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UNICEF DPR Korea:
PROGRAMME STRATEGY NOTE
Country Programme 2017 – 2021
(As of 23 February, 2016)
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UNICEF DPRK: Programme Strategy Note
Country Programme (2017-2021)
Contents
1 Context ............................................................................................................................................... 6
2 Priorities ............................................................................................................................................. 7
3 Opportunities ..................................................................................................................................... 9
4 Overview of the programme structure ........................................................................................... 10
5 Geographic Coverage and Convergence .......................................................................................... 12
6 Health Programme Strategy Note ................................................................................................... 16
6.1.1 Programme rationale ........................................................................................................ 16
6.1.2 The Results Structure (Outcome, Outputs and Indicators) .............................................. 17
6.1.3 Theory of Change .............................................................................................................. 17
6.1.4 Strategies .......................................................................................................................... 19
6.1.5 Health programme sub-components ................................................................................ 21
6.1.6 Disaster management and resilience building .................................................................. 23
6.1.7 Assumptions and Risks ...................................................................................................... 23
6.1.8 Monitoring outputs and UNICEF s contribution to outcomes ................................................. 24
7 Nutrition Programme Strategy Note ............................................................................................... 25
7.1.1 Programme rationale ........................................................................................................ 25
7.1.2 The Results Structure (Outcomes, Outputs, Indicators) ................................................... 29
7.1.3 Theory of Change .............................................................................................................. 29
7.1.4 Strategies .......................................................................................................................... 33
7.1.5 Assumptions and Risks ...................................................................................................... 33
7.1.6 Monitoring outputs and UNICEF s contribution to outcomes .......................................... 34
8 WASH Programme Strategy Note .................................................................................................... 36
8.1.1 Programme rationale ........................................................................................................ 36
8.1.3 Theory of Change .............................................................................................................. 37
8.1.4 Strategies .......................................................................................................................... 40
8.1.5 Assumptions and Risks ...................................................................................................... 40
8.1.6 Monitoring outputs and UNICEF s contribution to outcomes .......................................... 41
9 Social Inclusion Strategy Note ......................................................................................................... 41
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9.1.1 Programme rationale ........................................................................................................ 41
9.1.2 The Results Structure (Outputs, Outcomes, Indicators) ................................................... 45
9.1.3 Theory of Change .............................................................................................................. 47
9.1.4 Key partners ...................................................................................................................... 49
9.1.5 Strategies .......................................................................................................................... 49
9.1.6 Assumptions and Risks ...................................................................................................... 50
9.1.7 Monitoring Outputs and Demonstrating UNICEF s Contribution to Outcomes ............... 50
10 Fundraising Strategy .................................................................................................................... 52
5.3 Fund-Raising and Leveraging Resources Strategy: ............................................................... 56
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ACRONYMS
BCC - Behaviour Change Communication
BCG - Bacillus Calmette-Guérin
CBS - Central Bureau of Statistics
CHDs - Child Health Days
CMAM - Community Management of Acute Malnutrition
CMT - Country Management Team
CMW - Central Medical Warehouses
CO - Country Office
DOTS - Directly Observed Treatment, Short-Course
DPT - Diphtheria, Pertussis, Tetanus
EPI - Expanded Programme on Immunization
EVM - Effective Vaccine Management
EMOC - Emergency Obstetric Care
EPI - Expanded Programme on Immunization
ERM - Enterprise Risk Management
GAVI - HSS2 - Global Vaccine Initiative Health Systems Strengthening Projects 2
GF - Global Fund
GFS - Gravity Fed System
Hib - Haemophilus Influenza b
IEC - Information, Education and Communication
ICN - Institute of Child Nutrition
IDD - Iodine deficiency Disorders
IYCF - Infant and Young Child Feeding
IMNCI - Integrated Management of Newborn and Childhood Illnesses
INGO - International Non-Governmental Organisation
IRS - Indoor Residual Spraying
ITC - Insecticide-Treated Clothing
IMR - Infant Mortality Rate
IMNCI - Integrated Management of Neonatal & Childhood Illness
KAP - Knowledge, Attitude and Practices
MMR - Maternal mortality rate
MoPH - Ministry of Public Health
MDD - Micronutrient Deficiency Disorders/ Diseases
MMN - Multiple Micronutrient
MNP - Multi-micronutrient Powder (Sprinkles)
MNT - Multi-micronutrient Tablets
MOCM - Ministry of City Management
MOPH - Ministry of Public Health
MPPT - Mass Primaquine Preventive Treatment
NCC - National Coordination Committee
NNS - National Nutrition Survey
ORS - Oral Rehydration Salts
SAM - Severe Acute malnutrition
SOP - Standard Operating Procedure
TB - Tuberculosis
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EXECUTIVE SUMMARY
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1 Context
UNICEF has provided support to the Government of the Democratic People s Republic of Korea
(DPRK) since 1986. However, it was not till 1996 that a Basic Cooperation Agreement (BCA) was
signed and an office was established. The current programme cycle covers the period 2011
to2016, which was later extended by one year to 2017. The extension was prompted by the
fact that over a nine month period in 2014 UNICEF and other UN agencies were unable to
transfer funds into the country due to international sanctions. Mid-Term Review was held in
2013 which allowed adjustments to the programmatic focus. Many of these recommendations
were incorporated into the design and scope of this new country programme.
UNICEF and the UN System face specific programmatic and operational challenges. All
information and data in DPRK are in the hands of, and controlled by the Government, notably
the Central Bureau of Statistics (CBS) with which the UN works closely. The CBS releases official
data and statistics only to the extent that it can be convinced that it is required for the specific
purpose intended. The UN frequently feels this process seriously impedes its ability to
undertake or contribute adequately to situation analyses, monitoring, evaluation and
reporting.
Monitoring visits to project activities is an essential component of the UN's work. In DPRK, this
is complicated by the need to obtain advance clearance for any such travel;the detailed
itinerary to be planned in advance , international staffto be accompanied by seconded DPRK
nationals, as guides and interpreters. In some counties, only national staff are permitted
access. The current filtration process on monitoring diminishes the independence and
objectivity of such monitoring activities and the consequent credibility and accountability of
the UN. Even within a location where UNICEF has been granted access, all aspects of the field
trips are controlled by the People s Committee.
UNICEF's national personnel is, without exception, seconded from the government, mainly
from the Ministry of Foreign Affairs (MoFA) for a limited period of time, normally three years.
Only UNDP has agreed with the authorities that their staff be accorded UN contracts, but their
personnel is also released from government for a limited period for direct hiring in UN service.
Selection processes for seconded staff vary a little between UN agencies. There is general
consensus that the technical qualifications of those proposed do not always match the
requirements of the agencies- and that the three-year secondment provides insufficient time
to train them, nor for them to provide the traditional role of institutional memory, continuity
and perspective amidst a rotational international UN management. Accountability of seconded
staff is to the government, not to UNICEF.
The DPRK authorities also limit the number of international staff permitted into the country.
This cap on international staffing appears to be based on a ratio of staff member to UN funds
managed, and is not driven by the nature and scope of the programme. This might be
understandable if the UNICEF s primary role were resource transfer but our work often focused
on advocacy, technical assistance, capacity development and monitoring results for children
which is unrelated to its direct costs. Moreover, the continual turnover of national staff puts a
far greater responsibility for basic processes on international personnel.
When international staff members travel on mission, home leave or R and R, there is no one to
replace them. They leave a vacuum that is only filled on their return. An Ebola quarantine of 21
days were imposed on all international visitors resulting in prolonged absences and prevented
7
donor and other missions from taking place. Due to the consequences of the Ebola quarantine,
UNICEF CO had to operate without an international WASH officer for three months in 2015.
With sixty per cent of the programme dedicated to procurement, the long lead time for
supplies and logistics, a ban on imports from certain countries, and delays in port clearance,
represent major bottlenecks in the delivery and distribution of essential medicines and
commodities.
2 Priorities
The breakdown of the socialist bloc in the late 1980s had a detrimental impact on DPR Korea.
This resulted in downturn in industry and agriculture. Energy production declined. Capacity to
ensure food security and maintain social services were impaired. Floods and droughts,
beginning in the 1990s, further damaged industry, mines and agricultureled to acute food
shortages and malnutrition. There followed ten years of humanitarian assistance. The Situation
Analysis of Children and Women (2015) points to the fact that the indicators of child well-being
have not returned to the levels prior to the crisis of the 1990s.
The DPR Korea s economy remains fragile. Weak resilience and vulnerability to shocks
exacerbates economic vulnerability. Difficulties in securing energy, poor infrastructure,
imbalanced import-export policies, constraints in introducing new technologies, and
international sanctions contribute to the economy s instability and directly impacts vulnerable
populations.
State-owned industries account for nearly all of GDP. There is virtually no private sector and no
independent civil society organizations. Government allocations to the social sectors are
unknown. Overall, the Government s control over relevant and reliable data is a major barrier
to analysis, planning and monitoring results for children.
The country s isolation and geopolitical tensions make fundraising for children extremely
difficult. The UN country analysis proposes a revitalised narrative to mobilize international
support for development and humanitarian work.
The country faces recurring natural disasters such as floods and droughts. Flooding has
occurred almost every year over the last five years with the 2013 affecting 800,000 people. The
Office for the Coordination of Humanitarian Affairs (OCHA) ranks DPR Korea eighth in the
region in terms of risk and vulnerability. While there is no classical humanitarian crisis,
protracted needs persist. The UNestimates that 18 million people are food insecure, six million
people do not have access to essential health services, and seven million people are deprived
of clean water and proper sanitation.
The population figure currently stands at 24.6 million in 2014, with 24 per cent under 14 years
of age. Women represent 51.3 per cent of the population. Cultural patterns assign to them
child care, though the state quickly intervenes to assume that role. Social norms have a positive
effect on pregnancies as only 0.1 per cent of women become pregnant before the age of 20.
There is no data on domestic violence or human trafficking, and no credible gender analysis in
the country.
There has been no MDG progress report. The last report to the Committee on the Rights of the
Child was due in 2012. The report to CEDAW was due in 2006. The Convention on the Rights of
Persons with Disabilities was signed in 2013, but not yet ratified. UNICEF operates in a policy
environment that is evolving and requires ongoing support.
8
Disparities exist between the population in Pyongyang and those living outside the capital.
Without empirical evidence of income distribution, the extent of geographical disparities based
on quintiles cannot be ascertained. However, data emerging from the national nutrition survey
indicate major disparities in nutritional status, particularly stunting, between outlying provinces
and the capital. The limited data and the fact that UNICEF cannot communicate directly with
local communities make the work of advancing the equity agenda particularly challenging.
All aspects of everyday living fall under state control from social services and population
movements, to the institutionalized care of children in baby homes, boarding schools and
special schools for children with disabilities. The country thus presents to the world a unique
political, social and cultural environment in which programming for children takes place.
The breakthroughs in child survival and development, DPR Korea faces obstacles in the
progressive realization of child rights. With IMR at 23/1000, twenty-four children die every day.
A child born in DPR Korea is 6.4 times more likely to die before the age of 1 than a child in the
Republic of Korea. With U5M at 27/1,000, twenty-eight children die every day from
preventable and treatable illnesses. The two major killers of children are pneumonia (12 per
cent in 2015) and diarrhoea (6 per cent in 2015). Neonatal deaths stand at 16/1,000, with 13
children dying every day because of preterm birth, complications, infections or hypothermia.
According to UN estimates, the maternal mortality ratio (MMR) has increased from 81 in 2012
to 87/100,000 in 2013, with one mother dying every day in childbirth. The increase in MMR is
due to a non-responsive health system, limited coverage and compromised quality of maternal
health services. The inadequate nutritional status of women before pregnancy contributes to
high MMR. MDGs 4 and 5 were not achieved.
The 2012 National Nutrition Survey showed that there was a modest decrease in under-five
chronic malnutrition from 32.3 per cent in 2009 (MICS) to 27.9 per cent. Nutritional status
remains a major concern given the irreversible impact of stunting on child development. Severe
acute malnutrition (SAM) is at 0.6 per cent. Chronic and acute malnutrition result from food
insecurity, unsafe drinking water, poor sanitation and hygiene, degraded environments,
absence of essential medicines, and the inadequate nutritional status of mothers.
The piped water supply systems, constructed in the 1990s, are collapsing due tolack of
investment, poor maintenance and rehabilitation schemes. The situation in access to water has
worsened because of shortages in electricity and damage caused by recurrent flooding on the
infrastructure. Twenty-four per cent of the population use rudimentary latrines which are
ineffective in preventing faeces from entering the environment. There is open defecation,
unsafe handling of excreta in agriculture, and inadequate access to water and sanitation
facilities in schools, health facilities and childcare institutions.
The country has maintained near universal literacy. The 2009 MICS2009 showed net enrolment
at 100 per cent with gender parity, a primary level (grade one tofour) completion rate of 100
per cent, and a 100 per cent transition to secondary schools and 97.8 per cent of under-5 s
benefit from early childhood education. The first twelve years of schooling are compulsory.
There are a 1,000 branch schools for communities living more than four kilometres from a
school. Branch schools share the same national curriculum however are not able to deliver the
same quality of education. There are 13,000 children aged below the age 17 living in
institutions run by the state. Institutionalized care runs counter to international norms of
inclusive education. There are only 11 special schools throughout the country, three schools for
blind children and eight schools for deaf children of which none are located in Pyongyang.
9
Based on available data, UNICEF estimates that over 50,000 children with disabilities do not
have access to appropriate education and are amongst the most vulnerable.
3 Opportunities
DPR Korea s response to the Universal Periodic Report (UPR) in 014 offers the opportunity to
gauge national positions on key issues - from poverty and hunger to climate change and the
environment, all the more valuable as they are framed in human rights language. DPRK
accepted 113 of the 185 recommendations. . Fifty of these recommendations that enjoy the
support of the Government can be directly or indirectly linked to UNICEF s mandate. In
accepting these recommendations DPR Korea has acknowledged the right of the child to clean
drinking water, to improved hygiene and sanitation, to increased resources for the health
system, to lowering child and maternal mortality, to the better training of medical personnel,
and to ensure that children in the most disadvantaged areas enjoy equitable benefits in health
and education.
Thus, the new country programme offers UNICEF the opportunity to put Rights Up Front , to
advance the equity agenda as far as the political context and data gaps will allow. The new
Country programme will support the Government s efforts in progressively realizing the rights
of the child, and to continue to insist on normative principles in mother and child health,
nutrition, WASH and education.
The Sustainable Development Goals (SDGs) come at an opportune moment as they allow the
country programme to be aligned with renewed international targets, standards and indicators
across the development spectrum – from improved nutrition, healthy lives and well-being for
all, to inclusive quality education, equitable access to clean water and sanitation, and to
reducing inequalities.
United Nations Strategic Framework (UNSF) focuses on human rights issues through the
agencies mandates. The Government has agreed to provide a policy overview and new data
where possible to each of the four main pillars of the UNSF
(i) Pillar 1 prioritizes Food and Nutrition Security: Outcomes under this umbrella
focus on food and nutrition security through increased food production and
processing, improved household access to diversified food through enhanced
productivity and livelihood, and the improved nutritional status of women of
reproductive age and children under-five.
(ii) Pillar 2 prioritizes Social Development: Outcomes under this area targets sustained
universal health coverage with emphasis on primary health care, improved services
for communicable and non-communicable diseases and MCH, emergency
preparedness and response, a multisectoral approach to health, equitable and
sustainable WASH coverage, and equitable access to primary, secondary, tertiary
and vocational education.
(iii) Pillar 3 prioritizes Resilience and Sustainability: Outcomes under this area focuses
on the coping mechanisms of local communities in emergencies, and to respond to
ongoing energy needs, environmental management, climate change, and disaster
risk management
(iv) Pillar 4 prioritizes Data and Development Management. Outcomes under this
areafocuses on availability of reliable development and humanitarian data for
policy development, capacity to apply international norms, and compliance with
international treaties and conventions.
10
These four areas have been identified with the assumptions that the external environment will
continue to be difficult, that internal and external resources will continue to be challenging,
and that any support of the UN needs to be flexible and adaptive. The nature and scope of the
collective actions of the UN system within this agreed framework resonates well with the
mission and mandate of UNICEF in DPRK. UNICEF can make substantive contributions across all
four outcome areas of the UNSF..
