Avian and Human Influenza Control and Preparedness ...



GPAI Avian and Human Influenza Control and Preparedness Emergency Project

Indigenous Peoples Planning Framework

Phnom Penh, May 27, 2008

Introduction

1. Cambodia was among the first countries in Southeast Asia to experience Avian and Human Influenza (AHI) with the first case reported in Jan 2004 (for animals) and in 1005 (for humans). The series of repeated outbreaks and associated loss of human life highlight the country’s need to improve the disease surveillance system and limited capacity to control the disease.

2. Consistent with the Global Program for Avian Influenza and Human Pandemic Preparedness and Response (GPAI), this Cambodia Avian and Human Influenza Control and Preparedness Emergency Project supports the implementation of a comprehensive national plan to minimize the threat posed to humans and the poultry sector by AHI infection. There are three main aspects to this project: (i) an Animal Health Component; (ii) a Health Systems preparedness to tackle possible human infections; and (iii) an Inter- ministerial Cooperation for Pandemic Preparedness and Project Coordination.

3. Since the project will take place in areas with substantial ethnic diversity, and because ethnic minorities are often among the poorer and more vulnerable sections of the population, this Indigenous people Framework outlines principles to apply in project areas where indigenous peoples are located. This Framework – which will be used to develop site specific plans[1] – emphasizes the importance of developing a communications strategy which (i) purposefully reaches out to indigenous people groups in their local languages; (ii) tailors AHI messages according to cultural contexts respecting the likelihood that minority communities may not share the worldviews of the majority population. In the case of this project, they may have very different perceptions of animal/human disease. In line with the Ministry of Health’s Action Plan for Avian Influenza (2005), this Indigenous Peoples Framework includes guidelines for raising awareness and involving minority communities in AHI surveillance.

Ethnic Minorities in Cambodia

4. The population of Cambodia is 13.7 million of which 90-95% are Khmer. The remaining 5-10 percent is composed of ethnic minorities such as the Muslim Cham, Chinese and Vietnamese, and seventeen indigenous ethnic minority groups also called “Khmer Loeu” or “hill tribes” who are ethnically non-khmer. These groups are estimated to comprise around 120,000 persons and constitute about 1 percent of the Cambodian population. There are seventeen indigenous minority groups which range from 300 to 19,000 members and include Tampuan, Kui, Jarai, Phnong, Kreung, Kavaet, Brou, Stieng, Lun and others.[2] Under this Bank supported AHI project, only the indigenous peoples belonging to the “Khmer Loeu” or “hill tribes” will be covered under the Bank’s Policy.

5. These groups are distributed throughout the country, but concentrated in the northeast. The hill tribes are considered the most disadvantaged Cambodian population in that they live in isolated areas and have poor access to services including communication. Rapid social change, especially for the hill tribe communities is resulting in the loss of traditional livelihoods systems (swiddening, forest harvesting) with changes in land rights shifting towards the production of commercial crops including for rubber, coffee and cashew nuts. Education levels are low among the hill tribes and access to health services extremely poor.

Legal framework and policies

6. The Cambodian Constitution respects the rights of ethnic minorities, Article 31.2 states “Khmer citizens shall be equal before the law and shall enjoy the same rights, freedom and duties, regardless of their race, color, sex, language, beliefs, religions, political tendencies, birth of origin, social status, resources, and any position.”

7. The definition of Khmer citizens is however controversial. The National Assembly's interpretation in 1995 restricted the term [Khmer] to include some of the country's ethnic minorities, including the hill tribes and Cham, but excluded others such as the Chinese. The country's signature to several human rights conventions however means Cambodia is legally obliged to protect and respect the rights (as covered by the various conventions) of all peoples.

General health status and access to public health services

8. There is little comprehensive information on the health status of ethnic minorities, their health seeking behavior and use of health services. Government health information is not disaggregated by ethnicity. Health information available on ethnic minorities is mainly drawn from NGOs that have been working with specific ethnic groups. Since ethnic minorities typically live in remote areas making access to services (including information and health care) expensive and physically difficult, they may face special risks vis a vis AHI. These risks are compounded by:

▪ Fewer availability of health facilities near indigenous populations

▪ Scarcity of village animal health worker and village health worker

▪ Lack of trained health workers from local indigenous groups,

▪ Low levels of understanding that indigenous people may not share the worldviews of the majority groups, including on perceptions regarding human/animal disease

