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					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 ............... 13
    Project 3: Provision of personal hygiene packs to Tsunami-affected populations in Indonesia ... 16
    Project 4: Prevention of gender-based violence in the emergency and reconstruction phases ..... 17
    Mainstreaming Gender ................................................................................................................. 19
    General Constraints ...................................................................................................................... 20
    Factors that facilitated effective aid delivery ................................................................................ 21
    Conclusion .................................................................................................................................... 21

SRI LANKA ................................................................................................................................................... 22
    Project 1: Restoration of RH Services in the Tsunami Affected Districts of Sri Lanka ............... 22
    Project 2: Building Psychosocial well being among individuals and communities living in
    tsunami affected areas with improved responsiveness for the prevention and management of
    Gender based Violence in Sri Lanka ............................................................................................ 30
    Gender Component ....................................................................................................................... 31
    Psycho-Social Component ............................................................................................................ 36

MALDIVES .................................................................................................................................................... 43
    Project 1 - Restoration of Comprehensive Quality Reproductive Health Services and Rights
    among Populations Affected by the Tsunami (MDVTR201). ...................................................... 44
    Project 2 - UNFPA Response to the Psychosocial Impact of the Tsunami Disaster in the
    Maldives (MDVTR301) ............................................................................................................... 47

THAILAND .................................................................................................................................................... 51
    Summary of Overall UNFPA Response and Key Results ............................................................ 51
    Project 1: Reproductive Health Care Services in Tsunami Affected Areas in Thailand .............. 51
    Project 2: Expanding Reproductive Health Care Services to Tsunami Affected Areas ............... 52
EXECUTIVE SUMMARY
This report marks the mid-year update on UNFPA‘s activities following the massive devastation
caused by the Indian Ocean Tsunami on December 26th 2004. Thanks to the outpouring of
generous donor support, UNFPA has been part of the initial relief and recovery process and is now
focused on the reconstruction phase, together with its wide network of partners, sister UN
agencies, NGOs and community based youth, women and religious organizations.
In the post Tsunami response, UNFPA‘s priorities have focused on:
   Moving rapidly to protect maternal health in a region where more than 150,000 women were
    pregnant and maternal health infrastructure and services had been completely devastated.
    UNFPA has provided large quantities of medical equipment and supplies for the
    reestablishment of comprehensive maternal services, including basic and emergency obstetric
    care exceeding $1million. This includes, inter alia, safe delivery kits, midwifery kits,
    management of miscarriage kits, blood transfusion kits, prevention of RTI kits and
    contraceptives. In Indonesia, using UNFPA RH kits, 326 deliveries were recorded among IDPs
    at the four most affected districts as of March 2005. These included 47 high-risk pregnancies
    that were properly treated (33 women underwent caesarean sections, and 14 babies were born
    with the aid of vacuum extraction). In the Maldives, 600 mother-baby kits have also been
    distributed to 34 health facilities across 11 atolls. In Indonesia, ambulances have been supplied
    to 8 priority referral health centers. In addition, UNFPA is supporting treatment and
    counseling, strengthening of outreach services and trainings to improve the sensitivity of
    healthcare workers‘ response during the crisis. Where maternal healthcare infrastructure has
    been damaged, it is being restored or reconstructed. In Indonesia, UNFPA is supporting the
    Provincial and District Health Offices in the reestablishment of damaged health centers. In Sri
    Lanka, 20 healthcare facilities, including two maternity and neo-natal complexes are being
    fully reconstructed in 9 affected districts.

   Addressing specific needs and vulnerabilities of women: ensuring the safety and security of
    women and girls, and preventing gender-based violence. UNFPA is working with national and
    local governments and community-based organizations to minimize and treat cases of sexual
    violence by supporting safe shelters for women, monitoring the distribution of relief supplies to
    prevent exploitation, training community educators, and promoting personal security, including
    special facilities in temporary refuge shelters for unaccompanied women and children. In
    Indonesia, women are being provided safe access to basic services and mass media channels
    have been used to provide information on prevention of gender- based violence (GBV) in the
    temporary settlements. In Sri Lanka, a Gender Desk has been set up at the National Committee
    on Women (NCW) that addresses the issues of GBV in the Tsunami affected areas through
    raising awareness at all levels. As a result, protection measures have been considerably
    improved at the shelters and welfare camps.

   Safeguarding the hygiene and dignity of women and girls through distribution of hundreds of
    thousands of hygiene packs. These packs typically contain items like soap, toothbrush,
    toothpaste, detergent, disinfectant, sanitary napkins, underwear, towels, prayer mat and
    culturally appropriate clothing. In Indonesia alone, over 233,000 hygiene kits have been
    already distributed and tens of thousands are being assembled. In Sri Lanka and the Maldives
    over 55,000 have been distributed.

   Helping governments and communities meet the massive need for psychosocial support, to
    help people cope with the debilitating trauma and loss, and rebuild lives. In Aceh, four
    community support centres have been established. These centers, provide not only counseling

                                                                                                   3
    and outreach program with focus on traumatized women but also training in new skills to help
    women and young people rebuild their lives. Several more are in the pipeline. In Sri Lanka,
    UNFPA has contributed significantly to the development of the National Policy and Plan for
    psychosocial and mental health interventions and set up a Psychosocial Desk at the Centre for
    National Operations to direct external assistance. In the Maldives, emotional support brigade
    teams were formed in all tsunami affected islands to cater psychosocial first aid.

   UNFPA is promoting the participation of women in aid distribution and decision making in the
    rehabilitation and planning processes. In the case of Sri Lanka, UNFPA has supported the
    conduct of a gender audit, and established an information system for improved gender policy
    and planning responsiveness. The Gender Desk at the NCW in Sri Lanka with UNFPA support
    has appointed gender focal at the District Disaster Management Committees to ensure
    women‘s participation in the post- tsunami recover phase. In Indonesia, UNFPA has organized
    in conjunction with the National Development Planning Board (BAPPENAS), the French
    Government, and the Ministry of Women‘s Empowerment, a gender mainstreaming training
    for 500 sub-district authorities in Aceh to ensure full participation of communities in the
    development of the district plans.

   In Indonesia, UNFPA is currently supporting the Central Bureau for Statistics (BPS) to conduct
    a census on post-tsunami Aceh to get accurate demographic data. The much-needed census
    data will contribute towards the longer term rehabilitation and reconstruction of Aceh. The data
    will be available and disseminated in November 2005.

   UNFPA has from the beginning been committed to actively supporting a high level of donor
    coordination throughout both the planning and implementation stages. UNFPA joined the
    common OCHA led flash appeal and has throughout its work been fully engaged in the
    activities of the UN Country Teams (UNCT) and at Headquarters level is actively partaking in
    the IASC-UNDG task force for the tsunami. UNFPA is part of the Price Waterhouse Coopers
    sponsored joint financial tracking system and plans to participate in the joint programme
    evaluation led by the Evaluation and Studies Unit of OCHA.

Key Challenges
Although much has been achieved, the humanitarian needs and challenges are still enormous and
many complex issues (issues relating to equity, land tenure, sustainable livelihoods, planning, inter-
sectoral and district level coordination etc) still need to be resolved. Most governments have set up
institutional mechanisms with mandates for inter-sectoral coordination and are now focusing more
on long term reconstruction. However, there are still key challenges that need addressing. These
relate to:
   Weak capacities of implementing partners and at times too many donors. Absorptive capacity
    on the ground and speed at which projects move are largely dependent on the local capacity.
    The implementing partners are finding it difficult to cope with different donors trying to push
    their respective programs beyond capacity. Even prior to the Tsunami, Aceh for instance, was
    one of the least developed regions in the country.
   Overall coordination mechanisms at the district level and between the districts and
    central authorities remain weak. Effective coordination has been a challenge given the large
    number of players in the health sector. Besides, many government structures were already
    under resourced and in some cases strained by years of internal conflict.
   Start up challenges relating to the reconstruction work of health facilities, in Sri Lanka for
    instance, have been formidable. These relate to formalities like identification of alternate land


                                                                                                    4
    for reconstruction, coastal buffer zones, acquisition of land, surveys, transfer of ownership to
    the Ministry of Health, authorization by the Urban Development Authority, designing,
    planning, layouts, approvals, contract biddings, bill of quantities for health facilities etc.
    Meanwhile, to ensure proper fund utilization and accountability, UNFPA is adhering to its own
    internal financial regulations and procurement procedures regarding bidding, contract approval
    etc to the extent possible that at times poses some delays. But once all the approvals are in
    place, expenditure will rapidly accelerate.
   Changes in the structure of the implementing partners: There have been major operational,
    structural and personnel changes within the implementing agencies, which hindered an early
    start, and implementing of activities.
   Security Situation in the areas of work has been a concern. In Indonesia security remains the
    issue that constrains staff movement. For example Aceh Jaya and Aceh Barat - two of the four
    districts in which UNFPA works are under UN security phase four. Travels for assessments,
    appointments of staff to work in these areas are delayed or have not been able to start. In Sri
    Lanka too, the political environment continues to be volatile, with the decline in the security
    situation in the Eastern Provinces, resulting in a slower than expected rate of implementation.
   Reproductive Health and Gender issues tend to be neglected in the initial emergency
    phase. National mechanisms to address gender concerns and address gender-based violence as
    a multi-sectoral response were lacking in the beginning and required a lot of advocacy.
    Sensitizing policy makers and securing commitments at various levels to ensure gender equity
    in rebuilding of social and economic systems and ensuring that womens‘ concerns are not
    ignored posed challenges and initial delays in operationalizing UNFPA‘s gender projects.


Flash Appeal and Funding
   In the Flash Appeal launched on 6 January, UNFPA requested a total of USD 27.9 million. The
    continuously changing reality on the ground has now revealed a revised requirement of approx
    USD 31 million for UNFPA projects in Indonesia, Sri Lanka and the Maldives. In addition to
    the flash appeal UNFPA mobilized resources for tsunami related activities in Thailand and for
    the census in and around the affected areas in Indonesia.

   Total pledges to-date approximate USD                                    Pledges to Flash Appeal
    26.8 million (approx. 95% of the original      Country                      (Millions of USD)
    Flash Appeal). UNFPA‘s own contribution        Germany                             8.1
    from its regular resources has been USD 3      Japan                               5.5
    million towards the Tsunami. In addition       Norway                              2.0
    approximately USD 1 million has been           Finland                             1.9
    used for the purchase of RH                    OCHA                                1.8
    equipment/supplies and commodities out         Netherlands                         1.6
    of the Reproductive Health Commodity           EC                                  1.0
    Security Trust Fund. The largest donor-        China                               1.0
    pledged are shown in the table below. As       New Zealand                         0.7
                                                   Australia                           0.4
    of 30 June 2005, UNFPA as received a
                                                   UNF                                 0.4
    total of USD 24 million from external
                                                   Sweden                              0.3
    donors for the flash appeal.
                                                  Note: The funds contributed by Japan, Finland, Norway and
                                                  New Zealand, with the kind consent of the respective
                                                  donors, have been placed in a multi-donor Tsunami pooled
                                                  fund.




                                                                                                         5
Utilization of funds

            Utilization of funds as of 30 June (figures are in thousands of US dollars)
     Country             Funds         Funds Received           UNFPA         Total Available            Total
                      Received for      Outside Flash         contribution        Funds              Expenditures
                      Flash Appeal        Appeal             from Regular                           (Provisional as
                                                               Resources                           of 30 June 2005)
 India                                                                   50                  50                 50

 Indonesia                   14,260              1,821*                 370               16,451             6,628

 Malaysia                                                                35                  35                 35

 Maldives                      2,150                                    150                2,300               191

 Sri Lanka                     8,164                                    477                8,641             3,514

 Thailand                                             400               500                 900                268

 RH commodities                                                         971                 971                961

 Coordination                     19                                  1,418                1,437                95

 Total                       24,593               2,221               3,971               30,785            11,742

*Funds pledged for census in Indonesia. Contributions yet to be fully received.




                                         Distribution of Received Funds

                                                                                  RH commodities
                                                       Malaysia                        3%
                                                         0%        Thailand
                                                                                   Misc
                                                                     3%
                                              India                                5%
                                                                                           Maldives
                                               0%                                            7%




                      Indonesia
                                                                                              Sri Lanka
                         54%
                                                                                                28%




(For detailed analysis and utilization of the funding received, please see enclosed country-wise reports.)




                                                                                                                      6
Many Thanks To Our Donors and Partners
UNFPA extends its warm gratitude to all the donors and partners for enabling us to
address the maternal health needs and special vulnerabilities of women and girls
affected by the Tsunami. The generosity and timely support of our various donors has
meant that several thousand women have been able to give birth safely; thousands
have been granted their dignity and the necessary safety and counseling to help re-
build their lives and those of their families; governments are looking at
institutionalization of gender concerns in planning and relief distribution and long
term lasting capacities in the health-sector have been created.




