UNFPA RESPONSE TO INDIAN OCEAN TSUNAMI

UPDATE AT SIX MONTHS

EXECUTIVE SUMMARY...............................................................................................................................3 INDONESIA......................................................................................................................................................8

Project 1: Reestablishment of Reproductive Health Services......................................................11 Project 2: Provision of mental health services through psycho-social support centers for affected populations..................................................................................................................................1 Project : Provision of personal hygiene pac!s to "sunami-affected populations in #ndonesia...1$ Project %: Prevention of gender-based violence during the emergency and reconstruction phases .....................................................................................................................................................1& 'ainstreaming (ender................................................................................................................1) (eneral *onstraints.....................................................................................................................2+ ,actors that facilitated effective aid delivery...............................................................................21 *onclusion...................................................................................................................................21
SRI LANKA.....................................................................................................................................................22

Project 1: Restoration of RH Services in the "sunami -ffected .istricts of Sri /an!a...............22 Project 2: 0uilding Psychosocial 1ell being among individuals and communities living in tsunami affected areas 1ith improved responsiveness for the prevention and management of (ender based 2iolence in Sri /an!a........................................................................................... + (ender *omponent...................................................................................................................... 1 Psycho-Social *omponent........................................................................................................... $
MALDIVES.....................................................................................................................................................43

Project 1 - Restoration of *omprehensive 3uality Reproductive Health Services and Rights among Populations -ffected by the "sunami 4'.2"R2+15......................................................%% Project 2 - 67,P- Response to the Psychosocial #mpact of the "sunami .isaster in the 'aldives 4'.2"R +15..............................................................................................................%&
THAILAND.....................................................................................................................................................51

Summary of 8verall 67,P- Response and 9ey Results............................................................:1 Project 1: Reproductive Health *are Services in "sunami -ffected -reas in "hailand..............:1 Project 2: ;<panding Reproductive Health *are Services to "sunami -ffected -reas ..............:2

EXECUTIVE SUMMARY
"his report mar!s the mid-year update on 67,P-=s activities follo1ing the massive devastation caused by the #ndian 8cean "sunami on .ecember 2$ th 2++%. "han!s to the outpouring of generous donor support> 67,P- has been part of the initial relief and recovery process and is no1 focused on the reconstruction phase> together 1ith its 1ide net1or! of partners> sister 67 agencies> 7(8s and community based youth> 1omen and religious organi?ations. #n the post "sunami response> 67,P-=s priorities have focused on: 'oving rapidly to protect maternal health in a region 1here more than 1:+>+++ 1omen 1ere pregnant and maternal health infrastructure and services had been completely devastated. 67,P- has provided large @uantities of medical e@uipment and supplies for the reestablishment of comprehensive maternal services> including basic and emergency obstetric care e<ceeding A1million. "his includes> inter alia> safe delivery !its> mid1ifery !its> management of miscarriage !its> blood transfusion !its> prevention of R"# !its and contraceptives. #n #ndonesia> using 67,P- RH !its> 2$ deliveries 1ere recorded among #.Ps at the four most affected districts as of 'arch 2++:. "hese included %& high-ris! pregnancies that 1ere properly treated 4 1omen under1ent caesarean sections> and 1% babies 1ere born 1ith the aid of vacuum e<traction5. #n the 'aldives> $++ mother-baby !its have also been distributed to % health facilities across 11 atolls. #n #ndonesia> ambulances have been supplied to B priority referral health centers. #n addition> 67,P- is supporting treatment and counseling> strengthening of outreach services and trainings to improve the sensitivity of healthcare 1or!ers= response during the crisis. Chere maternal healthcare infrastructure has been damaged> it is being restored or reconstructed. #n #ndonesia> 67,P- is supporting the Provincial and .istrict Health 8ffices in the reestablishment of damaged health centers. #n Sri /an!a> 2+ healthcare facilities> including t1o maternity and neo-natal comple<es are being fully reconstructed in ) affected districts. -ddressing specific needs and vulnerabilities of 1omen: ensuring the safety and security of 1omen and girls> and preventing gender-based violence. 67,P- is 1or!ing 1ith national and local governments and community-based organi?ations to minimi?e and treat cases of se<ual violence by supporting safe shelters for 1omen> monitoring the distribution of relief supplies to prevent e<ploitation> training community educators> and promoting personal security> including special facilities in temporary refuge shelters for unaccompanied 1omen and children. #n #ndonesia> 1omen are being provided safe access to basic services and mass media channels have been used to provide information on prevention of gender- based violence 4(025 in the temporary settlements. #n Sri /an!a> a (ender .es! has been set up at the 7ational *ommittee on Comen 47*C5 that addresses the issues of (02 in the "sunami affected areas through raising a1areness at all levels. -s a result> protection measures have been considerably improved at the shelters and 1elfare camps. Safeguarding the hygiene and dignity of 1omen and girls through distribution of hundreds of thousands of hygiene pac!s. "hese pac!s typically contain items li!e soap> toothbrush> toothpaste> detergent> disinfectant> sanitary nap!ins> under1ear> to1els> prayer mat and culturally appropriate clothing. #n #ndonesia alone> over 2 >+++ hygiene !its have been already distributed and tens of thousands are being assembled. #n Sri /an!a and the 'aldives over ::>+++ have been distributed. Helping governments and communities meet the massive need for psychosocial support> to help people cope 1ith the debilitating trauma and loss> and rebuild lives. #n -ceh> four 3

community support centres have been established. "hese centers> provide not only counseling and outreach program 1ith focus on traumati?ed 1omen but also training in ne1 s!ills to help 1omen and young people rebuild their lives. Several more are in the pipeline. #n Sri /an!a> 67,P- has contributed significantly to the development of the 7ational Policy and Plan for psychosocial and mental health interventions and set up a Psychosocial .es! at the *entre for 7ational 8perations to direct e<ternal assistance. #n the 'aldives> emotional support brigade teams 1ere formed in all tsunami affected islands to cater psychosocial first aid. 67,P- is promoting the participation of 1omen in aid distribution and decision ma!ing in the rehabilitation and planning processes. #n the case of Sri /an!a> 67,P- has supported the conduct of a gender audit> and established an information system for improved gender policy and planning responsiveness. "he (ender .es! at the 7*C in Sri /an!a 1ith 67,P- support has appointed gender focal at the .istrict .isaster 'anagement *ommittees to ensure 1omen=s participation in the post- tsunami recover phase. #n #ndonesia> 67,P- has organi?ed in conjunction 1ith the 7ational .evelopment Planning 0oard 40-PP;7-S5> the ,rench (overnment> and the 'inistry of Comen=s ;mpo1erment> a gender mainstreaming training for :++ sub-district authorities in -ceh to ensure full participation of communities in the development of the district plans. #n #ndonesia> 67,P- is currently supporting the *entral 0ureau for Statistics 40PS5 to conduct a census on post-tsunami -ceh to get accurate demographic data. "he much-needed census data 1ill contribute to1ards the longer term rehabilitation and reconstruction of -ceh. "he data 1ill be available and disseminated in 7ovember 2++:. 67,P- has from the beginning been committed to actively supporting a high level of donor coordination throughout both the planning and implementation stages. 67,P- joined the common 8*H- led flash appeal and has throughout its 1or! been fully engaged in the activities of the 67 *ountry "eams 467*"5 and at Head@uarters level is actively parta!ing in the #-S*-67.( tas! force for the tsunami. 67,P- is part of the Price Caterhouse *oopers sponsored joint financial trac!ing system and plans to participate in the joint programme evaluation led by the ;valuation and Studies 6nit of 8*H-.

Key Challenges -lthough much has been achieved> the humanitarian needs and challenges are still enormous and many comple< issues 4issues relating to e@uity> land tenure> sustainable livelihoods> planning> intersectoral and district level coordination etc5 still need to be resolved. 'ost governments have set up institutional mechanisms 1ith mandates for inter-sectoral coordination and are no1 focusing more on long term reconstruction. Ho1ever> there are still !ey challenges that need addressing. "hese relate to: Weak ca ac!"!e# of implementing partners and at times too many donors. -bsorptive capacity on the ground and speed at 1hich projects move are largely dependent on the local capacity. "he implementing partners are finding it difficult to cope 1ith different donors trying to push their respective programs beyond capacity. ;ven prior to the "sunami> -ceh for instance> 1as one of the least developed regions in the country. O$e%a&& c''%(!)a"!') *ec+a)!#*# a" "+e (!#"%!c" &e$e& a)( ,e"-ee) "+e (!#"%!c"# a)( ce)"%a& a."+'%!"!e# %e*a!) -eak. ;ffective coordination has been a challenge given the large number of players in the health sector. 0esides> many government structures 1ere already under resourced and in some cases strained by years of internal conflict.

S"a%" . c+a&&e)/e# %e&a"!)/ "' "+e %ec')#"%.c"!') -'%k '0 +ea&"+ 0ac!&!"!e#1 in Sri /an!a for instance> have been formidable. "hese relate to formalities li!e identification of alternate land for reconstruction> coastal buffer ?ones> ac@uisition of land> surveys> transfer of o1nership to the 'inistry of Health> authori?ation by the 6rban .evelopment -uthority> designing> planning> layouts> approvals> contract biddings> bill of @uantities for health facilities etc. 'ean1hile> to ensure proper fund utili?ation and accountability> 67,P- is adhering to its o1n internal financial regulations and procurement procedures regarding bidding> contract approval etc to the e<tent possible that at times poses some delays. 0ut once all the approvals are in place> e<penditure 1ill rapidly accelerate. C+a)/e# !) "+e #"%.c".%e '0 "+e !* &e*e)"!)/ a%")e%#2 "here have been major operational> structural and personnel changes 1ithin the implementing agencies> 1hich hindered an early start> and implementing of activities. Sec.%!"3 S!".a"!') in the areas of 1or! has been a concern. #n #ndonesia security remains the issue that constrains staff movement. ,or e<ample -ceh Daya and -ceh 0arat - t1o of the four districts in 1hich 67,P- 1or!s are under 67 security phase four. "ravels for assessments> appointments of staff to 1or! in these areas are delayed or have not been able to start. #n Sri /an!a too> the political environment continues to be volatile> 1ith the decline in the security situation in the ;astern Provinces> resulting in a slo1er than e<pected rate of implementation. Re %'(.c"!$e Hea&"+ a)( 4e)(e% !##.e# "e)( "' ,e )e/&ec"e( !) "+e !)!"!a& e*e%/e)c3 +a#e. 7ational mechanisms to address gender concerns and address gender-based violence as a multi-sectoral response 1ere lac!ing in the beginning and re@uired a lot of advocacy. Sensiti?ing policy ma!ers and securing commitments at various levels to ensure gender e@uity in rebuilding of social and economic systems and ensuring that 1omens= concerns are not ignored posed challenges and initial delays in operationali?ing 67,P-=s gender projects.

Flash Appeal and Funding #n the ,lash -ppeal launched on $ Danuary> 67,P- re@uested a total of 6S. 2&.) million. "he continuously changing reality on the ground has no1 revealed a revised re@uirement of appro< 6S. 1 million for 67,P- projects in #ndonesia> Sri /an!a and the 'aldives. #n addition to the flash appeal 67,P- mobili?ed resources for tsunami related activities in "hailand and for the census in and around the affected areas in #ndonesia. "otal pledges to-date appro<imate 6S. 2$.B million 4appro<. ):E of the original ,lash -ppeal5. 67,P-=s o1n contribution from its regular resources has been 6S. million to1ards the "sunami. #n addition appro<imately 6S. 1 million has been used for the purchase of RH e@uipmentFsupplies and commodities out of the Reproductive Health Commodity Security Trust Fund. "he largest donor-pledged are sho1n in the table belo1. -s of + Dune 2++:> 67,P- as received a total of 6S. 2% million from e<ternal donors for the flash appeal.
Pledges to ,lash -ppeal 4'illions of 6S.5 B.1 :.: 2.+ 1.) 1.B 1.$ 1.+ 1.+ +.& +.% +.% +.

*ountry (ermany Dapan 7or1ay ,inland 8*H7etherlands ;* *hina 7e1 Gealand -ustralia 67, S1eden

7ote: "he funds contributed by Dapan> ,inland> 7or1ay and 7e1 Gealand> 1ith the !ind consent of the respective

donors> have been placed in a multi-donor "sunami pooled fund.

Utilization of funds U"!&!5a"!') '0 0.)(# a# '0 36 7.)e 80!/.%e# a%e !) "+'.#a)(# '0 US ('&&a%#9
*ountry ,unds Received for ,lash -ppeal ,unds Received 8utside ,lash -ppeal 67,Pcontribution from Regular Resources :+ 1%>2$+ 1>B21H &+ : 2>1:+ B>1$% %++ 1:+ %&& :++ )&1 1) 2%>:) 2>221 1>%1B >)&1 "otal -vailable ,unds "otal ;<penditures 4Provisional as of + Dune 2++:5 :+ $>$2B : 1)1 >:1% 2$B )$1 ): 11>&%2

#ndia #ndonesia 'alaysia 'aldives Sri /an!a "hailand RH commodities *oordination "otal

:+ 1$>%:1 : 2> ++ B>$%1 )++ )&1 1>% & +>&B:

H,unds pledged for census in #ndonesia. *ontributions yet to be fully received.

Distribution of Received Funds

RH &o++odi,ies *% Mis& 5%

Ma#a'sia (% India (%

T)ai#and *%

Ma#di$es %%

Indonesia 54%

Sri Lan a !"%

4,or detailed analysis and utili?ation of the funding received> please see enclosed country-1ise reports.5

Many Thanks To Our Donors and Partners 67,P- e<tends its 1arm gratitude to all the donors and partners for enabling us to address the maternal health needs and special vulnerabilities of 1omen and girls affected by the "sunami. "he generosity and timely support of our various donors has meant that several thousand 1omen have been able to give birth safelyI thousands have been granted their dignity and the necessary safety and counseling to help rebuild their lives and those of their familiesI governments are loo!ing at institutionali?ation of gender concerns in planning and relief distribution and long term lasting capacities in the health-sector have been created.

