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UNICEF DPR Korea:

PROGRAMME STRATEGY NOTE

Country Programme 2017 – 2021

(As of 23 February, 2016)

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UNICEF DPRK: Programme Strategy Note

Country Programme (2017-2021)

Contents

1 Context ............................................................................................................................................... 6

2 Priorities ............................................................................................................................................. 7

3 Opportunities ..................................................................................................................................... 9

4 Overview of the programme structure ........................................................................................... 10

5 Geographic Coverage and Convergence .......................................................................................... 12

6 Health Programme Strategy Note ................................................................................................... 16

6.1.1 Programme rationale ........................................................................................................ 16

6.1.2 The Results Structure (Outcome, Outputs and Indicators) .............................................. 17

6.1.3 Theory of Change .............................................................................................................. 17

6.1.4 Strategies .......................................................................................................................... 19

6.1.5 Health programme sub-components ................................................................................ 21

6.1.6 Disaster management and resilience building .................................................................. 23

6.1.7 Assumptions and Risks ...................................................................................................... 23

6.1.8 Monitoring outputs and UNICEF s contribution to outcomes ................................................. 24

7 Nutrition Programme Strategy Note ............................................................................................... 25

7.1.1 Programme rationale ........................................................................................................ 25

7.1.2 The Results Structure (Outcomes, Outputs, Indicators) ................................................... 29

7.1.3 Theory of Change .............................................................................................................. 29

7.1.4 Strategies .......................................................................................................................... 33

7.1.5 Assumptions and Risks ...................................................................................................... 33

7.1.6 Monitoring outputs and UNICEF s contribution to outcomes .......................................... 34

8 WASH Programme Strategy Note .................................................................................................... 36

8.1.1 Programme rationale ........................................................................................................ 36

8.1.3 Theory of Change .............................................................................................................. 37

8.1.4 Strategies .......................................................................................................................... 40

8.1.5 Assumptions and Risks ...................................................................................................... 40

8.1.6 Monitoring outputs and UNICEF s contribution to outcomes .......................................... 41

9 Social Inclusion Strategy Note ......................................................................................................... 41

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9.1.1 Programme rationale ........................................................................................................ 41

9.1.2 The Results Structure (Outputs, Outcomes, Indicators) ................................................... 45

9.1.3 Theory of Change .............................................................................................................. 47

9.1.4 Key partners ...................................................................................................................... 49

9.1.5 Strategies .......................................................................................................................... 49

9.1.6 Assumptions and Risks ...................................................................................................... 50

9.1.7 Monitoring Outputs and Demonstrating UNICEF s Contribution to Outcomes ............... 50

10 Fundraising Strategy .................................................................................................................... 52

5.3 Fund-Raising and Leveraging Resources Strategy: ............................................................... 56

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ACRONYMS

BCC - Behaviour Change Communication

BCG - Bacillus Calmette-Guérin

CBS - Central Bureau of Statistics

CHDs - Child Health Days

CMAM - Community Management of Acute Malnutrition

CMT - Country Management Team

CMW - Central Medical Warehouses

CO - Country Office

DOTS - Directly Observed Treatment, Short-Course

DPT - Diphtheria, Pertussis, Tetanus

EPI - Expanded Programme on Immunization

EVM - Effective Vaccine Management

EMOC - Emergency Obstetric Care

EPI - Expanded Programme on Immunization

ERM - Enterprise Risk Management

GAVI - HSS2 - Global Vaccine Initiative Health Systems Strengthening Projects 2

GF - Global Fund

GFS - Gravity Fed System

Hib - Haemophilus Influenza b

IEC - Information, Education and Communication

ICN - Institute of Child Nutrition

IDD - Iodine deficiency Disorders

IYCF - Infant and Young Child Feeding

IMNCI - Integrated Management of Newborn and Childhood Illnesses

INGO - International Non-Governmental Organisation

IRS - Indoor Residual Spraying

ITC - Insecticide-Treated Clothing

IMR - Infant Mortality Rate

IMNCI - Integrated Management of Neonatal & Childhood Illness

KAP - Knowledge, Attitude and Practices

MMR - Maternal mortality rate

MoPH - Ministry of Public Health

MDD - Micronutrient Deficiency Disorders/ Diseases

MMN - Multiple Micronutrient

MNP - Multi-micronutrient Powder (Sprinkles)

MNT - Multi-micronutrient Tablets

MOCM - Ministry of City Management

MOPH - Ministry of Public Health

MPPT - Mass Primaquine Preventive Treatment

NCC - National Coordination Committee

NNS - National Nutrition Survey

ORS - Oral Rehydration Salts

SAM - Severe Acute malnutrition

SOP - Standard Operating Procedure

TB - Tuberculosis

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EXECUTIVE SUMMARY

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1 Context

UNICEF has provided support to the Government of the Democratic People s Republic of Korea

(DPRK) since 1986. However, it was not till 1996 that a Basic Cooperation Agreement (BCA) was

signed and an office was established. The current programme cycle covers the period 2011

to2016, which was later extended by one year to 2017. The extension was prompted by the

fact that over a nine month period in 2014 UNICEF and other UN agencies were unable to

transfer funds into the country due to international sanctions. Mid-Term Review was held in

2013 which allowed adjustments to the programmatic focus. Many of these recommendations

were incorporated into the design and scope of this new country programme.

UNICEF and the UN System face specific programmatic and operational challenges. All

information and data in DPRK are in the hands of, and controlled by the Government, notably

the Central Bureau of Statistics (CBS) with which the UN works closely. The CBS releases official

data and statistics only to the extent that it can be convinced that it is required for the specific

purpose intended. The UN frequently feels this process seriously impedes its ability to

undertake or contribute adequately to situation analyses, monitoring, evaluation and

reporting.

Monitoring visits to project activities is an essential component of the UN's work. In DPRK, this

is complicated by the need to obtain advance clearance for any such travel;the detailed

itinerary to be planned in advance , international staffto be accompanied by seconded DPRK

nationals, as guides and interpreters. In some counties, only national staff are permitted

access. The current filtration process on monitoring diminishes the independence and

objectivity of such monitoring activities and the consequent credibility and accountability of

the UN. Even within a location where UNICEF has been granted access, all aspects of the field

trips are controlled by the People s Committee.

UNICEF's national personnel is, without exception, seconded from the government, mainly

from the Ministry of Foreign Affairs (MoFA) for a limited period of time, normally three years.

Only UNDP has agreed with the authorities that their staff be accorded UN contracts, but their

personnel is also released from government for a limited period for direct hiring in UN service.

Selection processes for seconded staff vary a little between UN agencies. There is general

consensus that the technical qualifications of those proposed do not always match the

requirements of the agencies- and that the three-year secondment provides insufficient time

to train them, nor for them to provide the traditional role of institutional memory, continuity

and perspective amidst a rotational international UN management. Accountability of seconded

staff is to the government, not to UNICEF.

The DPRK authorities also limit the number of international staff permitted into the country.

This cap on international staffing appears to be based on a ratio of staff member to UN funds

managed, and is not driven by the nature and scope of the programme. This might be

understandable if the UNICEF s primary role were resource transfer but our work often focused

on advocacy, technical assistance, capacity development and monitoring results for children

which is unrelated to its direct costs. Moreover, the continual turnover of national staff puts a

far greater responsibility for basic processes on international personnel.

When international staff members travel on mission, home leave or R and R, there is no one to

replace them. They leave a vacuum that is only filled on their return. An Ebola quarantine of 21

days were imposed on all international visitors resulting in prolonged absences and prevented

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donor and other missions from taking place. Due to the consequences of the Ebola quarantine,

UNICEF CO had to operate without an international WASH officer for three months in 2015.

With sixty per cent of the programme dedicated to procurement, the long lead time for

supplies and logistics, a ban on imports from certain countries, and delays in port clearance,

represent major bottlenecks in the delivery and distribution of essential medicines and

commodities.

2 Priorities

The breakdown of the socialist bloc in the late 1980s had a detrimental impact on DPR Korea.

This resulted in downturn in industry and agriculture. Energy production declined. Capacity to

ensure food security and maintain social services were impaired. Floods and droughts,

beginning in the 1990s, further damaged industry, mines and agricultureled to acute food

shortages and malnutrition. There followed ten years of humanitarian assistance. The Situation

Analysis of Children and Women (2015) points to the fact that the indicators of child well-being

have not returned to the levels prior to the crisis of the 1990s.

The DPR Korea s economy remains fragile. Weak resilience and vulnerability to shocks

exacerbates economic vulnerability. Difficulties in securing energy, poor infrastructure,

imbalanced import-export policies, constraints in introducing new technologies, and

international sanctions contribute to the economy s instability and directly impacts vulnerable

populations.

State-owned industries account for nearly all of GDP. There is virtually no private sector and no

independent civil society organizations. Government allocations to the social sectors are

unknown. Overall, the Government s control over relevant and reliable data is a major barrier

to analysis, planning and monitoring results for children.

The country s isolation and geopolitical tensions make fundraising for children extremely

difficult. The UN country analysis proposes a revitalised narrative to mobilize international

support for development and humanitarian work.

The country faces recurring natural disasters such as floods and droughts. Flooding has

occurred almost every year over the last five years with the 2013 affecting 800,000 people. The

Office for the Coordination of Humanitarian Affairs (OCHA) ranks DPR Korea eighth in the

region in terms of risk and vulnerability. While there is no classical humanitarian crisis,

protracted needs persist. The UNestimates that 18 million people are food insecure, six million

people do not have access to essential health services, and seven million people are deprived

of clean water and proper sanitation.

The population figure currently stands at 24.6 million in 2014, with 24 per cent under 14 years

of age. Women represent 51.3 per cent of the population. Cultural patterns assign to them

child care, though the state quickly intervenes to assume that role. Social norms have a positive

effect on pregnancies as only 0.1 per cent of women become pregnant before the age of 20.

There is no data on domestic violence or human trafficking, and no credible gender analysis in

the country.

There has been no MDG progress report. The last report to the Committee on the Rights of the

Child was due in 2012. The report to CEDAW was due in 2006. The Convention on the Rights of

Persons with Disabilities was signed in 2013, but not yet ratified. UNICEF operates in a policy

environment that is evolving and requires ongoing support.

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Disparities exist between the population in Pyongyang and those living outside the capital.

Without empirical evidence of income distribution, the extent of geographical disparities based

on quintiles cannot be ascertained. However, data emerging from the national nutrition survey

indicate major disparities in nutritional status, particularly stunting, between outlying provinces

and the capital. The limited data and the fact that UNICEF cannot communicate directly with

local communities make the work of advancing the equity agenda particularly challenging.

All aspects of everyday living fall under state control from social services and population

movements, to the institutionalized care of children in baby homes, boarding schools and

special schools for children with disabilities. The country thus presents to the world a unique

political, social and cultural environment in which programming for children takes place.

The breakthroughs in child survival and development, DPR Korea faces obstacles in the

progressive realization of child rights. With IMR at 23/1000, twenty-four children die every day.

A child born in DPR Korea is 6.4 times more likely to die before the age of 1 than a child in the

Republic of Korea. With U5M at 27/1,000, twenty-eight children die every day from

preventable and treatable illnesses. The two major killers of children are pneumonia (12 per

cent in 2015) and diarrhoea (6 per cent in 2015). Neonatal deaths stand at 16/1,000, with 13

children dying every day because of preterm birth, complications, infections or hypothermia.

According to UN estimates, the maternal mortality ratio (MMR) has increased from 81 in 2012

to 87/100,000 in 2013, with one mother dying every day in childbirth. The increase in MMR is

due to a non-responsive health system, limited coverage and compromised quality of maternal

health services. The inadequate nutritional status of women before pregnancy contributes to

high MMR. MDGs 4 and 5 were not achieved.

The 2012 National Nutrition Survey showed that there was a modest decrease in under-five

chronic malnutrition from 32.3 per cent in 2009 (MICS) to 27.9 per cent. Nutritional status

remains a major concern given the irreversible impact of stunting on child development. Severe

acute malnutrition (SAM) is at 0.6 per cent. Chronic and acute malnutrition result from food

insecurity, unsafe drinking water, poor sanitation and hygiene, degraded environments,

absence of essential medicines, and the inadequate nutritional status of mothers.

The piped water supply systems, constructed in the 1990s, are collapsing due tolack of

investment, poor maintenance and rehabilitation schemes. The situation in access to water has

worsened because of shortages in electricity and damage caused by recurrent flooding on the

infrastructure. Twenty-four per cent of the population use rudimentary latrines which are

ineffective in preventing faeces from entering the environment. There is open defecation,

unsafe handling of excreta in agriculture, and inadequate access to water and sanitation

facilities in schools, health facilities and childcare institutions.

The country has maintained near universal literacy. The 2009 MICS2009 showed net enrolment

at 100 per cent with gender parity, a primary level (grade one tofour) completion rate of 100

per cent, and a 100 per cent transition to secondary schools and 97.8 per cent of under-5 s

benefit from early childhood education. The first twelve years of schooling are compulsory.

There are a 1,000 branch schools for communities living more than four kilometres from a

school. Branch schools share the same national curriculum however are not able to deliver the

same quality of education. There are 13,000 children aged below the age 17 living in

institutions run by the state. Institutionalized care runs counter to international norms of

inclusive education. There are only 11 special schools throughout the country, three schools for

blind children and eight schools for deaf children of which none are located in Pyongyang.

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Based on available data, UNICEF estimates that over 50,000 children with disabilities do not

have access to appropriate education and are amongst the most vulnerable.

3 Opportunities

DPR Korea s response to the Universal Periodic Report (UPR) in 014 offers the opportunity to

gauge national positions on key issues - from poverty and hunger to climate change and the

environment, all the more valuable as they are framed in human rights language. DPRK

accepted 113 of the 185 recommendations. . Fifty of these recommendations that enjoy the

support of the Government can be directly or indirectly linked to UNICEF s mandate. In

accepting these recommendations DPR Korea has acknowledged the right of the child to clean

drinking water, to improved hygiene and sanitation, to increased resources for the health

system, to lowering child and maternal mortality, to the better training of medical personnel,

and to ensure that children in the most disadvantaged areas enjoy equitable benefits in health

and education.

Thus, the new country programme offers UNICEF the opportunity to put Rights Up Front , to

advance the equity agenda as far as the political context and data gaps will allow. The new

Country programme will support the Government s efforts in progressively realizing the rights

of the child, and to continue to insist on normative principles in mother and child health,

nutrition, WASH and education.

The Sustainable Development Goals (SDGs) come at an opportune moment as they allow the

country programme to be aligned with renewed international targets, standards and indicators

across the development spectrum – from improved nutrition, healthy lives and well-being for

all, to inclusive quality education, equitable access to clean water and sanitation, and to

reducing inequalities.

United Nations Strategic Framework (UNSF) focuses on human rights issues through the

agencies mandates. The Government has agreed to provide a policy overview and new data

where possible to each of the four main pillars of the UNSF

(i) Pillar 1 prioritizes Food and Nutrition Security: Outcomes under this umbrella

focus on food and nutrition security through increased food production and

processing, improved household access to diversified food through enhanced

productivity and livelihood, and the improved nutritional status of women of

reproductive age and children under-five.

(ii) Pillar 2 prioritizes Social Development: Outcomes under this area targets sustained

universal health coverage with emphasis on primary health care, improved services

for communicable and non-communicable diseases and MCH, emergency

preparedness and response, a multisectoral approach to health, equitable and

sustainable WASH coverage, and equitable access to primary, secondary, tertiary

and vocational education.

(iii) Pillar 3 prioritizes Resilience and Sustainability: Outcomes under this area focuses

on the coping mechanisms of local communities in emergencies, and to respond to

ongoing energy needs, environmental management, climate change, and disaster

risk management

(iv) Pillar 4 prioritizes Data and Development Management. Outcomes under this

areafocuses on availability of reliable development and humanitarian data for

policy development, capacity to apply international norms, and compliance with

international treaties and conventions.

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These four areas have been identified with the assumptions that the external environment will

continue to be difficult, that internal and external resources will continue to be challenging,

and that any support of the UN needs to be flexible and adaptive. The nature and scope of the

collective actions of the UN system within this agreed framework resonates well with the

mission and mandate of UNICEF in DPRK. UNICEF can make substantive contributions across all

four outcome areas of the UNSF..

