NDA PROGRAMME PLAN 2014 1. Introduction Rwanda has made impressive progress in a number of areas as noted in the 2013-2018 Economic Development Poverty Reduction Strategy II (EDPRS II), Rwanda was the tenth fastest growing economy in the world during the decade from 2000. Over the period of the EDPRS I (2007 2012), the country achieved sustained economic growth (8% average), poverty reduction (12% points to 44.9% with extreme poverty reducing from 35.8% to 24.1%) and a reduction in income inequality (from 0.52 to 0.49). Despite Rwanda s recent records in development and economic growth, the country is ranked 167 out of 187 in the Human Development Index (2013), positioning the country in the low human development category. The country also continues to face significant challenges in relation to persistent (though decreasing) high levels of chronic malnutrition (stunting) at 44% of children underfive years 1. Furthermore, hunger continues to be a critical issue, with Rwanda ranked at 57th among 79 countries with serious hunger as per the 2012 Global Hunger Index Report (GHI 2012). This can be explained in part, by difficulties in accessing food, as noted in the 2012 Comprehensive Food Security and Vulnerability Assessment (CFSVA), which indicates that 51% of households find some difficulty in accessing food and 14% of Rwandan households have almost year round chronic difficulties in accessing food for their families. The 2010 Rwanda Demographic and Health Survey RDHS also presents evidence of anaemia among younger children - ranging from 45 to 70% for children aged between 6 and 23 months. Rwanda has a Gender Inequality Index (GII) value of 0.414, ranking it 76 out of 148 countries in the 2012 index. The Economist Intelligence Unit's 2012 democracy index ranks Rwanda 132 nd out of 167 countries, up four places from 2011 and placing it among the countries considered to be "authoritarian" regimes. This designation includes other African states such as Angola, Ethiopia and Zimbabwe. The government faces a significant threat to fiscal sustainability following the reaction of foreign donors to allegations that Rwanda is involved in supporting a rebellion in the DRC. Several donors including the US, the UK, the Netherlands, Germany and the African Development Bank suspended aid disbursals at the end of July 2012, and the health of the public accounts hinges on whether this stance is maintained. The Rwandan budget for fiscal year 2012/13 (July-June) includes US$790m in aid, which is equivalent to 35% of total budgeted revenue. Some of this is offset by continued growth in the economy, which is forecast to grow by 8% this year. Ties with Rwanda's international partners have improved since the start of the year, and some donors have reinstated aid. Concern in Rwanda continues to foster strong relationships and engagement at local and national government level. The operating environment in Rwanda remains conducive for programming. Stakeholders, particularly decentralised structures place greater emphasis on demonstrating results. NGOs and INGOs are now required to sign performance contacts with their district partners, which indicate expected results to be achieved. Country Strategic Plan Time line 2011-2015 The Concern Worldwide Rwanda (CWR) strategic plan (2011-2015) has been completed and approved in 2011. During the life time of the strategic plan, the country programme will focus on enhancing programme quality. As part of this process, detailed contextual analysis was carried out in 2011 to inform programme design in 2012. Two programmes (Health (Nutrition) and FIM (Graduation) have approved results frameworks and are now fully operational. Overall programme plans -- brief summary: Based on the CWR strategic plan (2011-2015) and the findings of the contextual analysis, the country programme will address the needs of the resource-poor and most vulnerable groups by assisting them to meet their basic needs, facilitate their efforts to increase their productive assets and contribute 1 Household Demographic Survey (RDHS, 2010)
to reducing inequality by improving women s influence in decision making at household level. CWR will seek to sustainably reduce poverty by contributing to improved food security and elimination of malnutrition through the Linking Agriculture to Nutrition programme. The Unleashing the Productive Capacity of the Extreme Poor for Sustainable Graduation will increase returns from productive assets thereby increasing resilience to shocks; and the Education Programme, Literacy Language and Learning Programme will strengthen teaching and learning in Rwanda so that children leave primary school with strong literacy and numeracy skills. Health and FIM programmes will be concentrated in the Districts of Nyaruguru, Nyamagabe, Huye and Gisagara, with a total population 1,135,233, the FIM programme will target an additional 800 HH (4,000 beneficiaries), reaching cumulative total of 2,000 HH (10,000 beneficiaries). The nutrition programme will reach the combined population