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MDGF-1920: Strengthening equity in access to safe drinking water and sanitation by empowering citizens and excluded indigenous groups in rural areas [rd 2]

PLEASE NOTE THIS CONCEPT NOTE IS THE ORIGINAL SUBMISSION TO THE FUND. IN MANY CASES INDICATIVE BUDGET AMOUNTS APPROVED BY THE STEERING COMMITTEE ARE CONSIDERABLY LOWER THAN THAT REQUESTED AND INDICATED HERE-IN. FINAL BUDGET AMOUNTS WILL ONLY BE AVAILABLE AFTER APPROVAL OF THE FINALIZED DETAILED JOINT PROGRAMME DOCUMENT.
Thu, 2008/01/31 - 10:00am — mariaeugenia.mu...
Tue, 2008/02/05 - 1:46pm
Mon, 2008/02/25 - 1:17pm
mariaeugenia.mujica@undp.org
English  (current), Spanish 

ID: MDGF-1920

Democratic Economic Governance
Round 2
(10/12/2007 - 31/12/2009)
Panama
$7,504,531
36 Months
Strengthening equity in access to safe drinking water and sanitation by empowering citizens and excluded indigenous groups in rural areas [rd 2]

Attached Documents:

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A. Applicant Information

Latin America and the Caribbean
  • Upper Middle Income Country
  • High HDI, according to UNDP's 2006 Human Development Report
  • Jose Eguren
  • jose.eguren@undp.org
  • Maria Eugenia Mujica
  • mariaeugenia.mujica@un.org.pa
  • Guadalupe Verdejo
  • WHO - World Health Organization
  • Representante
  • verdejog@pan.ops-oms.org
  • María Eugenia Mujica
  • UNDP - United Nations Development Programme
  • Especialista de Coordinación - Oficina del Coordinador Residente
  • mariaeugenia.mujica@undp.org
  • UNDP - United Nations Development Programme ($845,300)
  • UNICEF - United Nations Children's Fund ($1,945,260)
  • WHO - World Health Organization ($3,200,991)
  • ILO - International Labour Organization ($1,512,980)
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B. Concept Note

Ninety-one per cent of the indigenous population of the Ngöbe-Buglé Region suffers from extreme poverty. Their dispersion, mobility and location in remote and inaccessible areas raise the cost of traditional sanitation solutions, making investment and private participation difficult to justify on economic grounds. The joint programme draws on an effective intercultural and gender-based approach to promote equity by developing water resource management capacities and extending development opportunities in health and education for the populations and their community organisations in the four districts of the Ngöbe-Buglé Region. In addition national counterpart organisations will enhance both their central and local institutional capacities to provide efficient basic services to communities suffering from extreme poverty. The result will reduce the human development gap by translating the empowerment of the population into an improvement in the quality of and access to public water and sanitation services.

