Country Programme Performance Summary for Haiti ISF

Transcription

1 Country Programme Performance Summary for Haiti ISF A. Country Information Country name: HAITI Category per decision 2013/31: Current programme period: Cycle of assistance: 5 B. Country Programme Outputs Achievement (please complete for all your CP outputs) Output 1: Maternal and neonatal health: - Increased capacity of the national health system to provide quality obstetrical and neonatal care, paying special attention to youth needs and to the disadvantaged areas. Indicators Baseline Target End-line data 1-..Number of health centers where the necessary skills and equipment are available to provide basic emergency obstetrical and neonatal care, in compliance with the national norms and standards Number of trained nurses and midwives deployed on the field through UNFPA, based on the national health map. 3-.Number of departmental health directorates supported for the implementation of a set of minimum reproductive health services in situations of crisis March

2 Key Achievements (input also from the last CP evaluation) The level of UNFPA coverage of the country s sexual and reproductive health decreased after the joint UNFPA-UNICEF-WHO project, financed by the Canadian cooperation, ended in 2014, with the number of supported EmONcs decreasing from 4 Donor support to Haiti was also put on hold due to the delayed elections in negatively affecting opportunities also for interventions in maternal health. Instead, consolidating our efforts UNFPA maintained the quality of EmONcs services in the remaining 4 UNFPA-supported centers (1 Ministry of Health (MSPP) EmONc in Marigot, in Petite Place Cazeau/CDS, Carrefour Feuille/Béthany/DSO, and one in Croix-des-Bouquets) that serve as model and training centers for students from the National Midwives Institute. During 2014 and, data from monitoring visits showed that UNFPA supported 18,461 deliveries and 85,841 prenatal visits through these centers. The continual strengthening of the National Midwives Institute (Institut National des Sages-Femmes INSF) remains one of the key contributions of UNFPA with the 3-year direct entry programme and the 18- months programme for qualified nurses. The two curricula were developed to meet the standards set by the International Confederation of Midwives (ICM), the Ministry of Health and Population s standards and the operational needs of the EmONcs. The number of graduates is still much lower than the theoretical needs. 160 midwifery students are currently receiving training. 215 midwives nurses are deployed in the institutions, whereas it is estimated that a total of 1,500 midwives are needed at the national level. An added benefit of this investment in curriculum and capacity building of midwives is that the graduating class of 2016 could be deployed as reinforcements to assist the Ministry of Health in the hurricane affected areas of Grande Anse, Sud and Nippes. Output 2: Family Planning: At the national, regional and local levels, the health institutions are in a better position to guarantee the provision of basic products in the area of reproductive health, including modern family planning methods, and to support actions in this area, creating demand within the communities, with special attention to the youth needs. Indicators Baseline Target End-line data 1-. Percentage of UNFPA supported health 90% 100% 100% institutions that propose at least three modern family planning methods. 2-.Number of supported community actions aiming at promoting the demand in the areas of sexual and reproductive health and of family planning. 3-. Number of supported initiatives aiming at improving access to sexual and reproductive health, and to education on that matter, for the youth March