                                                                                       7
INDONESIA
Before the Tsunami, Aceh was considered one of the least developed of the Indonesian provinces,
with high levels of unemployment, inadequate social services, and ongoing conflict. After the 26
December 2004 earthquake and Tsunami, casualties and destruction were beyond imaginable
scope, and dramatically deteriorated an already fragile economy. Essential infrastructures,
communications and utilities were wiped out, and the social safety net had been destabilized,
undermining social protection.
The humanitarian needs were and remain tremendous. The United Nations Populations Fund
(UNFPA) in Indonesia deployed its initial team to Aceh the first week of January. The only
reliable means of communication between Aceh and
Jakarta at that time was text messages sent by mobile
phone, yet the immediate assessment findings were
communicated, and projects were designed based on
these findings. While the staff sought to understand
the situation in Aceh, they themselves were
struggling to maintain their own wellbeing as well
(food, shelter, hygiene, etc. were not easy to access).
UNFPA has moved rapidly to protect maternal health
and to help ensure the security, hygiene and dignity
of women and girls.


Some facts and figures
 Number of bodies retrieved and buried: 131,029
 Number of missing persons: 37,000
 Number of IDPs: 500,000 (250,000 are staying in tents; 150,000 in barracks; and the rest with
  host families or have started rebuilding their houses).
 116,880 houses were destroyed
 693 hospitals or clinics were either damaged or destroyed, 66% were destroyed.
 1,416 government buildings were damaged or destroyed, 71% were destroyed. (Source: BRR)

At the same time, the Fund has been working with local women‘s, youth, and religious-based
organizations to reinforce their participation in relief, while planting the seed of recovery through
reestablishment of reproductive health services and reinforcement of urgently needed psychosocial
and counseling support. UNFPA is also working with partner agencies to advocate for and
implement gender- and culturally-sensitive relief and recovery approaches in the ground.


Key Results of UNFPA projects in Aceh
Reproductive Health. Besides supporting the Provincial and District Health Offices in the
reestablishment of damaged health centers, UNFPA also distributes various Reproductive Health
supplies to village midwives, health centers and hospitals so that 11,000 pregnant women living in
the camps can give birth safely. Financial support and contraceptive supplies have been provided to
the National Coordination Board for Family Planning (BKKBN) which is working to ensure
internally displaced persons (IDPs) have access to family planning services.




                                                                                                   8
Psychosocial Support. Four community-based psychosocial support centers have been opened.
These centers, provide not only counseling and outreach program with focus on traumatized
women but also training in new skills to help women and young people rebuild their lives. In
addition, cultural and religious activities are also conducted to help women express their pain and
suffering. UNFPA also helped revitalize a Women‘s Center in Aceh Besar managed by the
Provincial Office of Women‘s Empowerment and Sakinah Family Center in Banda Aceh, run by
BKKBN.


Hygiene Kits. Immediately after tsunami, UNFPA, in partnership with national authorities,
conducted need assessments on reproductive health and gender to identify the needs and priorities
of women and girls living in the IDP camps. The Fund designed and distributes around 233,300
personal hygiene kits – consisting of among others head scarf, prayer mat, sanitary napkins,
underwear and long-sleeved shirt - to make sure Acehnese women and girls can carry out activities
in public comfortably.


Health Promotion. For the promotion of gender equality and equity, UNFPA ensures that gender is
mainstreamed in the humanitarian agenda from emergency, rehabilitation and reconstruction
phases and beyond. The IDPs living in camps and barracks also need access to information and
UNFPA is cooperating with Aceh-based media through which various messages on reproductive
health, psychosocial and gender issues are conveyed to the entire community. There are weekly
radio and television programs and newspaper articles on issues related to reproductive health and
gender covering IDP populations in Aceh.


Census. With the support of UNFPA, the
Central Bureau for Statistics (BPS) is
currently preparing to conduct a census to
get accurate demographic data on post-
tsunami Aceh. The much-needed census
data will be used to contribute to the
rehabilitation and reconstruction or Aceh.
The data will be available and
disseminated in November 2005. This
project required additional time for
preparation as the mobility of IDPs and
the need to ensure confidentiality in this
conflict setting are key challenges that had
to be factored in. Donor visibility is helps
to make this initiative more locally
acceptable.


Monitoring. Three donor monitoring missions have taken place with, a Japanese delegation, and
also with ECHO in May, and a German delegation in June. More are scheduled for the next few
months.


Nias Earthquake
The UNFPA team responded quickly to the 28 March earthquake in Nias and Simeulue, which
killed about 1,500 people and left at least 2,000 homeless, and while also severely damaging

                                                                                                 9
infrastructure. A team of doctors was dispatched to Nias to conduct a rapid needs assessment.
UNFPA sent two truckloads of RH medical equipment and hygiene supplies to Nias, including
1,400 personal hygiene kits, information on health promotion and essential RH supplies and
commodities.


Extension of UN Flash Appeal
As a consequence of the UN Flash Appeal Mid-Term Review, the duration of the flash appeal
projects has been extended to end of December 2005 with no additional requests for funding. The
requirement for extension of implementation period is for a number of reasons:
1. Lower than expected absorptive capacity in areas where programmes are being implemented;
2. An increase in requirements/beneficiaries, meaning that a wider geographical area needs to be
covered from existing financing;
3. High level of funds available, enabling agencies to either increase the size of the project or
extend the implementation period, or a combination of the two.


Recovery and Reconstruction
The level of government commitment and sponsorship in supporting and coordinating the relief
effort has been heartening. The Government of Indonesia Reconstruction and Recovery Master
Plan (also known as Blue Print) formulation started in February. UNFPA contributed to the Blue
Print by facilitating inputs from the Reproductive Health Sector Working Group, the Gender
Working Group, and the Population to the central government (BAPPENAS) and the provincial
Government (BAPPEDA). Upon the request of the Bappenas,
    1. UNFPA has hired one independent consultant from the University of Indonesia to directly
       involve in the Taskforce on Religion, Social, Culture, and Human Resources. The
       consultant‘s role was, in consultation with UNFPA Programme Officer, to provide inputs
       to the taskforce based on field observation, as well as technical support as a member of the
       taskforce
    2. UNFPA Country Office (CO) has appointed another Programme Officer and project
       officers in Jakarta to deal and provide technical support on gender issues based on the field
       observation to the taskforce.
    3. UNFPA has asked the RH Advisor for Aceh consultant who worked for UNFPA CO to
       also provide RH technical support to the taskforce.
Reproductive health (RH) is covered under health in general. Family planning has been addressed
comprehensively.      Gender considerations, including women‘s empowerment, have been
incorporated in the document. Population and development strategies have been explicitly
mentioned in the document, in particular on the conduct of population census in Aceh and Nias.
UNFPA, upon the Government of Indonesia‘s request, has been the main donor to mobilize
resources to fund the population census.
The Rehabilitation and Reconstruction Executing Agency (BRR) was established on 30 April to
implement the masterplan or glue print of Aceh and Nias post-Tsunami rehabilitation and
reconstruction. Part of BRR‘s mandate is to ensure transparency and accountability. Former
minister of mining and energy Kuntoro Mangkusubroto heads the agency.




                                                                                                 10
Timeline and Resources
The Psychosocial support, Hygiene kit, and Health promotion projects are due to end in December
2005. The Reproductive health project will be completed in June 2006, as per the original proposal
in the UN Flash Appeal.
Under the initial Indian Ocean Earthquake-Tsunami Flash Appeal, UNFPA-Indonesia requested
US $ 16,943,693. UNFPA-Indonesia has received US $ 14,260,483, out of which US $ 11,781,489
(83%) has been allocated up to now to implementing partners. The implementation rate as of 30
June 2005 is 45.7% based on funding received and 55.4% based on fund allocation in Atlas system.


Project 1: Reestablishment of Reproductive Health Services
The UNFPA project covers ten affected districts in Nangroe Aceh Darussalam and North Sumatra
provinces, and is being implemented in two phases – immediate response (6 months) and medium-
term response (18 months). The first phase focuses on implementation of the Minimum Initial
Service Package (MISP) for reproductive health (RH) services, while the second phase strengthens
local government capacity for implementation of more comprehensive RH services.
                                         Although the project is divided into two phases, both
                                         immediate and medium term responses are being
                                         implemented      simultaneously.  A    comprehensive
                                         surveillance, monitoring and evaluation mechanism is
                                         being established.
                                         Around 500,000 people were made homeless by the
                                         disaster and are currently living in temporary shelters.
                                         There are at least 11,000 pregnant women, and an
                                         average of 800 births take place per month.
                                         UNFPA RH support focuses on two primary health
                                         centers (Puskesmas), in each of the districts most
                                         affected by the Tsunami: Banda Aceh, Aceh Barat, Aceh
                                         Jaya, Aceh Besar.


Key Objectives
To provide immediate response to meet RH needs, and to support local capacity in restoring RH
services


Intended Outcomes
To support the reestablishment of RH services in Aceh, with emphasis on 8 Puskesmas in 4
districts.


Activities
Assessments—have been conducted throughout the first 6 months after the Tsunami, with focus on
two Puskesmas in each of the following districts: Banda Aceh, Aceh Besar, Aceh Jaya, and Aceh
Barat. Assessments of referral hospitals in Banda Aceh and Meulaboh have also been conducted.
A general RH assessment was also conducted in Calang (west coast of Aceh). RH supplies have
been given according to needs.


                                                                                               11
Coordination mechanism—UNFPA set up the Reproductive Health sub-sector working group to
help coordinate government, UN, and NGO RH emergency response and to help reestablish RH
services through out Aceh. In the meantime, the government and UNFPA are working together
closely in this working group, which the Provincial Health Office and UNFPA co-chair.
RH Supply provision—250 midwives serving IDPs in Banda Aceh, Aceh Besar, Aceh Jaya, and
West Aceh have received UNFPA midwifery kits to help women in the camps give birth safely.
An additional 500 kits are in the pipeline. Furthermore, UNFPA sent enough RH supplies to cover
the needs of 500,000 IDPs for a 6 month period.
Ambulances—Each of the 8 priority Puskesmas will be supplied with ambulances which will
include basic resuscitation equipment and emergency obstetric care in July.
Non-RH equipment—UNFPA has provided the Provincial Health Office with 5 cars for logistic
support for programme operations, including field monitoring.
Reestablishing RH services—UNFPA is focusing comprehensive support to reestablishing RH
services on Zainul Abidin referral Hospital in Banda Aceh, and on two Puskesmas in each of the
following districts: Banda Aceh, Aceh Besar, Aceh Jaya, and Aceh Barat.
In addition, UNFPA is supporting a small health clinic in Jantho (Aceh Besar) run by Mitra
Perempuan (a foundation dealing with RH), right inside the tented encampment. The clinic
provides family planning services for around 1,500 women/couples, maternal care for 40 pregnant
women, and other RH services to around 4,300 IDPs living in 5 camps in the area.
Trainings—Midwives in the priority Puskesmas have received training on the use of RH kits.
Reconstruction & Rehabilitation            To support the R & R phases, UNFPA supporting the
capacity building of local counterparts, including government officials, local health providers, and
NGOs in the implementation of the RH programme. By doing so, UNFPA is promoting
sustainability by transferring skills and equipment to local counterparts.
Key results achieved Using UNFPA RH kits, 326 deliveries were recorded among IDPs at the 4
most affected districts as per March 2005. Among these, 47 high-risk pregnancies have been
properly treated (33 women underwent caesarean sections, and 14 babies were born with the aid of
vacuum extraction).
Conclusion RH surveillance revealed that unmet family planning needs are still prevalent among
IDPs, and also among the general population of Aceh.


Donor allocations and expenditures
        Donor               Allocation (USD)        Expenditures (USD)          Balance (USD)
Multi donor (pooled)                  2,200,000                1,626,071                   573,929
China                                   400,000                        0                   400,000
ECHO                                    618,776                   34,911                   583,865
Germany                               4,070,556                1,481,951                 2,588,605
UNFIP                                   380,952                  165,188                   215,764
Total                                 7,670,284                3,308,121                 4,362,163




                                                                                                 12
Project 2: Provision of mental health services through psycho-
social support centers for affected populations
                           with emphasis on women and young people
Before the Tsunami, the need for psychosocial support was already high, as the armed conflict
caused psychological distress to at least 50% of the population (source: Provincial Health Office,
PHO). During the Tsunami, 90% of Acehnese families lost 1 or more members to the disaster
(source: PHO). Through this project UNFPA is providing much-needed psychosocial services to
Tsunami-affected populations by establishing community support centers (CSCs) which have
psychosocial outreach services. The community psychosocial support centers include services to
prevent gender-based violence and provide care for victims of violence. In addition, livelihood
activities are organized through these centers, in addition to providing a venue for maintenance of
peer support groups; psychological counseling; counseling on reproductive health concerns; and
referrals.


Four CSCs have been established along with
accompanying outreach services. UNFPA has supported
the reestablishment of two additional community
centers. Four more CSC are under finalization (their
establishment was slowed down as a result of security
concerns), and more are in the pipeline as demand for
them is high. In line with the other projects under the
UN Flash Appeal, the centers have been and will
continue to be establishment in the districts most
affected by the Tsunami: Banda Aceh, Aceh Barat, Aceh
Jaya, Aceh Besar.