Although social expenditure in Panama is relatively high (equivalent to 18% of GDP and 35% of public expenditure in 2004), there are large disparities in terms of access to improved safe water, basic sanitation and solid waste management services (MDG 7: targets 10 and 11). The various economic and social indicators demonstrate that the poorest and most excluded sectors of the population are indigenous groups, that represent 10% of the country’s population and occupy 20% of the national territory. The National HR Report 2002 indicates that the indigenous population of Panama suffers from “massive deep-rooted” poverty, according to the government, and “colossal” poverty, according to the World Bank. The National Census of 2000 indicates that, while the national figure for those lacking basic sanitation services is 6.8%, the three largest indigenous regions (Emberá-Wounáan, Kuna Yala and Ngöbe-Buglé) have rates of between 57.1% and 92%. Of the five legally recognised indigenous regions, the Ngöbe-Buglé Region has the largest population and also has the lowest human development rates of the entire country: 91.5% of its inhabitants suffer from extreme poverty, 69.97% do not have drinking water, and 73.41% do not have sanitation services. The districts of Müna, Kankintpu, Besiko and Kusapín of the Ngöbe-Buglé Region have been selected for the interventions of this joint programme. Annex C contains two tables summarising the sanitation and safe water services currently available, and provides other socio-economic data about the population of 79,534 inhabitants in the four selected districts. A total of 40,721 women live in the four programme districts. The Ministry of Health (MINSA) is the lead body and is responsible for ensuring the right to health through the network for public drinking water and sanitation services. The MINSA has legal responsibility for drinking water and sanitation in rural areas with populations of less than 1,500 inhabitants, while the Institute for National Water Channels and Drains (IDAAN) serves larger settlements and urban areas. However, in the indigenous regions of the country, the MINSA operates under a set of special legal provisions. It is difficult to obtain external funding for projects in these areas due to the high per capita cost of investing in isolated areas. According to government sources, the absence of expressions of need and the lack of acknowledgement of the sanitation problem by indigenous populations have contributed to focus national investment on other needs and on other areas of the country. In communities with basic sanitation services, MINSA has promoted the establishment of Administrative Councils for Rural Water Channels (JAAR). These are officially constituted community bodies which aim to ensure the sustainability of these services. Some JAARs have been unable to fulfil their functions due to the lack of financial resources and, above all, lack of training. Likewise, the inhabitants of some communities lack skills or do not actively participate in decision-making. It is for this reason that this programme proposes integrating the JAARs into regional associations to strengthen them and create synergies. The unequal access of the Ngöbe and Buglé peoples to basic public water and environmental sanitation services reflects resource scarcity, MINSA’s ; institutional weakness which diminishes its capacity to attend geographically isolated, dispersed and migrant populations; and economic, social and cultural characteristics of these indigenous groups. These factors have caused their current marginalisation and exclusion. The resultant deficiencies expose the indigenous populations of the Ngöbe-Buglé Region to serious diseases and health problems, such as tuberculosis, intestinal infections, diarrhoea, whooping cough, infectious diseases and parasites, malnutrition and increased transmission of dengue and other vectors. It should be noted that in this region the three leading causes of death as a result of transmittable diseases are infectious intestinal diseases (21.2 per 100,000 inhabitants), acute respiratory infections (20.4 per 100,000) and tuberculosis (17.2 per 100,000). Despite government efforts to improve health indicators, the Region has high mortality rates in children under 5 years of age (55%) and infants (27.9%) and morbidity associated with unequal access to water and sanitation. Official sources partially attribute these rates to indigenous culture and customs: 69% of the population deposit excrement in rivers and streams; 65% do not have sewers or latrines and make little use of latrines; and 94% give no treatment to water for human consumption. Alternative methods used for disposal of excrement include the use of land or hillsides (50.0%) or of rivers, streams and the sea (42.1%). 46% of households have a kitchen which is separate from the house; and food is cooked in the sleeping area or other part inside the dwelling in 48% of homes. Local governments and communities have participated in planning, constructing, operating and maintaining the existing water and sanitation services. This joint programme will strengthen government efforts to achieve MDG 7 - Target 10 – Indicators 30 and 31, focusing on raising awareness and capacity building of the population and JAAR administrators on issues related to the need to increase the access to and quality of water for human consumption. The existing sanitation will be maintained and improved by the provision of latrine systems with equipment for removing and treating waste water and disposing of solid waste; an inventory of the existing water and sanitation services will be performed, projected requirements will be identified and these will feed into municipal investment plans. The programme will also seek to prevent contamination endangering water sources and undermining the already precarious health of the populations, through complementary actions such as monitoring water sources and community sanitation. Equity will be promoted, and other values essential to democratic economic governance will be strengthened, such as transparency, accountability and supervision by citizens, with an emphasis on the contributions which can result from the participation of indigenous women. With this objective, the capacities of the governmental institutions directly or directly involved in the process of improving the efficiency of the water and sanitation services will be strengthened within the context of local and community-based development. Given the legal status of the Ngöbe and Buglé Region and the particular nature of its peoples, interventions will be made in coordination with and with the participation of its General Congress and local congresses, giving special consideration to the means required so that the population may participate fully in these consultations, including interpretation into their languages and the appropriate teaching material. This programme is consistent with UNDAF cooperation areas 2 (Basic social guarantees for the fulfilment of human rights) and 3 (Modernization of the state and public sector reform) and with government priorities included in three of the five pillars of the 2005-2009 Government Plan, as follows: poverty reduction and integration of marginalised social groups and indigenous communities into national development by providing them with basic services; creation of Strategic Health Plan to improve coverage and quality of services in rural and indigenous areas; and State reform and modernisation so that it becomes a body which facilitates development, aimed at serving the community. Documented gaps related to access to sanitation services suffered by rural and indigenous populations highlight the need to attend to these national priorities with equity and gender perspectives. In this sense, the joint programme seeks to enhance the capacity of state institutions to increase access to high quality public services at accessible prices (direct subsidies initially and shared costs thereafter) and with sustainable strategies, and also to enhance the capacities of the communities themselves. This will enable specialized and technical staff to work more effectively with the communities while these, in turn, will be aware of the issues and able to monitor the quality of the services being provided to them. Note: The government is undertaking public works which complement the investments to be implemented under this programme.

