I. EXECUTIVE SUMMARY

USAID Strategic Objective 3.1: Reduced Human Suffering in Conflict-Affected Areas

A. OVERVIEW

This Final Report covers the entire 96 months, from January 15, 1998 to January 14, 2006, of the Azerbaijan Humanitarian Assistance Program (AHAP) managed by Mercy Corps and funded by the United States Agency for International Development (USAID) through an umbrella mechanism. The initial 24 months of programming under AHAP I (May 1998 through April 2000) provided health and nutrition services, shelter, economic opportunities, and information services. AHAP II programs (May 2000 through September 2005) addressed health, reproductive health, food, economic opportunities and social investment needs through community development and mobilization. During AHAP I, 16 programs operated throughout much of Azerbaijan, and during AHAP II the programming continued to reach much of the population in 23 regions in the country. In total, 18 subgrants operated in the four geographic areas of AHAP II: Southern area, Central area, Urban area and Nakhchivan Autonomous Republic (NAR). From May of 2000, AHAP provided assistance to 2,923,281 direct recipients, 1,551,100 (53%) of which are women. (See AHAP I and AHAP II sections for maps indicating geographic coverage and implementing partners.)

AHAP I addressed issues related to the displacement of people because of the Nagorno-Karabakh conflict. It provided mud brick shelters for IDPs to replace their deplorable living conditions in public buildings and makeshift dwellings; addressed water and sanitation issues; delivered primary health care, food and health education to over 300,000 IDPs; began working with people on ways to improve the economic situation including micro-credit, agriculture and business training, and providing agricultural inputs such as seeds and seedlings. An information network, Azerweb, providing updated resources on humanitarian aid and development assistance efforts and information on Azerbaijan in general was established and still exists. In May of 1999, a pilot community development program was funded. This program was AHAP’s first attempt at community development while integrating health and economic sector activities and laid the groundwork for future AHAP II programming. USAID developed a new strategy covering 2000 to 2003 and the AHAP II umbrella began implementation of that strategy with development rather than relief programming.

At the core of Mercy Corps management structure was the belief that the umbrella could produce far greater results as a partnership of agencies than any one agency could produce alone. The umbrella provided a tremendous opportunity for innovation as agencies offering a wide range of technical strengths came together to share their technical competencies and lessons learned. The task of achieving this level of coordination among agencies accustomed to competing against each other was not easy and required constant nurturing. Implementing partners reported in the 1999 Mid Term Evaluation that, for the most part, they “take pleasure from regular and repeated interaction with MCI’s management and program staff.” And “staff of both groups (MCI and IPs) voiced respect for the other’s competencies, knowledge, helpfulness and commitment.” Mercy Corps’ achievement was also recognized in an October 2002 external evaluation conducted by MSI/MetaMetrics Inc. The evaluation found the umbrella to be an extremely effective management tool that had yielded high quality programs and allowed for a broad mix of organizations to operate in Azerbaijan under a unique level of cooperation and coordination. To quote the report: “The most striking and most valuable aspect of the AHAP umbrella – and of Mercy Corps’ management – is the atmosphere of collaboration and cooperation that exists among the Partner organizations. It is rarely found in such degree and greatly increases the impact and effectiveness of the AHAP Partnership.”

Managing the umbrella demanded that Mercy Corps function as an informed and flexible management unit able to rapidly respond to significant political and socio-economic changes. Moreover, in working with peer agencies, Mercy Corps needed to provide significant flexibility and foster close cooperation with the partners to be able to deliver the level of programming necessary. While Mercy Corps took upon itself the role of liaison and some of the bureaucratic functions with

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 i USAID, the implementing partners were freed to focus more of their resources on implementing programs.

As the umbrella grant manager, Mercy Corps drafted, coordinated and issued RFAs covering essential programmatic sectors; reviewed applications and proposals; negotiated and awarded subgrants; monitored and evaluated program implementation, results and impact; monitored and analyzed the evolving conditions of IDPs and other vulnerable groups; supported field operations; and supported implementing partners (IP) in meeting USAID requirements, procedures and regulations. Programmatic changes and direction were based on analysis of results, impact and appropriateness of the approach. To avoid duplication and increase opportunities for leveraging resources and impact, on-going technical assistance and facilitation was provided to the implementing partners on a demand-driven basis.

B. PROGRAM HIGHLIGHTS

1. USAID PERFORMANCE INDICATORS – AHAP II

All activities of AHAP are within USAID SO 3.1: Reduced Human Suffering in Conflict - Affected Areas (see Consolidated Indicator Table following the Executive Summary and in Annex E for more detail on the indicator data and the Success Stories in Annex B for more detail on the people who are represented by these numbers.)

¾ USAID IR 3.1.1: Vulnerable Communities Better Able to Meet Their Own Needs Programs under AHAP worked with community groups who represented the interests of those living in the target communities. Groups were formed using different processes, and served as liaisons for agencies in identifying the needs of the communities and working to find solutions. Groups worked with partners to oversee and implement projects that were identified as priorities and helped raise money and resources from community members. Community leaders played a significant role in their communities and later, in cluster areas, as evidenced by the election of over 400 community group members to local Municipalities in the December 2004 elections.

• 3,290 community groups organized exceeded the planned target of 2,237 groups. • Communities were actively involved in micro-project implementation and provided $2,619,306 in contributions including cash, labor, and materials toward community projects. This represents a 33% contribution toward total project costs. • 2,923,281 direct recipients (53% women) benefited from AHAP programs including training, economic and health activities, as well as micro-projects. • 408 community group members were elected to local Municipal Councils in the December 2004 election.

¾ USAID IR 3.1.1.1: Increased Access to Economic Opportunities and Support Services Programming in the economic opportunities sector focused on creating sustainable jobs and businesses in target areas. This was done through the creation of local microfinance institutions and programs that sought to develop the business development service sector. Programs supported the growth of small family business, offered loans to small entrepreneurs, facilitated the development of associations and encouraged the concept of fee for service. As a result of these programs, two local microfinance institutions and 48,424 businesses were created.

• 41,013 loans were disbursed, including 268 small loans, 40,061 micro-loans, 259 emergency loans and 425 individual loans. • 9,068 jobs were created (40% women).

¾ USAID IR 3.1.1.2: Communities Organized to Address Self-Defined Needs Programs under AHAP focused on building the capacity of local community based organizations to be better able to identify their needs and to implement solutions. Implementing partners provided

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 ii trainings on a number of topics including project management and financial management and worked with community groups to take progressive responsibility for managing projects. After the suspension of Section 907, increasing focus was placed on working with government, both Municipal Councils and Executive Committees.

• 1,206 community projects were completed, exceeding the planned target of 829. • Communities were actively involved in micro-project implementation and provided $2,331,882 in labor and cash contributions. This represents 32% of the total project costs. Municipalities and local government contributed $81,043 (over 6%) to the total community contribution [1]. • Communities and Municipalities jointly implemented 323 micro-projects in the Community Development and Integrated Community Development Programs without AHAP funding. The total project cost for these micro-projects was $272,928, of which the Municipalities and local government contributed 47% the majority of the balance coming from community members.

¾ USAID IR 3.1.1.3: Communities Have Access to Better Quality Health Services Community groups were also organized within the health programs. The programs addressed two major issues: improving technical skills of health professionals at the community and regional levels and improving the quality and quantity of health information available to community members. The concept of peer education was utilized to ensure that health-oriented community groups were effective in increasing health information by receiving and then replicating training in order to build their and others’ knowledge. AHAP health partners also engaged government actors at all stages of programming through implementation of health information systems, development of cadres of national Master Trainers in various health topics, publishing of nationally endorsed and distributed health manuals, and organizing of mobile health units and monitoring teams comprised of state health officials.

• A total of 1127 health providers received and applied training to improve care at community based clinics and health services. • 1,302,273 beneficiaries (56% women) utilized health clinics. • 234 rehabilitated community health facilities met selected World Health Organization (WHO) standards. Trained providers and rehabilitated clinics led to more people using local facilities for health care.

2. AHAP PERFORMANCE INDICATORS

All AHAP activities also serve the overall AHAP objective of creating and increasing community development efforts to integrate, resettle, and provide economic opportunities to internally displaced persons (IDPs) and conflict-affected populations within Azerbaijan.

AHAP SO 1: To create sustainable jobs and businesses

¾ AHAP IR 1.1: Increased availability of credit and business support services • A culture of credit was established with the population in project areas. • Two MFIs are registered and have a license to operate in Azerbaijan. • The economic opportunities programs sustained 44,414 businesses.

[1] These numbers reflect the activities of the Community Development and Integrated Community Development Programs.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 iii AHAP SO 2: To strengthen community involvement and capacity through participation and leadership development

¾ AHAP IR 2.1: Communities organized and mobilized with strengthened capacity to address self-defined needs • 225 mature/experienced communities mentored and disseminated information to 172 nascent neighboring communities. • 144 community groups were registered as Mahalla Komitesi (MK) through their Municipalities, thereby creating more sustainable community level structures. • 646 communities participated in activities organized by cluster level structures. • 2,664 community-selected leaders applied training in improving responsiveness and effectiveness of community groups. • 1,077 Municipal Councilors were trained through partner staff and their peers and 1,112 Municipal Councilors in 171 Municipalities were directly involved in activities or participated in projects with community groups.

¾ AHAP IR 2.2: Communities organized and mobilized to manage more accessible and sustainable quality health services • 166,766 men, women, and adolescents were trained on family planning (FP) principles by their peers and 187,656 more received information on primary health care from peers in their communities. • National Reproductive Health Office (NRHO) Master Trainers trained 625 Ob/Gyns, midwives, nurses and primary health care providers on FP. • 129 community health funds and cost recovery mechanisms provided health related services to 12 districts. • Communities contributed $287,424 or 39% to the cost of community health projects, including FP/RH. • 153 communities participated in cluster health activities. • Over 2,000 peer educators were trained and delivered health education to their friends, families and acquaintances in the community through the health programs. • 11,502 adolescents participated in health education sessions on reproductive health.

3. PERFORMANCE TRENDS

¾ Overall Programmatic Issues

Effects of Section 907 Section 907 of the Freedom Support Act had been in place for some years before AHAP began and it continued for four years through AHAP I and until January 2002 in AHAP II. The artificial division between the humanitarian agencies and the Government of Azerbaijan (GOA) increased suspicions between NGOs and GOA as it also decreased the level of cooperation between NGOs, communities and the government. Communities were, of course, caught in the middle, and this limited the natural evolution of programs as they could not engage directly with regional and local government and needed to establish parallel systems of community management. For several months after the suspension of Section 907 in January 2002, there was confusion about the implications of the suspension and its possible duration. It took some time before IP staff and communities and eventually the ExComs operationalized the change. Programs needed to do considerable “damage control” with the regional government before government was willing to be engaged in the programs. In the last three years of AHAP considerable progress was made toward involving regional government, including the district health authorities, in the programs. Because the Municipalities had a much less clearly defined role, it was considerably easier for programs to engage them and they became integral parts of the community interventions, with many of the parallel community groups registering as Mahalla Komitesi (neighborhood committees).

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 iv

Problems with Registration AHAP program interventions were intended not to be stand-alone handouts, but rather to be activities that would build the capacity of communities to better address their concerns themselves long after the close of AHAP. In keeping with this intention, programs stressed the importance of forming viable and active community groups and sought to forge links with local and national government at the necessary junctures in order to ensure sustainability without an AHAP presence. A major challenge to generating this sustainability was the reticence of and difficulties posed by the GOA in registering community groups as community based organizations (CBO) and NGOs. The most significant challenge, however, was the inability of cluster groups to be registered as NGOs. These groups represent groups of 15-30 communities and many have evolved to functioning as NGOs in representing issues from their constituency to the regional authorities. Without a legal basis, they find themselves in a vulnerable position without the backup support of the implementing partner (IP). Nevertheless, other AHAP strategies to ensure sustainability, such as partnering with already-established local NGOs, requiring a high level of community contribution and participation in the carrying out of projects, and community groups registering as Mahalla Komitesi (MK) with the local Municipal Council helped to mitigate this challenge and create community structures that, if afforded the chance, can continue to thrive. The future of the cluster groups remains uncertain as registration remains out of reach.

Effects of Multiple Extensions AHAP II was originally designed to be a two and a half year program, from May 2000 through October 2002. It was extended annually three times, creating a very challenging programmatic environment. Because these were extensions, there could be no new RFAs for the current programming and therefore, the agencies had limited flexibility in making programmatic changes. Brand new ideas and program directions were not permitted within the limitations of the extension mechanism, the only mechanism available. The extensions did however provide Mercy Corps with a tool to influence program adjustments to a greater extent than would have been possible otherwise and it forced the entire partnership to critically assess the working environment annually and to respond to changes. Multiple extensions were not the most creative way to use the time or the funds and were definitely not the optimal way to do five years of development programming; however everyone, the IPs, USAID and Mercy Corps did our best to implement excellent programs.

¾ Increase access to economic opportunities and support services: Economic opportunities programming covered Business Development Services (BDS) and micro finance (MF) programs, as well as economic interventions within the Integrated Community Development Program (ICDP). Whereas during AHAP I, primary attention was focused on providing humanitarian assistance, development became the touchstone for AHAP II and economic development became one of the major components of the AHAP II program. The understanding that economically profitable regions and communities are better able to meet their own needs formed a foundational approach for designing and implementing economic programs. Early surveys revealed that two of the biggest challenges impeding economic development in Azerbaijan are a lack of available credit (particularly for the poor) and difficulty adjusting to and living under a newly developing market economy. Therefore, the general strategy for EO programming was to start provision of credit and business development services and, while doing so, to localize those credit and BDS providers such that after the program is over, sustainable micro finance institutions and local BDS providers would remain.

A culture of credit was established within the population and local government of the target areas as the first step in making credit available to the general population. The first Micro Finance Conference was held in 2001 and resulted in the formation of the Azerbaijan Micro Finance Association (AMFA) made up of implementing agencies that facilitated a follow-up conference in 2003 to move forward the national agenda of stronger collaboration with the GOA. The business development services (BDS) sector built on existing extension agent resources, strengthened their technical and advising skills, and helped farmers learn that making use of and paying for extension services enabled them to

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 v increase their crop yields and income. Community and Cluster level enterprises were established, that are fulfilling a business need in the area as well as providing income to community members. These businesses are also paying back the AHAP portion of their start-up capital to community funds for development projects. Producer associations were formed to help farmers and handicraft producers experience the value of pooling their resources for inputs and marketing.

All of these activities were strengthened by the yearly cross visits. First conducted in 1999, these visits became a very powerful tool for creating better partnership under the AHAP umbrella through cross-fertilization and staff capacity building. There were three types of cross-fertilization that were occurring – between BDS and microfinance programs, between same-sector programs of different partners, and between significantly different geographic regions (e.g. between the isolated enclave of Nakhchivan and conflict-affected parts of the mainland).

EO Impact • AHAP micro finance institutions, in collaboration with other micro finance institutions in the country, have laid a firm foundation for a credit culture in Azerbaijan. The population served by these programs is beginning to understand the importance of paying back their loans and the value of having those loans made available to them.

• Partner activities have built a cadre of experienced senior local staff and have contributed to the formation of community-based solidarity groups that have the potential to thrive beyond the program period. Through internal management and peer pressure mechanisms, these groups have consistently maintained high levels of loan repayments within their group, and have created a better understanding and adoption of micro finance services within their communities.

• Through the trainings in business techniques, the long-term viability of the respective core enterprises was ensured. The core enterprises continue provision of valuable services to the members of their market chains, thus creating a social net of community and business alliances that further solidifies the inherent stability of each market chain. Economic recovery groups have also taken a prominent role within their communities as training resources, offering expertise in areas such as food preservation training or on information sharing through outreach materials.

• BDS program activities have helped to deepen program impact in competitive sub-sectors, such as animal husbandry within the Southern cluster areas. In helping to organize communities around two feed mills directly established by AHAP efforts, the program worked with both demand and supply sides, on the one hand creating demand by providing information to the potential clients on the benefits of enriched mixed feed, and on the other enabling established enterprises through the capacity building trainings to supply this feed to the market.

• In areas where the agricultural Community Extensionist (CEs) program was implemented, both men and women farmers are diversifying their crops, improving their yields, increasing the efficiency of their farm operations by pooling land and operational resources, and improving overall farm management. Trained CEs are serving clients better and continue to update their knowledge. Farmers appreciate these services and are paying for them so that with the income and prestige, CEs are remaining engaged in their revitalized careers.

¾ Organize communities to address self-defined needs: Community development principles were used as the foundation for other programs under AHAP to help encourage communities to be actively involved in their own development. Decades of almost total dependence on the government served as a deterrent toward the empowerment of the citizenry and made it difficult to assume concepts such as self-help and self-reliance. Additionally, years of relief experience had encouraged strong dependency among IDP communities. As such, the Community Development program focused on assisting communities to develop the tools to identify, prioritize and address needs by assuming greater ownership of their problems, solutions and the resources they had available to them. Actual CD programming ranged from single sector CD which

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 vi began the mobilization process, to the Social Investment Initiative (SII) which further strengthening the capacity of previously formed community groups, and finally to the Integrated Community Development Program (ICDP) which by increased community mobilization coverage through cluster formation, addressing multi-sectoral community needs in an integrated fashion, and introducing regional structures and networks. ICDP programs covered a wide range of activities, including health education, support for community-based enterprises, and strengthening of local and regional community based organizations. With the introduction of integrated programs, the structure of community groups evolved to cluster-level structures whose members were elected amongst active group members and who became key people at the regional level to assist cluster communities in addressing their issues.

Community Development programming concentrated on helping communities to reach consensus at first around priorities and how a project might be implemented and later around larger community issues, and worked toward helping communities realize that the activities they did with the resources they themselves could mobilize were the most important and empowering. The National Community Development Conference (NCDC), planned by AHAP and strong local NGOs and held in October 2002 brought 300 CD activists, including community leaders, together for the first time. Participants worked in small groups to examine and discuss lessons learned from their work and identified strategies for more effective work in the future. Even more critically, they formed linkages with each other and built on those linkages as they continued their community and cluster leadership.

CD Impact • Community leaders, deeply engaged in assisting communities to address community level issues, were recognized as effective leaders by community members and in December, 2004 408 of these leaders were elected to Municipal Councils – some as Municipal Council leaders. These people, and others that may follow, are now in a position to strengthen the local development program, to broaden the reach of a culture of transparency and engagement, and eventually to influence development at higher levels.

• Communities are now identifying and addressing community level problems without outside assistance, often mobilizing community funds to resolve community issues and are frequently accessing Municipality or other resources. Moreover, communities and clusters are independently mobilizing other communities and the newly mobilized communities are paying a small fee to cover the travel costs of the mobilizers.

• Cluster entities representing 15–30 communities have developed the necessary skills and are being recognized by Government officials, Municipalities, Local and International NGOs as partners in the regional development process. Members of cluster groups are contributing participants in structures implementing government-funded development programs and are also representing their communities by addressing cluster level issues and by raising funds through different donors and private donations.

• Local and regional government bodies have begun to recognize the value of active communities and clusters in helping promote local and regional development and are conferring with them as development strategies are developed.

¾ Increase access to quality health services: Health programs under AHAP built upon community development and mobilization principles and strengthened the capacity of local, regional and national government staff in order to raise the health status of beneficiaries in Azerbaijan and improve the health care operating environment. These program efforts focused on primary health care and reproductive health/family planning, augmented by food distribution and a statistical survey on reproductive health. Mobilization of better equipped health care advocates—on the community and government levels—was the foundation for promoting long-term health in the country. Health information was delivered through peer educators allowing skills to remain in the community and programs prepared master trainers to conduct the health

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 vii professional training and/or trained District Health Authorities (DHA) to follow-up on the skill levels of professionals. In addition, health facilities were rehabilitated to provide a venue for delivering higher quality care and many communities established community health funds (CHF) to assist with health financial issues.

Health Impact • The population in target areas is now raising rural health concerns with District Health Authorities (DHA), requesting changes in personnel allocation and local policy as a result of community mobilization and effective peer education efforts as well as increased skills of trained health providers. DHAs are responding. Communities are also organizing themselves within a community/cluster to solve minor health problems by themselves.

• Regional Ministry of Health authorities are now willing to allow newly trained specialists to deliver professional care directly in communities around the region. Trained peripheral providers are delivering quality health care which means that people are able to access much of the health care they need directly in their communities.

• Peer Health Education is beginning to change the way the population relates to their own health. They now know how to identify common illnesses and conditions and where to go for what kind of treatment; they also are beginning to understand that it is possible to prevent some health problems; and in addition, they understand the importance of sharing the health information they learn with their friends and family.

• The MoH now has a trained cadre of IMCI master trainers and a cadre of trained monitors with experience implementing IMCI clinical training in the rural areas of the country.

• As a result of the Bridge to Reproductive Health Networks advocating for improvement in FP/RH issues, local, regional and central level authorities are better informed about FP/RH issues. Authorities are beginning to reinstate outreach activities by gynecologists thereby meeting a significant need in rural areas.

• Men are beginning to acknowledge their role in spread of STIs, countering traditionally held tendencies to locate responsibility for sexual illness, infertility, etc. solely on women. As a result of the program opening up a forum to address “taboo” issues, there is more open (and lively) discussion, particularly among men. Men are also increasingly willing to approach STI Clinics for advice and treatment. In addition, the RH/FP program final survey showed that there was a 27 % increase in people who spoke with their partners about FP.

• The multiple mass media components utilized in the FP/RH program had a direct impact in highlighting FP issues and the role of local and international NGOs working in Azerbaijan to address these issues in cooperation with government mechanisms. The final survey showed a 19% increase in the knowledge in the target population in general. Even if the population did not receive direct training, they benefited indirectly through the mass media brochures on FP topics, videos, public service announcements, and films on FP that were shown in rural areas.

• In addition, the final survey showed that there was a knowledge increase of + 26 % in the total population of the target districts on all the FP methods from the baseline survey; increases in the percent of the total population of the target districts using modern contraceptives specifically: Pills (+5%), IUD (+6%), and Condoms (+8%) compared with the 2001 RH Survey. In the Baseline Survey, more than half of the respondents refused to answer the question about their current contraceptive method while all respondents answered this question in the Final Survey therefore comparison with the Baseline is not possible.

• The Final Survey also showed a decrease of 16.9% in the number of abortions the respondents reported “in the past year” from the Baseline Survey, from 30% who reported an abortion “in

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 viii the past year” in the Baseline to 13.1% who reported an abortion “in the past year” in the Final Survey.

• Contraceptive demand of Apteks increased, sales condoms increased by 115% and sales of oral contraceptives increased by 44%. One pharmacist who is a member of a BRHN also started to sell contraceptives at cost to encourage the population to make the choice for modern contraception without increasing the financial burden to them.

¾ Gender Activities: Gender activities were a focus through out AHAP and proved to be some of the most difficult for all programs. Each program made progress but learned that interventions demanded continued efforts, the most successful ones being built into program structures. Sometimes successful activities modeled alternative behavior for women and men and other successful interventions focused on changing attitudes at the household level. The election of several women to the local Municipalities, and in some cases as Chair of the Municipal Council was an affirmation of the intense work that was done on raising gender issues within the communities.

¾ Youth Activities: Programs included a variety of youth-related activities that prepared and trained a base of future community leaders. Working with youth was often the most rewarding of the programming as the young people were the most willing to change their attitudes and be involved in the community activities. These activities provided an opportunity for the youth to demonstrate their capacity and gain a different kind of respect from their elders – a positive experience for all involved.

¾ IDPs: IDPs were the sole target of AHAP I and continued to be a primary focus during the first years of AHAP II. As the programs evolved, the primary focus was to assist with the integration of IDPs into the communities where they settled. While the focus of programming was exclusively on IDPs, the community members who also were affected by the conflict became angry as they often lost access to their school or clinic while these structures served as housing for the IDPs. AHAP programs found they needed to intensely negotiate with communities to help them resolve their differences and come together as a group as happened as the programs continued. In the Urban area, the problems were quite different. Their challenges were that buildings were exclusively housing IDPs from various regions of the country; their living conditions were especially difficult; and they believed they would be going “home” at any time. AHAP had many successes with IDPs however the issue of IDPs in Azerbaijan is not resolved even though many of those living in IDP camps have been resettled into government built housing. Many IDPs are still living in temporary housing and those in urban areas are living in buildings not intended for the current density.

4. PROBLEMS ENCOUNTERED AND LESSONS LEARNED: PROGRAMS

Some of the significant program implementation problems encountered and lessons learned include the following: (for program specific lessons learned, please see the individual program sections)

¾ Cross Visits Each of the sectoral programs learned the value of cross visits of staff and program beneficiaries to programs of other IPs in different areas or in the same general area. These cross visits shared the lessons learned across programs very quickly, provided staff and community members with an opportunity to discuss and question program interventions as well as to begin the process of adapting what they were seeing to their own situation. Because people were seeing what their peers had accomplished, the interventions were more believable and therefore more replicable. Programs quickly learned that if a particular community was doing very well, or not well at all, one way to either share the success or give them ideas for improvement, was a cross visit to another community. Programs also took staff and beneficiaries to neighboring countries to see how similar situations were

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 ix dealt with there. In all these instances, the visits pushed the program forward faster and with fewer missteps than might have been.

¾ Peer Training Much like the value seen from cross visits, peer training proved to be the most effective way to communicate information and ideas. The health programs used peer education to communicate primary health care and family planning messages to wide segments of the target population, and in the community development programs, mobilized communities and clusters mobilized other communities, usually at the request of the new community. Communities and community members found it much easier to talk with and learn from their peers than they did from the international agencies. After the IPs had trained a cadre of people within a community or cluster to train others, the program took on a life of its own. People feel a sense of pride and responsibility in their role as trainers for their peers, and took that responsibility very seriously. Especially in the health programs, they were seen as a real health resource in their communities and are representative of the sustainability possible in these programs.

C. MANAGEMENT

Coordination constituted one of the core functions in the AHAP Umbrella’s overall management. It required appropriate negotiation skills, consistency and persistency. It was necessary to reconcile interests of the partners with the USAID’s agenda, transform messages coming from the donor into policy actions and work with the implementing agencies to legitimize those actions in the eyes of the partner, in order to make them see it as their own objectives.

1. OVERALL MANAGEMENT ISSUES

¾ Umbrella Mechanism Mercy Corps firmly believed that the umbrella mechanism could produce far greater results as a partnership of agencies than any one agency could produce alone. The umbrella provided a tremendous opportunity for innovation as agencies offering a wide range of technical strengths came together to share their technical competencies and lessons learned. The task of achieving this level of coordination among agencies accustomed to competing against each other was not easy and required constant nurturing. Mercy Corps’ achievement was recognized in an October 2002 external evaluation conducted by MSI/MetaMetrics Inc. The evaluation found the umbrella to be an extremely effective management tool that had yielded high quality programs and allowed for a broad mix of organizations to operate in Azerbaijan under a unique level of cooperation and coordination. To quote the report: “The most striking and most valuable aspect of the AHAP umbrella – and of Mercy Corps’ management – is the atmosphere of collaboration and cooperation that exists among the Partner organizations. It is rarely found in such degree and greatly increases the impact and effectiveness of the AHAP Partnership.”

This is not to say that the partnership was always pleased with the AHAP umbrella especially during the times of frequent monitoring. However, that monitoring was central to breaking down the tendency for competition and increasing an environment that supported cooperation. Partners eventually took over responsibility for maintaining collaboration and cooperation within AHAP and with non-AHAP agencies. National level conferences were planned and implemented by the partnership; partners initiated cross visits to each other’s programs and invited each other to their lessons learned workshops. All of these things resulted in AHAP being much greater than a sum of its parts.

2. SUBGRANT MANAGEMENT

In total, 34 subgrants were awarded, 16 during AHAP I and 18 during AHAP II; the majority of the subgrants had multiple extensions. For more information on subgrant awards and extensions, please

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 x see Annexes F and G. Of these subgrants, 24 have been closed and 10 are currently in the process of closing out.

3. MONITORING AND OVERSIGHT

Program monitoring was the primary vehicle for managing the AHAP umbrella and staying in touch with IP leadership, field staff, challenges and program progress. The exact form that the monitoring took evolved over time, responding to the evolving programming needs in AHAP. For the last years of AHAP, the monitoring visit included in-depth discussions at the field office with program managers, field staff and partner LNGOs, site visits to communities or agencies implementing specific program components and an optional “wrap-up” session for interested staff and leadership to share the initial monitoring visit findings. The wrap-up served as an opportunity check the perceptions of the monitoring team and clear up any misinformation; a chance to raise issues or concerns with the implementation team and to begin the problem solving process; a time to reinforce any suggested linkages with other AHAP or non-AHAP programs; and an opportunity to look forward to the work ahead and to anticipate challenges facing the program. A comprehensive monitoring report was submitted to the IP after the visit.

During the rapidly changing environment of AHAP I and start-up phases of AHAP II, monitoring visits were made every two or three months to the projects. One of the lessons learned from AHAP I was the necessity to facilitate collaboration and cooperation between the AHAP-funded programs. This was a difficult issue to confront and frequent monitoring during the early years of AHAP II assisted in reinforcing this message. The Partners did see the frequency of monitoring visits as excessive in the early stages of the process. With the start of the two ICDP projects, the need for interagency coordination and leveraging programming across agencies became even more evident; again, the frequent monitoring to a broad geographic area rather than to a specific agency program assisted in changing the usual agency specific focus to one that involved all agencies serving those particular regions. Fortunately, as agencies began collaborating and coordinating with each other, the need for more frequent monitoring decreased and the focus of monitoring visits shifted back to individual programs.

In addition, Mercy Corps met periodically with individual partners to deal with specific programmatic or management issues and with USAID as necessary to report on issues needing their consideration. Information from monitoring and all interactions with IPs fed into future project planning, RFA development and developing potential directions for the multiple program extensions.

4. REPORTING

Mercy Corps and the Implementing Partners reported formally on the programs on a semiannual basis. Mercy Corps also supported USAID through considerable informal reporting and assisted in data and information preparation for USAID’s annual report. Mercy Corps provided information and consultation on a wide variety of topics as requested by USAID officers, submitted periodic programmatic updates, held in-depth meetings with USAID/Baku and Tbilisi technical support staff regarding health and economic issues, and participated in and organized meetings with IPs for USAID’s evaluations, sectoral assessments and the umbrella mechanism assessment. Mercy Corps organized the 1999 mid-term evaluation in collaboration with USAID, participated in the 2002 evaluation and assisted with the 2005 umbrella case study.

Mercy Corps supplied USAID/Azerbaijan with the information they needed to report to USAID/ Washington through the AHAP Consolidated Indicator Chart and the Consolidated Secondary Indicator Chart. These tables can be found at the end of this Executive Summary and in Annex E.

During AHAP I, sectoral indicators were developed and provided to bidders in the RFAs for inclusion in their proposals. The lower level indicators reported on by IPs generally feed into the intermediate

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 xi level indicators. The multiple AHAP I indicators were consolidated for this report by sector. For specific information on AHAP I indicators please see Annex D.

AHAP II programming began in May of 2000 and in September 2000 PriceWaterhouse Coopers (PWC) vetted sector specific indicators and indicator definitions to the AHAP partnership that would be in place throughout the life of AHAP. These indicators served the program well through the original grant period, however, during the three major extension periods that followed, the field programs evolved beyond what the indicators could capture with partners taking more of a facilitative rather than a direct implementation role. Mercy Corps then worked with the IPs to develop secondary indicators that would give USAID a more accurate picture of the actual program accomplishments.

5. COORDINATION AND INFORMATION SHARING

Coordination and sharing of information is as difficult as it is important in any umbrella and AHAP was no exception. During AHAP I, the situation was complicated by the relief nature of the programs and saw infighting among INGOs, considerable competition for space and influence, little communication and no collaboration. The Information component of AHAP I attempted to address these issues by creating a forum where information could be shared, however, real progress toward coordination required constant attention and encouragement for the IPs by Mercy Corps. Because Mercy Corps believed that the value of the umbrella was what could be achieved by multiple agencies working together, considerable attention was paid to helping agencies overcome their natural tendency to compete with each other and to find ways of collaborating. Occasionally that pressure to collaborate was rather forceful but by mid way through AHAP II, most agencies recognized that by building on each others programs, they were able to take their programs well beyond their goals. The level of collaboration and coordination achieved through AHAP required continual reinforcement, monitoring and encouragement.

AHAP Coordination constituted one of the core functions in AHAP’s overall management. It required appropriate negotiation skills, consistency and persistency. It was necessary to reconcile interests of the partners with the USAID’s agenda, transform messages coming from the donor into policy actions and work with the implementing agencies to legitimize those actions in the eyes of the partner, in order to make them see it as their own objectives.

A Public Information team was formed to help provide coordination and information to the AHAP partnership and to develop PI Communication Tools. The team also worked with partners to help each of them develop an information system and to share information. From mid-2003 Mercy Corps limited their PI/PR functions to maintaining existing tools in compliance with requirements in the USAID CA Extension agreement.

6. MERCY CORPS MANAGEMENT STRUCTURE AND PROCEDURES

Mercy Corps operated under a modified Cooperative Agreement (CA); the effective date of the award was January 15, 1998 and 16 modifications amended the CA. All AHAP subgrants completed programming by September 30, 2005 and the umbrella will conclude on January 14, 2006.

7. PROBLEMS ENCOUNTERED AND LESSONS LEARNED: MANAGEMENT

For overall AHAP operations, the most significant problems encountered and lessons learned are:

• GOVERNMENT Working with the Government of Azerbaijan has been a challenge throughout AHAP – during the first four years, because Section 907 was in place and during the last four years because the resulting suspicion and distrust remained. It took some time before IP staff, communities, Municipal Councils and eventually ExComs operationalized the change. Programs did the necessary “damage control” with regional government which means that now the ExComs, with

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 xii the exception of the urban ones, are largely accepting and occasionally supportive of the communities and clusters. The Municipality structure is quasi-governmental which makes relating to them awkward. Because they had a much less clearly defined role, it was considerably easier for programs to engage them and they became integral parts of the community interventions, with many of the parallel community groups registering as Mahalla Komitesi (neighborhood committees)..As they gained some clarity of role and a small tax function, competition began in earnest between the MCs and the ExComs. Again, the communities were often caught in the middle.

Over the past three years there have been elections in Azerbaijan: Presidential, Municipal Council and Parliamentary. During the run up to the election programming, especially the rural areas, came to a halt. Community and cluster leaders were not willing to implement programming that might cause them to be perceived as supporting the opposition; in addition public gatherings were often prohibited and as development programming by definition involved public gatherings, programs could proceed only slowly. This has meant that for two or three months each year, programming has slowed significantly.

The government has presented several additional challenges. As mentioned earlier in this report, the Government of Nakhchivan interfered with the NAR micro finance program, causing a stop in lending for over nine months. During that time, the health program in the area was also affected. The reasons given did not seem to relate to the program and it required significant efforts from USAID, the US Embassy, Mercy Corps and the IP, and considerable time to remedy the situation. The Azerbaijan Ministry of Health decreed a ban on charges for health care that was enforced in Nakhchivan, and dramatically impacted the program there, and is still a threat to health programming on the mainland if someone should decide to enforce it widely. NGO registration has been halted for several years now which makes the normal development of cluster groups more difficult. The legal frameworks within which programs, including micro finance programs, function have slowly been improved after considerable political pressure, however, there is more work to be done. Relating to NRHO, the quasi-MoH entity AHAP related to most intensely, was an ongoing challenge.

Under the leadership of Deputy Prime Minister, Ali Hasanov, the office of The Republican Commission on International Humanitarian Assistance has proven to be very helpful. On more than one occasion the Deputy Prime Minister intervened on behalf of AHAP to solve festering problems with government offices. The office has been very supportive of AHAP and the broader NGO community.

Coordinating and cooperating with the GOA at all levels is absolutely required to implement credible and sustainable programming, however, it is time consuming and labor intensive. It needs to be integrated into the program in terms of staff, time and budget.

• MULTIPLE EXTENSIONS As mentioned in various parts of this report, the umbrella was extended annually for three years in a row, creating a very challenging programmatic environment. Because these were extensions, there could be no new RFAs for the existing programming and therefore, the agencies had limited flexibility in making programmatic changes. Brand new ideas and program directions were not permitted within the limitations of the extension mechanism, the only mechanism available. In many cases, the extensions did provide Mercy Corps with a tool to influence program adjustments to a greater extent than would have been possible otherwise, however because each extension represented an additional subgrant period, USAID expected that there would be significant program accomplishments during the extension, which was only nine to twelve months long. This expectation was not realistic in most cases and forced partners to propose overambitious programs.

In addition, there were spin-off challenges that resulted from the frequent short term extensions. The indicators developed at the beginning of AHAP II became less and less useful as the

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 xiii extensions proceeded; (see the indicator section of Management for more detail) and secondary indicators needed to be developed based on the shifting program focus of the extensions without violating the extension mechanism. Each extension was awarded with the clear message from USAID that this would be the last extension, that message was clearly conveyed to partners and through them to communities. After the second “end of AHAP” announcement, communities ceased to believe that AHAP would ever end; that disbelief continued until September 2005. Staff also knew that there was a new end date for AHAP and many of them left for new positions only to discover, often just a couple of months before the “end” that the program was extended. This led to a talent drain that the programs could ill afford. USAID’s edict that the grant could not pay for any staff development coincided with the drain of trained staff because of the threatened close of the programs and caused further problems that the partners needed to overcome. And, of course, multiple short term extensions resulted in a nightmare for tracking data and progress toward log frame goals as within those short time frames, goals were often not completely reached and in some form were carried forward to the next short extension.

D. FINANCIAL OVERVIEW

• According to the last modification #16 signed on August 26, 2005 the total obligated amount is $56,511,630 leaving a balance of $400,158 to be obligated later.

• The total expenses for sub-grants through September 30, 2005 are $47,585,961. This figure represents 99.92% of the authorized budget. These figures are final subject to change in ICR.

• Mercy Corps management expenses during the quarter ended September 30, 2005 were $279,722 and the cumulative management expenses total $8,410, 758. This figure represents 94.17% of Mercy Corps’ total management budget.

• Mercy Corps management expenses for October 2005 – January 2006 will be submitted with the final financial report.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 xiv II. AHAP I (1998-2000): Emergency Relief

The Azerbaijan Humanitarian Assistance Program, or AHAP, was designed to reduce human suffering by improving the living conditions, health, nutrition, and income opportunities for the conflict-affected and vulnerable population of Azerbaijan. The issue of chronic displacement was addressed through programs that repaired or constructed shelter, provided primary health care training and services, and supplied support such as technical assistance and loans designed to increase household incomes.

As no single agency could meet the challenge alone of providing social stabilization in Azerbaijan, a partnership of ten international non-governmental organizations (INGOs) was forged and led by Mercy Corps, the recipient and manager of the $17 million USAID award. AHAP is thus termed an “umbrella grant,” with Mercy Corps as the manager, providing program direction, coordination, monitoring, documentation, and technical assistance to the ten Implementing Partners and their 16 subgrantees for a period of two years.

AHAP was designed to support:

USAID’s Strategic Objective 3.1 Reduced Human Suffering in Conflict Affected Areas

AHAP Strategic Objectives AHAP Intermediary Results

SO 1: Improved Living Conditions IR1.1 Physical living conditions and utilities constructed or repaired to acceptable safety standards

SO 2: Improved Health and Nutrition IR 2.1.a Achievable nutrition and nutritional practices enhanced

IR 2.1.b Integrated community-based health care strengthened

SO 3: Improved Economic Opportunities IR 3.1 Small and micro-enterprises enhanced

CCO: Enhanced Community Participation IR 4.1 Community participation and self-help enhanced through involvement in project development, implementation, and evaluation

The AHAP I umbrella covered the following sectors:

Economic

Opportunit es Community Shelter Health Development Information &

Nutrition

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 1 A. SHELTER

AHAP Strategic Objective 1: Improved Living Conditions

¾ AHAP IR1.1 Physical living conditions and utilities constructed or repaired to acceptable safety standards.

1. PROGRAM OVERVIEW

AHAP I addressed the shelter needs of approximately 21,000 Internally Displaced Persons (IDPs) living in deplorable conditions, such as makeshift homes and public buildings. Interventions under AHAP included Public Building Rehabilitation (PBR), construction of Single-family Shelter Units (SSUs), and implementation of water and sanitation micro-projects. Total funding for these projects was approximately $4.4 million. Community development and participation were the overarching methodologies for implementing program interventions and achieving project benefits. Shelter activities for AHAP I exceeded targets due to the extensive sectoral experience of the Implementing Partners in shelter projects. International Rescue Committee (IRC) and World Vision (WV) first introduced the mud-brick SSUs as well as the PBR component in Azerbaijan in 1995. The design, management and control systems of SSU construction underwent several modifications, resulting in improved designs and higher levels of efficiency. The mix of targeted populations, including urban, peri-urban, rural and remote IDP settlements, was effective in addressing urgent housing needs for the entire range of potential clients. Without AHAP I project interventions, these clients would have continued to live in uninhabitable conditions.

2. SHELTER IMPLEMENTING PARTNERS and PROGRAMS

Implementing Partner Program Title Period of Implementation

CARE Community Action for Shelter May 1, 1998 to March 31, and Public Infrastructure 2000 Needs Project (CASPIAN)

IRC Community Shelter and May 1, 1998 to October 31, Infrastructure Program 1999

World Vision Community Shelter May 1, 1998 to February 29, Rehabilitation Project 2000

CARE: Community Action for Shelter and Public Infrastructure Needs Project (CASPIAN) CASPIAN consisted primarily for the construction of 660 Single Shelter Units (SSUs) and the rehabilitation of 810 peri-urban public buildings, providing improved housing for 30,000 individuals in four districts of South Central Azerbaijan. In addition, CARE provided interventions in water and sanitation, including hand pumps, latrine slabs, and construction of solid waste disposal centers. With assistance from CARE, the communities formed Community Action Teams that were mechanisms for ensuring active involvement in addressing community-identified needs.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 2 IRC: Community Shelter and Infrastructure Program The Community Shelter and Infrastructure Rehabilitation program was improved the living conditions of 800 IDP families (approximately 4,000 individuals) living in two IDP camps in the central regions of the country. This was achieved by providing construction materials and technical expertise for the construction of SSUs and through activities aimed at improved water and sanitation. As a result of project interventions, families gained access to water supplies, benefited from garbage control and disposal, and had improved sanitation from newly constructed latrines as well as a reduction in rodent/insect infestation. An essential element to the program was the requirement that the community contribute significantly with their ideas, initiative, skills, plans, and labor to each project. This self-help methodology ensured the transfer of organizational and technical skills to the participating community members. IRC formed 28 Community Action Teams (CATs) and several Water and Sanitation committees. These groups proved effective in building a sense of community, a leadership structure, and the smooth implementation of program activities, as they were active in resolving disputes among residents that arose as a result of program interventions.