The UNSF has been explicitly designed as a hybrid document bridging both immediate and

short-term humanitarian assistance with long-term development support. The strategic vision

for the CPD has been anchored in both equity and sustainability, prioritizes the strengthening

of capacity of technical personnel at central and sub-national levels, plans, implements,

monitors, evaluates and reports results for children in both development and humanitarian

contexts. . Humanitarian action will provide an opportunity for capacity development and

systemic improvements, thus creating synergy between the humanitarian and development

nexus

4 Overview of the programme structure

The conceptual framework below provides an overview and focus of the UNICEF DPRK s

nutrition, health, WASH and social inclusion programmes. Emergency preparedness and

response in these four areas has been integrated into each programme component and not

treated as an add-on. Specific support for strengthening the capacity of the National

Commission for Emergency and Disaster Management will be covered under the WASH

Programme. Based on UNICEF s Strategic Plan 2014-2017, the programme integrates bundle of

data strengthening, technical assistance and policy dialogue. Capacity development in the

context of DPRK focuses on strengthening the skills and knowledge of services providers in

order to improve the quality of services as well as strengthening the knowlege and practice of

care givers in terms of child care and infant and young child feeding.

Communication for development addresses demand creation and behaviour change. UNICEF s

normative role is at the heart of the programme. Cross-sectoral synergies are made explicit in

the conceptual framework, and in the results and resources framework shown in Annex 1.

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DPR Korea

CPD Conceptual Framework

Social Inclusion

Policies, programmes and CRC reporting are better informed by evidence and analysis of disaggregated data.

• Education Commission (Learning Outcomes)

• Central Bureau of Statistics (Child Data Management Unit)

Water, Sanitation and Hygiene (WASH)

Increase access to improved water and sanitation

Improved hygiene practices• Policy, planning, data• Schools and Health Facilities• Gravity Feed Water Systems• Sanitation + Hygiene practices• Clean drinking water at

household level

Nutrition Reduced stunting and wasting Improved feeding practices and early

childhood stimulation.• Policy, planning, data, • Integrated Management of Acute

Malnutrition• Infant and Young Child Feeding (IYCF), • Micronutrients Maternal, Newborn and

Child Heath (MNCH)

Reduced maternal mortality Reduced Under 5 mortality

(Focus on neonatal health) • Policy, planning, data• Integrated Management of

Neonatal and Childhood Illnesses (IMNCI)

• Expanded Programme of

Immunization (EPI) Plus• Emergency Obstetric Care • Tuberculosis (TB) & Malaria

CRC CEDAW

CRPD

UNSF

SDGs

UPR

Stra

tegi

es1

Strategies 1

Strategies1

Strategies1

• Data/Advocacy

• Technical Assistance

• Policy dialogue

• Capacity Strengthening

• Service Delivery

• Key family practices

• Partnerships

• Integration of programmes

* CRC: Convention on the Rights of the Child

CEDAW: Convention on the Elimination of all

forms of Discrimination Against Women

UPR: Universal Periodic Review

UNSF: United Nations Strategic Framework

SDGs: Sustainable Development Goals

*

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5 Geographic Coverage and Convergence The new country programme seeks to align programme interventions geographically to extent possible

and at a scale that funding permits. The programme will continue to engage and build up capacity of

partners in the current programme counties.

5.1 National Level:

UNICEF will support policy, advocacy and data management across all programme at the national level.

As in the current country programme, certain activities supported under the health and the nutrition

programmes will continue to be implemented nationwide: immunization, vitamin A distribution,

deworming, TB and malaria activities. UNICEF will continue to collaborate closely with WHO in both the

immunization and the TB and malaria programmes.

5.2 Sub-national level:

At the sub-national level, specific counties will be selected for defined programmatic interventions to

strengthen convergence of programmes and to demonstrate measurable results for children. These

counties will be selected jointly by the Ministry of Public Health and UNICEF based on a balanced

consideration of the following geographical selection criterias:

(a) Epidemiological Criteria:

Areas with higher numbers of malnourished children, higher morbidity and mortality from

diarrhoea and pneumonia, cases of TB and malaria, and other key affected populations –

although country-wide data are extremely limited-.

(b) Programmatic Criteria:

Programmatic Continuity: Ongoing core activities under the health, nutrition and WASH

programmes will continue where there are needs,gaps in skills, lack of financial resources,

essential medicines and equipment, and exists a functional network of collaborating

institutions.

Impact: One county is selected in each of the ten provinces to serve as part of

convergence counties to demonstrate comprehensive multi-sectoral evidence-based

interventions to encourage wider replication in each province.

Equity & Physical Access: Remote but accessible counties will be selected where

programmes can be monitored regularly for documentation and learning purposes. Some

remote counties may be included to address issues of equitable access to services,

especially to ensure equity and gender-sensitivity in immunization and nutrition services.

Demographics: Catchment area, target population and potential beneficiaries of the

selected interventions.

Partnerships and Donor Harmonization: Areas where other UN agencies or INGOs are

already working to allow for increased synergies.

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(c) Financial Criteria (Capital & Operational Costs):

Infrastructure: Existing infrastructure capacities, needs and gaps, and counterpart

contributions to assure minimum start-up costs.

Prior Investments: Areas which have benefited from prior trainings and capacity building

activities.

Figure 1 shows the coverage by the Health, Nutrition and WASH programmes with further details

outlined below.

5.2.1 TB and Malaria supported counties.

TB activities are supported in 190 counties in 11 provinces, while Malaria activities are supported in

123 counties in 8 provinces as per the GF programme work plan,. All of these counties have already

been selected for TB and malaria programme support.

5.2.2 EMK and CMAM support in 89 selected counties:

EPI, Vit. A, deworming and multi-micronutrient supplementation programmes like Multiple

Micronutrient Powder (MMNP) for home fortification of complementary food for 6-23 months

children and Multiple Micronutrient Tablets (MMNT) for pregnant and lactating women are

implemented nationwide, while IYCF counselling is implemented in the targeted 89 CMAM

counties only. Essential Medicine Kit (EMK) distribution and the CMAM programme will be

implemented in 89 selected counties across the country. All programmes will focus in ten

convergence counties – one per province-, in order to demonstrate a convergence approach

and to further make monitoring as efficient as possible. Virtually, all of these countries are

included in the WFP s supplementary feeding programme that targets prevention of MAM

among 518,353 children in the nurseries of 89 counties.

5.2.3 EMK, CMAM and IMNCI integration in 50 counties:

UNICEF has secured funding until 2018 from GAVI to implement IMNCI in 50 counties. These counties

areincluded in the 89 counties where the CMAM programme is being implemented and EMKs are

distributed. These counties become central to UNICEF s implementation strategy in a context where

funding is increasingly unpredictable. The 50 counties will include counties in all provinces in order to

demonstrate and replicate IMNCI for wider coverage using the Government s own resources. Due to

restrictions in travel between provinces, it is important to have demonstration sites in each province

for replication as a model. Demonstration sites will be a good step for evidence based advocacy with

the Provincial and Country People s Committees. In the current programme, the Government has

already shown willingness to support expansion of trainings using their own resources. This was the

case with the training of doctors on maternal and newborn care where UNICEF facilitated training of

trainers at national, provincial and county level was replicated by MoPH. The People s Committees at

provincial and county level utilized their discretionary resources for completion of the trainings.

As the programme managers for CMAM and IMNCI programmes in the Ministry of Public Health are the

same, it is wise to strengthen the integration of these programmes and break down programmatic silos

and implement IMNCI and CMAM in the same geographical areas. IMNCI and health system

strengthening are perfect avenues towards institutionalization of SAM treatment in the health system

hence all efforts will be placed to take full advantage of this opportunity.

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UNICEF in collaboration with the Ministry of Public Health have already identified and initiated

increased integration of activities in these 50 counties towards the new country programme...

5.2.4 Multi-Sectoral convergence in eleven counties:

From among the 50 counties supported by GAVI, UNICEF and the MoPH will select eleven counties --

one county from each province -- in which UNICEF will increase converge of its Health, Nutrition and

WASH programmes and resources to provide an integrated approach for improving maternal, neonatal

and child health. In addition to the CMAM and IMNCI services supported in these 50 counties, in the

ten convergence counties , UNICEF will additionally support Emergency Obstetric and Neonatal Care

(EmONC) and WASH services. As diarrhoea is the second most common cause of U5 mortality, and poor

WASH is a major cause of undernutrition, especially stunting, therefore integration/convergence of

health, nutrition with WASH is critical for child survival and development, WASH will contribute

significantly to the health and nutrition outcomes.

These convergence counties will serve as demonstration counties with clear baselines, targets and

mechanism for tracking progress and documenting the success for evidence-based advocacy. The

approach will be documented to show the Government that responsive evidence-based services to

address the high rates of maternal and neonatal mortality can only be provided to the population

through an integrated, well- defined and comprehensive package of services. By having one

convergence county in each province, there is a scope for sharing best practices and learning across the

other counties in the province. UNICEF will collaborate closely with UNFPA in the area of midwife

training and also with WHO in the convergent counties. In 2016 and early in 2017, baseline information

– primary and secondary data - will be collected in the convergence counties including as possible,

determinants of undernutrition.

5.2.5 Monitoring and supportive supervision:

The Monitoring of Results in Equity System (MoRES) will be implemented with basic objective to

develop a simple, context-specific and reliable method for regularly assessing, analyzing situation and

taking actions for overcoming bottlenecks or the main drivers of child deprivation and disparities

across all counties and in all programmatic areas,. The MoRES approach will promote the use of data at

national and subnational levels to generate evidence for advocacy, policy and programme development

and tracking results in all programmes. In addition, UNICEF will facilitate supportive supervision, on the

job training, data collection and verification of programmeswith provincial and people committees

departments during the weekly field visits. Currently, the Government is providing annual CMAM and

related nutrition programme data per province on an annual basis. However, CBS agreed to share

nutrition data per county on quarterly bases once the CDMU project takes off.

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Figure 1: Schematic Diagram on Geographical Focus

CMAM: Community Management of Acute Malnutrition

EMK: Essential Medicine Kits

IMNCI: Integrated Management of Neonatal and

Childhood illnesses

EmONC: Emergency Obstetric and Neonatal Care

IYCF: Infant and Young Child Feeding counselling

MMNP: Multi-micronutriment Powder (Sprinkles)

MMNT: Multi-micronutriment tablets

Nationwide -

208 Counties: Immunization +

TB/Malaria , Vit A, deworming

89 Counties

CMAM+IMNC+EMK +IYCF+MMNP+MMNT

50 Counties IMNCI+CMAM

+EMK

11 Covergence Counties

Comprehensive MNCH and

Nutrition Package (EmONC +IMNCI+

CMAM+EMK+ WASH)

Coordination with

WHO and UNFPA

Coordination

with WHO

Coordination

with WFP

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6 Health Programme Strategy Note

6.1.1 Programme rationale

DPRK has fallen seriously short of achieving MDGs 4 and 5. . Although, there has been an

increasing trend in the Maternal Mortality Ratio (MMR) from 81 in 2010 to 87 in 2014 (UN

Global Estimates), despite the fact that 90 per cent of deliveries take place in health facilities.

New-born deaths comprise more than half of the under-five mortality (U5M). Pneumonia with

a prevalence of 12 per cent of U5M in 2015, is the leading cause of under-five mortality.

Although there has been significant reduction in diarrhoea prevalence from 15 per cent in 2009

to 6 per cent in 2015, it remains the second main cause of mortality among children under five.

The table below shows the limited progress towards achieving MDGs 4 and 5.

Key Indicators Current Status 2014 Country MDG

commitment/targets

for 2015

Maternal Mortality Ratio

(MMR)

87/100,000 (1 death / day 24/100,000

Infant Mortality Rate (IMR) 23/1,000 (22 deaths / day) 8/1000

Under Five Mortality (U5MR) 25/1,000 (28 deaths/day) 15/1000

Neonatal Mortality Rate

(NMR):

16/1,000 (>50% of U5 deaths) 13 deaths / day)

Table 1: DPRK made limited progress in achieving MDGs 4 and 5

Tuberculosis (TB) poses a public health challenge with an estimated 140,000 TB cases and

about 5,000 deaths attributed to TB, according to WHO estimates for 2014. WHO models

estimate 1.9 per cent Multidrug-resistant Tuberculosis (MDR-TB) cases amongst new cases and

15 per cent amongst retreatment cases, with an estimated 3,900 MDR-TB cases annually in the

country. TB and MDR-TB have direct and indirect impacts on children, families and

communities. Caregivers and family members can become ill for extended periods. Inadequate

preventative, diagnostic and treatment services contribute to continued high transmission

including to caregivers and children, and the impact is further exacerbated by inadequate

housing conditions and malnutrition.

Malaria transmission is seasonal, limited to P. vivax, and no deaths are attributed to malaria.

The overall malaria incidence is on the decline and only 2.1 per cent of malaria cases are

reported amongst children under 5 years and pregnant women, though outdoor transmission

and impact on farmers and night workers remain a concern.

Additionally, the country is disaster prone therefore an integrated risk-informed health,

nutrition and WASH programme components have been incorporated in the new programme

cycle. This integratation will ensure effective and timely response in humanitarian situations,to

fullfill the the Core Commitments for Children, and on buildon resilience at family and

community level.

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A situation analysis using causal and bottleneck analysis, and the ten determinants framework,

was undertaken with Government counterparts, as part of the CPD development process, to

ascertain the major bottlenecks and barriers resulting in slow progress in achieving global

targets. The analysis revealed major gaps in knowledge and skills of human resources, the lack

of essential medicines and equipment in health facilities as major causes of maternal, neonatal

and child morbidity and mortality in the country. The analysis focused on identifying inequities

in access to quality health and nutrition services, especially by vulnerable groups.

Based on the situation analysis, the bottlenecks faced in programme implementation, and

lesson learned from the previous country programme the priority health issues to be addressed

in the next country programme are:

I. Maternal Mortality: The immediate causes are haemorrhage (49 per cent); puerperal

sepsis/infection (15 per cent); and eclampsia (13 per cent). These three causes comprise an

estimated 72 per cent of preventable maternal mortality.

II. Neonatal Mortality: The immediate causes are: pre-term birth complications, such as

asphyxia and hypothermia (35 per cent); complications during labour and delivery, such as

intrapartum complications (24 per cent); and sepsis/infections (15 per cent). About 74 per

cent of neonatal mortality could be prevented with evidence-based, cost-effective

interventions.

III. Under Five Mortality: The immediate causes are: pneumonia (15 per cent); diarrhoea (5

per cent); and neonatal causes (52 per cent). About 72 per cent of under-five mortality is

preventable/treatable with focus on neonatal mortality reduction.

IV. Morbidity and mortality from Tuberculosis and Malaria: (estimated 140,000 TB cases and

about 5,000 deaths attributed to TB, according to WHO estimates for 2014). The malaria

cases amongst children under 5 years and pregnant women are low at 2.1 per cent.

V. Limited human and institutional capacities: There is limited human and institutional

capapcity to provide timely and appropriate response to prevent morbidity and mortality

in humanitarian situations, and to build resilience in communities.

6.1.2 The Results Structure (Outcome, Outputs and Indicators)

is presented in Annex 1.

6.1.3 Theory of Change

The Theory of Change described in this section is based on an analysis of the current situation

of maternal, neonatal and child health usesthe ten determinants framework to achieve desired

results. A multi-year context-specific and equity-focused results chain establishes linkages

between strategies, outputs and outcomes to achieve desired impact on maternal and child

survival The Theory of Change follows the concept of annual rate of reduction in mortality by

implementing the health programme and its sub-components. A mixed implementation

strategy including capacity development and service delivery drives the process of change. The

following graphic presents the logical link between the current situation, existing bottlenecks

and barriers, results to be achieved and outlines the pathway through annual rate of reduction

in maternal, neonatal and child mortality during the programme cycle and beyond. It also

presents the proviso of thegiven uncertainties of programming in DPRK, reflects the

assumptions and sisks that the narrative must be non-linear with the need to adapt constantly

to changing conditions and constraints over the five-year period.

18

The schematic representation of the results structure based on the Theory of Change is shown

on the next page.

19

Outc

om

e

indic

ators

Impac

t

indic

ators

O

utp

ut

ind

icat

ors

1. Non acceptance of global

standards and approaches.

2. Lack of funds

3. No reliable data available.

4. Possible cultural resistance.

Risks

Evidence-based advocacy

reinforced, an aggressive fund

raising strategy, strengthening

data management within

Ministry of Public Health and

Child Data Management Unit,

a comprehensive

communication strategy.

Mitigation

Strategies

1) Advocacy, policy and budget dialogue, technical assistance and scaling-up evidence-based interventions.

2) Capacity development to transfer knowledge, skills and motivation for policy makers, service providers and

caregivers, and to build community resilience and change behaviour.

3) Service delivery to ensure life-saving services and supplies in development and humanitarian settings, and to

monitor the extent to which bottlenecks and barriers are removed.