The UNSF has been explicitly designed as a hybrid document bridging both immediate and
short-term humanitarian assistance with long-term development support. The strategic vision
for the CPD has been anchored in both equity and sustainability, prioritizes the strengthening
of capacity of technical personnel at central and sub-national levels, plans, implements,
monitors, evaluates and reports results for children in both development and humanitarian
contexts. . Humanitarian action will provide an opportunity for capacity development and
systemic improvements, thus creating synergy between the humanitarian and development
nexus
4 Overview of the programme structure
The conceptual framework below provides an overview and focus of the UNICEF DPRK s
nutrition, health, WASH and social inclusion programmes. Emergency preparedness and
response in these four areas has been integrated into each programme component and not
treated as an add-on. Specific support for strengthening the capacity of the National
Commission for Emergency and Disaster Management will be covered under the WASH
Programme. Based on UNICEF s Strategic Plan 2014-2017, the programme integrates bundle of
data strengthening, technical assistance and policy dialogue. Capacity development in the
context of DPRK focuses on strengthening the skills and knowledge of services providers in
order to improve the quality of services as well as strengthening the knowlege and practice of
care givers in terms of child care and infant and young child feeding.
Communication for development addresses demand creation and behaviour change. UNICEF s
normative role is at the heart of the programme. Cross-sectoral synergies are made explicit in
the conceptual framework, and in the results and resources framework shown in Annex 1.
11
DPR Korea
CPD Conceptual Framework
Social Inclusion
Policies, programmes and CRC reporting are better informed by evidence and analysis of disaggregated data.
• Education Commission (Learning Outcomes)
• Central Bureau of Statistics (Child Data Management Unit)
Water, Sanitation and Hygiene (WASH)
Increase access to improved water and sanitation
Improved hygiene practices• Policy, planning, data• Schools and Health Facilities• Gravity Feed Water Systems• Sanitation + Hygiene practices• Clean drinking water at
household level
Nutrition Reduced stunting and wasting Improved feeding practices and early
childhood stimulation.• Policy, planning, data, • Integrated Management of Acute
Malnutrition• Infant and Young Child Feeding (IYCF), • Micronutrients Maternal, Newborn and
Child Heath (MNCH)
Reduced maternal mortality Reduced Under 5 mortality
(Focus on neonatal health) • Policy, planning, data• Integrated Management of
Neonatal and Childhood Illnesses (IMNCI)
• Expanded Programme of
Immunization (EPI) Plus• Emergency Obstetric Care • Tuberculosis (TB) & Malaria
CRC CEDAW
CRPD
UNSF
SDGs
UPR
Stra
tegi
es1
Strategies 1
Strategies1
Strategies1
• Data/Advocacy
• Technical Assistance
• Policy dialogue
• Capacity Strengthening
• Service Delivery
• Key family practices
• Partnerships
• Integration of programmes
* CRC: Convention on the Rights of the Child
CEDAW: Convention on the Elimination of all
forms of Discrimination Against Women
UPR: Universal Periodic Review
UNSF: United Nations Strategic Framework
SDGs: Sustainable Development Goals
*
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5 Geographic Coverage and Convergence The new country programme seeks to align programme interventions geographically to extent possible
and at a scale that funding permits. The programme will continue to engage and build up capacity of
partners in the current programme counties.
5.1 National Level:
UNICEF will support policy, advocacy and data management across all programme at the national level.
As in the current country programme, certain activities supported under the health and the nutrition
programmes will continue to be implemented nationwide: immunization, vitamin A distribution,
deworming, TB and malaria activities. UNICEF will continue to collaborate closely with WHO in both the
immunization and the TB and malaria programmes.
5.2 Sub-national level:
At the sub-national level, specific counties will be selected for defined programmatic interventions to
strengthen convergence of programmes and to demonstrate measurable results for children. These
counties will be selected jointly by the Ministry of Public Health and UNICEF based on a balanced
consideration of the following geographical selection criterias:
(a) Epidemiological Criteria:
Areas with higher numbers of malnourished children, higher morbidity and mortality from
diarrhoea and pneumonia, cases of TB and malaria, and other key affected populations –
although country-wide data are extremely limited-.
(b) Programmatic Criteria:
Programmatic Continuity: Ongoing core activities under the health, nutrition and WASH
programmes will continue where there are needs,gaps in skills, lack of financial resources,
essential medicines and equipment, and exists a functional network of collaborating
institutions.
Impact: One county is selected in each of the ten provinces to serve as part of
convergence counties to demonstrate comprehensive multi-sectoral evidence-based
interventions to encourage wider replication in each province.
Equity & Physical Access: Remote but accessible counties will be selected where
programmes can be monitored regularly for documentation and learning purposes. Some
remote counties may be included to address issues of equitable access to services,
especially to ensure equity and gender-sensitivity in immunization and nutrition services.
Demographics: Catchment area, target population and potential beneficiaries of the
selected interventions.
Partnerships and Donor Harmonization: Areas where other UN agencies or INGOs are
already working to allow for increased synergies.
13
(c) Financial Criteria (Capital & Operational Costs):
Infrastructure: Existing infrastructure capacities, needs and gaps, and counterpart
contributions to assure minimum start-up costs.
Prior Investments: Areas which have benefited from prior trainings and capacity building
activities.
Figure 1 shows the coverage by the Health, Nutrition and WASH programmes with further details
outlined below.
5.2.1 TB and Malaria supported counties.
TB activities are supported in 190 counties in 11 provinces, while Malaria activities are supported in
123 counties in 8 provinces as per the GF programme work plan,. All of these counties have already
been selected for TB and malaria programme support.
5.2.2 EMK and CMAM support in 89 selected counties:
EPI, Vit. A, deworming and multi-micronutrient supplementation programmes like Multiple
Micronutrient Powder (MMNP) for home fortification of complementary food for 6-23 months
children and Multiple Micronutrient Tablets (MMNT) for pregnant and lactating women are
implemented nationwide, while IYCF counselling is implemented in the targeted 89 CMAM
counties only. Essential Medicine Kit (EMK) distribution and the CMAM programme will be
implemented in 89 selected counties across the country. All programmes will focus in ten
convergence counties – one per province-, in order to demonstrate a convergence approach
and to further make monitoring as efficient as possible. Virtually, all of these countries are
included in the WFP s supplementary feeding programme that targets prevention of MAM
among 518,353 children in the nurseries of 89 counties.
5.2.3 EMK, CMAM and IMNCI integration in 50 counties:
UNICEF has secured funding until 2018 from GAVI to implement IMNCI in 50 counties. These counties
areincluded in the 89 counties where the CMAM programme is being implemented and EMKs are
distributed. These counties become central to UNICEF s implementation strategy in a context where
funding is increasingly unpredictable. The 50 counties will include counties in all provinces in order to
demonstrate and replicate IMNCI for wider coverage using the Government s own resources. Due to
restrictions in travel between provinces, it is important to have demonstration sites in each province
for replication as a model. Demonstration sites will be a good step for evidence based advocacy with
the Provincial and Country People s Committees. In the current programme, the Government has
already shown willingness to support expansion of trainings using their own resources. This was the
case with the training of doctors on maternal and newborn care where UNICEF facilitated training of
trainers at national, provincial and county level was replicated by MoPH. The People s Committees at
provincial and county level utilized their discretionary resources for completion of the trainings.
As the programme managers for CMAM and IMNCI programmes in the Ministry of Public Health are the
same, it is wise to strengthen the integration of these programmes and break down programmatic silos
and implement IMNCI and CMAM in the same geographical areas. IMNCI and health system
strengthening are perfect avenues towards institutionalization of SAM treatment in the health system
hence all efforts will be placed to take full advantage of this opportunity.
14
UNICEF in collaboration with the Ministry of Public Health have already identified and initiated
increased integration of activities in these 50 counties towards the new country programme...
5.2.4 Multi-Sectoral convergence in eleven counties:
From among the 50 counties supported by GAVI, UNICEF and the MoPH will select eleven counties --
one county from each province -- in which UNICEF will increase converge of its Health, Nutrition and
WASH programmes and resources to provide an integrated approach for improving maternal, neonatal
and child health. In addition to the CMAM and IMNCI services supported in these 50 counties, in the
ten convergence counties , UNICEF will additionally support Emergency Obstetric and Neonatal Care
(EmONC) and WASH services. As diarrhoea is the second most common cause of U5 mortality, and poor
WASH is a major cause of undernutrition, especially stunting, therefore integration/convergence of
health, nutrition with WASH is critical for child survival and development, WASH will contribute
significantly to the health and nutrition outcomes.
These convergence counties will serve as demonstration counties with clear baselines, targets and
mechanism for tracking progress and documenting the success for evidence-based advocacy. The
approach will be documented to show the Government that responsive evidence-based services to
address the high rates of maternal and neonatal mortality can only be provided to the population
through an integrated, well- defined and comprehensive package of services. By having one
convergence county in each province, there is a scope for sharing best practices and learning across the
other counties in the province. UNICEF will collaborate closely with UNFPA in the area of midwife
training and also with WHO in the convergent counties. In 2016 and early in 2017, baseline information
– primary and secondary data - will be collected in the convergence counties including as possible,
determinants of undernutrition.
5.2.5 Monitoring and supportive supervision:
The Monitoring of Results in Equity System (MoRES) will be implemented with basic objective to
develop a simple, context-specific and reliable method for regularly assessing, analyzing situation and
taking actions for overcoming bottlenecks or the main drivers of child deprivation and disparities
across all counties and in all programmatic areas,. The MoRES approach will promote the use of data at
national and subnational levels to generate evidence for advocacy, policy and programme development
and tracking results in all programmes. In addition, UNICEF will facilitate supportive supervision, on the
job training, data collection and verification of programmeswith provincial and people committees
departments during the weekly field visits. Currently, the Government is providing annual CMAM and
related nutrition programme data per province on an annual basis. However, CBS agreed to share
nutrition data per county on quarterly bases once the CDMU project takes off.
15
Figure 1: Schematic Diagram on Geographical Focus
CMAM: Community Management of Acute Malnutrition
EMK: Essential Medicine Kits
IMNCI: Integrated Management of Neonatal and
Childhood illnesses
EmONC: Emergency Obstetric and Neonatal Care
IYCF: Infant and Young Child Feeding counselling
MMNP: Multi-micronutriment Powder (Sprinkles)
MMNT: Multi-micronutriment tablets
Nationwide -
208 Counties: Immunization +
TB/Malaria , Vit A, deworming
89 Counties
CMAM+IMNC+EMK +IYCF+MMNP+MMNT
50 Counties IMNCI+CMAM
+EMK
11 Covergence Counties
Comprehensive MNCH and
Nutrition Package (EmONC +IMNCI+
CMAM+EMK+ WASH)
Coordination with
WHO and UNFPA
Coordination
with WHO
Coordination
with WFP
16
6 Health Programme Strategy Note
6.1.1 Programme rationale
DPRK has fallen seriously short of achieving MDGs 4 and 5. . Although, there has been an
increasing trend in the Maternal Mortality Ratio (MMR) from 81 in 2010 to 87 in 2014 (UN
Global Estimates), despite the fact that 90 per cent of deliveries take place in health facilities.
New-born deaths comprise more than half of the under-five mortality (U5M). Pneumonia with
a prevalence of 12 per cent of U5M in 2015, is the leading cause of under-five mortality.
Although there has been significant reduction in diarrhoea prevalence from 15 per cent in 2009
to 6 per cent in 2015, it remains the second main cause of mortality among children under five.
The table below shows the limited progress towards achieving MDGs 4 and 5.
Key Indicators Current Status 2014 Country MDG
commitment/targets
for 2015
Maternal Mortality Ratio
(MMR)
87/100,000 (1 death / day 24/100,000
Infant Mortality Rate (IMR) 23/1,000 (22 deaths / day) 8/1000
Under Five Mortality (U5MR) 25/1,000 (28 deaths/day) 15/1000
Neonatal Mortality Rate
(NMR):
16/1,000 (>50% of U5 deaths) 13 deaths / day)
Table 1: DPRK made limited progress in achieving MDGs 4 and 5
Tuberculosis (TB) poses a public health challenge with an estimated 140,000 TB cases and
about 5,000 deaths attributed to TB, according to WHO estimates for 2014. WHO models
estimate 1.9 per cent Multidrug-resistant Tuberculosis (MDR-TB) cases amongst new cases and
15 per cent amongst retreatment cases, with an estimated 3,900 MDR-TB cases annually in the
country. TB and MDR-TB have direct and indirect impacts on children, families and
communities. Caregivers and family members can become ill for extended periods. Inadequate
preventative, diagnostic and treatment services contribute to continued high transmission
including to caregivers and children, and the impact is further exacerbated by inadequate
housing conditions and malnutrition.
Malaria transmission is seasonal, limited to P. vivax, and no deaths are attributed to malaria.
The overall malaria incidence is on the decline and only 2.1 per cent of malaria cases are
reported amongst children under 5 years and pregnant women, though outdoor transmission
and impact on farmers and night workers remain a concern.
Additionally, the country is disaster prone therefore an integrated risk-informed health,
nutrition and WASH programme components have been incorporated in the new programme
cycle. This integratation will ensure effective and timely response in humanitarian situations,to
fullfill the the Core Commitments for Children, and on buildon resilience at family and
community level.
17
A situation analysis using causal and bottleneck analysis, and the ten determinants framework,
was undertaken with Government counterparts, as part of the CPD development process, to
ascertain the major bottlenecks and barriers resulting in slow progress in achieving global
targets. The analysis revealed major gaps in knowledge and skills of human resources, the lack
of essential medicines and equipment in health facilities as major causes of maternal, neonatal
and child morbidity and mortality in the country. The analysis focused on identifying inequities
in access to quality health and nutrition services, especially by vulnerable groups.
Based on the situation analysis, the bottlenecks faced in programme implementation, and
lesson learned from the previous country programme the priority health issues to be addressed
in the next country programme are:
I. Maternal Mortality: The immediate causes are haemorrhage (49 per cent); puerperal
sepsis/infection (15 per cent); and eclampsia (13 per cent). These three causes comprise an
estimated 72 per cent of preventable maternal mortality.
II. Neonatal Mortality: The immediate causes are: pre-term birth complications, such as
asphyxia and hypothermia (35 per cent); complications during labour and delivery, such as
intrapartum complications (24 per cent); and sepsis/infections (15 per cent). About 74 per
cent of neonatal mortality could be prevented with evidence-based, cost-effective
interventions.
III. Under Five Mortality: The immediate causes are: pneumonia (15 per cent); diarrhoea (5
per cent); and neonatal causes (52 per cent). About 72 per cent of under-five mortality is
preventable/treatable with focus on neonatal mortality reduction.
IV. Morbidity and mortality from Tuberculosis and Malaria: (estimated 140,000 TB cases and
about 5,000 deaths attributed to TB, according to WHO estimates for 2014). The malaria
cases amongst children under 5 years and pregnant women are low at 2.1 per cent.
V. Limited human and institutional capacities: There is limited human and institutional
capapcity to provide timely and appropriate response to prevent morbidity and mortality
in humanitarian situations, and to build resilience in communities.
6.1.2 The Results Structure (Outcome, Outputs and Indicators)
is presented in Annex 1.
6.1.3 Theory of Change
The Theory of Change described in this section is based on an analysis of the current situation
of maternal, neonatal and child health usesthe ten determinants framework to achieve desired
results. A multi-year context-specific and equity-focused results chain establishes linkages
between strategies, outputs and outcomes to achieve desired impact on maternal and child
survival The Theory of Change follows the concept of annual rate of reduction in mortality by
implementing the health programme and its sub-components. A mixed implementation
strategy including capacity development and service delivery drives the process of change. The
following graphic presents the logical link between the current situation, existing bottlenecks
and barriers, results to be achieved and outlines the pathway through annual rate of reduction
in maternal, neonatal and child mortality during the programme cycle and beyond. It also
presents the proviso of thegiven uncertainties of programming in DPRK, reflects the
assumptions and sisks that the narrative must be non-linear with the need to adapt constantly
to changing conditions and constraints over the five-year period.
18
The schematic representation of the results structure based on the Theory of Change is shown
on the next page.
19
Outc
om
e
indic
ators
Impac
t
indic
ators
O
utp
ut
ind
icat
ors
1. Non acceptance of global
standards and approaches.
2. Lack of funds
3. No reliable data available.
4. Possible cultural resistance.
Risks
Evidence-based advocacy
reinforced, an aggressive fund
raising strategy, strengthening
data management within
Ministry of Public Health and
Child Data Management Unit,
a comprehensive
communication strategy.
Mitigation
Strategies
1) Advocacy, policy and budget dialogue, technical assistance and scaling-up evidence-based interventions.
2) Capacity development to transfer knowledge, skills and motivation for policy makers, service providers and
caregivers, and to build community resilience and change behaviour.
3) Service delivery to ensure life-saving services and supplies in development and humanitarian settings, and to
monitor the extent to which bottlenecks and barriers are removed.