3 Key Achievements (input also from the last CP evaluation: UNFPA supported the Family Planning Campaign implemented by the Government and its partners in The short-term methods meet 94% of women s demand. Among the long-term methods, implants are preferred, covering 5% of the global demand, and 79% of the demand for long-term methods. By comparison, 2% of the clients of UNFPA supported implementing partners use long-term methods. From January 2014 to March 2016, 136,826 girls and women were using modern contraception methods, of which 3,112 were long-term and 133,714 were short-term methods. The FP needs of youth, and specifically of adolescent girls, are not adequately addressed by the public sector nor by UNFPA partners activities. The supported implementing partners do not propose services or specific implementation modalities for this group, because there are no specific or dedicated policies targeting the needs of adolescents. Current legislation also prohibits adolescents from accessing RH services without parental consent which further limits efforts to promote FP to this target group. Service supply improved. In, about 97% of the institutions offered at least 3 birthcontrol methods, which represents an improvement compared to the CPAP s reference point (90%). The value of this indicator is of 100% for the UNFPA supported partners (GPRHCS ). Output 3: Data collection: Improvement can be seen in the national statistics system s capacity to collect, produce and disseminate reliable socioeconomic data, broken down by age groups, (aimed at improving sexual and reproductive health policies at national and local levels). Indicators Baseline Target End-line data 1-. Number of UNFPA supported technical experts belonging to management structures trained to collect, analyze and disseminate data from surveys and censuses, including in humanitarian crisis situations. 2-. Number of management structures able to implement the directives of the national statistics system to update the normalized statistics on gender based violence, sexual and reproductive health, and youth Key Achievements (input also from the last CP evaluation) UNFPA made a significant contribution in the area of data production in the sectors covered by its mission, through the support it provided over the full period of the technical preparation of the General Population and Housing Census. Due to population movements following the earthquake, it was not possible to keep the initial date of 2013 for the Census. Instead, UNFPA s support made it possible to update the maps supporting the surveys and to provide technical support to the Haitian Institute of Statistics (IHSI) to prepare the logistics for the surveys. Ultimately, the Country Office successfully mobilized USD 30 million from donors to support the 5 th GPHC now planned for UNFPA participated in the preparation of EMMUS 5 also scheduled for Apart from these major surveys, the UNFPA s actions in the areas of data production and standardization were limited and directly operational (essentially administrative data for The Ministry of Health and the Ministry of Women s Affairs. 3 March

4 Output 4: Data analysis: The Government and the civil society organizations have increased capacities to use socio-demographic data to develop, implement and follow-up on policies and programmes related to the dynamics of the populations, the youth, gender equality, and sexual and reproductive health. Indicators Baseline Target End-line data 3-. Number of management structures supported by UNFPA for the use of updated data from censuses and surveys, to develop, implement and follow-up on public policies and programmes in the areas of the population dynamics, youth, gender equality, and sexual and reproductive health. Key Achievements (input also from the last CP evaluation) UNFPA financed the CEPODE (a teaching and research center). The center organized, with UNFPA s support, a Master s Degree on «Population and Development» (MAPODE) specifically for public servants. The objective was to take advantage of graduates acquired skills to improve the quality of the policy and programming documents when they return to their respective ministries. During the country programme implementation period, this initiative did not lead to an improved understanding of how reproductive health rights could be promoted within public policy, nor did the course analyze factors preventing young people, particularly teenage girls from accessing information on family planning, preventing early pregnancies or access to abortion. A fortiori, UNFPA could not raise the debate on these important issues using the human rights-based approach, as originally envisaged within the curriculum. Based on lessons learned, UNFPA will instead use the 2017 census as an opportunity to engage policy makers and ignite debate around population dynamics and the use of evidence based data in policy making. Output 5: Gender Equality and Rights: The public institutions and civil society organizations strengthened their capacity to design, implement and follow-up on policies and programmes meeting women and youth s expectations in the areas of gender equality, reproductive health and rights, gender based violence, and care to such violence s victims, including in humanitarian crisis situations. Indicators Baseline Target End-line data 1-. Number of supported public institutions and civil society organizations for the design, implementation and follow-up on policies and programs for gender equality, and reproductive rights. 2-. Number of technical experts at public institutions habilitated to coordinate and lead the efforts to fight against gender based violence, including in humanitarian crisis situations Number of UNFPA supported civil society organizations implementing gender based violence prevention and victims care programs, including in humanitarian crisis situations March