World Vision: Community Shelter Rehabilitation Project (CSRP) The Community Shelter Rehabilitation Project sought to achieve a basic standard of acceptable living conditions, sanitation and hygiene for 13,278 IDPs, or 3,006 families, living in 40 public buildings that were never intended for residential use and were therefore unsafe, unsanitary, and overcrowded. Of the 40 buildings rehabilitated, 30 were in Sumgait, nine in Baku, and one was in Nakhchivan. The benefits of shelter rehabilitation were maximized through the provision of seven adequate schooling facilities for 1,407 children in Sumgait. Communities were required to form Shelter Working Groups (SWG) responsible for prioritizing rehabilitation works, mobilizing community labor, as well as implementing and monitoring maintenance systems. Through the SWGs, communities were able to take an active role in the development of their community with minimal WV input, by organizing such activities as cleaning and tree planting days. To ensure maintenance of the buildings, WV selected and equipped craftsmen who provided their services on a fee-basis.

3. SUMMARY OF ACCOMPLISHMENTS

Improved Living 1,520 mud brick shelters constructed Conditions 225 public buildings were rehabilitated for 695 families 5,876 families constructed or received repaired latrines 5,559 families benefited from garbage control centers

Community 253 community teams formed Participation & 2,326 families participated in project activities Self-help 47 micro-projects were implemented in two regions assisting 1,955 families Enhanced 602 jobs were created completing micro-projects

4. PROBLEMS ENCOUNTERED/LESSONS LEARNED

Shelter programs encountered several challenges, and developed some useful lessons learned for future interventions. The programs encountered problems in trying to coordinate with government and other donors who were attempting to address shelter needs. There were also difficulties in meeting regularly and keeping IDPs adequately informed of program interventions. Section 907 of the Freedom Support Act made it particularly difficult for partners to work with the government, who wanted to keep IDPs in public buildings for political reasons, which ran counter to the objectives of the programs.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 3 In meeting these challenges, the programs identified some valuable lessons for their own future shelter programs. The programs learned the value of conducting market surveys as construction prices fluctuated, making planning and implementation challenging. Additionally a valuable lesson learned was that programs need to train contractors and involve experts where possible to help address the challenge of a shortage of skilled contractors. Programs found that involving community members in shelter construction and rehabilitation helped improve communication about program interventions, strengthen the programs and laid the groundwork for future community development in these and other communities.

5. SUCCESS STORIES:

• In Chemical Plant Dormitory #18 in Sumgait, many of the men were eager to work for the contractor and to begin solving the physical infrastructure problems with their building. However, on top of the lack of employment opportunities in Sumgait, many of the men did not even have tools to work with. In many cases, contractors also did not have their own tools and consequently they only employed workers who brought tools with them to the job. World Vision therefore decided that, as these craftsmen were so keen to begin work, they would experiment with giving the toolkits at the start of the contract for the actual work, rather than to give the toolkits at the end of the rehabilitation for maintenance, as was the usual practice. The reason for this was to test the commitment of the craftsmen to work if given the right tools, and to test the durability of the toolkits that WV was giving out in the maintenance stage. With this methodology, WV could more effectively empower people in the community, enabling them to be actively involved in work and to seek further employment opportunities. These craftsmen continued working with the toolkits and carried out maintenance in the buildings for a period of 6 months following the completion of rehabilitation, at which point the toolkits became their property. (World Vision)

• In the Agjabedi Turkish camp the handling of garbage had been one of the most difficult problems since the camp was established in 1993 since at no point was the garbage removed from the settlement. Eventually, the newly organized Water & Sanitation Committee planned a project whereby the community placed loose garbage in the disposal sites or in mounds, and the Chief of the Executive Committee (ExCom) provided a tractor and truck for its removal. On two separate occasions the ExCom provided equipment for removing the garbage, making it the first time in the camp’s history that garbage was actually removed. The committee continued to organize such projects as necessary. The committee further addressed the problem by identifying the need and location for six more disposal sites and organizing a project to construct them. The committee’s hard work had two very positive results for the community. First, the settlement was visibly much cleaner and the community recognized the importance of placing trash in the bins. According to the project survey, 82% of project clients used the garbage disposal sites which were an increase of almost 50% from six months previously. (IRC)

• In the settlements of Khamanli 1, 2, and 3 (Lachin Winter Grounds) CARE had been involved with the community since the 1996 building of shelters. CARE helped to mobilize these communities to form three Community Action Teams (CAT) to represent the 172 families residing there. The CATs approached CARE in February 1999 with the notion that collectively they might be able to resolve one of their most pressing problems which was the provision of electricity to these three settlements. The technical feasibility of the project was not in question; all that remained a concern was the cost factor and the required authorizations. The CATs gathered together and decided that even if they, as a community, could not raise the needed resources they could lobby the local authorities for assistance. Armed with the belief that no harm comes from trying and a little reassurance

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 4 from the CARE Community Mobilizers, a delegation from Khamanli set off to see the Chief of the Executive Committee (ExCom) of the Lachin Winter Grounds some 35 kilometers away. The ExCom was well aware of their situation, and had heard that CARE was trying to assist them. Over a period of one and a half months the CAT’s lobbying efforts paid off. By mid March the ExCom had agreed to provide one tractor with an augur, three engineers and forty-five concrete electric poles to complement the community’s contribution of transport services and labor for the implementation of the project. For CARE staff this was a wonderful project to realize. The community leaders had really taken the lead and worked as a team to make one small dream a reality. (CARE)

B. HEALTH AND NUTRITION

AHAP Strategic Objective 2: Improved Health and Nutrition

¾ AHAP IR 2.1.a Achievable nutrition and nutritional practices enhanced ¾ AHAP IR 2.1.b Integrated community-based health care strengthened

1. PROGRAM OVERVIEW

After the collapse of the Soviet Union the health status of IDPs/Refugees and conflict-affected people, as well as the health of the general population of Azerbaijan, decreased significantly. While poverty, inadequate nutrition, unsafe water and the effects of the massive population displacement played major roles in the decline of the health status, a health care delivery system that was profoundly weakened since 1991 contributed significantly to the burden of disease.

AHAP I provided assistance to a total target beneficiary population of over 300,000 IDPs and refugees through food assistance, fixed and mobile health units, health education programs for women and children, nutrition education, provision of pharmaceuticals, community health worker training, and hospital partnerships. Due to the nature of humanitarian relief assistance in emergencies, provision of primary health care was the main focus of activities. This ensured that the most basic health needs of the population could be met. Health education and community-based activities were also priorities. Total funding for health and nutrition programs, including food programs, was approximately $5.1 million.

2. HEALTH IMPLEMENTING PARTNERS and PROGRAMS

Implementing Partner Program Title Period of Implementation

ADRA Nakhchivan Health Assistance May 1, 1998 to April 30, 2000 Program

IRC Community Health Program May 1, 1998 to December 31, 1999

Relief International Health Project May 1, 1998 to May 31, 2000

UMCOR Primary Health Care Project May 1, 1998 to May 31, 2001

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 5

UMCOR/Baylor UMCOR/Baylor Hospital July 28, 1998 to October 31, Partnership 1999

World Vision International Food Assistance Program May 1, 1998 to August 31, 2000

ADRA: Nakhchivan Health Assistance Program provided comprehensive health care to approximately 40% of the IDP population in Nakhchivan through mobile health units, city polyclinics, and village health points. This was accompanied with regular training for health care providers and the distribution of medical supplies to a network of health posts. A community education component included seminars on nutrition, breastfeeding, Sexually Transmitted Infections (STIs), HIV/AIDS, diarrhea, Acute Respiratory Infections (ARI), and immunization awareness. With the creation of Health Care Management Systems (HCMS), ADRA introduced innovative cost recovery elements.

IRC: Community Health Program increased access to health care for approximately 30,000 individuals through promotion of preventative health practices, and the facilitation of referrals to other NGOs, the GoAz and mobile and stationary PHC units. The program filled an important gap in health education for women and children that were not being met by clinics and mobile health units by assisting communities to form Health Action Committees. These committees provided a forum in which women, teachers and parents were able to work together, in addition to receiving current health and nutrition information. In addition, the program distributed modern contraceptives to clinics, and improved nutrition through food hygiene awareness campaigns and the planting of school gardens.

Relief International: Health Project provided primary health care through mobile health units, polyclinics, Feldshar Acuchar Puncts (FAPs), Doctors Ambulatory Clinics (DACs), and Community Health Posts (CHPs). The program rehabilitated and provided training, medical supplies, and equipment to six polyclinics, 33 FAPs, 22 DACs, and 4 partnerships. The program also included health education through training medical professionals, community seminars, and the strengthening of local NGO partners and community-based groups to continue activities beyond the life of the project. In addition, food hygiene awareness campaigns and provision of multi-vitamins improved nutrition.

UMCOR: Primary Health Care Project targeted IDPs in seven ECHO (IDP) camps in the Southeastern part of Azerbaijan and in five districts of Baku. Medical facilities were established to provide free primary health care and pharmaceuticals to over 108,000 IDPs. The project provided training programs for clinic physicians on a variety of subjects, especially in Primary Health Care, and established a referral system that improved health care access by enabling patients to seek care in state health facilities when appropriate. Health leaflets covering a variety of child health topics were distributed to IDP mothers to increase their knowledge base on common childhood health problems.

UMCOR: UMCOR/BAYLOR Hospital Partnership was developed to coincide with the donation of excess military hospital equipment from the Department of Defense and drugs and supplies from the Department of State. Two hospitals, The Republican Clinical Hospital and the Republican Scientific Center of Experimental Surgery, were identified as the recipients based on their need. UMCOR provided on-site management, drug distribution, and equipment delivery and set-up. Training sessions were also organized and 14 physicians traveled to Houston and Istanbul for instruction. During the yearlong project, attitude changes occurred among Azerbaijani physicians. Once unreceptive to Western medicine, some western medical ideas and approaches were adopted at a hospital level.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 6 World Vision International: The Food Assistance Program distributed food to IDPs in 31 districts of Azerbaijan. The program linked food distribution with nutritional monitoring and nutrition and health education. Nutritional education brochures were developed, and the nutritional status of beneficiaries was monitored in 12 surveillance sites every two months.

3. SUMMARY OF ACCOMPLISHEMENTS

Nutrition Practices 1,816,843 food rations distributed Enhanced 46,232 women exclusively breastfeeding for four months after receiving training

Community-Based 448,000 people had access to health care services (33,115 patients per month) Health Care 112,146 people participated in health education activities Strengthened

Community 9,655 community health groups were formed Participation & 61% females and 39% males was the average gender distribution for the clinic Self-help attendance Enhanced

4. PROBLEMS ENCOUNTERED/LESSONS LEARNED

Health and Nutrition programs met a large unmet need in provision of basic health care to those most vulnerable. The programs also encountered challenges during implementation, and generated a number of useful lessons learned. During the early Emergency phase, primary health care provision through mobile health units was one of the main foci of NGO health activities. While this initially met a significant need, the number of villages to be served was in excess of 500 and the mobile health units could only reach each community once a month, which provided no opportunity for follow-up for acute illnesses. Because the mobile units targeted the IDP/refugee population, this approach also promoted the segregation of IDPs from other conflict-affected residents of the communities.

A lesson learned is that even in acute stages of humanitarian emergencies, health programs would benefit from trying to incorporate the existing health system as much as possible. In this instance it might have been prudent to simultaneously train the medical practitioners in remote areas at the FAP and DAC levels on Primary Heath Care, and ensure that they had a supply of basic pharmaceuticals so that they could treat patients in the absence of the mobile medical teams.

Another lesson learned is that programs created during the emergency phase should also focus on disease prevention as well as treatment. By adding a community-based health education component, the focus on prevention even during the emergency phase allows for community members to be empowered to get involved in the improvement of their health.

5. SUCCESS STORIES

• In addition to the distribution of food, World Vision continued its on going nutritional and food security surveys in the regions in which food was distributed, in order to monitor the status of the recipients’ health and determine the existing levels of household food security. Over the course of the initial eight months of the project, there had been no notable changes in the health, nutrition, and food security indicators. Later surveys, however, which followed a gradual reduction in rations and eventually a complete

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 7 cessation in distributions, demonstrated a clear downward shift in the measured indicators. During the later surveys, there was an increase in moderate malnutrition rates from 11% to 16%; a decrease in the number of families eating three meals a day, from 42% to 1%; an increase in families eating only one meal per day, from 11% to 60%; and an increase of 17% in household income spent on food. This demonstrated the positive effect of the food distribution on the health and wellbeing of the population since the indicators were negatively impacted when rations were reduced. (World Vision)

• Malaria, caused by mosquitoes breeding in pools of stagnant water, was an increasing problem in the Barda Turkish Camp where, during the spring of 1999, there was a report of an increase in new cases. The Relief International health program team promptly addressed the problem. RI’s health team coordinated with its construction team to determine if the breeding sites could be removed. They discovered that there were many stagnant water pools that were excellent breeding grounds for mosquitoes as a result of construction activities. It was found that ridding drainage areas of grass needed to be a priority in order to promote drainage. In response, RI provided the Executive Committee of the camp with funds for fuel for a bulldozer that could clean the ditches. Coordination also followed with the Barda SES to spray the area with a WHO-approved insecticide. These efforts effectively and dramatically helped reduce the incidence of malaria in the camp. (Relief International)

• After a few months of participating in health promotion workshops and organizing two previous campaigns on malaria and nutrition, project target schools were ready for something new. Many teachers rose to the occasion and organized creative and fun learning activities for students, including skits, songs, and poetry recitations promoting dental hygiene. Step by step, teachers and staff took them through the booklet, helped them open their kits, and showed them how to brush their teeth properly. By actually going through with the activity, teachers agreed that students had learned something new; with support to organize activities on their own, teachers came up with some wonderful learning opportunities for children and everyone came away with clean teeth! (IRC)

• The Nakhchivan Health Assistance Program saw an ever-increasing number of patients presenting themselves for treatment. In May 1998 a total of 6,381 patients were treated, and in May 1999 this number had risen to 13,064 patients. Since April 1998 there were 162,877 separate patient consultations across the NHAP network. This represents 162,877 human-interest stories – mothers, fathers, infants, children, and grandparents – presenting themselves and receiving appropriate treatment from trained clinicians. In most villages NHAP provides the only primary health care services, and the population of Nakhchivan is accessing these services on an ever-increasing basis. Not only do these patients receive health care, but in receiving it free of charge the project is diverting scarce household incomes to other desperately needed purchases such as food, clothing, and heating fuel. (ADRA)

• From January 1999 all Mercy Corps funded Primary Health Care clinics implemented their activities according to a new referral system. This system was developed to enhance collaboration with the appropriate state health facilities. A special Referral Form was designed in this regard. The clinic doctors filled these forms in order to refer their patients to the state health facilities for laboratory studies, X-ray examinations, immunizations, consultations of specialized physicians, etc. To assist in meeting the needs of the referrals, targeted state health facilities were provided with medicines and medical supplies. For this, beneficiaries expressed their appreciation for the improved access to primary health and medicines. (UMCOR)

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 8 • Many of the Azeri doctors who participated in the UMCOR/ Baylor program reported a change in their perception of their field of specialty after returning from the U.S. and Turkey, where they observed more advanced medical systems. One of the Azerbaijani physicians who traveled to the U.S. with the hospital partnership program commented, noting how radically his understanding of his specialty had changed as a result of the program: “Before I went to America, I thought I understood anesthesiology well and it was a big discipline that filled the room all the way to the ceiling. But, in America, I learned that the world of anesthesiology went a long way above the ceiling.” (UMCOR/Baylor)

C. ECONOMIC OPPORTUNITIES (EO)

AHAP Strategic Objective 3: Improved Economic Opportunities

¾ AHAP IR 3.1 Small and micro-enterprises enhanced

1. PROGRAM OVERVIEW

Before the collapse of collective farming, rural inhabitants were state employees with specialized skills focusing on one area of farming and little vision of the farm as a whole. With the collapse of this system, the local inhabitants suddenly became farmers, but lacked the entrepreneurial skills and a diverse set of farm management experience to push farming beyond a subsistence level and into effective economic development. Despite government efforts to put in place an appropriate legal framework to encourage private initiative, the institutional structures needed to promote and support investment and business were insufficient. This was especially burdensome for the small and medium enterprises and micro-enterprise sector. No regulatory framework existed for local or international NGOs to operate micro-credit lending programs, an essential activity for micro-enterprise development.

In Azerbaijan access to capital outside of Baku was restricted. The majority of loan capital, savings facilities, as well as non-financial services – including business planning, market research, product pricing and marketing – were not available to the general public. Agriculture is viewed, as a key growth sector for Azerbaijan and it is a very important contributor to the GDP. Yet, limited access to quality inputs and poor infrastructure inhibits that growth potential.

Under AHAP I, Mercy Corps funded five economic opportunities programs targeting IDPs and other conflict-affected individuals in 15 regions of Azerbaijan’s “IDP belt”. Total funding for these projects was approximately $1.4 million. The projects covered programming areas in micro-credit, agriculture and business training, training of trainers, formation of community organizations, and agricultural production inputs. The overarching methodology of the AHAP-EO sector was to provide focused, cost-effective interventions while increasing community participation in the implementation, development, and evaluation of the project.

2. EO IMPLEMENTING PARTNERS and PROGRAMS

Implementing Partner Program Title Period of Implementation

World Vision Azerbaijan Enterprise Fund May 1, 1998 to February 29, 2000

Children’s Aid Direct Agricultural Credit and Training May 1, 1998 to December 31, Scheme 1999

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 9

American Red Cross Assistance to Vulnerable May 1, 1998 to November 30, Populations in Frontline Districts 1998

ACDI-VOCA Food Preservation and Processing September 1, 1998 to December Income Generation Project 31, 1999

ADRA Nakhchivan Agricultural Micro- February 1, 1999 to October 31, Enterprise Project 2000

World Vision: Azerbaijan Enterprise Fund AHAP I provided World Vision with additional loan capital for an already existing micro-credit program. Individuals received loans of $300-$1,200 for up to 12 months at an interest rate of 3%-4% per month resulting in an end of program repayment rate of 91%. World Vision also established a pilot small-business lending program that provided credit of $2,500-$10,000 for 3-6 months at a monthly interest rate of 3%. The end of program repayment rate was 97%. With the creation of a local NGO (non-bank financial institution), new businesses and employment opportunities were created by expanding small businesses including bakeries, shoe repair workshops, and dry good stores. Since access to timely and reliable market information was one of the greatest needs, World Vision developed three local business associations for market information that represented the needs of the local business community. The program continued to deliver needed micro credit to the Azerbaijan population through to 2005.

Children’s Aid Direct: Agricultural Credit and Training Scheme provided 495 loans to new or existing agribusinesses for ten months at an interest rate of 3%. The loans were $300 to individuals and $700 to groups. The project trained farmers on farm management and business skills, thus improving the efficiency of their businesses. To support these activities, the project collected and disseminated market information that helped farmers receive credit and make better business decisions. Community-based credit committees proved a useful mechanism for rational and community-based loan disbursal and collection.

ACDI/VOCA: Food Preservation and Processing Income Generation Project trained 2,273 IDPs on proper food preservation techniques to increase shelf life and to help increase yields. In addition, ACDI/VOCA trained IDPs on specialty fruit and vegetable production/preservation, providing additional income. Two simple small-scale food-processing facilities were built that provided employment and income opportunities to IDPs, as well as products for the local market.

American Red Cross: Assistance to Vulnerable Populations in Frontline Districts distributed agricultural inputs of potato seedlings, vegetable seeds, and pesticides to over 9,000 families in seven districts. The goal of the program was to reduce dependence on humanitarian food assistance and to restore agricultural self-sufficiency to over 9,000 families in seven frontline districts.

ADRA: Nakhchivan Agricultural Micro-Enterprise Project (NAME) began implementation in February 1999. NAME developed village-based credit associations, delivered financial services to local producers, and provided agricultural and business skills training.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 10 3. SUMMARY OF ACCOMPLISHMENTS

Small & 4,033 clients received credit through individual and group lending Micro- 20,291 families received agricultural inputs Enterprises 9,824 clients received agriculture & business training and technical assistance Enhanced

Community 1,073 community groups participated in EO activities Participation & 5,319 jobs were created Self-help 26% female participation in EO activities Enhanced

4. PROBLEMS ENCOUNTERED/LESSONS LEARNED

The AHAP I Economic Opportunities programs encountered significant challenges in adapting their interventions to the humanitarian assistance environment. While the programs were overall successful in meeting targets, there were issues with sustainability. All of the implementing partners in this area were primarily humanitarian organizations with expertise in the delivery of humanitarian assistance and relatively little experience in the field of economic opportunities. In addressing these problems, partners identified a number of lessons learned, particularly with the micro finance programs.

As part of a humanitarian relief program, micro finance lending programs encountered delinquencies with repayments. This was largely as a result of an overall lack of a credit culture in Azerbaijan – including a legal framework – and confusion among beneficiaries between humanitarian distribution programs and the credit programs. The lack of a legal framework and the nascent state of micro finance development in Azerbaijan made it extremely difficult to deal with non-payments through the court system. The average Azerbaijani did not have experience with contracts for loans, because during Soviet times they did not generally need loans, as everything was provided by the state. As a result, developing the attitude of financial responsibility of beneficiaries was extremely difficult. The short length of the programs also influenced the commitment of beneficiaries to develop trustful relationships and financial discipline. When the programs were perceived as temporary, people were not as likely to trust and develop lasting relationships and therefore to repay loans. Lending programs were further hampered by being restricted to lending to IDPs instead of being able to broaden the client base to respond to market demands.

Partners learned that more training for the loan recipients was required so that they better understood their contractual legal obligations. In addition they developed ongoing relationships with the local courts that included routine reporting and laid the foundation for informed decisions when enforcement became necessary. In addition, it was clear that further work would need to be done to develop a culture of credit in Azerbaijan, including lobbying the government for a legal framework to encourage the sustainability of micro lending programs. This work would extend well beyond the life of AHAP I and would become the focus of AHAP II.

There were also occasions where a lack of coordination amongst partners and other agencies in the area contributed to a situation where a client who refused to pay his/her loan could easily receive credit from another agency, thus making it extremely difficult to control repayment issues. In an environment where loans and grants coexist, clear and concise messages are of utmost importance. An overarching lesson learned in this sector was that real coordination was required between and among partners and other agencies working in the same geographic area to avoid undermining efforts to ensure good programming.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 11 5. SUCCESS STORIES

• Before being drafted into the army, Mr. Sabir had been engaged in trade, buying and selling goods in the markets in his home area. He began his sewing business in Baku in 1996 and reports, “I wanted to give an opportunity to others who were affected by the conflict like myself.” Having heard of the loan program from an IDP client, he approached Azerbaijan’s Enterprise Fund for a $1,500 loan which he used for purchasing equipment – five sewing machines and equipment for cutting fabric. Using these he was able to substantially increase his production, which mainly consisted of trousers and uniforms which he sold in local markets, with some additional contracts for companies in Moscow. “Before taking my first loan,” reports Mr. Sabir, “I employed 15-20 people. The loan enabled me to expand to employ a further 15 people. Of these, 80% are IDPs so I can help others affected by the conflict.” (World Vision)

• The Husseinov family in Bolludara (Sheki region) was able to expand its sheep breeding enterprise during the first loan cycle. After paying off the first loan three months before the repayment deadline, the family reapplied for a second loan in order to diversify their agricultural activities into wheat production. The Husseinov family was successful in their efforts with wheat production. (CAD)

• Mr. Mamedov was a client of the agricultural program living close to the front lines. He and his wife and four children were pleased to receive the potato seedlings and vegetable seeds from the American Red Cross. Impressed, the wife repeatedly mentioned the high quality of the potato seedlings. Unlike some of his neighbors, Mr. Mamedov did not have any livestock and truly relied on the crops produced with these inputs. Although he did not sell any of the crops, he was able to save 25-30 kilograms of the potatoes for planting in the next season. (American Red Cross)

• In the early days of the program, in summer, a man brought a truckload of eggplants to a village hoping to sell them. When it got dark and the eggplants had not been sold, the owner dumped them unto the ground and drove off. The people in the village ate what they could but most of the eggplants spoiled because no one knew how to preserve them. The next summer, the women in the village formed a group to preserve and market vegetables. They were hoping the man would show up again and dump another truckload of eggplants in the middle of the village – they would not go to waste that time! (ACDI- VOCA)

• “There are many jobless people in our village,” said Bashir Dadashov, gesturing at the surrounding homes in the mountain village of Bichanak. “When we finish school, most of us go to work reaping mountain grasses and tending animals. Now we have two Credit Associations in our village, through which we can borrow money to expand our activities. The credit program loaned each of us $400 to use to develop animal husbandry. My friends in the Credit Associations and I were able to buy more than 100 sheep, with lambs, to raise this year. Every day two of us look after the sheep in the mountains. After three months – at the end of October – we will return back to the village to sell the lambs. The money that we will receive from the sale of the lambs will enable us to repay our loans, keeping the mother sheep as profit. I am now keeping records for my business to help me plan and expand my business. I want to build my business so that I can help the unemployed people of my village.” (ADRA)

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 12 D. COMMUNITY DEVELOPMENT

AHAP Strategic Objective 4: Enhanced Community Participation

¾ AHAP IR 4.1 Community participation and self-help enhanced through involvement in project development, implementation, and evaluation

1. PROGRAM OVERVIEW

The district of Goranboy borders the northern edges of Nagorno-Karabakh and thus sustained heavy shelling and occupation during the conflict. As a result, the residents were displaced, and schools, homes, clinics, irrigation systems, and public buildings suffered considerable damage. The pre-war agricultural-based economy was replaced by subsistence economic activities. Through the community development project, AHAP hoped to encourage repatriation, the resumption of community life, and an increase in the quality of life for the conflict-affected peoples. To achieve this goal an integrated ‘packaged’ approach was designed that combined interventions within the AHAP objectives of shelter and community infrastructure rehabilitation, enhancement of economic opportunities, and support of primary health care services. At the same time, the program promoted skills transfer, self-reliance, and community development though the direct involvement of the community in planning, implementation, and cost sharing interventions. Community involvement led to the broad-based participation essential to achieving sustainability beyond cessation of project activities. Goranboy Reconstruction, Rehabilitation, and Revitalization Project (GR3) were the first of AHAP’s programs that targeted the local conflict-affected people, as opposed to solely IDPs and refugees.

2. COMMUNITY DEVELOPMENT IMPLEMENTING PARTNER and PROGRAM

Implementing Partner Program Title Period of Implementation

CARE Goranboy Reconstruction, May 1, 1999 to November 30, 2000 Rehabilitation, and Revitalization Project

CARE: Goranboy Reconstruction, Rehabilitation and Revitalization Project As an integrated, multi-sectoral, community-based program, the GR3 project was the first of its kind in Azerbaijan. It marked the beginning of the transition from the provision of humanitarian relief assistance to long- term development activities. It was a pilot program that set the stage for AHAP II and development work in Azerbaijan. GR3 provided important lessons that would make AHAP II successful.

3. SUMMARY OF ACCOMPLISHMENTS

Improved 219 houses were reconstructed and repaired Living 18 Community infrastructure projects completed including health points, Conditions schools, and community centers.

Improved Training of 840 “point families” in better farming techniques Economic 550 people received a grant as a result of training or training assistance Opportunities 200 women received training on vegetable production and seeds. 6 Farmers Associations implemented agricultural mini-Projects.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 13

Improved Health 37% increase in women that made at least 2 prenatal visits and Nutrition 74% increase in women of reproductive age that reported using safe family planning methods. 52% increase in number of targeted children that are fully immunized. 60 community members trained to deliver health messages 16 Health care providers received skills training

Improved The information sector has brought a wide variety of information to the Access to community, on issues from vegetable prices to veteran’s rights. Information 3 Community Bulletin/Message boards were established in each village and according to a final survey they became important sources of information for the community.

Community 3 Community Action Teams established - one in each village. These groups Participation & showed more ability in democratic decision-making, maturity and confidence. Self-help 240 micro-projects completed with $107,000 of community contribution. Enhanced

4. PROBLEMS ENCOUNTERED/LESSONS LEARNED

As a pilot program, GR3 garnered numerous lessons learned, and was able to overcome many problems during implementation which allowed the program to achieve considerable success. Community development concepts such as self-help, voluntarism, community participation, and community management of projects were new to Azerbaijani citizens, both IDPs/refugees and local populations alike. Thus, in implementing a community development project, there were several challenges.

The GR3 program asked community members to come together as a group to make decisions through dialogue and consensus, and required participants to make presentations and contribute resources, all concepts that were new and required significant capacity building. As a result of insufficient project time and very limited resources for bringing in experts to help build staff and community capacity, the program encountered low participation of the community. GR3 was designed with the assumption that residents would “support community initiatives and mobilize local resources for communal benefit” with little necessary input.

In the first attempt at mobilization of communities, participants had yet to develop the necessary skills and understanding of how to successfully implement community development in Azerbaijan. Communities had no previous experience that would prepare them for the level of support they needed to implement successful community development activities. In the economic opportunities sector, GR3 was only 19 months long. This allowed for just one harvest cycle, which was not enough to establish the experience and skills necessary to sustain the interventions. The result was a nascent farmers association with little experience in the methods the project had worked so hard to introduce. The lack of time to effect change and resources were significant handicaps for the program.

These experiences revealed that community development programs require considerable time and resources in order for communities and staff to fully understand and implement the principles of community participation and civic duty. Because the concepts of citizen’s rights, responsibility, accountability and results were new to Azerbaijan, and therefore for program staff, significant resources and time needed to be devoted to training staff in preparation for their work with communities. In many cases, the program staff was able to overcome the issue of low participation by spending extended time with community members to help them understand the program and see the

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 14 benefits of community participation. The staff would have benefited from increased training and capacity building in these areas to help them serve the communities more effectively.

A further lesson learned is that it is necessary for the community to attain a certain degree of organizational consolidation or cohesion as a group before sustainability is viable. In addition, once training is done, it is important for participants to have the opportunity to apply their new skills in order to make the program sustainable. The process of community development needs to go beyond the formation of community groups and rather concentrate on a long-term participatory approach where citizens participate in all aspects of community planning, development, and skills practice, including with sectoral interventions like economic opportunities.

5. SUCCESS STORIES

• On Thursday, May 27, 1999 GR3 held its first ever-whole village meeting with community members from Todan. For 10 days the signs posted all over the village had been advertising the date, time and location of the meeting, as well as the main objectives: to meet GR3 staff, to hear their plans for the village, and to elect a representative board for Todan. Included in this notice was an invitation for all villagers to attend, both men and women. When CARE’s community development team arrived, there were about 20 old men in the designated meeting place. For a while it seemed as if CARE’s efforts to include women had not worked. However, over the course of the next 20 minutes, a crowd of women and men accumulated on the hillside, until it seemed like about three quarters of the families in the village were represented. The women stood together at the side of the group, but they were curious about what was going to happen, and listened attentively. The result was the election of a 12 person Community Action Team (CAT), including 6 men and 6 women. The members of this CAT were full of energy and enthusiasm for the project, and began working with GR3 staff immediately, showing irrigation specialists what their plans were to bring water to farmland, and taking construction engineers to see all the damaged houses in the village. They helped the Community Mobilizers to complete a baseline survey of the village, and spread information about the project to other community members as they themselves learned more. (CARE)

E. INFORMATION

1. PROGRAM OVERVIEW The AzerWeb Internet Information System provided updated information on humanitarian aid and development assistance efforts, and Azerbaijan in general to International Non-Governmental Organizations (INGOs), local NGOs, government officials, and international donors. Contents included information on humanitarian assistance activities (Situation Reports, Program Descriptions, Assessments and Strategy Papers, Technical Reports, etc.), directories of local NGOs and INGOs; IDP population profiles, flight schedules, directories of Embassies, UN agencies, detailed maps of Azerbaijan and activities, interagency meeting schedules, and extensive links to other websites and reference materials. AzerWeb can be accessed through the Internet but also through a telephone line, or Dial-up System, that functions as a separate telephone line without having to connect to the Internet, making AzerWeb accessible to those who cannot afford an Internet connection. This site continues to operate and to reflect up-to-date practical information. Azerweb includes information about regional NGOs, relief & development projects, as well as direct links to hundreds of pertinent Internet sites.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 15 2. INFORMATION IMPLEMENTING PARTNER and PROGRAM

Implementing Partner Program Title Period of Implementation

Save the Children AzerWeb September 1998 to January 2001

Save the Children: AzerWeb began in May 1997. It was originally envisioned as the Azerbaijan component of the United Nations Department of Humanitarian Affairs (UNHDA) effort to expand Relief Web, an online information system designed to provide prevention, preparedness, and rapid response to the humanitarian community. In September 1998 AzerWeb received AHAP funding to operate for a period of two years. In September 2001 AzerWeb was transferred to the care of Open Society Institute – Assistance Foundation Azerbaijan, and is still operational.

3. SUMMARY OF ACCOMPLISHEMENTS

Increase Clientele 229 presentations to NGOs, donors, and the commercial sector

Increase Information 119 activity advertisements available on-line Availability

4. SUCCESS STORIES

With the support of the program and administration staff, the AzerWeb Team hosted an Awareness Day Party on June 25, 1999. The AzerWeb Team set up three computers – two running an AzerWeb PowerPoint presentation, which presented the menus and highlights of the site. The third computer with a large monitor was connected to the site via remote access and guests were able to surf through the site at the event. The AzerWeb team circulated throughout the party informing guests of the benefits of AzerWeb and presenting the new site layout. Over 150 guests attended the party and the party received a very positive response with eight sign-ups for training sessions and over 30 hits a week consistently up. (SC)

Please see Annex D for AHAP I Indicator Tables

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 16 A. ECONOMIC OPPORTUNITIES (EO)

1. SECTOR OVERVIEW

Economic opportunities programming covered Business Development Services (BDS) and micro finance (MF) programs, as well as economic interventions within the Integrated Community Development Program (ICDP). Whereas during AHAP I, primary attention was focused on providing humanitarian assistance, development became the touchstone for AHAP II. Naturally, economic development thus became one of the major components of the AHAP II program. The understanding that economically profitable regions and communities are better able to meet their own needs formed a foundational approach for designing and implementing economic programs. Early surveys revealed that two of the biggest challenges impeding economic development in Azerbaijan are a lack of available credit (particularly for the poor) and difficulty adjusting to and living under a newly developing market economy. Therefore, the general strategy for EO programming was to start provision of credit and business development services and, while doing so, to localize those credit and BDS providers such that after the program is over, sustainable micro finance institutions and local BDS providers would remain. This approach proved to be useful and successful during the initial two years of AHAP II.

Experience gained during the early years of AHAP II indicated that there was a huge potential for synergy between the community, health and EO components. Therefore, it was decided to develop and start implementing integrated community development programs, under which referral mechanisms were built into the program design that enabled such synergy. Though in the early stages of activity, the integrated approach was useful for organizing solidarity groups, establishing eligibility for micro-credit services and developing credit culture in the regions, the very specific nature of microfinance (including accounting, financial reporting and local regulatory requirements), necessitated unification of ICDP program microfinance components with established microfinance institutions (MFIs). Therefore, one of the partners brought the credit component of its ICDP program under the auspices of an MF institution it had already created, and the other partner sub-contracted their credit component to the most advanced MF provider in the area. The EO interventions conducted initially within ICDP programs will be discussed in the Community Development section of this report.

In cooperation with USAID, extensions were provided to allow local MF institutions and BDS providers to reach sustainability and continue provision of their services after the close of AHAP. Integration among the programs and the partners, regional cooperation and referral between all sectors and partners were paid special attention during these extensions. One of the important features of EO programming under AHAP thus was regular yearly cross-visits. First conducted in 1999, these visits became a very powerful tool for creating better partnership under the AHAP umbrella through cross- fertilization and staff capacity building. There were three types of cross-fertilization that were occurring– between BDS and microfinance programs, between same-sector programs of different partners, and between significantly different geographic regions (e.g. between the isolated enclave of Nakhchivan and conflict-affected parts of the mainland).

AHAP EO partners also played a leading role in establishing and developing the Azerbaijan Microfinance Association (AMFA), which contributed significantly to the development of an improved microfinance, credit and business development environment in Azerbaijan. FINCA, World Vision, ADRA and Save the Children lead a coalition of eight microfinance organizations that in December 2001 established the association. During the next four years, AMFA became both a locally and internationally respected institution, successfully advocating for an improved domestic operating environment, bringing the best worldwide MF experience into the country, and representing the MF community of the country abroad.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 17 2. PROGRAM OVERVIEW

AHAP S.O. 1: To create sustainable jobs and businesses

¾ AHAP I.R. 1.1: Increased availability to credit and support services

The goal of economic opportunities programs under AHAP was to create employment opportunities by enabling conflict-affected populations to start or expand their businesses by providing group and individual loans and business development services, by stimulating the creation and development of small and medium sized businesses, and by forming business associations. By targeting a broad group– both IDPs and the surrounding local populations– EO activities would work to remove barriers between IDPs and local communities. In the area of agricultural and related enterprise development, AHAP II would work to improve production efficiencies and diversification at the farm level, remove market and processing bottlenecks, and establish viable agricultural development support organizations. In the area of small and medium enterprise development, AHAP EO programs would build the capacity and sustainability of start-up enterprises and foster the establishment of viable and competitive business development support organizations. The total budget for economic programs was $6,576,257. (For more information on program extensions, please see Annex G)

Mercy Corps worked with two micro finance partners over the life of the project – Adventist Development and Relief Agency (ADRA) in the Nakhchivan Autonomous Republic (NAR) and Save the Children (SC) in the Central area. The ADRA Nakhchivan Enterprise Development Program (NEDP) started in November 2000 and ran through September 2005 (see Annex G for detailed information about extensions). In June 2004 the program encountered difficulties with the Government of Nakhchivan (GNAR) and spent the next several months working to restore credit program operations with a guarantee of non-interference from the GNAR. Save the Children’s Economic Opportunities Development Program (EODP) started in June 2000 and ran through September 2005 (see Annex G for detailed information about extensions). Save the Children was able to keep operational sustainability above the level of 100% and is on the verge of reaching financial self-sufficiency. The EODP has also expanded its operations to three new regions in the western part of Azerbaijan and has opened a new branch in Ganja.

Mercy Corps worked with ACDI/VOCA in the Central area and with CHF in the Southern area on BDS programming. ACDI/VOCA implemented the Central Area Economic Opportunities Project (CEO), which used community economic recovery groups (CERG) to integrate the economic activities of IDPs and the local population through market chain participation and broadened technical and managerial capabilities. The Community Employment and Economic Opportunity Program (CEEOP) program, implemented in the Southern regions by CHF, started on May 15, 2000 and came to an end in December 2004, at which point the program linked its activities to other resources for back-up support. The original CEEOP objectives included increasing the productivity and profitability of associations; introducing business concepts and practices to entrepreneurs; providing direct consultation to clients; and providing timely information on market prices, business and economic opportunities. CHF ceased provision of direct business development services after the initial phase of the program, and during three subsequent extensions moved to the role of facilitator, thereby better preparing local BDS providers to work independently after the closure of the program. Separate EO activities were also conducted under the Integrated Community Development Program (ICDP). Please see the Community Development section for discussion of these activities.

3. PROGRAM INTERVENTIONS

In the early stages of the programs, both the Central area and the NAR micro finance partners had to deal with the absence of a borrowing or credit culture. Because of the post-Soviet attitude toward borrowing, any EO activity conducted by international organizations was liable to be seen by the local population as purely a humanitarian exercise rather than as a stimulant. Thus it took some time to

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 18 create a sense of responsibility for financial affairs within local communities, and building this community-held value for micro finance became an undercurrent of program activities.

In order to maintain high quality in service provision, the BDS programs invited international consultants to contribute to their efforts in conducting market needs assessments and baselines on the business environment, in capacity building, in examination of the business training materials and training of staff, and in conducting impact surveys based on a sub-sector analysis approach to enterprise development. These interventions allowed the best practices in BDS to be applied to the case of Azerbaijan. Micro-Finance Institutions: In the Central area, Save the Children applied an aggressive strategy for recruiting clients early on in the program. Unfortunately, this did not allow for appropriate attention on institutional strengthening of the nascent MFI and the necessary time to help to develop a credit culture among potential clients. This resulted in significant repayment problems that required a year to address. Once the problems were resolved, SC moved forward with a concentration on building staff capacity, conducting regular client surveys and program evaluation, loan product diversification and adjustment to the clients’ needs, financial and management discipline strengthening, and active participation in efforts to improve the overall lending environment in Azerbaijan. Another necessary element was the legalization of all activities, including registration with the Ministry of Justice and receiving a license from the National Bank. These efforts proved useful in expanding the program and in reaching operational sustainability.

As mentioned above, SC made product diversification a priority. Using client surveys, additional types of loans were added to the loan portfolio. The new agricultural group loan product was added to the portfolio in mid-2003. This product, designed primarily for cattle-breeders, offered $140-300 for a six- to eight-month term with a two-month grace period on the repayment of principal. The response by clients to this new product was very encouraging. Following an increase in the amount of the loan, longer repayment and grace periods made this product even more popular as it helped increase the ability of clients to improve the quality of their lives.

ADRA also encountered problems due to the lack of a credit culture in its effort to build a sustainable MFI. After working extensively with potential clients and authorities in the NAR, by March 2004 ADRA had achieved 144% in operational sustainability. Over the course of the program ADRA developed five loan products: Agriculture Supply Loans ranging from $300 to $1,500 for a period from 48 to 72 weeks; Trade Supply Loans for the same amount but for the period from 24 to 40 weeks; Small and Medium Enterprise Loans from $1,000 to $10,000 for 48 to 96 weeks; Emergency Loans from $50 to $300 for 8 to 24 weeks; and Individual Loans from $100 to $1,000 for 24 weeks for trade and 48 weeks for agriculture. The good design of the program, strong leadership and management, overall management and financial discipline, creative approach to product development and monitoring, and continuous capacity-building of the staff contributed to the high and early operational sustainability. Due to the expansion of the program to new areas and seasonal changes, the operational sustainability slightly decreased over a few months, but it stayed well above 100% and the program advanced towards financial sustainability.

However, in June 2004, ADRA Kredit (an Azerbaijani registered subsidiary of ADRA) encountered a traumatic shake-up of business operations following the emergence of a smear campaign levied against it by authorities of the GNAR accompanied by the GNAR actively restraining clients from paying back their loans. The allegations were countered by the well coordinated efforts of the U.S. Ambassador, USAID’s Country Coordinator, Mercy Corps and ADRA, in collaboration with the Deputy Prime Minister, to convince the Speaker of the GNAR parliament that the GNAR’s interference with the program was inappropriate and needed to be reversed. The GNAR’s unwarranted and unprecedented actions against loan beneficiaries and ADRA seriously damaged the program, and the progress toward financial sustainability was interrupted. The impact of the interference was significant, not only to NEDP, but also to ADRA’s other programs in the region, the micro finance lending culture in Azerbaijan, and to all future U.S.-funded program activities in the

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 19 region. The efforts countering the attack eventually resulted in the signing of a Memorandum of Understanding (MOU) with the GNAR on March 25, 2005 and immediate recommencement of lending activities by the program following which, repayments increased. While the long-term impact of the GNAR’s actions on the micro-credit culture in Nakhchivan remain to be seen, the coordinated actions to mitigate negative impact were able to help recover the partner MFI.