INDON !IA
0efore the "sunami> -ceh 1as considered one of the least developed of the #ndonesian provinces> 1ith high levels of unemployment> inade@uate social services> and ongoing conflict. -fter the 2$ .ecember 2++% earth@ua!e and "sunami> casualties and destruction 1ere beyond imaginable scope> and dramatically deteriorated an already fragile economy. ;ssential infrastructures> communications and utilities 1ere 1iped out> and the social safety net had been destabili?ed> undermining social protection. "he humanitarian needs 1ere and remain tremendous. "he 6nited 7ations Populations ,und 467,P-5 in #ndonesia deployed its initial team to -ceh the first 1ee! of Danuary. "he only reliable means of communication bet1een -ceh and Da!arta at that time 1as te<t messages sent by mobile phone> yet the immediate assessment findings 1ere communicated> and projects 1ere designed based on these findings. Chile the staff sought to understand the situation in -ceh> they themselves 1ere struggling to maintain their o1n 1ellbeing as 1ell 4food> shelter> hygiene> etc. 1ere not easy to access5. 67,P- has moved rapidly to protect maternal health and to help ensure the security> hygiene and dignity of 1omen and girls. !o"e facts and figures BRR) -t the same time> the ,und has been 1or!ing 1ith local 1omen=s> youth> and religious-based organi?ations to reinforce their participation in relief> 1hile planting the seed of recovery through reestablishment of reproductive health services and reinforcement of urgently needed psychosocial and counseling support. 67,P- is also 1or!ing 1ith partner agencies to advocate for and implement gender- and culturally-sensitive relief and recovery approaches in the ground. Key Results of UNF#A pro$ects in Aceh Reproductive Health. 0esides supporting the Provincial and .istrict Health 8ffices in the reestablishment of damaged health centers> 67,P- also distributes various Reproductive Health supplies to village mid1ives> health centers and hospitals so that 11>+++ pregnant 1omen living in the camps can give birth safely. ,inancial support and contraceptive supplies have been provided to the 7ational *oordination 0oard for ,amily Planning 4099075 1hich is 1or!ing to ensure internally displaced persons 4#.Ps5 have access to family planning services. 8 7umber of bodies retrieved and buried: 1 1>+2) 7umber of missing persons: &>+++ 7umber of #.Ps: :++>+++ 42:+>+++ are staying in tentsI 1:+>+++ in barrac!sI and the rest 1ith host families or have started rebuilding their houses5. 11$>BB+ houses 1ere destroyed $) hospitals or clinics 1ere either damaged or destroyed> $$E 1ere destroyed. 1>%1$ government buildings 1ere damaged or destroyed> &1E 1ere destroyed. (Source:

Psychosocial Support. ,our community-based psychosocial support centers have been opened. "hese centers> provide not only counseling and outreach program 1ith focus on traumati?ed 1omen but also training in ne1 s!ills to help 1omen and young people rebuild their lives. #n addition> cultural and religious activities are also conducted to help 1omen e<press their pain and suffering. 67,P- also helped revitali?e a Comen=s *enter in -ceh 0esar managed by the Provincial 8ffice of Comen=s ;mpo1erment and Sa!inah ,amily *enter in 0anda -ceh> run by 09907. Hygiene Kits. #mmediately after tsunami> 67,P-> in partnership 1ith national authorities> conducted need assessments on reproductive health and gender to identify the needs and priorities of 1omen and girls living in the #.P camps. "he ,und designed and distributes around 2 > ++ personal hygiene !its J consisting of among others head scarf> prayer mat> sanitary nap!ins> under1ear and long-sleeved shirt - to ma!e sure -cehnese 1omen and girls can carry out activities in public comfortably. Health Promotion. ,or the promotion of gender e@uality and e@uity> 67,P- ensures that gender is mainstreamed in the humanitarian agenda from emergency> rehabilitation and reconstruction phases and beyond. "he #.Ps living in camps and barrac!s also need access to information and 67,P- is cooperating 1ith -ceh-based media through 1hich various messages on reproductive health> psychosocial and gender issues are conveyed to the entire community. "here are 1ee!ly radio and television programs and ne1spaper articles on issues related to reproductive health and gender covering #.P populations in -ceh. Census. Cith the support of 67,P-> the *entral 0ureau for Statistics 40PS5 is currently preparing to conduct a census to get accurate demographic data on posttsunami -ceh. "he much-needed census data 1ill be used to contribute to the rehabilitation and reconstruction or -ceh. "he data 1ill be available and disseminated in 7ovember 2++:. "his project re@uired additional time for preparation as the mobility of #.Ps and the need to ensure confidentiality in this conflict setting are !ey challenges that had to be factored in. .onor visibility is helps to ma!e this initiative more locally acceptable. Monitoring. "hree donor monitoring missions have ta!en place 1ith> a Dapanese delegation> and also 1ith ;*H8 in 'ay> and a (erman delegation in Dune. 'ore are scheduled for the ne<t fe1 months. Nias arth%ua&e "he 67,P- team responded @uic!ly to the 2B 'arch earth@ua!e in 7ias and Simeulue> 1hich !illed about 1>:++ people and left at least 2>+++ homeless> and 1hile also severely damaging 9

infrastructure. - team of doctors 1as dispatched to 7ias to conduct a rapid needs assessment. 67,P- sent t1o truc!loads of RH medical e@uipment and hygiene supplies to 7ias> including 1>%++ personal hygiene !its> information on health promotion and essential RH supplies and commodities. 'tension of UN Flash Appeal -s a conse@uence of the 67 ,lash -ppeal 'id-"erm Revie1> the duration of the flash appeal projects has been e<tended to end of .ecember 2++: 1ith no additional re@uests for funding. "he re@uirement for e<tension of implementation period is for a number of reasons: 11. /o1er than e<pected absorptive capacity in areas 1here programmes are being implementedI 2. -n increase in re@uirementsFbeneficiaries> meaning that a 1ider geographical area needs to be covered from e<isting financingI . High level of funds available> enabling agencies to either increase the si?e of the project or e<tend the implementation period> or a combination of the t1o. Recovery and Reconstruction "he level of government commitment and sponsorship in supporting and coordinating the relief effort has been heartening. "he (overnment of #ndonesia Reconstruction and Recovery 'aster Plan 4also !no1n as 0lue Print5 formulation started in ,ebruary. 67,P- contributed to the 0lue Print by facilitating inputs from the Reproductive Health Sector Cor!ing (roup> the (ender Cor!ing (roup> and the Population to the central government 40-PP;7-S5 and the provincial (overnment 40-PP;.-5. 6pon the re@uest of the 0appenas> 1. 67,P- has hired one independent consultant from the 6niversity of #ndonesia to directly involve in the "as!force on Religion> Social> *ulture> and Human Resources. "he consultant=s role 1as> in consultation 1ith 67,P- Programme 8fficer> to provide inputs to the tas!force based on field observation> as 1ell as technical support as a member of the tas!force 2. 67,P- *ountry 8ffice 4*85 has appointed another Programme 8fficer and project officers in Da!arta to deal and provide technical support on gender issues based on the field observation to the tas!force. . 67,P- has as!ed the RH -dvisor for -ceh consultant 1ho 1or!ed for 67,P- *8 to also provide RH technical support to the tas!force. Reproductive health 4RH5 is covered under health in general. ,amily planning has been addressed comprehensively. (ender considerations> including 1omen=s empo1erment> have been incorporated in the document. Population and development strategies have been e<plicitly mentioned in the document> in particular on the conduct of population census in -ceh and 7ias. 67,P-> upon the (overnment of #ndonesia=s re@uest> has been the main donor to mobili?e resources to fund the population census. "he Rehabilitation and Reconstruction ;<ecuting -gency 40RR5 1as established on + -pril to implement the masterplan or glue print of -ceh and 7ias post-"sunami rehabilitation and reconstruction. Part of 0RR=s mandate is to ensure transparency and accountability. ,ormer minister of mining and energy 9untoro 'ang!usubroto heads the agency.

10

(i"eline and Resources "he Psychosocial support> Hygiene !it> and Health promotion projects are due to end in .ecember 2++:. "he Reproductive health project 1ill be completed in Dune 2++$> as per the original proposal in the 67 ,lash -ppeal. 6nder the initial #ndian 8cean ;arth@ua!e-"sunami ,lash -ppeal> 67,P--#ndonesia re@uested 6S A 1$>)% >$) . 67,P--#ndonesia has received 6S A 1%>2$+>%B > out of 1hich 6S A 11>&B1>%B) 4B E5 has been allocated up to no1 to implementing partners. "he implementation rate as of + Dune 2++: is %:.&E based on funding received and ::.%E based on fund allocation in -tlas system.

#ro$ect )* Reestablish"ent of Reproductive +ealth !ervices

"he 67,P- project covers ten affected districts in 7angroe -ceh .arussalam and 7orth Sumatra provinces> and is being implemented in t1o phases J immediate response 4$ months5 and mediumterm response 41B months5. "he first phase focuses on implementation of the 'inimum #nitial Service Pac!age 4'#SP5 for reproductive health 4RH5 services> 1hile the second phase strengthens local government capacity for implementation of more comprehensive RH services. -lthough the project is divided into t1o phases> both immediate and medium term responses are being implemented simultaneously. comprehensive surveillance> monitoring and evaluation mechanism is being established. -round :++>+++ people 1ere made homeless by the disaster and are currently living in temporary shelters. "here are at least 11>+++ pregnant 1omen> and an average of B++ births ta!e place per month. 67,P- RH support focuses on t1o primary health centers 4Pus!esmas5> in each of the districts most affected by the "sunami: 0anda -ceh> -ceh 0arat> -ceh Daya> -ceh 0esar. Key Ob$ectives "o provide immediate response to meet RH needs> and to support local capacity in restoring RH services Intended Outco"es "o support the reestablishment of RH services in -ceh> 1ith emphasis on B Pus!esmas in % districts. Activities A##e##*e)"#Khave been conducted throughout the first $ months after the "sunami> 1ith focus on t1o Pus!esmas in each of the follo1ing districts: 0anda -ceh> -ceh 0esar> -ceh Daya> and -ceh 0arat. -ssessments of referral hospitals in 0anda -ceh and 'eulaboh have also been conducted. - general RH assessment 1as also conducted in *alang 41est coast of -ceh5. RH supplies have been given according to needs.

11

C''%(!)a"!') *ec+a)!#*K67,P- set up the Reproductive Health sub-sector 1or!ing group to help coordinate government> 67> and 7(8 RH emergency response and to help reestablish RH services through out -ceh. #n the meantime> the government and 67,P- are 1or!ing together closely in this 1or!ing group> 1hich the Provincial Health 8ffice and 67,P- co-chair. RH S. &3 %'$!#!')K2:+ mid1ives serving #.Ps in 0anda -ceh> -ceh 0esar> -ceh Daya> and Cest -ceh have received 67,P- mid1ifery !its to help 1omen in the camps give birth safely. -n additional :++ !its are in the pipeline. ,urthermore> 67,P- sent enough RH supplies to cover the needs of :++>+++ #.Ps for a $ month period. A*,.&a)ce#K;ach of the B priority Pus!esmas 1ill be supplied 1ith ambulances 1hich 1ill include basic resuscitation e@uipment and emergency obstetric care in Duly. N'):RH e;.! *e)"<67,P- has provided the Provincial Health 8ffice 1ith : cars for logistic support for programme operations> including field monitoring. Ree#"a,&!#+!)/ RH #e%$!ce#K67,P- is focusing comprehensive support to reestablishing RH services on Gainul -bidin referral Hospital in 0anda -ceh> and on t1o Pus!esmas in each of the follo1ing districts: 0anda -ceh> -ceh 0esar> -ceh Daya> and -ceh 0arat. #n addition> 67,P- is supporting a small health clinic in Dantho 4-ceh 0esar5 run by 'itra Perempuan 4a foundation dealing 1ith RH5> right inside the tented encampment. "he clinic provides family planning services for around 1>:++ 1omenFcouples> maternal care for %+ pregnant 1omen> and other RH services to around %> ++ #.Ps living in : camps in the area. T%a!)!)/#K'id1ives in the priority Pus!esmas have received training on the use of RH !its. Rec')#"%.c"!') = Re+a,!&!"a"!') "o support the R L R phases> 67,P- supporting the capacity building of local counterparts> including government officials> local health providers> and 7(8s in the implementation of the RH programme. 0y doing so> 67,P- is promoting sustainability by transferring s!ills and e@uipment to local counterparts. Ke3 %e#.&"# ac+!e$e( 6sing 67,P- RH !its> 2$ deliveries 1ere recorded among #.Ps at the % most affected districts as per 'arch 2++:. -mong these> %& high-ris! pregnancies have been properly treated 4 1omen under1ent caesarean sections> and 1% babies 1ere born 1ith the aid of vacuum e<traction5. C')c&.#!') RH surveillance revealed that unmet family planning needs are still prevalent among #.Ps> and also among the general population of -ceh. Donor allocations and e'penditures .onor 'ulti donor 4pooled5 *hina ;*H8 (ermany 67,#P "otal -llocation 46S.5 2>2++>+++ %++>+++ $1B>&&$ %>+&+>::$ B+>):2 &>$&+>2B% ;<penditures 46S.5 1>$2$>+&1 + %>)11 1>%B1>):1 1$:>1BB > +B>121 0alance 46S.5 :& >)2) %++>+++ :B >B$: 2>:BB>$+: 21:>&$% %> $2>1$

12

#ro$ect ,* #rovision of "ental health services through psychosocial support centers for affected populations
ith emphasis on omen and young people 0efore the "sunami> the need for psychosocial support 1as already high> as the armed conflict caused psychological distress to at least :+E of the population 4source: Provincial Health 8ffice> PH85. .uring the "sunami> )+E of -cehnese families lost 1 or more members to the disaster 4source: PH85. "hrough this project 67,P- is providing much-needed psychosocial services to "sunami-affected populations by establishing community support centers 4*S*s5 1hich have psychosocial outreach services. "he community psychosocial support centers include services to prevent gender-based violence and provide care for victims of violence. #n addition> livelihood activities are organi?ed through these centers> in addition to providing a venue for maintenance of peer support groupsI psychological counselingI counseling on reproductive health concernsI and referrals. ,our *S*s have been established along 1ith accompanying outreach services. 67,P- has supported the reestablishment of t1o additional community centers. ,our more *S* are under finali?ation 4their establishment 1as slo1ed do1n as a result of security concerns5> and more are in the pipeline as demand for them is high. #n line 1ith the other projects under the 67 ,lash -ppeal> the centers have been and 1ill continue to be establishment in the districts most affected by the "sunami: 0anda -ceh> -ceh 0arat> -ceh Daya> -ceh 0esar. Key Ob$ectives "o provide psychosocial services> including counseling> for tsunami victims> through community support centers. "he centers 1ill also include services to prevent and deal 1ith violence against 1omen and girls. Intended Outco"es "o establish B *S*s> and revitali?e 2 community centers in the priority districts 1hich offer psychological> religious> creative and livelihood activities to facilitate return to normalcy. .emand for these multipurpose community centers is high> and $ more *S*s are being established in DulyI more are in the pipeline. Activities A##e##*e)"#K0efore the establishment of the *S*s> implementing partners 7(8s ,atayat 76 and ,lo1er -ceh conducted needs assessment in 0anda -ceh and -ceh 0esar. 'ost activities in -ceh Daya and -ceh 0arat have not been able to move as planned as a result of the security situation. 7eeds assessments are being conducted 1ith youth to identify their needs. 67,P- is launching its youth initiatives in collaboration 1ith #/8. 13