of the 4 districts through capacity building of all CHW s in health and nutrition but specifically will reach 1,600 HH with nutrition-sensitive agricultural activities. In 2014, the programme is expected to be scaled up to 638 schools, focusing on all primary schools the Southern Province. Programme FIM (Graduation) Health (Nutrition) Education Closure/opening new locations (if applicable) Continuing to consolidate in the Southern Province: Districts of Nyaruguru; Huye and moving to new district Nyamagabe Continuing to consolidate in the Southern Province: Districts of Nyaruguru, Nyamagabe, Huye and Gisagara Expanding to cover all 638 schools in the Southern province 2. Programmes Agri-Nut Programme- Integrated Support to Link Agricultural Production to the Prevention of Malnutrition in Rural Rwanda At meso level the programme will work through the established network of community health workers to offer improved quality of services for treatment and prevention of malnutrition across the broader population. Within this broad group, the main target for prevention of under nutrition will be pregnant women, lactating mothers and infants and young children. Extreme poor households who have access to land and have a member who meets the 1,000 days criteria (pregnant, lactating mothers or children under 2), will be supported to improve agricultural productivity through the use of improved inputs (seeds, organic fertilizer, and pest control) and through imparting skills (improved farming techniques, soil fertility management, and crop diversification). The key focus will be on supporting households to meet their food needs. Building on the previous FIM programme, target households will be encouraged and supported to form cooperatives for optimizing the use and productivity of limited resources (land, seeds, farm tools), developing and strengthening social networks; establishing informal savings and credit systems and trying and adopting new and improved farming techniques. It is recognised that resource-poor households with small land holdings cannot meet their food needs solely through agriculture. In this case, small livestock will be provided for breeding and generating income, which in turn will be used to purchase nutritious food and ultimately diversify household diet. Additionally, training on vegetable, fruit and mushroom production will be offered to optimize production from small homestead gardens, increase consumption and sell of surplus to augment income. Efforts to support behaviour change related to infant and young child feeding (IYCF), appropriate hygiene and positive care practices and the benefits of health insurance will be promoted at community level to: a) improve child care practices and access to health services; b) reinforce the potential nutritional benefits of increased agricultural production and income. The Agri-Nut programme has incorporated key complementary aspects of maternal, neonatal and child Health into this programme.
Programme Results Framework : Rwanda, Integrated Support to Link Agricultural Production to the Prevention of Malnutrition in Rural Rwanda Intended Impact Contribute towards improved food security and the elimination of malnutrition in Rural Rwanda ( PUN Model) 1. Dimensions 2. Programme of Extreme Outcome Poverty 3. Indicators 4.Baseline value and source 5. Target 2015 1.1 Increase in yield per Proxy indicators 50% increase in yield per hectare for chosen crop. hectare amongst target agriculture households Vegetables yield (kg/ ha) 11,063 (2011 MINAGRI) Assets (and Return on Assets) Outcome(s) 1 Increased food security and improved nutritional status among extremely poor households (micro) 1.2 Increase in number of meals per day amongst target agriculture households 1.3 Number of months of hunger per year experienced by target agriculture household 1.4 % increase in production of nutritious foods Children (6-23 months): 74.7% three meals or more. Adults: 74% 2 meals or more per day The average number of hunger months is 4.0 KPC 2012 Proxy: 16% of beneficiaries grew a new crop in past 3/4 yrs (NRI/Concern report, 2011) 85% of children 6-23 months eating three meals or more per day 85% of adults will eat two or more meals per day The average number of months that hhds experience hunger is 3 60% of HH grow a new nutritious crop over the course of the programme 2 Micronutrient deficiencies addressed through increased availability of nutritious food and supplements 1.5 % of target group children 0-59 months who are stunted 2.1 Individual Dietary Diversity (IDDS): % of target group children 6-23 months of age who received food from 4 or more food groups within the last 24 hours 46.6% (KPC 2012) IDDS = 46.5% Below 40% IDDS 60%