The aim of the joint programme is to improve the health of the indigenous inhabitants of the four districts of the Ngöbe-Buglé Region selected, by empowering the beneficiary population in order to extend the coverage of and access to water and sanitation services, and strengthening the sustainability of water resources through local and institutional actions. The beneficiary population will be empowered via the elaboration of rapid and participatory diagnoses to identify their needs, training of the population and the JAARs to sustain the services and protect water sources, and the strengthening and visibilization of the role of women. This is due to the fact that experiences of pilot projects in indigenous areas show that indigenous women participate actively in monitoring water quality and in sanitation activities. The joint programme will have the following outputs: Output 1.1 Indigenous populations trained in the management of water resources and health education with an inter-cultural focus to improve their living conditions. Output 1.2 Increased ability of community organisations, such as the Rural Water Channel Administrative Councils (JAAR), to efficiently manage, operate and maintain water and sanitation services. Output 1.3 JAARs able to plan and prioritise investments on a participatory basis for the sustainability of their own organisations, in the context of sustainable development. The institutional capacities of the MINSA and of local governments to promote the sustainability of water resources will be strengthened through relevant training that will result in them being able to formulate participatory municipal investment plans, execute works, and establish a monitoring and evaluation system to monitor health and environmental indicators to ensure implementation of the programme activities and their sustainability. This gives rise to the following outputs: Output 2.1: Participatory municipal investment plans formulated and enacted which ensure coverage of safe water and basic sanitation in the four programme districts, in the context of an increase in population and/or in demand for services. Output 2.2: Water and sanitation works developed and accepted by the communities, including sanitary landfills that utilize using technologies appropriate to the physical and sociocultural conditions of the districts. Note: The government is undertaking works which complement the investments to be implemented under this programme.