Picture: drawing y Tsunami survivor

T%a!)!)/ '0 c'.)#e&'%#K"he #ndonesian Psychologist -ssociation 4H#'PS#5 trained 22 psychologists on psychosocial counseling in Da!arta. "hese psychologists> in turn> trained 2 community based counselors 4*0*s5 in -ceh 1ho run % *S*> and the additional *S*s 1hich are being established. 8f the 2 counselors> 1$ have been recruited by ,atayat 76 and ,lo1er -ceh. - 12-day training on counseling s!ills for counselors is being conducted facilitated by H#'PS# in collaboration 1ith ,atayat 76 and ,lo1er -ceh. Starting Dune 2Bth> 2++: 67,P- in cooperation 1ith H#'PS# has started to train the second batch of potential counselors. "he counselors are placed in centers 1ithin 1est coast areaI /amno and "eunom 4-ceh Daya district5 and 'eulaboh> Coyla> and 9a1ay M2# 4-ceh 0arat district5. ,or counselors of the 1st batch> training session are conducted to sharpen their s!ills on participatory approach to community and additional !no1ledge on adolescent and child psychology. "he counselors of the 2nd batch are trained in basic counseling and other s!ills related to community participation. O."%eac+ #e%$!ce#K,rom the time the training in counseling services for affected community had been completed the community outreach program started 4'arch5 in order to speed up the response to the needs of "sunami-affected communities. E#"a,&!#+*e)" '0 CSC#K,our of the B planned *S*s have been established in 'ayI 2 in 0anda -ceh: 6lee 9areng and 0atohI and 2 in -ceh 0esar: Sibreh and Seulimeum 4see belo1 for details5. "hey are called Rumoh Peusi!u" Hatee or Soul Soothing Home. "he establishment of % *S* 1as delayed due to the security situation. 67,P- also helped reestablish Rumoh Putro #ceh a Comen=s *enter managed by the Provincial 8ffice of Comen=s ;mpo1erment 40iro PP5 and Sa"inah ,amily *enter> run by 09907> 1hich also provide psychosocial services. L!$e&!+''(# ac"!$!"!e#KCith #/8> 67,P- is providing livelihood s!ills for 1omen bet1een the ages of 1)-2). "he s!ills taught include: 0usiness -1areness> 0usiness Planning> and 2ocational s!ills on tile ma!ing. "he *S* of Sibreh is the first *S* that started to rollout the 1: day training starting 1ith 2+ participants. 6nfortunately> due to the limited supply of molds> vocational training 1as postponed to Duly. "he livelihood training 1ill continue rolling to other *S*s in 0anda -ceh and -ceh 0esar districts. ;mbroidery classes are being hosted at Rumoh Putro -ceh> and so far participated in this training. 2+ 1omen have

>#3c+'&'/!ca& +ea&!)/ #e%$!ce#K*ultural re-e<plorationK- combined team of artists> including artists from Da!arta and -ceh> have initiated a re-e<ploration e<ercise 1ith communities in -ceh. "he artists conducted activities 1ith participants> including dra1ing> traditional bamboo-flute ma!ing> poetry 1riting> and practicing traditional dance. "he program started in the S*S in 0atoh and are continued at the four sites in 0anda -ceh. "he *S*s are stoc!ed 1ith religious boo!s> and religious-based activities are hosted at the centers to provide a source of comfort to #.Ps. Ac"!$!"!e# 0'% 3'.)/ e' &eK"1o events started 67,P-=s NOouth #nitiativesP project. "he first 1as a 1ell-attended music concert in 0anda -ceh 1ith 'r. Rafly> a famous young -cehnese singer. "his event 1as funded by 67,P-> #/8> and #*'*. "he free concert 1as dedicated to displaced youths and 1as the first concert held in 0anda -ceh after the "sunami. 'ain purpose of the concert is to bring some entertainment to displaced populations especially the youth in 0anda -ceh and its vicinities but to also dra1 youth to some semblance of normalcy. - second event 1as a 1or!shop on issues related to young people=s health> social> cultural and economic aspects. #t is cosponsored by 67,P- and 67-#/8> and 1as held in 'ay 2++:. "he 1or!shop aimed to identify youth initiatives and finding 1ays to support them. Participants 14

included 67 agencies> international 7(8s> donors> local youth organi?ations and selected displaced youth representatives. 4e)(e%:,a#e( $!'&e)ceK%+ counselors> from all established *S*s and selected Pus!esmas> 1ere also training on responding to gender-based violence> by 7(8 #7S#S"> 1hich has a long history of 1or!ing on gender-related issues. "he counselors are no1 starting to lin! their activities 1ith Pus!esmas staff. .ore details on C!Cs Chile psychosocial outreach services started in 'arch> 67,P- has opened the follo1ing *ommunity Support *enters 4*S*s5 in 'ay: 1. T+e U&ee Ka%e)/ CSC 40anda -ceh5 "he center is located about 2++ meters a1ay from the Pus!esmas> mos@ue> and #.P camp. 2. T+e ?a"'+ CSC 40anda -ceh5 "his center is close to the communities in 1hich the #.Ps live. /ocated not more than :++ meters from 0atoh Pus!esmas> the *S* in 0atoh provides counseling service for #.Ps 1ho live 1ith host families as 1ell as common society 1ithin the neighborhood of the center. . T+e S!,%e+ CSC 4-ceh 0esar5 "he *S* of Sibreh had done simple assessment on its communities interest to1ard this training and the meeting decided that Sibreh 1ill be the first premise of /ivelihood and 2ocational "raining. 2ocational "raining 1ill be on bric! ma!ing module. %. T+e Se.&!*e.* CSC 4-ceh 0esar5 Cithin the radius of not more than :+ meters> the center is surrounded by public facilities and #.P camp. "he center is close to a Senior High School> a Pus!esmas> a Dunior High School> and an #.P campI in front of the center there is a grass field that is used by the community for playing football. Reconstruction / Rehabilitation 8ne of the objectives to establish lin! 1ith 0anda -ceh 'ental Health Hospital is to provide access for the *S*s to 'ental Health Hospital so that the counselors can directly interact 1ith the 'ental Hospital> especially as related to the early detection on any potentially acute cases of psychological distress 1ithin the communities. #t been decided that the counselors 1ill have bi1ee!ly meetings 1ith psychologists and psychiatrists of the 'ental Health Hospital to discuss psychological cases. "hese meetings 1ill be held at the *S*s> and 1ill serve as a forum for to share e<periences and discuss routine operational issues. #t is agreed that the first meeting 1ill be held in Duly 2++: in the 0atoh *S*. Key results achieved -round 2++ 1omen and girls including :+ traumati?ed people and 11 people affected by violence have received counseling from the counselors. #mmediate intervention is important to prevent deterioration of their mental health. Conclusion "he objectives of this project are being met through the *S*s that have been established. 8utreach 1or!ers are 1or!ing 1ith the communities to identify needs and address these. "he centers provide a multipurpose and versatile setting through 1hich immediate psychosocial needs are being met> including counseling using religious and creative approaches> and livelihood activities. 15

#n addition> livelihood activities had been identified as a need for 1omen> and as a result projects such as tile-ma!ing training have been established. ,unds have also been used to training the counselors in responding to gender-based violence. Donor allocations and e'penditures .onor 'ulti donor 4pooled5 ;*H8 (ermany 7etherlands "otal -llocation 46S.5 +1>:+ )2>%2$ 1> :$>B:2 ++>& + 2>+:1>:11 ;<penditures 46S.5 2$>)2) + )>+)1 1+B>&22 %&%>&%2 0alance 46S.5 2&%>:&% )2>%2$ 1>+1&>&$1 1)2>++B 1>:&$>&$)

#ro$ect 0* #rovision of personal hygiene pac&s to (suna"iaffected populations in Indonesia

#mmediately after the "sunami> 67,P- conducted needs assessments on reproductive health and gender to identify the needs and priorities of 1omen and girls living in #.P camps. 67,P- has moved rapidly to protect #.Ps> especially 1omen and girls> maintain hygiene and dignity. - hygiene !it 1as assembled based on the needs assessments> and include basic hygiene supplies such as> sanitary nap!ins> disinfectant> soap> toothpaste> toothbrushes> head-scarf> prayer mat> under1ear> and long-sleeved shirt> to ensure -cehnese 1omen and girls can carry out activities in public comfortably. "he !its are accompanied by information on basic reproductive health and hygiene> and 1ill be distributed along 1ith other basic supplies by implementing partners including government> 7(8s and voluntary organi?ations. Subse@uent assessment sho1ed the imminent hygiene needs of men> and a ne1 !it 1as designed for males. "he areas 1here the !its are mainly distributed to 0anda -ceh> -ceh 0arat> -ceh Daya> -ceh 0esar. -fter the earth@ua!e in 7ias> a shipment 1as also sent there. Key Ob$ectives "o safeguard personal hygiene of girls> 1omen> and men in temporary shelters in -ceh by providing hygiene !its> and reproductive health and hygiene information. Intended Outco"es "o provide hygiene !its to :+>+++ displaced persons. Activities H3/!e)e k!"#K- total of 2 > ++ personal hygiene !its> including have been purchased thus far> and more are in the pipeline. "hese have been and are being distributed on continuous basis> based 16

on production and logistical capacity. -bout B+ percent of the !its have been for females> and the rest for males. Chile communities identified 1omen=s hygienic needs as most urgent> it 1as also clear that men lost everything and are also in need of hygiene supplies. .istribution of hygiene !its through various implementing partners continues. ,rom -pril the distribution has been handled mainly by the Provincial 09907 office> 1hich uses its e<isting net1or! at the village level. .istribution is no1 covering 11 districts instead of four districts. 67,P- covers the distribution costs. 4e)(e%:,a#e( $!'&e)ce "%a!)!)/K#7S#S"> and 7(8 that speciali?es in gender issues> led a 1or!shop from 1&-1) Dune for *S* outreach 1or!ersFcounselors 4from all established *S*s and selected Pus!esmas5 on gender-based violence. .uring this 1or!shop> participants learned about the problems faced by victims of violenceI ho1 to response victims in a holistic and sensitive manner. Key results achieved -fter initial assessments from the 67,P- team in -ceh 4dispatched the first 1ee! of Danuary5> it became immediately clear that 1omen 1ere not able to access basic services because they did not have sanitary nap!ins> they 1ere not clothed properly> and also did not have headscarves. 67,Presponded immediately by purchasing hygiene !its 1hich 1ere specifically designed for the -cehnese conte<t. "he objective of this project is being achieved as the !its are reaching populations that need them> and this has reduced the vulnerability of 1omen and girls in the emergency phase. Conclusion /ogistics have been a challenge in -ceh> as a result of damage to infrastructure and security concerns. "his slo1ed the pace at 1hich the personal hygiene !its 1ere delivered significantly. Ho1ever> many partners 1ere interested in distributing the !its> and this eased the burden of 67,P- to solve the logistics issue. Donor allocations and e'penditures .onor 'ulti donor 4pooled5 -ustralia *hina ;*H8 7etherlands S1eden "otal
H,unds not received

-llocation 46S.5 1>$++>+++ 2++>+++H 2++>+++ 2&&>2&B %21>:)1 2B%>%): 2>)B > $%

;<penditures 46S.5 1> 11>:%% + 1B$>B%$ 2&$>& + B:>%21 2)%>++ 2>%:%>:%%

0alance 46S.5 2BB>%:$ 2++>+++ 1 >1:% :%B $>1&+ -)>:+B :2B>B2+

#ro$ect 1* #revention of gender-based violence during the e"ergency and reconstruction phases
"he brea!do1n of social and infrastructure systems in the disaster-affected areas may lead to an increase in se<ual violence and e<ploitation> un1anted pregnancies> preventable maternal and infant deaths> and an increase in the spread of H#2F-#.S and other se<ually transmitted infections

17

4S"#s5. "his project see!s to address these problems and reduce the ris! of gender-based violence for displaced populations through a phased approach. "he first $ months of this project focused on promoting safe access to basic services> by providing information on prevention of (02 in the temporary settlements through available media channels> including face-to-face and group discussions 1ith affected populations. Resource persons for television and radio programmes> and ne1spaper articles include (8#> decision-ma!ers and community leaders in the temporary settlements> 7(8s> partners and volunteers. "rained outreach 1or!ers involve sta!eholders> including vulnerable populations and service providers to identify and shape !ey messages. #;* materials providing information to project beneficiaries on access to services> safety and protection against (02 are being developed. Key Ob$ectives Prevention of gender-based violence by promoting safe access to basic services and building capacity in 1omen and youth groups to respond to and prevent (02. Intended Outco"es "o provide information on reproductive health and gender to #.P populations using mass media. Activities Ma## *e(!aKSince Danuary> there have been 1ee!ly radio and television programmes> and ne1spaper articles sponsored by 67,P-. Radio and television programmes funded by 67,P1ere played on station RR# 4coverage all of -ceh5> Radio 0aiturrahman 40anda -ceh5> Radio Pimpinan 'uhammadiyah 40anda -ceh5> "2R# 4-ceh5. 67,P- sponsored 1ee!ly ne1spaper articles in Serambi #ndonesia .aily 7e1spaper 1hich covers all of -ceh. 67,P- sponsored articles> and the donation of B>:++ ne1spapers 1hich are then distributed for free to #.Ps. "he topics 1ere as follo1s: ,amily planningI Safe pregnancy> and motherhoodI 0reastfeedingI Personal hygieneI (ender issues> gender-based violence> and 1omen=s empo1ermentI Safe pregnancy and post-partumI Promotion of family planning and free contraceptive service to the communityI Psychosocial information related to mental health> child trauma> and other people 1ho have lost family membersI .onor visitsI ;mergency contraceptivesI 7utrition for children under fiveI 67,P- activities. E(.ca"!')1 c'**.)!ca"!') !)0'%*a"!') 8IEC92 P90# published leaflets on H#2F-#.S> se<ual transmitted infections and reproductive health for the youth. 09907 published leaflets 1ith information on high ris! pregnancy and contraceptives use in -cehenese and #ndonesian languages. @'c.# ') 3'."+KPreparatory 1or! is being underta!en for specific promotion of adolescent reproductive health through a radio tal! sho1 programme to be facilitated by the #ndonesian 18

Planned Parenthood -ssociation 4P90#5 1ith the support from 67,P-. Supporting activities include provision of counseling for the youth> peer-educator programme> livelihood initiatives> prevention of S"#=sFH#2F-#.S and various games. "he 67,P- Health Promotion project is conducted through outreach and mass media activities. "he #ndonesian Planned Parenthood -ssociation 4P90#5 conducted outreach activities through a peer education modality to educate ++ students in $ senior high schools in 0anda -ceh about reproductive health. Re#'.%ce e%#')#KPersons from the follo1ing institutions serve as resource persons for the radio and television programs and ne1spaper articles: 09907> 0ureau of Comen=s ;mpo1erment> (ynecological -ssociation of 0anda -ceh> Provincial health 8ffice> Oayasan PulihI 'ental Health Hospital. Key results achieved Cee!ly radio and television programmes> and ne1spaper articles sponsored by 67,P- 1hich provide essential information to "sunami-affected populations. Conclusion "his project has faced some specific obstacles 1hich slo1ed do1n implementation.

