being debated, but the need for LRRD has been clearly recognised. We stress the need for promoting greater cross-sectoral interventions including health, education, rural development and livelihoods, disaster-risk reduction (DRR), LRRD and climate change, and close collaboration of DEVCO and ECHO in this regard. At a grass roots level the division between humanitarian aid and development cooperation instruments is artificial, and ensuring proper coordination between EEAS, DGs ECHO and DEVCO at the programming level ensures sustainable support to the most vulnerable communities. In order to ensure bridges between humanitarian aid and development funding, support to actions that fall under LRRD should be clearly outlined and supported in the programming. It is also imperative to build resilience in children, reduce their vulnerability and to support child protection systems through LRRD 24. Helping children to understand the root causes of, and the risks and they are exposed to will foster sustainable development and poverty reduction for the longer term. Children and young people have also proven to be an influential force for advocating change and raising public awareness, and should be empowered from being passive victims of the conflict to becoming agents of change for risks. We call on the EC to: Ensure long-term perspectives to all planned action in Afghanistan from humanitarian aid to development cooperation in the next programming. Crisis modifiers, e.g. including 22 Interview with MoE representative 9 th April 2012 & INGO representative 5 th April Interview with MoE representative, 14 th April, 2012 & NGO representative 5 th April Save the Children defines child protection as measures and structures to prevent and respond to abuse, neglect, exploitation and violence affecting children. The goal of child protection is to promote, protect and fulfil children s rights to protection from abuse, neglect, exploitation and violence as expressed in the UNCRC and other human rights, humanitarian and refugee treaties and conventions, as well as in national laws. 7

8 benchmarks to identify warning signs (such as increasing food prices) that enable revising the on-going action should be incorporated in the programme design. Ensure coordination with DG ECHO throughout the programming process in order to build on humanitarian aid action. At the programming level it must be ensured that gaps in supporting the communities are not created due to support ending through one instrument (humanitarian aid), while support was not planned in that specific area through the other (development). The programming process should be guided by the Joint Humanitarian- Development Framework (JHDF), developed by the EC. Support disaster preparedness initiatives in line with the government s social protection strategy. Such initiatives will reduce vulnerabilities and increase the impact of development cooperation. In practice, disaster preparedness could be integrated to support BPHS by ensuring contingency plans for health centres and schools in disaster prone areas. Promoting and Strengthening Democratic Practices: CSO participation The NGOs in Afghanistan play a key role in providing direct services and in capacity building of local partners. NGOs and the civil society at large can be a powerful partner to the government in the rehabilitation and development process. The EU must take a prominent role in promoting CSO participation and in strengthening the capacities of the CSO, and in creating coherence between the CSO actors. There is a need to support the most marginalized groups including children and youth movements. Respect for human rights, reducing inequities, ensuring gender- and childsensitive policies and promoting democratic and participatory processes should be at the heart of all EC support to Afghanistan. In its next programming cycle the EC should Clearly stress the EU s commitment to promote building of a democratic society and empowerment of the civil society; and Commit substantial support to capacity building and strengthening of civil society. F. Modalities for Development Assistance The majority of aid in Afghanistan has been channeled through multi-donor trust funds in the current Financial Perspectives; however, there are clear commitments to on-budget support (50%) in the coming years. In the case of social sectors, as of 2010 the absorption rates for the current development budget of Ministries of Education and Public Health were 50% 25 and 60% 26 respectively. We urge the EC to consider the following: The need for balanced use of thematic and geographic instruments and improved predictability of long-term funding. NGOs are continuously developing service delivery mechanisms with higher impact and outreach, which can be a great asset in finding durable solutions for sustainable development in Afghanistan. Capacity building of line Ministries at national, provincial and district levels, is essential before targets to on-budget support can be met. Increased capacity will also increase efficiency and absorption rates. Moreover, there is a need to put in place a mechanism to conduct assessments of key Ministries before awarding funds, and moving towards budget support gradually. 25 ibid 26 Interview with MoPH representative, 8 th April,

9 We support initiatives that enable Ministries to contract out programme implementation to NGOs, especially in rural areas where government structures are not available. The MoPH s Strategic Plan notes that contracting with NGOs has worked well in Afghanistan and has proven to be a way for the government to rapidly regain and maintain policy leadership, and that contracting has proven to be enormously successful in expanding service coverage and improving on quality of care. 27 Finally, we believe that monitoring and evaluation of the impact of budget support should be enhanced by strengthening general and sectoral indicators in the national plans, including indicators that focus on results for children. Brussels / Kabul August Ministry of Public Health Government of the Islamic Republic of Afghanistan, 'Strategic Plan ' (May 2011). 9

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