Swiss Red Cross International Cooperation Programme Report 2018

25 April 2019 Swiss Red Cross Rainmattstrasse 10/P.O. Box CH-3001 Bern Phone +41 58 400 4111 www.redcross.ch

Cover Page Role play in a health centre in Laos. Pregnant women attend an education session on the importance to give birth in a health centre or hospital.

Cover photo © SRC All photos © divers Table of contents

Synopsis 7

1. Institutional context 11

The International Red Cross and Red Crescent Movement 11 Swiss Red Cross 11 Department International Cooperation 12

2. Global context 15

3. Programme results 2018 19

Health 20 Reproductive health 22 Nutrition 26 Disease control 30 Water, Sanitation and Hygiene (WASH) 33 Ageing and health 40 Blood safety 46 Eye Health 51 Disaster Risk Management 55 Emergency response 56 Recovery 60 Disaster risk reduction 64 Institutional preparedness 72

4. Learning process: Partnership and National Society Development 77

5. Public Affairs and awareness-raising in Switzerland 83

6. Finance 85

Financial overview 85 Financial results and SDC programme and project contribution 87 Programme Budget 2019 88

3 Annex 1: Result framework of the SRC Programme 2017–20 90

Annex 2: Standard outcome indicators measured in 2018 92

Annex 3: Beneficiary statistics 2018 94

Annex 4: Expenditures and SDC contribution 2018 by country 96

Annex 5: Deviations budget versus expenditures 2018 by country 98

Annex 6: Learnings 2018 – Evaluations, studies and reviews 99

Annex 7: Publications and presentations at conferences 2018 100

Annex 8: Country Summaries 102 Armenia 102 Bangladesh 104 Belarus 107 Bhutan 108 Bolivia 109 Bosnia and Herzegovina 111 Ecuador 112 El Salvador 114 Ethiopia 116 Ghana 118 Haiti 120 Honduras 122 Kyrgyzstan 124 Lao PDR 126 Lebanon 128 Malawi 130 Moldova 132 Nepal 134 Pakistan 136 Paraguay 138 Philippines 140 South Sudan 141 Sudan 143 Syria 145 Togo 146 Vietnam 148

4 Abbreviations

AfSBT African Society for Blood Transfusion NBTS National Blood Transfusion Services ANC Antenatal Care NCD Non-communicable Disease BOCA Branch Organizational Capacity Assessment NGO Non-governmental Organisation CBDRM Community Based Disaster Risk Management NS National Society CBHFA Community Based Health and First Aid NSD National Society Development CBO Community Based Organisation MADAD EU Regional Trust Fund in response to Syrian Crisis CCA Climate Change Adaptation MoU Memorandum of Understanding CIS Commonwealth of Independent States OCAC Organisational Capacity Assessment & Certification CLTS Community Led Total Sanitation OCHA Office for the Coordination of Humanitarian Affairs CSPM Conflict Sensitive Project Management OD/CB Organisational Development and Capacity Building DAG Donor Advisory Group ODA Official Development Assistance DM Disaster Management OECD Organisation for Economic Cooperation and DRCE Disaster Response Capacity Evaluation Development DRM Disaster Risk Management OIAI Office of Internal Audit and Investigation DRR Disaster Risk Reduction PHAST Participatory Hygiene and Sanitation Transformation ECHO European Union Humanitarian Aid and Civil PLHA People Living with HIV and AIDS Protection Department PNC Postnatal Care ERU Emergency Response Unit PNS Partner National Society EU European Union RANAS Risks, Attitudes, Norms, Abilities and Self-regulation FACT Field Assessment Coordination Team RCRC Red Cross and Red Crescent HAI Healthcare acquired infections SDC Swiss Agency for Development Cooperation HBC Home Based Care SDG Sustainable Development Goal HNS Host National Society SECO Swiss State Secretariat for Economic Affairs HR Human Resources SHA Swiss Humanitarian Aid Unit IC International Cooperation Department of the SRC SMCC Strengthening Movement Coordination and ICRC International Committee of the Red Cross ooperation IDP Internally Displaced Person SOCI Selected Outcome Indicators IFRC International Federation of Red Cross and Red SRC Swiss Red Cross Crescent Societies STI Sexually Transmitted Infection IG Initiative Group UHC Universal Health Coverage IT Information Technology UN United Nations IP Institutional Preparedness WASH Water, Sanitation and Hygiene KOFF Swiss Platform for Peacebuilding WHO World Health Organisation LRRD Linking Relief, Rehabilitation and Development WPNS Well Prepared National Society MBTS Malawi Blood Transfusion Services MEL Monitoring, Evaluation and Learning MENA Middle East and Northern Africa MMS Medicus Mundi Schweiz Movement Movement of the Red Cross and Red Crescent National Societies

5 6 Synopsis

1. Insight into the organisation

Supreme body: Legal Form: Red Cross Assembly Founded 1866; Association; recognition Management body: as National Society renewed in 1951 by Red Cross Council federal decision President: Constituency: Annemarie Huber-Hotz Red Cross Assembly, 24 cantonal associa- Vice Presidents: tions, Red Cross rescue organisations, Red Toni Frisch and Marc Geissbühler Cross Institutions, Partner organisations Members of the Red Cross Council: Red Cross rescue organisations: Danielle Breitenbücher, Ivo Cathomen, Daniel Biedermann, Adriano P. Vassalli, Guy Mettan, Swiss First Aid Association, Swiss Life-Saving Dieter Widmer, Ursula Forrer, Annalise Eggimann, Barbara Schmid-Federer Society, Swiss search and rescue dogs Headquarters: REDOG, Swiss Army Medical Association Markus Mader, Director-General; Christine Kopp, Health & Integration, Vice director; Beat von Red Cross Institutions: Däniken, International Cooperation; Markus Sieber, Finance, HR & Services; Lukas Sallmann, SRC Swiss Blood Transfusion Service, Marketing & Communication SRC Humanitarian Foundation IC Department Head of Divisions: Partner organisations: Asia/Europe: Jürg Frei, (U. Schmid, deputy) Lindenhof School Foundation; Centre of Africa/Americas: L. Indermühle, (F. Molinari, deputy) competence for rescue services Disaster Management: Beatrice Weber, (P. Morf, deputy) Membership: 483,637 Programme Coordinators: Volunteers: 52,959 Asia/Europe: Y. Affolter, B. Müller, A. Papis, U. Schmid, E. Syfrig, A. Vondeling, G. Zipper, S. Hirsig Staff: 4,782, including 495 at headquarters Africa/Americas: F. Büsch, C. Hinden, C. Humboldt, G. Labhardt, F. Molinari, U. Schori, F. Weibel, (345 full-time positions) C. Zaugg, B. Gremion, L. Perroud, M. Rion, C. Grassi, H. Gambon Religious affiliation/political status: Disaster Management: P. Morf, A. K. Moore, A. Schmid; I. Aebersold, D. Garnier, Th. Büeler, independent and neutral D. Grolimund, W. Nellestein Quality standards/certificates: Assistants: ICS according to OR B. Chiofalo, M. Noor, N. Messner, M. Rodriguez, C. Ruchti, C. Centis, N. Lund-Jensen, S. Keller, ZEWO (re-accredited 09.03.2011) R. Brechbühl, L. Beutler, D. Hausammann, S. Perrinjaquet, A. Froelich, Th. Capelli, F. Habegger SWISS NPO-Code Policy and Advisory Unit: IC Department level: HQ and field manual Th. Gass (head), C. Aebischer (deputy), M. Christofori-Khadka, A. Jöhr, S. Loosli, N. Rähle, for Quality Management V. Wieland, F. Büsch, G. Heim, J. Pascual Audit: Ernst & Young AG, Bern Finance and Administration: S. Khadka (head), M. Secco, R. Oser, M. Casagrande, H. Schalenbourg, F. Habegger

Thematic Focus Programme Countries Activities in Switzerland Health Africa/MENA: Ghana, Togo, Mali, South Sudan, Health and integration of elderly care- Reproductive health Sudan, Ethiopia, Malawi, Lebanon dependent people and migrants, support Disease control for asylum seekers, outpatient care for Nutrition Latin America and the Caribbean: Bolivia, torture and war victims, Red Cross Service, WASH Paraguay, Ecuador, Honduras, El Salvador, Haiti. Youth Red Cross, rescue operations Ageing and health (Samaritans, lifeguards, REDOG, REGA), Blood safety Asia: Bangladesh, Nepal, Pakistan, Laos, volunteer work, blood transfusion services, Eye care Vietnam, Bhutan national disaster aid, SRC nursing assistant training, constructive conflict resolution for Disaster Risk Management Europa/CIS: Bosnia-Herzegovina, Moldova, young people, emergency relief. Shelter, housing, non-food items Belarus, Kyrgyzstan, Armenia WASH Economic support Reconstruction of public infrastructure Community-based DRM Institutional preparedness

7 Strategic orientation of the programme 2017–20 The SRC strategy 2020 for international cooperation defines the following strategic objectives: Particularly vulnerable and deprived people and communities: – receive appropriate support to meet emergency needs; – have the capacity to prepare for and respond to disasters appropriately and are in a position to adapt to climate change; – have access to good quality health care; – are able to have an impact on health determinants and to demand their right to health.

Context Programme goals 2017–2020 Climate change has become a key determinant for global health and for the Overall goal: Healthy living and improved disaster risk manage- occurrence of disasters, the two spheres of the SRC programme 2017–20. Cli- ment capacities among vulnerable groups and communities mate change is increasing the intensity, frequency and uncertainty of weath- Health: Improve the health status of all, particularly for vulner- er-related hazards, shocks and stresses. At the same time, extreme weather is able people, groups and communities. increasing the vulnerability of communities and individuals, especially when Disaster Risk Management: Strengthen the disaster resilience combined with other drivers of risk such as conflict, migration and urbaniza- of communities. tion. By 2030, it is estimated that up to 325 million of the world’s poor would Advocacy and awareness raising: Health and DRM issues are be living in the 49 most hazard-prone countries. In East Africa, for example, the high on Swiss and global development agenda. current drought has a devastating impact on vulnerable households. 815 million people worldwide suffer from hunger, two thirds of them live in sub-Saha- ran Africa and Southern Asia. At the same time, more than 2 billion people are affected by water stress, which will increase with population growth and the effects of climate change. The programme 2017–20 of the Swiss Red Cross aims at contributing to the Agenda 2030 for Sustainable Development, particularly to the Goals that are related to health, water and disaster risks. In the humanitarian sector, SRC through the IFRC supports the Grand Bargain, an agreement between more than 30 of the biggest donors and aid providers, which aims to allocate more means to local actors for a more effective response to disasters.

2. Financial Context

2018 (in CHF 1,000) SRC International Cooperation Department Projects (in CHF 1,000) SRC HQ Expense: Expenses/Budget 2017 2018 2019 2020 136,018 Emergency Relief & Humanitarian Aid 10,714 9,811 9,000 9,000

International Reconstruction and Rehabilitation 4,808 3,271 4,000 4,000 Cooperation Development Cooperation 31,379 32,812 36,000 35,000 Department Direct Project Expenses 46,901 45,893 49,000 48,000 Expense: 54,117 Indirect Project Expenses (HQ) 12,438 8,224 9,800 9,600 Remarks: Total IC Department Expenses 59,339 54,117 58,000 57,600 SDC Contribution SDC Contribution in % of IC Department Expenses 16,682 (28%) 16,198 (30%) 14,866 (26%) 16,340 (28%) to the IFRC through SDC Programme Contribution 10,100 (17%) 10,483 (19%) 10,410 (18%) 10,410 (18%) the SDC-SRC-IFRC agreements are not SDC Emergency Relief & Humanitarian Aid 2,500 (4%) 2,500 (5%) 2,500 (4%) 2,500 (4%) included in this total SDC Mandate Projects 4,082 (7%) 3,215 (6%) 1,456 (3%) 3,430 (6%)

8 3. Partnership with SDC

Strengths and weaknesses in the cooperation between SDC and SRC

 – Close coordination in emergency situations (ex. Tsunami Indonesia) – Fruitful exchange on the nexus humanitarian aid and development cooperation – Switzerland newly member of the IFRC Donor Advisory Group (DAG) thanks to increased contribution of SDC and SRC to IFRC – Learning process on “partnership and organisational development” (with Helvetas) – Improved communication and collaboration with new SRC focal point at SDC/IP

 – Weakened Water Consortia Partnership due to SDC funding regulations – NGO Policy process creating uncertainties concerning funding modalities and criteria Measures to be taken: – Discussions between Water Consortia responsible to clarify funding scheme and legal aspects of water consortia contributions – SRC to prepare a four-year International Cooperation Programme 2021-24 defining the main objectives, workstreams, countries, partnerships and resources – Joint learning event on OD and partnership

4. Success stories

REPORT School WASH in Laos VOR ORT DRR in Vietnam

Magazin Humanité Nr. 1/2019: Magazin Humanité Nr. 1/2019: https://www.redcross.ch/de/shop/ https://www.redcross.ch/de/shop/ magazin-humanite/magazin- magazin-humanite/magazin- humanite-nr-12019 humanite-nr-12019

Zuerst hat das SRK zusammen mit der Bevölkerung Wasserstellen in den Dörfern gebaut, jetzt sorgt es für Hygiene an Schulen Was die Kinder in der Schule über Umweltschutz und Hygiene lernen, erzählen sie zu Hause

Laos Katastrophenvorsorge in Vietnam Mehr Hygiene, bessere SDC contribution to the SRC Dem Wasser zuvorkommen SDC contribution to the SRC Gesundheit und Bildung Im Süden Vietnams ist Wasser die Basis für die Aquakultur, die den Bewohnern Nahrung und Einkommen sichert. Es wird aber zur Gefahr, wenn Unwetter zu Überflutungen führen. Das Das Binnenland Laos ist arm, die Infrastruktur nur schwach entwickelt. Der Staat verfügt, programme in Laos: programme in Vietnam: SRK unterstützt betroffene Gemeinden in der Katastrophenvorsorge und beim Umweltschutz. bis auf die Wasserkraft der vielen Flüsse, kaum über natürliche Ressourcen. Laotische Schu- TEXT: CARMEN STEIMANN FOTOS: REMO NÄGELI len müssen mit einem sehr kleinen Budget auskommen und haben kaum die Mittel für Hygiene und Trinkwasser. 1,388,000 CHF (57%) at Mui liegt am südlichen Ende des nem Weiler mit gut hundert Haushalten die Evakuierten zwei bis drei Tage unter- 472,000 CHF (65%) DMekong-Deltas und ist von fast al- ist die 58-jährige Danh Thi Soi zu Hause. kommen. Gebaut wurde es mit Unterstüt- TEXT: DANIELA MATHIS FOTOS: NICOLAS RIGHETTI len Seiten von Wasser umgeben. Die Ge- zung des Schweizerischen Roten Kreuzes meinde am Meer besteht aus fünfzehn Bevölkerung beteiligt sich (SRK), das acht Gemeinden der Region in achdem das SRK gemeinsam mit sauberem Wasser und Sensibilisierungs- sieht die Familie nur am Wochenende. Weilern, die über Wasserwege und erst Die resolute Familienfrau engagiert sich der Katastrophenvorsorge begleitet. Ndem Laotischen Roten Kreuz und massnahmen kann die Hygiene sicher- Der Schulweg ist zu lang und schwie- seit Kurzem via Strassen erreichbar sind. für die Gemeinde und ist an Neuerungen Danh Thi Soi wird die Informationen der der lokalen Bevölkerung fast in der gan- gestellt werden. Sie ist der Grundstein für rig. Drei bis vier Stunden Fussmarsch im Die einfachen Wohnhäuser sind ganz interessiert. Natürlich ist sie an vorderster Veranstaltung an ihre Nachbarn weiter- zen Provinz Luang Prabang bereits Was- eine bessere Gesundheit. bergigen Norden von Laos sind keine auf das Leben am Wasser ausgerichtet, Front dabei, wenn das Rote Kreuz zur In- geben. Zudem setzt sie sich bei der Behör- sersysteme und Latrinen in den Dörfern Seltenheit. So teilen sie sich einen be- denn der Mekong ist wichtiger Trans- formationsveranstaltung über den Kata- de für die Anliegen der Benachteiligten gebaut hat, konzentriert es sich seit 2017 Schlechte sanitäre Infrastruktur scheidenen Schlafsaal, die Küche und die portweg und Nahrungsgrundlage. Der strophenschutz ins neue Gemeindehaus ein. «Ein Damm müsste gebaut werden, auf die Infrastruktur in Sekundarschulen. Die 317 Schülerinnen und Schüler der Se- sanitären Anlagen der Schule. Fliessend Fluss liefert Wasser für die Reisfelder von Dat Mui einlädt. Das auf Pfeilern ge- um provisorische Behausungen vor Was- Denn nur mit genügend Latrinen, ei- kundarschule von Sopchia sind zwischen Wasser gibt es kaum, ebenso Latrinen. und für die Fischzucht, mit denen sich baute Haus dient nicht nur für Versamm- ser zu schützen», fordert Danh Thi Soi im nem funktionierenden Wasseranschluss, 12 und 17 Jahre alt. Ein Drittel von ihnen Das ist an Schulen in einer der ärmsten die Menschen selbst versorgen. In ei- lungen. Im Katastrophenfall könnten hier Gespräch mit dem Gemeindepräsidenten.

8 Humanité 1/2019 14 Humanité 1/2019

Social inclusion with young people ZUR SACHE Menstrual hygiene in Malawi in El Salvador Magazin Humanité Nr. 2 /2018: Magazin Humanité Nr. 3/2018: https://www.redcross.ch/de/thema/ https://www.redcross.ch/de/shop/ magazin-humanite-nr-22018 magazin-humanite/magazin-human-

ite-nr-32018 In Nepal werden Schulen und Arbeitgeber motiviert, den Frauen eigene Toiletten zur Verfügung zu stellen SDC contribution to the SRC Menstruationshygiene Jugendarbeit in El Salvador programme in Malawi: Alternativen zur Würde für Frauen Menstruation betrifft mehr als die Hälfte der Weltbevölkerung im Verlauf des Lebens. Darüber schiefen Bahn SDC contribution to the SRC gesprochen wird aber kaum. Noch immer halten sich in einigen Ländern hartnäckig Traditio- 480,000 CHF (45%) nen, die Frauen wegen der Menstruation beschränken. Mit Sensibilisierung und praktischen Die Hauptstadt von El Salvador ist einer der gefährlichsten Orte der Welt. Bewaff- Hilfsmitteln erhalten Frauen und Mädchen nun mehr Bewegungsfreiheit und Bildungschancen. nete Banden beherrschen die Quartiere, treiben Schutzgelder ein und terrorisieren programme in El Salvador: TEXT: CARMEN STEIMANN die Bevölkerung. Kinder und Jugendliche sind besonders gefährdet, in deren Fän-

ge zu geraten. Mit Bildungs- und Freizeitprojekten stärkt das Schweizerische Rote ie Tradition Chaupadi ist in Ne- Menstruierende Frauen gelten als un- ode der Schule fernbleiben und so bei der Kreuz junge Menschen in diesem schwierigen Umfeld. Daniel José López Huezo hat Dpal seit einigen Jahren gesetzlich rein, sie dürfen keine Lebensmittel be- Bildung benachteiligt werden. An diesem verboten – ganz aus den Köpfen ver- rühren oder nicht in die Sonne blicken. Punkt setzt das SRK in Afrika und Asien an. das Angebot genutzt. Hier hilft der 21-Jährige seiner Grossmutter mit dem Haus- 760,000 CHF (54%) schwunden ist sie aber noch nicht. Der Mit weitreichenden Folgen: Manchmal Chaupadi-Aberglaube unterstellt Frauen sind sie tödlich, wie in Nepal, wo es To- Praktische Hilfe halt. Er will ein Leben jenseits von Gewalt und Kriminalität. Unreinheit während der Menstruation. desfälle von verbannten Mädchen und Aber wie behilft sich ein Mädchen wäh- Diese überholte Vorstellung führt zur Frauen zu beklagen gibt, die während der rend der Menstruation, wenn Hygiene- TEXT: KATHARINA SCHINDLER BILDER: REMO NÄGELI Verbannung von Frauen aus dem Heim Menstruation schutzlos im Freien oder in artikel zu teuer oder gar nicht erhältlich und zu Schulabsenzen während der Pe- einfachen Unterkünften ausharren müs- sind? Eine einfache Anleitung zum Nä- riode. Auch in anderen Ländern halten sen. In vielen Ländern verbreitet ist das hen einer wiederverwendbaren Binde sich Mythen rund um die Menstruation. Problem, dass Mädchen während der Peri- aus Stoff ist eine erschwingliche Lösung,

Humanité 3/2018 5 26 Humanité 2/2018

REPORT The El Salvador Red Cross Society EINBLICK DRR in Haiti

Magazin Humanité Nr. 3/2018: Magazin Humanité Nr. 3/2018: https://www.redcross.ch/de/shop/ https://www.redcross.ch/de/shop/ magazin-humanite/magazin- magazin-humanite/magazin- humanite-nr-32018 humanite-nr-32018

Eine Notfallübung in der Gemeinde – die Wahrscheinlichkeit eines Ernstfalls ist höher als anderswo Hurrikans verursachen Überflutungen – die Farben zeigen, bei welchem Wasserstand der Weg passierbar ist

El Salvador Klimawandel und Gefahr durch Hurrikane Leben in der Gefahrenzone SDC contribution to the SRC Mehr Katastrophenvorsorge SDC contribution to the SRC El Salvador ist kein Kriegsland, und trotzdem ist es statistisch gesehen überdurchschnittlich und Schutz für Haiti gefährlich im kleinsten Land Mittelamerikas. Warum dem so ist und wie sich das Rote Kreuz behaupten kann, ist eindrücklich. programme in El Salvador: Ohne Massnahmen zur Katastrophenvorsorge werden Hurrikane künftig noch mehr Men- programme in Haiti: schenleben fordern und Leid verursachen. Besonders in von Armut betroffenen Ländern TEXT: JOËLLE SCACCHI BILDER: REMO NÄGELI wie Haiti braucht es aufgrund des Klimawandels mehr finanzielle Mittel, um die Menschen zu schützen. Jetzt erreicht die Hurrikansaison ihren jährlichen Höhepunkt. l Salvador, das kleinste Land Mittel- trums sind ganze Siedlungen mit Häu- am stärksten von Gewalt betroffen ist: Je- 760,000 CHF (54%) 1,306,500 CHF (51%) Eamerikas, ist dicht besiedelt. Auf ei- sern aus Wellblech und wiederverwer- des Jahr werden über 60 Tötungsdelikte TEXT: REGULA ZELLWEGER BILDER: FLORIAN KOPP UND REMO NÄGELI ner Fläche, die halb so gross ist wie die tetem Material in die steilen Hänge pro 100000 Einwohner begangen. Schweiz, leben 6,4 Millionen Menschen. gebaut. Zu den Naturgefahren kommt Ständig drohen Naturkatastrophen wie eine bewegte Geschichte, die von Gewalt Gewaltherrschaft brechen esonders die Opfer von früheren Im September 2017 wurde die Karibik In der Karibik dauert die Tsunamis, Erdbeben und Vulkanausbrü- und Unterdrückung geprägt ist. Sie hat Einige Viertel befinden sich ganz in der Sturmkatastrophen, wie Familie gleich von zwei verheerenden Wirbel- B Hurrikansaison von Juni bis che. 95,4 Prozent der Bevölkerung leben unauslöschliche Spuren in der salvadori- Hand der Maras, krimineller Banden, die Marseille, fürchten in Haiti diese Jahres- Ende November. stürmen heimgesucht. Zuerst verursach- in Gefahrenzonen. Die Hauptstadt San anischen Gesellschaft hinterlassen. Zum durch die Rückwanderung salvadoriani- zeit. Es ist Hurrikansaison. In der Karibik te Hurrikan Irma katastrophale Schäden Salvador wurde in hügeligem Gelände Glück gehören Militärregierungen und scher Emigranten aus Los Angeles ent- dauert sie von Juni bis Ende November. auf mehreren Inseln, keine zwei Wochen im tropischen Regenwald erbaut. Rei- der Bürgerkrieg der Vergangenheit an. standen sind. «In diese Quartiere wagt Ihren Höhepunkt erreicht sie meist von Familie fast begraben wurde, den Ge- später folgte Hurrikan Maria. Inseln wie che, sichere Quartiere grenzen hier an Doch abgesehen von Ländern, in denen sich der Staat nur noch mit Kalasch- August bis Oktober. Vor zwei Jahren hat müsegarten, die wenigen Schweine und St. Marteen und Dominica wurden fast Elendsviertel, in denen extreme Gewalt bewaffnete Konflikte herrschen, ist El Sal- nikows», erklärt Derek Spranger. Der Hurrikan Matthew der Familie Marseille Ziegen. Jedes Jahr droht eine neue Ka- vollständig verwüstet. In der Folge leis- herrscht. Etwas ausserhalb des Stadtzen- vador weiterhin das Land, das weltweit ehemalige Delegationsleiter des Inter- alles geraubt: das Haus, unter dem die tastrophe. tete das SRK umfangreiche Nothilfe-

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9 10 School boys at a muslim school in Nepal using newly built water taps. © SRC, Remo Nägeli 1. Institutional context

The International Red services and to prioritize on the most vulnerable. During the 38th Session of the IFRC Governing As of 2019, the Government of Switzerland and Board meeting in October 2018, the decision Cross and Red Crescent the SRC are full members of the Donor Advisory was taken to suspend the membership of the Movement Group (DAG) of the IFRC. The DAG is composed Hellenic Red Cross as of 1st January 2019. The of National Societies with their governments suspension is based on governance issues and who contribute more than 10 million CHF to the the non-completion of a long-standing recovery In 2018, the Swiss Red Cross (SRC) has further IFRC. The Group is a forum for high-level strategic plan. This verdict followed more than five years strengthened its involvement in the multi and policy dialogue on global issues that include of intensive work with the Hellenic Red Cross lateral systems and programmes of the In- both humanitarian and development assistance, leadership by the IFRC, a special Compliance and ternational Federation of Red Cross and Red and donor trends. It contributes to strengthen- Mediation Committee panel, the ICRC and the Crescent Societies (IFRC), particularly in the ing partnerships for the benefit of all members of Government of Greece. Following the suspen- domains of health and disaster risk manage- the DAG as well as of all member National Socie- sion, the Hellenic Red Cross has lost its rights as ment. The SRC deepened its dialogue and col- ties of the IFRC and provides high-level strategic a member, in accordance with Article 12.3 of the laboration both at strategic and technical level inputs to the IFRC as to how it can strengthen IFRC Constitution. As such, member National So- with various teams of the IFRC Secretariat in resource mobilization opportunities. cieties are requested to refrain from supporting Geneva and with its regional offices (Asia Pacific: the Hellenic Red Cross operationally. Kuala Lumpur; Europe: Budapest; Africa: Nairobi; The collaboration between IFRC, SRC and Swiss Americas: Panama). For example, the SRC was Agency for Development Cooperation (SDC) requested by IFRC to develop a new IFRC public is agreed upon in a Memorandum of Under- health Emergency Response Unit (ERU) module standing (MoU). In February 2018, a high-level for improved community case management of meeting on the implementation of the MoU Swiss Red Cross cholera. Furthermore, SRC contributed financial between the parties was held in Berne to take and human resources, such as the secondment stock of their mutual relationships and the im- In 2018, the SRC together with the ICRC has pub- of an expert to the logistics team and became a plementation of the MoU. Amongst other issues, lically launched its agreement concerning the rat- respected partner in the ERU system. Operation- the parties reconfirmed their commitment to ification of theTreaty of the Non-Proliferation ally, the SRC participated actively in the disaster join efforts with regards to the Grand Bargain of Nuclear Weapons. The SRC also intervened response for the Ebola crisis in the Northern Kivu, and the localization agenda, and to contribute after the Federal Council decided to loosen the in Greece during the migration crisis, and the to National Society Development (NSD). weapon and arm exports from Switzerland Tsunami in Indonesia. abroad. SRC argued that Swiss weapons might be In October 2018, the National Society Invest- used in conflict situations and thus deeply contra- In 2018, the Red Cross Red Crescent (RCRC) ment Alliance (NSIA) launched its first round dicting of the Movement principle of Humanity. Movement has strengthen its cooperation and for applications. The NSIA is an ambitious joint coordination capacity in disaster preparedness initiative between the IFRC and the ICRC to in- The SRC has developed a multitude of ap- and response. The Strengthening Movement vest in comprehensive capacity strengthening proaches to promote voluntarism and becom- Coordination and Cooperation (SMCC) process and organizational development in National ing more agile and flexible. Volunteers are the has gained momentum with the IFRC General Societies. Nearly 50 National Societies have ap- backbone of the National Societies. They are key Assembly resolution at the end of 2017 in An- plied for a NSIA investment in the domains of for assisting and providing relief to those in need. talya. Since then, disaster related crises such as branch development, youth, resource mobilisa- The SRC provides numerous services through vol- the Ebola outbreak in Eastern Congo have seen tion and others. The National Societies will be in unteers of the cantonal chapters (branches) or the emergence of joint appeals and improved the driving seat to implement the NSIA invest- the recue organisations. In the past, the number coordination and cooperation between IFRC and ments, and they are fully responsible for plan- of volunteers has diminished, and Red Cross and International Committee of the Red Cross (ICRC). ning, coordinating, implementing and learning. Red Crescent Societies have to find new ways of IFRC and ICRC aim at collecting the funds for the motivating and keeping their volunteers. Another important development in 2018 was NSIA from (donor) governments. By the end of the participation of the RCRC Movement at the 2018, the Swiss Government has committed 1.1 The SRC initiated a major review of its present United Nations (UN) led Global Compact for Mi- million CHF. information technology system. A reform is gration and Global Compact on Refugees. The imminent and a digitalisation strategy under IFRC and ICRC offices in New York (supported by The IFRC has launched the process of developing development. A new division for digital services the members of the Global Migration Taskforce, its new IFRC Strategy S2030. All 191 National was created developing new tools and processes including the SRC) collaborated closely with the Societies are involved in the consultation pro- at the SRC Headquarters (HQ). The International Swiss and Mexican governments, who led the cess and in the design and development of the Department of the SRC developed and intro- negotiation process. The positive spirit of collab- strategy, including leaders, youth, volunteers duced an integrated project management and oration gave the Movement a prominent role and staff. A first draft of the S2030 shall be avail- information system (“NGO online”, a Microsoft and place in the text of the Global Compact on able by End of March 2019. The strategy will be Sharepoint-based product used by various Red Migration. It defined the role of the Movement adopted at the General Assembly in Geneva in Cross National Societies) available online for all partners as to protect migrants from death, dis- November 2019. SRC International Cooperation (IC) employees in appearance along migration routes, to guaran- Switzerland and abroad. tee legal status and effective access to essential

11 The Swiss Red Cross has adapted its governing Department International After launching Conflict Sensitive Project Man- structures. The Board of the Cantonal chapters agement (CSPM) in the SRC headquarters and (Geschäftsführender Ausschuss der Kantonalver- Cooperation delegations in the previous year, the 2018 CSPM bände) was dissolved by the Board of the Red focus was on introductory or refresher trainings Cross (Rotkreuzrat). The Humanitarian Foundation of the SRC and at country level for project staff and partner or- the International Cooperation Department ganizations. While CSPM is well established in At the same time, a new division for Search and agreed on a new programme contribution mo- the SRC projects in Honduras, El Salvador and Rescue (SAR) in Switzerland was established at dality. The mechanism is comparable to the SDC Bangladesh, there is still need for capacity build- the level of the director’s office. Three staff mem- programme contribution and allows the IC De- ing of the National Societies. Within the scope bers are now establishing and coordinating the partment to allocate funds of the Humanitarian of its organizational development approach, the SAR capacities of the SRC for domestic purposes Foundation based on a programme rather than SRC program in Ethiopia conducted a specific together with relevant SRC member organiza- project approach. CSPM training addressed to the management tions and the Swiss civil protection mechanism. and staff of Red Cross branches. A comprehen- In 2018, the IC Department together with the sive support to the Ethiopian Red Cross Society Another milestone was the joint development Marketing Department finalised the evaluation in mainstreaming CSPM throughout the entire of a SRC Guidance Note on National Society of its global eye care programme. The results organization is under discussion. The outcomes Development by the Departments International have shown the relevance and effectiveness of of the context analysis in all trainings show the Cooperation and Marketing/Communication. In the SRC support for eye care in Ghana, Togo, Ne- strong need for close coordination of CSPM view of the Strategy 2030, the SRC is willing to in- pal and Kyrgyzstan. With the exception of Mali, and security. To that end, ICRC’s Safer Access vest more into the organisational development all four programmes made an important contri- approach is a useful addition to CSPM for RCRC of National RCRC Societies in the programme bution towards combating blindness through branches. For the coming years, CSPM capacity countries, and thus to contribute to the localisa- the collaboration between Red Cross Societies, building with RCRC partners (such as Ethiopia, tion of aid agenda of the international humani- the national health system and SRC between Nepal and Sudan) is in the pipeline. tarian community. The SRC’s approach to NSD is 2006 and 2016. The evaluation recommended based on three pillars that include organisational continuing the eye care programme while en- The processes and tools for improved and har- development, support to operational capacities, hancing the partnership and coordination for monized outcome monitoring at project level, and improved resource mobilisation. The SRC system strengthening considering a stronger introduced in 2017, were further rolled out and commitment goes hand-in-hand with SDC’s fi- focus on humanitarian settings as well. strengthened by the IC team responsible for nancial contribution to the newly launched NSIA. Monitoring, Evaluation and Learning. The The promotion of gender equality and diver- internal guidelines were reviewed based on the sity is one of the overarching principles of action experience of the first year, and the set of stand- of the present IC strategy 2020. The Head of the ard survey questionnaires, ready for import into IC Department declared Gender and Diversity digital data collection applications, have been as one of the priority topics of the year 2018. expanded. In 2018, 27 different standard indi- The IFRC toolkit for organizational assessment cators across SRC projects in 20 countries were on Gender and Diversity published by the end measured, as shown in the as show in the table of 2017 gave the impetus to assess the Gender on the next page. and Diversity mainstreaming within the IC De- partment. The overall goal of the process was Although outcome monitoring remains a chal- the enhancement of Gender and Diversity main- lenging learning process, it is a tangible improve- streaming in the IC program and organizational ment in SRC’s ability to track its results and to culture. The assessment showed that the major- gain evidence-based information about project ity of SRC staff is sensitised for gender sensitive progress and impact. Regarding its evaluation project management and workspace culture. practice, the IC introduced new tools for im- Nevertheless, there is a rather heterogeneous proved terms of reference, scoring of offers, and picture of its implementation throughout the management responses. Other internal guide- country programmes. The survey showed that lines are under revision, as important discussions one of the main factors for a successful imple- in the development evaluation community (e.g. mentation is the RCRC partner organization’s ongoing revision of the OECD/DAC criteria) are attitude towards this thematic. Also, capacity underway. Important insights in different evalu- building was given high priority. Concluding a ation approaches have been gained through the workshop on this topic in December 2018, the IC impact evaluation (co-financed by the SDC im- management decided to reinforce its resources pact award) implemented in a community-based and to establish a community of practice. It fur- disaster risk management (CBDRM) project in thermore called for a broader SRC commitment Honduras. in the frame of the new strategy 2030. Guided by the new IFRC Policy on Prevention and Response to Sexual Exploitation and Abuse, the SRC revised and adapted its internal regulations and code of conduct.

12 Outcome indicators measured 2018 per continent and thematic priority

Ageing Blood CBDRM Eye Care Nutrition RH Wash Wash in Total Safety schools

Africa/MENA 0 3 1 3 1 0 6 1 15

Americas 0 0 5 0 2 6 3 0 16

Asia 0 0 1 2 1 14 8 3 29

Europe 7 4 1 12

7 7 8 5 4 20 17 4 72

The Finance and Administration Unit of the The results of the fraud and corruption investi- IC department continued the training of the gations, evaluations and audits conducted in SRC country programmes and partners’ finance our programme countries during such incidents and accounting personnel that has significantly are used for institutional learning and to further enhanced the quality of financial management, develop risk mitigation procedures. The formula- transparency, compliance and due diligence. tion of a fraud and corruption prevention policy by end of December 2019 will provide clarity in The SRC maintains a zero-tolerance policy distinguishing approaches applied for the inter- against fraudulent and corrupt behaviour and nal incident reporting procedures and the whis- even the smallest suspicion of fraudulent behav- tle-blowing mechanisms. iour is followed by a proper investigation. This is one of the reasons why several cases of suspicion of fraud and corruption was shared with our donors and stakeholders during 2018. The absence of integrity, proven cases of fraud and corruption, and the access restriction to project areas for monitoring and evaluation compelled the SRC management to prematurely terminate its operation in Mali.

13 Young mother14 from Rhakine State, Myanmar, in the refugee camp in Cox’s Bazar, Bangladesh, where SRC with other Red Cross and Red Crescent partners is implementing a major programme. © SRC, Remo Nägeli 2. Global context

Despite unprecedented progress in poverty birth rate remains high in sub-Saharan Africa 2018 was the year of an emerging global move- reduction since 1990, pockets of the worst (101 per 1,000 women aged 15 to 19; compared ment against sexual harassment and sexual forms of poverty persist. The United Nations to 44 globally). Unsafe drinking water, unsafe assault. Latest estimates indicate that globally Sustainable Development Goals Report 2018 sanitation and lack of hygiene remain a major almost one quarter of adults suffered physical states about one billion people still living on less factor of global mortality, resulting in about abuse as a child and about one third of women than two dollars per day. This is especially true 870,000 deaths in 2016. Globally, the incidence experienced either physical and/or sexual vi- for the most disadvantaged and marginalized of HIV declined from 0.40 to 0.26 per 1,000 un- olence at some point in their life Research in- groups. Ending poverty requires universal social infected people between 2005 and 2016. HIV dicates that less than 40 percent of all women protection systems aimed at safeguarding all incidence among women of reproductive age who experience violence seek any kind of help. individuals throughout the life cycle. Based on in sub-Saharan Africa, however, is 10 times the Sexual violence results in serious short and long- 2016 estimates, only 45 percent of the world’s global average. The recent Ebola outbreak in term physical, mental, sexual and reproductive population were effectively covered by at least Central Africa dramatically raises awareness of health problems, leads to high social and eco- one social protection cash benefit. Ending pov- the burden of infectious disease and reiterates nomic costs for the person, their families and so- erty also requires targeted measures to reduce the questions on the preparedness of public cieties. While the risk and impact of sexual and vulnerability to disasters and to address under- health systems as well as international aid organ- gender-based violence (SGBV) is increasingly served geographic areas within each country. isations, particularly in fragile contexts. understood in conflict settings, its pervasiveness In 2017, economic losses attributed to disas- in disasters caused by natural hazards is less ters were estimated at over 300 billion USD. Although communicable diseases are still the well appreciated. Allegations and cases of sex- An increasing complexity of fragility, marked main cause of death in low-income countries, ual harassment against but also by UN or NGO by climate change, natural disasters, food and non-communicable diseases (NCD) are on collaborators has put the concern on the top of water crisis, violence and conflict in the world is the rise and will soon be a leading cause of ill the agenda of international and humanitarian threatening efforts to end extreme poverty and health, disability and premature death even in cooperation. promote shared prosperity. developing countries. In 2016, an estimated 41 million deaths occurred due to NCDs accounting At least half of the world’s population do not With the adoption of the Sustainable Devel- for 71 percent of the overall 57 million deaths. have full coverage of essential health services. opment Goals (SDGs) in 2015, the ambition to The majority of such deaths were caused by the Gaps in basic maternal, child and environmental ‘leave no one behind’ has become the mission four main NCDs, namely: cardiovascular disease health service coverage remain largest among statement of the international development (17.9 million deaths; accounting for 44 percent those in the poorest wealth quintile. Among agenda. Similar concerns have become urgent of all NCD deaths); cancer (9.0 million deaths; those who can access needed services, many in humanitarian aid as well. The gap between 22 percent); chronic respiratory disease (3.8 mil- suffer undue financial hardship. Globally, almost identified humanitarian needs and available re- lion deaths; 9 percent); and diabetes (1.6 million 12 percent of the world’s population (over 800 sources has reached new heights despite the size deaths; 4 percent). Meeting the SDG target of million people) spent at least one tenth of their of the international humanitarian sector, and the reducing premature NCD mortality by one third household budgets to pay for health services in levels of donor contributions, reaching historical by 2030 will require the acceleration of progress, 2010. Qualified, available and equitably distrib- peaks in 2016. At the same time, pressure to including action to reduce key risk factors such as uted health workforce continues to be a major truly address long-acknowledged blind spots tobacco use, air pollution, unhealthy diet, phys- challenge for many health systems. Available of the humanitarian community, such as those ical inactivity and harmful use of alcohol as well data from 2005 to 2016 indicate that close to 45 concerning gender, internal displacement and as improved disease detection and treatment. percent of all countries and 90 percent of least disability, has also grown evident in the World developed countries have less than one physi- Humanitarian Summit process. Linked to the rise of NCDs, many parts of the cian per 1,000 people, and over 60 percent have world are facing a “double burden” of malnu- fewer than three nurses or midwives per 1,000 Today, many more people are living healthier trition, where undernutrition coexists with people. Achieving Universal Health Coverage re- lives than in the past decade. Nevertheless, overweight and obesity within the same coun- mains the major challenge in reaching the SDG 3 weak health systems remain an obstacle to pro- try, the same community and even the same and contributing to poverty reduction. gress and lead to shortages in coverage of even household. In 2016 almost 340 million children the most basic health services, as well as poor and adolescents aged five to19 years or almost Many cities are growing dramatically, and ur- preparedness for health emergencies. one in every five (18.4 percent) were overweight banization is accelerating most rapidly in less or obese globally. The increase of obesity among developed contexts. By 2050, 70 percent of the The UN SDG report 2018 notes a considerable children and adolescents in low- and middle-in- world’s population will live in urban areas. Rapid progress in combating maternal, neonatal and come countries has occurred at the same time, and unplanned urbanization is a major develop- under-5 mortality at global level. And even in as issues of undernutrition remain unaddressed. ment concern and humanitarian responders are the region facing the greatest health challenges, Infants and children in these countries are more increasingly engaged in urban areas. progress is notable: Since 2000, the maternal vulnerable to inadequate nutrition, and there- mortality rate in sub-Saharan Africa has been re- fore at high risk of being affected simultaneously duced by 35 percent, and the under-5 mortality by stunted growth and overweight due to the rate has dropped by 50 percent. However, while consumption of nutrient-poor but energy-dense in South Asia a girl’s risk of marrying in childhood foods. has declined by over 40 percent, the adolescent

15 Climate-related disasters including floods, Therefore, Official Development Assistance The high political stakes, vast sums of funding storms and droughts account for more than 90 (ODA) to fragile contexts has been on the rise, aimed at migration management, and tensions percent of the world’s disasters. Over the pe- growing by 26 percent in real terms from 2009 between humanitarian action and state strate- riod of 2014 to 2017, disasters caused by natural to 2016. However, this growth is mainly due to gies for migration management, raise significant hazards affected more than 870 million people. the surge in humanitarian assistance, which in- dilemmas for humanitarian responders, as well Low- and lower-middle-income countries have creased by 144 percent in the same period. Hu- as barriers to action. In some contexts, humani- higher rates of affected people and struggle manitarian aid represents about one-fourth of tarian activities have been actively criminalized, more to meet financial, logistical and humanitar- total ODA to all fragile contexts but makes up restricted or discouraged as they intersect with ian needs for recovery from disasters. Natural dis- half of all ODA in the 15 extremely fragile con- state strategies for migration management. One asters often fuel preexisting tensions or conflicts texts, the top five being Syria, Ethiopia, Afghan- example is the efforts to criminalize humanitar- and increase the state of fragility of an affected istan, Pakistan, and Bangladesh – four of them ian search and rescue operations in the Mediter- country or region. programme countries of the SRC. ranean Sea. On the other hand, humanitarian involvement also bears the risk to be perceived Linked to extreme weather events such as The trend of aid increasingly being used for as legitimizing the migration control measures. droughts, hunger is on the rise again, after a pro- stopgap “firefighting” that ultimately extends Many western donor countries use their funding longed decline. Conflict, drought and disasters to prolonged humanitarian purposes, rather to implement their strategy to reduce migration. linked to climate change are among the key fac- than for longer-term development that actually European governments spent at least 17 billion tors causing this reversal in progress. The number addresses the drivers of fragility, is worryingly in- Euros outside Europe between 2014 and 2016 in of undernourished people has been on the rise consistent with visions for sustaining peace and an effort to stem migration. The EU Emergency up from 804 million in 2017 to nearly 821 million sustainable development. This calls for building Trust Fund for Africa, which aims to address the in 2018. Sever food insecurity increased in almost and strengthening the humanitarian-devel- root drivers of migration, is worth over 3.4 billion all African regions. opment nexus, to not only meet humanitarian Euros. needs but also address systemic vulnerabilities Yet, most humanitarian crises are not the prod- in order to prevent future humanitarian crises, Shrinking spaces for development cooperation uct of any single factor or event, but of the inter- through sustainable development strategies and limitations on humanitarian access to af- action between natural hazards, armed conflict that promote resilience and mobility. fected populations are not restricted to conflict and human vulnerability. The UN Office for the zones or developing countries. The increased Coordination of Humanitarian Affairs (OCHA) The world is witnessing the highest levels of dis- measures restricting provision of assistance to estimated that nearly 132 million people will placement on record. The UNHCR estimates a migrants, in particular in Europe, shows similar require humanitarian assistance and protection number of 258 million migrants globally, most tendencies. in 2019. However, at the time of writing this re- of them with a legal status. 68.5 million people, port, OCHA expects an additional 1.85 million however, were forced to flee their homes be- In 2017, net ODA from OECD DAC countries people in need of assistance due to the cyclone cause of violence, conflict and disasters. While total led 146.6 billion USD. This represents a de- Idai. In 2018, 86 percent of funding received was one third of them are refugees and 3.1 million crease of 0.6 percent in real terms from the 2016 for responses to protracted crises lasting longer asylum-seekers, at the end of 2017, some 40 level. The decline is mainly attributed to lower than five years. The UN and other humanitarian million people were internally displaced (IDPs). spending on refugees inside donor countries: organizations are aiming to reach close to 94 The burden of forced displacement falls dispro- In 2017, DAC countries reportedly spent 14.2 million of the most vulnerable people with hu- portionately on fragile contexts, which generate billion USD, or 9.7 percent of total ODA, to host manitarian assistance and protection, leaving a the largest numbers of refugees (85 percent), refugees in their countries; this represents a drop 29 percent gap, only be partially met by domestic and also host the largest shares of refugee pop- of 13.6 percent in real terms compared to 2016. authorities or other organizations. ulations and internally displaced. Bilateral ODA from DAC countries to least-developed countries increased by 4.0 percent in Working in fragile context is the major chal- In 2018, the Global Compact for Safe, Orderly real terms since 2016. Humanitarian aid total lenge for humanitarian aid and development and Regular Migration (GCM) – the first ever led 15.5 billion USD in 2017, an increase of 6.1 cooperation. Today, 1.8 billion people live in negotiated global agreement on a common percent in real terms compared to 2016. countries where development outcomes are approach on international migration – was affected by fragility, conflict, and violence. In adopted by 152 countries. The achievement at Only five DAC countries (Denmark, Luxembourg, 2016, estimated 180 000 people were killed in global level were overshadowed by a discourse Norway, Sweden and the United Kingdom) met wars and violent conflicts, not including deaths that sees migration as a security issue and a the ODA target of 0.7 percent of a country’s due to the indirect effects of conflict such as the phenomenon that needs to be constrained not gross national income (GNI). Overall, ODA re- spread of diseases, poor nutrition and collapse of managed. Switzerland contributed considerably mained at 0.31 percent of GNI in 2017. Switzer- health services. Moreover, the security of human- to the elaboration of the GCM, however, it finally land spent 3.09 billion CHF on ODA, which is 439 itarian aid workers, including Red Cross person- abstained from its adoption. million CHF less than in the previous year. Swit- nel, has deteriorated in many fragile countries, zerland’s ODA expenditure fell to 0.46 percent and thus hampered their ability to access the of the country's gross national income (GNI) last affected population. However, armed conflict year, its lowest level since 2013. is not the leading cause of violent death globally: Five of the ten most violent countries in the world are non-conflict countries, and all of these are located in Latin America or the Caribbean. The phenomenon of organized violence in urban settings remains out of scope for most humani- tarians despite affecting many cities globally.