Providing #;* materials to -ceh re@uires the careful development and testing resources as the setting is culturally> socially> and politically distinct. "his process re@uires time. "he production of #;* materials is also logistically challenging as there are not enough production companies 1hich can produce good @uality materials in -ceh. ,or no1 production has to ta!e place in 'edan or Da!arta.

*ommunications are usually a top concern in humanitarian situations> and it is thus not surprising that this project 1hich main aim is to communicate basic information is challenging to accomplish. 7evertheless> the mass media channels of communication have been less difficult use as a medium to convey information. Financial #rogress .onor 'ulti donor 4pooled5 *hina ;*H8 "otal -llocation 46S.5 1>2++>+++ 1++>+++ $%>$)) 1> $%>$)) ;<penditures 46S.5 2B+>2&$ >B&& + 2B%>1: 0alance 46S.5 )1)>&2% )$>12 $%>$)) 1>+B+>:%$

.ainstrea"ing 2ender

#n a H#2F-#.S a1areness 1or!shop run by the .epartment of .efence and 67-#.S> 67,P- contributed to a session gender and provided t1o resource persons to help raise the understanding of issues related to gender to 1++ military officers of different ran!s. -n agreement 1as signed bet1een 67,P- and the Comen=s ;mpo1erment 0ureau 40iro PP5 on 'ay 2nd 2++: to support the 0iro PP in resuming its post-"sunami activities. Support has been e<tended in form of e@uipment and financial support to train 1omen focal points in the selected barrac!s for counseling and life s!ills activities. 67,P- also supports the 0iro through provision of e@uipment and funds to reactivate the 19

activities of Comen=s Support *enter> NRumah Putro -ceh.P Cith this center> 67,P- is sponsoring embroidery classes for 1omen> as part of its livelihoods programme.

#n order to improve conditions for 1omen and girls in the barrac!s> 67,P- in collaboration 1ith 0iro PP sponsored the first coordination meeting 1ith inter-sectoral local government authorities and local and international 7(8s and 67- agencies to discuss gender issues in the barrac!s. "he *oordination meeting 1as held on the 21st of 'ay and 1as attended by $& participants. 2arious sectoral gender issues affecting the lives of 1omen in the barrac!s 1ere discussed and 09907 4the 7ational ,amily Planning 0oard5 has agreed to join this meeting 1hich 1ill be held every month. "his meeting is supported and coordinated by 67,P-. 67,P- in conjunction 1ith 7ational .evelopment Planning 0oard 40-PP;7-S5> the ,rench (overnment> and the 'inistry of Comen=s ;mpo1erment have organi?ed a gender mainstreaming training for :++ sub-district authorities in -ceh to ensure full participation of communities in the development of the district plans. "he preparatory activities too! place in 'ay. 67,P- supports publication and dissemination of information on violence against 1omen in disaster areas 1ith Durnal Perempuan. Research on this 1as conducted in 'ay. 67,P- is co-sponsoring an interagency project led by 67;S*8 to support comprehensive community education. 67,P-=s contribution to this project is to support the hiring of a consultant for three months integrates selected issues 4gender> reproductive health> and religious values5 and provide training on them. 6nder this project in-camp community educators 1ill be trained> and they 1ill in turn provide education to the #.P communities living in temporary settlements> and barrac!s. 67,P- and 8<fam have co-sponsored a 0iro PP-led (ender -ssessment. "he data collection phase of the -ssessment is finished> and no1 the data has been entered and analysed. 7o1 the report is under finali?ation. "he *enter for Comen=s Studies of the State #nstitute of #slamic Studies 4#-#75 -r-Raniry> 0anda -ceh conducted the gender needs assessment. Preliminary findings have identified the follo1ing gender-related priority issues: uncertainty of inheritance or landI changing roles for men and 1omen 1ho have lost their spousesI continuity of livelihoods. 8ther general concerns that 1ere mentioned include limited availability of vegetables and fishI uncomfortable living conditionsI lac! of privacyI lac! of sanitary garbage disposal or access to clean 1ater.

2eneral Constraints

L!*!"e( ca ac!"3 '0 I* &e*e)"!)/ >a%")e%#2 Chile 67,P- is committed to have as much participation from the affected communities> unfortunately human resources and capacity on the ground are limited and the abundance of international agencies operating in -ceh have absorbed @ualified local human resources. -bsorptive capacity on the ground and speed at 1hich projects move are largely dependent on the local capacity> even prior to the "sunami> -ceh 1as one of the least developed regions in the country.

20

C+a)/e# !) "+e #"%.c".%e '0 "+e !* &e*e)"!)/ a%")e%#2 "here have been major operational> structural and personnel changes 1ithin the implementing agencies> 1hich have hindered the early start> and implementing of activities. H!/+ +.*a) %e#'.%ce ".%):'$e% a*')/ )a"!')a& a)( !)"e%)a"!')a& #"a002 .ue to high stress levels from 1or!ing in -ceh> high staff turn over has been observed both 1ith the national and international staff. Some of the Qmemory and e<perience= 1ith the staff is lost in the process 1hich effects the programs. Sec.%!"3 S!".a"!') !) "+e a%ea# '0 -'%k2 -ceh Daya and -ceh 0arat the t1o of the four districts in 1hich 67,P- 1or!s are under 67 security phase %. "ravel for assessments> appointments of staff to 1or! in these areas are delayed or have not been able to start. -s a result of this> the establishment of % *S*s has been delayed. L'/!#"!c#2 -s a result of damage to infrastructure and security concerns logistics have been a challenge in -ceh. V!#a#2 uncertainty of visas for foreign personnel has added an additional stress. T'' *a)3 (')'%#2 "he implementing partners are over1helmed 1ith all the donors trying to push their respective programs beyond capacity> and are finding it difficult to cope 1ith this. >e%*a)e)" #"%e## a)( 0ea%2 ;arth@ua!es> storms> and ongoing armed conflict cause continued stress and an<iety to people living and 1or!ing in -ceh.

Factors that facilitated effective aid delivery

C'**!"*e)" '0 #"a00 a)( a%")e%#. .espite many obstacles that have to be overcome to implement the delivery of aid> persistence of staff and partners has allo1ed 67,Pprojects in -ceh to be operational and functioning.Partnerships 1ith the (overnment> 7(8s> and 67 agencies have led to the dynamic functioning of the *S*s. 8ther organi?ations have projects already formulated openness to partnership has allo1ed us to 1or! together to provide more comprehensive services to "sunami-affected areas. 8ne e<ample in 1hich 1e have been successful is in the area of livelihoods. D')'% C')"%!,."!')#. 67,P- 1ould li!e than! the donors 4-us-id> *hina> ;*H8> ,inland> (ermany> Dapan> the 7etherlands> 7e1 Gealand> 7or1ay> S#.--S1eden> 67,#PFHe1lett> and the privateF7(8 contributors5 1ho have made commitments and have contributed to the 67 ,lash -ppeal. Ce continue to ensure that our efforts are efficient and that 1e deliver @uality services geared to meet the needs of "sunami-affected communities and individuals.

Conclusion
People are starting to return to their normal lives in the affected areas> and as they are doing this they are submitting proposals and initiatives to donors> including 67,P-. -s a result> 67,P-#ndonesia 1ill be able to spend all funds granted for the "sunami-response as they are used to immediately address the needs the communities are identifying. Chile the "sunami brought destruction beyond imagination> it has been a positive e<perience to 1or! 1ith the resilient "sunami and ;arth@ua!e-affected populations of 7anggroe -ceh .arussalam and 7orth Sumatra. "ogether 1e are leaving behind the acute emergency phase> and leading the 1ay into the reconstruction and rehabilitation phases.

21

!RI 3ANKA
#ro$ect )* Restoration of R+ !ervices in the (suna"i Affected Districts of !ri 3an&a
"he health sector has been seriously affected by the tsunami. Several major hospitals and a large number of peripheral hospitals and health units 1ere partially or completely damaged thereby affecting the delivery of reproductive health 4RH5 services 1ithin the affected communities. -lso a large number of RH service facilities such as clinic centres and (ramodaya Health *entres 4(H*5 1ere destroyed to varying degrees. "he health staff in certain affected areas have e<perienced e<tensive suffering> as a result of the tsunami> 1hich could have a bearing on their day-to-day 1or!. #n addition> the lac! of transport facilities for field health staff 1ithin the affected areas 1ould further hamper RH service provision especially to the displaced populations 1ho currently live in temporary shelters and 1elfare centres andFor 1ith friends and relatives. "he reduced capacity to meet the reproductive health needs of individuals and communities may result in serious conse@uences that threaten the 1ellbeing of many people> and in particular 1omen and girls. ;mergency situations tend to increase the ris! of life-threatening complications related to pregnancy such as miscarriages brought on by trauma> unsafe deliveries due to lac! of appropriate facilities and higher rates of abortions as a result of unplanned pregnancies and disruption in family planning use. #n addition> the brea!do1n of the physical and social fabric as a result of the destruction and displacement has social and personal conse@uences for many individuals and families that may compromise their reproductive health status. /arge movements of people> change in social norms governing se<ual behaviours and the potential of coercing 1omen and adolescent girls and boys to e<change se< for food> shelter> income or protection can all contribute to the spread of se<ually transmitted infections including H#2F-#.S. #n spite of the above setbac!s> it is commendable that the 'inistry of Health has been able to provide the necessary health care services to the affected populations through the available health infrastructure and through out-reach programmes. "he biggest challenge the (overnment of Sri /an!a is no1 facing is to rapidly bring bac! the lives of the displaced communities to some level of normalcy. "he 'inistry of Health has begun the process of rehabilitation and reconstruction of health services including reproductive health services 1ith the necessary assistance and support from the bilateral and multilateral partners> *ivil Society 8rgani?ations including 7(8s and the private sector. #ro$ect Fra"e4or& 4'a&: "he goal of the proposed programmes is to contribute to the promotion of reproductive health including family planning and se<ual health among couples and individuals living in the tsunami affected districts of Sri /an!a. EA ec"e( O."c'*e: "he e<pected outcome is to contribute to sustained utili?ation of comprehensive reproductive health services> including information and commodities. EA ec"e( O." .": "he output of the programme is to have increased access to and availability of comprehensive> client oriented and gender sensitive reproductive health care through the restoration of reproductive health services in the tsunami-affected districts. ,ollo1ing are the main components of the project:

22

RestorationFrehabilitation of damaged RH service facilities in order to support the health recovery plan at national> provincial and district levels Provide essential RH e@uipment and supplies Re-establish outreach services for health promotion Support the 2oluntary Health Cor!ers programme in areas 1here there are Public Health 'id1ife vacancies Strengthen the capacities and s!ills of health personnel by providing training and supportive supervision Strengthen co-ordination> monitoring and evaluation mechanisms

Results Achieved Re#"'%a"!')B%e+a,!&!"a"!') '0 Da*a/e( RH Se%$!ce @ac!&!"!e# 67,P- has signed an agreement 1ith the 'inistry of Health for the construction andFor renovation of the 1 'edical 8fficers of Health 4'8H5 8ffices> : (ramodaya Health *entres 4(H*s5 and 2 maternity and neo natal comple<es. 8f the 1 '8H 8ffices to be constructed> action has been ta!en to initiate construction 1or! for 1+ out of the 1 facilities. 8f the : (H*s> preliminary 1or! has been completed and tender procedures finalised for the reconstruction of all (H*s and construction 1or! has started in the t1o (H*s in the 0atticaloa .istrict. 8f the 2 maternity and neo natal comple<es> preliminary 1or! on one unit has been finalised to initiate construction.

$evastated health in%rastructure

#n planning for the ne1 facilities> an effort has been made to liaise 1ith the local counterparts and sta!eholders to ensure that the facilities are designed to better cater for the communities they are meant to serve in terms of si?e and location. -n improved environment for the delivery of a comprehensive pac!age of @uality RH services> including counselling and health promotion services for couples and individuals 1ould also be a focus of the restoration effort. "he construction component of the programme is e<ecuted by 678PS> 1hich has established a strong field presence in the tsunami affected areas of Sri /an!a to manage and oversee the construction 1or!.

$amaged $elivery room

23

24

"he follo1ing table provides the progress 1ith regard to the construction component:
D!#"%!c"B D>DHS A%ea @ac!&!"3 T3 e '8H office >&ace 9almunai South Sainthamaruthu 9araitivu 7intavur 9anna!ipuram 'a1adipalli 0H 9almunai 7 9inniya 9uchchaveli 0atticaloa 9ala1anchchi!udy 9a!!ajaveddai "hampala1attai 'atara "angalle Hambantota 0eru1ela Pallai *hempianpattu ;lpitiya 0H >%'/%e## a# a" 7.&3 2665 /and not allocated yet /and found not suitable for building L being reassessed /and identified> surveyed L plans ready /and identified> surveyed L plans ready "ender documents ready "ender documents ready /and available. .elay in submission of plans by 'oH /and o1nership not yet confirmed /and identified. .ecision on further progress is delayed. /and identified> surveyed L plans ready /and identified> surveyed L plans ready *onstruction started *onstruction started "ender documents ready /and not identified yet /and to be cleared by 6./and o1nership not yet confirmed /and identified> surveyed L plans ready /and identified> surveyed L plans ready Plans ready

(H* 'aternity *omple< '8H office '8H office (H* Ma"a%a Ha*,a"'"a Ka&."a%a K!&!)'c+c+! 7a00)a 4a&&e '8H office '8H office '8H office '8H office (H* 'aternity *omple<

T%!)c'*a&ee ?a""!ca&'a

#rovision of ssential R+ %uip"ent and !upplies Personal Hygiene 9its for Comen and (irls

.uring the emergency phase of the tsunami disaster> ::>+++ personal hygiene !its 1ere distributed to displaced 1omen and girls housed in 1elfare camps and temporary shelters. "he !its contained essential items such a sanitary nap!ins> under1ear and other personal hygiene products. %:>+++ !its 1ere distributed through the 'edical 8fficers of Health in the disaster hit areas and 1+>+++ through 67H*R in the districts of 9ilinochchi and -mparai. "he !its 1ere assembled by youth volunteers mobili?ed by the 7ational Oouth Services *ouncil> a national partner of 67,P- under the current *ountry Programme. "he personal hygiene !its addressed a critical gap in the provision of emergency relief supplies to the displaced communities and made a significant contribution to1ards safeguarding the dignity of displaced 1omen and girls in the temporary shelters and 1elfare camps.