Both programs fully utilized the technical expertise of expatriate technical advisors and benefited from various trainings, cross visits and inter-agency meetings organized and facilitated by Mercy Corps. They also took advantage of cooperation with other INGOs and coordination with other development assistance programs. Over the life of the program, ADRA undertook activities to integrate its lending activities with the Nakhchivan Health Development Program (NHDP), ADRA Azerbaijan’s reforestation program and micro-project interventions in the region wherever feasible and appropriate. Save the Children took advantage of cooperation with its own ICDP program in the Central area, and also with other endeavors such as the CHF-implemented Social Investment Initiative. Close cooperation with other programs in the regions contributed to the minimization of operational expenses wherever possible; program planning and strategic management of mutually beneficial opportunities and shared resources; joint collaboration on community based development activities; and joint representation and dialogue with the local authorities.

Entrepreneurs: Early in the program, CHF conducted two market research surveys, a client baseline survey and a small business needs assessment. The assessment identified 45 individual clients who were trained in business and 45 more who were trained in advanced business concepts, including financial analysis, SWOT analysis and business planning. In addition to group trainings, the CHF program also offered individual consultations to entrepreneurs. In the Southern area, CHF worked with these entrepreneurs and successfully implemented interventions such as introducing the fee-for- service concept, facilitating regional linkages, organizing trade fairs and mobilizing gender-sensitive business practices. Through CEEOP, program participants began to view themselves as clients that value services rather than beneficiaries of free assistance. Over the life of the program, CEEOP had a tremendous impact on increasing conflict-affected communities’ knowledge of business practices, raising awareness of economic opportunities, catalyzing business start-ups and strengthening existing businesses. In total, more than 8,000 persons received timely and accurate data on market prices, best business practices and economic opportunities. Similarly, the market chain concept used by ACDI/VOCA proved to be a groundbreaking tool in the economic development of central Azerbaijan, providing much-needed locally produced agricultural goods and broadened technical and managerial capabilities of providers, thereby helping to create tangible benefits for thousands of participants. The program formed Community Economic Recovery Groups (CERGs) comprised of producers, processors, distributors and retailers, with the core enterprise as the heart of the process. CERG members met at least once a month to discuss future activities and to maintain the collective they had formed. Since CERG members were free to buy and sell their products to other market participants, it was careful cost analysis that tied them to each other. Under the program, the core enterprise withheld an average 8% of the monthly profit to secure the growth of the business and to allow communities to have more economic options in the future. There was a strict quality control established within the CERG sales process, and as soon as a low- quality product was revealed within the chain that could endanger CERG’s products’ reputation, remedial actions were immediately taken. Throughout this process farmers were linked with processors, distributors and retailers. The CEO project expected to form or sustain over 328 enterprises during its 24 months of operation. However, ACDI/VOCA exceeded the target by 80%, forming 599 enterprises. Following an audit with the participation of external consultants, ACDI/VOCA instituted a comprehensive quality assurance plan involving all CERGs involved in food production.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 20

Associations: With a goal of improving the local business environment, partners formed associations that allowed groups to jointly Market Chains Established by ACDI-VOCA solve issues confronting their businesses. In the Southern area, CHF began their Poultry Association Development component in the Vegetable and Fruit Preserving second half of 2001. Ten associations were Wool Processing formed, two of them being regional Sunflower Seed Oil associations. CHF developed a cycle that Dairy outlined a step-by-step process, defined roles Grain and responsibilities for associations, and also Feed Production introduced fees for the package of services provided to associations. In addition to more traditional BDS services, CHF facilitated the creation of an internal credit program organized and managed by the women of the Regional Handicraft Association. The credit capital was created through donations from CHF, membership fees of Association members, and by fees from the sales of handicrafts produced by association members. It provided association members the opportunity to raise their incomes through access to credit. Despite enormous efforts, CHF could not get the associations registered under the national law. This impacts the associations’ sustainability, as they are not allowed to be owners of property, hold bank accounts or be eligible for grant funding. In spite of the fact that CEEOP together with the Regional Handicraft Association’s Council Members submitted all documents required for registration to the Ministry of Justice in December 2002, there was no answer from the Ministry regarding this issue. Subsequently, documentation was re-submitted several times and each time the answer was either nothing or a request to change something minor. Despite this, the association continues to function, and is working toward sustainability. After closure of the program, the two feed mills established in the Southern area continued expanding their operations without any support and independently provided beneficiaries with quality livestock feed and embedded business services.

As mentioned earlier, the Central Area partner focused on market chains, and their Community Economic Recovery Groups (CERGs) were developed as precursors to formal associations based on common interests and opportunities. For each CERG a maintenance plan was developed, and a plan for local resources mobilization was prepared to bolster the capacity of each CERG to sustain their activities in the foreseeable future. CERGs received a number of different trainings to prepare them to become associations, including action plan preparation, accounting and marketing, culminating in the creation of a business plan for a core enterprise. Trainings provided proved to be very useful, and average increase of 28% was recorded for income of the training participants. Once they became more formalized, the nascent associations collected membership fees, and were able to purchase with better economies of scale and pool their resources for better strategic production.

Enterprises: In the Southern area, after researching the animal feed sub-sector, the CHF CEEOP team developed a list of 23 target communities. After the initial selection, nine communities were short- listed. The selection criteria for the remaining nine candidates was based on local businesses capacity in the animal husbandry and poultry production sector, lack of production facilities, geographical location, etc. Through a transparent selection process, the Shirinbey Community group from Saatli region was chosen to participate in the program. Once the selection had been finalized, a Memorandum of Understanding between CHF and Shirinbey Community Group members was signed and an estimate was prepared for the initial business start-up costs. In addition to procuring equipment and refurbishing a building, CHF contracted two specialists from the State Animal Husbandry Scientific Research Institution to develop specialized training material and conduct training sessions for the shareholders of the enterprise. The enterprise shareholders were given more general trainings in accounting, financial management and marketing, and also specific training in mixed fodder, including in feed for animals and for poultry. The total cost for setting-up the enterprise was $8,550 of which 52% was contributed directly from CHF. Shirinbey community contributed 48% of overall cost, which consisted of 20% in kind contributions and 28% in cash.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 21

LGNOs and LLCs: During the implementation of CEEOP, CHF partnered with several local organizations, stressing its commitment to partnership and capacity development. A strong relationship was developed with local NGO UMID, who provided key staff for the program and received capacity building trainings. As CHF transitioned to a BDS facilitator role, the partnership with UMID was revised and phased out. During the life of the program, CHF worked with a number of different local associations and partners including Support to Economic Development and Agrarian Projects (IIALD), who supported technical activities in animal husbandry. In its role as a BDS facilitator, CHF competitively selected key local providers and built their capacity. The five selected BDS providers were: Sabirabad AgriBusiness Consulting Company, Broiler Joint Stock Company, AgroInvest Credit Union, Komak Credit Union, and Elat AgriBusiness Consulting Company. A needs assessment was done for the BDS providers, after which materials were developed and trainings provided in strategic planning, business plan preparation, service package preparation, identification of high potential BDS markets and client assistance strategies. CHF conducted ongoing monitoring of services provided by the trained BDS providers.

4. ACCOMPLISHMENTS

4.1 Increased Availability of Business Development Services Activities in BDS programs concentrated primarily on developing associations and building business linkages. A total of 12 associations were formed by the two BDS partners, two of them CHF CEEOP held an opening ceremony for one of its being regional associations, and an additional feed mills on March 4, 2004 and invited all players in nine Community Economic Recovery Groups the market chain, including other BDS providers and (CERGs), eight Farmers’ Unions and two animal husbandry and poultry farmers from across the locally owned enterprises. target region. More than 60 farmers, media

representatives, and local and international Business Linkages and Market Information: organizations attended the ceremony. Based on the In the Southern area during full life of the results of the market research, four types of chicken program, more than 1,200 clients were trained feed and two types of cattle feed were displayed and consulted directly by CHF CEEOP, while during the event. These products were packed into more than 1,000 clients were trained and labeled sacks with the vender’s trade name label seal. consulted indirectly by CEEOP’s BDS providers. In addition to training, ten associations were formed and two mixed fodder production enterprises were established. In spring 2004 the Karvan Handicraft Association independently conducted a trade fair and an advocacy and lobbying workshop with the participation of government authorities, non-governmental organizations and businesses from the Southern region. In total, CEEOP organized four trade fairs in collaboration with the Karvan Association and facilitated various market linkages with souvenir shops and different business organizations. These activities resulted in sales totaling $1,845. In agriculture, CHF worked to create demand for BDS services. For example, marketing, product promotion and awareness raising campaigns conducted and facilitated by CHF increased demand for mixed fodder products. The surveys conducted revealed an approximately 30% increase in productivity of animals and poultry as a result of the mixed feed, and the increased awareness of farmers through appropriate marketing in turn increased demand for the fodder. CHF in total was able to recover $3,188 for services that were provided under the program through a cost recovery fund. At the end of the grant period, this money was granted to the Karvan Association, which used this amount to establish a credit fund for Association members. This fund has been increased further by membership fees, handicraft sales fees, and loan interest rates. Through their work, CHF helped establish the concept of fee-for-services among local BDS providers, which contributed to their overall sustainability.

In the Central area, ACDI-VOCA’s work led to increased linkages between CERG members, cooperative enterprises, distributors and retailers across the region. In average, the training

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 22 participants increased their income by more than 2.5 times, while eight core enterprises were established. More than 77% of training participants demonstrated documented change in knowledge, 19 economic groups were established instead of the 18 planned, and 599 businesses were started and sustained, exceeding the planned figure by more than 50%. 4.2 Increased Availability of Credit Services Over the life of the program, ADRA’s NEDP program provided 9,809 loans to solidarity groups and individuals through five loan products – The Agricultural Supply Loan, The Trade Supply Loan, SME Loan, Individual Loan and Emergency Loan. The loan portfolio exceeded $1,200,000 with a client base of over 3,000. As a result of lending activities in Nakhchivan, NEDP contributed substantially to the understanding and adoption of microfinance lending practices in Nakhchivan, in addition to supporting the general development of micro lending within Azerbaijan. As a result of lending under NEDP, the program contributed to the formation of 540 solidarity groups including both male and female entrepreneurs, and the sustainable development of 4,555 businesses resulting in 27,634 full- time and part-time positions. In response to the growing demand for micro-credit services and products, in May 2004 NEDP established a branch office in Sharur.

In the Central area, 27,711 micro, small and individual loans were provided to clients, most of them through solidarity group loans. In total 1,055 groups were formed. To help build the capacity of the nascent MFI, several staff capacity building activities were conducted, and the program ensured strict adherence to loan manuals. A Ganja service point was converted to a full-fledged branch toward the end of the project, and the Mingechevir service point was strengthened to better serve clients in the Central regions. Throughout the program, the overall on-time repayment rate was maintained at above 95% and the portfolio-at-risk remained below 2%, as per industry standards. Operational self- sufficiency over 100% (with and without expatriate technical assistance) has also been achieved. To increase their loan portfolio, an additional $80,000 was received from the Danish Refugee Council in the form of a loan for the CBLS program to increase their lending potential. As of September 30, 2005, the total outstanding loan portfolio was $472,028.

MFI Registration and Localization: As a preparatory step to establishing an MFI, ADRA Kredit LLC was set up in 2002. It was registered with the Ministry of Justice in 2002 and got its license from the National Bank of Azerbaijan in December 2003 to undertake microfinance activities. In May 2004 after negotiations with Mercy Corps and USAID, it received permission to capitalize itself. However, in early June 2004 GNAR’s above mentioned intervention started, significantly damaging and handicapping ADRA Kredit. In particular, the Government of Nakhchivan informed that it is not enough for ADRA to be registered at the Ministry of Justice in Baku. Finally, in March 2005 a Memorandum of Understanding was signed with the GNAR, with each side taking on obligations for the future that would help ADRA Kredit recover its activities. In addition to this, ADRA has to get registration with the GNAR. So, ADRA has since taken the steps necessary to get registration with the GNAR.

As a result of persistent work, Save the Children’s Community Based Lending and Savings (CBLS) program was registered as a local micro finance institution, Azeri Star Microfinance LLC (ASM), in June 2003. As part of the post-registration process, the official identity was obtained from the Regional Tax department and from the Social Fund. The license for providing micro finance services was received from the National Bank of Azerbaijan in July 2005.

Loan Disposition: Effective September 28, 2005, USAID approved disposition of $682,004.50 in loan capital to ADRA. The loan capital contributed by ADRA, as well as program income earned in relation to both ADRA’s and USAID/MC’s loan capital, had already been approved for disposition in favor of ADRA by USAID in May 2004.

Effective September 28, 2005, USAID approved disposition of $630,500 in loan capital to SC. Azeri Star is looking for additional opportunities to increase its loan capital and has approached different donors and financial institutions to get more funds. In particular, it is in the process of the

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 23 negotiations with the Asian Development Bank and with the Danish Refugee Council, which provided some other MFIs in Azerbaijan with the credit for increasing their loan capital.

Portfolio Management: In Nakhchivan the partner either reached or exceeded the majority of target levels of performance even with the interruption of operations from June 2004 through April 2005. By September 2003, NEDP had achieved an operationally sustainable level of service delivery and was looking to financial sustainability targets before the interruption to program operations in June 2004. As of May 2004, before the GNAR’s interference into the program began, NEDP had established a regular client base of approximately 3,000 clients, had already distributed over 8,000 loans, had achieved 117% in operational sustainability with the portfolio at risk just 1.19%, well below of industry standard of 2%, and was actively working to transfer operations and assets to an independent MFI ADRA Kredit LLC while investigating commercial funding opportunities beyond AHAP. NEDP issued some 9,809 loans across its five-loan product portfolio including the Agricultural Supply Loan (ASL), the Trade Supply Loan (TSL), SME Loan (SME), Individual Loan (IL) and Emergency Loan (EL), against a target performance of 8,480 loans. In addition the program contributed to the set-up and operation of some 540 solidarity groups against a life-of-project target of 250 groups and supported the sustainable development of some 4,555 enterprises in agriculture and trade, thereby helping to sustain some 27,634 full-time or part-time positions against targets of 3,000 and 16,500 respectively. As of September 2005, ADRA Kredit was actively working towards the re- attainment of operational sustainability with the recommencement of lending in April 2005. Now, since the MOU has been signed with the GNAR in March 2005 and loan distribution renewed in April 2005, NEDP has been able to provide new loans to eligible clients with a repayment rate in excess of 95%.

In the Central area, 27,711 loans were disbursed by the partner through 1,055 solidarity groups. Out of this, 12,896 loans (48%) were delivered to female and 6,951 (25%) to IDP clients. By the end of the project period there were 3,655 active loan clients united in 522 solidarity groups. Among them, 1,745 clients (47%) were female and 393 (11%) IDPs. As of September 2005 the total outstanding loan portfolio of CBLS was $472,028. The Portfolio at Risk was 0.57% ($2,707), well below the industry standard of 2%. Due to the arrears problems in 2002, the repayment rate declined to 75%, but was improved and remained over 95% during the rest of the reporting period. Since October 2002, the repayment rate has remained consistently above 95%, the last three years even exceeding 99%. As a result of program activities 18,676 clients were able to sustain and/or expand their businesses due to continued access to financial services. The total number of direct recipients reached 24,410 out of which 10,930 are females and 5,690 IDPs. The cumulative amount of loans disbursed was more than $5,500,000. A client satisfaction survey was conducted by CBLS to identify the reasons for the dropout rate among clients and to collect information about services provided. Based on the results of this survey, some changes were made to the existing loan products and a new product was introduced to reduce the drop out rate and increase clients’ satisfaction, which contributed to high repayment rates.

Progress toward Sustainability: Institutional Central Area Nakhchivan sustainability of both MFI 27,711 loans disbursed 9,809 loans disbursed programs was achieved 522 solidarity groups formed 540 solidarity groups formed through building staff 18,676 clients expanded businesses 27,634 jobs were sustained capacity, creating, registering and licensing the local non-bank financial institutions, creating a governing board, improving policies and procedures and introducing new loan products. Through careful planning and solid management, ADRA avoided serious problems in the beginning of the program. By September 2003, NEDP had achieved operational sustainability and was seeking to expand its capital base to achieve financial sustainability. Further progress towards this goal was significantly impacted by the GNAR’s interference in program activities starting from June 2004. With the recommencement of lending in April 2005 and continuing efforts to recover loans in default ADRA Azerbaijan remains hopeful that

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 24 NEDP in the form of ADRA Kredit LLC will return to full operational sustainability status in the coming months. In support of operations and the continued growth and development of ADRA Kredit LLC in Nakhchivan, ADRA Azerbaijan is currently in negotiations with another international micro-credit provider operating in Azerbaijan to explore areas of mutual cooperation for the future delivery of existing and expanded micro-credit services to targeted and eligible loan beneficiaries in Nakhchivan.

As it has been mentioned above, SC’s program sustainability started to increase from the beginning of the program and reached 70% in September 2001. Later there was a decline in operational and financial self-sufficiency due to a serious delinquency problem in 2002. Starting in the fall of 2002, operational and financial self-sufficiency gradually started to increase and by September 2004, the program attained more than 100% self-sufficiency. Despite that increase, there was a decrease in operational self-sufficiency starting from 2005 due to the opening of the Ganja branch and a reduction in loan portfolios, but this measure reached 100% again within six months. ASM approached the Asian Development Bank (ADB) and Danish Refugee Council (DRC) to develop further funding relationships and is progressing well in developing those prospects.

Improved Operating Environment: ADRA actively encouraged and supported the sharing of information with other micro-credit service providers and complementary projects in the NAR. To this end, ADRA established a dialogue with the International Organization for Migration’s (IOM) credit program in Nakhchivan to include sharing of client management and products. In addition, NEDP attempted to establish and maintain an on-going dialogue with the World Bank micro credit program in the region. At a national level, NEDP and ADRA Azerbaijan are active members of the Azerbaijan Micro-Finance Association (AMFA) in the promotion of a sound operating and legal environment for MFIs in Azerbaijan. The NEDP program also cooperated extensively with ADRA’s Nakhchivan Health Development Program (NHDP) and ADRA’s reforestation and community level micro-projects program. Cooperation with these complementary programs included the sharing of program information and planned activities, the development of joint strategies for the engagement of existing and additional rural communities, joint community presentations, and resource sharing opportunities to optimize cost sharing opportunities wherever possible.

The Central Area partner also developed effective collaboration mechanisms to cooperate with other micro credit providers in the area, namely FINCA, OXFAM, ADRA, WV, ACDI/VOCA and NHE. CBLS also played an active role in the Azerbaijan Micro Finance Association (AMFA), maintaining a functional relationship with AMFA members, and the MFI will continue this relationship in the future to work toward a more enabling legal environment for micro finance institutions. So far the advocacy efforts have had positive effects and due to MFIs’ joint efforts through AMFA, the government lowered the amount of licensing fees for MFIs.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 25 5. SECTOR PROBLEMS ENCOUNTERED/LESSONS LEARNED AND IMPACT

PROBLEMS ENCOUNTERED/LESSONS LEARNED

The Importance of Targeted BDS Interventions When a BDS program is narrowly focused, chances that interventions will create more tangible results are higher. In the early stages of BDS program implementation under AHAP, it was believed that emergent farmers lacked knowledge and skills in general business management, general marketing and finance. The initial design of BDS interventions was to provide them with such knowledge through training. This approach turned out to be difficult to sustain, as many of the clients had different business activities, and trying to provide assistance to them all was difficult. It also became clear that many of the BDS providers chosen by the program did not in fact have viable businesses, due to a lack of market research when choosing partners to work with. Once these issues were identified, the programs were redesigned based on a sub-sector analysis, which allowed for a targeted focus on a small sector that was demonstrated to be in demand. The results of the survey identified that lack of quality feed and embedded services are one of major constrains that hinder growth of farmers income within the livestock sub-sector. The program worked exclusively in this area, and eventually opened two feed mills in the Central area. One feed mill had over 200 repeat clients and average sales of feed per person increased from 10 kg to 200 kg within the first year.

The Value of Building on Existing Expertise In most communities, there are usually unofficial advisers in crop and livestock production from whom local people ask advice. Any development initiative or program that is attempting to develop agriculture should attempt to include these people into their programs. Programs that begin with these existing resources are able to quickly gain traction in communities and benefit from an existing peer education structure. Successful AHAP BDS programs utilized their knowledge in providing additional formal, classroom and on-the-job training.

Creating a Culture of Credit When international organizations began implementing micro credit programs in Azerbaijan, there was no culture of credit – neither among potential clients nor at the government level. There was also no comprehensive legal framework in Azeri legislation covering micro finance activities. The law allowed for registration of MFIs, but only as limited liability companies, which put them on equal grounds with commercial banks and exposed them to the same taxes and fees imposed on commercial entities. Potential clients were not aware of the procedures required for receiving loans, and some programs struggled initially with repayment and had to pursue several cases through the legal system to demonstrate the seriousness of failing to repay. Implementing partners were able to overcome many of these issues by working together with Mercy Corps and USAID to advocate for a better legal environment for MFIs in Azerbaijan. These efforts, which included articles in local journals, conferences, and the creation of the Azerbaijan Micro Finance Association, led to the licensing of the two MFIs under the AHAP umbrella, and to increased support of MFI activities by government.

IMPACTS:

• AHAP micro finance institutions, in collaboration with other micro finance institutions in the country, have laid a firm foundation for a credit culture in Azerbaijan. The population served by these programs is beginning to understand the importance of paying back their loans and the value of having those loans made available to them.

• Micro finance program efforts have consolidated the presence of sustainable MFIs in rural Azerbaijan that cater effectively to the needs of the local community. By increasing activities in remote or underserved areas such as the west of the country, the institutions are poised to provide much-needed services beyond the life of the program.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 26 • Both partners’ efforts have also built a cadre of experienced senior local staff now able to operate and develop the MFIs’ operations without the need for expatriate intervention. Through local capacity building efforts, programs have left in place the skills, experience, and confidence within staff to operate and further develop the MFIs within their own resources and experience.

• Similarly, partner activities have contributed to the formation of community-based solidarity groups that have the potential to thrive beyond the program period. Through internal management and peer pressure mechanisms, these groups have consistently maintained high levels of loan repayments within their group, and have created a better understanding and adoption of micro finance services within their communities.

• Through the trainings in business techniques, the long-term viability of the respective core enterprises was ensured. The core enterprises continue provision of valuable services to the members of their market chains, thus creating a social net of community and business alliances that further solidifies the inherent stability of each market chain. Economic recovery groups have also taken a prominent role within their communities as training resources, offering expertise in areas such as food preservation training or on information sharing through outreach materials.

• BDS program activities have helped to deepen program impact in competitive sub-sectors, such as animal husbandry within the Southern cluster areas. In helping to organize communities around two feed mills directly established by AHAP efforts, the program worked with both demand and supply sides, on the one hand creating demand by providing information to the potential clients on the benefits of enriched mixed feed, and on the other enabling established enterprises through the capacity building trainings to supply this feed to the market.

Please see Annex E for EO Sector Indicator Tables

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 27 B. COMMUNITY DEVELOPMENT (CD)

1. SECTOR OVERVIEW

Community Development programming under AHAP covered several different types of programs, including Community Development, Social Investment Initiative and Integrated Community Development. Introduction of these programs opened a new phase in AHAP by shifting from relief to development objectives, and by increasing self-reliance and self-sufficiency of program participants and beneficiaries. The second phase of the AHAP strategy focused on the introduction of a new community development component to help organize and strengthen communities, facilitate the rehabilitation of economic and social infrastructure, and establish coordination mechanisms to ensure meaningful interaction among implementing partners.

Community development principles were used as the foundation for other programs under AHAP to help encourage communities to be actively involved in their own development. Decades of almost total dependence on the government served as a deterrent toward the empowerment of the citizenry and made it difficult to assume concepts such as self-help and self-reliance. Additionally, years of relief experience had encouraged strong dependency among IDP communities. As such, the Community Development program focused on strengthening capacities and mobilizing communities to identify, prioritize and address needs by assuming greater ownership of their problems and solutions. The Social Investment Initiative program built on the accomplishments of the CD programs by further strengthening the capacity of previously formed community groups to implement their self- prioritized and initiated projects. Building on the lessons learned from the previous strategy, an Integrated Community Development Program (ICDP) represented the next step in the community development portfolio by increasing community mobilization coverage through cluster formation, addressing multi-sectoral community needs in an integrated fashion, and introducing regional structures and networks. ICDP programs covered a wide range of activities, including health education, support for community-based enterprises, and strengthening of local and regional community based organizations. With the introduction of integrated programs, the structure of community groups evolved to cluster-level structures whose members were elected amongst active group members and who became key people at the regional level to assist cluster communities in addressing their issues.

Throughout the implementation of CD programs, the community and cluster groups sought ways to register within the local government. However, due to significant challenges for the third sector registration as a local NGO, none of the cluster groups were able to register as LNGOs. However, more innovative solutions were considered and community groups were registered as Mahalla Komitesi within the local Municipality. This was a positive step, as this helped community groups to gain legality within the local government and strengthened linkages and cooperation among Municipalities and their constituencies.

In the later phase of the programs, increased emphasis was placed on ensuring that CD activities were carried out within the context of the ICDP model. As a result, program activities became more diverse, increasingly focusing on linkages and also looking at ways to start integrating with ICDP programs. All CD programs focused on building the capacity of experienced community groups and supported them in taking a more direct and interactive role in cluster activities and in outreach and mentoring of nascent communities. The formation of these partnerships enhanced self-sufficiency by building capacity to initiate and implement problem solving techniques at both the community and cluster level. Moreover, the later phase of the programs coincided with the waiver of Section 907, which allowed more opportunities to strengthen linkages with local government. The main focus during later program extensions was on ensuring full sustainability through handing over responsibilities to cluster-level structures and local NGOs to mentor new communities and providing necessary support, including networking and cooperation with local government.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 28 2. COMMUNITY DEVELOPMENT

AHAP S.O. 2: To Strengthen Community Involvement and Capacity through Participation and Leadership Development ¾ AHAP I.R. 2.1: Communities organized and mobilized, with strengthened capacity to address self-defined needs 2.1 PROGRAM OVERVIEW

In 2000 Community Development (CD) programs became operational and were implemented by Save the Children (SC) in the Central area, World Vision (WV) in the Urban area and International Rescue Committee (IRC) in the Southern area. The overall amount budgeted was $4,801,853. (For more information on program extensions, please see Annex G) The goal of these programs was to develop the capacity of communities to address their priority issues to enhance the quality of life in the community. WV worked in the urban setting to respond to the particular needs of Internally Displaced Persons (IDPs) who fled from Nagorno-Karabakh and bordering regions, while IRC and SC programs focused on the community development needs of rural areas. IRC and SC CD programs closed in summer 2003, and WV closed on September 30, 2005.

Initially the CD programs were implemented as single sector programs, however with the introduction of the integrated community development strategy these programs transitioned to integrated community development. The SC and IRC CD programs closed in June 2003, integrating their activities at that time with their ICDP programs. The WV CD program was extended and continued to transition towards ICDP-like interventions by focusing on developing cluster-level structures and introducing an economic opportunities component. The goal of the economic opportunities component of the Urban Community Development Project (UCDP) was to develop and implement a program of expansion of economic opportunities for IDPs.

Throughout the implementation of CD programs, 229 community groups were formed with a total of 2,650 members. An additional 46 groups were formed through mentoring by experienced community members, which was one of the key achievements of the programs. Several community groups applied to the Ministry of Justice to register as local NGOs, though none were successful. A total of 25 groups were registered as Mahalla Komitesi (MK) in the Urban area. Under the community development program, communities completed 779 micro-projects that benefited 466,515 people, including 67% IDPs and 53% women. Communities were able to complete an additional 111 projects by leveraging non-AHAP resources.

All three programs faced challenges and underwent key staff/management changes during implementation. In addition to management challenges in various periods of implementation, WV faced particular staffing challenges towards the end of the project. However, the employment of an Expatriate Program Manager and seconding of a local senior staff member in March 2005 ensured successful program completion. SC and IRC nationalized all positions—SC after one year and IRC after two years.

2.2 Program Interventions To respond to the AHAP Sectoral Objective 2, CD partners undertook a number of different interventions. Throughout all programs, the communities participated in Participatory Rapid Appraisal (PRA) sessions, attended multiple trainings on various topics and were given opportunities to apply their skills. Overall 1,943 people applied training they received in strengthening responsiveness and effectiveness of the community groups. The interventions were implemented on various levels—including community, community groups, local NGOs and local government— through a variety of technical trainings and consultations. In addition, regional workshops and cross- visits made between community members and cluster leaders from different areas enabled them to share experiences and learn from each other’s activities. All interventions that involved micro-

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 29 projects were done in compliance with relevant regulations. Observing USAID environmental guidelines was a key to ensuring that the projects implemented during the life of the project did not harm the environment; thus all communities received environmental awareness information. Furthermore all projects were checked for potential environmental hazards based on Environmental Action Plans developed by each partner, who had benefited from an Environmental Training Manual and related environmental training provided by Mercy Corps. Consequently, mitigation measures were incorporated into all the micro-projects to reduce environmental risk. As community members developed a sense of ownership of their community they became more careful about their environment and put efforts to preserve their environment beyond project implementation. In addition, all the completed projects were monitored and evaluated. Partners did extensive monitoring on various levels and began involving community members in monitoring their projects according to their monitoring & evaluation plans.

Communities: Community-level interventions initially raised the awareness of communities about the community development process and overall AHAP activities. Later on, PRA processes were conducted that helped community members to identify strengths and concerns in their communities (See text box below for more information on PRA activities.) The orginal PRA process helped to identify community members to participate in community groups. In total, 229 community groups were formed, using various models including secret ballots and open voting, that represented 2,650 community members. General criteria for group members included their willingness and proven committment to assist communties, transparency, skills and representation of men, women, youth and IDPs. The average group size consisted of 9-11 people, including two youth and approximately four women. Overall, of 2,650 community group members, 46% were women and 72% were

Communities were PRA tools also strengthened In general, the participatory rapid Community resource mapping through sensitization appraisal (PRA) is a series of Community History campaigns focused participatory activities and on health and workshops that enables communities Daily and monthly calendar environmental issues, to address local issues by building Venn/ Institutional Diagram allowing them to their capacity, empowers them to Economic opportunity Mapping more effectively make decisions, and focuses on Trend line assess their heath and community resources rather than Problem Analysis Tree environmental needs. The communities contributed Transect walk situations. Programs enormous energy to the planning Agricultural opportunities mapping also helped them to process and learned the value of the Gender role analysis understand the following PRA techniques and tools: Community action planning concept of ownership Focus group discussions over projects and taught them how to mobilize internal resources and contribute towards community-driven projects. Other types of community-level interventions included voter education trainings that were conducted for different layers of Urban area communities to increase their participation. In the Urban area, nine Mahalla Komitesi members were trained on voter education topics and provided with a training of trainers (TOT) in preparation for Municipality elections. These nine individuals then replicated training for 187 MK and Municipality members. In addition, 227 community members received vocational trainings and 102 people received training on how to access credit.

Under WV’s economic opportunities interventions in the Urban area, vocational trainings were provided in all clusters. Training topics were selected by community members and reflected the demand of the current market. WV invited both experienced community members who were willing to share their knowledge with peers as well as external and local experts to conduct vocational trainings. WV continued training aimed to equip beneficiaries with “critical life skills” defined by WV as CV writing, preparation for interviews, business ethics, English language and computer literacy. English and computer courses were made available for program beneficiaries and non- beneficiaries on a fee basis through Resource Centers that are now functioning in four clusters.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 30 Topics such as hairdressing, manicure and pastry production were in the highest demand among beneficiaries. Over the life of CD interventions, communities became less dependent on the implementing agency and more proactive in fundraising and leveraging other sources of funding as a result of the variety of trainings they received. The training efforts subsequently led to enhanced community ties with local and regional government and especially with the Municipal Councils.

Community/Cluster groups: Once community groups had been formed, partners energized the process of mobilization by providing community groups with trainings in mobilization, project planning and implementation, as well as by providing funds for micro-projects and encouraging linkages to outside resources. The process of planning and implementing projects with the partners allowed community groups to apply the training they had learned, and allowed them to take on greater responsibilities in subsequent project cycles. Through the technical assistance provided by AHAP, community groups also achieved remarkable progress in their advocacy skills. Now they are in the position to plan advocacy initiatives and participate in dialogue with relevant stakeholders and decision makers at different levels. A total of 1,943 community group members applied training in strengthening responsiveness and effectiveness of community groups. To enhance the self- sufficiency of community groups, AHAP CD programs provided forums for information exchange that promoted dialogue between a variety of stakeholders and also resulted in the development of a more advanced program methodology involving mentoring between communities. Also, Lessons Learned seminars arranged through CD programs gave community groups the possibility to reflect on the positive accomplishments of the program, as well as to share experiences, ideas and concerns. These seminars also refreshed their knowledge on how to choose good leaders, ensure transparency, involve all social groups in community activities, and cooperate with the local government and neighboring communities. In addition, SC contracted with Initiative for Social Action and Renewal in Eurasia (ISAR) to provide advanced training courses for community group members on topics including fundraising, social partnership, conflict management, financial management, proposal writing and strategic planning.

With the phase-out of two CD programs in summer 2003, activities focused on consolidating established structures and establishing linkages in order to ensure future, independent operation of community and cluster groups. First, programs helped experienced groups expand their scope by assisting them in the process of mentoring neighboring communities in development principles and by developing more formalized partnerships with municipalities to promote partnership and sustainability. Second, programs increasingly worked to form and support cluster-level structures. In these two ways, functionality and self-sufficiency of groups was improved, thus enhancing their ability to address self-defined needs now and in the future.

Resource Centers: In the Urban area, WV established six cluster-level resource centers (RCs). RCs were established to serve as hubs for development activities in the target areas. Once the centers were established, WV contracted with the local NGO Dirchelish to determine community needs with regard to the RCs. According to the contract, Dirchelish conducted a community needs assessment survey. The members of the communities and MK were interviewed, and the preliminary results of the survey identified needs in financial planning and management of the Resource Centers, and improvement of the price policy for the offered services. Computer, Internet and tutoring courses and job exchange programs have been identified as the most promising areas for development in the future. Dirchelish has also created a system of labor exchange centers that employ one community member from each cluster as a recruitment agent. These agents will continue linking the community members to available jobs and will earn their salaries and income from the relevant cluster funds. Those who find jobs pay 20% of the first-month salary to the relevant community fund.

Local NGOs: During the last five years of AHAP, CD interventions focused on increasing the capacity of local NGOs to better serve communities. In many instances, local NGOs were subcontracted by partners and initially trained on project management, training needs assessments, sustainability and strategic planning topics. Following the training sessions they were involved in the

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 31 mobilization of new communities and project implementation. Within the programs, LNGOs delivered training to communities on gender issues, human rights, conflict resolution, civic education and civil society development. Several local NGOs were subcontracted to implement specific program components. In the IRC program, 12 community groups were linked with four local NGOs: Aran, Refugee and IDP Committee, Azerbaijan Development Agency and Araz. These LNGOs mentored the communities through project implementation and strategic planning, strengthening them to do these things on their own. IRC also sub-contracted with Mulki Cemiyyete Doghru (MCD) to provide technical services and training on Municipality issues.

Government/Municipality: At the early stages of CD interventions, programs faced challenges working with ExComs and Municipalities because of Section 907 restrictions. At that point in time some ExComs were very hostile to the program. However, the suspension of this restriction since 2002 has created an opportunity for agencies to revise their procedures. The partners commenced introductory meetings with local authorities in order to keep them informed about all activities, and as a result, ExComs and Municipalities have been almost universally cooperative. Experience showed that, once ExComs come on board, they can help convince others of the need and importance of community development. After the suspension of Section 907 the main focus of CD programs thus shifted toward strengthening awareness and understanding of the roles and responsibilities of Municipalities both among Municipal Councilors and community members in order to build stronger and more collaborative relations between these two groups.

To further strengthen the Municipal institution, special curriculums targeting Municipal Councilors were developed that included training on such topics as Role of the Municipal Councilor, Municipality Legislation, Leadership, Community Mobilization, Cooperation and Maintenance, Needs Assessment and Confidence Building, Strategic Planning, etc. In addition, in the Southern area, IRC worked with Municipal Councilors and community group members and conducted a two- day skills sharing and a four-day gender training in cluster communities. In general, activities carried out through CD interventions raised the profile of Municipalities. They learned how to be responsive to their constituency and report back to them. Trainings provided to Municipal Councilors enabled them to apply their new knowledge by training their counterparts in other communities. The Municipal Councilors also worked with their constituencies to increase their understanding of Municipal legislation, rights and responsibilities. In the Southern area, 13 people including Municipal Councilors, community group members and local NGO staff participated in a Municipality skill- sharing visit to Turkey to learn from their more advanced and effective Municipality structure.

Youth: Youth received special attention through the formation of youth groups and the implementation of youth micro-projects across CD programs. In general, youth demonstrated an exceptional level of engagement with the development of their communities; in order to fully utilize them for development activities, CD programs thus focused on working with youth groups. As such, these groups were trained on basic project cycle methodologies while also receiving sustainability training that enabled them to draft sustainability plans for their projects. CD programs also worked with youth in many communities to help raise their awareness on environmental issues. To further strengthen the capacity of talented youth, partners arranged for them to be trained in different vocational and life skills training courses provided by agencies that helped them to get jobs.

2.3. Accomplishments

2.3.1 Communities Organized and Mobilized Community/cluster group formation: A total of 229 community groups were formed through mobilization by partners, and 46 more were formed by experienced communities. In addition, 5 cluster groups were formed by WV in the Urban area. Many of the IRC and SC community group members joined cluster groups later formed under ICDP and continued development activities in their

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 32 communities. Six Resource Centers were established through WV to provide development services as well as to provide various vocational and life skill courses for community members.

Increased links with Municipalities and Municipalities’ role in peer training: The extensions enabled CD programs to consolidate and expand the positive impact and outreach of their mobilization activities. Benefiting from the waiver of Section 907, partners focused more on strengthening linkages with government entities, particularly with Municipalities. IRC built the capacity of Municipalities to become significant actors in community development and facilitated linkages between community groups and Municipal Councilors through joint trainings and activities. Overall, 175 Municipal Councilors and 598 community members received Municipality training on topics including roles of Municipal Councils, gender and fundraising in close cooperation with the local NGO MCD in the Southern area. Following Municipality trainings, the Councilors applied new skills and carried out awareness raising workshops, while also conducting at least one civic initiative in their communities with limited support from IRC. SC further strengthened the capacity of experienced community groups and Municipality members to mentor and train nascent communities. The training topics provided in the Central area included training of trainers, organizational management (including positive deviancy inquiry), organizational assessment tools, proposal development and fundraising. As a result of these activities, 141 community group members and 16 Municipalities in the Central area applied their knowledge and skills in strengthening the effectiveness of community groups. While WV received limited support from local authorities at the central government level, the project was eventually able to work successfully with Municipalities who supported community projects fiscally and through contributions to administrative resources. WV provided project design and implementation training to nearly all Municipalities who participated in the program and conducted regular coordination meetings with them. As a result of increased linkages, 25 community groups registered as Mahalla Komitesi in the Urban area and are jointly continuing to address community issues. A total of 62 Municipal Councilors in 29 Municipalities were directly involved in community activities together with community groups.

Community Group formation through outreach: CD partners emphasized building the capacity of community groups to mobilize other communities to promote sustainability. As a result of outreach activities, a total of 46 new communities were mobilized by trained community and cluster group members. SC focused on establishing a set of “Star Communities” and additionally formed five Star Community /Municipal Council coalitions. The Star Communities mentored 24 nascent community groups and conducted further training for community members and Municipal Councilors. In the Southern area groups trained by IRC mobilized two communities under their own initiative. In the Urban area trained cluster volunteers outreached and trained 20 new communities and facilitated the formation of community groups.

Linkages: The CD partners empowered communities to strengthen inter-community linkages and to seek and use non-AHAP development resources. IRC linked 15 previously formed groups with four local NGOs through their NGO Linkages Project (NLP). SC linked 120 groups with other sources, allowing more than 100 issue-based community problems to be addressed by other programs in the Central area of which 34 were funded including through CHF/SII. In general, 28 communities in Central area and 26 communities in Southern area received grants from SII to solve their problems.

2.3.2 Strengthened Capacity Community/Cluster group formation: As a result of CD mobilization activities, 229 community groups were formed comprising 2,650 community members, of whom 46% were women and 72% were IDPs. In the Urban area five cluster groups and six Resource Centers were formed.

Cluster entities and mature community members took over development activities: CD programs focused on enhancing capacity and leadership skills of mature community groups and cluster leaders by providing training in advanced community development methodology to increase their capacity to take on more responsibilities in development activities. This training increased the level of technical

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 33 knowledge within experienced communities and equipped them with the knowledge needed to take on a mentoring role for others. A total of 1,943 people applied training skills to strengthen the responsiveness and effectiveness of community groups. Of this number, 1,348 (67%) were women.

In the Urban area, cluster leaders received training covering a variety of topics including gender and development, conflict resolution, organizational development, financial management, and fundraising, and transferred their skills and knowledge to others by providing “training of trainer” sessions to ten volunteers to increase their effectiveness in community outreach activities. Through outreach 20 new communities were formed, and training conducted for outreach communities increased their capacity to participate in cluster level decision-making processes, as well as to plan and implement micro- projects. Overall in CD programs, experienced community and cluster members formed 46 new community groups. In addition, 111 self-initiated projects were implemented by leveraging non- AHAP resources. Six Resource Centers in the Urban area also provided computer courses to 400 participants and English courses to 117 community members.

Coordination and linkages, including with Government: Coordination, cooperation and information sharing among cluster leaders was enhanced through increased interaction as a result of joint activities including cross visits and trainings with other AHAP partners. WV organized a regional cluster-level Lessons Learned workshop and other cluster-level workshops. In the Urban area, cluster leaders participated in a town hall meeting organized by SPPRED. Another regional-level workshop was organized by SC and IRC to provide a forum for sharing experiences and knowledge, as well as for building relationships among community and Municipal Council members.

WV put efforts toward strengthening coordination between communities and Municipalities. Memoranda of Understanding (MOUs) were signed between some MKs and corresponding Municipalities as evidence of this enhanced coordination. In addition, cluster and MK members organized round tables between MKs and Municipalities, taking ownership of the processes of collaboration and exchange. In the Urban area, 25 community groups were registered as Mahalla Komitesi. CD programs’ interactions with Municipalities have resulted in increased fundraising and information provision capacity, as evidenced by the increased Municipality participation in ongoing projects. Overall in all CD programs, 62 Municipal Councils in 29 Municipalities participated in projects jointly with community groups. Strengthened relations encouraged municipalities to contribute cash and in-kind contributions of $26,754 toward AHAP and non-AHAP micro-projects.