4) Cross-se toral li kages ade y applyi g the days approa h , pro oti g i tegrated ser i es i the selected o erge e ou ties , a d i pro i g oordi atio a ross li e i istries y esta lishi g multisectoral coordination body.

5) Partnerships will be centered within the UN, with UNICEF providing leadership in nutrition, WASH and

education. UNICEF will continue to work with donors, academia and other international organizations.

Assumptions

1. National capacity building

mechanism are functional.

2. Global standards well

adopted in policy

development.

3. Government allocates

sufficient resources.

4. Uninterrupted, timely

access to donor funds.

5. Uninterrupted cash flow

and timely in country

access to funds.

6. Optimal use of services.

.

.

.

.

Programme Rationale

HEALTH

Following table shows the annual and cumulative mortality reduction during the country

program cycle.

20

Key indicator Current

status

Expected Annual Rate of Reduction*

2017 2018 2019 2020 2021

Maternal Mortality

Ratio

87/100000 80 72 66 60 57

Neonatal Mortality 16/1000 13 11 9 7 6

Infant Mortality Rate 23/1000 18 15 12 10 8

Under Five Mortality 25/1000 20 17 13 11 9

Table 2 : Expected annual and cumulative mortality reduction during the country program cycle

Following is graphic presentation of the expected Annual Rate of Reduction in maternal,

neonatal and child mortality using 2015 baseline.

UNICEF held discussion with key development

partners, other UN agencies and with the Ministry of

Public Health as part of the process of developing the

Theory of Change and deciding the expected results.

Discussion focused on identification of issues,

selection of appropriate implementation strategies,

analysis of assumptions, and review of risks and

mitigations measures. It is important to ensure

convergence of actions and resources to bring the

change and impact on maternal and child survival.

6.1.4 Strategies

The proposed strategies are based on clear understanding of the current health situation,

recent developments in the field of maternal, neonatal and child health strategies and

comparative advantage of UNICEF in the field of health.

Capacity Development: There are major knowledge and skill gaps among human resource at

different levels. The in-service training is based on outdated knowledge and practices and

hamperedwith non-existence of on-the job training mechanisms. This leads to poor quality of

service provision without consideration of global standards and treatment protocols.

Therefore, capacity development will be central to bridge the gaps in knowledge and skills at

different levels. A wide range of trainings will be conducted through simplified and competency

specific approach. To achieve this, UNICEF will modify and enhance its role towards provision of

technical assistance. Other UN agencies especially WHO and UNFPA will be involved in capacity

development as part of the UNSF:Strengthening of training facilities, to support regular on-

the-job training of the training facilities at provincial level will be strengthened to provide

quality training to the staff from county and Ri (or sub-county) level health facilities. Scale up

Evidence based interventions: a set of evidence-based interventions will be promoted across

the country. A large number of human resources especially household doctors and midwives

across the country will be trained for effective implementation. Simplified guidelines will be

developed to ensure scaling up with quality at national, provincial, county and Ri level. The

capacity development will particularly focus on the following programme areas:

21

Immunization service (-Expanded Program on Immunization(EPI)) to prevent vaccine

preventable diseases

Provision of EmONC services to ensure a healthy delivery for mothers and newborn babies

Implementation of Integrated Management of Newborn and Childhood Illnesses (IMNCI)

and provision of services as per global standard treatment protocols

Scaling up of evidence-based interventions across the country

Establishment of monitoring and supportive supervision system

Strengthening capacities for data collection, analysis, dissemination and use for evidence

based programing with greater focus on gender disaggregated data.

There will be a major shift in UNICEF support from supplies to provision of technical support

especially in maternal, neonatal and child health areas. This shift on engagement with

capapcity development will require technical support from the UNICEF regional office and

other networks for which UNICEF DPRK office is well positioned.

Service Delivery: There is chronic shortage of essential medicines and equipment at all levels.

Furthermore, the support from UN agencies is very limited as the health care delivery network

is unable to provide essential services. This is one of the major causes of morbidity and

mortality in the country. To address this, a service delivery mechanism has been suggested to

reach the population, especially most vulnerable, with an essential package of services. In the

convergence counties, one per province and depending on availability of

resources,comprehensive services will be provided to serve as a model for replication.

Household doctors and midwives close to the community, currently underutilized, will be

mobilized. The service delivery strategy will focus on immunization, EmONC, IMNCI, ORS and

provision of essential medicines and scaling up evidence-based interventions.

Evidence generation and advocacy: Reliable and quality data is required for evidence-based

advocacy and resource mobilization to . to strengthen equity and evidence-based programing

reaching to vulnerable populations. Strengthening evidence generation is key to ensure that

service providers and policy-makers have access to quality data and analysis and use it for

programme planning and monitoring. Within the GAVI funding helath system strengthening

projest, UNICEF together with WHO successfully advocated for the MoPH to provide

immunization coverage data disaggregated by gender.

Integration, cross sectoral linkages and partnership building: The common barriers identified

in health, nutrition and WASH will be addressed through integrated multi-sector programming.

Diarrhoea, maternal health and nutrition are areas of common focus and 1000 day s window

of opportunity will facilitate synergies and the provision of an integrated package of services.

The partnership with GAVI and WHO will be further strengthened to ensure continuity of GAVI

funding past 2018. The programme will support the convergence of actions and resources from

key stakeholders for implementing the theory of change, with significant impact on maternal

and child survival. UNICEF, WHO and UNFPA will partner in these ten convergence counties by

providing support based on their comparative advantage and expertise, such as UNFPA will

look into the midwifery component while WHO in providing support in strengthening referral

services at provincial level institution and through technical support.

The programmes for malaria and tuberculosis represent a partnership between the Global

Fund, Ministry of Public Health (MOPH), WHO and UNICEF. These programmes are

implemented by the MoPH. WHO is the technical lead, providing advice and technical support

to MoPH, whereas UNICEF is the principal recipient of funds responsible for procurement,

22

financial management, and monitoring implementation according to the Global Fund work

plan. In its role as Principal Recipient, UNICEF has a negligible role in programme design, which

is developed between MoPH and WHO and approved by the GFATM Executive Board till 2018.

Integrated behaviour change communication: Healthy practices for sustainable change will be

promoted through an integrated behaviour change communication programme. The focus will

be on demand-creation. However, due to local sensitivities, this will need very careful and

highly context-specific through an indirect approach most probably viahousehold doctors and

midwives to achieve the desired result.

6.1.5 Health programme sub-components

Five main sub-components of the health programme include Maternal, Neonatal, child health

care, TB and malaria, and disaster management. It is important to implement a fully integrated

approach to achieve outcome and impact. Interventions will be implemented in different

geographical locations and will dependon prioritization and availability of funds

EmONC services will be strengthened in 10 convergence counties as the basis for

replication by Government, integrating health, nutrition and WASH service.

The integrated management of newborn and childhood Illness (IMNCI) will be

implemented in 50 counties as agreed in GAVI HSS2 2014-18. In addition, 89 counties with

CMAM will benefit from an essential medicine programme.

The immunization programme including expansion of cold chain,and quality improvement

and,TB/malaria will be implemented nationwide.

Scaling up of evidence-based interventions focused on maternal and neonatal health will

be implemented across the country in all health facilities

Maternal Health Care 6.1.5.1

Due to increasing trends in maternal mortality ,from 81

in 2010 to 87 in 2014 APR 2015, there will be a greater

focus in ensuring availability of essential package of

services to ensure safe and healthy outcomes of

pregnancy both for mothers and newborn babies. The

basic approach is to contribute to the reduction of

preventable maternal and new-born morbidity and

mortality. The main components of maternal health are

provision of Emergency Obstetric and New-born Care (EmONC), quality of antenatal and

postnatal care. Following shows the expected reduction in maternal mortality during the

country programme cycle.

New-born Health Care. 6.1.5.2

More than half of under-five mortality occur during

neonatal period. It is not be possible to achieve set

targets for under five mortality ithout reduction in

mortality during this critical period.. This strategy

promotes scaling up of the evidence based

interventions across the country and also ensure

16 14

13 11

9 7 6

0

10

20

2015 2016 2017 2018 2019 2020 2021

Neontal Mortality Reduction

23

availability of life saving support mechanism during first 28 days of life. The Every Newborn

Action Plan (ENAP) will guide the direction to achieve reduction targets placed below during

the CP.

Child Health Care 6.1.5.3

The focus of child health is on preventive

and curative services with particular focus

on two major childhood diseases

pneumonia and diarrhoea, while the bulk of

the mortality which occurs in neonatal

period will be addressed through

aforementioned newborn care (ENAP). The

sub-components of child health program

are:

Immunization Program (GAVI HSS2) to prevent vaccine preventable diseases.

IMNCI (community) with focus on reduction of Pneumonia and Diarrhea. It will include

extensive capacity building and also facilitating access to ORS and Essential Medicines.

Integrated approach for effective results (Health, Nutrition and WASH).

It is expected to achieve the mortality reduction targets with these interventions

Note: Extensive consultation was held with Ministry of Public Health during all stages of

strategy note preparation including the identification of key issues through causal and

bottleneck analysis,an agreement on key strategies, the idea of convergence counties

and multi-sector approach and on developing implementation plan for achieving the

desired targets and expected change.

TB and Malaria 6.1.5.4

The Global Fund programme component contributes to the National Strategic Plan for TB

Control (NSP) 2015-18 and National Malaria Strategic Plan (2013-2017) and aims to:

Decrease morbidity and mortality of TB through universal access to TB care and support

service.

Scale up services for prevention, diagnosis and treatment of all forms of TB to achieve case

notification rate of 444 per 100,000 population by 2018 and to sustain 90 per cent success

rate for notified new smear positive cases.

Ensure timely enrolment of all confirmed Multidrug-Resistant-TB cases and achieve 75 per

cent treatment success rate.

Engage other health programmes, civil society, NGOs and Key Affected Populations in TB

control.

Reduce overall malaria incidence by 70 per cent of the 2011 level by 2017.

Reduce malaria incidence in all high-risk ri (sub-county level) to less than <3/1,000 by

2017.

24

6.1.6 Disaster management and resilience building

The objective is to build capacities of the Ministry of Public Health and its Disaster

Management Unit in enabling an effective response in a humanitarian situation.

Thepreparedness and response capapcity will be enhanced inorder to prevent morbidity and

mortality amongst girls, boys and women through timely and appropriate actions in line with

UNICEF s Core Commitments for Children. Prepositioning of essential medicines will be ensured

for timely response. In addition context specific resilience-building activities will be initiated.

6.1.7 Assumptions and Risks

If the assumptions are wrong and risks actually materialize the transition from outputs to

desired outcome could be blocked or delayed. The logic of the causal linkages between input,

outputs and outcome will be ensured in the choice of specific activities laid out in detailed

annual work plans and monitored. The programme design makes the following assumptions:

Assumptions:

The change pathway makes the assumptions that the country has a conducive policy

environment, the donor fund flow and in-country cash flow remain intact and optimal service

utilization is ensured, following further specify the assumptions in the country context:

Political commitment to coordinate and contribute to implement a multi-

sectoral approach to address women and children health and nutrition needs

with equity focus.

Capacity building mechanisms are functional.

Global standards are well adopted in policy development.

Government allocates sufficient human and financial resources for the

programme.

Stable and conducive programme environment, particularly an uninterrupted

and timely access to donor funds, as well as uninterrupted cash flow and timely

acces to funds in the country.

Risks:

Government lacks capacity to manage and coordinate multi-sectoral

programme.

Non-acceptance of global standards and approaches.

Sub-optimal knowledge and practices of service providers and care givers

Insufficient budget allocation.

Infrastructure and logistical constraints.

Non-availability of reliable data.

Data management, sensitivities and related constraints.

Potential contextual barriers.

Given the absence of civil society partners, UNICEF inputs and outputs may be

necessary but insufficient to reach the outcome.

The mitigation measures include re-enforced evidence-based advocacy, an aggressive fund

raising strategy, strengthening data management within Ministry of Public Health and Child

Data Management Unit, and implementation of a comprehensive communication strategy.

Alignment to national sector plans and strategies:

25

The health programme, following a Theory of Change paradigm, will contribute to

achievement of reduction in maternal, neonatal and childhood morbidity and mortality as per

results envisaged in:

United Nations Strategic Framework (UNSF) 2017-21,

Goal 3 of SDGs Ensure healthy lives and promote well-being for all at all ages

National Medium Term Strategic Health Plan (MTSP) DPRK 2016-20.

National Strategic Plan for TB Control (NSP) 2015-18.

Progressive realization of the rights of the children through UNICEF normative role.

Equity agenda of reaching most vulnerable and reducing disparities.

6.1.8 Monitoring outputs and UNICEF’s contribution to outcomes

Government s monitoring and supportive supervisory mechanisms will be strengthened

andestablished to ensure tracking of the results and undertakings over the on-the-job trainings.

Tools have been developed to conduct results-oriented monitoring and supportive supervision.

An innovative monitoring tool has been developed for collecting data during field monitoring

and communicating key messages on critical components of health programme. In addition, a

feedback and follow up mechanism on findings of monitoring has also been established to

ensure that corrective actions are taken to ensure quality and timely completion of activities in

achieving the desired results and expected change envisaged in ToC. Monitoring of Results in

Equity System (MoRES) will enable UNICEF and partners to undertake organized approach in

tracking progress and removing of program implementation bottlenecks. In addition to the

above selected programme evaluations will be implemented including i: EPI Coverage

Evaluation Survey, ii: evaluation of IMNCI, iii: evaluation of convergence counties will be

conducted to verify the coverage and quality of care.

26

7 Nutrition Programme Strategy Note

7.1.1 Programme rationale

DPRK has a population of more than 24 million, out of which 1.74 million are under-five

children. There are 5.9 million women of reproductive age (WRA) aged 15 to49 years, and

720,000 pregnant or lactating women. The country has a history of more than two decades of

chronic food insecurity affecting about three-quarters of the population. Eighty-four per cent of

households, 18 million people, are considered as moderate to severely food insecure as they

are dependent on the public distribution system (PDS), in addition to being susceptible to

environmental and economic shocks.

Available survey data from 2012 shows that about one-third of under-five (U5) children are

stunted; wasting affects four per cent of the U5 children. Severe wasting is at 0.6 per cent. Each

year, an estimated 60,000 children under 5 are expected to suffer from SAM , and 150,000

from moderate wasting. Mothers with low MUAC and anaemia usually give birth to low birth

weight babies affected by intra-uterine growth restriction (IUGR). Those children are born at a

disadvantage because of the nutritional status of their mothers. This leads to undernutrition

and stunting among U5 children if not addressed within the first 1,000 days of life – the

window of opportunity . These conditions of low MUAC and high rates of anaemia perpetuate

the inter-generational cycle of undernutrition and entrench children and their mothers in

poverty and disease.

About one-third of Women of Reproductive Age (WRA) are anaemic and/or have low Mid-

Upper Arm Circumference (MUAC) of <225 mm. The MoPH has already developed and

endorsed the National Nutrition Strategy and Action Plan for 2014-2018, along with three

technical guidelines focussing mainly on reduction of undernutrition among U5 children. These

national documents are already touching upon the importance of women nutrition especially

PLW and outlining the main interventions to address this problem. However, the need for

comprehensive approach to address the nutritional needs of WRA, especially adolescent girls

and PLW is very critical. The programme is planning to review and further upgrade the National

Strategy and Action Plan to accommodate related programmatic interventions for adolescent

and maternal nutrition as stated in the global UNICEF strategy and operationalise these

interventions in collaboration with WFP, WHO and UNFPA.

The nutritional situation of women, adolescents and children is exacerbated by the fact that

communities live in a complex social environment marked by economic isolation, recurrent

droughts and floods, limited surface area of arable land as 80 per cent of the country is

mountainous, and a collapsing infrastructure. The country suffers from lack of investment in

social sectors and services, limited capacity of service providers, and their exposure to

innovative ideas and technical updates, and restricted population movement to seek services.

Recently, the country made progress in reducing undernutrition - the underweight target-and

achieved MDG 1.. However, stunting still remains a public health concern along with high

levels of anaemia and different micronutrient deficiencies, including iodine deficiency disorders

(IDD).

The 2012 National Nutrition Survey (NNS) showed that infant and young child feeding (IYCF)

practices are sub-optimum, with a negative impact on a child s growth and development. Only

33 per cent of women initiate breastfeeding immediately after birth (UNFPA supported, 2016

Social-Economic and Health Survey) or introduce complementary food at the right time.

27

Although exclusive breastfeeding rate appeared to be high in the same survey, the data is not

plausible given the fact that all children entered nurseries at three months at that time.