Key Objectives
To provide psychosocial services, including counseling,
for tsunami victims, through community support centers.
The centers will also include services to prevent and deal
with violence against women and girls.                                 Picture: drawing by Tsunami
                                                                                           survivor

Intended Outcomes
To establish 8 CSCs, and revitalize 2 community centers in the priority districts which offer
psychological, religious, creative and livelihood activities to facilitate return to normalcy. Demand
for these multipurpose community centers is high, and 6 more CSCs are being established in July;
more are in the pipeline.


Activities
Assessments—Before the establishment of the CSCs, implementing partners NGOs Fatayat NU
and Flower Aceh conducted needs assessment in Banda Aceh and Aceh Besar. Most activities in
Aceh Jaya and Aceh Barat have not been able to move as planned as a result of the security
situation.
Needs assessments are being conducted with youth to identify their needs. UNFPA is launching its
youth initiatives in collaboration with ILO.

                                                                                                  13
Training of counselors—The Indonesian Psychologist Association (HIMPSI) trained
22 psychologists on psychosocial counseling in Jakarta. These psychologists, in turn, trained 32
community based counselors (CBCs) in Aceh who run 4 CSC, and the additional CSCs which are
being established. Of the 32 counselors, 16 have been recruited by Fatayat NU and Flower Aceh.
A 12-day training on counseling skills for counselors is being conducted facilitated by HIMPSI in
collaboration with Fatayat NU and Flower Aceh.
Starting June 28th, 2005 UNFPA in cooperation with HIMPSI has started to train the second batch
of potential counselors. The counselors are placed in centers within west coast area; Lamno and
Teunom (Aceh Jaya district) and Meulaboh, Woyla, and Kaway XVI (Aceh Barat district).
For counselors of the 1st batch, training session are conducted to sharpen their skills on
participatory approach to community and additional knowledge on adolescent and child
psychology. The counselors of the 2nd batch are trained in basic counseling and other skills related
to community participation.
Outreach services—From the time the training in counseling services for affected community had
been completed the community outreach program started (March) in order to speed up the response
to the needs of Tsunami-affected communities.
Establishment of CSCs—Four of the 8 planned CSCs have been established in May; 2 in Banda
Aceh: Ulee Kareng and Batoh; and 2 in Aceh Besar: Sibreh and Seulimeum (see below for details).
They are called Rumoh Peusijuk Hatee or Soul Soothing Home. The establishment of 4 CSC was
delayed due to the security situation.
UNFPA also helped reestablish Rumoh Putro Aceh a Women‘s Center managed by the Provincial
Office of Women‘s Empowerment (Biro PP) and Sakinah Family Center, run by BKKBN, which
also provide psychosocial services.
Livelihoods activities—With ILO, UNFPA is providing livelihood skills for women between the
ages of 19-29. The skills taught include: Business Awareness, Business Planning, and Vocational
skills on tile making. The CSC of Sibreh is the first CSC that started to rollout the 15 day training
starting with 20 participants. Unfortunately, due to the limited supply of molds, vocational training
was postponed to July. The livelihood training will continue rolling to other CSCs in Banda Aceh
and Aceh Besar districts.
Embroidery classes are being hosted at Rumoh Putro Aceh, and so far 320 women have
participated in this training.
Psychological healing services—Cultural re-exploration—A combined team of artists, including
artists from Jakarta and Aceh, have initiated a re-exploration exercise with communities in Aceh.
The artists conducted activities with participants, including drawing, traditional bamboo-flute
making, poetry writing, and practicing traditional dance. The program started in the SCS in Batoh
and are continued at the four sites in Banda Aceh.
The CSCs are stocked with religious books, and religious-based activities are hosted at the centers
to provide a source of comfort to IDPs.
Activities for young people—Two events started UNFPA‘s ―Youth Initiatives‖ project. The first
was a well-attended music concert in Banda Aceh with Mr. Rafly, a famous young Acehnese
singer. This event was funded by UNFPA, ILO, and ICMC. The free concert was dedicated to
displaced youths and was the first concert held in Banda Aceh after the Tsunami. Main purpose of
the concert is to bring some entertainment to displaced populations especially the youth in Banda
Aceh and its vicinities but to also draw youth to some semblance of normalcy.
A second event was a workshop on issues related to young people‘s health, social, cultural and
economic aspects. It is cosponsored by UNFPA and UN-ILO, and was held in May 2005. The
workshop aimed to identify youth initiatives and finding ways to support them. Participants


                                                                                                  14
included UN agencies, international NGOs, donors, local youth organizations and selected
displaced youth representatives.
Gender-based violence—40 counselors, from all established CSCs and selected Puskesmas, were
also training on responding to gender-based violence, by NGO INSIST, which has a long history of
working on gender-related issues. The counselors are now starting to link their activities with
Puskesmas staff.


More details on CSCs
While psychosocial outreach services started in March, UNFPA has opened the following
Community Support Centers (CSCs) in May:
    1. The Ulee Kareng CSC (Banda Aceh) The center is located about 200 meters away from
       the Puskesmas, mosque, and IDP camp.
    2. The Batoh CSC (Banda Aceh) This center is close to the communities in which the IDPs
       live. Located not more than 500 meters from Batoh Puskesmas, the CSC in Batoh provides
       counseling service for IDPs who live with host families as well as common society within
       the neighborhood of the center.
    3. The Sibreh CSC (Aceh Besar) The CSC of Sibreh had done simple assessment on its
       communities interest toward this training and the meeting decided that Sibreh will be the
       first premise of Livelihood and Vocational Training. Vocational Training will be on brick
       making module.
    4. The Seulimeum CSC (Aceh Besar) Within the radius of not more than 50 meters, the
       center is surrounded by public facilities and IDP camp. The center is close to a Senior High
       School, a Puskesmas, a Junior High School, and an IDP camp; in front of the center there
       is a grass field that is used by the community for playing football.


Reconstruction & Rehabilitation
One of the objectives to establish link with Banda Aceh Mental Health Hospital is to provide
access for the CSCs to Mental Health Hospital so that the counselors can directly interact with the
Mental Hospital, especially as related to the early detection on any potentially acute cases of
psychological distress within the communities. It been decided that the counselors will have bi-
weekly meetings with psychologists and psychiatrists of the Mental Health Hospital to discuss
psychological cases. These meetings will be held at the CSCs, and will serve as a forum for to
share experiences and discuss routine operational issues. It is agreed that the first meeting will be
held in July 2005 in the Batoh CSC.


Key results achieved
Around 200 women and girls including 50 traumatized people and 11 people affected by violence
have received counseling from the counselors. Immediate intervention is important to prevent
deterioration of their mental health.


Conclusion
The objectives of this project are being met through the CSCs that have been established. Outreach
workers are working with the communities to identify needs and address these. The centers
provide a multipurpose and versatile setting through which immediate psychosocial needs are
being met, including counseling using religious and creative approaches, and livelihood activities.


                                                                                                  15
In addition, livelihood activities had been identified as a need for women, and as a result projects
such as tile-making training have been established. Funds have also been used to training the
counselors in responding to gender-based violence.


Donor allocations and expenditures
        Donor               Allocation (USD)        Expenditures (USD)          Balance (USD)
Multi donor (pooled)                    301,503                   26,929                   274,574
ECHO                                     92,426                        0                    92,426
Germany                               1,356,852                  339,091                 1,017,761
Netherlands                             300,730                  108,722                   192,008
Total                                 2,051,511                  474,742                 1,576,769


Project 3: Provision of personal hygiene packs to Tsunami-
affected populations in Indonesia
Immediately after the Tsunami, UNFPA conducted
needs assessments on reproductive health and gender to
identify the needs and priorities of women and girls
living in IDP camps. UNFPA has moved rapidly to
protect IDPs, especially women and girls, maintain
hygiene and dignity. A hygiene kit was assembled based
on the needs assessments, and include basic hygiene
supplies such as, sanitary napkins, disinfectant, soap,
toothpaste, toothbrushes, head-scarf, prayer mat,
underwear, and long-sleeved shirt, to ensure Acehnese
women and girls can carry out activities in public
comfortably.
The kits are accompanied by information on basic
reproductive health and hygiene, and will be distributed
along with other basic supplies by implementing partners
including    government,      NGOs      and   voluntary
organizations. Subsequent assessment showed the imminent hygiene needs of men, and a new kit
was designed for males. The areas where the kits are mainly distributed to Banda Aceh, Aceh
Barat, Aceh Jaya, Aceh Besar. After the earthquake in Nias, a shipment was also sent there.


Key Objectives
To safeguard personal hygiene of girls, women, and men in temporary shelters in Aceh by
providing hygiene kits, and reproductive health and hygiene information.


Intended Outcomes
To provide hygiene kits to 350,000 displaced persons.


Activities
Hygiene kits—A total of 233,300 personal hygiene kits, including have been purchased thus far,
and more are in the pipeline. These have been and are being distributed on continuous basis, based


                                                                                                 16
on production and logistical capacity. About 80 percent of the kits have been for females, and the
rest for males. While communities identified women‘s hygienic needs as most urgent, it was also
clear that men lost everything and are also in need of hygiene supplies. Distribution of hygiene
kits through various implementing partners continues. From April the distribution has been handled
mainly by the Provincial BKKBN office, which uses its existing network at the village level.
Distribution is now covering 11 districts instead of four districts. UNFPA covers the distribution
costs.
Gender-based violence training—INSIST, and NGO that specializes in gender issues, led a
workshop from 17-19 June for CSC outreach workers/counselors (from all established CSCs and
selected Puskesmas) on gender-based violence. During this workshop, participants learned about
the problems faced by victims of violence; how to response victims in a holistic and sensitive
manner.


Key results achieved
After initial assessments from the UNFPA team in Aceh (dispatched the first week of January), it
became immediately clear that women were not able to access basic services because they did not
have sanitary napkins, they were not clothed properly, and also did not have headscarves. UNFPA
responded immediately by purchasing hygiene kits which were specifically designed for the
Acehnese context. The objective of this project is being achieved as the kits are reaching
populations that need them, and this has reduced the vulnerability of women and girls in the
emergency phase.


Conclusion
Logistics have been a challenge in Aceh, as a result of damage to infrastructure and security
concerns. This slowed the pace at which the personal hygiene kits were delivered significantly.
However, many partners were interested in distributing the kits, and this eased the burden of
UNFPA to solve the logistics issue.


Donor allocations and expenditures
        Donor              Allocation (USD)        Expenditures (USD)          Balance (USD)
Multi donor (pooled)                 1,600,000                1,311,544                  288,456
Australia                             200,000*                        0                  200,000
China                                  200,000                  186,846                   13,154
ECHO                                   277,278                  276,730                      548
Netherlands                            421,591                  385,421                   36,170
Sweden                                 284,495                  294,003                   -9,508
Total                                2,983,364                2,454,544                  528,820
*Funds not received


Project 4: Prevention of gender-based violence during the
emergency and reconstruction phases
The breakdown of social and infrastructure systems in the disaster-affected areas may lead to an
increase in sexual violence and exploitation, unwanted pregnancies, preventable maternal and
infant deaths, and an increase in the spread of HIV/AIDS and other sexually transmitted infections



                                                                                               17
(STIs). This project seeks to address these problems and reduce the risk of gender-based violence
for displaced populations through a phased approach.
                                         The first 6 months of this project focused on promoting
                                         safe access to basic services, by providing information
                                         on prevention of GBV in the temporary settlements
                                         through available media channels, including face-to-face
                                         and group discussions with affected populations.
                                        Resource persons for television and radio programmes,
                                        and newspaper articles include GOI, decision-makers
                                        and community leaders in the temporary settlements,
                                        NGOs, partners and volunteers. Trained outreach
                                        workers involve stakeholders, including vulnerable
                                        populations and service providers to identify and shape
                                        key messages. IEC materials providing information to
                                        project beneficiaries on access to services, safety and
protection against GBV are being developed.


Key Objectives
Prevention of gender-based violence by promoting safe access to basic services and building
capacity in women and youth groups to respond to and prevent GBV.


Intended Outcomes
To provide information on reproductive health and gender to IDP populations using mass media.


Activities
Mass media—Since January, there have been weekly radio and television programmes, and
newspaper articles sponsored by UNFPA. Radio and television programmes funded by UNFPA
were played on station RRI (coverage all of Aceh), Radio Baiturrahman (Banda Aceh), Radio
Pimpinan Muhammadiyah (Banda Aceh), TVRI (Aceh). UNFPA sponsored weekly newspaper
articles in Serambi Indonesia Daily Newspaper which covers all of Aceh. UNFPA sponsored
articles, and the donation of 8,500 newspapers which are then distributed for free to IDPs.
The topics were as follows: Family planning; Safe pregnancy, and motherhood; Breastfeeding;
Personal hygiene; Gender issues, gender-based violence, and women‘s empowerment; Safe
pregnancy and post-partum; Promotion of family planning and free contraceptive service to the
community; Psychosocial information related to mental health, child trauma, and other people who
have lost family members; Donor visits; Emergency contraceptives; Nutrition for children under
five; UNFPA activities.