25

Reproductive Health 9its

"he Reproductive Health 9its are designed for use in emergencies situations. -t the re@uest of the 'inistry of Health> 67,Psupplied Reproductive Health 9its to all districts affected by the tsunami. "hese !its 1ere used often in ma!e shift facilities that had limited or no e@uipment to handle deliveries and obstetric complications during the emergency phase. "he !its also include supplies to cater to the other RH needs of the displaced communities. - total of &2) RH 9its 1ere supplied and distributed as follo1s:

&outh 'olunteers #ssem le Personal Hygiene (its

K!" C + 2% : $ B ) 11110 12

De#c%! "!') "raining administration

U)!"# )2 2++ 1++ 1& 1++ : 1++ :+ 2+ 1+ +>+++ :

*lean delivery sub!it 8ral and injectable contraceptives S". drug !it .elivery sub-!it 'anagement of complications of abortion !it Suture for vaginal and cervical tears !it Referral sub !it /evel Referral sub !it /evel 0 0lood "ransfusion !it #njectable .'P*urettage sets

D!#"%!c"#BD>DHS A%ea# = I)#"!"."!')# S. &!e( (alle> 'atara> Hambantota> -mpara 9almunai> 0atticaloa> "rincomalee> 'ullaitivu> 9ilinochchi L Daffna (alle> 0atticaloa> "rincomalee> 'atara> -mpara .istributed through ,H0 to all "sunami affected areas .istributed through 'S. to S". clinics in the affected areas (alle> 'atara> Hambantota> -mpara 9almunai> 0atticaloa> "rincomalee> 'ullaitivu> 9ilinochchi Daffna L ,H0 ,H0 .istributed by ,H0 to all "sunami affected areas (alle> 'atara> Hambantota> -mpara 9almunai> 0atticaloa> "rincomalee> 'ullaitivu> Daffna (alle> 'atara> Hambantota> -mpara 9almunai> 0atticaloa> "rincomalee> 0lood 0an! *olombo .istributed by ,H0 to all "sunami affected areas ,H0

26

27

RH 'edical ;@uipment and Supplies for RH Service ,acilities

"he e@uipment and supplies to be provided in the recovery and reconstruction phase 1ere identified by the ,amily Health 0ureau of the 'inistry of Health and the list 1as closely assessed 1ith the technical support of the 67,P-=s Procurement and Support Services 8ffice in *openhagen prior to processing the order. "hese e@uipment and supplies 1ill be provided to the aforementioned health units being rehabilitatedFreconstructed under the 67,P- programme to ensure that the same health units are fully operational once completed. #n addition> a limited number of vehicles 1ill be supplied to promote out-reach services as 1ell as to increase capacities for supervision at the district level in order to improve the @uality of service delivery through regular monitoring and oversight.

!upport for Developing Capacities of +ealth 5or&ers in R+ !ervice Delivery - detailed RH assessment 1as conducted by 67,P- in collaboration 1ith the ,amily Health 0ureau of the 'inistry of Health and the local health authorities of the affected districts. "his assessment documents an analysis of the RH situation in the tsunami affected districts and identifies the availability of human resources> the coverage of RH services> the RH commodity security status> the needs for s!ills development and the availability and use of standard guidelines and protocols for RH care. "he assessment also covers the specific needs identified by the displaced communities as 1ell as those that pertain to the health providers themselves. "he assessment has highlighted some serious gaps in the provision of primary> secondary and tertiary health care services> 1hich need to be addressed to prevent maternal mortality and morbidity as 1ell as the spread of S"#s and H#2F-#.S. #t also identifies gaps in the availability of services that cater to the specific RH needs of adolescents and youth. "he assessment recommends concrete action to address the human resource constraints> including interim plans to bridge the capacity constraints such as support for 2oluntary Health Cor!ers and reestablishment of outreach services in areas 1here there are Public Health 'id1ife vacanciesI support for enhancing the s!ills of health 1or!ers currently deployed in the affected districtsI greater attention to @uality assurance and best practices for RH and enhanced supervision and support for monitoring and evaluation of the RH interventions. "here is also a need identified to prepare and adopt national protocols and guidelines for @uality RH service delivery> including in disaster and post-disaster situations and to properly e@uip the staff and health 1or!ers at the district levels> particularly in the 7orth and ;ast> to apply these standards and update their !no1ledge and s!ills. "he assessment has been an effective tool for mobili?ing support to revamp the RH services in the affected districts. *urrently> plans are under1ay at district level to put in place interim measures to address the human resource constraints and build capacities for better RH services. *oordination among the health partners 4bilateral> multilateral and 7(8s5 has improved through regular meetings> held at the central and districts levels 1ith the involvement of relevant local counterparts and sta!eholders. Key Challenges - major challenge in the reconstruction of damaged facilities has been the delay in the identification of alternate land for such constructions. "he government has yet to articulate a firm policy 1ith regard to the buffer ?one. "he ambiguity in relation to the reconstruction of buildings 28

in the 2++ metre and 1++ metre buffer ?one in the coastal belt has delayed the construction process in some areas. #n response to the lobbying and concerns of the affected communities related to the buffer ?one> the (overnment of Sri /an!a is currently re-e<amining this issue. "he start up challenges related to the construction component 1ere considerable. "he relevant national counterparts needed to conclude several formalities> such as ac@uisition of land> survey> transfer of o1nership to the 'inistry of Health> authori?ation of the 6rban .evelopment -uthority for construction 1or! prior to the commencement of 1or! related to the planning> designing> layout and 083 for the health facilities. "his process caused setbac!s and delayed the implementation of the construction 1or!. 0oth 67,P- and 678PS have maintained close dialogue 1ith the relevant national counterparts> at the highest levels> to ensure that any bottlenec!s are resolved efficiently and progress is not further hampered. Chile the '8H has ta!en the lead role in planning the recovery of the health sector> the consultation process 1ith the provincial and district authorities has often been inade@uate. "his has necessitated> at each stage of programme implementation> discussions at the district and provincial levels to ensure that the RH interventions are responsive to local needs and realities. 8verall> coordination mechanisms at the district level as 1ell as the lin!s bet1een the district and central authority in the recovery process needs to be enhanced. 8ne of the constraints has been the 1ea! capacities at the district level to play an effective coordination role given the large number of players in the health sector. 'oreover> the delegation and level of authority at the district level remains ambiguous. ;fforts are no1 under1ay by the 'inistry of Health to resolve these issues. "he political environment in the country remains volatile> 1ith the decline in the security situation in the ;astern Provinces> resulting in a slo1er pace of implementation than planned.

Financial #rogress
D')'% 'ulti-donor fund 4pooled5 *hina (ermany T'"a& A&&'ca"!')# 8USD9 >):+>++1 2++>+++ 2>+B2>&$B D12321EDF EA e)(!".%e# 8USD9 1>&B&>%11 2++>+++ 1> %&>&&2 313351183 ?a&a)ce 8USD9 2>1$2>:)+ + & %>))$ 218FE158D

29

#ro$ect ,* 6uilding #sychosocial 4ell being a"ong individuals and co""unities living in tsuna"i affected areas 4ith i"proved responsiveness for the prevention and "anage"ent of 2ender based 7iolence in !ri 3an&a
'any individuals and communities are e<pected to e<perience considerable psychosocial 1 difficulties as a result of the tsunami. Personal stressors include the loss of family members> friends> income> security and social status. Social stresses include disrupted community and social net1or!s> lac! of mobility> and lac! of access to goods and services previously available. People may also be distressed over e<pected changes to their lifestyles and livelihoods follo1ing the rebuilding and recovery process. -dditionally> children> 1omen and men in particularly challenging or vulnerable circumstances 1ill need special psychosocial interventions to support them during the process of rebuilding their lives. "he tsunami may have directly compounded many of the difficulties e<perienced by people living in conflict-affected areas. "he lac! of privacy in the 1elfare centres 1here large numbers of people share cramped living arrangements increases intra- or inter-family problems> community disruption> se<ual harassment> and violent behaviours. 8vercro1ding also brings 1ith it opportunities for se<ual abuse to occur. "his may happen as a result of brea!do1n of protective community structures> social net1or!s and orderly community spaces. #n situations of overcro1ding> the vulnerability of 1omen> girls and boys is increased and they can be inadvertently placed at ris! of both se<ual and physical violence. *onflict $isplaced -other and $aughter bet1een host and displaced communities is often prevalent> and if unchec!ed can prevent social integration and relationship amongst both communities. "hese and other problems may emerge also during the permanent resettlement period. "here is concern around the dangers of marginalisation> lac! of participation in the decisionma!ing and planning process> long-term stigmatisation and labelling> and increased potential for local-level conflicts. Comen and girls face specific and additional constraints in all these issues. "he tsunami is also e<pected to affect service providers 1ho are attempting to respond to and meet the needs of affected individuals and communities. -s these actors are often re@uired to 1or! long hours> deal 1ith diverse and evolving situations and the concerns of specific individuals and groups> they are li!ely to become fatigued and stressed. "his may negatively affect their o1n 1ellbeing and that of their families> and result in affected people receiving services of reduced @uality and empathy.
1

QPsychosocial= refers to the psychological and social responses of individuals and communities that enhance or reduce their overall 1ellbeing. "he dimensions of human capacity> social relations and net1or!> culture> and material status are used to understand the psychosocial responses of individuals and communities. -t the same time> it is recogni?ed that the broader political> economic> environmental and infrastructural milieu plays a significant role in enhancing and reducing psychosocial 1ellbeing 4Psychosocial Cor!ing (roup> 2++ 5 Psychosocial )ntervention in Comple* +mergency: # Conceptual Framewor", Cor!ing Paper. -vailable at 111.forcedmigration.orgFpsychosocialFPC(info.htm 8ctober 2++

30

"he immediate and medium term challenges is the rebuilding of social> economic and environmental systems and ensuring that gender e@uity is addressed as a priority concern. - !ey gender concern is the potential for increased violence and abuse that 1omen may confront. "he additional conse@uences caused by gender-based violence 1ill seriously affect the resilience and capacity of 1omen and girls to recover from the impacts of the tsunami. "his ac!no1ledges that issues of safety for 1omen and girls are intrinsically lin!ed to their psychosocial 1ell-being. Nonetheless, it is important to recognize that people do have considerable resilience and should not be seen primarily as passive helpless victims in the event of extremely distressing experiences such as the tsunami. It is believed that the majority of people will be able to cope with the disaster, if their lives are brought speedily to normalcy and their basic needs and self-sufficiency is guaranteed.

#ro$ect Fra"e4or& 4'a&: "o contribute to the enhanced 1ellbeing of couples and individuals living in the tsunami affected areas including safeguarding their reproductive health and rights. ;<pected 8utcome: "o strengthen utili?ation of services related to psychosocial needs and those addressing gender based violence in the tsunami-affected areas. ;<pected 8utput: #mproved community and state capacities to effectively respond to psychosocial needs and gender based violence concerns of individuals and communities living in the tsunami affected areas.

2ender Co"ponent
!trengthening the policy environ"ent for i"proved coordination and integration of gender concerns in the recovery and reconstruction efforts Set up the (ender .es! at the 7ational *ommittee on Comen 47*C5 67,P- has provided support to the 7ational *ommittee on Comen in establishing a (ender .es! through provision of staff> in order to help mainstream gender concerns in the tsunami emergency and recovery efforts and to ensure that 1omen=s needs are not marginali?ed. "he initial 1or! of the (ender .es! focused on addressing the increase in se<ual and gender based violence in the tsunami affected areas through raising a1areness at all levels. -s a result of this protection measures 1ere considerably improved in temporary shelters and 1elfare camps. Cith the transition from relief to recovery support> the (ender .es! is no1 in the process of putting mechanisms to promote 1omen=s participation in the post tsunami recovery phase into place> including the appointment of gender focal points in the .istrict .isaster 'anagement *ommittees. "he staff of the (ender .es! also undertoo! field visits to the affected districts to sensiti?e the (overnment -gents and other senior administrators in the .istrict Secretariats on the need to address gender concerns in the 31

tsunami recovery process. Since the national recovery efforts are being implemented through sectoral planning approaches> 1ith lead institutions often lac!ing gender sensitive programming perspectives> there is a clear need to strengthen the capacities of e<isting mechanisms such as the 7*C to play a more proactive role in mainstreaming gender concerns. ;stablished an information system for improved gender policy and planning responsiveness (iven the paucity of data on S(02 and the lac! of se< disaggregated data in general> there has been inade@uate attention and recognition given to the specific needs and vulnerabilities of 1omen and girls in the aftermath of the tsunami. 6nder the project> the capacities of 7*C 1ill also be developed to gather and analy?e data using the gender focal points at the districts> for improved gender responsiveness in policy and planning processes. "his is particularly relevant in the Sri /an!an conte<t> 1here the perception is generally that 1omen enjoy e@ual status 1ith men in most spheres of society and that S(02 occurs only in isolated cases. "he need for concrete data and evidence is critical to increase a1areness of the gaps and to effectively guide policy and planning responses in the recovery efforts. #nitial 1or! to establish an information system has already commenced at 7*C. -dditional support 1ill be provided 1ith the placement of an -ustralian 2olunteer> 1ith the relevant technical competencies> to accelerate this process. Supported the conduct of a (ender -udit of the tsunami response Cith the aim of enhancing the policy and planning environment for addressing the needs of 1omen and girls> a gender audit of the tsunami response is currently ongoing. "he e<traordinary level of support mobili?ed for the tsunami created high e<pectations among the affected population as 1ell as a recognition of the need to set up systems to trac! the flo1 of funds to the affected areas to ensure transparency and accountability in the utili?ation of resources. Since 1omen 1ere identified as one of the vulnerable groups during the emergency phase> it is appropriate to also e<amine the level of support that 1as directed to1ards addressing the needs of 1omen during the emergency phase and in planning the recovery response. - gender audit has been initiated to ascertain the gender dimension of the support provided during the relief and recovery phases. Some of the preliminary findings under the first phase of the assessment indicate a primarily gender neutral response during the emergency period especially in the distribution of supplies and management of temporary shelters and 1elfare camps. ,urthermore> the lac! of gender disaggregated data and information as 1ell as 1ea! mechanisms for gender mainstreaming has resulted in inade@uate attention being given to the needs of 1omen and girls in the recovery process.