4) Cross-se toral li kages ade y applyi g the days approa h , pro oti g i tegrated ser i es i the selected o erge e ou ties , a d i pro i g oordi atio a ross li e i istries y esta lishi g multisectoral coordination body.
5) Partnerships will be centered within the UN, with UNICEF providing leadership in nutrition, WASH and
education. UNICEF will continue to work with donors, academia and other international organizations.
Assumptions
1. National capacity building
mechanism are functional.
2. Global standards well
adopted in policy
development.
3. Government allocates
sufficient resources.
4. Uninterrupted, timely
access to donor funds.
5. Uninterrupted cash flow
and timely in country
access to funds.
6. Optimal use of services.
.
.
.
.
Programme Rationale
HEALTH
Following table shows the annual and cumulative mortality reduction during the country
program cycle.
20
Key indicator Current
status
Expected Annual Rate of Reduction*
2017 2018 2019 2020 2021
Maternal Mortality
Ratio
87/100000 80 72 66 60 57
Neonatal Mortality 16/1000 13 11 9 7 6
Infant Mortality Rate 23/1000 18 15 12 10 8
Under Five Mortality 25/1000 20 17 13 11 9
Table 2 : Expected annual and cumulative mortality reduction during the country program cycle
Following is graphic presentation of the expected Annual Rate of Reduction in maternal,
neonatal and child mortality using 2015 baseline.
UNICEF held discussion with key development
partners, other UN agencies and with the Ministry of
Public Health as part of the process of developing the
Theory of Change and deciding the expected results.
Discussion focused on identification of issues,
selection of appropriate implementation strategies,
analysis of assumptions, and review of risks and
mitigations measures. It is important to ensure
convergence of actions and resources to bring the
change and impact on maternal and child survival.
6.1.4 Strategies
The proposed strategies are based on clear understanding of the current health situation,
recent developments in the field of maternal, neonatal and child health strategies and
comparative advantage of UNICEF in the field of health.
Capacity Development: There are major knowledge and skill gaps among human resource at
different levels. The in-service training is based on outdated knowledge and practices and
hamperedwith non-existence of on-the job training mechanisms. This leads to poor quality of
service provision without consideration of global standards and treatment protocols.
Therefore, capacity development will be central to bridge the gaps in knowledge and skills at
different levels. A wide range of trainings will be conducted through simplified and competency
specific approach. To achieve this, UNICEF will modify and enhance its role towards provision of
technical assistance. Other UN agencies especially WHO and UNFPA will be involved in capacity
development as part of the UNSF:Strengthening of training facilities, to support regular on-
the-job training of the training facilities at provincial level will be strengthened to provide
quality training to the staff from county and Ri (or sub-county) level health facilities. Scale up
Evidence based interventions: a set of evidence-based interventions will be promoted across
the country. A large number of human resources especially household doctors and midwives
across the country will be trained for effective implementation. Simplified guidelines will be
developed to ensure scaling up with quality at national, provincial, county and Ri level. The
capacity development will particularly focus on the following programme areas:
21
Immunization service (-Expanded Program on Immunization(EPI)) to prevent vaccine
preventable diseases
Provision of EmONC services to ensure a healthy delivery for mothers and newborn babies
Implementation of Integrated Management of Newborn and Childhood Illnesses (IMNCI)
and provision of services as per global standard treatment protocols
Scaling up of evidence-based interventions across the country
Establishment of monitoring and supportive supervision system
Strengthening capacities for data collection, analysis, dissemination and use for evidence
based programing with greater focus on gender disaggregated data.
There will be a major shift in UNICEF support from supplies to provision of technical support
especially in maternal, neonatal and child health areas. This shift on engagement with
capapcity development will require technical support from the UNICEF regional office and
other networks for which UNICEF DPRK office is well positioned.
Service Delivery: There is chronic shortage of essential medicines and equipment at all levels.
Furthermore, the support from UN agencies is very limited as the health care delivery network
is unable to provide essential services. This is one of the major causes of morbidity and
mortality in the country. To address this, a service delivery mechanism has been suggested to
reach the population, especially most vulnerable, with an essential package of services. In the
convergence counties, one per province and depending on availability of
resources,comprehensive services will be provided to serve as a model for replication.
Household doctors and midwives close to the community, currently underutilized, will be
mobilized. The service delivery strategy will focus on immunization, EmONC, IMNCI, ORS and
provision of essential medicines and scaling up evidence-based interventions.
Evidence generation and advocacy: Reliable and quality data is required for evidence-based
advocacy and resource mobilization to . to strengthen equity and evidence-based programing
reaching to vulnerable populations. Strengthening evidence generation is key to ensure that
service providers and policy-makers have access to quality data and analysis and use it for
programme planning and monitoring. Within the GAVI funding helath system strengthening
projest, UNICEF together with WHO successfully advocated for the MoPH to provide
immunization coverage data disaggregated by gender.
Integration, cross sectoral linkages and partnership building: The common barriers identified
in health, nutrition and WASH will be addressed through integrated multi-sector programming.
Diarrhoea, maternal health and nutrition are areas of common focus and 1000 day s window
of opportunity will facilitate synergies and the provision of an integrated package of services.
The partnership with GAVI and WHO will be further strengthened to ensure continuity of GAVI
funding past 2018. The programme will support the convergence of actions and resources from
key stakeholders for implementing the theory of change, with significant impact on maternal
and child survival. UNICEF, WHO and UNFPA will partner in these ten convergence counties by
providing support based on their comparative advantage and expertise, such as UNFPA will
look into the midwifery component while WHO in providing support in strengthening referral
services at provincial level institution and through technical support.
The programmes for malaria and tuberculosis represent a partnership between the Global
Fund, Ministry of Public Health (MOPH), WHO and UNICEF. These programmes are
implemented by the MoPH. WHO is the technical lead, providing advice and technical support
to MoPH, whereas UNICEF is the principal recipient of funds responsible for procurement,
22
financial management, and monitoring implementation according to the Global Fund work
plan. In its role as Principal Recipient, UNICEF has a negligible role in programme design, which
is developed between MoPH and WHO and approved by the GFATM Executive Board till 2018.
Integrated behaviour change communication: Healthy practices for sustainable change will be
promoted through an integrated behaviour change communication programme. The focus will
be on demand-creation. However, due to local sensitivities, this will need very careful and
highly context-specific through an indirect approach most probably viahousehold doctors and
midwives to achieve the desired result.
6.1.5 Health programme sub-components
Five main sub-components of the health programme include Maternal, Neonatal, child health
care, TB and malaria, and disaster management. It is important to implement a fully integrated
approach to achieve outcome and impact. Interventions will be implemented in different
geographical locations and will dependon prioritization and availability of funds
EmONC services will be strengthened in 10 convergence counties as the basis for
replication by Government, integrating health, nutrition and WASH service.
The integrated management of newborn and childhood Illness (IMNCI) will be
implemented in 50 counties as agreed in GAVI HSS2 2014-18. In addition, 89 counties with
CMAM will benefit from an essential medicine programme.
The immunization programme including expansion of cold chain,and quality improvement
and,TB/malaria will be implemented nationwide.
Scaling up of evidence-based interventions focused on maternal and neonatal health will
be implemented across the country in all health facilities
Maternal Health Care 6.1.5.1
Due to increasing trends in maternal mortality ,from 81
in 2010 to 87 in 2014 APR 2015, there will be a greater
focus in ensuring availability of essential package of
services to ensure safe and healthy outcomes of
pregnancy both for mothers and newborn babies. The
basic approach is to contribute to the reduction of
preventable maternal and new-born morbidity and
mortality. The main components of maternal health are
provision of Emergency Obstetric and New-born Care (EmONC), quality of antenatal and
postnatal care. Following shows the expected reduction in maternal mortality during the
country programme cycle.
New-born Health Care. 6.1.5.2
More than half of under-five mortality occur during
neonatal period. It is not be possible to achieve set
targets for under five mortality ithout reduction in
mortality during this critical period.. This strategy
promotes scaling up of the evidence based
interventions across the country and also ensure
16 14
13 11
9 7 6
0
10
20
2015 2016 2017 2018 2019 2020 2021
Neontal Mortality Reduction
23
availability of life saving support mechanism during first 28 days of life. The Every Newborn
Action Plan (ENAP) will guide the direction to achieve reduction targets placed below during
the CP.
Child Health Care 6.1.5.3
The focus of child health is on preventive
and curative services with particular focus
on two major childhood diseases
pneumonia and diarrhoea, while the bulk of
the mortality which occurs in neonatal
period will be addressed through
aforementioned newborn care (ENAP). The
sub-components of child health program
are:
Immunization Program (GAVI HSS2) to prevent vaccine preventable diseases.
IMNCI (community) with focus on reduction of Pneumonia and Diarrhea. It will include
extensive capacity building and also facilitating access to ORS and Essential Medicines.
Integrated approach for effective results (Health, Nutrition and WASH).
It is expected to achieve the mortality reduction targets with these interventions
Note: Extensive consultation was held with Ministry of Public Health during all stages of
strategy note preparation including the identification of key issues through causal and
bottleneck analysis,an agreement on key strategies, the idea of convergence counties
and multi-sector approach and on developing implementation plan for achieving the
desired targets and expected change.
TB and Malaria 6.1.5.4
The Global Fund programme component contributes to the National Strategic Plan for TB
Control (NSP) 2015-18 and National Malaria Strategic Plan (2013-2017) and aims to:
Decrease morbidity and mortality of TB through universal access to TB care and support
service.
Scale up services for prevention, diagnosis and treatment of all forms of TB to achieve case
notification rate of 444 per 100,000 population by 2018 and to sustain 90 per cent success
rate for notified new smear positive cases.
Ensure timely enrolment of all confirmed Multidrug-Resistant-TB cases and achieve 75 per
cent treatment success rate.
Engage other health programmes, civil society, NGOs and Key Affected Populations in TB
control.
Reduce overall malaria incidence by 70 per cent of the 2011 level by 2017.
Reduce malaria incidence in all high-risk ri (sub-county level) to less than <3/1,000 by
2017.
24
6.1.6 Disaster management and resilience building
The objective is to build capacities of the Ministry of Public Health and its Disaster
Management Unit in enabling an effective response in a humanitarian situation.
Thepreparedness and response capapcity will be enhanced inorder to prevent morbidity and
mortality amongst girls, boys and women through timely and appropriate actions in line with
UNICEF s Core Commitments for Children. Prepositioning of essential medicines will be ensured
for timely response. In addition context specific resilience-building activities will be initiated.
6.1.7 Assumptions and Risks
If the assumptions are wrong and risks actually materialize the transition from outputs to
desired outcome could be blocked or delayed. The logic of the causal linkages between input,
outputs and outcome will be ensured in the choice of specific activities laid out in detailed
annual work plans and monitored. The programme design makes the following assumptions:
Assumptions:
The change pathway makes the assumptions that the country has a conducive policy
environment, the donor fund flow and in-country cash flow remain intact and optimal service
utilization is ensured, following further specify the assumptions in the country context:
Political commitment to coordinate and contribute to implement a multi-
sectoral approach to address women and children health and nutrition needs
with equity focus.
Capacity building mechanisms are functional.
Global standards are well adopted in policy development.
Government allocates sufficient human and financial resources for the
programme.
Stable and conducive programme environment, particularly an uninterrupted
and timely access to donor funds, as well as uninterrupted cash flow and timely
acces to funds in the country.
Risks:
Government lacks capacity to manage and coordinate multi-sectoral
programme.
Non-acceptance of global standards and approaches.
Sub-optimal knowledge and practices of service providers and care givers
Insufficient budget allocation.
Infrastructure and logistical constraints.
Non-availability of reliable data.
Data management, sensitivities and related constraints.
Potential contextual barriers.
Given the absence of civil society partners, UNICEF inputs and outputs may be
necessary but insufficient to reach the outcome.
The mitigation measures include re-enforced evidence-based advocacy, an aggressive fund
raising strategy, strengthening data management within Ministry of Public Health and Child
Data Management Unit, and implementation of a comprehensive communication strategy.
Alignment to national sector plans and strategies:
25
The health programme, following a Theory of Change paradigm, will contribute to
achievement of reduction in maternal, neonatal and childhood morbidity and mortality as per
results envisaged in:
United Nations Strategic Framework (UNSF) 2017-21,
Goal 3 of SDGs Ensure healthy lives and promote well-being for all at all ages
National Medium Term Strategic Health Plan (MTSP) DPRK 2016-20.
National Strategic Plan for TB Control (NSP) 2015-18.
Progressive realization of the rights of the children through UNICEF normative role.
Equity agenda of reaching most vulnerable and reducing disparities.
6.1.8 Monitoring outputs and UNICEF’s contribution to outcomes
Government s monitoring and supportive supervisory mechanisms will be strengthened
andestablished to ensure tracking of the results and undertakings over the on-the-job trainings.
Tools have been developed to conduct results-oriented monitoring and supportive supervision.
An innovative monitoring tool has been developed for collecting data during field monitoring
and communicating key messages on critical components of health programme. In addition, a
feedback and follow up mechanism on findings of monitoring has also been established to
ensure that corrective actions are taken to ensure quality and timely completion of activities in
achieving the desired results and expected change envisaged in ToC. Monitoring of Results in
Equity System (MoRES) will enable UNICEF and partners to undertake organized approach in
tracking progress and removing of program implementation bottlenecks. In addition to the
above selected programme evaluations will be implemented including i: EPI Coverage
Evaluation Survey, ii: evaluation of IMNCI, iii: evaluation of convergence counties will be
conducted to verify the coverage and quality of care.
26
7 Nutrition Programme Strategy Note
7.1.1 Programme rationale
DPRK has a population of more than 24 million, out of which 1.74 million are under-five
children. There are 5.9 million women of reproductive age (WRA) aged 15 to49 years, and
720,000 pregnant or lactating women. The country has a history of more than two decades of
chronic food insecurity affecting about three-quarters of the population. Eighty-four per cent of
households, 18 million people, are considered as moderate to severely food insecure as they
are dependent on the public distribution system (PDS), in addition to being susceptible to
environmental and economic shocks.
Available survey data from 2012 shows that about one-third of under-five (U5) children are
stunted; wasting affects four per cent of the U5 children. Severe wasting is at 0.6 per cent. Each
year, an estimated 60,000 children under 5 are expected to suffer from SAM , and 150,000
from moderate wasting. Mothers with low MUAC and anaemia usually give birth to low birth
weight babies affected by intra-uterine growth restriction (IUGR). Those children are born at a
disadvantage because of the nutritional status of their mothers. This leads to undernutrition
and stunting among U5 children if not addressed within the first 1,000 days of life – the
window of opportunity . These conditions of low MUAC and high rates of anaemia perpetuate
the inter-generational cycle of undernutrition and entrench children and their mothers in
poverty and disease.
About one-third of Women of Reproductive Age (WRA) are anaemic and/or have low Mid-
Upper Arm Circumference (MUAC) of <225 mm. The MoPH has already developed and
endorsed the National Nutrition Strategy and Action Plan for 2014-2018, along with three
technical guidelines focussing mainly on reduction of undernutrition among U5 children. These
national documents are already touching upon the importance of women nutrition especially
PLW and outlining the main interventions to address this problem. However, the need for
comprehensive approach to address the nutritional needs of WRA, especially adolescent girls
and PLW is very critical. The programme is planning to review and further upgrade the National
Strategy and Action Plan to accommodate related programmatic interventions for adolescent
and maternal nutrition as stated in the global UNICEF strategy and operationalise these
interventions in collaboration with WFP, WHO and UNFPA.
The nutritional situation of women, adolescents and children is exacerbated by the fact that
communities live in a complex social environment marked by economic isolation, recurrent
droughts and floods, limited surface area of arable land as 80 per cent of the country is
mountainous, and a collapsing infrastructure. The country suffers from lack of investment in
social sectors and services, limited capacity of service providers, and their exposure to
innovative ideas and technical updates, and restricted population movement to seek services.
Recently, the country made progress in reducing undernutrition - the underweight target-and
achieved MDG 1.. However, stunting still remains a public health concern along with high
levels of anaemia and different micronutrient deficiencies, including iodine deficiency disorders
(IDD).
The 2012 National Nutrition Survey (NNS) showed that infant and young child feeding (IYCF)
practices are sub-optimum, with a negative impact on a child s growth and development. Only
33 per cent of women initiate breastfeeding immediately after birth (UNFPA supported, 2016
Social-Economic and Health Survey) or introduce complementary food at the right time.