Program to Assist Indigenous Peoples

9. To enable indigenous communities to better address both the animal and human health risks of AHI, an indigenous people focused communications strategy will be developed which emphasizes:

▪ Learning about AHI via face to face meetings

▪ Having exposure to culturally appropriate forms of media that is gender sensitive, inter-generation ally inclusive; sensitive to varying levels of education (thus creative use of marching, radio, songs, posters, discussions,)

▪ Hearing from respected indigenous people leaders to reinforce the credibility of AHI messages

10. Considerable work has been done in Cambodia to develop AHI communications materials. FAO and AED developed AHI materials to increase public awareness on the animal side whereas UNICEF has developed the human IEC materials. For example, a Bird Flu IEC Committee was established in 2005[3] to harmonize AHI communications materials. In addition, an AHI IEC strategy and program is being drafted by UNICEF with input from IEC committee members.

11. Little attention, however, has been given to the production of indigenous specific AHI communications materials. The Indigenous People’s Plans that will be developed using this Framework as a basis will leverage existing AHI IEC materials and re-craft them to ensure their suitability/appropriateness for the indigenous hill tribes. If possible, the Bank-supported AHI project’s indigenous peoples plan will be folded as part of the IEC strategy based on discussions with the Government and other stakeholders under the coordination of NCDM.

12.The cornerstone of any plan to reach indigenous peoples is to invite their participation and consultation as well to incorporate their views into the design of AHI outreach materials (for example: brochures, booklets, radio messages, plays, songs, posters) and to seek their advice regarding the design of an effective communication strategy (unit of engagement, institutional arrangements, time frame). Using health workers (for both the animal and human side) or facilitators from indigenous communities or NGOs accustomed to working in indigenous is a further step to ensure effectiveness. Elements of this framework which will guide the design of plans once project locations are identified are presented in an attached Annex I.

Institutional Arrangements

|Level |Entity |Responsibility |

|Central/National |Ministry of Agriculture, Forestry and Fisheries (MAFF) |Overall implementation responsibility for IP |

| |Ministry of Health (MoH) |framework |

| |National Committee for Disaster Management (NCDM) |NCDM will coordinate as necessary |

|Provincial level |Provincial Animal Health and Production Office |Implement Annex I |

| |Provincial Health Department | |

|District level |District of Animal Health and Production Office |Implement Annex I |

| |Operational Health District | |

|Village level |Village Animal Health Worker |Implement Annex I |

| |Village Health Worker | |

13. This project will work with existing relevant AHI structures. For example, a Bird Flu IEC Committee was established in 2005[4] to harmonize AHI communications materials. This committee - which meets on an ad-hoc basis - briefs the AHI Partnership Meeting. Since it is a requirement that all AHI materials are passed through this committee, using this committee to assess the availability of IEC materials and to harmonize efforts in this area is crucial.

14. The services of special agencies (Ministry of Culture, ethnology institutes or other) that are able to provide key input and advice regarding the design of communications tools (oral, visual, written using an array of media forms) in minority languages will be developed.

Disclosure of documents

15. This IPPF (Indigenous Peoples Framework) will be made available to the indigenous people communities in the appropriate, form, manner and language.

Monitoring and Evaluation

16. The National Committee for Disaster Management (NCDM) will coordinate with MOH and MAFF to establish and maintain an M&E system for the Indigenous People’s Plan. The Dept of Animal Health and Production (DAHP) and CDC from MOH will establish M&E indigenous indicators to assess progress of outreach to indigenous people areas.

Budget

17. All activities (ultimately through Indigenous Peoples Plans – or IPPs) will be financed from the training/workshop expenditure categories of under Components A & B (Animal and Human Health). The disbursement arrangements for these funds are through the Ministry of Economy and Finance to be channeled to designated accounts under the Implementation Agencies (IAs). Details of budgets needed; allocation measures and entity responsible for implementation of the principles of this IPPF will be detailed in IPPs that will be developed once specific indigenous people project locations are known.