(micro, meso) 2.2 Increased consumption of Vitamin A rich fruits and vegetables among children aged 6-23 months Vitamin A rich Fruits and Veg: 14% Green leafy Vegetables = 64.6% (KPC 2012) Consumption of Vitamin A rich fruits and vegetables increased to above 35% Green leafy vegetables to above 70% 3 More effective national policy implementation on issues pertaining to the prevention of chronic malnutrition(mac ro & meso) 2.3 % of children age 6-23 months who received a dose of Vitamin A in the last six months 2.4 % of children 6-23 months of age who consumed food rich in iron or fortified with iron 3.1 Programme learning on linking agriculture and nutrition informs action plans of the National Committee to Eliminate Malnutrition 3.2 Strengthen implementation of DPEM and JADF action plans 39.1% 37.2% N/A Inadequate implementation of DPEM and JADF action plans 50% 45% of children 6-23 months consume food rich in Iron. The NCEM action plan incorporates at least two recommendations from programme learning DPEM s finalised across all districts with a timeframe for review in place (Meeting minutes, Project documents) 4 Improved capacity of decentralized health system in Rwanda to deliver quality community health services for the management of acute malnutrition 4.1 % coverage of treatment services for severe acute malnutrition treatment 56% Nyaruguru; 62% Nyamagabe (SQUEAC survey, 2010) 43.7% point coverage in Gisagara (SQUEAC survey, 2012) 65% coverage across all districts No SQUEAC survey done in Huye 4.2 Quality of care for acute 2011 routine data: International sphere standards:
(meso) malnutrition as measured against international sphere standards (e.g. cure rate, death rate, default rate) 4.3 Average number of supervision visits completed by health center staff per CHW per quarter SAM Cure rate 93% Death rate 0.8% Default rate 4.2% MAM Cure rate 94.5% Death rate 0.0% Default rate 2.2% Nyaruguru: 0.34 Gisagara: 1.10 Huye: 0.40 (Rwanda HMIS, 2012) Cure rate greater than 75% Death rate less than 10% Default rate less than 15% Nyaruguru: 0.60 Gisagara: 1.10 Huye: 0.60 Inequality Outcome(s) Risk and Vulnerability Outcome(s) 6 Increased decision-making power of women regarding health and nutrition practices (micro) 7 Adoption of positive health and hygiene behaviours within the household for the prevention of under nutrition and reduction of childhood illness 6.1 % of mothers of children age 0-23 months who report that they usually make the decisions regarding their children s health care either alone or jointly with their husband/partner 6.2 % of mothers of children age 0-23 months who report that they usually make the decisions regarding major household purchases for food either alone or jointly with their husband/partner 7.1 2 % of children age 6-23 months who receive a minimum acceptable diet (apart from breast milk) 7.2 % of children age 0-5 months who were exclusively breastfed during the last 24 hours 83.4% 58.0% 35.3% 82.4%% 87% 70% 45% 86% 2 MAD is a better indicator for food consumption, as it is a composite of both meal frequency and IDDS.
(meso) 7.3 % of mothers of children age 0-23 months who report washing their hands with soap at least two of the appropriate times during the last 24 hours 59.7% 65%
Programme Results Framework : Rwanda, Unleashing the Productive Capacity of the Extreme Poor for Sustainable Graduation Intended Poverty sustainably reduced among the extreme poor 3 in four districts in the Southern Province in Rwanda Impact 1. Dimensions of Extreme Poverty 2. Programme Outcome 3. Indicators 4.Baseline value and source 5. Target 2015 Assets (and Return on Assets) Outcome (s) 1 Increased income to meet basic needs including access to food, education and health services (micro) 2 Improved skills and access to productive assets to sustainably generate income (micro) 3 Improved engagement in formal and informal financial services (micro) 1.1 % increase in number of target households subscribing to health insurance 1.2 Number of primary school-age children in target HH attending school 1.3 % Increase in number of target HH who eat at least two meals per day 2.1 % increase in target households income generating activities 2.2 Increase in productive asset index amongst target households 3.1 Increase in formal and informal savings 6.5 % of target HH were able to purchase health insurance (baseline 1 st cohort, 2011) 46% of primary school-age children in target HH in school (baseline 2 nd cohort 2012) 31.3% of target HH eat twice a day (baseline 1 st cohort, 2011) 84.1% casual labour on others farms Productive Asset Index mean = 2.2 (0=very deprived; 7=well off) (45.2% own their own house 22.6% of own more than a plot 0.5% own bicycle 0% own cow and/or domestic animals 0.5% own mobile phone) 6% and 5.5% of target HH were saving formally and informally respectively 50% of Extreme poor households subscribe to health insurance 70% of target HH with primary schoolage children in school 70% of target HH eat twice a day 80% of target households have diversified their livelihoods sources beyond subsistence farming Productive Asset Index mean = maintained at >3.5 for target HH At least 50% of target households saving formally or informally 3 The extreme poor include small holder agriculturalists, agro-labourers, and people with marginal livelihoods and female headed households.