Participating UN Agencies will be coordinated by the UN Resident Coordinator Office, while the Ministry for the Economy and Finance (MEF) will facilitate coordination of government counterparts. The Ministry of Health (MINSA) has been identified as the implementing body. The National Environmental Authority (ANAM) will participate in monitoring activities and those related to the conservation of river basins and natural resources. The programme will coordinate with the Ministry of Education (MEDUCA) in order to ensure that students and teachers at schools located in the intervention areas participate in awareness-raising campaigns about the issues involved. The training component will respect intercultural issues and promote gender equality. The population will benefit as a result of improved citizens’ participation skills and will acquire knowledge which will allow then to adapt this to their cultural situations. Public officials will receive training which will strengthen their planning skills and help them to ensure that interventions are better focused. In this way, the programme will achieve synergies and will build on existing resources, such as schools and local staff with knowledge of indigenous languages. The main indicative activities and their relation to the products and outcomes identified are described below. Output 1.1 Indigenous populations trained in management of water resources and health education with an inter-cultural focus to improve their living conditions. Activity 1.1.1 On-site training workshops for households on the importance and management of drinking water, sanitation and disposal of solid waste in the four districts selected, with multicultural and gender perspective (PAHO/WHO, ILO, UNICEF). Output 1.2 Increased ability of community organisations, such as the Rural Water Channel Administrative Councils (JAAR), to efficiently manage, operate and maintain water and sanitation services. Activity 1.2.1 Training workshops for community organisations, such as the Rural Water Channel Administrative Councils (JAAR), using participatory tools such as Integrated Rural Accessibility Planning (IRAP) to deliver the participatory prioritisation of interventions in the water and sanitation sector. (PAHO/WHO, ILO, UNICEF) Activity 1.2.2 Adaptation of teaching methodology by updating and/or producing multilingual manuals and information material regarding health education and water and sanitation management (PAHO/WHO, UNDP, ILO). Output 1.3 JAARs able to plan and prioritise investments on a participatory basis for the sustainability of their own organisations, in the context of sustainable development. Activity 1.3.1 Training workshops for JAARs on participatory planning and decision-making processes for resource generation as a result of sustainable productive activities (PAHO/WHO, ILO, UNDP). Output 2.1: Participatory development of municipal investment plans which ensure coverage of safe water and basic sanitation in the four programme districts, in the context of an increase in population and/or in demand for services. Activity 2.1.1 Completion of rapid participatory diagnoses of the water, sanitation and solid waste management situations in the programme districts (UNICEF, PAHO/WHO). Activity 2.1.2 Completion of participatory municipal plans for the development of water, sanitation and solid waste disposal infrastructure, by district (PAHO/WHO, UNICEF, ILO). Output 2.2: Water and sanitation works developed and accepted by the communities, including sanitary landfills using appropriate technologies to the physical and sociocultural conditions of the districts. Activity 2.2.1 Water and sanitation infrastructure development–via local governments and traditional authorities—including aqueducts and sanitary landfills, that utilize local technologies and are accepted by the communities in the districts of Müna, Kankintú, Besiko and Kusapín, located in the Ngöbe-Buglé Region (PAHO/WHO, UNDP). Activity 2.2.2 Formulation of mechanisms to facilitate community participation in water and sanitation infrastructure development (PAHO/WHO, UNDP). Activity 2.2.3 Creation of a community programme for monitoring and protection of water sources, with gender and youth perspectives (PAHO/WHO, UNICEF, UNDP). Activity 2.2.4 Technical training of MINSA staff and local authorities to effectively accompany communities in the management, oversight, monitoring and evaluation of the water and sanitation infrastructure (UNDP, PAHO/WHO). This Concept Note is the result of a genuine joint effort of Participating UN Agencies and government counterparts. PAHO/WHO was the Lead Agency and the Minister of Economy and Finance (especially the Directorate for International Cooperation) coordinated government counterparts. Documents and sources consulted include statistics produced by the General Comptroller’s Office; “Strategic Vision of Economic Development and Employment 2005-2009” produced by the Government as it main public policy document; NHDR 2002; Common Country Assessment 2005; and UNDAF 2007-2011. The experience of the Spanish Agency for International Cooperation (AECI) in Panama was also reviewed, as was the recently approved Environmental Window draft joint programme document submitted to the MDG-F.. Initially, the Participating UN Agencies and the Government worked on the elements of the proposal individually (i.e. UN on one side, Government on the other). Three joint technical meetings were then held to agree on the scope of the programme and the expected results. Finally, a team composed of a consultant hired by the UN, 1 representative from Participating UN Agencies, and 3 representatives from the Government was appointed to produce the final document. In order to ensure the sustainability of results in a unique cultural context, the joint programme must stress the adequate and sufficient transfer of knowledge and the need for indigenous inhabitants and their traditional authorities to take ownership of the issue of water and sanitation. The clearest risk, then, is that the beneficiaries may not accept typically western themes and approaches, leading to resistance to change or indifference. This can be reduced by ensuring the careful selection and effective implementation of the participatory methodologies and training used. Furthermore, the execution of the programme in phases will mean that valuable time is available to help promote the acceptance and assimilation of the programme on the basis of the evidence of pilot experiences. Another possible risk is that there may be a change in the strategic interest of the government after the election of a new administration in the next 20 months. This risk may be reduced by organising the programme activities in such a way that these are already being executed and benefit from the participation of the UN to ensure continuity during the transition period.