Cluster and Municipality mentorship: Community leaders and Municipal Councilors applied their new knowledge by training their counterparts in other communities. In the Southern area during the extension phase, Municipal Councils from 12 targeted Municipalities participated in civic initiatives. An average of 70 community members participated in each event; these included clean-up campaigns, tree planting and sporting events. These 12 municipalities were linked with the Cluster Development Councils formed under the ICDP project. In the Central area, five Municipal Council-community group coalition activities centered on joint training, mentoring and implementation of micro-projects as capacity building for nascent communities.

In the Southern and Central areas, mature community groups also took on a mentorship role and developed more formalized relationships with Municipal Councils. Advanced trainings on effective mentoring and training techniques, the living university concept1 and related tools and organizational and project management were provided to experienced community leaders, Municipal Councilors and cluster-level representatives in the Central area. In the Southern area, the Municipal Councilors worked with their constituencies to increase understanding of municipal legislation, rights and responsibilities. Seventy-nine municipal Councilors in the ICDP clusters attended these workshops.

1 The ‘Living University’ concept was first developed by Save the Children Vietnam as a mechanism to promote peer learning. This concept, along with its incorporated tools of Positive Deviance Inquiry (PDI) and the Organizational Assessment Tool (OAT) were adapted to the Azerbaijani context and are being used in the Central area during the extension period.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 34 Overall, during the extension, 175 Municipal Councilors and 598 community members benefited from Municipality skill-sharing workshops in the Southern area.

2.3.3 Addressing Self-Defined Needs

Micro-projects: Community development partners built capacity of community members through implementation of 779 micro-projects. Communities contributed 33% to these projects, which was 7% more than planned. Community contribution was a key to achieving sustainable projects and a valuable tool to ensure self-sustained and self-reliant communities, as it is critical for developing a sense of ownership within the community. A total of 466,515 people benefited from these projects, of which 67% were IDPs and 53% were women. In addition, communities implemented 111 projects with total funding of $142,480 through leveraging of non-AHAP resources, including funds from embassies, Municipalities and other sources. In the Southern area, IRC supported community groups and municipalities in conducting 43 civic initiatives to discuss relevant issues in a large-scale community forum and assisted them to organize clean-up campaigns, tree planting, sporting events, youth art exhibitions and dramas. In addition to traditional micro-projects, WV implemented four income generation micro-projects in the Urban area as part of their economic interventions. Three of the four income generation schemes are open and functioning. The final project, a bakery, has been completed but is not yet operational due to administrative problems with the local gas authorities. Two of the income generation projects are making repayments, and a third is due to begin repaying soon. In total, of the 620 projects implemented, seven were economic opportunity projects and three were income generation projects.

Resource Centers and Critical Life Skills Activities: Various vocational and critical life skills trainings were provided to cluster communities through Resource Centers. Five new vocational training programs were established, two in carpentry, one in men’s hairdressing, and two more in women’s hairdressing. Of the 227 individuals trained in vocational and life skills classes (including English language, computer literacy, business ethics, etc.), it was shown that 86 persons have found jobs during the course of the project as a result. The RCs have indeed become a hub for life skills and income generation training. Significant training materials for English and computer skills courses have been added to the libraries of the RCs. As well, the RC facilities have on hand the basic course material for all courses taught, and these curricula are now part of the cluster communities’ standing resources.

Business Development Services: Dirchelish conducted trainings with 75 individuals on business ethics, job preparation, job-related professional skills, licensure requirements and tax/labor law as part of its contracted activities. As a direct result of the trainings, 13 community members found jobs and are applying their acquired knowledge. Moreover, two people from the community who had passed BDS trainings offered by Dirchelish were later employed by this local NGO as trainers. In addition, the successful pilot labor exchange model in Sari-Gaya community is still active. For this pilot program, Dirchelish identified 2 people from the BDS TOT courses and together with them interviewed 90 businesses operating in the areas of Novkhani and Sumgayit city. The survey identified the availability of 50 jobs with 32 businesses. Dirchelish met with 80 families from one community and asked them to fill out a questionnaire that would describe their skills, education, etc. Later, Dirchelish picked people from the list whose background would best fit the job requirements of the surveyed businesses. As a next step, 32 people, formed in 3 groups, went through a series of trainings on business ethics, job regulation, and rights and responsibilities of employees. In the end, 25 people - 9 women and 16 men - found jobs with businesses identified by the WV project through this effort.

Please see Annex E for CD Sector Indicator Table

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 35 3. INTEGRATED COMMUNITY DEVELOPMENT PROGRAM (ICDP)

AHAP S.O. 1: To create sustainable jobs and businesses

¾ AHAP I.R. 1.1: Increased availability to credit and support services

AHAP S.O. 2: To strengthen community involvement and capacity through participation and leadership development

¾ AHAP I.R. 2.1:Communities organized and mobilized, with strengthened capacity to address self-defined needs ¾ AHAP I.R. 2.2:Communities organized and mobilized to manage more accessible and sustainable quality health care ¾ AHAP I.R. 2.3:Rehabilitated community economic and social infrastructure through community organization and mobilization

3.1 PROGRAM OVERVIEW

The Integrated Community Development programs were implemented in the Southern area by the International Rescue Committee (IRC) and in the Central area by Save the Children (SC). The overall amount budgeted was $8,199,407. A total of 748,550 people in 16 clusters representing 455 conflict- affected and IDP communities benefited from ICDP through awareness raising, participating in public events, information education campaigns and peer-to-peer activities and accessing services from micro-projects. SC, began implementing the Integrated Community Development Program in June 2001; the total budget was $4,024,996. IRC began implementation of the program on July 1, 2001 with a total budget of $4,174,411. Both programs finished on September 30, 2005. (For more information on program extensions please see Annex G.)

Building on lessons learned from the single sector community development programs, ICDP represented the next step in transitional development programming under AHAP. The programs expanded the range of community development interventions through the formation of clusters, thus providing an integrated range of economic opportunities and health activities through cluster targeting and establishing the foundations for a regional development process. As the programs progressed, ICDP activities built the capacity of cluster groups to take over development activities in the communities. Toward the end of the programs, implementing partners served a supporting role as trained community and cluster leaders increasingly assumed greater responsibility and initiative for planning and conducting community and cluster activities and services. This approach served to strengthen ICDP communities’ capacity for sustainable self-reliance through skill consolidation and the creation of relationships among existing community structures. Several LNGOs were sub- contracted to help with implementing specific program components.

The focus for the health programs under ICDP was to strengthen the capacity of communities to identify and address their health needs through interventions based at the community level. These interventions were linked to capacity building for community groups who became the leaders in health initiatives, as well as capacity building for the health professionals and MoH staff who were tasked with taking on the responsibilities of the partners by the end of the project. Many interventions were carried out simultaneously to reach all segments of society that enabled a successful approach to integrated health care. Peer-to-peer education focused on greater public awareness of health issues while capacity building training was critical for the community and cluster groups so that they could act as true advocates for health. The provision of technical training for medical health professionals and rehabilitating medical points to WHO standards ensured that communities could have an improved standard of medical care. Capacity building of local NGOs prepared them to assist communities with civic initiatives. In addition, the supportive links made with the Ministry of Health (MoH) assisted the health authorities of Azerbaijan to become more active participants in securing the health of their citizens.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 36

The goal of economic opportunities programs under ICDP was to rehabilitate community economic and social infrastructure through community organization and mobilization. This was to be accomplished through the promotion of demand-driven, multi-sector economic opportunities including expanded market activity. The creation of viable employment opportunities was also among the goals of the program. Partners implemented program interventions including micro finance, establishment of business development services (BDS), support for local agricultural extension agents and capacity building for micro enterprises.

3.2 ICDP PROGRAM INTERVENTIONS The cornerstone of the ICDP approach is to strengthen the capacity of communities to access and utilize resources and to empower cluster-level structures to provide support services for the communities in their regions. Throughout ICDP programs, capacity building was a core component to help communities to address their concerns. As ICDP held sustainability to be an integral part of all activities, the main focus was on building capacity of community and cluster-level entities (Ijmalar Mejlisi, Development Resource Centers, etc.) or identifying local educators such as health peer educators, paralegals, and trained Municipalities to provide services and technical assistance for other community members. Furthermore, the staff and local NGO capacity was built to provide better services to communities. Throughout the programs, environmental and gender issues were cross- cutting issues. Partners developed a number of different materials to increase available information on program activities including newsletters, brochures and lessons learned workshops. In addition, specific training courses were provided to communities using resources from other local and international NGOs including IFES, World Learning, and Village Earth and other experts from government entities including SPPRED through contracting of their services. In general, ICDP programs empowered the cluster communities to learn skills to mobilize the resources necessary to address self-defined needs related to economic development, health needs, infrastructure and social services. Community: Community members were key stakeholders in ICDP programs. Both of the ICDP programs focused on covering 100% of the communities within each cluster and facilitated initial awareness raising events in all cluster communities. ICDP facilitated beneficial spillover effects by building capacity of experienced community members to continue raising awareness and to mentor other communities throughout program implementation. By training community members to be peer educators, the programs guaranteed the sustainability of the mobilization. In both the SC and the IRC programs, community members had a chance to attend Participatory Rapid Appraisal (PRA) trainings that enabled them to be part of development activities from the beginning and identify their priorities in a participatory manner. Furthermore, the cluster-level workshops conducted by various government entities, including SPPRED and members of Parliament, provided a forum for community members to be in direct contact with national structures to advocate for their issues. Community members regularly attended various public events organized by cluster group members and local NGO partners. These events brought the broader community members together to learn/share information on specific issues such as the environment, health and agricultural topics and to collaboratively identify solutions related to those issues. Moreover, the communities had the opportunity to participate in awareness raising campaigns on themes such as gender-based violence, voter education and environmental awareness. The ICDP program conducted voter education campaigns in both areas with the help of IFES. In the Southern area, 52 cluster group members were trained with TOTs and then conducted voter education campaigns in 121 communities, which benefited over 7,500 people. Additionally, over 10,000 copies of IFES brochures regarding voter rights and the roles and responsibilities of Municipalities were distributed. Additionally, in the Southern area, 122 of 124 target communities participated in cluster events. In the Central area, a total of 168 community, cluster and sub-cluster events were conducted for over 4,500 community members to raise awareness about cluster services and activities. Overall, interventions at the community-wide level were geared toward awareness raising on specific issues and toward ensuring transparency by keeping the broader community informed about activities in the area.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 37 To promote improved health knowledge and practices throughout the wider community, ICDP health programs focused on public awareness of health issues as well as on community education and training. Community participation in health education was elicited through peer-to-peer education, promotion of health training days in schools, community health campaigns and training for community health groups. The community health groups formed through ICDP received training that gave structured tools of learning to these groups that included management, proposal writing, leadership skills and training relating to specific health issues. Peer educators disseminated health trainings to community members on reproductive health, malaria, diarrhea, personal hygiene, dental hygiene and promotion of a healthy environment. Peer educators also facilitated health festivals, health days and media campaigns.

Community Based Groups and Organizations: Partners put considerable efforts into organizing and building the capacity of a variety of community based organizations to consolidate their skills to carry out development activities. Community based organizations under ICDP programs covered a wide range of groups, from community groups to health committees to enterprise shareholders to cluster entities. Community group members were trained on PRA techniques, management, project design, proposal writing, project implementation, leadership skills, sustainability and registration. ICDP facilitated formation of community groups in a number of different ways, including directly forming groups and also building the capacity of experienced groups to mobilize new communities. The communities directly targeted by partners were characterized by several factors: a) No current assistance from AHAP/Non-AHAP sources; b) located within the geographic clusters of the target area; and c) committed to participating fully in the program and contributing physical and cash contributions. A total of 171 community groups were formed in direct communities through electing community representatives in a transparent process; IRC elected them through secret ballot and SC through open voting. A total of 127 community groups were formed by experienced and cluster group members. Each community structure had sector-specific subgroups. Partners in ICDP programs put efforts into strengthening the capacity of experienced communities to enable them to support new indirect beneficiary communities. The indirect communities have had no previous AHAP support except previous relief activities. During the ICDP program, they received awareness raising and information about available resources/services and formed groups with support from experienced communities.

As part of the integrated nature of the program, community groups were taught how to use existing business opportunities and, in turn, how to utilize profits gained through those opportunities for community needs. For example, IRC’s USDA-funded Agricultural and Economic Development program worked with and through the Action Plan Committees (APCs) and utilized the Community Participatory Appraisal (CPA) problem ranking tool, in which the community identified its main needs, to develop and implement agricultural and economic development interventions in target communities. In this way, ICDP was well coordinated and integrated at the organizational level with on-going IRC projects funded by other donors. Also in the IRC program, community enterprises were established and, as designated in their project contract, devised a schedule for payments to repay a portion of their initial start-up capital to their community APC. In order to track and manage these funds, the APCs established community funds into which the enterprise repayment funds were collected. By the end of the program, some APCs had already used a portion of these funds to implement small-scale community development projects to address community problems. To support the repayment process and collaboration, the IRC staff facilitated regular meetings between the enterprise shareholders/management and respective APCs to encourage greater collaboration and accountability.

Similarly, the cornerstone of the ICDP health approach was to strengthen the capacity of communities to be able to identify and address their own health needs. This was accomplished through formation and development of action groups both at the community and regional levels. Implementing partners provided capacity building training activities to communities in target regions. The emphasis on training included community mobilization, participatory approaches to problem identification and development of action plans. A total of 161 health community groups were mobilized through the

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 38 ICDP interventions. A number of the health community group members became peer educators after they received additional training on relevant health topics including respiratory infections, immunizations, TB, nutrition, malaria, HIV/AIDS and others. Trainings of Trainers (TOT) workshops were held to prepare the peer educators to teach at the community level. In the Central area under Save the Children, a total of 697 Health Action Group (HAG) members and 213 teachers were involved in trainings while in the Southern area under IRC, 185 Health Action Committee (HAC) members were trained. There were a total of 24 community health groups who practiced peer- to-peer health education.

The Save the Children and IRC partners involved 38 communities in cost recovery mechanisms, thus promoting sustainable access to health care and increased community involvement in health management. Workshops and trainings were conducted to assist communities in identifying the most suitable type of cost recovery to meet their particular needs. Health Community Groups and cluster groups selected the locations for the development of these systems and later helped to establish and track these funds. The ICDP partners provided Community Health Fund (CHF) leaders with trainings on topics such as community health fund policies and procedures, roles and functions of CHF leaders, financial management, conflict resolution, team building, business development and social marketing. Workshops included a training seminar on health insurance and other cost recovery schemes given by the insurance company “Groups A”. The attendees included 31 CHF leaders, IRC and SC staff and LNGO Care for the Children representatives in the Central area. In the initial stages of CHF development, the IRC and SC partners also provided monitoring and evaluation to ensure systems were well established and meeting the needs of the community.

Development Resource Centers: IRC built the Community Groups Cluster Groups/Resources institutional and operational capacity of Development IRC Action Plan Committee Cluster Executive Board Resource Centers (DRCs) to (APC) (CEB) become valuable cluster Health Action Committee Cluster Development Council resources. DRCs are present in (HAC) (CDC) two regions and are designed to Development Resource Center promote access to quality (DRC) social, economic, technical and SC Community Action Group Ijmalar Mejlisi (IM) financial services to foster self- (CAG) reliance among target Health Activist Group community populations. In the (HAG) longer term, the DRCs are expected to continue supporting nascent linkages between the private and public sectors and to serve as a focal point for development activities. Cluster and DRC members received TOT sessions on many topics to be able to transfer their knowledge to others. In addition, DRC members were trained to take over youth initiatives and learned how to organize youth events. To continue to help the DRCs and their branch offices expand their services and become a more extensive resource for communities, trainings on topics such as training needs assessment; organizational development, volunteer management, funding options and support for training and information services have been conducted. Following a training needs assessment, 12 expert trainers conducted trainings on agriculture and economic development for DRC members.

Cluster groups: When clusters were formed, members of community-level groups were elected to membership of cluster groups where they had chance to get more advanced trainings on clustering, management, overseeing project implementation, leadership skills, sustainability, monitoring & evaluation, etc. SC’s Organizational Assessment Tool (OAT), which is a method of assessing and evaluating the capacity of organizations, was utilized to assess the cluster entities’ capacity and training needs, and in turn was used as a tool by cluster leaders to assess community groups. These groups along with local NGOs were trained on organizing community and civic events. Throughout

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 39 both programs, building the capacity of cluster groups to mentor and mobilize new communities was a major focus. Multiple cross visits, workshops and training sessions including regional cross visits facilitated an exchange of knowledge and experience and contributed to relationship-building between cluster leaders and Municipalities at the regional level. In the Central area, a representative from the State Programme on Poverty Reduction and Economic Development (SPPRED) Secretariat and an expert on regional issues from the Parliament made presentations on topics including ways to promote communities’ involvement in SPPRED activities, Mahalla Komitesi (MK) formation and registration, and the promotion of agricultural development through cluster linkages. To ensure cluster committees provided the necessary assistance to communities in a professional manner, several sub- groups including health, agriculture, environment, infrastructure, monitoring & evaluation and legal services were formed. The role of sectoral committees included technical assistance to cluster communities and providing support for the implementation of local initiatives. In the Central Area, the monitoring & evaluation committee monitored local initiative projects and provided necessary assistance in response to findings. In the Southern area, sub-committees including agriculture, health, infrastructure, economic development, education and gender/environment/youth were established within all of the Cluster Executive Boards (CEBs). One CEB member serves as a coordinator of each sub-committee consisting of five other members selected from Cluster Development Council (CDC), APC, and Municipality members through an open ballot election. The sub-committees each developed a three-month action plan, and several sub-committee members have organized civic events in the communities on their own initiative and with their own funding. Civic initiatives have included formation of parent-teacher associations, environmental cleanups, community health trainings and demonstrations of new agricultural techniques. Overall, capacity building for cluster entities focused on building structures that would be able to assist communities in participating in regional development initiatives and serve as links between communities and local and regional government structures. Regional cluster structures for health were operative for both Save the Children and IRC. Both programs promoted cluster-level awareness-raising events, trainings and mentoring activities resulting in the formulation of joint action plans between cluster and community bodies. The formation of health sub-committees in cluster entities further strengthened the links between health groups and cluster bodies. Local ExComs and Municipalities, representatives from the Ministries of Health and Education, as well as teachers and local NGOs also participated in these activities, providing a forum for communities and clusters to advocate for their health-related needs. LNGOs: ICDP programs provided technical, organizational management, and training skills for local NGO partners to improve their ability to assist in specific program components. In the CD component, after assessing their training needs the LNGOs received training on financial management and organizational development, among other topics. Cluster-level groups in the Central area and local NGOs in the Southern area received training to assist communities’ local initiatives and Integrated Community Activity (ICA) project implementation. SC’s local partner ARAN enabled paralegals through training on legal issues to train and serve the communities’ legal needs. ARAN’s main foci included advocacy, lobbying and raising awareness of civil society principles as well as social protection, taxation, etc. Mulki Cemiyyete Dogru (Towards Civil Society) facilitated the Municipality component in Southern area. Partners in both areas also placed increased emphasis on youth, gender and environment activities through conducting trainings and ensuring women and youths’ participation in community-based groups. LNGO partners Debate in Civil Society Center (DCSC) in the Southern area and Bridge to the Future in the Central area facilitated the youth component; Dalga (Wave) facilitated the environment component; and Azad Gadin (Independent Woman) facilitated the gender component. While working with local NGOs on economic opportunities interventions, the aim was to have locally available business service providers after the program is over. SC and AIM thus worked to provide training and technical assistance to farmers through selected and trained community extensionists. In addition, ICDP fostered the development of a group of community-based extension agents in collaboration with the local NGO AIM that provided classroom and field visit trainings for 46 extension agents. With KOSIA/SMEDA, the program offered direct provision of Business

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 40 development services. The work with AIM continued up to January 2005, while the cooperation with KOSIA/SMEDA ceased in September 2003. During the second extension period, SC worked with the local NGO MADAD on vocational training for youth.

ICDP programs also strengthened links between LNGOs and other health actors. In the Central area, SC supported the community health funds (CHFs) initiated by the local NGO Care for the Children and included them in their programming. This NGO was later selected by Save the Children to take over the management of CHFs in ten communities. IRC worked with LNGOs to prepare them to assist communities with civic initiatives.

IPs LNGO Partners Focus of Activities

IRC Debate in Civil Society Center Youth Mulki Cemiyyete Doghru Municipality training Dalgha (Wave) Environment Azad Gadin (Independent Woman) Gender SC ARAN Legal training and services Bridge to the Future Youth Agro-Information Center Agricultural business development training and services KOSIA/SMEDA Business Development Services MADAD Vocational Training Care for the Children Health

Government/Municipality: The suspension of Section 907 created more chances to work with government actors. A total of 878 Municipal Councilors in 346 Municipalities were trained over the life of the project. In the Southern area, Municipalities and cluster members received trainings on their roles and responsibilities, project design and project management. The Central area partner trained Municipalities on Asset-Based Community Development to increase their skills in basic community development methodologies. To support Municipal training activities, IRC worked with their local partner MCD to form a Municipality training team from 24 previously trained Municipal Councilors and provided technical and TOT sessions. This team then directly trained 509 Municipal Councilors, community group members and ExCom representatives. Particularly during extensions, Municipalities demonstrated a high level of collaboration with community leadership groups in activities, such as through joint proposal submission and implementation of community micro- projects and numerous coordination meetings conducted between cluster groups and Municipality sectoral sub-committees. In general, local government representatives’ participation in awareness raising events and trainings increased their familiarity with community issues and enhanced linkages between them and their constituents.

Also after the suspension of Section 907, ICDP partners were able to directly assist the government through capacity building for regional health authorities and government representatives. Seminars and workshops were organized for community leaders, doctors, Municipal Councils and ExCom representatives to advocate for community health needs. In addition, health authorities were invited to participate in awareness raising campaigns and community trainings, thereby strengthening linkages between community and civic authorities.

Workshops and trainings for district level MoH staff were conducted on Health Information Systems and the efficient use morbidity and mortality data. IRC conducted joint monitoring and supervision visits of medical professionals to transfer monitoring and evaluation techniques and increase the

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 41 responsibility of the MoH in monitoring and evaluation. SC conducted a conference to link CHFs with local MoH officials and municipalities, all of which helped highlight the success of CHFs and generated discussions about the role of CHFs in future health reforms. Both SC and IRC collaborated with WHO and MoH representatives to train a team of 12 national level Master Trainers in Integrated Management of Childhood Illnesses (IMCI), which insured a cadre of trainers in Azerbaijan for future expansion of IMCI.

Youth: ICDP activities in both areas supported youth groups to encourage youth engagement and leadership. The youth groups participated in environment, human rights, anti-smoking and other workshops/trainings specifically modified for youth audiences. The trainings were aimed at increasing the ability of youth to identify their specific issues and to learn how to address them in order to improve their lives. Youth mobilizers worked to increase opportunities for their peers and to integrate them into all aspects of community development activities. In the Southern area, the local partner Debate conducted debate workshops for youth and their advisors, which inspired the creation of debate clubs in several schools. SC formed five Scout Youth Clubs in partnership with the Ministry of Youth, Sport and Tourism (MYST), who received trainings on scouting, environment and other issues.

Adolescent peer-to-peer health education training was a focus in both the Southern and Central areas. Partners offered TOT courses and health education training in topics such as reproductive health, personal and dental hygiene, environmental issues and tree planting. SC created 16 adolescent peer education groups in cooperation with the Baku-based Khazar Youth Group to continue health education activities. In addition, they assisted teachers in establishing 23 Youth Health Information Centers (YHICs) in schools and equipped them with health outreach materials that supported teacher and peer educator health trainings.

HIV/AIDS: HIV/AIDS training was conducted in both target areas for 70 community health group members, 34 teachers and 138 Peer Educators in the Central area, and 62 community health group members in the Southern area. IRC worked with the National HIV Center to create an HIV/AIDS standard training package that included a training curriculum, handouts, and other training-related outreach materials.

Professional Health Providers: AHAP partners provided training for professional medical service providers, thereby enhancing their ability to address community health needs. Activities to build the capacity of health professionals included training on Primary Health Care topics, the development of clinical training manuals, joint training and monitoring by Ministry of Health and partner staff, and support for the national initiative on IMCI. In the Southern area, trainings for health professionals were conducted on the diagnosis and treatment of common illnesses and the rational use of essential drugs using manuals developed by the Southern partner and approved by the MoH. Follow-up monitoring highlighted improved skills of trained professionals in accurate diagnosis, treatment and patient communication. Trainings were also provided through other AHAP partners, which highlight the degree of integration present within the AHAP partnership. Guest speakers from the University of Oregon provided training to 154 health providers on malaria, breast and cervical cancer prevention in the Central area.

Partners supported nationwide IMCI efforts to train over 220 health professionals on IMCI. This initiative supported by the World Health Organization included clinical trainings on Acute Respiratory Infection (ARI), diarrhea, measles and malaria case management and breast feeding, Trainings were provided for Health Professionals by certified MoH Master Trainers. A total of 83 professional providers successfully completed training on IMCI through ICDP. TOT was also conducted for 15 selected local health professionals on Emergency First Aid to improve the quality of emergency health care services provided.

In mid-2003 the Southern partner held two Health Information Systems (HIS) Workshops in which a total of 142 health professionals from six Southern regions participated. This initiative had a positive

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 42 impact on the quality of HIS, as indicated by an increase in the number of referral activities and the reported use of health facilities. These workshops also increased opportunities for coaching community groups on advocating with district officials regarding health issues. Medical Information Centers (MICs) were established in two district hospitals of the Central area to further upgrade the skills of district medical professionals. They were equipped with computers and computer courses as well as medical books and other health education resources. The centers were created as a result of the collaborative efforts between the Central District Hospital, cluster level groups and SC.

Micro finance institutions: As a part of the integrated approach in community development, ICDP planned micro credit activities in addition to other services. In the Central area, it was proposed to mobilize 30 communities through functioning loan groups with 2,000 new active clients. During implementation of the micro finance component of ICDP in the Central area, it became clear that considering the micro finance component of ICDP as a stand-alone activity created several managerial and reporting problems. Therefore, the micro finance component of ICDP was transferred to the SC EO program at the end of the reporting period # 12, which ended in September 2003. This transfer was successfully accomplished, and starting from the first extension period micro credit activities were continued through Community Based Lending and Savings (CBLS) structures. By September 2003, after which SC’s microfinance activities were absorbed by the Community Saving and Lending program, the microfinance component of the ICDP program had reached 68% operational sustainability and had distributed 3,167 small loans to 1,450 clients organized in 157 groups. IRC selected FINCA, a licensed micro-finance institution, through a competitive tender process to provide micro credit services on its behalf in the ICDP target regions. The goal of having a microfinance component within ICDP was to promote demand-driven, multi-sector economic opportunities inciting expansive market activity. Following donor approval of IRC’s sub-grantee selection, FINCA began providing micro credit services to ICDP communities in mid-2003. Under this component, a total of 315 clients united in 47 solidarity groups received rural loans; an additional 11 clients accessed the individual loan product. Of the total 326 active clients, 61 (19%) were women.

Producer Groups: In the Southern area, IRC’s BDS development strategy consisted of two main components: 1) agricultural development and 2) support for community-based enterprises. In both cases the goal was to bring the best business development practices into the region and to disseminate this experience through creation of advanced enterprises and information dissemination. To support agricultural development in target communities, ICDP formed 22 producer groups—for wheat, potatoes, maize production and animal husbandry—to increase the effectiveness of their activities through training and collaboration. During the original ICDP period, 2,153 individuals received training on business skills, marketing and enterprise development.

Enterprises: The Economic Development Unit in the IRC program developed a training curriculum for small enterprises in their target communities. Training for the enterprises included basic and advanced business training, marketing, accounting, enterprise management, fund raising, business planning, strategic planning, sales, product development and enterprise sustainability. IRC program staff supported 27 community-based enterprises through training, technical assistance, management and marketing skills development. In total, 3,205 individuals from producer groups, enterprises, or community members working on economic development micro-projects participated in the trainings. To promote greater access to economic development services, IRC established a Business Resource Center in Beylagan (with non-AHAP funds) to provide business development services for surrounding communities that was eventually integrated into the subsequently established Development Resource Center. During the later phase of the program, IRC worked with seven enterprises, which were given support and were to then make repayments to community funds through the Action Plan Committees. During the extension phase, IRC activities concentrated on strengthening six small-scale enterprises established under the original phase of ICDP and one newly established enterprise. The IRC staff provided technical assistance and management support for these enterprises, such as updating business plans, dissemination of regular financial reports, developing tailored training curriculum, assistance in solving technical problems, expanding markets and building networks with other producer and consumer groups. At the end of the program, six of the seven

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 43 enterprises had obtained registration as LLCs with the remaining enterprise’s registration pending approval.

3.3 ACCOMPLISHMENTS

3.3.1 Communities Organized and Mobilized with Strengthened Capacity to Address Self– Defined Needs

Community/Cluster group formation: As a result of ICDP mobilization activities, 171 community groups were formed of 1947 members and experienced community members then formed 127 community groups through mobilization. Additionally, 16 cluster groups, two DRCs, two Legal Advice Centers and five Scout Clubs were formed.

Cluster entities and local partners took over organizing public events: Civic initiatives became one of the key events to bring community members together to address their issues and receive thorough information on identified topics including on environmental and economic infrastructure and youth. Furthermore, these civic initiatives strengthened interaction between community, cluster, and regional stakeholders to solve problems jointly– particularly between communities and government. Cluster groups, in conjunction with local NGOs, took over organizing these events with little support from partners. In addition, they oversaw conducting cleaning days and tree planting events to increase awareness of and engagement in community issues.

Development Resource Centers (DRC): DRC activities included training courses for community members, planning and implementing micro-projects, conducting awareness raising events and increasing linkages with communities and external entities. DRCs provided demand-driven courses such as English and computer training on a fee-for-service basis, along with other specific courses such as business management skills and micro-project management. Moreover, they served as a hub for distribution of health and business information for cluster communities and carried out outreach activities including a youth art exhibition, a three-day debate competition for youth from six communities and a football tournament involving more than 120 youth. DRCs also facilitated health days to raise awareness on HIV/AIDS, malaria and typhoid. DRCs endeavored to ensure their sustainability through increased linkages with other AHAP and non-AHAP community structures, participating in and conducting trainings, planning and implementing micro-projects and facilitating the development process in communities through mobilizing new groups and providing technical assistance when needed.

Youth: In the Central area, five Scout Clubs became operational through a joint initiative with the MYST. The Scout movement promoted positive citizenship and encouraged youth to value the environment through education programs such as events, posters, workshops, etc. and by carrying out garbage clean-up, tree-planting and other campaigns. In addition, 1430 youth were trained on social skills and 3000 hours were volunteered by youth for public service delivery. In the Southern area, youth-focused activities were handed over to local institutions including the LNGO partner Debate, cluster entities and the DRCs. For example, the DRCs carried out sports and debate events and excursions for youth, and the cluster entities conducted a number of youth-focused civic initiatives and mobilized youth peer health educators as well as implementing youth focused micro-projects. In general, 122 communities participated in multi-community youth activities in the Southern area. Linkages, including with government/municipality: Increasing emphasis was placed on training Municipalities and MKs about their roles and responsibilities, and in the Southern area trained Municipality members provided training to their counterparts in 24 communities on topics including the Municipality’s roles and responsibilities. In the Central area 36% of Municipality Councilors were trained on Asset-Based Community Development. Cluster entities have increasingly undertaken advocacy efforts with local government structures by inviting them to meetings and developing mechanisms for involving them in projects and activities. 119 groups registered as Mahalla Komitesi within their respective municipalities. The benefits of registration as MK included gaining some kind

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 44 of legitimacy and strengthening their negotiation position with regional line ministries. In the December 2004 Municipality elections, 408 community group members were elected to Municipalities, laying a foundation for increased collaboration between community groups and local government. As a result of SC activities, 36% of Municipal Councils created permanent linkages with non-formal community structures while 84 Municipal Councils pro-actively responded to their communities’ priorities. As cluster entities assumed more responsibilities, their recognition by government officials increased. Several Ijmalar Mejlisi (IM) from the Central area had representation in regional structures of the SPPRED secretariat and State Program of Socio-Economic Development of Regions. This representation helped to bring a community approach to the activities of state agencies. In turn, using state resources and the powerful tool of administrative recourse, this involvement helped to include community priorities into the agenda of state agencies.

Legal Advisory Services: Legal Advisory Services were a main focus in the Central area. The LNGO ARAN finished its contract with SC in 2003. ARAN provided legal services in communities through training community paralegals who in turn worked with community members to assist them in addressing issues related to legislation and other legal needs. Two regional Legal Advice Centers (LACs) were established where professional lawyers provided free services to community members. As was envisaged in the program, seven information campaigns were held; 17,500 copies of information booklets and 1,800 copies of information leaflets were subsequently distributed. Experts from relevant state bodies held five seminars on priority issues benefiting 6,846 people. The trained paralegals rendered legal advice services to 5,089 applicants throughout program implementation. A total of 31,215 people benefited from the information and advice services.

3.3.2 Communities Organized and Mobilized to Manage more Accessible and Sustainable Quality Health Care

Community Health Groups: IRC trained Health Action Committee (HAC) members to take an active role in addressing community health issues. Communities worked together to organize community health events such as festivals and school health days to raise awareness of community health issues and promote broad stakeholder engagement. Wide participation characterized most of these events, drawing neighboring communities as well as district health authorities. In addition to promoting health, these civic initiatives provided health groups with the opportunity to gain experience working together with local authorities. With time, experienced community groups took over functions previously carried out by IRC and SC, such as training other communities to implement peer education in their communities or to initiate community health funds and manage health programming in their community.

Peer-to-Peer Health Education (including health promotion materials): Health Action Committees, in cooperation with Municipalities and ExComs, independently trained neighboring communities in health topics to equip them to conduct their own peer education, thus greatly increasing the possibility for sustainability beyond the life of AHAP. Additionally, youth groups and trained volunteer teachers provided health education to their peers through a series of creative health campaigns including festivals, competitions, distribution of pamphlets and the completion of wall paintings communicating health messages. Topics included healthy lifestyle, environmental issues, personal hygiene, calisthenics, smoking, alcohol and drug abuse, HIV/AIDS, nutrition, child education and iodine deficiency. By the end of ICDP, a total of 20,890 community members had received trainings by peer educators on health topics.

LNGOs: In the Central area, the LNGO partner Care for the Children took over the maintenance and upkeep of several of Save the Children’s Community Health Funds. LNGO partners Dalga, Debate, and Azad Gadin assisted communities in the organization of community civic initiatives.

Health Providers: AHAP partners broadened health provider participation in community health activities as a result of trainings and workshops and prepared them to deliver quality care. Regional head doctors contributed medical equipment to community clinics and provided first aid training to

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 45 community group members. Through some hospitals, outreach activities were established through mobile health groups consisting of gynecologists, pediatricians and other specialists. These mobile groups made monthly visits to surrounding communities to provide patient examinations and consultations. Medical specialists held more than one thousand outreach visits, reaching 268 communities. Improved quality of the HIS increased the number of referral activities and reported use of health facilities.

Regional Health Authorities: Regional authorities became engaged in AHAP health activities through participation in community health events and workshops. Subsequently, Municipalities showed increased interest in collaborating with community groups on civic initiatives. For example, some Municipalities contributed toward implementation of health micro-projects and district health authorities responded positively to community requests for medical specialists to routinely travel to more remote communities to deliver health care. Overall, 82 target health facilities were monitored/supervised by district health authorities.

Community Health Funds (CHFs): Cost recovery mechanisms helped to increase community access to health services by providing communities with the financial resources to address their health needs. The types of mechanisms included revolving drug funds, insurance mechanisms, loan funds and fee-for-service primary health care. To promote awareness and foster the development and viability of the health funds, communities held innovative activities such as lotteries, tapping into resources from community members living outside the community, and establishing small community businesses and leaving the profits with the fund. CHFs grew progressively, reaching a membership of more than 70% of the community families by the end of AHAP. A total of thirty-eight cost recovery mechanisms were implemented over the life of AHAP in the Southern and Central areas.

CHF activities included organizing outreach visits by specialists such as gynecologists and pediatricians (as well as ophthalmologists through the Caspian Compassion Project), the provision of laboratory supplies and services, support to community health groups in the implementation of health education campaigns and the creation of drug stocks. With resources generated from earnings, CHFs implemented small micro-projects including potable water projects and stagnant water drainage projects to prevent malarial mosquitoes. Experienced CHFs in the Southern area assisted neighboring communities in establishing six new CHFs. In the Central area, local NGO Care for the Children took over CHF monitoring and oversight responsibilities for the ten most active CHFs, thus ensuring the maintenance of the funds. The creation of developed and sustained CHFs by both partners is a big step towards health reform in Azerbaijan.

Micro-Projects: Micro-projects primarily consisted of rehabilitation of health facilities and equipping them with basic supplies to meet selected WHO standards. Micro-projects were important to address community health and infrastructure needs as well as to build the community’s sense of self-reliance. These activities, combined with health care provider training in proper usage of the new equipment, contributed to an improvement in the quality and access to primary health care and thus increased utilization rates of community facilities. In the Southern are, IRC supported the rehabilitation of community clinics as well as the rehabilitation of three hospital departments: the surgical department at the Beylagan Central hospital, the tuberculosis hospital in Sabirabad, and the Department of Infectious and Skin Diseases in Imishli. Other micro-projects included the construction of public baths and potable water pipelines. Micro-project funds were also used to train and equip three teams of teachers to provide health education in schools.

It is noteworthy that communities and municipalities contributed 42% of the resources for these projects, including cash, building materials and labor. There were high levels of collaboration with the Municipalities and other community stakeholders, including the participation of cluster entities who took an active role in the project monitoring process.

HIV/AIDS: Both the IRC and SC trained community groups and the larger community on basic HIV/AIDS information. A number of HIV/AIDS-related campaigns were conducted in the Central

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 46 and Southern areas, such as an awareness campaign conducted by the Barda Scout Club involving the participation of local authorities. Additionally, the Development Resource Centers both facilitated health days to raise awareness on several health issues with an emphasis on HIV/AIDS. In the Southern area, 62 trained community members trained their own communities and then trained people on HIV/AIDS in 23 additional communities.

3.3.3 Rehabilitated Community Economic and Social Infrastructure

Integrated Community Activities (ICA), Local Project Initiatives, Self-initiative projects: To ensure the sustainability of program interventions in the future, the cluster groups and local NGOs assumed increased roles in overseeing the implementation and monitoring of local initiatives and ICAs. In the Central area, cluster entities oversaw implementation of over 60 local initiatives; local NGOs in the Southern area oversaw implementation of 27 ICA projects addressing gender, youth and environmental issues. The unique nature of local initiatives involves the fact that the majority of the project budget is required from communities—approximately 50% for local initiatives and 75% for ICAs. They were designed to build the community’s sense of self-reliance in its ability to solve problems on its own. Since these projects required more resources from the communities, they were able to mobilize internal resources as well as leverage from local government and other sources. These projects assisted in shifting attitudes away from the amount of external funding granted by showing communities that their own initiatives are valuable and sustainable. In addition, communities completed 212 self-initiated projects with non-AHAP funding. Communities took all the initiatives into their own hand in identifying, prioritizing and planning 212 projects and leveraged resources from community (56%), municipalities (40%), and other sources to implement these projects.

Community, cluster and DRC projects: Community micro-projects addressed community-identified needs and provided practical experience for community leaders. A total of 274 projects were implemented of which 87 were local initiatives, 20 cluster and sub-cluster level projects. The community contribution for these projects reached 33%, including 9% from Municipality, and the projects benefited 764,237 people in total, of which 53% were women. Additionally, 1050 Municipal Councilors in 142 Municipalities participated in projects together with community members. Cluster Development Projects: Strengthening of cluster level structures was one of the major objectives of ICDP and implementation of cluster level development projects was seen as one of the tools to fulfill this task. These projects involved and benefited a minimum of five or more communities each, and required joint planning and contribution by the participating communities; sub-cluster projects involved two to five communities with the same planning and contribution requirements. The cluster level projects were funded on a competitive basis. For example, SC encouraged each IM to design a cluster level project, but awarded funding to only five of these projects. Submitted proposals were selected according to certain criteria, including number of beneficiaries, number of communities directly impacted and sustainability. These projects had relatively higher funding (e.g., SC had a budget of $30,000 on average.) IRC implemented cluster level projects with average funding of $12,000 and sub-cluster level projects with average funding of $10,000. The sub-cluster level projects implemented multiple multi-community projects focused on a similar theme or problem throughout the cluster, as well as building the cluster level group’s coordination/outreach capacity.

These projects addressed a variety of different sectors including economic opportunities, education, health and agriculture through projects such as the following: reconstruction of irrigation channels, irrigation and drainage systems, main roads, and hospitals and establishment of a paving slab factory. For example, the Saatli Paving Slab Factory manufactures paving slabs and is the only such enterprise within the region that is able to provide the entire cluster with building materials that are cheaper and of better quality than those currently being imported from other regions. The factory has been a great success so far, selling all the material it produces and already expanding its product line. The factory is repaying 50% of IRC’s project contribution to the Saatli CEB fund for implementing future

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 47 development projects; they have repaid over $2,000, or 56%, of their obligation to date. Other projects such as Fizuli Veterinary Laboratory were done to analyze meat and dairy products in order to promote cluster-wide cattle health and prevent animal diseases from being spread to the human population. This laboratory serves 23 communities.

DRC projects: In addition to other projects, DRCs in the Southern area implemented IRC-funded micro-projects, the processes of which helped shareholders and board members to hone the skills necessary to work together, while providing the centers with financial support to expand the range of development-oriented services they can offer to the cluster. The completed micro-projects began to provide the DRC with a small but growing source of income. The projects completed include a Saatli office and computer equipment project, a Beylagan project to provide medical equipment to the regional hospital; construction of new Beylagan DRC building and rehabilitation of Saatli DRC. As part of DRC Outreach projects, Saatli DRC completed a project to provide Internet services as well as to offer educational and recreational activities for cluster youth. Beylagan DRC also completed a project to startup Internet services with a community outreach component in order to expand the services it provides at its three branch DRCs far away from the main center in Beylagan town.