However, the new 2015 Maternity Leave Law offers eight months of maternity leave – two

months before delivery and six months after- in order to support exclusive breastfeeding and

so improvements are expected.

Only seven per cent of children aged 6 to11 months and 27 per cent of children aged 6 to23

months met the standard of minimum acceptable diet. Results from the same survey showed

that there are opportunities to improve children s feeding practices as their mothers have

access to a wider range of food groups, although their own feeding practices were sub-

optimum as well. The age-specific stunting data from the NNS showed clearly that the stunting

level progressively deteriorates straight after delivery because of sub-optimum IYCF practices.

Once the child reaches 24 months, stunting becomes irreversible. In 2015, UNICEF facilitated

integration of selected components of the IYCF counselling into the CMAM training package

and rolled-out the training package to four provinces affected by the drought. In total about

180 health workers from 90 counties hospitals trained in 2015.

Currently IYCF and CMAM services are being delivered through the paediatric wards in the

targeted CMAM counties in only four provinces. The Government of DPRK recognised the

importance of optimum IYCF practices and in response to UNICEF advocacy efforts to extend

the maternity leave after delivery from three to six months. In mid2015, the Government

issued directives to grant all women with eight months of paid maternity leave (two months

before delivery and six months after) to ensure maximum opportunity to all mothers to

practice exclusive breastfeeding.

In 2015, MoPH also issued general directive to all maternities in the country to close-down all

newborn rooms and to encourage early initiation of breastfeeding and skin-to-skin contact

within one hour after birth. During 2015, UNICEF also achieved 23 per centof the targeted 6

to23 months old children reached with MMNP; 47 per cent of the targeted PLW reached with

MMNT and about 50 per centof the targeted non-pregnant women received IFA tablets.

UNICEF also facilitated bi-annual Vit. A supplementation and reached to 99 per cent of the

targeted children while reached about 90 per cent of the targeted children with deworming

tablets and screened about 92 per cent of 6 to59 months children in four provinces in the

CMAM focus counties using MUAC through two rounds of Child Health Days in April and

October 2015.

The CMAM programme in 2013 and 2014 focused on 29 counties in the four north-eastern

provinces as well as 14 baby homes and 13 provincial paediatric hospitals across the country.

Data from this UNICEF-supported programme shows that there has been a 38 per cent increase

in children being treated for SAM in 2014 compared to 2013 which coincides with the onset of

the drought. This can be broken down as 43 per cent increase in the number of SAM children

with complications and a 32 per cent increase in the number of SAM without complications

treated. These figures reflect the deteriorating nature of the situation since mid-2014, in terms

of increasing incidence of childhood illnesses associated with higher prevalence of

undernutrition and indicates an increasing demand on and higher utilization of CMAM services.

In addition to the reported increase in the number of SAM children, UNICEF field assessment

missions in May and June 2015 to South Hwanghae and North Pyongan provinces, identified

the most severe cases of SAM that it has ever observed to date. In terms of the severity of SAM

with complications on treatment in the CMAM sites, in the past UNICEF has observed SAM

children with their weight for height minus two or three standard deviations below the norm,

28

but recently, for the first time, UNICEF found children with minus four and even minus five

standard deviations. These extremely severe cases are an indication of a deteriorating situation

in the community and corroborates Government data.

Coverage

Category of

Undernutrition

About 16% of SAM

accessed CMAM services

About 60% of

SAM access

CMAM services

Estimated Annual

Burden – 2016* 2013 2014 2015

SAM children treated 8,025 14,418 64,910 60,000

MAM with complications treated

16,478 20,004 105,400 150,000

Table 3 : Estimated number of SAM and MAM Children in need of treatment

*The est. burden of SAM and MAM in need of treatment need to be revised in view of the

recently received 2015 CMAM coverage data from MOPH in Feb. 2016.

The NNS showed regional inequalities, consistent with earlier nutrition surveys, in which the

prevalence of wasting and stunting is relatively higher in the northern and eastern provinces

compared to the rest of the country and the capital. However, the burden of wasting is much

higher in the capital, the main cities and municipalities in the central and western provinces

where there are densely populated urban areas.

Vitamin A coverage with two doses annually and Mebendazole remained high at 98 per cent

and 100 per cent respectively during the last 2015 annual two rounds of child health days

(CHD) in May and November. In 2015, UNICEF facilitated the availability of a third dose of

Vitamin A supplementation for the treatment and prevention of Vitamin A deficiency diseases.

In 2016, UNICEF will introduce two additional doses of deworming into routine health services

while maintaining the CHD activities to bridge the gaps and maintain high coverage.

The 2009 MICS showed that only 25 per cent of households are consuming adequately iodized

salt at more than 15 ppm. The prevalence of goitre among children 6-12 years old was 19.5 per

cent (higher in girls than in boys) and the average value of median urinary iodine concentration

UIC as . ug/ℓ, hile the proportio of elo ug/ℓ as .3 per e t. The ai challenges facing the IDD programme are as follows: a) Power interruptions/ cuts and low

voltage, b) lack of loading and unloading equipment, c) low production capacity of raw

materials, d) lack of transport means to and from the salt factories, and e) many other

challenges facing the Public Distribution System (PDS).

Given the limited presence of international NGOs, UNICEF is the only agency supporting MoPH

to implement different nutrition-specific interventions since 2008. All Government sectoral

partners are dependent on UNICEF s technical, financial and material support. They have little

or no access to other resources. UNICEF is also the only agency supporting the State Planning

Commission (SPC) in salt iodization since 1996 in which technical assistance is provided at

different levels along with supplies to the salt iodization industry.

In 2014 and 2015, the Government endorsed the National Nutrition Strategy and Action Plan,

and three technical guidelines for the management of acute malnutrition through CMAM,

promotion of optimum IYCF practices, and prevention and treatment of micronutrient

deficiency disorders and diseases. There were also multi-sectoral efforts to address the

problems of undernutrition among WRA and U5 children, and micronutrient deficiencies,

29

including IDD. In the new country programme, UNICEF will strengthen synergies between

WASH, health and nutrition programmes coordination including their planning, messaging and

trainining activities and geographic convergence

The new country programme will pay special attention towards high level advocacy to establish

a national food security and nutrition secretariat and will facilitate strengthening the sectoral

linkages among different line ministries and within UNICEF programme in the convergence

areas.

The situation described above underscores the importance of designing a comprehensive

package of nutrition-specific interventions that need to be delivered to mothers and children

through the health service delivery platform. At the same time, the country needs to move fast

on designing a comprehensive multi-sectoral approach to address the endemic nature of

undernutrition through delivering both nutrition specific interventions and supporting

nutrition-sensitive actions to mitigate the immediate and underlying causes respectively, and

to break the vicious inter-generational circle. This is possible only if Government establishes a

national multi-sectoral coordination mechanism in which all sectors plan together to achieve

the sustainable reduction of undernutrition.

In 2015, the Government recognized the importance of the multi-sectoral approach. Maternity

leave was extended from five to eight months in June 2015 and early initiation of breast

feeding is being promoted and practiced in all provincial maternity facilities. These are

dramatic shifts in Government policies in which separate newborn rooms were closed and

exclusive breastfeeding for six months was promoted, demonstrating the Government s

commitment to addressing undernutrition. Multi-sectoral approaches to achieve USI were also

adopted with UNICEF support in which many sectors have started working in early 2015 to

develop a National Plan of Action to achieve USI by 2021, along with the accompanying legal

framework. UNICEF supported a study tour of six government officials to study the multi-

sectoral approach adopted in Cambodia. UNICEF will support further efforts of the Government

to strengthen the multi-sectoral planning.

national social mobilisation campaigns are requiered to promote nutrition education, inform

and motivate women and service providers to adopt IYCF and caring practices. These are

mainly: IYCF counselling and caring services in all maternity hospitals; early initiation of

breastfeeding; and exclusively for six months; and timely introduction of home-made

complementary foods, fortified with multi-micronutrients and energy dense; and early

stimulation during the critical period of 1,000 days. There is a need to further strengthen and

expand the service coverage to make it accessible to the most vulnerable populations,

particularly WRAs and U5 children in underserved communities.

Free health services are accessible to the whole population. A cadre of 50,000 household

doctors, nurses and 800 midwives exists. At community level, household health workers are

providing basic preventive and curative services. Health services are available at nurseries and

day care facilities, which offer an opportunity to address the health and nutritional needs of

most vulnerable 6-59 months old children. Screening services for wasting, referral and early

treatment of wasted children and follow-up, are available in all clinics and nurseries.

Limited reliable data is one of the major bottlenecks to assess, monitor and evaluate the

nutrition programme. There are no opportunities for organized civil society, limited

opportunities for the different government sectors to interact, and limited capacity to plan

because of systematic segregation of all sectors and related social services. Logistical

30

constraints in relation to lack of transportation means and road conditions constitutes another

major constraint, in addition to limited movement of citizens between provinces and counties.

7.1.2 The Results Structure (Outcomes, Outputs, Indicators)

is presented in Annex 1

7.1.3 Theory of Change

It is widely recognized that malnutrition is an outcome by itself, which is due to lack of and/ or

sub-optimum interactions of different sectoral interventions. The main causes of malnutrition

are mainly related to immediate causes like food/ nutrient intake and health/ illnesses

encountered. The underlying causes are mainly related to lack of access to adequate quantity

of diversified food, efficiency and quality of the WASH and health services and in the core there

is maternal and child caring practices. The health sector alone can not reduce the prevalence of

malnutrition without concerted efforts and intensive investment in the food security, health,

WASH sectors and with strong communication for behaviour change component to promote

optimum maternal and child caring practices, hence the need to adapt a comprehensive

multisectoral approach to achieve sustainable impact. To address the immediate and

underlying causes of malnutrition, effective nutrition-specific interventions, including

community-based programmes, should be implemented at scale. These interventions need to

be complemented with nutrition-sensitive interventions like strengthening of the health

system, strengthening the agriculture and food production/ processing sectors, education,

water and sanitation sectors, addressing gender issues along with women empowerment in

decision making, social protection system and other poverty reduction measures.

The road from the challenges and opportunities described above to reaching U5 children,

adolescent girls and women, and facilitating their equitable access to multi-sectoral nutrition

services, is non-linear, but can be travelled over a five-year cycle. The critical behaviour

changes needed of service providers, care and right-holders themselves adds to the challenges

on the journey ahead. Progress along the causal pathway will be circuitous, with deviations

needed to sidestep barriers and overcome setbacks along the way.

The key to success for UNICEF will be toassist the Government in implementing a

comprehensive multisectoral nutrition plan and strategies that address the immediate and

underlying causes of undernutrition with a specific focus on the immediate causes and the

cross sectoral linkages with WASH and food security. The main interventions are as follows;

promotion of maternal nutrition with focus on adolescent girls, promotion of optimum IYCF

practices at community and health facilities level, institutionalizing screening and early referral

of wasted children to CMAM services, increasing geographical coverage and access and uptake

of the CMAM services and improving quality of these life saving services, sustaining the high

coverage of VAS and deworming along with increasing coverage of MMNP and MMNT

supplementation. These will need to be implemented at scale to achieve sustainable

improvement in the nutritional status of children, adolescent girls and women, and bring about

a lasting social change. The expected impact is to reduce stunting or chronic malnutrition,

reduce wasting or acute undernutrition, improve the nutritional status of girls and women.

The UNICEF nutrition programme is accountable for the following actions and will consist of the

following priorities:

(i) Creating the enabling, multi-sectoral policy and budgetary environment.

(ii) Prevention and treatment of micronutrient deficiencies and disorders nation-wide

31

(iii) Community management of acute malnutrition, targetingthe most at-risk 89 counties

(CMAM)

(iv) Promotion of mproved young child feeding nation-wide (IYCF)

(v) Promotion of maternal nutrition with focus on promotion of nutrition status of

adolescent girls

(vi) Prevention and treatment of IDD nation-wide

(vii) Humanitarian assistance

(viii) Geographic convergence in 50 counties (included among the 89 CMAM counties)

i) Enabling Environment: The programme will establish a national multisectoral coordination

body which will be responsible to formulate a National Plan of Action to reduce

undernutrition. This plan would need to be costed, with clear targets, defined management

roles and strategies, and supported by clear monitoring frameworks. This national

coordination body will be accountable for addressing the problem of undernutrition and be

represented by all stakeholders. It should be chaired by a senior Government official to

reflect strong political commitment. The programme will work closely with Ministry of

Public Health, and the Academia represented by the Institute of Child Nutrition (ICN) and

the Medical Universities along with other key line ministries (Ministry of City Management,

Ministry of Agriculture, Ministry of Food Distribution and Education Commission). The

programme will update the current National Nutrition Strategy and Action plan to

accommodate additional components to improve adolescent girls and women s nutrition

and support development of related technical guidelines. The programme will provide the

required technical inputs to revise and upgrade the national policies on CMAM, IYCF and

micronutrient deficiencies, including IDD/ USI plan of action, and also development of

national guidelines on complementary feeding, ECD to be used in all nurseries, guidelines

for adolescent and maternal nutrition. The programme will facilitate collection of a specific

set of nutrition indicators on a quarterly basis in coordination with Central Bureau of

Statistics under the Child Data Monitoring Unit, and the line ministries involved.

ii) Micronutrients: The programme will promote adequate micronutrient status of

adolescent girls, women of reproductive age, pregnant and lactating women and U5

children. The programme will improve the health and nutritional outcomes of expectant

women and the growth, development and survival of their children through promotion of

micronutrient supplementation ( bi-annual Vitamin A supplements along with dewoming,

zinc to all diarrhoea cases, weekly iron-folic acid to non-pregnant women, weekly

micronutrient tablets for PLW and powder for 6-23 months children), complementary food

fortification and the use of iodized salt, or oil capsules where iodized salt is unavailable.

Delivery of nutritionspecific interventions will be tailored to address underlying gender

barriers to adequate nutritional status of women and adolescent girls. Strategies to address

adolescent maternal nutriton will include communication and behaviour change strategy to

promote minimum acceptable diet, dietary diversity, advocacy efforts with the

Government to allocate additional food ration through the PDS to PLW, and further

collaboration with WFP to provide supplementary food rations to PLW.

iii) Community Management of Acute Malnutrition (CMAM) : Moderate and severe wasting

is still a major threat to child survival and development, hence the need to geographically

expand the CMAM services to increase service uptake and accessibility to lifesaving

services, and to mitigate the needs of nutritionally compromised U5 children. The

programme will improve quality of CMAM services through nutrition education,

32

capacitating health workers, ensuring timely availability of therapeutic foods, monitoring

forms and reporting, institutionalizing screening services for early detection, and

prevention of wasting. Since 2013, UNICEF through the operational CMAM service delivery

sites are providing treatment for SAM children with and without medical complications and

to MAM children with medical complications only in the provincial and county hospitals as

well as in the baby homes. UNICEF is advocating with WFP and the Government to

establish MAM treatment services in all the operational CMAM counties.

iv) Improved Young Child Feeding (IYCF): The programme will pay special attention for roll out

of the IYCF counselling services to reach to all maternity and paediatric hospitals in the

counties and in the targeted CMAM service delivery network to strengthen the efforts of

prevention of undernutrition. Household doctors trained under the health programme will

be equipped with key IYCF messages to be disseminated to households. By doing this, the

programme aims to empower women and caregivers to better utilize the meagre resources

at home in order to achieve higher nutritional outcomes for themselves and their children

like early initiation of breast feeding, exclusiveness, timely introduction of complementary

feeding, promotion of food diversity and frequency, and improved hygiene practices,

including handwashing. This component will also help in building community and

household resilience and strengthen coping mechanisms in emergency settings.

v) Iodine Deficiency Disorders/Universal Salt Iodization (IDD/USI): To achieve the USI

output, the programme will provide technical assistance to a multi-sectoral body led by

State Planning Commission and represented by the Salt Bureau, Government Commissions

and line ministries to finalize the USI plan of action and IDD legislation and to facilitate their

implementation. The USI plan of action will be guided by logframe with clear milestones

and roles and responsibilities of different partners. UNICEF will be responsible to support

key components of the plan within its mandate and will advocate for wider investment in

the salt iodization programme from the Government and other partners. The USI project

will be implemented within the context of UN Strategic Framework and technical

assistance from the UN Nutrition Sector Working Group chaired by UNICEF. The USI

programme will work closely with MoPH, Academy of Medical Sciences and with line

ministries on QC/ QA issues, internal and external monitoring, and on generating

programmatic evidence for high level advocacy. It will strengthen the collection of

disaggregated data, management and dissemination, identifying the bottlenecks and

barriers to be able to address them early to achieve USI. UNICEF will engage in policy

dialogue, advocating for budget allocations and multisectoral collaboration.

vi) Humanitarian assistance: The programme will facilitate national and regional capacity

building activities in nutrition in emergencies tosupport the Government to deliver quality

nutrition services to U5 boys, girls and PLW and other vulnerable groups during

humanitarian situations, and to protect and promote their nutritional status. . The

programme will also facilitate pre-positioning of emergency nutrition supplies at national

and at provincial medical warehouses.

vii) Geographic convergence: The programme will work closely with health and WASH

programmes to develop a minimum package of an integrated health, nutrition and WASH

services that can be delivered at different levels in the health system, but more specifically

in the convergent counties as shown in the diagram in section five.