In order to carry out adequate monitoring and evaluation of the joint programme, it is necessary to produce a baseline of affected areas , including demographic and economic determinants, frequency of waterborne diseases, and population and nutritional data. This will be complemented by conducting knowledge, attitudes and practices (KAP) surveys around the issues of water, personal hygiene and the handling of solid waste which will provide more precise data with which to set the scope of the interventions. The use of an intercultural approach in indigenous regions will enable understanding of the world view, habits and customs of the indigenous populations regarding water and sanitation issues, permitting the implementation of new effective and efficient strategies to meet the requirements of the beneficiary communities. By using the information derived from the analysis and regular measurement, it will be possible to monitor and evaluate the impact of the programme. The agencies and their government counterparts will meet at least once a year to review progress of the programme. The performance indicators are as follows: Output 1.1 Indigenous populations trained in management of water resources and health education with an inter-cultural focus to improve their living conditions. 1.1.1 At least 80% of the inhabitants of the programme districts participate in the management of water and sanitation services. 1.1.2 At least 80% of the inhabitants of the programme districts are aware of and trained in water management and health-sanitation education . 1.1.3 Training of trainers on water management and health-sanitation education:15 workshops for government trainers and 15 workshops for trainers drawn from the communities. 1.1.4 25,000 popular education manuals, posters and other audiovisual materials distributed per district. Output 1.2 Increased ability of community organisations, such as the Rural Water Channel Administrative Councils (JAAR), to efficiently manage, operate and maintain water and sanitation services. 1.2.1 At least 85% of JAARs trained in basic water and sanitation management. 1.2.2 40 workshops for JAARs on legal, administrative and operational issues, as well as maintenance of aqueducts (800 participants). 1.2.3 1,000 manuals distributed per district on administration and maintenance of rural aqueducts. Output 1.3 JAARs able to plan and prioritise investments on a participatory basis for the sustainability of their own organisations, in the context of sustainable development. 1.3.1 100% of JAARs trained in delivering additional benefits in the management of basic water and sanitation. Output 2.1: Participatory development of municipal investment plans which ensure coverage of safe water and basic sanitation in the four programme districts, in the context of an increase in population and/or in demand for services. 2.1.1 All aqueducts and sanitation infrastructure in the programme districts are well maintained and operating efficiently by 2010. 2.1.2 Four documents encompassing Investment Plans (one per district) have been published by 2010. 2.1.3 80% of relevant MINSA staff and and municipal and regional authorities trained to implement investment plans. Output 2.2: Water and sanitation works developed and accepted by the communities, including sanitary landfills that utilize technologies appropriate to the physical and sociocultural conditions of the districts. 2.2.1 At least 100 aqueducts built or improved in the four programme districts. 2.2.2 At least 9,300 sanitation solutions built or improved in the programme communities. 2.2.3 At least 1,000 solutions for the handling of solid waste built in the programme communities, including at least four sites for sanitary landfills (The concept “solution” refers equally to dispersed dwellings with individual solutions and to groups of dwellings with communal solutions.) 2.2.4 A community programme for monitoring and protecting water sources, with gender and youth perspectives. 2.2.5 At least five technical training workshops for MINSA staff and local authorities to accompany the communities in the management, supervision, monitoring and evaluation of the programme (UNDP, PAHO/WHO).

