|© UNICEF/Kyrgyz Republic|
|In 2011, a pilot was designed to remove barriers and bottlenecks to equitable access to a range of essential services in 18 disadvantaged villages in remote Batken province.|
By Abhijit Shanker
15 May 2012 - A recent series of socio-economic, political and security shocks in the Kyrgyz Republic adversely affected the lives of the poor and disadvantaged and slowed progress towards achieving the Millennium Development Goals (MDGs). UNICEF and its partners have supported government and civil society in alleviating the impact of those shocks by refocusing on programmes benefiting the poorest and most vulnerable children and families.
In 2011, a pilot was designed to remove barriers and bottlenecks to equitable access to a range of essential services in 18 disadvantaged villages in remote Batken province. The pilot aimed to tackle supply and demand side issues by increasing the capacity of service providers and bridging the knowledge and information gap of service-users.
The project demonstrated the role UNICEF can play in addressing discrepancies between the formal provisions of national laws and policies and the realities of their implementation at local level. It also evidenced the need to increase families’ awareness of their social entitlements and of remedies in the event of violations. The lessons learned from the Batken project have informed the design of a new Country Programme. Funding has now been secured from DFID to expand the piloted equity-based approach to a further 55 disadvantaged municipalities in the Southern provinces of Batken, Osh and Jalal-Abad.
Kyrgyzstan became independent in 1991 with the break-up of the Soviet Union. Its population of just over 5 million is concentrated in two fertile valley regions while the majority of the country is mountainous and sparsely populated. It is one of the poorest countries in the CEE/CIS region with a Gross National Income of $2291 per capita in 2008.
Kyrgyzstan has had mixed results in its efforts to meet its commitments envisaged in the Millenium Declaration. It has shown progress in tackling extreme poverty, yet poverty levels remain significant and raise major equity concerns. Children are among the most vulnerable with almost half the country’s children (48.5%) living in poverty. Progress has been reported on MDGs 7 and 8, but the achievement of MDGs in the health sector remains a serious challenge and there are concerns over quality in the education system.
The country has additionally been hit by several major shocks in recent years. Problems of food and energy insecurity in the period 2007-2009 fuelled significant social discontent that reached a head in early 2010. In April 2010, violent protests in the capital ended with the overthrow of the Government of then president Bakiev. In June 2010, persistent social tensions that had been on the rise in the South, where large ethnic Kyrgyz and Uzbek communities live side by side, climaxed in violent inter-ethnic clashes over several days. At least 415 people lost their lives in the violence and large numbers fled their homes. An estimated 400,000 children were directly or indirectly affected by the conflict.
A joint economic assessment carried out by several international organizations found that socioeconomic stresses had aggravated the conflict in southern Kyrgyzstan. These included poor state accountability and service delivery, chronic poverty and widening socioeconomic disparities, competition over resources, widespread unemployment and underemployment and a lack of civic participation in wider social, political and economic processes.
Informed by these recent events, and in order to explore how equity programming could be integrated into UNICEF’s 2012-16 Country Programme, a pilot project, “Promoting equity in the most deprived and remote communities”, was initiated in 2011.
Strategy & Implementation
The pilot was rolled out in 18 villages in mountainous Batken district that were identified as remote, deprived and at risk of not achieving health-related MDGs. The project took a multi-sectoral approach, and was designed collaboratively by UNICEF’s health, social protection, communication and early childhood development (ECD) teams. The project aimed to address bottlenecks and barriers in essential service provision by increasing the capacity of health providers and local authorities, while empowering families with knowledge of social entitlements and child and maternal health issues.
The pilot involved several sectoral situation assessments to identify supply and demand side barriers. Notably, three in-depth assessments were undertaken to determine access to and use of quality emergency medical services and access to medicines. A survey assessed the awareness of mothers and family members of risk signs during pregnancy and of childhood disease, as well as their awareness of cash transfer programmes. An information gap was identified in the knowledge of rural families with regard to their social entitlements and there were also complaints about corruption with regard to social cash transfers in one municipality.
The health component of the project sought to enhance the capacity of district healthcare workers to deliver quality care and to manage appropriate referrals of young children and pregnant women in a timely manner. It also aimed to train healthcare workers to communicate key messages on childhood diseases and danger signs during pregnancy, thereby leading to reductions in maternal and child mortality and morbidity.
The social protection component built the capacity of local social protection staff and potential beneficiaries to ensure that the most disadvantaged families are provided with the social cash transfers to which they are entitled.
Meanwhile, the ECD component worked at the community level to address obstacles to pre-school attendance among the most deprived community members and to promote the integration of children with special needs.