The schematic representation of the Results Structure based on the Theory of Change is shown on the

next page. The ToC Schematic is prepared as a separate document.

33

34

Ou

tco

me

indic

ato

rs

Imp

act

ind

icat

ors

O

utp

ut

ind

icat

ors

a) Government lack capacity to

manage and coordinate multi-

sectoral nutrition programme

b) Insufficient budget allocation

c) Infrastructure and logistics

constraints

d) Sub-optimum knowledge and

practices of service providers

and care givers.

e) Data management, sensitivities

and related constraints.

Risks

a) Evidence-based advocacy

reinforced,

b) an aggressive fund raising

strategy,

c) strengthening data

management within Ministry of

Public Health and Child Data

Management Unit,

d) a comprehensive

communication strategy.

Mitigation

Strategies

1) Advocacy, policy and budget dialogue, technical assistance and scaling-up evidence-based interventions.

2) Capacity development to transfer knowledge, skills and motivation for policy makers, service providers and

caregivers, and to build community resilience and change behaviour.

3) Service delivery to ensure life-saving services and supplies in development and humanitarian settings, and to

monitor the extent to which bottlenecks and barriers are removed.

4) Cross-se toral li kages ade y applyi g the days approa h , pro oti g i tegrated ser i es i the sele ted o erge e ou ties , a d i proving coordination across line ministries by establishing

multisectoral coordination body.

5) Partnerships will be centered within the UN, with UNICEF providing leadership in nutrition, WASH and

education. UNICEF will continue to work with donors, academia and other international organizations.

Assumptions a) Political commitment to

coordinate and contribute to

implementation of the multi-

sectoral approach to address

women and children nutrition

with equity focus.

b) Political commitment to

coordinate and contribute to

implementation of the multi-

sectoral approach to achieve

USI with equity focus.

c) Government have enough

capacity and resources in food,

Health and WASH.

d) Stable and conducive

programme environment.

.

.

.

.

Programme Rationale

NUTRITION

35

7.1.4 Strategies

i) Capacity development at central level to strengthen evidence-based sector planning,

coordination, monitoring and evaluation in order to reach universal access to a

comprehensive set of evidence-based nutrition-specific interventions (as a contribution to

SDGs). MoRES will be used as a tool to monitoring and report on equity. Capacity

development of care providers at community level is needed to improve the quality of

nutrition services, screening, early referral for treatment, follow-up during treatment,

relapse prevention and to build resilience to cope with humanitarian situations.

ii) Service delivery will strengthen and improve quality and to promote effectiveness of the

nutrition interventions at community and household levels, baby-homes, nurseries and at

health facilities. UNICEF support for service delivery will target the counties and provinces

with the highest annual caseload of Severe Acute Malnutrition (SAM) to provide treatment

as a lifesaving intervention.

iii) Communication for Development (C4D) will develop nutrition education materials to

promote optimum infant and young child feeding and caring practices, promote

micronutrient supplementation (including deworming) to U5 children, adolescent girls,

WRA and PLW. Empowering women as care providers and nutrition services providers in

health facilities and day care and baby homes will be used to change behaviours and create

demand for quality nutrition services.

iv) Advocacy will aim at leveraging Government resources to establish national nutrition

coordination body to develop multisectoral policies and plans of action, and to scale-up

implementation.

v) Partnerships with WHO and WFP, line ministries and Government Commissions will

strengthen inter-sectoral linkages and enhance efficiency and synergies. This broad-based

partnership has been created, thanks to UNICEF convening power, to include, not only the

MoPH, State Planning Commission and Institute for Child Nutrition, but also the Ministry of

Agriculture, Ministry of Food Administration, the State Academy of Sciences, and

Pyongyang University of Science and Technology, inter alia.

vi) Cross-sectoral linkages will be made through the first 1,000 days of life approach, in the

convergent counties, and through the wide range of partnerships described above.

7.1.5 Assumptions and Risks

If the assumptions are wrong and risks actually materialize the transition from outputs to

desired outcome could be blocked or delayed. The logic of the causal linkages between input,

outputs and outcome will be ensured in the choice of specific activities laid out in detailed

annual work plans and monitored. The programme design makes the following assumptions:

36

Assumptions:

Government shows political commitment and has the capacity to coordinate and

contribute to implementation of the multisectoral approach to address

undernutrition and the multisectoral plan of action to achieve USI.

Openness from communities to receiving information and actually being able and

willing to change behaviours.

National capacity building mechanisms are functional.

Standards are well adopted in policy development

Government allocates sufficient human and financial resources for the programme.

Stable and conducive programme environment, particularly uninterrupted, timely

access to donor funds as well as uninterrupted cash flow and timely in-country

access to funds

Optimal use of services

Risks:

Government lacks capacity to manage and coordinate a multi-sectoral nutrition

programme

Adequate data on programme implementation, coverage and outcomes is not

made available

Insufficient budget allocation by partners or the ability to translate the allocated

budget into operational actions.

Infrastructure and logistics constraints such as accessibility, road conditions,

warehouses capacity and supply management

Given the absence of civil society partners, UNICEF inputs and outputs may be

necessary but insufficient to reach the outcome.

Communication and counselling messages on IYCF and maternal nutrition are not

feasible to implement by caregivers and households due to various external

barriers

Mitigation measures of the above risks: the programme will grasp every opportunity to

advocate with the Government and the line ministries along with the people s committees to

overcome the above risks and to work with all partners in addressing them within the Food and

Nutrition Security Thematic Group, the Nutrition Sector Working Group and the overall UNSF.

7.1.6 Monitoring outputs and UNICEF’s contribution to outcomes

The nutrition programme component will be implemented in support of the overall efforts to

promote child and women wellbeing and to achieve full realization of their rights to survive and

develop to their full potential. In this regard, the programme has already developed specific

statistical forms that will capture key indicators on performance of the project in terms of the

number of beneficiaries and quality of performance indicators (disaggregated data by age,

gender and geography). These indicators were agreed with MoPH and the Institute of Child

Nutrition and compiled in one full set and shared with CBS to be incorporated into the CDMU.

The CBS and MoPH will be able to report on these indicators on quarterly bases. The

programme will undertake regular field monitoring visits to the beneficiaries sites in the clinics,

37

counties hospitals, provincial hospitals, nurseries and baby-homes and will undertake

quarterly programme reviews with the focal persons in MoPH and ICN to properly analyse the

data and to provide feedback and corrective actions.

UNICEF s contribution towards the planned outcomes will be tracked through a programme

component monitoring plan to be developed internally in collaboration with the Monitoring

and Evaluation Specialist. The indicators in the results matrix will be tracked and updated

annually along with undertaking MoRES exercises twice during the country programme.

Progress towards the achievement of the outputs and outcome will be tracked by monitoring

selected set of indicators and milestones developed on an annual basis with the Government

counterpart and line ministries in the rolling annual work plans. Field monitoring visits will be

undertaken, some jointly with the counterpart ministries and other government bodies.

38

8 WASH Programme Strategy Note

8.1.1 Programme rationale

DPRK attained the MDG target for sanitation, but missed the target for improved water

sources, with better progress made in urban compared to rural areas.Eighteen per cent of the

population lack access to improved sanitation and two per cent (one per cent urban; three per

cent rural) lack access to improved drinking water sources (WHO/UNICEF Joint Monitoring

Platform, 2014). About 33 per cent of the population depend on dug wells, which are also

used as alternative sources of drinking water when piped water supply is non-functional.

Operational constraints such as intermittent electricity and aging and non-functional

equipment, considerably reduce the effective coverage from the piped water infrastructure for

77 per cent of households. UNICEF s analysis of recent data from a Water Assessment Survey

carried out by the Ministry of City Management (MoCM) and the Central Bureau of Statistics

(CBS) between 2013 and 2014 indicates low sustainability of pumped water delivery systems.

Approximately 49 per cent of all piped schemes are affected by intermittent power supply from

grid electricity. About 25 per cent are affected by dysfunctional pumping equipment. The

alternative sources are traditional sources (dug wells and tube wells) which require protection

from contamination. Only 20 per cent of piped schemes have water treatment plants; 6.7 per

cent of households did not at all treat drinking water from the piped systems. The situation for

learning institutions is worse where as much as 50 per cent of the child care and learning

institutions lack adequate or sustainable access to WASH services (UNICEF field observations

and MOCM/CBS Water Assessment Survey, 2013-2014).

Use of rudimentary latrine designs with shallow pits and often without slabs is common among

40 per cent of the rural population. The shallow pits require frequent evacuation and the

excreta is recycled prematurely to make compost manure. This practice creates conditions of

virtual open defecation as undecomposed faecal matter is reintroduced to the environment

and later spread on agricultural fields, where it easily comes into contact with insects, rodents

and people, and can contaminate water sources like dug wells, and food as well as the living

environment.

According to global studies, faecal contamination also causes environmental enteropathy

which adversely impacts on nutrition and contributes to stunting as it causes malabsorption of

micronutrients. The recycling of the sludge presents the risk of ingestion of faecal matter

through consumption of contaminated drinking water and food and therefore predisposes the

rural population to diarrhoea and the impact of environmental enteropathy.

These conditions are manifested in the health and nutrition of children and women. Diarrhoea

is reported to be the cause of five per cent of the deaths in children under-five, second only to

pneumonia, and is cited by teachers as the most common cause of absenteeism from school. It

is among the leading causes of hospital admissions.

The 2012 National Nutrition Survey indicated that among children below five years of age, the

prevalence rate of stunting was 28 per cent. Therefore, priority must be given to water,

sanitation and hygiene based on the direct correlation between safe drinking water, improved

hygiene practices and the nutrition, health and education outcomes for children.

During the current country programme, the construction of gravity-fed water systems (GFS)

contributed to increasing access to safe and sustainable water supply for over one per cent of

39

the population (about 250,000 people by 2014). Demand for GFS continues to grow. GFS has

proven to be sustainable solutions where they are feasible. GFS provided a relieable and a

cost-effective alternative to pumpbased water systems. This successful intervention can be

taken to scale to benefit a larger number of communities that are lacking sustainable services

for lack of electricity, or dilapidated infrastructure. Alternative energy sources, such as solar,

are needed for pumped water supply systems.

In hygiene and sanitation, consensus was reached at national level that the rudimentary latrine

designs and the present management of sludge from latrine recycled as manure in agriculture

is akin to virtual open defecation. This situation is considered among the key contributing

factors to the child mortality due to diarrhoea and to the non-clinical condition of

environmental enteropathy which is a contributing factor to the stunting in 28 per cent of the

children under-5. Both latrine designs and the management of excreta recycled for agricultural

use need improvement. The double urn sanitary latrine model adopted from China is being

piloted for adaptation to the context of DPRK at household level. Similar improvements are

under consideration for health facilities and learning institutions.

Gravity-fed schemes are popular and sustainable, though capital intensive. The DPRK

Government is willing to increase local contribution and would like to target large population

centres as a priority in the roll out of GFS country-wide. Further advocacy at high levels and at

provincial and county levels is needed to raise the profile and urgency of improving latrine

designs for households and learning institutions, and the management of excreta recycled for

use as manure in agriculture.

A hygiene behaviour education and communication strategy centring on key behaviours to

improve health and nutrition outcomes for children and women is needed to synergize efforts

in health, WASH, nutrition and education programmes. Particular effort is needed to

comprehensively address hygiene and sanitation needs of children in boarding schools and

adolescent girls in all schools, including menstrual hygiene management. .

8.1.2 The Results Structure (Outcome, Outputs, Indicators)

is presented in Annex 1

8.1.3 Theory of Change

The Theory of Change is based on an analysis of the current situation of WASH using bottleneck

analysis, causality analysis and the ten determinants framework to achieve outputs and

outcome. A multi-year context-specific and equity-focused results chain establishes linkages

between strategies, outputs and outcomes in achieving desired results. A mixed

implementation strategy, focusing on capacity development and service delivery in particular,

will facilitate this process of social change. The diagram below presents the logical link between

the current situation, existing bottlenecks and barriers, results to be achieved, and outlines

graphically the overall direction of the WASH programme for the next five years. But any vision

of social development in DPRK must be caveated by the possibility of deviations from a causal

pathway as the programme attempts to move from input to activities, and from outputs to

outcome. Programming in WASH, as in the other sectors, must be susceptible to adaptation as

the context evolves, or in the light of a humanitarian crisis.

The WASH programme component, therefore addresses the priorities described in the

programme rationale section above, and in line with the UNSF. It will contribute to improving

access to sustainable clean water supplies, ensuring water quality, and promoting improved

40

sanitation and hygiene practices, including the safe management of excreta used as manure in

agriculture. The programme will focus on schools and health facilities, respond to humanitarian

needs, and be cognisant of the specific hygiene and sanitation needs of women and girls. It will

provide technical and critical material support to complement local resources in order to

establish gravity-fed water systems. The programme will focus its activities in the ten

convergent counties prioritized in the health and nutrition programmes.

WASH programme will support policy-makers and service providers through technical

assistance,evidence-based sector planning, coordination, monitoring and leveraging of

resources for expanded service delivery. Policy dialogue will include guidance on gender

standards in WASH. Resilience at provincial, county, community and family levels will be

strengthened to cope with floods and droughts. The programme will be strengthened with

hygiene education and behaviour change communication inorder to demonstrate provitive

impact on child and maternal health and address the underlying causes of mortality due to

diarrhoea and poor nutrition, including stunting and wasting.

The schematic representation of the Results Structure based on the Theory of Change is shown on the

next page. The ToC Schematic is prepared as a separate document.

41

Ou

tco

me

indic

ato

rs

Imp

act

ind

icat

ors

O

utp

ut

ind

icat

ors

a) Inadequate data

b) Adherence to traditional

practices

c) Lack of engagement with

community

Risks

1. Evidence-based advocacy

reinforced,

2. an aggressive fund raising

strategy,

3. strengthening data

management within Ministry of

Public Health and Child Data

Management Unit,

4. a comprehensive

communication strategy.

Mitigation

Strategies

1) Advocacy, policy and budget dialogue, technical assistance and scaling-up evidence-based interventions.

2) Capacity development to transfer knowledge, skills and motivation for policy makers, service providers and

caregivers, and to build community resilience and change behaviour.

3) Service delivery to ensure life-saving services and supplies in development and humanitarian settings, and to

monitor the extent to which bottlenecks and barriers are removed.

4) Cross-sectoral linkages made by applyi g the days approa h , pro oti g i tegrated ser i es i the sele ted o erge e ou ties , a d i pro i g oordi atio a ross li e i istries y esta lishi g multisectoral coordination body.

5) Partnerships will be centered within the UN, with UNICEF providing leadership in nutrition, WASH and

education. UNICEF will continue to work with donors, academia and other international organizations.

Assumptions 1. National capacity building

mechanism are functional.

2. Global standards well adopted

in policy development.

3. Government allocates sufficient

resources.

4. Uninterrupted, timely access to

donor funds.

5. Uninterrupted cash flow and

timely in country access to

funds.

6. Optimal use of services.

.

.

.

.

Programme Rationale

WASH

42

8.1.4 Strategies

i) Capacity Development at central level to strengthen evidence-based sector planning,

coordination, monitoring and evaluation in order to reach universal access inline with

Sustainable Development Goals (SDGs). MoRES will be used as a tool for monitoring and

reporting on equity.

ii) Service Delivery to strengthenand promote sustainable accces to WASH in county towns

and ris, learning institutions and health facilities. UNICEF support for service delivery will

target the counties with the worst performance on nutrition outcomes and diarrhoea

incidence.

iii) Communication for Development (C4D) to promote good hygiene practices, to improved

sanitation and safe management of excretapractices. The programme will create demand

for services. The communication strategy will target behaviours that are most risky and

considered as major contributors to child mortality due to diarrhoea, and poor sanitation.

iv) Capacity Development at community level to strengthen WASH resilience to cope with

perennial floods and droughts.

v) Advocacy will aim at leveraging Government resources to scale up high impact nutrition-

sensitive WASH interventions; sustainability of WASH services, and promotion of

sustainable technologies.

vi) Partnerships with WHO and UNFPA, and other line ministries in efforts to make cross-

sectoral linkages.