16 The past decade has shown the instability of Sources: the actual global governance mechanisms to adequately address global issues such as cli- Federal office of Foreign Affairs (FDFA): mate change, peace and security or migration. https://www.eda.admin.ch/deza/en/home/ The scale and capacity of nation-states is insuf- activities-projects/figures-statistics/swiss-oda. ficient for the problems facing the increasingly html (Website accessed on 2019-03-27) globalized world. Power politics are additionally weakening the multilateral systems. At the same International Federation of Red Cross and Red time, forms of cross-border governance, such as Crescent Societies (IFRC 2019). World Disaster the Chinese One Belt One Road initiative, and re- Report 2018. Geneva 2019 gional multilateral institutions, e.g. the ASEAN, https://media.ifrc.org/ifrc/world-disaster-re- increase in strength and shape new forms of port-2018/ cooperation. The private sector has taken on increased roles in delivering humanitarian and OECD State of fragility report 2018 (OECD development aid, questioning the governance 2018). OECD Publishing, Paris. roles played by nation states and reshaping pri- http://www.oecd.org/dac/conflict-fragility-re- orities. On the other hand, enduring economic silience/listofstateoffragilityreports.htm stagnation and incrementing distrust of politics is driving populism, nationalism, and cultural and United Nations Office for the Coordination religious contrasts. It is indicative of increased of Humanitarian Affairs (OCHA 2019): scepticism in governance and bureaucracy Global Humanitarian Overview 2019. Geneva, among the population of many democracies. New York Dec 2018. While overarching frameworks like the Agenda https://www.unocha.org/global-humanitari- 2030 provides common visions and goals for an-overview-2019 sustainable development at global and national level, increasing nationalism is questioning the United Nations: Sustainable Development international norms and agreements and puts Goals Report 2018 (SDG 2018). New York 2018 under pressure international cooperation and https://unstats.un.org/sdgs/report/2018 global compacts e.g. for migration. World Health Organization (WHO 2018): In Switzerland, with a view of the new dispatch World Health Statistics - Monitoring health for on international cooperation 2021–2024, but the SDG. Geneva 2018. also in response to the strategic outline of the https://www.who.int/gho/publications/wor- new foreign minister, the debate on interna- Fragility, Conflict & Violenceld_health_statis- tional cooperation has gained increasing polit- tics/2018/en/ ical and public interest, in 2018. The new strategic orientation, tight fiscal environment, but also Worldbank (WB 2019: Fragility, Conflict & political headwinds challenge the substance and Violence. (Website accessed 18.03.19) shape of Switzerland’s future international co- http://www.worldbank.org/en/topic/fragility- operation and foreign policy. conflictviolence/overview

World bank/UN (WB 2018) Pathways for Peace Inclusive Approaches to Preventing Violent Conflict.

17 SRC programme countries 2018

Belarus

Moldova

Bosnia Armenia Kyrgyzstan

Syria Lebanon Pakistan Nepal Bhutan Bangladesh Laos Mali Sudan Honduras Haiti Vietnam El Salvador Togo South Ethiopia Ghana Sudan Ecuador

Malawi Bolivia

Paraguay

18 3. Programme results 2018

In 2018, SRC implemented 122 health and disaster The programme reached 7,455,466 beneficiaries, risk management projects in 38 countries. 26 coun- of which 54 percent in Asia, 22 percent in Africa tries are considered priority “programme countries” and the Middle East, 20 percent in Europe, and 5 where SRC is present with a delegation office and percent in Latin America and the Caribbean. The a long-term country strategy. In 2018, SRC closed number of beneficiaries increased substantially its programme in Cambodia, and declared Bhutan from 4.6 million in 2017 to 7.4 million in 2018 due “programme country” instead. The SRC combined to an expansion of the programmes in Kyrgyzstan, long-term development cooperation with tempo- Laos, Bangladesh, and Bhutan. rary emergency relief operations in 20 out of the 26 programme countries. Linking relief, recovery and This chapter reports results, knowledge sharing development is a distinctive cooperation approach and policy dialogue, and lessons learnt along the of SRC’s, particularly in fragile contexts and disas- SRC thematic priorities in health (reproductive ter-prone countries. health, nutrition, disease control, WASH, ageing and health, blood safety, eye care) and along the phases of Disaster Risk Management (relief, recovery, Disaster Risk Reduction, and institutional preparedness).

Total Number of beneficiares

2017 2018

Total Number of beneficiares 4,596,351 7,455,466

Development 3,991,292 6,929,141

Reconstruction 55,498 33,952

Relief 549,561 492,373

The SRC monitoring approach Since 2017, SRC International Cooperation has risk served by a functional emergency commit- In addition to the standard outcome indicators, a continuously developed its monitoring system. tee. In the latter case, for example, functionality set of beneficiary indicators measure the number In order to track results and assess progress measurement includes the quality criteria of be- of people reached through project interventions across the international programme, SRC de- ing trained, equipped, recognized, linked to the or the number of selected outputs delivered signs its projects in line with a programmatic system and being active. Out of our thematic (e.g. houses reconstructed, cataract surgeries impact model. Based on this generic theory of indicator toolboxes, each country programme performed). Beneficiaries are defined as people change, 48 standard outcome indicators and 60 started in 2017 measuring at least two standard who thanks to the SRC project received any kind beneficiary indicators were defined and are in outcome indicators. In 2018, the process was of service during the reporting year. Information use since. further rolled out, so that most countries now disseminated through media such as radio, TV, measure more than two standard outcome in- the Internet or the press are excluded from the Outcome indicators measure the changes result- dicators. In total, 27 standard outcome indica- SRC beneficiary count. A beneficiary can receive ing from the services and interventions delivered tors are currently measured (see annex 1 and 2). services in more than one thematic domain, for by the project. In most of the cases, our outcome SRC also developed standard surveys to measure example, a health promotion message and a indicators are quantitative and relate to cover- the standard indicators and provided technical food package from the same project. To deter- age: they measure what proportion of a target and methodological support to delegations and mine the total number of beneficiaries, double population fulfils a quality criterion defined by partners. Outcome results based on the standard counting was taken into consideration to avoid the indicator. Standard indicators were chosen indicators are visualized in the thematic sections over-reporting beneficiary numbers. The benefi- in line with globally recognized SDG targets in chapter 2 and in the country summaries in an- ciary statistics for 2018 are available in annex 3. and indicators. Examples are the percentage nex 8. The full list of standard outcome indicators of households using and maintaining an im- measured 2018 across the programme countries proved latrine, or the percentage of villages at is available in annex 2.

19 Health

In accordance with the SRC health policy 2016, the All country programmes have strengthened com- SRC international health programmes aim at the munity involvement through the formation and col- following three outcomes: laboration with new or existing community groups, mothers’ clubs and health committees. In line with 1. Increasing equitable access to health services the global “One Million Community Health Workers and to goods and services that determine health; Campaign”, SRC programmes have contributed to 2. Improving quality of services, care and goods; train and support 12,868 community health work- and ers, with outstanding numbers in Togo and Ghana. 3. Changing health behaviour by promoting Red Cross and Red Crescent volunteers have made healthy living and healthy lifestyle. a great effort and invested ample time to provide integrated community case management for pneu- The SRC applies different approaches at individ- monia, diarrhoea and malaria, promote maternal ual, community and health system level to achieve and child health care services and good practices, these outcomes, and thus addresses both the de- and to assist beneficiaries to access services in time. mand and the supply side of health systems. All Investigations into problems related to transport actions include advocacy and local policy dialogue and referral in maternal and newborn health and for health through the SRC and the implementing other emergencies have called for new solutions. partner organisations. Innovative initiatives and partnerships between communities, local partners and government au- In 2018, the SRC health programme reached thorities were launched, for example the joint 4,614,379 beneficiaries. Large-scale primary health development of referral guidelines between two care programmes, for example in Bangladesh, and health directorates in Bangladesh, a security train- the expansion of social health protection to seven ing for drivers in Laos, or the conceptual develop- provinces in Laos have contributed to an increase of ment of local ambulance tricycles in Ghana. health beneficiaries from 2017 to 2018. The seven thematic priority areas in health are described in SRC programme teams have also successfully detail in this chapter. SRC programmes pay grow- strengthened local governance, lobbying with ing attention to gender and social inclusion as part local authorities, and exploring local sources for of the health programming. 7,500 boys and girls, co-financing of different health interventions. In women and men were reached with activities ad- Kyrgyzstan for example, the Red Crescent Society dressing sexual and gender based violence. More was able to fund-raise more than 50,000 CHF for than 25,000 persons were targeted through social the ageing and health programme; in Bangladesh, inclusion interventions. Thanks to a reproductive the primary health care programme successfully health project with the Honduras Red Cross, for ex- tapped funds from the local authorities (Union ample, the teenage pregnancy rate in the project Parishad) for health centre renovations; the same area has declined by 45 percentage points between applies to Nepal where major water supply infra- 2015 to 2018. structure was co-financed by local authorities. The SRC successfully initiated a multiple partnership approach with the Ministry of Health and various NGOs in the refugee camps in Bangladesh for people from Rakhine state (Myanmar) to provide one- step primary health care services under one roof. This model was officially endorsed by the government and is now replicated by other donors for the whole camp.

20 All SRC programmes support the principles of Uni- versal Health Coverage (UHC), a key target of the Sustainable Development Goal 3 on health. The SRC promotes UHC either by improving the quality of services, the access to prevention, promotion, treatment and care, and/or by supporting and promoting the financial protection of beneficiaries. Programmes also engage in awareness raising and linking beneficiaries to financial protection mechanisms. In Nepal, beneficiaries and programmes benefit from financial reimbursements. In Bolivia, however, the number of women benefitting from the state economic support for pre-and postnatal care remains unsatisfactory, and in Laos, because of the financial cuts of the government in the health insurance package, poor women were again excluded from access to services. The SRC stays engaged in these contexts with the aim to leave no one behind in health.

Number of beneficiaries in health

2017 2018

Total Health 4,145,800 4,614,379

Primary health care services 1,499,786 2,691,853

Health promotion 698,283 860,967

Social health protection 418,442 1,137,260

Community Health Workers trained 8,435 12,868

Health groups supported 1,978 6,466

21 Reproductive health

RH4: % of births attended by skilled health personnel RH5: % of women having received four or more ante- natal care check-ups during the last pregnancy

100% 100%

80% 80%

60% 60%

40% 40%

20% 20%

0% 0% Before 2017 2018 Target Before 2017 2018 Target

Bangladesh Honduras Bangladesh Bolivia Ecuador Laos Luang Prabang Laos Sekong Laos Luang Prabang Laos Sekong Nepal Pakistan Nepal Pakistan

RH6: % of children between 12–23 months vaccinated three RH7: % of women of reproductive age using at least one times for DTP 3 and any other additional vaccine method of contraception

100% 100%

80% 80%

60% 60%

40% 40%

20% 20%

0% 0% Before 2017 2018 Target Before 2017 2018 Target

Bolivia Laos Luang Prabang Bolivia Pakistan Paraguay Laos Sekong Pakistan

SRC contribution to the following SDG targets: 3.1: By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births 3.2: By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births 3.7: By 2030, ensure universal access to sexual and reproductive health-care services, in-cluding for family planning, information and education, and the integration of reproductive health into national strategies and programmes

22 Major Outcomes Ensuring the provision of quality of care remains a challenge in many project countries. With the Reproductive health continues to be an important aim to strengthen local health systems, SRC invests pillar of SRC international cooperation programmes largely in coaching and on-the-job supervision for and thus contributes to achieve SDG 3 (health) and public health providers. Yet, the lack of government 5 (gender equality). SRC projects focus on maternal, resources and, in some areas, poorly performing su- neonatal and child health and on sexual and repro- pervising authorities constitute important obstacles ductive health and rights. Depending on the local in achieving better care of quality. Governments of- context, SRC reproductive health interventions are ten request NGOs to invest in digital solutions, but linked with other health themes, such as nutrition, digital solutions will not replace clinical supervision. disease control and Water, Sanitation and Hygiene They may however contribute to improved health (WASH). SRC reproductive health projects operate information systems, for example through a web- in Bangladesh, Bolivia, Ecuador, Ghana, Honduras, based mother and child tracking system in Bhutan, Laos, Malawi, Nepal, Pakistan, Paraguay, South Su- or a digital patient record system in Bolivia, which dan and Togo. Across these countries, SRC tracks have improved recording and data quality. Thanks four standard indicators on reproductive health to the SRC contribution, data quality in the Luang (see the diagrams): Prabang district in Laos has much improved and the Ministry of Health decided to launch a next version Indicator RH4 Safe delivery: Births attended by of the data health information system (DHIS), pilot- skilled health personnel remain high in Honduras ing event-based patient data entry. and Ghana, where locally anchored birth attendants as well as the members of mother clubs have an immense impact on birthing practices. While in Good practice: the impact of mothers’ clubs Luang Prabang/Laos only 39 percent of women de- and tricycle ambulances in Ghana livered in SRC supported health centres, better road infrastructure and transport has increased the de- In Ghana, the SRC in collaboration with the Ghana livery rate in the provincial hospital, thus increasing Red Cross and the Regional Directorate of the overall delivery with skilled birth attendants to 52 Ghana Health Services expanded its maternal, ne- percent. Cutting of transport funds and allowances onatal and child health project in the Upper East in the health insurance package resulted in a 40 and Northern Region to 80 new communities. The percent decline of outpatient visits in those health project aims at improving access to safe mother- centres of Sekong/Laos, which remain in the most hood through peer education and support as well remote and poorest area and where quality of care as community-based and community-managed is low. transport facilities.

Indicator RH5 Ante-natal care: The percentage of In each community, a mothers club was estab- women having received four or more antenatal lished, consisting of women of all age groups who care (ANC) check-ups during the last pregnancy in- are interested to volunteer in their community. creased in projects in Bangladesh, in Ecuador, Nepal The mothers clubs engaged the beneficiary com- and Pakistan and remained steady in Laos. munities (both male and female) by disseminating information on positive maternal health practices Indicator RH6 Vaccination: Vaccination rates for to increase knowledge and promote change of children between 12–23 months of age were above attitudes. The mothers clubs' members engaged 90 percent in Bolivia and Togo and are gradually in- with 3,259 pregnant mothers and visited all 2,154 creasing in Laos and Pakistan. Health promotion in mothers who delivered in 2018 to encourage post- the communities as well as intensive outreach work natal care. The mothers clubs saw 89 percent of and Community-Integrated Management of Child- the newborn children within the first seven days of hood Illnesses have contributed to the increase. life. The mothers of these babies were counselled and supported in how to keep the baby warm, on

23 Knowledge Management & Policy Dialogue

––In 2017, the SRC initiated a community of practice (CoP) on Reproductive Health between the SRC delegations and partners in Asia. The CoP conducted monthly skype calls, shared practical experiences and exchanged ideas on on-the job supervision, safe motherhood revolving funds and referral transport of pregnant women. Expe- riences from Ghana and from other organisations (SolidarMed in Zimbabwe) were also shared. The group met for a three-day face-to-face workshop and field visit in Bangladesh. Gabriela (16) and Jasmin (17) having fun during a sexual and reproducive health ––SRC participated in knowledge exchange of the session at school in Paraguay, provided by SRC’s partner organisation Tesãi Reka. Sexual and Reproductive Health and Rights work- © SRC, Remo Nägeli ing group facilitated by Medicus Mundi. ––In Bangladesh it was a novelty that both Direc- exclusive breastfeeding and personal hygiene, on torates of Health and the Directorate of Family the importance of sleeping under long-lasting im- planning equally involved stakeholders in the pregnated bed nets and the newborns were also Primary Health Care Initiative project in Rajshahi, checked for possible danger signs. Mothers club’s facilitated by the SRC partner DASCOH. Through members reached almost 50,000 people in the regular meetings, these Directorates have started communities through community assemblies and to exchange visions and developments and to interactive radio discussion sessions with maternal align their approaches and resources more effec- and child health related messages, self-composed tively. The jointly developed referral guidelines songs, discussions and plays. The radio sessions are a first step. received 653 call-ins with 75 percent of the calls ––Despite an increasingly conservative political coming from men. All these interventions resulted environment in Latin America, SRC supported in 97 percent (2,154 of 2,212) of pregnant women projects have successfully managed to continue delivering at a health facility by skilled health work- and scale up their activities in sexual and repro- ers. 38.7 percent (883 of 2,154) of mothers were ductive health and rights. Policy dialogue reaches escorted by mothers clubs’ members. 58 women departmental and municipal levels (but rarely who delivered at home had no access to a health state level). facility because of difficult access, bad terrain, or no ––The SRC contributed financially and with techni- means of transport), but after delivery they were cal expertise to the development of the various quickly escorted to the health facilities for check-up. IFRC eCBHFA (Community based health and first aid) modules in reproductive health and beyond. Women were escorted either by private transport This tool includes topics such as nutrition, WASH, or by using one of the eleven tricycle ambulances, disease control and is now more easily accessible procured in the previous project phase. A direct rela- in the partner countries than before due to its on- tion between the strength of the health committee line version. and the usage, management and operation of the tricycles was found. A strategy for the operation- alisation of the Community Emergency Transport Services with the tricycles was developed together with the Ghana Health Service in order to address the challenges encountered in the past, notably the lack of communication between drivers and clients and insufficient financial incentives for drivers.

24 Number of beneficiaries in maternal and child health

2017 2018

Maternal health: deliveries 11,762 30,117

Maternal health: ante-natal care 20,206 63,042

Child health services 269,429 622,834

Lessons learnt ––The SRC’s approach to work on demand (com- ––Quality care and positive experiences outweigh munity) and supply (health system) in health financial implications when seeking help at a continues to be a recipe for success. Investing health facility. The experience from Laos in outreach in hard-to-reach areas is resource showed that quality matters. When health in- intensive but yields good results and matches surance cuts were done, patients still paid out the objective to go the last mile and leave no of pocket and mobilised money and transport one behind. to reach a good health provider. Establishing ––A “personalised” approach through dedicated financial safety nets in the community and con- peers (e.g. mothers, parents groups, volun- tinuing to lobby for and support on-the job teers) is labor intensive, but yields a high im- supervision are good approaches to support pact, which again perpetuates the motivation Universal Health Coverage in reproductive of the peers. The mothers clubs and/or groups health. in Ghana, Togo, South Sudan and Nepal and parents groups in Paraguay are good examples. ––While digitalisation is on the forefront, reliabil- ity of the health management information system data is still questionable. SRC projects should seek a good understanding of the local Health Management Information Systems and think about possible support to local health authorities in improving data quality, analyses and data utilisation.

25 Nutrition

NU2: % of children from 0–59 months that appear for NU3: % of infants < 6 months of age received only breast regular check ups and growth monitoring milk on the previous day

100% 100%

80% 80%

60% 60%

40% 40%

20% 20%

0% 0% Before 2017 2018 Target Before 2017 2018 Target

Bolivia Haiti Pakistan Togo

SRC contribution to the following SDG targets: 2.2: By 2030, end all forms of malnutrition, including achieving, by 2025, the internationally agreed targets on stunting and wasting in children under 5 years of age, and address the nutritional needs of adolescent girls, pregnant and lactating women and older persons By 2030, end preventable deaths of new-borns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births

Major Outcomes and South Sudan, reached 58,909 beneficiaries in 2018. The SRC uses two standard outcome indica- Droughts, floods, migration and poverty have tors to track progress in the domain of nutrition (see contributed to an increasing number of people diagrams). living in food insecurity, and consequently at risk of malnutrition. However, not only undernutrition Indicator NU3: Infants under 6 months of age re- but also over- and malnutrition are an increasing ceived only breast milk on the previous day: An im- global health problem with an estimated 20 per- portant element of infant health is exclusive breast- cent of the world population being obese and an feeding up to six months followed by adequate estimated two billion people suffering from micro- weaning with age-adapted and varied food. Several nutrient deficiency. SRC projects tackle chronic and projects promote exclusive breastfeeding, mainly acute malnutrition by promoting healthy food, hy- combined with other mother and child health ac- giene promotion, as well as community and school tivities and often supported by state or non-state gardening. SRC country programmes with nutrition actors. In Pakistan, for example, the district health elements in Pakistan, Laos, Bangladesh, Nepal, El department held a “Mother and Child Week” to cre- Salvador, Bolivia, Paraguay, Haiti, Ethiopia, Sudan ate awareness about mother and child health issues

26 and the importance of care during pregnancy and new-born period. The project team participated in the activities with banners and posters to convey key messages on institutional deliveries, antenatal care, postnatal care, family planning, immuniza- tion and breast-feeding. Although the proportion of children below the age of six months who were exclusively breastfed improved from 25.5 percent at project baseline in 2016 to 37 percent in 2018, the improvement over the past year has only been marginal (from 34 percent to 37 percent). Thanks to the project intervention in Haiti, there has been an increase of exclusive breastfeeding from 31 percent in 2017 to 46 percent in 2018. Although this is Cristina Isabel Galicia working in her garden in Los Cedros, El Salvador, where the Red Cross implements a nutrition project. © SRC, Florian Kopp higher than in Pakistan, both projects are below the target set by WHO which aims to reach 50 percent of exclusive breastfeeding by 2025. Togo was able to increase exclusive breastfeeding from 77 percent in 2017 to 85 percent in 2018. In Paraguay, the project sensitised communities in the domain of nutrition and healthy food. Despite Indicator NU2: Children from 0–59 months that ap- an increase of 14 percent of people who know pear for regular check-ups and growth monitoring: nutritional risk factors in children under five years Regular child growth monitoring is essential for of age, there are still 25 percent of children under early detection of malnutrition. Many mother and five years of age at risk of malnutrition and 5.5 per- child health projects therefore integrate the promo- cent of children under five years of age are moder- tion of growth monitoring. In Bolivia, health staff as ately or severely malnourished. This illustrates that well as staff from the infant nutrition unit, in coordi- knowledge does not necessarily lead to behaviour nation with community leaders and municipalities, change. carried out community trainings. Topics tackled included healthy nutrition, preparation of nutritious In Laos, SRC supported school garden training and food with local products, and handling of food hy- school garden development in five schools, target- gienically. Growth monitoring of children from 0 to ing 5,243 beneficiaries. Training included vegeta- 59 month has increased by 18 percentage points ble production, nutrition education, hygiene pro- to 81 percent. Chronic malnutrition stagnated or motion, and cooking demonstrations. The project even slightly decreased. In Laos, the number of child provided seeds and tools and assisted in the con- growth monitoring increased steadily over the last struction of school kitchens. Thanks to the project, three years. 64 percent of children under the age the consumption of four or more food groups in- of five had at least four growth monitoring visits, creased from 15 percent to 43 percent. From the which is a substantial increase in comparison to baseline in 2017 to mid-term, students’ knowledge the previous year where it was only 37 percent. It is of food groups increased by 9 percent. assumed that mothers have recognized the importance of bringing their children for growth monitoring and it may reflect the intensified engagement, influence and good work of the Village Health Vol- unteers in the community.

27 Good practice: families in Haiti improving their proximity has been developed and more links were nutrition in a sustainable way created between the project and the communities. These efforts have led to a gradual increase in the In Haiti, SRC trained volunteers, families and com- populations’ level of knowledge and practice in munity committees in various nutrition topics such terms of exclusive breastfeeding, health, nutrition as nursery, natural pesticides, terra preta, grafting, and food hygiene. seed preparation, conservation and composting as well as topics in the domain of healthy food, hy- Selling food in the streets is common in Haiti. How- giene and other health topics. Several communities ever, food hygiene is not respected in these food have established nurseries to produce fruit and for- stalls. For this reason, food hygiene and nutrition est seedlings, planting around 5,660 seedlings in activities were also carried out with street food 21 sites. Volunteers carried out the maintenance of vendors. The activities were concluded with a com- these plantations. In addition, nearly 12,800 seed- petition during which, beside the first price for the lings were distributed to beneficiaries to be planted winner, all participants received hygiene kits. in their gardens. The fruit tree plantations will be used to increase the food basket of families. 80 new Three more schools were included into the school families were trained in the technique of terra preta feeding program. At present there are five func- and were enabled to establish their own family veg- tional school canteens that serve 509 children with etable gardens. Thanks to these trainings, families healthy food. Out of the eight school modules that started to produce their own seeds, which made were developed by the project, six are being imple- it possible to continue gardening in a sustainable mented. School pedagogical kits were distributed, way. One of the challenges in Haiti remains the lim- and 424 children sensitised on the consumption ited motivation and wait-and-see attitude of some of healthy food. Many parents stated that their beneficiaries. However, through clear and transpar- children had asked them to name the three food ent communication, active listening and the assid- groups on their plates and talked about healthy uous presence of project officers in the field, more nutrition.

Number of nutrition beneficiaries

2017 2018

Nutrition 94,918 58,909

28 Lessons learnt ––Nutrition projects focus on growth monitoring, shows that with adequate training and super- nutrition education and counselling with refer- vision, volunteers can carry out successful ral to other institutions for treatment of acute- growth monitoring at community level. This ly malnourished children. However, there seem increases the detection and referral of mal- to be no, or limited follow-up of these children nourished children who otherwise would not once discharged from feeding centres. This appear at a health facility. would be an important further step in order to ––Integrated interventions such as combining nu- reassure that recovered children do not fall into trition with gardening and/or WASH activities a relapse. seem to have a greater impact on behaviour ––Implementation of treatment as part of com- change than stand-alone nutrition awareness munity management of acute malnutrition re- projects, and therefore should be fostered. In mains a challenge because SRC projects often addition, the combination between nutrition, do not negotiate any partnerships with special- ageing and disease control should be explored. ised institutions. However, the Bangladesh ––In order to achieve behaviour change, barriers Cox’s Bazar operation benefitted from an over- for nutritional behaviour change need to be all agreement between IFRC and Action Contre analysed in-depth. This analysis should ideally la Faim (ACF). No other SRC project has yet es- be done during the assessment and planning tablished a partnership with any agency active phase in order to engage in adequate knowl- in nutrition that could support community edge transmission later. management of acute malnutrition (e.g. SUN, ––Many countries where SRC is active suffer from UNICEF, WFP etc.). a double burden of over- and under-nutrition ––Projects that intensified outreach and involved as well as from diseases related to micronutri- volunteers in growth monitoring have reached ent deficiencies such as vitamin A or iron defi- higher numbers of detected cases of malnour- ciencies. More attention must be paid to differ- ished children than projects that did not. This ent aspects of malnutrition.

29 Disease control

Major Outcomes ually Transmitted Infection/HIV counselling and testing coverage of migrants and their families has Although communicable diseases are still the main increased. The project supported the treatment cause of death in most SRC programme countries, of those identified positive in close coordination non-communicable diseases are on the rise and will with the District AIDS Coordination Committee, soon be a leading cause of ill health, disability and Red Cross District Chapter and HIV/AIDS related premature death even in low-income countries. non-government organisations such as Dang Plus Over the past year, non-communicable disease and Rolpa Plus. People living with HIV facilitated prevention as well as epidemic preparedness and awareness sessions in communities and schools in response has gained more attention. Countries order to reduce stigma and discrimination of peo- that had disease control elements in their projects ple living with HIV. were Bolivia, Paraguay, El Salvador, Ecuador, Hon- duras, Bhutan, Nepal, Moldova, Kyrgyzstan, Ghana, In Paraguay the project tackled topics of HIV and Malawi, Egypt and South Sudan, reaching 46,680 Sexual and Reproductive Health (SRH). 29 teachers people. and directors were trained in SRH and HIV prevention and de-stigmatisation topics. Parent circles In several countries where epidemics such as chol- served as information and knowledge hubs as well era or other diarrhoeal disease are endemic, pre- as support to tackle SRH/STI/HIV at schools. These paredness and response activities have been inte- circles were not only a support but also provided grated into general disease prevention. In Ghana, an enabling environment for teachers to express Community Disaster Preparedness and Response frustrations and anxieties encountered when ad- Teams were able to assist 45 communities in addressing these issues with students. This is of great dressing major health hazards, including malaria importance, considering that the Ministry of Educa- and cholera. Clean-up campaigns were organised tion, rather than promoting the teaching of these in which 10,133 community members and volun- topics, censored the subject in educational institu- teers participated. A survey revealed that 67 per- tions. Eight family health units were strengthened cent of pregnant women and 90 percent of new- in STI/HIV counselling and HIV testing increased born babies slept under a long-lasting insecticide from 521 in 2016 to 832 adolescents and young treated bed net the night prior to the survey. In Ma- people in 2018. It remains a major challenge to in- lawi, where one of the project areas was affected by crease the number of people living with HIV to get cholera, trained Red Cross staff and volunteers were and remain on treatment. able to respond timely to the outbreak through a scale-up of household visits. Nearly 60,000 people In order to tackle the increasing global problem of were reached with health and hygiene messages, healthcare acquired infections (HAI), the healthcare doubling the number of 2017. A decrease of diar- waste management project in Kyrgyzstan imple- rhoea cases in Ikwotos, South-Sudan, (13,335 cases mented infection control measures in 227 health fa- in 2017 and 11,730 cases in 208) was registered, cilities. 1,181 health professionals (doctors, nurses, thanks to hygiene promotion delivered by volun- students) were trained in infection control. Overall, teers and health committees. 1.16 million people, inpatients and outpatients of these 227 health facilities benefitted from infection In Nepal, HIV/AIDS forms an important part of the control measures. All 227 healthcare facilities were community health project. The project is aligned compliant with the upgraded national infection with the national strategy and its targets on Test- control standard, increasing the use of periopera- ing, Treatment and Retention. The efforts were tive antibiotic prophylaxis to 96 percent. In surgical directed to create awareness about HIV through units, the HAI rate decreased from 7.6 percent to health interaction sessions in all community groups 5 percent and in intensive care units HAI rates de- and through radio messages. HIV prevention was creased from 16.9 percent to 13.1 percent. In the integrated in the 'Meet the Mother' campaign, en- maternity units, the HAI prevalence among new- couraging the spouses of migrants for voluntary borns, remained at the same level of 5,5 percent counselling and testing and as a result, the Sex- (5,1 percent in 2016). Disaggregated analysis by

30 weight for new-borns showed a decrease of HAI rate from 24.5 percent in 2016 to 15.8 percent in 2018 in small new-borns (≤ 2500 g). Women with caesarean section showed a decrease of HAI rate to 7.6 percent (8.5 percent in 2016). The level of infections in the field of surgical intervention went down to 3.1 percent (6.2 percent in 2016). In general, the number of revealed HAI cases lies within international standards. Data analysis suggests that experts have learned to distinguish infections and properly record detected cases, which is crucial to develop an effective strategy to prevent and address HAI. A refugee child getting a Cholera vaccination in Cox’s Bazar, Bangladesh, where SRC with the Red Crescent Society implements a major health programme. © IFRC, Angela Hill More beneficiaries have benefitted from non-communicable disease projects in 2018, mainly though health promotion. Many projects tackle disease control from both, the demand and the supply side. As for example in Egypt, where more than 20,000 153 in 2015 to 126 cases in 2018. Suspected Dengue people were reached through health awareness cases decreased from 2,395 in 2015 to 233 in 2018. campaigns. During these campaigns, topics such 80 percent of beneficiary families apply at least five as hypertension, diabetes, healthy diet as well as basic disease prevention measures. The project also personal and domestic environment hygiene were contributed to health system strengthening by im- tackled. In addition, the project supported two hos- proving infrastructure and equipment as well as pitals, run by the Egyptian Red Crescent, with an training of health personnel. This allowed health update of the patient registration system as well as units to remain operational even during emer- the provision of essential medical equipment and gencies. In addition, non-communicable diseases non-medical supplies. Also El Salvador, Bhutan, Ne- gained greater importance in Honduras, where the pal and Moldova tackled non-communicable dis- second most common reason for premature deaths eases in their projects. is attributable to these diseases. Health committees were trained in cancer prevention, community first aid, H1N1 influenza and chronic diseases. 30 health Good practice: better health in Honduras facilities have a diabetes and hypertension club and thanks to a combined approach with organised 49 workshops. The project also provided communities and the health system psychological counselling that contributed to an increase of self-confidence, acceptance of their con- Health committees and local emergency commit- dition and improvement of their physical condition tees in Honduras carried out home visits, monthly in up to 80 percent of the cases. Complex cases meetings, community assemblies and campaigns were referred to municipal health care centres. in order to increase disease prevention awareness among community members. This included vector control as well as health, house and food hygiene activities. These activity bundles that were carried out in a participative and integrated way led to a reduction of common diseases such as pneumonia, diarrhoea, Dengue, Zika and Chikungunya. Accord- ing to assessments at the level of the department of Choluteca, pneumonia in children under five has decreased from 44 in 2015 to 17 cases in 2018 and diarrhoea in children under five has decreased from

31 Knowledge Management & Policy Dialogue SRC contribution to the following SDG targets: 3.3: By 2030, end the epidemics of AIDS, tubercu- ––The SRC and SDC funded project in Kyrgyzstan losis, malaria and neglected tropical diseases and contributed significantly to the development combat hepatitis, water-borne diseases and other communicable diseases of the new upgraded national infection control 3.4: By 2030, reduce by one third premature mortality from standards and the compliance of health facilities non-communicable diseases through prevention and treat- to these standards. ment and promote mental health and well-being ––In Paraguay, the project substantially contributed to an inter-institutional roundtable where different state and non-state actors sat together and discussed the effective and efficient implementation and compliance with current HIV regulations. One of the immediate products of the roundtable was the publication of a communiqué by the Min- istry of Labour, which indicates the full validity of all laws and ministerial resolutions that refer to the prohibition of requiring HIV testing as a requirement to access or remain in a job.

Number of disease control beneficiaries

2017 2018

NCD services 25,503 4,748

NCD promotion 18,590 28,788

Infectious disease control 61,182 13,144

Lessons learnt ––Involving parents, like in Paraguay, and directly ––SRC continues to be challenged to take clear affected people as for example people living decisions when specific health topics, e.g. HIV/ with HIV (Nepal, Paraguay) in the implementa- AIDS or nutrition, should be better approached tion of sensitive and stigmatised topics seems with a clear integrated multi-partner ap- to have a positive effect. proach. ––Linking communicable disease prevention ––Linking non-communicable disease, ageing with epidemic preparedness enables commu- and health and nutrition is partially developed nities and emergency teams to better respond in Eastern European country programmes but to epidemics and scale up health and hygiene could still be further discussed and developed. promotion in emergencies.

32 Water, Sanitation and Hygiene (WASH)

Major Outcomes Improving people’s access to safe water, sanitation and hygiene thus remains integral for SRC to foster With an increasing water scarcity affecting already healthy living among particularly vulnerable com- more than 40 percent of the global population, munities. In 2018, SRC implemented WASH projects ensuring access to clean water and proper sanita- in 14 countries, namely Bangladesh, Bhutan, Ecua- tion remains key for achieving the Sustainable De- dor, El Salvador, Ethiopia, Haiti, Honduras, Laos, velopment Goals, including good health. Despite Malawi, Nepal, South Sudan, Sudan, Togo and Viet- significant successes in the past 25 years, 1.8 billion nam. Thanks to a strategic approach combining wa- people still consume drinking water contaminated ter and sanitation infrastructure development with by faeces and 2.4 billion people lack access to basic hygiene promotion and capacity building of local sanitation facilities, such as toilets or washing sta- partners and communities, 386,764 beneficiaries tions. At least 892 million people continue to prac- were reached. 184,647 people gained new access tice open defecation and handwashing and proper to an improved drinking water source, 76,553 peo- handling of water remain a challenge in many con- ple gained access to improved sanitation facilities, texts. Poor hygiene and unsafe water are responsi- 330,423 people were reached with hygiene pro- ble for nearly 90 percent of the more than 2 million motion messages, and 56341 schoolchildren were people who die every year from diarrhoeal diseases, reached with WASH interventions at school level. most of them children (UN 2019: Clean Water and Sanitation: Why it matters).

WH2: % of households using and maintaining clean latrines WH3: % of households using an improved drinking water source

100% 100%

80% 80%

60% 60%

40% 40%

20% 20%

0% 0% Before 2017 2018 Target Before 2017 2018 Target

Haiti Togo Vietnam Bangladesh El Salvador Nepal Togo Vietnam

33 WH2school: % of schools using and maintaining clean WH4school: % of schools using safely managed latrines sanitation facilities

100% 100%

80% 80%

60% 60%

40% 40%

20% 20%

0% 0% Before 2017 2018 Target Before 2017 2018 Target

Sudan Laos

WH5school: % of schools adopting safe water handling WH6: % of households with soap and water at the hand practises washing station

100% 100%

80% 80%

60% 60%

40% 40%

20% 20%

0% 0% Before 2017 2018 Target Before 2017 2018 Target

Laos Bangladesh Haiti Malawi Nepal Sudan Togo

WH6school: % of schools with soap and water at the hand washing station

100% SRC contribution to the following SDG targets: 6.1: By 2030, achieve universal and equitable ac- 80% cess to safe and affordable drinking water for all 6.2 By 2030, achieve access to adequate and equi- 60% table sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and 40% girls and those in vulnerable situations 6.3 By 2030, improve water quality by reducing pollution, eliminating dumping and minimizing release of hazardous 20% chemicals and materials, halving the proportion of un- treated wastewater and substantially increasing recycling 0% and safe reuse globally Before 2017 2018 Target 6.a: By 2030, expand international cooperation and capacity-building support to developing countries in water and Laos sanitation-related activities and programmes, including water harvesting, desalination, water efficiency, wastewater treatment, recycling and reuse technologies 6.b: Support and strengthen the participation of local communities in improving water and sanitation management

34 Water Sanitation

Indicator WH3 Improved drinking water: In 2018, Indicator WH2 Use and maintenance of clean la- SRC monitored substantial progress of the indica- trines: Equally important as the improved access to tor measuring improved drinking water across all water, the SRC monitoring system shows that the program countries. In El Salvador 41 systems for use and maintenance of clean latrines has increased grey water treatment were installed according to across the programme countries. A project in Bang- national standards. Grey water treatment is a com- ladesh has shown how the combination of several pulsory prerequisite from the state in order to con- strategies and approaches can lead to good results. nect communities to drinking water systems. The The involvement of a wide group of stakeholders, communities that were connected to grey water good communication and support from the local treatment were supported to receive access to the government, the creation of demand and the es- national water system. In 14 communities, elected tablishment of local markets, the involvement from community members were trained in maintenance community members in different committees dur- and repair of sanitation systems. By the end of 2018, ing the whole project management cycle, and the 68 percent of the targeted population were using application of different methods in hygiene promo- an improved drinking water source. tion in schools and in communities all contributed to a substantial improvement in sanitation and hy- In Vietnam, 325 water tanks for rainwater harvest- giene conditions of the beneficiaries. The usage and ing were procured and distributed to poor benefi- maintenance of clean latrines increased from 13 ciaries’ households to increase access to safe drink- percent at baseline to 83 percent in 2018. The safe ing water. 99.8 percent of beneficiaries or about management of sanitation facilities is supported by 1,650 people gained new access to safe drinking a team of trained sweepers. Hand washing at crit- water, which marks an increase of more than 20 ical times increased from 7 percent to 81 percent percent compared to 2017. while the availability and use of soap at the hand washing facility only showed a moderate increased In Bangladesh, an integrated WASH project in the from 51 percent to 64 percent (see diagram WH2). Barind tract dramatically improved the WASH conditions of 52,000 beneficiaries as access to safe wa- In Cormier, Haiti, the second phase of a WASH ter increased from 24 percent in 2014 at baseline project pursued a locally adapted form of commu- to 100 percent in 2018 (cf. “good practice” below). nity-led total sanitation, the so-called “stratégie d’assainissment communautaire”. The approach Other interventions focusing on water included the proved to be successful as the set target was not construction and rehabilitation of water systems at only reached but exceeded. At the end of the pro- community and school level (Ethiopia, Laos), the ject, 82 percent (target: 72 percent) of households construction (Ethiopia), repair (Malawi, South Su- had a toilet, which almost corresponds to the na- dan) and protection of boreholes, and the forma- tional target of at least 90 percent by 2022. Three tion and training of water committees and pump elements created a social environment conducive technicians (Ethiopia, Malawi, South Sudan, Hon- to the construction of latrines by households them- duras) to ensure the correct operation and mainte- selves: 1. Involvement of community structures in nance of installed water systems. mobilizing communities to build latrines; 2. the “konbitism” system used to facilitate mutual assistance between households in digging the hole; and 3. targeting households in small housing groups. Apart from exceeding the initial target for latrine coverage, the endline survey also showed that 89 percent of households had soap in their homes and 84 percent of respondents demonstrated knowledge on hand washing. 92 percent of the population had access to drinking water.