27
Although exclusive breastfeeding rate appeared to be high in the same survey, the data is not
plausible given the fact that all children entered nurseries at three months at that time.
However, the new 2015 Maternity Leave Law offers eight months of maternity leave – two
months before delivery and six months after- in order to support exclusive breastfeeding and
so improvements are expected.
Only seven per cent of children aged 6 to11 months and 27 per cent of children aged 6 to23
months met the standard of minimum acceptable diet. Results from the same survey showed
that there are opportunities to improve children s feeding practices as their mothers have
access to a wider range of food groups, although their own feeding practices were sub-
optimum as well. The age-specific stunting data from the NNS showed clearly that the stunting
level progressively deteriorates straight after delivery because of sub-optimum IYCF practices.
Once the child reaches 24 months, stunting becomes irreversible. In 2015, UNICEF facilitated
integration of selected components of the IYCF counselling into the CMAM training package
and rolled-out the training package to four provinces affected by the drought. In total about
180 health workers from 90 counties hospitals trained in 2015.
Currently IYCF and CMAM services are being delivered through the paediatric wards in the
targeted CMAM counties in only four provinces. The Government of DPRK recognised the
importance of optimum IYCF practices and in response to UNICEF advocacy efforts to extend
the maternity leave after delivery from three to six months. In mid2015, the Government
issued directives to grant all women with eight months of paid maternity leave (two months
before delivery and six months after) to ensure maximum opportunity to all mothers to
practice exclusive breastfeeding.
In 2015, MoPH also issued general directive to all maternities in the country to close-down all
newborn rooms and to encourage early initiation of breastfeeding and skin-to-skin contact
within one hour after birth. During 2015, UNICEF also achieved 23 per centof the targeted 6
to23 months old children reached with MMNP; 47 per cent of the targeted PLW reached with
MMNT and about 50 per centof the targeted non-pregnant women received IFA tablets.
UNICEF also facilitated bi-annual Vit. A supplementation and reached to 99 per cent of the
targeted children while reached about 90 per cent of the targeted children with deworming
tablets and screened about 92 per cent of 6 to59 months children in four provinces in the
CMAM focus counties using MUAC through two rounds of Child Health Days in April and
October 2015.
The CMAM programme in 2013 and 2014 focused on 29 counties in the four north-eastern
provinces as well as 14 baby homes and 13 provincial paediatric hospitals across the country.
Data from this UNICEF-supported programme shows that there has been a 38 per cent increase
in children being treated for SAM in 2014 compared to 2013 which coincides with the onset of
the drought. This can be broken down as 43 per cent increase in the number of SAM children
with complications and a 32 per cent increase in the number of SAM without complications
treated. These figures reflect the deteriorating nature of the situation since mid-2014, in terms
of increasing incidence of childhood illnesses associated with higher prevalence of
undernutrition and indicates an increasing demand on and higher utilization of CMAM services.
In addition to the reported increase in the number of SAM children, UNICEF field assessment
missions in May and June 2015 to South Hwanghae and North Pyongan provinces, identified
the most severe cases of SAM that it has ever observed to date. In terms of the severity of SAM
with complications on treatment in the CMAM sites, in the past UNICEF has observed SAM
children with their weight for height minus two or three standard deviations below the norm,
28
but recently, for the first time, UNICEF found children with minus four and even minus five
standard deviations. These extremely severe cases are an indication of a deteriorating situation
in the community and corroborates Government data.
Coverage
Category of
Undernutrition
About 16% of SAM
accessed CMAM services
About 60% of
SAM access
CMAM services
Estimated Annual
Burden – 2016* 2013 2014 2015
SAM children treated 8,025 14,418 64,910 60,000
MAM with complications treated
16,478 20,004 105,400 150,000
Table 3 : Estimated number of SAM and MAM Children in need of treatment
*The est. burden of SAM and MAM in need of treatment need to be revised in view of the
recently received 2015 CMAM coverage data from MOPH in Feb. 2016.
The NNS showed regional inequalities, consistent with earlier nutrition surveys, in which the
prevalence of wasting and stunting is relatively higher in the northern and eastern provinces
compared to the rest of the country and the capital. However, the burden of wasting is much
higher in the capital, the main cities and municipalities in the central and western provinces
where there are densely populated urban areas.
Vitamin A coverage with two doses annually and Mebendazole remained high at 98 per cent
and 100 per cent respectively during the last 2015 annual two rounds of child health days
(CHD) in May and November. In 2015, UNICEF facilitated the availability of a third dose of
Vitamin A supplementation for the treatment and prevention of Vitamin A deficiency diseases.
In 2016, UNICEF will introduce two additional doses of deworming into routine health services
while maintaining the CHD activities to bridge the gaps and maintain high coverage.
The 2009 MICS showed that only 25 per cent of households are consuming adequately iodized
salt at more than 15 ppm. The prevalence of goitre among children 6-12 years old was 19.5 per
cent (higher in girls than in boys) and the average value of median urinary iodine concentration
UIC as . ug/ℓ, hile the proportio of elo ug/ℓ as .3 per e t. The ai challenges facing the IDD programme are as follows: a) Power interruptions/ cuts and low
voltage, b) lack of loading and unloading equipment, c) low production capacity of raw
materials, d) lack of transport means to and from the salt factories, and e) many other
challenges facing the Public Distribution System (PDS).
Given the limited presence of international NGOs, UNICEF is the only agency supporting MoPH
to implement different nutrition-specific interventions since 2008. All Government sectoral
partners are dependent on UNICEF s technical, financial and material support. They have little
or no access to other resources. UNICEF is also the only agency supporting the State Planning
Commission (SPC) in salt iodization since 1996 in which technical assistance is provided at
different levels along with supplies to the salt iodization industry.
In 2014 and 2015, the Government endorsed the National Nutrition Strategy and Action Plan,
and three technical guidelines for the management of acute malnutrition through CMAM,
promotion of optimum IYCF practices, and prevention and treatment of micronutrient
deficiency disorders and diseases. There were also multi-sectoral efforts to address the
problems of undernutrition among WRA and U5 children, and micronutrient deficiencies,
29
including IDD. In the new country programme, UNICEF will strengthen synergies between
WASH, health and nutrition programmes coordination including their planning, messaging and
trainining activities and geographic convergence
The new country programme will pay special attention towards high level advocacy to establish
a national food security and nutrition secretariat and will facilitate strengthening the sectoral
linkages among different line ministries and within UNICEF programme in the convergence
areas.
The situation described above underscores the importance of designing a comprehensive
package of nutrition-specific interventions that need to be delivered to mothers and children
through the health service delivery platform. At the same time, the country needs to move fast
on designing a comprehensive multi-sectoral approach to address the endemic nature of
undernutrition through delivering both nutrition specific interventions and supporting
nutrition-sensitive actions to mitigate the immediate and underlying causes respectively, and
to break the vicious inter-generational circle. This is possible only if Government establishes a
national multi-sectoral coordination mechanism in which all sectors plan together to achieve
the sustainable reduction of undernutrition.
In 2015, the Government recognized the importance of the multi-sectoral approach. Maternity
leave was extended from five to eight months in June 2015 and early initiation of breast
feeding is being promoted and practiced in all provincial maternity facilities. These are
dramatic shifts in Government policies in which separate newborn rooms were closed and
exclusive breastfeeding for six months was promoted, demonstrating the Government s
commitment to addressing undernutrition. Multi-sectoral approaches to achieve USI were also
adopted with UNICEF support in which many sectors have started working in early 2015 to
develop a National Plan of Action to achieve USI by 2021, along with the accompanying legal
framework. UNICEF supported a study tour of six government officials to study the multi-
sectoral approach adopted in Cambodia. UNICEF will support further efforts of the Government
to strengthen the multi-sectoral planning.
national social mobilisation campaigns are requiered to promote nutrition education, inform
and motivate women and service providers to adopt IYCF and caring practices. These are
mainly: IYCF counselling and caring services in all maternity hospitals; early initiation of
breastfeeding; and exclusively for six months; and timely introduction of home-made
complementary foods, fortified with multi-micronutrients and energy dense; and early
stimulation during the critical period of 1,000 days. There is a need to further strengthen and
expand the service coverage to make it accessible to the most vulnerable populations,
particularly WRAs and U5 children in underserved communities.
Free health services are accessible to the whole population. A cadre of 50,000 household
doctors, nurses and 800 midwives exists. At community level, household health workers are
providing basic preventive and curative services. Health services are available at nurseries and
day care facilities, which offer an opportunity to address the health and nutritional needs of
most vulnerable 6-59 months old children. Screening services for wasting, referral and early
treatment of wasted children and follow-up, are available in all clinics and nurseries.
Limited reliable data is one of the major bottlenecks to assess, monitor and evaluate the
nutrition programme. There are no opportunities for organized civil society, limited
opportunities for the different government sectors to interact, and limited capacity to plan
because of systematic segregation of all sectors and related social services. Logistical
30
constraints in relation to lack of transportation means and road conditions constitutes another
major constraint, in addition to limited movement of citizens between provinces and counties.
7.1.2 The Results Structure (Outcomes, Outputs, Indicators)
is presented in Annex 1
7.1.3 Theory of Change
It is widely recognized that malnutrition is an outcome by itself, which is due to lack of and/ or
sub-optimum interactions of different sectoral interventions. The main causes of malnutrition
are mainly related to immediate causes like food/ nutrient intake and health/ illnesses
encountered. The underlying causes are mainly related to lack of access to adequate quantity
of diversified food, efficiency and quality of the WASH and health services and in the core there
is maternal and child caring practices. The health sector alone can not reduce the prevalence of
malnutrition without concerted efforts and intensive investment in the food security, health,
WASH sectors and with strong communication for behaviour change component to promote
optimum maternal and child caring practices, hence the need to adapt a comprehensive
multisectoral approach to achieve sustainable impact. To address the immediate and
underlying causes of malnutrition, effective nutrition-specific interventions, including
community-based programmes, should be implemented at scale. These interventions need to
be complemented with nutrition-sensitive interventions like strengthening of the health
system, strengthening the agriculture and food production/ processing sectors, education,
water and sanitation sectors, addressing gender issues along with women empowerment in
decision making, social protection system and other poverty reduction measures.
The road from the challenges and opportunities described above to reaching U5 children,
adolescent girls and women, and facilitating their equitable access to multi-sectoral nutrition
services, is non-linear, but can be travelled over a five-year cycle. The critical behaviour
changes needed of service providers, care and right-holders themselves adds to the challenges
on the journey ahead. Progress along the causal pathway will be circuitous, with deviations
needed to sidestep barriers and overcome setbacks along the way.
The key to success for UNICEF will be toassist the Government in implementing a
comprehensive multisectoral nutrition plan and strategies that address the immediate and
underlying causes of undernutrition with a specific focus on the immediate causes and the
cross sectoral linkages with WASH and food security. The main interventions are as follows;
promotion of maternal nutrition with focus on adolescent girls, promotion of optimum IYCF
practices at community and health facilities level, institutionalizing screening and early referral
of wasted children to CMAM services, increasing geographical coverage and access and uptake
of the CMAM services and improving quality of these life saving services, sustaining the high
coverage of VAS and deworming along with increasing coverage of MMNP and MMNT
supplementation. These will need to be implemented at scale to achieve sustainable
improvement in the nutritional status of children, adolescent girls and women, and bring about
a lasting social change. The expected impact is to reduce stunting or chronic malnutrition,
reduce wasting or acute undernutrition, improve the nutritional status of girls and women.
The UNICEF nutrition programme is accountable for the following actions and will consist of the
following priorities:
(i) Creating the enabling, multi-sectoral policy and budgetary environment.
(ii) Prevention and treatment of micronutrient deficiencies and disorders nation-wide
31
(iii) Community management of acute malnutrition, targetingthe most at-risk 89 counties
(CMAM)
(iv) Promotion of mproved young child feeding nation-wide (IYCF)
(v) Promotion of maternal nutrition with focus on promotion of nutrition status of
adolescent girls
(vi) Prevention and treatment of IDD nation-wide
(vii) Humanitarian assistance
(viii) Geographic convergence in 50 counties (included among the 89 CMAM counties)
i) Enabling Environment: The programme will establish a national multisectoral coordination
body which will be responsible to formulate a National Plan of Action to reduce
undernutrition. This plan would need to be costed, with clear targets, defined management
roles and strategies, and supported by clear monitoring frameworks. This national
coordination body will be accountable for addressing the problem of undernutrition and be
represented by all stakeholders. It should be chaired by a senior Government official to
reflect strong political commitment. The programme will work closely with Ministry of
Public Health, and the Academia represented by the Institute of Child Nutrition (ICN) and
the Medical Universities along with other key line ministries (Ministry of City Management,
Ministry of Agriculture, Ministry of Food Distribution and Education Commission). The
programme will update the current National Nutrition Strategy and Action plan to
accommodate additional components to improve adolescent girls and women s nutrition
and support development of related technical guidelines. The programme will provide the
required technical inputs to revise and upgrade the national policies on CMAM, IYCF and
micronutrient deficiencies, including IDD/ USI plan of action, and also development of
national guidelines on complementary feeding, ECD to be used in all nurseries, guidelines
for adolescent and maternal nutrition. The programme will facilitate collection of a specific
set of nutrition indicators on a quarterly basis in coordination with Central Bureau of
Statistics under the Child Data Monitoring Unit, and the line ministries involved.
ii) Micronutrients: The programme will promote adequate micronutrient status of
adolescent girls, women of reproductive age, pregnant and lactating women and U5
children. The programme will improve the health and nutritional outcomes of expectant
women and the growth, development and survival of their children through promotion of
micronutrient supplementation ( bi-annual Vitamin A supplements along with dewoming,
zinc to all diarrhoea cases, weekly iron-folic acid to non-pregnant women, weekly
micronutrient tablets for PLW and powder for 6-23 months children), complementary food
fortification and the use of iodized salt, or oil capsules where iodized salt is unavailable.
Delivery of nutritionspecific interventions will be tailored to address underlying gender
barriers to adequate nutritional status of women and adolescent girls. Strategies to address
adolescent maternal nutriton will include communication and behaviour change strategy to
promote minimum acceptable diet, dietary diversity, advocacy efforts with the
Government to allocate additional food ration through the PDS to PLW, and further
collaboration with WFP to provide supplementary food rations to PLW.
iii) Community Management of Acute Malnutrition (CMAM) : Moderate and severe wasting
is still a major threat to child survival and development, hence the need to geographically
expand the CMAM services to increase service uptake and accessibility to lifesaving
services, and to mitigate the needs of nutritionally compromised U5 children. The
programme will improve quality of CMAM services through nutrition education,
32
capacitating health workers, ensuring timely availability of therapeutic foods, monitoring
forms and reporting, institutionalizing screening services for early detection, and
prevention of wasting. Since 2013, UNICEF through the operational CMAM service delivery
sites are providing treatment for SAM children with and without medical complications and
to MAM children with medical complications only in the provincial and county hospitals as
well as in the baby homes. UNICEF is advocating with WFP and the Government to
establish MAM treatment services in all the operational CMAM counties.
iv) Improved Young Child Feeding (IYCF): The programme will pay special attention for roll out
of the IYCF counselling services to reach to all maternity and paediatric hospitals in the
counties and in the targeted CMAM service delivery network to strengthen the efforts of
prevention of undernutrition. Household doctors trained under the health programme will
be equipped with key IYCF messages to be disseminated to households. By doing this, the
programme aims to empower women and caregivers to better utilize the meagre resources
at home in order to achieve higher nutritional outcomes for themselves and their children
like early initiation of breast feeding, exclusiveness, timely introduction of complementary
feeding, promotion of food diversity and frequency, and improved hygiene practices,
including handwashing. This component will also help in building community and
household resilience and strengthen coping mechanisms in emergency settings.
v) Iodine Deficiency Disorders/Universal Salt Iodization (IDD/USI): To achieve the USI
output, the programme will provide technical assistance to a multi-sectoral body led by
State Planning Commission and represented by the Salt Bureau, Government Commissions
and line ministries to finalize the USI plan of action and IDD legislation and to facilitate their
implementation. The USI plan of action will be guided by logframe with clear milestones
and roles and responsibilities of different partners. UNICEF will be responsible to support
key components of the plan within its mandate and will advocate for wider investment in
the salt iodization programme from the Government and other partners. The USI project
will be implemented within the context of UN Strategic Framework and technical
assistance from the UN Nutrition Sector Working Group chaired by UNICEF. The USI
programme will work closely with MoPH, Academy of Medical Sciences and with line
ministries on QC/ QA issues, internal and external monitoring, and on generating
programmatic evidence for high level advocacy. It will strengthen the collection of
disaggregated data, management and dissemination, identifying the bottlenecks and
barriers to be able to address them early to achieve USI. UNICEF will engage in policy
dialogue, advocating for budget allocations and multisectoral collaboration.
vi) Humanitarian assistance: The programme will facilitate national and regional capacity
building activities in nutrition in emergencies tosupport the Government to deliver quality
nutrition services to U5 boys, girls and PLW and other vulnerable groups during
humanitarian situations, and to protect and promote their nutritional status. . The
programme will also facilitate pre-positioning of emergency nutrition supplies at national
and at provincial medical warehouses.
vii) Geographic convergence: The programme will work closely with health and WASH
programmes to develop a minimum package of an integrated health, nutrition and WASH
services that can be delivered at different levels in the health system, but more specifically
in the convergent counties as shown in the diagram in section five.