Education, communication information (IEC):
 PKBI published leaflets on HIV/AIDS, sexual transmitted infections and reproductive health
    for the youth.
 BKKBN published leaflets with information on high risk pregnancy and contraceptives use in
    Acehenese and Indonesian languages.
Focus on youth—Preparatory work is being undertaken for specific promotion of adolescent
reproductive health through a radio talk show programme to be facilitated by the Indonesian


                                                                                                18
Planned Parenthood Association (PKBI) with the support from UNFPA. Supporting activities
include provision of counseling for the youth, peer-educator programme, livelihood initiatives,
prevention of STI‘s/HIV/AIDS and various games.
The UNFPA Health Promotion project is conducted through outreach and mass media activities.
The Indonesian Planned Parenthood Association (PKBI) conducted outreach activities through a
peer education modality to educate 300 students in 6 senior high schools in Banda Aceh about
reproductive health.
Resource persons—Persons from the following institutions serve as resource persons for the radio
and television programs and newspaper articles: BKKBN, Bureau of Women‘s Empowerment,
Gynecological Association of Banda Aceh, Provincial health Office, Yayasan Pulih; Mental Health
Hospital.


Key results achieved
Weekly radio and television programmes, and newspaper articles sponsored by UNFPA which
provide essential information to Tsunami-affected populations.


Conclusion
This project has faced some specific obstacles which slowed down implementation.
           Providing IEC materials to Aceh requires the careful development and testing resources as
            the setting is culturally, socially, and politically distinct. This process requires time.
           The production of IEC materials is also logistically challenging as there are not enough
            production companies which can produce good quality materials in Aceh. For now
            production has to take place in Medan or Jakarta.
Communications are usually a top concern in humanitarian situations, and it is thus not surprising
that this project which main aim is to communicate basic information is challenging to accomplish.
Nevertheless, the mass media channels of communication have been less difficult use as a medium
to convey information.


Financial Progress
        Donor                   Allocation (USD)        Expenditures (USD)           Balance (USD)
Multi donor (pooled)                      1,200,000                  280,276                    919,724
China                                       100,000                    3,877                     96,123
ECHO                                         64,699                        0                     64,699
Total                                     1,364,699                  284,153                  1,080,546


Mainstreaming Gender
            In a HIV/AIDS awareness workshop run by the Department of Defence and UNAIDS,
             UNFPA contributed to a session gender and provided two resource persons to help raise
             the understanding of issues related to gender to 100 military officers of 3 different ranks.
             An agreement was signed between UNFPA and the Women‘s Empowerment Bureau
             (Biro PP) on May 2nd 2005 to support the Biro PP in resuming its post-Tsunami
             activities. Support has been extended in form of equipment and financial support to train
             women focal points in the selected barracks for counseling and life skills activities.
             UNFPA also supports the Biro through provision of equipment and funds to reactivate the


                                                                                                      19
           activities of Women‘s Support Center, ―Rumah Putro Aceh.‖ With this center, UNFPA is
           sponsoring embroidery classes for women, as part of its livelihoods programme.


          In order to improve conditions for women and girls
           in the barracks, UNFPA in collaboration with Biro
           PP sponsored the first coordination meeting with
           inter-sectoral local government authorities and local
           and international NGOs and UN- agencies to discuss
           gender issues in the barracks. The Coordination
           meeting was held on the 21st of May and was
           attended by 67 participants. Various sectoral gender
           issues affecting the lives of women in the barracks
           were discussed and BKKBN (the National Family
           Planning Board) has agreed to join this meeting
           which will be held every month. This meeting is
           supported and coordinated by UNFPA.
          UNFPA in conjunction with National Development
           Planning Board (BAPPENAS), the French
           Government, and the Ministry of Women‘s
           Empowerment have organized a gender mainstreaming training for 500 sub-district
           authorities in Aceh to ensure full participation of communities in the development of the
           district plans. The preparatory activities took place in May.
          UNFPA supports publication and dissemination of information on violence against
           women in disaster areas with Jurnal Perempuan. Research on this was conducted in May.
          UNFPA is co-sponsoring an interagency project led by UNESCO to support
           comprehensive community education. UNFPA‘s contribution to this project is to support
           the hiring of a consultant for three months integrates selected issues (gender, reproductive
           health, and religious values) and provide training on them. Under this project in-camp
           community educators will be trained, and they will in turn provide education to the IDP
           communities living in temporary settlements, and barracks.
          UNFPA and Oxfam have co-sponsored a Biro PP-led Gender Assessment. The data
           collection phase of the Assessment is finished, and now the data has been entered and
           analysed. Now the report is under finalization. The Center for Women‘s Studies of the
           State Institute of Islamic Studies (IAIN) Ar-Raniry, Banda Aceh conducted the gender
           needs assessment. Preliminary findings have identified the following gender-related
           priority issues: uncertainty of inheritance or land; changing roles for men and women who
           have lost their spouses; continuity of livelihoods. Other general concerns that were
           mentioned include limited availability of vegetables and fish; uncomfortable living
           conditions; lack of privacy; lack of sanitary garbage disposal or access to clean water.


General Constraints
           Limited capacity of Implementing Partners: While UNFPA 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 Aceh have absorbed qualified local human resources. Absorptive capacity on the
            ground and speed at which projects move are largely dependent on the local capacity,
            even prior to the Tsunami, Aceh was one of the least developed regions in the country.



                                                                                                    20
             Changes in the structure of the implementing partners: There have been major
              operational, structural and personnel changes within the implementing agencies, which
              have hindered the early start, and implementing of activities.
             High human resource turn-over among national and international staff: Due to high
              stress levels from working in Aceh, high staff turn over has been observed both with the
              national and international staff. Some of the ‗memory and experience‘ with the staff is
              lost in the process which effects the programs.
             Security Situation in the areas of work: Aceh Jaya and Aceh Barat the two of the four
              districts in which UNFPA works are under UN security phase 4. Travel for assessments,
              appointments of staff to work in these areas are delayed or have not been able to start.
              As a result of this, the establishment of 4 CSCs has been delayed.
             Logistics: As a result of damage to infrastructure and security concerns logistics have
              been a challenge in Aceh.
             Visas: uncertainty of visas for foreign personnel has added an additional stress.
             Too many donors: The implementing partners are overwhelmed with all the donors
              trying to push their respective programs beyond capacity, and are finding it difficult to
              cope with this.
             Permanent stress and fear: Earthquakes, storms, and ongoing armed conflict cause
              continued stress and anxiety to people living and working in Aceh.


Factors that facilitated effective aid delivery
           Commitment of staff and partners. Despite many obstacles that have to be overcome to
            implement the delivery of aid, persistence of staff and partners has allowed UNFPA
            projects in Aceh to be operational and functioning.Partnerships with the Government,
            NGOs, and UN agencies have led to the dynamic functioning of the CSCs. Other
            organizations have projects already formulated openness to partnership has allowed us to
            work together to provide more comprehensive services to Tsunami-affected areas. One
            example in which we have been successful is in the area of livelihoods.
           Donor Contributions. UNFPA would like thank the donors (AusAid, China, ECHO,
            Finland, Germany, Japan, the Netherlands, New Zealand, Norway, SIDA-Sweden,
            UNFIP/Hewlett, and the private/NGO contributors) who have made commitments and
            have contributed to the UN Flash Appeal. We continue to ensure that our efforts are
            efficient and that we deliver quality services geared to meet the needs of Tsunami-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 UNFPA. As a result, UNFPA-
Indonesia will be able to spend all funds granted for the Tsunami-response as they are used to
immediately address the needs the communities are identifying. While the Tsunami brought
destruction beyond imagination, it has been a positive experience to work with the resilient
Tsunami and Earthquake-affected populations of Nanggroe Aceh Darussalam and North Sumatra.
Together we are leaving behind the acute emergency phase, and leading the way into the
reconstruction and rehabilitation phases.



                                                                                                    21
SRI LANKA

Project 1: Restoration of RH Services in the Tsunami Affected
Districts of Sri Lanka
The health sector has been seriously affected by the tsunami. Several major hospitals and a large
number of peripheral hospitals and health units were partially or completely damaged thereby
affecting the delivery of reproductive health (RH) services within the affected communities. Also a
large number of RH service facilities such as clinic centres and Gramodaya Health Centres (GHC)
were destroyed to varying degrees. The health staff in certain affected areas have experienced
extensive suffering, as a result of the tsunami, which could have a bearing on their day-to-day
work. In addition, the lack of transport facilities for field health staff within the affected areas
would further hamper RH service provision especially to the displaced populations who currently
live in temporary shelters and welfare centres and/or with friends and relatives.

The reduced capacity to meet the reproductive health needs of individuals and communities may
result in serious consequences that threaten the wellbeing of many people, and in particular women
and girls. Emergency situations tend to increase the risk of life-threatening complications related to
pregnancy such as miscarriages brought on by trauma, unsafe deliveries due to lack of appropriate
facilities and higher rates of abortions as a result of unplanned pregnancies and disruption in family
planning use. In addition, the breakdown of the physical and social fabric as a result of the
destruction and displacement has social and personal consequences for many individuals and
families that may compromise their reproductive health status. Large movements of people, change
in social norms governing sexual behaviours and the potential of coercing women and adolescent
girls and boys to exchange sex for food, shelter, income or protection can all contribute to the
spread of sexually transmitted infections including HIV/AIDS.

In spite of the above setbacks, it is commendable that the Ministry 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. The biggest challenge the Government of Sri
Lanka is now facing is to rapidly bring back the lives of the displaced communities to some level
of normalcy. The Ministry of Health has begun the process of rehabilitation and reconstruction of
health services including reproductive health services with the necessary assistance and support
from the bilateral and multilateral partners, Civil Society Organizations including NGOs and the
private sector.

Project Framework
Goal: The goal of the proposed programmes is to contribute to the promotion of reproductive
health including family planning and sexual health among couples and individuals living in the
tsunami affected districts of Sri Lanka.

Expected Outcome: The expected outcome is to contribute to sustained utilization of
comprehensive reproductive health services, including information and commodities.

Expected Output: The 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.
Following are the main components of the project:



                                                                                                   22
   Restoration/rehabilitation of damaged RH service facilities in order to support the health
    recovery plan at national, provincial and district levels
   Provide essential RH equipment and supplies
   Re-establish outreach services for health promotion
   Support the Voluntary Health Workers programme in areas where there are Public Health
    Midwife vacancies
   Strengthen the capacities and skills of health personnel by providing training and supportive
    supervision
   Strengthen co-ordination, monitoring and evaluation mechanisms


Results Achieved
Restoration/rehabilitation of Damaged RH Service Facilities

                                           UNFPA has signed an agreement with the Ministry of
                                           Health for the construction and/or renovation of the 13
                                           Medical Officers of Health (MOH) Offices, 5
                                           Gramodaya Health Centres (GHCs) and 2 maternity and
                                           neo natal complexes. Of the 13 MOH Offices to be
                                           constructed, action has been taken to initiate
                                           construction work for 10 out of the 13 facilities. Of the
                                           5 GHCs, preliminary work has been completed and
                                           tender procedures finalised for the reconstruction of all
                                           GHCs and construction work has started in the two
                                           GHCs in the Batticaloa District. Of the 2 maternity and
       Devastated health infrastructure   neo natal complexes, preliminary work on one unit has
                                          been finalised to initiate construction.

In planning for the new facilities, an effort has been
made to liaise with the local counterparts and
stakeholders to ensure that the facilities are designed to
better cater for the communities they are meant to serve
in terms of size and location. An improved environment
for the delivery of a comprehensive package of quality
RH services, including counselling and health promotion
services for couples and individuals would also be a
focus of the restoration effort. The construction
component of the programme is executed by UNOPS,
which has established a strong field presence in the
tsunami affected areas of Sri Lanka to manage and                    Damaged Delivery room
oversee the construction work.




