Assessing UNFPA’s Humanitarian Response in Nepal

FINAL REPORT

May 8, 2009

A Joint Initiative of Columbia University and the United Nations Population Fund (UNFPA)

Evaluation Team: Lydia Allen, Kristen Cox Mehling, Mohammad Hasnain, Amanda Ree, Nadia Selim, Aki Yoshino

School for International and Public Affairs (SIPA) Columbia University New York, NY Acknowledgements

This project and final report have been made possible thanks to the significant efforts of a great number of people.

First, the Columbia University (CU) team would like to thank Pamela DeLargy, Priya Marwah, and Cecile Mazzacurati of the UNFPA Humanitarian Response Branch (HRB) in New York City for their tireless support and dedicated commitment to the CU team. The team is exceedingly thankful for the resources and overwhelming energy that UNFPA staff commits to this endeavor.

The team would also like to thank the staff of the UNFPA Nepal Country Office in Kathmandu, led by UNFPA Country Representative Ian McFarlane and Deputy Representative Ugochi Daniels. The UNFPA Nepal staff was tremendously supportive and generous with their time and expertise. The CU team was one of three evaluation teams working simultaneously in Nepal in March 2009. As evaluators, we not only deeply appreciate the generosity that UNFPA staff in Nepal exhibited with their time and resources, but also the willingness that the staff demonstrated in opening up their books and programs for evaluation. This enthusiasm speaks volumes about UNFPA Nepal’s dedication to improving their humanitarian response. The staff provided not only logistical support, but also the substantial and critical local knowledge that was invaluable in the production of this report. We offer a very special thanks to all Kathmandu staff that supported our mission; namely, Silla Ristimaki, Vandana Shrestha, Hom Raj Sharma, Michiyo Yamada, Sujata Tuladhar, and the drivers of UNFPA Nepal. In the field, the team was also supported by Chiranjeeb Sah and Bal Krishna Sharma, as well as Dr. Niraj Kumar Sinha, Ganesh Shahi, and Salina Khatoon.

We also benefited greatly from the assistance and cooperation of multiple officials within the Government of Nepal as well as staff within UN agencies and NGOs who were exceedingly generous with their time and resources in support of this project.

Professor Dirk Salomons of Columbia University’s School of International and Public Affairs (SIPA) has been an integral component of the graduate student workshop from the beginning and it is to his credit that projects such as this are undertaken. More specifically, Professor Salomons provided invaluable guidance and counsel throughout the project.

Finally, the team would like to offer sincere thanks to the patient and hard-working staff and faculty of the Economic and Political Development (EPD) Department at SIPA through which this workshop project was organized. Namely, the team would like to thank Eugenia McGill and Melissa Giblock who dedicated themselves tirelessly to the students undertaking these projects. For your constant support and dedication, thank you.

Table of Contents

List of Acronyms Page 4

Executive Summary Page 5

Summary of Findings and Recommendations Page 6

Introduction Page 7

Methodology Page 10

Background Page 9

Findings Page 28

Recommendations Page 47

Appendices Page 55 I. Explanation of Methodology II. Table of Interviews III. Partnership Matrix IV. Table of UNFPA Response V. Survey Guides/Research Instruments VI. Bibliography

LIST OF ACRONYMS

ADRA Adventist Development and Relief Agency ALNAP Active Learning Network for Accountability and Performance in Humanitarian Action CAP Common Appeals Process CDO Chief Development Officer CERF Central Emergency Relief Fund CU Columbia University DDRC District Disaster Relief Committee EHA Evaluation of Humanitarian Action GBV Gender-Based Violence GoN Government of Nepal HAWG Humanitarian Assistance Working Group (UNFPA Nepal) HC Humanitarian Coordinator HRB Humanitarian Response Branch (UNFPA HQ) IASC Inter-Agency Standing Committee ICPD International Conference on Population and Development IRA Initial Rapid Assessment KYC Kirat Yakthung Chumlung LDO Local Development Officer MISP Minimum Initial Service Package NFI Non-food item NGO Non-Governmental Organization NHSP-IP Nepal Health Sector Programme Implementation Plan NSRC Nepal Red Cross Society OCHA Office for the Coordination of Humanitarian Affairs OHCHR Office of the High Commissioner for Human Rights RH Reproductive health RRT Rapid Response Team SIPA School of International and Public Affairs STI Sexually Transmitted Infections UN United Nations UNDP United Nations Development Programme

UNFPA United Nations Population Fund UNFPA-CU United Nations Population Fund - Columbia University Joint Initiative VDC Village Development Committee WDO Women’s Development Officer WFP World Food Programme

Executive Summary

Nepal is simultaneously a developing country, a country in transition, and a country in humanitarian crisis. The fact that Nepal is vulnerable to natural disasters only further compounds the country’s challenge for social, economic, and political development. Nepal is ranked as the 11th most at-risk country to earthquakes, the 30th most vulnerable to floods, and remains one of 20 of the most multi- hazard prone countries in the world.1 The unremitting rains in 2008 flooded large swaths of the heavily populated southern plains, known as the Terai. As a result, between 70,000 and 100,000 persons were affected and 40,000 persons were displaced.2 Because of the country’s susceptibility to natural disasters and given that the newly democratic state remains relatively untested at this early stage, the populations of Nepal are especially vulnerable.

As a result of recent humanitarian situations, the United Nations (UN) set up an Inter-Agency Standing Committee in Nepal (IASC) to coordinate UN, donor, and non-governmental organization (NGO) humanitarian response with the Government of Nepal (GoN). UNFPA’s work is imperative in humanitarian relief in Nepal due to significant unmet need in the areas of reproductive health (RH) and gender-based violence (GBV).

In order to better respond to humanitarian emergencies, the Country Office of UNFPA Nepal recently established a Humanitarian Assistance Working Group (HAWG). The objective of this joint UNFPA- Columbia University (UNFPA-CU) initiative was to conduct an assessment of UNFPA’s response to the 2008 floods in Nepal using the Minimum Initial Service Package (MISP) for Reproductive Health in Crisis Situations3 as the guiding framework, and to provide recommendations on what steps UNFPA Nepal’s HAWG should take in order to ensure service delivery and coordination in emergencies.

The team of six students from the School of International and Public Affairs (SIPA) at Columbia University (CU) formed its recommendations based on findings from a comprehensive literature review and from interviews with stakeholders in New York and in Nepal during a two-week field visit in March 2009. The CU team’s fieldwork focused on the collection of qualitative data through interviews with staff of government ministries, the UN, UNFPA staff, implementing partners and community-based organizations, as well as focus group discussions with Internally Displaced Persons (IDPs) communities, and other key stakeholders.

The findings of this assessment revolved around issues of UNFPA Nepal’s presence in the field during the floods, preparedness and timeliness of response, participation in UN agency wide response networks, collaboration with humanitarian partners, and monitoring and evaluation of on-going efforts. The findings also focused on operational and logistical issues of financial procedures, reporting requirements, human resource managements and non-food item(NFI) distributions. Lastly, the assessment also examined the degree to which UNFPA is engaged in returning communities through early recovery work. The findings are analyzed through the Active Learning Network for Accountability and Performance in Humanitarian Action (ALNAP) framework criteria of efficiency, effectiveness and coordination, impact, relevance and appropriateness, sustainability and connectedness, and coverage. The findings from this research and the CU team’s recommendations are presented within this final report.

1 OCHA. “Nepal IASC Contingency Plan.” 2008. 2 United Nations. “Nepal Common Appeal for Transition Support.” 2008.

SUMMARY OF RECOMMENDATIONS

The recommendations of the evaluation aim to strengthen UNFPA Nepal’s emergency response capacity, and are prioritized into immediate, medium- and long-term categories. Immediate priority recommendations are listed below.

Priority 1: Conduct a brainstorming session on the findings and recommendations of the CU evaluation.

Priority 2: Institute mandatory training for all Country Office and district-level staff on the MISP.

Priority 3: Continue ADRA’s work in the Koshi flood region as an interim measure to fill significant gaps in RH service delivery.

Priority 4: Identify personnel who could serve as RH Coordinators in the event of a humanitarian crisis to implement the MISP. At a minimum, identify two persons in the Koshi region and two persons in the Far Western region. Arrangements should be made to address any gaps in training for these personnel.

Priority 5: Continue coordination with UNICEF to identify the contents of a basic hygiene kit that can be assembled jointly and prepositioned in vulnerable districts. Simultaneously, communicate to district offices that they will have primary responsibility for local procurement of culturally and contextually appropriate NFIs in the event of an emergency. Plans should be made for kits to be prepositioned for district use in the event of an emergency. District offices should identify locations to store prepositioned NFIs.

Priority 6: Support district offices in identifying possible implementing partners for the 2009 flood response. Begin the process of assessing capacity of these partners.

Priority 7: Assign staff members to the health and protection clusters. Assign staff to attend the early recovery network meetings. Identify alternates to attend these meetings when assigned staff is unavailable. Formalize this arrangement in the Performance Appraisal and Development System (PAD).

Priority 8: Follow-up on the revision of the UNFPA Country Contingency Plan, following the HRB mission. Contact district officials for input on the Country Contingency Plan.

Priority 9: Contribute to the development of the IASC contingency plan, with emphasis on the Health and Protection Clusters.

Medium- and long-term recommendations are further described in the report, and are divided into programmatic, coordination and partnerships, and operational and procedural categories. Programmatic recommendations include suggestions for how UNFPA can: re-establish presence in flood- affected areas; better utilize the MISP framework; develop and deliver hygiene kits and NFIs, better coordinate an initial needs assessment; work on early-recovery initiatives; and establish a GBV referral system. Recommendations for coordination and partnership include suggestions for how UNFPA can: improve leveraging partnerships; develop a contingency plan; improve cluster coordination; and increase the speed of humanitarian response. Lastly, operational and procedural recommendations include suggestions for how UNFPA can: better utilize funding sources; improve coordination between programmatic and operational staff; facilitate the processing of reporting requirements; empower district and local staff to. work effectively during crises; and strengthen its monitoring and evaluation.

INTRODUCTION

Client Agency UNFPA is a specialized agency of the UN that works with demographic data to inform policies for improving reproductive health, sexual health, and women’s rights. The agency aims to promote “the right of every woman, man and child to enjoy a life of health and equal opportunity.”4 Areas of emphasis include safe motherhood, family planning, adolescent health, reduction of GBV, and prevention of sexually transmitted infections (STIs) including HIV.5

Recognizing the critical importance of mainstreaming RH and gender issues in humanitarian work, UNFPA established the Humanitarian Response Unit in 2002, to “better respond to reproductive health needs in conflict and post-conflict settings,” 6 which is now the Humanitarian Response Branch (HRB).

UNFPA started its operations in Nepal in 1971 and is now implementing its sixth country program. One of the overarching goals of its work in Nepal is to contribute to lasting peace by improving health care access for the most excluded groups in society. UNFPA Nepal has identified humanitarian emergency response as an issue of critical importance to Nepal, as extreme poverty, natural disasters, legacies of the decade-long civil war, and the still-fragile and untested peace process represent considerable threats to the population.

Columbia University and UNFPA The relationship between the HRB at UNFPA in New York and Columbia University’s School of International and Public Affairs (SIPA) began in 2003-2004, when SIPA provided UNFPA with a team of graduate consultants to evaluate the agency’s HIV/AIDS programming in Sierra Leone. In 2004-2005, a second team mapped HIV/AIDS and GBV programming in Liberia. In 2005-2006, a third team evaluated reproductive health programming in the broader development and geo-political context of Sudan.

The successes of previous years’ UNFPA-CU partnerships led to yet another collaborative project in Nepal. The CU team, comprised of six graduate students from diverse professional and academic backgrounds, participated in the study as part of a Workshop in Applied Development at SIPA’s Economic and Political Development Program.

Project Rationale The floods and landslides in 2008 occurred in the wake of a decade-long civil war and highlighted the need for UNFPA Nepal to strengthen and systematize its humanitarian response capacity to reach vulnerable populations. Additionally, the participation of UNFPA Nepal in the UNFPA “Capacity Building Workshop on Emergency Preparedness and Response in South and West Asia” held in Bangkok in November 2008 identified a gap in logistical and operational planning in UNFPA Nepal’s contingency plan. In response, UNFPA Nepal established the Humanitarian Assistance Working Group (HAWG) in December 2008 to facilitate and operationalize the implementation of UNFPA’s humanitarian response. An evaluation of UNFPA’s recent humanitarian response in Nepal was therefore timely in informing the work of the HAWG, to bolster UNFPA Nepal’s humanitarian response capacity, by integrating past

4 UNFPA. “Assisting in Emergencies.” www.unfpa.org/about 5 Ibid. 6 Columbia University’s School of International and Public Affairs Professor. Personal Communication. November 17, 2008.

lessons learned into its future planning as well as by strengthening and identifying current and potential partnerships.

Project Objectives The objectives of the assessment are to:

1. Evaluate the effectiveness of UNFPA’s The MISP Objectives are: humanitarian response to the 2008 floods in Kailali and Kanchanpur in the west, and in 1. Identification of organizations and Saptari and Sunsari in the east, using the individuals to coordinate and Minimum Initial Service Package (MISP) for implement the MISP; Reproductive Health (RH) in Crisis Situations as a 2. Prevention of sexual violence with framework of analysis; appropriate assistance to GBV survivors; 2. Identify the steps UNFPA can take to be better 3. Reduction of the transmission of HIV; prepared for future humanitarian response to 4. Prevention of excess maternal and natural disasters such as floods, earthquakes, neonatal morbidity and mortality; and and droughts. 5. Planning for the provision of comprehensive RH services.7 UNFPA Nepal recommended that the CU team use the MISP as the framework of the research. The MISP is a set of specific guidelines for how humanitarian actors can address RH needs during the initial days and weeks of a crisis.8 The five objectives of the MISP served as key areas of focus throughout the CU team evaluation. The MISP also includes objectives related to data collection and health system assessment, an extremely important issue for program development, implementation, and monitoring and evaluation during and after emergencies.

METHODOLOGY The methodology employed by the CU team can be broken down into three parts:

1. Fact-finding a. Data collection and literature review: to gain a grounded understanding of the situation in Nepal in general and of UNFPA’s work in particular.

b. Interviews with UN staff, NGOs, and other stakeholders at the Headquarters level in New York: to identify the degree to which RH and gender issues are mainstreamed in other organizations’ emergency work.

2. Field Work: Interviews with Stakeholders a. Interviews with strategic partners, including UNs, NGOs, and government agencies: to evaluate UNFPA’s response to the 2008 Nepal floods from the perspective of strategic partners and other agencies; to identify ways in which UNFPA can better advocate for RH and gender issues; and to ascertain the potential for strengthening current partnerships and identifying new opportunities for collaboration.

7 Women’s Commission for Refugee Women and Children (Women’s Commission). “Minimum Initial Service Package (MISP) for Reproductive Health in Crisis Situations.” 2006. 8 Ibid.

b. Interviews with current implementing partner organizations, including government counterparts and health workers: to conduct a capacity assessment of partners with respect to the MISP and evaluate the partnership with UNFPA.

c. Interviews with UNFPA Nepal central- and district-level staff, and former UNFPA consultants: to understand UNFPA’s role in terms of gender mainstreaming and GBV programming in Nepal; and to identify lessons learned and opportunities for improving service delivery in the future.

d. Focus group discussions with target populations: to evaluate UNFPA Nepal’s response to recent flooding with respect to the needs of the flood affected population, and with respect to the MISP criteria.

3. Framework of Analysis a. Active Learning Network for Accountability and Performance in Humanitarian Action (ALNAP) framework. Developed by an interagency forum, the ALNAP provides a guide and standard for evaluators and practitioners in humanitarian response. Evaluation of humanitarian action (EHA) is a major component of the ALNAP, and the interagency group has developed a Quality Proforma tool for EHA, which is an industry standard for evaluating humanitarian response. The ALNAP Quality Proforma for EHA consists of six standardized criteria: efficiency, effectiveness, impact, relevance and appropriateness, sustainability and connectedness, coverage, and coherence.9 The CU team tailored these criteria to analyze and synthesize the findings as appropriate for this specific research study.

Potential Limitations of Evaluation It is important to note that this methodology contained certain limitations, which hindered the effectiveness of the evaluation. Specifically, issues of data scarcity and verification, constraints of time, and limitations of language impacted the evaluation.

1. Limitations of Data a. Scarcity of data: lack of data that is disaggregated by gender, and the inability to verify data, both in terms of a baseline as well as of UNFPA response to the 2008 floods, made this evaluation especially difficult. Without a clear picture of the RH situation in the flood affected areas it is very difficult to ascertain whether or not RH related service provision is on track to meet needs. The CU team recognizes the following limitations concerning data: i. While humanitarian agencies conducted needs assessments through tools such as the Initial Rapid Response (IRA) under the coordination of OCHA, these assessments did not include RH and related gender vulnerability indicators. ii. These assessments were largely carried out in the east and similar assessments were not completed in the west. iii. In the districts where assessments were conducted, there remained contradictions among the documentation and personal interviews regarding the timing of these assessments, and whether or not these needs assessments were conducted immediately or much later.

9 ALNAP 2001. “Humanitarian Action: Learning from evaluation.” ALNAP Annual Review. 2001. London: ALNAP/ODI.

iv. It is difficult to accurately verify the extent of UNFPA service provision in terms of the number of RH kits delivered, when and to whom; the number of women patients served, by who and where; the number of non-food items (NFIs) distributed and when, due to the differing numbers given by UNFPA district reports, UNFPA Kathmandu reports, and implementing partners’ reports.

The CU team strove to overcome this issue by first triangulating data from different reports, and by providing ranges for services provided where applicable. Nonetheless, many times it was impossible to verify the accuracy of specific data and consequently, only data that could be triangulated were included.

2. Constraints of Time: The CU team conducted one field visit of two weeks, which limited the team’s ability to (1) gain an in-depth understanding of extremely complex local dynamics, and (2) gather data needed for an exhaustive analysis, which might be obtained through an extended field visit. Given the short duration of the field visit, which was designed around the academic calendar, the CU team focused the interviews on primarily strategic and implementing partners. As a result, the team was only able to have limited interactions with community members and flood-affected individuals, hindering the ability of the team to ascertain the efficacy and impact of the humanitarian activities on target populations, based on the needs of the target populations.

3. Limitations of Language: While two CU team members speak Hindi, none of the team members speak Nepali. Therefore, most of the interviews in the field were conducted in Nepali and or in Hindi with reliance on translators. As a result, some information and nuance may have been lost through the translation process.