35 In Vietnam, the WASH sensitisation campaigns in Hygiene communes and schools advanced well, but overall the progress was relatively slow. Some of the chal- Indicator WH6 Households with soap and water lenges relate to the latrine design development at the hand washing station: Hand washing with and approval process. Others concern the still low soap is a globally acknowledged key behaviour acceptance, understanding and ownership of to reduce diarrhoea. As a standard indicator, SRC the RANAS (Risks, Attitudes, Norms, Abilities and measures the proportion of households with soap Self-regulation) approach. A Doer/Non-Doer anal- and water at the hand washing station to track pro- ysis carried out in the course of the baseline study gress in hygiene behaviour (see diagram WH6). The revealed that a high proportion of respondents still positive impact of health sessions on hand washing use fish-pond latrines that many do not perceive practices was observed in a slum project in Bangla- to be a form of open defecation. So even though desh when comparing results from 2017 with the the percentage of households using latrines has findings of an endline survey carried out in Octo- increased from 26 percent to 37.8 percent (see di- ber 2018. Hand washing had improved at all critical agram WH2), this increase should be treated with times, most significantly before preparing food (31 caution as these latrines are mainly fish-pond la- percent increase) followed by before feeding the trines. The project’s behaviour change strategy is child (30 percent increase), and before eating (23 thus focusing on this key behaviour, with the aim percent increase). 100 percent of the study’s partic- to help people understand the critical link between ipants reported that they washed their hands after the use of fishpond latrines and open defecation. defecation.

A baseline study in Togo revealed that only 40 per- Within the context of two resilience projects in the cent of households were using and maintaining fragile contexts of Gambella and Moyale, the Ethio- clean latrines in the project area. In 2018, about 600 pian Red Cross focused on health and hygiene pro- new latrines with hand-washing facilities were built motion through trained CBHFA volunteers, aiming and used by more than 3,000 people. The strong in- at improving WASH related health determinants. volvement of women in the Mothers Clubs contrib- The volunteers reached 20’540 people. As a result, uted to the achievement of 28 open defecation free as observed by field staff, 80 percent of the project villages, which are awaiting official certification. targeted communities in Moyale practice proper Similarly, in Laos, 5 villages were awarded the sta- water treatment before drinking, for example by tus of “Model Health Village” by the relevant District using water purification tablets, water filtration or Health Offices because community members, fol- boiling water. Despite the difficult security situation, lowing the construction of 260 household latrines, 287 new households constructed latrines and 520 not only used and maintained the latrines but also households built their own hand washing facility, repaired water systems and tap stands where nec- equipped with water and soap for hand washing. essary, and maintained good village, household, and personal hygiene. In Malawi, the Red Cross also focused on CBHFA and trained/retrained 295 volunteers. Local staff Other interventions focusing on sanitation included was trained in Behavioural Change Communica- the construction of flush toilets (Bhutan), the com- tion (BCC) techniques and supported the volun- pletion of garbage collection and clean-up cam- teers. More than 70,000 people were thus reached paigns (South Sudan), the elaboration of locally through sanitation and hygiene behaviour sensi- adapted costs-effective latrine models (El Salvador), tisation activities. The volunteers used household and the elimination of vector breeding grounds visits, the engagement of local leaders, community (Honduras). sessions, and school-based activities to communi- cate their health messages. For schools the themes also included Menstrual Hygiene Management (MHM), which has received special attention in Ma- lawi this year (cf. knowledge management below).

36 Other interventions focusing on hygiene included training of staff, volunteers and teachers on hygiene promotion (South Sudan), awareness-raising activities on good WASH practices (Togo), and joint hygiene promotion campaigns with health authorities (El Salvador).

WASH at schools

The SRC portfolio on WASH at schools continues to grow, which is reflected in a set of three school-based WASH standard indicators: schools Hand washing is a critical factor to prevent diarrhoea. The Nepal Youth Red Cross teaches pupils at a mulim school the importance of hand washing. © SRC, Remo Nägeli using safely managed sanitation facilities (diagram WH4school), schools adopting safe water handling practices (WH5schools), and schools with soap and water at the hand washing station (WH6school). The school WASH project in Laos reached 2,068 ben- pleted at supported schools in Malawi. The ratios of eficiaries by providing 70 percent of the targeted pupils per latrine have improved by at least 100 per- schools with access to safely managed toilets, with cent at each targeted school and the ratios are now construction work still ongoing. Hand washing and meeting the national standard in most schools. bathing facilities in 10 supported schools was not yet complete in 2018 and only 10 percent of schools Other WASH interventions at school level included have soap and water at the hand-washing station. the construction of a grey water treatment system By the end of 2018, all 10 schools had a functioning in Trashi Yangtse district (Bhutan) in cooperation water supply. As water quality in none of the water with the Public Health Engineering Division of the systems complied to the national water standard MoH, the implementation of a CHAST programme due to coliform contamination, water filters were at primary schools (Vietnam) reaching 3,746 stu- purchased locally for water treatment. 97 percent dents, the improvement of waste management of students of the two schools where water filters systems (Laos), and the training of 32 hand-pump were already provided now get their drinking water technicians in 8 villages to ensure the sustainable from school compared to 43 percent at baseline. management of WASH infrastructure on school Safe water handling practices have also increased premises (Sudan). Only 3 percent of these schools significantly from 14 percent to 40 percent. Analy- in Sudan are yet equipped with functioning latrines. sis was based on correct adoption of all four of the following observed practices: water was taken from the storage unit using a vessel; the vessel appeared Good practice: water governance a key clean; the vessel was cleaned at least one time per element for success in Bangladesh day; the vessel was stored safely. Findings from the pre- and post- tests conducted during MHM train- The Integrated Water Resource Management ings show that 98 percent of respondents improved (IWRM) project has been recognised as an impor- their knowledge and attitudes of MHM. tant building block for improved water governance in Bangladesh. The aim of the project is to improve In Togo, 20 new schools were trained in the blue the well-being of people by means of promoting school concept and developed an implementation coordinated, equitable and sustainable develop- roadmap. A total of 28 schools are now pursuing ment and management of water, land and related gardening and environmental protection activities. resources. With an additional five school latrines serving 600 students, latrine construction activities were com-

37 Knowledge Management & Policy Dialogue

In recent years, menstrual hygiene has gained growing attention, particularly in WASH at schools where girls’ needs have long been neglected. SRC projects in various countries address menstrual hygiene management at schools with different approaches. A Knowledge, Attitudes and Practices (KAP) study on Menstrual Hygiene Management (MHM) was carried out in Malawi by a SRC supported Master Student from Barcelona University in cooperation with the Malawi Red Cross Society. The study aimed at identifying evidence-based and Children in the refugee camp in Cox’s Bazar fetching water from a supply system culturally acceptable menstrual health solutions built by the SRC. © SRC, Remo Nägeli to empower girls to reach their full potential. The report concluded that knowledge and information on MHM is limited, often rendering it a scary experience. Negative attitudes towards menstrua- The project strategy of reward, recognition and tion and teasing hinder girls to fully participate in rebate to enhance appropriation of improved wa- school. Schools do not offer sufficient facilities, and ter management practices proved to be effective. pain and fear of soiling lead to school absence. The To address water scarcity in the region, 4R princi- study was published by SRC and presented at MHM ples (reduce, re-use, recycle, restore) were con- forums by IFRC and a virtual conference of UNICEF. sistently applied to develop water schemes and Building on the study, Malawi Red Cross Society has programmes. A massive capacity development ex- planned MHM activities for 2019 including orien- ercise was mounted by the project to familiarise var- tations for Mothers Clubs and sanitary pad making ious stakeholders – communities, union parishads pilots. In Switzerland, SRC HQ contributed to the re- (councils), government officials and other non-state vision of the MHM Guidelines and Tools of the IFRC. actors – with the IWRM principles and practices and their institutionalisation through the Bangladesh The Nepal Red Cross Society (NRCS) WASH team Water Act, 2013. New irrigation technologies such was requested by municipality authorities to com- as alternate wetting and drying, drip irrigation and plement government water schemes because the furrow irrigation were piloted. 12,000 people (37 government is not yet successful in getting the “one percent disadvantaged, 22 percent ethnic minor- household-one tap” approach off the ground. Pol- ities and 15 percent extreme poor) were directly icy and advocacy activities at the new political ad- engaged with IWRM initiatives and 55 percent of ministrative structure at province and municipality local government initiatives incorporated IWRM level aim at supporting the formation and reforma- operation and maintenance into their budgetary tion of different local administrative structures in provisions. Health and WASH. Municipalities are supported to have their own WASH and health plan that guides Eventually, households’ involvement in improved them to conduct the activities effectively. water management practices has increased from 5.6 percent at baseline in 2014 to 83 percent at the end of the project (June 2018). All IWRM activities were co-financed by the project, local government initiatives and communities, with local government initiatives cumulatively contributing 116,793 CHF and communities contributing 205,343 CHF by the end of the project.

38 Building on already established joint monitoring lages. The Togo the project team participated in the practices, a CLTS management framework is being regional exchange workshop in Bamako as part of established in Togo between UNICEF, the Ministry the Swiss NGO consortium: Blue schools, integrity of Health, the Togolese Red Cross, and the Swiss in water governance were the main themes of this Red Cross, with the aim of creating a regional cer- workshop. tification committee for open defecation free vil-

Number of WASH beneficiaries

2017 2018

Improved water 390,829 185,972

Improved sanitation 170,695 76,553

Hygiene promotion 648,308 327,950

WASH in schools n/a 56,341

Lessons learnt ––The availability of quality service providers for the devel- ––Integrating hygiene and health promotion in all WASH opment of WASH infrastructure (design, skilled labour, and all health projects enhances the reach and possible supervision) continues to be a challenge in fragile and impact on beneficiaries’ behaviour change. More and structurally under-resourced contexts and leads to imple- more projects are integrating and addressing MHM in mentation delays (Sudan). schools. ––Investment in community participation during the early ––Availability of soap at the hand washing station is still low, stages of project development is often time-consuming. even in projects that demonstrate otherwise high impact It pays off in the long run as local community structures/ on water and sanitation. Reasons for this need more in- organisations are more likely to continue their activities vestigation. beyond the time limits of a project. For example, in Togo ––Faecal sludge management is still an important issue not where Water and Sanitation committees and Mothers’ tackled enough by the WASH projects. While quite a few Clubs have continued the management of rehabilitated projects in Asia mention a high impact on access to water water points, monitoring of the achievement of ODF vil- and sanitation with ODF declaration, only one project in lages, or the promotion of water treatment at HH-level Bangladesh mentions measures taken for improved through the production and distribution of liquid chlorine sludge management. and chlorine tablets. ––Despite good access to piped drinking water and hygiene –– Developing and implementing good and cost-effective promotion sessions that included personal hygiene, man- technical designs for safe hygienic latrines in areas with a agement of communal water systems and sessions on safe high water table and scarcity of land remain a huge chal- water handling practices, a substantial number of people lenge (Vietnam, Haiti). in Bolivia still suffered from diarrhoea. Water quality test- ––Co-funding of water and sanitation structures through ing is not always available and done in a routine manner the local Government and/or other local NGOs increases and the possible presence of disease-causing pathogens buy-in from local authorities, but also challenge the ca- as harmful E. coli bacteria may thus go undetected, which pacity of local administration to coordinate donors and underlines the importance of water testing. communication flow about the financial commitments.

39 Ageing and health

AH1: % of care givers/organisations adhering to quality standards

100%

80%

60%

40%

20%

0% Before 2017 2018 Target

Kyrgyzstan

AH2: % increase in number of clients benefitting from the AH3: % increase in group members in AA groups services

1200 1600

1500 1000 1400

1300 800 +52% 1200

600 1000 –5% 800 +9% 400 600 +29% +70% 400 +3% 200 +100% +36% +11% 200 +0% 0 0 before 2017 2018 Target before 2017 2018 Target

Armenia Bosnia and Herzegovina Moldova Armenia Bosnia and Herzegovina Moldova

SRC contribution to the following SDG target: 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being

40 Major Outcomes

Ageing of populations is happening faster than ever. According to the WHO, the number of people aged 60 years or over is projected to rise from 900 million in 2015 to 2 billion people in 2050 with a four-fold increase of older people in low and middle-income countries. The Swiss Red Cross with its partners is engaged in providing home-based care services for elderly and handicapped people, and supports elderly people to become active, engaged and recognized citizens in their community. 10,855 elderly people in Armenia, Belarus, Bosnia-Herce- govina, Kyrgyzstan, Macedonia, Moldova, Ukraine The Red Cross volunteer Vladimir is listening to a patient in a home care project in Novopolotsk, Belarus. © SRC, Monika Flückiger and Bolivia were reached with programs that aim at creating an environment, which sees age as an opportunity and not a burden, where older people address issues that are important to them and receive assistance whenever they need help along the way. In Bolivia, 4,000 elderly people were supported to tribute to the SRC’s overall ageing strategy empha- get better access and to monitor the provision of sising SRC’s approach and values at international, social benefits and entitlements. national and cantonal level.

Over the years, the SRC supported programs have gained in national and international reputation and Home based care recognition. In 2018, SRC programs received national and local awards (Moldova and Bosnia-Her- Home based care has experienced an increasing cegovina), national accreditation for high stand- demand in all program countries, with an increase ards of excellence in service delivery (Moldova) of clients with respect to the previous year by 30 or invitations to participate in high level working percent in Bosnia-Hercegovina and 36 percent in groups (Belarus). As a spill-over effect of the good Armenia. The rise was due to expansion of the in- reputation of the home-based care program in tervention areas. In Bosnia, the demand has risen to Bosnia-Hercegovina, the financial support to the a point, where waiting lists for enrollment into the respective partner Red Cross branches from the home-based care program now exist. In Moldova localities has also increased. Within the Red Cross clients decreased by five percent in comparison to Movement, the SRC is known as a National Society the previous year. Client satisfaction is high with with special competence in “Ageing and Health”. 95 percent in Moldova and compliance to quality standards in Kyrgyzstan is 97 percent. Recruiting To draw on SRC’s capacities and experiences, the nurses to provide home-based care remains an on- SRC international cooperation developed and going challenge in all countries except Armenia. launched a concept on “Ageing and Health” in Sep- Perpetuated by the instable and poor political envi- tember 2018. The concept outlines SRC’s vision and ronments, health personnel are migrating to West- approach to scale up interventions and develop ern Europe. The program in Moldova for example competence in geographical areas beyond Europe has experienced a staff turnover of 37 percent in and to better meet the needs of elderly in emer- 2018. In order to address human resource short- gency, reconstruction and long-term development. ages, the program in Kyrgyzstan has successfully The “Ageing and Health” concept as well as exam- endorsed a concept with the Ministry of Labor and ples from the International Cooperation will con- social affairs, whereby students from medical and

41 social educational institutions will assist the elderly Active Aging as volunteers while at the same time practicing social and professional skills. More than 2,000 elderly people are engaged in different initiative groups (IGs), who get together All home based programs successfully lobbied for regularly to learn, share, socialize and implement and introduced paid services and increased local actions they have planned. Group membership has fundraising. The Belarus Red Cross registered a uni- increased by 52 percent in Bosnia-Hercegovina and tary enterprise, which will provide paid home based Belarus and by three percent in Moldova in com- care services to clients and training in kinesthetics parison to the previous year. The work on active as well as first aid courses to formal and informal ageing in Kyrgyzstan for example initiated changes health providers including family carer. With a in self-perception of older people, helped them to similar goal, the Ukrainian Red Cross has started a overcome barriers, stigmas and prejudices. As a re- working group with the Ministry of Social Welfare sult, the Red Crescent Society of Kyrgyzstan (RCSK) to define home care provider standards and curric- managed to engage over 70 older persons as silver ula and establish itself as a training provider. Mace- volunteers, which is about 12 percent of the pro- donian Red Cross collaborates with the Ministry of ject beneficiaries. As community volunteers, older Labor by training long-term unemployed women as people assist in RCSK humanitarian activities partic- home-helpers in order to provide home-based care ipating in aid distributions, providing psycho-social with a fee, which will be paid by the clients. In Bos- support to vulnerable groups, taking care of their nia 80 percent of the clients contribute financially peers and continue their work with abandoned to the services they received. Local fundraising in children in children rehabilitation centers. In Bos- Kyrgyzstan generated 52,253 CHF in 2018 for co-fi- nia-Hercegovina, 28 percent of the group members nancing of activities over the reporting period. This (383 persons) became volunteers to help others. represents a four-fold increase from the previous year. The groups plan and carry out their own initiatives and activities. The provision of mini-grants to the groups has demonstrated a multi-fold impact:

1) groups learnt how to write small proposals and were thus able to successfully compete for grants; 2) groups were able to address needs which they have identified; 3) the successful completion of the mini-projects motivated the groups to continue; 4) groups started to raise funds from other sources, such as local public authorities.

Even though IGs are beginning to have a strong voice in the community, more could still be done by local authorities to benefit from IGs commitment, for example by inviting them to public meetings and hearings. Further lobbying and positioning by the groups is therefore required.

42 Good practice: age-friendly community Looking back on the successful completion of so initiatives in Moldova many actions, it became clear that there is no recipe valid for everyone on how to carry out an age- In 2018, various age-friendly environment actions friendly community project. The approach must be were implemented in 14 communities in Moldova, individual for each locality, taking into account the financed through local mini-grants and project local context, existing culture, traditions, social and co-financing. The figure below depicts the many financial situation, and communication between different actions planned and carried out by the citizens. Important aspects to consider are the active local IG groups. participation of older people, the empowerment of intergenerational relationships, an open mind of

8 4 10 Timetable Local roads Waiting stations of public transport Parks Seats installed to repaired 5 Builded/renovated displayed arranged public institutions 7 5 Public WC 1 Public library 8 Places lighten 5 renovated Sidewalks builded 5 Citizens‘ database builded in 2 Playgrounds which have damaged communities 1 builded houses created 1 Stadium built Transportation Market Old person’s wood 27 1 landscaped stove renovated Detectors of Outdoor Spaces & Buildings smoke installed Age Housing Friendly Information panels 10 installed and updated initiatives 5 Water supply Communication 10 General assemblies service and information with citizens conducted developed Community Support & 12 AFC pages developed and Health Services Respect & Inclusion. shared Social &civic HBC services participation developed in 15 1 communities 9 Local newspaper 1 edited Waste service 14 Communities conducted Communities Collection established Communities intergenerational 6 developed conducted activities (seating, festivals, workshops on socio / cultural Eco marathon, etc.) interests for activities the old people

Different age-friendly initiatives carried out in Moldova in 2018

43 the local government and a continuous support for SRC supported programs have presented their age-friendly initiatives. Fostering relationships with work and experiences at various international the local Government is necessary, as well as to pro- conferences, for example at the International Con- vide technical advice and tools and align strategic ference of Integrated Care in Utrecht (Kyrgyzstan, policy thinking to inspire age-friendly actions at lo- Bosnia-Hercegovina, Belarus), at conferences and cal level. Becoming age-friendly is a lengthy process international meetings on ageing in Prague, Baku that can bring the expected results only if there is a (both for the Kyrgyzstan program), Zagreb (Bosnia) strong commitment of key stakeholders, as well as a and Brussels (Belarus). strong and constant promotion of age-friendliness through neighborhood volunteers and ambassa- All country programs have been very active and dors, as well as showcasing and celebrating results. successful in pushing local policy forward. In Arme- The formation of a steering committee with mem- nia, the program contributed substantially to the bers from different backgrounds and professions in finalization of the annual work plan for the national each community, as well as engaging in a constant strategy on Active and Healthy Ageing 2017–2020. feedback process with the local stakeholders and Working groups were established and standards for the community has helped to push age-friendliness home based care for the elderly were developed forward. between the Red Cross and local Governments in Armenia and Ukraine. In Belarus, a representative of the Belarus Red Cross became member of the work- Knowledge Management & Policy Dialogue ing group to develop the new national Strategy on Active Aging. The SRC maintains its knowledge exchange platform on Ageing and Health among the different Since December 2018, the SRC finances a focal programs. 2018 saw a new dynamic within the plat- person for ageing in the regional delegation of the form, namely that regional exchange and advising IFRC in Budapest, in order to assist the European each other has gained momentum with e.g. the National Societies technically and increase the net- program staff of Belarus supported the program de- working and exchange in the region. Moreover, velopment in Ukraine; the active ageing specialist SRC supports IFRC to translate guidance manuals from Bosnia-Hercegovina provided expertise in the for community-based home care which had been mid-term review of the Moldova program. Other developed with SRC support in the past into Rus- National Societies are interested in joining the sian, which helps the IFRC and Russian-speaking platform and the exchange, such as the Austrian National Societies to strengthen their position as Red Cross and their implementing partners, such key players in home care in their countries. as Macedonia and Georgia. The program in Bos- nia-Hercegovina has additionally won a one-year The SRC is the first PNS to have an Ageing and long mentorship from the WHO and International Health Concept. The concept was shared within Federation on Ageing and is now benefitting from the IFRC and Movement partners. The IFRCS has further professional coaching. contemplated to start a working group on Ageing and Health in 2019, where SRC has been invited and agreed to participate.

44 Number of beneficiaries in ageing and health

2017 2018

Older persons reached through targeted 6,590 10,855 interventions

Lessons learnt ––The sustainability of home based care as well as ––Migration of health care professionals and as- active ageing groups remains an important is- sociated brain drain remains a big challenge. sue and a challenge. Development of paid ser- Innovative models, such as the engagement of vices, local fundraising, mini-grants, and medical and social work students, need to be matching grants have proved good instru- embarked on and tested. ments to finance local activities. ––SRC and its partners has gained substantial rec- ––Kinaesthetics, a physical therapy approach ognition and competence in the area of Ageing based on movement-associated awareness, is and Health. An expansion and scale up of the an important pillar in all SRC programs, not on- momentum with the IFRC and other PNSs has ly for clients’ wellbeing and psycho-motoric started. However, opportunities need to be improvement, but also for care takers, self-care seized further. This requires more investment at workplace and as income-generating activi- on the subject from SRC and in particular from ty in the different RC branches. the IFRC focal person Ageing and Health in Bu- ––SRC experience shows that the recognition of dapest. the Initiative Groups in their communities and by the local authorities has increased. Thanks to the intensive networking, promotion of activities and showcasing of good results, the local authorities and public services increasingly respond to the needs of older people. Visible and quick outputs of the Initiative Groups help increase visibility, motivation and acceptance of older people and the groups.

45 Blood safety

BS1: % of blood donations screened for transfusion-trans- BS2: NBTS meets x% of the needs of requested blood missible infections products

100% 100%

80% 80%

60% 60%

40% 40%

20% 20%

0% 0% Before 2017 2018 Target Before 2017 2018 Target

Moldova Lebanon Malawi Moldova

BS3: % of voluntary non-remunerated blood donations

100% SRC contribution to the following SDG target: 3.3: By 2030, end the epidemics of AIDS, tubercu- 80% losis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other 60% communicable diseases

40%

20%

0% Before 2017 2018 Target

Kyrgyzstan Moldova Malawi

46 Major Outcomes

One long-lasting core competency of the SRC are blood transfusion services, both in Switzerland and in international cooperation. Blood transfusion services are extremely relevant to the reinforcement of health systems and have a direct impact on other SRC thematic priorities, such as reproductive health (e.g. in midwifery) and emergency relief (e.g. emergency medicine). In the special context of blood safety, partnerships depend on the national set-up of the blood services and the identified gaps. In 2018, the Swiss Red Cross supported blood safety projects in nine countries (Egypt, Haiti, Honduras, A young man donating blood in a SRC supported blood safety project in Chisinau, Moldova. © SRC, Caspar Martig Kyrgyzstan, Lebanon, Malawi, Moldova, South Su- dan and Togo), mobilizing a total of 655,636 blood donations. SRC uses three standard outcome indicators to measure progress in blood safety projects (see diagrams): Syrian refugees served in 2018 – for whom access to affordable health services is a major concern. Indicator BS1: blood donations screened for trans- The SRC and LRC signed a multilateral cooperation fusion-transmissible infections agreement in 2017, the EU MADAD fund, which Indicator BS2: NBTS meets x percent of the needs of secured 1.8 million USD over three years for blood requested blood products transfusion services for refugees. It was finally im- Indicator BS3: voluntary non-remunerated (VNR) plemented in 2018 and greatly contributed to meet blood donations the increased demand due to the Syrian crisis and helped to build up sustainable structures and part- In Lebanon, the SRC launched the third phase of a nerships with the LRC. blood safety project in 2018 with the Lebanese Red Cross (LRC). The objective is to increase voluntary In Malawi, the blood donor recruitment project was donations, enforce international quality standards entering its second year as a joint initiative between and complete an organisational development pro- the SRC, the Malawi Red Cross Society (MRCS) and cess started in the previous project phase. A ma- the Malawi Blood Transfusion Services (MBTS). The jor game-changer was a policy dialogue with the overall objective is to combat the chronic shortage Ministry of Health and other stakeholders. Conse- of blood in the country by recruiting more voluntary quently, LRC has received more funding from the blood donors. In 2018, the MBTS collected a total of Lebanese Government in 2018 and has a clear man- 62,951 donations, thereby meeting approximately date to increase the number of voluntary regular 56 percent (vs. 50 percent in 2017) of the national blood donors and improve blood safety in all parts needs for blood products. The amount of blood of the country. The LRC as a sole national provider collected this year by MRCS alone doubled com- collected 24,628 units of blood in 2018, an increase pared to the first year of operation. “Blood sucker” of 25 percent compared to 2017. This is a signifi- rumours that kept potential donors away in 2017 cant increase compared to previous years but still luckily did not rear their heads to heavy in 2018 accounts for only 18.9 percent of the blood needs thanks to awareness campaigns of the Red Cross. in the country, which are estimated at 150,000 At the same time, volunteers continued to pro- blood units. Yet, this share is key; first, because the mote voluntary blood donation through personal LRC blood services are the only ones systematically contact in their villages in ten sub-districts. By now, pursuing a voluntary donor program and, secondly people were gradually getting used to collection LRC is providing blood at no costs to the vulnerable events and the number of repeat donors passed population. This was a lifesaving factor to the 3,628 30 percent in the project areas. Youth volunteers

47 organized football events attracting for example donation, and 27 CNTS staff was trained on qual- in the capital Lilongwe more than 5000 people. ity management. However, only 5,327 volunteer The relationship between Malawi Red Cross Soci- donations were collected out of 40,000 planned ety (MRCS) and Malawi Blood Transfusion Services for 2018. Compared to 2017, in 2018 there was a (MBTS) is maturing as the capacity of MRCS to mo- reduction of 3,163 collected blood bags (or an 11 bilise donors increases, and the strategic partner- percent decrease from 2017 in total donations) ship is acknowledged in the new Voluntary Blood with a reduction of 6,256 voluntary blood bags (or Donor Recruitment Strategy developed by MBTS. a 54 percent decrease from 2017 voluntary blood donations). This decrease in voluntary blood dona- In Haiti, the year 2018 has marked the end of the tion in 2018 possibly implies an increase in “family second and provisionally last phase of the project replacement” donations, which presents a higher and its no-cost extension. The findings of an exter- risk of Transfusion Transmitted Infection (TTI). This, nal project evaluation in September 2018 suggested in combination with the funding constraints CNTS is not prolonging the support with a consecutive fol- faced with, raises concerns in terms of blood safety low-up phase under the current circumstances. The and ultimately questions of the cost-efficiency of main partner, the Centre National de Transfusion further programming and a possible reputational Sanguine (CNTS), has experienced a decrease in risk for the SRC. This development underlines the service delivery and quality due prolonged absence importance of a strong commitment and a good of CNTS management and increased funding prob- governance from the partner in blood safety pro- lems. Despite these constraints, SRC technical sup- jects. It does, however, not overturn the progress port, in collaboration with other partners, has made made in the Haitian blood transfusion services until it possible to achieve some results in 2018: Aware- 2017, and rather calls for the SRC senior manage- ness campaigns reached 5,253 people (partners, ment to intensify the dialogue with the HRCS man- potential donors and the general population), 65 agement to address the management problems awareness sessions were held on voluntary blood and sustain the results achieved.

Screenshot of the newly launched blood donation training program on the IFRC e-learning platform.

48 Good practice: development of an e-learning the decision was taken to evaluate the global SRC tool on Blood Donor Recruitment blood safety program in the past years and comprehensive evaluation synthesis of all relevant blood In many SRC supported projects, training and ca- projects to be delivered before the end of 2019. pacity building of RCRC staff and volunteers on blood donor recruitment is indispensable for reach- To foster regional networking and exchanges in ing and retaining blood donors. In 2018, the SRC 2018, SRC funding was made available to allow five translated and reshaped a training program in col- people to attend the annual congress of the Africa laboration with thematic experts from IFRC’s Global Society for Blood Transfusion (AfSBT) in Arusha, Advisory Panel as self-directed e-learning courses. Tanzania. The sponsored participates from South Three independent online modules were created, Sudan, Egypt, Zimbabwe were presenting project scope and content tailored to the role and respon- outcomes and could link-up with other thematic sibility of the learner. experts.

The initiative builds on the success of an e-learn- Bringing innovations to partner countries is a pri- ing program in Spanish, originally developed in the ority for the SRC: having conducted multiple pro- frame of a project in Honduras with the Honduras jects in the field of blood management systems, the Red Cross. Until today, 291 people from 22 Latin SRC co-founded and supports the African Society American countries have completed the course in for Blood Transfusion (AfSBT) working group on IT Spanish. The new, improved course in English was systems. In late 2017, the AfSBT Board endorsed uploaded, hosted and made available on the global the thematic working group as part of the society’s IFRC e-learning platform where it was instantly structure. In 2018, the working group has made made available to 125,000 active users – RC/RC significant progress: three sub-projects were com- staff and volunteers, IFRC and ICRC staff globally pleted. The first AfSBT IT WG meeting was held in and others who register on the platform. Johannesburg in December 2018 funded by SRC. The plans of the IT WG were jointly defined; one of The SRC will launch a guided capacity building the highlights in 2019 will be a new training course initiative in the frame of the blood donor recruit- for IT managers of Blood Services to be hosted in an ment project in South Sudan using this tool. GAP African country. will also use the online training package in one of their VNRBD pilot countries, and it is foreseen that The SRC is also in regular exchange with the IFRC both initiatives will be reviewed and evaluated in Global Advisory Panel on Corporate Governance the course of 2019. and Risk Management of Blood Services in Red Cross and Red Crescent Societies (GAP). A new program designed to promote VNRBD and make Knowledge Management & Policy Dialogue family donors safer in countries with National So- ciety blood programs, was launched by GAP. This In a complex and multidisciplinary field like blood program has been made possible through signifi- safety, a good expert network and effective knowl- cant support provided by Swiss Red Cross Humani- edge management are key. The Blood Safety Ex- tarian Foundation together with additional critical pert Group, which consists of 12 to 15 participants, resources provided by Belgian Red Cross. VNRBD is all IC Department or Swiss Transfusion SRC staff well established as a fundamental cornerstone in members, meets three to four times per year. The the development of safe and sustainable blood pro- expert group reviews new or ongoing SRC blood grams. The International Red Cross and Red Cres- safety projects and discusses evaluation outcomes, cent Movement has been a strong advocate for VN- innovations and new approaches, and brings the RBD and continues to work towards this objective sound Swiss Blood Service knowledge into the in- internationally. ternational cooperation and vice-versa. Further,

49 Number of blood donations

2017 2018

Total blood donations 667,864 655,636

Voluntary non-renumerated blood n/a 411,899 donations (VNRBD)

Other blood donations n/a 243,737

Lessons learnt ––National Red Cross and Red Crescent Societies ––Stakeholder involvement was important dur- highly value the SRC’s cooperation in the field ing the process of drawing up blood transfu- of blood safety, specifically because the SRC sion service legislation or any other form of provided not only funding, but also technical policymaking. Projects will continue to engage assistance and is linking the partners to an in- in a policy dialogue where required to reach ternational network of resources. This ap- and sustain the project objectives improve the proach should be maintained, and the network blood safety. further enlarged. ––Political, institutional and financial challenges ––While introducing IT-supported blood man- in ministries and blood services can limit the agement systems to improving blood safety results of blood transfusion projects. A risk and the efficiency of blood services, the pro- analysis and a contingency plan must accompa- jects are becoming increasingly complex. More ny every blood safety project. capacity building is required, and expert knowl- ––The evaluation of the overall SRC blood pro- edge must be made available at all stages of gram in 2019 will help to redefine the SRC con- the project. cept on blood safety and inform the blood safe- ––The visibility and positioning of the SRC as a ty programming in the strategy 2030. National Society with expertise in blood safety is important and will be further strengthened through active participation at international events and working groups.

50 Eye Health

EC1: % of eyes with good visual acuity after 6 weeks of cataract surgery between 6/6 and 6/18

100% SRC contribution to the following SDG target: 3.8: Achieve universal health coverage, including 80% financial risk protection, access to quality essential health-care services and access to safe, effective, 60% quality and affordable essential medicines and vaccines for all

40%

20%

0% Before 2017 2018 Target

Ghana Nepal Togo

Major Outcomes The Ghana, the eye health programme remained a top performer in 2018. Recording a Cataract Surgi- From a global perspective, SRC’s contribution to cal Rate (CSR) of 1,017 (per million population per the reduction of blindness and vision impairment is year), Ghana ranks above the African average. Given particularly relevant to SDG 3 on good health and the high poverty rate and over 70 percent of the wellbeing but also to other SDGs such as those on population living in rural settings, well performing poverty reduction (SDG 1), inclusive quality edu- eye health programmes have a significant impact cation (SDG 4), gender (SDG 5), decent work and on rural health as well as on the socio-economic economic growth (SDG 8) and the reduction of wellbeing of families, communities and the state. inequalities (SDG 10). In 2018, the SRC eye health 292,333 beneficiaries were reached through Red programme reached a total of 728,898 people in Cross public awareness campaigns. With 16,518 five countries. Project progress at oucome level was juveniles receiving treatment for their allergies or measured through two standard indicators. infections and over 200 classroom children receiving spectacles for their refractive errors, the project contributed significantly to the development of education. Cataract surgeries reached a peak (2,664), but unfortunately, the cataract surgical outcome of 62 percent is below the WHO standards. Stricter quality measures must be applied. Ghana Red Cross Volunteers took specific one-to-one care of eye patients to ensure that patients followed the prescribed therapy and did not dropout. A pool of 924 volunteers was engaged over the year, while 240 were freshly trained. Continuous medical education was provided to 14 nurses. Still unclear and unsatisfactory is the commitment and contribution of the Ghana Health Service, while the Ghana Red Cross Society remains engaged in the finalisation of a volunteer policy.

51 Good practice: eye health study as door opener in Kyrgyzstan

The eye health programme in Kyrgyzstan – a cooperation between the Red Crescent Society of Kyrgyzstan (RCSK), the MoH and SRC – started in 2016 in Batken oblast and just entered its second phase (until 2021) expanding to all three southern oblasts of Kyrgyzstan. With its interventions in curative and preventive services (mainly cataract and pterygium), its professional training programme and its inclusive collaboration with the MoH, the National Health Insurance, local authorities, Vil- A woman testing her eye sight at Surkhet hospital, an eye care clinic supported lage Health Volunteers and the RCSK, it tackled by the SRC. © SRC, Remo Nägeli shortcomings in service delivery, financing and acceptance. Initially, SRC and RCSK faced substantial scepticism by the MoH whether the partners would be in the position to observe quality standards; but The projects in Nepal and Togo continued both two major milestones achieved in 2017 won the to be successful to a certain extent. In Nepal, the commitment not only of the MoH in Bishkek but in newly elected local government started contrib- the southern oblasts as well as interest of the WHO uting to outreach campaigns, and negotiations to and the International Agency for the Prevention include eye health into the annual health budget of Blindness (IAPB). The first Rapid Assessment of on municipal level are progressing. With a cataract Avoidable Blindness (RAAB) study ever conducted surgical outcome of 90 percent visual acuity and in Kyrgyzstan (and Central Asia) provided data on an increase of cataract operations (1,626) the pro- the prevalence and distribution of eye problems. ject performance is increasing. The target for the Secondly, through the concerted effort of MoH, the future is at least 2,000 cataract surgeries per year. insurance and RCSK, fully-fledged outpatient clinics In 2020 the SRC will pull out of eye health in Nepal and operating theatres were established. In total and the Nepal Red Cross will be fully responsible 245,676 people were reached in 2018 in compari- to manage the Surkhet Eye Hospital. A Midterm son to an almost non-existing eye health service in Review in October 2018 set a roadmap for the last 2016. The results are so encouraging that the MoH 24 months. In Togo, the programme continued to requested RCSK and SRC to support the develop- perform few but high-quality cataract surgeries. Of ment of a National Eye Care Programme as well as the 733 cataract cases detected, 304 (41 percent) conducting a second RAAB in all Northern Oblasts were operated on. This low rate of cataract surgery in 2019. It is expected that the WHO and IAPB will is related to the poverty of the population, which is commit their support. not always able to overcome.

The SRC started to support its ageing and health Knowledge Management & Policy Dialogue projects by donating reading glasses. In Moldova, the local public authorities from Rezina co-funded In 2017/2018, the SRC evaluated its global eye care an Ophthalmic Screening campaign, which was in- programme. Positive findings were the measurable itiated by the local Active Ageing initiative group. impact at beneficiary level, the fact that SRC closes It resulted in 127 older people screened by an oph- a gap in under-served geographical areas, the bal- thalmologist and receiving reading glasses. ance between curative and preventive aspects, and the efforts at integrating eye programmes into health systems. The SRC board endorsed a plan for transition of the present programme, which will

52 possibly expand to new countries and to new inter- casted video and audio material developed during vention areas in the future, including humanitarian the first phase of the project. Content for new video settings. Even though eye health is not a strategic and audio materials were discussed with ophthal- objective of the IFRC, the IFRC Geneva health direc- mologists during the exchange visit to Batken. tor and his team encouraged SRC to continue its Press conferences dedicated to WSD took place in eye health interventions and offered to promote it each oblast. The Kyrgyzstan SRC Country Coordina- further in the Movement via IFRC platforms. It is ex- tor, the RCSK Head of the Health Department and pected that by end 2019 a new eye health strategy Batken Branch Officer attended the International for the coming years will be developed. Agency for Preventable Blindness (IAPB) Hyderabad Conference in September 15–16, 2018. The partici- The World Sight Day (WSD) 2018 was celebrated by pants from Kyrgyzstan, with guidance from the SRC the SRC projects in Nepal, Ghana and Kyrgyzstan. HQ and an Eye Care Expert, successfully linked up In Kyrgyzstan, for the first time, each oblast broad- with the IAPB representatives.

Number of eye care beneficiaries

2017 2018

Cataract surgeries 3,978 5,397

Other eye surgeries 2,380 981

Eye care consultations 125,842 117,479

Eye care school screenings 59,427 87,956

Eye care awareness raising 439,834 728,898

Lessons learnt ––The SRC eye health projects are reaching the ––SRCs work in eye health is not sufficiently rec- poor in underserved areas. As the evaluation ognised and promoted. SRC must connect pro- revealed, this comes with a price not only in fi- actively to other partners and networks such as nancial terms (high costs and parallel systems) IAPB, WHO, universities and other eye health but also in terms of challenges to maintain ser- NGOs. vices and have adequate medical staff present. ––In the past, SRC eye health projects, except for In previous years, SRC did not always sufficient- the application of portable eye examination ly negotiate cooperation with the partners (RC kits in Nepal, have not been open enough to and MoH) to have equal responsibilities. innovative tools and practices. ––Eye care projects help to establish links between the RC National Society and the MoH where links did not exist before. Thanks to the strong messages that eye health interventions such as cataract operations can convey, the visibility and reputational benefits for the RC and the MoH are high.

53 54 Disaster Risk Management

The SRC’s core mandate is to save lives, alleviate The effects of climate change are increasing uncer- suffering and protect the livelihoods of vulnerable tainty for people living in disaster-prone areas, and people. In order to achieve this goal, it follows an increasingly create uncertainty in areas that have integrated and multi-sector approach of disaster not been prone to disasters in the past. Disaster risk risk management and is operational in emergency management and climate change adaptation share response, recovery and long-term development co- a common understanding of how to reduce risks, operation. The nexus between the three phases is and therefore it is of highest importance to create as based on the institutional understanding of linking much synergies between these two areas, in terms relief, rehabilitation and development where com- of knowledge sharing, instruments and resources. plementarity and coherence are core values, which Risk and hazard analysis must consider longer-term are operationalized through sound assessments climate change scenarios. Due to the increased and through mainstreaming processes. need for risk reduction and protection measures, the capacities for cost-effectiveness analysis must The nexus is reflected in the SRC DRM cycle, as be strengthened, and DRM mainstreaming must shown in the figure above. The cycle is embraced take place throughout all programme activities and by the concept of resilience. This concept has been is an important issue in the dialogue with partners discussed and used in the Red Cross Movement for and in the support of their organisational devel- quite some years, defined as “the ability of indi- opment. Together with partners, especially with viduals, communities, organizations, or countries the Swiss NGO DRR platform, SRC has increased its exposed to disasters and crises and underlying capacities in this area and increased the human re- vulnerabilities to: anticipate, reduce the impact of, sources made available. cope with, and recover from the effects of shocks and stresses without compromising their long-term prospects”. During the last two years, it has constantly gained clarity and operationalization thanks to the further development of the assessment and monitoring instruments "resilience star" and "resilience radar". The “resilience star” was developed by IFRC and combines well-known participatory as- Event sessment tools, such as the IFRC Vulnerability and Hazardous Capacity Assessment (VCA) with the measurement of the characteristics of resilient communities. The SRC DRM “resilience radar”, developed by a consultant in co- Cycle operation with several Red Cross societies, is a very flexible quantitative monitoring tool. Both instruments match well. First experiences in the SRC programme in Bangladesh in 2018 showed very useful results and produced robust foundations regarding the planning, monitoring and steering of multi-sectoral programmes in complex contexts, aiming at strengthening this capacity to maintain or return to a pre-disaster state, and also to adapt to changes The SRC cycle of disaster risk management and uncertainty.

55 Emergency response

Number of beneficiaries in emergency relief

2017 2018

Total Relief 549,561 492,373

Health in emergencies 446,329 278,369

Non-food items (e.g. family kits) 201,856 20,319

WASH 112,082 52,289

Food aid (incl. seeds & tools) 110,246 34,783

Cash 61,373 3,895

Shelter 1,114 7,333

Emergency deployments 34 20

Migrants 190,854 63,508

SRC contribution to the following SDG targets: 1.5 By 2030, build the resilience of the poor and those in vulnerable situations and reduce their exposure and vulnerability to climate-related extreme events and other economic, social and environmental shocks and disasters 11.5 By 2030, significantly reduce the number of deaths and the number of people affected and substantially decrease the direct economic losses relative to global gross domestic prod-uct caused by disasters, including water-related disasters, with a focus on protecting the poor and people in vulnerable situations

56 Major Outcomes

In 2018, the number of people in need of humanitarian assistance remained at a very high level of 131.7 million. Protracted crises continued to be the main driver of humanitarian needs and absorbed most resources of the humanitarian system. Fund- ing levels only hesitantly followed the needs. On the positive side, the humanitarian system has increased its efficiency while increasing its capacity to better identify the needs of various vulnerable groups.