5 Key Achievements (input also from the last CP evaluation) UNFPA's assistance aims to achieve institutional strengthening of the Ministry of Women Affairs to better coordinate actions to improve the situation of women in Haiti. UNFPA supported advocacy efforts to preserve hard-won gains in fighting GBV as well as to ensure the implementation of laws and policies aimed at the empowerment of women, particularly adolescent girls. For example, UNFPA provided technical and financial assistance for the adoption and the awareness of the law on Responsible Fatherhood as a way of including men in efforts to empower women. UNFPA also supported legislation and current policies on gender equality. In addition, UNFPA has supported The Ministry of Women s Affairs participation in international conferences to guide the integration of international and regional strategies into Haiti s efforts to enhance gender equity. Outreach to young women was central to the current country programme. UNFPA supported young mothers to gain financial independence and control over their reproductive health. For example, a good number of adolescent mothers Were able to earn a living thanks to the training and tools given to them. Moreover, civil society organizations (COFAVIV, Hope of Women) were supported to facilitate their contribution to the struggle for gender equality. Medical assistance to victims of gender-based violence is one of the highlights of the programme. All institutions supported by UNFPA are equipped with tools and staff for medical care and referrals for legal and psychosocial assistance. The CO also conducted annual trainings on MISP (Minimum Integrated Services Package) to ensure that the reproductive health and rights of women and girls are respected during emergencies. However, following the hurricane, despite having staff within the Ministry of Health trained on MISP, due to lack of supplies and clear organizational structures, it was clear that more needs to be addressed in this area. Among the other UNFPA partners, CPFO (the Center for the Promotion of Women Workers) develops an approach based on human rights for gender equality which will form the platform for engagement with the private sector in the coming country program where the garment industry will be targeted to provide family planning services to their employees. The EmONcs have an important role to play in the provision of medical care to victims of gender based violence. The UNFPA s annual support mentions 172 out of 252 female victims (68%) who received support. However, the number of female victims and the number of victims who received care, and the nature of the provided care, remains unclear. C. National Progress on the Strategic Plan s Outcomes 1 Start value Year End value Year Comments Outcome 1: Increased availability and use of integrated sexual and reproductive health services (including family planning, maternal health and HIV) that are gender-responsive and meet human rights standards in terms of care quality and equity of access Percentage at which at least seven life-saving maternal/reproductive health drugs in the WHO priority list are available at 95% of the service delivery points in the country. N/A % 6 at 95% except Hydralazine at 88%. 1 The format is aligned to the UNFPA Strategic Plan s outcomes,. 5 March

6 Contraceptive prevalence rate (total) 31% % 2012 Percentage of the total demand for contraception that is satisfied 65% % 2012 Percentage at which at least 60% of the service delivery points in the country did not experience any stock-out of contraceptives during the last six months 40% % Percentage at which at least 80% of live births in the country are attended by skilled health personnel 37% % 2012 Number of adapted and implemented family planning services protocols in the country that meet human rights standards, and that are free of discrimination, coercion and violence NA NA 25% in 2005 waiting for next DHS (2016). Waiting for next DHS (2016). Waiting for next DHS (2016). Percentage of women and men aged who had more than one sexual partner during the past 12 months who reported that they used condoms during their last intercourse (female/male) Was the country s national budget for sexual and reproductive health increased by at least 5 per cent? 23.6% % 2012 NA Waiting for next DHS (2016). No specific budget for RH 6 March

7 Summary of National Progress Use of contraception among women of child bearing age does not seem to have significantly increased to date. The available data indicates that in the absence of extensive efforts in the near future, the objective of 25% prevalence rate by the end of 2016 will not be reached. The statistical yearbook of the Ministry of Health estimates the number of FP methods users to be 531,770, or a prevalence rate of 18.6%. The data should be confirmed by the DHS (EMMUS VI). In, about 97% of the institutions were offering 3 contraceptive methods, which represents an improvement compared to the CPAP s reference point (90%). The value of this indicator is of 100% for the UNFPA supported partners (GPRHCS ). UNFPA s Contributions The takeover of the distribution of FP inputs by the DSF using the CHANNEL software produced some improvement in the availability of the products. The GPRHCS survey report indicates that only 53% of the PPSs did not experience any stock-out of at least one of the three contraceptive methods. It is an improvement compared to the year 2014 when only 18% of the PPSs did not experience any stock-out. However, significant efforts are still needed to guarantee the availability of family planning inputs throughout the year. UNFPA-supported partners also conducted community outreach in market places, industrial parks (garment factories), schools, and for out-of-school youth. UNFPA selected as partner organizations working with the youth that, in principle, promote health and reproductive rights of youth through their policies and programmes. UNFPA also targeted organizations that were able to provide adapted SRH/FP services to youth. For example, youth organizations (FOSREF/VDH) and/or SRH/FP services providers (PROFAMIL, CDS, DSSE, DSNI, DSO, ZL) were selected, but the focus of their programmes was on the implementation of the SH and FP prioritized as part of the Haiti National Strategic Plan rather than on promoting a broader SRH agenda for youth. Outcome 2: Increased emphasis on adolescents, especially on very young adolescent girls, in the national development policies and programs. Particularly, increased availability of comprehensive sexuality education and sexual and reproductive health. Percentage of young women and men aged who correctly identify ways of preventing the sexual transmission of HIV and who reject major 87% 2012 DHS 4 misconceptions about HIV transmission (female/male) Does the country have laws and policies that give adolescents (regardless of marital status) access to sexual and reproductive health services? No 2012 No March