Please see Appendices for a complete description of methodology and the table of interviews.

BACKGROUND

Nepal is a landlocked country in South Asia, surrounded by China in the north and India in the south. Its terrain is mostly mountainous with a flat plain in the south, known as the Terai region. Nepal is inhabited by a highly diverse population. Among its 29.5 million people, there are over 30 different 10 indigenous groups speaking at least 90 distinct languages.

10 CIA. “World Factbook Nepal.” https://www.cia.gov/library/publications/the-world-factbook/geos/np.html.

Figure 1: Map of Nepal11

Nepal is one of the 50 least developed countries in the world, with a Human Development Index (HDI) of 142 out of 177 countries.12 In 2005, the GDP per capita growth rate was only two percent, with 79 percent of its people still living in rural villages.13 In the same year, 31 percent of its population lived below the national poverty line, and six percent of the working population were unemployed.14

It is important to note that these statistics mask great inequality by ethnicity, gender, region, religion, and urbanicity. In particular, women remain one of the most under-served and vulnerable groups within Nepalese society – especially if they belong to one of the more marginalized segments of society such as the Dalits, Janajatis, and Madhesis. For example, the average life expectancy for the Nepalese is 63 years; however, Dalit15 women only live an average of 40 years.16 A decade-long conflict, continued unrest, and natural disasters have only served to exacerbate these disparities.

Gender Inequality: Issues of RH and GBV Gender inequality continues to be a major hindrance to Nepal’s development. Women’s low position in Nepalese society in proportion to its poverty profile is reflected by its Gender Development Index (GDI), which ranks the nation at 127 in 2005 – 15 positions lower than its HDI rank. Most improvements, particularly in access to education and health care, have accrued disproportionately to urban women and women of majority ethnic groups. For example, the 2001 National Demographic and Health Survey found that access to and use of a range of health and family planning services was the lowest amongst

11 Nepal Red Cross Society, http://www.nrcscehp.org/images/nepal.png 12 UNDP. “2007/2008 Human Development Index Rankings.” http://hdr.undp.org/en/statistics/ 13 Ibid. 14 UNCT Nepal. “Common Country Assessment for Nepal.” 2007. 15 Dalits who make 13 percent of the country’s population, are placed at the bottom of the Hindu caste. 16 UNFPA & Government of Nepal. “Country Programme Action Plan (CPAP) 2008-2010.” 2008.

Dalit women.17Similarly, in 2004, the Far Western hill districts had a GDI score of only 0.33 compared to 0.56 for the more urban Central Region hill districts.18

Reproductive and Maternal Health

Access to RH services in Nepal is limited by a number of factors. First, a large portion of the Nepalese population lives in rural and remote areas, where mountainous terrain and limited infrastructure are impediments to reaching health clinics. Second, Nepal’s armed conflict set back progress in the RH sector by destroying facilities, intimidating health personnel, and disrupting local governance systems. Where facilities exist, there are often not staffed with qualified health personnel and do not have sufficient drugs and supplies to provide basic health services. As a result, only about 44 percent of women receive antenatal care of any kind.19 Third, inequality among various caste, ethnic, and religious groups leads to differential RH outcomes. Fourth, there is a lack of demand for health services due to low levels of health service seeking behaviors.

In 2005, the lifetime risk of maternal death was estimated at one in 31.20 While maternal health is generally poor, there is evidence of improvement, especially in urban areas. This improvement puts Nepal is on track to achieve Millennium Development Goal Five, which calls for reducing by three quarters the maternal mortality ratio.21 However, socioeconomic differences in Nepal lead to differential access to RH services. In the wealthiest quintile, 84 percent of women have a skilled birth attendant, whereas among women in the poorest quintile, just 17 percent have a skilled birth attendant.22

While maternal morbidity in Nepal takes many forms, uterine prolapse,23 a highly stigmatizing condition, is unusually common in Nepal with approximately 10 percent of all women of reproductive age suffering from this injury.24 One study of the Western region of Nepal estimated the prevalence of genital prolapse at one in four women.25

Fertility and Contraception

The contraceptive prevalence rate has increased substantially in the past decade, from 35 to 44 percent.26 However, there is still a large unmet need for family planning services. About 25 percent of the women in Nepal report that they would like to delay or prevent pregnancy and yet have no access to

17 Ibid. 18 UNFPA & Government of Nepal. “Country Programme Action Plan (CPAP) 2008-2010.” 2008. 19 UNFPA & Government of Nepal. “Country Programme Action Plan (CPAP) 2008-2010.” 20 UNICEF. http://www.unicef.org/infobycountry/nepal_nepal_statistics.html 21 United Nations Millennium Development Goals, Goal Five: Improve Maternal Health, http://www.un.org/millenniumgoals/maternal 22 UNFPA & Government of Nepal. “Country Programme Action Plan (CPAP) 2008-2010.” 2008. 23 Uterine prolapse, also called genital prolapse, consists of the herniation of the uterus or an adjacent pelvic organ into the vagina. 24 UNFPA & Government of Nepal. “Country Programme Action Plan (CPAP) 2008-2010.” 2008. 25 International Urogynecology Journal. “Risk factors for uterine prolapse in Nepal” Springer London (Vol. 18: 11). 2007. 26 Ministry of Health and Population. “Department of Health Services, Annual Report 2060/61.” 2003-2004.

contraception.27 One in four women in villages has an unmet need for contraception, compared to one in five in the cities.28

HIV/AIDS

At present, Nepal’s HIV/AIDS prevalence is relatively low, but it threatens to grow rapidly if effective prevention efforts are not implemented. UNFPA estimates the HIV prevalence rate to be 0.49 in 200729 with approximately 70,000 persons living with HIV in Nepal.30 The most at-risk populations in Nepal include injection drug users, female sex workers and their clients, trafficked persons, men who have sex with men, and migrants. Approximately 50 percent of HIV infections are in the Terai highway district, while 20 percent of infections are in the Far Western region.31

Gender-based violence

As UNFPA reports in their comprehensive 2007 study of Gender Equality and Empowerment of Women in Nepal, GBV is largely culturally accepted.32 The Office for the High Commissioner of Human Rights (OHCHR) recorded 108 allegations of GBV in the first half of 2006. It is important to note, however, that these recorded cases represent only a small fraction of the actual cases. Nepal’s culture of impunity and the social acceptability of GBV discourage women and families from seeking protection and taking legal action. The literature shows that Dalit, Janajati, Madhesi and Muslim women suffer the most from GBV and other forms of mistreatment. In fact, it is reported that 65 percent of all girls trafficked to India for prostitution are from Dalit and Janajati families.33

Natural Disasters Nepal is one of the most multi-hazard prone countries in the world. Among the major hazards, floods and landslides are the most recurrent and have claimed more than 200 lives annually over the past ten years.34 Natural disasters tend to lead to more deaths in Nepal than in most South Asian countries. In fact, a recent study indicates that 0.4 percent of all people affected by natural disasters in Nepal will die,35 which is four times higher than the average for South Asia.

27 UNFPA & Government of Nepal. “Country Programme Action Plan (CPAP) 2008-2010.” 2008. 28 Ibid. 29 “Nepal 2007 Estimations of HIV Infections: Key Messages.” http://nepal.unfpa.org/pdf/2007HIVEstimationsBriefingNotesFinal15Apr2008.pdf 30 Ibid. 31 “Nepal 2007 Estimations of HIV Infections: Key Messages.” http://nepal.unfpa.org/pdf/2007HIVEstimationsBriefingNotesFinal15Apr2008.pdf 32 Culturally acceptable violence includes polygamy, polyandry, the deuki32 and jari32 traditions, bonded labor, child marriage, dowry-related violence, witch-hunting, and the ill-treatment of widows. Within this context, there is a large unmet need for psychosocial support services for survivors. 33 “Nepal 2007 Estimations of HIV Infections: Key Messages.” http://nepal.unfpa.org/pdf/2007HIVEstimationsBriefingNotesFinal15Apr2008.pdf 34 Ibid. 35 UNFPA & Government of Nepal. “Country Programme Action Plan (CPAP) 2008-1010.” 2008.

36 Figure 2: The Most Lethal Hazards in Nepal (1971-2005)

16000

14000

12000 16000 10000 14000 8000 12000 6000 10000 8000 4000 6000 2000 4000 0 2000

Fire 0

Flood

Epidemic

Landslide

Avalanche

Cold Wave

Earthquake

Boat Boat Capsize

Thunderstorm Structural Collapse

Given the high likelihood of natural disasters, the GoN has several response mechanisms in place for emergency preparedness and response, including the 1996 National Action Plan on Disaster Management and a new national strategy based on the Hyogo Framework.37 In addition, the Local Self- Governance Act of 1999 organizes disaster management at the district and local levels.

Specifically, District Disaster Relief Committees (DDRCs) have been established in all 75 administrative districts in Nepal. These DDRCs draw representatives from the district-level offices of the various line agencies to constitute the Rapid Response Team (RRT). The RRTs are responsible for delivering necessary services, conducting needs assessments, and play a critical role in social mobilization. The Chief District Officer (CDO) who leads the DDRC as the highest-ranking official within the district is therefore responsible for making critical decisions regarding rescue and the distribution of compensation and services following a disaster.

It is important to note that the national mechanisms and plans to prevent, prepare, and respond to natural disasters do not provide adequate attention to gender issues and RH needs. This omission is particularly problematic in Nepal given the context of gender inequality and discrimination, and because disaster in Nepal has been shown to impact men and women differently. For example, in rural areas, women tend to be more vulnerable to natural hazards as few of them can swim to safety in floods and they spend more time at home where landslides and earthquakes cause the largest loss of life.

36 IASC Contingency Plan, 2008

37 The Hyogo Framework was drafted in 2005 at the World Conference on Disaster Reduction.

Additionally, women have specific RH needs that cannot be answered without a gender inclusive approach.

To support the government’s efforts, the UN set up an Inter-Agency Standing Committee (IASC) at the country level in 2006 to coordinate donor and NGO humanitarian responses through the cluster approach. The committee includes all the UN agencies, the Nepal Red Cross Society (NRCS), and international NGOs. The cluster approach established different “clusters” of activities such as camp management, water and sanitation, health, protection etc. to ensure humanitarian response is strategic, well-planned, inclusive, coordinated and effective.38 Within the cluster approach, UNFPA is an integral member of the Health and Protection Cluster. Additionally, the UN is working with the government to strengthen coordination with the Central Disaster Relief Committee.

HUMANITARIAN SITUATION IN 2008

Humanitarian Situation Following the 2008 Floods In 2008, Nepal suffered from one of the worst natural disasters in its recent history. The first emergency occurred when the Koshi River embankment in the east was breached on August 18, 2008, changing the course of the Koshi River. This was an unprecedented event and affected more than 70,000 people in the Sunsari and Saptari districts.39 The Koshi flood also affected the Indian state of Bihar where at least 45,000 persons were displaced.40

The second emergency occurred in the Far Western region on September 19, 2008 when excessive rainfall caused the worst flash floods in the region in 63 years, affecting an estimated 170,000 persons and destroying homes, livelihoods, and crops.41 Among all the districts that were affected,42 the worst affected districts were Kailali and Kanchanpur. It is estimated that 144,000 persons were affected in Kailali and 31,962 persons affected in Kanchanpur.43

UNFPA’s response, like most other UN agencies and International NGOs, was focused more intensely on the Koshi floods rather than the Far Western floods, largely due to political concerns and contextual constraints. Although more than twice the people were affected by the flash floods in the Far Western Region than in the east, the dramatic Koshi disaster received the majority of the funding, attention, and assistance during the flood response.44 There were several reasons for this discrepancy. First, the rapid recession of flood waters in the Far Western region led to the assumption that the need for support was lesser than in the east where land had been destroyed which created a protracted situation of displacement.45 Second, because the Koshi floods preceded the floods in the Far Western region, organizations had already committed all or most of their financial and human resources in the east and

38 Humanitarian Reform, “IASC Cluster/Sector Leadership Training: Explaining Clusters to an RC,” 2007. 39 UNFPA Nepal. “A National Emergency: UNFPA Nepal’s Response to Eastern and Far Western Floods 2008.” 2009. 40 OHCHR. “Lessons Learned from Protection Activities in Nepal. Based on Experience Gained During the flood Response in 2008.” 2009. 41 Ibid. 42 The flood affected districts in the west are: Kailali, Kanchanpur, Bardiya, Dadeldhura, Kalikot, Doti, Bajhang, Mugu and Dang districts. 43 In Kailali, the worst affected VDCs were Bhajani, Khailad, Thapapur, Lalbhoji, Tikapur, Dasinhapur and Narayanpur. Similarly, in Kanchanpur, the worst affected VDCs included Dekhatbuli and Shankarpur. 44 UNFPA Nepal. “A National Emergency: UNFPA Nepal’s Response to Eastern and Far Western Floods 2008.” 2009 45 UNFPA Nepal. “A National Emergency: UNFPA Nepal’s Response to Eastern and Far Western Floods 2008.” 2009.

were therefore consequently handicapped in responding adequately to the situation in the Far Western region. 46 Moreover, media attention primarily directed toward the Koshi region may have also contributed to neglect of the Far Western Region.47

Third, political considerations were influential. Due to the settlement of some flood-affected persons on natural reserve land, the government forbade relief distribution to these settlements.49 Many displaced communities were thereby excluded from much of the relief extended to other IDPs. This was particularly true of any government relief efforts, but also of UN agencies and NGOs. There have been indications of forced evictions of flood-affected persons by the government from this reserve land. The evaluation team did observe abandoned villages that had clearly been burned. In addition to the insufficient magnitude of the response in the Far Western region, and agencies’ inability to reach the populations in the jungle camps, there were also other populations that were not “In the Eastern Region, the Government showed reached by services due to the remoteness and difficult great reluctance to ease the registration process terrain in this region. for Indian nationals. At times, this reluctance was expressed in discriminatory language. There was a By contrast, formal IDP camps were established general attitude that Indian national seeking food immediately after the Koshi flood, and the GoN announced aids were interlopers and not entitled to a nine-month support plan for the IDPs. An estimated assistance. International aid agencies were 64,000 people were living either in IDP camps or the areas reluctant to push the Government on this issue for surrounding the Koshi barrage in the east.50 However, in the fear that it might disrupt the larger aid effort. The Eastern Region, the GoN was not eager to provide aid to position of the Government in both affected Indian nationals. The policy towards Indian IDPs was districts was sometimes ambiguous, with the CDOs telling aid agencies, including Protection Cluster contradictory – at times encouraging international aid members, that Indian Nationals would be included agencies to provide assistance, while simultaneously in the registration, verification and aid distribution instructing district staff and national aid agencies to exclude process, while at the same time instructing 51 Indian nationals from aid registration and distribution. subordinates and national agencies (such as the International aid agencies, in an effort to remain neutral Nepal Red Cross Society) to exclude them. It was and impartial, and for fear that overall aid effort would be common to see small spontaneous camps of stalled, did not pressure the GoN on this sensitive issue.52 Indian nationals located outside but near official IDP camps from which they had been excluded. In both regions, religious and caste discrimination within The situation was complicated by a disagreement the camps have been a serious concern. In the Koshi region, among agencies about the legal obligations of the Government towards non-nationals in an discord among Hindus and Muslims as well as Nepalese emergency situation. Advice was sought by the IDPs and Indian refugees further exacerbated local-level Global Protection Working Group, who responded tensions in the east where community mobilization has (rather unhelpfully) that this [is] one of the been very low and suspicion of IDPs is prevalent among the situations that currently lacked regulation in 53 host communities. international law.”48

46 OCHA. Personal Interview. March 23, 2009. 47 WHO. Personal Interview. March 24, 2009 48 OHCHR. “Lessons Learned from Protection Activities in Nepal. Based on Experience Gained During the flood Response in 2008.” 2009. 49 OCHA. Personal Interview. March 23, 2009. 50 Ibid. 51 OHCHR. “Lessons Learned from Protection Activities in Nepal. Based on Experience Gained During the flood Response in 2008.” 2009. 52 Ibid. 53 OCHA. Personal Interview. 19 March, 2009.

Figure 3: Map of Flood Affected Areas54

Contextual Constraints on Effective Humanitarian Response While floods are a common event in Nepal, the floods of 2008 were an unprecedented disaster, challenging even the most seasoned humanitarian actors. The overall lack of development and poor health infrastructure in Nepal also created significant challenges. Similarly, a culture of silence around issues of GBV and psychosocial health also poses challenges for providing needed services.55 Lastly, given pervasive poverty, targeting relief assistance to people in the camps often created tensions among communities and camp members. In Kailali, for example, flood-affected people settled in nearby villages, where their receipt of relief item caused significant tension.56

In the east, lack of access to the flood-affected areas immediately following the flood was a major constraint in emergency response. Lack of access was caused not only by the extensive infrastructure damage, but also due to political volatility and frequent political strikes in the area. For example, humanitarian relief workers were prevented from accessing the IDP camps for up to two weeks due to political strikes.57 General security concerns also created a challenge for humanitarian work in both the east and the Far West, given the presence of over 40 armed groups in the Terai region.58 The location of IDP camps has also posed challenges for humanitarian response. In both regions, for example, the camps were spread far from one another, and given the poor road conditions, efficient relief distribution was difficult.

54 International Federation of Red Cross and Red Crescent Societies. “Nepal: Floods.” 2008. 55 UNFPA Nepal Country Office. Personal Interview. March 16, 2008. 56 Columbia University Nepal Team. Team Notes from Kailali. March 19, 2009. 57 OCHA. Personal Interview. 19 March, 2009. 58 ADRA. “Delivery of Emergency Reproductive Health, Sexual and Gender-based violence and HIV/AIDS Awareness and Services on Flood Affected Population of Saptari District, Eastern Region of Nepal Project Completion Report submitted to UNFPA.” 2008.

Fluid population movements have also made it extremely difficult to discern who the true flood victims are – identification and registration efforts following the floods proved extremely difficult given the movement of populations, 59 and as arrival of victims to registration centers was delayed due infrastructure damage.60 Consequently, many displaced persons who have been living with host families have not being adequately reached.

