Concept Note. I. Programme Summary: *

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1 Concept Note I. Programme Summary: * The programme goal is to support existing national policies and local actions for the improvement of food and nutritional security of indigenous children in the regions of Dourados (MS) and Alto Rio Solimões (AM), Brazil. Two fronts of action will be developed: (i) promoting access to public programmes and services, with the aim of reducing cases of malnutrition and the infant mortality rate; (ii) promoting the sustainability of production and access to food by strengthening local productive systems that rely on and respect the food and economic culture of these peoples. The proposal is focused on Children, but will also place emphasis on women, as infant malnutrition can only be effectively addressed if the mother-child unit is considered. Crosscutting actions to empower Indigenous communities, leaders and organizations, and strengthen public capacities will be developed. All initiatives will count with full participation from the communities and public agents. II. Background and Rationale A human-rights based approach to the Millennium Development Goals implies that public actions and policies should be primarily directed to the most vulnerable groups, ensuring that the MDGs are a reality for all, regardless of gender, race, ethnicity and income situation. Brazil has made considerable progress regarding nutritional and health conditions of its population. The most recent health and demographics survey shows that the percentage of women that do not undergo any pre-natal examination is practically zero (falling from 14%in 1996 to 1% in 2006). As for the nutritional and health state of under-five children, even in the regions where malnutrition has been traditionally high, there have been significant improvements. A case in point is the Northeast Region, where the levels of growth deficiency are now similar to those found in the Southeast (6%). As for low weight to height ratios, these were not in excess of 2% in any region of the country, suggesting that any acute forms of energy deficiency in children have virtually been eliminated. The infant mortality rate was reduced by 44% between 1996 and 2006 to 22 per 1000 live births (PNDS, 2006). If, the national averages are indeed satisfactory, the same cannot be said when the most vulnerable groups in are analyzed. In the case of indigenous peoples, the information currently available suggests a situation where there has been a weakening of self-management capability and economic autonomy with consequent cultural fragmentation, sickness and hunger. An analysis of the infant mortality rate for 2005 shows that, whereas the national average was 21.2 per 1000 live births, amongst indigenous communities this coefficient was 52.7 (FUNASA, 2008). The situation is particularly challenging in the regions of Dourados and Alto Rio Solimões (see attached map). Dourados, located in the state of Mato Grosso do Sul, has almost 182,000 inhabitants of which approximately 15% are indigenous people, mainly of the Guarani and Kaiowá ethnic groups. The Alto Rio Solimões region, lies in the middle of the Amazon Forest, close to Peru. In Dourados, 10% of indigenous children under 5 have low weight for their ages (FUNASA, 2008). Cases of deaths resulting from malnutrition have been reported in recent years and the community also suffers from cases of homicides, suicides and alcoholism. The land ownership situation is precarious and there are a large number of indigenous settlements along the roadsides. In this region, it is particularly noticeable that there is a severe food and nutrition insecurity situation a large part of the communities have lost their capacity to produce food and depend on the distribution of food baskets by the public authorities. As for the people in the Alto Rio Solimões Region (37,838 indigenous people, mainly from the Ticuna, Cocama, Kaixana, Katutina, Madija and Kambeba ethnic groups), around 28% of the

2 children under 5 years old have low weight for their ages. The large distances involved and difficult access have resulted in the low provision of pre-natal and vaccination services, and Indigenous Surveillance System (SISVAN-Indígena). A subsystem that is integrated to the National Public Health System (SUS) is responsible for taking care of the health of indigenous people. This subsystem includes the Special Indigenous Health Districts (DSEIs). The main objective of a DSEI is to set up a network of basic health services in order to expand the area covered by the service and to facilitate access. Every DSEI is programmed to offer different services and to operate linked to a reference network for providing more complex services. However, the majority of settlements and communities do not even have a primary health unit. In general, the number of professionals is not enough to guarantee a universal coverage of health services, and there are also shortages of materials, equipment and medicines. As a result, service is centralized and reduced to meeting the spontaneous demand, which compromises resolvability and the development of actions to prevent diseases and promote health. This lack of access to public services and a loss of self-managing capacity have permeated a scenario where cultural and community values have been committed, presenting cases of suicides, consumption of alcohol, and intra-family violence against women. Aware of these disparities, the Brazilian Government has been improving policy mechanisms focused on Indigenous Peoples, strengthening the dialogue with Indigenous Leaders and Organizations and progressively increasing public investment in the promotion of Indigenous Rights. In 2008, a total of USD 160 million