8 Summary of National Progress There are some achievements in the area of reproductive health for the youth, and specifically in the school environment. After repeated discussions, the Ministry of National Education committed to including reproductive health in the education curriculum, which would contribute to improving knowledge and attitude about reproductive health. Initially this meant a focus on after school health clubs but UNFPA and its partners will follow up with the Ministry to ensure that this goal is realized. UNFPA s Contributions UNFPA s strategic approach of working through partners to reach out to groups that do not have access to reproductive health services did not produce the expected results despite the fact that the IPs are situated in underprivileged areas where they are likely to reach these groups. Two NGOs (VDH and FOSREF) had the expertise and the logistics for interventions among the youth. Their cooperation with UNFPA came to an end in 2013 (FOSREF after participating in the 2013 FP campaign) and in 2014 (VDH). The opportunity to make significant progress in this area is hampered by current legislation that prevents young people from accessing RH services without parental consent. Further work is needed on behavior change communication in order to challenge the status quo. As a result, actions to reach out to youth were limited to awareness-raising only. Training and retraining activities on sexual and reproductive health were implemented by said organizations for staff, providers and youth. These organizations promoted youth-adapted SRH services in underserved communities, and offered services at youth centers. Through awareness-raising activities targeting sexual heath by peer educators, many schools were reached. Very often, youth are not in a position to exercise their rights, making informed decisions on their sexuality so as to better plan their lives. The UNFPA supported services are open to all, including the youth; but the implementing partners did not offer full and integrated quality SRH services, or ageappropriate information and education on sexual and reproductive health for youth, with a human rightsbased, gender and culturally sensitive approach. Providing care to minors (under 17 years old) in the absence of their parents raised legal issues in Haiti, which did not as yet find an appropriate solution. The situation for 18 to 24 years old youth is different; most often they are individuals with a limited purchasing power and time (school, college) and who are very sensitive to the quality of the services offered. For the next cycle, UNFPA partners should implement specific and age appropriate interventions for this target group. Outcome 3: Advanced gender equality, women s and girls empowerment, and reproductive rights, including for the most vulnerable and marginalized women, adolescents and youth Does the country have gender equality national action plans that integrate reproductive rights with specific No 2012 No 2016 targets and national public budget allocations? Proportion of actions undertaken by the country on all of the Universal Periodical Review (UPR) accepted recommendations on reproductive rights from the NA previous reporting cycle Percentage of women aged who think that a husband/partner is entitled to hit or beat his wife/partner under certain circumstances 16.7% % 2012 DHS 4 8 March

9 Summary of National Progress Public institutions and civil society organizations strengthened their skills in the design of policies and programmes to meet the expectations of youth in the area of gender equality, reproductive health and rights, gender-based violence, and care to the victims of violence. UNFPA s Contributions UNFPA had previously supported the strategic strengthening of the Ministry of Women s Affairs (MSCFDF) in some aspects linked to the regulation, legal and sector policies frameworks. These actions were discontinued under the 5 th country programme to avoid overlap when UN WOMEN was created and started to work on gender equity at a policy level. UNFPA s contribution to raising awareness about gender based violence and to improving the response also involved training of new human resources: Deployment of staff trained on gender issues to the different directorates of the Ministry of Women s Affairs (UPE, Disputes Office, DatabaseUnit); Training of staff members in collecting, producing and analyzing data on gender issues, which will support documentation of gender-based violence in Haiti; Reinforcing the Ministry of Women s Affairs with staff trained by the Haitian Institute of Statistics in order to pull out data and information from DHS (EMMUS) and produce gender analysis documents; Elaboration of an inventory of studies on violence in Haiti There is an overall consistency between the content of the AWPs (activities, action plans) and the CPAP s products and results. As for gender equality and reproductive rights, the 5th Country Programme showed weaknesses in terms of internal consistency at an operational level. While the objectives were clearly established for the partners, the activities of some of them seem to be either mainly aligned to their usual workplan with a low level of contextual adaptation to the results expected by UNFPA, or responding to circumstantial events, lacking coherent logic. Much more can be done with partners to align them with results-based, human rights-based thinking, but it will require greater focus on behavior change communication. With regards to GBV, qualified staff was available at the UNFPA-supported health institutions to receive and provide care to victims of gender-based violence victims. Medical care in cases of GBV is included in the UNFPA-supported EmONc s mandate. One of the objectives in the area of medical care was to train providers on GBV and to strengthen GBV-related services at the EmONCs. These services were in fact available at the UNFPA supported structures. The partners (CDS, Zanmi Lasante, PROFAMIL, DSSE, DSNI, DSO) strengthened their service offerings. CPFO has interventions in the areas of providing medical and psychosocial care to victims of violence, and offering SRH services to women and girls. Contrary to other partners, the CPFO partly adopted the human rights-based approach. Evidence suggests that individual and community empowerment can become another entry point towards improving the situation of women in Haiti. Outcome 4: Strengthened national policies and international development agendas through integration of evidencebased analysis of population dynamics and their links to sustainable development, sexual and reproductive health and reproductive rights, HIV and gender equality Was at least one quality census conducted in the country, producing data that was processed, analyzed and disseminated following internationally agreed recommendations (during the last 10 years)? Was a national household survey conducted in the country, producing data that was analyzed and disseminated, and making it possible to have estimates related to key population and reproductive health indicators (during the last 5 years)? No Planned for 2017 Yes 2012 DHS 4 9 March