For the SRC, the Syria crises, including the refugees A man preparing building material for shelter in the refugee camp in Cox’s Bazar, Bangladesh, where more than a million refugees live. © SRC, Remo Nägeli in Lebanon, continued to absorb the biggest share of its response operations. The situation of the people in Cox’s Bazar (Bangladesh) who fled violence in Myanmar Rakhine state in 2017 showed more and more characteristics of a protracted crises and needed to be treated as such. This context absorbed As expected, the response operation in Cox’s Ba- the second biggest share of SRC response resources zar (Bangladesh) in favour of the people displaced in 2018. In total, SRC relief operations 2018 reached from Rakhine state (Myanmar) extended into a 492,373 beneficiaries. protracted crises in 2018. The SRC continued its support to the field hospital of the IFRC, run by the While the number of natural disasters continued to Finnish RC, with the deployment of health person- grow in 2018, there was no major rapid onset dis- nel (nurses, midwives, doctors). At the end of the aster. This partially also reflects the growing capac- year – after almost 16 months in operation – the ities of national and local actors to prepare for and field hospital and its equipment was handed over respond to disasters. A consequence of this devel- to the Bangladesh RC. The SRC – together with the opment is also that governments rely less on inter- Ministry of Health and the BDRCS – built three Pri- national assistance – examples that illustrated this mary Health Care Centres in the camps. The project in 2018 were the restrictions imposed on interna- also included a component for the host communi- tional humanitarian assistance by the governments ties. A second phase of the PHC project has been of the Philippines (after Taifun Mangkhut) and the designed and approved and will assure the SRC’s government of Indonesia (after the earthquake and presence in Cox’s Bazar until 2021. Tsunami in Sulawesi). In Somaliland, the SRC ended its engagement for Population Movements due to Conflicts and over 50,000 people in the regions of Togdheer, Droughts Sanag and Saahil in the aftermath of the 2017 drought. The project was supported by Swiss Sol- For the SRC in Syria, 2018 was marked by the open- idarity and implemented by the IFRC and the So- ing of a delegation in Damascus with the arrival maliland Red Crescent. Through the construction of the Country Coordinator illustrating the com- of water reservoirs (Berkads), latrines and hygiene mitment to assist Syria’s transition into recovery. trainings, the project contributed to a reduced prev- The Delegation took up relations with SARC and alence of waterborne diseases. The project also in- assisted them in a Wash emergency project in Al- cluded cash grants to support people’s livelihood Raqqa and a livelihoods project in rural Aleppo. In recovery. Lebanon, the SRC continued its assistance for the Syrian refugees in the camps through relief, Cash and winter assistance projects.

57 In the context of the worsening humanitarian Earthquakes, Tsunami crises in Venezuela and the massive population movement to the surrounding countries, the SRC Indonesia was hit hard by a series of natural disas- contributed to the response of the Colombian RC ters in 2018. The most severe and internationally to the needs of the Venezuelan migrants in their most noted was the earthquake and tsunami that country in the domains of shelter, health, psychoso- hit Sulawesi island on 28 September. The Indonesia cial support and information. The SRC also set up a government only reluctantly and partially accepted bilateral project with the Ecuador RC supporting its international assistance reflecting the trust in its services for the Venezuelan migrants at the border own capacities and its challenges with international posts and in major cities. humanitarian aid in the past. The Indonesian Red Cross (PMI) was given a strong role in response and Hurricanes, floods coordination by the authorities. PMI handled the largest share of international aid pouring into Su- As in 2017, South and Southeast Asia were hit lawesi. The IFRC increased its ongoing Emergency hard by hurricanes and floods in 2018. The SRC re- Appeal by 13 million. CHF and deployed a FACT/ sponded to the floods in Kerala (SouthernIndia), ERU team to support the PMI response. The SRC de- the dam break in Southern Laos and Typhoon ployed a FACT logistician into the RC response and Manghkut in the Philippines by contributing to the contributed 500,000 CHF to the revised Appeal. IFRC emergency appeals. Looking into recovery, the SRC will offer further support to PMI. In June, strong rainfalls and water streams from up- stream hills caused extensive flooding in the Sylhet Epidemics and Moulvibazar districts in the Northeast of Bang- ladesh. The SRC’s in-country delegation supported Probably the most complex response in 2018 was the Bangladesh RC in providing multi-purpose cash the fight of the Ebola Virus Disease (EVD) outbreak grants to 1,000 affected families. in the Democratic Republic of the Congo (DRC). The first outbreak between May and July affected the In the Caribbean, fortunately, there was no major Equateur province; 54 people were infected and 33 humanitarian impact by a Hurricane in 2018. How- of them died. In the much bigger, still ongoing out- ever, the SRC continued to support the people af- break in Kivu, 960 people have been infected and fected by the Hurricanes Matthew in Haiti (2016) more than 600 of them died (as of March 2019). and Irma/Maria in Dominica (2017) in the transition With this numbers, the second outbreak is now the from relief to recovery as well as in their prepared- second biggest ever recorded Ebola outbreak after ness for future impacts. the large disaster in Western Africa in 2014. The IFRC launched a FACT/ERU mission and an Emer- Lastly, the SRC also provided emergency aid to the gency Appeal in close coordination with WHO and affected populations after the floods in the depart- the Congolese RC, focusing on Community Engage- ments of La Paz and Chuquisaca in Bolivia. ment and Accountability, Safe and Dignified Burials and Infection Prevention Control measures (no RC Ebola treatment centre). The SRC supported the response with three missions of its BHC personnel and three missions of logisticians. In the extremely fragile and complex environment of the North Kivu, the response was implemented under the security umbrella of the ICRC.

58 Knowledge Management & Policy Dialogue ––The SRC – in coordination with its movement partners – continues to advocate for the respect of the ––he SRC closely coordinates its Disaster Response fundamental principles in humanitarian aid with the SDC Humanitarian Aid Division by par- ––Operationally, the Disaster Response Capacity of ticipating in the Task Force Meetings and in the the SRC – especially in larger disasters – is embed- field. An example in 2018 was the response after ded into the IFRC response architecture (most no- the Sulawesi EQ and Tsunami. tably the FACT and ERU instruments). To ensure ––SRC also coordinates its response with Swiss Sol- this, there is ongoing participation in the relevant idarity – and its partners – by participating in co- technical meetings of the IFRC. It is also member ordination meetings and as member of the SwS of the Rapid Deployment mechanism working institutions. group of the ICRC, which is putting the response ––The SRC – including members of its disaster re- capacity at the disposal of ICRC missions. With sponse pools – present its activities to interested several other Partner Red Cross Societies, the SRC media, public groups in order to increase under- has agreements in collaboration standing of what it is exactly doing (and what not).

Lessons learnt ––The reaction of the Indonesia government af- ––In the population movement crises in Cox’s Ba- ter the Sulawesi EQ and Tsunami was a remind- zar, the RCRC movement was compelled to deal er that localization of aid is happening (and with the longer term characteristics of the dis- fast in some parts of the world). Governments placement. Planning and reporting processes increasingly rely on their own resources to re- had to be introduced in order to capture Move- spond to disasters. In the case of Indonesia, this ment-wide data in a longer haul while allowing also represents an opportunity for the Red members room for flexibility. Cross as PMI (the Indonesia Red Cross) is oper- ––The Ebola outbreak in the highly complex op- ationally strong and the preferred partner of erational context and set up in the North Kivu the government. For foreign assistance – in- (DRC), brought the resources of the IFRC (CEA) cluding the one of the RC - partners will need and the ICRC (security, presence) together. to learn to step back. While this as such was a good thing, there remains much room for improvement, i.e. in the use of common systems and tools.

59 Recovery

Number of beneficiaries in recovery

2017 2018

Total Recovery 55,498 33,952

Improved drinking water 15,500 20,570

Improved sanitation 3,800 5,075

Hygiene promotion 10,898 15,780

Housing beneficiaries 8,574 4,467

Houses repaired/reconstructed 1,518 764

Health facilities reconstructed 22 –

Schools reconstructed 10 5

Disaster Risk Reduction 22,312 27,021

Major Outcomes all these programmes, such as WASH components, DRR, preparedness and capacity development. In 2018, the SRC supported recovery projects after natural disasters, mostly with interventions in the 764 houses were repaired or reconstructed with housing and public infrastructure sector, in three an owner-driven approach in the Philippines and countries. These comprised a school reconstruc- in Haiti, reaching 4,467 housing beneficiaries dur- tion project in a consortium with Caritas in earth- ing the reporting year. These beneficiaries and their quake-affected regions of Nepal; a last project wider communities also benefited from technical phase in the Philippines in response to typhoon Hai- guidance and build-back-safer trainings; in Haiti, yan; and ongoing activities in Haiti in the aftermath SRC accompanied these with more comprehensive of hurricane Matthew. The SRC reached 33,952 DRR and CCA measures as well as early warning people in 2018 through these programs. In line systems. In the Philippines, a collaboration with with its holistic approach to recovery programming, the NPO Build Change proved valuable to further SRC integrated aspects beyond reconstruction in increase the building back safer aspects of the last

60 phase of SRC’s post-Haiyan program. Build Change developed an options-based guideline for upgrading repairable houses, which the engineers of the Philippines Red Cross then used in their assistance to house owners. Meanwhile, in Sindhupalchowk district of Nepal, five public schools are under construction in cooperation with Caritas and Helvetas, providing a safe learning environment for 1,270 pupils every year. This project integrates operation and maintenance trainings as well as school attendance campaigns together with local partners.

WASH components were incorporated in all of these reconstruction and rehabilitation projects. This family in Corail, Haiti, rebuilt their house after hurricane Matthew. Thanks to the SRC recovery programme, it is now stronger than before the disaster. © SRC, Florian Kopp In the Philippines, for example, both core shelter constructions and repair works were carried out simultaneously with the construction of twin-pit pour-flush household latrines, and community water supply systems were rehabilitated or recon- and other safe shelter construction techniques and structed depending on the level of damage of each measures to increase storm safety of shelters were system. Likewise, in SRC’s projects in Corail, Haiti, integral component and core learning objective of 3,800 people affected by Matthew gained access to the trainings. improved drinking water sources in 2018. In Nepal, sanitation and hand-washing facilities are recon- Beyond the reconstruction programs, SRC worked structed in all five schools, and the project contains in many protracted crises in the context of invol- extensive hygiene promotion campaigns together untary migration. Two examples are Greece and with local partners. A particularly valuable part of Cox’s Bazar in Bangladesh, where recovery think- the project is the Menstrual Hygiene Management ing was integrated into the humanitarian response (MHM) component, introduced after earlier assess- in these complex settings, with the aim to support ments showed that the needs of girls were not suf- the affected population to cope with the humani- ficiently addressed. tarian challenges in these prolonged states of crisis. In Cox’s Bazar, this approach led SRC and the The SRC’s aim to strengthen local capacities and BDRCS to establish three Primary Health Centers in anchor build-back-safer techniques through the semi-permanent structures. The planning for these recovery programs is evident in the Haiyan recovery facilities started while the immediate humanitar- program, where a core component of the project ian response was still in full swing and served to was the training and engagement of local carpen- set the foundation for more comprehensive deliv- ters in the building works. This not only generated ery of health, nutrition and protective services to employment opportunities throughout the project the Rohingya population in the camps in coop- period. The training and capacity building activ- eration with the Ministry of Health and local and ities also allow for replication beyond the project international partners. Upon their establishment, and benefit the wider community. The two-week the facilities served as a reference model for pol- trainings were carried out in partnership with the icy development, and the Ministry requested other Technical Education and Skills Development Au- stakeholders to replicate the SRC/BDRCS approach. thority (TESDA) of the Philippines, whose certified Also, SRC and its partner included host community trainers delivered the trainings with a curriculum interventions into the early recovery projects in jointly developed with the Red Cross. The trainings Cox’s Bazar, applying a conflict-sensitive approach were composed of classroom sessions and the con- to the Rohingya response (see also chapter Emer- struction of a model core shelter in each of the six gency Response above). barangays. The “Building Back Better” key messages

61 Good practice: focusing on social inclusion in Knowledge Management & Policy Dialogue the migration context in Greece In the domain of recovery programming, SRC in- The SRC’s recovery concept (former reconstruction tensified coordination with IFRC in 2018 through and rehabilitation concept) was revised in 2018 regular exchange with the shelter and settle- through a participatory process analysing trends ments unit and with the recovery unit, as well as and opportunities with delegates, specialists and through contributions to the “surge optimization program managers. In addition to reinforcing SRC’s process” which reorganizes the RC/RC Movement’s key commitments to holistic, locally adapted, partic- HR deployments after disasters. SRC also partici- ipatory and sustainable approaches in post-disaster pated in working groups on recovery as well as on contexts, the revised concept also outlines newer cash-transfer programming together with the Aus- focal areas for the coming years for SRC’s work in re- trian and the German Red Cross, which led to joint covery, including for instance the provision of social learning exercises in several contexts, as for exam- and legal services and more focus on ensuring social ple a peer exchange between Austrian RC projects inclusion of the most vulnerable people (including in refugee camps in Uganda and SRC’s project in the migrants) in post-disaster programming. refugee camps in Cox’s Bazar).

An example for the stronger focus on protection Regarding policy dialogue and advocacy, SRC and social inclusion in recovery stems from SRC’s took on a strong role in Cox’s Bazar, for instance as work in Greece in partnership with Spanish and mentioned above. Concerning the wider region, Hellenic Red Cross. This project addressed obstacles in May the Regional DRM Adviser took part in the identified in earlier phases in the Greek migration Asia Shelter Projects and Asia Shelter Forum, which context and improved the access of refugees and brought shelter practitioners from a variety of back- migrants to the health system. On the one hand, grounds together to discuss recent trends and ways SRC replicated its domestic department’s trainings to improve learning and outcomes from the Shelter on “transcultural competences” in Greece. On the Projects publication (published every two years by other hand, SRC and its partners set up an “accom- the Shelter Cluster). During the forum, SRC advo- panied referrals” service, through which migrants cated for more attention to community centered can request interpreters for accompaniment when approaches as well as approaches that utilise cash visiting hospitals or other health and social service as a modality to promote self-recovery, dignity and providers. Reviews of the project confirmed the rel- a greater sense of control for beneficiaries. evance and effectiveness of this double approach addressing service providers’ sensitivity and aware- Within Switzerland, the series of learning and ex- ness of obstacles while accompanying migrants change meetings among Swiss actors (NGOs, SDC/ with people who help not only to overcome lan- SHA, Swiss Solidarity, consultants) which had been guage barriers, but also cultural obstacles in access initiated by SRC and Caritas in 2016 continued in to services. 2018 with a workshop in December about self-recovery approaches.

SRC also elaborated several written knowledge management publications in 2018. These include case studies on the recovery programs in the Phil- ippines (typhoon Haiyan) and Pakistan (floods). Moreover, SRC contributed to the Global Shelter Cluster’s bi-annual compilation of case studies with a paper on the repair component in its Haiyan recovery program.

62 Lessons learnt ––The post-Haiyan recovery program in the Phil- increases the vulnerability of these groups and ippines has confirmed once again the mean- exacerbates access to their rights and services. ingfulness of working in phases that allow for Experience shows that the Red Cross can play flexibility and learning while a program and an important role in identifying, addressing the context in which it is embedded evolves. and mobilizing such vulnerable groups through For the last program phase in Ormoc (the only its network of volunteers at community level. part of the program that was still active in SRC hence trains its delegations, partners and 2018), the phasing allowed for changes to be HR pools to strengthen CEA and protection/ made following community input or feedback inclusion in the projects. from other stakeholders in earlier phases. At ––At the same time it is worth noting that in the this “late” stage of the recovery process in the school reconstruction project in Nepal in 2018, affected communities, identifying the highly which also emphasizes community engage- vulnerable people who had evidently had in- ment, it became evident that for a strong CEA sufficient coping mechanisms to recover from mechanism a lot of time, HR and capacity build- the consequences of the disaster themselves ing has to be invested in the beginning. This became easier. project also revealed that the combination of ––In terms of working with Partner National Soci- hardware/technical components with soft- eties in recovery programs, the Philippines pro- ware/social components is meaningful, as gram has also shown that the collaboration – in through the provision of hardware, the project this case SRC with Philippine Red Cross – is gained commitment from the community to much more effective when addressing core ser- take part in the social components, which gen- vices and areas of core competences of the Na- erated more lasting behavior change and thus tional Society. For example, in the last phase of contribute to the sustainability of the project. the Haiyan program, the DRR component was ––A recurring topic in recent recovery programs a flagship service of PRC and highlighted their of the SRC is a certain dilemma between local- valuable roots in community-based structures, ization of aid and quality assurance. The in- along with their effective relations with the re- creased reliance on local partners and actors sponsible local authorities for DRR. and the aim to build on their preferences and ––While community engagement and accounta- choices (in the framework of localization of bility (CEA) as well as social inclusion of vulner- aid) collides with the effort to defend quality able groups are important in any program, in standards and expectations “made in Switzer- SRC’s work in 2018 these topics proved to be land”. SRC explores answers to this challenge particularly crucial in the context of protracted both in its internal working groups and with crises such as the refugee settings in Greece partners (such as the Swiss NGO network and and Cox’s Bazar. In these settings, the affected the Red Cross partners), collecting experience population often has not only undergone dan- and learnings from programs applying self-re- gerous journeys during which many of them covery, cash-transfer and other owner-driven suffered from abuse and violence; the informal approaches, and revisiting the “must-have” status in transit and at their destination further standards and the “nice-to-haves”.

63 Disaster risk reduction

DRM1: % of communities at risk with a functional SRC contribution to the following SDG targets: emergency committee 1.5: By 2030, build the resilience of the poor and those in vulnerable situations and reduce their ex- 100% posure and vulnerability to climate-related extreme events and other economic, social and environmental 80% shocks and disasters 9.1: Develop quality, reliable, sustainable and resil- 60% ient infrastructure, including regional and trans- border infrastructure, to support economic development and human well-being, with a focus on affordable 40% and equitable access for all. 11.1: By 2030, ensure access for all to adequate, 20% safe and affordable housing and basic ser-vices and upgrade slums. 0% 11.5: By 2030, significantly reduce the number of deaths and Before 2017 2018 Target the number of people affected and substantially decrease the direct economic losses relative to global gross domestic Ecuador El Salvador Ghana prod-uct caused by disasters, including water-related dis- Haiti Kyrgyzstan Paraguay asters, with a focus on protecting the poor and people in vulnerable situations. 13.1: Strengthen resilience and adaptive capacity to climate related hazards and natural dis-asters in all countries.

DRM1: % of communities at risk with functional emergency committee/Functionality per criteria (maximum score 500)

500

450

400

350

300

250

200

150

100

Bolivien Ecuador El Salvador Ghana Haiti Kyrgystan Nepal Paraguay

fully trained fully equipped fully recognized fully linked fully active

64 DRM2: % of community based structural protective DRM3: % of communities/municipalities at risk with tested measures functioning and managed properly disaster management plans

100% 100%

80% 80%

60% 60%

40% 40%

20% 20%

0% 0% Before 2017 2018 Target Before 2017 2018 Target

Honduras Vietnam

Natural hazards affect particularly the poor and Major Outcomes vulnerable people and communities in developing countries and can lead to significant economic Disaster preparedness and social loss and damage. Climate change is projected to increase the frequency and intensity of Disaster preparedness acts as entry point of extreme weather events. Therefore, successful and SRC support in CBDRM programming. Capacity long-term reduction of disaster risks and effective strengthening of local level DRM structures, multi- climate action are both imperative to sustainable stakeholder collaboration, awareness raising, early development. warning systems, contingency planning and evacuation systems are thereby essential elements. Many SRC country programmes are active in areas that are highly exposed to climate and natural haz- Indicator DRM1 Communities at risk with a func- ard risks, implement disaster risk reduction (DRR) tional emergency committee: SRC measures in- components and mainstream DRR and climate creased disaster preparedness in almost all CBDRM change adaptation (CCA). In 2018, the SRC imple- projects with this indicator. Emergency committees mented 19 community-based DRM projects in 14 are the first responders in the communities and programme countries, reaching 242,845 benefi- their functionality a crucial component for commu- ciaries. This figure is lower than in the two previous nity level disaster preparedness. In order to be func- years mainly because two projects ended in 2017 tional, an emergency committee must comply with (Pakistan, Bosnia and Herzegovina). the following five criteria: 1) trained, 2) equipped, 3) recognized by the national DRM system, 4) linked Six projects apply a standalone CBDRM methodol- to the superior level, and 5) active (emergency re- ogy; 13 have a broader approach with a resilience sponse and recovery, simulation exercises). focus, integrating DRR and CCA with health and/or WASH. The SRC is increasingly supporting DRR in In 2018, eight country programmes reported on urban contexts, 2018 in Honduras, Nepal, Bangla- this indicator (see diagram DRM1). Bolivia, Ecuador, desh, Kyrgyzstan and El Salvador. CBDRM projects Paraguay and Nepal started project activities in typically comprise disaster preparedness and disas- 2017. None of them already have communities with ter prevention/mitigation components. functional emergency committee, but particularly in Ecuador and Paraguay, they are on the way towards functionality according to the functionality criteria. In Paraguay, the project observed an interesting dy-

65 namic in the process of setting up community DDR maintenance of drainage systems, or tree trimming. committees. This was expressed in the increased The project initiated the same process in the 40 participation of villagers in training spaces, increased new communities. An important challenge identi- interest in the topic, greater awareness of the impor- fied was that the municipal level authorities still do tance of community participation in risk reduction, not fully take on a protagonist role regarding the and the importance of coordinating with local au- formation, training, equipment and linking - which thorities to manage risks and reduce vulnerabilities would be their task according to the national policy. at both the community and family levels. The mobilizing effect started bottom up from the individual In Haiti, unlike in 2017, the communities luckily to the community and from the municipal to the de- experienced a calm cyclonic season. However, im- partmental level. In Nepal, the CBDRM programme proved emergency infrastructure, ongoing training is implemented in an urban setting and in addition and awareness sessions and increasingly functional to the mentioned typical characteristics that the SRC community structures are a reflection of the in- measures for functionality, the newly formed com- crease of the population's response capacities. This mittees established disaster management funds was noticed during the simulation exercises carried which are kept in a separate bank account and which out in the five communal sections, involving the lo- amount up to 2,500 CHF after the first year. cal population as well as all the local DRM actors. The result was that participants knew all their roles Ghana, El Salvador and Kyrgyzstan have achieved an and were able to respond appropriately to the var- acceptable level of functional committees. In 2018, ious alerts issued. While none of the communities all three country programmes experienced a new has a functional committee yet, the functionality project phase extending the collaboration with criteria show a promising level for many commit- new communities and all show a similar record of tees to attain functionality in 2019. accomplishment: while most of the communities of the previous phase have functional committees this Indicator DRM3 Communes with tested disaster is not yet the case for the new communities. In El management plans updated at regular intervals Salvador for instance, all the committees of the 21 and linked to superior level response: A slightly communities have been formed, equipped, recog- different indicator measuring preparedness was nised by the system, and trained in various issues, applied in Vietnam (see diagram DRM2). In order namely first aid, early warning, emergency shelter to comply with the indicator criteria, disaster man- management, security and surveillance, DRR and agement plans must fulfil a set of quality standards climate change, formulation of disaster response concerning their content and have been tested and plans, monitoring of family emergency plans, and updated in the last two years. The following table simulation exercises. The committees implement shows progress in disaster preparedness in the DRR mitigation activities such as cleaning campaigns, project in Vietnam, measured by five criteria.

Criterion Communes meeting the criteria (in percent)

2016 2017 2018

Clear chain of command 25 75 75

Clear roles and responsibilities for agencies 12 87 100

Early Warning Systems clearly articulated 38 87 75

Evacuation points identified 75 100 87

Plans tested annually – 25 100

66 Between 2017 and 2018, two improvements were noted, with 100 percent of communes reporting that they tested their plans in 2018 (as compared to 25 percent in 2017) and all commune plans demonstrating clearly defined roles and responsibilities for key agencies (2017: 87 percent). How- ever, there was also a notable 13 percent decline in the number of communes identifying evacuation routes and having clearly articulated early warning systems, and there was no additional improvement in the number of communes having a clear chain of command identified in their plans. The key reasons for this are most likely due to a decision taken in 2017 by the Red Cross to leave it to the government A village group is looking after its tree nursery in Léogâne, Haiti. © SRC, Florian Kopp authorities how to improve their existing plans, and rather support specific contingency plans for typhoon. Thus, some communes who failed to meet these three criteria at the beginning of this project still failed to meet them at the end of the project. tion conducted together with EFPL (Impact Award However, it is worth noting that in 2018, 100 per- 2017). In order to comply with the indicator criteria, cent of the communes reported improvements of measures must 1) be periodically (once per season) their plans, 37 percent of the communes adjusted controlled by the community, 2) show no signs of the early warning systems, 75 percent made im- avoidable deterioration, and 3) have fulfilled the provements to the articulation of roles and respon- protection objective in the case of a hazardous sibilities for key agencies identified in the plan and event. Community level structural protective meas- 12 percent made improvements to their chain of ures include i) critical sites i.e. areas of origin of haz- command. This indicates that even if 50 percent of ards and ii) community infrastructure e.g. schools, the communes failed to meet all of the criteria for health centres, multi-purpose buildings, markets, improved disaster plans, the project was still able to access roads, bridges. With the start of a new phase foster a culture of making regular improvements to in 2018, the project restarted the targeting and disaster plans within all communes. monitoring process. In 2018, the project accompanied the communities with 45 protective measures, Disaster prevention and mitigation reflecting 30 percent towards achieving the indicator target for the project phase (150). A further After increased disaster preparedness, reduced 74 critical sites intervened in previous phases were hazard exposure and vulnerability is the second followed up in 2018. Community level protection expected outcome of SRC CBDRM programming. measures such as reforestation, soil bio-engineer- The key ingredients are climate- and hazard-resil- ing, check dams, dry barriers etc. were executed ient critical infrastructure and sites at community as micro projects under the leadership and man- and household level as well as the protection, reha- agement of the community level committees. All bilitation and sustainable management of natural micro projects were integrated in the municipal resources. development plans, backed by the local authorities and co-financed by municipal budgets. In the in- Indicator DRM2 Community level structural pro- tervention area of the department of Olancho, be- tective measures in zones exposed to hazards that haviour of the communities towards reforestation are functioning and managed properly by the com- has changed as it is perceived not only as a resource munities: SRC uses indicator DRM3 in Honduras in protection and risk mitigation mechanism, but as the project area of Olancho to measure progress part of sustainable livelihoods. In the departments in disaster mitigation. The indicator is also an im- of Valle and Choluteca in the South of the country portant element in the ongoing impact evalua- and prone to drought, the use of potassium acrylate

67 (solid water) as an input to consolidate the planta- Good practice: the “Productive Protective tions in the micro-watersheds had a positive effect, System” in Haiti reflected in a considerable increase of the survival rate of the planted trees in the reforested plots. The “Productive Protective System” is a newly introduced method in Haiti that includes the integration DRR and CCA mainstreaming of socio-permaculture concepts to reduce the population's exposure and vulnerability through meas- The SRC practices DRR and – increasingly – CCA ures that directly target the living environment. mainstreaming throughout the IC programme. The system is based on the terra preta hill garden Progress still varies among the different country technology as the foundation and includes other programmes: components such as raised gardens, edible fences, vertical gardens, climbing plants and animal breed- 1) Programme countries with a distinctive resilience ing. The plants used are banana, vine basket, “Mala- approach, either at project or country programme bar” spinach, leaf cabbage, sugar cane, small fruits level, systematically integrate DRR and CCA in by layering, etc. which are almost exclusively of per- health and/or WASH. The integrated projects ennial nature. The system promotes an organic ap- demonstrate a range of DRR and health synergetic proach. The animal protein production (e.g. rabbit effects at the level of communities and project staff in a cage) closes the natural cycle of chemical ele- that go beyond mere DRR and CCA mainstream- ments. If applied altogether the system allows for a ing. This is the case for Honduras, Haiti, El Salvador, shift from simple vegetable gardening to permac- Bangladesh, and to a lesser extent for Vietnam and ulture nano farming. In addition to the nutritional, Ethiopia. The programme countries in Bolivia, Par- ecological and economic benefits, the system offers aguay, Ecuador and Ghana have started new pro- a protection component by integrating local risk gramme phases with comprehensive DRR and CCA mitigation measures (e.g. soil bio-engineering). For components. detailed information, refer to the video „Productive Protective System“ on the SRC YouTube channel. 2) Nepal mainstreams DRR and CCA by using risk-in- formed outcome and output indicators. The same The combination of production and protection in accounts in general for the integrated recovery particular triggers a greater interest of the local programmes in the Philippines and Pakistan. Kyr- population for application, which adds for the sus- gyzstan, Armenia, Bosnia and Herzegovina inte- tainability of the measures put in place. It is creating grate DRR and CCA elements into several activities a similarly high level of ownership and replication as in health and WASH projects, such as hazard and the ongoing soil conservation and organic agricul- risk assessments, awareness raising and capacity ture measures. The two main disadvantages men- building e.g. in first aid. All these programme coun- tioned by the communities are the need for higher tries have reached a satisfactory level of DRR and reflective and technical skills for the application and CCA mainstreaming. the fruiting time, which greatly exceeds other simple vegetable gardens. The method also aroused 3) In Togo, Lebanon, Sudan, South Sudan, Malawi, the interest of development partners, such as the Moldova and Belarus, mainstreaming efforts can Italian and Spanish Red Cross and Caritas Switzer- still be improved, even though not all programme land whose staff benefitted from a two-day training countries are equally affected by climate and haz- course offered by the Haitian and Swiss Red Cross. ard risk. This will require a stronger SRC in-house support.

68 Knowledge Management & Policy Dialogue The SRC aligned its contribution to the IFRC on the implementation of the Roadmap to Resilience, par- In 2018, the SRC coordinated the three working ticipating in a lessons learned workshop in South areas of the Swiss NGO DRR Platform (Indicator Korea to validate and update the roadmap to resil- Toolbox, Cost-Benefit-Analysis and Dialogue with ience guidelines as well as in an expert workshop in Swiss Solidarity) and contributed to a fourth work- Germany to initiate and provide the key ingredients ing area (DRR and CCA mainstreaming guidelines) for the development of a resilience “dashboard” to and with a case study presentation to the Platform measure resilience. The SRC is furthermore mem- learning event “DRR and fragility”. It furthermore ber of the IFRC DRR Group and the Asia Pacific DRM participated at the International Tech4Dev Confer- Working Group working on actual IFRC topics like ence in Switzerland with two oral and one poster resilience, enhanced VCA, forecast-based financing presentation. and urban DRR.

Policy dialogue in Switzerland was realised through The SRC elaborated the DRR Concept in a participa- the Swiss NGO DRR Platform. The SRC is represent- tory process with several feedback loops with del- ing the Platform in the DRR Consultative Group that egates, programme coordinators and advisors. The involves all major Swiss DRR stakeholders. In-coun- concept adheres to the DRM Policy with equal goal try advocacy activities were mostly part of project and outcomes and details out approach and collab- implementation: oration in particular. The concept will be published ––In Honduras, the projects were strongly engaged in early 2019. in the policy dialogue at the local and depart- A major publication in the frame of the Swiss NGO mental levels, mostly through the roundtable on DRR Platform was the compendium of good prac- national risk management advocacy, in the South tices in DRR “where people and their land are safer” for instance for the attention of the drought in in collaboration with the University of Bern. The SRC that zone. contributed in co-authorship and with good prac- ––In Ecuador, the project began coordinating with tice case studies from Honduras, Haiti and Bangla- the Ministry of Education to support the imple- desh. Several instruction videos, published on the mentation of the national Environmental Educa- SRC YouTube Channel, illustrate the practices. tion strategy to promote and strengthen environmental awareness in the educational community. ––In Nepal, ward (sub municipal level) offices and schools were encouraged to form disaster management committees and to establish emergency funds, which are important to enable a response in case of a hazardous event.

69 Number of beneficiaries in disaster risk reduction

2017 2018

Total DRR beneficiaries 303,820 242,845

DRR awareness 167,486 137,551

Early warning systems 166,907 134,353

Risk mitigation 76,280 82,871

DRR education 28,156 23,969

DRR committees supported 563 358

Lessons learnt ––Preparedness: experience to date highlights ––DRR and CCA mainstreaming: government in- the importance of building on and working stitutions must be involved in the capacity with existing local structures for sustainably building of their staffs (e.g. education, health) strengthening the DRM system. Even if work- at the local level for increased sustainability of ing community based, focus must be as much mainstreaming measures. As a minimum stand- on strengthening the structures at the munici- ard, the SRC ensures that ensures that all pal level and on linking communities with local (health, WASH, reconstruction etc.) infrastruc- authorities, in order to achieve sustainable re- ture constructed or repaired with SRC support sults. As a minimum standard, CBDRM pro- is climate and hazard-resilient. gramming must imply working simultaneously at the community and local authority level. ––Mitigation: contribution of communities and local authorities increases ownership and sustainability of measures. To ensure maintenance, focus must be on affordable and envi- ronmentally sound solutions that are technically adapted to local skills and based on locally available materials. As a minimum standard, CBDRM programming must insist on in-cash or in-kind contribution of all major stakeholders.

70 71 Institutional preparedness

Major Outcomes In Vietnam, the SRC has started a three-years project with the Vietnamese RC (VNRC) on supporting Institutional Preparedness (IP) refers to ensuring capacity strengthening of VNRC at the national the preparedness of any RC National Society (and level in Hanoi and chapters in nine Provinces, in its branches) to respond effectively to a given dis- the fields of Emergency Shelter and Cash Transfer aster scenario in its country according to the needs Programming. The project aims at strengthening and the role given by the authorities. The SRC inte- VNRC’s capacity to deliver cash at scale and advo- grates this typical Red Cross task into its portfolio cates with VNRC leadership to use Cash Transfer at country-level, either as part of a DRR project, as Programming (CTP) as a key modality in disaster a standalone IP project or as part of the support to response and to promote the use of standardized the partner’s capacity development. The SRC also CTP tools. VNRC staff are further trained in CTP and supports the RC movement in its preparedness, ge- support is provided to VNRC to increase their visi- ographically and thematically. Moreover, the SRC bility as key partner in the humanitarian sector in constantly keeps working on its own preparedness, Vietnam. Under the shelter component, objectives in Switzerland and in its delegations. include strengthening VNRC’s capacity to take over the role of shelter coordination in-country and lead The Institutional Preparedness project of the SRC the Shelter Working Group, as well as the develop- with the RC of Bosnia Herzegovina (RCSBiH) went ment of a national shelter manual. into its second phase in 2018. The project aims to strengthen the disaster management capacities of In Bangladesh, the many disaster responses in 2017 three branches of the RCSBiH (Orasje, Šamac and and 2018 have highlighted the capacities, but also Brčko) and at headquarters level. Based on the the gaps in the response system of the Bangladesh findings of the branch organisational capacity as- Red Crescent Society (BDRCS), and the Movement. sessment (BOCA) in the first phase, the branches The SRC recognized the need to step up its support focused their efforts especially on increasing the for the institutional preparedness of the BDRCS at volunteer management capacities. The project headquarters and branch level. The delegation was also facilitated exposure missions and peer-to- reinforced by a new deputy head of delegation to peer exchanges with international RC partners. support the country coordinator in implementing The trainings and drills of the RC emergency teams the capacity development components with the with the local authorities continued in this phase. BDRCS. In 2018, the SRC consistently passed on At national headquarters level, the project aspires responsibilities in the project management cycle to facilitate the elaboration of a Disaster Manage- to BDRCS. The SRC also changed the approach of ment Strategy based on a Risk Mapping (using the the former DRR project in Gaibandha more into a IFRC prevention web). In terms of coordination with DRM program (including preparedness of BDRCS authorities at national level, the bi-weekly meetings HQ in Dhaka). A horizontal learning programme with the Ministry of Security around the migration will allow peer-to-peer learning among the BDRCS crises at the border with Croatia contributed to the branches, while the proposed emergency fund will RCSBiH visibility and their understanding of this cru- significantly decrease BDRCS lead time in its disas- cial ministry’s role. This will serve as a useful based ter response. on discussions on roles and responsibilities in a next stage.

72 In Ghana, the SRC responded together with the Ghana Red Cross Society (GRCS) to the floods in the Northern Region in September. The response highlighted that the NS was not ready to run an efficient emergency operation. There were delays due to lack of ownership, slow planning and lack of a procurement system to support a quick procurement and arrival of the non-food items. This information has been fed back to support the implementation of the institutional preparedness component of the ongoing DRR project. This component aims at enhancing ownership and capacities of the GRCS in disaster response. In 2018, a Zero Draft of the strategy was developed based on a hazards mapping. In Haiti, 1.4 million people needed humanitiarian aid after hurricane Matthew. The Red Cross Movement in collaboration with the Haiti Red Cross was well prepared GRCS together with the National Disaster Manage- to deliver aid. © IFRC, Nicole Robicheau ment Authorities (NADMO) facilitated refreshers trainings in the Ashanti, Eastern, Brong Ahafo, Cen- tral, Greater Accra, Volta, Upper West and Western Regions. The development of contingency plans for The SRC also continued to increase the prepared- the districts is planned for 2019. ness of its own delegations for response. In 2018, the delegation preparedness process has been in- In Ethiopia, the Institutional Preparedness compo- troduced in Ethiopia and Nepal. The processes in nent of the SRC in support of the Ethiopia Red Cross Bangladesh and Vietnam continued. Society (ERCS) used to be embedded into resilience projects in the ERCS branches in Moyale and Gam- bella. In 2018, both resilience projects ended. They Knowledge Management & Policy Dialogue will be replaced with branch capacity development projects at the request of the ERCS. In 2018, capac- ––SRC contributed to the dialogue within the Swiss ity development plans were developed and will be DRR NGO Platform on preparedness of delega- implemented in 2019. Institutional preparedness is tions and partners. a key component of the branch development,. ––SRC is part of the IFRC Reference Group for the ‘Preparedness for Efficient Response’ tool; SRC is The SRC continued its engagement with its RCRC part of the Surge Optimization process, the Cash partners at global and regional level to enhance Preparedness Working Group and the Logistics coordination and cooperation in institutional Pre- Capacity Development working group. paredness: –– In some countries, the SRC supports the National –– Harmonizing the IFRC assessment tools and pro- Society in its advocacy towards the authorities cesses designed for increasing preparedness of concerning the clarification of its role in the Na- the NS’s. tional Disaster Management Mechanism. –– Harmonizing Competencies (profiles and trainings) required for RCRC surge personnel across regions and across sectors. –– Technically support the efforts of the IFRC and other Partner National Societies to increase the institutional preparedness of Operating National Societies, i.e. in logistics.

73 Number of trained staff in institutional preparedness (IP)

SRC contribution to the following SDG target: Africa/Middle East 159 11.b By 2020, substantially increase the number of cities and human settlements adopting and imple- Americas 70 menting integrated policies and plans towards inclusion, resource efficiency, mitigation and adaptation to Asia 72 climate change, resilience to disasters, and develop and implement, in line with the Sendai Framework for Disaster Europe/CIS 8 Risk Reduction 2015–2030, holistic disaster risk management at all levels Total 309

Lessons learnt ––To put systematic emphasis on linking the ex- ––Only accepting the pace of the concerned part- periences of ‘real’ disaster response operations ner and his ownership to the process will allow and the institutional preparedness process and sustainability of the institutional preparedness. vice versa is crucial to its success ––Only when the capacity building efforts of all ––To seek the synergies between the operational partners involved are coordinated, the Nation- aspects of Institutional Preparedness and the al Society will benefit from those efforts, other- larger, more ‘managerial’ capacity building ef- wise the risk of it being stretched even further fort is too high.

74 75 Saifur Rahman Saffi, ein Mitarbeiter des Bangladesch Roten Halbmondes hält einen Säugling, während seine Mutter von76 der Krankenschwester Francis Duclos in der mobilen medizinischen Klinik des Kanadischen Roten Kreuzes ©in derICRC, Notunterkunft Marko Kokic Kutupalong, Bangladesch untersucht wird. © IFRC, Victor Lacken 4. Learning process: Partnership and National Society Development

Number of volunteers and employees of partner organisations trained

2017 2018

Number of volunteers and employees of partner 23,738 20,328 organisations trained

RCRC employees trained 971 1,097

RCRC volunteers trained 8,779 7,481

NGO/CBO employees trained 858 352

NGO/CBO volunteers trained 7,756 7,578

Government employees trained 5,374 3,820

In 2018, the SRC kicked off reflections on the strat- has become evident that short-term project fund- egy for international cooperation beyond 2020. ing cannot be the foundation for sustainable servic- The role of National Red Cross Societies working es to vulnerable people, and for self-sustained insti- internationally – the so-called Partner National So- tutional development. cieties (PNS) – is rapidly changing. With their 165,000 branches worldwide, the Red Cross and To break the vicious circle, new partnership and Red Crescent National Societies are at the forefront funding modalities must be applied in the Red of the localization of aid agenda. Rooted in and ac- Cross cooperation system, and self-directed pro- cepted by their constituencies, they are better gramme development and domestic fund raising placed to act as local change makers and to respond for core cost recovery must become a priority for to humanitarian needs than external actors. As the National Societies. case of the emergency response after the tsunami in Sulawesi in 2018 showed, the Indonesia Red Based on this analysis, the SRC in 2018 developed Cross was able to deliver humanitarian aid without an internal document “Vision 2030” that foresees a much operational support of PNSs. However, many stronger commitment of the SRC for institutional National Societies face serious problems related to partnerships and organizational development with their governance, leadership, managerial, opera- RCRC National Societies. The SRC commitment goes tional and financial capacities. They are caught in a together with SDC’s financial contribution to the vicious circle of financial dependency and weak ser- newly launched National Society Investment Alli- vice delivery: weak governance, leadership and or- ance by the ICRC and the IFRC. ganizational capacities hamper strategic and operational planning of services. Donor-driven, often As a first step in this process, the Departments Inter- short-term project grants often draw them away national Cooperation and Marketing/Communica- from pursuing their own strategy and operations, tion have jointly developed an SRC Guidance Note and overstretch their management capacities. Poor on “National Society Development” (NSD) in services aggravate their inability to mobilize do- 2018. The Note confirmed the SRC’s commitment mestic resources to cover their organizational core to take on a more active role in the IFRC and to costs, which keeps them entirely dependent from make a stronger contribution towards strengthen- project funding by international donors. Hence, it ing the organisational capacities of National Socie-

77 ties. The SRC’s approach to NSD includes not only Case 2 Ethiopia: Partnership in a fragile context improved organisational and operational capaci- In Ethiopia, the SRC has learnt that the fragile con- ties, but also investments in domestic resource mo- text combined with extreme weather events – both bilisation. The two Departments are currently pilot- drought and floods – require flexible intervention ing this approach in Belarus by boosting the Nation- modalities. At the nexus between development al Societies’ domestic fund raising in order to sustain and humanitarian response, the partnership be- its the services in home-based care for older people tween the Ethiopian Red Cross and the SRC is a bal- (see the case example below). ancing act between short-term results and long- term sustainability. Key Learnings: Majors recommendations were that Learning process between SRC and Helvetas the OD process in a fragile context needs to build on the capacities of the local actor and its priorities and With the aim to gain evidence and learn more not the priorities or ambitions of the donor. It was about best practices in organizational development therefore recommended to make the capacity and partnership, and to inform the future strategy building not too structural but to build the OD pro- and programme, SRC, Helvetas and SDC have em- cess around concrete activities. It is important to let barked on a joint learning process. The process the local actor develop its capacity while imple- was launched in October 2018 with a learning menting their core activities and to give the local event between SRC and Helvetas practitioners. The actor the space and freedom to learn from this ex- participating Programme Coordinators conducted perience. The branch development approach which case examples on partnerships and organizational SRC is piloting in Ethiopia, could be a promising development from Belarus, Ethiopia, Bangladesh approach. Moreover, in fragile contexts it is impor- and Kyrgyzstan: tant not to be too ambitious and set clear bounda- ries for what can be achieved and what not. Case 1 Belarus: Organisational development and resource mobilization Case 3 Bangladesh: Shaping partnerships in The Belarus Red Cross (BRC) has been running a emergency contexts home-based care service for many years. After mak- Since 2017, Helvetas has been engaged in human- ing large investments and financing large parts of itarian response for the people from Rakhine state the running costs, the SRC aims at phasing out (Myanmar) who have migrated to Bangladesh. In its funding support. BRC and SRC have agreed on a development projects, Helvetas Bangladesh has sustainability strategy that includes domestic fund been working with partners instead of doing direct raising for the home-based care service in Belarus. implementation for a long time. How can the Hel- Key Learnings: The main take-away was that SRC vetas partnership approach rooted in development and Helvetas hold different strategies and ap- cooperation be adapted for humanitarian response proaches regarding long-term sustainability. Helve- interventions? What are opportunities? What are tas participants critically commented the time con- limitations? straints of the SRC exit strategy in Belarus. Different Key Learnings: There was a consensus that the part- factors for success in such type of partnership and nership cycle – including a mutual partnership explo- OD were discussed, such as exit strategy develop- ration, selection, capacity development, etc. – can ment, the application of more suitable approaches and must be applied in humanitarian projects as well. like Outcome Mapping as well as the challenges to Even if collaboration cycles are shorter, we should not ensure stability through HR succession planning shy away from launching an institutional dialogue within the partner organisations. The case exam- with partners in order to identify capacity develop- ples concluded that the two organisations should ment needs. An OD process might not be possible or use this specific case to learn more about each oth- appropriate during an emergency. However, punctu- ers‘ approaches, especially with regard to exit and al measures can be supported, which should be sustainability strategies. owned and driven by the local partner. It is crucial to engage in a partner dialogue on institutional capacities despite time constraints, and to invest in building trust. As international organisations, we need to lobby with our funding agencies to include capacity development in partnership contracts.