3.2 Number of target HH accessing formal or informal credit 30% for Male headed HH and 32% for female headed HH. 65% target HH access informal credit, and 20% of target HH accessing formal credit (Baseline, 2 nd cohort, 2012) Inequality Outcome (s) 4 Equitable impact between male and female headed households(micro) 5 Effective policy development and implementation on issues related to sustainable graduation in Rwanda (macro) 6 Reduced isolation of extreme poor and improved social cohesion (micro) 4.1 % difference in level of satisfaction with the programme among target men and women 4.2 4 %Increase in target FHH and MHH who own their own house and diversify their livelihoods beyond subsistence farming is of equal proportion 5.1 Improved national social protection framework which promotes sustainable graduation and targets the most vulnerable 6.1 Reported increase in perception by target HH member of respect given by other people 100% satisfaction with the programme among both men and women in target HH (2012 Annual review (FGD) 44.1% of MHH and 46.1% of FHH own their own house; No significant difference in MHH or FHH engaging in livelihood activities beyond subsistence agriculture (15.9% overall engage in activities other than subsistence agriculture) National Social Protection Strategy finalised in December 2012 promotes limited social protection model based on Vision 2020 Umurenge Programme (VUP). VUP targets one able-bodied person per household in Ubudehe Cateogry 1 &2 (extreme poor) and provides wage of approx. $1 a day. This is insufficient to enable target groups to sustainably graduate from poverty. No respect for the extreme poor HH in 2011, Annual review (FGD) Maintain less than 5% difference in level of satisfaction among target men and women 10% point increase in MHH and FHH household ownership; 25% of MHH and FHH diversity their livelihood beyond subsistence agriculture 2 nd Economic Development and Poverty Strategy (EPDRS 2) to be published in 2013 includes commitment to improved sustainable graduation from poverty. At least 80% of HH report improved respect from the community members (2012 indicated improved respect by the community) 4 The poverty score was not applied in the baseline. Replacement with more appropriate indicator
6.2 Increased engagement by target HH in community activities 5.5% of target HH are saving informally. (Baseline 1 st cohort, 2011) 80% of target HH are members of savings groups Membership of Co-operative: 18% 28% Membership of co-operative 42 % participating in community meetings) or Umuganda every month (2011 baseline) 80% of target HH regularly attending community meetings (Umuganda) 6.3 % increase in positive community perceptions of individuals infected or affected by HIV and AIDS. Proxy: % of people who have heard of AIDS virus who express specific accepting attitudes towards people with HIV (rural men and women age 15-49) Rural: 52.2% women, 63.2% men (DHS 2010) 57.2% women, 68.2% men Risk and Vulnerability Outcome(s) 7 Improved diversity of effective livelihoods options to improve resilience to shocks (micro) 7.1 % HH with more than one livelihood option 7.2 % people (age 15-49) tested for HIV and received results in the last 12 months 15.9% engaged in diversified livelihoods beyond subsistence farming 35.1% of women and 32.4% of men aged 15-49 have been tested and received results in the last 12 months (Southern Province) DHS, 2010) 25% of MHH and 25% FHH diversity their livelihood beyond subsistence agriculture 50% of women and 40% of men aged 15-49 have been tested and received results in the last 12 months
Education Programme - Rwanda Literacy Language and Learning Programme (L3) The team in Rwanda will continue to implement the USAID funded Rwanda Literacy Language and Learning Programme (L3) in consortium with the Education Development Centre (EDC) and Voluntary Service Overseas (VSO) and International Education Exchange. The main objective of this programme is to strengthen teaching and learning in Rwanda so that children leave primary school with strong literacy and numeracy skills. The L3 seeks the following results: improved quality of teaching, improved availability of teaching and learning materials, support for English, strengthened ministry capacity and improved equity in education The Education programme will reach all districts in the Southern Province in 2014, reaching an additional 638 schools throughout Rwanda in 2014, with a cumulative total of 728 reached since the programme began. The total primary school population in the southern province is 583,211 and total number of Parent Teacher Committee (PTC) members is 7,018. The Rwanda programme role will focus on improving equity in education by: Mobilizing community support for literacy/numeracy and for teacher incentive