8.1.5 Assumptions and Risks

The assumptions and risks described below reflect the fact that progress in the WASH sector

will be non-linear, with many variables coming into play that delay or accelerate the

achievement of results. Activities detailed in annual work plans will serve to tighten the logic

between inputs, outputs and the overarching outcome in the Theory of Change.

Assumptions

National capacity building mechanism are functional.

Global standards well adopted in policy development.

Government allocates sufficient resources.

Uninterrupted, timely access to donor funds.

Uninterrupted cash flow and timely in-country access to funds.

Optimal use of services.

Risks

Inadequate data

Adherence to traditional practices

Lack of engagement with community

Given the absence of a wide range of partners, UNICEF s inputs and outputs could

be necessary but insufficient to reach the planned outcome.

Mitigation measures include: reinforced evidence-based advocacy, development and

implementation of an aggressive fund raising strategy, strengthened data management within

Ministry of City Management and implementation of a comprehensive communication

strategy.

43

8.1.6 Monitoring outputs and UNICEF’s contribution to outcomes

UNICEF s contribution towards outcomes will be tracked through a programme component

monitoring plan to be developed internally in collaboration with the Monitoring and Evaluation

Specialist. The indicators in the results matrix will be tracked and updated annually using

MoRES. Progress towards the achievement of the outputs and outcome will be tracked by

monitoring appropriate indicators and milestones developed on an annual basis with the

Government counterpart ministries in the rolling annual work plan. Field monitoring visits will

be undertaken some jointly with the counterpart ministries and other partners in the sector.

9 Social Inclusion Strategy Note

9.1.1 Programme rationale

Social Inclusion was not a specific component of the 2011-2016 country programme, but has been a

core consideration in all UNICEF s work in DPRK. In the new country programme, addressing

disparities remains part and parcel of the health, nutrition and WASH components. The Social Inclusion

component supports data collection, analysis and management as essential and overarching requisites

to addressing the equity agenda, to making duty-bearers more accountable, and to strengthening

government reporting on the CRC, CEDAW and eventually the CRPD, once it is ratified. Regular and

robust data analysis will contribute to creating an enabling policy environment and effective systems

across the work of the UN, but critical to realizing the rights of all children, adolescents and women

across the sectors, including in education. The social inclusion programme component is in line with the

data and development management thematic area of the UNSF.

Positive indicators in education (shown in Table 1 below) do not justify a separate programme

component, with one notable exception – that of children with disabilities as a specifically invisible and

excluded group. For this reason, the Social Inclusion component takes a two-pronged approach –

addressing data gaps as a barrier to addressing inequity, and disability as a specific focus of social

exclusion including in education. There is anecdotal evidence of stigma associated with disabilities and

this is an issue which needs to be researched and addressed accordingly. The CP will support and

follow-up on a National Learning Assessment Study, which will include sampling of children with

disabilities, and the findings will be used to support the Education Commission in addressing inequities

identified.

Data 9.1.1.1

All information and data in DPRK are controlled by the Government, notably the Central Bureau of

Statistics (CBS) with which the UN works closely. The CBS releases official data and statistics only to the

extent that it can be convinced that it is required for the specific purpose intended. This situation

seriously impedes its ability to undertake or contribute adequately to situation analyses, monitoring,

evaluation and reporting and for this reason one of the four thematic areas in the new UN Strategic

Framework 2017-2022 is Data and Development Management .

The programme component will therefore help to address the long standing issue of lack of data and

analysis for effective sectoral planning and for monitoring and reporting on child rights and women

rights. Based on data and evidence, the programme will specifically support critical actions by the

Education Commission to address disparities faced by children with disabilities as also identified in the

UN Strategic Framework (UNSF).

44

There are significant gaps in analytical data available to the UN agencies for planning purposes, notably

national income statistics, a national MDG report, an updated Multiple Indicator Cluster Survey (MICS)

or a credible gender analysis. Data gaps limit the ability of the UN to undertake or contribute

adequately to situation analyses and confine its perspective on some issues too narrowly. This

constraint extends even to the rationale for the selection of pilot counties for UN programme activities.

Demographic Data: One area in which DPRK is exceptionally strong is that of demographic statistics.

The 2008 Census satisfied international standards and its 2018 successor is already being planned with

UNFPA support. The forthcoming UNFPA-supported Socio-Economic and Demographic Health Survey

will provide a useful complement to this. Registration data (birth and deaths) is also of a high quality, as

might be expected of a government which provides specific food rations to each of its citizens. This is

complemented by detailed patient records, thanks to the outreach capacity, dedication and diligence of

50,000 household doctors. For domestic legal and other reasons, data from the sub-national level is,

however, difficult for the UN to obtain, which makes identifying disadvantaged and vulnerable groups

more difficult.

Income data: The Government is highly restrictive on the matter of national income statistics, which

are not made available to the UN. This makes it impossible to prepare a National Human Development

Report (NHDR) and renders any assessment of DPRK's Human Development Index (HDI) and its

consequent international ranking impossible. Such data is an important baseline for much development

policy formulation.

National MDG Report: There have been similar issues relating to DPRK's efforts to prepare a National

MDG Report (MDGR) although one was prepared but not submitted by the government in 2009. One of

the metrics for measuring the current UN Strategic Framework was that of the MDGs, so this is an

important gap, especially with the expected transition to Sustainable Development Goals for the new

UNSF.

Multiple Indicator Cluster Survey (MICS): this UNICEF-designed global household survey analyses the

rights and needs of children and women and serves as the basis for determining the nature and scope

of programmes. Although a MICS was undertaken in 2009, it was never finalized because of issues with

regard to exporting data to UNICEF's central database, a difficulty that continues to stand in the way of

an updated survey. UNICEF will advocate with the Government and provide technical support to

address this problem. MICS is included as part of UNICEF s costed evaluation plan in the new country

programme.

Humanitarian Needs Assessment: Given the annual, predictable recourse to the CERF and the

international community for funding to address immediate humanitarian needs in the country, it is

important to ensure an evidence-based and independently-verified assessment of these needs,

supported by a process which is acceptable to both the Government and the UN. Donors' willingness to

continue supporting such appeals could be positively influenced by such a consensual approach to

assessments.

The Government has demonstrated impressive results in the education sector. The DPRK has

maintained near universal literacy. Any illiteracy recorded within the 2008 Census is said to be amongst

a subset of the population 80 years and above. The MICS 2009 showed a primary level (grades 1 to4)

completion rate to be well over 100 per cent with a 100 per cent transition to secondary school.

According to the EFA MDA 2008, school enrolment rate for primary schools is a 100 per cent with

complete gender parity, and the transition rate to secondary school is 99 per cent.

The 2009 MICS suggests that there is a small portion of repetition or return of drop outs as 2.4 per cent

of children of secondary school age (11-16 years) were attending primary school.

45

Indicator %

Percentage of children aged 36 -- 59 months currently attending early childhood education 97.8

Percentage of children attending first grade who attended kindergarten in the previous year 99.0

Percentage of children of primary school entry age attending grade 1 96.4

Children of secondary school age [11 -- 16 years old] attending secondary or higher school 97.1

Percentage of children of secondary school age [11 -- 16 years old] attending primary school 2.4

Net primary school completion rate 87.8

Transition rate to secondary education 100

Table 4: Select Education Data

Disability 9.1.1.1

Despite the achievement in education sector, one area where there are serious disparities is for

children with disabilities. According to the 2008 census, 6.7 per cent of the total population has a

disability (deaf 1.7 per cent; sight 2.5 per cent; mobility 2.5 per cent). The census also found that the

prevalence of disability varied by age with older people having proportionately more disability than

younger people.

The census also disaggregates data by age and Table 5 shows the total number of children with

disabilities aged 5 to 19 broken down by type of disability. This age group approximates the age of

school age children.

Age

Total

Population

Type of Impairment

Seeing

(%)

Estimated

Number

Hearing

(%)

Estimated

Number

Mobility

(%)

Estimated

Number

Use of mental

faculty

(%)

Estimated

Number

5-9

1,846,785 0.1 1,847 0.1 1,847 0.1 1,847 0.1 1,847

10-19

3,889,346 0.2 7,779 0.1 3,889 0.2 7,779 0.1 3,889

Total

5,736,131 0.2 11,472 0.2 11,472 0.3 17,208 0.2 11,472

Table 5 Number of children with disabilities by age and type of disability

There are 11 special residential schools in DPRK currently with 1,144 students. The only special schools

available are residential and only provide education to a small number of children with disabilities.

Table 3 shows the estimated number of children needing special education as well as data on those

receiving it. It is positive to note the increasing number of children receiving special education between

46

2012 and 2015 – an increase from 573 to 1,144. However, when compared to the estimated number of

school age children with disabilities, it is clear many children do not yet have their right to education

fulfilled.

The Education Commission has informed UNICEF that that parents of children with disabilities do not

want to send their children to special schools. The Korean Federation for People with Disabilities has

informed UNICEF that the reason for this is that parents to not want to send their children to school as

they are residential schools and which means the parents would only see their children twice a year. It

would be preferable for CWD to attend regular school with special classes to meet their needs

Type of

Special School

Number

of

Special

Schools

Number of

children

in special

schools (2012)

Number of

children

in special schools

(April 2015)

Estimated number of children

requiring special education

(aged 5 to 19)

(2008 Census)

Special Schools for blind

(in South Pyongyang,

South Hwanghae, South

Hamgyong.

3 49 116 Approximately 11,000

Special schools for deaf

children (in South

Pyongan, South

Hwanghae, South

Hamgyong and Kangwon

and Jagang provinces)

8 524 1028 Approximately 11,000

Table 6: Children in Special Schools

There is a serious lack of information on CWD which makes a detailed situation analysis at the

start of the programme not possible. This is in itself a bottleneck. There is, however, enough

data on the number of CWD and the number of CWD receiving education to know that there is

a serious issue that needs to be explored. Clearly, only a small number of children are in special

schools. If all of the other CWD have been mainstreamed into regular classrooms, one would

hope all teachers have been trained in how to meet the needs of these children, however,

there is no training of teachers in this regard. In establishing a system for education of CWD

that is in the best interests of the child , the option of having a classroom in a mainstream

school which caters to the needs of sensorially deprived children has not been explored in

DPRK. Much more analysis and advocacy is needed for CWD in the new Country Programme.

47

9.1.2 The Results Structure (Outputs, Outcomes, Indicators)

Levels Indicators Baseline Target MoV Geographical

focus Risks and Assumption

Outcome Statement:

By 2021, Government

uses disaggregated data

for equity-focused

social policy

development and

planning, and reporting

on the rights of children

and women.

# of sectors using

current disaggregated

data in policies and

plans

CRC/CEDAW/CRPD

reports use current

disaggregated data

NA

NA

4 sectors (Health,

Nutrition, WASH and

Education)

3 reports

(CRC/CEDAW/CRPD)

Sectoral policies and

plans

CRC/CEDAW/CRPD

Report

National Assumptions:

Government is committed

to disaggregated data

generation and use

Government accepts human

rights approaches critical to

inclusive development

Risks:

Political sensitivities to

making child rights related,

disaggregated data available

Social attitudes to

marginalization and

mistreatment do not change

Discrimination difficult to

quantify and aggregate

Output Statement:

By 2021, the Central

Bureau of Statistics has

capacity to coordinate,

analyse and

disseminate

disaggregated data

related to children,

adolescents and

women

CBS (CDMU) reports on

a set of indicators for

children, adolescents

and women.

Nil 3 reports CDMU report National

Output Statement: By National learning NA Assessment Reports Assessment reports National

48

2021, the Education

Commission uses

evidence based

planning to improve

learning outcomes and

address the needs of

children with

disabilities.

achievement

assessments

National guidelines for

learning outcomes

National Plan for

Inclusive Education

NA

NA

National plan

National guidelines

National Plan

National guidelines

49

9.1.3 Theory of Change

The Theory of Change is based on analysis of the current situation and context specific interventions to

achieve desired results. There are several barriers to the more effective use of data to support planning and

removing bottlenecks and barriers. To develop the outcome level results, the key bottlenecks were

identified and analyzed to overcome them. Capacity development, evidence generation, policy dialogue and

advocacy, partnership building, south-south and triangular cooperation and service delivery were identified

as key strategies to facilitate the process of change. The following diagram presents the logical link between

the current situation, results to be achieved and providing a clear overall direction. As in all Theories of

Change, progress will be dependent on multiple variables, both constraints and opportunities, upon which

success in reaching the overarching outcome will depend, along with the outputs of other partners and

stakeholders, especially Government, in reaching that outcome.

The schematic representation of the Results Structure based on the Theory of Change is shown on the next

page. The ToC Schematic is prepared as a separate document.

50

Ou

tco

me

indic

ato

rs

Imp

act

ind

icat

ors

O

utp

ut

ind

icat

ors

a) Political sensitivities to making

child rights related,

disaggregated data available

b) Social attitudes to

marginalization and

mistreatment do not change

c) Discrimination difficult to

quantify and aggregate

Risks

1. Evidence-based advocacy

reinforced,

2. an aggressive fund raising

strategy,

3. strengthening data

management within Ministry of

Public Health and Child Data

Management Unit,

4. a comprehensive

communication strategy.

Mitigation

Strategies

1) Advocacy, policy and budget dialogue, technical assistance and scaling-up evidence-based interventions.

2) Capacity development to transfer knowledge, skills and motivation for policy makers, service providers and

caregivers, and to build community resilience and change behaviour.

3) Service delivery to ensure life-saving services and supplies in development and humanitarian settings, and to

monitor the extent to which bottlenecks and barriers are removed.

4) Cross-se toral li kages ade y applyi g the days approa h , pro oti g i tegrated ser i es i the sele ted o erge e ou ties , a d i pro i g oordi atio a ross li e i istries y esta lishi g ulti-sectoral coordination body.

5) Partnerships will be centered within the UN, with UNICEF providing leadership in nutrition, WASH and

education. UNICEF will continue to work with donors, academia and other international organizations.

Assumptions 1. Government is committed to

disaggregated data generation

and use

2. Government accepts human

rights approaches critical to

inclusive development

3. Community is willinjg to accept

the behavior change, related to

caring and infant feeding

practices.

.

.

.

.

Programme Rationale

Social Inclusion

51

9.1.4 Key partners

The Social Inclusion Programme Component will work with a number of partners as detailed below.

The Child Data Management Unit (CDMU) of the Central Bureau of Statistics (CBS)will be a cornerstone of

this programme. UNICEF will support the strengthening of its capacity to undertake data analysis and

research, and update the 2009 MICS indicators. The programme aims to identify the patterns and locations

of exclusion and inequality through the collection, analysis and reporting of quality data. Based on routine,

disaggregated, gender-sensitive data, programmes across the social sectors can be better planned,

implemented, monitored and evaluated with the prime purpose of closing the inequity gap. Understanding

the immediate, underlying and root causes of vulnerability, and with knowledge supported by reliable

evidence, the programme will contribute to policy dialogue and programming, to reporting to the

Committee on the Rights of the Child, CEDAW and CRPD, and to building resilience in both humanitarian and

non-emergency settings.

Decision-makers in key ministries and Government institutions will become aware of their obligations as

duty-bearers, have the capacity to track indicators, and to remove the bottlenecks and barriers that lie in the

way of social inclusion. These ministries and institutions will include Ministry of Public Health, Education

Commission, Ministry of Foreign Affairs, Ministry of City Management, and the Grand People s Study House.

The National Commission for Disaster Management (NCDM) will have increased capacity in planning based

on vulnerability mapping and in responding to humanitarian situations in order to reach the most vulnerable

communities.

The Division for Human Rights of theMinistry of Foreign Affairs is responsible for reporting on all conventions

as well as the Universal Periodic Review. UNICEF will provide support to the Division for the preparation of

reports.

The Education Commission will play a central role in ensuring that disaggregated data and measurement of

learning outcomes will sharpen education planning, monitoring and evaluation towards enhancing learning

achievement, reducing geographic disparities, and addressing inequities, with a specific focus on addressing

the educational needs of children with disabilities. The Korean Federation for People with Disabilities is

active in addressing issue of inclusion for people with disabilities.