78 Case 4 Kyrgyzstan: Partnerships between The case examples evokedHelvetas and SRC agreed cooperation and competition to jointly conduct a case study on partnership and In Kyrgyzstan, one of the strongest partners of Hel- organisational development in selected countries vetas, with whom a joint mandate for SDC on local where the two parties and their partner organisa- governance is implemented, has ambitions to ex- tions have an interest to review their respective pand its activities to the international level. Through partnerships. The goal of the case study will be to the partnership with Helvetas, the local NGO would learn with partners how to shape effective partner- like to get access to international funding opportu- ships for jointly strengthening institutions and sys- nities. Sometimes, Helvetas feels that there is more tems in their countries. The study will gain evidence competition than cooperation in the partnership. on roles and mutual expectations, success factors, How to deal with this tension field? enabling environments, methods how to measure, Key Learnings: The key challenge is to redefine com- areas of tension, and donor influence. In addition to plementarity between the partners. The partner- the two chosen primary case of Kyrgyzstan, the ship is “given” because of the current consortium, study will undertake a document review of other so the partners need to find a match. With growing partnerships of Helvetas and the SRC as secondary expertise, the local partner will be capable and will- cases. The case study shall also bring clarity how ing to take over more responsibility. Yet, in the given government actors and funding agencies like SDC set-up of the mandate for SDC, Helvetas will still be can contribute to shaping more effective and equi- responsible for quality assurance and accountable table partnerships. to the donor. In conclusion, when a consortium is established between a local organization and an international organization, it is important to define SRC contribution to the following SDG targets: a clear vision from the outset of partnership per- 17.16 Enhance the Global Partnership for Sustain- spectives. The case illustrates that the set-up of a able Development, complemented by multi-stakeholder partnerships that mobilize and share knowl- project heavily influences the roles of actors in part- edge, expertise, technology and finan-cial resources, to nerships which can lead to tensions, especially if support the achievement of the Sustainable Development assigned roles and own perception do not match, Goals in all coun-tries, in particular developing countries or change, over time. 17.17 Encourage and promote effective public, public-private and civil society partnerships, building on the experience and resourcing strategies of partnerships

79 Partnership for sustainability between the Belarus Red Cross and the SRC

The Swiss Red Cross (SRC) aims at gradually phas- 1. Analysis of the donations market – individual ing out funding support to the home-based care giving and corporate sponsorship – in Belarus services of the Belarus Red Cross. BRC and SRC and its potential; have agreed on a sustainability strategy that 2. Analysis of motivation for donations and builds on domestic fund raising. The exit phase of awareness of the BRC activities among the the project pursues three outcomes: population and the corporate sector; 3. Analysis of the BRC fundraising and related ––The first outcome addresses quality of care and communication activities. greater professionalization of the visiting nurs- 4. Portfolio and fundraising methods of the char- es services (VNS) of the BRC, including paid ser- ity organisations in Belarus. vices for those who can afford it, and training courses to generate income. The study assessed the volume of the domestic ––The second outcome is the improved overall fi- market for donations from individuals as well as nancial sustainability of the BRC through the small and medium businesses and large corpora- development of a comprehensive, evi- tions. The study also investigates the motivation dence-based fundraising strategy and a re- of the people and organisations who make dona- branding of the VNS. This project component is tions as well as the rating of charitable organisa- implemented in close cooperation with the SRC tions. Moreover, the main fundraising channels Marketing and Communication Department. and mechanisms were described and the efficien- ––The third outcome covers community mobilisa- cy of the BRC activities on domestic resource motion in support to the provision of quality home- bilisation was assessed. Based on the results of based care services, and promotion of healthy the study, the BRC developed the BRC in-country ageing through the promotion of “initiative Fundraising Strategy for 2019-2020. The draft groups” of volunteers. BRC Fundraising Strategic Action Plan was presented at the workshop "Developing the BRC In 2018, great progress was made regarding the fundraising system" (September 5-6) for feed- second outcome on financial sustainability. In or- back and revision. 39 people attended the semi- der to train the BRC staff in fundraising and com- nar: The BRC management, experts of the Swiss munications and to improve the efficiency of the Red Cross, the BRC strategy development work- fundraising system, a fundraising position was ing group, heads of the BRC HQ departments, and introduced at the BRC Headquarters, funded by specialists of regional branches responsible for the project. A working group on fundraising and fundraising work. Simultaneously with the strat- communication was created, including the fund- egy development, building of infrastructure and raising specialist, a communications specialist, an implementation of the recommendations of the economist, and a project development specialist. study started in the third quarter. In order to sup- With the support of the project team, the Belaru- port this activity, a new contract with Satio was sian company Satio conducted a market study signed. To raise funds from individuals, the BRC "Analysis of awareness of the BRC activities. Mar- evaluated a Customer-Relationship Manage- ket potential to raise funds for charity and hu- ment (CRM) system. Another milestone was the manitarian activities in the Republic of Belarus ", review of the BRC membership system that would which consisted of the following parts: allow growth of income. It was agreed that in ad-

80 dition to the current system that generates membership fees, the focus will be on building a parallel system of individual giving’s collection and forming a pool of Red Cross supporters that will allow the integration of the current BRC members. To improve fundraising communications, the BRC employed a content specialist, renewed the BRC website, and rebranded the Visiting Nurses Services. The BRC Board agreed on a new name and logo: the Medico-social Ser- vice of the Red Cross "Dapamoha" (Belarusian for “help”). Since the end of 2018, the website subdomain www.dapamoha.redcross.by is online. In order to promote and strengthen a positive image of the service and to raise funds, the character "Babushechka" (Russian for “a kind-hearted Granny”) was developed to represent the image of the clients of "Dapamoha." Another character – “Dedushechka” (Russian for “a kind-hearted Grand Dad”) will be developed and introduced into the service promotional video in the beginning of 2019. The character and the new logo of the service were used for marketing products, such as an animated New Year card and a desk calendar 2019. BRC also established interactions with the media. A total of 214 publications (110 in national and 104 in regional media), 2 radio broadcasts, 12 TV reports were produced.

SRC and BRC learnt that the market study as such has already enhanced the image of the BRC and positioned it as a serious player in the developing charity market in the country. Although the strategy development took longer than initially planned, it was effective thanks to the in- depth analysis of marketing and communication opportunities. Based on a broad consensus within BRC, the process contributed to development of the BRC long-term vision for membership and in-country fundraising that will be reflected in the new BRC programme strategy for 2021–2025.

81 82 WASH in schools, like here in Nepal, is an important domain of the SRC health programme. © SRC, Remo Nägeli 5. Public Affairs and awareness-raising in Switzerland

Public Affairs School portal www.abenteuerroteskreuz.ch In 2018, the SRC launched an initiative to reinforce Over the past year, other topics were added to the its Public Affairs activities, particularly the dialogue Red Cross Adventure educational portal launched and lobbying efforts with members of parliament, by the SRC Competence Centre for Youth Work in government authorities, and other decision-mak- 2016. In April, another interactive storyline was ers. The new SRC Public Affairs team issued the launched on the current topic of migration. It tells first four numbers of the bulletin “Standpunkte” the story of a young Syrian girl living as a refugee in that were addressed to the members of parliament Lebanon, linking it to the fate of a Syrian boy who before each session. Amongst others, the bulletins has arrived as a migrant in Switzerland. The new covered the Agenda 2030, the global fight against storyline has attracted more users to our portal: in non-communicable diseases, the Compact on 2018, there were more than 41,000 visitors. Global Migration, and climate change. Integrated communications on the Agenda 2030 Red Cross Around the World For several years, the SRC has been applying an In the domain of public awareness-raising, the SRC integrated communications policy, combining the in 2018 emphasised youth as an important target awareness-raising messages with its marketing group of its information activities on international campaigns, to benefit from synergies. The topics cooperation. The exhibition Red Cross Around The are aligned with the UN's Sustainable Development World that was tailored to a young audience, was Goals (SDG) that the SRC focuses on in its work. The shown at the Urgence Humanitaire exhibition at main topics in 2018 were health for all (SDG 3, for the Maison du Futur at Berges de Vessy in Geneva. example in Ecuador), prospects for youth in violent Alongside the SRC exhibition, the Fondation Brail- urban areas (SDG 11, for example in El Salvador), lard presented an exhibition on emergency archi- and health in emergencies (SDG 3, for example in tecture and Vanna Karamaounas exhibited photos Bangladesh and Myanmar). Media trips were or- on migration and homelessness. 7,500 people vis- ganized for all three topics and resulted in good ited the three exhibitions in a cultural centre in the coverage, especially thanks to our media partner- outskirts of Geneva. The response was entirely pos- ships with Ringier and Coop. itive, both the feedback from visitors and the coverage in local media. As many as 18 classes, with Humanité a total of 400 pupils, visited the exhibition, and Four times a year, the SRC magazine Humanité the teaching packs provided by the SRC enabled reaches 156,000 households in Switzerland. In 2018, teachers to expand on the visit in their lessons. The the issues covered stories from SRC International Co- exhibition team also organized activities as part of operation projects in Ecuador (access to healthcare for the Museum Night in Geneva and other special ac- marginalised people), Nepal (water, sanitation and tivity days. On 13 September, the SRC held a public hygiene), El Salvador (social inclusion of youth), Haiti debate with representatives of Swiss Solidarity, the (disaster risk reduction), and others. Various articles Geneva City authorities, a historian from Geneva on international cooperation were published on the University, and the SRC. Entitled 'Is money a sub- SRC website in German, French and Italian language. stitute for food parcels?', the debate covered new types of emergency relief, especially the provision Networks and partners of cash instead of relief supplies. Other important platforms for awareness and Once over in Geneva, the exhibition will be move advocacy work in Switzerland were the Swiss NGO to the Umweltarena in Spreitenbach, where it will DRR Platform and the Medicus Mundi Schweiz be open to the public from 30 May to 24 November (MMS) health network. Through MMS, the SRC 2019. regularly addressed the general public with presentations and articles by health specialists. In 2018, there has also been closer cooperation with Alli- ance Sud, in which the SRC is a partner organization and is represented in both the programme and the communications groups. 83 Jose Domingo84 Cruz was trained in radio communicatoin by the El Salvador Red Cross. He is member of a emergency committee in Bajo Lempa. © SRC, Florian Kopp 6. Finance

Financial overview

The SRC invested 45.89 million Swiss Franc in tutional Partnership (IP), 2.5 million CHF through emergency relief, rehabilitation and long-term the Humanitarian Aid (HH) and 3.0 million CHF development projects in 2018. The SDC contrib- through other mandated SDC projects. The ta- uted 16.28 million Swiss Franc (CHF) through ble below shows the project volumes of the IC various sources, covering 35 percent of the IC department by sector for the SDC Programme department’s total project expenses. The SDC Contribution Phase 2017–2020. contributed 10.5 million CHF through the Insti-

Expenses Expenses Budget Budget 2017 2018 2019 2020 Emergency Relief & Humanitarian Aid 10,714,000 9,810,500 9,000,000 9,000,000 Reconstruction & Rehabilitation 4,808,000 3,270,500 4,000,000 4,000,000 Development Cooperation 31,379,000 32,812,000 36,000,000 35,000,000 Total IC Department Projects 46,901,000 45,893,000 49,000,000 48,000,000

Indirect IC Department Expenses 12,438,000 8,224,000 9,800,000 9,600,000 Total IC Department Projects 59,339,000 54,117,000 58,800’000 57,600,000

International Cooperation Department Expenses 2018 (in CHF 1,000) Emergency Relief & Humanitarian Aid 9,811 Reconstruction and Rehabilitation 3,271 Development Cooperation 32,812 Project Implementation Expenses 45,893 Indirect Project Expenses 8,224 Total Expenses 54,117

Contribution from the Swiss Government Income 2018 (in CHF 1,000) SDC Programme Contribution 10,483 SDC Mandate Projects Development Cooperation 2,194 SDC Emergency Relief & Humanitarian Aid 2,500 SDC Mandate Projects Emergency Relief 265 SDC Service Contract SKH 756 Total SDC 16,198 SECO Mandate Projects 83 Total Swiss Govt. Contribution 16,281

85 Additionally, the SDC contributed total of CHF 5.3 million towards international humanitarian aid projects, core cost contribution and other institutional events under the tripartite agreement signed between the SDC-SRC-IFRC in 2018. Since this SDC contribution is passed on to the IFRC directly, the amount does not appear as SDC contribution in the SRC financial statement. Further details about the individual contribution and programme funding is presented in annex 4. The project expenditure trend as shown in the figure below exhibits how the sectoral expenditure has varied over the last six years. The emergency relief project volumes include the value of goods in kind received for the Twice Christmas campaign.

Project expenses

60,000,000

50,000,000

40,000,000

30,000,000

20,000,000

10,000,000

0 Actual 2014 Actual 2015 Actual 2016 Actual 2017 Actual 2018 Budget 2019

Emergency Relief Reconstruction & Rehabilitation Development Cooperation

86 Financial results and SDC programme and project contribution

The statutory audit of the SRC Headquarters for IC Department Expenses Actual 2017 Actual 2018 the fiscal year ending 2018 represents the fol- Direct IC Department project expenses 46,901,000 45,893,000 lowing operating results for the International Cooperation department. The table allows a Indirect IC Department expenses 12,438,000 8,224,000 comparative view over the first two years of the Total Expense 59,339,000 54,117,000 SDC Programme Contribution Phase 2017–2020. The contribution reported under the Humanitar- IC Department Income 2017 2018 ian Foundation SRC (HF SRC) also includes the management support cost at the rate of 15 per- SDC Programme Contribution for Development Cooperation 10,100,000 10,483,000 cent for the project contribution and 10 percent projects (IP) for the programme contribution. All the figures SDC Contribution to Emergency Relief & Humanitarian Aid 2,500,000 2,500,000 reported below have been rounded to the near- projects (HH) est thousand Swiss Franc. SDC Mandate from SDC Country Cooperation Offices 0 412,000 SDC Mandated projects 2,841,000 2,023,000 The protracted conflicts, ongoing population SDC Mandated Water Consortium projects 509,000 26,000 movements, climate-prone disasters, and epi- SDC Contracted Services (SKH) 732,000 754,000 demics continue to havoc people’s lives and live- SECO Project Contribution 59,000 83,000 lihoods around the world demanding humanitarian organization like the SRC to respond at a Private Donations 7,442,000 958,000 rate faster than it is able raise funds. The volumes Foundations and Institutions 2,186,000 2,832,000 of private contribution for the SRC international Canton and Communes 1,947,000 2,296,000 humanitarian and development responses has reduced to half in the last four years leaving us Sponsoring/Fund Appeals 2,118,000 1,658,000 to cover 25 percent of the total IC department Legacy and Bequest 98,000 20,000 expenses through the SRC’s reserve capital. If this Income from sale of old gold & services 2,388,000 2,337,000 trend continues, the SRC IC will have to reduce its Programme Contribution Humanitarian Foundation SRC 0 2,000,000 portfolio focusing on less programme countries. – (HF SRC) The SRC fundraising will explore further income streams such as thematic fundraising and enlarg- Project Contribution – Humanitarian Foundation SRC (HF SRC) 9,434,000 6,595,000 ing private partnerships. Lindenhof Foundation (FGL) 555,000 813,000 Swiss Solidarity 5,880,000 2,746,000 Annex 4 and 5 show the IC Department’s expenses, explanation to the budget deviation, Red Cross Organizations & NGO Contributions 865,000 1,336,000 and SDC contribution by countries. Total Income 49,654,000 39,872,000

Net Operating Deficit 9,685,000 14,245,000

87 Programme Budget 2019

The table below shows the programme budget and the planned programme contribution from the SDC and the Humanitarian Foundation of the SRC for 2019.

Budget SDC HF SRC Programme Programme Contribution Contribution Country CHF CHF % CHF % Egypt 160,000 150,000 94% – 0% Lebanon 840,000 250,000 30% – 0% Ghana 2,265,000 350,000 15% 400,000 18% Togo 1,614,000 350,000 22% 300,000 19% Syria 1,050,000 350,000 33% – 0% South Sudan 1,857,000 550,000 30% – 0% Sudan 1,102,000 400,000 36% 300,000 27% Ethiopia 430,000 200,000 47% 200,000 47% Malawi 1,048,000 600,000 57% – 0% Total Africa & the Middle East 10,366,000 3,200,000 31% 1,200,000 12% Bolivia 934,000 290,000 31% – 0% Paraguay 1,163,000 375,000 32% – 0% Ecuador 959,000 360,000 38% 250,000 26% Honduras 2,825,000 875,000 31% 600,000 21% El Salvador 1,998,000 600,000 30% – 0% Haiti 2,263,000 200,000 9% 250,000 11% Central America – Resilience 100,000 – 0% – 0% Total Latin America & the Caribbean 10,242,000 2,700,000 26% 1,100,000 11% Bangladesh 1,835,000 1,300,000 71% 90,909 5% Nepal 1,600,000 280,000 18% 200,000 13% Bhutan 421,000 – 0% – 0% Pakistan 200,000 – 0% – 0% Laos 3,497,000 1,985,000 57% – 0% Vietnam 1,078,000 – 0% – 0% TOTAL Asia 8,631,000 3,565,000 41% 290,909 3% Bosnia and Herzegowina 798,000 132,000 17% – 0% Moldova 1,126,000 132,000 12% – 0% Belarus 603,000 132,000 22% 300,000 50% Ukraine 52,000 – 0% – 0% Kyrgyzstan 1,107,000 132,000 12% 200,000 18% Armenia 817,000 132,000 16% – 0% Total Europe 4,503,000 660,000 15% 500,000 11% →

88 Budget SDC HF SRC Programme Programme Contribution Contribution CHF CHF % CHF % Quality, Innovation & Sensitization 500,000 210,000 42% – 0% IFRC – Health and DRR 230,000 75,000 33% – 0% Worldwide Specific Sector Support 72,000 – 0% – 0% TOTAL Strategy & Conceptual Development 802,000 285,000 36% – 0%

Development Cooperation with Progr. Contrib. 34,544,000 10,410,000 30% 3,090,909 9% Development Cooperation Mandate Projects 1,456,000 1,456,000 100% – 0% Total Development Cooperation Projects 36,000,000 11,866,000 33% 3,090,909 9%

Total Emergency Relief 9,000,000 2,500,000 28% – 0% Total Reconstruction/Rehabilitation 4,000,000 500,000 13% – 0% Total International Cooperation Projects 49,000,000 14,866,000 30% 3,090,909 6%

The anticipated sources of the total programme funding 2019 are:

Project Funding Sources Funding in % Public Fundraising/Sponsoring 10,472,000 21% Swiss Government (SDC) 14,866,000 30% Swiss Solidarity 4,000,000 8% Programme Contribution Humanitarian Foundation (HF SRC) 3,100,000 10% Project Contribution Humanitarian Foundation (HF SRC) 4,762,000 6% Other NGOs Contribution 1,500,000 3% SRC Own Fund/Others 10,308,674 21% Total International Cooperation 49,000,000 100%

89 Annex 1: Result framework of the SRC Programme 2017–20

Thematic area Programme Outcome Standard Outcome Indicator (SOCI) SDG target

Communities have improved access % of skilled health personnel using sterile delivery kits and apply clean 2.2, 3.2 to quality services and change their cord-clamping behaviour in reproductive health. % of women of reproductive age (15–49 years) practise healthy timing and 3.7, 5.6 spacing of pregnancy Reproductive % of health personnel correctly following standard treatment protocols 3.7 Health % of women having received a family planning counselling within 6 weeks after 3.7 childbirth % of births attended by skilled health personnel 3.7 % of women having received four or more ante-natal care check-ups during the 3.7 last pregnancy % of children between 12–23 month vaccinated three times for DTP3 and other 3.2 additional vaccine (national guidelines) % of women of reproductive age (15–49 years) using at least one method of 3.7, 5.6 contraception % of pregnant women who have a preparedness plan for birth and complication 3.7 % of infants < 6 months of age received only breast milk 3.7 Communities change their behaviour to % of patients whose blood pressure was taken by health facility admission 3.4 prevent infectious and non-communicable % of health personnel correctly following standard treatment protocols 3.4 diseases, and have improved access to care % of eligible people receiving drug therapy and counselling to prevent heart 3.4 and treatment. attacks and strokes Disease Control % of children < 5 years of age with suspected pneumonia, dysentery or malaria 3.4 taken to a health care provider % in insufficiently physical active persons > 18 years of age 3.4 % using a condom during last sexual intercourse with a higher-risk partner 3.4 % of population sleeping under insecticide-treated nets the previous night 3.4 Population/households have increased % of water sources that meet drinking water quality standards 6.1 access to improved water and sanitation % of households using and maintaining clean latrines 6.2, 6.3, 4.a facilities and change their hygiene % of households using an improved drinking water source 6.1, 6.a, 6.b behaviour. % of the population using safely managed sanitation facilities 6.2, 6.3 WASH % of population adopting safe water handling practises 6.1 % of households with soap and water at the hand washing station commonly 6.2, 6.3 used by the family Schools/students have increased access % of schools using and maintaining clean latrines 6.2, 6.3, 4.a to improved water and sanitation facilities % of schools using safely managed sanitation facilities 6.2, 6.3 and change their hygiene behavior. % of schools adopting safe water handling practises 6.1 % of schools with soap and water at the hand washing station commonly used by 6.2, 6.3 WASH in schools the students Communities have access to nutrition % of severely malnourished children under 5 correctly identified and referred to 2.2, 3.2 services and have improved the nutrition therapeutic feeding centre of particularly vulnerable groups. % of children from 0–59 months that appear for regular check ups and growth 2.2, 3.2 monitoring Nutrition % of infants under 6 months of age received only breast milk 2.2, 3.2 % of children 6–23 months of age who receive foods from 4 or more food groups 2.2, 3.2 Elderly, disabled and chronically ill people % of care givers/organizations that adhere to quality standards 3.4 have access to quality integrated home- based care services and enjoy living in an % increase in number of clients benefitting from the service 3.4 age-friendly environment. % increase in members in active aging groups 3.4 Ageing Patients in need receive blood products National blood transfusion service meets x % of the needs of requested 3.3 through improved, well-organized and blood products financially viable blood transfusion. % of blood donations screened for TTIs 3.3 % of voluntary non-remunerated blood donations 3.3 Blood safety % of VNR low-risk blood donors who donate blood more than one time per year 3.3

→

90 Thematic area Programme Outcome Standard Outcome Indicator (SOCI) SDG target

Communities have access to comprehen- % of increase of utilization of the eye care facility from previous year to current 3.8 sive and quality eye care services. year % of eyes with good visual acuity after 6 weeks of cataract surgery 3.8 % of school children who were given spectacles wearing them at school 3.8 Eye Care Lives are safed and suffering alleviated Number of hours from notification of suspected outbreak until outbreak 3.4 by responding to the basic health needs of investigation vulnerable people affected by disasters. % of population affected by an emergency using SRC supported health care 3.4 facilities Health in % of population treating their water with chlorine before drinking 3.4 Emergencies Communities have improved capacities % of tested disaster response plans updated annually and linked to the superior 1.5, 11.5, 11.B, to identify and reduce exposure and level response mechanism 13.1 vulnerability to hazards and to act with % of communities at risk with a functional emergency committee 1.5, 11.5, 11.B, appropriate preparedness measures. 13.1 Community- % of community based structural protective measure functioning and managed 1.5, 11.5, 11.B, based disaster properly 13.1 risk management Red Cross and Red Crescent Societies % National Society branches with disaster management capacities rated 1.5, 11.5, 11.B, in disaster-prone area prepared to engage “well-functioning” 13.1 in emergency relief operations.

Institutional Preparedness

91 Annex 2: Standard outcome indicators measured in 2018

Indicator Country (project number) Before* 2017** 2018** Target All figures are in percent except for OCAH2, OCAH3, OCEC2. OCAH1: % of care givers/organisations adhering to Kyrgyzstan (445991) 0 94 97 100 quality standards OCAH2: % increase in number of clients benefitting from Armenia (445600) 79 88 (11%) 120 (36%) 10% increase p.a. the services Bosnia and Herzegovina 208 354 (70%) 459 (29%) 10% increase p.a. (412945) Moldova (415928) 626 592 (–5%) 10% increase p.a. OCAH3: % increase in group members in AA groups Armenia (445600) 146 150 (0%) 10% increase p.a. Bosnia and Herzegovina 835 916 (9%) 1394 (52%) 10% increase p.a. (412945) Moldova (415928) 136 273 (100%) 281 (3%) 10% increase p.a.

OCBS1: % of blood donations screened for transfusion- Moldova (415929) 0 100 100 100 transmissible infections (TTIs) OCBS2: NBTS meets x% of the needs of requested blood Lebanon (442668) 15 15 19 20 products Malawi (422607) 0 50 56 70 Moldova (415929) 0 100 100 100 OCBS3: % of voluntary non-remunerated (VNR) blood Kyrgyzstan (445994) 0 11 12 50 donations Malawi (422607) 50 63 70 Moldova (415929) 0 86 94 92 OCDRM1: % of communities at risk with a functional Ecuador (431521) 0 80 emergency committee El Salvador (431698) 62 62 80 Ghana (421455) 44 64 80 Haiti (432362) 0 0 0 80 Kyrgyzstan (445996) 70 100 Paraguay (433562) 0 0 75 OCDRM2: % of community based structural protective Honduras (430076) 0 30 80 measures in zones exposed to hazards that are functioning and managed properly by the community OCDRM3: % of communities/municipalities at risk with Vietnam (445439) 0 31 50 80 tested disaster management plans OCEC1: % of eyes with good visual acuity after 6 weeks of Ghana (421457) 84 62 85 cataract surgery between 6/6 and 6/18 Nepal (443215) 91 90 80 Togo (424756) 96 80 OCEC2: % of increase of utilisation of the eye care facility Ghana (421457) 37741 39630 (5%) 38451 (–3%) 8% increase p.a. Nepal (443215) 53 68 60 OCNU1: % of severely malnourished children <5 years of Sudan (424444) 0 0 60 age correctly identified and referred to therapeutic feeding centre OCNU2: % of children from 0–59 months that appear for Bolivia (430823) 70 81 90 regular check ups and growth monitoring OCNU3: % of infants < 6 months of age received only Haiti (432360) 0 31 46 40 breast milk Pakistan (443658) 26 34 37 65 Togo (424760) 77 85 80 OCRH4: % of births attended by skilled health personnel Bangladesh (440459) 76 70 50 Honduras (430067) 62 95 96 90 Nepal (443214) 44 45 50 Pakistan (443658) 46 65 76 85 Laos (442595) 16 43 39 65 Laos (442596) 29 42 41 60

92 Indicator Country (project number) Before* 2017** 2018** Target All figures are in percent except for OCAH2, OCAH3, OCEC2. OCRH5: % of women having received four or more ante- Bolivia (430823) 90 84 90 natal care check-ups (ANC) during the last pregnancy Bangladesh (440459) 59 54 50 Ecuador (431521) 40 46 95 Nepal (443214) 36 29 50 60 Pakistan (443658) 8 17 36 65 Laos (442595) 46 52 75 Laos (442596) 47 45 55 OCRH6: % of children between 12–23 month vaccinated Pakistan (443658) 58 71 74 80 three times for DTP 3 and any other additional vaccine Laos (442595) 72 80 Laos (442596) 53 61 60 Bolivia (430823) 68 99 100 OCRH7: % of women of reproductive age who are cur- Pakistan (443658) 29 35 34 50 rently using at least one method of contraception Paraguay (433562) 68 66 75 Bolivia (430823) 54 44 90 OCWH2: % households using and maintaining clean Haiti (432368) 41 95 latrines Togo (424761) 40 75 Vietnam (445442) 0 26 38 50 OCWH3: % of households using an improved drinking Bangladesh (440458) 24 85 100 90 water source El Salvador (431695) 69 68 80 Nepal (443274) 24 60 Togo (424761) 44 75 Vietnam (445442) 78 100 80 OCWH4: % of the population using safely managed Nepal (443274) 4 40 sanitation facilities OCWH5: % of population adopting safe water handling Nepal (443274) 13 60 practises OCWH6: % of households with soap and water at the Bangladesh (440458) 10 59 64 80 hand washing station commonly used by the family Haiti (432368) 78 80 members Malawi (422609) 0 29 29 80 Nepal (443274) 33 60 Sudan (424444) 0 0 40 Togo (424761) 40 80 OCWHS2: % schools using and maintaining clean latrines Sudan (424444) 0 0 3 70 OCWHS4: % of schools using safely managed sanitation Laos (442594) 0 37 70 75 facilities OCWHS5: % of schools adopting safe water handling Laos (442594) 0 14 40 75 practises OCWHS6: % of schools with soap and water at the hand Laos (442594) 0 10 75 washing station commonly used by the students

* missing values means that the project started in 2017 (2017 = baseline) ** missing values means that the indicator was not measured

93 Annex 3: Beneficiary statistics 2018

Overview Africa/Middle East Latin America Asia Europe/CIS Total & the Caribbean Number of projects 40 25 35 22 122 Number of countries 12 8 9 9 38 Development 1,359,286 304,286 3,759,918 1,505,651 6,929,141 Recovery 11,750 21,582 620 33,952 Relief 258,914 23,804 207,876 1,779 492,373 Total 1,618,200 339,840 3,989,376 1,508,050 7,455,466

Health Africa/Middle East Latin America Asia Europe/CIS Total & the Caribbean Total Health 1,122,291 188,617 2,939,784 363,687 4,614,379 Primary health care services 36,520 67,422 2,587,911 2,691,853 Health promotion 603,860 107,399 145,754 3,954 860,967 Social health protection 806 1,136,454 1,137,260 Community Health Workers involved 7,113 4,486 1,083 186 12,868 Health groups supported 235 451 5,771 9 6,466 Maternal health: deliveries 4,002 1,410 24,705 30,117

Maternal health: ante-natal care 5,752 2,090 55,200 63,042 Child health services 15,053 13,728 594,053 622,834 Nutrition 20,091 17,964 20,854 58,909 NCD services 2,153 2,013 582 4,748 NCD promotion 15,645 1,273 11,870 28,788 Infectious disease control 12,478 666 13,144 Older persons reached 3,979 6,876 10,855 Blood donations 475,322 69,354 110,960 655,636 Health in Emergencies 127,871 8,780 141,718 – 278,369 Total WASH 194,812 29,762 159,717 – 384,291 Improved water 68,606 18,298 99,068 185,972 Improved sanitation 11,905 4,872 59,776 76,553 Hygiene promotion 153,903 25,962 148,085 327,950 WASH in schools 40,909 3,800 11,632 56,341 Total Eye care 389,833 93,409 245,656 728,898 Cataract surgeries 3,152 1,626 619 5,397 Other eye surgeries 245 337 399 981 Eye care consultations 47,451 57,195 12,833 117,479 Eye care school screenings 53,309 34,647 87,956 Eye care awareness raising 389,833 93,409 245,656 728,898

94 Emergency relief Africa/Middle East Latin America Asia Europe/CIS Total & the Caribbean Total Emergency Relief 258,914 23,804 207,876 1,779 492,373 Health in emergencies 127,871 8,780 141,718 278,369 Non-food items (e.g. family kits) 12,218 1,440 6,661 20,319 WASH 11,815 4,732 35,742 52,289 Food aid (incl. seeds & tools) 19,161 5,141 10,481 34,783 Cash 2,800 100 995 3,895 Shelter 300 7,033 7,333 Emergency deployments 3 1 16 20 Migrants 41,748 9,260 12,500 63,508

Recovery Africa/Middle East Latin America Asia Europe/CIS Total & the Caribbean Total recovery beneficiaries 11,750 21,582 620 33,952 Improved drinking water 3,800 16,770 20,570 Improved sanitation 5 5,070 5,075 Hygiene promotion 3,282 993 11,505 15,780 Housing beneficiaires 387 12 4,068 4,467 Houses repaired/reconstructed 86 678 764 Schools reconstructed 5 5 Disaster Risk Reduction 6,709 20,312 27,021

Disaster Risk Reduction Africa/Middle East Latin America Asia Europe/CIS Total & the Caribbean Total DRR and CCA beneficiaries 68,633 92,066 56,066 26,080 242,845 DRR awareness 65,267 44,859 18,422 9,003 137,551 Early warning systems 64,215 28,808 41,330 – 134,353 Risk mitigation 38,336 34,035 10,500 82,871 DRR education 3,366 7,088 5,162 8,353 23,969 DRR committees supported 89 212 36 21 358 Trained staff in institutional preparedness 159 70 72 8 309

Capacity building Africa/Middle East Latin America Asia Europe/CIS Total & the Caribbean Total capacity buliding beneficiaries 5,926 2,785 9,642 1,975 20,328 RCRC employees trained 379 285 81 352 1,097 RCRC volunteers trained 5,386 276 824 995 7,481 NGO/CBO employees trained 264 75 13 352 NGO/CBO volunteers trained 784 6,547 247 7,578 Government employees trained 161 1,176 2,115 368 3,820

Transversal Africa/Middle East Latin America Asia Europe/CIS Total & the Caribbean Social Inclusion 992 23,717 411 25,120 Sexually and Gender-Based Violence 1,853 5,648 – 7,501 Migrants 26,282 620 63,508 90,410

95 Annex 4: Expenditures and SDC contribution 2018 by country

Budget 2018 Expenditure 2018

Country SDC Contract Project Budget SDC Contribution Plan Project Expenses SDC Contribution Actual HF SRC Contribution Actual Number CHF % CHF CHF CHF % CHF %

Egypt 7F-03945.15.01 250,000 50% 125,000 2,617 – 0% – 0% Ethiopia 7F-03945.15.01 615,000 49% 300,000 1,110,358 – 0% – 0% Ghana 7F-03945.15.01 1,530,000 29% 450,000 1,669,016 350,000 21% 341,818 20% Lebanon 7F-03945.15.01 228,000 88% 200,000 669,664 – 0% – 0% Malawi 7F-03945.15.01 1,000,000 60% 600,000 1,078,516 480,000 45% 175,000 16% Mali 7F-03945.15.01 1,050,000 33% 350,000 426,791 – 0% – 0% South Sudan 7F-03945.15.01 1,245,000 29% 365,000 2,258,882 490,000 22% – 0% Sudan 7F-03945.15.01 860,000 47% 400,000 674,199 205,000 30% 181,818 27% Togo 7F-03945.15.01 985,000 35% 340,000 854,711 258,500 30% – 0% Total Africa and the Middle East 7,763,000 40% 3,130,000 8,744,755 1,783,500 20% 698,636 8% – Programme Contribution South

Bolivia 7F-03945.15.01 910,000 44% 400,000 797,066 350,000 44% – 0% Central America 7F-03945.15.01 - – 69,779 – 0% – 0% Ecuador 7F-03945.15.01 800,000 48% 380,000 885,678 380,000 43% 227,273 26% El Salvador 7F-03945.15.01 2,030,000 39% 800,000 1,418,606 760,000 54% – 0% Haiti 7F-03945.15.01 2,345,000 9% 200,000 2,562,248 1,306,500 51% 119,545 5% Honduras 7F-03945.15.01 2,695,000 22% 600,000 2,075,031 640,000 31% 227,273 11% Paraguay 7F-03945.15.01 985,000 53% 520,000 1,058,179 810,000 77% – 0% Total Latin America and the Caribbean 9,765,000 30% 2,900,000 8,866,588 4,246,500 48% 574,091 6% – Programme Contribution South

Bangladesh 7F-03945.15.01 2,365,000 52% 1,235,000 2,383,066 1,085,000 46% – 0% Bhutan 7F-03945.15.01 775,000 0% – 648,656 200,000 31% – 0% Cambodia 7F-03945.15.01 - – 33,075 – 0% – 0% Laos 7F-03945.15.01 2,400,000 40% 950,000 2,435,905 1,388,000 57% 90,909 4% Nepal 7F-03945.15.01 1,400,000 52% 730,000 1,035,454 260,000 25% 181,818 18% Pakistan 7F-03945.15.01 565,000 0% – 84,735 30,000 35% – 0% Vietnam 7F-03945.15.01 1,350,000 39% 520,000 723,101 472,000 65% – 0% Total Asia 8,855,000 39% 3,435,000 7,343,991 3,435,000 47% 272,727 4% – Programme Contribution South

Armenia 7F-08544.03.01 650,000 22% 146,000 709,600 60,000 8% – 0% Belarus 7F-08544.03.01 350,000 42% 147,000 434,326 153,000 35% 181,819 42% Bosnia and Herzegowina 7F-08544.03.01 850,000 17% 147,000 706,741 100,000 14% – 0% Bulgaria 7F-08544.03.01 130,000 0% – 129,128 – 0% – 0% Kyrgyzstan 7F-08544.03.01 1,020,000 14% 146,000 1,021,193 100,000 10% 90,909 9% Moldova 7F-08544.03.01 775,000 19% 147,000 1,545,209 320,000 21% – 0% Europe 7F-08544.03.01 - – 286,156 – 0% – 0% Total Europe/CIS 3,775,000 19% 733,000 4,832,353 733,000 15% 272,728 6% – Programme Contribution East

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96 Budget 2018 Expenditure 2018

Country SDC Contract Project Budget SDC Contribution Plan Project Expenses SDC Contribution Actual HF SRC Contribution Actual Number CHF % CHF CHF CHF % CHF %

Quality, Innovation & 7F-03945.15.01 500,000 57% 285,000 368,275 285,000 77% – 0% Sensitization Worldwide Sector 7F-03945.15.01 242,000 0% – 131,563 – 0% – 0% Support Total Strategy & Conceptional 742,000 38% 285,000 499,837 285,000 57% – 0% Development

Total Development Cooperation with 30,900,000 34% 10,483,000 30,287,524 10,483,000 35% 1,818,182 6% Programme Contribution – South/Transtion East

SDC Mandate Projects 1,300,000 138% 1,790,000 2,478,616 2,168,255 87% – 0% Total Development Cooperation 1,300,000 1,790,000 2,478,616 2,168,255 87% – 0% Mandate Projects SDC Water Consortium Project – – – 25,617 – Total Development 7F-07770.01.01 – – – 25,617 – Cooperation Water Consortium Project

Total Development Cooperation SDC 1,300,000 138% 1,790,000 2,478,616 2,193,872 89% – 0% Mandate Projects

Total Development Cooperation with 32,200,000 38% 12,273,000 32,766,139 12,676,872 39% 1,818,182 6% SDC Contribution

SECO Mandate – 45,890 83,151 181% – 0% Total SECO Mandate – – 45,890 83,151 181% – 0%

Total Development Cooperation with 32,200,000 38% 12,273,000 32,812,029 12,760,023 39% 1,818,182 6% SDC/SECO Contribution

Reconstruction & Rehabilitation 6,000,000 0% – 3,270,549 – 0% – 0% Total Reconstruction & Rehabilitation 6,000,000 0% – 3,270,549 – 0% – 0%

Emergency Relief and Humanitarian Aid 9,000,000 28% 2,500,000 9,281,714 2,500,000 27% – 0% Total Emergency Relief and Humani 9,000,000 28% 2,500,000 9,281,714 2,500,000 27% – 0% tarian Aid with SDC Contribution

SDC Mandated Emergency Relief and 528,810 265,000 50% – 0% Humanitarian Aid Project Total SDC HH Mandated Emergency – – 528,810 265,000 50% – 0% Relief and Humanitarian Aid

Total SRC International Cooperation 47,200,000 31% 14,773,000 45,893,103 15,525,023 34% 1,818,182 4% Projects

Contractual services & other – – – 756,088 – Total Contractual services & other – – – 756,088 –

Total SDC/HF SRC Contribution 47,200,000 31% 14,773,000 45,893,103 16,281,110 35% 1,818,182 4%

97 Annex 5: Deviations budget versus expenditures 2018 by country (if > 10%)

Country Budget 2018 Expenses 2018 Deviation% Comment if deviation more than –/+ 10% against country programme budget Egypt 250,000 2,617 –99% Slow start of project implementation and delayed expenditure reporting from the project partner in 2018. Ethiopia 615,000 1,110,358 81% Deviation mainly due to additional interventions for Internally Displaced People in Moyale. Lebanon 228,000 669,664 194% The third phase of the blood project in Lebanon was not considered during the budgeting in 2018. Mali 1,050,000 426,791 –59% Low implementation rate between January and September (with temporary suspension in June–July due to security incident). All project activities suspended from mid-October onwards. South Sudan 1,245,000 2,258,882 81% Protracted crisis required adaptation to the intervention measures resulting increase in project costs, cost of security measures, transport and logistic in general. Sudan 860,000 674,199 –22% Various delays in implementation, in particular for construction activities (borehole drilling and school latrines constructions). Several payments with contractors for ongoing constructions are pending by end of 2018. Togo 985,000 854,711 –13% Slow start of WASH III project implementation. In addition, sporadic demonstrations of political opposition hindered timely implementation of certain activities in all four projects. Total Africa/Middle-East 7,763,000 8,744,755 13%

Bolivia 910,000 797,066 –12% Planned project with Bolivian Red Cross could not be implemented due to organizational crises. Ecuador 800,000 885,678 11% The overspending represents purchase of two ambulances with the funds raised through the SRC fund raising department. This was not foreseen in the country programme budget. El Salvador 2,030,000 1,418,606 –30% The formulation of major investments in rehabilitation of infrastructure (latrines, water system, community infrastructure, micro project) took longer than expected. Honduras 2,695,000 2,075,031 –23% Several investments in DRR infrastructure were co-financed by local authorities or have been delayed. Slow start of a new project with a longer inception phase. Total Latin America & 9,765,000 8,866,588 –9% the Carribean

Bhutan 775,000 648,656 –16% Bhutan RC received additional support from the IFRC/ICRC, reducing SRC’s contribution towards their programme expenses in 2018. Nepal 1,400,000 1,035,454 –26% Two of the new projects could not take the momentum implementing projects, as the SRC had to adapt partnership and coordination modality according to the federal structure of new local governments. Pakistan 565,000 84,735 –85% Change of government policy, the SRK/AKU could no longer work in the health centres, but only in the district and the municipalities. Project intervention will continue in 2019. Vietnam 1,350,000 723,101 –46% Considerable under-spending due to delay in implementation of construction and FbF activities. The official project approval was delayed and only the most important activities were implemented. Total Asia 8,855,000 7,343,991 –17%

Belarus 350,000 434,326 24% Additional expenses due to market study. Bosnia and Herzegowina 850,000 706,741 –17% Delay in Institutional Preparedness Component. Moldova 775,000 1,545,209 99% Under-budgeted during the planning phase because the blood safety project was not considered during the budget plan. Total Europe/CIS 3,775,000 4,832,353 28%

Quality, Innovation & 500,000 368,275 –26% Regional technical support not required as foreseen and learning process OD/CB Sensitization getting slow start. Worldwide Specific Sector 242,000 131,563 –46% Sectoral support for the IFRC was differed Support Total Strategy/Concept 742,000 499,837 –33%

Total Development 30,900,000 30,287,524 –2% Cooperation

98 Annex 6: Learnings 2018 – Evaluations, studies and reviews

Country Project name/Thematic area Project number Type of evaluation/study/review Bangladesh Urban empowerment project 440455 External review, final (endline) Bangladesh Health system strengthening of Public Health Improvement 440459 Implementation research Initiative in Rajshahi Bangladesh Resilience radar and star baseline assessment of urban 440455/440518 External, initial empowerment project Bangladesh Water Sanitation and Hygiene for Vulnerable Barind Tract 440458 External, final Communities Process documentation, video documentary Belarus Home Based Care and Active Ageing programming 415461 External, Market Analysis Haiti Eau, assainissement et hygiène à Cormier 432356 External evaluation, final Haiti Service de Transfusion Sanguine II 432358 External evaluation, final Honduras Fortalecimiento de la resiliencia comunitaria a través de gestión 430067 External evaluation, final de riesgos de desastres y de salud, Zona Sur/Salud y GRD Honduras Fortalecimiento de la Resiliencia en Olancho/Gestión de riesgo de 430076 Impact Evaluation, Impact Award SDC/ETHZ (final desastres report 2019) Kyrgyzstan Health Care Waste Management/Infection Control 445995 Impact Evaluation Kyrgyzstan Voluntary Non-Remunerated Blood Donation 445994 External evaluation, mid-term Laos Contribution towards Universal Health Coverage 442596 Assessment of National Health Insurance Scheme Malawi Menstrual Hygiene Management Knowledge in rural primary 422603 External, KAP study schools in Malawi Nepal Surkhet Eye Hospital 443215 Internal review, mid-term Nepal Urban Disaster Risk Reduction Birendranagar 443218 Internal review, mid-term Paraguay Prävention von HIV/AIDS und Unterstützung von Personen, die 433559 External evaluation, mid-term mit HIV leben Togo Santé oculaire/Région des Plateaux 424756 External evaluation, final Vietnam Community-based disaster risk management Ca Mau 445439 External, final Most-significant change approach, video documentary Vietnam Water, Sanitation and Hygiene 445442 Applied Research and Consultancy Research on Solid Waste Management Ca Mau Province (Status, Assessment, Recommendations) Global Global Eye Care programme 450121 External, programme evaluation, institutional (HQ) and across five countries

99 Annex 7: Publications and presentations at conferences 2018

SRC Publications

Active, empowered and young at heart: implications of participatory community work with older people. A comparative study of Swiss Red Cross projects in Belarus, Bosnia-Herzegovina and Bulgaria. Issue Paper on Health Series, No. 7. SRC, December 2017.