10 Were national evaluations of strategic interventions on sexual and reproductive health, and on adolescents and youth conducted? Proportion of new national development plans that address population dynamics, taking into account population trends and projections in setting development targets NA NA 10 March

11 Summary of National Progress Haiti has a national policy document, the Strategic Plan for the Development of Haiti- Horizon This document, issued in 2012, takes into account the ICPD and the MGDs goals, is aligned with SDGs and has mostly the same indicators. The last Housing and Population Census dates back to 2003, prior to the 2010 earthquake. However, population projections were conducted on a regular basis in 2011, 2013, and. The 5 th Census is planned to be held in Haiti conducted its 5 th survey on mortality, morbidity and use of services (DHS V) in 2012; the 2017 version is in its preparation phase. Haiti conducted a major post-earthquake socio-economic survey: Living Conditions of Households after the Earthquake. Final reports of the MDGs and the ICPD were produced in UNFPA s Contributions As a member of the national steering committee, UNFPA has contributed to the Strategic Plan for the Development of Haiti- Horizon 2030, providing some basic data to support the analysis and establish baselines. The 5th Country Programme is aligned with the national policy document, so that the contribution of UNFPA to results is straightforward. With respect to the Census, UNFPA has funded much of the preparatory phase, including the update of the census mapping. In addition, UNFPA has successfully mobilized resources to support the implementation of the Census in In addition, regular population projections were supported by UNFPA though its partnership with the Latin American Association of Population (ALAP). UNFPA supported the last DHS, held in 2012 and will be supporting the next DHS with a funding of up to US$ 200,000. UNFPA participated with the government in the monitoring of the MDGs. Also, periodic ICPD reports were shared with the government. A SDGs monitoring system is being launched. UNFPA is part of the small group that spearheaded this process. UNFPA partners with the Ministry of Planning and the Ministry of Foreign Affairs for the promotion and monitoring of the SDGs. UNFPA supports the Haitian Institute for Statistics for the expansion of the National Statistics System so that thematic data produced are validated and used for decision-making purposes. In this context, UNFPA has supported the Ministry of Women s Affairs in order to set up a GBV database. Although the architecture of the database has been developed, it needs to be fed with data and periodic statistics. An ongoing partnership with the Haitian Institute of Statistics allows UNFPA to provide technical assistance in this phase. 11 March

12 D. Country Programme Resources SP Outcome Choose only those relevant to your CP Regular Resources (Planned and Final Expenditure) In million US$ Others (Planned and Final Expenditure) In million US$ Total (Planned and Final Expenditure) In million US$ Increased availability and use of integrated sexual and reproductive health services Youth policies and programmes, and increased availability of comprehensive sexuality education Advanced gender equality, women s and girls empowerment, and reproductive rights Strengthened national policies and international development agendas with the integration of evidence-based analysis of population dynamics Programme coordination and assistance Total March