9.1.5 Strategies

i) Capacity development. Capacity development will be a main UNICEF implementation strategy for this

component. To strengthen the capacity of the Central Bureau of Statistics, UNICEF focuses on training

and technical assistance in the areas of data management and analysis. Communication for development

will address stigma and discrimination towards children with disabilities and also to encourage demand

for special education services. The programme will support more systematic use of disaggregation to

enhance equity-focused design and implementation of policies and programmes and to strengthen

reports on the CRC, CEDAW and CRPD, once it is ratified.

ii) Evidence generation, policy dialogue and advocacy. The programme will generate insights and evidence

that contribute to the realization of child rights and the promotion of equity. The programme will

support policy dialogue and advocacy objectives, including emphasis on the obligations of human rights

duty-bearers and to address issues of equity, most notably for children with disabilities to have equitable

access to education.

iii) Partnerships. UNICEF will work closely with other UN Agencies under this programme component to

strengthen the use of data under the fourth UNSF thematic area of Data for Management .

52

iv) South-South and triangular cooperation will be an important strategy under this component and will

actively support experience exchange with other countries in the areas of data management, CRC

promotion and in the area of inclusive education.

v) Support to integration and cross-sectoral linkages. Effective generation and use of data for planning

and policy development will require support to integration and cross-sectoral linkages as an explicit

implementation strategy. This strategy will contribute to and inform evidence generation, policy

dialogue and knowledge management specific to cross-sectoral dimensions. The CRC/CEDAW/CRPD will

be promoted across Ministries. The needs and rights of disabled children will be addressed through

programmes in health, nutrition,WASH, and in humanitarian situations.

vi) Service delivery will not be specifically supported in this programme component. If policies and plans

are in place, service delivery in the area of special education with the objective of addressing inequities

in education, may be considered at the mid-term review. However,UNICEF does not foresee a

construction component in the programme as the focus will be on providing services in mainstream

schools.

9.1.6 Assumptions and Risks

The assumptions and risks described below reflect the fact that progress will be non-linear, with many

variables coming into play that will delay or accelerate the achievement of results. Activities detailed in

annual work plans will serve to tighten the logic between inputs, outputs and the overarching outcome in

the Theory of Change.

Assumptions:

Social Inclusion is accepted as part of the development paradigm and the basis of policy and

programming dialogue

The Central Bureau of Statistics is willing to make to make data available.

The Child Data Management Unit functions effectively

The Government conducts the Learning Needs Assessment in 2016 and is willing to address the

inequities identified.

Government will allocate financial and human resources to strengthen education for children with

disabilities.

UNICEF will be able to build the capacity of Government counterparts.

Risks:

Funding is not available.

The identified assumptions are not valid

The capacity of Government counterparts is insufficient.

Government lack capacity to manage and coordinate multi-sectoral data management.

Data management, sensitivities and related constraints.

Potential contextual barriers (including stigma social attitudes to disabilities and inclusion, sensitively to

data)

Given the absence of partners, UNICEF inputs and outputs could be necessary but insufficient to reach

the planned outcome.

The mitigation measures include re-enforced evidence-based advocacy, an aggressive fund raising strategy,

strengthening data management within Ministry of Public Health and Child Data Management Unit, Ministry

of City Management, and implementation of a comprehensive communication strategy.

53

9.1.7 Monitoring Outputs and Demonstrating UNICEF’s Contribution to

Outcomes

UNICEF contribution towards the outcome and will be tracked through a monitoring plan to be developed

internally. The indicators in the results matrix will be tracked and updated on an annual basis. Progress

towards the achievement of these outputs and outcomes will be tracked through MoRES, and by monitoring

appropriate indicators and milestones developed on an annual basis with the Government counterpart

ministries in the rolling annual work plans. Field monitoring visits will be undertaken some jointly with the

counterpart ministries and other partners in the sector.

54

10 Fundraising Strategy

The overarching goal of UNICEF DPRK s fund raising strategy is to proactively mobilize resources for

children and ensure predictable and long-term funding to facilitate quality programming by UNICEF

for the most disadvantaged children in the country.

The current country programme 2011-2015 has an approved budget of 9.3 million Regular Resources

(RR), and 118.8 million of Other Resources (OR). The RR increased to 12.3 million because of the

one-year extension of the current CP. Forty-five per cent of RR goes to funding staff salaries.

Fundraising for DPR Korea has traditionally proven difficult. The unpredictability of funding

enviroenemnt has been the most challenging factor to design and implement programmes to

improve health and nutrition status of children and women in DPRK .

Despite injections of multilateral OR received through GAVI (3.2 million in 2015) and the Global Fund

for AIDS, Tuberculosis and Malaria (3.3 million in 2015), as of December 2015, the unfunded portion

of OR stood at 28 per cent. Apart from GAVI and The Global Fund, other resources, when they are

secured, are usually short-term.

Programme

Ceiling amount as per

Country Programme

Document (Planned)

Total Funded Amount from

1 Jan 2011 to 24 Sep 2015

Other

Resources

Funding

Gap

Unfunded

Regular

Resources

Other

Resources

Regular

Resources

Other

Resources

(a) (b) (c) (d) ( e) f = e/b

Health 1,396,000 83,842,000 4,510,042 68,186,762 15,655,238 19%

Nutrition and care 2,326,000 10,000,000 2,631,043 7,702,200 2,297,800 23%

WASH 1,396,000 12,500,000 2,004,150 5,169,781 7,330,219 59%

Education 2,326,000 10,000,000 2,227,827 5,055,418 4,944,582 49%

Advocacy 930,000 2,500,000 486,546 -- 2,500,000 100%

Cross sectoral 931,000 -- 817,206 8,844 -8,844

Total 9,305,000 118,842,000 12,676,814 86,123,005 32,718,995 28%

Out of US$ 12,676,814 Regula Resources funded, US$ 2,369,035 represent Emergency loan funds and US$

198,992 are 7% set-aside funds.

Table 7: Funding Status as of September 2015 (US$)

During the current country programme, there has been a worrisome decline in the number of

donors: The Government of Australia informed the office in 2014 that they were stopping further

funding; the German National Committee does not appear to be interested in continuing support

55

past 2015; the Australian NatCom has stopped funding; support from the Norwegian Committee for

UNICEF has not continued; the Swiss Government has indicated they will no longer fund the WASH

programme beyond 2015. The Norwegian Government was contacted for possible support but has

not resulted in funding.

CERF funding for the UN System through the underfunded emergency window declined significantly

over the course of the current country programme from a high of USD 15.4 million in 2011 to only

USD 2 million in 2015 in light of competing global emergencies. The level of CERF funding is unlikely

to increase and is likely to decline further if not totally discontinued. While an additional USD 2.5

million in funding was received from CERF in 2015 though the Rapid Response window for the

drought, again this kind of support is situational and is not likely to be repeated.

Republic of Korea (ROK) is the largest government resource partner to UNICEF DPRK and the

Ministry of Unification (MoU) channels the aid fund which is not considered to be a part of Korean

ODA. MoU started to provide humanitarian assistance funds to DPRK through UNICEF s program

since 2003. Since then, the level of contributions from MoU to UNICEF has been increased, but the

lingering political tension between ROK and DPRK makes year by year support highly unpredictable.

As the ROK is the only provider of basic vaccines and essential medicines and their funding

commitments are only made annually through a protected and uncertain consideration process, the

programme faces constant uncertainty.

UNICEF DPRK programme funded by MOU is mainly in the areas of health and nutrition, and data

collection. In 2009, ROK stopped funding UNICEF s WASH programme, which involves construction

of gravity-fed water systems as one of its components and requires pipes and cement. UNICEF was

informally told that the ROK government was reluctant to support this programme component due

to fear on potential diversion of supplies such as pipes and cement for other purposes.

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

$0.5 mil

$1 mil

$1 mil

$2.2 mil

$1 mil

$4.1 mil

$3.9 mil

Nil $5.6 mil

Nil $6.04 mil

Nil $ 4.0

ORE ORE ORE ORE ORE ORE ORE ORE ORE ORE

Table 8: MoU’s contributions to UNICEF, 2003-2015

UNICEF and Ministry of Unification worked to develop new and multi-year partnership agreement

and in May 2015, the UNICEF Executive Director and Minister signed the Memorandum of

Understanding (MOU) on the Partnership Programme 2015-2020 for DPRK Children ; however, the

MoU does not specify the levels of support beyond USD 4 million for health and USD 2 million for

nutrition in 2015. In May 2015, Ministry of Unification provided USD 4 million for UNICEF Health

programme after the agreement signing; however the ROK has still not met its commitment in the

MOU to provide funding for nutrition in 2015. .

It is clear from the graph below that ORR with the Global Fund and GAVI artificially inflates the total

programmable budget. Funding from RR, ORR and ORE remains flat or is declining. It is against a

backdrop of a shrinking resource base and an unpredictable fundraising environment that the broad

lines of a strategic vision need to be drawn.

56

Funding sources Amount Total

2011 2012 2013 2014 2015 2011-2015

RR 3,686,379

1,593,480

1,933,993

2,668,489 2,799,473

12,681,814

ORR 8,853,808

13,060,656

16,899,857

12,417,259

36,215,663

87,447,243

ORR without

GF/GAVI 1,773,987

2,425,314

5,196,856

3,069,682

7,993,808

20,459,648

ORE 4,065,040

8,199,446

7,550,527

8,175,142

6,963,718

34,953,873

GF 7,079,821

10,536,752

11,244,637

9,271,380

22,189,646

60,322,235

GAVI Fund -

98,590

458,363

76,197

6,032,209

6,665,360

Total Funding 16,605,227

22,853,582

26,384,376

23,260,891

45,978,854

135,082,930

Table 9: Summary of Types of Funding by Year

-

5,000,000

10,000,000

15,000,000

20,000,000

25,000,000

30,000,000

35,000,000

40,000,000

45,000,000

50,000,000

2011 2012 2013 2014 2015

Ye

arl

y F

un

din

g (

$)

Year

DPRK Funding: 2011-2016

RR ORR ORR without GF/GAVI ORE GF GAVI Fund Total Funding

57

5.1 Factors continuing to declining funding:

Attracting funds to DRK is hampered by the general global perspective of the country which is

reinforced by the fact there are sanctions imposed on it. The country s self-imposed isolation and

the limited information available globally and to donors, reinforces the general perception.

The following concerns are shared with UNICEF by current and potential donors with regard to DPR

Korea:

Monitoring is perceived to be insufficient to ensure that all supplies reach to the intended

end-users.

Inadequate technical support to ensure supplies are effectively used: The need for balance

between supply and technical assistance.

Insufficient data available on the real situation.

Donors believe that the Government should increase their contributions to the social sector.

( Donor fatigue or expecting more responsive governance)

There are competing global needs for humanitarian funds.

Difficult for the public to support fund raising for DPRK due to the public s lack of trust of the

Government

Concern supplies have dual purpose and will be diverted.

5.2 Historical source of funds by programme

The Health Programme has reviewed funding from ROK for vaccine and essential medicine and also

funds form GAVI for the immunization and health system strengthen programme. With the GAVI

funding extending to 2018 and are the only source of long term predictable funding. Indications are

that GAVI will continue funding past 2018, but at a reduced level.

The TB and Malaria programme is 100% funded by the Global Fund and UNICEF has funds until mid-

2018.

This is a well-funded programme; however, it is a standalone programme and does not support

UNICEF s main goals, rather UNICEF, as the Principle Recipient, serves as a contractee to support

WHO s mandate in TB and Malaria.

The UNICEF WASH programme has received SDC funding – which will not continue beyond 2015 –

and global thematic funding.

The Education Programme has never received funds from any donor directly and the only funds uses

are global Thematic Funds and RR.

UNIC

EF

DPR

Korea

:

Sourc

es of

Funds

-

2011

to

2015

$58,998,880 $20,023,876

$14,621,666 $10,886,988

$6,665,360 $5,236,595

$2,691,492 $1,440,803

$711,214 $559,129 $530,004 $509,951 $275,896 $243,132 $220,153 $28,038

The Global Fund to Fight Aids, Tube

Republic of Korea

The GAVI Fund

Canada/IHA

German Committee for UNICEF

Switzerland

Micronutrient Initiative

Consolidated Funds from NatComs

58

5.3 Fund-Raising and Leveraging Resources Strategy: It is expected that the UNICEF Executive Board will approve the aggregate indicative budget of

US$ 12,735,000 million in RR, subject to the availability of funds, and US$ 58,636,589 million in ORR

for 2017-2021 (a reduction from the previous cycle of 58 per cent.) The major reason for the decline

is there is no money from the Global Fund past 2018.

UNICEF DPRK will revise its overarching resource mobilization strategy to support the country

programme to reflect the new country programme priorities and the changing funding environment.

UNICEF DPR Korea s resource mobilization strategy will combine the following key actions:

i) The Government of DPRK: Advocate with the Government for increased co-funding for GAVI

supported immunization programme and for their own funding for basic vaccines; seek to

leverage increase local resources for the WASH Programme and for gravity-fed water systems

(GFS) where UNICEF will provide technical support and will supply only the critical inputs and key

components not available nationally; seek to leverage more local resources in the areas of

nutrition; generally UNICEF s advocacy focus will be on areas to be taken over by Government

as part of the self-reliance philosophy.

ii) UNICEF DPRK: Improve the quality of monitoring and donor reports seeking writing assistance

from professional communicators. Hiring a communications consultant to develop a donor

toolkit using human interest stories and showing success stories. Consider a fundraising tour by

the Representative, armed with presentations and toolkit, to various potential donor and

NetCom s - Russia, China, Viet Nam, Cambodia, and other countries/multilaterals that have

representations in Pyongyang. Advocate with NCC to grant visas for visiting donor delegations

from diverse countries. Directly engage with the new Regional Director for increased thematic

funding as per EAPRO s regional priorities such as the ' first 1,000 days' and 'second generation

focus.

iii) Consolidating the current funding base: Make bi-annual visits to Seoul to meet Government

officials, the Korean Committee for UNICEF and Embassies. Use home leaves of IPOs to make

visits to current and potential donor governments and NatComs, such as to SIDA and Canadian

government. Strengthen relations with the Ministry of Unification (ROK) by operationalizing

the Memorandum of Understanding through establishing a more systematic process for

submitting proposals toward increasing predictability.

59

iv) Reaching out to non-traditional donors: Explore funding with new partners including the BRICs

(Brazil, Russian, India, and China), Vietnam and others.

v) Korean diaspora in the USA, Europe and China: Explore working with the US and Canadian

NatComs to fundraise with the Korean diaspora (diaspora in USA: 2 million; in Canada 200,000).

Look into the possibility of individual philanthropy through organizations such as Acumen.

As effective programmes are the best fundraising tools, the office will emphasise evidence-based

management through strong technical competencies, results-based monitoring and reporting and

more flexible UNICEF internal processes. UNICEF will address some of the donors concerns that have

an impact of fundraising in the new country programme by strengthening monitoring and evaluation

and technical support.

UNICEF will also ensure that all fundraising proposals include funding for the Social Inclusion and

Programme Effectiveness components of the Country Programmes ensuring adequate funding for

evaluation, communication for development, and operating expenses.

Contingency Planning: In the event that other resources become severely limited, UNICEF will

prioritize support for the most impactful life-saving interventions in the country programme namely

the immunization programme, the provision of essential medicines and the treatment of severely

malnourished children.

60

ANNEX 1: CPD 2017-2021: Result Matrix

Health Programme

# Levels Indicators baseline target MoV

geographical

focus

Assumption and

Risks

1.10 Outcome Statement:

By 2021, maternal

mortality reduced

from 87 to 57, U5M

reduced from 25 to 16,

and tuberculosis and

malaria prevented and

controlled.

% of under one children and

pregnant women fully

vaccinated.

94% (Q2 EPI

report 2015)

98% Health Information

Management

System (HMIS)

Coverage

Evaluation Survey

(CES), A Promised

Renewed (APR),

National TB &

Malaria

Surveillance

Systems,

DHS/MICS, IMNCI

evaluation

National Assumptions

1. National capacity

building

mechanism are

functional.

2. Global standards

well adopted in

policy

development.

3. Government

allocates sufficient

resources.

4. Uninterrupted,

timely access to

donor funds.

5. Uninterrupted

cash flow and

timely in country

access to funds.

6. Optimal use of

services.

% of under five children with

diarrhea received ORS.

6% (Promise

Renewed

2015)

3% National

% of under five children with

pneumonia treated with

antibiotics.

14% (Promise

Renewed

2015)

7% 50 counties

Case Notification Rate of all

forms of TB per 100,000

population

394 (National

TB

Surveillance

System, 2013)

414 190 counties

% of population at-risk

covered by LLINs

51.9%

(National

Malaria

Surveillance

System, 2013)

100% 123 counties

% of Households in targeted

areas covered by IRS

81.4%

(National

95% 123 counties

61

Malaria

Surveillance

System, 2013)

Risks.