The schematic representation of the Results Structure based on the Theory of Change is shown on the
next page. The ToC Schematic is prepared as a separate document.
33
34
Ou
tco
me
indic
ato
rs
Imp
act
ind
icat
ors
O
utp
ut
ind
icat
ors
a) Government lack capacity to
manage and coordinate multi-
sectoral nutrition programme
b) Insufficient budget allocation
c) Infrastructure and logistics
constraints
d) Sub-optimum knowledge and
practices of service providers
and care givers.
e) Data management, sensitivities
and related constraints.
Risks
a) Evidence-based advocacy
reinforced,
b) an aggressive fund raising
strategy,
c) strengthening data
management within Ministry of
Public Health and Child Data
Management Unit,
d) a comprehensive
communication strategy.
Mitigation
Strategies
1) Advocacy, policy and budget dialogue, technical assistance and scaling-up evidence-based interventions.
2) Capacity development to transfer knowledge, skills and motivation for policy makers, service providers and
caregivers, and to build community resilience and change behaviour.
3) Service delivery to ensure life-saving services and supplies in development and humanitarian settings, and to
monitor the extent to which bottlenecks and barriers are removed.
4) Cross-se toral li kages ade y applyi g the days approa h , pro oti g i tegrated ser i es i the sele ted o erge e ou ties , a d i proving coordination across line ministries by establishing
multisectoral coordination body.
5) Partnerships will be centered within the UN, with UNICEF providing leadership in nutrition, WASH and
education. UNICEF will continue to work with donors, academia and other international organizations.
Assumptions a) Political commitment to
coordinate and contribute to
implementation of the multi-
sectoral approach to address
women and children nutrition
with equity focus.
b) Political commitment to
coordinate and contribute to
implementation of the multi-
sectoral approach to achieve
USI with equity focus.
c) Government have enough
capacity and resources in food,
Health and WASH.
d) Stable and conducive
programme environment.
.
.
.
.
Programme Rationale
NUTRITION
35
7.1.4 Strategies
i) Capacity development at central level to strengthen evidence-based sector planning,
coordination, monitoring and evaluation in order to reach universal access to a
comprehensive set of evidence-based nutrition-specific interventions (as a contribution to
SDGs). MoRES will be used as a tool to monitoring and report on equity. Capacity
development of care providers at community level is needed to improve the quality of
nutrition services, screening, early referral for treatment, follow-up during treatment,
relapse prevention and to build resilience to cope with humanitarian situations.
ii) Service delivery will strengthen and improve quality and to promote effectiveness of the
nutrition interventions at community and household levels, baby-homes, nurseries and at
health facilities. UNICEF support for service delivery will target the counties and provinces
with the highest annual caseload of Severe Acute Malnutrition (SAM) to provide treatment
as a lifesaving intervention.
iii) Communication for Development (C4D) will develop nutrition education materials to
promote optimum infant and young child feeding and caring practices, promote
micronutrient supplementation (including deworming) to U5 children, adolescent girls,
WRA and PLW. Empowering women as care providers and nutrition services providers in
health facilities and day care and baby homes will be used to change behaviours and create
demand for quality nutrition services.
iv) Advocacy will aim at leveraging Government resources to establish national nutrition
coordination body to develop multisectoral policies and plans of action, and to scale-up
implementation.
v) Partnerships with WHO and WFP, line ministries and Government Commissions will
strengthen inter-sectoral linkages and enhance efficiency and synergies. This broad-based
partnership has been created, thanks to UNICEF convening power, to include, not only the
MoPH, State Planning Commission and Institute for Child Nutrition, but also the Ministry of
Agriculture, Ministry of Food Administration, the State Academy of Sciences, and
Pyongyang University of Science and Technology, inter alia.
vi) Cross-sectoral linkages will be made through the first 1,000 days of life approach, in the
convergent counties, and through the wide range of partnerships described above.
7.1.5 Assumptions and Risks
If the assumptions are wrong and risks actually materialize the transition from outputs to
desired outcome could be blocked or delayed. The logic of the causal linkages between input,
outputs and outcome will be ensured in the choice of specific activities laid out in detailed
annual work plans and monitored. The programme design makes the following assumptions:
36
Assumptions:
Government shows political commitment and has the capacity to coordinate and
contribute to implementation of the multisectoral approach to address
undernutrition and the multisectoral plan of action to achieve USI.
Openness from communities to receiving information and actually being able and
willing to change behaviours.
National capacity building mechanisms are functional.
Standards are well adopted in policy development
Government allocates sufficient human and financial resources for the programme.
Stable and conducive programme environment, particularly uninterrupted, timely
access to donor funds as well as uninterrupted cash flow and timely in-country
access to funds
Optimal use of services
Risks:
Government lacks capacity to manage and coordinate a multi-sectoral nutrition
programme
Adequate data on programme implementation, coverage and outcomes is not
made available
Insufficient budget allocation by partners or the ability to translate the allocated
budget into operational actions.
Infrastructure and logistics constraints such as accessibility, road conditions,
warehouses capacity and supply management
Given the absence of civil society partners, UNICEF inputs and outputs may be
necessary but insufficient to reach the outcome.
Communication and counselling messages on IYCF and maternal nutrition are not
feasible to implement by caregivers and households due to various external
barriers
Mitigation measures of the above risks: the programme will grasp every opportunity to
advocate with the Government and the line ministries along with the people s committees to
overcome the above risks and to work with all partners in addressing them within the Food and
Nutrition Security Thematic Group, the Nutrition Sector Working Group and the overall UNSF.
7.1.6 Monitoring outputs and UNICEF’s contribution to outcomes
The nutrition programme component will be implemented in support of the overall efforts to
promote child and women wellbeing and to achieve full realization of their rights to survive and
develop to their full potential. In this regard, the programme has already developed specific
statistical forms that will capture key indicators on performance of the project in terms of the
number of beneficiaries and quality of performance indicators (disaggregated data by age,
gender and geography). These indicators were agreed with MoPH and the Institute of Child
Nutrition and compiled in one full set and shared with CBS to be incorporated into the CDMU.
The CBS and MoPH will be able to report on these indicators on quarterly bases. The
programme will undertake regular field monitoring visits to the beneficiaries sites in the clinics,
37
counties hospitals, provincial hospitals, nurseries and baby-homes and will undertake
quarterly programme reviews with the focal persons in MoPH and ICN to properly analyse the
data and to provide feedback and corrective actions.
UNICEF s contribution towards the planned outcomes will be tracked through a programme
component monitoring plan to be developed internally in collaboration with the Monitoring
and Evaluation Specialist. The indicators in the results matrix will be tracked and updated
annually along with undertaking MoRES exercises twice during the country programme.
Progress towards the achievement of the outputs and outcome will be tracked by monitoring
selected set of indicators and milestones developed on an annual basis with the Government
counterpart and line ministries in the rolling annual work plans. Field monitoring visits will be
undertaken, some jointly with the counterpart ministries and other government bodies.
38
8 WASH Programme Strategy Note
8.1.1 Programme rationale
DPRK attained the MDG target for sanitation, but missed the target for improved water
sources, with better progress made in urban compared to rural areas.Eighteen per cent of the
population lack access to improved sanitation and two per cent (one per cent urban; three per
cent rural) lack access to improved drinking water sources (WHO/UNICEF Joint Monitoring
Platform, 2014). About 33 per cent of the population depend on dug wells, which are also
used as alternative sources of drinking water when piped water supply is non-functional.
Operational constraints such as intermittent electricity and aging and non-functional
equipment, considerably reduce the effective coverage from the piped water infrastructure for
77 per cent of households. UNICEF s analysis of recent data from a Water Assessment Survey
carried out by the Ministry of City Management (MoCM) and the Central Bureau of Statistics
(CBS) between 2013 and 2014 indicates low sustainability of pumped water delivery systems.
Approximately 49 per cent of all piped schemes are affected by intermittent power supply from
grid electricity. About 25 per cent are affected by dysfunctional pumping equipment. The
alternative sources are traditional sources (dug wells and tube wells) which require protection
from contamination. Only 20 per cent of piped schemes have water treatment plants; 6.7 per
cent of households did not at all treat drinking water from the piped systems. The situation for
learning institutions is worse where as much as 50 per cent of the child care and learning
institutions lack adequate or sustainable access to WASH services (UNICEF field observations
and MOCM/CBS Water Assessment Survey, 2013-2014).
Use of rudimentary latrine designs with shallow pits and often without slabs is common among
40 per cent of the rural population. The shallow pits require frequent evacuation and the
excreta is recycled prematurely to make compost manure. This practice creates conditions of
virtual open defecation as undecomposed faecal matter is reintroduced to the environment
and later spread on agricultural fields, where it easily comes into contact with insects, rodents
and people, and can contaminate water sources like dug wells, and food as well as the living
environment.
According to global studies, faecal contamination also causes environmental enteropathy
which adversely impacts on nutrition and contributes to stunting as it causes malabsorption of
micronutrients. The recycling of the sludge presents the risk of ingestion of faecal matter
through consumption of contaminated drinking water and food and therefore predisposes the
rural population to diarrhoea and the impact of environmental enteropathy.
These conditions are manifested in the health and nutrition of children and women. Diarrhoea
is reported to be the cause of five per cent of the deaths in children under-five, second only to
pneumonia, and is cited by teachers as the most common cause of absenteeism from school. It
is among the leading causes of hospital admissions.
The 2012 National Nutrition Survey indicated that among children below five years of age, the
prevalence rate of stunting was 28 per cent. Therefore, priority must be given to water,
sanitation and hygiene based on the direct correlation between safe drinking water, improved
hygiene practices and the nutrition, health and education outcomes for children.
During the current country programme, the construction of gravity-fed water systems (GFS)
contributed to increasing access to safe and sustainable water supply for over one per cent of
39
the population (about 250,000 people by 2014). Demand for GFS continues to grow. GFS has
proven to be sustainable solutions where they are feasible. GFS provided a relieable and a
cost-effective alternative to pumpbased water systems. This successful intervention can be
taken to scale to benefit a larger number of communities that are lacking sustainable services
for lack of electricity, or dilapidated infrastructure. Alternative energy sources, such as solar,
are needed for pumped water supply systems.
In hygiene and sanitation, consensus was reached at national level that the rudimentary latrine
designs and the present management of sludge from latrine recycled as manure in agriculture
is akin to virtual open defecation. This situation is considered among the key contributing
factors to the child mortality due to diarrhoea and to the non-clinical condition of
environmental enteropathy which is a contributing factor to the stunting in 28 per cent of the
children under-5. Both latrine designs and the management of excreta recycled for agricultural
use need improvement. The double urn sanitary latrine model adopted from China is being
piloted for adaptation to the context of DPRK at household level. Similar improvements are
under consideration for health facilities and learning institutions.
Gravity-fed schemes are popular and sustainable, though capital intensive. The DPRK
Government is willing to increase local contribution and would like to target large population
centres as a priority in the roll out of GFS country-wide. Further advocacy at high levels and at
provincial and county levels is needed to raise the profile and urgency of improving latrine
designs for households and learning institutions, and the management of excreta recycled for
use as manure in agriculture.
A hygiene behaviour education and communication strategy centring on key behaviours to
improve health and nutrition outcomes for children and women is needed to synergize efforts
in health, WASH, nutrition and education programmes. Particular effort is needed to
comprehensively address hygiene and sanitation needs of children in boarding schools and
adolescent girls in all schools, including menstrual hygiene management. .
8.1.2 The Results Structure (Outcome, Outputs, Indicators)
is presented in Annex 1
8.1.3 Theory of Change
The Theory of Change is based on an analysis of the current situation of WASH using bottleneck
analysis, causality analysis and the ten determinants framework to achieve outputs and
outcome. A multi-year context-specific and equity-focused results chain establishes linkages
between strategies, outputs and outcomes in achieving desired results. A mixed
implementation strategy, focusing on capacity development and service delivery in particular,
will facilitate this process of social change. The diagram below presents the logical link between
the current situation, existing bottlenecks and barriers, results to be achieved, and outlines
graphically the overall direction of the WASH programme for the next five years. But any vision
of social development in DPRK must be caveated by the possibility of deviations from a causal
pathway as the programme attempts to move from input to activities, and from outputs to
outcome. Programming in WASH, as in the other sectors, must be susceptible to adaptation as
the context evolves, or in the light of a humanitarian crisis.
The WASH programme component, therefore addresses the priorities described in the
programme rationale section above, and in line with the UNSF. It will contribute to improving
access to sustainable clean water supplies, ensuring water quality, and promoting improved
40
sanitation and hygiene practices, including the safe management of excreta used as manure in
agriculture. The programme will focus on schools and health facilities, respond to humanitarian
needs, and be cognisant of the specific hygiene and sanitation needs of women and girls. It will
provide technical and critical material support to complement local resources in order to
establish gravity-fed water systems. The programme will focus its activities in the ten
convergent counties prioritized in the health and nutrition programmes.
WASH programme will support policy-makers and service providers through technical
assistance,evidence-based sector planning, coordination, monitoring and leveraging of
resources for expanded service delivery. Policy dialogue will include guidance on gender
standards in WASH. Resilience at provincial, county, community and family levels will be
strengthened to cope with floods and droughts. The programme will be strengthened with
hygiene education and behaviour change communication inorder to demonstrate provitive
impact on child and maternal health and address the underlying causes of mortality due to
diarrhoea and poor nutrition, including stunting and wasting.
The schematic representation of the Results Structure based on the Theory of Change is shown on the
next page. The ToC Schematic is prepared as a separate document.
41
Ou
tco
me
indic
ato
rs
Imp
act
ind
icat
ors
O
utp
ut
ind
icat
ors
a) Inadequate data
b) Adherence to traditional
practices
c) Lack of engagement with
community
Risks
1. Evidence-based advocacy
reinforced,
2. an aggressive fund raising
strategy,
3. strengthening data
management within Ministry of
Public Health and Child Data
Management Unit,
4. a comprehensive
communication strategy.
Mitigation
Strategies
1) Advocacy, policy and budget dialogue, technical assistance and scaling-up evidence-based interventions.
2) Capacity development to transfer knowledge, skills and motivation for policy makers, service providers and
caregivers, and to build community resilience and change behaviour.
3) Service delivery to ensure life-saving services and supplies in development and humanitarian settings, and to
monitor the extent to which bottlenecks and barriers are removed.
4) Cross-sectoral linkages made by applyi g the days approa h , pro oti g i tegrated ser i es i the sele ted o erge e ou ties , a d i pro i g oordi atio a ross li e i istries y esta lishi g multisectoral coordination body.
5) Partnerships will be centered within the UN, with UNICEF providing leadership in nutrition, WASH and
education. UNICEF will continue to work with donors, academia and other international organizations.
Assumptions 1. National capacity building
mechanism are functional.
2. Global standards well adopted
in policy development.
3. Government allocates sufficient
resources.
4. Uninterrupted, timely access to
donor funds.
5. Uninterrupted cash flow and
timely in country access to
funds.
6. Optimal use of services.
.
.
.
.
Programme Rationale
WASH
42
8.1.4 Strategies
i) Capacity Development at central level to strengthen evidence-based sector planning,
coordination, monitoring and evaluation in order to reach universal access inline with
Sustainable Development Goals (SDGs). MoRES will be used as a tool for monitoring and
reporting on equity.
ii) Service Delivery to strengthenand promote sustainable accces to WASH in county towns
and ris, learning institutions and health facilities. UNICEF support for service delivery will
target the counties with the worst performance on nutrition outcomes and diarrhoea
incidence.
iii) Communication for Development (C4D) to promote good hygiene practices, to improved
sanitation and safe management of excretapractices. The programme will create demand
for services. The communication strategy will target behaviours that are most risky and
considered as major contributors to child mortality due to diarrhoea, and poor sanitation.
iv) Capacity Development at community level to strengthen WASH resilience to cope with
perennial floods and droughts.
v) Advocacy will aim at leveraging Government resources to scale up high impact nutrition-
sensitive WASH interventions; sustainability of WASH services, and promotion of
sustainable technologies.
vi) Partnerships with WHO and UNFPA, and other line ministries in efforts to make cross-
sectoral linkages.