                                                                                                 23
24
The following table provides the progress with regard to the construction component:

District/          Facility Type    Place                 Progress as at July 2005
DPDHS Area
                   MOH office       Kalmunai South        Land not allocated yet
                                    Sainthamaruthu        Land found not suitable for building &
                                                          being reassessed
                                    Karaitivu             Land identified, surveyed & plans ready
                                    Nintavur              Land identified, surveyed & plans ready
                   GHC              Kannakipuram          Tender documents ready
                                    Mawadipalli           Tender documents ready
                   Maternity        BH Kalmunai N         Land available. Delay in submission of
                   Complex                                plans by MoH
Trincomalee        MOH office       Kinniya               Land ownership not yet confirmed
                                    Kuchchaveli           Land identified. Decision on further
                                                          progress is delayed.
Batticaloa         MOH office       Batticaloa            Land identified, surveyed & plans ready
                                    Kalawanchchikudy      Land identified, surveyed & plans ready
                   GHC              Kakkajaveddai         Construction started
                                    Thampalawattai        Construction started
Matara             MOH office       Matara                Tender documents ready
                                    Tangalle              Land not identified yet
Hambatota          MOH office       Hambantota            Land to be cleared by UDA
Kalutara           MOH office       Beruwela              Land ownership not yet confirmed
Kilinochchi        MOH office       Pallai                Land identified, surveyed & plans ready
Jaffna             GHC              Chempianpattu         Land identified, surveyed & plans ready
Galle              Maternity        Elpitiya BH           Plans ready
                   Complex



Provision of Essential RH Equipment and Supplies

        Personal Hygiene Kits for Women and Girls

During the emergency phase of the tsunami disaster, 55,000 personal hygiene kits were distributed
to displaced women and girls housed in welfare camps and temporary shelters. The kits contained
essential items such a sanitary napkins, underwear and other personal hygiene products. 45,000 kits
were distributed through the Medical Officers of Health in the disaster hit areas and 10,000 through
UNHCR in the districts of Kilinochchi and Amparai. The kits were assembled by youth volunteers
mobilized by the National Youth Services Council, a national partner of UNFPA under the current
Country Programme. The personal hygiene kits addressed a critical gap in the provision of
emergency relief supplies to the displaced communities and made a significant contribution
towards safeguarding the dignity of displaced women and girls in the temporary shelters and
welfare camps.




                                                                                                    25
       Reproductive Health Kits

The Reproductive Health Kits are designed
for use in emergencies situations. At the
request of the Ministry of Health, UNFPA
supplied Reproductive Health Kits to all
districts affected by the tsunami. These kits
were used often in make shift facilities that
had limited or no equipment to handle
deliveries and obstetric complications during
the emergency phase. The kits also include
supplies to cater to the other RH needs of
the displaced communities. A total of 729
RH Kits were supplied and distributed as
follows:                                                    Youth Volunteers Assemble Personal
                                                                       Hygiene Kits




        Kit #   Description              Units    Districts/DPDHS Areas & Institutions Supplied
        0       Training           &     92       Galle, Matara, Hambantota, Ampara Kalmunai,
                administration                    Batticaloa, Trincomalee, Mullaitivu, Kilinochchi &
                                                  Jaffna
        2A      Clean delivery sub-      200      Galle, Batticaloa, Trincomalee, Matara, Ampara
                kit
        4       Oral and injectable      100      Distributed through FHB to all Tsunami affected
                contraceptives                    areas
        5       STD drug kit             17       Distributed through MSD to STD clinics in the
                                                  affected areas
        6       Delivery sub-kit         100      Galle, Matara, Hambantota, Ampara Kalmunai,
                                                  Batticaloa, Trincomalee, Mullaitivu, Kilinochchi
                                                  Jaffna & FHB
        8       Management          of   5        FHB
                complications       of
                abortion kit
        9       Suture for vaginal       100      Distributed by FHB to all Tsunami affected areas
                and cervical tears kit
        11A     Referral sub kit         50       Galle, Matara, Hambantota, Ampara Kalmunai,
                Level A                           Batticaloa, Trincomalee, Mullaitivu, Jaffna
        11B     Referral sub kit         20       Galle, Matara, Hambantota, Ampara Kalmunai,
                Level B                           Batticaloa, Trincomalee,
        12      Blood Transfusion        10       Blood Bank Colombo
                kit
                Injectable DMPA          30,000   Distributed by FHB to all Tsunami affected areas
                Curettage sets           35       FHB




                                                                                                     26
27
       RH Medical Equipment and Supplies for RH Service Facilities

The equipment and supplies to be provided in the recovery and reconstruction phase were
identified by the Family Health Bureau of the Ministry of Health and the list was closely assessed
with the technical support of the UNFPA‘s Procurement and Support Services Office in
Copenhagen prior to processing the order. These equipment and supplies will be provided to the
aforementioned health units being rehabilitated/reconstructed under the UNFPA programme to
ensure that the same health units are fully operational once completed. In addition, a limited
number of vehicles will be supplied to promote out-reach services as well as to increase capacities
for supervision at the district level in order to improve the quality of service delivery through
regular monitoring and oversight.


Support for Developing Capacities of Health Workers in RH Service Delivery
A detailed RH assessment was conducted by UNFPA in collaboration with the Family Health
Bureau of the Ministry of Health and the local health authorities of the affected districts. This
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 skills development and the availability and use of standard guidelines
and protocols for RH care. The assessment also covers the specific needs identified by the
displaced communities as well as those that pertain to the health providers themselves.

The assessment has highlighted some serious gaps in the provision of primary, secondary and
tertiary health care services, which need to be addressed to prevent maternal mortality and
morbidity as well as the spread of STIs and HIV/AIDS. It also identifies gaps in the availability of
services that cater to the specific RH needs of adolescents and youth. The assessment recommends
concrete action to address the human resource constraints, including interim plans to bridge the
capacity constraints such as support for Voluntary Health Workers and reestablishment of outreach
services in areas where there are Public Health Midwife vacancies; support for enhancing the skills
of health workers currently deployed in the affected districts; greater attention to quality assurance
and best practices for RH and enhanced supervision and support for monitoring and evaluation of
the RH interventions.

There is also a need identified to prepare and adopt national protocols and guidelines for quality
RH service delivery, including in disaster and post-disaster situations and to properly equip the
staff and health workers at the district levels, particularly in the North and East, to apply these
standards and update their knowledge and skills.

The assessment has been an effective tool for mobilizing support to revamp the RH services in the
affected districts. Currently, plans are underway at district level to put in place interim measures to
address the human resource constraints and build capacities for better RH services.

Coordination among the health partners (bilateral, multilateral and NGOs) has improved through
regular meetings, held at the central and districts levels with the involvement of relevant local
counterparts and stakeholders.

Key Challenges
A major challenge in the reconstruction of damaged facilities has been the delay in the
identification of alternate land for such constructions. The government has yet to articulate a firm
policy with regard to the buffer zone. The ambiguity in relation to the reconstruction of buildings


                                                                                                    28
in the 200 metre and 100 metre buffer zone in the coastal belt has delayed the construction process
in some areas. In response to the lobbying and concerns of the affected communities related to the
buffer zone, the Government of Sri Lanka is currently re-examining this issue.

The start up challenges related to the construction component were considerable. The relevant
national counterparts needed to conclude several formalities, such as acquisition of land, survey,
transfer of ownership to the Ministry of Health, authorization of the Urban Development Authority
for construction work prior to the commencement of work related to the planning, designing,
layout and BOQ for the health facilities. This process caused setbacks and delayed the
implementation of the construction work. Both UNFPA and UNOPS have maintained close
dialogue with the relevant national counterparts, at the highest levels, to ensure that any bottlenecks
are resolved efficiently and progress is not further hampered.

While the MOH has taken the lead role in planning the recovery of the health sector, the
consultation process with the provincial and district authorities has often been inadequate. This 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. Overall,
coordination mechanisms at the district level as well as the links between the district and central
authority in the recovery process needs to be enhanced. One of the constraints has been the weak
capacities at the district level to play an effective coordination role given the large number of
players in the health sector. Moreover, the delegation and level of authority at the district level
remains ambiguous. Efforts are now underway by the Ministry of Health to resolve these issues.

The political environment in the country remains volatile, with the decline in the security situation
in the Eastern Provinces, resulting in a slower pace of implementation than planned.


Financial Progress
             Donor                 Allocations (USD)      Expenditures (USD)       Balance (USD)
 Multi-donor fund (pooled)                   3,950,001              1,787,411            2,162,590
 China                                          200,000               200,000                    0
 Germany                                     2,082,768              1,347,772              734,996
 Total                                       6,232,769              3,335,183            2,897,586




                                                                                                     29
Project 2: Building Psychosocial well being among individuals
and communities living in tsunami affected areas with improved
responsiveness for the prevention and management of Gender
based Violence in Sri Lanka
Many individuals and communities are expected to experience considerable psychosocial1
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
networks, lack of mobility, and lack of access to goods and services previously available. People
may also be distressed over expected changes to their lifestyles and livelihoods following the
rebuilding and recovery process. Additionally, children, women and men in particularly
challenging or vulnerable circumstances will need special psychosocial interventions to support
them during the process of rebuilding their lives. The tsunami may have directly compounded
many of the difficulties experienced by people living in conflict-affected areas.

                                          The lack of privacy in the welfare centres where
                                          large numbers of people share cramped living
                                          arrangements increases intra- or inter-family
                                          problems,      community     disruption,    sexual
                                          harassment,       and     violent      behaviours.
                                          Overcrowding also brings with it opportunities for
                                          sexual abuse to occur. This may happen as a
                                          result of breakdown of protective community
                                          structures, social networks and orderly
                                          community spaces. In situations of overcrowding,
                                          the vulnerability of women, girls and boys is
                                          increased and they can be inadvertently placed at
                                          risk of both sexual and physical violence. Conflict
          Displaced Mother and Daughter
                                          between host and displaced communities is often
prevalent, and if unchecked can prevent social integration and relationship amongst both
communities. These and other problems may emerge also during the permanent resettlement
period.

There is concern around the dangers of marginalisation, lack of participation in the decision-
making and planning process, long-term stigmatisation and labelling, and increased potential for
local-level conflicts. Women and girls face specific and additional constraints in all these issues.

The tsunami is also expected to affect service providers who are attempting to respond to and meet
the needs of affected individuals and communities. As these actors are often required to work long
hours, deal with diverse and evolving situations and the concerns of specific individuals and
groups, they are likely to become fatigued and stressed. This may negatively affect their own
wellbeing and that of their families, and result in affected people receiving services of reduced
quality and empathy.

1
  ‗Psychosocial‘ refers to the psychological and social responses of individuals and communities that enhance or reduce
their overall wellbeing. The dimensions of human capacity, social relations and network, culture, and material status are
used to understand the psychosocial responses of individuals and communities. At the same time, it is recognized that the
broader political, economic, environmental and infrastructural milieu plays a significant role in enhancing and reducing
psychosocial wellbeing (Psychosocial Working Group, 2003) Psychosocial Intervention in Complex Emergency: A
Conceptual Framework. Working Paper. Available at www.forcedmigration.org/psychosocial/PWGinfo.htm October
2003



                                                                                                                     30
The immediate and medium term challenges is the rebuilding of social, economic and
environmental systems and ensuring that gender equity is addressed as a priority concern. A key
gender concern is the potential for increased violence and abuse that women may confront. The
additional consequences caused by gender-based violence will seriously affect the resilience and
capacity of women and girls to recover from the impacts of the tsunami. This acknowledges that
issues of safety for women and girls are intrinsically linked to their psychosocial well-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.




Project Framework
Goal: To contribute to the enhanced wellbeing of couples and individuals living in the tsunami
affected areas including safeguarding their reproductive health and rights.
Expected Outcome: To strengthen utilization of services related to psychosocial needs and those
addressing gender based violence in the tsunami-affected areas.
Expected Output: Improved 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.



Gender Component
Strengthening the policy environment for improved coordination and integration of
gender concerns in the recovery and reconstruction efforts

      Set up the Gender Desk at the National Committee on Women (NCW) UNFPA has
       provided support to the National Committee on Women in establishing a Gender Desk
       through provision of staff, in order to help mainstream gender concerns in the tsunami
       emergency and recovery efforts and to ensure that women‘s needs are not marginalized.
       The initial work of the Gender Desk focused on addressing the increase in sexual and
       gender based violence in the tsunami affected areas through raising awareness at all levels.
       As a result of this protection measures were considerably improved in temporary shelters
       and welfare camps. With the transition from relief to recovery support, the Gender Desk is
       now in the process of putting mechanisms to promote women‘s participation in the post
       tsunami recovery phase into place, including the appointment of gender focal points in the
       District Disaster Management Committees. The staff of the Gender Desk also undertook
       field visits to the affected districts to sensitize the Government Agents and other senior


                                                                                                31
       administrators in the District Secretariats on the need to address gender concerns in the
       tsunami recovery process. Since the national recovery efforts are being implemented
       through sectoral planning approaches, with lead institutions often lacking gender sensitive
       programming perspectives, there is a clear need to strengthen the capacities of existing
       mechanisms such as the NCW to play a more proactive role in mainstreaming gender
       concerns.

      Established an information system for improved gender policy and planning
       responsiveness Given the paucity of data on SGBV and the lack of sex disaggregated data
       in general, there has been inadequate attention and recognition given to the specific needs
       and vulnerabilities of women and girls in the aftermath of the tsunami. Under the project,
       the capacities of NCW will also be developed to gather and analyze data using the gender
       focal points at the districts, for improved gender responsiveness in policy and planning
       processes. This is particularly relevant in the Sri Lankan context, where the perception is
       generally that women enjoy equal status with men in most spheres of society and that
       SGBV occurs only in isolated cases. The need for concrete data and evidence is critical to
       increase awareness of the gaps and to effectively guide policy and planning responses in
       the recovery efforts. Initial work to establish an information system has already
       commenced at NCW. Additional support will be provided with the placement of an
       Australian Volunteer, with the relevant technical competencies, to accelerate this process.