stablish prevention and protection "easures8 and an i""ediate and effective response8 for 4o"en and girls at ris& of or 4ho have e'perienced !267 in the after"ath of the tsuna"i In the immediate aftermath of the tsunami, several womens organizations with grassroots networks reported an increase in SGBV. However, the lack of concrete evidence undermined these claims. UNFPA in collaboration with the NCW and the Coalition for Assisting Tsunami Affected Women, a newly created alliance of womens NGOs, organized an open media forum with the participation of grassroots women providing support in the camps. This forum offered these women an opportunity to share their experiences and first hand knowledge of the situation of

32

women in the tsunami affected areas and to recommend actions to safeguard the rights of women and girls. The open forum served to create awareness of the ground situation and strengthen commitment and actions to addressing SGBV including setting up protection measures in temporary shelters and welfare camps. #n order to develop the s!ills of front-line government and 7(8 1or!ers to effectively respond to the needs of 1omen=s and girls in relation to psychosocial 1ell-being> safety and access to services> a series of capacity building activities 1ere initiated. - critical mass of trainers 1ere trained in ,ebruary 2++:. "he participants 1ere dra1n from both government institutions and 7(8s in the tsunami affected districts. "echnical support to conduct the training 1or!shops 1as mobili?ed through the *entre for Refugee Research of the 6niversity of 7e1 South Cales> -ustralia. "he follo1ing table provides a profile of the trainers 1ho 1ere trained: E"+)!c!"3 Sinhala "amil 'uslim "otal 4'$". I)#"!"."!')# +& +1 +1 +) N4O# 1% +% + 1B T'"a& 21 +: +1 2&

,ollo1ing the training of trainers 4"o"5 programme> the 7*C through a consultative process and learning from the initial round of training developed a comprehensive training manual for the training of front line 1or!ers. *urrently> preparatory activities are under1ay to build the capacities of front line 1or!ers. "eams of trainers have been set up at the district level and trainees have been identified> giving priority to front line 1or!ers providing services to the displaced population in temporary shelters and 1elfare camps. #rovide support for the establish"ent of 4o"en9s centres and referral net4or&s in te"porary shelter and per"anent settle"ent sites: "he issue of safety for 1omen and girls is also lin!ed to their full participation in the recovery and rebuilding process. "he rationale for establishing 1omen=s centres at the community level is to provide 1omen 1ith a Nsafe spaceP that 1ill cater to their specific needs and allo1 support mechanisms to develop. "hese centres 1ill be located in areas 1here there are temporary shelters andFor plans for permanent settlements. "hey 1ill be managed by 1omen from the area under the supervision of local 7(8s. "hese 1omen 1ill be among the front line 1or!ers 1ho 1ill benefit from the training due to be conducted by the 7*C. "hree 1ell established 7(8s have been selected to oversee the management of these centres> namely 'uslim Comen=s Research and -ction ,orum> Comen in 7eed and Sarvodaya. "he follo1ing services 1ill be provided through these 1omen=s centres: Sensitisation of 1omen and girls on S(02 ris!s and safety measures. - safe haven for 1omen and girls subjected to S(02. Provision of information and counselling services. -ccess to specialised services through referral mechanisms 4for legal support> health care> vocational training and livelihood options5. Space for recreation and net1or!ing opportunities designed to empo1er 1omen. Sensitisation of men and boys on S(02 and increased male participation in safeguarding the 1elfare and 1ellbeing of their families and the community.

33

;<tensive discussions have been held 1ith the above mentioned 7(8 partners and the communities they are serving in the districts of 0atticaloa> -mparai> Hambantota and 'atara to select appropriate sites and agree on a basic concept and design for the 1omen=s centres. mapping of sites has already been underta!en and design finali?ed. Integrating health sector response to !267 Health care 1or!ers at the community level are often in the best position to recogni?e and address the needs of 1omen and adolescents related to S(02. Ho1ever> they need to develop the s!ills to respond to S(02 cases and 1or! in a supportive and enabling environment to be able to handle sensitive and potentially high ris! situations. 6nder the project> support 1ill be provided to integrate S(02 response into healthcare settings> based on the e<periences of a pilot project that 1as implemented in -nuradhapura 1ith 67,Psupport. "his 1ill entail sensiti?ing '8H officials as 1ell as training all categories of health care staff> including public health mid1ives and inspectors> using the manual developed through the pilot initiative N- Practical -pproach to (ender 0ased 2iolence: - Programme (uide for Healthcare Providers and 'anagersP. "o strengthen the utili?ation of such services> the referral mechanisms and support systems 1ill need to be enhanced through the net1or! of 1omen=s centres and 7(8 partners. - feasibility assessment 1as recently underta!en to revie1 ho1 best to upscale the pilot e<perience in the tsunami affected areas.

34

35

Key Challenges Some delays 1ere e<perienced in processing the approval of the project as it involved multiple partners and sta!eholders. (iven the lac! of national mechanisms available to address gender concerns> considerable ground 1or! had to be underta!en to start up the initiative> including sensiti?ing policy ma!ers and securing commitments at various levels to operationali?e the project. -t the initial phase> much of the assistance has also been channelled to1ards establishing net1or!s and building the necessary capacities to respond effectively. Chile the early investments 1ere minimal> the results in terms of setting up a sound foundation for the implementation of the project have been significant. #n order to accelerate the pace of implementation and enhance capacities of the implementing agencies> 67,P- provided both programme and technical staff support to the 7*C. #n addition> 67,P- has established a fully fledged project office to support the management and oversight of the project. Cith these inputs> it is anticipated that the absorptive capacities of partners> both state and 7(8s> to utili?e the funds efficiently 1ithin the given time frame 1ill be enhanced. Chilst this project aims to promote S(02 as a public health concern> it also see!s to develop a multi-sectoral response to S(02> 1hich is a formidable challenge. "his implies strengthening lin!ages 1ith other partners to ensure that appropriate support services are available for protection> legal counselling> livelihood and shelter> among other potential areas of support. - multi-sectoral response re@uires the cooperation of other partners and an effective coordination mechanism> 1hich 67,P- 1ill help facilitate. "he need for better coordination and strategic lin!ages bet1een various actors is also essential as the policy environment and support for S(02 interventions is less than conducive> as seen in the lac! of resources and redress mechanisms available at present. -dvocacy and sensiti?ation programmes 1ill be an integral part of the support provided to develop an enabling policy environment and efforts 1ill be made to forge strategic partnerships> both at #dolescent .irl in Temporary Shelter /ashing Coo"ing Pots the central and district levels.

#sycho-!ocial Co"ponent
Results Achieved "he immediate post-tsunami scenario sa1 an unprecedented proliferation of agencies and individuals from both 1ithin and outside Sri /an!a attempting to address the psychosocial needs of people affected by the tsunami. - large proportion of these psychosocial actors 1ere either ne1 to the psychosocial sector or ne1 to Sri /an!a. #n many of these cases> ne1 psychosocial service providers 1ere unfamiliar 1ith prevailing culturally acceptable psychosocial interventions in Sri /an!a and also to the Sri /an!an socio-historical-cultural conte<t. /ong-standing psychosocial 1or!ers in Sri /an!a describe being s1amped 1ith offers of capacity building and additional 36

human resources to direct intervention. "he first post-tsunami psychosocial coordination meeting held in *olombo by the *onsortium of Humanitarian -gencies sa1 a participation rate of over $+ agencies and individuals> of 1hom %& 1ere from ne1 organisations to Sri /an!a or to the psychosocial sector. "he large numbers of agencies and individuals 1ho undertoo! to provide psychosocial support in the immediate aftermath of the Sri /an!a inevitably meant that there 1as uneven understanding about 1hat constituted psychosocial interventions> and especially so in different parts of Sri /an!a. #n the urgency to provide psychosocial support> there 1as inade@uate space and time to reflect on 1hether the approaches and interventions being offered 1ere suitable to the Sri /an!an conte<t. #t 1as also unclear 1hether these 1ere> in general> helpful and effective in post-disaster situations as is revealed by the many references to Qtraumatised= populations even in the very first fe1 days after the tsunami> 1hen such a diagnosis 1ould have been clinically inaccurate. "his and many other incidents sho1 that there 1as no clear consensus amongst psychosocial actors on ho1 to understand and respond to the psychosocial distress caused by the tsunami and its conse@uences. "he state responded @uic!ly to the large numbers of incoming humanitarian aid and intervention> by setting up the *entre for 7ational 8perations> 1hich 1as to coordinate the national response to the tsunami. Ho1ever> there 1ere constraints 1ith regard to s!illed resources in the psychosocial sector 1ithin the state. "he main protagonists of mental health and 1ellbeing in the state are psychiatrists> amongst 1hom there 1ere differences of opinion about the best psychosocial practices and approach to psychosocial care in Sri /an!a. Prior to the tsunami> the state had mainly been involved in providing individually oriented clinical mental health services as treatment for mental disorders. "herefore> the state healthcare system 1as not 1ell e@uipped either technically or logistically to deal 1ith the promotion and protection of 1ellbeing in the event of mass postdisaster suffering and distress. -lthough the state and non-state sectors in Sri /an!a have 1or!ed together in some areas> the relationship 1as fairly 1ea! in the psychosocial sector. "here 1as a lac! of coordination and information sharing bet1een the state and non-state actors> especially at district level. Cithin this conte<t> the 67,P- has played an increasingly significant role in bringing together many of the psychosocial actors from 1ithin the state as 1ell as bet1een the state and non-state actors and in facilitating consensus amongst diverse actors. !upport for state response to psychosocial interventions in post-tsuna"i conte't #n the immediate aftermath of the tsunami> the 67,P- offered support to the .irectorate of 'ental Health Services in conducting the follo1ing activities and achieved the results described belo1. *ontributed significantly to the development of the 7ational Policy and Plan for Psychosocial and 'ental Health #nterventions

-s a member of the Psychosocial and 'ental Health *ommittee elected by the President of Sri /an!a> the 67,P- 1as a !ey contributor to both the 7ational Policy document and the 7ational Plan of -ction for Psychosocial and 'ental Health #nterventions. "he development of these documents re@uired the facilitation of many meetings 1here diverse e<pert opinions 1ere moulded into a coherent comprehensive frame1or!> signifying the role of different responsible authorities and actors for psychosocial and mental healthcare in Sri /an!a. 8nce prepared> though> these documents served as the cornerstone in directing national and non-governmental efforts for the provision of psychosocial and mental healthcare in the post-tsunami conte<t. "hey 1ere distributed 1idely and helped to streamline interventions into the frame1or! of the national policy and plan of action. 37

Set up the Psychosocial .es! at the *entre for 7ational 8perations to direct e<ternal assistance

"he 67,P- supported the setting up of the psychosocial des! at the *entre for 7ational 8perations> 1hich directed foreign assistance for psychosocial support. 7ational e<perts on psychosocial and mental healthcare operated the Psychosocial .es! until the completion of 1or! under the 7ational *entre for 8perations. -ll agencies and individuals 1ho sought to provide psychosocial and mental healthcare 1ere provided 1ith information of local organisations that may be able to support the initiatives or needed the support themselves. "he 7ational Policy and Plan of -ction substantiated the guidance on suitable and locally appropriate interventions provided by the Psychosocial .es! for foreign assistance. *oordinated meetings bet1een the .irectorate of 'ental Health Services and non-state actors

"he 67,P- 1as responsible for organising 2 half-day briefing meetings bet1een the state and non-state actors on planned state interventions and ho1 to lin! up to them. "he meetings clarified the state-appointed district-level authorities and service providers> enabling permits and referrals to operate much more smoothly. *onvenor for both 1or!ing groups on Psychosocial -ssessment 1ithin and outside of the state

0oth the state and non-state sectors set up 1or!ing groups on psychosocial assessments> although 1ith different purposes. "he state 1or!ing group on psychosocial impact assessment 1anted to revie1 the suitability of particular psycho-metric research instruments for assessing psychosocial 1ellbeing of tsunami affected communities. "he non-state 1or!ing group on psychosocial assessment 1as concerned 1ith the development of guidelines for good practice for those agencies interested in underta!ing assessment initiatives. "he 67,P- played a significant role in both groups and acted as the chair for both groups. "he guidelines for needs assessments 1ere distributed 1idely. - number of agencies shared the usefulness of these documents at different coordination meetings. *apacity building efforts 1ith the .irectorate of 'ental Health Services and other sta!eholders

Cith regard to capacity building efforts in the immediate aftermath of the tsunami and recently> the 67,P- has been active at different levels. - number of discussions 1ere held 1ith the staff of the .irectorate of 'ental Health Services and the *ollege of Psychiatrists to clarify the psychosocial approach to be adopted as 1ell as plan the interventions to be implemented. -s part of these efforts> the 67,P- supported the 'inistry of Health to: - conduct % psychosocial sessions for 11+ state administrators> healthcare and social service personnel from B districts to inform them on promoting psychosocial 1ellbeingI - distribute over 2++ copies of guidelines for healthcare 1or!ers on ho1 to develop and implement psychosocial responsesI - draft the curriculum outline and !ey points to guide training conducted by individual state healthcare service providers in the districtsI - conduct % meetings for + state health providers to direct> coordinate and document psychosocial interventions

38

!upport for psychosocial progra""ing in the UN syste" in post-tsuna"i !ri 3an&a "he 67,P- 1as appointed as the lead agency in the psychosocial sector for the 67 agencies in Sri /an!a as a result of its immediate recognition and flagging of the potential psychosocial dimensions in the aftermath of the tsunami. #n this capacity> the 67,P- has carried out the follo1ing activities and achieved these results: 4e)e%a"e( !)"e%:a/e)c3 c')#e)#.# ') "+e #3c+'#'c!a& a %'ac+ "' ,e "ake)

-s part of the agenda in the inter-agency group meetings> the different 67 agencies involved in the provision of psychosocial and mental healthcare shared their psychosocial approaches. ,urther discussion resulted in the adoption of a preferred approach to psychosocial programming in Sri /an!a by the 67 agencies. 0The two e*tremes o% the (psychosocial) approaches are (1) the models which pathologises the people2s reactions and attempts to cure or treat these as a mass intervention3 at one end and (4) the models which attempts to promote well eing using the strategies o% protection and recovery at the other end, /H53 )657)P+C3 )5-3 89)C+F and 89FP# agreed that the latter model was the pre%erred 89 approach and there%ore support would e given to those proposals supporting the latter approach,: (-inutes o% ;th -ay 89 Psychosocial Coordination -eeting) C''%(!)a"e( "+e !)"e%:a/e)c3 #3c+'#'c!a& %e# ')#e