In the west, one of the main constraints has been the limited presence of all UN agencies in the flood- affected districts. The mountainous terrain makes movement and logistics for relief very difficult. What is more, as previously mentioned the issue of jungle settlements makes providing aid in this area politically sensitive. Another complicating factor has been the presence of other extremely vulnerable groups in the area including the newly freed, landless people who have migrated to the area from the hills.61

FINDINGS

UNFPA Response UNFPA Nepal intervened both in the emergency phase of the floods and during the mid-term response phase. UNFPA collaborated with the district-level public health office(DPHO), the Women’s Development Office (WDO), other UN agencies, and international and local NGOs, to implement their response on the ground. Despite the limited human and operational capacity of the Country Office, UNFPA Nepal succeeded in providing services that reached a wide number of people. For example, through direct efforts as well as partner activities, UNFPA Nepal was able to serve close to 12,000 patients and clients in Saptari along with DPHO and zonal hospital teams.62 Below, a brief overview of UNFPA Nepal’s response to the 2008 floods is provided.

Specifically, UNFPA’s response included the following:  Conducted a joint household survey with Oxfam, United Nations Children’s Fund (UNICEF), and the World Food Programme (WFP) in the east.  Placed district-level medical teams, a public health nurse and an auxiliary nurse midwife on the ground to conduct shelter visits for immediate rescue and medical response after the flooding occurred in the east.63  Established one-week mobile clinic through UNFPA’s Kapilvastu district office in the west.  Assumed technical coordination roles in the health and protection clusters for a limited time in the east.  Delivered UNFPA’s RH kits for 10,000 persons for three months to hospitals and IDP camps in the east.64  Provided 50 blood transfusion bags and 100 HIV/hepatitis B surface antigen testing kits, and one centrifuge machine to the NRCS in the east.65

59 OCHA. Personal Interview. March 16, 2009. 60 Columbia University Nepal Team. Team Notes from Kanchanpur. March 20, 2009. 61 UNFPA Nepal Mission Trip. UNFPA Mission Travel Report to Kailali, Kanchanpur, Dadeldhura. 18-23 March, 2009. 62 UNFPA Saptari. Presentation on UNFPA Response in Koshi Flood Relief. March 22, 2009. 63 Ibid. 64 UNFPA Saptari. Presentation on UNFPA Response in Koshi Flood Relief. March 22, 2009. 65 Ibid.

 Raised awareness around HIV/AIDS prevention, involved youth by establishing 8 youth corners66, and trained 18 peer educators on HIV/AIDS prevention in the east.67  Responded to GBV by establishing protection committees, conducted a qualitative GBV assessment in eight camps, trained police officers, and provided GBV screening and counseling services in the east.68  Supported programs that provided psychosocial support and counseling for 34 people in the east.69  Provided 107 community orientations to address RH and protection issues in the west.70  Distributed relief items to vulnerable women and girls in both the east and the west.  Mobilized $272,000 from the Central Emergency Relief Fund (CERF) to support humanitarian activities in both the east and west.71

A more detailed response to the 2008 floods can be found in the appendices.

Findings with respect to the MISP Framework

Objective 1: Coordination and Implementation  There was no RH coordinator in place in the west. In the east, there was an RH Coordinator; however, the coordinator was placed three months after the floods hit and coordinated efforts in Sunsari, but not Saptari.  There were no RH focal persons in place in camps in either the east or the west.  Some RH kits were available in each location; however, availability was very limited. In the west, two kits were sent to Dadeldhura, but their type and whether they were used has not been documented. In the east, the kits were principally made available to the Zonal Hospital in Saptari.

Objective 2: Prevent Sexual Violence and Assist Survivors  There was no systematic protection system in the west. In the east, UNFPA conducted some effective protection work, but security remained poor in several camps, especially those of the Indian refugees.  Medical services and psychosocial support were largely unavailable in the west, although UNFPA supported some programs through a local NGO, WOREC. In the east, UNFPA delivered psychosocial support through implementing partners, including CVICT and WOREC.

Objective 3: Prevent Transmission of HIV/AIDS  The degree of enforcement of universal precautions has been unclear. In the west, the DPHOs of Kailali and Kanchapur requested trainings on universal precautions. One training was conducted for 60 health workers in Kanchanpur. In the east, universal precautions are applied at the District and Zonal hospitals, but are inconsistently applied elsewhere.  Free condoms were not widely available in the west. In the east, KYC provided condoms 24 hours a day in many - but not all - camps through the youth corners.

66 The youth corners were community centers in the IDP camps specifically geared towards youth activities. 67 KYC. “HIV Prevention and Awareness Program Including ASRH for People affected by Koshi Flood in Sunsari and Saptari District in Nepal. Final Report to UNFPA.” 2009. 68 UNFPA Nepal. “Joint Sunsari and Saptari Situation report #4.” November 14-22nd, 2008. 69 UNFPA Saptari. Presentation on UNFPA Response in Koshi Flood Relief. March 22, 2009. 70 WOREC Nepal. “Programme Progress Report from October 2008 to December 31, 2008.” 2009. 71 UNFPA. “A National Emergency. UNFPA Nepal’s Response to Eastern and Far Western Floods 2008.” 2009.

 Safe blood transfusion was not generally available in the west. In the east, this access was limited.

Objective 4: Preventing Excess Maternal and Neonatal Mortality/Morbidity  There were no clean delivery kits provided in the west. In the east, about 600 kits were distributed.  In the west, there were no midwife delivery kits provided. In the east, there is not precise data at this time, but it seems distribution of midwife delivery kits was limited.  There was no establishment of a referral system for emergency obstetric care in the west. This objective is greatly complicated by poor health systems and the remoteness of many of the Far Western region Village Development Committees (VDCs).

Objective 5: Planning for Comprehensive RH services  A few agencies collected RH baseline data in the east, but there has been no systematic data collection in the west.  Some health facility surveys have been conducted for identification of future sites for service delivery. For example, there have been some facility surveys previously conducted in Dadeldhura, in the west, as part of regular development work. A facilities assessment is presently happening in the east.  An assessment of partner capacity to deliver comprehensive RH is currently happening in the east. There has not been such an assessment in the west.  In both the east and west, there is some knowledge of procurement channels for RH and family planning drugs. There are known sources for local procurement where possible, and non-local procurement for certain emergency RH drugs.

Figure 4: UNFPA 2008 Flood Response: Performance by the MISP

Koshi Flood Far West Flood OBJECTIVE 1: Coordination and Implementation RH Coordinator LIMITED NO RH focal person in place in camps NO NO RH kits available and used LIMITED LIMITED OBJECTIVE 2: Prevent Sexual Violence and Assist Survivors Protection system in place LIMITED NO Medical services and psychosocial support YES NO OBJECTIVE 3: Prevent Transmission of HIV/AIDS Universal precautions enforced LIMITED LIMITED Free condoms available LIMITED NO Safe blood transfusion LIMITED NO OBJECTIVE 4: Prevent Excess Maternal and Neonatal Mortality/Morbidity Provide clean delivery kits LIMITED NO Provide midwife delivery kits LIMITED NO Referral system for EOC YES NO OBJECTIVE 5: Plan for Comprehensive RH services Collect baseline data LIMITED NO Identify sites for service delivery IN PROGRESS IN PROGRESS Assess staff capacity IN PROGRESS IN PROGRESS Identify procurement channels YES YES

EVALUATION FRAMEWORK

As mentioned, the CU team based its evaluation on guidelines developed by the ALNAP framework.72 The ALNAP Quality Proforma for EHA is a tool for assessing the quality of evaluations in humanitarian work. The Quality Proforma embodies the unique requirements of evaluations on humanitarian action as well as overall good practices for evaluation. ALNAP’s Quality Proforma outlines specific requirements for EHA, including evaluation based on seven standardized criteria: efficiency; effectiveness; impact; relevance and appropriateness; sustainability and connectedness; coverage; and coherence. Cross- cutting issues considered throughout the criteria include gender, protection, capacity building, and attention to vulnerable and marginalized groups. The CU team tailored the standardized criteria slightly to meet the needs of the specific evaluation. As such, the six requirements this evaluation is based on are the EHA criteria with the addition of “coordination” in the effectiveness category, and the omission of the category for “coherence.” This report specifically utilizes these criteria in organizing, analyzing, and synthesizing the findings of the evaluation.

Efficiency

The EHA efficiency criterion measures qualitative and ALNAP Definition of Evaluation of Humanitarian quantitative outputs in relation to the inputs that were Action (EHA) is as follows: “A systematic and applied to the humanitarian action. In evaluating impartial examination of humanitarian action efficiency, the CU team considered the cost- intended to draw lessons to improve policy and effectiveness of the humanitarian action by evaluating practice, and enhance accountability. It has the the extent to which the resources devoted to the following characteristics: i) it is commissioned by humanitarian action yielded a proportionate impact in or in cooperation with the organization(s) whose the flood-affected areas. performance is being evaluated; ii) it is undertaken either by a team of non-employees UNFPA achieved a remarkable level of service (external) or by a mixed team of non-employees provision given its limited prior capacity in the flood- (external) and employees (internal) from the commissioning organization and/or the affected areas and the reactive nature of the organization being evaluated; iii) it assesses policy humanitarian response of the newly activated cluster and/or practice against recognized criteria (e.g., approach in Nepal. However, it is important to note efficiency, effectiveness/ timeliness/ coordination, that the efficiency of the response was nonetheless impact, connectedness, weak in some areas. Despite an extensive allocation of relevance/appropriateness, coverage, coherence human resources, time, and financial resources to the and as appropriate, protection); and, iv) it humanitarian action, the coverage and impact articulates findings, draws conclusions and makes 73 achieved was sometimes disproportionately low by recommendations.” comparison.

One of the most striking examples of a shortcoming in efficiency was the limited distribution of RH kits that were ordered from the UNFPA Procurement Branch in Copenhagen. While the RH kits that were delivered and utilized in the affected districts prevented significant morbidity and mortality in the wake of the disasters – constituting a major achievement for the Nepal Country Office - the absence of tracking mechanisms for RH kits meant that majority of the kits were not delivered. The cost associated with these kits was therefore not translated into an effective output, as the flood-affected population was unable to access the potentially life-saving medicines and supplies that remained in Kathmandu. Moreover, this bottleneck in logistics was not detected for a long period of time. As a result, some of the

72 Evaluation of Humanitarian Action. www.alnap.com. 73 ALNAP 2001, Humanitarian Action: Learning from evaluation, ALNAP Annual Review 2001. London: ALNAP/ODI.

pharmaceuticals expired, requiring additional expenditure of human and financial resources to identify the kits containing expired pharmaceuticals, replace them, and organize distribution to flood-affected areas.

UNFPA procedures may also have indirectly impacted the efficiency of field consultants and implementing partners. For example, reporting requirements were often seen as cumbersome and inflexible. While reporting must be rigorous to ensure proper monitoring and evaluation, reporting requirements should also be adapted to the nature and fast pace of a humanitarian response. Focal points in the field noted the importance of weekly situational reports, which were required by UNFPA at the central level, especially during the beginning of the emergency, when the conditions on the ground were changing rapidly. 74 However, as the situation stabilized, the time-consuming weekly reports may not have been necessary. 75 In general, reporting constituted a very large share of the staff and consultants’ time. Specifically, the clarification and feedback process for the situational reports became burdensome, such that the time and effort spent on preparing and finalizing these reports took away valuable time from humanitarian work itself. For implementing partners, reporting requirements were the same regardless of the length of the contract. Thus the same input of staff effort was required whether the agency worked for one month or six months, leading to a disproportionate use of human resources in cases where short-term contracts were in place.76

The difficulty that staff and consultants faced in navigating the financial allocation and reporting requirements also reduced efficiency during UNFPA’s response. At the central level, the requirement that receipts be presented for each line item, however small the expenditure, was often unrealistic and burdensome given the nature of the response and the conditions on the ground.77 In addition, personnel at the district level had little discretion with regard to expenditures.78 A disproportionate amount of operational time and effort were devoted to receiving permission for each expenditure needed to carry out the relief work, leading to inefficiencies in the response.

Other losses in efficiency occurred through ineffective allocation of human resources or ineffective prioritization of humanitarian activities. For example, a great deal of time, effort, and money was expended for providing NFIs. In the Koshi region, the time-consuming task of assembling these kits largely fell to the Protection Cluster Officer, whose valuable time might have been better utilized elsewhere.79 Prepackaged, prepositioned kits might have allowed the protection officer to spend less time on this part of the response.

Effectiveness and Coordination

Effectiveness measures the extent to which the humanitarian actions achieve their purpose given the particular outputs that were realized. While UNFPA responded effectively in many instances throughout the humanitarian situation, several factors impeded the degree of efficacy of their response. Specifically, issues of timeliness and lack of overall response, arising from short-term contracts, delay in funds disbursal and human resource management, negatively affected the effectiveness of UNFPA’s response. Lack of coordination and monitoring and evaluation also hampered UNFPA’s performance.

74 Former UNFPA Consultant. Telephone Interview. March 26, 2009. 75 Former UNFPA Consultant. Personal Interview. March 25, 2009. 76 Kirat Yakthung Chumlung. Personal Interview. March 20, 2009. 77 Adventist Development Relief Agency. Personal Interview. March 17, 2009. 78 UNFPA District Project Support Unit Saptari Team. Personal Interview. March 22, 2009. 79 Former UNFPA Consultant. Telephone Interview. March 26, 2009.

Before detailing the ways in which UNFPA’s response was not adequately effective, it is important to note that the agency consistently acted in ways that are characteristic of highly effective humanitarian responses. For example, UNFPA recruited consultants and added capacity by partnering with agencies that had extensive local knowledge. UNFPA also allowed considerable programmatic flexibility to its implementing partners, which was key to the dynamic response they were able to execute.80 Several government counterparts lauded UNFPA for being one of the few organizations to procure resources locally, thus supporting the local economy.81 Another UNFPA strength was the involvement of the local community in project implementation.82 In the Koshi flood response, with respect to coordination, there was strong collaboration between UNFPA and other cluster members that enhanced the overall response in this area.83 Of notable example is the collaboration with UNICEF in NFI distribution, which was highly successful in effectively reaching the target population.

Delayed and Limited Response

Despite these successes, effectiveness was curtailed in a few cases, most dramatically by the significant delay in response both in the east and Far West. In Saptari and Sunsari, district-level staff provided some service immediately after the floods. However, contracts for UNFPA Nepal’s implementing partners were not authorized for another three months. In the Far Western region, there was a delay of at least two months. These delays undermined the effectiveness and relevance of UNFPA’s response. In addition, as previously mentioned, UNFPA’s logistics systems were not adequately developed and monitored at the time of the floods. As a result, RH kits containing life-saving emergency supplies did not reach the flood-affected area on time.84

These lapses and delays were compounded by an overall lack of presence in the Far Western region, and greatly interrupted presence in the Koshi region. Although UNFPA previously committed to continuing support through May 2009, humanitarian action ended in March 2009. For example, contracts for implementing agencies ended too soon while there was still a significant RH need amongst flood- affected populations. This effectively ended UNFPA’s humanitarian response and thereby reduced implementing agencies’ ability to adequately meet the needs of the flood-affected population. Reasons for this early termination are not clear to the CU team.

UNFPA’s response should have continued through May, in line with the government’s nine month plan.85 However, UNFPA’s early withdrawal left government counterparts without support in key areas. For example, in the Koshi area, the protection cluster stalled when UNFPA’s GBV focal point left the region upon completion of her contract. This example speaks to the important and positive influence UNFPA humanitarian coordination had in the Koshi region, as well as the negative effects of its truncated response and early withdrawal.

Support for critical medical services was also terminated prematurely. Financial support for five auxiliary nurse midwives (ANMs) in Saptari and Sunsari ended by December 2008 due to financial procedural

80 Center for Victims of Torture in Nepal. Personal Interview. March 16, 2008. 81 Women’s Development Officer Sunsari. Personal Interview. March 20, 2009. 82 Kirat Yakthung Chumlung. Personal Interview. March 20, 2009. 83 Adventist Development Relief Agency. Personal Interview. March 17, 2009. 84 Please see the Efficiency criteria for more information on logistical delays involving RH kits. 85 UNFPA. “UNFPA Recovery Strategy Planning Meeting for Support to the Koshi Flood Victims Meeting Minutes.” 2009.

requirements, despite the high unmet need for RH services. Government counterparts have indicated that there is an immediate need for these ANMs, due to a severe shortage of qualified RH providers.86 Multiple stakeholders within the government and target population have also expressed a desire that UNFPA extend the contract of the Adventist Development and Relief Agency (ADRA) which ended in March 2009 when UNFPA ceased all humanitarian response activities. ADRA is especially important as it is viewed as a critical provider of RH services in the Koshi region given that government counterparts are not currently able to provide RH services of adequate quality. Additionally, ADRA is in a position to immediately resume RH service provision, with capacity for laboratory testing, trained personnel, and vital pharmaceuticals.87

Short-term Contracts of Implementing Partners

UNFPA’s use of short-term contracts with implementing partners also resulted in decreased effectiveness. Month-to-month contracts left implementing partners insecure which thereby undermined their ability to plan programming and therefore work effectively on the ground.88 Short- term contracts also meant that implementing partners had insufficient time to evaluate programs and adjust their response as necessary. Particularly with complex interventions such as psychosocial counseling, the effect in the community is difficult to measure on such a short timeline, making programmatic improvement difficult.

Delay in Funds Disbursal

Even after the launch of the response, a significant delay in the disbursement of funds meant that many implementing partners and government counterparts could not carry out their functions as necessary. UNFPA uses the ATLAS system to track financial distributions. However, program staff at the central level has not received sufficient training on ATLAS and financial management procedures. As a result, staff often found it difficult to determine whether or not partners had received funding. Some organizations, such as ADRA, used their own funding to carry out essential functions before the UNFPA funding was dispersed.89 However, part of the reason for this could have stemmed from the fact that ADRA delayed the submission of their final report, without which subsequent funds cannot be released. In other cases, however, the delay in promised funding permanently limited the response. For example, the WDO in Kanchanpur never received the promised funding for packaging and distribution of NFIs. As a result, half of the NFIs supplied to the WDO have not been distributed to flood-affected areas due to lack of funding.90

Human Resource Management

Problems with human resource management, including unclear directives and division of labor, made it difficult for staff at both the central and district levels to effectively carry out their functions, thereby reducing the effectiveness of UNFPA’s humanitarian response. Resolution of these challenges is particularly important because UNFPA Nepal’s highly dedicated, capable, and energetic staff is perhaps its greatest strength. Because humanitarian response was still a new activity for UNFPA Nepal in 2008, effective allocation of human resources was sure to be a challenge. However, Country Office managers have been proactive in redressing these challenges.