was dedicated by Government for nutritional and food security projects in Indigenous communities, health surveillance and assistance, as well as land demarcation and ethno-development. The National Foundation for Indigenous People FUNAI (Ministry of Justice), has dedicated important efforts to address the main Indigenous priorities, such as health, food security and land demarcation. With the aim of supporting the Brazilian society in these efforts to guarantee that the most vulnerable groups will also achieve the MDGs, this programme will operate to promote food and nutritional security for the indigenous children of Dourados and Alto Rio Solimões. III. Joint Programme Results This proposal is related to goals (1) eradicate extreme poverty and hunger and (4) reduce child mortality. Nevertheless, improvements in these Goals will facilitate the achievement of all other MDGs for the Indigenous Peoples. The development of this proposal aims to achieve the following results: 1. Improved food and nutritional security for indigenous children and women in the Alto Rio Solimões (AM) and Dourados (MS), regions of Brazil. The food and nutritional security will be improved by the promotion of the access to health and social protection policies and by the promotion of sustainable and local agrobiodiversity initiatives; 2. Indigenous peoples empowered to demand their human right to adequate food and the right to health, and public institutions strengthened to carry out their duties. The assumption of achieving the Millennium Development Goals (MDG) with respect to Economic, Social and Cultural Human Rights introduces principles and dimensions into the public agenda that can significantly alter the way of thinking and implementing public policies. Firstly, using this approach every citizen, regardless of his/her characteristics, is a rights holder and the State is considered to be a duty bearer. As a duty bearer, the State must respect, protect, promote and provide the Right, by amongst other things carrying out public policies that implement and respect the principles of Human Rights, such as active and informed participation, the preferential inclusion of the most vulnerable, the promotion of equality and non-discrimination, the obligation to render accounts (responsibility of those that have the duty) and action within the parameters of the Rule of

3 Law (principle of legality). 3. Diagnosis, monitoring and assessment of the food and nutritional security of indigenous populations carried out. Diagnosis, monitoring and assessment will be developed with 2 perspectives, the first one will contribute to expand coverage and assure quality of the public systems and parallel the indicators and process will be developed in partnerships with the communities and their leaders. IV. Joint Programme Design and Implementation Plan: This project has been proposed by FAO, ILO, PAHO/WHO, UNDP and UNICEF in coordination with its Brazilian partners, especially the National Foundation for Indigenous People (FUNAI) and the National Health Foundation (FUNASA). The National Food and Nutritional Security Council (CONSEA), comprised of government officials and civil society representatives, was also consulted during the development process of this concept note. For this project to be developed, partnerships will be set up with different federal, state, and municipal government institutions, universities, indigenous people s organizations and non governmental organizations. The project will be managed in a way that coordinates the national coordinating body and the local coordinating teams. Each of these teams will be made up of representatives from all the sectors involved at their level of action. They will be responsible for defining and implementing the work plan, monitoring its progress and preparing annual reports to be sent to the MDG Achievement Fund and to all partnership organizations and sectors. The project will be developed in 3 years. The project foresees the following outputs as regards its expected results: (1) Improved food and nutritional security for indigenous children and women in the Alto Rio Solimões (AM) and Dourados (MS) regions: Indigenous children and women given increased access to public health and social protection policies (PAHO and UNICEF); Health professionals and managers, teachers, trained and women (especially pregnant women), and indigenous leaders informed about how to promote mother-child health and childcare based on scientific evidence, whilst respecting Indigenous People s culture (PAHO and UNICEF); Local, integrated strategies for the prevention, diagnosis, treatment and reduction of mother-child malnutrition developed (PAHO and UNICEF); Increased use of land, production, availability, access and consumption of healthy food, whilst respecting the Indigenous People s culture (FAO and UNDP); Sustainable management of the local agrobiodiversity promoted and valued (ILO, FAO and UNDP). (2) Empowered indigenous peoples able to demand their human right to adequate food and the right to health, and public institutions trained and strengthened to carry out their duties: Indigenous Peoples Leaders and Organizations strengthened to demand their human right to adequate food and the right to health in the context of public policies (FAO and UNDP); Traditional knowledge and wisdom of Indigenous Peoples revitalized to promote the rights of women and children (UNICEF and FAO); Discrimination and violence against indigenous children and women reduced (PAHO, UNICEF); Health professionals and public administrators trained and strengthened to carry out their duties of promoting, respecting, protecting and ensuring children s rights in the context of supplying public policies from a human rights perspective (OPAS, UNICEF, FAO).