3.3.4 Increased Availability of Credit and Support Services

Financial Services: Access to financial services was provided through the ICDP programs in both regions. The reporting period # 12 was the last one in which financial services were officially reported through the ICDP section. It is important to note that credit activities continued and provided services complementary to the ICDP programs in both geographic areas. However, recognizing that credit operations had to be streamlined in order to attain self-sufficiency, reporting was adjusted. Furthermore, this change allowed ICDP to place increased emphasis on BDS activities during the extension phase since this type of intervention was better suited to the ICDP framework. In the Southern area after several delays due to an extensive negotiation process, IRC’s sub-contractor FINCA began provision of credit services through two loan products – the Rural Loan Product for solidarity group borrowers, and the newly launched Small Enterprise Loan Product for individual clients. During the period of these loan services, a total of 315 clients from 47 solidarity groups received rural loans; an additional 11 clients accessed the individual loan product. Of the total 326 active clients, 61 (19%) were women. This period also saw the expansion of the sub-contractor into two new geographic regions (Beylagan and Bilasuvar), and the establishment of a commercial partnership with BUS Bank for processing payments and disbursements, thus increasing efficiency and operational security of providing financial services in support of ICDP activities. In the Central region, the partner added 49 new solidarity groups during the six-month period during period # 12, which became the last one before microfinance activities under ICDP were transferred to CBLS. By the end of that period, 113 loan groups formed under ICDP program were functional. The program served a total of 1,119 clients, including 260 women (23%) and 134 IDPs (11%), and maintained a repayment rate of 100%.

Business Development Services: The Central area partner’s BDS sub-contractor KOSIA/SMEDA phased out its operations on completion of its contract in September 2003. However, SC agreed to provide it with a two-month no-cost extension to ensure consolidation of outputs and appropriate final monitoring and evaluation. The network of community-based BDS providers in this area, consisting of four groups for a total of approximately 40 people, actively disseminated Facts for Economic Life (FEFL) business development services in the targeted areas. Their activities resulted in KOSIA/SMEDA earning $1,490 in license fees. During the sub-contract period, over ten thousand individuals were trained in basic business skills, with 90% change in knowledge and 66% increase in applied knowledge. In line with the sub-contract target, KOSIA/SMEDA achieved approximately 50% in operational sustainability. However, their ability to maintain their network of BDS providers to continue services in the target areas was limited.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 48 Agricultural Extension Services: Agricultural services were provided in the Central area by a network of extensionists trained and supported by the local NGO AIM. They worked to improve the quality of the advisory services and improve business skills of selected agricultural extension agents. Seven trainings and relevant field coaching were provided to the selected Community Extensionists (CE). In turn, those 25 CEs (26% women) delivered extension services to 1,987 farmers (8% females and 7% IDPs) on plant growing, cattle breeding, poultry raising, farm business management and marketing. Additionally, 173 out of 179 farmers trained in farm planning, bookkeeping, farm finance analysis, projection of expenses and identification of credit needs, applied the knowledge they gained. In total, 20 independent CEs concluded 505 fee-based agreements with 1,662 farmers. The average monthly income of the CEs was about 277,000 AZM. After closure of the program, 25 independent extensionists in seven Central regions maintained their network of agents, representing experts in livestock, agronomy and agricultural economy, and continued to disseminate information and provide services to ICDP communities.

Vocational Training: The Local NGO MADAD, in collaboration with SC, initiated a Vocational Skills Training Center (VSTC) program within the Ganja Vocational Skills Lyceum (GVSL) to improve access to high quality vocational skills training and education, including Information and Communication Technology (ICT). In consultation with the GVSL management, two vocational skills training packages taught at the Lyceum were selected for further modification: barber and radio- electronics courses. There were delays in the start of the project because of the need to get approval for the training packages from the Ministry of Education. Despite the delay, MADAD was able to ensure that the training was completed by the end of the grant period. In total, during the second extension period MADAD provided vocational training to 145 youth.

Micro Enterprise Development: In the Southern area, an increased interest in economic activities led to the diversification of BDS provision offered through the program into areas such as market access, infrastructure, input supply, business training and technical assistance and technology development. Through program activities 27 enterprise groups were formed, supporting the development of new enterprises such as mobile community centers, sewing workshops, a dairy plant, and vegetable canning shop. Of these initiatives, an animal feed mill and dairy processing unit in Beylagan, mobile community centers in Sabirabad and Saatli, and a Bilasuvar Camp service center were established and fully operational. Sixty shareholders are involved in operating these enterprises; some of their profits are being used to fund projects that benefit the broader community. ICDP communities’ developing enterprises were required to make a provision in their proposal and business plans to regenerate the amount of direct commercial investment provided by IRC over the first year of operations through retained earnings in the business. In the second year, the enterprises were obligated to reinvest at least 50% of these funds to the community through the relevant APC, and the remaining balance into further growth of the enterprise. During extension periods, seven functioning enterprises were established and all but one are repaying their initial grant obligations to their community/cluster group.

Please see Annex E for ICDP Sector Indicator Tables

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 49 4. SOCIAL INVESTMENT INITIATIVE (SII)

AHAP S.O. 2: To strengthen community involvement and capacity through participation and leadership development ¾ AHAP I.R. 2.3: Rehabilitated community economic and social infrastructure through community organization and mobilization 4.1 Program Overview The SII Program was implemented from January 15, 2001 to October 31, 2002 by CHF International(CHF). This program contributed to the well-being of IDPs and conflict-affected populations by enabling community members to identify and implement 153 demand-driven, highly participatory projects. SII supported community projects that increased social capital between conflict-affected and IDP populations, reflected community priorities, were gender and environmentally sensitive and significantly strengthened organizational capacity and leadership within conflict-affected communities. SII was implemented in the Central, Southern and Urban areas of Azerbaijan, benefiting 212,429 people. The total project budget was $4,999,793. CHF achieved its overall SII goal to strengthen organizational capacity through the implementation of demand-driven social infrastructure projects set within a longer-term planning framework. CHF framed SII activities around five core objectives: 1) Promote the integration of IDPs into the socio- economic life of their community; 2) Generate substantial employment through labor-intensive community projects; 3) Shift beneficiaries’ perspective and development approaches from short-term relief assistance toward longer-term sustainable development; 4) Build communities’ organizational capacity to prepare, implement and sustain community projects within a long-term planning framework; 5) Spark civic initiative and reward active participation that will sustain operations and maintenance of social investments. CHF operated in 16 different regions throughout Azerbaijan and developed a variety of tools and systems to facilitate decentralized decision-making and develop standards for regional variations of program processes. CHF invested a significant amount of time to develop, test and finalize the design of operational systems and guidelines, all of which were developed and utilized to ensure demand- driven and professional assistance to communities. As time progressed all tools were synthesized into one overall SII Operations Manual that was translated into Azeri and includes a variety of items, as shown in the tables below. The SII program assisted communities in developing long-term sustainability plans, the formation of community funds and increased access to community resources. SII underwent significant management changes over the project life. The original key personnel, save for the Deputy Director for Community Projects, were replaced several times during project implementation.

4.2 Program Interventions Community: CHF specifically designed their Social Outreach Strategy as the core of their information campaign, and as one which provided a basic framework to build effective partnerships with communities, community groups, local and international NGOs and other stakeholders in the process. As part of their outreach strategy, CHF informed community members of program activities and appropriate eligibility criteria through various information campaigns, including community meetings, community support and contribution evaluation events. In addition, the broader community participated in all aspects of program implementation by providing in-kind and cash contributions. Moreover, 100% of the communities that implemented a project with CHF/SII received a one-day Environmental Awareness training that successfully built knowledge of general environmental issues, increased and/or established community commitment to environmentally friendly practices and identified appropriate community actions that mitigated negative environmental impact. “Environmental Practices” was ranked by Impact Survey respondents as one of the top three positive impacts that CHF/SII technical assistance efforts made on the quality of life in their communities.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 50 Community Groups: SII planned to work with communities already mobilized by various international and local organizations and to further strengthen their organizational capacity. In order to take stock of the social investments made and to map out organizational capacity in targeted areas, SII worked with local NGO partner Sigma to conduct a Social Inventory Assessment (SIA) with 513 groups, using this information to then shape the SII process. Interested communities went through a screening process, and SII further improved the organizational capacity of 221 groups who were considered eligible to participate. SII developed a comprehensive and demand-driven technical assistance package to increase the knowledge and skills of community members to better address their socio-economic needs. The training package was designed to make the implementation goals as straightforward as possible: transfer skills to the community group to self-manage future initiatives and strengthen the management structure of the communities. To ensure that appropriate trainings were carried out, SII developed five training curricula, two more than originally planned, in order to support the specific stages of 10-step Social Outreach Strategy. All of the communities participating in SII received training sessions based on the curricula in the following topics: How to Apply/SII Informational Training; Long-term Community Action Plan (LCAP); Community Mobilization; Environmental Awareness; Sustainability and Maintenance. The LCAP shifted the emphasis from a single-project intervention funded externally to a long-term development framework that incorporates internally-funded and managed projects. This shift in emphasis also alerted communities to the processes involved in community planning, which ultimately helped to build social capital within communities and contribute to their sustainability. According to monitoring results, 85% of communities either began or implemented the next priority defined in their LCAP after the completion of the SII project—evidence that SII efforts have had a positive effect beyond the life of the project.

LNGOs: SII competitively selected local NGOs to provide technical assistance to communities, building the capacity of local NGOs UMID, Sulh and ECOS to provide services based on community demand. UMID conducted community mobilization, sustainability and maintenance, and LCAP training for community members. Sulh provided other training services to participating communities. ECOS provided environmental services, developed water test quality standards, geological and environmental assessments, and conducted monitoring. The local NGO SIGMA served as a part of a team to conduct the Social Inventory Assessment (May 2001) and Impact Survey (September 2002).

4.3 Accomplishments

4.3.1 Community mobilization and organization SII organized its activities around the five core objectives through three program components: community-driven projects; demand-driven technical assistance and training; and information exchange and best practices/lessons learned. The major impact and accomplishments of the project were gauged through monitoring activities and the Impact Survey conducted in September 2002. The information collected through these efforts show that SII was successful in building the organizational capacity of local groups and promoting civic initiatives through rehabilitating economic and social infrastructure in community-initiated projects.

IDP integration and labor generation: SII also promoted the integration of IDPs and refugees into the social fabric and socio-economic life of communities in which they reside. IDPs comprised 36% of those directly benefiting from SII projects. In addition, IDP representation in community groups increased and relations between IDPs and local populations were improved. As a result of SII activities, 71% of “mixed” target communities continued to jointly plan community initiatives. SII also generated employment through labor-intensive micro-projects.

Long-term development focus: SII the helped shift both the beneficiaries’ perspectives and the development trend from focus on short-term relief assistance toward a commitment to long-term sustainable development. Long-term Community Action Plans utilizing an asset-based approach were developed to create projects that were internally funded and managed. Through technical assistance

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 51 9,119 community members increased their capacity in helping their communities to solve their problems. According to the Impact Survey, respondents indicated nearly 100% confidence in the community groups’ abilities to self-manage key steps of project implementation and maintenance.

Information Exchange and Best Practices Awareness: SII focused on organizing multiple workshops, conferences, cross fertilization community visits, and information sharing/dissemination tools to spark civic initiatives and reward active participation to sustain operations and maintain project and social investments. SII held two capacity-building regional conferences where leaders from 67 communities exchanged information and knowledge, facilitating sessions and presenting their experiences during the conference. The capacity-building conferences were valuable in developing inter-community cooperation and a decreased dependence on NGOs. In order to cover demand-driven topics identified in the conferences, over 50 cross visits were organized through the initiative of partner communities, with limited support (transportation) being provided by SII. In addition, nine formal information exchange workshops were organized by SII. Moreover, 6,600 monthly bulletins were disseminated to donors, partner organizations and community members to regularly increase the awareness of SII activities.

Environmental activities: To comply with USAID environmental guidelines, CHF delivered a comprehensive environmental assistance service package through a competitively selected local NGO partner, ECOS. This local organization undertook the development and implementation of high quality geological and environmental assessments; development of water test quality standards and processes; development and execution of implementation monitoring for “high risk” projects; and development and implementation of environmental awareness curriculum that included the identification of mitigation activities for SII project construction. In total, 93% of SII project communities implemented environmental mitigation measures including planting/greenery, trash collection, water treatment, sanitation and soil treatment.

4.3.2 Rehabilitated community economic and social infrastructure

The core of the SII strategy was to work with communities that have a proven capacity to address self-identified needs through complex rehabilitation projects that improve social conditions. To ensure the implementing of effective projects, SII developed systems and tools particularly appropriate for larger, more complex rehabilitation activities such as these that measured the capacity of the communities to move from smaller activities to more complex ones. These tools included Monitoring & Evaluation procedures, Social Outreach Strategy and Procurement Manual. To ensure full participation of AHAP communities in SII, the referral system between AHAP partners and SII was established. In keeping with the emerging trend of clustering within the AHAP target area, neighboring communities working together with SII began to pool their financial and labor resources to achieve mutually beneficial results such as shared irrigation systems, schools and clinics. During SII the average grant size increased from $8,000 to $17,000 and the level of community contributions increased proportionately. To assure that projects were ecologically sound, SII contracted with ECOS to conduct environmentally related activities, as described above. In addition, SII staff addressed occupational health issues associated with infrastructure and started to identify ways of combining water/sanitation education with their water projects. To assure that requests for medical facilities were realistic, SII sub-contracted with IMC to establish a framework for making judicious decisions concerning proposed community health clinics and medical points. IMC also assisted in conducting a professional review of medical point proposals to ensure that SII medical projects would be beneficial to the community and would meet a minimum set of acceptable WHO facility standards. Using its monitoring systems, SII ensured monitoring of projects at the end of the second, third, fourth and sixth months. The monitoring process looked at institutional growth of the community management structure, maintenance of the project, new initiatives, and linkages or outreach to other communities.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 52 SII shared the funding and implementation status of submitted community proposals and distributed weekly project overviews to the AHAP partners and the Social Fund for Development of Internally Displaced Persons (SFDI).

Throughout SII 153 projects were implemented. For more information on types of projects, please see table. A SII Projects total of 212,429 people directly benefited from projects, 53% of which School rehabilitation/reconstruction 46 are women. Out of $3,317,472 of total Potable water systems 46 project cost, communities contributed Electrical systems 35 31%, of which 9.5% were in-cash Sewage systems 5 contributions well exceeding the Community centers were rehabilitated 5 project’s 5% in-cash requirement. Bathhouse construction 4 Through participation in community Roads repaired 4 projects, inter-community relations Others 8 positively increased, as did the Total 153 communities’ willingness to contribute. For example, 17 communities together initiated a $31,000 hospital project and contributed $11,000 of total project cost. All the projects within SII were assessed for environmental impact. In addition, 93% of the communities implemented environmental mitigation measures including planting/greenery, trash collection, water treatment, and sanitation and soil treatment.

Please see Annex E for SII Sector Indicator Table

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 53 5. CD SECTOR PROBLEMS ENCOUNTERED/LESSONS LEARNED AND IMPACT (Including Community Development, Social Investment Initiative and Integrated Community Development)

PROBLEMS ENCOUNTERED/LESSONS LEARNED

Working with Government, including Municipalities

Government involvement throughout a community development program is critical to success. Often governmental officials are not aware of the concept of community contribution and assume that an INGO is responsible for funding all activities. They then begin to distrust the INGO when communities are expected to contribute to community projects. This highlights the importance of ensuring constant information flow and full cooperation with all local and regional authorities, which simultaneously helps to promote understanding at the national level. To minimize misunderstanding, AHAP partners began advocating with government before initiation of any activities by providing letters issued to all relevant authorities that described programs in detail, including methodology, requirements, and activities. They also communicated with government through introductory meetings. While initially, because of Section 907, activities with the government were discouraged, it became apparent how important these linkages were to the success of both the programs and community groups. In fact, many people expressed that these linkages might even be more important than the donor linkages and that perhaps community groups should have conducted micro-projects in coordination with the Municipalities from the beginning. For future programming, working with communities to raise the Municipality’s profile, and working with Municipalities to ensure responsiveness to their constituency, is of critical importance.

The Importance of Transparency

Transparency is essential to maintaining communities’ trust in their leaders. Ensuring transparency means leaders must work hard to keep the entire community informed about the activities of the community group, specifically when it comes to implementation of micro-projects, collection of funds and problems that they face. Partners learned that transparency cannot be taught at one or two training sessions, but rather requires significant time and effort. Community development programs in the future need to make sure that transparency is a fundamental part of the project and is integrated from the beginning. Ensuring mechanisms to consistently promote transparency will help programs maintain community support and will allow community leaders to communicate more effectively with their constituents. For example, partners began encouraging community groups to include transparency awareness raising sessions for community members, establish and maintain transparency boards, consistently report back to a broad range of community members on all activities, involve community members in monitoring projects, and involve the broader community in the project bidding process.

Ensuring Broad Community Participation

The need for broad participation from all segments of the community is another critical lesson learned from community development programs, including SII. Equal participation from women and youth is essential to the success of all community projects, and ensuring this participation can be a real challenge. In many communities, involving women and youth can run counter to traditional societal roles, and working with the community to help them recognize the value of such participation can take considerable time and constant focus. Experience shows that when the community was proactive about sharing information and involving women, the projects were, not surprisingly, much more successful, cooperative and in tune with the community’s needs. Partners worked with communities to find appropriate mechanisms for involving women and youth, including women’s groups, youth activities and, in some cases, requiring minimum representation of women on community groups; these strategies were overall successful in securing broad participation.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 54

Community-Based Organization Sustainability

Throughout AHAP, community development programs focused on the formation and development of various types of community entities with the goal of establishing formalized structures to independently address community needs after the end of AHAP. However, the inability of community groups to register as independent entities under the current legal framework raised several concerns about their longer-term viability. Faced with this challenge, partners looked for ways to help community groups secure some kind of registration that would ensure their future sustainability. Although many experienced community groups hoped to register as NGOs, the only efficient way turned out to be registration with the local Municipalities as Mahalla Komitesi. From that point onward, many community groups applied for registration as Mahalla Komitesi within their local Municipal Councils. This enabled groups to have their own stamp and bank account, increased their negotiation power with the government structures and, most importantly, created opportunities to access Municipal funds for micro-project implementation. The adaptability of both partners and community groups in finding a solution in the face of a difficult legal environment was commendable, and future programs should take the lessons learned by these programs when considering the sustainability of grassroots community-based organizations.

The Challenge of Urban Community Mobilization

In Urban settings, defining the boundaries of a community and creating community cohesion was particularly challenging. In urban areas, physical boundaries of a community are often unclear; additionally, IDPs from different regions and backgrounds ended up living together in the urban context. When working with marginalized IDP groups, the challenge is mobilizing individuals who are from different geographic and social backgrounds; when working in areas in which IDPs are integrated with local residents, the challenge is to mobilize the communities simultaneously. Despite these challenges, the program was successful in mobilizing urban communities. The partner was able to work with urban residents to define community groups to work with and was able to help promote community cohesion through awareness raising activities. The most significant and sustainable successes were achieved where both IDPs and the local community were involved in project activities.

The Value of Participatory Monitoring

Community involvement in the monitoring process reassures communities that the program is not only about the rehabilitating the infrastructure; it focuses on sustainability and capacity building issues in the community as well. The main lessons learned in SII were that monitoring mechanisms and adequate checks and controls need to be in place from the beginning of all activities. During the program, staff worked with communities to enhance their skills so they could participate in the monitoring process. The project involved a lot of technical monitoring, and despite the fact that SII employed engineers and site supervisors for each project, it became very challenging to manage all of the technical activities. To help address this challenge, an international consultant developed a full technical monitoring system that incorporated procurement guidelines and suggested corruption prevention measures. The adoption of this system helped to improve project management, and involving the community in the new system promoted transparency and encouraged sustainability as the community felt increased ownership over projects.

Challenges with Clustering

The clustering approach in ICDP programs was essential to achieving coverage of large geographic areas. Programs faced some challenges in establishing clusters since the concept can be difficult for communities to understand. Community members needed to move from a notion of cohesion at a household level to the community level before forming clusters, and partners learned that it is critical

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 55 to have a firm basis of mobilizing communities before forming clusters. Another challenge was in the solidification of cluster structures. While the notion of communities working together is not new, formalizing the structure proved to be more of a challenge than expected. Once the cluster entities were established, the leaders also faced challenges in planning cluster level projects. Often they had a difficult time putting the needs of the cluster ahead of the needs of their own individual communities. While implementing programs it became clear that cluster groups need more time and support to be productive than do community-level groups. However, with the additional time needed, it is important to give full independence to cluster groups and reduce by at least 90% the support provided to them long enough before the program ends so that they can take full responsibility, face challenges and practice problem solving skills with limited support from the agency. In general, this illustrates the challenges of establishing strong cluster structures, even among experienced community group leaders, and highlights the need for adequate time to develop and mentor cluster entities. Partners learned that support for cluster structures should be decreased as the program progresses to permit them to be strong enough to sustain and deal with all issues independently, including financial sustainability issues after the close of the program. Given the amount of time they need to develop, this means interventions with clusters need to be rather long term.

Community/Cluster Structures

In community development programs, it is critical to form groups that are able to adequately represent and mobilize communities around community issues. In ICDP programs, multiple groups were formed including various sub-groups and levels of cluster structures. Partners learned that the creation of multiple groups and sub-groups and a lack of clear roles and responsibilities between them resulted in confusion. The structure of cluster groups should be simple rather than complex. In most cases the same people were represented in various groups, which became burdensome and contributed to the formation of an elite group that controlled community and cluster structures. The lesson from this experience is that the formation of groups should be demand-driven to the greatest extent possible, and structures should be kept simple and need-based for maximum efficiency.

Community Empowerment

Communities taking initiative and assuming responsibility is critical to program success. Early in the programs, when partners led the process for all interventions including formation of groups, training and overseeing micro-project implementation, communities felt dependent on partners. With increased time, partners were able to hand over more responsibilities to experienced community members as well as to local partners. To ensure that responsibilities were handed over effectively, partners provided all necessary training and capacity building for these groups and provided support. Throughout the programs the transfer of responsibilities to groups proved to be very successful, including examples of peer education in health, between experienced and new Municipalities, and actual mobilization of new communities by experienced communities. The communities showed more interest in their peer trainers since the latter were aware of local conditions that made their information even more relevant. Handing over responsibility to community groups and individuals allowed for the transfer of skills that will allow program interventions to continue beyond the life of the projects. The lesson from this is to involve community members in program implementation activities to the greatest extent possible from the early stages of program.

Integration

While integration was a key element of ICDP programs, partners faced challenges in ensuring full integration of the various sectoral interventions. Some of the issues lay in the fact that the ICDP programs lacked the internal structure needed to ensure that community development, health and economic opportunities interventions were integrated. While partners initially planned to use integrated teams in the program, this was not maintained, and teams were later divided by sector. This resulted in a feeling of three different programs rather than one united model. The lesson from this is that the staffing structure for an integrated program needs to ensure that sectoral interventions

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 56 are integrated with each other and do not devolve into sectoral units that operate independently from one another.

Developing a Community-Based Enterprise

One of the economic opportunities interventions under ICDP was supporting small enterprises. The enterprises were formed with community members contributing funds and becoming shareholders, and a percentage of the profits representing some of the initial investment was to be paid to community funds to support community-identified projects. In this type of intervention, there must be a very delicate balance struck between community interests and business interests, and this type of balance requires a great deal of time and effort. A culture of business must be created within a community development framework, and transparency needs to be a major focus to ensure community buy-in. When community members are shareholders, the overlap between community group members and shareholders can cause problems, and it is best to keep the groups separate. In addition, large numbers of shareholders can complicate the process and increase the chances for overlap between the community group and the shareholders; it is better to work with a smaller group of people. (for more Economic Opportunity Lessons Learned, please see the EO single sector section of this report)

PHC Integration into ICDP Interventions

Because PHC necessarily relates very closely with the Ministry of Health and involves health professionals, it is rather difficult to integrate health programming into non-health, community development programs. Health professionals on staff and in the communities tend to see what they do as especially technical and not to see the commonalities with the CD interventions, although the community level interventions are by definition based on CD principles. It is also difficult for CD staff to relate to the more technical nature of the health interventions, particularly when the program is training MoH professionals and all staff tend to leave each to their own technical field. This, of course, does not result in highly integrated programming that leverages each other’s work and builds bridges for the communities and clusters to work together. As mentioned above, deliberately developing an internal structure that ensures sectors rely on each other is one way to move closer to the ideal, knowing that within the health sector, this level of integration will demand continued attention. (for more Primary Health Care Lessons Learned, please see the Health and Nutrition sector section of this report)

IMPACTS:

• Community leaders, deeply engaged in assisting communities to address community level issues, were recognized as effective leaders by community members and in December, 408 of these leaders were elected to Municipal Councils – some as Municipal Council leaders. These people, and others that may follow, are now in a position to strengthen the local development program, to broaden the reach of a culture of transparency and engagement, and eventually to influence development at higher levels.

• Communities are now identifying and addressing community level problems without outside assistance, often mobilizing community funds to resolve community issues and are frequently accessing Municipality or other resources. Moreover, communities and clusters are independently mobilizing other communities and the newly mobilized communities are paying a small fee to cover the travel costs of the mobilizers.

• Cluster entities representing 15–30 communities have developed the necessary skills and are being recognized by Government officials, Municipalities, Local and International NGOs as partners in the regional development process. Members of cluster groups are contributing participants in structures implementing government-funded development programs and are also

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 57 representing their communities by addressing cluster level issues and by raising funds through different donors and private donations.

• Local and regional government bodies have begun to recognize the value of active communities and clusters in helping promote local and regional development and are conferring with them as development strategies are developed.

• Regional Ministry of Health authorities are now willing to allow newly trained specialists to deliver professional care directly in communities around the region. Trained peripheral providers are delivering quality primary health care and the combination means that people are able to access much of the health care they need directly in their communities.

• Peer Health Education is beginning to change the way the population relates to their own health. They now know how to identify common illnesses and conditions and where to go for what kind of treatment; they also are beginning to understand that it is possible to prevent some health problems; and in addition, they understand the importance of sharing the health information they learn with their friends and family. (for more Primary Health Care Lessons Learned, please see the Health and Nutrition sector section of this report)

• In areas where the agricultural Community Extensionist (CEs) program was implemented, both men and women farmers are diversifying their crops, improving their yields, increasing the efficiency of their farm operations by pooling land and operational resources, and improving overall farm management. Trained CEs are serving clients better and continue to update their knowledge; they formed a network which allows them to develop links with governmental and private information sources, and access each others’ information and skills for client needs. Farmers appreciate these services and are paying for them so that with the income and prestige, CEs are remaining engaged in their revitalized careers. (for more Economic Opportunity Impacts, please see the EO sector section of this report)

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 58 C. HEALTH AND NUTRITION

1. SECTOR OVERVIEW

Health and nutrition programs under AHAP built upon community development and mobilization principles and strengthened the capacity of local and national government actors in order to raise the health status of beneficiaries in Azerbaijan and improve the health care operating environment. These program efforts focused on primary health care and reproductive health/family planning, augmented by food distribution and a statistical survey on reproductive health to target two more specific needs that arose within the health and nutrition arena during the life of the project. In AHAP health and nutrition programs, mobilization of better equipped health care advocates—on the community and government levels—was the foundation for promoting long-term health in the country.

Similar to EO and CD programs, the organization and training of community groups to function as frontline actors in promoting improved health status was key in health and nutrition programs. The concept of peer education was utilized to ensure that these health-oriented community groups were maximally effective in increasing health information by receiving and then replicating training in order to build their and others’ knowledge. Men, women and youth were all mobilized as peer educators in order to address all sectors of society. Mass media and information education campaigns were employed to fully maximize the amount of impact that health education interventions were making on the community level—television programs, radio spots, festival events, and materials emblazoned with health slogans were evidence of this information blitz.

Community micro-projects were encouraged in AHAP health and nutrition programs in order to build the capacity of communities to effectively address their needs while providing tangible improvements to health care facilities and other health infrastructure in the country. Micro-projects ranged from refurbishment of district health facilities to potable water projects. Community cash and in-kind contributions to these health micro-projects were significant, demonstrating their value to communities.

AHAP health and nutrition partners also engaged government actors at all stages of programming in order to increase ownership and strengthen the framework within which individual citizens pursue healthy lives. The implementation of health information systems, development of a cadre of national Master Trainers in various health topics (including reproductive and child health), publishing of nationally endorsed and distributed health manuals, and organizing of mobile health units and monitoring teams comprised of state health officials are some examples of the creative ways in which AHAP health and nutrition programs strengthened the link between government capacity and community health.

The capacity of local NGOs was also tapped and strengthened during AHAP health and nutrition program implementation. LNGOs served as a link between communities and AHAP partners in helping to ensure that health interventions were context-sensitive and sustainable over the long term. LNGOs played a particularly significant role in organizing training efforts, while some LNGOs overtook the operation of community health funds and other direct service provision.

AHAP programming in this sector also sought to fill information gaps that were impeding the forward progress of community health and the national health infrastructure, most notably through the conducting of a nationwide reproductive health survey that was the first of its kind and established a baseline for future programming. In order to respond to acute needs in the area of nutrition, AHAP programming in this sector also included a food distribution project to vulnerable IDP communities.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 59

2. PRIMARY HEALTH CARE (PHC)

AHAP S.O. 2: To strengthen community involvement and capacity through participation and leadership

¾ AHAP I.R. 2.2. Communities organized and mobilized to manage more accessible and sustainable health care

2.1 PROGRAM OVERVIEW

In 2000 Primary Health Care programs became operational under AHAP II and were implemented by International Rescue Committee (IRC) in the Central area, by Pathfinder in the Urban area, by International Medical Corps (IMC) in the Southern area and by Adventist Development and Relief Agency (ADRA) in Nakhchivan Autonomous Republic. The total funds allocated for the program were $6,467,359. (For more information on program extensions, please see Annex G.) The goal of the program was to address basic health care needs at the community level through involvement of health stakeholders: the community as a whole, health providers, government representatives, Ministry of Health (MoH) and local NGOs. The focus was on strengthening health education as a means to prevention as well as improving the level of clinical care delivered by health professionals. The means to achieve this goal was through organization of community members who became advocates for PHC.

The PHC program went through a transition at the close of IRC and Pathfinder programs in 2003; IMC and ADRA continued programming through September 2005. The Save the Children (SC) Integrated Community Development Program (ICDP) expanded their target area to include the IRC PHC communities after the IRC closure, and these communities are now part of the ICDP cluster groups. The Pathfinder-trained individuals continue conveying health information based on the relationships formed during the program.

The PHC programs realized a great success in the formation of community groups who became the advocates to identify and address community health needs. A total of 442 community groups were formed throughout the target areas. The community groups received a comprehensive training package that enabled them to function as leaders and as trainers at the community level. Peer education was the backbone for this community-level training.

As a result of program efforts, over 160,000 individuals benefited from the trainings and community- organized health campaigns, 107 clinics were rehabilitated with 33% community contribution, and one million people received medical treatment in their communities. Simultaneously, links were strengthened with local government and Ministry of Health in the form of training, cross visits, monitoring and advocacy. By the end of the project, MoH began to take on more responsibilities and the partners assumed the role of advisors. Local NGOs, who worked in tandem with the partners, also figured prominently throughout the program to ensure that a mechanism would be in place to continue health activities beyond the life of the project.

2.2 PROGRAM INTERVENTIONS

Community: AHAP II community health education consisted of health education for individuals who visited clinics as well as mass education through more formal mechanisms. These mechanisms included health worker activities, classes for sectors of the community with special interests, general health information campaigns through creation and distribution of leaflets and brochures, and public service announcements. All partners conducted health prevention and awareness campaigns in topics including reproductive health, immunizations, home remedies for acute respiratory infections (ARI), exclusive breastfeeding for infants, adequate micronutrient intake, prenatal care, health hygiene, and

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 60 STD/HIV/AIDS awareness and prevention. The formation and training of community health groups served as the foundation for the community-based primary health care initiative.

During AHAP II health education activities were primarily conducted through community health groups, women’s health groups, schools and other civic initiatives. To ensure a high teaching standard, partners conducted Training of Trainers (TOT) for teachers, students, community members and affiliated NGO representatives who were active participants in health education activities.

The AHAP partners used various mechanisms to reinforce health education and reach larger segments of the population. IRC, in conjunction with the SC ICDP program in the Central area, and ADRA worked with Sevil Women’s Association to develop trainings on reproductive health and emphasized key messages for community groups and through the media. Health education interventions included radio broadcasts, painting of educational murals on clinic walls, creation and distribution of posters, scripts for puppet plays, dramas, songs and banners. The broadcasts included a half-hour talk show each month and one to two-minute radio public service announcements focusing on health issues. With approval from the MoH, ADRA created an illustrated flipchart covering basic PHC topics such as breastfeeding and immunization and made them available to peer educators working in the region. IRC in the Central area organized competitions to raise health awareness among the broader community, with events including speeches, poster making, quizzes, wrestling and awards presentations. In addition, health groups in this area showed health videos in teahouses, community clubs and schools. Pathfinder’s program in the Urban area produced leaflets on HIV/AIDS and STIs, and community workers distributed materials developed by the National Office for Family Planning and Reproductive Health on adolescent health. In the Southern area, IMC established community- based reference libraries located in clinic facilities and schools that provided sustained access to health information materials for community members.

Community and Cluster Groups: AHAP partners formed a total of 442 community groups in Southern, Central and Urban Azerbaijan as well as in Nakhchivan. The purpose of these groups was to identify and address community health needs and facilitate increased access to health services through participatory and inclusive group structures. Target groups included men, women and youth, with women representing 54% of participants and IDPs representing 23%. In the Urban area, the project reached approximately 88,000 individuals, of which 87% were IDPs and 88% were women. The total number of individuals reached through all community groups was over 160,000. The community groups varied in names, such as Health Education Units (HEUs), Mobile Health Units (MHUs), Village Health Education Groups (VHEGs), and Women’s Health Groups (WHGs). But these community groups shared a common goal to mobilize and empower communities so that they would be more adept at accessing and managing sustainable health care.

Members of community groups received trainings that would enable them to be advocates for health. Training topics included organizational development, program planning and implementation, monitoring and evaluation, program sustainability, gender and environmental issues. Technical training included first aid, reproductive health and child health issues, malaria, chronic adult diseases and psychological disorders. The topics were selected based on the findings of the Knowledge, Attitude and Practice survey (KAP) completed early in the program as well as on communities’ self- identified concerns. In turn, these trainings increased the capacity of community groups to conduct further training sessions for their peers in the community.

Throughout AHAP II community health groups continually increased their ability to address community health needs through on-going training and capacity building provided by AHAP partners. There was also increased outreach to and linkages with neighboring communities, local government authorities, MoH officials and other stakeholders. In the last few years of AHAP II, partner efforts centered on building self-reliance and sustainability by strengthening relationships between cluster- level structures, government and municipality authorities, as well as between other stakeholders. For example, ADRA formed a Nakhchivan Advisory Board (NAB) and several Regional Advisory Boards (RABs) that served to increase the role of community groups at the cluster level. The RABs were

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 61 established as cluster-level information exchange and health promotion structures and were comprised of the VHC chairmen from each region. The creation of these cluster-level activities was complemented by the training of 14 VHC leaders in topics such as negotiation, conflict resolution, leadership principles, and building strong relationships between the ExCom, Municipality and community leaders.

In the Urban area, where the focus was on reproductive health, group mobilization was not incorporated since the issue of reproductive health education was considered highly sensitive and more appropriately handled through individual counseling for women. Nevertheless, groups were loosely formed to increase effectiveness, and women who received individual counseling participated as leaders in other AHAP community development projects. Groups were organized separately for men, women and youth.

In order to better reach young women, established community groups and ADRA partnered to create 38 new Women’s Health Groups halfway through the program to address the isolation among these young women which had been seen earlier in the program to be an obstacle for their participation. The WHGs and VHCs worked together to reach the broader population by creating a safe and welcoming space for women to access community health information. This was an exciting example of communities solving the needs of their members creatively in immediate response to a perceived concern.

Health Provider Capacity Building: Throughout AHAP, implementing partners conducted on-going training for health care professionals to increase their level of practical skills and theoretical knowledge, thereby enhancing the quality of health care provided. Topics centered on PHC, rational use of drugs, chronic disease management and reproductive health. TOT was also provided to health professionals, who subsequently trained their communities on primary health care issues. Health care professionals were monitored by the Partner, often in collaboration with the District Health Authorities (DHA), on the quality of their clinical skills as well as the accuracy and consistency with which they applied their training. The monitoring visits proved useful in motivating clinical staff and gave the opportunity to offer immediate feedback.

Government: Both the IRC and Pathfinder programs, which ended in mid-2003, had worked with MoH at the local level. Between 2003 and 2005, with the restriction of Section 907 lifted, IMC and ADRA were able to expand collaboration with the MoH significantly. Capacity building of MoH representatives in the form of training, cross visits, joint monitoring and advocacy helped the Southern and Nakhchivan partners as well as communities move toward self-owned and sustainable health care programs. Both health partners generally enjoyed a fruitful collaboration with regional MoH staff that focused on increasing the MoH monitoring capacity, putting health information system (HIS) mechanisms into practical use, and positioning MoH authorities for front-line work while relegating the role of the implementing partner to that of a supportive resource.

The Nakhchivan program focused on training MoH staff at the central, regional and local levels. With the suspension of section 907, ADRA transitioned away from direct service delivery by strengthening the role of MoH medical providers and staff to assume program implementation responsibility. The initial focus was on the Expanded Program for Immunization and then expanded to include general PHC activities. Trainings were focused on increasing the capacity and motivation of physicians to conduct training and health education sessions and on encouraging the use of standard practices among the medical staff. MoH rural health staff received comprehensive training on community development to encourage increased involvement between health community groups and the broader community. TOT was also conducted for 15 selected local health professionals on emergency first aid to improve the quality of emergency health care services provided.

Partners supported nationwide Integrated Management of Childhood Illnesses (IMCI) efforts to train twelve IMCI Master Trainers and six IMCI Monitors and to begin training child health personnel in Azerbaijan. This coalition of agencies also coordinated and funded training for over 210 health

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 62 professionals on IMCI. This initiative was also supported by the World Health Organization and included integrated clinical trainings on IMCI topics such as the following: ARI, diarrheal disease, breastfeeding, nutrition, malaria, immunizations and recognizing danger signs in sick children. A total of 68 professional providers successfully completed training on IMCI through PHC programs.

Both the Nakhchivan and Southern area partners improved the capacity of regional health authorities by conducting joint monitoring visits to regional rural health points, thus engaging and increasing their level of participation and responsibility in the programs. Both partners also worked with regional health authorities and the MoH through trainings and linkages to institute a functional Heath Information System. ADRA worked with the MoH in Baku and in Nakhchivan to coordinate activities to deliver a long-awaited HIS training. IMC coordinated with key personnel from the district health authorities through District Training and Monitoring Teams (DTMT) to report accurate health statistics to the MoH in Baku and to assess health problems occurring in their areas. To support data collection, health statistic forms were developed and computers were installed in two district hospitals– Saatli and Imishli. Training workshops on the use of these forms and computers were conducted.

Youth: Partners worked with the MoH and the Ministry of Education (MoE) to prepare secondary teachers and students to conduct peer health education in the schools. Training topics included participatory training skills, first aid and trauma, immunizations, respiratory infections, TB and HIV/AIDS. In turn, teachers and students organized health education activities involving health dramas, competition and other creative activities for their fellow students. One partner’s collaborative efforts with a local NGO called Sevil Women’s Association led to two HIV/AIDS awareness campaigns targeting university students that focused on transmission and prevention practices as well as the stigma of HIV/AIDS. Additionally, partners assisted some target schools in organizing “health corners” containing health informational materials available for student use. In the Southern area, the partner found that by working with teachers, the community was more accepting of reproductive health education targeting young girls.

LNGOs: The AHAP health partners worked extensively in collaboration with LNGOs. This cooperation had the effect of simultaneously broadening program impact and increasing the capacity of these LNGOs to continue health-related community activities after the life and presence of the AHAP program. IMC worked with four national NGOs: Shafali Allar, the Azerbaijan National Nurse Association (ANNA), the Azerbaijan Women and Development Center (AWDC), and Sevil Women’s Association (SWA). ADRA also worked with SWA, while Pathfinder worked with AWDC. These NGOs were involved in community mobilization and peer training activities, as well as in health education campaigns. In the Urban area, community health workers provided information on reproductive health and services through a subcontract with AWDC.

Sevil Women’s Association was an important partner to both ADRA and IMC. Both agencies worked on developing the organizational capacity of SWA to conduct successful health education campaigns through the development of their procedures and dissemination of health education tools. To further strengthen the capacity of SWA, IMC furnished it with health education reference libraries in Imishli and Saatli regions. The partner also organized joint meetings in four districts between Health Education Unit leaders and SWA members on health education techniques. ADRA partnered with SWA in Nakhchivan to conduct a month-long reproductive health campaign, marking the beginning of a long and collaborative relationship promoting health education in the regions.

2.3 ACCOMPLISHMENTS

2.3.1 Communities Organized and Mobilized through Health Education and Community Campaigns

Community Health Groups: Community group activities were centered on peer-to-peer health education campaigns, community campaigns and events, the development of cost recovery schemes

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 63 and revolving drug funds, overseeing the improvement and maintenance of health facilities, and the formation of emergency transport teams. Eighty-nine community micro-projects were completed with an average of 33% community contribution, primarily in the areas of clinic rehabilitation, waste disposal and water projects. Through these activities community groups learned how to function as teams, developing solid capacities that enabled them to become sustainable bodies able to address PHC issues independently.

The momentum of community development grew in the region as a result of partner efforts, and community groups began taking the lead in activities previously organized directly by the partner agencies. By the end of the AHAP program, partners only occasionally monitored the community activities and referred community leadership to regional and national resources as needed. Community groups independently took over the formation of new health groups in neighboring communities. Groups from 13 communities in the Southern area worked with the partner to organize four Children’s Day events that provided entertainment and delivered important health education messages for children and their families. In the Central area, community groups facilitated eye and vision care for vulnerable people. This was done in collaboration with the Caspian Compassion Project independently from the partner. Another example of independent community activities was the formation of seven emergency transport teams to respond to obstetrical complications and other emergencies. These were organized largely through the efforts of women in the area who worked with individual communities to organize emergency response mechanisms.

Community health groups also conducted successful information exchanges with local government authorities and local MoH representatives. Health groups participated in regular meetings organized by the local MoH, local Municipalities and regional ExComs resulting in the improvement of collaborative efforts, such as the transportation of vaccines from the district to the village level. Moreover, community groups began to include representation from local government authorities as well as the MoH, further improving the support from health authorities on community group activities.

Peer-to-Peer: One of the most critical roles of community groups was that of promoting health education and awareness mechanisms to their peer community members. Peer education proved to be an exponential and sustainable method of community health education. Through TOT workshops and seminars for peer educators, the health partners in the Southern, Central and Nakhchivan areas enabled the education of nearly 160,776 individuals, thereby reducing the gap that exists in health education and advocacy in the country. By the end of AHAP, partners had established community health education structures that functioned independently and continued to add diverse health activities in their communities. Community health groups conducted outreach campaigns in both target and neighboring communities, demonstrating the wide-reaching effect that peer education activities can have.

Peer school activities were also highly successful. Twenty-two peer-to-peer school “health parties” were organized conveying health messages through drama, poetry and recitals for 3,046 fellow- students and 238 teachers. Thirty-eight schools developed “health corners” containing health informational materials available for student use. The TOT and resulting health education activities encouraged communities and MoH staff to improve their collaboration on the school level.