Enzler, Daniela Maria: Menstrual Hygiene Management. Knowledge, attitude and practices of adolescents in rural primary schools in Malawi. Swiss Red Cross & Malawi Red Cross Society. October 2018.

Steinmann, Carmen: „Gesundheit als Menschrecht ist immer gültig“. Vreni Wenger und Thomas Gass vom SRK im Interview. MMS Bulletin, No. 141, August 2018.

Haplichnik, Tatyana: NCD Prevention: Does it really work? Swiss Red Cross experience in addressing social determinants of NCDs through community mobilization. Swiss Red Cross experience in addressing social determinants of NCDs through community mobilization. MMS Bulletin, No. 145, March 2018

Conferences

Conference Poster or oral presentation Title of the presentation/poster Authors

Medicus Mundi Switzerland Oral presentation The Red Cross approach to UHC: a framework Emanuele Capobianco, IFRC Symposium, Basel for the next decade

World Water Week, Stockholm Oral presentation Blue Schools: linking WASH in schools with Caritas Switzerland/Sandec at Eawag/HELVETAS other SDG 6 targets Swiss Intercooperation/Terre des Hommes/ Swiss Agency for Development and Cooperation/ Swiss Water and Sanitation Consortium/Swiss Red Cross

Tech4Dev EPFL Lausanne Oral Holistic Early Warning System and Community- Grégoire Labhardt based Climate Change Observatory in El Salvador

Tech4Dev EPFL Lausanne Oral Impact Evaluation: Increasing Community Christina Aebischer/Silvia Hostettler EPFL Resilience through Community-Based Disaster Risk Management in Honduras

Tech4Dev EPFL Lausanne Poster Combined Risk Assessments for the Improvement Anton Jöhr of Land Management at the Municipal Level in Olancho, Honduras

100 101 Annex 8: Country Summaries

Armenia

Objectives of the country programme Thematic priorities 2017 – 2020

Ageing and Health: Health and well-being of elderly, chronically ill and disabled persons is improved through a focus on active ageing and better access to well-functioning integrated medical and social services. Disaster Risk Management: DRM capacity of SRC and partners are strengthened through relevant and adequate preparedness measures for emergency preparedness and response. Capacity development of partner organizations: The ARCS as well as selected non-RC partner organisations have improved organizational and operational capacities to implement and sustain relevant programs in favour of the most vulnerable.

Selected Outcome Indicators

AH2: % increase in number of clients benefitting from the services AH3: % increase in group members in AA groups

300 300

250 250

200 200 target: annual increase of 10 per cent target: annual increase of 10 per cent

150 150 +36%

100 100

+11% 50 50

0 0 before 2017 2018 Target before 2017 2018 Target

102 Summary results 2018

Integrated community-based home care Food support to four regions of Armenia service provision and active/healthy ageing (445603) (445600) The following results were registered by the pro- In 2018 SRC in cooperation with the ARCS con- ject implemented in cooperation with the Ara- tinued the implementation of the project started rat, Armavir, Lori and Shirak branches of ARCS. in 2016 aimed at building of an integrated med- In 2018 263 food parcels were distributed to el- ico-social home-based care service model in Ar- derly people in Lori and Shirak Regions. 31,000 menia. In Vanadzor and Gyumri the acting cen- dinners were provided to 200 elderly people tres are fully established: renovated, equipped through Soup Kitchens in Ararat and Armavir re- and staffed in accordance with the project docu- gions. The project contributed to the increased ment. One hundred and twenty clients (23 male, visibility of the branch office and ARCS in general. 97 female) were served. Staff of the regional branches learnt project cy- The ARCS continued also the work in the area cle management and implementation; and was of Active and Healthy Ageing in Lori and Shi- able to apply it directly in their work with elderly rak marzes. The results are as follows: 1) ARCS people. Through the increased cooperation with staff in HQ and branches was trained on Active local authorities and other structures the project and Healthy Ageing issues and main principles received a lot of support in the targeted commu- of specifics of work with elderly people; 2) Ten nities with the effect of higher social well-being Initiative Groups (IGs) consisting of 146 elderly of older people. More ARCS volunteers were people (58 women and 88 men) were estab- trained and looked after elderly people and con- lished and supported in Lori and Shirak Regions tributed to the holistic system of home-based of Armenia. care. Feedback of the project beneficiaries is in- In 2018 SRC supported ARCS organizational cluded into the short video on programs imple- development issues, especially volunteer man- mented in social and health areas prepared by agement and delegation of authorities to the re- ARCS (https://youtu.be/X4P856_9s0o). gional branches, elderly care and active ageing. Sixty volunteers were recruited to provide home care services: 28 out of them have been already ARCS Branch Capacity Building through food trained and involved in service provision. In 2018 support projects in the Marzes of Armenia with the project support of ARCS HQ in Yerevan (445605) as well as Community based Home Care centers The project was launched in November 2018 in and branch offices in Lori and Shirak were fully Ararat, Aragatsotn, Gegharkunik, Vayots Dzor re- renovated and are operational. gions of Armenia. During that period 295 lonely elderly and people with disabilities received food support provided by the regional branches of ARCS. During the implementation ARCS and its branches increased their abilities to implement elderly related and community-based projects. They recruited more than 50 volunteers in the respective regions and organized special trainings on project and volunteer management, as well as resource mobilization. More than CHF 3,200 were fundraised form the local communities for project implementation.

103 Bangladesh

Objectives of the country programme Thematic priorities 2017 – 2020

Health: Health of communities in Rajshahi dis- is strengthened through relevant preparedness trict and selected neighboring Upazilas as well measures for emergency response and disaster as Dhaka slum, with a special focus on vulnerable risk prevention. groups, is improved through access to health ser- Capacity development of partner organi- vices that meet national minimum standards and zations: The SRC’s partnership approach is re- through addressing health determinants. viewed and responds to the capacity needs of Disaster Risk Management: The resilience of our partners in order to enhance their capability/ communities and the operational DM capacity performance to sustainably contribute to shared of partner organizations and governmental in- thematic objectives. stitutions in two Upazilas of Gaibandha district

Selected Outcome Indicators

WH3: % of households using an improved drinking water source WH6: % of households with soap and water at the hand washing station

100% 100%

80% 80%

60% 60%

40% 40%

20% 20%

0% 0% Before 2017 2018 Target Before 2017 2018 Target

RH4: % of births attended by skilled health personnel RH5: % of women having received four or more ante-natal care check-ups during the last pregnancy 100% 100% 80% 80% 60% 60% 40% 40% 20% 20% 0% Before 2017 2018 Target 0% Before 2017 2018 Target

104 Summary results 2018

Combining DRM and Emergency response Integrated Water Resource Management Public Health Improvement Initiative with stronger National Society partnership, (IWRM) in the Barind Tracts I (440456) Rajshahi (PHIIR) II (440459) Gaibandha (440514/440502) In June 2018 the first phase of the project was Despite overwhelming challenges, the project Compared to the first half of 2018 when project completed. Within the sub-national component, has fared reasonably well in 2018. There is de- activities were just initiated, the project gathered the imperatives of citizen engagement with Lo- finitive progressive trend in all critical areas of momentum in the second half of the year. A cal Governemnt Institutions to improve water service utilization and institutional deliveries. whole range of planned hardware and software management and governance were successfully Increased local government involvement is lead- activities, which included substantial amounts of tested. A key dimension of the project – i.e. the ing the project towards a sustainable model. Still civil works were executed. This visibly strength- developed rules and guidelines – are meant to there are constrains of government human re- ened the capacity of Village/Upazila disaster be replicated and up-scaled. The implemented sources especially at the UHC level. Apart from management committees. They were involved activities piloted core elements of the rules and this, the human resource status at all other fa- with all aspects of planning, execution, and mon- these new guidelines; they ensured that the cilities are satisfactory. The project is continuing itoring of all risk mitigation work. Many consul- guidelines are concrete and reflect the situa- to lobby with both Director General of Health tation workshops and trainings were conducted tion on the ground. It has helped operationalize Services and Director General of Family Planning to improve the collaboration of the project team these new bylaws and guidelines into a format for further improvement and commitment to and the disaster management committee mem- which is now ready for formal approval by the position sufficient qualified staff in the facilities. bers. An extended dialogue with the Local gov- government and its subsequent up-scaling Post Flood Rehabilitation in Naogaon District ernment institutions and district administration across Bangladesh. (440507) The ongoing WASH project has the finally resulted in a formal collaboration with aim to make the Upazila open defecation free the 4 Union Parishads and the Upazila Parishad. Institutionalization of Integrated Water and water secure. The support was provided Adhering to the key requirement of the agree- Resources Management (IWRM) in the to those households who were affected during ment that obligates both parties, to co-finance Barind Area of Bangladesh II (440511) August 2017 flood and to the especially poor. all risk reduction related infrastructure work in The new phase (continuation of 440456) The project reconstructed fully and partially pre-agreed proportion, the parishads contrib- strengthened its engagement in the new Upazi- damaged water and sanitation facilities. A total uted 10% of the costs of DRR mitigation work las of Porsha and Sapahar in Naogaon district. of 136 fully damaged latrines were rebuilt reviv- and the community gave another 10%. Target The village water and sanitation committees ing the access of 143 households/833 people to communities and local government were ac- formed through the WASH project were re- sanitation facilities. 1,078 partially damaged la- tively involved in quality control and monitoring formed as water resource management com- trines were repaired reviving the access of 1,090 of ongoing activities. mittees (WRMC). 517 new WRMCs were formed households/6,320 people to safe latrines. 961 taking the total number of WRMCs to 1,272. latrine pits filled by flood water were emptied The project mapped all settlements having inad- allowing the latrines to be reused by 972 house- Urban Empowerment Project, Dhaka equate drinking water supply. 29 surface water holds/5680 people. (440455) schemes were implemented of which 25 were In 2018 community-led interventions were fur- water retention schemes (24 pond (re)excava- ther reinforced. Linkage building efforts were tion and 1 check dam construction), and 4 were Flood response in Gaibandha II (440508) strengthened to impart sustainability to ongo- surface water irrigation schemes. Following the A multipurpose cash grant was distributed to ing interventions. Project interventions espe- rules, decentralized IWRM committees have 4000 flood affected families through cash-in-en- cially those related to rights, entitlements and been formed at the Union and Upazila level. velope. The distribution was spread across 17 un- awareness generation led to greater cohesion in ions and included 2,722 beneficiaries that were slums. This was strongly validated by an assess- covered through initial distribution of food and ment carried out at the end of the year. A dis- Water, Sanitation and Hygiene for non-food items. The logic to extend cash support tinct improvement can be noticed in the social, Vulnerable Barind Tract Communities in to these families was to facilitate their compre- individual and physical determinants of health. Naogaon II (440458) hensive recovery as they belonged to the most Though much remains to be done with regard The applied community-based process strength- vulnerable and disadvantaged groups. Since to capacity development of BDRCS and Gazipur ened the demand for improved sanitation and irregularities in the beneficiary selection were branch, a positive engagement of the branch hygiene services; while simultaneously strength- detected, an investigation was carried out. Con- could be leveraged during the reporting period. ening the supply chain (i.e. the contractors, local sequently, the beneficiary list was revisited and Overall, the urban empowerment project has entrepreneurs, masons, mechanics, sweepers) to re-validated, the mistakes were corrected, and all successfully developed a collective ownership deliver more effective and efficient services; this omitted families got the cash grants as deserved. over project initiatives and established a high has created spin-off effects beyond the project The work continued without involvement of the level of credibility and trust between community that have led to improved sanitation and hy- BDRCS Gaibandha unit and was completed in and BDRCS and SRC. giene in schools, madrasas, health facilities and March 2018. other public places. Today all houeseholds in the project area have access to an improved drinking water source and 99% of people use a safely managed sanitation facility.

105 Primary Health Care Centers (PHC) with Ex- Flash Flood Response Northeast 2018 tended Services and Host Community Assis- (440515) tance in Cox’s Bazar (440510) The project provided two types of support to All three planned PHCs were built, equipped, the beneficiaries as follows: A Multi-Purpose adequately staffed and made operational dur- Cash Grant for 1,000 families of BDT 4,500 per ing the reporting period. The establishment of household (as guided by National Cash Working the PHCs involved a protracted process of site Group) to serve their needs on food, house re- selection, obtaining approvals for a new type of pairing and other urgent needs. A bearer cheque structure that the government wanted to set up. worth 4,500 BDT has been distributed to each Officers and community health workers received beneficiary at distribution points in the nearest trainings in protection, community engagement vicinity of the effected communities. Addition- and health. During the reporting period, 77,845 ally, each family received one packet of hybrid people received health services from the three vegetable seeds to enable a resumption of farm- facilities. To reduce disaster risks, the host coming. munity risk assessment identified a range of risk mitigation options such as repair of rural link roads, drainage repair, canals, culvert and latrine Upgrading and Streamlining Primary Health construction. Due to protracted negotiations be- Services in the camp (440516) tween BDRCS and the District administration the The project ensured continuity of services but MoU signing was delayed and could be carried positively impacted overall quality of care ren- out only in the month of October, which delayed dered at the PHCs. Upgrading of facilities allowed the construction to 2019. the centers to operate effectively on a 24/7 basis with an improved supply and dispensation of essential medicines. Staff continuity led to greater Response support for victims of a fire inci- turnout of patients exhibiting high level of sat- dent at Mirpur slum (440512) isfaction with the services received. Further, the BDRCS/SRC supported 1,000 households in the support for staff to the government revealed an slums of Elliuser Basti, and in Kabirer Basti in Mir- impact beyond the PHCs allowing them to per- pur area with a total population of 4,000 that form their mandated function without any dis- were in the process to rebuild their lives after ruption for health sector actors at Cox’s Bazar. the fire incident. They were supported with non- food items (NFI) such as cooking utensils, plates, glasses, mosquito nets, buckets and poly bags. The NFIs were complemented with hygiene kits and jerry cans provided by IFRC, as well as 30 kg of rice from the deputy commissioner on an immediate basis.

106 Belarus

Objectives of the country programme Thematic priorities 2017 – 2020

Health and ageing: Health and well-being of elderly, chronically ill and disabled persons is improved through a focus on active ageing and better access to well-functioning integrated medical and social services.

Summary results 2018

Consolidation and Belarus Red Cross A model of providing home-based care through ownership of active ageing and home-based a team approach was piloted in Vileika district care program (415461) and described for further scaling-up within the Within the project implementation a new en- Medico-Social Service of the BRC. The BRC in- terprise providing paid home care services and formation and referral system in terms of med- trainings on home care, kinesthetics and first aid ico-social services provision was developed and was initiated by the Belarus red Cross (BRC) and approved. Nine new Initiative Groups of older officially registered according to the national people with a focus on home care (volunteering legislation. The first national marketing research supporting to the Medico-Social Service) were on fundraising in Belarus was conducted cover- established, covering now all geographical re- ing individual givers, corporate sector donations gions of Belarus (all-in-all 83 Initiative Groups). and work of the Belarussian charitable organizations, as well as addressing BRCs image and brand perception. The results demonstrated Disaster Risk Management Mainstreaming solid potential of the in-country fundraising (transversal) market and confirmed positive image of the Red Regarding strengthening DRM capacities of BRC, Cross and high recognition of the BRC brand. the focus has been set on DRM mainstreaming. Results of the market research and recommen- Preliminary discussions with the BRC showed dations of the “Satio” company that conducted their interest in developing organisational ca- it has laid a basis for development of the first BRC pacity in cash transfer programming. In the light fundraising strategic plan for 2019–2020. of the continuing programme for Ukrainian dis- Standards of the provision of medico-social placed people and considering intensive work home-based care were developed within the with the most vulnerable groups, the BRC is in- joint BRC and Ministry of Health working group terested in training staff and further discussing and are to be approved in the 1st quarter of ways of integrating cash transfer programming 2019. Before only some nursing processes within into the BRC work. hospital settings were standardised. Rebrand- ing of the BRC Visiting Nurses Service was done. The new name is BRC Medico-Social Service “Dapamoha” (Belarusian word for “help” or “assistance”). A new logo was also designed.

107 Bhutan

Objectives of the country programme Thematic priorities 2017 – 2020

National Society Development: The Bhutan Red Cross Society (BRCS) is founded. Health: Contribute to improved quality of life of the people of the project area in Bhutan. Disaster Risk Management: The Department for Disaster Management enhances the National preparedness for disasters in cooperation with the Bhutan Red Cross Society.

Summary results 2018

Community Health Pilot Project (440702) Disaster Preparedness Pilot Project (440703) A successful collaboration between Depart- A national seismic risk contingency plan is un- ments in the Ministry of Health has been fos- der development with the support through an tered. ’Traditionally’ the different departments in international consulting company. Trainings the Ministry of Health seldom collaborated with in Urban/Search and Rescue were carried out each other in one project. This project brought in one rural district and one municipality. The the WASH and MNCH Departments together. All first responders included volunteers from BRCS. staff confirmed that this was a new experience. Study tours as preparation to establish a nation- Under the WASH component a successful fair wide Emergency Operations Centers’ system especially in the remote district of Trashiyantse including infrastructure and standard operating provided access for villagers to construction ma- procedures are under way. terial. Besides latrine for households, a grey water station and bio sand filters where introduced BRCS National Society Development to the communities. (440705) After a gap assessment was conducted, the min- SRC supports the development of BRCS with istry was able to increase its medical emergency un-earmarked contributions to the NSD plan, preparedness and response. Main factors were which runs until 12/2020. Progress has been communication materials and training for basic made in terms of volunteer and membership health units as well as training equipment such drive with a focus on most remote districts. BRCS as mannequins. succeeded in getting the accreditation as the only non-medical First Aid training provider in Bhutan. Supporting Red Cross partners are the ICRC, IFRC and SRC. No new partners entered the cooperation. The government supports salary expenses for the four-core staff.

108 Bolivia

Objetivos del programa de país Prioridades temáticas 2017 – 2020

Salud: El acceso a los servicios de salud ha mejorado. El comportamiento de la población en relación con la salud ha mejorado. Gestion de riesgos: Las comunidades están mejor preparadas ante desastres y mejor protegidas contra los riesgos climáticos y de desastres. Fortalecer organizaciones contrapartes: Las organizaciones han sido fortalecidas en sus capacidades y en coordinación con otros actores.

Indicadores de efecto seleccionados

NU2: % of children from 0–59 months that appear for regular RH5: % of women having received four or more ante-natal care check ups and growth monitoring check-ups during the last pregnancy

100% 100%

80% 80%

60% 60%

40% 40%

20% 20%

0% 0% Before 2017 2018 Target Before 2017 2018 Target

RH6: % of children between 12–23 months vaccinated three RH7: % of women of reproductive age using at least one times for DTP 3 and any other additional vaccine method of contraception

100% 100%

80% 80%

60% 60%

40% 40%

20% 20%

0% 0% Before 2017 2018 Target Before 2017 2018 Target

109 Resumen de los resultados de 2018

Salud communitaria (430823) Resultados alcanzados: Lo que se logro como resultado ha sido reconocer A través de procesos de capacitación, de coordi- –– Todos los estudiantes de los dos últimos años la necesidad de concentrar esfuerzos y promover nación, de alianzas institucionales y de promover del nivel secundario han participado en talle- el análisis para comprometer acciones concretas la participación de la sociedad civil, el acceso a la res de IEC sobre temas de SSR, al igual que las que contribuyan a soluciones estructurales. salud y la situación de salud está mejorando, lo mujeres en edad fértil (de 4044 mujeres en En esta gestión se logró reconocer y capacitar que muestran los siguientes indicadores: edad fértil, 1799 utilizan algún método anti- a 98 de los 103 Responsables Comunales en la –– Mujeres embarazados y madres de niños/-as conceptivo). Sin embargo el embarazo adoles- Gestión de Riesgos de Desastres. Las capacita- menores de dos años califican para recibir el cente es un problema aún no resuelto. ciones y recursos invertidos consideraron la miti- Bono Juana Azurduy. De 280 mujeres quienes –– Nutrición: Es muy pronto para mostrar resul- gación de desastres producidos por granizadas. deberían recibir ese bono, solo 153 se han tados cuantitativos, pero con el seguimiento y Lamentablemente los resultados alcanzados no beneficiado. El 45% no pudo acceder por no acompañamiento a cada uno de los niños/-as pueden ser medibles, pero se llego a que está contar con cedula de identidad y/o la larga menores de 5 años, se tiene un desarrollo esta estructura sea parte y reconocida para la distancia al sistema bancario. hacia lo positivo. La producción de hortalizas construcción de planes desde comunales hasta –– En 2018 se realizó el control de crecimiento y (todavía muy incipiente) puede jugar un papel municipales de GRD. desarrollo a 1303 (= 81%) de los 1608 meno- importante Por otra parte, con el apoyo y asesoramiento de res de 5 años. Se debe a la migración temporal –– Se apoyó en al programa ampliado de inmu- expertos de la sede se focalizó la atención en el que el restante 19% no pudo asistir. De estos nizaciones y se logró vacunar a 582 de los 585 desarrollo de acciones sobre eventos causados niños controlados 173 tiene desnutrición cró- niños/as entre 12 y 23 meses de edad, alcan- por inundaciones y aluviones, además de direc- nica, alcanzando una tasa del 13%. zando un 99% cionar acciones enmarcadas en políticas y estra- –– Se realizaron 4669 visitas domicialiarias de las –– Gestión y manejo de agua: Se ha realizado va- tegias gubernamentales. 4725 planificadas, alcanzando el 99%. rios análisis físicos y químicos de redes de dis- –– 14’793 personas recibieron por lo menos una tribución de agua. Los resultados preliminares atención de salud, lo que representa algo más muestran altos niveles de contaminación, en Ayuda en Emergencia inundaciones de 75% de la población total de las regiones Coliformes, Escherichia coli, lamblias, amebas, (430824) –– El control prenatal alcanzó un 84%, de las 280 etc. Ante los desastres naturales (inundaciones, des- embarazadas, 235 fueron atendidas en su 4to –– Construcción de una sociedad libre de violen- laves, destrucción de cultivos) causados por las control. cia: Se logró la consolidación de un equipo intensas lluvias de inicios de 2018 se apoyó con la interinstitucional y se están sentado las bases ejecución de un proyecto de ayuda humanitaria Para alcanzar el comportamiento mejorado de para la ruta de atención. Sobre todo se ha visi- en el Dpto. La Paz (en Inquisivi) y en el Dpto. de la población en relación a la salud se ha infor- bilizado y considerado el tema en las agendas Chuquisaca (en Presto y Yamparáez). Las carac- mado, sensibilizado y promovido la educación de las organizaciones y de los Municipios. terísticas de la intervención han apuntado a una en el tema de salud, pretendiendo influir en un respuesta inmediata. cambio positivo del comportamiento de hábitos El proyecto contribuyó en la mejora de la situa- para el cuidado de la salud. En estos procesos Gestion de riesgos (430823) ción de las poblaciones afectadas, entregando participaron: El personal de salud, la estructura Respecto al objetivo de que las comunidades equipos de trabajo agrícola, alimentos, elemen- social de salud (representantes de la sociedad han mejorado su preparación para situaciones tos de higiene, tanques de agua y fortaleciendo civil), profesores y alumnos, autoridades de las de emergencia y más protegidas frente a desas- las capacidades de respuesta y prevención en las organizaciones sociales comunales y distritales, tres y riesgos climáticos, las acciones realizadas comunidades. y autoridades municipales. Se llegó a través de nos muestran un desarrollo con poco avance, El proyecto benefició a 639 familias y fue ejecu- reuniones, talleres, ferias de salud, visitas domi- ello no significa el esfuerzo realizado, en todo tado por las filiales de La Paz y Chuquisaca. ciliarias, reuniones mensuales de las comunida- caso denota la complejidad y la importancia CRS encargó para el seguimiento una consultoría des y en los CAIs comunales. Se ha realizado el que representa en la calidad de vida y como se especializada. esfuerzo de aprovechar todo evento y recurso la encara. posible que contribuya ha este propósito. A pesar que se ha logrado promover la consi- Además de estos esfuerzos, vale mencionar la deración del tema en la agenda del desarrollo experiencia de la alianza estratégica con Solidar comunal, comprometer la participación de la Suiza: Esta ONG tiene mucha experiencia en la sociedad civil y municipal, de promover el desa- construcción de una sociedad libre de violencia, rrollo de capacidades y conocimientos técnicos lo que constituye un aspecto que tiene gran in- desde el equipo de la CRS e involucrar a todos fluencia en la situación de salud, haciendo posi- los actores. ble de modificar positivamente.

110 Bosnia and Herzegovina

Objectives of the country programme Thematic priorities 2017 – 2020

Ageing and Health: The health and wellbeing Capacity Development of partner organisa- of elderly, chronically ill and disabled persons is tions: The implementing partners (RC and oth- increased by living in an age-friendly environ- ers) have improved management structures and ment and increased access to integrated com- mechanisms to implement and sustain programs munity-based medical and social services. and projects. Disaster Risk Management: Local communities in the North-East of BIH are better prepared to respond to disasters.

Selected Outcome Indicators

AH2: % increase in number of clients benefitting from the services AH3: % increase in group members in AA groups

600 1600

target: annual increase of 10 per cent target: annual increase of 10 per cent 500 1400

400 +52% +29% 1200

300

+70% +9% 800 200

400 100

0 0 before 2017 2018 Target before 2017 2018 Target

Summary results 2018

Ageing and Health (412945) authorities and demanded support. The active and 3 DM officers attended 5 trainings in the DM In total five home based care centers with 29 ageing network was officially registered and field). nursing staff and 29 active volunteers were decision-making structures (assembly, steering running continuously and performed a total board, and presidency) were put in place. of 31.946 visits for 459 clients. Through a mul- Winter Assistance 2018 ti-funding approach which co-financed the ser- Winter Assistance in the Posavina region sup- vices ownership from all sides were achieved. Institutional Preparedness Building for ported the most vulnerable families bringing a Financial contributions from SRC, local adminis- Disaster Management (412920) little bit of joy for them during the winter time trations and the clients made the services com- The young project established a project team and holiday season. Cash vouchers were distrib- petitive. The Red Cross was able to lobby for a and steering committee, which is actively work- uted to 948 families (2.233 beneficiaries). unified approach in developing the home-based ing. The knowledge exchange within the Balkan care services. A Rule book was even accepted by region was established and two exchange visits the Presidency at the national level. With 1394 with at least 10 volunteers were carried out. The Migrants in BiH 2018 (412921) members (65% women and 35% men) the 35 Red Cross capacities in being prepared and man- Support in food and non-food items (hygiene, elderly people’s Interest groups became almost aging disaster at branch level developed through underwear, socks, sleeping bags) for up to 1,000 a social movement. The groups were more pres- trainings. The number of Red Cross staff and vol- migrants in Una Sana Canton and Mostar/Salak- ent in the communities and became more aware unteers active in DM increased by 20% in the ovac was given. The RCSBiH gained through this of their role. Through their community outreach target locations (15 staff/volunteers per branch emergency new and better technical capacities process, they started to involve local community trained/tested during trainings and simulations of to respond.

111 Ecuador

Objetivos del programa de país Prioridades temáticas 2017 – 2020

Salud: Acceso incrementado a servicios de salud en las comunidades de alta vulnerabilidad, y mejorar sus prácticas respecto a cuidados de salud. Gestión de Riesgos: Comunidades aplican sus conocimientos incrementados en gestión de riesgo y adaptación al cambio climático. Fortalecimiento Organizativo : Organizaciones fortalecidas con estrategias de sostenibilidad.

Indicadores de efecto seleccionados

DRM1: % of communities at risk with a functional emergency RH5: % of women having received four or more ante-natal care committee check-ups during the last pregnancy

100% 100%

80% 80%

60% 60%

40% 40%

20% 20%

0% 0% Before 2017 2018 Target Before 2017 2018 Target

112 Resumen de los resultados de 2018

Salud y Gestión de Riesgos comunitarias han fortalecido redes de trabajo locales para sos- Población en situación de movilidad humana RIOS (431521) tener este proceso. Se iniciaron gestiones a nivel CRE (431530) Acceso incrementado a los servicios de salud de los Municipios para implementar normativa Desde mediados de 2018, la CRE apoya a los Se han mantenido y potenciado coordinaciones de GRD, con buenos resultados. migrantes venezolanos en 3 cruces fronterizos intersectoriales realizando agendas conjuntas y Se realizaron acuerdos con Distritos de Educa- diferentes y en 6 grandes ciudades del interior ejecutando acciones. Se impulsó la vigilancia co- ción para proyectos ambientales en las comuni- del país. La CRS está financiando la Fase II de este munitaria en las organizaciones en coordinación dades como parte de la ACC. proyecto, que prevé acciones en las siguientes con los Distritos de Salud (= entidades descen- áreas: Restablecimiento de los contactos fami- tralizadas del Ministerio de Salud Pública, MSP). Fortalecimiento Organizativo liares, primeros auxilios y atención médica bá- Se lograron visitar 639 hogares de mujeres em- Se trabajó en fortalecimiento de capacidades de sica, apoyo psicológico, suministro de alimentos barazadas en comunidades de difícil acceso en las organizaciones copartes de RIOS, y en esfuer- y agua, y satisfacción de las necesidades básicas coordinación con el MSP, se capacitaron parteras zos por construir una metodología de trabajo de información y comunicación. comunitarias para llevar a cabo acompañamien- que brinde más argumento conceptual, técnico La situación en los diferentes lugares donde tos y dinamizar mejor el trabajo en prevención y social para avanzar en alternativas sostenibles. se apoya a los migrantes venezolanos cambia de muerte y complicaciones en salud materna. Se apoyaron asambleas comunitarias, y se ela- prácticamente día a día. La CRE – con muchos boraron propuestas de proyectos presentadas a voluntarios – tuvo y tiene que proceder con gran Comunidades con mejores prácticas respecto a otros donantes. flexibilidad. los cuidados de su salud La fase financiada por el CRS no comenzó hasta El apoyo que brinda el proyecto a nivel logís- finales de noviembre de 2018, por lo que la pre- tico es determinante para que se cumplan los Mejora de la resiliencia posterremoto CRE sentación de informes sobre los resultados ob- lineamientos de la política pública. A pesar de (431520) tenidos no tendrá lugar hasta 2019. Esta fase se la dilatación de acciones por las circunstancias Las actividades de socorro de emergencia tras el completará a finales de marzo de 2019. de inseguridad en la mayoría de las regiones de terremoto de abril de 2016 identificaron la ne- trabajo, se llegó a una cobertura 6’885 personas cesidad de restaurar los sistemas de agua pota- con acciones de promoción de salud a través de ble como base para unas condiciones sanitarias visitas domiciliarias, Brigadas Integrales de Sa- aceptables en las zonas afectadas por el terre- lud (BIS), talleres de capacitación y réplicas de moto. La CRE y CRS (con el apoyo del equipo de trabajo comunitario. la FICR) acordaron trabajar juntos en un proyecto Una de las acciones del proyecto que es reco- de rehabilitación. Comunidades beneficiarias nocida como positiva por todos los actores son eran San Roque (174 familias), San Miguel de Pi- las BIS, dado que al ejecutar estas acciones se quiagua (211 familias), La Mocora (128 familias) confronta con barreras geográficas, carencia de y Tabuga (126 familias). recursos y poco conocimiento de comunidades. Después de que sólo el trabajo preparatorio Las organizaciones y el proyecto logran hacer po- esencial pudiera completarse en 2017, el pro- sible la llegada a las comunidades. En este sen- ceso de construcción y, en parte, también la tido se han cubierto a 32 comunidades que han implementación de los otros componentes de tenidos dos ingresos de BIS durante el 2018. Adi- WASH, se llevó a cabo en 2018. La CRE comisionó cionalmente el proyecto ha llegado a 58 comuni- a un supervisor de construcción (fiscalizador). dades con un solo ingreso durante el año. Estos Esto no fue suficiente para la CRS, por lo que se ingresos han dado como resultado la posibilidad contrató una empresa privada suiza que se ende cooperar en 4696 atenciones médicas, 2729 cargó de la supervisión técnica. Tras importantes atenciones odontológicas, 1787 inmunizaciones sugerencias de mejora, la construcción avanzó y 702 consultas a menores de 5 años. a satisfacción de las comunidades de las aldeas. Los sistemas de agua potable están terminados Comunidades aplican sus conocimientos en ges- y en funcionamiento. tión de riesgo y adaptación al cambio climático La capacitación en materia de higiene y el forta- Se tuvo avances importantes a través del acuerdo lecimiento de las Juntas de Agua fueron esen- de participación firmado entre RIOS Ecuador, la cialmente satisfactorios, pero cabe señalar que CRE y la SNGR: Ello permitió activar (y parcial- fueron gestionados por la CRE a la sombra del mente reactivar) el trabajo con los comités de proceso de construcción. gestión de riesgo comunitarios en los territorios El proceso de construcción ha finalizado y se han de frontera. De un total de 21 comités, en 2018 se cumplido los contratos con la empresa construc- capacitaron a 10 (se realizará este trabajo de ma- tora, la supervisión de la construcción y el con- nera escalonada), y se realizó el proceso de con- trato de seguimiento. formación y legalización que está avanzando. Se

113 El Salvador

Objetivos del programa de país Prioridades temáticas 2017 – 2020

Gestión de riesgo: Las capacidades de gestión de desastres y de adaptación al cambio climático a nivel comunitario y regional están fortalecidos. Salud: La situación de salud y el acceso a servicios de salud de calidad adecuada están mejorados para la población en las comunidades más vulnerables. Inclusión social: Los factores de exclusión y de riesgo social de jóvenes y sus familias están redu- cidos a través de la promoción de oportunidades que favorecen la inclusión social. Fortalecimiento institucional: Las capacidades organizativas y estructurales de la Cruz Roja Sal- vadoreña se han fortalecido.

Indicadores de efecto seleccionados

WH3: % of households using an improved drinking water source DRM1: % of communities at risk with a functional emergency committee

100% 100%

80% 80%

60% 60%

40% 40%

20% 20%

0% Before 2017 2018 Target 0% Before 2017 2018 Target

114 Resumen de los resultados de 2018

Promoviendo Oportunidades de Inclusión saneamiento y los diagnósticos técnicos de dos Social,OIS, III, Ciudad Delgado y Apopa/San sistemas de agua. A nivel de comunitario cabe Salvador (431662) resaltar que los Comités de Salud se mantienen El propósito de esta tercera fase es de contribuir activos en el proceso de formación en salud pre- al fortalecimiento de capacidades locales a tra- ventiva e iniciaron replicas con familias sobre el vés del desarrollo de la resiliencia comunitaria, proceso de aprendizaje en conjunto con volun- con prioridad en la población joven de 11 co- tarios de Cruz Roja sobre prácticas en salud e hi- munidades urbanas de los municipios de Ciu- giene. Los procesos de sensibilización en género dad Delgado (5 comunidades de fase anterior) y masculinidades tienen buena acogía. Se siguió y Apopa (6 nuevas comunidades). El proyecto también con la capacitación a persónales institu- pone a la población de mayor riesgo, la juven- cionales, como el personal de salud en tema de tud, y en particular los jóvenes que NI estudian, salud comunitaria y contraloría social, personal NI trabajan (NINI), en el centro de la intervención. docente en tema de salud comunitaria y edu- Se plantea construir la robustez y resiliencia de cación integral para la Sexualidad, y miembros las comunidades mejorando el acceso a la educa- ADESCOS en organización comunitaria y gestión ción, promoviendo la reinserción de los jóvenes de proyectos, entre otros. A nivel de construcción en el sistema de educación formal, y aumen- se realizaron tres espacios comunitarios con par- tando las capacidades de protección no sólo de ticipación activa de la comunidad y actores loca- los jóvenes, sino de toda su comunidad. les y se mejoró la infraestructura de la Seccional. Durante los seis primeros meses de implemen- tación el proyecto logró posicionarse en las nuevas comunidades de intervención que son Fortalecimiento de la resiliencia en de muy difícil acceso por razones de violencia. comunidades vulnerables del Municipio de El proyecto cuenta ahora con una red de apoyo Jiquilisco, Municipio de Jiquilisco (431698) con las comunidades, los gobiernos locales de los El proyecto contribuye al fortalecimiento de la municipios de intervención, las instituciones de resiliencia de las comunidades del municipio de salud, los centros escolares, y otras instituciones Jiquilisco mediante el establecimiento de con- referentes en temáticas de derechos de niñez y diciones para una vida sana y segura frente a adolescencia. Además se logró que algunas ins- riesgos de desastre. Esta meta se logra a través tituciones vuelvan a ser activas en dichas comu- de dos áreas principales de intervención: la salud nidades. comunitaria y la gestión comunitaria de la reduc- ción de riesgos. Durante el año 2018 se han tenido avances signi- Salud e Integración social en San Vicente ficativos en varias actividades logrando compen- y Tecoluca, Municipios de San Vicente y sar la mayor parte de los retrasos que se presen- Tecoluca (431695) taban a finales del primer año de ejecución. Así Iniciado en julio de 2017, esta segunda fase del mismo durante el año 2018 se comenzó a rea- proyecto con el objetivo de mejorar el estado de lizar acciones en la zona “nueva” del municipio salud y la inclusión social de la población, amplió la cual comprende 40 comunidades situadas al la zona de trabajo, pasando de 3 a 14 comuni- norte del municipio de Jiquilisco. En estas comu- dades. Este año cierre con avances significativos nidades se realizó un Análisis de Vulnerabilidad y en los procesos de formación, pero con algunos Capacidad (AVC) para poder contar con informa- retrasos en los procesos constructivos. Sin em- ción actualizada del contexto. De la misma ma- bargo entre los logros más importantes de este nera, se ha comenzado la transición y salida de año se encuentran las etapas de planificación de comunidades al sur del municipio (zona costera) las futuras obras, como por ejemplo la definición la cual se denomina como Bajo Lempa. de un nuevo modelo participativo de obras de

115 Ethiopia

Objectives of the country programme Thematic priorities 2017 – 2020

Health: Better water, sanitation and hygiene is ensured in rural villages. Disaster Risk Management: Villagers get stronger at dealing with droughts, floods and conflicts. Organizational Development: The Ethiopian Red Cross Society gets better at supporting community resilience.

Summary results 2018

Integrated and Community Managed Community Resilience – Moyale/Somali and built their own handwashing facility. This means Resilience – Gambella (420565) Oromia Woredas (420569) that since the beginning of the project, 6,110 Driven by an increase of volunteers recruited and Throughout the year, Moyale has been affected households installed handwashing facilities with trained in Community Based Disaster Risk Man- by conflicts. This lead to a high number of inter- their own means. agement (CBDRM), First Aid and Community nally displaced people (IDPs) in the project area. The seven Red Cross Committees and the six DRR Based Health and First Aid (CBHFA), the Ethio- Due to the conflicts, it was not possible to do the Committees remained active and operational. pian Red Cross Society (ERCS) in Gambella has outcome monitoring. The DRR committees engaged in the construc- contributed to strengthen the resilience of six As part of the emergency response, 12,612 tion of the water facilities and updated and im- communities. All six project villages have Disaster children under five and pregnant and lactating plemented their action plans. To improve safe Risk Reduction (DRR) committees who carry out women were supported with supplementary access of staff to the communities despite the their action plan. In 2018, two DRR committees food. Moreover, thanks to 452 trained CBHFA conflicts, dissemination sessions on Red Cross were further strengthened through trainings volunteers (221 women), about 8,000 house- principles and discussion with local authorities, and the review of their action plans and risk holds (44,000 people) of host communities and religious leaders, youth leaders and elders as maps. 80% of the targeted households can now IDPs were reached with hygiene and health pro- well as members of the armed forces were con- correctly identify actions to pursue following a motion with a special focus on malnutrition and ducted. Moreover, three branch staff have been warning. diarrhoea. trained in CSPM. 40 volunteers were newly recruited and trained Whenever the security situation was stable in First Aid. ERCS has now 359 trained volun- enough, implementation of the regular devel- teers in the project area. This is more than a opment activities continued. Four new ponds Resilience-boosting through WASH for twenty-fold increase since the beginning of the with a water storage capacity of 25,000 m3 were Shalla (420573) project. 10 CBHFA volunteers received refresher constructed. Moreover, the project rehabilitated The project reached 8,000 people in the Shalla training. They conducted 168 hygiene promo- four water sources. In addition, two latrine blocks area of West Arsi Zone in Oromia Region. It im- tion session reaching more than 700 people. and one rainwater harvesting system were con- proved resilience to drought through increased Moreover, 2,432 new Red Cross members have structed at one school. A total of 439 students access to water and sanitation, as well as capac- been recruited. and staff benefit from this support. Before the ity building of communities, local artisans and Thanks to the construction of one shallow well rainy season, the project team also ensured that government officials. with a hand pump in Opagna, 100% of the peo- 16 school rainwater systems at 11 schools were Two ERCS staff working in Shalla received CSPM ple in this village now have access to safe drink- clean and ready to catch the rains. training. Nine artisans from the community ing water within 30 minutes walking distance. The 286 (168 women) trained CBHFA volunteers received training in construction of water har- Moreover, thanks to the hygiene promotion together with the government Health Exten- vesting and water tank construction. Thereaf- of the CBHFA volunteers, 55 new household sion Workers continued to do hygiene promo- ter, they were engaged in the construction of latrines with hand washing facilities were con- tion with 6,150 households reaching about 16 water collection schemes and water tanks structed. 30,750 people. They sensitize the households serving 1,200 people. Four water tanks in four In addition, to better support the community in on health, hygiene and sanitation, including institutions were also completed. Moreover, two this fragile context, three branch staff have been successfully promoting the construction, use school latrines serving 853 students were con- trained in Conflict Sensitive Program Manage- and maintenance of latrines and handwashing structed. In addition, 46 CBHFA volunteers (15 ment (CSPM). facilities. Despite the difficult security situation, women) received refresher training on hygiene 232 new households constructed latrines. Since and sanitation promotion and 500 students re- the beginning of the project 2,481 households ceived hygiene promotion messages. constructed latrines. Moreover, 485 households

116 Branch Development – Moyale (420575) ERCS and SRC have agreed to enter into a long- term strategic partnership which, in addition to emergency and development projects, also includes support for the organisational development (OD) of ERCS. To develop this project, an assessment of the capacity of the branch was conducted. Based on this assessment, four core capacities were identified that need to be strengthened to provide sustainable services for the resilience of communities in Moyale. Firstly, to strengthen awareness of the mandate and services of the Red Cross and to ensure safe access, staff and volunteers will increasingly engage with stakeholders (sector offices, religious and clan leaders). Secondly, more volunteers will be recruited and trained. Active volunteers are key to a well-functioning branch. Thirdly, the branch will be supported in resource mobilisation. Fourthly, the branch will be supported to ensure delivery of sustainable services to communities such as hygiene and health promotion, first aid and ambulance services.