8.1.5 Assumptions and Risks
The assumptions and risks described below reflect the fact that progress in the WASH sector
will be non-linear, with many variables coming into play that delay or accelerate the
achievement of results. Activities detailed in annual work plans will serve to tighten the logic
between inputs, outputs and the overarching outcome in the Theory of Change.
Assumptions
National capacity building mechanism are functional.
Global standards well adopted in policy development.
Government allocates sufficient resources.
Uninterrupted, timely access to donor funds.
Uninterrupted cash flow and timely in-country access to funds.
Optimal use of services.
Risks
Inadequate data
Adherence to traditional practices
Lack of engagement with community
Given the absence of a wide range of partners, UNICEF s inputs and outputs could
be necessary but insufficient to reach the planned outcome.
Mitigation measures include: reinforced evidence-based advocacy, development and
implementation of an aggressive fund raising strategy, strengthened data management within
Ministry of City Management and implementation of a comprehensive communication
strategy.
43
8.1.6 Monitoring outputs and UNICEF’s contribution to outcomes
UNICEF s contribution towards outcomes will be tracked through a programme component
monitoring plan to be developed internally in collaboration with the Monitoring and Evaluation
Specialist. The indicators in the results matrix will be tracked and updated annually using
MoRES. Progress towards the achievement of the outputs and outcome will be tracked by
monitoring appropriate indicators and milestones developed on an annual basis with the
Government counterpart ministries in the rolling annual work plan. Field monitoring visits will
be undertaken some jointly with the counterpart ministries and other partners in the sector.
9 Social Inclusion Strategy Note
9.1.1 Programme rationale
Social Inclusion was not a specific component of the 2011-2016 country programme, but has been a
core consideration in all UNICEF s work in DPRK. In the new country programme, addressing
disparities remains part and parcel of the health, nutrition and WASH components. The Social Inclusion
component supports data collection, analysis and management as essential and overarching requisites
to addressing the equity agenda, to making duty-bearers more accountable, and to strengthening
government reporting on the CRC, CEDAW and eventually the CRPD, once it is ratified. Regular and
robust data analysis will contribute to creating an enabling policy environment and effective systems
across the work of the UN, but critical to realizing the rights of all children, adolescents and women
across the sectors, including in education. The social inclusion programme component is in line with the
data and development management thematic area of the UNSF.
Positive indicators in education (shown in Table 1 below) do not justify a separate programme
component, with one notable exception – that of children with disabilities as a specifically invisible and
excluded group. For this reason, the Social Inclusion component takes a two-pronged approach –
addressing data gaps as a barrier to addressing inequity, and disability as a specific focus of social
exclusion including in education. There is anecdotal evidence of stigma associated with disabilities and
this is an issue which needs to be researched and addressed accordingly. The CP will support and
follow-up on a National Learning Assessment Study, which will include sampling of children with
disabilities, and the findings will be used to support the Education Commission in addressing inequities
identified.
Data 9.1.1.1
All information and data in DPRK are controlled by the Government, notably the Central Bureau of
Statistics (CBS) with which the UN works closely. The CBS releases official data and statistics only to the
extent that it can be convinced that it is required for the specific purpose intended. This situation
seriously impedes its ability to undertake or contribute adequately to situation analyses, monitoring,
evaluation and reporting and for this reason one of the four thematic areas in the new UN Strategic
Framework 2017-2022 is Data and Development Management .
The programme component will therefore help to address the long standing issue of lack of data and
analysis for effective sectoral planning and for monitoring and reporting on child rights and women
rights. Based on data and evidence, the programme will specifically support critical actions by the
Education Commission to address disparities faced by children with disabilities as also identified in the
UN Strategic Framework (UNSF).
44
There are significant gaps in analytical data available to the UN agencies for planning purposes, notably
national income statistics, a national MDG report, an updated Multiple Indicator Cluster Survey (MICS)
or a credible gender analysis. Data gaps limit the ability of the UN to undertake or contribute
adequately to situation analyses and confine its perspective on some issues too narrowly. This
constraint extends even to the rationale for the selection of pilot counties for UN programme activities.
Demographic Data: One area in which DPRK is exceptionally strong is that of demographic statistics.
The 2008 Census satisfied international standards and its 2018 successor is already being planned with
UNFPA support. The forthcoming UNFPA-supported Socio-Economic and Demographic Health Survey
will provide a useful complement to this. Registration data (birth and deaths) is also of a high quality, as
might be expected of a government which provides specific food rations to each of its citizens. This is
complemented by detailed patient records, thanks to the outreach capacity, dedication and diligence of
50,000 household doctors. For domestic legal and other reasons, data from the sub-national level is,
however, difficult for the UN to obtain, which makes identifying disadvantaged and vulnerable groups
more difficult.
Income data: The Government is highly restrictive on the matter of national income statistics, which
are not made available to the UN. This makes it impossible to prepare a National Human Development
Report (NHDR) and renders any assessment of DPRK's Human Development Index (HDI) and its
consequent international ranking impossible. Such data is an important baseline for much development
policy formulation.
National MDG Report: There have been similar issues relating to DPRK's efforts to prepare a National
MDG Report (MDGR) although one was prepared but not submitted by the government in 2009. One of
the metrics for measuring the current UN Strategic Framework was that of the MDGs, so this is an
important gap, especially with the expected transition to Sustainable Development Goals for the new
UNSF.
Multiple Indicator Cluster Survey (MICS): this UNICEF-designed global household survey analyses the
rights and needs of children and women and serves as the basis for determining the nature and scope
of programmes. Although a MICS was undertaken in 2009, it was never finalized because of issues with
regard to exporting data to UNICEF's central database, a difficulty that continues to stand in the way of
an updated survey. UNICEF will advocate with the Government and provide technical support to
address this problem. MICS is included as part of UNICEF s costed evaluation plan in the new country
programme.
Humanitarian Needs Assessment: Given the annual, predictable recourse to the CERF and the
international community for funding to address immediate humanitarian needs in the country, it is
important to ensure an evidence-based and independently-verified assessment of these needs,
supported by a process which is acceptable to both the Government and the UN. Donors' willingness to
continue supporting such appeals could be positively influenced by such a consensual approach to
assessments.
The Government has demonstrated impressive results in the education sector. The DPRK has
maintained near universal literacy. Any illiteracy recorded within the 2008 Census is said to be amongst
a subset of the population 80 years and above. The MICS 2009 showed a primary level (grades 1 to4)
completion rate to be well over 100 per cent with a 100 per cent transition to secondary school.
According to the EFA MDA 2008, school enrolment rate for primary schools is a 100 per cent with
complete gender parity, and the transition rate to secondary school is 99 per cent.
The 2009 MICS suggests that there is a small portion of repetition or return of drop outs as 2.4 per cent
of children of secondary school age (11-16 years) were attending primary school.
45
Indicator %
Percentage of children aged 36 -- 59 months currently attending early childhood education 97.8
Percentage of children attending first grade who attended kindergarten in the previous year 99.0
Percentage of children of primary school entry age attending grade 1 96.4
Children of secondary school age [11 -- 16 years old] attending secondary or higher school 97.1
Percentage of children of secondary school age [11 -- 16 years old] attending primary school 2.4
Net primary school completion rate 87.8
Transition rate to secondary education 100
Table 4: Select Education Data
Disability 9.1.1.1
Despite the achievement in education sector, one area where there are serious disparities is for
children with disabilities. According to the 2008 census, 6.7 per cent of the total population has a
disability (deaf 1.7 per cent; sight 2.5 per cent; mobility 2.5 per cent). The census also found that the
prevalence of disability varied by age with older people having proportionately more disability than
younger people.
The census also disaggregates data by age and Table 5 shows the total number of children with
disabilities aged 5 to 19 broken down by type of disability. This age group approximates the age of
school age children.
Age
Total
Population
Type of Impairment
Seeing
(%)
Estimated
Number
Hearing
(%)
Estimated
Number
Mobility
(%)
Estimated
Number
Use of mental
faculty
(%)
Estimated
Number
5-9
1,846,785 0.1 1,847 0.1 1,847 0.1 1,847 0.1 1,847
10-19
3,889,346 0.2 7,779 0.1 3,889 0.2 7,779 0.1 3,889
Total
5,736,131 0.2 11,472 0.2 11,472 0.3 17,208 0.2 11,472
Table 5 Number of children with disabilities by age and type of disability
There are 11 special residential schools in DPRK currently with 1,144 students. The only special schools
available are residential and only provide education to a small number of children with disabilities.
Table 3 shows the estimated number of children needing special education as well as data on those
receiving it. It is positive to note the increasing number of children receiving special education between
46
2012 and 2015 – an increase from 573 to 1,144. However, when compared to the estimated number of
school age children with disabilities, it is clear many children do not yet have their right to education
fulfilled.
The Education Commission has informed UNICEF that that parents of children with disabilities do not
want to send their children to special schools. The Korean Federation for People with Disabilities has
informed UNICEF that the reason for this is that parents to not want to send their children to school as
they are residential schools and which means the parents would only see their children twice a year. It
would be preferable for CWD to attend regular school with special classes to meet their needs
Type of
Special School
Number
of
Special
Schools
Number of
children
in special
schools (2012)
Number of
children
in special schools
(April 2015)
Estimated number of children
requiring special education
(aged 5 to 19)
(2008 Census)
Special Schools for blind
(in South Pyongyang,
South Hwanghae, South
Hamgyong.
3 49 116 Approximately 11,000
Special schools for deaf
children (in South
Pyongan, South
Hwanghae, South
Hamgyong and Kangwon
and Jagang provinces)
8 524 1028 Approximately 11,000
Table 6: Children in Special Schools
There is a serious lack of information on CWD which makes a detailed situation analysis at the
start of the programme not possible. This is in itself a bottleneck. There is, however, enough
data on the number of CWD and the number of CWD receiving education to know that there is
a serious issue that needs to be explored. Clearly, only a small number of children are in special
schools. If all of the other CWD have been mainstreamed into regular classrooms, one would
hope all teachers have been trained in how to meet the needs of these children, however,
there is no training of teachers in this regard. In establishing a system for education of CWD
that is in the best interests of the child , the option of having a classroom in a mainstream
school which caters to the needs of sensorially deprived children has not been explored in
DPRK. Much more analysis and advocacy is needed for CWD in the new Country Programme.
47
9.1.2 The Results Structure (Outputs, Outcomes, Indicators)
Levels Indicators Baseline Target MoV Geographical
focus Risks and Assumption
Outcome Statement:
By 2021, Government
uses disaggregated data
for equity-focused
social policy
development and
planning, and reporting
on the rights of children
and women.
# of sectors using
current disaggregated
data in policies and
plans
CRC/CEDAW/CRPD
reports use current
disaggregated data
NA
NA
4 sectors (Health,
Nutrition, WASH and
Education)
3 reports
(CRC/CEDAW/CRPD)
Sectoral policies and
plans
CRC/CEDAW/CRPD
Report
National Assumptions:
Government is committed
to disaggregated data
generation and use
Government accepts human
rights approaches critical to
inclusive development
Risks:
Political sensitivities to
making child rights related,
disaggregated data available
Social attitudes to
marginalization and
mistreatment do not change
Discrimination difficult to
quantify and aggregate
Output Statement:
By 2021, the Central
Bureau of Statistics has
capacity to coordinate,
analyse and
disseminate
disaggregated data
related to children,
adolescents and
women
CBS (CDMU) reports on
a set of indicators for
children, adolescents
and women.
Nil 3 reports CDMU report National
Output Statement: By National learning NA Assessment Reports Assessment reports National
48
2021, the Education
Commission uses
evidence based
planning to improve
learning outcomes and
address the needs of
children with
disabilities.
achievement
assessments
National guidelines for
learning outcomes
National Plan for
Inclusive Education
NA
NA
National plan
National guidelines
National Plan
National guidelines
49
9.1.3 Theory of Change
The Theory of Change is based on analysis of the current situation and context specific interventions to
achieve desired results. There are several barriers to the more effective use of data to support planning and
removing bottlenecks and barriers. To develop the outcome level results, the key bottlenecks were
identified and analyzed to overcome them. Capacity development, evidence generation, policy dialogue and
advocacy, partnership building, south-south and triangular cooperation and service delivery were identified
as key strategies to facilitate the process of change. The following diagram presents the logical link between
the current situation, results to be achieved and providing a clear overall direction. As in all Theories of
Change, progress will be dependent on multiple variables, both constraints and opportunities, upon which
success in reaching the overarching outcome will depend, along with the outputs of other partners and
stakeholders, especially Government, in reaching that outcome.
The schematic representation of the Results Structure based on the Theory of Change is shown on the next
page. The ToC Schematic is prepared as a separate document.
50
Ou
tco
me
indic
ato
rs
Imp
act
ind
icat
ors
O
utp
ut
ind
icat
ors
a) Political sensitivities to making
child rights related,
disaggregated data available
b) Social attitudes to
marginalization and
mistreatment do not change
c) Discrimination difficult to
quantify and aggregate
Risks
1. Evidence-based advocacy
reinforced,
2. an aggressive fund raising
strategy,
3. strengthening data
management within Ministry of
Public Health and Child Data
Management Unit,
4. a comprehensive
communication strategy.
Mitigation
Strategies
1) Advocacy, policy and budget dialogue, technical assistance and scaling-up evidence-based interventions.
2) Capacity development to transfer knowledge, skills and motivation for policy makers, service providers and
caregivers, and to build community resilience and change behaviour.
3) Service delivery to ensure life-saving services and supplies in development and humanitarian settings, and to
monitor the extent to which bottlenecks and barriers are removed.
4) Cross-se toral li kages ade y applyi g the days approa h , pro oti g i tegrated ser i es i the sele ted o erge e ou ties , a d i pro i g oordi atio a ross li e i istries y esta lishi g ulti-sectoral coordination body.
5) Partnerships will be centered within the UN, with UNICEF providing leadership in nutrition, WASH and
education. UNICEF will continue to work with donors, academia and other international organizations.
Assumptions 1. Government is committed to
disaggregated data generation
and use
2. Government accepts human
rights approaches critical to
inclusive development
3. Community is willinjg to accept
the behavior change, related to
caring and infant feeding
practices.
.
.
.
.
Programme Rationale
Social Inclusion
51
9.1.4 Key partners
The Social Inclusion Programme Component will work with a number of partners as detailed below.
The Child Data Management Unit (CDMU) of the Central Bureau of Statistics (CBS)will be a cornerstone of
this programme. UNICEF will support the strengthening of its capacity to undertake data analysis and
research, and update the 2009 MICS indicators. The programme aims to identify the patterns and locations
of exclusion and inequality through the collection, analysis and reporting of quality data. Based on routine,
disaggregated, gender-sensitive data, programmes across the social sectors can be better planned,
implemented, monitored and evaluated with the prime purpose of closing the inequity gap. Understanding
the immediate, underlying and root causes of vulnerability, and with knowledge supported by reliable
evidence, the programme will contribute to policy dialogue and programming, to reporting to the
Committee on the Rights of the Child, CEDAW and CRPD, and to building resilience in both humanitarian and
non-emergency settings.
Decision-makers in key ministries and Government institutions will become aware of their obligations as
duty-bearers, have the capacity to track indicators, and to remove the bottlenecks and barriers that lie in the
way of social inclusion. These ministries and institutions will include Ministry of Public Health, Education
Commission, Ministry of Foreign Affairs, Ministry of City Management, and the Grand People s Study House.
The National Commission for Disaster Management (NCDM) will have increased capacity in planning based
on vulnerability mapping and in responding to humanitarian situations in order to reach the most vulnerable
communities.
The Division for Human Rights of theMinistry of Foreign Affairs is responsible for reporting on all conventions
as well as the Universal Periodic Review. UNICEF will provide support to the Division for the preparation of
reports.
The Education Commission will play a central role in ensuring that disaggregated data and measurement of
learning outcomes will sharpen education planning, monitoring and evaluation towards enhancing learning
achievement, reducing geographic disparities, and addressing inequities, with a specific focus on addressing
the educational needs of children with disabilities. The Korean Federation for People with Disabilities is
active in addressing issue of inclusion for people with disabilities.