Peer groups also used art and media, such as video productions, to communicate key health messages to their peers at local teahouses and other commercial settings. Campaigns also included environmental clean-up days combined with malaria education. During the last month of the program, a Knowledge Practice and Coverage (KPC) final survey showed that communities with active peer educators demonstrated a much better knowledge of key health messages.

The Southern partner trained 738 volunteers on family planning, prenatal care and sexually transmitted infections. The training led to 334 community group members providing educational

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 64 outreach to 2,500 peer community members. The partner found that by working with teachers the community was more accepting of reproductive health education targeting young girls. With minimal assistance from the partner and using their own resources, the communities’ Health Education Units and management committees conducted health education campaigns on self-identified topics including nutrition, diabetes, malaria and acute respiratory infections. These campaigns led to increased clinic utilization rates in relation to the health topics discussed. Sustainability was also strengthened through successful cooperation with two ICDP Development Resource Centers (DRCs) to teach health education classes accessible to a wider portion of the population.

LNGOs: In the Urban area, the local NGO AWDC collaborated with the partner to implement program interventions. Ninety community-based health workers and six supervisors provided information on reproductive health and services, reaching over 88,500 people. With AHAP closeout, the AWDC has assumed responsibility for facilitating the work of the community workers to provide health services for clients, and will continue to do so through its five strategically-located offices in the Urban area.

With ADRA funding, Sevil Women’s Association conducted seminars and discussions on reproductive health in both the Nakhchivan and Southern areas. Reproductive health messages were promoted through radio and TV outlets, culminating in a Nakhchivan women’s conference in late April 2004 that brought together over 150 women and involved the partner as a conference presenter. SWA also actively participated in the selection and facilitation of women’s health groups in Nakhchivan, providing SWA with the benefit of experts involved in other program activities. SWA will continue to launch education activities initiated by the AHAP partners in neighboring communities not yet reached through programming.

2.3.2 Managing Accessible and Sustainable Quality Health Care through Upgrading of Clinical Services and Management of Clinics

Health Providers: The professional health providers continued to provide improved PHC services in clinics by applying the skills and knowledge they gained through partner trainings, capacity building activities, and through use of rehabilitated facilities and equipment. Utilization and satisfaction of health services was higher in target communities as a result of improved health provider knowledge. Trained health providers also supported health peer educators as they communicated health messages to the community at large. It was particularly encouraging to see the increased interaction between local health care providers and communities in the pursuit and delivery of quality PHC services.

Partners trained senior medical staff in monitoring and evaluation, who then conducted monitoring activities for peer doctors and nurses. The medical staff also accompanied program field teams on monitoring visits to rural PHC facilities and practitioners. In this manner, partners transferred the responsibility for overseeing the quality of service delivery to regional health authorities.

Regional Health Authorities: The MoH became an increasingly active and supportive partner to PHC programs and eventually took on some of the AHAP program’s efforts as part of its agenda. MoH staff will continue to provide support to AHAP-initiated activities by conducting on-going refresher trainings for health providers. In Nakhchivan, MoH organized outreach health service visits to remote communities and participated actively in the joint supervision and monitoring of its field sites. IMC also handed medical provider monitoring responsibility to district health authorities through training in the Total Quality Assurance System (TQAS). As a part of the TQAS, a District Training Monitoring Team (DTMT) comprised of senior medical staff from each District Central Hospital conducted regular monitoring visits. In total, 182 PHC clinics received at least one monitoring visit from a DTMT. DTMTs became fully operational and demonstrated a strong willingness to monitor and supervise district health care systems on a regular basis. During these visits, health professionals also had the opportunity to discuss important health issues and trends in their particular region with District MoH leadership. With time, DTMTs began taking complete responsibility for supervision while the AHAP partner shifted to an observation role. These activities of DTMT included the

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 65 monitoring and training of health care providers, as well as the accurate collection of health information for better management of health care.

Both partners worked with regional health authorities and the MoH to institute a functional Health Information System. As a result, morbidity, mortality and other vital health information statistics were regularly entered into databases on a monthly basis to be analyzed by health authorities. By reporting accurate health statistics, health authorities are now better able to make correct and timely health service management and planning decisions.

Cost Recovery Mechanisms: All implementing partners developed cost recovery mechanisms at the community level. The type of services provided by these cost recovery mechanisms depended on the creativity of the specific mechanism and included the following: Revolving Drug Funds (RDFs) that enabled isolated communities to access basic medication locally; a Pre-Paid Fee For Service (PPFFS) component for reproductive health exams, counseling and contraceptives; a combination of pre-paid insurance and fee-for-service that also provided employment opportunities associated with the clinic; Community Health Funds (CHFs) raised from a monthly membership fee, donations, and the sale of supplies addressing the emergency and public health needs of communities; and the provision of basic services, such as blood pressure tests, for a fee. Each partner worked with communities in improving their skills to own and manage the funds. The funds were used to replenish drug supplies, pay for fixed and running costs of clinics and support the work of community health committees.

Overall, cost recovery mechanisms proved a promising vehicle for facilitating the delivery of needed PHC services and attending to community-level public health issues on a sustainable basis. Yet the growth of community-based cost recovery systems was constrained by Azerbaijan’s current legal framework. Partners struggled with the legal issues facing communities who collect and are responsible for cash without legal registration and thus without the advantages and protection of a bank account. In June 2003 a national decree pledging free health care thwarted the development of cost recovery mechanisms in Azerbaijan. Partners were slowly forced to suspend cost recovery activities in the areas where the decree was most rigorously enforced.

Micro-Projects: Funds for micro-projects included health project grants as a means to strengthen community involvement in accessing and sustaining quality health care. Communities significantly supported clinic improvement by contributing between 22% to 33% of the total costs of the projects, with ExComs and Municipalities actively involved by contributing cash and equipment to the projects. The funds were predominantly used for clinic construction or rehabilitation to WHO standards, as well as for creation of medical waste disposal sites and installation of water systems. AHAP partners rehabilitated a total of 107 clinics throughout the target districts. Clinics were also supplied with basic equipment necessary for treatment and diagnosis, and health professionals were trained in the use of professional supplies. In one example, the Sevil Women’s Association used their micro-project funds to hold a series of seminars and campaigns on reproductive health reaching an estimated 50,000 young and adult women in Nakhchivan.

In all program areas except the Urban area, health care service delivery was supported by the provision of medical equipment and supplies to community health groups and clinic facilities. In Nakhchivan, the partner supported the MoH through the donation of medical equipment to health facilities. All rehabilitated clinics in the Central area were supplied with the necessary equipment, and a full list of this equipment was provided to the district MoH representatives who were encouraged to monitor the equipment on a regular basis.

Clinical Services: Throughout AHAP, clinical utilization rates increased continually, reflecting improved community confidence in the quality of care given in local clinics as well as improvements in access to that care. By the end of AHAP, 984,206 people received treatment in their respective communities and did not need to be referred to the district center or other clinics.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 66 The Nakhchivan partner focused on developing Mobile Health Units staffed with MoH specialists that brought vital pediatric and gynecological services to women and children in two regions of Nakhchivan. The partner worked with the MoH to set up three regionally-based and a fourth centrally-managed MHU to serve the population of the target regions. The value of the MHUs was felt both by patients and by doctors who, as a result of the outreach into remote areas, noticed a direct increase in their reputations and clientele. To cover the transportation costs of these MHUs, communities developed fundraising plans. As with a number of other activities, in August of 2004, the MHUs ceased activities upon GNAR’s restrictions and the subsequent memorandum articulating the MoH’s intention to handle future MHU activities, leaving the partner with no formal role in the area. To increase the motivation and capacity of health professionals through other mechanisms, the Nakhchivan partner continued to conduct joint follow-up visits with MoH that are now centrally organized.

Please see Annex E for Primary Health Care Sector Indicator Table

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 67 3. FAMILY PLANNING/REPRODUCTIVE HEALTH (FP/RH)

AHAP S.O. 2: To strengthen community involvement and capacity through participation and leadership

¾ AHAP I.R. 2.2: Communities organized and mobilized to manage more accessible and sustainable quality health care

3.1 PROGRAM OVERVIEW

The AHAP Family Planning and Reproductive Health (FP/RH) program, comprised of both Community and National Components, became operational in August 2003. Save the Children (SC) spearheaded the Community Component in a consortium partnership with United Methodist Committee on Relief (UMCOR) and International Relief and Development Inc. (IRD). International Medical Corps (IMC) led the National Component in the first year and closed their activities in September 2004. The SC Consortium continued both the Community and National Components when a one-year extension was granted from October 1, 2004 to September 30, 2005 following the program close. The combined total cost for these programs was $3,127,987. (For more information on program extensions, please see Annex G.) The overall purpose of the FP/RH program was to increase the level of knowledge of families and health care providers about safe, effective options for spacing children that would result in healthier, stronger children and mothers.

A total of 176 communities were served in the 17 districts where the program was implemented. The target beneficiaries at the national level included 27 gynecologists prepared to be Master Trainers as well as the health professionals including gynecologists, doctors, nurses, midwives and pharmacists who would be the recipients of subsequent training. At the community level, beneficiaries included married women and men as well as adolescents in the target communities. Within this group, there was a mixture of refugees and IDPs as well as the conflict affected population.

Major program achievements made headway in ensuring that family planning and reproductive health reached the national health agenda as well as in informing the target population that they have a choice concerning their reproductive lives. The 27 gynecologists who became Master Trainers were supported by the National Reproductive Health Office (NRHO). These Master Trainers in turn trained and monitored 625 gynecologists, doctors, nurses, midwives and pharmacists. Training manuals were developed in conjunction with Johns Hopkins University (JHU) and Ministry of Health (MoH) for gynecologists, doctors, nurses, midwives and pharmacists. The program also trained a total of 809 Peer Educators; following the training and mobilizing they went on to train 166,766 men, women and youths in target communities on FP/RH. In addition, 21,289 refresher trainings for community members were also conducted. Fourteen education leaflets on FP/RH were developed and distributed to three-quarters of a million people. Rehabilitations of 47 clinics or rooms for the use of FP/RH activities were completed to WHO standards. Mass media initiatives included televised programs and public service announcements (PSAs) on family planning messages. The groundwork was also laid to increase access for FP in target areas through work with selected Pharmicies (Apteks) who, through training and participation in collaboration mechanisms such as the Bridge to Reproductive Health Networks (BRHN), became more active in service and advocacy.

With the close of AHAP programs, the BRHNs and local NGOs will figure prominently as sustainable entities from program activities. The BRHNs consisted of health professionals, government representatives, Peer Educators and community members who had a vested interest in FP/RH activities. Through training and guidance, these groups became strong enough to start implementing FP/RH activities that benefited the regions where they lived. SC, IRD and UMCOR each mentored a national NGO to help build their capacity so that they could take over program

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 68 activities and be better prepared to approach donors for funding of their own projects in the future. At the end of the AHAP RH programs, the national NGO Healthy World, was awarded a subgrant by Engender Health to assist with similar program activities in the AQUIRE project.

The program left behind a cadre of trained professionals and Peer Educators who have the information and educational tools to continue offering training and advice at the community level. The trained professionals who received intensive FP training will be better equipped to offer a wide range of FP services. The 45 rehabilitated facilities and FP rooms will continue to be used for FP/RH-related patient consultations and training.

3.2 PROGRAM INTERVENTIONS

Community: In addition to receiving individual trainings on FP and RH, the target communities were also active participants in the activities being carried out within them. For example they often opened their homes as the venues where training could be conducted, actively participated in festivals that focused on FP and RH and contributed to all the clinic rehabilitations by matching 29% of the cost. To promote wide coverage of FP and RH messages among the target population, the program used a variety of media interventions including television programs, local newspaper articles, information calendars and educational leaflets. Under the Community Component, a Materials Production Committee (MPC) was formed to contribute to the development and review of all media materials. Television programs were aired on such topics as “Introduction to Family Planning and Reproductive Health,” “Birth Control Pills” and “Reproductive Health and Sexually Transmitted Infections.” Two excellent Russian-produced videos on FP were dubbed into Azerbaijani for use in training sessions and by Peer Educators. In addition to health education through media interventions, nearly 167,000 men, women, and adolescents were trained during the program on vital FP/RH information through peer-to-peer education activities.

Partners also put efforts into strengthening communities to effectively advocate for their FP/RH needs beyond the life of the program. Regional advocacy training courses were held in which key staff, BRHN members, community members, trainer/mobilizers and other stakeholders built their skills and confidence around advocacy. The use of mass media strategies to disseminate FP/RH key messages for communities complemented these advocacy efforts by multiplying awareness of and action regarding FP/RH issues across the country.

Bridge to Reproductive Health Networks: A key part of the Community Component was the establishment of 17 “Bridge to Reproductive Health” Networks that strengthened and cemented existing community networks and bridged existing information gaps. The networks involved educators, community members, Aptek representatives, health providers, regional MoH leadership and other relevant parties in a highly participatory process for enhanced cooperation, discussion and promotion of FP/RH information and services. In phase II of activities, BRHN members received intensive training on negotiation skills and advocacy, including subjects such as active listening, consensus building and conflict management.

Peer Educators: Save the Children initially trained a group of 458 Peer Educators (PEs) from 79 communities. They included men, women and adolescents from the target communities who received a five-day Training of Trainers (TOT) course as well as four days’ training on the basics of FP. The topics included basic anatomy and physiology, oral contraceptives, intrauterine devices (IUDs), condoms, natural family planning methods such as calendar and Standard Days Method, sexually transmitted diseases (STDs) and HIV/AIDS, among others. The Peer Educators then went on to train their respective communities in family planning and reproductive health issues. The PEs were trained and monitored by health professionals who were hired by the consortium members as Trainers/Mobilizers for the duration of the program. In preparation for these trainings, the partner had conducted a TOT for all program trainers, mobilizers, and local NGO partners Sevil, Tomriz, and Healthy World. The TOT focused on adult learning techniques, as well as the design, preparation,

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 69 implementation and follow-up evaluations of the training sessions. All Peer Educators with Save the Children, IRD and UMCOR followed the same training curriculum to ensure consistency across the program.To ensure the quality of the trainings, Peer Educators were trained in small groups of ten to fifteen people where individual attention could be given. Additionally, they were equipped with training resources such as a training manual and flipchart. Refresher trainings were given to update and maintain the quality of trainings with a special emphasis on family planning, STDs, and HIV/AIDS.

An additional group of 351 PEs were recruited and trained during the cost extension period for a total of 809 trained Peer Educators for the life of the project. In response to the Lessons Learned assessment that was conducted at the end of the first year, the training days were extended by 25% to promote deeper knowledge levels in the community. The target number of people to be trained by PEs was reduced to allow more time for conducting well-developed education activities. When the number of PEs doubled during the second phase of activities, partners hired 40 new mentor trainers to monitor and assist them. These mentor trainers were chosen from the first pool of Peer Educators, therefore acknowledging their efforts and providing an incentive for other Peer Educators. Their role was to assist with training of the new Peers in Phase II, to be resource persons for them as they began to train, to monitor program activities and to participate in health related community events and festivals. Save the Children staff also strengthened their knowledge on volunteer management principles and developed a strategy for creating incentives and motivation among PEs. The partner was also able to secure outside funding from UNOCAL to print and distribute 5,000 copies of the FP/RH manual “Training Guidelines for Community Health Workers” (developed by UNFPA in collaboration with AHAP partners) in target areas to augment the peer education work already being done.

Master Trainers: IMC, in coordination with the Technical Working Group (TWG) established in the program among interested FP/RH actors, conducted a national competition to identify a qualified team of 28 obstetricians/gynecologists (Ob/Gyns) of which 11 were experienced trainers (originally trained in 1996 by UNFPA and Pathfinder) and 17 were new. This national reproductive health team of Master Trainers covered a large geographic area from Baku and Sumgayit urban areas to rural districts across Azerbaijan (including the AHAP target areas) as well as Nakhchivan, thus facilitating future countrywide RH programming. A team of three medical consultants from John Hopkins University initially conducted a seven-day TOT course for all 28 Master Trainers to prepare them to develop, plan and conduct a professional medical training curriculum for in-service refresher training. This TOT as well as future ones covered topics on participatory adult learning approaches, presentation techniques, and curriculum development for RH training programs through group lectures, small group exercises and discussions. Two additional workshops were conducted by IMC and the NRHO to improve technical skills on FP/RH issues. During the first of these activities, Master Trainers worked together to develop the Family Planning training package for pharmacists. The second workshop was a five-day Practical Skills workshop also conducted in cooperation with reproductive health experts from JHU. It focused on improving the team’s skills in patient consultation, providing information on the benefits and risks of family planning methods, the role of family planning in public health and the need for modern family planning.

The Master Trainers were also taught monitoring techniques and were tasked with conducting a minimum of two monitoring sessions for every health professional trained. The monitoring was to ensure the practical application to a high standard of the theoretical classroom lessons. There was a minimum of one joint monitoring with partner and Master Trainers through NRHO in Phase II. The NRHO did not release Master Trainers as frequently as planned to conduct the monitoring and therefore, the second monitoring of trained professionals was only partially completed. In future training programs it is important to follow up with full complements of monitoring, without which the benefit of training will always be regarded as less than optimal.

Pharmicies (Apteks): Save the Children focused on developing Apteks as a resource for providing FP/RH information, referrals into the service delivery system and contraceptive commodities. The

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 70 Knowledge Practice and Coverage (KPC) survey conducted early in the program had indicated a low level of knowledge of family planning concepts among Apteks. Thus the Save the Children Consortium hired Aptek-specific trainer/mobilizers to engage these stakeholders in the development process. Trainer/mobilizers trained Apteks on family planning and social marketing, emphasizing the connections between increased family planning knowledge and the potential growth of their business. Trainer/mobilizers worked with individual pharmacists through on-the-job trainings, especially for those unable to leave their jobs to attend the training. Trainer/mobilizers helped to strengthen the role of pharmacists in the BRHN meetings, of which pharmacists were members, and assisted them in setting up “Family Planning Corners” in each pharmacy where relevant posters and brochures were displayed. In total, 44 Apteks were trained on FP, and the pre-and post-test results indicated a dramatic increase in knowledge of FP, with more than 90% of the questions answered correctly after training, compared with almost 0% pre-training. It is noteworthy that, as Apteks became involved in FP activities, the demand for contraceptives increased.

Government: IMC worked together with NRHO staff and RH experts from John Hopkins University to update, redesign and bring into conformity with international standards the NRHO family planning training manuals for Ob/Gyns. This training package for obstetrician/gynecologists then served as a model for the development of three new family planning training packages, one geared towards nurses/midwives, one for PHC doctors and feldshers, and the last for Pharmacists. Upon completion, the packages were submitted to the MoH for review and approval. The new manuals are concise practical guides filling a serious information gap in Azerbaijan. The program additionally worked with the MoH to establish the Technical Working Group and to train Master Trainers.

Technical Working Group: A Technical Working Group was established involving cooperation between the two implementing partners and the Ministry of Health as well as UNFPA and other AHAP and non-AHAP representatives. The group provided the UNFPA and the NRHO with the opportunity to actively participate in the program and contribute valuable technical assistance and resources. For example, the TWG was responsible for coordinating the selection process of Master Trainers and discussion on the TOT course curriculum. Moreover they established a sub-group in charge of designing the family planning training materials, teaching aids and curricula for midwives, nurses and PHC health providers. The TWG was a very important forum for the active exchange of program information, joint planning, team building and problem solving. Over time, the responsibility of administering TWG meetings was handed over to the NRHO, thus establishing the latter’s potential to continue as an FP/RH advocacy and information-exchange structure. The NRHO and the MoH by the end of the program did not pick up responsibility for serving as this national level forum although their capacity building was part of the AHAP interventions. The NRHO did originally acknowledge the importance of the TWG when there were separate National and Community Components. Even though the NRHO did not consider TWG a priority in Phase II when the two Components were combined, there was still weekly communication between SC and NRHO to coordinate activities for training and monitoring of health professionals.

Youth: Training of adolescents was difficult in the first phases of the program due to reticence from the Ministry of Education (MoE) to approve standard training manuals for formal use among adolescent groups. Alternatively, partners held extra-curricular and non-formal trainings using other training manuals to promote family planning and reproductive health to interested youth. Adolescents’ access to FP/RH information increased over the life of the project as a result of trainings, formation of adolescent discussion clubs and the participation of parents, many of whom wanted their adolescent children trained on aspects of FP and RH. Adolescents were also part of the peer education initiatives at the community level where they trained their peers in the communities and also in universities. Adolescent participation was also highly visible in the community festivals.

LNGOs: Local NGOs were integrated into most program activities with the vision that organizations would take over some of the partner activities after the life of AHAP. Each member of the Save the Children consortium teamed up and worked closely with a local NGO –Healthy World, Tomriz,

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 71 Azerbaijan Civil Union and Sulh, which replaced Sevil in 2005. LNGO members participated in all the trainings on FP and TOT, as well as receiving specialized training on proposal writing, finance, report writing, and conflict management through World Learning. With training and close guidance, these groups became strong enough to start implementing FP/RH activities that benefited the regions where they lived.

3.3 ACCOMPLISHMENTS

3.3.1 Communities Organized and Mobilized through Health Education and Community Campaigns

Community Health Groups: Communities organized successful awareness raising and information sharing campaigns on family planning and reproductive health, creating a sense of social responsibility and breaking the barriers in FP discussion. The momentum for organizing these activities came from the partner initially, but within a short period of time the communities themselves, through the assistance of peers within the community and the local NGOs, were instrumental in organizing the campaigns and getting their full community support. The quality of the festivals was high, attracting between 150 and 500 participants at each event and with as many as 1,000 participants during the summer months. Multi-media presentations with local musicians, comic groups, pantomime and other performances, as well as the generous distribution of informational materials, helped to reinforce key messages. Participants included consortium members, municipality representatives, and health authorities. In some instances, partners collaborated with the AHAP ICDP programs through cross visits and the sharing of experiences, generating additional creative momentum in the area. Enthusiasm over and receptivity to these activities was high, as evidenced by beneficiaries’ responses in focus group discussions conducted during the Lessons Learned assessment.

With time, the BRHNs also achieved an important degree of community ownership and confidence. They were able to utilize their power to draw regional authorities’ attention to important FP/RH issues and to address community FP/RH problems effectively. For example, after BRHN discussions on the advantages of outreach visits, three members from a Southern district independently organized gynecologist outreach visits to their village on a monthly basis, attesting to the truly networking effect across regions that BRHNs achieved. Gynecologists were a vital part of the BRHN, and through them they developed a strong sense of advocacy for improving RH in their regions. This was especially true for those who had been trained by the Master Trainers because, in addition to the advocacy skills required, they also had updated clinical skills. Through the Bridges, they had an opportunity to be stronger voices at the community level.

The BRHN were also instrumental in focusing on taking FP/RH training to adolescents. In early 2005, a MoE representative member of one BRHN enabled the creation of a training room for adolescents allowing for positive steps in the mechanisms by which adolescents were being reached for training.

Peer-to-Peer: Peer education activities were the backbone of the Reproductive Health program and the primary means through which all other activities were based. The partners trained a cadre of Peer Educators who are equipped with the necessary knowledge and tools to continue offering training and advice to their communities. Once trained, the cadre of 809 PEs trained a total of 166,766 married women and men as well as adolescents in vital family planning and reproductive health information. A total of 21,289 of these trainees also received refresher trainings to deepen and reinforce their knowledge and promote long-term retention during Phase II. The average number of trainings conducted by each PE was 17-18 per month, with an increased focus on quality of trainings over quantity. Periodic questionnaires were delivered to the trained population to assess the level of knowledge and quality of the trainings. Peer Educators collected information on qualified trainees and topics covered to maintain a record for future trainings. From these records it is estimated that

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 72 more than 1500 women and men were referred to gynecologists and pharmacists per semi-annual period by PEs.

LNGOs: All of the national NGO partners managed small projects and received funding from international donors. They each managed a subgrant, including reporting and financial obligations, to a high standard. They also were responsible for the Peer Education activities in designated communities. For example, the local NGO Tomriz took a lead role in targeting institutions such as secondary schools, colleges, and kindergartens to do outreach education activities. Tomriz assisted in conducting training sessions reaching 1,300 community members of which 300 were adolescents. The LNGO Healthy World was subcontracted by Engender Health to continue FP activities.

3.3.2 Managing Accessible and Sustainable Quality Health Care through Upgrading of Clinical Services and Management of Clinics

Health Providers: Both partners worked with the cadre of Master Trainers to provide training for a total of 625 peripheral health providers identified by the Community Component of the program from within its target communities. Partners worked collaboratively throughout the process, adding value to each component of the program. Upon approval of the FP and RH training manuals by the MoH, Master Trainers trained and monitored 121 gynecologists, 142 midwives, 297 PHC providers and 65 Pharmacists. All participants were equipped with the newly updated family planning textbook, “Clinical Guidelines on Family Planning for Obstetrician/Gynecologists”, a World Health Organization medical eligibility criteria wall chart, a family planning methods wall chart, family planning leaflets and a community education flipchart. Partner implementers monitored all training activities by the Master Trainer team to ensure quality and measure the application of training. Pre and post-test measurements indicated a knowledge increase of approximately 40% among the participants, positioning them well to serve as informed FP/RH resources in their work.

Ministry of Health and Regional Health Authorities: The NRHO proved to be an instrumental partner for the success of the program. The active involvement of these health authorities at BRHNs and the TWG provided a productive forum for stakeholders to discuss local FP/RH issues at a national level. The BRHNs brought decision makers as well as empowered Peer Educators and Aptek representatives into close collaboration, providing a great opportunity for advocacy-oriented exchanges on FP/RH issues. NRHO staff became advocates for the program, and they smoothed the relationships with the MoH regional staff as well as removing potential obstacles. The knowledge increase as a result of trainings for the professionals under NRHO could serve as a base for behavior change in the future.

As a result of AHAP efforts, the NRHO now has a four-part national standard training package of FP/RH materials to use among gynecologists, pharmacists, midwives and PHC providers. This will allow the NRHO to work independently to improve medical provider’s knowledge on FP/RH in Azerbaijan beyond AHAP.

Facility Rehabilitation: Save the Children contributed basic renovations of 45 health facilities to WHO standards with an average 29% community contribution. Although it was scheduled to rehabilitate 32 facilities, community enthusiasm and contributions encouraged paying attention to other facilities, for a total of 45. Renovations generally included complete rehabilitation of health rooms, but sometimes involved construction of extensions. Occasionally, provision of furniture and medical equipment was all that was required. The end result was always functioning rooms that could be used to provide quality FP/RH care or training.

Please see Annex E for FP/RH Sector Indicator Table

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 73 4. AZERBAIJAN REPRODUCTIVE HEALTH SURVEY

4.1 Program Overview

AHAP S.O. 2: To strengthen community involvement and capacity through participation and leadership

¾ AHAP I.R. 2.2. Communities organized and mobilized to manage more accessible and sustainable health care

The Azerbaijan Reproductive Health Survey (AZRHS) was undertaken from October 24, 2000 to December 31, 2002 with a total project cost of 164,615. (For more information on program extensions, please see Annex G) The Division of Reproductive Health (DRH) at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia was responsible for coordinating survey activities and provided technical assistance to the local implementing agency, the Adventist Development and Relief Agency (ADRA) in Baku. Funding was jointly provided by USAID— through the AHAP umbrella managed by Mercy Corps—as well as the United Nations Population Fund (UNFPA) and United Nations High Commissioner for Refugees (UNHCR). The AZRHS represented the first comprehensive attempt of its kind to gather information on the reproductive health (RH) status of women in Azerbaijan.

Major socio-economic and political changes, war, and population displacement are a few of the factors that had a profound effect on health needs and access to health care services in Azerbaijan. Within such an environment, the AZRHS was initiated to assess the reproductive health situation in the country in order to identify unmet programmatic needs and serve as a baseline for future studies or evaluations in the country related to women’s, family and reproductive health. The AZRHS was based on a CDC model that had been previously conducted in the former Soviet Republic of Georgia, and incorporated the following objectives: • To assess fertility, abortion, contraception and various other RH issues in Azerbaijan • To enable policy makers, program managers, and researchers to evaluate existing RH programs and develop new strategies • To study factors that affect fertility, contraceptive use and maternal and infant health, such as geographic and socio-demographic factors, breastfeeding patterns, use of induced abortion, and availability of family planning services • To identify characteristics of women at risk of unintended pregnancy • To identify high-risk groups and focus additional RH studies on them • To obtain data on the knowledge, attitudes and behavior of young adults 15-24 years of age • To provide data on the level of reported sexually transmitted disease (STD) symptoms and knowledge about transmission and prevention of HIV/AIDS • To provide data on women living in prolonged displacement

The project included sampling, pre-testing and the survey itself and resulted in the publishing of a survey report and conference on findings.

4.2 PROGRAM INTERVENTIONS

During the AZRHS project period, USAID funds enabled the implementing partner ADRA to undertake the following activities, in cooperation with CDC: • survey design and sampling • translation and printing of documents • pretest • staff recruitment • fieldwork • data entry

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 74 • data analysis • translation and printing of preliminary report • organization and execution of preliminary conference

Additional activities included in the cost extension were: • translation and printing of final report • organization and execution of final conference

Following the period of survey design based on the CDC model, sampling and pre-testing were undertaken to further prepare the survey for nationwide, population-based implementation. The pre- test was administered to a small group in Baku and other urban and rural settings to allow the team to test the questionnaire for the Azerbaijan context. The pre-testing period established the timetable for the resulting fieldwork and gave estimates of time for the questionnaire based on the experiences gained. Following the pre-test, the questionnaire was revised to suit the Azeri context.

The survey was conducted through fieldwork designed around four major timeframes for administering the questionnaires. An average of 27 individual questionnaires were completed each day, and revisits were not necessary in most cases, allowing the survey to be conducted in a shorter timeframe than initially anticipated. A total of 7,668 individuals ultimately participated in the survey, comprised of women aged 15-44. The response rate for the survey was 93%. The survey was designed to oversample in UNHCR intervention areas to create data specific to IDP reproductive health, while at the same time remaining balanced enough to provide for realistic figures of overall indicators in the country.

A nutrition element was also incorporated into the survey and was unique to implementation of reproductive health surveys in the region. This element was conducted by a separate nutritionist trained by CDC and included in each of the six survey teams. After interviews identified women of reproductive age with children under five years of age, respondents were informed of the opportunity to have the nutritionist attend the household with permission in order to take certain measurements of the woman and her children under five relating to nutrition and health development.

Following the conduction of the survey itself in which responses were gathered, data analysis was performed by CDC experts with support from ADRA partners in Azerbaijan. ADRA helped during this time by collecting supplemental information, such as specific statistical indicators from the government, source material for report referencing and non-governmental statistics. The analysis resulted in the drafting of a comprehensive report incorporating revision, clarification and translation as necessary with the significant assistance of the implementing partner ADRA.

The process of designing the report demanded close coordination with CDC to ensure that the Azeri version was as close a replication of the English template as possible. The printing of the Azeri language report was done in-country, and the report, numbering approximately 100 pages, was printed in a timely fashion for distribution at a preliminary conference. It was decided by CDC to entitle the report ‘Selected Findings’ in order to take into account the fact that certain data collected during the survey was not included in this report. This title conveyed the message that the final report would be a more exhaustive exposition of the findings of the survey.

Following the meetings held with CDC AZRHS staff, USAID, UNFPA and Ministry of Health (MoH), the report was published with the endorsement of the Government of Azerbaijan. This endorsement incorporated a secondary level of review, in addition to the ADRA review process outlined above. This was conducted by the MoH, which created a review committee to scrutinize the document and offered considered comments. This process was completed twice, with each set of comments discussed and responded to by ADRA and CDC. In many cases the comments of the MoH review committee were found to be beneficial, and were taken into account in the final revision of ‘Selected Findings.’ The achievement of Ministry of Health endorsement builds upon the original

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 75 intention of the survey to be a national baseline for future programming and research, and reflected the changing reality of US Government policy towards Azerbaijan with the waiver of Section 907 of the Freedom Support Act at that point in the process (when the AZRHS was initiated, Section 907 was in effect and thus precluded direct government involvement.) All comments incorporated into the report from the Ministry of Health were for the purpose of clarity and correctness, while ADRA made it clear to the review committee that no survey findings could be altered by the request of Ministry of Health or any other party in order to preserve the independent and objective nature of the survey.

Organization and execution of a preliminary conference to present the selected findings was conducted by ADRA. It was agreed that the MoH would host the preliminary conference at their conferencing facilities in the MoH building in Baku. This concurred with CDC requests for national ownership of the findings of the report. ADRA secured all necessary conferencing services including translators, simultaneous translating equipment, conference information kits and catering.

The conference took place on May 21, 2002. Attendance was approximately 140 individuals and included representatives from multilateral and bilateral donor agencies, implementing agencies, government and non-government entities and interested parties. Seven presentations were given by CDC and ADRA staff and key MoH personnel that corresponded to each chapter of ‘Selected Findings’: • Methodology • Characteristics of the sample • Fertility and pregnancy experience • Contraceptive knowledge and use • Pregnancy, delivery and breastfeeding • Women’s health • Knowledge and experience of sexually transmitted diseases

Following the conference, copies of the selected findings and, ultimately, the comprehensive survey report were prepared and made available for wide distribution throughout Azerbaijan.

4.3 ACCOMPLISHMENTS

The undertaking of AZRHS was successful in its goals to gather a picture of the reproductive health situation in Azerbaijan and provide a baseline point for future activities. The AZRHS survey and report continue to inform efforts related to the improvement of reproductive health status in the country, as evidenced by the nationwide RH health programming undertaken through AHAP in the years following the AZRHS documented elsewhere in this report. Specific positive outcomes of the AZRHS endeavor include the following:

• Completion of first comprehensive national statistics for reproductive and family health in Azerbaijan • Distribution of 6,500 packets on reproductive health and family planning information to survey participants • Cooperation in and ownership of the survey’s goals and contributions by national actors, such as was evidenced by the MoH logo and introduction by Minister Ali Insanov that appeared on the final report.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 76 5. FOOD ASSISTANCE

5.1 PROGRAM OVERVIEW

AHAP programming included the undertaking of a food distribution effort to relieve the vulnerability to hunger and malnutrition of IDP populations in Azerbaijan. The World Vision (WV) Food Assistance Program was thus implemented in 14 districts in the Northern, Central and Southern regions of Azerbaijan to ensure that IDPs in these areas had consistent levels of basic nutrition. World Vision distributed food in accordance with the World Food Program’s Protracted Relief and Recovery Operation and was awarded funding under the AHAP umbrella to help cover effective monitoring and control procedures for the distribution program. The program started July 1, 2002 and closed January 31, 2003 with a total budget cost of $74,993 and during which time it served over 180, 000 beneficiaries.

Ten years after the outbreak of the Nagorno-Karabakh conflict, 550,000 people remained displaced in difficult conditions, residing in a mixture of camps, railway wagons, single shelters and public buildings throughout the country. Although there were some improvements in food security due to continuing relief and development assistance programs, and due to the initiative of the people themselves, there remained a significant number of people who were substantially food insecure.

Food rations of a daily caloric level of 1,106 kcal were distributed from two offices, one located in the northwest and one in the southwest of the country. Distributions were made every two months, and distribution schedules were announced to local authorities and IDP communities. Distribution teams verified each beneficiary’s identity document as recorded in the beneficiary’s Commodity Control Card before rations were distributed, and the program had an exceptionally low commodity loss rate. Food rations included fish, peas, salt, sugar, vegetable oil, wheat flour and tea.

The Food Assistance Program also collected data, funded by WV Australia, to a) evaluate rates of malnutrition in children ages 6-59 months from the target population b) to identify variations in malnutrition among the districts receiving aid and c) to provide a platform to evaluate further response to IDP children concerns.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 77 5. Health and Nutrition SECTOR PROBLEMS ENCOUNTERED/LESSONS LEARNED AND IMPACT (including PHC – single sector and ICDP, FP/RH, RH Survey and Food)

PROBLEMS ENCOUNTERED/LESSONS LEARNED Primary Health Care

Community Peer Education Community peer education is a powerful and effective means of communicating health messages to community members, organizing the community around health issues, strengthening linkages between the community and the clinic and forming a foundation for community advocacy with local and district health officials.

Health Authorities As capacity building activities continue with the health providers, it is important to involve the district authorities as much as possible to enable them to provide back up support to the programs and to their staff in the future. Programs found this to be especially important in relation to training of health staff on technical/caregiving issues and the health information system. DHAs were involved in the training whenever possible and received extra training and mentoring to enable them to supervise their staff on these issues. Supervisory interactions were difficult both for the supervisors and for the health staff, as almost no supervision has happened in the recent past and the previous style was more about criticisms than mentoring for improvement. All programs found that consistent and regular interaction with health authorities on program issues began to change local policy and helped protect programming from outside interference.

Health Provider Training Health providers throughout the programs became very enthusiastic about receiving any technical training available. At the beginning of the program, many staff were reluctant to attend training, but after experiencing the new training style and the significant information they gained, they began to request training and, in one case near the end of the program, enthusiastically paid all of their own expenses while the partner only provided the trainer and materials. Improving the clinical skills of health providers increased the utilization rates of clinics and strengthened linkages between the community and their clinics. Providers were enthusiastic about serving the community often for the first time and, of course, the quality of care improved.

Community Health Funds/Cost Recovery Mechanisms Through two different models, communities became financially involved in health issues. The nine cost recovery mechanisms are totally clinic-based and are focused on the technical care provided in the community; over 120 community health funds are focused on building a fund in the community to assist: 1) individuals to deal with the health situations that arise, 2) the community as a whole to address public health needs and 3) bringing in health specialists to meet special clinical needs of the population. The cost recovery mechanisms are more complex, take longer to firmly establish in the community and, during the life of this project, were unable to attract a significant percent of the population. They do significantly improve the range of health services available in the community. The health funds are less expensive for community members, require relatively concise and simple training for establishment in a community, and attract large percentages of the community as members. Both strategies are effective, facilitate organizing the community around health issues, function as a way to mobilize financial resources for the community to use for health issues, and link the community with their clinics.

Government Decrees During program implementation, the GOA together with the MoH issued a decree to eliminate fees for health care throughout the country. This decree has been enforced to varying degrees depending on the political situation and the wishes of the Minister of Health at any given moment. It has

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 78 however been implemented absolutely in Nakhchivan and made a significant impact on health programming there. The community health funds that were to pay transportation costs for the mobile health units were closed down and the drug revolving funds that would have provided medication for very remote communities were not allowed to begin. In the remainder of the country, programs and communities have so far ensured the safety of their CHFs and cost recovery mechanisms by maintaining a strong supportive relationship with the DHAs. If the decree is enforced nationally, both the cost recovery programs and, to a slightly lesser extent, the CHFs would be at risk.

National Level Program – IMCI IMCI, as an internationally promoted method of addressing child and maternal mortality issues, is accepted in Azerbaijan but not funded or actively promoted. A network of the AHAP NGOs led by the Mercy Corps Child Survival Program pushed the IMCI agenda forward, involving the former IMCI coordinator. It was difficult, but possible, to implement the program with agreement from the MoH even though at higher levels they were not interested promoting the program. A group of Master Trainers were given a training of trainers and IMCI training was rolled out to AHAP areas. Other MoH staff were trained as monitors of the resulting clinical care. It is possible for NGOs to implement IMCI in selected regions of the country with minimal MoH acceptance, and INGOs are able to implement the community component of IMCI with minimal MoH involvement.

Reproductive Health/Family Planning

Peer Education Training women, men and adolescents as peer educators to communicate family planning messages to their peers in their communities proved to be an effective mechanism for delivering information at the community level. As has been true throughout AHAP, when people in the community gain new information and share that information with their peers, people are more likely to both listen and process the implications of the information for their own behavior. Supporting a peer education program through its startup is a time and human resource consuming process; however, when peer educators are well trained and committed they contribute significantly to attitude changes in the community.

Electronic Media The use of electronic media is a very effective way to reach the broader population and begin to change attitudes. The media reinforces messages from peer educators and health professionals, produces informed consumers of health care and creates a general awareness of the issues that professionals and peer educators can then build upon. Two of the significant challenges identified by the program are: 1) it is very costly to measure the effective reach of the media and therefore indicators are costly to measure and, 2) the technical demands for creation and production of effective messages are significant.

Obstetricians/Gynecologists Ob/Gyns are slow to change their ways of practicing medicine regardless of the training and education they receive, but many will make some changes with continued input. The financial implications of changing are much too great for radical change. Those who are making some changes often are willing to conduct information sessions in the communities as a way to build up their client base; however, it is important to closely monitor the information they give to be sure community members are receiving consistent messages. The programs discovered that younger Ob/Gyns, who do not have a long-established abortion practice, are much more willing to incorporate contraceptive technologies into their practice and to deliver community education sessions, especially as those sessions serve as an entry point that will build relationships with potential clients.

Other Health Professionals Primary health care physicians, midwives, nurses and feldshers also received training in modern contraceptive methods through the program. It was found that these groups were much more open to

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 79 the new information and more willing to incorporate it into their practice. They, of course, have much less to lose as they generally do not perform abortions and see the modern methods as a way to increase their practice.

Apteks With major efforts to increase the demand for contraceptives there must be an increase in supply. There is virtually no public supply of contraceptives and the supplies through the Apteks, especially in the rural areas, are generally inconsistent. Therefore there is a need for significant work with Aptek owners and staff to increase their technical knowledge about modern contraceptives. With a program staff person dedicated to the Apteks in an area, it was possible to increase knowledge and the ability to provide correct basic information to customers while at the same time increasing their motivation to stock more consistent supplies of modern contraceptives. It is important to remember that the Apteks are part of the private sector and programs need to be adapted to meet their needs.

Advocacy Networks Regional advocacy networks are effective mechanisms to pull together reproductive health stakeholders from community to district levels to address the needs for RH policy change. These networks require time and program support to come together and to develop enough strength to effect change as the concept is relatively new to Azerbaijan. In addition, they were much more effective after the health professionals had been trained in family planning skills and those professionals could add their “weight” to the discussions. By the end of the program, several of them were able to effect changes in RH programming through lobbying different government agencies.

Ministry of Health It is very difficult, time consuming and vitally important to work with the Ministry of Health. The Ministry, during the life of this project, has had an agenda that often did not complement the program agenda. When those agendas conflicted, the program came to a halt until a compromise was reached. The amount of effort demanded to maintain a reasonably productive relationship with the Ministry should not be underestimated and it is critical that this level of effort be built into the program. Without doing what it takes to maintain a working relationship with the MoH, it is not possible to implement sustainable health programming.