Emergency Response – Gedeo and West Guji (420576) The project contributed to save lives and reduced morbidity amongst drought and conflict affected IPDs, especially children under five and pregnant and lactating women. Some of the intervention areas have changed due to the decision of the government to dispatch supplies to other areas. Therefore, not all assistance has been provided as planned. As a result, the project has been extended into 2019 to continue reaching the affected population in the areas newly prioritized by the government. Up to now, approximately 12,000 children under five and pregnant and lactating women were supported with supplementary food.

117 Ghana

Objectives of the country programme Thematic priorities 2017 – 2020

Health: Reduction in prevalence of avoidable Disaster Risk Management: Communities re- blindness by improving the quantity and quality silience to disasters is strengthened through im- of Eye Care Services and increasing access to eye proving the communities’ capacity, knowledge health services. Improved health status of moth- and behaviour to cope with disasters and to miti- ers, new-borns and children through increased gate their effect; and the capacity of the National access to health services and improved behav- Society in disaster preparedness is increased at iour among beneficiaries in the target commu- national level and in target branches. nities.

Selected Outcome Indicators

DRM1: % of communities at risk with a functional emergency committee

100%

80%

60%

40%

20%

0% Before 2017 2018 Target

EC1: % of eyes with good visual acuity after 6 weeks of cataract EC2: % of increase of utilisation of the eye care facility from surgery between 6/6 and 6/18 previous year to current year

100% 45000 40000

80% 35000 target: annual increase of 8 per cent 30000 60% 25000

20000 40% 15000

20% 10000 5000

0% 0 Before 2017 2018 Target before 2017 2018 Target

118 Summary results 2018

Disaster Risk Reduction (421455) phase (2017–2020) included commitment on There was improved adoption of health services Disaster preparedness structures were estab- the OCAC and overall organizational develop- for mothers, new-borns and children with re- lished in 45 new communities in Northern (NR) ment (OD) of the GRCS. The GRCS was to identify cords (ANC register) at the health facilities indi- and Upper East Regions (UER) and structures their priority areas for OD which would catapult cating 53.7% (1,749 of 3,259) of the pregnant consolidated in the previous 25 communities in them to the next level of development. There women counselled and referred sought ANC NR. Total of 45 Community Disaster Preparedness was however very little progress on the OD front services at the health facilities. The reviewed and Responses Teams (CDPRTs) supported their apart from the NS policy development and/or ANC cards revealed 86% (2,808 of 3,259) of the communities to adopt good disaster prepared- review; and increased activities for resource women received at least 4 ANC check-ups dur- ness and prevention practices to ensure commu- mobilization (multipurpose building GRCS HQs ing the gestation period. 97% (2,154 of 2,212) nity resilience. The project established a stronger and CFA initiative with NRC) but was hoped that of the pregnant women who delivered at health link between the CDPRTs and the NADMO Zonal GRCS would develop an OD plan of action in facilities/received skilled delivery. 38.7% (883 of structures. The CDPRTs were provided technical 2019. 2,154) of them were escorted by the MC’s. All the support by the NADMO Zonal structures and 169 cases identified with various danger signs the district teams (NADMO, Ghana Fire Services, and referred, received medical care at the health Forestry Commission, Ghana Health Services and Flood Response in Northern and Upper East facilities with subsequent follow up visits to the Ghana Red Cross Society). Regions (421414) health facilities confirming compliance. Reduction of exposure related to climate, natu- The project provided immediate humanitarian The project gave recognition and publicity to ral and health hazards is an important objective assistance to 12,218 floods affected people the GRCS and strengthened the existing collab- in 90 selected communities. Awareness was in- from 2,200 households in Northern & Upper oration between the GRCS and the GHS in the creased through community education and sen- East Regions of Ghana by providing emergency regions. The GHS at all levels periodically invited sitization on good disaster management and on shelter and household kits to help mitigate the the MCs to sing some of the composed health climate change adaptation practices. Clean-up impact of the floods. The project also carried out songs during launch of regional level health initi- campaigns were organized by the CDPRTs, and awareness campaigns to ensure that the com- atives as well as during community engagement interactive radio discussions and sensitization munities at risk an affected received updated activities at district and community levels. on climate change adaptation and DRR related flood and government information to forestall issues were organised by the Ghana Red Cross and further impact and prevent disease. A total Society in collaboration with NADMO in the pro- of 3,764 (31%) girls, 2,170 (18%) boys, 3,766 ject regions. (31%) women and 2,518 (21%) men directly The Process to improve the disaster manage- benefitted from the shelter and NFIs distributed, ment capacity of GRCS to prepare and respond while a further 27,000 people were reached with to disaster was initiated. District Disaster Pre- relevant information related to the floods. paredness and Response Teams (DDPRTs) were trained in all the 10 Regions. Development of the DRM Strategy started, with the final document Mother, New-born and Child Health expected to be ready by end of February 2019. (421458) The Mother Clubs of GRCS worked with pregnant and lactating women through health promotion Eye Health Service (421457) activities to increase their knowledge and atti- The project successfully supported surgeries for tude on positive maternal health practices. A to- over 2,000 individuals. The regain of sight was tal of 3,259 pregnant mothers and 2,154 lactat- expected to translate into their improved social ing mothers who delivered within the year were and economic wellbeing. Over 230 children engaged, and 2,158 babies examined by RC with refractive errors were supported to acquire volunteers for possible danger signs associated spectacles and this was expected to boost the with new-born. About 27,000 additional com- classroom learning for the children, translating munity people were reached through commu- into far reaching benefits to the development nity meetings and interactive radio discussions. of the child and her/his future. 16,518 children A total of 653 call-ins were received, 75% (488 were treated for allergies and other pathologies. calls) coming from males, thus indicating a grow- It is expected that this will reduce pain, aesthetic ing number of male populations taking women disorders and allow them to socialise as growing and children health seriously. children and improve their education. The project also increased access to health facili- The project through the Ghana Red Cross Soci- ties for the community members through use of ety volunteers reached over 290,000 individuals tricycle ambulances. A total of 985 patients were directly with health awareness messages and ferried by the 11 available ambulances to reach interaction. The volunteers referred over 60% of the nearest health facility to access medical care. the patients for cataract surgery. Development Majority (466) representing 47% of the cases of capacity for eye health professionals con- were labour cases, 27% (264) pregnancy related tinued with 14 nurses supported to undertake cases (ANC), 11% (104) were children under five ophthalmic nursing training. Eight (8) graduated (CU5) and 15% (151) were other community and reported back to their stations in the project members with general emergency health con- areas. The remaining 6 were to graduate in 2019. ditions including snake bites and miscellaneous The MoU between GRCS and SRC of the current injuries.

119 Haiti

Objectifs du Programme Pays 2017 – 2020 Priorités thématiques

Santé Communautaire : Améliorer la situation WASH: Améliorer l’accès aux infrastructures de santé de la population vulnérable dans la ré- d’eau potable, d’assainissement et d’hygiène gion rurale de Léogâne. et promouvoir auprès des communautés les Sécurité sanguine : Renforcer le service haïtien bonnes pratiques pour une utilisation de façon de transfusion sanguine au niveau national. durable. Gestion de risques des désastres : Développer Développement organisationnel : Renforcer la et améliorer les capacités au niveau communal et CRH et les partenaires du programme au niveau régional en gestion communautaire des risques local et communal. des désastres (GRD communautaire), notam- ment dans la préparation et la mitigation, et les lier avec le système officiel national de GRD.

Indicateurs d’effet sélectionnés

NU3: % of infants < 6 months of age received only breast milk on WH2: % of households using and maintaining clean latrines the previous day

100% 100%

80% 80%

60% 60%

40% 40%

20% 20%

0% 0% Before 2017 2018 Target Before 2017 2018 Target

WH6: % of households with soap and water at the hand washing station

100%

80%

60%

40%

20%

0% Before 2017 2018 Target

120 Aperçu des résultats 2018

WASH, Cormier (432356) Gestion des Risques des Désastres, Léogâne WASH III, Léogâne (432368) L’année 2018 a marqué la fin de ce projet. Les (432362) Pour améliorer les changements de comporte- activités étaient concentrées sur la finalisation Pour la préparation communautaire aux ris- ments, 61 professeurs et directeurs de 23 écoles de six systèmes hydrauliques ainsi que la con- ques des désastres, 5’541 personnes ont déjà ont été formés sur la promotion à l’hygiène. En struction de 50 latrines par les ménages à l’aide été sensibilisées et la capacité en Évaluation plus, 12 évènements communautaires ont été de l’approche SAC (Stratégie d’Assainissement des Vulnérabilités et des Capacités, Éducation, réalisés sur 23 prévus pour le projet. Ces événe- Communautaire). Organisation et Préparation Communautaire ments ont permis de sensibiliser 314 écoliers et et Introduction sur le changement climatique 1’278 personnes en promotion à l’hygiène. a été renforcée pour 26 Équipes d’Intervention Pour l’accès aux infrastructures hydrauliques, Renforcement du Système National de Sécu- Communautaires et les Comités Locaux de la quatre nouveaux systèmes d’eau ont été con- rité Transfusionnelle en Haïti (432358) Protection Civile. struits et 120 sources ont été répertoriées dans Le projet et sa prolongation se sont clôturés fin Pour la protection communautaire, 40 OCB ont les zones d’intervention pour l’évaluation de leur décembre 2018. Pendant le projet, trois outils participé dans un programme de production et utilisation. IEC (Information, Education, Communication) et transplantation d’arbres forestiers et fruitiers Pour le renforcement de la collaboration entre 65 séances de sensibilisation sur le don volon- au niveau des communautés. Ainsi, 105’200 les autorités locales, deux tables sectorielles ont taire de sang ont été réalisés. Cela a permis de plantules ont été replantées et 8’876 autres été réalisées avec la DINEPA et les CASEC. toucher directement 5’253 personnes. Pour les ont été distribuées. D’autres mesures de miti- transfusions, 24’855 sur 40’000 poches de sang gation ont été aussi mise en place comme trois prévues ont été collectées (soit une diminution murs de soutènement, 51,6 kilomètres linéaires de 11% en comparaison à 2017. De plus, 27 per- de rampes vivantes et 383 m3 de gabionnage. sonnes ont été formées sur des sujets relatifs aux Dans les gorges et ravines, 668 structures en dons de sang en vue d’améliorer la gestion de clayonnage et 59 seuils en pierres sèches ont été la qualité et de rendre plus efficace le service de réalisés. transfusion sanguine. Deux auditeurs sur les trois formés ont été opérationnels et cinq audits ont Recouvrement rapide, Corail (432366) ainsi été réalisés au niveau des différents Postes Ce projet d’urgence était monté en réponse à de Transfusion Sanguine (PTS). L’ensemble des l’ouragan Matthew d’octobre 2016 afin de sup- PTS (14/14) ont été équipés de matériel essentiel porter la population affectée dans la commune à la sélection, au prélèvement et à la préparation de Corail. Il s’agissait d’auto-reconstruction et des Produits Sanguins Labiles. de réparation de maisons. Pour cela, 21 artisans et deux ingénieurs ont été formés sur les Techniques de Construction Locale Améliorée. A cela, s’est ajouté une distribution de 387 kits Santé Communautaire et nutrition, Léogâne de reconstruction ce qui a permis, entre autres, (432360) l’achèvement de 86 maisons. Pour le relèvement Au total, 14’296 personnes ont été touchées à économique, 1’250 Agriculteurs ont reçu de se- travers les activités de changement de compor- mences vivrières. Pour la promotion à l’hygiène, tement en santé communautaire et nutrition. De 2’732 personnes ont été sensibilisées au niveau plus, en vue de l’augmentation de l’accès aux des communautés. aliments, 80 nouvelles familles ont pu réaliser des jardins potagers. Une alimentation saine a été distribuée à 509 enfants via cinq restaurants Réhabilitation communautaire, Corail scolaires fonctionnels (trois mis en place en (432367) 2018). Afin de renforcer le système communau- En matière de préparation communautaire, taire de soins de santé, trois outils de gestions 23 membres du CCPC ont été formés en Sys- ont été développés avec l’Unité Communale de tème Alerte Communautaire (SAP) et 5’119 Santé. Ceci a contribué à la réalisation de qua- habitants plus 1’119 élèves ont été sensibilisés tre activités préventives et à la formation de 16 aux phénomènes de catastrophes naturelles. institutions de santé en Alimentation du Nour- Comme mesure de mitigation, cinq maisons ont risson et du Jeune Enfant. Enfin, quatre réun- été protégées par des ceintures végétales et dix ions d’échange entre médecins traditionnels et maisons ont été réparées. Pour la promotion à l’Unité Communale de Santé ont été conduites l’hygiène, cinq latrines ont été construites et pour favoriser le lien entre les systèmes de santé 1’009 personnes plus 1’181 élèves ont été sensi- formel et traditionnel. bilisés en promotion à l’hygiène.

121 Honduras

Objetivos del programa de país Prioridades temáticas 2017 – 2020

Salud: Mejora del acceso a servicios de salud de calidad y fortalecimiento de capacidades. Gestión de riesgos: Fortalecimiento de sistemas y de capacidades de gestión de riesgo y adaptac- ión al cambio climático. Inclusión social: Reducción de factores de riesgo social y de exclusión. Fortalecimiento organizativo: Fortalecimiento de capacidades organizativas y estructuras de contrapartes.

Indicadores de efecto seleccionados

RH4: % of births attended by skilled health personnel DRM2: % of community based structural protective measures functioning and managed properly

100% 100%

80% 80%

60% 60%

40% 40%

20% 20%

0% 0% Before 2017 2018 Target Before 2017 2018 Target

122 Resumen de los resultados de 2018

Proyecto Ampliando Oportunidades para los Fortalecimiento de la resiliencia comunitaria jóvenes en la ciudad de Choluteca (430074) a través de gestión de riesgos de desastres y Inició el primer año del proyecto implementando de salud, Valle/Choluteca (430065) acciones para la atención de jóvenes en condi- Durante este último año se logró el fortaleci- ciones de exclusión social y violencia en 6 barrios miento de las capacidades locales a nivel indi- con condiciones de vulnerabilidad ante riesgos vidual, familiar y comunitario en relación con la sociales, naturales y de salud de la ciudad de protección de la salud, reducción de riesgos y ad- Choluteca. Se están ampliando las oportuni- aptación al cambio climático. La red de parteras dades de estos jóvenes mediante una estrate- sigue promoviendo la salud materna e infantil, gia integral que incluye una atención dirigida con esto, actualmente se mantiene el 96% de a favor de éstos, de sus entornos directos y a parto institucional. Las estructuras comunitarias las instituciones a cargo de ellos. Se identifica- están realizando una importante labor educativa ron 306 jóvenes que no estudian ni trabajan, se en las comunidades promoviendo la aplicación organizaron 6 redes de jóvenes y 6 grupos de de medidas básicas para la prevención de las en- auto apoyo familiar, e inició la formación técnica fermedades y de desastres entre la población. El vocacional. Igualmente se realizaron 590 visitas 100% de estas estructuras comunitarias ejecu- domiciliarias sobre saneamiento básico y auto- taron de manera autónoma sus planes de acción. cuidado involucrando más de 1’400 personas. Asimismo, los centros educativos integraron en En cada barrio se organizaron las estructuras su currículo básica los temas promovidos por el comunitarias (patronatos, comités de emergen- proyecto. A través de los microproyectos, se re- cia, y comités de salud), que fueron legalizadas y dujo la exposición local de la infraestructura y reconocidas. Además se capacitó a 112 docentes de los bienes tanto familiares como públicos. El y 45 miembros del personal de salud, realizando sistema de salud se fortaleció con el mejorami- diversas jornadas educativas y campañas preven- ento de infraestructuras y bienes de los establec- tivas en centros escolares. Se capacitó. A nivel in- imientos de salud. Como resultado el 98% de los terinstitucional está en proceso la firma de varios usuarios siente que le resolvieron su problema acuerdos de cooperación con las instituciones de salud. Finalmente se logró la certificación locales. de las microcuencas como zonas de protección forestal.

Resiliencia comunitaria en Olancho (430076) Actualmente implementa el primer año de la Fortalecimiento de del Programa Nacional fase incrementando de 75 a 100 comunidades de Sangre de la Cruz Roja Hondureña, y agregando actividades en el municipio de Tegucigalpa/San Pedro Sula (430071) San Francisco de la Paz. En las comunidades de A finalizar el proyecto el Programa Nacional de seguimiento se observa un incremento en la ap- Sangre de la Cruz Roja Hondureña (PNS) cuenta ropiación de las temáticas de gestión de riesgos con una estructura de gobierno propia y un sis- y salud comunitaria por parte de las estructuras tema de costeo de los productos sanguíneos. comunitarias, la comunidad educativa y de la Igualmente se realizó incidencia a nivel del sis- población. Los estructuras comunitarias están tema de salud para contar con un borrador fi- empoderándose desarrollando actividades de nal de la política Nacional de Sangre. La política prevención y promoción de la salud como visitas ya fue socializada, sin embargo la inestabilidad domiciliarias o campañas preventivas por inici- política del país no permitió que se convierte ativa propia. Igualmente, se están gestionando todavía en ley. La prórroga durante el año 2018 proyectos en las comunidades convirtiendo a la permitió finalizar en gran parte la formación de población en gestora de su propio desarrollo. personal y la compra y la instalación de equipa- Muchas personas están formándose como lí- mientos, e iniciar con el diseño preliminar de deres ejerciendo una función vital sobre la co- nuevo edificio para el Centro Nacional de San- munidad. Por otro lado, los niños de los centros gre (CENASA). Para fortalecer la Donación Vol- educativos están transfiriendo conocimientos untaria No Remunerada de Sangre (DVNRS) se sobre salud y RRD a sus padres. A finales del año realizaron formaciones de promotores en DVNRS iniciaron las actividades en las comunidades y campañas de captaciones de sangre. Además nuevas con la organización de las estructuras se cuenta con una unidad móvil equipada y con comunitarias. un programa en línea para la formación.

123 Kyrgyzstan

Objectives of the country programme Thematic priorities 2017 – 2020

Health: The RCSK runs a successful programme Disaster Risk Management: Communities in where older people have opportunities to solve Talas Oblast are more resilient to hazards due to their problems. The civil society (and the popula- sustainable DRM measures. The RCSK and the tion involved) remains visible and vocal to act on SRC delegation are better prepared for emer- public health topics. The population in selected gency response and risk mitigation. areas of Kyrgyzstan have improved access to Organizational Development: The RCSK is quality services of the national health system. strengthened to secure and run its core tasks.

Selected Outcome Indicators

AH1: % of care givers/organisations adhering to quality BS3: % of voluntary non-remunerated blood donations standards 100% 100%

80% 80%

60% 60%

40% 40%

20% 20%

0% 0% Before 2017 2018 Target Before 2017 2018 Target

DRM1: % of communities at risk with a functional emergency committee

100%

80%

60%

40%

20%

0% Before 2017 2018 Target

124 Summary results 2018

Elderly Care Phase II (445991) Promotion of Voluntary Non-Remunerated Volunteer Management (445962) The RCSK, through continuing the provision of Blood Donation (445994) The project was successfully launched in May elderly-care services and sharing best practices In 2018, the project reached over 61,000 peo- 2018 with an assessment phase commencing with other organizations, played an active role ple with information sessions and awareness in the RCSK’s 7 regional offices and Bishkek. A in facilitating service provision to the vulnerable raising activities. The RCSK organized a number comprehensive analysis of strengths and gaps in older people in Kyrgyzstan. The project reached of events, dedicated to the World and National the National Society’s volunteer management over 6,600 beneficiaries and successfully facili- Blood Donors Days, in partnership with the Re- system, priorities in working with volunteers for tated the establishment of 14 self-help groups publican and Provincial Blood Centers (R/PBC), each branch, as well as opportunities at local and in three target cities, which now unite 83 older attracting new voluntary donors. More than national levels was conducted. Building on the persons and create numerous opportunities 3,434 blood donors were mobilized during assessment findings, detailed log frame, budget for interesting, useful initiatives. The RCSK’s these events by the RCSK team. A total number and operational plan were developed, and the experienced volunteers provided home care of blood donations in 2018 reached 40,664, implementation phase was launched in Novem- to 583 older people in 2018. The project team which is an increase by 12.4% compared to ber 2018 for three years until April 2021. With an also successfully mobilized additional resources, 2017, according to the RBC reports. The number overall goal of enhancing the RCSK’s volunteer attracting over CHF 52,000 in-kind and in cash of voluntary blood donors reached 6,135, which system, the project focuses on upgrading rele- during the reporting year in support of vulner- is an increase by 4% (223 cases) compared to the vant policies of the National Society, on improv- able elderly. previous year. ing recruitment and retention mechanisms, and building up the RCSK’s volunteers’ capacities. In the last two months of 2018, the RCSK reviewed Eye Care in Batken I/II (445993/445964) Community Based Disaster Risk Manage- and updated its policy on volunteers, recruited Additional 186 surgeries were carried out at ment II (445996) and trained additional volunteers, and started the fully operational eye care unit of the Batken The second phase of the CBDRM project was systematizing volunteers’ feedback mechanisms. Oblast Hospital (BOH) during January – August successfully launched on 1 January 2018 with an 2018. 94 cataract surgeries were performed suc- aim to reduce risks in disaster-prone rural and cessfully at the BOH. 2,800 people received di- urban communities in Talas through decreasing Cash-Transfer Programming Mainstreaming agnostics services and additional 2,439 reached their vulnerabilities and increasing their capac- and Preparedness (445966) through information sessions in communities. ities. In 2018, the RCSK project team facilitated Since the start of the initiative in early 2018, The project was successfully completed as of 31 the establishment of additional 8 Local Disaster the RCSK has enhanced its cash-readiness August 2018, according to the work plan. The Management Committees (LDMCs) in target 8 through development and integration of rel- initiative set a solid foundation for extension of rural communities in Talas province and 1 LDMC evant standard operating procedures into its the activities to the second phase, including ad- in an urban area – Talas town. School-based pre- systems, streamlining its policy-base for further ditional two provinces in southern Kyrgyzstan. paredness activities, including training, climate implementation of activities. At the same time, The second phase (445964) was prepared in the change adaptation sessions, and simulation through the implementation of the pilot pro- first and second quarters of 2018 and launched exercises, benefited over 8,500 children, focus- jects, the National Society has been strengthen- on 1 September 2018. ing on simulation exercises and drills. The newly ing collaboration with partners from a private The second phase of the Eye Care project (time- established LDMCs and new target schools sector at national and regional levels, establish- frame – 40 months) was launched on 1 Sep- received essential disaster preparedness and ing new partnerships with experienced financial tember 2019 and aims at improving access to response equipment. Collaboration continued service providers. The RCSK has strengthened its and quality of eye care services for disadvan- with three institutions that host children and staff and volunteers knowledge/cash expertise taged communities of Batken, Jalal-Abad and adults with disabilities, as well as with the Min- through providing training locally and engaging Osh provinces of Kyrgyzstan. It was developed istry of Emergency Situations, local administra- more experienced staff internationally in specific considering the recommendations of the pro- tions, and other stakeholders. technical trainings. ject mid-term review, the SRC Global Eye Care Programme evaluation, and the findings of the Rapid Assessment of Avoidable Blindness conducted in southern Kyrgyzstan in 2017. In 2018, the project team successfully started off with signing agreements with key stakeholders, defining roles and responsibilities. Information sessions were organized, and outreach activities conducted, including during celebration of the World Sight Day in October 2018. The eye care equipment for target hospitals and family medical centers were procured internationally, with delivery expected in early 2019.

125 Lao PDR

Objectives of the country programme Thematic priorities 2017 – 2020

Health: The population in selected areas of Laos have access to quality services of the national health system. Target population in selected areas in Laos are empowered to act on the determinants of health. Disaster Risk Management: The SRC country delegation is empowered to play a strong role in case of disasters. Organisational Development/Capacity Build- ing: Capacity of Lao Red Cross Branch staff in Luang Prabang and/or Oudomxay is enhanced.

Selected Outcome Indicators

RH4: % of births attended by skilled health personnel RH5: % of women having received four or more ante-natal care check-ups during the last pregnancy

100% 100%

80% 80%

60% 60%

40% 40%

20% 20%

0% 0% Before 2017 2018 Target Before 2017 2018 Target

Laos Luang Prabang Laos Sekong Laos Luang Prabang Laos Sekong

WH4school:% of schools using safely managed sanitation WH5school: % of schools adopting safe water handling practises facilities

100% 100%

80% 80%

60% 60%

40% 40%

20% 20%

0% 0% Before 2017 2018 Target Before 2017 2018 Target

126 Summary results 2018

WASH in Schools & Communities, Luang Strengthening Mother, Neonatal & Child Contribution towards Universal Health Prabang and Oudomxay (442594) Health Services II, Luang Prabang (442595) Coverage II (442596) In 2018, continued and consistent high-level en- In this 2nd phase, activities are being scaled up The CUHC2 project continues from the previous gagement of LRC and all other stakeholders had to all health facilities and some new aspects are project that focused on supporting the MOH in been a remarkable success. The communication, being introduced or focused on like the intro- achieving Universal Health Coverage (UHC) in coordination and support have significantly im- duction of Family Planning (FP) and Nutrition. Lao PDR, with the aim to: 1) strengthen Social proved between the project staff, LRC staff, the Co-management with the provincial and district Health Protection; 2) improve Health System Provincial Education, the District Education, authorities is also strengthened. In 2018, there Management (HSM) and 3) enhance MNCH ser- the school authorities and the communities, in was no maternal death reported in the two vice delivery and quality especially in Sekong. The general. As a result, the Volunteer Teachers (VT) districts. Based on health statistics (Dhis2), the 2nd phase of the project (11/2017–10/2020) is and Red Cross Volunteers (RCYs) assumed more Maternal Mortality Rate (MMR) for Luang Pra- implemented at both, the central level and in 7 responsibilities in implementing and maintain- bang Province stands at 59/100,000 (set target: provinces (SRC target provinces: Saravan, Sekong, ing the school support program. The LRC staff ≤ = 160/100,000 deliveries). Attapeu, Luang Prabang/LuxDev target prov- actively participated in the planning and imple- The quality of care could further be improved. inces: Vientiane, Bolikhamxay, Khammuan) and mentation of the project activities in all the areas Most senior government staff have good knowl- improvement of MNCH services only in Sekong. (schools and villages) and in implementing a pi- edge and skills. 84% of those women inter- The project well processed all necessary adminis- lot DRM project in six villages. viewed indicated that they are satisfied with trative requirements, including signing of Mem- The Nutrition support component is integrated, the services. Lessons learned are that in 2019, orandum of Understanding (MOU) with Ministry consisting of Nutrition awareness and educa- more responsibility for supervision will have to of Foreign Affairs (MOFA) and Memorandum of tion, practical training in the growing of organic be shifted to the District Trainers. The focus will Agreement with the MOH departments involved vegetables, establishment of school gardens and be put on informing and educating pregnant (four Provincial Health Offices and Provincial support to the dormitory children with basic fa- women about birth preparedness and danger Health Insurance Bureau (PHIB), recruitment of cilities and materials for cooking, hygiene and signs in pregnancy, possibly via additional com- project staff, procurement of main equipment sanitation. The project supported school garden munity-based activities. (IT, vehicles), and agreement on partnership training and school garden development at the Access to health services is also further improv- with LuxDev, Population Service Int’l (PSI), Inter- first set of 5 schools. The VTs and RCYs partici- ing. However, the coverage of health facility- national Labour Organization (ILO) and Clinton pated in a 5-day Organic Vegetable Production based deliveries within district is still low with Health Access Initiative (CHAI). training at the NAFC (Northern Agriculture and 39% (source Dhis2, baseline in 2017: 38%). The The project has achieved notable progress in Forestry College). The last day of training focused main reason is that with the improved road in- 2018 on SHP. Despite some challenges in mobi- on the school garden development specific to frastructure more and more women are by-pass- lizing sufficient funds and ensuring timely pay- each school, including the development of plans, ing the district’s health facilities (especially in ment, the central NHIB and PHIB/DHIBs in 7 prov- needs assessments, management systems, and Chomphet) and seek services in Luang Prabang inces have managed to implement the National action and funding plans. Subsequently, just town. Counting both, the deliveries which took Health Insurance Scheme (NHI) without major after training, with continued support from SRC place at health facilities in the districts and in problems. Various policy and technical work to through monitoring, technical advice, and pro- Luang Prabang town, the coverage for 2018 is guide, inform and support the implementation curement of seeds and equipment, all the five 52%. Factors contributing towards better access of NHI have been initiated in good collaboration schools established vegetable garden in the are a) infrastructure of the health facilities are in with development partners, including the first school premises. This activity supported signifi- a good state, b) good management of compli- NHI assessment (facility assessment, household cant positive impacts in both the Outcome and cations during and after delivery in the Health survey, risk assessment), integrated costing Output indicators. The project also provided Centers and c) strengthening of the referral sys- exercise on NHI benefit package, essential ser- seeds and tools for an additional 3 schools who tem. In fact, during the last years, a steadily in- vice package and health facilities, the NHI-NSSF have showed commitment in starting or improv- creasing number of referrals could be observed. merging pilot in two provinces, and developing their existing gardens. In 2014, only 61 patients have been referred ment of NHI IEC materials and feedback mecha- In Oudomxay, a remarkable achievement has to a higher service level; in 2018, this number nism. The project will maintain same intensity of been that five out of the 6 villages received increased to 989. The preliminary findings of policy and operational support on SHP in 2019. ’Model Health Village’ certification/award from the Village Health Volunteer pilot interven- Substantial preparatory work has been done the government. There has been a positive be- tion indicate that further strengthening of the in the last quarter on HSM and in RMNCH, that havior change in the majority of families in 5 of VHV system in the area of delivering key health should produce outcomes in 2019. For HSM, a the 6 villages supported and monitored by the messages to individuals and to the community major focus will be at advancing delayed activi- project in 2018. The LRC staff reported that in would contribute to further sensitize women to ties on Drug Management and Financial Man- most villages, families are using latrines, repair- utilize health services. agement systems at both, central and provincial ing water systems and tap-stands as necessary, In order to enhance health practices by commu- level, while continuing work on Rational Use maintaining village, household, and personal hy- nities the project provided training in growth of Drugs to provide vital inputs to the MOH on giene. Feedback from villages included improved monitoring and ensured that outreach included service quality improvement. On MNCH/Service knowledge in health and hygiene situation, ap- all services like health education, immuniza- Development component, the project has con- preciation for support from LRC staff, Village tion, growth monitoring, antenatal care and centrated its efforts in assessing the health center Health Volunteers (VHVs) and VTs, the impor- family planning in 34 pilot villages. The number service readiness and initiating supervision visits. tance of having access to basic First Aid services, of Growth Monitoring (GM) events increased and mechanism for sustainable management of steadily and in 2018, on average 64% of Children water and sanitation facilities supported by the Under 5 received 4 Growth Monitoring check- project. ups per year. Capacity building of Luang Prabang PHD and of both target DHOs was continued in the areas of HMIS and planning.

127 Lebanon

Objectives of the country programme Thematic priorities 2017 – 2020

Relief: SRC assist its partners in Lebanon during times of humanitarian emergencies with financial and technical support, delivering relief assistance in its different forms. Health: SRC supports its partners in Lebanon in the long-term with specific know-how and capacity building in the blood transfusion sector, improving thus the overall availability of safe blood. Organizational Development: SRC helps its partners in Lebanon in their organizational development, with a specific focus on the areas of resource mobilization/fundraising and HR.

Selected Outcome Indicators

BS2: NBTS meets x % of the needs of requested blood products

100%

80%

60%

40%

20%

0% Before 2017 2018 Target

128 Summary results 2018

Safe Blood for the General Public and Cash Assistance for Syrian Refugees in Contingency Planning Process, Beirut and Refugees in Lebanon III (442668) Lebanon Phase II, Akkar (442666) 14 DM teams (442643) The total number of blood units collected in Unconditional cash grants of USD 175 were dis- The CPP focal points, which were trained in 9 2018 is 24,628, which represents approx. 25 per- tributed monthly in Akkar from January to April branches in 2017, on a response system and on cent increase comparing to 2017 (19,671 blood 2018. 450 families (358 Syrian and 92 Lebanese response equipment, continued to attend work- units). Donor processing using Compoguard families) received monthly cash assistance for 4 shops and trainings to maintain and expand was connected to e-Delphyn and completed in months. their knowledge. 1 bronze simulation, 4 work- 11 branches allowing direct entry of all collec- shops (SOP, logistics and sheltering process) and tion data, weight, time of collection, traceability 2 technical trainings on the use of the response of tubes and bags. Semi-automated immunohe- Relief for Syrian Refugees, in-kind, equipment were conducted during the year. Fur- matology analyzers were installed in all branches Hermel (442658) thermore, one additional DM team (Keserwan) and connected to e-Delphyn software making With the Syrian conflict unresolved and the re- was trained on the use of response equipment. LRC BTS the first blood bank in Lebanon to perspective demand for basic items (including food) An assessment tool was created and dissemi- form Rh and Kell phenotyping on all blood units in Lebanon remaining high, the SRC extended nated to the DM centers to select facilities and collected. its funding for in-kind assistance until the end assess them as potential temporary shelters and of 2018. In accordance with the new Basic As- reception areas. sistance strategy of the LRC, this in-kind support A second batch of response equipment and BTS for Syrian Refugees (EU MADAD Fund) was provided only in areas where cash was not contingency stocks (tents and family kits) worth (442665) feasible. In 2018, 7,200 food parcels were distrib- 300,000 CHF was procured as a contingency and The mobile blood drive team (including technol- uted. 297 Lebanese and 884 Syrian families – to- are being stored in LRC warehouse. The current ogists) has been trained and is acquiring more tal of 1,181 different families – benefitted from a contingency stocks are stored in 5 warehouses, experience in performing the blood drives. LRC’s SRC supported food-parcel during 2018. each covering 1,000 individuals (5,000 individ- BTS organized 123 blood drives in 2018 through- A field visit from a Swiss German journalist visited uals). out the country. The total number of blood units the project and made a video on one of the pro- collected during blood drives was 4,491 in 2018, ject’s beneficiary that was later on broadcasted which represents a 124% increase compared to on the TV Programme “Mitenand”. 2017. A partnership with a local blood organization (DSC) was operationally activated in October Winterization Assistance 2017–2018, 2018 resulting in several coordination meetings, Arsal (442667) two training workshops and 876 blood units col- The findings of the post-distribution monitor- lected from a total of 16 blood drives done in the ing activities of previous projects and the cur- last trimester of the year. rent winter strategy of LRC indicated that an extended support in winter is crucial during the five months between November 2017 and PRCS-L Safe Blood for Palestinian Refugees March 2018, temperature maps are a useful tool QM II (442642) for targeting and fuel vouchers are an excellent BTS QM trainings for Blood Bank technicians tool: they are easy to distribute and to monitor as and seminars for all relevant hospital staff was transparency is given at all time. 100 USD cover completed. approximately 70% of the heating fuel expenses. After BTS QM Software eDelphyn licenses have 625 households received fuel vouchers of USD been procured and installed in all five blood 100 in Arsal from November 2017 to March banks, it is being used by the Blood bank tech- 2018. nicians. Some trainings are still needed once all the Software modifications will have been completed. Winterization Assistance 2018–2019, Preventive and regular maintenance contract Arsal and Hasbayia (442669) were signed with a third-party service provider. As the number of Syrian did not significantly Equipment and materials have been procured decrease and as the conditions of living of the (centrifuges, reagents and consumables for Syrian refugees are further deteriorating, SRC proper blood type grouping) extended its winterization assistance to 1000 A mid-term evaluation of the project was con- households in Arsal and Hasbaya starting from ducted by an external consultant which high- November 2018. Each HH received fuel vouchers lighted the gaps still present. of USD 100, covering approximately 70% of the heating fuel expenses from November 2018 to February 2019.

129 Malawi

Objectives of the country programme Thematic priorities 2017 – 2020

Health: Improve health and hygiene behavior. Increase Access to safe water and sanitation and primary health care services. Improve the quality and quantity of safe blood transfusion services. Organizational Development: Capacity building of Malawi Red Cross Society.

Selected Outcome Indicators

BS2: NBTS meets x % of the needs of requested blood products BS3: % of voluntary non-remunerated blood donations

100% 100%

80% 80%

60% 60%

40% 40%

20% 20%

0% 0% Before 2017 2018 Target Before 2017 2018 Target

WH6: % of households with soap and water at the hand washing station

100%

80%

60%

40%

20%

0% Before 2017 2018 Target

130 Summary results 2018

Blood Donor Recruitment Project (422607) Turnaround Strategy, Support to Phase 1 The amount of blood collected this year doubled (422612) compared to the first year of operation. Blood Turnaround efforts to reduce financial risks at sucker rumours that kept potential donors away Malawi Red Cross Society started in September in 2017 luckily did not rear their heads to heavy 2017 based on the Inception Report from the in 2018. At the same time the teams increased new SG. The project is a joint MRCS and in-coun- its approaches to attract donors. Volunteers try partners plan for Turnaround, with contribu- continue to promote voluntary blood donation tions in kind and financially from Belgium Red through personal contact in their villages in 10 Cross, DRC/Consortium, IFRC and SRC. The focus sub districts. By now, people were gradually get- was first on clarifying what was behind the debt ting used to collection events and the number of and the cash flow problems. Poor decision mak- repeat donors passed 30% in the project areas. ing (spending before earning, non-productive Youth volunteers and Club25 members organ- investments) but also inadequate cost recovery ized football events attracting for example in played a role. MRCS and Crisis Group used the Lilongwe more than 5000 people. The relation- opportunity of a meeting in London of Heads of ship between Malawi Red Cross Society (MRCS) International to update them on these findings and Malawi Blood Transfusion Services (MBTS) and to ask for a meeting of partners to address is maturing as the capacity of MRCS to mobilize this. This led to a meeting in The Hague in Oc- donors increases, and the strategic partnership tober where MRCS tabled a proposal for fairer is acknowledged in the new Voluntary Blood cost sharing and increased admin fees, sup- Donor Recruitment Strategy developed by MBTS. ported by up to date income and expenditures statements and other documents as requested by the July meeting. The meeting in The Hague Integrated Community Based Health accepted the proposal, effective from 1 January Program, Phase 2 (422609) 2018, provided MRCS agreed to an accountabil- With the completion of all hardware plans the ity framework. MRCS President and SG accepted, project by now resulted in 10 new blocks of la- and the The Hague declaration and accounta- trines in schools, and 21 additional boreholes (9 bility framework were agreed. During the year new, 12 rehabilitated), serving more than 11,000 the Turnaround also identified other changes people. In 2 districts a new resource center with a needed, like improving the finance management meeting hall and 2 offices provides facilities and system, HR and organisational set up. This led to income generating opportunities for Red Cross the introduction of new finance software (Quick- volunteers. For blood donor recruitment new books) and a new organisation set up. Four peo- strategies like football events to attract donors ple were released, 30 people were shifted to resulted in an increase in units of blood collected new positions, 8 new vacancies emerged, and in the project; in Mzimba it nearly doubled that 126 people kept their same positions but within way. There was a deliberate focus on schools this a new system. year to reinforce the behavior change messages from household and community sessions. Volun- teers reached 17,132 households with hygiene Salima Cholera Intervention (422613) and health promotion visits and nearly 180,000 Malawi like other Southern African Developing people through household and community ses- Countries faced the 2017/2018 rainy season sions covering topics like diarrhea, HIV/AIDS and cholera outbreak. As of 15th April 904 cases in- malaria prevention. The menstrual hygiene cam- cluding 30 deaths had been reported from 13 paigns reached more than 6,000 female learners districts including Salima. Of these 30 deaths, as well as teachers, fellow learners and mothers 12 were community deaths and the case fatal- clubs. The second cholera outbreak this year in ity rate was at 3.3 per cent . Then Salima District Salima was quickly and successful halted by the registered a second outbreak on 7 June, this time volunteers and staff working hand in hand with with 2 community deaths in the ICBHP interven- the local Ministry of Health staff. 295 Red Cross tion area. During the first outbreak the regular volunteers were trained in Community Based ICBHP work turned its focus to cholera preven- Health and First Aid as well as Behaviour Change tion and management. Now, with the 2nd out- Communication. Support to mobile clinics con- break, MRCS and SRC quickly responded with tinued to provide critical services in remote lo- an additional, quick intervention. An intensive cation, recording for example more than 8,000 5-day door to door campaign to spread preven- growth monitoring entries and reaching more tive messages, chlorinate drinking water, supply than 600 pregnant women with PMTC support. ORS and soap and identify and refer diarrhea cases resulted in 481 diarrhea cases identified and 134 referred, 8 registered as cholera (2 confirmed). Meanwhile the volunteers in the project area intensified their regular hygiene and sanitation promotion campaigns as well as CLTS. In total the intervention reached 13,718 households.

131 Moldova

Objectives of the country programme Thematic priorities 2017 – 2020

Ageing and Health: Elderly, chronically ill and Blood Safety: The quality of the blood products disabled persons have improved access to in- produced by the National Blood Transfusion Pro- tegrated, community-based medical and social gramme is improved through training of medical services and live in an age-friendly environment. and paramedical staff, upgrading the IT system Disease control: NCD information and health and increasing voluntary non-remunerable education are continued in the existing project blood donations. communities and extended to new municipali- Institutional Preparedness: The institutional ties in the North of Moldova with the support of preparedness of the delegation is strengthened. the SRC implementing partners.