86 Saptari Public Health Facility for IDP camps. Personal Interview. March 21, 2009 87 Saptari IDP Camp Clinic Health Workers. Personal Interview. March 20, 2009. 88 Center for Victims of Torture in Nepal. Personal Interview. March 16, 2008. 89 Ibid. 90 Kanchanpur Women’s Development Officer. Personal Interview. March 20, 2009.

During the 2008 flood response, central-level personnel were not always clear on who was responsible for different activities within the emergency response. Those who were not involved in the response initially were unclear of how – and to what extent – to become involved in emergency response as the situation progressed. Staff members at the district level were often unsure of their roles as well. As a result, district staff primarily continued with their regular development work despite the emergency. Focal points were not always clear about to whom they reported,91 and often lacked needed support. The absence of focal points in each of the affected districts reduced effectiveness and overburdened the existing focal points.

Problems with information sharing were often at the root of human resource management problems. Breakdowns in vertical channels of communication meant insufficient guidance provided to the district office. Guidelines on humanitarian activities, such as distribution of NFIs to the target population, were delayed, resulting in uncertainty on the best manner in which to target populations given pervasive ethnic, religious, and communal tensions in the IDP camps.92

Communication between local-level and central-level staff was difficult due to a lack of necessary communication equipment, such as phones, computers, and internet cards, for focal points stationed in the flood-affected areas.93 Communication was further hindered by high turnover among UNFPA consultants and staff, resulting in incomplete transfer of knowledge among staff and impeding smooth transition of responsibilities. Information sharing and ensuring institutional memory within the office was difficult because there is no central location for storing digital files and information relevant to the humanitarian response.

The absence of proper training also reduced staff effectiveness. Few UNPFA staff members were fully equipped to begin humanitarian work, as there was insufficient training and guidance with respect to emergency preparedness and service delivery under the MISP framework. Local personnel were especially under-trained in the MISP, and as a result, were unsure of how the RH kits were to be optimally utilized.94

Finally, the challenges and hardships UNFPA staff and consultants faced in working in a fast-paced humanitarian emergency should not be overlooked. Duties were sometimes disproportionately distributed, placing high burdens on particular staff members at both the central and district levels. In particular, personnel working at the epicenters of the emergency were exposed to constant, high-level stress without sufficient opportunities for time off. All staff members, regardless of designation and location, need to be encouraged to take time off. UNFPA Nepal has a policy in place designed to improve work/life balance, and should continue to work to fully implement this policy so that the demands of humanitarian work are better balanced with staff members’ own psychosocial health and work/life balance needs.

Coordination

With respect to coordination, UNFPA faced many challenges to their effectiveness. In the views of many partners, UNFPA did not always have a strong presence in the cluster meetings, both in Kathmandu and at the local level. On one hand, UNFPA achieved a remarkable attendance record at cluster meetings in Kathmandu, especially given the limited number of personnel available to attend these meetings in

91 Former UNFPA Consultant. Telephone Interview. March 26, 2009. 92 Ibid. 93 Former UNFPA Consultant. Telephone Interview. March 26, 2009. 94 UNFPA Public Health Nurse. Personal Interview. March 21, 2009.

comparison to larger agencies. In addition, the UNFPA protection officer played a highly significant role in the Protection Cluster in Saptari and Sunsari. These are both notable achievements. Nonetheless, several agencies did not recognize UNFPA as an active participant in district-level cluster meetings, or did not feel that UNFPA played a strong consistent role. Many felt it was difficult for UNFPA to adequately advocate for consideration of gender, RH, and GBV issues. The reason for this discrepancy is not entirely clear to the CU evaluation team, and may merit additional investigation by the Country Office.

Oftentimes coordination with other UN agencies and NGOs proved to be underdeveloped during the 2008 flood response. For example, despite UNFPA’s significant efforts to coordinate with other providers of GBV services and training, including UNICEF, CARE, and OHCHR, gaps in communication and coordination persisted.95 This caused UNFPA to need to establish implementation routes from scratch, thus delaying the humanitarian activities and reducing their effect. For example, rather than using UNICEF’s existing women’s networks in the IDP camps, UNFPA developed duplicate networks for RH and GBV activities.

Furthermore, difficulty in coordinating with data-collecting agencies within the government and NGOs has meant that UNFPA’s core issues are not well reflected in data collection. This gap may stem, in part, from agencies’ reluctance to include data on RH, GBV, and HIV, or insufficient capacity to measure incidence and prevalence of these outcomes. For example, here was no incorporation of GBV components into the Initial Rapid Assessments (IRA) conducted in the aftermath of the floods. In addition, the collection of epidemiologic surveillance data on RH morbidity and mortality has been an admitted weakness of the EDCD, although they acknowledge that RH was one of the highest-need areas after the floods, and express a desire to improve collection of RH data. To date, UNPFA has not been able to coordinate with EDCD to provide technical assistance for incorporating RH surveillance into its emergency data collection procedures.

Issues of Monitoring and Evaluation

Problems with monitoring and evaluation were compounded by the lack of relevant data collection in Except from the report of Psychosocial Care and Support to the Koshi Affected Women and their the initial needs assessment as well as during the Families: monitoring phase. Later, there were no effective monitoring and evaluation procedures put into place to “Although the victims of the flood have been inform the service delivery. In part, this stemmed from a placed in camps, there are not sufficient facilities, lack of UNFPA district staff involvement. District staff privacy or security. Due to lack of sufficient space was not consulted on the selection of implementing or room for girls and women to change their partners or defining their scope of work, which made clothes as well as use toilets, the women and girls are at risk to more harassment and continuous, strategic monitoring of implementing 97 vulnerable to sexual and psychological partners’ activities difficult. This monitoring gap was exploitations. As a result, social, cultural, and not adequately filled by UNFPA’s central level during the political infrastructures are further eroded.”96 humanitarian response. Inadequate UNFPA involvement at the district level made it much harder for partners to implement and adjust programs as appropriate.98 Monitoring and evaluation were typically not well integrated into the project design of

95 UNICEF Biratnagar. Personal Interview. March 19, 2009 96 Center for Victims of Torture. “Report of Psychosocial Care and Support to the Koshi Affected Women and their Family: Immediate Short Term Response” 2009. 97 UNFPA District Project Support Unit Saptari Team. Personal Interview. March 22, 2009. 98 Adventist Development Relief Agency. Personal Interview. March 17 2009.

these programs. Ex-post evaluations conducted by independent consultants, such as the evaluation of the HIV-prevention activities undertaken by Kirat Yakthung Chumlung (KYC), are a good practice. However, on-going monitoring and evaluation is also necessary to ensure a dynamic and effective program.

Impact

Impact moves beyond the effectiveness criteria and looks at the wider influence of humanitarian action on institutions, individuals, gender, communities, ethnic groups, and age groups. Both positive and negative impacts on social, economic, technical or environmental systems are all relevant to this EHA criteria. Impact is perhaps the most difficult of the EHA criteria to assess, as it requires that the humanitarian action produce an observable difference in morbidity, mortality, policy, or practice. Thus the UNFPA activities likely to have had the highest impact are the medical services provided. In Kailali and Kanchanpur, the mobile medical teams provided vital access to RH and other medical services to communities that had no other opportunity to access care. In the Koshi region, the services provided through ADRA and the UNFPA-funded ANMs filled a critical need for quality RH care.

Although delivery of NFIs was an important “In the Saptari area camp, packages were distributed in the contribution to the relief effort, the impact of following manner: this activity may have been lower than ideal. In  Package number one: (3,000 for adolescent girls – the best-case scenario, NFIs are designed to between age 13-18): 1 piece sanitary cloth / 1 torch provide a measure of dignity that allows with battery / 1 undergarment set / 1 shawl / 1 soap. women, in particular, to leave their homes and  Package number two: (1,000 for all women): 1 cotton access additional relief services. Hygiene items, saree / 1 sanitary cloth / 1 soap when used properly, can help families stay  Package number three: (500 for most vulnerable clean and prevent infectious illness. In women – pregnant, lactating, elderly and lower caste): addition, torch lights can be used as a 1 torch with battery / 1 shawl / 1 undergarment set. protection tool. Within UNFPA’s flood In Sunsari, instead of individual beneficiaries receiving response, however, the supplied NFIs likely had packages, each household received one saree, one shawl, a less significant impact, due to delayed one soap, one torch and one piece of sanitary cloth.” 99 distribution, lack of coordination, and duplication. Many of the items were not appropriate, were not well understood, or were not used as intended. For example, in the Far Western region, in Jogbuda village, some of the women were not aware of how to use the sanitary pads or the hygiene benefits of using the sanitary pads. Additionally, the training in Jogbuda on how to use the items in the NFI kits, were mostly attended by men, and thus women did not receiving information on the items intended use.100 In the east, some IDPs reported that they received summer clothes at the start of winter.101

Even in the best-case scenario, however, providing NFIs may prove to be a low-impact intervention in comparison to activities that work toward fulfilling the life-saving objectives of the MISP. UNFPA Nepal should continue to consider ways in which it can meet its goals for NFI distribution through partner organizations with more established distribution mechanisms so that it can concentrate on higher-impact humanitarian actions geared towards saving lives. UNFPA Nepal is currently working with UNICEF to

99 UNFPA. “A National Emergency: UNFPA Nepal’s Response to Eastern and Far Western Floods 2008.” 2009. 100 Jogbuda Nepal Red Cross Society (NRCS). Personal Interview. March 21, 2009. 101 Saptari IDP camp. Semi-focus group with IDP camp residents. March 21, 2009.

standardize and preposition hygiene kits. This important collaboration will help to pave the way for more streamlined, effective NFI distribution in future emergencies.

The UNFPA Nepal Country Office is acutely aware of the possibility that UNPFA’s humanitarian action at times can yield unintended negative impacts as working with extremely vulnerable populations often means there is a high risk of creating a harmful impact. In one instance, UNFPA discovered that the disposable sanitary pads included in hygiene kits for adolescent girls created a protection issue, as girls often felt the need to leave their tents at night to dispose of the pads.102 This example illustrates that protection of vulnerable persons often involves reaching a delicate balance.

In addition, UNFPA discovered several problems with the GBV interventions in December 2008 and concluded that the work may even have been causing harm.103 For example, loss of confidentiality, potential for corruption, and misuse of information risked harm to GBV survivors.104 These problems stemmed largely from a limited local capacity for handling GBV and inadequate supervision from the central to local levels.

In the Koshi region, UNFPA organized a three-day GBV training in such a way that police were temporarily removed from their posts in the IDP camps to participate. Although this training may have been an important step in enhancing local knowledge and capacity to address GBV, it nonetheless led to a security gap.105 Additionally, UNFPA and OHCHR conducted two separate trainings, as a result of miscommunication between the agencies.106 UNFPA, OHCHR, and other Protection Cluster members have since reflected on the lack of coordination and division of labor within the cluster, and are currently working on a Protection Cluster contingency plan.107 This contingency plan aims to ensure comprehensive coverage of protection issues during future humanitarian responses.

The potential for harm is present anytime The evaluation team that went to the Far humanitarian aid is directed at one group over Western region witnessed first-hand the kind of another. This challenge is not unique to UNFPA, but is tensions that have been created by competition an important consideration for all humanitarian for humanitarian goods and services. The convoy passed through a village on the way to a flood- agencies. Although this is very difficult impact to affected community known as the Farm Village. mitigate, UNFPA must continue to be aware of the When the driver paused to ask directions, potential for this impact so that it can be active in residents expressed anger that the Farm Village efforts to minimize it. Particularly in the Far Western received so much assistance in comparison to flood response, tensions arose between camps and their own village. The villagers then looked village communities that received assistance and those through the empty truck beds in an effort to loot that did not.109 Competition among villages is a source relief supplies.108 of potential harm in many situations. In the Far Western region, there was often a very fine line between affected and unaffected villages, as all villages in the area dealt with the effects of the monsoons to some extent. In the Koshi region, displaced persons

102 Personal Communication with UNFPA Nepal staff. 3/16/09 103 UNFPA Nepal Staff. Personal Interview. March 16, 2008. 104 Columbia University Nepal Team. Notes from Workshop on Protection Cluster Contingency Planning. March 25, 2009. 105 OHCHR. Personal Interview. March 17, 2009. 106 OHCHR.“Lessons Learned from Protection Activities in Nepal. Based on Experience Gained During the flood Response in 2008.” 2009. 107 Workshop on the Protection Cluster Contingency Planning, Kathmandu, Nepal, March 25, 2009. 108 Columbia University NepalTeam. Notes from Kailali. March 19, 2009. 109 UNFPA Nepal Mission Trip. UNFPA Mission Travel Report to Kailali, Kanchanpur, Dadeldhura. 18-23 March, 2009.

living in close proximately to local fields sometimes came into conflict with the host population.”110 Tension among IDPs also manifested as Madhesi-Pahadi111 conflict, conflict between Nepalese and Indian IDPs who crossed over the open border to Nepal, 112 and religious and caste discrimination within camps. For example, Muslims and Hindus lived in segregated areas of camps.113

UNFPA Nepal is already sensitized to the possibility of tension between men and women regarding NFI distribution. While some communities acknowledged that women and children were disproportionately affected by the floods, and welcomed emergency supplies for these groups, the lack of NFIs for men was a potential source of tension in some communities. In Jogbuda, in the Far Western region, this was expressed as a potential problem. Men would have liked to receive hygiene kits and footwear.114

The long-term impact of humanitarian aid is another important consideration. In the Koshi region, several agencies and personnel have described concern over creating dependency among displaced populations. IDPs in the east have been refusing to leave the camps. To some extent, this is because there is a not yet a good solution for their return or relocation. In part, however, the refusal stems from the quantity and quality of goods and services they receive in the camps. ADRA expressed concern that “relief items distributed hindered health-seeking attitude of the community” in Saptari.115 NFIs are of particular concern, as they tend to have a low impact relative to other services, yet carry a high risk of dependency. This impact is by no means a product of UNFPA’s humanitarian response alone, but UNFPA can play a positive role in this dialogue within the humanitarian community.

Relevance and Appropriateness

The relevance criterion is concerned with assessing whether the overall goals and purpose of the humanitarian action are in line with local needs and priorities. Appropriateness is assessed, as a component of relevance, by the degree to which humanitarian activities have been tailored to local needs and have fostered ownership and accountability. Much of UNFPA’s response was both highly relevant and appropriate, and recruitment of locally knowledgeable individuals and organizations was a clear strength of UNFPA’s response.

The work of UNFPA’s implementing partners often illustrates the relevance and appropriateness of UNFPA’s response. CVICT’s utilization of locally-based psychosocial counselors in Saptari and Sunsari and training of community psychosocial workers was exemplary in this way. The community psychosocial workers who participated in the 10-day training were selected with support from community-based organizations, and most of them represented the IDP camps.116 Similarly, KYC was responsive to community needs in identifying HIV prevention and adolescent sexual and reproductive health services as an important area of service delivery. Following a needs assessment of adolescents of the Koshi region, KYC conducted an HIV prevention and awareness program in Sunsari and Saptari districts in an

110 UNFPA Nepal. “A National Emergency. UNFPA Nepal’s Response to Easter and Far Western Floods 2008.” 2009. 111 Madhesi-Pahadi conflict refers to tensions among the traditionally Indian originated plains people and the hill peoples. 112 UNFPA “A National Emergency. UNFPA Nepal’s Response to Easter and Far Western Floods 2008,” 2009. 113 Ibid. 114 Columbia University Nepal Team. Team Notes from Jogbuda. March 21, 2009. 115 ADRA. “Delivery of Emergency Reproductive Health, Sexual and Gender-based violence and HIV/AIDS Awareness and Services on Flood Affected Population of Saptari District, Eastern Region of Nepal Project Completion Report to UNFPA.” 2008. 116 Center for Victims of Torture in Nepal. “Report of Psychosocial Care and Support to the Koshi Affected Women and their Family: Immediate Short Term Response.” 2009.

effort to improve knowledge and awareness of HIV/AIDS among young people. Most importantly, the program involved community members during project planning, development, implementation, and monitoring.117

One of the major challenges to creating relevant and appropriate humanitarian interventions was the lack of a proper needs assessment, as mentioned previously. This made it difficult to truly understand the needs of the community. Of the assessments conducted, including the IRAs, the United Nations Disaster Assessment and Coordination (UNDAC) assessment, and the assessment on child protection, none were equipped to accurately gauge the local needs and priorities with respect to RH and GBV,118 as the assessments did not identify pregnant and lactating women, or ask about access to health facilities.119 Moreover, as mentioned, the IRAs were not conducted until approximately two months after the flood.120 The objectives of the assessments were not always clear, and there were problems with lack of communication within IASC, as well as challenges due to the fluid movement of the local population.121 In the Far Western region in particular, the review of the IRA by OCHA and the DDRC of Kailali indicated that there was poor coordination, problems with proper training and orientation for the assessment team, and overall concerns about lack of accuracy, validity, and uniformity in the data.122 In addition, shortcomings in monitoring and evaluation also made it difficult to ensure that goods and services were relevant and appropriate in time to make necessary changes.

Lack of proper data and monitoring meant that while UNFPA’s NFIs, including hygiene and dignity items, were an important source of support for displaced persons in both the east and west, the NFIs were not always relevant or appropriate. For example, some of the saris were of insufficient length, some communities received summer clothes as winter was starting, and some locally-needed items were omitted, such as heavy blankets or bed nets.

The local need for improved access to medical services was an important finding in the Far Western region. Most communities that the evaluation team visited named health care as their foremost need during the time of the floods. In villages in Kailali, people asked for additional basic health services as well as health trainings for community members.123 Additional health services would have made the humanitarian interventions in Kailali and Kanchanpur more relevant and appropriate to the needs of the affected populations. In the Koshi region, some characteristics of the medical services provided were inappropriate. For instance, the location of mobile health camps in Saptari was not always suitable to the setting, as they were often too far off the static camps,, making access difficult.124 Early in the response, the health camps had no privacy for women giving birth, and no beds or tents for admitted patients.125

117 KYC. “HIV Prevention and Awareness Program Including ASRH for People affected by Koshi Flood in Sunsari and Saptari District in Nepal. Final Report submitted to UNFPA.” February 01 to March 15 2009. 118 OHCHR. “Lessons Learned from Protection Activities in Nepal. Based on Experience Gained During the flood Response in 2008.” 2009. 119 OCHA. Personal Interview. March 29, 2009. 120 Ibid. 121 OCHA. Personal Interview. Mach 16, 2009. 122 District Disaster Relief Committee (DDRC)-Kailali. “Workshop Report Flood Response Lesson Learnt Workshop.” 2009. 123 Columbia University Nepal Team. Notes from Kailali. March 20, 2009. 124 ADRA. “Delivery of Emergency Reproductive Health, Sexual and Gender-based violence and HIV/AIDS Awareness and Services on Flood Affected Population of Saptari District, Eastern Region of Nepal Project Completion Report submitted to UNFPA.” 1 November 2008 to 31 December 2008. 125 UNFPA Public Health Nurse. Personal Interview. March 21, 2009.