4 2.5 - ILO Convention 169 concerning indigenous peoples and traditional communities translated into the native language of the Peoples concerned (ILO); Input for the formulation of Food and Nutrition Security Policies which respect indigenous culture from the adolescent viewpoint (UNICEF and FAO). (3) Diagnosis, monitoring and assessment of the food and nutritional security of indigenous populations carried out: Diagnosis of the food and nutritional security situation of Indigenous Peoples in the Alto Rio Solimões (AM) and Dourados (MS) regions implemented (PNUD); Monitoring of food and nutritional security indicators for indigenous populations developed and assessed (PAHO, UNICEF, FAO, ILO and UNDP); 3.3 Public managers and social actors trained, and indigenous leaders informed about the Convention 169 and the monitoring of the food and nutritional security situation of indigenous populations and (PAHO, UNICEF, FAO, ILO and UNDP); 3.4 Local food and nutritional security monitoring systems (SISVAN and SIASI) strengthened (PAHO, UNICEF, FAO, ILO and UNDP); 3.5 Monitoring indicators, lessons learned and good practices related to the project evaluated, documented and disseminated nationally and internationally, with a view to strengthening South-South cooperation (PAHO, UNICEF, FAO, ILO and UNDP). Women and children will be the main focus of the process in the sense that this is an approach which considers people s phase on the life cycle, promotes the health and development of the mother-child unit and guarantees human rights. Crosscutting actions will include empowering community organizations and indigenous leaders; building competences; and the institutional strengthening of public organizations. Empowerment actions for all partners and the institutional and material strengthening of the social and public organizations will generate conditions for the actions to be sustainable in the future. The principle underlying all the initiatives will be the informed action and participation of the communities, their leaders and local public agents. This is a condition and a principle that is assumed by the proponents: it is, on the other hand, also the main risk and challenge of the proposal. It is vital to build up legitimate communications with the communities, their leaders and organizations, as well as with public institutions and the professionals who work for them. The project has also the innovative characteristic of proposing the implementation of a strategy that coordinates the actions, sectors and institutions that make up the different aspects of the broad concept of food and nutritional security as adopted by Brazil1, and based on the principles and dimensions of human rights as the structure that holds all the proposed actions together. V. Monitoring and Evaluation Strategy: * One of the project outputs will be the evaluation and documentation of the process indicators and project results, the lessons learned and a report of the good practices adopted. All the knowledge generated by the project must be disseminated in the form of documents and events to all partners and domestic institutions, and may also be shared with the countries involved in South-South cooperation. Project monitoring and assessment will be carried out in a way that provides information at 3 different times: 1) - at the start of the activities with the preparation of a baseline study which will enable comparisons to be made at the end of the project; 2) - on the collection and documentation of internal project monitoring indicators during all the period that the activities are being implemented; and 1 Food and nutritional security is the realization of the right to have regular and permanent access to quality food, in sufficient quantity, without compromising access to other essential needs, based on eating habits that promote health, respect cultural diversity and are socially, economically and environmentally sustainable 2 nd National Health Conference, Olinda, Brazil, 2004.