Selected Outcome Indicators

AH2: % increase in number of clients benefitting from the services AH3: % increase in group members in AA groups

800 1200

–5% 1000 600 800 target: annual increase of 10 per cent

400 600 target: annual increase of 10 per cent 400 200 +3% 200 +100%

0 0 before 2017 2018 Target before 2017 2018 Target

132 Summary results 2018

Ageing and Health (415928) Winter assistance for the most vulnerable The project provided integrated care services at people (415931) home to 592 elderly in need (468 female and The project benefitted 330 older persons (286 124 male clients). The monitoring of beneficiar- women and 44 men), persons with disabilities ies’ level of satisfaction was done and 90% of and children from 9 communities (7 villages beneficiaries expressed satisfaction for the pro- and 2 towns) with Social Canteen services for 4 vided services. 31,449 Home-based-care (HBC) months. Hot lunches were provided 5 days per visits (23,450 social and 7,999 medical) were week, once a day in the value of 24 MDL/day/ conducted. Age-friendly Steering Committees person. During the weekends, the beneficiaries were established in 15 project communities. The received a food package. In total, 32,775 warm vulnerability capacity assessment (VCA) on age meals and 1,380 food packages were offered. friendliness was conducted in 7 project commu- 21% of total costs of the project were covered nities. In addition, 8 new communities (to the 7 by the LPAs. 32,700 MDL were collected as a old ones) developed age-friendly strategies; 10 result of fundraising campaigns. Over a ton of of them were approved by the local council to be food products was collected. 140 older people included in the community plan. 26 representa- received support from the members of IGs by in- tives from the 15 partner Local Public Authorities volvement in social activities and reducing social (LPA) improved their knowledge in community isolation. development, writing project proposals and fundraising topics. 2 new Initiative Groups (IGs) were created and 15 IGs have 247 members. Social accountability (415932) IGs implemented annually activity plan by hav- The preparatory phase was used to assess the ing over 180 community actions, involving over assumptions made in this proposal, conduct 5,400 community members and fundraising over a thorough context and stakeholder analysis, 8,000 CHF. The concept of Peer Mentoring Sys- to design, through a participatory process, the tem is in place and 4 IGs act as mentors. project set-up, involvement of partners and final identification of activities and outputs. With the support of the SAcc expert, a methodology was Strengthening the Transfusions Blood developed to carry out a two-stage in-depth po- Service II (415929) litical economy analysis through the involvement All donated blood/blood components are of key informants from locality, rayon to national tested using the automated donor blood test- level – including both government and civil soci- ing techniques (the immune-chemical method ety stakeholders. Existing complaint mechanisms through Electrochemiluminescence (ECLIA) and in the health sector, such as the books of com- PCR, real-time automated technique). MoHLSP plaints in health facilities, the electronic com- approved Donation Program for the year 2019, plaints platform of the MoHLSP, the NHIC 24/7 including the functioning of the new methods hotline, the green line of the MoHLSP 24/7, were ECLIA and PCR used for blood screening pro- explored and understood in terms of accessibility, vided the products required for testing the do- whether core issues were being addressed, and nated blood. transparency in reporting. In an additional step, The National Blood Transfusion Centre was in- the aim was to reach a balance of approaches cluded in the external quality control of blood with possible “quick wins” (i.e. strengthening borne infections testing (HBsAg, anti-HCV, an- patient groups/organisations) and some “harder ti-HIV/p24 and anti-Treponema) by the EDQM win” accountability approaches, which require a Council of Europe. An IT company for the de- long-route approach (i.e. strengthening of the velopment of the software was selected and 2 existing SAcc mechanisms from the national stages out of 4 for the development of the new health policy as well and introduction and in- IT system for the Blood Transfusion System imple- stitutionalisation of new SAcc mechanisms). For mented. All IT equipment necessary for the Blood the project phase, we therefore proposed not to Service was purchased is in place and functional. apply a Public Expenditure Tracking but to do a 6 National Clinical Protocols in haemorrhage tailored cost-effectiveness analysis looking at the management (surgery, cardio-surgery, somatic, investments made and running costs of different obstetrics, gynaecology, paediatrics), the algo- SAcc mechanisms versus their effectiveness, i.e. rithms for post-transfusion reaction manage- number and quality of redress actions based on ment, were revised, approved and distributed, the SAcc mechanism. Assessing the cost-effec- as well as the pocket variants of the protocols. tiveness of SAcc mechanisms will be an integral 230 health professionals who use transfusion part of the monitoring activities, for which the therapy were trained in the use of rational blood project will develop specific tools. products and hemovigilance. The Action Plan for the VNRBD recruitment strategy for 2019–2021 was developed and submitted for approval. 7 National Blood Donation Campaigns and 377 mobile drives were organised.

133 Nepal

Objectives of the country programme Thematic priorities 2017 – 2020

Health: Improve the health and well-being status of the target population by Community Em- powerment for Health Promotion, Community Action for WASH and Community Eye Care. Disaster Risk Management: Strengthen the operational Disaster Risk Management capacity through relevant and adequate preparedness measures for emergency response and risk mitigation. Organizational Development: Include capacity building into projects and focus on district chapters (and possible provincial chapters) support including NRCS staff below headquarters level.

Selected Outcome Indicators

RH4: % of births attended by skilled health personnel RH5: % of women having received four or more ante-natal care check-ups during the last pregnancy

100% 100%

80% 80%

60% 60%

40% 40%

20% 20%

0% 0% Before 2017 2018 Target Before 2017 2018 Target

EC1: % of eyes with good visual acuity after 6 weeks of cataract EC2: % of increase of utilisation of the eye care facility from surgery between 6/6 and 6/18 previous year to current year

100% 100%

80% 80%

60% 60%

40% 40%

20% 20%

0% Before 2017 2018 Target 0% Before 2017 2018 Target

134 Summary results 2018

Community Action for Health Project I and II Urban Disaster Risk Management (443218) (443214 )/(443273) Urban Disaster Risk Management (UDRM) is a The Community Health Project (443214) started pilot project implemented in Birendranagar Mu- in January 2015 and had a six months no-cost nicipality of Surkhet district. It started in October extension till June 2018. The project was imple- 2017 as a joint initiative between Birendranagar mented in the former VDCs although the ad- Municipality, Environment Development Soci- ministrative structures have now changed. The ety (EDS) and NRCS District chapter Surkhet. This Community Health related activities primarily project is planned to run for 39 months and cov- contributed to an increased utilization of health ers 16 wards of the municipality and intensifies services and improved the quality of health ser- its main activities in the 6 targeted wards. The vice delivered by local health centres. It further- project targets to cover a total of 21,087 people more increased the capacity of local partners to as direct beneficiaries and 52,000 populations as provide quality health services in collaboration indirect beneficiaries. with District (Public) Health Offices and District Chapters of NRCS. The second phase continues in the same line with Community Action for Water, Sanitation and a stronger focus to influence decision and policy Hygiene (443274) making through capacity building of local part- Community Action for WASH project also started ners. It is gradually picking up pace along with in July 2018 and ends in June 2021. Both health many preparatory level activities. The initial quar- and WASH projects are implemented together ter of the project was more dedicated towards by the DC in the same project Palikas. The project finalizing the agreement with District Chapters will contribute to improve the health of the most and signing of written commitments by relevant disadvantaged population groups with the focus Rural Municipalities of project districts, hiring of on sustainable WASH initiatives in the selected requisite staffs, setting up of offices for project Palikas. Most of the preparatory activities have areas and conduction of baseline survey. Project been completed during the first quarter – same induction and stakeholders’ meetings have been as in the Health Project. The project has direct carried out in all program districts. The project involvement and supports the local government has now a closer engagement with local govern- authorities and stakeholders in implementation ment authorities and stakeholders to implement of project activities. the project activities. The implementation of planned activities at field level has been picking up better pace from second quarter. Rehabilitation of earthquake affected schools in Sindhupalchok (443239) This project is implemented by a consortium of Mid-west Eye Care Project (443215) three Swiss actors, namely Caritas Switzerland The current phase of Mid-West Eye Care Project (CACH), the Swiss Red Cross (SRC) and Helvetas (443215) started in January 2016 and runs till Swiss Intercooperation (HSI). Good coordination March 2019. The project is being implemented mechanisms between the partner organizations by NRCS with the financial and technical support have been established. of SRC. The service area population of the project Contracts with contractors for the rehabilitation is around 1.7 million within the 8 districts of the of all five schools have been signed. The esti- Karnali Province (earlier State 6) for preventive, mated costs for construction or refurbishment promotional and curative eye care services. of classrooms as well as for site development are The hospital is gaining popularity because of within the budget submitted with the funding its comprehensive services. The number of out- request. The majority of expenses will arise in patient and surgical patients are gradually in- 2019 when the contractors and the local partner creasing. The eye care service is linked with the organizations submit bills of services rendered. Government Health Insurance board. Being the With a volatile exchange rate from CHF to the only eye hospital in the province, it has become Nepali Rupee (loss in value of NPR of about 9%), a referral base for all eye care and other health savings can most probably be realized. facilities of Karnali province. SRC conducted a The overall objective of this project is to con- midterm review in April 2018 which highlights tribute to the sustainable recovery of the ed- the number of positive achievements, challenges ucation sector in Nepal by providing safe and and shortcomings including some recommen- child-friendly school environments for students, dation related to quality and sustainability of teachers and School Management Committees services. (SMCs) in five schools. This is achieved through the rehabilitation of school infrastructure and WASH facilities for 1,200 current students as well as future generations of students in two municipalities in Sindhupalchok; and through supporting students, teachers and SMCs in the five schools in developing processes and structures to maintain a safe and child-friendly school environment. 135 Pakistan

Objectives of the country programme Thematic priorities 2017 – 2020

Health: Health and well-being of particularly vulnerable and deprived people and communities are improved through equitable access to health services that meet national minimum standards and through addressing health determinants.

Selected Outcome Indicators

NU3: % of infants < 6 months of age received only breast milk on RH4: % of births attended by skilled health personnel the previous day

100% 100%

80% 80%

60% 60%

40% 40%

20% 20%

0% 0% Before 2017 2018 Target Before 2017 2018 Target

RH5: % of women having received four or more ante-natal care RH6: % of children between 12–23 months vaccinated three check-ups during the last pregnancy times for DTP 3 and any other additional vaccine

100% 100%

80% 80%

60% 60%

40% 40%

20% 20%

0% 0% Before 2017 2018 Target Before 2017 2018 Target

136 Summary results 2018

Strengthening Mother, Neonatal and Child Health (MNCH) Services (443658) The quality of health services in the project area has further improved. Health facilities were made functional and supplies are sustained. All targeted health facilities were renovated. Health facilities are equipped and staff is trained. The capacity of the staff in the target health facilities has further improved through trainings and on- the-job coaching. All staff participated in the initial training workshop and on-going refresher trainings on essential package of Mother Neonatal and Child Health (MNCH) care by the end of project. Almost all health care providers including government medical officers and health supervisors attended MNCH training including training on common childhood illnesses and integrated management of neonatal and childhood illnesses. Trained Lady Health Visitors (LHV) supervisors supervised and monitored the performance of LHVs working at the facilities and provided on the job coaching and feedback to improve clinical skills. The numbers of maternal and paediatrics OPD turn over tremendously improved at the target health facilities by 80%. The percentage of births attended by skilled birth attendants increased from 44% to 76% in result of improved number of pregnant women having received antenatal care (ANC) visits during the whole pregnancy. Similarly, the proportions of couples using mod- ern family planning methods increased by 34%. At the same time, the percentage of women reaching the health facility in time when danger signs occur has also improved. A functional referral and back referral system was established through which women were referred to a higher healthcare facility. During 2017, project support was narrowed down to specific target health facilities due to Sindh governments’ supported Peoples’ Primary Health Initiative (PPHI) which took over the services within BHUs. Project support was entirely withdrawn from BHUs after December 2017 and services remained continued in GDs and catchment communities until June 2018 and at THQ Johi until December 2018. This is the reason why the project was prematurely ended in December 2018.

137 Paraguay

Objetivos del programa de país Prioridades temáticas 2017 – 2020

Mejorar la situación de salud: Se apoya y fortalece el acceso de poblaciones vulnerables a salud de calidad, lo que contribuya a una vida saluda- ble y segura de la población más vulnerable. Disminuir riesgos, salvar vidas y proteger medios de vida: Se fortalece el potencial comunitario e institucional en la prevención, mitigación, preparación, respuesta y recuperación ante situaciones de desastres. Fortalecer organizaciones contrapartes: Se fortalece la capacidad de las contrapartes de la CRP, en coordinación con otros actores, re- spetando las estructuras y tradiciones, ofreci- endo aporte conceptual, herramientas, asesoría, financiamiento y capacitación.

Indicadores de efecto seleccionados

RH7: % of women of reproductive age using at least one method of contraception

100%

80%

60%

40%

20%

0% Before 2017 2018 Target

Resumen de los resultados de 2018

Salud Familiar Comunitaria (433562) mismas y ampliar la cobertura de las mismas en 368 aumentó a 1.215 personas; niveles de cono- Se conformaron/reactivaron 12 Mesas de SSR y Salud MI. cimiento de población general sobre signos de Diálogo Multisectorial (MDM) con participación Datos del monitoreo de la línea de base y del alarma en el embarazo de 52% aumentó a 71%; de varias instituciones y actores claves de los ter- control de gestión de las USF revelan un au- niveles de conocimiento de población general ritorios. Han estado en formación 293 promo- mento en indicadores del proyecto, comparando sobre factores de riesgo nutricional en menores tores voluntarios de Tesãi Reka Paraguay (TRP) datos 2017 y 2018. En conocimientos sobre de 5 años de 76% aumentó a 90%. en la promoción de la SSR y MI quienes cuentan condiciones que pueden aumentar el riesgo de Estrategias utilizadas para el logro de estos con kit de prevención para sensibilización comu- adquirir ITS/VIH de adolescentes y jóvenes de resultados fueron: charlas comunitarias en nitaria y control (presión arterial/temperatura) 32% subió a 81%; conocimiento sobre medi- conjunto con las USF; instalación y/o fortaleci- cuando la USF está cerrada. 13 Sub-Consejos de das o métodos para evitar el embarazo precoz miento de Clubes de Madres y/o embarazadas; salud (instancias de participación comunitaria de 60% aumentó a 86%; realización del testeo campañas relacionadas a las temáticas a nivel de referentes a las USF) han sido fortalecidos. Se do- rápido de VIH/Sida de 3.417 personas aumentó los territorios; difusión masiva de spots a través taron de equipamientos y mobiliarios a 17 USF. a 4.968 personas; embarazadas que realizaron su de radios locales y/o comunitarias; y, visitas casa Todo esto permitió mejorar las condiciones de las primera consulta pre-natal antes del 4to mes de por casa realizadas por promotores voluntarios.

138 Se mejoró la preparación de las comunidades Hacia la inclusión social, el acceso universal a Ayuda en emergencia para familias afecta- ante posibles desastres. Se cuenta con una in- la prevención y atención integral en VIH/ das por tormentas y granizadas (433564) vestigación que identificó las comunidades de sida en el Paraguay (433559) Se benefició a 951 familias de 26 comunidades alto riesgo del proyecto, resultando 40 las comu- Se capacitó a 458 adolescentes y jóvenes de de 3 Departamentos. Se entregaron kits de ali- nidades en esta situación. El 60% de las autori- instituciones educativas para identificar su mentos a las familias afectadas, conforme a los dades de las comunidades de alto riesgo, expre- condición de riesgo de trasmisión del VIH. El estándares de Esfera. En pos de la reactivación saron voluntad política para promover acciones proyecto apoyó a 3 instituciones educativas. 29 de sus medios de vida se entregaron kits de sede GRD; reconocieron a los comités de GRD y docentes y directivos incluyeron en sus acciones millas de rubros que forman parte habitual de su acompañaron los procesos de implementación pedagógicas el abordaje de la prevención y no producción, que fueron seleccionados en base al de las acciones de RRD a nivel comunitario. estigmatización del VIH. 1.384 personas conocen diagnóstico realizado. Esto estuvo acompañado Se desarrollaron 3 estrategias de concientización como evitar embarazos adolescentes Estrategias con capacitaciones y visitas a las fincas para el sobre los riesgos de desastres a consecuencia de implementadas en las instituciones educativas: buen manejo del cultivo. las principales vulnerabilidades y amenazas del talleres, ferias educativas, campañas comunica- Como cierre del proyecto se realizaron: Talleres territorio: promociones radiales, visitas casa por cionales de promoción y difusión de las temáti- de evaluación con los promotores voluntarios de casa de los promotores voluntarios, y, la organ- cas del proyecto fueron desarrolladas con apoyo TRP quienes valoraron positivamente el proyecto; ización comunitaria; esto como resultado de la de toda la comunidad educativa, directivos, do- la oportunidad que tuvieron de conocer más a investigación realizada. centes y padres de familia lo que contribuyó al fondo la situación de los miembros de su propia 156 comunidades cuentan con AVC, siendo logro de este resultado. Se consolidaron los cír- comunidad; el trabajo en equipo y la cooper- principales hallazgos de vulnerabilidades las culos de padres como espacio de conocimiento ación para el relevamiento de datos y la entrega estructurales (falta de agua potable, caminos en y apoyo a instituciones educativas para abordar de los insumos a los beneficiarios; y, el conoci- mal estado y tendidos eléctricos precarios), y, el SSR/ITS/VIH con sus hijos. Se fortalecieron 8 USF miento y la experiencia adquiridas durante el avance de grandes extensiones de monocultivos en consejería y testeo en ITS/VIH aumentando a proyecto. Otro punto positivo destacado por hacia las comunidades, siendo el peligro más 832 los adolescentes y jóvenes que accedieron al los promotores fue la rapidez de la respuesta grande los agrotóxicos. El 35% de las comuni- testeo (2017: 521). ante la situación de emergencia; Rendición de dades de alto riesgo sufren esta última amenaza. Se fortaleció la adherencia al tratamiento de PVV cuenta pública en todos los municipios benefi- De las 40 comunidades identificadas de alto para disminuir el desarrollo de enfermedades ciados por el proyecto; Encuesta de satisfacción riesgo 33 cuentan con comités comunitarios de oportunistas, se favorecieron los vínculos inter- a beneficiarios aplicada a una muestra del 15% GRD, 25 de los comités están reconocidos, y 21 personales, la autoestima de las PVV alcanzadas, de los beneficiarios de cada comunidad, un total de ellos realizan acciones. Los planes están enfo- mediante los distintos espacios y medios de ac- de 146 encuestas fueron realizadas utilizando la cados en la gestión integral de la reducción de ción del área de Salud; la consejería de pares, y 3 aplicación ODK evaluando criterios de calidad de riesgos y se desarrollan en dos escalas: comuni- Grupos de Autoayuda. 424 personas tuvieron ac- los productos recibidos, calidad de la asistencia taria (infraestructuras) y familiares (medios de ceso a servicios sociales derivados y gestionados técnica recibida, estado de recuperación de la vida, viviendas y personas con discapacidades). por Vencer. Importancia tuvo el apoyo de Vencer agricultura familiar, y, grado de pertinencia de la Se estableció cooperación con la Dirección de para PVV privadas de libertad y el monitoreo de ayuda humanitaria; todos ellos calificados posi- Meteorología para la ampliación de la Red Na- la prestación de servicios en varias Regiones San- tivamente. cional de Meteorología instalándose 2 estac- itarias (afuera de Asunción). iones meteorológicas para cubrir vacíos de cob- Se formalizó el espacio intersectorial creado para ertura e información (en algunos territorios del trabajar en el marco de la Respuesta Nacional proyecto). al VIH/Sida en Paraguay, el CONASIDA. Vencer Se fortalecieron las capacidades organizativas y tuvo un aporte significativo en la elaboración de técnicas de TRP y sus organizaciones miembros. la agenda y la hoja de ruta del CONASIDA para La visibilidad y presencia institucional de TRP fue el 2019. Se intervino en el ámbito laboral imple- reforzada y elevada mediante el plan comunica- mentando una mesa intersectorial integrada cional implementado. Se logró la firma del Con- por el Ministerio de Trabajo, Empleo y Seguridad venio Marco Interinstitucional entre la Secretaría Social, el Instituto de Previsión Social, Vencer y de Emergencia Nacional y TRP para desarrollar organizaciones miembros de la Red de ONGs acciones conjuntas, apoyar y acompañar las ac- que trabajan en VIH. tividades organizadas y planificadas en el marco Se fortaleció la estructura política, operativa e in- del proyecto. Se instaló una unidad de Tec- stitucional de Vencer a partir de: la implement- nología de la Información y Comunicación (TIC) ación de estrategias Comunicacionales como la que permite acceso, producción, tratamiento y difusión masiva de contenidos, eventos, comu- comunicación de las informaciones de manera nicados y posicionamientos de Vencer, la dis- interactiva. Se registró a TRP en redes digitales tribución electrónica de boletines informativos como Winnconect3 diseñada por el BID para en- mensualmente; la consolidación del sistema de lazar instituciones. En la implementación del pro- monitoreo; la participación en eventos internac- ceso de Certificación ISO 9001 se desarrollaron ionales que colocan a Vencer en el mapa regional 5 procedimientos de apoyo para el sistema de de las acciones conjuntas con otros países; la gestión. En el área de monitoreo, se instaló un consolidación del área de Voluntariado logrando sistema eficiente de recolección de datos cuan- desde el mismo sistematizar las buenas prácticas titativos y cualitativos que facilita la detección de Vencer. rápida de debilidades, así como de los avances en la implementación del proyecto.

139 Philippines

Objectives of the country programme Thematic priorities 2017 – 2020

Post-disaster rehabilitation and reconstruction: Humanitarian aid in the aftermath of Typhoon Haiyan is provided to contribute to strengthening the resilience of affected communities. Health: WASH projects are run that have an environmental sanitation component as a minimum and include environmental health where feasible.

Summary results 2018

Typhoon Haiyan: Ormoc Recovery Project II were largely foreseen, such as for example the (443819) difficulties of the PRC procurement system or the While the team was able to include learnings lack of interest in certain project activities, and from phase 1 into phase 2 implementation, accordingly, the project team had experience many aspects such as designs, and methodol- in dealing with them successfully. Unforeseen ogies were largely retained from phase 1. The occurrences such as the lumber moratorium or cooperation with the organization Build Chang the natural events described in section 2.3 are improved the ’Building Back Better and Safer’ always a possibility and despite being affected aspect further. Build Change developed an op- for a certain number of days, the project team tions-based guideline to upgrade the houses was able to continue. whereby the PRC/SRC engineers were encour- The project was completed in March 2018. aged to focus their designs and direct the limited budget available to one room in the house. Engi- neers could choose from different options with Typhoon Tembin: Early Recovery Project, varying degrees of strength and costs to make Mindanao (443821) the room stronger. The objective was to create The Conditional Cash Grant of 10,000 PHP per a complete load path in this ’core’ room, which beneficiary was distributed 26th July to all 125 means the forces from earthquakes or strong beneficiaries. CGI sheets have been handed over winds could be transferred into the ground, in- to 23 houses of SRA and have been later evalu- stead of dissipating inside the walls, beams, roof, ated on the repaired houses to meet PRC Stand- etc. of a house and resulting in damage. Certain ards on Safe Shelter. For the relocation the CGI changes were also made following community sheets have been handed over to 33 houses so input or feedback from other stakeholders, and far with the progress of the house construction the implementation period being further from (69 sets are ready for the remaining houses). In the emergency phase in general allowed more October a house to house re-orientation to the time to review and adapt processes, focus on 23 beneficiaries of the SRA has been conducted quality and target of the activities, as well as to regarding Safe Shelter Awareness. For techni- increase interaction with and inclusion of com- cal monitoring PRC’s Recovery Unit Engineer munities and their individual members. visits the relocation site on a regular basis and The collaboration with the local PRC chapter his feedback and evaluation is shared with the had improved a lot, especially due to the ca- LGU and PRC/GRC for appliance of the agreed pacity building activities under the DRR compo- work plan. Constant meetings and coordination nent, which targeted a flagship service of PRC have been initiated from PRC/GRC between PRC and highlighted their service rooted in com- project team, GRC Delegate and LGU engineers munity-based structures. Cooperation with the and Municipal Mayor for advice and guidance on City government, and especially the CDDRMO, Relocation implementation. had also increased significantly. The challenges encountered during phase 2 implementation

140 South Sudan

Objectives of the country programme Thematic priorities 2017 – 2020

Health: Strengthening community based health Organizational Development: Organizational care and health systems as part of the SRC,s over- and program management capacity of the South all goal for South Sudan “Health Status for South Sudan Red Cross is strengthened. Sudanese improved”. Access and utilization of safe water and sanitation (WASH) are improved. Blood safety: Recruitment and retention of voluntary non-remunerated blood donors are improved.

Summary results 2018

Improving health status of crises affected Health Improvement in Ikwotos (424476) Blood donor recruitment and First Aid people in Pageri County (424478) The project is highly appreciated within the (424472) The implementation of project activities in 2018 community and on track. Nevertheless, 2018 The project has contributed a lot in changing in- has been affected by various factors. Inflation has been characterized by continuous inflow dividual and community perception about blood and, as a result, under-budgeted allocations and outflow of population in and out of South donation by involving youth from secondary in the budget, logistical constraints and delays Sudan due to continuous rebel movement schools, universities, talking to religious, church formed great challenges. Some of the project and food scarcity. A midterm review including and opinion leaders, and orientation sessions staff had to be replaced due to weak manage- budget and logframe revision was conducted in with humanitarian agencies and integrating ment and leadership skills. Due to this erratic August 2018. The team is active in first aid and blood donation activities as part of public events. management style and lack of coordination, a carried out treatments of 47 casualties. A total 3,588 voluntary blood donors were registered number of activities are very much delayed. of 33,168 individuals (13,976 male and 19,192 by the end of 2018 and 78 public awareness To enhance prevention of MAM/SAM middle female) were reached with key health issues. 33 sessions were conducted out of those donated upper arm circumference (MUAC) screening car- children (15 male and 18 female) with moder- 3,217 blood units (663 female, 2,577 male) 72 ried out with 1,818 children and 397 lactating ate acute malnutrition were referred to Ikwotos SSRC volunteers and SSRC five staffs on VNRBD mothers, with the result that 751 children and health centre for medical management, while and additional 38 donor club members were 146 pregnant women and lactating mothers the mothers received nutrition education, four trained to enhance their capacity in recruitment were referred to be treated. mother to mother support groups (MtMSG) of voluntary donors and to conduct awareness The SSRC team conducted 31 health sessions were formed accordingly and six kitchen gardens sessions. For this SSRC volunteers were pro- on different topics reaching 6,721 individuals. were established afterwards. Due to health ed- vided with protective clothes and visibility and Five Boma Health Committees (BHC) were also ucation more pregnant women preferred skilled IEC materials. – through weekly house to house trained. BHC is a strategy of MoH to overcome birth attendants compared to 2017. 21,251 peo- visits 13,756 households (56,000 people) were the tremendous lack of health facilities in the ple were reached and sensitized on psychosocial reached with key messages on voluntary blood country. To improve the people’s nourishment support and SGBV. donation, which increased tremendously the the team procured seed to establish kitchen gar- To improve the access to safe water four hand willingness to donate blood. 15 NBTS staff re- den. 37 awareness sessions on psychosocial sup- pumps have been protected by fencing, five hand ceived training on VNRBD and for knowledge port had been carried out including education pumps were repaired, 33 pit latrines have been exchange SSRC and four NBTS staffs participated of teachers on the same. Approximately 7,000 constructed, six water management committees in the 9th African Society for Blood Transfusion beneficiaries have additional access to safe wa- were trained (out of the eight that were formed (AfSBT) Congress in Tanzania (Arusha) in June ter. Construction of six institutional latrines has in 2017) on water point management and 61 2018. As the project is very successful, even still started and borehole drilling and garbage col- staff, volunteers and teachers (48 males and 13 in its infancy, the MoH asked for expanding the lection points kicked off. female) were educated on hygiene promotion. approach into other geographical areas Wau 52 new volunteers were recruited and trained on 3,215 people (1,359 male and 1,856 female) re- and Torit. the Red Cross Red Crescent Movement and Inter- ceived hygiene and sanitation promotion mes- national Humanitarian Law, social mobilization sages. To prevent diarrheal diseases and cholera and Ebola prevention. The team is still involved in outbreaks powdered chlorine were distributed Ebola screening at the border to Uganda. to a total of 24 households besides hygiene education. For this, 34 volunteers (20 male and 14 female) were trained on cholera prevention and response. Project Cycle Management (PCM) and monitoring tools are in place but intense training on that will take place in 2019. 54 volunteers (31 male and 23 female) attended training on SSRC Volunteering Policy, RC/RC movement principles, guidelines and code of conduct.

141 Integrated Partnership of primary health stood at 24,765 at the end of 2018. The attend- care in Maiwut (424475) ance rate continues to increase, especially in This joint project with ICRC, started in January Udier, after the upgrade to PHCC and additional 2017, has been extend until February 2020. staff joined the team. The number is not very far The SRC supports the ICRC operations in South from the estimated catchment population of Sudan mainly in Udier and Maiwut with the 33,863. The number of <5 years consultations secondment of a health delegate. The project is with 6,739 cases rather low because the care- started in Maiwut to support the PHCU and the takers (usually the mothers) are busy with other hospital. The health delegate who was placed in household activities. Sensitization messages on Maiwut also supported a heaPHCU in Udier once SGBV were done in Udier, however, sexual vio- a month and accompanied medical evacuation if lence cases are still not identified. needed. After evacuation of Maiwut, when vio- ANC consultations for new and follow up cases lence spread into this area and the whole place were 3,275. There were 887 women who came were looted, the ICRC did emergency operations in the third trimester. This number is linked to and Udier PHCU has been upgraded from PHCU the number of clean delivery kits distributed. The to a PHCC, through the communities’ and local number of deliveries for 2018 is 103. The moth- authorities’ initiative with support of the project ers still prefer to deliver in the homes. team. The vaccination coverage (Penta1 & 3) in Udier Community health committees (CHC) have also is 58,2%, with 4,949 vaccine doses used. 6,750 been established and more than 1 million ben- children underwent growth monitoring. eficiaries were reached with treatment. Capac- ity building, not only of the PHC staff, but the network of traditional birth attendants as well, Strengthening Resilience among Young Men improved the attendance in the maternity sec- in UN House POC 3 (424481) tion. Community health committees (CHC) have This is a second phase of a project which had also been established so the communities have started after the end the phase one in June direct involvement in monitoring the health sit- 2018. The project is implemented by SSRC and uation in the area and to provide solutions to the the Danish RC. SRC is co-funding the project. This various challenges and also link the PHC to the phase has started in August 2018 and is still in authorities and the communities. the preparation phase with clarifying implemen- The previously open waste zone in Udier and tation, discussions with local leaders and camp Maiwut is a fenced where the cleaners are dis- managers and SSRC Due to violence, which had posing and burning the waste, without break- been broken out in the camp POC 3, most of the downs. Out of the 34 staff (medical, paramedical target group had to be evacuated, which addi- and support), five qualified staff are performing tionally delayed the start of the project. Finally, consultations and nursing activities. The number all agreements are signed and recruiting process of consultations per key morbidity and rabies is ongoing for project staff.

142 Sudan

Objectives of the country programme Thematic priorities 2017 – 2020

Health: Health knowledge, attitude and prac- Disaster Risk Management: The SRCS is sup- tices of beneficiaries and their capacity to ad- ported in disaster response capacities. dress health issues are strengthened. Access to Organizational Development: Capacity is built quality health services and water and sanitation on the SRCS Branch staff through the support of (WASH) are improved. the Organizational Development process.

Selected Outcome Indicators

WH6: % of households with soap and water at the hand WH2school: % of schools using and maintaining clean latrines washing station

100% 100%

80% 80%

60% 60%

40% 40%

20% 20%

0% Before 2017 2018 Target 0% Before 2017 2018 Target

Summary results 2018

School Health Sennar (424444) (construction of 56 latrine blocks) have experi- Khartoum-based Delegation, as well as the de- The School Health Project aims at improving enced delays and are still ongoing: by the end of ployment of a field delegate and construction health status of school-aged children through 2018 a total of 15 boreholes/handpumps were specialist) in order to build up capacity of the providing access to safe drinking water & sani- certified and handed over. 32 hand pumps tech- local team, increase implementation rate and tation in 36 rural schools (located in 28 different nicians (50% women) out the planed 96 have improve monitoring. villages), as well as improving health knowledge, been trained so far. Globally, the project is being very much appre- attitude and practices (KAP) of students and The project soft component consists mainly in ciated by the beneficiaries and local authorities, community members. introducing a comprehensive health education and is being implemented according to the Following a preparatory period in late 2017 package in all schools. By the end of 2018, 1 out original proposal in terms of methodological (baseline survey and recruitment of project of 8 key topics (First Aid) was completed, with approach and project content. However, the staff), the project was officially launched in Feb- 900 students trained and First Aid kits provided project is suffering from important delays due ruary 2018 with the organisation of an inception in all schools. In addition, 473 VDC members to multiple internal and external factors, such as workshop and the signature of a multipartite (27% women) have been trained during 3-day lengthy tendering and procurement procedures, agreement with key stakeholders (Sudanese Red health awareness workshops. unreliability of some contractors, high turnover Crescent Society (SRCS), Swiss Red Cross (SRC), Ownership and accountability to beneficiaries among key personal, limited skills, floods, eco- State Ministries of Education (MoE), Health is being promoted through participatory ap- nomic and political crisis countrywide, etc. Those (MoH) and Physical Planning (MoPP). Village De- proaches and the introduction of suggestion delays will require an overall planning review for velopment Committees (VDC) have been estab- boxes (16 suggestions received over the last two the remaining two years (2019–2020), with a lished in all 28 villages. 25 SRCS expert volunteers months of 2018), but remains within certain lim- possible renunciation to implement certain pro- (44% women) and 14 project staff (43% women) its considering the conservative social and polit- ject components, such as the output related to have received ad hoc training. ical environment. early detection of malnutrition among < 5-year- Construction works to provide access to Although SRCS Sennar Branch has the primary old children. safe drinking water (drilling of 29 boreholes responsibility for project implementation, a equipped with handpumps) and sanitation strong support was provided SRC (through its

143 West Bara Integrated Community Health Emergency Response to 2018 Floods Sennar (424445) (424446) SRC and SRCS engaged in a new partnership dur- Severe flooding occurring in the September ing 2018 by expanding its cooperation to North 2018 in different localities of Sennar State due to Kordofan State, located in central Sudan. above average rainfall and overflowing of Dindir Following a partnership assessment, a Letter river. A total of 3,287 households were report- of Intent between SRC HQ, SRCS HQ and SRCS edly affected throughout Sennar State. North Kordofan Branch was signed in April 2018. A Project Idea was developed with a proposed The emergency response project is providing duration of 4½ years from 1 July 2018 until 31 support to 1,247 affected families in 24 villages December 2022, including a half-year prepara- of Dindir locality through provision of NFIs, hy- tory phase in 2018, during which a detailed field giene kits and carrying out hygiene promotion assessment was carried out with the support of and information dissemination across the af- SRC Field Delegate deployed in North Kordofan. fected communities. By the end of December The findings from the assessment confirmed the 2018, all materials have been procured and de- high needs in terms of access to drinking water, livered to SRCS Sennar Branch. Distribution will sanitation, improved health services, as well take place in the first weeks of January 2019 and as the low level on awareness on health issues will be reported in the 2019 annual report. among the population. A detailed project proposal has been developed and by end of 2018 was awaiting final approval. The expected impact of the West Bara Integrated Community Health Project is to reduce morbidity and mortality related to waterborne disease and maternal health. A comprehensive framework of 3 outcomes, 10 outputs and 28 activities has been developed. The first outcome aims at increasing access to water, sanitation and key basic health services (in particular midwifery services at community level). The second outcome will address health and WASH behaviour of the beneficiaries, while the third outcome will enhance SRCS capacity at Branch and Unit levels. The project will cover ten villages of West Bara Locality with an estimated total number of 48,000 beneficiaries. Project activities are expected to start at the beginning of 2019.

144 Syria

Objectives of the country programme Thematic priorities 2017 – 2020

Relief: SRC supports the Syrian Arab Red Cres- cent (SARC) to respond to the basic needs of the most vulnerable. Recovery: SRC assists its partner in Syria to help vulnerable and restore their livelihoods with in- kind or economic support. Health: SRC supports its partners in Syria to ensure communities have access to basic services (water and sanitation and health services).

Summary results 2018

Humanitarian Assistance for the Population Emergency WASH Al-Raqqa (442704) Affected by the Conflict in Syria (442700) Due to the lack of access to water, the project in Seven clinics in Rural Damascus, Homs, Idlib, Al-Raqqa aims at providing 2,000 water tanks of Sweida, Hama, Latakia, and one ophthalmology 1,000 litres and connecting equipment to return- mobile clinic in Aleppo are supported. 100,458 ees’ households with a high number of family patients benefitted from health services in these members in Al-Raqqa city. These returnees have clinics from January to October 2018. The ma- been internally displaced due to intensive fight- jority were treated for respiratory infections. ing in the city. The beneficiaries install the water 74,904 people benefitted from psychosocial tank themselves at the location they deem the support (PSS) through seven community centres most suitable. These water tanks enable vulner- and eleven outreach teams in Damascus, Rural able families to store water for their household Damascus, Aleppo, Homs, Deir Ezzor, Idlib and use despite the frequent interruptions of water Suweida. Two SARC branches in Rural Damascus supply and electricity. 2,000 water tanks were and Deir Ezzor and sixteen sub-branches in Rural procured locally by SARC, transported to Al- Damascus, Homs, Hama, Tartous, Quneitra, ru- Raqqa and stored in a warehouse. 1,170 water ral Aleppo and Idleb are supported in order to tanks were distributed in three different neigh- strengthen their capacity to deliver life-saving borhoods in Raqqa city in 2018. Approximately services to the most vulnerable in their commu- 2,340 families (approximately 12,500 beneficiar- nities. ies) have benefitted from this project so far. The water tanks at the household level increases the families’ ability to store clean water, while reduc- Complementary Basic-Kits for IDPs (442703) ing the financial burdens (from buying water The delivery of emergency relief items to inter- from water trucking) and safety risk (unexploded nally displaced women and elderly to comple- ordinances of war) that the people are exposed ment the content of the basic hygiene kits is the to while searching for water. It also gives the objective of this project, as a gap in the coverage family breadwinner more time to search for an of basic needs was identified, such as sanitary income for the family rather than fetching water. pads for women, slippers or underwear. The effect of these kits is to ensure a minimal dignity to the IDPs staying in camps. 2,046 women’s kits Restoring Livelihoods in rural Aleppo and 1,046 elderly kits were procured by Decem- (442705) ber 2018. Due to a delay in the procurement of Vulnerable households, who had been internally the items, the kits, which were primarily aimed displaced due to heavy fighting in their area and for IDPs in Eastern-Ghouta, could not be distrib- who came back to their village of origin in the uted in 2018. The stock is being kept aside as part rural area of Aleppo, are supported in restoring of a contingency plan of the SARC for future dis- their livelihoods, which was agriculture and live- placements of population. stock prior to the conflict. 100 families in two different villages were selected based on vulnerability criteria such as single woman headed household, more than five family members and no other source of income. Feed (oat and barley) was distributed to the selected families followed by the distribution of two pregnant sheep per family. 145 Togo

Objectifs du Programme Pays 2017 – 2020 Priorités thématiques

Santé: Améliorer l’accès aux services et soins de Gestion de risques: Développer et améliorer les qualité à base communautaire, spécialement capacités de la SN et des populations pour faire dans le domaine de la santé maternelle et infan- face aux défis de santé et aux désastres. tile, le VIH/Sida, et l’eau et l’assainissement de Développement organisationnel: Renforcer base. les capacités de la CRT pour permettre à la SN Santé oculaire et sécurité sanguine: Améliorer de maintenir son leadership dans le domaine l’accès aux services de soins oculaires et de trans- humanitaire. fusion sanguine de qualité.

Indicateurs d’effet sélectionnés

EC1: % of eyes with good visual acuity after 6 weeks of cataract NU3: % of infants < 6 months of age received only breast milk on surgery between 6/6 and 6/18 the previous day

100% 100%

80% 80%

60% 60%

40% 40%

20% 20%

0% 0% Before 2017 2018 Target Before 2017 2018 Target

WH2: % of households using and maintaining clean latrines WH3:% of households using an improved drinking water source

100% 100%

80% 80%

60% 60%

40% 40%

20% 20%

0% 0% Before 2017 2018 Target Before 2017 2018 Target

146 Aperçu des résultats 2018

Santé oculaire (424756) Survie de la mère et de l’enfant (424760) L’année 2018 correspond à la fin du projet. La 106 CM (2380 membres) sont formés pour as- couverture en USO dans les Plateaux est passé surer les séances de sensibilisation sur les PFE de 33% (2014) à 55% (2018) grâce au projet. ont continué avec les CM. Au total, le projet a Le cataract surgical rate (CSR) est estimé à 800 formé 169 CM (3936 membres) appuyés par (contre 300 au démarrage du projet). Un objec- 150 coachs locaux ont permis l’atteinte des prin- tive important atteint par ce projet est le taux de cipales cibles en matière de suivi vaccinal, allait- succès de la chirurgie de cataracte (nombre de ement maternel exclusif et alimentation complé- yeux avec une acuité visuelle > 3/10 au-delà de mentaire. 565 PVVIH et 510 OEV ont été suivis 4 semaines après opération) qui est de 96%. De en 2018 par les 100 conseillers visiteurs formés. plus, le projet a réussi un pourcentage de cata- Certaines PVVIH et OEV ont bénéficié d’appuis racte dépistée en stratégie avancée de 59%. La divers (kits alimentaires, appuis médicamenteux, mobilisation sociale a permis de toucher 71’000 appuis en fournitures scolaires...) personnes avec 4800 séances de prise d’acuité 152 enfants de moins de 5 ans souffrant de visuelle par les volontaires. L’évaluation externe paludisme confirmé, ont été pris en charge par du projet a conclu à l’atteinte plus ou moins des les 50 volontaires formés à cet effet. résultats fixés. Il faut aussi signaler que des EVC ont été conduites dans 20 localités. Les résultats sont atten- dus pour un meilleur suivi des plans communau- Appui à la Transfusion Sanguine (424757) taires de réduction de risque. Le projet a permis la mise en place de 20 clubs 25 dont les membres aux dons bénévoles de sang. Au total, 14’343 poches de sang collecté (con- WASH (424761) tre 14’000 prévues) dont 9% détruites. Avec le 3058 litres de chlore liquide produite par les CM dynamisme de la mobilisation communautaire, ainsi que 41’346 comprimés de chlore ont été un véhicule a été acheté pour le CRTS par la CRS cédés à plus de 56’000 personnes pour la chlo- afin de lui permettre d’assurer plus facilement la ration de l’eau de boisson. collecte mobile de sang. Sur le plan de l’assainissement, 28 localités sont actuellement en état de pré-certification. 20 nouvelles écoles ont été formées au concept de l’école bleue et ont mis en place leurs jardins scolaires. La réalisation des ouvrages est repoussée sur 2019.

147 Vietnam

Objectives of the country programme Thematic priorities 2017 – 2020

Disaster Risk Management: To increase the re- Institutional Preparedness: To develop the silience of vulnerable communes to natural dis- institutional capacity of VNRC and local govern- asters and climate change through an integrated ment to identify and respond to disaster and DRR programming approach that addresses dis- climate risk through effective and participatory aster and climate change related risk, including planning and implementation of activities aimed those related to health. at reducing risk or providing relief and support to the recovery of affected populations.

Selected Outcome Indicators

DRM3: % of tested disaster response plans updated annually WH2: % of households using and maintaining clean latrines and linked to the provincial response mechanisms

100% 100%

80% 80%

60% 60%

40% 40%

20% 20%

0% 0% Before 2017 2018 Target Before 2017 2018 Target

WH3: % of households using an improved drinking water source

100%

80%

60%

40%

20%

0% Before 2017 2018 Target

148 Summary results 2018

Community Based Disaster Risk Manage- Building resilience through community- ment Ca Mau Phase II (445439) based WASH and household mitigation The activities under this project were largely fin- measures in Ca Mau Province (445442) ished in the previous reporting period. A num- The hygiene practices in target hamlets improved ber of different activities were carried over to after a behavior change strategy was finalized this year, which mainly included the completion and partially implemented. WASH campaigns of the mitigation measure constructions, some commenced in three communes and 24 project procurement of equipment and simulations to staff were trained in PHAST. Due to this roll out, test communal response plans, and documen- 1,540 beneficiaries attended hygiene promo- tation and monitoring activities. Overall six tion sessions and 3,746 children from 9 primary Evacuation Centers and two Evacuation Roads schools across the three communes participated were completed and benefiting 4,815 benefi- in CHAST modules. Sustainable drinking water ciaries directly. Eight communes have disaster and sanitation services were aimed for and 200 management plans in place; and 50% of them beneficiaries received water tanks. To improve meet all of the key criteria of having clearly ar- environmental hygiene three Solid Waste Man- ticulated: early warning systems (EWS); chains agement Stakeholder groups were established of command; roles and responsibilities; evacua- in 3 communes. tion points and are tested annually. In terms of Preparedness as part of resilience for poor preparedness and response mechanism, eight households was increased by connecting to the emergency response teams (ERT) in eight com- Institute of Meteorology, Hydrology and the munes completed refresher training in search Environment and agreements on research into and rescue (SAR). VNRC’s results were evaluated drought were signed and completed. A Forecast through most-significant change (MSC) stories. based Financing baseline data collected. Eight stories were completed toward capacity building on M&E; a documentary film about the project was completed and aired on national TV; Capacity Development VNRC (445443) EWS in 4 communes were installed and tested SRC supports VNRC’s capacity to deliver cash at through annual simulation exercises. VNRC’s scale. A cash position paper was endorsed and provincial chapter officially recognized in Provin- signed by the VNRC leadership. A survey was cial Disaster Management Plan with RDRT being undertaken on Financial Service Providers in Vi- given a formal role in conducting disaster needs etnam and 22 VNRC staff from 12 provinces at- assessments. tended a Cash Level 2 training. By 2018 VNRC’s capacity to lead the national Shelter Working Group is enhanced. One VNRC staff member attended a Short Masters Course on Shelter Coor- dination and VNRC established Shelter WG and finalised TOR with members.

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