Sustainability and Connectedness

Sustainability and connectedness are concerned with the degree to which the impact of a humanitarian action is likely to persist in after the funding has ended. Although humanitarian activities are designed to be short-lived, it is important that they take into consideration the early recovery and longer-term development phases of the affected areas. MISP MISP Objective 5: Objective Five, planning for the provision of comprehensive reproductive health services, directly Plan for the provision of comprehensive addresses the issues of sustainability and reproductive health services, integrated into connectedness. primary health care (PHC), as the situation permits by: Some aspects of UNFPA’s humanitarian response have  Collecting basic background information; fostered sustainability, such as the relationships built  Identifying sites for future delivery of with implementing partners, and the enhanced comprehensive RH services;  capacity developed through trainings in the affected Assessing staff and identifying training protocols; communities and for government counterparts such as  Identifying procurement channels and WDOs. In particular, the training of camp-based assessing monthly drug consumption.126 psychosocial counselors by CVICT, 127 and KYC’s recruitment and training of flood-affected youth to act as peer educators and advocates in their communities128 continue to positively impact the target population. UNFPA has also participated in partnerships with other organizations and shown that it can be a major player in humanitarian response in Nepal, an impact that should not be underestimated.

However, at this point in time, UNFPA has largely withdrawn from the humanitarian response in both the Koshi and Far Western regions. As a result, early recovery efforts have been insufficient in both regions. These efforts are particularly vital activities for UNFPA because of the vulnerability of these regions. Natural disasters weaken the capacity of governments and local communities to access, plan, and implement early recovery initiatives in a timely manner. Extreme poverty, the post-conflict context, and environmental vulnerability make the link between humanitarian response and early recovery all the more critical.

UNFPA, along with many other UN agencies, has been essentially absent in returning communities in both regions. As a result, UNFPA has not provided scaled-up services to improve existing health structures for communities which host returning populations. This is particularly unfortunate as these sorts of scale-up activities are often regarded as UNFPA’s niche, and because women and families who are returning to their communities may be especially vulnerable to issues of poverty and GBV. In addition, because of the high likelihood of a recurring flood in these regions, early recovery must include future preparation. For 2008, there was no prior training given to implementing partners or government officials, such as WDOs, on the intersections of disaster preparedness and the MISP.129 Such capacity gaps must be filled as a part of ongoing development and disaster preparedness in these vulnerable regions.

126 Minimum Initial Service Package for Reproductive Health in Crisis Situations, November 2007 127 Center for Victims of Torture in Nepal. Personal Interview. March 16, 2009. 128 Kirat Yakthung Chumlum. Personal Interview. March 20, 2009. 129 Women’s Development Officer, Sunsari. Personal Interview. March 23, 2009.

Coverage

Coverage refers to the ability of the humanitarian intervention to reach all the major population groups facing life-threatening conditions and respond with proportionate assistance and protection. The coverage criteria entails reaching populations “wherever they are” in a way that is “devoid of extraneous political agendas.”130

Consistent with its mandate, UNFPA’s service delivery in the post-flood situation was primarily directed toward vulnerable women and adolescents in the affected areas. Even though the effect of the floods (and also landslides in the Far Western region) spread out to many other districts, Sunsari and Saptari in the east and Kailali and Kanchanpur in the west were by far the most affected districts. Like most other organizations, UNFPA also directed its efforts primarily in these districts.

In the east, as well as the Far West, there was some suggestion of failure to meet the needs of certain ethnic and religious groups. For example, as previously mentioned, issues of jungle camps and the lack of access to these groups meant that UNFPA was unable to provide services to this population. Additionally, Indian refugees in the Koshi disaster were constrained in accessing the goods and services they needed due to racial and ethnic discrimination. There is always the danger that by adhering too closely to UNFPA’s usual target populations, broader issues of discrimination among populations may not be recognized. Thus, caste-based discrimination in the camps should be considered by UNFPA during humanitarian relief efforts. 131

RECOMMENDATIONS

Immediate Recommendations

The following prioritized action items were recommended to UNFPA Nepal as immediate steps that can be taken by the Country Office in the short term in order to prepare for the upcoming monsoon season.

Priority 1: Conduct a brainstorming session on the preliminary findings and recommendations of the Columbia University evaluation.

Priority 2: Arrangements should be made for all Country Office and district-level staff to complete MISP training.

Priority 3: Continue ADRA’s work in the Koshi flood region as an interim measure to fill significant gaps in RH service delivery. Although the long-term goal is to build government capacity to meet these needs, partnering with ADRA is a stop-gap measure, since building government capacity is a longer-term effort.

Priority 4: UNFPA should identify personnel who could serve as RH Coordinators in the event of a humanitarian crisis to implement the MISP. At a minimum, UNFPA should identify two persons in the Koshi region and two persons in the Far Western region, given the high risk of a repeated flood crisis in these areas. Arrangements should be made to address any gaps in training for these personnel.

130 ALNAP 2001. “Humanitarian Action: Learning from evaluation.” ALNAP Annual Review 2001. London: ALNAP/ODI 131 OHCHR. “Lessons Learned from Protection Activities in Nepal. Based on Experience Gained During the flood Response in 2008.” 2009.

Priority 5: Continue coordination with UNICEF to identify the contents of a basic hygiene kit that can be assembled jointly and prepositioned in vulnerable districts. Simultaneously, communicate to district offices that they will have primary responsibility for local procurement of culturally and contextually appropriate NFIs in the event of an emergency. Plans should be made for kits to be prepositioned for district use in the event of an emergency. With central-level support, district offices should identify locations to store prepositioned NFIs.

Priority 6: Support district offices in identifying possible implementing partners for the 2009 flood response. Begin the process of assessing capacity of these partners.

Priority 7: Assign staff members to the health and protection clusters. Additionally, staff should be assigned to attend the early recovery network meetings. Identify alternates to attend these meetings when assigned staff is in the field or otherwise unavailable. Formalize this arrangement in the staff’s Performance Appraisal and Development System (PAD).

Priority 8: Follow-up on the revision of the UNFPA Country Contingency Plan, following the HRB mission. Contact district officials for input on the Country Contingency Plan.

Priority 9: Actively contribute to the development of the IASC contingency plan, with emphasis on the health and protection clusters. Far Western region

Medium- and Long-Term Recommendations

The following long-term recommendations are considerably more ambitious, and often require some degree of institutional change. These items were recommended to UNFPA Nepal recommendations for improving overall humanitarian response over the coming months and years.

Programmatic Recommendations

Recommendation 1: UNFPA should reestablish presence in flood-affected areas. UNFPA provides critical services to vulnerable women and adolescents in emergency situations. However, absence in the field and at the central level resulted in dramatic gaps in service provision. As such, UNFPA should immediately reestablish presence in the field, and it is recommended that UNFPA: a. Leverage partnerships with other organizations with higher capacity, especially the WDOs, to ensure that effective and adequate service provision in emergencies. b. Reinstate key contracts such as those with ADRA given the magnitude of need and inadequacy of service provision. This can be done in an addendum to the agreement with ADRA through the procedures established by the UNFPA Nepal Operations Unit. For future disaster contexts, agreements with implementing partners should be framed using longer time periods. c. Place Focal Points on the ground in disaster-affected districts for both the Health and Protection Clusters to better support the work of the government leads. Support to the Protection Cluster is especially necessary given the cultural silence and general lack of awareness on gender issues. The focal point for the Protection Cluster can ensure that women’s protection issues are adequately addressed.

Recommendation 2: UNFPA should better utilize the framework of the MISP.

There are several ways in which better MISP utilization will be helpful to UNFPA humanitarian response. First, UNFPA can use the MISP to help prioritize service delivery. Second, UNFPA should use the MISP in its advocacy efforts to help achieve recognition by other agencies of the importance of RH in emergencies. Because each MISP objective is concretely life-saving, it illustrates to partner agencies that UNFPA’s work is indispensible. In this way, the MISP framework serves as a tool for garnering funding and support. There are two concrete actions that the team would recommend the Country Office undertake with respect to the MISP: a. Ensure presence of RH Coordinator. At the onset of a humanitarian emergency, the very first step must be to ensure that a RH coordinator is present and that coordination mechanisms are in place. b. Provide MISP training to all Country Office staff. Ideally, trainings should also be provided to district-level operational and senior-level staff as well as key staff of key partner organizations.

Recommendation 3: UNFPA should develop, evaluate, and deliver hygiene kits and other NFIs with the following characteristics in mind: a. Quality: Establish quality assurance within procurement procedures to periodically verify the quality and specifications of NFIs. b. Appropriateness: Systematically reevaluate the contents of NFIs and hygiene kits. c. Awareness: Work with the WDO, NRCS and partners on the ground to strategize ways to convey the proper use of hygiene items and healthy practices. d. Package items jointly: Group items together so that each relief package has the same number and variety of NFIs within a single camp or community. e. Avoid Duplication: Coordinate with other agencies and deliver NFIs in a timely manner to prevent unnecessary duplication.

Recommendation 4: UNFPA should coordinate initial needs assessment when a crisis hits. An initial needs assessment should be conducted as soon as possible after an emergency hits. The needs assessment should be better coordinated. UNFPA should work with other agencies, such as OHCA, WHO, and members of the Protection Cluster, in order to determine the immediate needs of flood- affected populations, and organize an efficient response. It is recommended that UNFPA: a. Utilize the MISP to help guide data collection. The MISP indicates what types of questions and RH indicators should be included in the assessment. b. Seek technical assistance of the UNFPA internal working group on data in crises. The working group is developing tools and guidelines for data collection in emergency settings, which will be finalized in May 2009. c. Provide adequate training to field staff and implementing partners. These trainings would be an important step on how to use the assessment tool.

Recommendation 5: UNFPA should begin systematic early-recovery initiatives in disaster-affected regions. Recovery and development must be nationally-owned processes. It is therefore vital that UNFPA focuses on building the local and government capacity to respond by utilizing government warehouses or storage, capitalizing upon government and local distribution channels, and providing training to relevant stakeholders to strengthen the link between humanitarian, early recovery, and development phases. UNFPA should: a. Train VRRT and DDRT on intersections of disaster response and MISP.132

132 EDCD. Personal Interview. March 24, 2009.

b. Launch scale-up missions in communities to improve upon existing health structures on which returning populations rely. c. Provide material and technical support such as RH kits, clean delivery kits, and trainings on the MISP and emergency preparedness to health clinics and health workers in communities with host returning populations. d. Establish active (1) involvement and (2) advocacy efforts within the Early Recovery Network to ensure that a gender focus is mainstreamed throughout early recovery activities.133 This is an important step for UNFPA to take so as to develop tools and methodologies aligned with early recovery, coordinated activities, and information sharing. a. For example, UNDP in Nepal identified UNFPA as not only an important partner, but as a critical partner. UNDP has communicated that issues of gender in their own programming are often included only very superficially and that a broad partnership with UNFPA would be very valuable to inform their own work as it relates to women and gender issues. Therefore, the team recommends UNFPA explore partnerships with UNDP to inform the organization’s various long-term livelihood projects with a strong and mainstreamed gender component. i. Specifically, UNDP is working on microfinance in 63 of Nepal’s 75 districts. UNFPA can partner with UNDP in the development of these programs to ensure that (1) the increased income goes to fund health and education, or (2) that the groups include a revolving fund mechanism to fund women or families in distress, such as those who have lost a head of household or those with complicated pregnancies and therefore require more intensive care.134

Recommendation 6: UNFPA should establish a GBV referral system. To strengthen accountability for cases of GBV, UNFPA should collaborate more effectively with Protection Cluster agencies, such as OHCHR, to develop a functioning referral system for GBV cases before an emergency hits, as part of on-going development programming. UNFPA, as the lead of the GBV sub-cluster, should: a. Develop standard operating guidelines for enhanced preparedness and response capacity for GBV by June 2009. b. Work with other Protection Cluster members to strengthen partners’ capacity to address GBV by coordinating security forces training, by conducting a joint workshop on GBV in districts, and by sensitizing RRTs and other government officials on GBV issues.

Recommendations for Coordination and Partnerships

Recommendation 7: UNFPA should improve leveraging of partnerships. To provide effective humanitarian response, UNFPA must collaborate with strategic and implementing partners. UNFPA should: a. Utilize UNICEF’s established and effective community network within the IDP camps – such as youth and women’s groups – to mobilize communities on RH, GBV, HIV/AIDS, and gender issues. b. Coordinate with the WHO for initial response assessments and monitoring on RH indicators of IDPs in the camps. c. Advocate to IOM for gender sensitive programming.

133 Albers, Mike, Early Recovery Specialist, UNDP; In-Person. Personal Interview; March 26, 2009.; Nepal 134 Ibid.

a. IOM collects data of the IDP population through OXFAM to develop initial registration and returned community assessment. UNFPA should advocate to IOM to include RH indicators in data collection for initial registration and returned community assessment. b. IOM conducts parts of the SPHERE training for government, NGOs, and UN agencies. UNFPA should advocate to IOM for greater emphasis of MISP training into its SPHERE training. d. Develop partnerships with the following organizations and government agencies: a. Central and district-level government agencies such the EDCD, WDO, DHO/DPHO, DDRC and RRT to build government capacity, implement programs, and mobilize communities. i. UNFPA should provide MISP trainings to WDOs, DPHO/DPOs, RRT, and DDCRs to raise awareness and ensure that RH and gender issues are adequately integrated in government response in emergencies. 1. Specifically, UNFPA should provide technical assistance to EDCD such that not only communicable diseases are considered in response, but also RH issues. b. The Nepal Red Cross Society (NRCS), which has country-wide presence and high capacity for logistics and distribution in all districts. UNFPA should identify ways in which components of hygiene kits could be prepositioned and distributed through their existing channels. c. Oxfam has a high level of expertise and experience in emergency preparedness and response. Recently, Oxfam conducted simulations for disaster response and management. UNFPA should explore ways in which this expertise can be fused into its own disaster preparedness and response. d. CARE, which has experience in GBV and RH, as these issues relate to humanitarian contexts and early recovery. Given the similarity in focus areas, CARE will be a good partner for UNFPA both in the immediate emergency response and recovery response. e. Local NGOs are critical in ensuring that culturally and contextually appropriate service provision is being implemented in emergencies. UNFPA should continue assessing and identifying local NGOs as implementing partners. However, the partnership with local NGOs should be carefully assessed given operational constraints.

In leveraging partnerships to operationalize this recommendation, UNFPA can utilize the partnership matrix provided in the appendix which catalogs activities of relevant organizations at the central and district level in Nepal in technical areas of emergency response, RH, GBV, HIV, and psychosocial work.

Recommendation 8: UNFPA should engage in a systematic and participatory contingency planning process. Technical missions to UNFPA Nepal during March 2009 from the Procurement Services Branch in Copenhagen, and from the Humanitarian Response Branch in New York, were seen as key steps in the Country Office’s contingency planning process. However, the development of the contingency planning process ideally should involve central and district staff. A draft contingency plan outline, workplan, and timeline have already been drafted, and a small team in UNFPA Nepal will soon be identified to lead the development of this document. To continue this process, UNFPA should: a. Include district staff in the writing and planning process of contingency plan development for the Nepal Country Office. Participation from all levels will help to ensure ownership and effectiveness of the contingency plan and emergency operations.

b. Test contingency plans, through participation of staff and implementing partners in simulation exercises - such as UNFPA participation in the IASC simulation exercise conducted on April 16- 17, 2009 in Kathmandu - to evaluate the level and comprehensiveness of the preparedness plan. c. Review contingency plans after the next emergency response, and update contingency plans regularly. d. Build community awareness on natural disaster preparedness. UNFPA can build upon the good practices of communities that are well prepared to strengthen national capacity. For example, in one particularly prepared community in Jogbuda, Dadeldhura, NRCS collected food and NFIs from community members in case of an emergency. Also, in Kanchanpur, one village collected savings for a local relief fund. UNFPA should encourage more of these good practices in the community and actively work to sensitize RRTs and DDRC on emergencies preparation and response with respect to reproductive health and gender issues. a. UNFPA can do this by incorporating provisions for appropriate trainings into the contingency planning process so that staff and partners are trained on MISP, GBV, universal HIV precautions, and the cluster approach. Ideally, trainings for flood response should occur before the rainy season.

Recommendation 9: UNFPA should improve cluster coordination through increased field presence, training, and better communication with partners. UNFPA plays an important role within the cluster system to mainstream gender issues. However, because there was a general lack of cluster-level coordination during the response to the floods, it is recommended that UNFPA should: a. Work towards field presence and, more specifically, enhanced impact within cluster meetings. Increased field presence and attendance at the cluster meetings can work to address issues both of lack of communication and coordination. For example, and as previously mentioned, UNFPA staff is still very much needed but absent in continued response and preparedness for the upcoming monsoon season. b. Train staff on effectiveness within the cluster approach itself to enable and empower staff to represent and successfully advocate for RH and GBV when the next emergency strikes, and to provide concrete ways to incorporate these issues into the cluster response. c. Work to advocate within the clusters more generally to ensure that protection and RH issues are being infused properly into the response. More specifically, this is an important step to understand the evolution of needs and responses on the ground and how UNFPA can cater its own response.

Recommendation 10: UNFPA should improve the speed of humanitarian response. To enable UNFPA Nepal to activate resources immediately after the next crisis hits, it is recommended that UNFPA: a. Preposition NFIs and medicine in district facilities. For example, work closely with UNICEF to jointly preposition hygiene kits, so as to avoid duplication and to maximize distribution channels. b. Formalize relationships with vendors and implementing partners, by preparing memorandums of understanding ahead of time. c. Improve logistics for delivery, by working closely with global procurement teams and by identifying logistical partners who have large logistic capacities, such as NRCS. d. Improve coordination with NGOs and other UN agencies. See recommendation 7

Recommendations for Operational and Procedural Efficiency

Recommendation 11: Establish greater coordination between UNFPA Nepal programmatic staff and the operational unit to increase information sharing and improve program development. Facilitating communication between UNFPA programmatic staff and operational staff can enhance UNFPA’s ability to respond with greater flexibility during the next crisis. As such it is recommended that UNFPA: a. Institute regular trainings for program staff, both in Kathmandu and in the districts, on operational and financial trainings. b. Allow for operational staff to conduct routine visits to the disaster affected areas to become better aware of the operational and logistical constraints on the ground during emergencies and the ways in which UNFPA programs need to adjust during emergencies. a. Establish a focal point from the operational unit to be included in the HAWG, to allow for greater understanding, information sharing, and finance tracking by programmatic staff in times of emergency.