5 3) - studies carried out after the actions have been implemented, near the end of the project. The strategy to be used to obtain information must involve a combination of the following methodologies: i) specific, internal project indicators, collected and documented by the agencies responsible for each action; ii) the carrying out of a survey of the population about the food and nutritional security of Indigenous Peoples during the first year of the project; iii) Information and indicators available from the public systems (SISVAN-Indígena, SIASI and others), public institutions, and indigenous organizations; and iv) contracting surveys and studies, if necessary. All the indicators produced as part of the project will be broken down by gender, age, and ethnicity and will consider the indigenous peoples to be the universe that is to be compared to the general population in the project regions, in order to reflect any gender, stage on the life cycle, and social and economic vulnerabilities, inequalities and imbalances. The respective internal quantitative and qualitative indicators for each expected result are given below. 1- Improved food and nutritional security for vulnerable indigenous children and women in the Alto Rio Solimões (AM) and Dourados (MS) regions of Brazil. Output i) Pre-natal cover: number of pre-natal examinations given/total number of pregnant women; ii) Low birth weight: % of underweight children born; iii) Infant mortality rate; iv) % of children under 10 years old up-to-date with their vaccinations; v) % of children under 5 years old with a weight/age deficit; vi) % of children under 5 years old with iron deficiency anaemia; vii) % of children under 10 years old with a weight/age deficit (all indicators relative to the indigenous population universe in the project regions). Output i) Number of professionals per category: health managers, trained teachers and informed indigenous leaders; ii) indigenous women actively participating in empowering activities. Output i) strategies and protocols implemented; ii) decision and reference strategies and flowchart for calling timely attention to mother-child malnutrition implemented. Output 1.4 -i) study of local productive systems carried out; ii) number of information documents prepared and distributed; iii) Number of indigenous producers, technicians and public institutions informed; iv) Number of events held for debating productive and sustainable strategies; v) Local availability of food produced by Indigenous Peoples; vi) No. of initiatives implemented by schools to promote the food and nutritional education of children. Output 1.5 -i) Indigenous Leaders and Organizations informed about the sustainable management of local agrobiodiversity. 2. Empowered indigenous peoples able to demand their human right to adequate food and the right to health and public institutions trained and strengthened to carry out their duties. Output 2.1 i) Community Support Network in place, recognized by Indigenous Peoples and their Organizations; ii). Number. of Indigenous Leaders and Organizations identified and supported; iii) primer prepared, printed and distributed. Output 2.2 i) Indigenous Leaders and Organizations informed about the rights of children; ii) Support material prepared with the participation of Indigenous Peoples, printed in the local languages, and distributed. Output 2.3

6 i) Number of initiatives supporting indigenous women complemented by public institutions. Output 2.4 i) Number of health professionals and public managers trained in children s rights and the human rights of the Indigenous People; ii) manual on human rights prepared, printed and distributed, Output 2.5 i) ILO Convention 169 translated, printed and distributed amongst Indigenous Peoples and their Organizations. Output 2.6 i) Inputs for local food and nutritional security policies developed. 3. Diagnosis, monitoring and assessment of the food and nutritional security of indigenous populations carried out. Output 3.1 i) Investigation into food and nutritional security carried out in the project regions; ii) indicators and a report of the investigation concluded and results shared with public institutions and Indigenous Leaders and Organizations. Output 3.2 i) indicators developed with Indigenous Leaders and Organizations. Output 3.3 i) public managers and Indigenous Leaders and Organizations trained to monitor the food and nutritional security situation and enforce Convention 169. Workshops held. Output 3.4 i) population covered by Nutrition Surveillance System (SISVAN-Indígena- FUNASA): % of children and pregnant women monitored); ii) Number. of equipment items obtained (computers, weighing scales, stadiometers, etc.); iii) event held for disseminating the food and nutritional security indicators for Indigenous Peoples in the project regions; i) workshops held; ii) national seminar held. Output 3.5 i) documents on project result indicators, lessons learnt, and good practices developed and disseminated; ii) national and international event for disseminating the results of the project held. VI. Institutional Arrangements and Management Plan: * In March 2008, the UN