9.1.5 Strategies
i) Capacity development. Capacity development will be a main UNICEF implementation strategy for this
component. To strengthen the capacity of the Central Bureau of Statistics, UNICEF focuses on training
and technical assistance in the areas of data management and analysis. Communication for development
will address stigma and discrimination towards children with disabilities and also to encourage demand
for special education services. The programme will support more systematic use of disaggregation to
enhance equity-focused design and implementation of policies and programmes and to strengthen
reports on the CRC, CEDAW and CRPD, once it is ratified.
ii) Evidence generation, policy dialogue and advocacy. The programme will generate insights and evidence
that contribute to the realization of child rights and the promotion of equity. The programme will
support policy dialogue and advocacy objectives, including emphasis on the obligations of human rights
duty-bearers and to address issues of equity, most notably for children with disabilities to have equitable
access to education.
iii) Partnerships. UNICEF will work closely with other UN Agencies under this programme component to
strengthen the use of data under the fourth UNSF thematic area of Data for Management .
52
iv) South-South and triangular cooperation will be an important strategy under this component and will
actively support experience exchange with other countries in the areas of data management, CRC
promotion and in the area of inclusive education.
v) Support to integration and cross-sectoral linkages. Effective generation and use of data for planning
and policy development will require support to integration and cross-sectoral linkages as an explicit
implementation strategy. This strategy will contribute to and inform evidence generation, policy
dialogue and knowledge management specific to cross-sectoral dimensions. The CRC/CEDAW/CRPD will
be promoted across Ministries. The needs and rights of disabled children will be addressed through
programmes in health, nutrition,WASH, and in humanitarian situations.
vi) Service delivery will not be specifically supported in this programme component. If policies and plans
are in place, service delivery in the area of special education with the objective of addressing inequities
in education, may be considered at the mid-term review. However,UNICEF does not foresee a
construction component in the programme as the focus will be on providing services in mainstream
schools.
9.1.6 Assumptions and Risks
The assumptions and risks described below reflect the fact that progress will be non-linear, with many
variables coming into play that will delay or accelerate the achievement of results. Activities detailed in
annual work plans will serve to tighten the logic between inputs, outputs and the overarching outcome in
the Theory of Change.
Assumptions:
Social Inclusion is accepted as part of the development paradigm and the basis of policy and
programming dialogue
The Central Bureau of Statistics is willing to make to make data available.
The Child Data Management Unit functions effectively
The Government conducts the Learning Needs Assessment in 2016 and is willing to address the
inequities identified.
Government will allocate financial and human resources to strengthen education for children with
disabilities.
UNICEF will be able to build the capacity of Government counterparts.
Risks:
Funding is not available.
The identified assumptions are not valid
The capacity of Government counterparts is insufficient.
Government lack capacity to manage and coordinate multi-sectoral data management.
Data management, sensitivities and related constraints.
Potential contextual barriers (including stigma social attitudes to disabilities and inclusion, sensitively to
data)
Given the absence of partners, UNICEF inputs and outputs could be necessary but insufficient to reach
the planned outcome.
The mitigation measures include re-enforced evidence-based advocacy, an aggressive fund raising strategy,
strengthening data management within Ministry of Public Health and Child Data Management Unit, Ministry
of City Management, and implementation of a comprehensive communication strategy.
53
9.1.7 Monitoring Outputs and Demonstrating UNICEF’s Contribution to
Outcomes
UNICEF contribution towards the outcome and will be tracked through a monitoring plan to be developed
internally. The indicators in the results matrix will be tracked and updated on an annual basis. Progress
towards the achievement of these outputs and outcomes will be tracked through MoRES, and by monitoring
appropriate indicators and milestones developed on an annual basis with the Government counterpart
ministries in the rolling annual work plans. Field monitoring visits will be undertaken some jointly with the
counterpart ministries and other partners in the sector.
54
10 Fundraising Strategy
The overarching goal of UNICEF DPRK s fund raising strategy is to proactively mobilize resources for
children and ensure predictable and long-term funding to facilitate quality programming by UNICEF
for the most disadvantaged children in the country.
The current country programme 2011-2015 has an approved budget of 9.3 million Regular Resources
(RR), and 118.8 million of Other Resources (OR). The RR increased to 12.3 million because of the
one-year extension of the current CP. Forty-five per cent of RR goes to funding staff salaries.
Fundraising for DPR Korea has traditionally proven difficult. The unpredictability of funding
enviroenemnt has been the most challenging factor to design and implement programmes to
improve health and nutrition status of children and women in DPRK .
Despite injections of multilateral OR received through GAVI (3.2 million in 2015) and the Global Fund
for AIDS, Tuberculosis and Malaria (3.3 million in 2015), as of December 2015, the unfunded portion
of OR stood at 28 per cent. Apart from GAVI and The Global Fund, other resources, when they are
secured, are usually short-term.
Programme
Ceiling amount as per
Country Programme
Document (Planned)
Total Funded Amount from
1 Jan 2011 to 24 Sep 2015
Other
Resources
Funding
Gap
Unfunded
Regular
Resources
Other
Resources
Regular
Resources
Other
Resources
(a) (b) (c) (d) ( e) f = e/b
Health 1,396,000 83,842,000 4,510,042 68,186,762 15,655,238 19%
Nutrition and care 2,326,000 10,000,000 2,631,043 7,702,200 2,297,800 23%
WASH 1,396,000 12,500,000 2,004,150 5,169,781 7,330,219 59%
Education 2,326,000 10,000,000 2,227,827 5,055,418 4,944,582 49%
Advocacy 930,000 2,500,000 486,546 -- 2,500,000 100%
Cross sectoral 931,000 -- 817,206 8,844 -8,844
Total 9,305,000 118,842,000 12,676,814 86,123,005 32,718,995 28%
Out of US$ 12,676,814 Regula Resources funded, US$ 2,369,035 represent Emergency loan funds and US$
198,992 are 7% set-aside funds.
Table 7: Funding Status as of September 2015 (US$)
During the current country programme, there has been a worrisome decline in the number of
donors: The Government of Australia informed the office in 2014 that they were stopping further
funding; the German National Committee does not appear to be interested in continuing support
55
past 2015; the Australian NatCom has stopped funding; support from the Norwegian Committee for
UNICEF has not continued; the Swiss Government has indicated they will no longer fund the WASH
programme beyond 2015. The Norwegian Government was contacted for possible support but has
not resulted in funding.
CERF funding for the UN System through the underfunded emergency window declined significantly
over the course of the current country programme from a high of USD 15.4 million in 2011 to only
USD 2 million in 2015 in light of competing global emergencies. The level of CERF funding is unlikely
to increase and is likely to decline further if not totally discontinued. While an additional USD 2.5
million in funding was received from CERF in 2015 though the Rapid Response window for the
drought, again this kind of support is situational and is not likely to be repeated.
Republic of Korea (ROK) is the largest government resource partner to UNICEF DPRK and the
Ministry of Unification (MoU) channels the aid fund which is not considered to be a part of Korean
ODA. MoU started to provide humanitarian assistance funds to DPRK through UNICEF s program
since 2003. Since then, the level of contributions from MoU to UNICEF has been increased, but the
lingering political tension between ROK and DPRK makes year by year support highly unpredictable.
As the ROK is the only provider of basic vaccines and essential medicines and their funding
commitments are only made annually through a protected and uncertain consideration process, the
programme faces constant uncertainty.
UNICEF DPRK programme funded by MOU is mainly in the areas of health and nutrition, and data
collection. In 2009, ROK stopped funding UNICEF s WASH programme, which involves construction
of gravity-fed water systems as one of its components and requires pipes and cement. UNICEF was
informally told that the ROK government was reluctant to support this programme component due
to fear on potential diversion of supplies such as pipes and cement for other purposes.
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
$0.5 mil
$1 mil
$1 mil
$2.2 mil
$1 mil
$4.1 mil
$3.9 mil
Nil $5.6 mil
Nil $6.04 mil
Nil $ 4.0
ORE ORE ORE ORE ORE ORE ORE ORE ORE ORE
Table 8: MoU’s contributions to UNICEF, 2003-2015
UNICEF and Ministry of Unification worked to develop new and multi-year partnership agreement
and in May 2015, the UNICEF Executive Director and Minister signed the Memorandum of
Understanding (MOU) on the Partnership Programme 2015-2020 for DPRK Children ; however, the
MoU does not specify the levels of support beyond USD 4 million for health and USD 2 million for
nutrition in 2015. In May 2015, Ministry of Unification provided USD 4 million for UNICEF Health
programme after the agreement signing; however the ROK has still not met its commitment in the
MOU to provide funding for nutrition in 2015. .
It is clear from the graph below that ORR with the Global Fund and GAVI artificially inflates the total
programmable budget. Funding from RR, ORR and ORE remains flat or is declining. It is against a
backdrop of a shrinking resource base and an unpredictable fundraising environment that the broad
lines of a strategic vision need to be drawn.
56
Funding sources Amount Total
2011 2012 2013 2014 2015 2011-2015
RR 3,686,379
1,593,480
1,933,993
2,668,489 2,799,473
12,681,814
ORR 8,853,808
13,060,656
16,899,857
12,417,259
36,215,663
87,447,243
ORR without
GF/GAVI 1,773,987
2,425,314
5,196,856
3,069,682
7,993,808
20,459,648
ORE 4,065,040
8,199,446
7,550,527
8,175,142
6,963,718
34,953,873
GF 7,079,821
10,536,752
11,244,637
9,271,380
22,189,646
60,322,235
GAVI Fund -
98,590
458,363
76,197
6,032,209
6,665,360
Total Funding 16,605,227
22,853,582
26,384,376
23,260,891
45,978,854
135,082,930
Table 9: Summary of Types of Funding by Year
-
5,000,000
10,000,000
15,000,000
20,000,000
25,000,000
30,000,000
35,000,000
40,000,000
45,000,000
50,000,000
2011 2012 2013 2014 2015
Ye
arl
y F
un
din
g (
$)
Year
DPRK Funding: 2011-2016
RR ORR ORR without GF/GAVI ORE GF GAVI Fund Total Funding
57
5.1 Factors continuing to declining funding:
Attracting funds to DRK is hampered by the general global perspective of the country which is
reinforced by the fact there are sanctions imposed on it. The country s self-imposed isolation and
the limited information available globally and to donors, reinforces the general perception.
The following concerns are shared with UNICEF by current and potential donors with regard to DPR
Korea:
Monitoring is perceived to be insufficient to ensure that all supplies reach to the intended
end-users.
Inadequate technical support to ensure supplies are effectively used: The need for balance
between supply and technical assistance.
Insufficient data available on the real situation.
Donors believe that the Government should increase their contributions to the social sector.
( Donor fatigue or expecting more responsive governance)
There are competing global needs for humanitarian funds.
Difficult for the public to support fund raising for DPRK due to the public s lack of trust of the
Government
Concern supplies have dual purpose and will be diverted.
5.2 Historical source of funds by programme
The Health Programme has reviewed funding from ROK for vaccine and essential medicine and also
funds form GAVI for the immunization and health system strengthen programme. With the GAVI
funding extending to 2018 and are the only source of long term predictable funding. Indications are
that GAVI will continue funding past 2018, but at a reduced level.
The TB and Malaria programme is 100% funded by the Global Fund and UNICEF has funds until mid-
2018.
This is a well-funded programme; however, it is a standalone programme and does not support
UNICEF s main goals, rather UNICEF, as the Principle Recipient, serves as a contractee to support
WHO s mandate in TB and Malaria.
The UNICEF WASH programme has received SDC funding – which will not continue beyond 2015 –
and global thematic funding.
The Education Programme has never received funds from any donor directly and the only funds uses
are global Thematic Funds and RR.
UNIC
EF
DPR
Korea
:
Sourc
es of
Funds
-
2011
to
2015
$58,998,880 $20,023,876
$14,621,666 $10,886,988
$6,665,360 $5,236,595
$2,691,492 $1,440,803
$711,214 $559,129 $530,004 $509,951 $275,896 $243,132 $220,153 $28,038
The Global Fund to Fight Aids, Tube
Republic of Korea
The GAVI Fund
Canada/IHA
German Committee for UNICEF
Switzerland
Micronutrient Initiative
Consolidated Funds from NatComs
58
5.3 Fund-Raising and Leveraging Resources Strategy: It is expected that the UNICEF Executive Board will approve the aggregate indicative budget of
US$ 12,735,000 million in RR, subject to the availability of funds, and US$ 58,636,589 million in ORR
for 2017-2021 (a reduction from the previous cycle of 58 per cent.) The major reason for the decline
is there is no money from the Global Fund past 2018.
UNICEF DPRK will revise its overarching resource mobilization strategy to support the country
programme to reflect the new country programme priorities and the changing funding environment.
UNICEF DPR Korea s resource mobilization strategy will combine the following key actions:
i) The Government of DPRK: Advocate with the Government for increased co-funding for GAVI
supported immunization programme and for their own funding for basic vaccines; seek to
leverage increase local resources for the WASH Programme and for gravity-fed water systems
(GFS) where UNICEF will provide technical support and will supply only the critical inputs and key
components not available nationally; seek to leverage more local resources in the areas of
nutrition; generally UNICEF s advocacy focus will be on areas to be taken over by Government
as part of the self-reliance philosophy.
ii) UNICEF DPRK: Improve the quality of monitoring and donor reports seeking writing assistance
from professional communicators. Hiring a communications consultant to develop a donor
toolkit using human interest stories and showing success stories. Consider a fundraising tour by
the Representative, armed with presentations and toolkit, to various potential donor and
NetCom s - Russia, China, Viet Nam, Cambodia, and other countries/multilaterals that have
representations in Pyongyang. Advocate with NCC to grant visas for visiting donor delegations
from diverse countries. Directly engage with the new Regional Director for increased thematic
funding as per EAPRO s regional priorities such as the ' first 1,000 days' and 'second generation
focus.
iii) Consolidating the current funding base: Make bi-annual visits to Seoul to meet Government
officials, the Korean Committee for UNICEF and Embassies. Use home leaves of IPOs to make
visits to current and potential donor governments and NatComs, such as to SIDA and Canadian
government. Strengthen relations with the Ministry of Unification (ROK) by operationalizing
the Memorandum of Understanding through establishing a more systematic process for
submitting proposals toward increasing predictability.
59
iv) Reaching out to non-traditional donors: Explore funding with new partners including the BRICs
(Brazil, Russian, India, and China), Vietnam and others.
v) Korean diaspora in the USA, Europe and China: Explore working with the US and Canadian
NatComs to fundraise with the Korean diaspora (diaspora in USA: 2 million; in Canada 200,000).
Look into the possibility of individual philanthropy through organizations such as Acumen.
As effective programmes are the best fundraising tools, the office will emphasise evidence-based
management through strong technical competencies, results-based monitoring and reporting and
more flexible UNICEF internal processes. UNICEF will address some of the donors concerns that have
an impact of fundraising in the new country programme by strengthening monitoring and evaluation
and technical support.
UNICEF will also ensure that all fundraising proposals include funding for the Social Inclusion and
Programme Effectiveness components of the Country Programmes ensuring adequate funding for
evaluation, communication for development, and operating expenses.
Contingency Planning: In the event that other resources become severely limited, UNICEF will
prioritize support for the most impactful life-saving interventions in the country programme namely
the immunization programme, the provision of essential medicines and the treatment of severely
malnourished children.
60
ANNEX 1: CPD 2017-2021: Result Matrix
Health Programme
# Levels Indicators baseline target MoV
geographical
focus
Assumption and
Risks
1.10 Outcome Statement:
By 2021, maternal
mortality reduced
from 87 to 57, U5M
reduced from 25 to 16,
and tuberculosis and
malaria prevented and
controlled.
% of under one children and
pregnant women fully
vaccinated.
94% (Q2 EPI
report 2015)
98% Health Information
Management
System (HMIS)
Coverage
Evaluation Survey
(CES), A Promised
Renewed (APR),
National TB &
Malaria
Surveillance
Systems,
DHS/MICS, IMNCI
evaluation
National Assumptions
1. National capacity
building
mechanism are
functional.
2. Global standards
well adopted in
policy
development.
3. Government
allocates sufficient
resources.
4. Uninterrupted,
timely access to
donor funds.
5. Uninterrupted
cash flow and
timely in country
access to funds.
6. Optimal use of
services.
% of under five children with
diarrhea received ORS.
6% (Promise
Renewed
2015)
3% National
% of under five children with
pneumonia treated with
antibiotics.
14% (Promise
Renewed
2015)
7% 50 counties
Case Notification Rate of all
forms of TB per 100,000
population
394 (National
TB
Surveillance
System, 2013)
414 190 counties
% of population at-risk
covered by LLINs
51.9%
(National
Malaria
Surveillance
System, 2013)
100% 123 counties
% of Households in targeted
areas covered by IRS
81.4%
(National
95% 123 counties
61
Malaria
Surveillance
System, 2013)
Risks.