Azerbaijan Reproductive Health Survey

Ministry of Health It was critically important to have the involvement of the Ministry of Health in this process even though Section 907 was in place at the beginning of the survey project and the project was designed to stand alone with little input from the Ministry. The AZRHS was and still is a sensitive issue in Azerbaijan, both because the subject is very personal and because the implementation was conducted without direct governmental influence. However despite the odds, the survey was completed without any major problems. After the suspension of Section 907, extra efforts were made to engage the MoH in the results of the survey. Through hard work and persistence, key governmental representatives became actively involved in the final stages of the program and were part of the preliminary conference and data presentation, thus claiming a sense of ownership of the findings. The Ministry of Health provided written approval of the preliminary findings of the survey and the Preliminary Report carried the Government of Azerbaijan Ministry of Health logo and preface by the Minister of Health—giant steps considering the obstacles overcome throughout the life of the project. As has become apparent in the years since the publication of the survey results, the MoH still finds the data in the report difficult to accept and still publicly and frequently criticizes the data. The official letter from the former Minister of Health gives the report important legitimacy in spite of the ongoing criticism.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 80 IMPACTS:

• The population in target areas is now raising rural health concerns with DHAs, requesting changes in personnel allocation and local policy as a result of community mobilization and effective peer education efforts as well as increased skills of trained health providers. DHA are responding. Communities are also organizing themselves within a community/cluster to solve minor health problems by themselves.

• As a result of the Bridge to Reproductive Health Networks advocating for improvement in FP/RH issues, local, regional and central level authorities are better informed about FP/RH issues. Authorities are beginning to reinstate outreach activities by gynecologists thereby meeting a significant need in rural areas.

• Through intensive peer education and IEC interventions for both PHC and FP/RH, vast numbers of people have been reached with basic health information, helping individuals and communities develop sustainable self-help approaches to maintaining healthy families.

• As a result of open trainings, formation of adolescent discussion clubs, and prioritizing the involvement of parents, adolescents’ access to FP training was established and is beginning to be institutionalized. This is especially important considering that the provision of FP/RH information to adolescents has been virtually nil in public or educational settings.

• Men are beginning to acknowledge their role in spread of STIs, countering traditionally held tendencies to locate responsibility for sexual illness, infertility, etc. solely on women. As a result of the program opening up a forum to address “taboo” issues, there is more open (and lively) discussion, particularly among men. Men are also increasingly willing to approach STI Clinics for advice and treatment. In addition, the RH/FP program final survey showed that there was a 27 % increase in people who spoke with their partners about FP.

• The quality of Primary Health Care services in target facilities improved as a result of on-going skill training and monitoring for health professionals. In addition, the quality of FP/RH services is improved with 625 health providers trained, and there is a dramatic increase in the amount of FP/RH information available both to professionals and the general public.

• District health authorities are now able to use modern techniques for supervision and management of professional personnel. In some cases, they are even beginning to use their own resources to provide supervision of local health facilities.

• Initial steps have been taken with district health authorities to improve the regional health information system (HIS). A health statistics database was established in pilot central district hospitals and basic health information is collected on a monthly basis and analyzed by health authorities to take correct and timely decisions on the management of district health care.

• The MoH now has a trained cadre of IMCI master trainers and a cadre of trained monitors with experience implementing IMCI clinical training in the rural areas of the country.

• The multiple mass media components utilized in the FP/RH program had a direct impact in highlighting FP issues and the role of local and international NGOs working in Azerbaijan to address these issues in cooperation with government mechanisms. The final survey showed a 19% increase in the knowledge in the target population in general. Even if the population did not receive direct training, they benefited indirectly through the mass media brochures on FP topics, videos, public service announcements, and films on FP that were shown in rural areas.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 81 • In addition, the final survey showed that there was a knowledge increase of + 26 % in the total population of the target districts on all the FP methods from the baseline survey; increases in the percent of the total population of the target districts using modern contraceptives specifically: Pills (+5%), IUD (+6%), and Condoms (+8%) compared with the 2001 RH Survey. In the Baseline Survey, more than half of the respondents refused to answer the question about their current contraceptive method while all respondents answered this question in the Final Survey therefore comparison with the Baseline is not possible.

• The Final Survey also showed a decrease of 16.9% in the number of abortions the respondents reported “in the past year” from the Baseline Survey, from 30% who reported an abortion “in the past year” in the Baseline to 13.1% who reported an abortion “in the past year” in the Final Survey.

• Contraceptive demand of Apteks increased, sales condoms increased by 115% and sales of oral contraceptives increased by 44%. One pharmacist who is a member of a BRHN also started to sell contraceptives at cost to encourage the population to make the choice for modern contraception without increasing the financial burden to them.

• There are now at least two rehabilitated health facilities in each of the 17 target districts where community members can go for FP examinations, counseling, and group trainings. The improved physical quality of these facilities lends a feeling of privacy and security to patients accessing FP/RH care or advice, while increasing community pride over improved health care facilities and the role that community members have played in realizing them. Facilities were also used for professional training for Gynecologists, Midwives, Peripheral Health Providers and Nurses.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 82 III. MANAGEMENT

A. OVERVIEW

Mercy Corps began managing the USAID-funded Azerbaijan Humanitarian Assistance Program (AHAP) umbrella grant in January 1998. AHAP I was a two year, $17 million initiative funding 16 programs that were implemented by 10 international implementing partners (IPs). The programs provided assistance in the following sectors: Shelter, Health & Nutrition, Information, Economic Opportunities and a pilot Integrated Community Development program. The programs were implemented in a wide range of regions throughout Azerbaijan especially providing support in areas where IDPs had resettled.

In 2000 AHAP transitioned from the provision of humanitarian assistance to long-term development activities under AHAP II. This second phase was a reflection of a change in the needs of the communities served, the attitudes of the Government of Azerbaijan, renewed hopes for peace, and the evolving priorities of USAID and other donors to meet the challenges of the resettlement and social economic reintegration of IDPs and refugees. While the vast majority of the IDP population still faced deplorable conditions, by 2000 the humanitarian crisis had stabilized and some of the immediate needs of IDPs had been met. AHAP II was a six year, nearly $40 million program funding 18 programs through eight international implementing partners in the following areas: Primary Health Care, Nutrition, Community Development, Economic Opportunities, Reproductive Health and Integrated Community Development. AHAP II was implemented in 23 regions.

Mercy Corps issued ten requests for applications (RFAs) over the course of the umbrella, and funded and managed a total of 34 programs with 16 partners through multiple extensions.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 83

1. HISTORY OF AHAP AWARD AND MODIFICATIONS

Mercy Corps International (MCI) responded to USAID’s RFA # M/OP-98-003 issued on September 12, 1997 with a closing date of November 12, 1997. On February 2, 1998, MC received confirmation of the award under Cooperative Agreement # EE-A-00-98-0005-00 to implement the “Azerbaijan Humanitarian Assistance Program” (AHAP) over a three year period. The effective date of the award was January 15, 1998 to January 14, 2001. The total estimated grant amount was $17 million. Out of the total estimated amount of $17M, the management cost was estimated to be $3,537,176. The original obligation was $1 million in March of 1998 and in August 1998; two obligations were made for $5,930,000 (Modification #1) and $4,000,000 (Modification #2) respectively, making the total obligation $10.93 million.

MCI issued RFAs in 1998 and awarded a total of $13,294,064 in subgrants in the fields of Health, Economic Opportunity, Shelter and Food. A total of 16 subgrants were awarded under AHAP I. Under the above stated obligated funds, a separate subgrant was awarded for the frontline area of Goranboy after Congress provided earmarked funds of $2.9M for the frontline area. In January 1999, an additional obligation of $2,109,113 (Modification #3) was awarded, taking the total obligation to $13,039,113 in June of 1999. Additional obligation for an amount of $3,960,887 via Modification #5 was made, making the total obligation equal to the estimated amount of $17,000,000.

On November 4, 1999, USAID issued modification #7 to the Cooperative Agreement (CA), increasing the total estimated amount and total obligation by $2,213,535.

On March 27, 2000, USAID issued another Modification #8 to the CA increasing the total estimated amount to $45,000,000 and obligated an additional $12,681,868 mainly to issue RFAs for programs geared to transitional development in emergencies. Out of the total of $45,000,000 an amount of $39,362,443.00 was estimated for subgrants, leaving $5,637,557 for the management cost. In May 2000, Modification #9 was issued to the CA making an additional obligation of $2,738,479 and also amending the end date to January 14, 2003. MC awarded 14 more subgrants to cover interventions in the fields of Health, Economic Opportunity and Community Development.

On June 19, 2001 Modification #10 to the CA was issued raising the obligation by $6,105,000 to a new total of $40,738,882. As a result of an RFA on an integrated approach to community development, two subgrants were signed in July 2001. A special subgrant for $75,000 was awarded to World Vision under the Food sector to support the management costs of their World Food Program (WFP) activities.

On May 20, 2002 Modification #11 to the CA was issued raising the obligated amount by $4,261,118 and making the total obligated amount equal to the estimated amount of $45,000,000. Once again the CA was fully funded.

Through Modification #12, issued on May 19, 2003, USAID raised the total estimated amount to $51,111,788 but obligated only an additional amount of $5,500,000. The end date of the CA was once again extended to January 14, 2005. Through the new obligation and as a result of an RFA, two reproductive health subgrants were awarded. A cost extension was also awarded to the 10 ongoing subgrants. The revised new budget total of $51,111,788 carried a total amount of $43,158,089 for subgrants.

Two additional Modifications #13 and #14 were made on June 28, 2004 and on July 29, 2004 for an amount of $661,630 and $5,000,000 respectively. The purpose of these additional Modifications was to increase the time periods of the CA through January 14, 2006 and to provide funds for cost extensions to the eight ongoing subgrants. Currently, the total estimated cost of the umbrella stands at $56,911,788 with an obligated amount of $56,511,630 through Modification #16 dated August 26, 2005. A total of 34 subgrants were awarded and the adjusted total of the subgrants stands at $47,486,580. Under the terms of the budget for the CA, MC was required to subgrant a total of $47,980,589.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 84 B. SUBGRANT MANAGEMENT

1. RFAs ISSUED

The AHAP program was launched by issuing three RFAs (Economic Opportunities, Health and Shelter) on February 4, 1998, which led to the award of 13 subgrants between May 7 and June 8 of that year for a total of $7,841,000.

On December 4, 1998 an RFA was issued to solicit proposals for the integrated village project with an earmark from within the AHAP budget of $2.9 million for the liberated areas in Azerbaijan. Five proposals were received in response to the RFA. A consortium led by CARE was awarded the Goranboy Integrated program. The project site selected was Goranboy district and the program operated from May 1999 through November 2000.

AHAP II was launched with three RFAs being issued on February 14, 2000 for the Economic Opportunities, Community Development and Health sectors. Applicants were given six weeks to respond and a total of 16 organizations submitted 29 proposals in response to RFAs. Of the 16 organizations that applied, seven had not received AHAP funding in the past. Proposals counted by sectors were: Economic Opportunities – 10, Community Development – 9 and Health – 10. The division of proposals by regions was: Central area – 16, Southern area – 9, Urban area – 5, and Nakhchivan – 4. Eleven awards were made.

One RFA was issued on October 6, 2000 for the Social Investment Initiative (SII). Applicants were given six weeks to respond to the RFA. Three organizations submitted proposals in response to the RFA; each of them had received AHAP funding in the past. One award was made and the program operated from January 2001 through October 2002.

One RFA was issued on March 2, 2001 for the Integrated Community Development Program. Applicants were given six weeks to respond to the RFA. A total of eight organizations submitted proposals in response to the RFA. Two awards were made and the programs operated from July 2001 through September 2005.

An RFA for Reproductive Health, the final RFA, was issued with USAID approval on April 22, 2003. A total of ten organizations submitted expressions of interest. Mercy Corps held an applicants’ conference on May 6, 2003; official responses to questions were vetted with USAID and then posted on May 12, 2003. Four submissions - each representing a consortium of agencies - were received by the stated May 30, 2003 deadline. All four of the lead agencies were AHAP partners; however, some of the consortium members in the submissions were new to Azerbaijan. Eight of the ten agencies that had expressed an interest in the RFA were represented in the final submissions either as lead agencies or as consortium members. Two awards were made, one to implement the National Component and one to a consortium of three agencies to implement the Community Component. The National Component operated from August 1, 2003 to September 30, 2004 and the Community Component operated for one additional year until September 30, 2005.

2. SUBGRANT STATUS: Negotiations, Award, Extensions, and Closeout of Subgrants by sector (For more information on program extensions, please see Annexes F and G)

2.1 Closed Subgrants

HEALTH

• ADRA (H-01): On May 1, 1998 MCI / USAID funded the Nakhchivan Health Assistance Project (NHAP). This was an extension of the previous Nakhchivan Emergency Health Initiative (EHI), funded by SCF / USAID. NHAP’s initial LOP completed on October 31, 1999 with an approved budget of $735,166. Following ADRA’s submission of a cost-extension proposal (NHAP-CE), and cooperation between ADRA and MCI, MCI / USAID approved NHAP-CE, extending NHAP

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 85 until April 30, 2000. The extension amount was $269,857, thus increasing approved budget to $1,005,023. However ADRA submitted their final adjusted expense report for $981,252. The grant closed with final adjusted expenses of $962,796.

• International Rescue Committee (H–02): IRC implemented a Women and Health program starting in 1996. The AHAP grant focused on family, women and children’s health through education, increased access to health facilities and community participation. This grant was also funded by MCI/USAID from May 1998 till October 1999 with an approved budget of $421,515. The grant was extended till December 1999. The final report submitted by IRC was for $353,700. The grant closed with final adjusted expenses of $348,554.

• Relief International (H-03): Relief International was also among the first partners of MCI/USAID. They received a health grant in May 1998. The original grant period was until October 1999 with a total approved budget of $916,947. This grant received a cost extension starting from November 1999 till April 2000 for $306,698 thus increasing the total budget to $1,223,645. A further one-month no-cost extension was awarded for the month of May in 2000. RI subgrant #H03 ended its period on May 31, 2000 and the final expenses were $1,223,366, which is under the approved budget by $279. No capital assets were procured under this subgrant and there were no unused supplies. The grant closed with final adjusted expenses of $1,223,366.

• UMCOR (H-04): UMCOR continued its Primary Health Care project activities targeting IDPs in medical points in the ECHO Camps (6 clinics), 2 medical points in Fizuli and Imishli and 5 Clinics in Baku/Absheron District. The original subgrant period was for 18 months from May 1, 1998 to October 31, 1999 with an approved budget of $802,604. A cost extension for six months was granted in November 1999. The cost extension increased the Total Estimated Cost (TEC) for the subgrant by $175,655 to a new subgrant total of $978,259. The new closing date for the project was extended to April 30, 2000. A one-month no-cost extension for UMCOR’s Health Care Program was approved and the revised project period was from May 1, 1998 to May 31, 2000. UMCOR H-04 was going to receive an additional twelve month cost extension starting June 1, 2000. However, due to some organizational problems, MC replaced UMCOR with ADRA for the implementation of the CDC RH survey. The total expense of the UMCOR subgrant was $966,044. The grant closed with final adjusted expenses of $965,737.

• UMCOR/Baylor Health Partnership (H 05): In July, the UMCOR/Baylor Health Partnership project was initiated with two Baku hospitals (Republican Center of Surgery; and Mir-Kasimov Republican Clinic Hospital). The project duration was July 28, 1998 to July 27, 1999 with an approved budget of $408,432. In August, UMCOR received USAID approval for a three-month no-additional cost extension of the UMCOR/Baylor Hospital Partnership project. The new closing date for the project was October 31, 1999. The grant closed with final adjusted expenses of $408,432.

• IRC (H-08): The İRC project proposal for Community Health Program in Central Area of Azerbaijan under Azerbaijan Humanitarian Assistance Program (AHAP) was approved by MCI/USAID with a total budget of $1,200,000 for a period of thirty months effective as of May 1, 2000 to October 31, 2002. IRC was awarded an eight month cost extension for subgrant # H-08 from November 1, 2002, through June 30, 2003. The original subgrant period had an approved budget of $1,200,000. The requested eight-month extension increased the TEC for the subgrant by $201,112. The grant total was $1,401,112. The grant closed with final adjusted expenses of $1,221,988.

• ADRA (H–10): The purpose of this subgrant was to provide financial support to Adventist Development and Relief Agency (ADRA), for implementing a “Nationwide Survey on Family Planning and Reproductive Health”. The original period of this subgrant was from October 24, 2000 to December 31, 2001 with an approved budget of $149,615. A cost extension was approved for the subgrant #H-10 under AHAP covering the CDC survey, to expire on December

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 86 31, 2002 with an additional amount of $15,000, adjusting the grant total to US $164,615. The grant is closed with final adjusted expenses of $164,615.

FOOD ASSISTANCE

• World Vision (F-01): This program had distributed supplementary food rations in partnership with World Food Program for over 4 years in Azerbaijan. Mercy Corps International approved a grant to World Vision (WV) with the sum of $317,027. This subgrant started May 1, 1998 through the period ending December 31, 1998. This subgrant received a cost extension for six months from January to June 1999, to support the continuation of food distribution. Under the approved budget, the cost-extension was $291,805 increasing the total approved to $608,832. The second cost extension of subgrant # F-01 was approved, the subgrant was extended from July 1, 1999 through December 31, 1999 and the total subgrant budget increased from $608,832 to $859,962. The extended amount was $251,130. Another cost extension for the food distribution subgrant # F-01 for January1, 2000 to July 31, 2000 period was approved with additional funds of $299,942, thus increasing the total approved budget to $1,159,904. Lastly, one month no- additional-cost extension and budget realignment of subgrant #F-01 was approved. The revised subgrant period was May 1, 1998 to August 31, 2000. The grant closed with final adjusted expenses of $1,144,602.

• WV (F-03): The purpose of this subgrant was for Mercy Corps (MC) to provide financial support to World Vision (WV) and for the Food Assistance Program for IDPs. The period of this subgrant was from July 1, 2002 to January 31, 2003 with an approved budget of $74,993. The grant closed with final adjusted expenses of $74,993.

SHELTER

• CARE (S-01): A subgrant agreement was signed with CARE USA for a sum of $1,527,169 to fund the Community Action for Shelter & Public Infrastructure Assistance Needs (CASPIAN) Project. This subgrant was effective as of May 1, 1998 to October 31, 1999. The project was given a cost extension up to March 31, 2000 with additional funds of $223,487. Approved budget was increased from $1,527,169 to $1,750,656. The grant closed with final adjusted expenses of $1,750,636.

• IRC (S-02): The purpose of this subgrant was for Mercy Corps to provide financial support to International Rescue Committee and the Community-Based Shelter Project. The total estimated amount of this subgrant for the period was $898,704. The period of this subgrant was from May 1, 1998 to October 31, 1999. The grant closed with final adjusted expenses of $888,687.

• WVI (S-03): WV continued its public building rehabilitation (PBR) project in the urban centers of Baku and Sumgait. MCI/USAID approved a subgrant to World Vision for a sum of $1,500,000 to fund the Community Shelter Rehabilitation Project, effective as of May 1, 1998 through the period ending October 31, 1999. A three months cost extension was approved for $287,922 thus increasing total approved budget to $1,787,922. The new period of subgrant was May 1, 1998, through January 31, 2000. The grant closed with final adjusted expenses of $ 1,779,740.

ECONOMIC OPPORTUNITIES

• ACDI/VOCA (E–01): The purpose of the program was to increase the incomes of IDP families through training in improved food preservation, processing and marketing techniques. This subgrant to ACDI/VOCA was awarded for the Food Preservation and Processing Income Generation (FPPIG) project. The period of this subgrant was from September 1, 1998 to September 30, 1999. The total estimated amount of this Subgrant for the period was $224,859. A no-additional-cost extension was given for October 1, 1999 through December 31, 1999 period. The grant closed with final adjusted expenses of $221,941.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 87 • ARC (E-02): The purpose of this subgrant was for Mercy Corps International (MCI) to provide financial support to the American Red Cross (ARC) and for ARC/ICRC’s Assistance to Vulnerable Population in the Frontline Districts - The Agricultural Sustainability Component project. The proposal was originally submitted in the first round of RFAs. After the initial subgrant was approved, ARC requested a major change in the budget. The final agreement was signed August of 1998. The total budget of this subgrant for the period was $191,845. The period of this subgrant was from May 1, 1998 to November 30, 1998. This subgrant expired on November 30, 1998. The subgrant fully achieved its targets. The subgrant spent $26,636 less than their allocated budget. The grant closed with final adjusted expenses of $165,209.

• CAD (E-03): Funding to Children’s Aid Direct (CAD) for the Agricultural Credit and Training Scheme was secured from MC in May 1998 under AHAP. The period of this subgrant was from May 1, 1998, to October 31, 1999. The total approved budget amount of this subgrant for the period was $402,882. A three month no additional cost extension for subgrant #E-03 from November 1, 1999 to January 31, 2000 was approved. The original subgrant period was for 18 months effective May 1, 1998 with an approved budget of $402,883. The grant closed with final adjusted expenses of $235,401.

• WVI (E-04): The purpose of this subgrant was for Mercy Corps to provide financial support to World Vision Relief & Development for the Azerbaijan Enterprise Fund (AZEF). The total approved budget of this subgrant for the period was $500,000. The period of this subgrant was from May 1, 1998, to October 31, 1999. After four months, a no-additional-cost extension was approved. The new project period was May 1, 1998, to February 29, 2000. The grant closed with final adjusted expenses of $380,000.

• ADRA (E-05): This subgrant was to provide micro-credit on agriculture and related activities to approximately 820 families in the Nakhchivan Autonomous Republic. Project period was for 21 months from February 1, 1999 to October 31, 2000 and had a budget of $578,209. The grant closed with final adjusted expenses of $392,932.

• ACDI-VOCA (E-08): The purpose of this subgrant was to integrate the economic activities of IDPs, refugees, and the local population through market chain participation and broadening technical and managerial capabilities.. The project’s total funding was $1,200,000 with a project period from June 15, 2000 to June 14, 2002. ACDI/VOCA’s Subgrant # E-08 budget had final expenses of $1,184,745 which was $15,255 less than the allocated budget. The grant closed with final adjusted expenses of $1,184,745.

LIBERATED AREA

• CARE (L-01): The overarching emphasis of the Goranboy Integrated Program was community mobilization to implement the integrated programs. Integrated program sectors included: health, shelter, public infrastructure, economic opportunities and mass information. This 19-month subgrant was started in May 1999 and ended November 30, 2000. The grant closed with final adjusted expenses of $2,265,165.

MULTI SECTOR

• SC (M-01): The subgrant was finalized in January 1999 with an effective date of September 1998. Save the Children implemented the AzerWeb project to disseminate information electronically to the international community on humanitarian assistance activities. The subgrant period was September 1, 1998 to August 31, 1999 with approved budget of $170,000. Save the Children’s request for a five-month no additional cost extension of subgrant #M-01 was approved. The extension period allowed AzerWeb to transition into a social research center, which ultimately provided financial and institutional sustainability to the overall operations. With this extension, the subgrant period was September 1, 1998 to January 31, 2001. The grant closed with final adjusted expenses of $160,935.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 88

COMMUNITY DEVELOPMENT

• SC (CD-01): The original subgrant period was for 30 months effective May 1, 2000 to October 31, 2002 with an approved budget of $1,409,278. Save the Children was granted an extension for eight months from November 1, 2002 thru June 30, 2003. The requested eight-month extension increased the TEC for the subgrant of $218,608 to a new subgrant total of $1,627,886. The grant closed with final adjusted expenses of $1,596,713.

• IRC (CD-03): MC/USAID approved IRC’s Community Development Program in the Southern area of Azerbaijan with a total budget of $1,100,000. The project was approved for a period of twenty-seven months effective on August 1, 2000 to October 31, 2002. A nine-month cost extension was granted for IRC’s Southern area Community Development Project (CDP) subgrant # CD-03 from November 1, 2002 thru July 31, 2003. The original subgrant period was for 27 months effective August 1, 2000 with an approved budget $1,100,000. The nine-month extension increased the TEC for the subgrant by $162,797 to a new subgrant total of $1,262,797. The grant closed with final adjusted expenses of $ 1,221,988.

SOCIAL INVESTMENT INITIATIVES

• CHF (SII-01): The subgrant period for the Social Investment Initiative under AHAP was from January 15, 2001 thru October 31, 2002 with an approved budget of $4,999,793. The final financial report for subgrant expenses totaled $4,999,793.

REPRODUCTIVE HEALTH

• IMC (RH-01): The International Medical Corps in collaboration/subcontract with John Hopkins University was awarded a subgrant for the National Component of the Reproductive Health program. The approved budget was $428,000 for the time period of August 1, 2003 to September 30, 2004. The grant closed with final adjusted expenses of $427,939.

2.2 Subgrants Pending Closure

HEALTH

• ADRA H 06: Mercy Corps subgranted to ADRA $1,200,000 to fund the Nakhchivan Health Development Program. The subgrant was effective as of May 1, 2000 ending October 31, 2002. The first cost extension for its NHDP subgrant #H-06 was granted for eight months from November 1, 2002, through June 30, 2003. The original subgrant period was for thirty months effective May 1, 2000, with an approved budget of $1,200,000. The requested eight-month extension increased the Total Estimated Cost (TEC) for the Subgrant by $211,693. The proposed subgrant total was $1,411,693. A second cost extension was granted to ADRA for fifteen months for its Nakhchivan Health Development Program (subgrant # H-06) from July 1, 2003 through September 30, 2004. The previous subgrant period was for 38 months effective May 1, 2000 with an approved total budget $1,411,693. The requested fifteen-month extension increased the TEC for the subgrant by $407,399 to a new subgrant total of $1,819,092 with ending date of September 30, 2004. The third twelve-month cost extension to ADRA for its Nakhchivan Health Development Program (subgrant # H-06) from October 1, 2004 through September 30, 2005 was granted. The previous subgrant period was for 53 months effective May 1, 2000 with an approved total budget of $1,819,092. The twelve-month extension increased the TEC for the subgrant by $449,998 to a new subgrant total of $2,269,090 with an ending date of September 30, 2005. The grant is under closure process.

• IMC (H 07): A subgrant agreement was signed between Mercy Corps and International Medical Corps (IMC) for the Community Based Primary Health Care Development Program in Southern area. Subgrant period was from May 1, 2000 to October 31, 2002. The total estimated amount of

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 89 this subgrant was $1,097,911. A cost extension was approved for the period starting from November 1, 2002 to May 15, 2003 with an increase of $214,936 for the period. A no-additional cost extension for subgrant #H-07 through June 7, 2003 was approved. A further twenty-three day cost extension from June 8, 2003- June 30, 2003 was given with additional cost of $26,554. Another fifteen-month cost extension for IMC for its Community Based Primary Health Care Development Program from July 1, 2003 through September 30, 2004 was approved. The previous subgrant period was for 38 months effective May 1, 2000 with an approved total budget of $1,339,400. The requested fifteen-month extension increased the TEC for the subgrant by $324,788 to a new subgrant total of $1,664,188 and with a proposed ending date of September 30, 2004. A final cost extension for IMC for its Community Based Primary Health Care Development Program from October 1, 2004 through September 30, 2005 was approved. The requested twelve-month extension will increase the Total Estimated Cost (TEC) for the subgrant by $349,995 to a new subgrant total of $2,014,184 and with ending date of September 30, 2005. The grant is under closure process.

• Pathfinder (H-09): This subgrant was awarded to Pathfinder International for Primary Health Care Program in the Urban Area. The original period of this subgrant was from May 1, 2000 to October 31, 2002 with an approved budget of $599,745. Pathfinder International requested a nine month cost extension for subgrant #H-09 from November 1, 2002, through July 31, 2003 which was approved by MCI/USAID. The original subgrant period was for thirty months effective May 1, 2000, with an approved budget of $599,745. The nine-month extension increased the TEC for the subgrant by $183,229. The subgrant’s total was $782,974. The grant is under closure.

ECONOMIC OPPORTUNITIES

• CHF (E-06): This grant was awarded to CHF for its Community Employment and Economic Opportunity Program (CEEOP). The grant period was May 1, 2000 thru October 31, 2002 and the approved budget was $1,000,036. An eight month cost extension from November 1, 2002 thru June 30, 2003 was approved under the grant. The original subgrant period was for 30 months effective May 1, 2000 with an approved budget of $1,000,036. The requested eight-month extension increased the TEC for the subgrant by $217,004 to a subgrant total of $1,217,040. A second fifteen-month cost extension was approved for CHF’s Community Employment and Economic Opportunities Program (CEEOP) subgrant # E-06. This extension carried the grant from July 1, 2003 through September 30, 2004. The previous subgrant period was 38 months commencing May 1, 2000 with an approved total budget of $1,217,040. The requested fifteen- month extension increased the TEC for the subgrant by $320,933 bringing the new subgrant total to $1,537,973 with an approved ending date of September 30, 2004. A final three-month cost extension for CHF’s Community Employment and Economic Opportunities Program (CEEOP) subgrant # E-06 was approved. This extension carried the grant from October 1, 2004 through December 31, 2004. The previous subgrant period was 53 months (including an eight-month and a fifteen-month extension) commencing May 1, 2000 with an approved total budget of $1,537,973.00. The requested three-month extension increased the TEC for the subgrant by $74,185, bringing the subgrant total to $1,612,158. The grant is pending closure.

• SC (E-07): The Economic Opportunities subgrant #E-07 for Community Based Lending and Savings Program was awarded to Save the Children (US). The grant period was May 1, 2000 through October 31, 2002 with an approved budget of $1,000,036. Save the Children requested a nine-month cost extension and realignment of budget for subgrant # E-07 from November 1, 2002 through July 31, 2003. This was subsequently approved. The original subgrant period was for twenty-nine months effective June 1, 2000, with an approved budget of $1,451,169. Save the Children discovered an error in the calculation of the current ICR rate in the amount of $8,492. To compensate for the error of calculation, SCF requested $8,492.00 in additional funds. This brought the grand total to $1,459,661. Two additional cost extensions were granted to SC E-07 subgrant. The first one was for $98,282 from August 1, 2003 to December 31, 2003 and the second one was for $218,453 from January 1, 2004 to September 30, 2004. In September 2004, the subgrant was again extended from October 1, 2004 through June 30, 2005. The subgrant

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 90 period was for 51 months (including the nine-month previous extension) effective June 2000 with an approved total budget of $1,776,395. The requested nine-month extension increased the TEC of the subgrant by $208,701 to a subgrant total of $1,985,097. A further extension of 3 months carried the grant until September 30, 2005 with a cost extension of $54,664 and a final budget of $2,039,761. The last no additional cost extension was granted until December 2005. This extension did not include management oversight from MC. The grant is pending closure.

• ADRA (E-09): The original subgrant period was for 24 months effective November 1, 2000 to October 31, 2002 with an approved budget of $882,005. An eight month cost extension was approved for subgrant # E-09 from November 2002 through June 2003. The requested eight- month extension increased the TEC for the subgrant by $217,333 to a subgrant total of $1,099,338. A fifteen-month cost extension was awarded to subgrant # E-09 from July 01, 2003 through September 30, 2004. The subgrant period was for 32 months effective November 1, 2000 with an approved total budget of $1,099,338. The requested fifteen-month extension increased the TEC of the subgrant by $350,000 to a new subgrant total of $1,449,338. The proposed ending date was September 30, 2004. A no additional cost extension was granted for the period October 1, 2004 to January 31, 2005. A further eight-month cost extension for ADRA’s Nakhchivan Economic Development Program (subgrant # E-09) from February 1, 2005 through September 30, 2005 was approved. The previous subgrant period was for 51 months effective November 1, 2000 with an approved total budget of $1,449,338.00. The requested eight-month second extension increased the TEC for the subgrant by $275,000 to a new subgrant total of $1,724,338 with an ending date of September 30, 2005. The last no additional cost extension was granted until December 2005. This extension did not include management oversight from MC. The grant is pending closure.

COMMUNITY DEVELOPMENT

• WV (CD 02): The original subgrant period was 24 months effective July 3, 2000 to June 30, 2002 with an approved budget of $899,715. World Vision’s formal request for a nine-month cost extension for the Urban Community Development Project (UCDP) subgrant #CD-02 was approved. The project period was July 1, 2002 thru March 31, 2003. The nine-month extension increased the TEC for the subgrant by $229,963. The subgrant total was $1,129,679. World Vision requested a three-month cost extension for the project from April 1, 2003 thru June 30, 2003. The request was approved. The three-month extension increased the TEC for the subgrant by $59,777 to a subgrant total of $1,189,456. The subgrant was further extended for fifteen months from July 1, 2003 through September 30, 2004. The subgrant period was for 36 months effective July 3, 2000 with an approved total budget $1,189,456. The fifteen-month extension increased the TEC for the subgrant by $321,816 to a new subgrant total of $1,511,272 with approved ending date of September 30, 2004. A twelve-month cost extension was granted to WV for its Urban Community Development Program (UCDP) subgrant # CD-02 from October 1, 2004 through September 30, 2005. The twelve-month extension increased the TEC for the subgrant by $399,898 and the subgrant total to $1,911,170. The grant is in the process of closure.

INTEGRATED COMMUNITY DEVELOPMENT (ICD)

• SC (ICD-01): This subgrant was awarded to Save the Children for their Central area Integrated Community Development Program. The total amount approved was $2,200,000 for July 1, 2001 to October 31, 2003. Save the Children (SC) requested an eleven-month cost extension for its Integrated Community Development Program (ICDP subgrant # ICD-01) from November 1, 2003 through September 30, 2004, which was approved. The original subgrant period was for 28 months effective July 1, 2001 with an approved total budget of $2,200,000. The eleven-month extension increased the TEC of the subgrant by $850,000 to a subgrant total of $3,050,000. Save the Children was granted a further twelve-month cost extension for its Integrated Community Development Program (subgrant # ICD-01) from October 1, 2004 through September 30, 2005.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 91 The twelve-month extension increased the TEC of the subgrant by $974,996 to a subgrant total of $4,024,996. The grant is in the process of closure.

• IRC (ICD-02): The subgrant to the International Rescue Committee (IRC) was for implementation of the Southern Area Integrated Community Based Development Program (ICBD). The total approved budget was $2,799,984 covering the period from July 1, 2001 to October 31, 2003. IRC was granted two extensions for this grant. The original subgrant period was for 28 months effective July 1, 2001 with an approved total budget of $2,799,984. The first extension was for eleven months from November 1, 2003 to September 30, 2004 with a cost extension of $542,921 for eleven months. A twelve-month cost extension from October 1, 2004 through September 30, 2005 was granted with additional $831,506 in funds. The subgrant total became $4,174,411 after both extensions. The grant is in the process of closure.

REPRODUCTIVE HEALTH (RH)

• SC (RH 02): The purpose of this subgrant was for Mercy Corps to provide financial support to Save the Children (SCF-USA), in partnership with United Methodist Committee on Relief (UMCOR) and International Relief and Development, Inc. (IRD), for their “Program for Family Planning Reproductive Health Initiative.” It was for fourteen months starting from August 1, 2003 and ending September 30, 2004. The initial approved budget was for $1,200,000. The grant received a twelve-month cost extension. This extension carried the grant from October 1, 2004 through September 30, 2005. The twelve-month extension increased the TEC for the subgrant by $1,499,996 bringing the subgrant total to $2,699,996. The grant is in the process of closure.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 92

C. MONITORING AND OVERSIGHT

1. MONITORING

Program monitoring was the primary vehicle for managing the AHAP umbrella and staying in touch with IP leadership and field staff and for tracking challenges and program progress. Implementing partners were provided with a monitoring plan including objectives and requests for site visits regarding specific issues in advance of the visit. The final itinerary and schedule were negotiated with the partner, and the monitoring plan was based on partner proposals, especially the logical frameworks and Gantt charts. The exact nature of the monitoring visits evolved over time, responding to the changing programming in AHAP. For the last years of AHAP, the monitoring visit included in- depth discussions in field offices with program managers, field staff and partner LNGOs, site visits to communities or agencies implementing specific program components and an optional “wrap-up” session for interested staff and leadership to share the initial monitoring visit findings. The wrap-up served as an opportunity check the perceptions of the monitoring team and clear up any misinformation; a chance to raise issues or concerns with the implementation team and to begin the problem solving process; a time to reinforce any suggested linkages with other AHAP or non-AHAP programs; and an opportunity to look forward to the work ahead and to anticipate challenges facing the program. A comprehensive monitoring report was submitted to the IP after each visit. In the report, and in the wrap-up discussion that preceded it, Mercy Corps made recommendations for modifications to the program as necessary; these recommendations were followed up on at the next monitoring visit.

During the rapidly changing environment of AHAP I and start-up phases of AHAP II, monitoring visits to the projects were made every two or three months. One of the lessons learned from AHAP I was the necessity to facilitate collaboration and cooperation between the AHAP-funded programs. This was a difficult issue to confront and frequent monitoring during the early years of AHAP II assisted in reinforcing this message. With the start of the two ICDP projects, the need for interagency coordination and leveraging programming across agencies became even more evident; again, the frequent monitoring to a broad geographic area rather than to a specific agency program assisted in changing the usual agency specific focus to one that involved all agencies serving those particular regions. Fortunately, as agencies began collaborating and coordinating with each other, the need for more frequent monitoring decreased. Monitoring every two or three months became unnecessary and USAID’s mid term evaluation of the umbrella recommended that monitoring visits be reduced to two per year. The focus of monitoring visits shifted back to individual programs rather than to all partners in a certain geographic area. The new focus on individual program allowed for increased attention to the technical aspects of programs once the issues of collaboration and networking had been addressed.

One of the ongoing issues dealt with through monitoring was the need for programs to continue the transition from relief to development by empowering communities, and eventually clusters, to take responsibility for their own development. This “next step” was particularly difficult for IPs to operationalize as their staff preferred to actually implement rather than move to a facilitation role. Monitoring enabled Mercy Corps to continually reinforce this message and help programs, and individual staff, to understand the importance of this program shift to the long term development process.

In addition, Mercy Corps met periodically with individual partners to deal with specific programmatic or management issues and with USAID as necessary to report on issues needing their consideration. Project monitoring and individual discussions enabled Mercy Corps to report to USAID on the status of key program activities, progress toward objectives and help ensure program compliance with USAID guidelines. These discussions also allowed Mercy Corps to respond to programmatic shifts such as the Government of Nakhchivan Autonomous Republic (GNAR) attack on the ADRA EO programming or developing a draft loan capital disposition criteria for USAID to use as they considered disposition to the Mercy Corps MFI grantees. Discussions also addressed matters concerning IP program management challenges and other larger issues affecting program

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 93 implementation. Additionally information from monitoring and all interactions with IPs fed into future project planning, RFA development and developing potential directions for the multiple program extensions.

2. COMPLIANCE

Mercy Corps required that the partners maintain a high level of compliance with USAID rules and regulations and provided demand-driven support to all partners on issues related to finance and compliance throughout their subgrants. Mercy Corps maintained a constructive relationship with the Government of Azerbaijan (GOA), enabling the subgrants to also comply with the evolving GOA laws on tax, VAT, personnel and other issues.

As minor compliance issues arose, Mercy Corps dealt directly with implementing partners, individually or in groups, to assure their compliance with USAID and GOA regulations.

3. EVALUATIONS AND ASSESSMENTS

A number of evaluations and assessments were conducted concerning AHAP. Some of these were undertaken by implementing partners for specific subgrants while others were for the umbrella as a whole. USAID also conducted several assessments not directly related to the umbrella; however they provided insights into the activities implemented under the umbrella. They are as follows: 3.1 AHAP Level:

• September 2004: external evaluation of two AHAP MFI programs conducted by external consultant Kershaw Burbank Jr., Ph.D. hired by Mercy Corps. The Scope of Work (SOW) was to evaluate the status of the two MFI programs and to provide specific recommendations for steps that each program should take in order to continue their development towards sustainability as a stand-alone micro finance institutions. • September - October 2003: sustainability assessment of the two AHAP ICDP programs. Conducted by external consultant, Dr. Terry Bergdall, hired by Mercy Corps. The SOW was to complete a general technical assessment of progress to date; to evaluate the overall efficacy of mechanisms, systems and approaches with a particular focus on the integrated and clustering aspects of the programs; to examine the sustainability of interventions; to determine upcoming challenges and opportunities; and to determine specific actions necessary to help each program promote further self-sufficiency. • March 2003: external evaluation of two AHAP MFI programs conducted by external consultant Ms. Lauren Hendricks hired by Mercy Corps. SOW was to evaluate the status of the two MFI programs and to provide specific recommendations for steps that each program should take in order to continue their development towards self-sufficiency. • October 2002: external evaluation of the overall AHAP umbrella. Conducted by MetaMatrix, independent evaluators hired by USAID. The SOW was to evaluate the program and management structure of AHAP and to determine efficacy of the umbrella and of Mercy Corps as the umbrella manager. • February 1999: external evaluation of the overall AHAP umbrella. Conducted by Judith Watson, Independent Consultant and submitted to USAID/Baku. The SOW was to conduct a review of progress toward achieving the objectives set out at the start of AHAP one year previously.

3.2 IP Level:

• September 2005: internal final evaluation survey of IMC’s Community Based Primary Health Care Development Program (subgrant H-07) conducted by IMC staff. The internal evaluation/survey compared knowledge and attitudes in “control” and “intervention” communities. The evaluation report was not available at the time of writing this report and the partner reports that it will be submitted directly to USAID in late January 2006.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 94 • September 2005: external final evaluation of IRC’s Integrated Community Development program (ICDP) (sub-grant ICD-02) conducted by external consultant Ms. Kerry Abbott. The SOW was to evaluate program activities including the sustainability of micro-projects; the effectiveness of community and cluster organizations, the durability of local NGO partners’ to support community development activities; the training effects on individuals and established entities; the effectiveness of health interventions—trainings and micro-projects; the level of viability of seven enterprises; the status of relationships among all key stakeholders and the degree of collaboration; and effective and less effective program aspects. • September 2005: evaluation of ADRA’s Nakhchivan Economic Development Program (NEDP) (sub-grant E-09) conducted by external consultant Graham Perrett. The SOW was to evaluate the effectiveness of the program in meeting the basic economic needs of recipients; assess the target population’s competence and prospects for continuing sustainable and effective economic development activities; and identify lessons learned from the program. • August 2005: final evaluation of ADRA’s Nakhchivan Health Development Program (NHDP) (sub-grant H-06) conducted by independent consultant Robert Mark Weeks jointly with two MoH doctors. The SOW was to evaluate program impact, status, management and implementation; effectiveness of health education approach; relationships and interrelationships between key stakeholders including MoH; extent to which GNAR pressures and challenges have impacted the program; as well as identify key lessons learned and recommendations for other strategic health interventions and operational relationships with the MoH and other partners in the NAR. • August 2005: external final evaluation of World Vision’s Urban Community Development Program (UCDP) (sub-grant CD-02) conducted by Ms. Harriet Epstein. SOW was to assess compliance with contract obligations. • December 2003: external evaluation of ADRA’s Nakhchivan Health Development Program (NHDP) (sub-grant H-06) conducted by external consultant Dr. Robert Mark Weeks. The SOW was to evaluate program impact and achievements; program management and implementation; strategic and operational relationships with key stakeholders in Nakhchivan; and to conduct an interim assessment of the program’s transition from direct service delivery to capacity building. • September 2003: internal evaluation of ADRA’s microfinance program (subgrant E-09) conducted by external consultant Mr. Paul Bouwmeester. The purpose was to review operations and human resources practices and procedures and to develop suggestions for improvement, where needed. • July 2003: external evaluation of IRC’s Community Development Project (subgrant CD-03) conducted by Dr. Emily C. Moore. The SOW was to evaluate the program overall, particularly focusing on impact and sustainability of micro-projects, effectiveness of community organizations, and impact of trainings and linkages between various stakeholders. • June 2003: external evaluation of IRC’s Community Health and Development (CHD) Project (subgrant H-08) conducted by external consultant Dr. Lea Bethune. The SOW was to evaluate the overall program with particular focus on the sustainability of health care services by the CHD clinics; impact of trainings for medical professionals, community members and media; effectiveness of community organizations formed through CHD; and linkages with other stakeholders • June 2003: internal survey of Pathfinder’s Primary Health Care Program (subgrant H-09) conducted by the Azerbaijani Sociological Association. The purpose was to examine effect/efficiency of the reproductive health activities carried through the program including beneficiary knowledge, attitudes and practices. • March – April 2003: assessment of CHF’s Community Employment and Economic Opportunity Program (CEEOP) (subgrant E-06) conducted by external consultant Mr. Tim Canedo. The purpose was to develop an assistance strategy to build the capacity of selected BDS providers. • September 2002: impact survey of CHF’s Social Investment Initiatives (SII) program (subgrant SII-01) conducted by Ms. Donna Jean Frago. The purpose was to conduct a

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 95 comprehensive survey of SII’s impact on building the organizational capacity of community groups. • June 2002: assessment of CHF’s Community Employment and Economic Opportunity Program (CEEOP) (subgrant E-06) conducted by the external consultant Mr. Carlos Murillo. The SOW was to conduct a comprehensive survey on CEEOP’s impact and to carry out market research for the Southern region.