1. Non acceptance

of global standards

and approaches.

2. lack of funds

3. No reliable data

available.

4. Possible cultural

resistance.

1.1.1 Output Statement: By

2021, the Ministry of

Public Health (MoPH)

has knowledge, skills

and evidence to

develop, implement

and monitor MNCH

national policies,

strategies, tools and

guidelines.

# of national guidelines

developed, implemented

and monitored on newborn

care, community IMNCI,

EmONC and equity in

immunization.

0 (new

initiative)

3 National guidelines

on equity in

immunization,

community IMNCI,

ENAP and EmONC

National

1.1.2 Output Statement: By

2021, a package of

knowledge, skills and

tools available to

ensure equitable

access to quality

maternal, neonatal and

child health services

including EmONC.

# Training materials on EPI,

EmONC, and IMNCI

developed, implemented

and monitored.

0 (new

initiative)

3 Training materials,

training reports and

performance

assessment

National

# of counties scaled up

evidence-based

interventions

0 (new

initiative)

208 HMIS National

# of counties with training

centres and trained staff

0 10 # of training center

established

Monitoring reports

10 counties

62

1.1.3 Output Statement: By

2021, health system

provides equitable

access to quality

immunization and

IMNCI services.

# of health facilities

equipped with immunization

services

208 1200 EPI reports

Coverage

evaluation survey

(CES)

National

# of counties implement

EmONC package

16 26 HMIS 26 counties

# of EPI managers and

vaccination staff trained on

vaccine & cold chain

management.

600 5,000 Training report National

% of U1 Pentavalent

coverage

% of mother with TT2+

coverage

94% (EPI

report 2015)

98% (EPI

report 2015)

98%

98%

EPI reports

Coverage

evaluation survey

(CES)

DHS/MICS

National

2 Effective Vaccine

Management

(EVM)Assessment

conducted

0 1 (EVM

2018)

EVM assessment

report

National

CES conducted

0 1 CES report National

# of counties implement

community IMNCI

10 50 Training reports

counties

implementing

50 counties

IMNCI Evaluation 0 1 Evaluation report National

63

# of HHDs trained on

community IMNCI

500 5000 Training reports

Monitoring reports

50 counties

Output Statement: By

2021, MoPH provides

quality-assured

diagnosis, treatment of

malaria cases, and

implements targeted

vector control

interventions.

% of suspected malaria cases

that receive a parasitological

test at public sector health

facilities

88.9%

(National

Malaria

Surveillance

System, 2013)

98% Quarterly Lab,

M&E, and

Supervisory

Reports; NMP

Surveillance system

123 counties

Number of LLINs distributed

to at-risk populations

through mass campaigns

711960

(National

Malaria

Surveillance

System, 2013)

866100 Quarterly M&E

Report; NMP

Surveillance system

123 counties

% of population protected

by IRS within the last 12

months

81.4%

(National

Malaria

Surveillance

System, 2013)

95% Quarterly M&E

Report; NMP

Surveillance system

123 counties

1.1.4 % of target population that

receive Mass Primaquine

Prevention Treatment

(MPPT)

30.2%

(National

Malaria

Surveillance

System, 2013)

95% Quarterly M&E

report; NMP

Surveillance system

123 counties

1.1.5 Output Statement: By

2021, MoPH scales up

preventative,

diagnostic and

treatment services for

TB and MDR TB cases.

# of notified cases of all

forms of TB

97665

(National TB

Surveillance

System, 2013)

100044 NTP Quarterly M&E

Report; TB patient

register; TB

treatment card; TB

R&R system

190 counties

# of children <5 receiving IPT NA 6650 NTP Quarterly M&E

Report; TB R&R

system

190 counties

64

% of previously treated TB

patients receiving DST

1.7%

(National TB

Surveillance

System, 2013)

9% NTP Quarterly M&E

Report; TB R&R

system

190 counties

# of bacteriological

confirmed drug resistant TB

cases notified

240 (National

TB

Surveillance

System, 2013)

525 NTP Quarterly M&E

Report; TB R&R

system

190 counties

65

CPD 2017-2021: Result Matrix

Nutrition Programme

# Levels Indicators Baseline Target MoV Geographical

focus

Assumptions and Risks

1.1 Outcome: By 2021,

adolescent girls, WRA, PLW

and U5 children utilize

nutrition services equitably

and practise age and context

appropriate behaviours for

the prevention and

treatment of undernutrition.

% infants who initiated BF within

one hour.

% infants <6 months exclusively

breastfed

% 6-23 months old children

received age-appropriate

Minimum Acceptable Diet.

% 6-23 months old children

received MMNP (Sprinkles).

% of HH consumed adequately

iodized salt

% of SAM children treated

% pregnant women received

MMNT (tablets).

% children 6-59m received bi-

annual doses of Vitamin A & Age

appropriate deworming.

% of lactating women received

MMNT (tablets).

28%

69%

26%

20%

25%

40%

20%

98%

30%

All the

above from

the 2012

NNS.

60%

80%

50%

50%

50%

50%

40%

98%

50%

National nut.

status survey

MICS, DHS.

Health and

Nutrition Info.

Management

system

Routine data on

SAM treatment,

MMNP

(Sprinkles) & VAS

and deworming

coverage data

CMAM

evaluation.

National and

convergence

counties-

CMAM

Assumptions:

a) Political commitment to coordinate

and contribute to implementation of the

multisectoral approach to address

women and children nutrition with

equity focus.

b) Political commitment to coordinate

and contribute to implementation of the

multisectoral approach to achieve USI

with equity focus.

c) Government have enough capacity

and resources in food, Health and

WASH.

d) Stable and conducive programme

environment.

e) Community is willing to accept the

behavior change, related to caring and

infant feeding practices.

Risks:

a) Government lack capacity to manage

and coordinate multi-sectoral nutrition

programme

b) Insufficient budget allocation

c) Infrastructure and logistics constraints

d) Sub-optimum knowledge and

practices of service providers and care

givers.

e) Data management, sensitivities and

related constraints.

66

1.1.1 Output Statement -1: By

2021, the MOPH has

developed, implemented

and monitored a

comprehensive package

of women, adolescent and

child related nutrition-

specific interventions.

Proportion of hospitals

implementing the CMAM-IYCF

counselling package of services.

Proportion of hospitals which

received supportive supervision

visits;

Proportion of counties submitting

timely and complete monitoring

data

number of planned bottleneck

analysis exercises undertaken, etc

90/208

(43%)

20%

0%

0

208

(100%)

60%

60%

3

Nutrition-

specific set of

interventions

are under

implementation

at national

level.

1.1.3 Output Statement-2: By

2021, the State Planning

Commission (SPC) and

Ministry of Chemical

Industry (MCI) have

implemented and

monitored the national

plan to achieve USI.

% of households using

adequately iodized salt IDD survey among Pregnant

women – Median Urinary Iodine

Concentration (MUIC)

25% MICS

2009

96.8ug/L

<100

among

school age

children in

all

provinces

except

Pyongyang

(134) and

N Pyongan

(102) (IDD

survey-

2010

50%

150-249

ug/L.

National

Nutrition

Survey, IDD

survey among

pregnant

women, MICS,

DHS

National

67

CPD 2017-2021: Result Matrix

Social Inclusion Programme

# Levels Indicators Baseline Target MoV Geographical

focus

Risks and Assumption

1.1 Outcome Statement:

By 2021, Government

uses disaggregated

data for equity-

focused social policy

development and

planning, and

reporting on the rights

of children and

women.

# of sectors using

current disaggregated

data in policies and plans

CRC/CEDAW/CRPD

reports use current

disaggregated data

NA

NA

4 sectors (Health,

Nutrition, WASH and

Education)

3 reports

(CRC/CEDAW/CRPD)

Sectoral policies and

plans

CRC/CEDAW/CRPD

Report

National ASSUMPTIONS:

Government is

committed to

disaggregated data

generation and use

Government accepts

human rights

approaches critical to

inclusive development

RISKS:

Political sensitivities to

making child rights

related, disaggregated

data available

Social attitudes to

marginalization and

mistreatment do not

change

68

Discrimination difficult

to quantify and

aggregate

1.1.1 Output Statement:

By 2021, the Central

Bureau of Statistics has

capacity to coordinate,

analyse and

disseminate

disaggregated data

related to children,

adolescents and

women

CBS (CDMU) reports on a

set of indicators for

children, adolescents

and women.

Nil 3 reports CDMU report National

1.1.2 Output Statement: By

2021, the Education

Commission uses

evidence based

planning to improve

learning outcomes and

address the needs of

children with

disabilities.

National learning

achievement

assessments

National guidelines for

learning outcomes

National plan for

enrolment and retention

NA

NA

NA

Assessment Reports

National plan

National guidelines

Assessment reports

National Plan

National guidelines

National

69

of children with

disabilities

CPD 2017-2021: Result Matrix

WASH Programme

70

# levels indicators baseline target Move geographical

convergence

Assumptions

and Risks

1.1 Outcome

Statement: By

2021, women and

children have

equitable access

to sustainable,

clean water and

sanitation

services, and

practise improved

hygiene and

sanitation

behaviours

including in

humanitarian

situations.

(1) % of national population using improved

and safely managed drinking water services

(2) # of health care facilities with basic water,

sanitation and hygiene facilities

(3) Average weekly time spent in water

collection (including waiting time at public

supply points) {by gender, age and location}

(4) % national pop using improved and safely

managed sanitation services

(5) % of national households with a hand

washing facility with soap and water in the

household

(6) % national pop practising virtual open

defecation (safely using faecal matter in

agriculture)

(7) % schools (nationally) providing gender

and disability-friendly basic sanitation

facilities including handwashing

(1) 77% (derived from

CBS/MOCM Water

Assessment, 2013)

(2) Unknown

(3) Unknown

(4) 82% (WHO/UNICEF

JMP, 2014)

(5) Unknown

(6) 23 % (Virtual open

defecation, derived from

field observations and

WHO/UNICEF JMP, 2014)

(7) Unknown

(1) 90%

(2) At least 20%

above the

baseline

(3) less than 8

hours per week

(4) 92%

(5)100% by 2021

(6) reduced to

less than13%

(7) 20% above

the baseline

MICS; Census;

DHS/equivalent

survey; EMIS;

HMIS; Water

Assessment

Surveys and

other surveys;

Annual

WHO/UNICEF

JMP reports

convergence

Counties

(CMAM, SAM,

High diarrhoea,

low WASH

coverage)

Assumptions

1. Govt

facilitates

multi-

sectoral

approaches

2. Govt will

increase

fund

allocation

3. Adequate

resources

are available

Risks

1.

Inadequate

data

2.

Adherence

to

71

1.1.1 Output

Statement: By

2021, government

has developed,

implemented and

monitored WASH

Strategy and

Action Plan

reflecting a multi-

sectoral approach.

WASH strategy and implementation

guidelines with a Multi-sectoral action plan

Not developed Developed Government

records

National traditional

practices

3. Lack of

engagement

with

community

1.1.2 Output

Statement: By

2021, selected

cooperative farms,

households,

schools and health

facilities in 10

convergence

counties apply

knowledge and

skills to practise

hygiene

behaviours and

safe use of faecal

matter in

agriculture.

(1) % pop in target areas using improved and

safely managed sanitation services

(2) % pop in target areas using improved and

safely managed drinking water services

(3) % pop in target areas with a hand

washing facility with soap and water in the

household.

(4) Average weekly time spent in water

collection (including waiting time at public

supply points) {by gender, age and location}

(1) unknown (TBA during

the Feasibility study)

(2) unknown (TBA during

the FS)

(3) unknown (TBA during

the FS)

(4) unknown (TBA during

the FS)

(1) 92% by 2021

(2) 90 % by 2021

(3) 100 % by

2021

(4) less than 8

hours per week

MICS; Census;

DHS/equivalent

survey; EMIS;

HMIS; Water

Assessment

Surveys and

other surveys;

Field

monitoring and

evaluation

reports

convergence

counties

72

1.1.3 Output

Statement: By

2021, water

quality testing

data, meeting

international

standards, used

for water sector

policy dialogue.

(1) minimum national standards for water

quality surveillance published

(2) % of counties (nationally) conducting

routine water quality surveillance in

accordance with the national standards

(1) No

(2) Unknown

(1) Yes

(2) 80%

Assessment

survey

Convergence

counties

1.1.4 Output

Statement: By

2021, people's

committees in 10

convergence

counties have the

capacity to assess

WASH needs,

plan, manage and

monitor WASH

services.

(1) % County Peoples Committees in target

areas complete feasibility and design studies

and raise local contribution for WASH for All

(2) % county Peoples Committees in target

areas that receive DPRK/UNICEF support for

WASH for All

(1) Unknown

(TBA:Central Planning)

(2) Unknown (CPAP)

(1) 100%

(2) TBD

(CPD/CPAP)

Feasibility and

Design Reports

convergence

counties

(1) 100 % County Peoples Committees in

target area have core trainers for

Management of Maintenance and Operation

of WASH services

(2) 100 % of WASH schemes in target area

have trained operators

(3) % WASH schemes in target area with

breakdowns exceeding 30 days before repair

(1) No

(2) No

(3) Unknown

(1) Yes

(2) Yes

(3) less than 10%

Surveys

73

1.1.5 Output

statement: By

2021, the capacity

of the State

Commission for

Emergency and

Disaster

Management

strengthened for

multi-sectoral

response in line

with the Core

Commitment for

Children, and to

build community

resilience.

(1) National WASH resilience standards

developed

(2) 100 % drought/flooding prone counties

have Provincial flood/ drought preparedness

plan

(3) 100 % vulnerable counties implementing

mitigation/ contingency plans for WASH

resilience

(1) No

(2) No

(3) No

(1) Yes

(2) Yes

(3) Yes

Surveys and

DPRK reports

National

74

Annex 2. Draft Annual Budget Breakdown 2017-2021

Programme

Components and

Outcomes

2017 2018 2019 2020 2021 2017-21

Programme Component 1: Health

A. Health

RR

439,200

439,200

439,200

439,200

439,200

2,196,000

ORR

5,034,565

5,034,565

4,103,450

3,776,300

3,449,151

21,398,029

Subtotal

5,473,765

5,473,765

4,542,650

4,215,500

3,888,351

23,594,029

B. Malaria

RR

ORR

1,679,161

64,461

1,743,622

Subtotal

1,679,161

64,461

1,743,622

C. Tuberculosis

RR

ORR

9,302,897

1,325,435

10,628,332

Subtotal

9,302,897

1,325,435

10,628,332

Outcome 1. Health (A+B+C)

RR

439,200

439,200

439,200

439,200

439,200

2,196,000

ORR

16,016,623

6,424,461

4,103,450

3,776,300

3,449,151

33,769,983

Total

16,455,823

6,863,661

4,542,650

4,215,500

3,888,351

35,965,983

Programme Component 2: Nutrition

Outcome 2:

RR 565,200 565,200 565,200 565,200 565,200 2,826,000

ORR 2,580,390 2,580,390 2,580,390 2,580,390 2,580,389 12,901,949

Total 3,145,590 3,145,590 3,145,590 3,145,590 3,145,589 15,727,949

Programme Component 3: WASH

Outcome 3:

RR

579,200

579,200

579,200

579,200

579,200

2,896,000

ORR

846,466

1,269,699

2,962,630

2,116,164

1,269,699

8,464,657

Total

1,425,666

1,848,899

3,541,830

2,695,364

1,848,899

11,360,657

75

Programme Component 4: Social Inclusion

Outcome 4: Social Inclusion

RR 305200 305200 305200 305200 305200 1526000

ORR 200000 200000 200000 200000 200000 1000000

Total 505200 505200 505200 505200 505200 2526000

Total Programmes:

RR

1,888,800

1,888,800

1,888,800

1,888,800

1,888,800

9,444,000

ORR

19,643,478

10,474,549

9,846,470

8,672,854

7,499,238

56,136,589

Total

21,532,278

12,363,349

11,735,270

10,561,654

9,388,038

65,580,589

Institutional Budget

Outcome – Programme Effectiveness

RR 492200 492200 492200 492200 492200 2461000

ORR* 500000 500000 500000 500000 500000 2500000

Grand Total –

Integrated Budget

RR

2,381,000

2,381,000

2,381,000

2,381,000

2,381,000

11,905,000

ORR*

20,143,478

10,974,549

10,346,470

9,172,854

7,999,238

58,636,589

Total

22,524,478

13,355,549

12,727,470

11,553,854

10,380,238

70,541,589