-gencies dealing 1ith similar issues or 1ith the same partners 1ere encouraged to 1or! together. ,or e<ample> both 67#*;, and #/8-#P;* 1or! the .epartment of *hildcare and Probation> the 'inistry of ;ducation and the 7ational *hild Protection -uthority to implement their respective programmatic mandates> 1hilst the CH8 and #8' 1or! together 1ith the health services in the area of mental health. -t the coordination meetings> consensus 1as generated on the type of approach> agencies 1ere facilitated in revie1ing their reference material and encouraged to ensure coherent programming. -t the re@uest of 67#*;, and in the capacity of chair and lead agency> the 67,P- also facilitated a number of dialogue and consensus-generating meetings bet1een 67#*;, and the (erman "echnical *o-operation both of 1hom 1or! e<tensively 1ith the 'inistry of ;ducation> and specifically the 7ational #nstitute of ;ducation 1here most teacher training is designed and implemented. !upport for national and district-level coordination in post-tsuna"i conte't Cith its main interest in building long-term sustainable interventions both at the centre and the districts> the 67,P- has ta!en on various activities designed to meet the needs of the hourI namely> long-term focus> sustainable intervention> coordinated effort and district-level capacity building. "he follo1ing activities highlight some of the results achieved to1ards these outcomes. *o-developer of the 'apping of Psychosocial #nterventions in the "sunami-affected area together 1ith the Psychosocial Support Programme and the *onsortium of Humanitarian -gencies

"he 67,P- provided technical and logistical support in the development of a matri< Q'apping Psychosocial #nitiatives in "sunami-affected -reas= jointly 1ith the *onsortium of Humanitarian -gencies and the Psychosocial Support Program. "hese maps 1ere a comprehensive mapping that enabled ne1 and e<isting actors to identify organisations involved in activities 1ith similar 39

psychosocial objectives at divisional and district level. "hese maps 1ere shared at coordination meetings as 1ell as 1ere made available on the *H- 1ebsite for those 1ho are interested in obtaining such information. -s reports by various agencies reveal> these maps enabled them to pool resources> refer clients to agencies for re@uired services and identify the gaps in the field at divisional level 4smaller than a district5. #n this sense> young people> children 1ho had dropped out of school and men 1ere identified as neglected groups> re@uiring further support services to 1hat 1as already being provided in the field. "he issue of sustainable livelihoods for young people and 1omen 1ere sho1n to need further strengthening. Similarly> it 1as noted that almost all support for children comprised of play activities> and that it 1as important that other forms of support needed to be provided to children. Provision of logistical support to the *ommunity ;mpo1erment 7et1or! - "rincomalee

"he 67,P- provides ongoing logistical support to the *ommunity ;mpo1erment 7et1or! J "rincomalee 4*;7"5> a district coordinating body for psychosocial 1or! functioning under the office of the .eputy Provincial .irector for Health Services and chaired by .r (adampananthan> the psychiatrist assigned by the 'inistry of Health to the "rincomalee district. "he 67,P- support enables regular visits by .r (adampananthan and other resource persons to "rincomalee> 1here they conceptualise> coordinate and implement needs assessment and capacity building activities for local and international 7(8s in the area of psychosocial 1or!. "his ensures that emerging issues are highlighted and addressed> that there is @uality in the provision of care and support and that a community-based approach is favoured over a clinical one> thereby promoting and protecting the 1ellbeing of communities. 'ember of the Psychosocial ,orum *ommittee to develop consultatively a /ong-term Strategic Plan for Psychosocial #nterventions in Sri /an!a in the post-tsunami and conflict conte<t

"he 67,P- is also actively involved in the development and implementation of a consultative process for a long-term strategic plan for psychosocial interventions in Sri /an!a in the posttsunami and conflict conte<t. "his involves bringing together relevant actors from the state and non-state sectors in a 1or!shop to discuss the promotion and protection and psychosocial 1ellbeing> and develop a joint action plan. "he main objective of the strategic plan is to have a shared long-term vision for psychosocial 1ellbeing in Sri /an!a and a set of common principles 1ithin 1hich agencies function. "his 1ill avoid duplication and inconsistency in the overall psychosocial response> and 1ill ensure a more effective and coordinated effort from the state and non-state actors in the psychosocial field. "he 67,P-=s initial and enduring analysis of the psychosocial sector emphasised the lac! of ade@uate capacities of persons carrying authority at the central and at the district levels on psychosocial 1ellbeing promotion and protection. "his 1as identified as a significant issue that could impair the sustainability and efficacy of interventions. "herefore> efforts focused on building capacities of policy- and decision-ma!ers at central and district level as the first step. -s part of this e<ercise> it is important to build consensus of approach> a shared vision and acceptance of diversity of roles in psychosocial and mental healthcare. "he lo1 e<penditure rate in the first si< months= reflects 67,P-=s commitment to sustainable processes. "he ground1or! is no1 ready to begin in earnest the 1or! of building capacities of service providers to provide direct services to people affected by the tsunami.

40

Key Challenges One of the main implementing partners, the Ministry of Health required significant time and support to come to a consensus on the approach to promoting psychosocial wellbeing from a community perspective as this was a significantly new area to the health sector. Human resources in this area of work are extremely scarce. Additionally, they employ significantly varying approaches. This meant that the UNFPA had to delay the implementation of the main bulk of its work until consensus was reached. In addition, new actors continue to enter the sector in Sri Lanka although in not so high numbers as before. This also poses additional problems as these actors also have to become familiar with the predominant psychosocial approaches and the existing socio-cultural context. Additionally, the non-academic staffs of all Universities is on strike, thereby causing some delay to the second part of the psychosocial component, which involves the development of appropriate psychosocial impact assessment methodologies. This has also delayed the subcontracting of the University to some extent. .isplaced -dolescent 0oys

Financial #rogress .onor 'ulti-donor fund 4pooled5 7etherlands 4Psycho Social5 (ermany 4(ender5 "otal -llocation 46S.5 & >+++ )2$>)): $ +>) : 1>) +>) + ;<penditures 46S.5 1$>&12 B+>:B1 &2>2&2 1$)>:$: 0alance 46S.5 :$>2BB B%$>%1% ::B>$$ 1>&$1> $:

41

42

.A3DI7 !
"he tsunami affected all the people of the 'aldives to some degree and severely affected one-third of the total population of 2)+>+++. #t rendered some islands uninhabitable and initially displaced 2)>:&& people. "here 1ere some %>+++ pregnant 1omen in .ecember 2++: and it 1as estimated that 1>:++ of those 1omen 1ere amongst the displaced. "oday 11>:$B people remain in temporary shelters> 1ith host families andFor 1ith relatives. -ppro<imately $>$:+ are displaced on their o1n islands> 1ith %>)1B hosted on other islands. Support is being provided for #.Ps registered on 1: different atolls> including food> shelter and health care. "he tsunami destroyed boats> harbours> jetties and transportationFcommunication infrastructure> tools and e@uipment used for production. "ourist resorts> 1here many 'aldivians 1ere employed> 1ere also severely damaged. "he tsunami 1ashed a1ay fertile topsoil> depositing salt and sand in its place> and generated a massive amount of debris. (round1ater a@uifers> already contaminated from inade@uate se1age disposal 1ere further polluted and inundated 1ith salt 1ater. "he Corld 0an!> -sian .evelopment 0an! and 67 estimate the total damages at 6SA %&+ million or $2 percent of (.P. (ro1th projections for 2++: have dramatically reduced from $.: to just 1.+E. Physical $estruction in )slands

UNF#A Response to the (suna"i "he follo1ing !itsH 1ere distributed by 67,Pfollo1ing the tsunami: o 2+ *linical .elivery -ssistance 9its to 2+ health centers across 1: atolls o 1 0lood "ransfusion 9its to 1 health facilities across 11 atolls o 2acuum ;<traction .elivery 9its to 'ale= Hospital and the 'inistry of Health o $ *ondom 9its to $ health facilities across : atolls o $ #ndividual .elivery 9its to $ health facilities across % atolls o 1 'anagement of 'iscarriages and *omplications 4''*5 of -bortion 9its to 1 regional and atoll hospitals o $ ;@uipment for 0irth -ttendants 9its to $ health facilities across : atolls o $ 8ral and #njectable *ontraception 9its to $ health facilities across : atolls o $ "reatment of S"# 9its to atoll and regional hospitals o 12B1 sanitary nap!in cases to %: health facilities across 1 atolls and in 'ale= o $++ mother and baby !its to % health facilities across 11 atolls and in 'ale=

43

:++ hygiene !its to 'ale= #.Ps

H;ach *lean .elivery 9it> S"# 9it> contraception and condom !it serves a population of 1+>+++ for
months. *linical delivery !its> ''* !its and vacuum e<traction !its serve a population of +>+++ for months. 0lood transfusion !its serve a population of 1:+>+++ persons for months.

:+>+++ leaflets on reproductive health 4RH5 and family planning 4,P5 1ere re-printed and distributed via the .epartment of Public Health. :++ copies of guidelines on breastfeeding> pregnancy> elderly care and managing #.Ps 1ere distributed to all affected health facilities. "he services of volunteer gynecologists and mid1ives 1ere provided in 'eemu and (aaf .haalu atolls. )+ enumerators 1ere trained to conduct psychosocial and RH modules of the "sunami #mpact -ssessment. Psychosocial ,irst -id 4P,-5 1as provided to 1+%$ people in (aaf -lifu -toll> B%% in .haalu -toll> 2& in 'eemu -toll> %%2 and in "haa -toll through 67,P- support. ;motional Support 0rigade 4;S05 teams 1ere formulated in all the tsunami affected islands. "he teams comprised 1$: people in .haalu -toll> : people in 'eemu -toll> 2) people in "haa -toll> 11: people in /aamu -toll. &B community health 1or!ers 4*HCs5> family health 1or!ers 4,HCs5 and nurses have been sensiti?ed on mental health> psychosocial issues> reproductive health> substance abuse and protection issues in 'eemu> ,aafu> .haalu> /aamu> "haa> 7oonu> and Raa -tolls.

67,P- 'other and 0aby 9its

67,P- RH 9its

#ro$ect ) - Restoration of Co"prehensive ;uality Reproductive +ealth !ervices and Rights a"ong #opulations Affected by the (suna"i <.D7(R,=)>:
,ollo1ing the devastating impact of the "sunami .isaster on the 2$ th .ecember 2++%> 67,P- together 1ith the 'inistry of Health formulated the project Restoration o% Comprehensive <uality Reproductive Health Services and Rights among Populations #%%ected y the Tsunami (-$'TR4=1) under the "sunami ,lash -ppeal. "he project 1as formulated 1ith technical assistance of 67,P- in close consultation 1ith the sta!eholders. "he project 1ill be e<ecuted by 67,P-. "he 'inistry of Health 1ill be the main implementing partner. 67,P- 1ill liaise 1ith national 7(8s 1or!ing in the field of Reproductive Health. "he duration of the project is 12 months. Key Ob$ectives and Intended Outco"es

44

"he objective is promotion and protection of reproductive and psychosocial health and rights among persons affected by the "sunami in the 'aldives. "he e<pected outcome is increased utilisation of comprehensive> @uality RH services> commodities and information. "he main outputs of the project are to rehabilitate the health facilities affected by the .ecember 2++% "sunami focusing on: 1. #mproving availability and accessibility to @uality safe motherhood 4including ne1born5 services> family planning services and services for prevention and management of R"#sFS"#s and H#2 through provision of e@uipment> staffing and strengthening of mobile services in selected atolls. 2. ;nhancing capacity of the health 1or!ers to deliver @uality reproductive health and psychosocial support services to the affected population through training and development of guidelines. . Reducing vulnerability to reproductive $isplaced -other and Child health problems among the affected population through sensiti?ing and a1areness raising. %. Strengthening national capacity for preparedness to address reproductive health> and psychosocial concerns in natural disaster situations. 67,P- intends achieving the above outputs through follo1ing strategies: Restoration of RH services that are of high @uality in the tsunami affected islands through renovationFrefurbishment and replacementFprovision of essential medical e@uipment to rapidly initiate emergency obstetric care services in facilities 1ith minimal damageI 6pgrading capacities of affected facilities in the islandsI Strengthening referral services> including referrals to the #ndhira (handi 'emorial Hospital 4#('H5. 8rgani?ing short term refresher training of selected ,amily Health Cor!ers 4,HC5> *ommunity Health Cor!ers 4*HC5> 7urse -ssistants> Staff 7urses and 'edical 8fficers in provision of @uality reproductive health and psychosocial support servicesI Providing mid1ifery training and upgrading s!ills of Staff 7urses and 7urse -ssistants in provision of selected basic emergency obstetric care. -1areness generation on reproductive health issues through focus group discussions> group meetings> and posters on select topics that 1ill be developed and displayed in health facilities and campsites. 67,P- is collaborating 1ith the Society for Health ;ducation 4SH;5> an 7(8 that has the capacity to provide reproductive health support to 1omen 1ith chec!-ups and family planning counselling. #dentification and referral of people 1ith psychosocial support needs to the counsellors trained under the psychosocial project> and creation of an enabling environment for 1omen and adolescent girls to access private facilities for bathing 4by lin!ing 1ith agencies providing support for shelter5. Special efforts are being made to mobilise the community and build partnerships 1ith agencies providing shelter to ensure privacy and protection for 1omen and girls. Specifically for adolescent girls> a system of referral to health facilities for iron and folic acid and for menstrual problems is being developed. .eveloping training materials and a plan for logistics management is being developed.

45

"he activities 1ill remain focussed on the five most impacted atolls namely: Raa> 'eemu> "haa> .haalu and /aamu -tolls.