      Supported the conduct of a Gender Audit of the tsunami response With the aim of
       enhancing the policy and planning environment for addressing the needs of women and
       girls, a gender audit of the tsunami response is currently ongoing. The extraordinary level
       of support mobilized for the tsunami created high expectations among the affected
       population as well as a recognition of the need to set up systems to track the flow of funds
       to the affected areas to ensure transparency and accountability in the utilization of
       resources. Since women were identified as one of the vulnerable groups during the
       emergency phase, it is appropriate to also examine the level of support that was directed
       towards addressing the needs of women during the emergency phase and in planning the
       recovery response. A 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 welfare camps. Furthermore, the lack of gender
       disaggregated data and information as well as weak mechanisms for gender mainstreaming
       has resulted in inadequate attention being given to the needs of women and girls in the
       recovery process.



Establish prevention and protection measures, and an immediate and effective
response, for women and girls at risk of or who have experienced SGBV in the
aftermath of the tsunami

In the immediate aftermath of the tsunami, several women’s 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 women’s 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.

In order to develop the skills of front-line government and NGO workers to effectively respond to
the needs of women‘s and girls in relation to psychosocial well-being, safety and access to services,
a series of capacity building activities were initiated. A critical mass of trainers were trained in
February 2005. The participants were drawn from both government institutions and NGOs in the
tsunami affected districts. Technical support to conduct the training workshops was mobilized
through the Centre for Refugee Research of the University of New South Wales, Australia. The
following table provides a profile of the trainers who were trained:

                  Ethnicity         Govt. Institutions        NGOs        Total
                   Sinhala                 07                  14          21
                    Tamil                  01                  04          05
                   Muslim                  01                   0          01
                    Total                  09                  18          27

Following the training of trainers (ToT) programme, the NCW through a consultative process and
learning from the initial round of training developed a comprehensive training manual for the
training of front line workers. Currently, preparatory activities are underway to build the capacities
of front line workers. Teams of trainers have been set up at the district level and trainees have been
identified, giving priority to front line workers providing services to the displaced population in
temporary shelters and welfare camps.

Provide support for the establishment of women’s centres and referral networks in
temporary shelter and permanent settlement sites.
The issue of safety for women and girls is also linked to their full participation in the recovery and
rebuilding process. The rationale for establishing women‘s centres at the community level is to
provide women with a ―safe space‖ that will cater to their specific needs and allow support
mechanisms to develop. These centres will be located in areas where there are temporary shelters
and/or plans for permanent settlements. They will be managed by women from the area under the
supervision of local NGOs. These women will be among the front line workers who will benefit
from the training due to be conducted by the NCW. Three well established NGOs have been
selected to oversee the management of these centres, namely Muslim Women‘s Research and
Action Forum, Women in Need and Sarvodaya.

The following services will be provided through these women‘s centres:

   Sensitisation of women and girls on SGBV risks and safety measures.
   A safe haven for women and girls subjected to SGBV.
   Provision of information and counselling services.
   Access to specialised services through referral mechanisms (for legal support, health care,
    vocational training and livelihood options).
   Space for recreation and networking opportunities designed to empower women.
   Sensitisation of men and boys on SGBV and increased male participation in safeguarding the
    welfare and wellbeing of their families and the community.




                                                                                                   33
Extensive discussions have been held with the above mentioned NGO partners and the
communities they are serving in the districts of Batticaloa, Amparai, Hambantota and Matara to
select appropriate sites and agree on a basic concept and design for the women‘s centres. A
mapping of sites has already been undertaken and design finalized.

Integrating health sector response to SGBV
Health care workers at the community level are often in the best position to recognize and address
the needs of women and adolescents related to SGBV. However, they need to develop the skills to
respond to SGBV cases and work in a supportive and enabling environment to be able to handle
sensitive and potentially high risk situations.

Under the project, support will be provided to integrate SGBV response into healthcare settings,
based on the experiences of a pilot project that was implemented in Anuradhapura with UNFPA
support. This will entail sensitizing MOH officials as well as training all categories of health care
staff, including public health midwives and inspectors, using the manual developed through the
pilot initiative ―A Practical Approach to Gender Based Violence: A Programme Guide for
Healthcare Providers and Managers‖. To strengthen the utilization of such services, the referral
mechanisms and support systems will need to be enhanced through the network of women‘s
centres and NGO partners. A feasibility assessment was recently undertaken to review how best to
upscale the pilot experience in the tsunami affected areas.




                                                                                                  34
35
Key Challenges
Some delays were experienced in processing the approval of the project as it involved multiple
partners and stakeholders. Given the lack of national mechanisms available to address gender
concerns, considerable ground work had to be undertaken to start up the initiative, including
sensitizing policy makers and securing commitments at various levels to operationalize the project.
At the initial phase, much of the assistance has also been channelled towards establishing networks
and building the necessary capacities to respond effectively. While the early investments were
minimal, the results in terms of setting up a sound foundation for the implementation of the project
have been significant. In order to accelerate the pace of implementation and enhance capacities of
the implementing agencies, UNFPA provided both programme and technical staff support to the
NCW. In addition, UNFPA has established a fully fledged project office to support the
management and oversight of the project. With these inputs, it is anticipated that the absorptive
capacities of partners, both state and NGOs, to utilize the funds efficiently within the given time
frame will be enhanced.

Whilst this project aims to promote SGBV as a public health concern, it also seeks to develop a
multi-sectoral response to SGBV, which is a formidable challenge. This implies strengthening
linkages with other partners to ensure that appropriate support services are available for protection,
legal counselling, livelihood and shelter, among other potential areas of support. A multi-sectoral
response requires the cooperation of
other partners and an effective
coordination      mechanism,      which
UNFPA will help facilitate. The need
for better coordination and strategic
linkages between various actors is also
essential as the policy environment and
support for SGBV interventions is less
than conducive, as seen in the lack of
resources and redress mechanisms
available at present. Advocacy and
sensitization programmes will be an
integral part of the support provided to
develop       an     enabling     policy
environment and efforts will be made
to forge strategic partnerships, both at
the central and district levels.            Adolescent Girl in Temporary Shelter Washing Cooking Pots




Psycho-Social Component
Results Achieved
The immediate post-tsunami scenario saw an unprecedented proliferation of agencies and
individuals from both within and outside Sri Lanka attempting to address the psychosocial needs of
people affected by the tsunami. A large proportion of these psychosocial actors were either new to
the psychosocial sector or new to Sri Lanka. In many of these cases, new psychosocial service
providers were unfamiliar with prevailing culturally acceptable psychosocial interventions in Sri
Lanka and also to the Sri Lankan socio-historical-cultural context. Long-standing psychosocial
workers in Sri Lanka describe being swamped with offers of capacity building and additional


                                                                                                   36
human resources to direct intervention. The first post-tsunami psychosocial coordination meeting
held in Colombo by the Consortium of Humanitarian Agencies saw a participation rate of over 60
agencies and individuals, of whom 47 were from new organisations to Sri Lanka or to the
psychosocial sector.

The large numbers of agencies and individuals who undertook to provide psychosocial support in
the immediate aftermath of the Sri Lanka inevitably meant that there was uneven understanding
about what constituted psychosocial interventions, and especially so in different parts of Sri Lanka.
In the urgency to provide psychosocial support, there was inadequate space and time to reflect on
whether the approaches and interventions being offered were suitable to the Sri Lankan context. It
was also unclear whether these were, in general, helpful and effective in post-disaster situations as
is revealed by the many references to ‗traumatised‘ populations even in the very first few days after
the tsunami, when such a diagnosis would have been clinically inaccurate. This and many other
incidents show that there was no clear consensus amongst psychosocial actors on how to
understand and respond to the psychosocial distress caused by the tsunami and its consequences.

The state responded quickly to the large numbers of incoming humanitarian aid and intervention,
by setting up the Centre for National Operations, which was to coordinate the national response to
the tsunami. However, there were constraints with regard to skilled resources in the psychosocial
sector within the state. The main protagonists of mental health and wellbeing in the state are
psychiatrists, amongst whom there were differences of opinion about the best psychosocial
practices and approach to psychosocial care in Sri Lanka. Prior to the tsunami, the state had mainly
been involved in providing individually oriented clinical mental health services as treatment for
mental disorders. Therefore, the state healthcare system was not well equipped either technically or
logistically to deal with the promotion and protection of wellbeing in the event of mass post-
disaster suffering and distress. Although the state and non-state sectors in Sri Lanka have worked
together in some areas, the relationship was fairly weak in the psychosocial sector. There was a
lack of coordination and information sharing between the state and non-state actors, especially at
district level.

Within this context, the UNFPA has played an increasingly significant role in bringing together
many of the psychosocial actors from within the state as well as between the state and non-state
actors and in facilitating consensus amongst diverse actors.

Support for state response to psychosocial interventions in post-tsunami context
In the immediate aftermath of the tsunami, the UNFPA offered support to the Directorate of Mental
Health Services in conducting the following activities and achieved the results described below.

       Contributed significantly to the development of the National Policy and Plan for
        Psychosocial and Mental Health Interventions

As a member of the Psychosocial and Mental Health Committee elected by the President of Sri
Lanka, the UNFPA was a key contributor to both the National Policy document and the National
Plan of Action for Psychosocial and Mental Health Interventions. The development of these
documents required the facilitation of many meetings where diverse expert opinions were moulded
into a coherent comprehensive framework, signifying the role of different responsible authorities
and actors for psychosocial and mental healthcare in Sri Lanka. Once 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 context. They were distributed
widely and helped to streamline interventions into the framework of the national policy and plan of
action.


                                                                                                  37
       Set up the Psychosocial Desk at the Centre for National Operations to direct external
        assistance

The UNFPA supported the setting up of the psychosocial desk at the Centre for National
Operations, which directed foreign assistance for psychosocial support. National experts on
psychosocial and mental healthcare operated the Psychosocial Desk until the completion of work
under the National Centre for Operations. All agencies and individuals who sought to provide
psychosocial and mental healthcare were provided with information of local organisations that may
be able to support the initiatives or needed the support themselves. The National Policy and Plan of
Action substantiated the guidance on suitable and locally appropriate interventions provided by the
Psychosocial Desk for foreign assistance.

       Coordinated meetings between the Directorate of Mental Health Services and non-state
        actors

The UNFPA was responsible for organising 2 half-day briefing meetings between the state and
non-state actors on planned state interventions and how to link up to them. The meetings clarified
the state-appointed district-level authorities and service providers, enabling permits and referrals to
operate much more smoothly.

       Convenor for both working groups on Psychosocial Assessment within and outside of the
        state

Both the state and non-state sectors set up working groups on psychosocial assessments, although
with different purposes. The state working group on psychosocial impact assessment wanted to
review the suitability of particular psycho-metric research instruments for assessing psychosocial
wellbeing of tsunami affected communities. The non-state working group on psychosocial
assessment was concerned with the development of guidelines for good practice for those agencies
interested in undertaking assessment initiatives. The UNFPA played a significant role in both
groups and acted as the chair for both groups. The guidelines for needs assessments were
distributed widely. A number of agencies shared the usefulness of these documents at different
coordination meetings.

       Capacity building efforts with the Directorate of Mental Health Services and other
        stakeholders

With regard to capacity building efforts in the immediate aftermath of the tsunami and recently, the
UNFPA has been active at different levels. A number of discussions were held with the staff of the
Directorate of Mental Health Services and the College of Psychiatrists to clarify the psychosocial
approach to be adopted as well as plan the interventions to be implemented. As part of these
efforts, the UNFPA supported the Ministry of Health to:
  - conduct 4 psychosocial sessions for 110 state administrators, healthcare and social service
       personnel from 8 districts to inform them on promoting psychosocial wellbeing;
  - distribute over 200 copies of guidelines for healthcare workers on how to develop and
       implement psychosocial responses;
  - draft the curriculum outline and key points to guide training conducted by individual state
       healthcare service providers in the districts;
  - conduct 4 meetings for 30 state health providers to direct, coordinate and document
       psychosocial interventions




                                                                                                    38
Support for psychosocial programming in the UN system in post-tsunami Sri Lanka

The UNFPA was appointed as the lead agency in the psychosocial sector for the UN agencies in Sri
Lanka as a result of its immediate recognition and flagging of the potential psychosocial
dimensions in the aftermath of the tsunami. In this capacity, the UNFPA has carried out the
following activities and achieved these results:

       Generated inter-agency consensus on the psychosocial approach to be taken

As part of the agenda in the inter-agency group meetings, the different UN agencies involved in the
provision of psychosocial and mental healthcare shared their psychosocial approaches. Further
discussion resulted in the adoption of a preferred approach to psychosocial programming in Sri
Lanka by the UN agencies.