3.3 USAID Level:

• February 2005: Micro Enterprise Umbrella Program study – the study conducted by Mr. Charles Johnson was to analyze the advantages and disadvantages of “umbrella programs” for micro enterprise and micro finance development and provide improve guidance to missions on whether and how to design and implement umbrellas. • December 2004: Community Development and Economic Developments - an assessment team was fielded to help USAID explore options for a community-based social and economic development program in Azerbaijan to follow the Azerbaijan Humanitarian Assistance Program, which is scheduled to end on/about September 2005. The task was to determine if and how USAID should continue community mobilization efforts to advance social and economic development and meet the needs of the poor and other vulnerable groups. • December 2004: Primary Health Care - describes the context within which further USAID initiatives will operate, outlines a number of important problems and potential areas of intervention in general, analyzes a number of specific gaps and issues identified over the course of the two week assessment, and provides a set of recommendations to the Mission. • September - October 2004: Civil Society - assessment conducted by a three-person assessment team in Azerbaijan from September 27 to October 22, 2004. The assessment was to evaluate the state of development of the Azerbaijani civil society sector and provide recommendations for the future direction of USAID civil society assistance. • February 2004: Primary Health Care - advance assessment on the general state of health care in Azerbaijan conducted by Richard Greene and Sangita Patel. The purpose was to assess the health situation, in particular, maternal and child survival interventions in areas with greatest needs.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 96

D. REPORTING

1. NARRATIVE AND FINANCIAL REPORTING

Mercy Corps and the Implementing Partners reported formally on the programs on a semiannual basis. Through AHAP I and to May 2002 in AHAP II, the reporting schedule was based on the timing of the original AHAP I grant award. Grantees had 30 days after the end of the semi annual period to report to Mercy Corps on their programs and Mercy Corps had 30 days to consolidate their reports into the report to USAID. In October, 2002, USAID changed the reporting period to coincide with the USG fiscal year and the reports were then due May 15 and November 15; 45 days after the end of the semi annual period. Mercy Corps and the partners worked together to schedule the respective reports to ensure USAID had the information in a timely manner.

Mercy Corps also supported USAID through considerable informal reporting and assisted in data and information preparation for USAID’s annual report. Mercy Corps provided information and consultation on a wide variety of topics as requested by USAID officers, and also submitted periodic programmatic updates, held in-depth meetings with USAID/Baku and Tbilisi technical support staff regarding health and economic issues, and participated in and organized meetings with IPs for USAID’s evaluations, sectoral assessments and the umbrella mechanism assessment. Mercy Corps organized the 1999 mid-term evaluation in collaboration with USAID, participated in the 2002 evaluation and assisted with the 2005 umbrella case study.

Throughout AHAP, Mercy Corps also continued to provide financial data required on a quarterly basis for the USAID local mission’s reporting requirements and met with the USAID financial team regarding financial pipeline information as requested.

2. INDICATORS

Mercy Corps supplied USAID/Azerbaijan with the information they needed to report to USAID/ Washington through the AHAP Consolidated Indicator Chart and the Consolidated Secondary Indicator Chart. These tables can be found at the end of the Executive Summary and in Annex E.

2.1 Strategic Objective (SO) Level Indicators

AHAP I: During AHAP I, sectoral indicators were developed and provided to bidders in the RFAs for inclusion in their proposals. The lower level indicators reported on by IPs generally feed into the intermediate level indicators. The multiple AHAP I indicators were consolidated for this report by sector. For specific information on AHAP I indicators please see Annex D.

AHAP II: AHAP II programming began in May of 2000 and in September 2000 Pricewaterhouse Coopers (PWC) vetted sector specific indicators and indicator definitions to the AHAP partnership that would be in place throughout the life of AHAP. PWC also developed SO level indicators intended to track the impact of the overall program. There were some problems with those indicators and changes were made as are reflected below.

• Nutrition: This SO level indicator identified in the Performance Management Plan (PMP) was the “Nutritional status of children under five.” Data was collected early in AHAP II on this indicator; however, Mercy Corps and USAID had extensive conversations about the difficulties associated with the meaningfulness of this data for the indicator, and difficulties were exacerbated by the limited available resources. After receiving input from Mercy Corps, USAID explored options for resolving this issue and eventually determined to eliminate the indicator altogether. Mercy Corps received written notice from USAID that the indicator had been officially removed and that Mercy Corps and its partners no longer were required to report against it. Therefore, nutritional information does not appear in this Final Report.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 97 • Morbidity/Mortality: Information on this SO level indicator was collected as per PMP instructions from the same six communities throughout the life of AHAP II. Unfortunately information from the two communities in Nakhchivan was unavailable from 2003 onwards since the MoH assumed responsibility for managing the health facilities and did not allow the data to be collected. During FY 2005 much of the population of the two IDP camps representing the Southern area communities was resettled and so it is difficult to compare the data across time. Data from the Central area was collected throughout the project. These indicators were reported on annually to USAID.

Working with its implementing partners, Mercy Corps collected the required data for both the crude mortality rate and the morbidity rate for FY 2005: October 2004 to September 2005. The baseline for the crude mortality rate is 3.6 per 1,000 population for the period of June to November 2000. The baseline for the morbidity rate is 70.7 per 1,000 population for the same period. The identified communities for data collection are:

Central: Hoylu (Goranboy), Garadagli (Agdam)

Southern: Sharg (Beylagan), Camp # 1 (Saatli) Due to resettlement of the IDPs, the population of the Camp# 1 decreased from 4,800 to 350 and the population of the Sharg in Beylagan decreased from 2,100 to 1,620 during fiscal year 2004.

Nakhchivan: Nahajir (Julfa), Garab (Babek) – did not report because of resistance from GNAR. As previously discussed with USAID, AHAP was unable to collect morbidity/mortality data from the Nakhchivan communities due to the fact that the clinics have been handed over to the Nakhchivan MoH and they are resistant to collecting the data themselves.

Crude Mortality Rate: Crude Mortality Rate is calculated as the number of deaths per 1,000 population over a period of time. Mortality rate is considered one of the safe livelihood indicators and an observed decrease might indicate improvement of the livelihood of the targeted population. The baseline data reported to USAID (3.6 deaths per 1,000) was based on six months worth of data whereas the comparable information is based on 12 months of data. Adjusted for one year, the baseline data would be 7.2 deaths per 1,000 population per year. Calculation for fiscal year 2005 indicates 7.1 deaths per 1,000 population per year. The crude mortality rate for FY 2005 is higher than that of 2004. Mercy Corps and its partners believe that this increase can be mainly attributed to the improvements in data collection practices and Health Information Systems in the AHAP communities. Cardiovascular diseases continue to be the leading cause of mortality amongst the eight categories of diseases that were tracked in FY 2005

Morbidity Rate: Morbidity Rate is calculated as the number of sick people per 1,000 population per year. General morbidity was calculated as well as proportional morbidity for five pre-selected groups of diseases. Proportional Morbidity analyses did not reveal a disturbing prevalence of any disease group. Acute Respiratory Infections (36%) are the leading cause of morbidity in the targeted communities followed by Cardio-Vascular Diseases (25%), Musculo-Skeletal Disorders (19%), Urinary Tract Infections (11%), and Diarrheal Diseases (9%). The low level of diarrheal diseases in the overall morbidity figures could be due to massive education campaigns on nutrition and hygiene throughout AHAP II implementation.

The general morbidity rate is 544.9 for fiscal year 2005, two times the baseline data, correcting for the differing reporting periods. A review of activities and data for intermediate results indicators has revealed the following reasons behind the high reported morbidity:

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 98 • Training health professionals in local health centers enabled better recognition and reporting on diseases and earned the trust of communities resulting in people seeking care at the local level. • Local health centers have been renovated, supplied with basic equipment and pharmaceuticals, and now provide additional health services enabling patients to receive care locally rather than seeking medical assistance elsewhere. • Newly established community peer education services introduced early recognition of health conditions and increased the referrals to local health centers. • District Health Authorities (DHAs) are releasing district level specialists to make outreach visits to see patients at local clinics.

The increase in morbidity rate is a result of improved reporting and increased utilization of services at the health centers and needs to be viewed as a program success. A review of the results of both indicators demonstrates that pre-selected communities are managing more accessible, affordable and better health care-- a required prerequisite for safe livelihood. This achievement would not be possible without multi-sectoral interventions that enable the community to take responsibility for segments of the health care system, health education and outreach services.

2.2 IR Indicators

As mentioned above, PWC developed indicators that were operational throughout AHAP II. These indicators served the program well through the original grant period however, during the three major extension periods that followed, the field programs evolved beyond what the indicators could capture with partners taking more of a facilitative rather than a direct implementation role. Mercy Corps then worked with the IPs to develop secondary indicators that would give USAID a more accurate picture of the actual program accomplishments.

In addition in early 2003, USAID held a workshop on the PMP attended by USAID grantees and a few AHAP IPs representatives. The training was modified for local staff of IPs, translated into Azeri and was rolled out to the AHAP partnership by a coalition led by Mercy Corps.

• Usefulness of Indicators: As mentioned above the indicators developed by PWC were generally appropriate for the initial grant period, however, because the subgrants were extended annually many of the indicators outlived their usefulness. The indicator definitions were a continual challenge especially as the programs evolved and they needed to be remarkably specific in order to result in consistent information. The secondary indicators, developed by AHAP attempted to fill the gap and provide some useful information on the project. Also, of course, they are output indicators and are not qualitative indicators. Determining a way to gather information on the effects of the activities would have been interesting but was not possible because it was not built into the Partner’s programs originally. If we could have learned if the school attendance went up after a school was rehabilitated or if children had less diarrheal disease after a potable water supply was completed, that would have been more interesting.

Specifically the EO indicators generally were productive with the exception of the ones on both Financial Services and Business Development Services tables dealing with businesses started and jobs created. In both cases, the program interventions targeted very small businesses – usually family businesses. Most of the time these businesses existed before the intervention and the activity allowed them to slowly expand. This meant that a particular family member simply worked more time with the business. This is certainly growth, but is not easily quantifiable to equal a job. The amount of effort that would be required by the program to track actual % increases of family members’ time working in all of these businesses would not be at all cost effective. Likewise, indicators that deal with training participants applying training, is also problematic. It would require considerable effort to track the attribution of jobs and businesses to the training programs. Again, if this is used in the future, serious thought needs to be put into

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 99 what actual information is needed and how feasible and cost effective it would be to gather accurate information to meet the indicator demands.

• Data Quality Assessment: Mercy Corps worked with all partners to conduct a data quality assessment over several reporting periods mid way through AHAP II. During this assessment a variety of difficulties were encountered, most particularly in identifying a complete list of breakout numbers from the early periods of the projects. Mercy Corps included the available numbers in the Life of Project (LOP) data, realizing that they will provide relative, if not actual, comparisons. The partnership has continued to update the data as needed and the final adjustments were made with the closeouts of the grants just completed. Indicator targets continue to be included in the final tables and reflect the targets from the multiple extensions to each subgrant. The final numbers are included in the AHAP II indicator tables found in Annex F.

2.3 AHAP II Secondary Indicators

The programmatic diversity created by the multiple extensions required a thorough process for determining appropriate secondary indicators. This challenge began early in 2003 and continued throughout the life of AHAP as Mercy Corps worked with partners and USAID to develop additional secondary indicators for each of the program sectors. These indicators needed to be concrete and uniform as well as meaningful, while also being broad enough to encompass the wide variety of activities and the multiple programs IPs were implementing. As a result of a detailed internal process, Mercy Corps developed several potential sector specific indicators with draft definitions. Consultations were then held with partners to solicit their feedback. As a result of the discussions these indicators and their definitions were narrowed down and refined. In each instance, the additional indicators and definitions were discussed with USAID and after approval, were reported on by IPs in the following semi annual report. After their first use, partners often identified problems with the indicator or more usually, with the definition. Adjustments were made as necessary and the indicators were subsequently reported on as adjusted.

The following Secondary Indicators were developed by the partnership and approved by USAID:

Community Development (CD): The following secondary indicators were reported on by CD partners starting in early 2003.

1. Number of community groups organized in nascent communities as a result of mentoring by experienced communities.

2. Number of community-led projects completed by leveraging non-AHAP resources. (includes information on the total project cost as well as the variety of resources for the project).

3. Number of Municipal Councilors/employees directly involved in community activities together with community groups (includes number of Municipality people trained and involved in community projects).

Community Development (CD): The above CD secondary indicators were adapted and added to for the remaining single sector CD program and the CD portion of the Integrated Community Development Programs (ICDP). Reporting on these indicators began in fall of 2004 and included some information from the previous periods.

1. Number of community groups organized in nascent communities as a result of mentoring by experienced communities.

2. Number of groups (community & cluster) applied/registered (includes information on the types of registration applied for and received).

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 100 3. Number and value of community-led projects completed with non-AHAP resources (includes information on the total project cost as well as the variety of resources for the project).

4. Number of Municipal Councilors/employees directly involved in community activities together with community groups (includes number of Municipality people trained and involved in community projects).

Primary Health Care: The health and ICDP health secondary indicators were reported on starting in the spring of 2005 and included information from the previous period and in some cases, included information IPs collected from the start of their programs.

1. Number and percent of target health facilities supervised/monitored by regional health authorities.

2. Number and percent of communities served by medical specialists through outreach visits.

3. Number of outreach visits to communities made by medical specialists.

4. Number and percent of child health care providers successfully completing training on IMCI (includes a breakout of health provider specialties).

5. Number of community members trained by Peer Educators on health topics (includes gender and migration breakdown).

Reproductive Health: FP/RH secondary indicators were developed immediately after the awards of the two subgrants, were reported on starting in fall 2003 and revised during the first full period of program operations.

1. Number of national family planning training modules developed and approved by the MoH and meet international standards

2. Number and percent of direct recipients of training and capacity building by NRHO master trainers, applying training

3. Number of individuals who have received Family Planning and Reproductive Health information through Peer Educators.

4. Utilization rates of Apteks for Family Planning and Reproductive Health.

Economic Opportunities - BDS: The ICDP BDS secondary indicators were reported on starting in the spring of 2005 and included information from the previous period

1. Percent of total repayment made to communities/clusters by enterprises (includes the percent of the investment paid to date).

2. Number of formal and non-formal linkages made between suppliers and buyers.

3. Average monthly income per extension agent in US$ (includes gender and migration status breakdown).

3. PROGRAM IMPACT

Mercy Corps requested that AHAP partners assess the programs and report on how the people and/or institutions in the project area are now different as a result of the program interventions over the life of the project. Because the indicators covering AHAP are output indicators and not impact indicators, the following information would be lost without specific attention. A summary of the Program Impact information follows:

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 101

• Community leaders, deeply engaged in assisting communities to address community level issues, were recognized as effective leaders by community members and in December 2004, 408 of these leaders were elected to Municipal Councils – some as Municipal Council leaders. These people, and others that may follow, are now in a position to strengthen the local development program, to broaden the reach of a culture of transparency and engagement, and eventually to influence development at higher levels.

• Cluster entities representing 15–30 communities are being recognized by Government officials, Municipalities, and Local and International NGOs as partners in the regional development process. Members of cluster groups are contributing participants in structures implementing government-funded development programs and are also representing their communities by addressing cluster level issues and raising funds through different donors and private donations.

• Men are beginning to acknowledge their role in the spread of sexually transmitted infections (STIs), countering traditionally held tendencies to locate responsibility for sexual illness, infertility, etc. solely on women. As a result of the program opening up a forum to address “taboo” issues, there is more open (and lively) discussion, particularly among men. Men are also increasingly willing to approach STI Clinics for advice and treatment.

• As a result of open trainings, formation of adolescent discussion clubs, and prioritizing the involvement of parents, adolescents’ access to FP training was established and is beginning to be institutionalized. This is especially important considering that the provision of FP/RH information to adolescents has been virtually nil in public or educational settings.

• Contraceptive demand of Apteks increased. Sales of condoms increased by 115% and sales of oral contraceptives increased by 44%. One pharmacist who is a member of a BRHN also started to sell contraceptives at cost to encourage the population to make the choice for modern contraception without increasing the financial burden to them.

• The FP/RH final survey showed that there was a knowledge increase of + 26 % in the total population of the target districts on all the FP methods from the baseline survey; increases in the percent of the total population of the target districts using modern contraceptives specifically: Pills (+5%), IUD (+6%), and Condoms (+8%) compared with the 2001 RH Survey. In the Baseline Survey, more than half of the respondents refused to answer the question about their current contraceptive method while all respondents answered this question in the Final Survey.

• The final survey also showed a decrease of 16.9% in the number of abortions the respondents reported “in the past year” from the Baseline Survey, from 30% who reported an abortion “in the past year” in the Baseline to 13.1% who reported an abortion “in the past year” in the final survey.

• The Nakhchivan Ministry of Health has become an active partner calling for increased acceptance and support of health education interventions, changing the focus from curative care towards preventive care and decreasing the number of hospitals during the life of this project.

• Regional health authorities are now able to use modern techniques for supervision and management of professional personnel. In some cases, they are even beginning to use their own resources to provide supervision of local health facilities.

• Micro finance program efforts have established a credit culture in program areas and consolidated the presence of sustainable MFIs in rural Azerbaijan that cater effectively to the needs of the local community. By increasing activities in remote or underserved areas, the institutions are poised to provide much-needed services beyond the life of the program.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 102 • Extension Agents are helping men and women farmers to diversify their crops, improve their yields, increase the efficiency of their farm operations by pooling land and operational resources, and improve overall farm management. Farmers appreciate these services and are paying for them so that with the income and prestige, EAs are remaining engaged in their revitalized careers.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 103

E. COORDINATION AND INFORMATION SHARING

1. PUBLIC INFORMATION/PUBLIC RELATIONS (PI/PR)

AHAP I: AzerWeb was managed by AHAP and expanded activities through outreach with 56 presentations resulting in inputting 60 documents per month and 73 new links, as well as holding 6 steering meetings. The Goranboy Information team identified and trained three Community Liaison Groups, established three community bulletin boards, and held multiple information exchanges.

AHAP II: A Public Information (PI) team was formed to help provide coordination and information to the AHAP partnership and to develop PI Communication Tools which included the following: AHAP Bulletin; EO Bulletin; AHAP Brochure; Conference Concept Papers; MC Azerbaijan web site; Conferences; Workshops. From mid-2003 Mercy Corps limited their PI/PR functions to maintaining existing tools in compliance with requirements from USAID in the Mercy Corps CA Extension.

• Publications and Media Productions: Mercy Corps: Starting January 2001 Mercy Corps began issuing the AHAP bulletin which provided important information for each sector. The bulletin featured articles covering topics such as the AHAP partnership’s achievements, specific project activities, and interviews with community leaders. The EO bulletin targeted field-based staff with updates on the Azeri economy and a snapshot of the micro business activities in the country. These bulletins evolved to a bi-monthly “Partnership News” newspaper in January 2003 that allowed the AHAP partnership to better address its information, coordination and public relations needs and to reach an even broader audience than before. In addition, an AHAP brochure highlighted information on AHAP program activities. Mercy Corps and AHAP partners also assisted UNFPA in developing the “Community FP/RH Manual” now used throughout the country.

Partners: AHAP partners produced bulletins and newsletters to share information and raise awareness of their activities. These included the following: IRC’s quarterly the “New Way Newsletter” bulletin; ADRA’s monthly “ADRA Bulletin” and “Healthcare bulletin;” Pathfinder International’s quarterly “Pathfinder Bulletin”, IMC’s health information newsletter, “Insan, Meishet, Cemiyyet”, (Health, Daily Living, Society) and a jointly prepared “Taraqqi” bulletin. FP/RH Consortium member IRD developed several mass-media TV programs on “Birth Control Pills” and IUD’s and articles were published in the newspaper Ganja Basar. The MoH and ADRA developed six radio spots in Nakhchivan.

• Website, Database and Resource Center: Mercy Corps designed the interactive website www.mercycorps.az in English and Azeri that included comprehensive information on AHAP by regions, partner agencies and programs. Additionally, the web site provided a unique opportunity for all key stakeholders to access online the AHAP Database and overview of Mercy Corps Resource Center materials. A multi-purpose database was developed to track the key indicators for measuring the program achievements and to identify geographic and programmatic gaps in regions. The resource center managed by Mercy Corps provided a collection of information recourses to meet the informational needs of AHAP Implementing Partners and to facilitate Mercy Corps’ role for quality programming through a variety of activities. The resource center consisted of 700 books, video recordings, various newspapers and magazines mainly in the sphere of Community Development, Health, Business and Economics, Environment and Civil Society. Upon closing of AHAP, Resource Center materials on health and EO were sent to USAID.

• Media Relations: Mercy Corps media relations included various press releases regarding the launch of new programs, partnership information and events such as the “National Community Development Conference,” (NCDC), “Micro Finance Conference” and “The World Refugee Day.” In addition, as part of the media campaign for NCDC, Mercy Corps facilitated a successful Media Workshop to educate journalists in preparation for the conference. As a follow on to NCDC, Mercy Corps organized a media tour to the regions to create an opportunity for the

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 104 Azerbaijan media to see projects and beneficiaries in person and to gain a deeper understanding of CD methodology and accomplishments. Mercy Corps also fulfilled a major role by assisting Internews with preparation of a 30-minute educational TV program on community development activities in Azerbaijan that was broadcasted on ANS, and in six regional TV channels.

2. COORDINATION

2.1 AHAP Partnership Level Coordination

AHAP Coordination constituted one of the core functions in AHAP’s overall management. It required appropriate negotiation skills, consistency and persistency. It was necessary to reconcile interests of the partners with the USAID agenda, transform messages coming from the donor into policy actions and work with the implementing agencies to legitimize those actions in the eyes of the partner, in order to make them see it as their own objectives.

• USAID: During the entire program period Mercy Corps maintained constant formal and informal communication with USAID on a wide variety of programmatic and management issues. This included keeping USAID informed about the status of the programs, collaboration on RFA development, discussion on extension strategies, semiannual report discussions, maintenance of administrative and compliance issues and others. In addition, field trips and briefings were organized for both US Embassy and USAID representatives and consultants from Baku, Tbilisi and Washington DC. These frequently necessitated arranging meetings with implementing partners and/or visits to multiple partner project sites.

The US Embassy and the USAID leadership took very seriously and played a crucial role in addressing the situation with the ADRA’s micro-finance program in Nakhchivan. Multiple visits of the US Ambassador and the USAID’s Country Representative to Azerbaijan in summer-fall 2004 and their direct negotiations with the GNAR helped to find a solution to the problem.

• Extensions: The necessity to extend grants several times during the life of the program and provide cost and no-cost extensions was a challenge to the entire partnership. It was important to ensure there were appropriate bridges between initial project plans and later interventions, and keep talented personnel. The extensions did however provide an opportunity for Mercy Corps to reinforce coordination messages to partners and to influence the program direction on a yearly basis.

• Partnership Meetings: Mercy Corps held regular meetings with IPs each semi annual period during which major issues were discussed. Before each extension, similar extension meetings were conducted. During those meetings Mercy Corps provided partners with additional information concerning the USAID strategy and changes in the strategy. Very often sectoral meetings occurred as well around such issues as secondary indicators, management of difficult relations with the MoH, Integrated Management of Childhood Illnesses (IMCI) coordination meetings and the monthly EO IP meeting. The topics discussed in EO IP meetings included methods for accessing female clients, marketing skills, and group development methodology. Throughout AHAP, Mercy Corps conducted meetings for IP Country Directors on an as-needed basis.

• Inter-Agency Meetings: Mercy Corps played a central role in the organization of several sector coordination meetings and in 2002 took over hosting monthly Inter-agency CD Meetings and made significant changes to its structure to make it more participatory and a forum for interactive discussions on issues of common interest for CD practitioners. The topics discussed included: community funds, community development councils, links between municipalities and communities, CBOs and their legal status, role of youth in CD, perspectives of registering as a local NGO; and presentations on programs new to Azerbaijan with possible links to existing CD programs. Mercy Corps was actively involved in the health inter-agency meetings that were a combined collaboration between MoH, UNICEF, WHO, AHAP partners, and other INGOs and

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 105 NGOs. Mercy Corps also continued to be an active participant at the monthly interagency meetings hosted by UNDP. Staff members also represented and supported the World Bank- funded Community Empowerment Network Steering Committee.

2.2 Subgrant Level Coordination

• Regional Coordination Meetings. To foster cooperation between different partners operating in the same area early in the program, Mercy Corps facilitated monthly coordination meetings in each geographic area. Mercy Corps used the powerful tools of monitoring trips and wrap-up meetings to foster such cooperation. These meetings became regular and later in the program were organized and run independently by the partners themselves. They helped to link AHAP partners effectively with one another and with agencies outside the umbrella, especially those working in the regions, to plan effectively and share their knowledge. AHAP Health agencies came together to work with UNFPA on a community-level reproductive health training manual which has now been published with the MoH approval; and these same agencies worked with WHO and Mercy Corps’ Child Survival program to train MoH trainers for IMCI implementation and rolled out the intervention in their project areas.

• Visits. Agency to Agency Cross-Visits: Mercy Corps organized yearly joint economic opportunities cross visits for AHAP and non-AHAP partners to EO programs around the country. These visits enabled staff to see first hand how different agencies implemented programs, have discussions with beneficiaries, and discuss among themselves the key issues in the field. In addition to this partners also organized agency-to-agency cross-visits to familiarize themselves with each other’s program interventions, to discuss problems and to exchange ideas of solving them. For example, ADRA staff consulted other AHAP partners to adapt their experience to the reality in Nakhchivan, and in particular, visited World Vision to review, discuss and exchange information about the challenges associated with mobilization in urban areas. There were also cross-visits organized for entrepreneurs to various enterprises operating different regions, to exchange experience, learn new technologies, and promote linkages among complimentary enterprises. Cross-visits were a very effective method of peer-to-peer education across programs and gave program staff and beneficiaries the opportunity to easily adapt successful program strategies to different geographic and cultural areas.

Donor to Agency Site Visits: At USAID’s request, Mercy Corps worked with partners to organize itineraries for high-level dignitaries to visit the field programs. These site visit itineraries demanded considerable coordination between partners, flexibility to change the schedule multiple times for each visit and usually again during the visit, the good will of communities who were in the end not visited although they were ready, and the willingness of all involved to put the work of the project to one side to prepare for and manage the visit. Frequently the visits resulted in changes in attitudes of those who saw the programs in the field and made it easier for them to factor in the discrepancies between Baku and rural Azerbaijan as new programs were developed.

• Program Related, Baku-Based Initiatives: Mercy Corps actively supported the Technical Working Group on Reproductive Health established under the new RH/FP program and supported the efforts of the Community Empowerment Network (CEN) to share community development lessons with the CD community in Azerbaijan and the Central Asia region.

• Improving Language and Report Writing Skills: To assist AHAP partners with report writing in English, Mercy Corps organized an Advanced Report Writing Seminar attended by staff from partner agencies. The courses were designed for staff that were responsible for writing program reports in English and for whom English was not their first language. In addition, Mercy Corps helped to organize and covered expenses for English language courses at Language Services Direct in Baku.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 106 2.3 National Level Coordination

• Government of Azerbaijan: Even though coordination at the national level may be divided conditionally into two periods—before and after Section 907—Mercy Corps always paid appropriate attention and understood the importance of good working relations with the Government of Azerbaijan. Mercy Corps worked closely with the Cabinet of Ministers, with the respective line ministries such as the Ministry of Justice, Ministry of Taxes, National Bank, SPPRED Secretariat and many others throughout the entire program period. Mercy Corps worked closely also with the Ministry of Health, particularly with the National Reproductive Health Office (NRHO), introducing new and somewhat sensitive activities to Azerbaijan. In addition, there were issues such as a dysfunctional VAT reimbursement system and disagreement over contributions to the Social Fund that were addressed by a coalition of INGOs lead by the partnership. The coalition negotiated with the GOA and enlisted the support of the US Embassy to eventually resolve these issues and create a more favorable operating environment.

• National Conferences: The National Community Development Conference (NCDC), planned and led by Mercy Corps and the AHAP Partnership with strong local NGOs, was held in October 2002 and together with the two Microfinance conferences organized in 2001 and 2003 serve as good examples of a strong national-level leadership. The NCDC conference, which was the first in Azerbaijan, brought together over 300 community development activists including community leaders, local and international NGOs, community development specialists and donors. Participants worked in small groups to examine and discuss lessons learned from their work and identified strategies that would improve their work in the future. Even more critically they formed linkages with each other and built on those linkages as they continued their community and cluster leadership. Discussions surrounded issues of mutual interest and concern, including overall development of communities, NGO movement, registration and taxation among others. The materials of the conference that were prepared and shared by Mercy Corps with the entire NGO community in Azerbaijan still remain a valuable source of information about the NGO movement in Azerbaijan.

In turn, the Micro Finance Conference organized by Mercy Corps in October 2001 had representatives from 43 organizations including international NGOs, commercial banks, donors and private companies. The conference highlighted issues facing micro finance institutions and government relations and was instrumental in the creation of the Azerbaijan Micro finance Association (AMFA). The second micro finance conference, sponsored by OSCE and organized by AMFA with the active support of Mercy Corps in December 2003, enhanced the overall profile of micro finance in Azerbaijan and attracted attention of donors and policy makers. One of the greatest achievements was reduction of the licensing fees for MFIs in Azerbaijan from $5,500 back to the original $110, and in so doing, recognizing the difference between MFIs and commercial banks.

During AHAP I, the first national Health Conference was organized and held in October 1999. Health stakeholders from 43 organizations came together to discuss health issues particular to the needs of Azerbaijan including Primary Health Care, Reproductive Health, Community Participation with special emphasis on transition of health systems in former Soviet countries. The conference provided a forum for health organizations to meet, exchange ideas and present research data. The practical output of the conference was the collections of research papers and health articles addressing the experiences of both governmental and non governmental agencies. This served as a tool for future program planning and evaluation. The conference was also instrumental in forging stronger relationships and linkages among the NGOs.

In addition to national level conferences that Mercy Corps was instrumental in organizing, Mercy Corps represented AHAP in other national conferences and initiatives including the conference organized by UNHCR “10 Years of Humanitarian Intervention in Azerbaijan: Impact, Lessons, Future Directions”. In addition, Mercy Corps took an active part in ADB’s conference focusing on Early Childhood Development issues in Azerbaijan, including health and education

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 107 components, in a TB/HIV/AIDS conference and in several MoH/WB/UNICEF conferences addressing health policy.

• AMFA: Mercy Corps provided AMFA with considerable technical support and guidance during its first two years of existence. AMFA members, AHAP partners along with non-AHAP microfinance organizations, learned to appreciate the value of coming together to advocate for national policy changes. AMFA is now functioning on its own and acting as a resource for nascent micro finance associations in other parts of the developing world.

• Strategic Directions: Mercy Corps met regularly with UN and other agencies in its on-going efforts to ensure strong coordination between AHAP programs and the larger development community in Azerbaijan. Mercy Corps provided support to organizations seeking to define their development role in Azerbaijan, briefed them on the work of AHAP partner agencies and clarified development issues arising out of the field work in progress. Every effort was made to support the continued progress of development programs by making time and other resources available to all relevant stakeholders. Links were made with specific AHAP programs and partners to further the program goals of all involved. Discussions were held with the development banks, INGOs, UN agencies, bi-lateral agencies, and the private sector regarding their development plans and efforts.

• Links with Baku-Based Resources: Mercy Corps regularly participated in meetings with agencies based in Baku to link them with AHAP implementing partners and represented AHAP at a series of meetings organized by the NGO Forum to be informed about local NGO development in Azerbaijan. In the lead up to each of the elections in the country, Mercy Corps assisted with linkages between AHAP partners and IFES and other election resources regarding cooperation on voter education. Mercy Corps also kept in permanent contact with OSCE regarding NGO registration, maintained a working relation with the SPPRED Secretariat of the Ministry of Economic Development to support AHAP partners relations with the secretariat and to encourage community participation in their activities.

• Contribution to the Library of Professional Literature in Azerbaijan. Over the course of the program, Mercy Corps staff contributed significantly to the development of literature on community development, health and economics in Azerbaijan. A community-level reproductive health manual, manual on environmental protection, a book on internal control for micro finance, and many other documents were either translated or written directly in Azeri by using foreign sources and represent a significant contribution to their respective areas.

• Courtesy Meetings. In addition to its core activities, Mercy Corps helped to provide information to other agencies that were interested in the development situation in Azerbaijan and in AHAP programs, specifically. On a constant basis, Mercy Corps assisted such agencies by meeting with interested stakeholders and by sharing with them requested information and input. Some of the many agencies with which Mercy Corps cooperated included, though were not limited to OSCE, International Foundation for Election Systems (IFES), German Agency for Technical Cooperation (GTZ), International Federation of the Red Cross, World Bank, International Organization for Migration, TACIS, International Alert, US Embassy’s Democracy Commission, CareLift, relevant UN agencies, various local NGOs, all other US funded organizations working in Azerbaijan such as Eurasia Foundation and Catholic Relief Services, and key international non- government organizations with whom coordination is critical such as Norwegian Refugee Council, Danish Refugee Council, Norwegian Humanitarian Enterprise and Oxfam.

3. TECHNICAL ASSISTANCE

3.1 Assessments and Surveys

• Initial Environmental Examination: To ensure adherence to USAID Environmental Guidelines, Mercy Corps contracted ERT Caspian to prepare an Initial Environmental

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 108 Examination (IEE) in 2000, they then prepared an Environmental Training Manual in English and Azeri. Under the leadership of Mercy Corps’ environment team, IP environmental focal persons received training and obtained a manual to incorporate the recommended environmental mitigation measures for micro-projects and increase awareness of community members by developing and using their Environmental Action Plans. Mercy Corps continuously monitored these plans and provided additional refresher training and technical assistance to partners as requested.

• Business Development Services Survey (BDS): In 2000 the EO team completed a BDS market survey to gain a better understanding of BDS in Azerbaijan, to assess the current rate of BDS utilization by medium and small enterprises (MSE) and their self-identified needs for current and future programs. The results were shared with partners and confirmed that MSEs are willing to pay for services rendered that strengthen the economic viability of their businesses. The BDS services most demanded include: Business Planning, Credit Sources & Management, New Product Development, and Quality Improvement. The BDS programs shifted their activities to incorporate BDS best practices.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 109 F. MERCY CORPS MANAGEMENT STRUCTURES AND PROCEDURES

1. COOPERATIVE AGREEMENT (CA)

Mercy Corps operated under a CA from January 15, 1998 that was modified numerous times to reflect USAID’s changing strategy and direction. (For more information on the progress of the CA please see: Management, Section A, number 1. HISTORY OF AHAP AWARD AND MODIFICATIONS.) The programming operating under the CA closed on September 30, 2005 and the CA closes on January 14, 2006.

2. STAFF CHANGES

2.1 Mercy Corps Team: There were numerous changes within the Mercy Corps team over the life of the umbrella both in expatriate and local staff. Although the gaps in staffing were difficult for the partnership to deal with at times, the team was strengthened by new additions. Key management staff were worked with the program for at least two to three years and numerous national staff were awarded scholarships for foreign study. Several have returned and are now working in Azerbaijan. The normal staff attrition prior to the close of the program demanded considerable flexibility to meet the closeout demands.

2.2 AHAP Partnership: Mercy Corps followed compliance procedures and approved or recommended for approval all key management and program personnel. There were instances when this procedure prevented an agency from hiring a non-qualified person for a position and they were requested to seek more appropriate personnel. There were also gaps in staffing within the partnership, however, in most instances they did not significantly interfere with program implementation. When the lack of personnel in key positions did interfere with programming, Mercy Corps informed USAID of the problem and worked closely with the partner to resolve the situation in a timely manner. The greatest loss of staff occurred prior to the close of the program and again, demanded considerable flexibility to meet the closeout demands.

3. STAFF DEVELOPMENT

One of the negative consequences of the multiple short term extensions to the umbrella and the partner programs was that USAID became reluctant to invest in staff development for personnel. Agencies realized however that if they wanted to continue to implement creative and cutting edge programs, they needed to continually provide training to their staff to update their skills. Most of the time that training came out of agency core funds and the programs reflected the new skills obtained through training.

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G. PROBLEMS ENCOUNTERED AND LESSONS LEARNED

1. GOVERNMENT

Working with the Government of Azerbaijan has been a challenge throughout AHAP – during the first four years, because Section 907 was in place and during the last four years because the resulting suspicion and distrust remained. It took some time for USAID, IP staff, communities, Municipal Councils and eventually ExComs to operationalize the change. Programs did the necessary “damage control” with regional government which means that now the ExComs, with the exception of the urban ones, are largely accepting and very often supportive of the communities and clusters. On many infrastructure projects, ExComs supplied heavy equipment and materials, facilitated technical resources from ministries and provided much needed political support. The Municipality structure is quasi-governmental which makes relating to them awkward. Because they had a much less clearly defined role, it was considerably easier for programs to engage them and they became integral parts of the community interventions, with many of the parallel community groups registering as Mahalla Komitesi (neighborhood committees.) As they gained some clarity of role and a small tax function, competition began in earnest between the MCs and the ExComs. Again, the communities were often caught in the middle.

Over the past three years there have been elections in Azerbaijan: Presidential, Municipal Council and Parliamentary. During the run up to the election, programming especially the rural areas came to a halt. Community and cluster leaders were not willing to implement programming that might cause them to be perceived as supporting the opposition. In addition, public gatherings were often prohibited and as development programming by definition involved public gatherings, programs could proceed only slowly. This has meant that for two or three months each year, programming has slowed significantly.

The government has presented several additional challenges. As mentioned earlier in this report, the Government of Nakhchivan interfered with the NAR micro finance program, causing a stop in lending for over nine months. During that time, the health program in the area was also affected. The reasons given lacked substance and showed little relationship to the program. It required significant time and effort from USAID, the US Embassy, Mercy Corps and the IP, to remedy the situation. The Azerbaijan Ministry of Health decreed a ban on charges for health care that was enforced in Nakhchivan, and dramatically impacted the program there, and is still a threat to health programming on the mainland if it should be enforced widely. NGO registration has been halted for several years now which makes the normal development of cluster groups more difficult and community based organizations (CBOs) are not allowed a legal existence in Azerbaijan except as Mahalla Komitesi. The legal frameworks within which programs, including micro finance programs, function have slowly been improved after considerable political pressure; however, there is more work to be done. Relating to NRHO, the quasi-MoH entity AHAP related to most intensely was an ongoing challenge.

We are grateful for the support of the office of Deputy Prime Minister Ali Hasanov, Republican Commission on International Humanitarian Assistance. He and his office have provided important support for the ongoing work of AHAP and its International Partners. On more than one occasion, he has stepped in to resolve critical issues beyond the ability of Mercy Corps or the IPs to solve. In addition, he and his office were very supportive of the several national conferences. His office enabled the partnership to work with minimal interference; they smoothed the way and helped resolve problems.

Coordinating and cooperating with the GOA at all levels is an absolute requirement in order to implement credible and sustainable programming. However, because it is time consuming and labor intensive, it needs to be integrated into the program in terms of staff, time and budget.

Mercy Corps AHAP Final Report January 15, 1998 – January 14, 2006 111 2. MULTIPLE EXTENSIONS

As mentioned in various parts of this report, the umbrella was extended annually for three years in a row, creating a very challenging programmatic environment. Because these were extensions, there could be no new RFAs for the existing programming and therefore, the agencies had limited flexibility in making programmatic changes. New program directions and ideas were not permitted within the limitations of the extension mechanism, the only mechanism available. In many cases, the extensions did provide Mercy Corps with a tool to influence program adjustments to a greater extent than would have been possible otherwise, however because each extension represented an additional subgrant period, USAID expected that there would be significant program accomplishments during the extension, which was only nine to twelve months long. This expectation was not realistic in most cases and forced partners to propose overambitious programs. The proposal development process was never ending. During most of those three years, either Mercy Corps was writing and negotiating a proposal with USAID or the IPs were writing and negotiating proposals with Mercy Corps. Sometimes because of very tight timeframes, the advance work on the IP proposals began before the Mercy Corps CA was finalized.

There were additional challenges that resulted from the frequent short term extensions. The indicators developed at the beginning of AHAP II became less useful as the extensions proceeded; (see the indicator section of Management for more detail) and secondary indicators needed to be developed based on the shifting program focus of the extensions without violating the extension mechanism. Each extension was awarded with the clear message from USAID that this would be the last extension and that message was clearly conveyed to partners and through them to communities. After the second “end of AHAP” announcement, communities ceased to believe that AHAP would ever end; that disbelief continued until September 2005. Staff also knew that there was a new end date for AHAP and many of them left for new positions only to discover, often just a couple of months before the “end” that the program was extended. This led to a talent drain that the programs could ill afford. USAID’s edict that the grant could not pay for any staff development coincided with the drain of trained staff because of the threatened close of the programs and caused further problems that the partners needed to overcome. Multiple short term extensions made it horrendous for tracking data and progress toward log frame goals. Within the short extension period, goals were often not completely reached and in some form were carried forward to the subsequent short extension.

Multiple extensions were a poor choice when trying to achieve solid program results and minimized the constructive use of both time and funds. Even though the IPs, USAID and Mercy Corps made the most of it, it must be recognized that this is certainly not the optimal way to do programming.

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