1. Non acceptance
of global standards
and approaches.
2. lack of funds
3. No reliable data
available.
4. Possible cultural
resistance.
1.1.1 Output Statement: By
2021, the Ministry of
Public Health (MoPH)
has knowledge, skills
and evidence to
develop, implement
and monitor MNCH
national policies,
strategies, tools and
guidelines.
# of national guidelines
developed, implemented
and monitored on newborn
care, community IMNCI,
EmONC and equity in
immunization.
0 (new
initiative)
3 National guidelines
on equity in
immunization,
community IMNCI,
ENAP and EmONC
National
1.1.2 Output Statement: By
2021, a package of
knowledge, skills and
tools available to
ensure equitable
access to quality
maternal, neonatal and
child health services
including EmONC.
# Training materials on EPI,
EmONC, and IMNCI
developed, implemented
and monitored.
0 (new
initiative)
3 Training materials,
training reports and
performance
assessment
National
# of counties scaled up
evidence-based
interventions
0 (new
initiative)
208 HMIS National
# of counties with training
centres and trained staff
0 10 # of training center
established
Monitoring reports
10 counties
62
1.1.3 Output Statement: By
2021, health system
provides equitable
access to quality
immunization and
IMNCI services.
# of health facilities
equipped with immunization
services
208 1200 EPI reports
Coverage
evaluation survey
(CES)
National
# of counties implement
EmONC package
16 26 HMIS 26 counties
# of EPI managers and
vaccination staff trained on
vaccine & cold chain
management.
600 5,000 Training report National
% of U1 Pentavalent
coverage
% of mother with TT2+
coverage
94% (EPI
report 2015)
98% (EPI
report 2015)
98%
98%
EPI reports
Coverage
evaluation survey
(CES)
DHS/MICS
National
2 Effective Vaccine
Management
(EVM)Assessment
conducted
0 1 (EVM
2018)
EVM assessment
report
National
CES conducted
0 1 CES report National
# of counties implement
community IMNCI
10 50 Training reports
counties
implementing
50 counties
IMNCI Evaluation 0 1 Evaluation report National
63
# of HHDs trained on
community IMNCI
500 5000 Training reports
Monitoring reports
50 counties
Output Statement: By
2021, MoPH provides
quality-assured
diagnosis, treatment of
malaria cases, and
implements targeted
vector control
interventions.
% of suspected malaria cases
that receive a parasitological
test at public sector health
facilities
88.9%
(National
Malaria
Surveillance
System, 2013)
98% Quarterly Lab,
M&E, and
Supervisory
Reports; NMP
Surveillance system
123 counties
Number of LLINs distributed
to at-risk populations
through mass campaigns
711960
(National
Malaria
Surveillance
System, 2013)
866100 Quarterly M&E
Report; NMP
Surveillance system
123 counties
% of population protected
by IRS within the last 12
months
81.4%
(National
Malaria
Surveillance
System, 2013)
95% Quarterly M&E
Report; NMP
Surveillance system
123 counties
1.1.4 % of target population that
receive Mass Primaquine
Prevention Treatment
(MPPT)
30.2%
(National
Malaria
Surveillance
System, 2013)
95% Quarterly M&E
report; NMP
Surveillance system
123 counties
1.1.5 Output Statement: By
2021, MoPH scales up
preventative,
diagnostic and
treatment services for
TB and MDR TB cases.
# of notified cases of all
forms of TB
97665
(National TB
Surveillance
System, 2013)
100044 NTP Quarterly M&E
Report; TB patient
register; TB
treatment card; TB
R&R system
190 counties
# of children <5 receiving IPT NA 6650 NTP Quarterly M&E
Report; TB R&R
system
190 counties
64
% of previously treated TB
patients receiving DST
1.7%
(National TB
Surveillance
System, 2013)
9% NTP Quarterly M&E
Report; TB R&R
system
190 counties
# of bacteriological
confirmed drug resistant TB
cases notified
240 (National
TB
Surveillance
System, 2013)
525 NTP Quarterly M&E
Report; TB R&R
system
190 counties
65
CPD 2017-2021: Result Matrix
Nutrition Programme
# Levels Indicators Baseline Target MoV Geographical
focus
Assumptions and Risks
1.1 Outcome: By 2021,
adolescent girls, WRA, PLW
and U5 children utilize
nutrition services equitably
and practise age and context
appropriate behaviours for
the prevention and
treatment of undernutrition.
% infants who initiated BF within
one hour.
% infants <6 months exclusively
breastfed
% 6-23 months old children
received age-appropriate
Minimum Acceptable Diet.
% 6-23 months old children
received MMNP (Sprinkles).
% of HH consumed adequately
iodized salt
% of SAM children treated
% pregnant women received
MMNT (tablets).
% children 6-59m received bi-
annual doses of Vitamin A & Age
appropriate deworming.
% of lactating women received
MMNT (tablets).
28%
69%
26%
20%
25%
40%
20%
98%
30%
All the
above from
the 2012
NNS.
60%
80%
50%
50%
50%
50%
40%
98%
50%
National nut.
status survey
MICS, DHS.
Health and
Nutrition Info.
Management
system
Routine data on
SAM treatment,
MMNP
(Sprinkles) & VAS
and deworming
coverage data
CMAM
evaluation.
National and
convergence
counties-
CMAM
Assumptions:
a) Political commitment to coordinate
and contribute to implementation of the
multisectoral approach to address
women and children nutrition with
equity focus.
b) Political commitment to coordinate
and contribute to implementation of the
multisectoral approach to achieve USI
with equity focus.
c) Government have enough capacity
and resources in food, Health and
WASH.
d) Stable and conducive programme
environment.
e) Community is willing to accept the
behavior change, related to caring and
infant feeding practices.
Risks:
a) Government lack capacity to manage
and coordinate multi-sectoral nutrition
programme
b) Insufficient budget allocation
c) Infrastructure and logistics constraints
d) Sub-optimum knowledge and
practices of service providers and care
givers.
e) Data management, sensitivities and
related constraints.
66
1.1.1 Output Statement -1: By
2021, the MOPH has
developed, implemented
and monitored a
comprehensive package
of women, adolescent and
child related nutrition-
specific interventions.
Proportion of hospitals
implementing the CMAM-IYCF
counselling package of services.
Proportion of hospitals which
received supportive supervision
visits;
Proportion of counties submitting
timely and complete monitoring
data
number of planned bottleneck
analysis exercises undertaken, etc
90/208
(43%)
20%
0%
0
208
(100%)
60%
60%
3
Nutrition-
specific set of
interventions
are under
implementation
at national
level.
1.1.3 Output Statement-2: By
2021, the State Planning
Commission (SPC) and
Ministry of Chemical
Industry (MCI) have
implemented and
monitored the national
plan to achieve USI.
% of households using
adequately iodized salt IDD survey among Pregnant
women – Median Urinary Iodine
Concentration (MUIC)
25% MICS
2009
96.8ug/L
<100
among
school age
children in
all
provinces
except
Pyongyang
(134) and
N Pyongan
(102) (IDD
survey-
2010
50%
150-249
ug/L.
National
Nutrition
Survey, IDD
survey among
pregnant
women, MICS,
DHS
National
67
CPD 2017-2021: Result Matrix
Social Inclusion Programme
# Levels Indicators Baseline Target MoV Geographical
focus
Risks and Assumption
1.1 Outcome Statement:
By 2021, Government
uses disaggregated
data for equity-
focused social policy
development and
planning, and
reporting on the rights
of children and
women.
# of sectors using
current disaggregated
data in policies and plans
CRC/CEDAW/CRPD
reports use current
disaggregated data
NA
NA
4 sectors (Health,
Nutrition, WASH and
Education)
3 reports
(CRC/CEDAW/CRPD)
Sectoral policies and
plans
CRC/CEDAW/CRPD
Report
National ASSUMPTIONS:
Government is
committed to
disaggregated data
generation and use
Government accepts
human rights
approaches critical to
inclusive development
RISKS:
Political sensitivities to
making child rights
related, disaggregated
data available
Social attitudes to
marginalization and
mistreatment do not
change
68
Discrimination difficult
to quantify and
aggregate
1.1.1 Output Statement:
By 2021, the Central
Bureau of Statistics has
capacity to coordinate,
analyse and
disseminate
disaggregated data
related to children,
adolescents and
women
CBS (CDMU) reports on a
set of indicators for
children, adolescents
and women.
Nil 3 reports CDMU report National
1.1.2 Output Statement: By
2021, the Education
Commission uses
evidence based
planning to improve
learning outcomes and
address the needs of
children with
disabilities.
National learning
achievement
assessments
National guidelines for
learning outcomes
National plan for
enrolment and retention
NA
NA
NA
Assessment Reports
National plan
National guidelines
Assessment reports
National Plan
National guidelines
National
69
of children with
disabilities
CPD 2017-2021: Result Matrix
WASH Programme
70
# levels indicators baseline target Move geographical
convergence
Assumptions
and Risks
1.1 Outcome
Statement: By
2021, women and
children have
equitable access
to sustainable,
clean water and
sanitation
services, and
practise improved
hygiene and
sanitation
behaviours
including in
humanitarian
situations.
(1) % of national population using improved
and safely managed drinking water services
(2) # of health care facilities with basic water,
sanitation and hygiene facilities
(3) Average weekly time spent in water
collection (including waiting time at public
supply points) {by gender, age and location}
(4) % national pop using improved and safely
managed sanitation services
(5) % of national households with a hand
washing facility with soap and water in the
household
(6) % national pop practising virtual open
defecation (safely using faecal matter in
agriculture)
(7) % schools (nationally) providing gender
and disability-friendly basic sanitation
facilities including handwashing
(1) 77% (derived from
CBS/MOCM Water
Assessment, 2013)
(2) Unknown
(3) Unknown
(4) 82% (WHO/UNICEF
JMP, 2014)
(5) Unknown
(6) 23 % (Virtual open
defecation, derived from
field observations and
WHO/UNICEF JMP, 2014)
(7) Unknown
(1) 90%
(2) At least 20%
above the
baseline
(3) less than 8
hours per week
(4) 92%
(5)100% by 2021
(6) reduced to
less than13%
(7) 20% above
the baseline
MICS; Census;
DHS/equivalent
survey; EMIS;
HMIS; Water
Assessment
Surveys and
other surveys;
Annual
WHO/UNICEF
JMP reports
convergence
Counties
(CMAM, SAM,
High diarrhoea,
low WASH
coverage)
Assumptions
1. Govt
facilitates
multi-
sectoral
approaches
2. Govt will
increase
fund
allocation
3. Adequate
resources
are available
Risks
1.
Inadequate
data
2.
Adherence
to
71
1.1.1 Output
Statement: By
2021, government
has developed,
implemented and
monitored WASH
Strategy and
Action Plan
reflecting a multi-
sectoral approach.
WASH strategy and implementation
guidelines with a Multi-sectoral action plan
Not developed Developed Government
records
National traditional
practices
3. Lack of
engagement
with
community
1.1.2 Output
Statement: By
2021, selected
cooperative farms,
households,
schools and health
facilities in 10
convergence
counties apply
knowledge and
skills to practise
hygiene
behaviours and
safe use of faecal
matter in
agriculture.
(1) % pop in target areas using improved and
safely managed sanitation services
(2) % pop in target areas using improved and
safely managed drinking water services
(3) % pop in target areas with a hand
washing facility with soap and water in the
household.
(4) Average weekly time spent in water
collection (including waiting time at public
supply points) {by gender, age and location}
(1) unknown (TBA during
the Feasibility study)
(2) unknown (TBA during
the FS)
(3) unknown (TBA during
the FS)
(4) unknown (TBA during
the FS)
(1) 92% by 2021
(2) 90 % by 2021
(3) 100 % by
2021
(4) less than 8
hours per week
MICS; Census;
DHS/equivalent
survey; EMIS;
HMIS; Water
Assessment
Surveys and
other surveys;
Field
monitoring and
evaluation
reports
convergence
counties
72
1.1.3 Output
Statement: By
2021, water
quality testing
data, meeting
international
standards, used
for water sector
policy dialogue.
(1) minimum national standards for water
quality surveillance published
(2) % of counties (nationally) conducting
routine water quality surveillance in
accordance with the national standards
(1) No
(2) Unknown
(1) Yes
(2) 80%
Assessment
survey
Convergence
counties
1.1.4 Output
Statement: By
2021, people's
committees in 10
convergence
counties have the
capacity to assess
WASH needs,
plan, manage and
monitor WASH
services.
(1) % County Peoples Committees in target
areas complete feasibility and design studies
and raise local contribution for WASH for All
(2) % county Peoples Committees in target
areas that receive DPRK/UNICEF support for
WASH for All
(1) Unknown
(TBA:Central Planning)
(2) Unknown (CPAP)
(1) 100%
(2) TBD
(CPD/CPAP)
Feasibility and
Design Reports
convergence
counties
(1) 100 % County Peoples Committees in
target area have core trainers for
Management of Maintenance and Operation
of WASH services
(2) 100 % of WASH schemes in target area
have trained operators
(3) % WASH schemes in target area with
breakdowns exceeding 30 days before repair
(1) No
(2) No
(3) Unknown
(1) Yes
(2) Yes
(3) less than 10%
Surveys
73
1.1.5 Output
statement: By
2021, the capacity
of the State
Commission for
Emergency and
Disaster
Management
strengthened for
multi-sectoral
response in line
with the Core
Commitment for
Children, and to
build community
resilience.
(1) National WASH resilience standards
developed
(2) 100 % drought/flooding prone counties
have Provincial flood/ drought preparedness
plan
(3) 100 % vulnerable counties implementing
mitigation/ contingency plans for WASH
resilience
(1) No
(2) No
(3) No
(1) Yes
(2) Yes
(3) Yes
Surveys and
DPRK reports
National
74
Annex 2. Draft Annual Budget Breakdown 2017-2021
Programme
Components and
Outcomes
2017 2018 2019 2020 2021 2017-21
Programme Component 1: Health
A. Health
RR
439,200
439,200
439,200
439,200
439,200
2,196,000
ORR
5,034,565
5,034,565
4,103,450
3,776,300
3,449,151
21,398,029
Subtotal
5,473,765
5,473,765
4,542,650
4,215,500
3,888,351
23,594,029
B. Malaria
RR
ORR
1,679,161
64,461
1,743,622
Subtotal
1,679,161
64,461
1,743,622
C. Tuberculosis
RR
ORR
9,302,897
1,325,435
10,628,332
Subtotal
9,302,897
1,325,435
10,628,332
Outcome 1. Health (A+B+C)
RR
439,200
439,200
439,200
439,200
439,200
2,196,000
ORR
16,016,623
6,424,461
4,103,450
3,776,300
3,449,151
33,769,983
Total
16,455,823
6,863,661
4,542,650
4,215,500
3,888,351
35,965,983
Programme Component 2: Nutrition
Outcome 2:
RR 565,200 565,200 565,200 565,200 565,200 2,826,000
ORR 2,580,390 2,580,390 2,580,390 2,580,390 2,580,389 12,901,949
Total 3,145,590 3,145,590 3,145,590 3,145,590 3,145,589 15,727,949
Programme Component 3: WASH
Outcome 3:
RR
579,200
579,200
579,200
579,200
579,200
2,896,000
ORR
846,466
1,269,699
2,962,630
2,116,164
1,269,699
8,464,657
Total
1,425,666
1,848,899
3,541,830
2,695,364
1,848,899
11,360,657
75
Programme Component 4: Social Inclusion
Outcome 4: Social Inclusion
RR 305200 305200 305200 305200 305200 1526000
ORR 200000 200000 200000 200000 200000 1000000
Total 505200 505200 505200 505200 505200 2526000
Total Programmes:
RR
1,888,800
1,888,800
1,888,800
1,888,800
1,888,800
9,444,000
ORR
19,643,478
10,474,549
9,846,470
8,672,854
7,499,238
56,136,589
Total
21,532,278
12,363,349
11,735,270
10,561,654
9,388,038
65,580,589
Institutional Budget
Outcome – Programme Effectiveness
RR 492200 492200 492200 492200 492200 2461000
ORR* 500000 500000 500000 500000 500000 2500000
Grand Total –
Integrated Budget
RR
2,381,000
2,381,000
2,381,000
2,381,000
2,381,000
11,905,000
ORR*
20,143,478
10,974,549
10,346,470
9,172,854
7,999,238
58,636,589
Total
22,524,478
13,355,549
12,727,470
11,553,854
10,380,238
70,541,589