        “The two extremes of the (psychosocial) approaches are (1) the models which
        pathologises the people’s reactions and attempts to cure or treat these as a mass
        intervention, at one end and (2) the models which attempts to promote wellbeing
        using the strategies of protection and recovery at the other end. WHO, ILO-IPEC,
        IOM, UNICEF and UNFPA agreed that the latter model was the preferred UN
        approach and therefore support would be given to those proposals supporting the
        latter approach.” (Minutes of 5th May UN Psychosocial Coordination Meeting)

       Coordinated the inter-agency psychosocial response

Agencies dealing with similar issues or with the same partners were encouraged to work together.
For example, both UNICEF and ILO-IPEC work the Department of Childcare and Probation, the
Ministry of Education and the National Child Protection Authority to implement their respective
programmatic mandates, whilst the WHO and IOM work together with the health services in the
area of mental health. At the coordination meetings, consensus was generated on the type of
approach, agencies were facilitated in reviewing their reference material and encouraged to ensure
coherent programming. At the request of UNICEF and in the capacity of chair and lead agency, the
UNFPA also facilitated a number of dialogue and consensus-generating meetings between
UNICEF and the German Technical Co-operation both of whom work extensively with the
Ministry of Education, and specifically the National Institute of Education where most teacher
training is designed and implemented.

Support for national and district-level coordination in post-tsunami context
With its main interest in building long-term sustainable interventions both at the centre and the
districts, the UNFPA has taken on various activities designed to meet the needs of the hour;
namely, long-term focus, sustainable intervention, coordinated effort and district-level capacity
building. The following activities highlight some of the results achieved towards these outcomes.

       Co-developer of the Mapping of Psychosocial Interventions in the Tsunami-affected area
        together with the Psychosocial Support Programme and the Consortium of Humanitarian
        Agencies

The UNFPA provided technical and logistical support in the development of a matrix ‗Mapping
Psychosocial Initiatives in Tsunami-affected Areas‘ jointly with the Consortium of Humanitarian
Agencies and the Psychosocial Support Program. These maps were a comprehensive mapping that
enabled new and existing actors to identify organisations involved in activities with similar


                                                                                                39
psychosocial objectives at divisional and district level. These maps were shared at coordination
meetings as well as were made available on the CHA website for those who are interested in
obtaining such information. As reports by various agencies reveal, these maps enabled them to pool
resources, refer clients to agencies for required services and identify the gaps in the field at
divisional level (smaller than a district). In this sense, young people, children who had dropped out
of school and men were identified as neglected groups, requiring further support services to what
was already being provided in the field. The issue of sustainable livelihoods for young people and
women were shown to need further strengthening. Similarly, it was noted that almost all support
for children comprised of play activities, and that it was important that other forms of support
needed to be provided to children.

       Provision of logistical support to the Community Empowerment Network - Trincomalee

The UNFPA provides ongoing logistical support to the Community Empowerment Network –
Trincomalee (CENT), a district coordinating body for psychosocial work functioning under the
office of the Deputy Provincial Director for Health Services and chaired by Dr Gadampananthan,
the psychiatrist assigned by the Ministry of Health to the Trincomalee district. The UNFPA support
enables regular visits by Dr Gadampananthan and other resource persons to Trincomalee, where
they conceptualise, coordinate and implement needs assessment and capacity building activities for
local and international NGOs in the area of psychosocial work. This ensures that emerging issues
are highlighted and addressed, that there is quality in the provision of care and support and that a
community-based approach is favoured over a clinical one, thereby promoting and protecting the
wellbeing of communities.

       Member of the Psychosocial Forum Committee to develop consultatively a Long-term
        Strategic Plan for Psychosocial Interventions in Sri Lanka in the post-tsunami and conflict
        context

The UNFPA is also actively involved in the development and implementation of a consultative
process for a long-term strategic plan for psychosocial interventions in Sri Lanka in the post-
tsunami and conflict context. This involves bringing together relevant actors from the state and
non-state sectors in a workshop to discuss the promotion and protection and psychosocial
wellbeing, and develop a joint action plan. The main objective of the strategic plan is to have a
shared long-term vision for psychosocial wellbeing in Sri Lanka and a set of common principles
within which agencies function. This will avoid duplication and inconsistency in the overall
psychosocial response, and will ensure a more effective and coordinated effort from the state and
non-state actors in the psychosocial field.

The UNFPA‘s initial and enduring analysis of the psychosocial sector emphasised the lack of
adequate capacities of persons carrying authority at the central and at the district levels on
psychosocial wellbeing promotion and protection. This was identified as a significant issue that
could impair the sustainability and efficacy of interventions. Therefore, efforts focused on building
capacities of policy- and decision-makers at central and district level as the first step. As part of
this exercise, it is important to build consensus of approach, a shared vision and acceptance of
diversity of roles in psychosocial and mental healthcare. The low expenditure rate in the first six
months‘ reflects UNFPA‘s commitment to sustainable processes. The groundwork is now ready to
begin in earnest the work 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 sub-
contracting of the University to some extent.


                                                                 Displaced Adolescent Boys




Financial Progress
           Donor               Allocation (USD)   Expenditures (USD)      Balance (USD)

 Multi-donor fund (pooled)              373,000                16,712             356,288
 Netherlands (Psycho Social)            926,995                80,581              846,414
 Germany (Gender)                       630,935                72,272              558,663
 Total                                1,930,930               169,565            1,761,365




                                                                                          41
42
MALDIVES

The tsunami affected all the people of the Maldives to some degree and severely affected one-third of the
total population of 290,000. It rendered some islands uninhabitable and initially displaced 29,577 people.
There were some 4,000 pregnant women in December 2005 and it was estimated that 1,500 of those
women were amongst the displaced. Today 11,568 people remain in temporary shelters, with host
families and/or with relatives. Approximately 6,650 are displaced on their own islands, with 4,918 hosted
on other islands. Support is being provided for IDPs registered on 15 different atolls, including food,
shelter and health care.

The tsunami destroyed boats, harbours, jetties and transportation/communication infrastructure, tools and
                                                 equipment used for production. Tourist resorts, where
                                                 many Maldivians were employed, were also severely
                                                 damaged. The tsunami washed away fertile topsoil,
                                                 depositing salt and sand in its place, and generated a
                                                 massive amount of debris. Groundwater aquifers,
                                                 already contaminated from inadequate sewage disposal
                                                 were further polluted and inundated with salt water. The
                                                 World Bank, Asian Development Bank and UN estimate
                                                 the total damages at US$ 470 million or 62 percent of
                                                 GDP. Growth projections for 2005 have dramatically
                                                 reduced from 6.5 to just 1.0%.

Physical Destruction in Islands


UNFPA Response to the Tsunami

   The following kits* were distributed by UNFPA
    following the tsunami:
        o 20 Clinical Delivery Assistance Kits to 20
           health centers across 15 atolls
        o 13 Blood Transfusion Kits to 13 health
           facilities across 11 atolls
        o 3 Vacuum Extraction Delivery Kits to Male‘
           Hospital and the Ministry of Health
        o 6 Condom Kits to 6 health facilities across 5
           atolls
        o 6 Individual Delivery Kits to 6 health facilities
           across 4 atolls
        o 13 Management of Miscarriages and Complications (MMC) of Abortion Kits to 13 regional
           and atoll hospitals
        o 6 Equipment for Birth Attendants Kits to 6 health facilities across 5 atolls
        o 6 Oral and Injectable Contraception Kits to 6 health facilities across 5 atolls
        o 6 Treatment of STI Kits to 3 atoll and regional hospitals
        o 1281 sanitary napkin cases to 45 health facilities across 13 atolls and in Male‘
        o 600 mother and baby kits to 34 health facilities across 11 atolls and in Male‘
        o 500 hygiene kits to Male‘ IDPs


                                                                                                       43
       *Each Clean Delivery Kit, STI Kit, contraception and condom kit serves a population of 10,000 for 3
       months. Clinical delivery kits, MMC kits and vacuum extraction kits serve a population of 30,000 for 3
       months. Blood transfusion kits serve a population of 150,000 persons for 3 months.

   50,000 leaflets on reproductive health (RH) and family
    planning (FP) were re-printed and distributed via the
    Department of Public Health.
   500 copies of guidelines on breastfeeding, pregnancy, elderly
    care and managing IDPs were distributed to all affected health
    facilities.
   The services of 3 volunteer gynecologists and midwives were
    provided in Meemu and Gaaf Dhaalu atolls.
   90 enumerators were trained to conduct psychosocial and RH
    modules of the Tsunami Impact Assessment.                             UNFPA Mother and Baby Kits
   Psychosocial First Aid (PFA) was provided to 1046 people in
    Gaaf Alifu Atoll, 844 in Dhaalu Atoll, 327 in Meemu Atoll,
    442 and in Thaa Atoll through UNFPA support.
   Emotional Support Brigade (ESB) teams were formulated in
    all the tsunami affected islands. The teams comprised 165
    people in Dhaalu Atoll, 35 people in Meemu Atoll, 29 people
    in Thaa Atoll, 115 people in Laamu Atoll.
   78 community health workers (CHWs), family health workers
    (FHWs) and nurses have been sensitized on mental health,
    psychosocial issues, reproductive health, substance abuse and
    protection issues in Meemu, Faafu, Dhaalu, Laamu, Thaa,
    Noonu, and Raa Atolls.
                                                                                UNFPA RH Kits


Project 1 - Restoration of Comprehensive Quality Reproductive Health
Services and Rights among Populations Affected by the Tsunami
(MDVTR201).
Following the devastating impact of the Tsunami Disaster on the 26th December 2004, UNFPA together
with the Ministry of Health formulated the project Restoration of Comprehensive Quality Reproductive
Health Services and Rights among Populations Affected by the Tsunami (MDVTR201) under the Tsunami
Flash Appeal. The project was formulated with technical assistance of UNFPA in close consultation with
the stakeholders.

The project will be executed by UNFPA. The Ministry of Health will be the main implementing partner.
UNFPA will liaise with national NGOs working in the field of Reproductive Health. The duration of the
project is 12 months.

Key Objectives and Intended Outcomes
The objective is promotion and protection of reproductive and psychosocial health and rights among
persons affected by the Tsunami in the Maldives. The expected outcome is increased utilisation of
comprehensive, quality RH services, commodities and information.


                                                                                                          44
The main outputs of the project are to rehabilitate the health facilities affected by the December 2004
Tsunami focusing on:

    1. Improving availability and accessibility to
       quality safe motherhood (including
       newborn) services, family planning
       services and services for prevention and
       management of RTIs/STIs and HIV
       through provision of equipment, staffing
       and strengthening of mobile services in
       selected atolls.
    2. Enhancing capacity of the health workers
       to deliver quality reproductive health and
       psychosocial support services to the
       affected population through training and
       development of guidelines.
    3. Reducing vulnerability to reproductive
                                                                 Displaced Mother and Child
       health problems among the affected
       population through sensitizing and awareness raising.
    4. Strengthening national capacity for preparedness to address reproductive health, and psychosocial
       concerns in natural disaster situations.

UNFPA intends achieving the above outputs through following strategies:
 Restoration of RH services that are of high quality in the tsunami affected islands through
  renovation/refurbishment and replacement/provision of essential medical equipment to rapidly initiate
  emergency obstetric care services in facilities with minimal damage;
 Upgrading capacities of affected facilities in the islands;
 Strengthening referral services, including referrals to the Indhira Ghandi Memorial Hospital (IGMH).
 Organizing short term refresher training of selected Family Health Workers (FHW), Community
  Health Workers (CHW), Nurse Assistants, Staff Nurses and Medical Officers in provision of quality
  reproductive health and psychosocial support services;
 Providing midwifery training and upgrading skills of Staff Nurses and Nurse Assistants in provision
  of selected basic emergency obstetric care.
 Awareness generation on reproductive health issues through focus group discussions, group meetings,
  and posters on select topics that will be developed and displayed in health facilities and campsites.
 UNFPA is collaborating with the Society for Health Education (SHE), an NGO that has the capacity
  to provide reproductive health support to women with check-ups and family planning counselling.
 Identification and referral of people with psychosocial support needs to the counsellors trained under
  the psychosocial project, and creation of an enabling environment for women and adolescent girls to
  access private facilities for bathing (by linking with agencies providing support for shelter). Special
  efforts are being made to mobilise the community and build partnerships with agencies providing
  shelter to ensure privacy and protection for women 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.
 Developing training materials and a plan for logistics management is being developed.

The activities will remain focussed on the five most impacted atolls namely: Raa, Meemu, Thaa, Dhaalu
and Laamu Atolls.




                                                                                                           45
Results achieved
   Assessments have been conducted, together with the Management of the Internally Displacement
    People‘s Unit, to determine the needs of the displaced and host populations in relation to the
    reproductive health care including psychosocial support.

   UNFPA provided reproductive health kits as
    immediate relief, which included safe delivery
    equipment, management of miscarriage kits, and
    prevention of STI kits as well as contraceptive
    commodities.