ANNEX I: Indigenous People’s Framework

▪ Language is a barrier that excludes ethnic minorities from participating in development processes and the lack of information and educational materials in the languages of ethnic minorities would be a major impediment towards effective outreach on AHI prevention communication. Thus carrying out all training, awareness raising and development of media products must be in the local language and in a form and manner that is accessible to the local communities

▪ This framework will build on the AHI-IEC developed by the Government in partnership with international donors (UNICEF, FAO, WHO etc). The framework will work with the Bird Flu IEC Committee developed (2005) to harmonize AHI IEC efforts

▪ This framework will also build on, support, or complement the on-going IEC strategy being drafted by UNICEF with input from IEC Committee members. This new AHI project will seek to influence this strategy by ensuring there are indigenous specific strategies included in it.

|Indigenous Peoples Plan for the Avian and Human Influenza Project |

|IDENTIFY THE TARGET AUDIENCE TO IMPLEMENT THE INDIGENOUS PEOPLE’S FRAMEWORK |

|Target Audience |PRIMARY AUDIENCE |Implementer at PRIMARY LEVEL |

| |Indigenous people leaders (formal and informal): screen for their presence in all project locations |Village Health Volunteer (VHVs) for human disease |

| |School teachers |Village Animal Health Worker (VAHW) for animal disease |

| |Poultry traders | |

| | | |

| |SECONDARY TARGETS |Implementer at SECONDARY LEVEL |

| |Health based NGOs |PHD and OD[5] CDC Offices – for human health |

| |Government health units |District Animal Health and Production Office (DAHPO) for |

| |News media sources |animal health |

| |Veterinarians | |

| |Agency and individuals concerned with indigenous people affairs | |

| |Teachers | |

| |Poultry traders | |

|DEVELOP A TRAINING PROGRAM INDIGENOUS PEOPLES AND AHI |

|PHD and OD training |Training to District Veterinary/Health Staff on communicating with, learning from, and how best to effectively reach out|Responsible entity |

| |to indigenous communities |Animal side: NaVRI |

| | |Human side: PHD and OD, monitored by CDC |

| | |Note: organizations such as the Institutes of Ethnology, |

| | |Ministry of Culture and academics working on IP issues should|

| | |help in developing this training module |

|Village level |Train village-based VAHWs and VHVs on AHI and on cultural practices of indigenous communities |Cascade training on Communicable Disease Control (CDC) on |

|training |Try to include indigenous peoples as the local animal and human health workers when possible |human side |

| |Train important people from indigenous peoples’ communities who can best help with outreach of AHI materials. These |District Animal Health and Production Office – animal side |

| |include: | |

| |Children of IPs who can speak Khmer and also indigenous language | |

| |IP formal and informal leaders | |

| |Village Chief (appointed by Ministry of Interior) | |

| |Informal/traditional IP leaders | |

|DEVELOP A VILLAGE CAMPAIGN OF SPECIFIC ACTIVITIES |

|Start the AHI |“Marching” through villages with loudspeakers in indigenous languages |Responsible entity |

|Campaign |Teach children in school about animal and human dimensions of AHI |Animal side: NaVRI |

| |Include “Open Forums, Open Q&A on AHI” in indigenous languages |Human side: PHD and OD, monitored by CDC |

| |Develop community forums on AHI |Note: organizations such as the Institutes of Ethnology, |

| |Community contest on AHI |Ministry of Culture and academics working on IP issues should|

| | |help in developing this training module |

|MONITOR AND EVALUATE EFFECTIVENESS OF REACHING INDIGENOUS COMMUNITIES ON AHI-IEC |

|Monitor and Evaluate|Develop indicators of outreach |Responsible entities are Project Directors of: |

|Activities |Develop M&E Framework |Ministry of Agriculture, Forestry and Fisheries (MAFF) |

| | |Ministry of Health (MoH) |

| | |National Committee for Disaster Management (NCDM) |

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[1] According to the World Bank Policy on Indigenous Peoples (OP 4.10), an Indigenous people Framework is prepared when all programs or subprojects are yet to be fully identified. When all programs, subprojects are known and the presence of ethnic minorities in project locations is determined, then Indigenous Peoples Plans (IPPs) have to be prepared in advance of individual program or subproject implementation and in accordance to the Bank’s Policy.

[2] Pathways to Justice: Access to Justice with a Focus on Poor, Women and Indigenous People. Ministry of Justice, UNDP, September 2005.

[3] This IEC Committee is comprised of the following Ministries: Health, Agriculture, and Information. It also includes UNICEF, FAO, WHO and the UN Resident Coordination Body.

[4] This IEC Committee is comprised of the following Ministries: Health, Agriculture, and Information. It also includes UNICEF, FAO, WHO and the UN Resident Coordination Body.

[5] PHD: Provincial Health Department, OD: Operational District

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IPP381

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