Recommendation 12: Implement greater flexibility for expenditures between central- and district-level offices. While in theory, approval from the Country Office to the field level for expenditures should not involve any significant time lag, in reality, questions of clarifications and justifications from multiple sources resulted in a significant time lag and burdensome procedures. District-level offices need to have quick access to funds during an emergency. As such, it is recommended that the UNFPA Country Office: a. Set up a small emergency fund for the field level for emergency times in the same manner as the emergency fund that is available to the Country Office from the UNFPA global headquarters. This emergency fund can allocate a limited amount of funding, which will enable the Development Coordinator to spend at the onset of an emergency with simplified approval mechanisms from the Country Office. a. For example, the development coordinator should be able to authorize expenditure within 24 hours of an emergency with an initial email approval from the senior management team.

Recommendation 13: Make reporting requirements flexible while maintaining quality to allow for information sharing, accountability, and effective monitoring and evaluation. Reporting requirements need to be adjusted, so that UNFPA can respond to an emergency with flexibility, and while maintaining quality of effective monitoring and evaluation. As such, it is recommended that UNFPA: a. Set flexible guidelines for internal reporting procedures in the emergency phase. As the emergency situation stabilizes and effective vertical and horizontal communication systems among staff and offices have been established, situational reports can be scaled down to bi- weekly periods. It is important to note that the timing period of reporting requirements will depend on the degree and level of the emergencies that is deemed appropriate by the Development Coordinator and the Humanitarian Coordinator. b. Establish flexible guidelines for external reporting procedures in the emergency phase. While external finance reports and expenditure proofs are extremely important in ensuring accountability and transparency, reporting requirements should take into consideration the length and nature of the contracts. For example, implementing partners who are receiving significant funds from UNFPA can use these funds to contract small term organizations. Or, small term assistance from implementing partners who already have an agreement with UNFPA can be folded into the existing overall agreement.

Recommendation 14: UNFPA should empower district and local staff to work effectively in times of emergency. UNFPA Nepal has extremely dedicated and capable staff that is passionate about working in humanitarian context. However, issues of human resource management have made it difficult for staff at both the country and field level to effectively carry out their functions. To enable field staff to work effectively in times of emergencies, UNFPA should: a. Provide field staff in disaster prone areas as well as Country Office staff with trainings on emergency preparedness and the MISP, including trainings on RH kits for UNFPA medical personnel b. Consider logistical needs in the field before focal points are deployed to the districts. Accordingly, focal points in the field should be given equipments such as internet cards, and mobile phones, for example, at the onset of the emergencies to facilitate communication during the time of the humanitarian response. c. Include clear divisions of labor for emergency response in the TORs of staff operating at the central and district level. This will allow for a smooth transition from development work to emergency work. a. For example, the Development Coordinator can be established as the emergency focal point in the field and the specific responsibilities for this position can be included in his or her TOR. b. Moreover, a Humanitarian Focal Point should be established in the Country Office to facilitate coordination and communication both horizontally and vertically through clear reporting lines. The Focal Point should have management responsibility with the Development Coordinator and the HAWG d. Avoid transferring staff responsibilities during times of emergencies. If unavoidable, UNFPA Nepal must institutionalize mechanisms for transfer of knowledge between the original consultant and the successor to ensure smooth transitions. a. For example, there can be an overlap of at least one week between the staff who is leaving and the successor for knowledge transfer. If this overlap is not possible, a detailed hand over note should be provided to the successor. b. Moreover, the Humanitarian Focal Point at the Country Office and the Development coordinator as the emergency focal point need to also be aware of the humanitarian work to fill in gaps in knowledge as necessary. e. Strive to support a more sustainable work/life balance for staff. While a policy exists on supporting work-life balance, the high level stress during emergency response skews work-life balance. A clear division of labor should help to lessen excessive responsibilities on staff at both the country and field level. Additionally, in times of emergencies, there should be a focal point for both health and protection in each of the areas affected to allow for greater coverage and ease of working.

Recommendation 15: UNFPA should strengthen monitoring and evaluation (M&E) for humanitarian action. Development coordinators should supervise all field consultants and implementing partners. Not only do local staff members know more about the situation in the field, but also it is difficult for central-level staff to be able to monitor issues on the ground. As such, UNFPA should: a. Consult with and include district staff in the selection of implementing partners for which they are responsible for supervising. This will help ensure that on-going monitoring at the local level is effective because district-level staff has more knowledge about field-level partner capacities and reputation.

b. Provide clear and comprehensive information to district staff on the specific activities and objectives of the implementing partners. This is especially important if implementing partners are chosen at the central level. c. Empower district staff to monitor district-level projects. When this proves impossible, then a central level staff member should conduct the initial field monitoring visit.

Conclusion Due to the fact that natural disasters are a recurring phenomena in Nepal, it is important for UNFPA to take stock of its strengths and weaknesses in order to respond more effectively the next time a natural disaster occurs. With this evaluation, the team aims to provide concrete and implementable recommendations to assist UNFPA in achieving its short and long-term goals of providing effective and sustainable humanitarian responses to future crises with respect to reproductive health and gender issues.

The CU team recognizes that UNFPA is not an implementing agency, but rather supports partners who provide on-the-ground assistance – and therefore, cannot achieve all of its humanitarian response objectives alone without building local capacity and fostering partnerships. As such, this evaluation may be useful to international and national partners in Nepal, because many of the findings and recommendations focus on the need for UNFPA to build and strengthen relationships with strategic and implementing partners.

The broader implication of this evaluation is the question of how the UNFPA Nepal Country office will strategically plan for responding to the next crisis. As a result of the CU evaluation, the UNFPA Nepal Country Office has already begun to reconsider what the overall framework for the Country Office response to emergencies should be, and how the MISP should be applied during emergencies. More specifically, the Country Office has initiated a discussion about whether the UNFPA Nepal CO should (1) be expected to take responsibility for implementing the MISP in emergencies in its entirety – which has resource implications – or (2) whether the MISP should be used as a guidance and advocacy tool on which UNPFA Nepal advocates its partners to work on and from which it draws out only some responsibilities.

The CU team is thankful to have the opportunity to spark such a discussion among the staff at UNFPA Nepal. The CU team is confident that no matter which decision the Country Office takes regarding UNFPA Nepal’s role in humanitarian response with regard to the MISP, that the energetic and dedicated staff at UNFPA Nepal will have taken important steps to ensure that UNFPA Nepal has more humanitarian response capacity in preparation for the next humanitarian crisis.

APPENDICES

I. Explanation of Methodology

The following section provides a more in-depth account of the methodology that this report employed.

Step 1: Fact-finding Literature Review: The CU team reviewed relevant literature from a variety of sources to gain a grounded understanding of the situation in Nepal in general and of UNFPA’s work in particular. The CU team collected and analyzed a number of key documents in an attempt to recognize overarching issues, understand current operations in the field, and identify key gaps and challenges Also, the CU team reviewed documentation of humanitarian actions by UN agencies, NGOs, and government actors, particularly in response to natural disasters. This research focused largely on previous humanitarian responses within the South Asia region, in an effort to identify contextually relevant and effective practices and “lessons learned” in the area of emergency response.

Step 2: Interviews with Stakeholders The CU team conducted semi-structured interviews with current and potential strategic and implementing partners, government officials, health workers, and UNFPA staff. More specifically, the key stakeholders/informants included:

1. Strategic partners in New York, and corresponding strategic partners in Nepal to (1) provide information on the impact of the 2008 Nepal floods on different areas of reproductive health; (2) evaluate UNFPA’s response to the 2008 Nepal floods from the perspective of strategic partners and other agencies; (3) identify the environment in which UNFPA is functioning by revealing the degree to which reproductive health and gender issues are mainstreamed in other organizations’ emergency work; and (4) ascertain the potential for strengthening current partnerships as well as identifying new opportunities for collaboration with key organizations involved in related activities in Nepal. Strategic partners included staff from organizations such as the United Nations Development Programme (UNDP), the United Nations Children’s Fund (UNICEF), and the United Nations Office for the Coordination of Humanitarian Affairs (OCHA).

2. Implementing partners from international and local organizations in Nepal, to conduct a capacity assessment of each partner with respect to the MISP, and to evaluate the partnership with UNFPA. These interviews were also important in evaluating the efficacy of the UNFPA Nepal’s response in the 2008 floods and also in determining the capacity and their effectiveness of the implementing partners in rolling out programs, respectively. Furthermore, the interviews provided information ways in which UNFPA Nepal can better support and build the capacity of implementing partners such that they themselves are more equipped to respond to future emergencies. Implementing partners included staff from organizations such as theNRCS, and tCVICT.

3. Nepal government officials, in Kathmandu and in the districts, to identify ways in which UNFPA can better advocate for RH and gender issues in national disaster-related policies and plans, and to understand the government’s response to the floods. Such government agencies included the WDO, and EDCD, for example.

4. Health workers, in the districts, to collect information concerning the response to the 2008 floods, and to evaluate the capacity of the district health systems. For example, The CU team interviewed staff from the ‘team hospital’ and ‘district hospital’ in Dadeldhura, and staff from a temporary flood relief hospital and a 24-hour clinic in Sunsari.

5. UNFPA Nepal staff and former consultants from UNFPA Nepal in Kathmandu and in the districts to evaluate the effectiveness of UNFPA and implementing partner’s response to the floods in 2008, and to identify lessons learned and ideas for improving service delivery.

6. UNFPA Headquarters staff from the UNFPA Humanitarian Response Unit in New York, staff from the Inter-Agency Standing Committee (IASC) Gender Sub Working Group in Geneva through a phone interview, to understand UNFPA’s role at the global level in terms of gender mainstreaming and GBV programming.

Additionally, the CU team conducted focus group discussions with:

7. Flood-affected populations in IDP camps and flood-affected villages in Sunsari, Saptari, Kailali, and Kanchanpur districts, to evaluate UNFPA Nepal’s response to recent flooding with respect to the needs of the flood affected population, and with respect to the MISP criteria.

Step 3: Framework of Analysis

The CU team based its evaluation on guidelines developed by the Active Learning Network for Accountability and Performance in Humanitarian Action (ALNAP), an international interagency forum working to improve the quality and accountability of humanitarian action.135 Evaluation of humanitarian action (EHA) is a major area of work for ALNAP. The network has established a Quality Proforma136 for EHA, a tool for assessing the quality of evaluations of humanitarian work. The Quality Proforma embodies the unique requirements of evaluations of humanitarian action as well as overall good practices for evaluation. ALNAP’s Quality Proforma outlines specific requirements for EHA, including evaluation based on standardized criteria. The CU team tailored the standardized seven criteria of the EHA slightly to meet the needs of the specific evaluation. As such, the six requirements this evaluation is based on are the EHA criteria with the addition of “coordination” in the effectiveness category, and omission of the category for “coherence.” The criteria are described below.

1. Efficiency – Efficiency measures the relationship between outputs and inputs, and whether different outputs could have been produced that would have had a greater impact in achieving the project objectives.137

2. Effectiveness and Coordination – Effectiveness measures to the extent to which an activity achieves its objective, or whether this objective can be expected to happen on the basis of the outputs. Effectiveness also measures the timeliness of the response. Coordination refers to the

135 Evaluation of Humanitarian Action. www.alnap.com. 136 ALNAP 2001. “Humanitarian Action: Learning from evaluation.” ALNAP Annual Review. 2001. London: ALNAP/ODI. 137 Ibid.

degree to which partnerships and interagency cooperation contributed to the effectiveness of the activity.138

3. Impact – Impact measures the larger effects of the project – social, economic, political, and environmental – on different groups (individuals, gender, age-groups, communities, and institutions).139

4. Relevance and Appropriateness – Relevance measures the project – and the overall goal or purpose of a program – is in line with local needs and priorities. Appropriateness refers to the need to tailor humanitarian response to local needs, which can increase local ownership, accountability, and cost-effectiveness.140

5. Sustainability and Connectedness – Sustainability and Connectedness refer to the degree to which the impact of humanitarian response is likely to continue after the funding has ended, through relationships build with implementing partners and through capacity development of local actors.141

6. Coverage – Coverage refers to the need for humanitarian response to reach major population groups facing life-threatening circumstances, and provide them with aid and protection proportionate to their need and without of ulterior political motives.

Additionally, the EHA criteria states that consideration throughout the evaluation must be given to cross-cutting issues, such as adherence to international standards in the planning, implementation and evaluation of humanitarian intervention; gender equality; protection; capacity building of key stakeholders, government and civil society partners; advocacy; and vulnerable and marginalized groups that suffer from discrimination and disadvantage.142

138 ALNAP 2001. “Humanitarian Action: Learning from evaluation.” ALNAP Annual Review. 2001. London: ALNAP/ODI. 139 Ibid. 140 ALNAP 2001. “Humanitarian Action: Learning from evaluation.” ALNAP Annual Review. 2001. London: ALNAP/ODI. 141 Ibid. 142 ALNAP 2001. “Humanitarian Action: Learning from evaluation.” ALNAP Annual Review. 2001. London: ALNAP/ODI.

II. Table of Interviews

For the field visits to the Eastern and Western districts, the CU team divided up into two teams of three members. One team traveled to the Far Western districts of Kailali, Kanchanpur and Dadeldhura and the other team traveled to the Eastern districts of Saptari and Sunsari. A few UNFPA Nepal staff members from both Kathmandu and the relevant districts accompanied each team.

Below is the Table of Interviews, which provides details regarding the location, language, and contact person of the interview.

UN AGENCIES AND INTERNATIONAL ORGANIZATIONS

HEADQUARTER LEVEL

United Nations Population Fund (UNFPA), Humanitarian Response Branch; New York Date February 23, 2009 Location of Meeting UNFPA, New York Language of Interview English Contact Person Henia Dakkak, Senior Technical Advisor [email protected] Focus Activities Inter Agency Standing Committee (IASC) Working Group on gender and humanitarian action, GBV sub-cluster Potential for NA Partnership

United Nations Children’s Fund (UNICEF), Humanitarian Support Unit; New York Date March 5, 2009 Location of Meeting UNICEF, New York Language of Interview English Contact Person Vincent Cauche, Emergency Specialist, [email protected] Focus Activities Child Rights, HIV/AIDS and Children, Child Protection, Child Survival and Development, Basic Education and Gender Equality Potential for Knowledge sharing regarding resource mobilization and thematic Partnership supports to the Country Office at the New York level

United Nations Population Fund (UNFPA), Humanitarian Response Branch; Geneva Date March 11, 2009 Location of Meeting Telephone Interview Language of Interview English Contact Person Maha Muna, Humanitarian Response Branch Specialist [email protected] Focus Activities Strengthening GBV in the Protection Cluster; implementation of the Security Council Resolutions 1820 and 1325, strengthening gender through GBV training capacity in humanitarian contexts Potential for NA Partnership

United Nations Development Programme (UNDP), New York Date March 12, 2009 Location of Meeting UNDP office, New York Language of Interview English Contact Person Razina Bilgrami [email protected] Focus Activities Democratic governance, poverty reduction, gender and social development, crisis prevention and recovery, HIV/AIDS Potential for Very interested in working with UNFPA on gender mainstreaming in Partnership their development and community development work

CENTRAL LEVEL – Kathmandu

Office of the High Commissioner for Human Rights (OHCHR) Date March 16, 2007 Location of Meeting OHCHR office, Kathmandu Language of Interview English Contact Person Richard Bennett [email protected]; Lukas Heinzer [email protected]; Frederick Rawski [email protected]; Andrew Palmer [email protected] Focus Activities Protection and promotion of human rights for all people. Helps people to understand their rights and assists governments to ensure respect of human rights for all people. Potential for In the Protection Cluster, on GBV activities such as protection and Partnership sensitization training of implementing actors, and GBV referral mechanisms

Office for the Coordination of Humanitarian Affairs (OCHA) Date March 16, 2009 Location of Meeting OCHA office, Kathmandu Language of Interview English Contact Person Karen Brewster, Humanitarian Affairs Officer, [email protected] Focus Activities Mobilize and coordinate humanitarian action in partnership with national and international actors in disasters and emergencies, promote preparedness and prevention, facilitate sustainable solutions. Potential for Information sharing Partnership

Office of the High Commissioner for Human Rights (OHCHR) Date March 17, 2007 Location of Meeting Kathmandu Language of Interview English Contact Person Annette Lyth, Human Rights Officer [email protected] Focus Activities Protection and promotion of human rights for all people. Helps people to understand their rights and assists governments to ensure respect

of human rights for all people. Potential for Protection Cluster trainings on protection issues such as GBV. Partnership Coordination of GBV referral mechanism; Linking OHCHR’s monitoring with UNFPA’s service provision to provide comprehensive protection services

International Organization for Migration (IOM) Date March 18, 2009 Location of Meeting OCHA office, Kathmandu Language of Interview English Contact Person Christopher Hoffman, Logistics and Construction Officer [email protected] Focus Activities Camp management including IDP registration, capacity development of the GoN and community stabilization for the returned IDPs. Potential for Partnership Interested in working with UNFPA in camp coordination activities

Office for the Coordination of Humanitarian Affairs (OCHA) Date March 23, 2009 Location of Meeting OCHA office, Kathmandu Language of Interview English Contact Person Vincent Omuga, Humanitarian Affairs Officer, [email protected] Focus Activities Mobilize and coordinate effective and principled humanitarian action in partnership with national and international actors in order to alleviate human suffering in disasters and emergencies, advocate for the rights of people in need, promote preparedness and prevention, facilitate sustainable solutions. Potential for UNFPA could help OCHA with coordination of implementation and Partnership information management (especially because OCHA is downsizing in Nepal). OCHA could help UNFPA with joint preparedness planning and response. OCHA suggests a partnership that goes beyond the cluster approach – to a bilateral relationship, especially for issues such as RH and reporting to increase coverage.