Results achieved -ssessments have been conducted> together 1ith the 'anagement of the #nternally .isplacement People=s 6nit> to determine the needs of the displaced and host populations in relation to the reproductive health care including psychosocial support. 67,P- provided reproductive health !its as immediate relief> 1hich included safe delivery e@uipment> management of miscarriage !its> and prevention of S"# !its as 1ell as contraceptive commodities. Services of volunteer gynaecologists and mid1ives 1ere provided at 'eemu 'uli Regional -toll and in "hinadhoo Regional Hospital. -nother 672 gynaecologist has recently been placed at 'uli Regional Hospital and 1ith 67,P- support many of the services have no1 resumed at this hospital. "he gynaecologists and mid1ives have provided mobileFoutreach antenatal> postnatal care as 1ell as reproductive health and family planning services. Cor! on strengthening the outreach services is ongoing. 67,P- 2olunteer (ynaecologist "he procurement of e@uipment for re-e@uipping the tsunami-affected health facilities under phase one has been initiated. Specification details and an operationalisation plan are being developed for t1o ambulance boats to be procured under the project. (uidelines on pregnancy> breastfeeding> elderly care and the management of displaced people have been developed and 1idely distributed. - national 1or!shop on Reducing 'aternal and 7eonatal 'ortality has been conducted for medical officers in connection 1ith the Corld Health .ay at the #('H. Participants from throughout the country attended this 1or!shop. "he 672 RH trainer has recently arrived in 'ale= and is based at the ,aculty of Health Sciences. She 1ill develop and support the implementation of a one year training plan for all the capacity building initiatives under the project. "he 672 trainer 1ill also revie1 and strengthen the RH content of the ,HS curriculum for training of health service providers. 8rientation of health service providers on RH has been conducted on tsunami affected islands in 'eemu> .haalu> Raa> ,aafu> "haa> 7oonu and /aamu in collaboration 1ith the 'inistry of Health and CH8. ,ollo1ing a number of discussions 1ith the #ndira (andhi 'edical Hospital 4#('H5> the 'inistry of (ender> ,amily .evelopment and Social Security and the 'inistry of Health> gender-based violence 4(025 gynaecologist focal points have been identified and a comprehensive 1or!-plan for the (02 pilot in #('H has been developed. Recruitment of staff for the pilot and initiation of activities is under1ay. 46

- t1o-day briefing and sensiti?ing 1or!shop on #.P issues has been conducted for senior level government staff> media> 7(8=s and donor agencies. 67,P- also conducted an interactive session on RH during the training programme for people 1or!ing 1ith the #.Ps organised by 8ffice for the *oordination of Humanitarian -ffairs 48*H-5 in Raa atoll. 67,P- 1ill also be liaising 1ith 8*H- in training of trainers> 1ho 1ill impart RH information to #.P committees currently being set up at atoll and island levels. - module on reproductive health issues has been developed for inclusion in the "sunami #mpact -ssessment 42ulnerability and Poverty -ssessment ###5 to be carried out by the government. "he training of enumerators has been completed and data collection began on 1+ th Duly and is due to be completed by mid -ugust 2++:.

Key Challenges 8ne challenging factor is the magnitude of the tsunami impact and the 1ea! capacities amongst counterparts to respond to the needs that have arisen. "here is also a continuous need to advocate for reproductive health to ensure that the level of national commitment and o1nership of the programme is maintained and that the momentum of support is not diminished. "his re@uires the active participation of the sta!eholders in all stages of programme delivery> regular revie1 of progress and challenges and fle<ibility to ma!e adjustments that secure the relevance of interventions in relation to national priorities. .elays in obtaining official clearances and signatures on the project document and difficulties in mobili?ing international e<perts to bridge the capacity constraints have contributed to slo1ing do1n the implementation of the project. #t is li!ely that the project duration 1ill need to be e<tended to early ne<t year. Financial #rogress "he total budget of the project is 6SA 1.) million. "he main donors are 8*H-> Dapan> 7e1 Gealand and other private sources. .onors Pooled ,und 8*H"otal -llocation ;<penditure at 0alance end Dune +: 2 %$+>+++.++ $&> .++ )2>$$&.++ 1>%%+>+++.++ +.++ 1>%%+>+++.++ 1>)++>+++.++ $&> .++ 1>B 2>$$&.++

#ro$ect , - UNF#A Response to the #sychosocial I"pact of the (suna"i Disaster in the .aldives <.D7(R0=)>
,ollo1ing the devastating impact of the "sunami .isaster on the 2$ th of .ecember 2++%> the project on 89FP# Response to the Psychosocial )mpact o% the Tsunami $isaster in the -aldives (-$'TR>=1) 1as formulated under the "sunami ,lash -ppeal. "he project 1as developed by 67,P- 1ith technical inputs from #nternational *entre for 'igration and Health 4#*'H5> and in close consultation 1ith the 7ational .isaster 'anagement *entre and 'inistry of Health. "he project 1ill be e<ecuted by 67,P- and the
2

;<penditure includes pre-encumbered and encumbered figures.

47

'inistry of (ender> ,amily .evelopment and Social Security in close partnership 1ith the 6nit for the 'anagement of the #nternally .isplaced Population.

Key Ob$ectives and Intended Outco"es "he project objective is to promote and protect the psychosocial 1ell being of people affected by the "sunami in the 'aldives. "he e<pected outcome is to contribute to1ards increased utili?ation of appropriate and effective services for better health and 1ellbeing of people affected by the tsunami. "he project aims to focus on the follo1ing outputs on the most impacted five atolls namely: Raa> 'eemu> "haa> .haalu and /aamu -tolls. 1. -ssess the psychosocial 1ellbeing of the affected populations by conducting @uantitative and @ualitative studies on the post disaster responses> needs and problems of the affected communities. 2. Strengthen the capacity of the health and social services staff to respond in an ade@uate and timely manner to the psychosocial needs of the community giving special consideration to the different groups in the community. 3. Place trained staff in the affected communities to enhance the sustainability of the national and community level capacities to respond to the psychosocial 1ellbeing of its people. 4. 0rief and sensiti?e community leaders and decision-ma!ers on psychosocial support needs of the #.Ps. 5. Support a process for the development of an appropriate and relevant policy frame1or! for the provision of psychosocial and mental health care to the affected population. "he !ey strategies for achieving the above outputs are: 'odules on psychosocial and reproductive health> including (02> have been included in a larger nation1ide 2ulnerability and Poverty -ssessment planned for Duly 2++:I *onducting @ualitative studies 4using participatory techni@ues5 of vulnerable groups to determine special needs and 1ays of responding to them and developing integrated monitoring and evaluation tools for a community-based surveillance system that 1ill generate on-going collection of !ey information on evolving psychosocial issues and impacts of psychosocial interventionsI .evelopment of curriculum and trainings of national resource persons> counselors> community health 1or!ers> nurses and general practitioners and their placement at island and atoll levelsI Recruitment of community educators in consultation 1ith the 'inistry of Health> .epartment of Public Health and the '#.P 6nit of the 'inistry of (ender> ,amily .evelopment and Social Security and the 'inistry of -tollsI Setting up evaluation mechanisms for assessing the 1or! and impact of community educators and other health and social services staffI 8rgani?ation of 1or!shops 1ith policyma!ers and atolls administrators to advocate a better understanding of the nature of the psychosocial problem> emerging needs and roles and responsibilities of atoll administrative staff> atoll health and social services staffI and

48

.esigning a mechanism through 1hich the displaced individuals and representatives of the displaced group and host communities> atoll administrators and health and social services staff can communicate their needs to the concerned authorities. "he duration of the project is 12 months.

Results achieved 67,P- formed ;motional Support 0rigade teams that made field trips to provide Psychological ,irst -id during the early days follo1ing the disaster. ,ocus group discussions and individual discussions have been held 1ith the affected community members on an ongoing basis. - @uantitative assessment tool on psychosocial issues has been developed and included in the 7ational "sunami #mpact -ssessment Study 42ulnerability and Poverty -ssessment ###5. "he training of enumerators has been completed and data collection 1ill begin on 1+th Duly and is due to finish in mid--ugust.

-dolescent (irls in an #.P Shelter

Health care providers have been briefed and sensiti?ed on the early identification and management of psychosocial issues through trainings conducted by 67,P- at #('H> 'ale= and 'eemu> .haalu> Raa> ,aafu> "haa and /aamu atolls in collaboration 1ith CH8 and the 'inistry of Health. ,urther training 1or!shops are being planned for the future. ,ive *ommunity ;ducators to be placed in the atolls by early -ugust have been recruited and are currently undergoing training. 8ngoing support and supervisions 1ill also be provided. - t1o-day briefing and sensiti?ing 1or!shop on #.P issues 1as conducted for senior level government staff> media> 7(8=s and .onor agencies. 67,P- also carried out an interactive sessions on psychosocial 1ellbeing and (02 during the training programme for people 1or!ing 1ith the #.Ps organised by 8*H- at Raa atoll. -t the 'ental Health ,orum> $-) Dune> organi?ed by the 'inistry of Health> 67,P- presented results of the gender-based violence and psychosocial support activities and research 1or! underta!en recently. #n particular> 67,Phighlighted the need for greater attention to psychosocial support and mental health care in the 'aldives> and the provision of support services such as counselling for the protection of 1omen and children> particularly in light of increased needs stemming from the tsunami.
Focus .roup $iscussions with $isplaced /omen

49

Key Challenges 8ne challenging factor is the magnitude of the tsunami impact and the 1ea! capacities amongst counterparts to address all the needs> under each sector> at once. Psychosocial support and mental health interventions has been 1ea! in the past and lac! of national capacities has hindered progress. .elays in obtaining official clearances and signatures on the project document and difficulties in mobili?ing technical support in this area have hindered progress. #t is e<pected that the project activities 1ill be implemented through to end of Dune 2++$. Financial #rogress "he total budget of the project is 6SA 2:+>+++. ,unding 1as secured from Dapan> *hina and 8*H-. .onors Pooled ,und *hina 8*H"otal -llocation 46SA5 ;<penditure 0alance 1++>+++ 2 > )$.++ &$>$+%.++ 1++>+++ 22>)2$.++ &&>+&%.++ :+>+++ +.++ :+>+++.++ 2:+>+++ %$> 2.++ 2+ >$&B.++

50

(+AI3AND
8n a clear morning of 2$ .ecember 2++% the une<pected tsunami hit Southern "hailand 1here hundreds of thousands of people have been affected. 8ver :+ fishing villages along the -ndaman coast of "hailand 1ere seriously affected. 7early 1+>+++ fishing boats 1ere destroyed and over +>+++ households that depend on fisheries have lost their means of livelihood. "his included also the foreign migrant 1or!ers and their families mostly from 'yanmar. -bout 12+>+++ people have lost jobs in the tourism sector. "he natural environment also suffered 1ith several marine and coastal national par!s severely damaged> coral reefs destroyed by debris> and agricultural land affected by salt 1ater intrusion. -t the end of 'arch 2++%> the "hai 'inistry of #nterior reported fatalities and casualties resulting from the 2$ .ecember tsunami as follo1s: :>%1 dead 41>):& "hais> 1>): foreigners and 1>:+ unidentified5 and 2>) 2 missing 42>+2 "hais and )+) foreigners5 Since the tsunami disaster hit "hailand on 2$ .ecember 2++%> the 67,P- *8 has received a total amount of 6SA)++>+++ 46SA:++>+++ from 67,P- Head@uarters and 6SA%++>+++ from 8*H- and 67R*FH*

!u""ary of Overall UNF#A Response and Key Results

"ergency #hase* A:+>+++ 1as contributed in late .ecember 2++% to the 67 ;mergency Relief ,unds 0an! -ccount at the 'inistry of ,oreign -ffairs. .etails on ho1 the funds 1ere used 1ill be available soon from the "hailand #nternational .evelopment *ooperation -gency 4"#*-5. A&>:++ 1as used to purchase safe drin!ing 1ater for the affected communities in 9raper .istrict> Ranong Province and 9uraburi .istrict in Phang-nga Province. A1 >%2+ 1as used for survival !its including food> rice> mil!> sanitary nap!ins> vitaminsFminerals for pregnant 1omen in the affected areas. A$> B+ 1as used in conducting 7eed -ssessment and ,ollo1-up 'issions by 67,P- e<perts together 1ith representatives from the .epartment of Health> #PSR of 'ahidol 6niversity> Corld 2ision ,oundation of "hailand 4C2,"5.

>'#" E*e%/e)c3 >+a#e2 "1o tsunami projects 1ere approved follo1ing the recommendations from the 7eed -ssessment 'ission conducted in Danuary 2++:.

#ro$ect )* Reproductive +ealth Care !ervices in (suna"i Affected Areas in (hailand

Project duration: 'arch 2++:-.ecember 2++$I "otal budget: A%:+>+++I Source of funds: 67,P-I "arget group: "hai communities in Ranong> Phang-nga> Phu!et and 9rabi Provinces. >%'Gec" S.**a%3: "his project proposes to address t1o of the most urgent and needy areas recommended by the 7eed -ssessment 'ission namely: 415 improved access to RH information> counseling services for 1omen> men> adolescents and older persons in the ne1ly developed communitiesI and 425 capacity development of health service providers and community volunteer groups. #t 1ill cover: provision of basic needs and sanitationI emergency obstetric careI involvement of communityFyouth health volunteers including 1omen and girls>

51

trauma related counseling> through e<isting or ne1 one-stop health service centres and mobile clinicsI behavioural changeI development of community health plansI outreach servicesI net1or!ing 1ith local sta!eholdersI and sharing of e<periences. Ac"!$!"!e#: - Rapid -ssessment Research 1as conducted by the *ollege of Public Health> *hulalong!orn 6niversity in the "hai communities affected by the tsunami. - preliminary report has been submitted to 67,P-. - 0aseline survey 1ill be completed in September 2++:. @!)a)c!a& >%'/%e## .onors 67,P-F8*H"otal -llocation 46S.5 %:+>+++ %:+>+++ ;<penditure 46S.5 11+>1%% 11+>1%% 0alance 46S.5 )>B:$ )>B:$

#ro$ect ,* 'panding Reproductive +ealth Care !ervices to (suna"i Affected Areas

'arch J .ecember 2++:I "arget group: foreign migrant 1or!ers. *overage: selected communities in Phang-nga and Ranong Provinces. >%'Gec" S.**a%3: "his project targets one of the most vulnerable population groups affected> namely the migrant 1or!ers and their families from 'yanmar. -bout 1+>+++ migrant 1or!ers and their families and )>+++ local population 1ill have access to general and RH care services through the e<isting service delivery points and the 67,P--funded mobile clinics for the hard to reach clients. Ac"!$!"!e#: ,unds have been used on purchasing a mobile clinic> medical e@uipment for the mobile clinic> and personnel cost including baseline survey done by #PSR of 'ahidol 6niversity. "he findings 1ill serve as inputs to develop interventions on the target beneficiaries in improving access to RH services including H#2F-#.S prevention> psychosocial care and counseling services. @!)a)c!a& >%'/%e## .onors 67,P-F8*H"otal -llocation 46S.5 %:+>+++ %:+>+++ ;<penditure 46S.5 1:&>:$& 1:&>:$& 0alance 46S.5 2)2>%& 2)2>%&

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