Participating UN Agencies are the following: Pan-American Health Organization/World Health Organization (PAHO/WHO). In Panama, PAHO/WHO manages various regional and sub-regional technical assistance programmes. It has specialized experience and knowledge in public health, including programmes to promote specific sanitation actions and access to drinking water; programmes to prevent and control transmittable diseases (malaria, dengue, influenza); and projects such as that demonstrating sustainable alternatives for the integrated control of malaria in Mexico and Central America (GEF). It includes the Pan American Center for Sanitary Engineering and Environmental Sciences (CEPIS) and the Basic Sanitation Unit of the Sustainable Development and Environmental Health Area (SDE). CEPIS is dedicated to specialized technical assistance on basic environmental sanitation. Its work focuses on strengthening countries’ capacities by providing methodologies and technologies for handling environmental risks to health, with an emphasis on the management of specialised information, strengthening sanitary legislation and regulation, and the management of direct interventions. United Nations Development Programme (UNDP): Two of the four central areas of UNDP are the eradication of poverty and the promotion of democratic governance. These issues provide the framework for UNDP’s contribution in this area, which is based on previous experience of organising and training JAARs and in creating specialized educational material targeted at population with low levels of formal education (e.g. popular manuals). In addition, UNDP has been contributing to the development of local governance by promoting decentralisation and strengthening local capacities, both at the local government and community level. Within this context, it has acquired important experience in areas which suffer from poverty, such as Darién, Bocas del Toro, Veraguas and Chiriquí, and this will provide the basis of its contribution to this project. The United Nations Children’s Fund (UNICEF): UNICEF Panama Office supported local authorities and the MINSA in developing the Municipal Water and Environmental Sanitation Plans in the Chiriquí region of the Ngobe-Buglé comarca, during between 1997 and 2003. This project was qualified as excellent by the World Bank final report. The project developed a methodology which integrated the actions of the central government with local authorities and community participation to identify, construct and operate water channels and latrines in inaccessible areas. Since 2003 UNICEF Panama has provided organisational and training support to communities and local authorities in other projects relating to water and environmental sanitation, such as infant mortality and early child development. International Labour Organization (ILO): For more than 30 years the ILO has been working to strengthen communities and micro and small enterprises in the construction, maintenance and management of infrastructure and public services, together with capacity building of public sector institutions via its Employment Intensive Investments Programme. It has worked in various countries in the region to review and adapt the relevant legislation, enabling greater participation of community organisations and micro and small enterprises. It has generated a huge collection of training materials and other relevant documentation, and this will be used and adapted within the context of this programme. It recently held a training workshop for consultants from the region, including Panama, in the different aspects of strengthening public bodies and promoting the participation of local organisations and business in infrastructure and public service projects. ILO is also a Participating UN Agency in joint programme proposals in the MDG-F Governance window in Nicaragua and Honduras, and possibly in Paraguay as well, allowing it to benefit from the exchange of experiences between these countries. The ILO will coordinate its contribution to this programme from its sub-regional office in San José, Costa Rica, and through its other projects in Panama. The members of the joint programme at government level are: the Ministry of the Economy and Finance (MEF), Ministry of Health (MINSA), the Ministry of Education (MEDUCA) and the National Environmental Authority (ANAM). Their respective functions are described below. The Ministry of the Economy and Finance (MEF) will participate as the body facilitating Government inter-institutional coordination and will monitor the performance and execution of the programme. The Ministry of Health (MINSA) will serve as the lead government counterparts in its role as the body in charge of the health sector. It will contribute the expertise of officers both at its head office and in the field to carry out the bulk of the programme activities. It will also develop and implement an information system to monitor the indicators. Through MINSA, there will be access to the advice of the Inter-institutional Committee for Drinking Water and Sewers. The Ministry of Education will also be included in order to facilitate the participation of students and teachers at schools located in the intervention areas in awareness-raising campaigns about the issues involved. The National Environmental Authority (ANAM) will be included in the monitoring activities and the conservation of river basins and natural resources. The plan is to coordinate with the Ngöbe-Buglé General Congress and the local congresses of the four districts selected, as traditional authorities recognised by Act 10 of 1997, which created the region and their participation in taking important decisions. The local authorities in the four districts selected will be involved in implementing the programme in order to enhance synergies at community level. It is expected that at the government level there will be an expedite operations coordination mechanism with the Ministry of Health through its National Department of the Drinking Water Sub-sector; operations will also be coordinated with municipal, local and regional counterparts with experience in water and sanitation, to create synergies and make best use of the resources of all participants. The UNDAF Theme Group (specifically, the UNDAF Group for Cooperation Area 2: “Basic social guarantees for the fulfilment of human rights”) will take into account this joint programme intervention in its monitoring and evaluation of the results of UN cooperation in Panama. At the same time, the Human Rights - Gender Thematic Group will analyse the degree to which a focus on rights and gender have been incorporated into the joint programme. The other management and coordination mechanisms will be designed in accordance with the Operating Guidelines for the Management of Joint Programmes which have been drawn up by the Administrative Agent (UNDP Multi-Donor Trust Fund).

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C. MDG-Related Indicators

  • Goal 0: Millennium Declaration: an enabling environment (human rights, democracy and good governance)
  • Goal 1: Eradicate extreme poverty and hunger
  • Goal 4: Reduce child mortality
  • Goal 7: Ensure environmental sustainability
  • 13. Under-five mortality rate
  • 14. Infant mortality rate
  • 30. Proportion of population with sustainable access to an improved water source, urban and rural
  • 31. Proportion of population with access to improved sanitation, urban and rural
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D. Formulation Advance

Yes
$20,000
WHO - World Health Organization
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E. Resident Coordinator's Undertakings

  • The Concept Note has been reviewed by the national government and the UN Country Team.
  • If approved by the MDG-F Steering Committee, the UN Participating Organizations undertake to submit a draft Joint Programme Document within eight weeks of notification.
  • All UN Participating Organizations have or will sign the global Memorandum of Understanding with the Multi-Donor Trust Fund Office.