Country Team in Brazil has created an interagency Task-Force to develop a harmonized position on the Global Food Price Crisis and to foster a coherent support to National Authorities. A One-Pager entitled Global Food Challenge: The UNCT Approach was produced by the Task-Force, reflecting not only a common view of the crisis, but also outlining possible strategies to support the Country. The document reinforced that all support by the UN system to address the food crisis needs to be contextualized within its broader agenda for the achievement of the Millennium Development Goals and the support to the most vulnerable. In this sense, the document stated that UN support provided to the national authorities would be twofold: (i) internally, actions would be designed to address the effects of the crisis and protect the most vulnerable populations, such as pregnant and lactating women, children, the poor, indigenous and afro-descendent populations; (ii) in the regional and international context, efforts would be deployed to foster south-south cooperation. In addition, the UNCT has established a coordinated dialogue with relevant National Authorities, such as the President of the National Food Security and Nutritional Council (CONSEA) and the

7 General-Coordinator for International Actions against Hunger (CG-FOME) from the Ministry of Foreign Affairs. At different meetings, these authorities have expressed their interest to count with the UN System in their efforts to promote food security. Building on top of the good coordination platform developed in the context of the Food Crisis, the present joint programme proposal offers a great opportunity to implement the strategy defined in the above-mentioned One-Pager, placing emphasis on the most vulnerable populations and ensuring that the MDGs are a reality for all regions and groups. This joint programme would count with full involvement of the participating UN Agencies and Brazilian partners in all decisions related to project implementation, through the following management and coordination arrangements: i) Due to their mandate and management capacity, WHO/PAHO and UNICEF will be responsible for the technical coordination of this JP. While each participating agency shall be responsible for the execution of its respective components, the lead agencies will ensure that the common workplan is on track and that promised results are being delivered. The lead agencies will also be responsible for convening technical meetings as per programme needs, maximizing complementarities and synergies between agencies. Finally, they will guarantee the preparation and submission to the MDTF office in New York of a single annual narrative report on the joint programme, as well as the quarterly narrative reports. This dual leadership is expected to guarantee an effective coordination of the joint work, hence facilitating the implementation of common outcomes. ii) Under the leadership of the UN/RC, who will coordinate the overall programme design and ensure programmatic oversight of the JP, two committees are to be established for the supervision and implementation of activities: the National Steering Committee (NSC); and the Programme Management Committee (PMC). The NSC, aside from bearing responsibility for supervision, will also play the role of providing strategic guidance for the Programme. It will be comprised of no less than three members, representing the Brazilian Government (co-chair), the Government of Spain, and the Resident Coordinator (co-chair). The implementing agencies and national partners of the Programme may participate in the Committee as observers. At the invitation of the co-chairs, representatives of other bodies, including members of organizations of civil society, may also participate in the Committee. The NSC shall hold meetings, at which decisions will be taken by consensus. The PMC, as the body responsible for operational coordination, will be comprised of members representing the United Nations agencies implementing the Joint Programme (WHO/PAHO, UNICEF, ILO, UNDP and FAO), the national counterparts (notably FUNAI) and Indigenous Organizations. Networks involving Civil Society (such as the National Food and Nutritional Security Council CONSEA and the National Commission on Indigenous Policies - CNPI) will be involved and consulted throughout the JP formulation process and subsequent implementation. The PMC meetings are to be held each quarter, or more often if the need arises, to deal with issues relating directly to management and implementation of the Programme. BUDGET C. MDG- Related Indicators Millennium Development Goal(s) Addressed by the Programme Goal 2: Halve, between 1990 and 2015, the proportion of people who suffer from hunger. Goal 5: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate. Millennium Development Goal Indicators targeted by the Programme

8 Goal 2: 4. Prevalence of underweight children under five years of age. 5. Proportion of population below minimum level of dietary energy consumption. Goal 5: 13. Under-five mortality rate. 14. Infant mortality rate. 15. Proportion of 1 year-old children vaccinated against measles.