   Services of volunteer gynaecologists and midwives
    were provided at Meemu Muli Regional Atoll and
    in Thinadhoo Regional Hospital. Another UNV
    gynaecologist has recently been placed at Muli
    Regional Hospital and with UNFPA support many
    of the services have now resumed at this hospital.
    The gynaecologists and midwives have provided
    mobile/outreach antenatal, postnatal care as well as
    reproductive health and family planning services.
    Work on strengthening the outreach services is
    ongoing.
                                                             UNFPA Volunteer Gynaecologist
   The procurement of equipment for re-equipping the
    tsunami-affected health facilities under phase one has
    been initiated. Specification details and an operationalisation plan are being developed for two
    ambulance boats to be procured under the project.

   Guidelines on pregnancy, breastfeeding, elderly care and the management of displaced people have
    been developed and widely distributed. A national workshop on Reducing Maternal and Neonatal
    Mortality has been conducted for medical officers in connection with the World Health Day at the
    IGMH. Participants from throughout the country attended this workshop.

   The UNV RH trainer has recently arrived in Male‘ and is based at the Faculty of Health Sciences.
    She will develop and support the implementation of a one year training plan for all the capacity
    building initiatives under the project. The UNV trainer will also review and strengthen the RH
    content of the FHS curriculum for training of health service providers. Orientation of health service
    providers on RH has been conducted on tsunami affected islands in Meemu, Dhaalu, Raa, Faafu,
    Thaa, Noonu and Laamu in collaboration with the Ministry of Health and WHO.

   Following a number of discussions with the Indira Gandhi Medical Hospital (IGMH), the Ministry of
    Gender, Family Development and Social Security and the Ministry of Health, gender-based violence
    (GBV) gynaecologist focal points have been identified and a comprehensive work-plan for the GBV
    pilot in IGMH has been developed. Recruitment of staff for the pilot and initiation of activities is
    underway.

   A two-day briefing and sensitizing workshop on IDP issues has been conducted for senior level
    government staff, media, NGO‘s and donor agencies. UNFPA also conducted an interactive session
    on RH during the training programme for people working with the IDPs organised by Office for the
    Coordination of Humanitarian Affairs (OCHA) in Raa atoll. UNFPA will also be liaising with


                                                                                                      46
      OCHA in training of trainers, who will impart RH information to IDP committees currently being set
      up at atoll and island levels.

     A module on reproductive health issues has been developed for inclusion in the Tsunami Impact
      Assessment (Vulnerability and Poverty Assessment III) to be carried out by the government. The
      training of enumerators has been completed and data collection began on 10th July and is due to be
      completed by mid August 2005.

Key Challenges
One challenging factor is the magnitude of the tsunami impact and the weak capacities amongst
counterparts to respond to the needs that have arisen. There is also a continuous need to advocate for
reproductive health to ensure that the level of national commitment and ownership of the programme is
maintained and that the momentum of support is not diminished. This requires the active participation of
the stakeholders in all stages of programme delivery, regular review of progress and challenges and
flexibility to make adjustments that secure the relevance of interventions in relation to national priorities.

Delays in obtaining official clearances and signatures on the project document and difficulties in
mobilizing international experts to bridge the capacity constraints have contributed to slowing down the
implementation of the project. It is likely that the project duration will need to be extended to early next
year.

Financial Progress
The total budget of the project is US$ 1.9 million. The main donors are OCHA, Japan, New Zealand and
other private sources.

           Donors                                Allocation     Expenditure at Balance
                                                                end June 05 2
           Pooled Fund                               460,000.00      67,333.00     392,667.00
           OCHA                                    1,440,000.00            0.00  1,440,000.00
           Total                                   1,900,000.00      67,333.00   1,832,667.00




Project 2 - UNFPA Response to the Psychosocial Impact of the
Tsunami Disaster in the Maldives (MDVTR301)
Following the devastating impact of the Tsunami Disaster on the 26th of December 2004, the project on
UNFPA Response to the Psychosocial Impact of the Tsunami Disaster in the Maldives (MDVTR301) was
formulated under the Tsunami Flash Appeal. The project was developed by UNFPA with technical inputs
from International Centre for Migration and Health (ICMH), and in close consultation with the National
Disaster Management Centre and Ministry of Health. The project will be executed by UNFPA and the
Ministry of Gender, Family Development and Social Security in close partnership with the Unit for the
Management of the Internally Displaced Population.




2
    Expenditure includes pre-encumbered and encumbered figures.


                                                                                                           47
Key Objectives and Intended Outcomes
The project objective is to promote and protect the psychosocial well being of people affected by the
Tsunami in the Maldives. The expected outcome is to contribute towards increased utilization of
appropriate and effective services for better health and wellbeing of people affected by the tsunami.

The project aims to focus on the following outputs on the most impacted five atolls namely: Raa, Meemu,
Thaa, Dhaalu and Laamu Atolls.

1. Assess the psychosocial wellbeing of the affected populations by conducting quantitative and
   qualitative 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 adequate 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 wellbeing of its people.
4. Brief and sensitize community leaders and decision-makers on psychosocial support needs of the
   IDPs.
5. Support a process for the development of an appropriate and relevant policy framework for the
   provision of psychosocial and mental health care to the affected population.

The key strategies for achieving the above outputs are:

Modules on psychosocial and reproductive health, including GBV, have been included in a larger nation-
wide Vulnerability and Poverty Assessment planned for July 2005;

Conducting qualitative studies (using participatory techniques) of vulnerable groups to determine special
needs and ways of responding to them and developing integrated monitoring and evaluation tools for a
community-based surveillance system that will generate on-going collection of key information on
evolving psychosocial issues and impacts of psychosocial interventions;

Development of curriculum and trainings of national resource persons, counselors, community health
workers, nurses and general practitioners and their placement at island and atoll levels;

Recruitment of community educators in consultation with the Ministry of Health, Department of Public
Health and the MIDP Unit of the Ministry of Gender, Family Development and Social Security and the
Ministry of Atolls;

Setting up evaluation mechanisms for assessing the work and impact of community educators and other
health and social services staff;
Organization of workshops with policymakers 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 staff; and

Designing a mechanism through which 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.

The duration of the project is 12 months.




                                                                                                      48
Results achieved
       UNFPA formed Emotional Support
        Brigade teams that made field trips to
        provide Psychological First Aid during the
        early days following the disaster. Focus
        group      discussions      and     individual
        discussions have been held with the
        affected community members on an
        ongoing basis. A quantitative assessment
        tool on psychosocial issues has been
        developed and included in the National
        Tsunami Impact Assessment Study
        (Vulnerability and Poverty Assessment III).
        The training of enumerators has been
        completed and data collection will begin on
        10th July and is due to finish in mid-August.
                                                              Adolescent Girls in an IDP Shelter
       Health care providers have been briefed and sensitized on the early identification and
        management of psychosocial issues through trainings conducted by UNFPA at IGMH, Male‘ and
        Meemu, Dhaalu, Raa, Faafu, Thaa and Laamu atolls in collaboration with WHO and the Ministry
        of Health. Further training workshops are being planned for the future.

       Five Community Educators to be placed in the atolls by early August have been recruited and are
        currently undergoing training. Ongoing support and supervisions will also be provided.

       A two-day briefing and sensitizing workshop on IDP issues was conducted for senior level
        government staff, media, NGO‘s and Donor agencies. UNFPA also carried out an interactive
        sessions on psychosocial wellbeing and GBV during the training programme for people working
        with the IDPs organised by OCHA at Raa atoll.

       At the Mental Health Forum, 6-9 June, organized
        by the Ministry of Health, UNFPA presented
        results of the gender-based violence and
        psychosocial support activities and research work
        undertaken recently.     In particular, UNFPA
        highlighted the need for greater attention to
        psychosocial support and mental health care in
        the Maldives, and the provision of support
        services such as counselling for the protection of
        women and children, particularly in light of
        increased needs stemming from the tsunami.
                                                             Focus Group Discussions with Displaced Women
Key Challenges
One challenging factor is the magnitude of the tsunami impact and the weak capacities amongst
counterparts to address all the needs, under each sector, at once. Psychosocial support and mental health
interventions has been weak in the past and lack of national capacities has hindered progress.




                                                                                                       49
Delays in obtaining official clearances and signatures on the project document and difficulties in
mobilizing technical support in this area have hindered progress. It is expected that the project activities
will be implemented through to end of June 2006.


Financial Progress
The total budget of the project is US$ 250,000. Funding was secured from Japan, China and OCHA.

           Donors                    Allocation (US$) Expenditure      Balance
           Pooled Fund                        100,000       23,396.00         76,604.00
           China                              100,000       22,926.00         77,074.00
           OCHA                                50,000             0.00        50,000.00
           Total                              250,000       46,332.00        203,678.00




                                                                                                         50
THAILAND
On a clear morning of 26 December 2004 the unexpected tsunami hit Southern Thailand where hundreds
of thousands of people have been affected. Over 350 fishing villages along the Andaman coast of
Thailand were seriously affected. Nearly 10,000 fishing boats were destroyed and over 30,000
households that depend on fisheries have lost their means of livelihood. This included also the foreign
migrant workers and their families mostly from Myanmar. About 120,000 people have lost jobs in the
tourism sector. The natural environment also suffered with several marine and coastal national parks
severely damaged, coral reefs destroyed by debris, and agricultural land affected by salt water intrusion.
At the end of March 2004, the Thai Ministry of Interior reported fatalities and casualties resulting from
the 26 December tsunami as follows: 5,413 dead (1,957 Thais, 1,953 foreigners and 1,503 unidentified)
and 2,932 missing (2,023 Thais and 909 foreigners)

Since the tsunami disaster hit Thailand on 26 December 2004, the UNFPA CO has received a total
amount of US$900,000 (US$500,000 from UNFPA Headquarters and US$400,000 from OCHA and
UNRC/HC


Summary of Overall UNFPA Response and Key Results
Emergency Phase:
         $50,000 was contributed in late December 2004 to the UN Emergency Relief Funds Bank
          Account at the Ministry of Foreign Affairs. Details on how the funds were used will be
          available soon from the Thailand International Development Cooperation Agency (TICA).
         $7,500 was used to purchase safe drinking water for the affected communities in Kraper
          District, Ranong Province and Kuraburi District in Phang-nga Province.
         $13,420 was used for survival kits including food, rice, milk, sanitary napkins,
          vitamins/minerals for pregnant women in the affected areas.
         $6,380 was used in conducting Need Assessment and Follow-up Missions by UNFPA experts
          together with representatives from the Department of Health, IPSR of Mahidol University,
          World Vision Foundation of Thailand (WVFT).

      Post Emergency Phase:
       Two tsunami projects were approved following the recommendations from the Need
         Assessment Mission conducted in January 2005.


Project 1: Reproductive Health Care Services in Tsunami Affected
Areas in Thailand

          Project duration: March 2005-December 2006; Total budget: $450,000; Source of funds:
          UNFPA; Target group: Thai communities in Ranong, Phang-nga, Phuket and Krabi Provinces.
          Project Summary: This project proposes to address two of the most urgent and needy areas
          recommended by the Need Assessment Mission namely: (1) improved access to RH
          information, counseling services for women, men, adolescents and older persons in the newly
          developed communities; and (2) capacity development of health service providers and
          community volunteer groups. It will cover: provision of basic needs and sanitation; emergency
          obstetric care; involvement of community/youth health volunteers including women and girls,
          trauma related counseling, through existing or new one-stop health service centres and mobile


                                                                                                       51
      clinics; behavioural change; development of community health plans; outreach services;
      networking with local stakeholders; and sharing of experiences.
      Activities: A Rapid Assessment Research was conducted by the College of Public Health,
      Chulalongkorn University in the Thai communities affected by the tsunami. A preliminary
      report has been submitted to UNFPA. A Baseline survey will be completed in September 2005.

     Financial Progress

       Donors                Allocation (USD)     Expenditure (USD)      Balance (USD)
       UNFPA/OCHA                      450,000                110,144           339,856
       Total                           450,000                110,144           339,856




Project 2: Expanding Reproductive Health Care Services to Tsunami
Affected Areas

      March – December 2005; Target group: foreign migrant workers. Coverage: selected
      communities in Phang-nga and Ranong Provinces.
      Project Summary: This project targets one of the most vulnerable population groups affected,
      namely the migrant workers and their families from Myanmar. About 10,000 migrant workers
      and their families and 9,000 local population will have access to general and RH care services
      through the existing service delivery points and the UNFPA-funded mobile clinics for the hard
      to reach clients.
      Activities: Funds have been used on purchasing a mobile clinic, medical equipment for the
      mobile clinic, and personnel cost including baseline survey done by IPSR of Mahidol
      University. The findings will serve as inputs to develop interventions on the target
      beneficiaries in improving access to RH services including HIV/AIDS prevention, psychosocial
      care and counseling services.

     Financial Progress

       Donors                Allocation (USD)     Expenditure (USD)      Balance (USD)
       UNFPA/OCHA                      450,000                157,567           292,473
       Total                           450,000                157,567           292,473




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