United Nations Children’s Fund (UNICEF) Date March 24, 2009 Location of Meeting UNICEF office, Kathmandu Language of Interview English Contact Person Radha Gurung, Project Officer, Child Protection [email protected] Avigail Shai, Child Protection Officer [email protected] Focus Activities Health, Nutrition, Education, Water and sanitation, and Child Protection for children and women. Potential for Partnership UNICEF wants UNFPA to provide more technical knowledge on GBV standards to partner organizations and make applicable the IASC standards in Nepal. Potential partnership on: psychosocial issues; coordination of training on GBV; coordination of preparedness

training for WDO staff; general Protection Cluster involvement; and more coordination on distribution of NFIs and hygiene kits to reduce duplication.

World Health Organization (WHO) Date March 25, 2009 Location of Meeting WHO office, Kathmandu Language of Interview English Contact Person Hyo-Jeong Kim, Technical Officer, Emergency & Humanitarian Action, DoHS, EDCD [email protected]; Damodar Adhikari, National Operation Officer, Emergency & Humanitarian Action, DoHS, EDCD [email protected] Focus Activities Financial and technical support in the health area to the Government of Nepal. Potential for Partnership Interested in working with UNFPA as a humanitarian response agency in the field. Need to promote WHO to integrate RH and GBV issues in their assessments. WHO is also looking for better logistics collaboration.

United Nations Development Programme (UNDP) Date March 26, 2009 Location of Meeting UNDP Office, Kathmandu Language of Interview English Contact Person Mike Albers, Early Recovery Programme Specialist Dr. Ghulam M. Sheraini, Disaster Management Portfolio Manager Focus Activities Democratic governance, poverty reduction, gender and social development, crisis prevention and recovery, HIV/AIDS. Potential for Partnership Very interested in working with UNFPA on gender mainstreaming in their development and community development work.

DISTRICT OFFICES

United Nations Children’s Fund (UNICEF) Date March 18, 2009 Location of Meeting UNICEF Field Office, Biratnagar Language of Interview English Contact Person Sunita Kayastha Focus Activities Primary health care, immunization, child protection and emergency response. Potential for Partnership Interested in working with UNFPA again on NFI distribution as well as in expanding protection beyond child protection; suggests that UNFPA utilize already established UNICEF networks in IDP camps for RH, GBV, HIV awareness.

Office for the Coordination of Humanitarian Affairs (OCHA) Date March 19, 2009 Location of Meeting OCHA Office Biratnagar Language of Interview English Contact Person Kendra Clegg, Humanitarian Officer [email protected] Focus Activities General coordination of the emergency activities in the east Potential for Partnership Information sharing

Office of the High Commissioner for Human Rights (OHCHR) Date March 19, 2009 Location of Meeting OCHA office, Biratnagar Language of Interview English Contact Person Kamdev Ksanal, Interpreter/Translator; Camp Coordinator Focus Activities Advocacy of human rights; headed the protection cluster. Potential for Partnership Interested in partnering with UNFPA on training of human rights monitors on GBV and-related protection issues in the IDP camps.

GOVERNMENT OF NEPAL

CENTRAL LEVEL - Kathmandu

Epidemiology and Disease Control Division (EDCD) Date March 24, 2009 Location of Meeting EDCD Offices, Kathmandu Language of Interview English Contact Person Dr. Senendra Raj Upreti, Director, EDCD Mr. Sagar Dahal, Chief, Disaster Management Section, EDCD Focus Activities Disease control; epidemiology; disaster management, including Rapid Response Teams at the central, regional, district, and village levels Potential for Partnership EDCD expressed a need for serious and extended collaboration between UNFPA and EDCD on emergency preparedness. The MISP needs to be incorporated into their guidelines (they use Sphere). EDCD also works on prepositioning for disasters, but needs additional help with logistical support, warehouse capacity, and prepositioning of supplies. UNFPA can also help EDCD in strengthening gap areas such as referral mechanisms and emergency obstetric care.

Department of Women’s Development (Ministry of Women, Children and Social Welfare) Date March 25, 2009 Location of Meeting DWD Office, Kathmandu Language of Interview English Contact Person Mamta Bisht, Focal point for UNFPA Focus Activities Gender Mainstreaming, Women’s empowerment, Coordinate

government’s women development programs, Develop policy regarding women’s development. Potential for Partnership Training for government line agency staff on GBV issues, needs UNFPA support in its work GBV and trafficking in other districts, Prepositioning with the WDOs ahead of time.

DISTRICT LEVEL

District Administration Date March 19, 2009 Location of Meeting CDO office, Kailali Language of Interview Nepali Contact Person CDO, LDO, WDO, representative from NRCS Focus Activities Overall administration of development programs, head of DDRC. Potential for Partnership There is a small amount of space for NFI prepositioning and cold storage of medicines in the Dandadhi hospital in Kailali; district officials, including the WDO, requested that UNFPA provide technical assistance on preparedness, particularly in the prepositioning of NFIs; Workshop on GBV for district Protection Cluster members and police; UNFPA could provide technical assistance to DDRC with respect to GBV and RH capacity building; UNFPA can provide MISP training to district officials, focusing on GBV.

District Administration Date March 20, 2009 Location of Meeting WDO office, Kanchanpur Language of Interview Nepali Contact Person CDO, LDO, WDO, local NGOs including NRCS and NNDSWO Focus Activities Overall administration of development programs, head of DDRC Potential for Partnership Improve coordination regarding distribution of NFIs; data collection; The WDO has space for prepositioning supplies; UNFPA could provide technical assistance to district cluster members on GBV, universal HIV precautions and emergency preparedness for communities; partner with youth clubs that are linked to the WDO for awareness/educational programs on HIV and RH

Sub Health Center, Dhakka Chandau VDC Date March 20, 2009 Location of Meeting PHC, Dhakka Chandau, Kanchanpur Language of Interview Nepali/Hindi Contact Person Health Assistant, Nurse Midwife Focus Activities Manage and provide health services at clinic Potential for Partnership Prepositioning of medical supplies

Local Development Office (LDO) Date March 20, 2009 Location of Meeting City Hall, Sunsari Language of Interview Hindi Contact Person Guru Prasad Subedi, Local Development Officer, Sunsari Focus Activities DDRC management, Overall district development and humanitarian assistance co-ordination. Potential for Partnership UNFPA could assist in scaling up services and systems in returning communities.

Chief Development Office (CDO) Date March 20, 2009 Location of Meeting District Administration Office, Sunsari Language of Interview Hindi/English Contact Person Hari Krishna Prasad Upadhay, Chief district officer, Sunsari Focus Activities Overall coordination of administrative affairs of the district including DDRC management. Potential for Partnership Keep them informed of UNFPA’s mandate for better coordination with DDRC.

District Health Office (DHO) Date March 20, 2009 Location of Meeting DHO office, Sunsari Language of Interview Hindi Contact Person Dr. Shree Ram Mehta, District Health Officer, Saptari Focus Activities Management and coordination of health facility of the district, management, coordination, and awareness of the district public health issues in general; leads health cluster. Potential for Partnership Provision of medical kits and equipment; trainings on the MISP and emergency preparedness

24-hour health center at IDP Camp, (Bhardah Temporary Hospital) Date March 21, 2009 Location of Meeting Bhardah Temporary Hospital, Saptari Language of Interview Hindi Contact Person Dr. Sanjay Sah, Ambika Oli, Gauri Sankar Dev Focus Activities Primary health care, maternal and neonatal Care, emergency health service Potential for Partnership Provision of ANMs; provision of medical kits and equipment, including furniture, lab equipment, tents, etc; deployment of ADRA for improved service provision

24-hour health center, (Koshi Flood Relief Health Camp) Date March 21, 2009

Location of Meeting Koshi Flood Relief Health Camp, Saptari Language of Interview Hindi Contact Person Ram Avatar Mandal, Ambika Oli, Gauri Sankar Dev, Ram Dev Yadav, Bibha Jha, Pamchi Yadav Focus Activities Primary health care, maternal and neonatal Care, emergency health services Potential for Partnership Provision of ANMs, medical kits, and equipment including an ambulance

Local Development Office (LDO) Date March 22, 2009 Location of Meeting LDO Office, Saptari Language of Interview Hindi/Nepali Contact Person Bishwo Raj Dotel, Local Development Officer, Saptari Focus Activities DDRC management, overall district development and humanitarian assistance coordination Potential for Partnership GBV trainings to camp management committees

District Public Health Office (DPHO) Date March 22, 2009 Location of Meeting DPHO Office, Saptari Language of Interview English Contact Person Chandra Dev Meheta, Senior Public Health Administrator, Saptari Focus Activities Management and coordination of health facility of the district; management, coordination, and awareness rising of the district public health issues in general; leads health cluster Potential for Partnership Provision of medical personnel, including ANMs; provision of medical kits and equipment; trainings on the MISP and emergency preparedness

District Administration Date March 22, 2009 Location of Meeting CDO office, Dhadeldura Language of Interview Nepali Contact Person CDO, LDO, WDO, NRCS representative Focus Activities Overall administration of development programs, head of DDRC Potential for Partnership The DHO maintains disaster management storage units in Jogbuda and the DDL district hospital; UNFPA could coordinate on prepositioning of supplies.

Women’s Development Office (WDO) Date March 22, 2009 Location of Meeting WDO Office, Saptari Language of Interview Hindi

Contact Person Ms. Devki Neupane, WDO, Saptari Focus Activities Gender mainstreaming, specifically GBV and child protection, lead on protection cluster, coordination of women development sector of the district Potential for Partnership NFI distribution, trainings on GBV issues, psychosocial counseling and emergency management

Chief Development Office (CDO) Date March 22, 2009 Location of Meeting District Administration office, Saptari Language of Interview Nepali/Hindi Contact Person Chief district officer, Saptari Focus Activities Overall coordination of administrative affairs of the district including DDRC management Potential for Partnership Keep them informed of UNFPA’s mandate for better coordination with DDRC

NON GOVERNMENT ORGANIZATIONS

CENTRAL LEVEL – Kathmandu

Center for Victims of Torture (CVICT) Date March 16, 2009 Location of Meeting UNFPA, Kathmandu Language of Interview English Contact Person Anup Poudel [email protected], Ganga Laxmi Awal [email protected] Focus Activities Psychosocial services Potential for Partnership Wants to expand further into emergency response and gender based violence.

Women’s Rehabilitation Centre (WOREC) Date March 16, 2009 Location of Meeting UNFPA, Kathmandu Language of Interview English/Hindi Contact Person Parvati Basnet, Program Manager, Parag Sivakoti, Child Health Coordinator Focus Activities Psychosocial counseling Potential for Partnership Need for a much wider coverage of psychosocial counseling in the affected areas and for longer durations.

Nepal Red Cross Society (NRCS) Date March 17, 2009 Location of Meeting NRCS office, Kathmandu

Language of Interview English Contact Person Pitambar Aryal, Director, Disaster Management Division [email protected] Focus Activities Arrange for emergency relief services for disaster victims. Work for reducing disaster and disaster preparedness as well as raise public awareness. Serve war victims in times of armed conflict. Potential for Partnership Does not focus specifically on RH but is interested in expanding into this area with UNFPA assistance.

Adventist Development and Relief Agency in Nepal (ADRA Nepal) Date March 17, 2009 Location of Meeting ADRA office, Kathmandu Language of Interview English Contact Person Amy Prevatt, Program Director [email protected]; Mohan Nepal, Finance & Admin. Director [email protected]; James Pradhan [email protected] Focus Activities Reproductive health, emergency management, education, economic development, good governance. Potential for Partnership Generally provides overall health needs, but is interested in working more in emergency situations with UNFPA assistance and trainings.

CARE Nepal Date March 25, 2009 Location of Meeting CARE office, Kathmandu Language of Interview English Contact Person Karuna Onta, Program Development & Quality Assurance Coordinator [email protected]; Rita Dhakal, Project Manager, Dipecho Samadhan [email protected] Focus Activities Child Health and Family Health, Disaster and Emergencies, HIV/AIDs, Peace Building, Drinking Water and Sanitation, Income Generation, Non-Formal Education, Good Governance, Child and Family Health. Potential for Partnership CARE is already very active in gender issues and emergency response and welcomed the opportunity to partner with UNFPA.

NON GOVERNMENT ORGANIZATIONS

DISTRICT LEVEL

Kirat Yakthung Chumlung (KYC) - Punarjeewan Kendra Date March 20, 2009 Location of Meeting Sunsari Hospital, Sunsari Language of Interview English Contact Person Kamal Tigela Limbu, Director Focus Activities HIV/AIDS awareness for the youth Potential for Partnership KYC is interested in continuing partnership with UNFPA on issues relating to HIV/AIDS, youth training, and reproductive health.

Nepal Red Cross Society (NRCS) Date March 21, 2009 Location of Meeting NRCS sub-office, Jogbudha Language of Interview Nepali Contact Person NRCS sub-office representatives Focus Activities Preparedness, coordination, implementation of relief assistance (including distribution of NFIs), data collection during emergencies Potential for Partnership Better coordination of NFI distribution

Oxfam GB Nepal Date March 22, 2009 Location of Meeting Oxfam office, Saptari Language of Interview English Contact Person Binesh Roy, Project Officer, RBP [email protected] Focus Activities Shelter and camp management Potential for Partnership GBV trainings to camp management committees; information sharing on emergency prediction; initial assessment including demographic data collection

Community Development and Human Rights Protection Forum(SETU) Date March 22, 2009 Location of Meeting Community Development and Human Rights Protection Forum, Saptari Language of Interview Hindi Contact Person Jang Bahadur Singh, Abha Setu Singh Focus Activities Gender-based violence, human rights protection. Potential for Partnership Very interested in receiving technical and management trainings. Also, possibility of collaboration on GBV service provision in the returning communities

Team Hospital Date March 22, 2009 Location of Meeting Team Hospital, Dhadeldura Language of Interview English/Nepali Contact Person Doctor and hospital staff Focus Activities Basic health care including in-house patient services. Potential for Partnership Can be a referral for birth related complications and services such as uterine prolapse etc.

Meeting with local NGOs on GBV issues Date March 22, 2009 Location of Meeting UNFPA office, Dhadeldura

Language of Interview Nepali Contact Person 17 local NGOs and UNFPA staff Focus Activities Dadeldhura-based NGOs and activists groups working on building awareness and combating GBV Potential for Partnership Lots of potential to partner on GBV awareness building programs

IDP CAMPS AND AFFECTED VILLAGES

IDP Camp, Date March 21, 2009 Location of Meeting I, J, H, and G camps, Saptari Language of Interview Hindi and Nepali Contact Person Camp residents Focus Activities NA Potential for Partnership NA

IDP Camp, Khailad VDC Date March 19, 2009 Location of Meeting Khailad village Language of Interview Hindi/Nepali Contact Person Camp residents Focus Activities NA Potential for Partnership NA

Ram Shikharjhala VDC Date March 19, 2009 Location of Meeting Ram Shikharjhala (Farm Village) Language of Interview Nepali Contact Person Village residents Focus Activities NA Potential for Partnership NA

Dhakka Chandau VDC Date March 20, 2009 Location of Meeting Dhakka Chandau, Kanchanpur Language of Interview Nepali Contact Person VDC members and village residents Focus Activities Collect and manage funds for emergencies Potential for Partnership Follow up with this VDC as to how their local initiative for preparedness can be replicated in other VDCs.

UNFPA STAFF/CONSULTANTS

UNFPA staff Name Date Location Sujata Tuladhar, GBV and Reintegration Officer March 16, 2009 UNFPA, Kathmandu Sila Ristimaki, Humanitarian Assistance & Resource March 16, 2009 UNFPA, Kathmandu Mobilization Officer Salina Khatoon, Public Health Nurse, Saptari March 21, 2009 STAR Hotel, Saptari Chiranjeeb Sah, Development Coordinator, Saptari March 22, 2009 UNFPA, Saptari Ugochi Daniels, Deputy Representative March 25, 2009 UNFPA, Kathmandu Bishnu Kumari, Public Health Nurse, Kapilbastu March 25, 2009 Telephone Interview Rajendra Gakhar, International Operations Manager March 27, 2009 UNFPA, Kathmandu

UNFPA former Consultants Name Date Location Vaijayanti Karki, Protection Cluster Coordinator, March 25, 2009 UNFPA, Kathmandu Saptari Priyanka Barra, Protection Cluster Coordinator, Saptari March 26, 2009 Telephone Interview

III. Partnership Matrix

UNFPA emphasizes the importance of fostering partnerships, developing relationships, and especially building the capacity of local non-governmental organizations and government agencies, through its work on relief and development programs. Additionally, during the CU field research, a few UNFPA partners suggested that a catalogue of activities would help reduce duplication of efforts in the field. To those ends, the CU team developed a partnership matrix below in an effort to catalog such activities. This matrix maps the relevant organizations working at the central or district level in Nepal in technical areas such as emergency response, RH, GBV, HIV and psychosocial work. The CU team anticipates that regular maintenance and distribution of this list by UNFPA staff to reflect the activities of UN agencies, government offices, and international and local NGOs will help mainstream services and help coordinate efforts during relief operations and development periods.