programmes, and for girls success in school, primarily by supporting the Parent-Teacher Committees (PTCs). Operationalise the research results of on gender and poverty-related barriers to classroom performance through development and roll-out of key behavior change messages for national mentors and PTC trainings and a behavior change media campaigns. Rolling out the School-based Mentoring Programmes, prioritizing disadvantaged (rural, lowincome) communities and Teacher Training Centers that serve them Emergencies As a result of the heightened conflict in Eastern DRC, since April 2012, Rwanda has seen a fresh influx of refugees fleeing the escalation of fighting in North Kivu Province. To accommodate expanded numbers, in July, a new refugee camp (Kigeme) was established in Nyamagabe District, one of our areas of operation. Currently, the camp is being served by MIDIMAR, the UN and NGO s already managing the three other refugee camps in the country. Concern has been supporting nutrition in Kigeme and Nkamira Transit camp and building the capacity and skills of Congolese refugee Community Health Workers in nutrition case identification, correct assessment and prompt referrals to appropriate services, including equipping them with basic working tools, in collaboration with African Humanitarian Action, the NGO responsible for health and nutrition in the camp. As part of our humanitarian mandate and as outlined in the CWR strategic plan, Concern will engage with coordinating agencies and, should the situation worsen, be ready to act. Concern has submitted a proposal for management of nutrition in the new camp, to be established in Gisagara District. Equality CWR will continue contributing to efforts being made by the Government of Rwanda and development partners to address inequality as an underlying cause of poverty through mainstreaming actions in all programmes and will closely monitor progress made in achieving set indicators. The Agri-Nutrition programme will mainstream equality issues to improve decision making of women regarding nutrition practices with the aim of improving sharing of decision making on use of resources for positive nutritional outcome. The graduation programme will ensure improved social cohesion and perceived programme impact among male and female beneficiaries by increasing opportunities for interaction through tontines (savings groups), solidarity groups and attendance of community meetings. The Language, Literacy and Learning programme will continue to work with Parent-Teacher Committees and local partners to raise awareness to communities about the harmful
effects of Gender Based Violence and provide guidelines for preventing Gender Based Violence with emphasis on the girl child. HIV and AIDS mainstreaming The key health risk cited in the contextual analysis was HIV and AIDS. The estimated total number of people in Rwanda living with HIV and AIDS is 169,200 (2009 EST.). Households affected by HIV and AIDS will be among the targeted beneficiaries of our programmes, particularly in Health and FIM. With support from the Mainstreaming HIV and AIDS Officer, each programme will assess how households affected by HIV and AIDS are best supported while at the same time ensuring that other selected households will not increase their vulnerability to HIV and AIDS. The agriculture-nutrition programme will ensure that national nutrition protocols are adhered to and children admitted to OTP receive a HIV test and are referred to VCT or PMTCT services as appropriate. As part of the Graduation programme, we will target those extreme poor households with labour capacity, while at the same time, we will seek to influence to government on the need to provide long-term support to those who are chronically ill and without labour capacity. A barrier analysis was recently conducted in relation to taking a VCT test amongst graduation programme beneficiaries. Specific activities will be implemented in 2014 to tackle barriers to VCT testing. DRR In Rwanda, extreme poor people could be affected by drought, irregular rains, dry spells, floods, crop diseases, hailstones, heavy torrential rains and tremors. Our programmes in Health and FIM are directly attempting to improve the lives and livelihoods of our beneficiaries so that, in future, they will be better able to manage and fight off shocks and stresses. 3. Monitoring and Evaluation Programme Contextual Analysis Survey (e.g. baseline/ mid line/ end line) M T Review / Evaluation Internal / External Donor (if Applicable) Health (Agri- Nutrition) FIM (Graduation) Equality Programme Evaluation 2011 Small Area June Internal IAPF Survey SQUEAC January Internal (with External support) IAPF 1st Cohort: 18 Mths after final transfer September Internal (with External support) IAPF February Internal IAPF