Emergency Management

Geographical Emergency Management Organization Type Emergency Management

Focus

Emergency

Assessment

and Facilities

Preparedness

Essential Drugs Essential

NFIDistribution

HealthEducation

Emergency Needs

EmergencyServices

Disease Disease Surveillance HealthInfrastructure Ministry of Health and Population (MoHP) GoN Nation Wide X X X X X X X Department of Women's Development (DWD) GoN Nation Wide X Epidemiology and Disease Control Division (EDCD) GoN Nation Wide X X X X X X X Nepal Army GoN Nation Wide X X X X District Public Health Office (DPHO)/District Health Office (DHO) GoN District X X X X X X X District Disaster Relief Committee (DDRC) GoN District X X X X District Administrative Office (DAO) GoN District X X X X Local Development Office (LDO) GoN District X X X Women's Development Office (WDO) GoN District X X X X X District Police Office (DPO) GoN District X X X X United Nations Development Programme (UNDP) UN Nation Wide X International Organisation for Migration (IOM) UN Nation Wide X X X United Nations Office for the Coordination of Humanitarian Affairs UN Nation Wide X X (OCHA) Offfice of the High Commissioner for Human Rights (OHCHR) UN Nation Wide X X X United Nations Children's Fund (UNICEF) UN Nation Wide X X X X X X X World Health Organization (WHO) UN Nation Wide X X X X X X X Joint United Nations Program on HIV/AIDS (UNAIDS) UN Nation Wide X X X X Aventist Development and Relief Agency Nepal (ADRA Nepal) INGO Nation Wide X X X X X X X CARE Nepal (CARE) INGO Nation Wide X X X X X X International Rescue Committee (IRC) INGO Nation Wide X X X X X X X Medical Emergency Relief International (Merlin) UK INGO Nation Wide X X X X X X X X Geographical Emergency Management Organization Type Emergency Management

Focus

Emergency

Assessment

and Facilities

Preparedness

Essential Drugs Essential

NFIDistribution

HealthEducation

Emergency Needs

EmergencyServices

Disease Disease Surveillance HealthInfrastructure World Vision International (WVI) INGO Nation Wide X X X X X X X Oxfam Great Briten (OXFAM) INGO Nation Wide X X X X X X PLAN Nepal (PLAN) INGO Nation Wide X X X X X X X Save the Children (SC) INGO Nation Wide X X X X X X Action Aid Nepal INGO Nation Wide X X X X Action Contra La Faim (ACF) INGO West X X X X X Norwegian Refugee Council (NRC) INGO Nation Wide X X X X MSF - Holand (MSF) INGO Nation Wide X X X X X X X X Caritas Nepal (CARITAS) INGO Nation Wide X X X X Medicins Du Monde Nepal(MDM) INGO District X X Nepal Red Cross Society (NRCS) NGO Nation Wide X X X X X X X Women's Rehabilitation Center (WOREC) NGO Nation Wide X X X X Community Development and Human Rights (SETU) NGO East X X X Center for Victims of Torture (CVICT) NGO Nation Wide X X X Kirat Yakthung Chumlung (KYC) NGO Nation Wide X X X Forum for Awareness and Youth Activities (FAYA) NGO West X X X X X Transcultural Psychosocial Organisation (TPO) NGO Nation Wide X X X X Backward Society Education (BASE) NGO West X X X X Nepal National Dalit Social Wellfare Organization (NNDSWO) NGO Nation Wide X International Nepal Fellowship (INF) NGO District X X Koshi Victims Society (KVS) NGO East X X X X Concern Worldwide Nepal (CONCERN) NGO Nation Wide X X X X National Society for Earthquake Technology, Nepal (NSET) NGO Nation Wide X X X X

Geographical Emergency Management Organization Type Emergency Management

Focus

Emergency

Assessment

and Facilities

Preparedness

Essential Drugs Essential

NFIDistribution

HealthEducation

Emergency Needs

EmergencyServices

Disease Disease Surveillance HealthInfrastructure

Nepal Family Health Programme (NFHP) NGO Nation Wide X X X

Reproductive Health and HIV/AIDS

Geographical Organization Type Reproductive Health HIV/AIDS

Focus

treatment treatment

Awareness Awareness

Counseling

Antiretroviral

STI TreatmentSTI

Educationand

Family Planning Family

Safe Motherhood Safe

Treatment Service

Testing/Blood Supply (e.g.UterineProlapse) Ministry of Health and Population (MoHP) GoN Nation Wide X X X X X X X X X Department of Women's Development (DWD) GoN Nation Wide X X Epidemiology and Disease Control Division (EDCD) GoN Nation Wide X X X X Nepal Army GoN Nation Wide District Public Health Office (DPHO)/District Health Office GoN District X X X X X X X X (DHO) District Disaster Relief Committee (DDRC) GoN District District Administrative Office (DAO) GoN District Local Development Office (LDO) GoN District Women's Development Office (WDO) GoN District X X X X District Police Office (DPO) GoN District United Nations Development Programme (UNDP) UN Nation Wide

Geographical Organization Type Reproductive Health HIV/AIDS

Focus

treatment treatment

Awareness Awareness

Counseling

Antiretroviral

STI TreatmentSTI

Educationand

Family Planning Family

Safe Motherhood Safe

Treatment Service

Testing/Blood Supply (e.g.UterineProlapse) International Organisation for Migration (IOM) UN Nation Wide United Nations Office for the Coordination of Humanitarian UN Nation Wide Affairs (OCHA) Offfice of the High Commissioner for Human Rights (OHCHR) UN Nation Wide United Nations Children's Fund (UNICEF) UN Nation Wide X X X X X X X World Health Organization (WHO) UN Nation Wide X X X X X X X Joint United Nations Program on HIV/AIDS (UNAIDS) UN Nation Wide X X X X X X X Aventist Development and Relief Agency Nepal (ADRA Nepal) INGO Nation Wide X X X X X X X CARE Nepal (CARE) INGO Nation Wide X X X X X X X International Rescue Committee (IRC) INGO Nation Wide X X X X X X X X Medical Emergency Relief International (Merlin) UK INGO Nation Wide X X X X X X X X X World Vision International (WVI) INGO Nation Wide X X X X X Oxfam Great Briten (OXFAM) INGO Nation Wide X X X X PLAN Nepal (PLAN) INGO Nation Wide X X X Save the Children (SC) INGO Nation Wide X X Action Aid Nepal INGO Nation Wide X X Action Contra La Faim (ACF) INGO West Norwegian Refugee Council (NRC) INGO Nation Wide MSF - Holand (MSF) INGO Nation Wide X X X X X X X X X Caritas Nepal (CARITAS) INGO Nation Wide X Medicins Du Monde Nepal(MDM) INGO District X X X X Nepal Red Cross Society (NRCS) NGO Nation Wide X X X X X X Women's Rehabilitation Center (WOREC) NGO Nation Wide Community Development and Human Rights (SETU) NGO East Center for Victims of Torture (CVICT) NGO Nation Wide Kirat Yakthung Chumlung (KYC) NGO Nation Wide

Geographical Organization Type Reproductive Health HIV/AIDS

Focus

treatment treatment

Awareness Awareness

Counseling

Antiretroviral

STI TreatmentSTI

Educationand

Family Planning Family

Safe Motherhood Safe

Treatment Service

Testing/Blood Supply (e.g.UterineProlapse) Forum for Awareness and Youth Activities (FAYA) NGO West X X X X Transcultural Psychosocial Organisation (TPO) NGO Nation Wide Backward Society Education (BASE) NGO West X Nepal National Dalit Social Wellfare Organization (NNDSWO) NGO Nation Wide X International Nepal Fellowship (INF) NGO District X X X Koshi Victims Society (KVS) NGO East Concern Worldwide Nepal (CONCERN) NGO Nation Wide X National Society for Earthquake Technology, Nepal (NSET) NGO Nation Wide Nepal Family Health Programme (NFHP) NGO Nation Wide X X X X X

GBV and Psychosocial Services Geographical Psychosocial Organization Type Gender Based Violence

Focus Services

Referral

Training

Advocacy

Protection

Awareness Awareness

Counseling Counseling

Legal Legal Services

Screeningand GBV Assessment GBV

Ministry of Health and Population (MoHP) GoN Nation Wide X X Department of Women's Development (DWD) GoN Nation Wide X X X X X X X Epidemiology and Disease Control Division (EDCD) GoN Nation Wide Nepal Army GoN Nation Wide District Public Health Office (DPHO)/District Health Office GoN District X X (DHO) District Disaster Relief Committee (DDRC) GoN District District Administrative Office (DAO) GoN District Local Development Office (LDO) GoN District ` Women's Development Office (WDO) GoN District X X X X X X X X District Police Office (DPO) GoN District X X X X United Nations Development Programme (UNDP) UN Nation Wide International Organisation for Migration (IOM) UN Nation Wide United Nations Office for the Coordination of Humanitarian UN Nation Wide X Affairs (OCHA) Offfice of the High Commissioner for Human Rights (OHCHR) UN Nation Wide X X X X X United Nations Children's Fund (UNICEF) UN Nation Wide X X X X X X X X X World Health Organization (WHO) UN Nation Wide X X X Joint United Nations Program on HIV/AIDS (UNAIDS) UN Nation Wide X Aventist Development and Relief Agency Nepal (ADRA Nepal) INGO Nation Wide X X X X CARE Nepal (CARE) INGO Nation Wide X X X X X X X X X International Rescue Committee (IRC) INGO Nation Wide X X X X X X X X X Medical Emergency Relief International (Merlin) UK INGO Nation Wide X X X X X X X X X World Vision International (WVI) INGO Nation Wide X X X X X X X X Oxfam Great Briten (OXFAM) INGO Nation Wide X X X X X

Geographical Psychosocial Organization Type Gender Based Violence

Focus Services

Referral

Training

Advocacy

Protection

Awareness Awareness

Counseling Counseling

Legal Legal Services

Screeningand GBV Assessment GBV

PLAN Nepal (PLAN) INGO Nation Wide Save the Children (SC) INGO Nation Wide Action Aid Nepal INGO Nation Wide X X X X X X Action Contra La Faim (ACF) INGO West Norwegian Refugee Council (NRC) INGO Nation Wide MSF - Holand (MSF) INGO Nation Wide X X Caritas Nepal (CARITAS) INGO Nation Wide X Medicins Du Monde Nepal(MDM) INGO District Nepal Red Cross Society (NRCS) NGO Nation Wide X X X Women's Rehabilitation Center (WOREC) NGO Nation Wide X X X X X X X X X Community Development and Human Rights (SETU) NGO East X X X X X X X Center for Victims of Torture (CVICT) NGO Nation Wide X X X X Kirat Yakthung Chumlung (KYC) NGO Nation Wide Forum for Awareness and Youth Activities (FAYA) NGO West Transcultural Psychosocial Organisation (TPO) NGO Nation Wide X X X Backward Society Education (BASE) NGO West X Nepal National Dalit Social Wellfare Organization (NNDSWO) NGO Nation Wide International Nepal Fellowship (INF) NGO District Koshi Victims Society (KVS) NGO East Concern Worldwide Nepal (CONCERN) NGO Nation Wide National Society for Earthquake Technology, Nepal (NSET) NGO Nation Wide Nepal Family Health Programme (NFHP) NGO Nation Wide

IV. Table of UNFPA Response

East: Sunsari & Saptari West: Kailali, Kanchanpur & Dadeldhura Within 1

Within 1 month 1 month 1-3 months 3-6 months month 1 month 1-3 months 3-6 months Participated in Provided RH kits Procured RH kits for Established RH Established 1- agency-wide joint for 10,000 90,000 persons for Coordinator wk mobile health persons for 3 three months (not (Saptari) clinics through Reproductive assessment months to the distributed yet) UNFPA's Health (Sunsari, Saptari) Sagrmatha Zonal Kapilvastu Hospital and the office (Kailali, Blood Bank at Kanchanpur) Rajbiraj Delivered 200 Provided one Financially supported Provided Conducted clean home vehicle with 2 5 ANMs at request of funding to day visits to delivery kits to nursing staff to DPHO (Saptari) operate on 20- worst affected Reproductive DPHO (Sunsari) the Kalyanpur 33 women VDCs Health Primay Health with UTP in Care Center for the Koshi severe and Zonal Hospital referral cases Provided financial Transported 17 Served 4678 flood Attended to 3 support to flood pregnant women victims (1362 male complicated affected pregnant to Rajbiraj and 3316 female, 999 post delivery and lactating hospital people received RH cases Reproductive women (Saptari) counseling, and 129 Health people received health education in different topics) in 45 IDP camps (ADRA Accompanied Provided street drama women to Provided on RH issues to 5336 Reproductive hospital for USD7000 to WDO people (ADRA) Health normal/complicat in Sunsari and to ed deliveries Rahbiraj Zonal

(Saptari) Hospital in Saptari

Provided Provided 2 Provided funds for 15 Reproductive nutritious food medical tents for beds for 24-hr clinic Health for pregnant 24-hr outreach (Saptari) women (Saptari) clinics Provided vehicle Reproductive for women Health needing cesarean sections (Saptari) Established 8 youth Trained 32 aid corners, 4 in each workers, HIV/AIDS district (KYC) including RRTs (EDCD) East: Sunsari & Saptari West: Kailali, Kanchanpur & Dadeldhura Within 1

Within 1 month 1 month 1-3 months 3-6 months month 1 month 1-3 months 3-6 months Collected baseline Conducted HIV/STI data re: HIV/STI orientations to 160 HIV/AIDS situation and youth (KYC) perceptions among young adults (KYC) Built capacity by Trained 2 additional hiring 13 flood peer educators for HIV/AIDS affected individuals youth corners (KYC) (KYC)

Mobilized 8 peer Reached additional 90 groups: train 4 individuals ( 44 boys, educators (16 46 girls) (KYC) HIV/AIDS total); 2 counselors and 2 RH focal points HIV/STI awareness (KYC) Peer educators Peer educators reached 227 youth provided HIV/STI HIV/AIDS (98 boys, 129 girls) education to 256 (KYC) youth(KYC)

Performed 2 street dramas and showed 1 HIV/AIDS video re: HIV/STI awareness (KYC) Referred 66 cases Referred 289 cases for VCT/STI for VCT/STI treatment HIV/AIDS treatment (10 (47 male, 242 female) male, 56 female) (KYC) (KYC) Distributed 1154 Conducted 3 condom HIV/AIDS condoms (KYC) demonstrations (KYC)

UNFPA RESPONSE East: Sunsari & Saptari West: Kailali, Kanchanpur & Dadeldhura

Within 1 month 1 month 1-3 months 3-6 months Within 1 month 1 month 1-3 months 3-6 months Conducted 28 condom HIV/AIDS demonstrations (KYC) Conducted International AIDS HIV/AIDS Day (300 people attended) Oriented 80 people HIV/AIDS on HIV/STI in emergency (Sunsari) Established protection GBV committees.

Conducted one GBV GBV training session at camp management

training conducted by OXFAM143 Conducted a qualitative GBV GBV assessment in eight camps. 144 Provided GBV screening and counseling services GBV as a result 35 women were helped (SETU)145 Counseled 46 people Mobilized 2 Provided on psychosocial female PSWs, 1 psychosocial health (13 men, 33 from each district counseling for Psychosocial Health women) (CVICT) (CVICT) 145 people (WOREC; 145 in families and 182 in groups) Held press Conducted 10- Organized 10- conference for day psychosocial day psychosocial National and local trainings (14 training for 19 Psychosocial Health News Papers on the paticipants incl. coordinators CVICT program DPHO from each (Kailali, (CVICT) district) (CVICT) Kanchanpur) Provided Psychosocial psychosocial care coordinators to 52 female reached out to Psychosocial Health flood victims 200 people (Saptari, Sunsari) (CVICT) Oriented 2038 Psychosocial Health people on

143 Former UNFPA consultant, Personal Interview, March 26, 2009 144 UNFPA Nepal. “Joint Sunsari and Saptari Situation report #4.” November 14-22nd, 2008. 145 Community Development and Human Rights, Personal Interview, March 22, 2009

psychosocial needs (Sunsari, Saptari; 383 men, 1655 women) (CVICT)

Assessing UNFPA’s Humanitarian Response in Nepal A Joint Initiative of Columbia University and UNFPA Survey Instrument 2, Version 2: Strategic Partners

This semi-structured survey instrument is intended for use in conducting interviews with New York-based personnel from organizations involved in humanitarian response in Nepal. The cover page information will be filled in via desk research by the Columbia University team prior to the interview. Note: The information on the cover page is to be used only for background information for the interviewer, and is not a formal part of the evaluation.

Name of organization:

Date of interview:

Location of interview:

Contact person (name and title):

Email address:

Website:

Organization’s mission:

Areas of work:

Organization’s position within UN Structure (if applicable):

Organization’s position with respect to parent organization (if applicable):

Organization’s position within cluster approach (if applicable):

Preamble

[Introduce each of the interviewers, give business cards.] Thank you once again for speaking with us today. As you are aware, this interview is part of a joint initiative between Columbia University and UNFPA. Our objective is to undertake an assessment of UNFPA Nepal’s humanitarian interventions in 2008 in order to make recommendations to the UNFPA

Nepal office. We want to understand what UNFPA did well in the 2008 flood response, as well as what parts of UNFPA’s response were ineffective and need to be improved. Although this is a joint initiative, those of us present today are external to UNFPA so that we can get a fair assessment of UNFPA’s successes and shortcomings. We will begin the interview with some structured survey questions. The latter half of the interview will be more open-ended. The interview will take 30-45 minutes.

With your agreement, we would like to record this interview. The recording will be used only by members of the Columbia University team for research purposes. Recordings will be used for this initiative only, and will be destroyed at the conclusion of the research phase of the initiative. If you would like to provide information confidentially, we ask that you let us know. Any statements provided confidentially will be used for informational purposes only, and will not be traceable to an individual or organization. The initiative’s final report will be issued to our client, UNFPA, in May. Do you

have any questions or concerns? May we begin?

[If interviewee agrees, turn on digital recorder.]

Assessing UNFPA’s Humanitarian Response in Nepal A Joint Initiative of Columbia University and UNFPA Survey Instrument 1, Version 1: Implementing Partners

This semi-structured survey instrument is intended for use in conducting interviews with Nepal-based personnel from implementing organizations involved in humanitarian response in Nepal. The cover page information will be filled in via desk research by the Columbia University team prior to the interview. Note: The information on the cover page is to be used only for background information for the interviewer, and is not a formal part of the evaluation.

Name of organization:

Date of interview:

Location of interview:

Contact person (name and title):

Email address:

Website:

Organization’s mission:

Areas of work:

Organization’s position within the overall humanitarian response (if applicable):

Organization’s position with respect to parent organization (if applicable):

Organization’s position within cluster approach (if applicable):

Preamble (Introduce each of the interviewer, give business cards)

Thank you once again for speaking with us today. This interview is part of a joint initiative between Columbia University and UNFPA. Our objective is to evaluate UNFPA Nepal’s humanitarian interventions in 2008 to understand which aspects of the intervention were effective and what needs to be strengthened. At the end, the evaluation will be used to make recommendations to the UNFPA Nepal office. Although this is a joint initiative with UNFPA, we are not part of UNFPA staff and this is an independent evaluation, which will be critical in gaining a fair assessment of UNFPA’s successes and shortcomings. This interview will take 30-45 minutes.

With your agreement, we would like to record this interview. The recording will be used by members of the Columbia University team for research purposes. Recordings will be used for this initiative only, and will be destroyed at the conclusion of the research phase of the initiative. If you would like to provide information confidentially, we ask that you let us know. Any statements provided confidentially will be used for informational purposes only, and will not be traceable to an individual or organization. The initiative’s final report will be issued to the client in May. Do you have any questions or concerns? May we begin?

[If interviewee agrees, turn on digital recorder.]

Additional information if interviewee asks: A list of people and organizations interviewed will be attached to the final report.

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