The communication component informed families about health risks for young children and during pregnancy though mobilization of Village Health Committees’ volunteers and community media.
An end-line survey was conducted in November 2011 to assess to what extent the identified issues had been resolved.
Progress & Results
In the health sector, all primary health care staff, first aid and ambulance service staff covering the target villages as well as 130 nurses from in-patient departments and 45 doctors enhanced their capacity in the areas of antenatal and emergency obstetrics care and Integrated Management of Childhood Illnesses (IMCI). Trainees demonstrated significant improvements in their knowledge and skills. All trainings were followed by post-training support, supervised practice and coaching to ensure full and correct application of the knowledge and techniques acquired.
In social protection, five social protection administrators and 17 local social workers received on-the-job coaching and consultations on new eligibility criteria and access procedures for poverty-targeted cash transfers. 5000 leaflets and 500 posters were produced with details on enrolment procedures and contacts for registering complaints and making inquiries. Leaflets were distributed to all households in the 18 villages and posters put on display in local authority offices, social protection departments, post offices, local markets, schools and rural health points in the three municipalities.
In the early childhood development field, a 2-day training seminar on screening of young children was carried out for medical personnel in Batken district in July. This was followed by a 3-day seminar in October on early detection and the integration of children with disabilities into preschool educational institutions, attended by preschool teachers, representatives of district education departments, and parents.
As a result of close collaboration between health, education and social protection services at municipal level, 121 children with special needs were identified. Individual development plans have been designed for each of the children to support their social integration through educational and care programmes. Four children with disabilities have entered preschool and one child is now attending primary school.
The introduction of a shift system in the community-based kindergarten in Kyzyl Bel village paved the way for 55 additional children to enjoy their right to development and socialization. Children from poor families have been prioritised for enrolment. Additionally, fifty-eight healthcare workers, teachers, social workers and parents from five villages in Karabak were trained in the basics of early childhood development approaches.
Communications activities resulted in heightened awareness of danger signs during pregnancy and of childhood diseases and boosted knowledge of social protection entitlements in all households with pregnant women and children under five in the 18 targeted villages. Beneficiaries were given the chance to raise their concerns with local village health committees, which were trained to provide relevant information on danger signs of childhood illnesses and complications during pregnancy as well as on social protection entitlements. The local radio station provided additional information on these key health and social issues through five 30-second public service announcements, seven 15-minute radio programmes and 20 10-minute
quizzes to generate active participation.
More than 50 local government representatives, including financial specialists, councillors and village heads benefited from technical assistance, training and coaching on participatory strategic planning and management. As a result, one municipality (Dara) has revised its local two-year local development strategy (2012-2013) and strengthened its social block with earmarked funding. For the other two local governments this is still work in progress.
Lessons learned in the Batken project were used in planning the next Country Programme and continue to feed into ongoing work. One of the key gaps identified has been the discrepancy between the formal provisions of policies and laws and the way they are implemented at local level.
Across all sectors, the project has revealed barriers and bottlenecks that prevent national-level laws, regulations and policies designed to address vulnerability and inequity from being implemented in the communities where they could make the biggest difference. This reflects a need for those developing strategies and legislation at national level to further reflect on how policy is implemented at community level. It also points to a need for capacity building at the local level, as local authorities in some cases were not aware of their responsibilities under law, or of steps they could take to reduce deprivation and inequity in their areas.
Additionally, it emerged from the project that many people in the target area had limited knowledge of their entitlements and opportunities to seek remedy where their rights are violated. This signaled the importance of further work on outreach and C4D.
The pilot also demonstrated the value of cross-sectoral approaches in solving complex issues. During the course of the project, professionals and service users consistently expressed a desire for more cross-sectoral work.
In the Kyrgyz Republic, UNICEF will expand its equity approach focused on reaching the most vulnerable and disadvantaged children and families. The process will take place at two levels: all UNICEF programme areas in the country will integrate equity approaches into their ongoing work; in parallel, UNICEF will, with funding from DFID, support equitable implementation of social policies across sectors in a further 55 municipalities, modeled on the experience in the pilot described here.
The process of replication and scaling up at national level will depend in part on buy-in to the equity-focused approach at policy and decision-making levels, which should ultimately be reflected in the relevant national strategies. Political will is also necessary at the local level to ensure inclusion of the equity approach in local development strategies, along with appropriate funding.
Given that the dynamics described above regarding discrepancies in policy implementation are unlikely to be unique, the Batken project experience, with its strategy of evidence generation, capacity-building of service providers and empowering families with knowledge and skills, has significant potential for broader application in other countries and contexts.
UNICEF is already engaged in expanding the equity approach tested in Batken to 55 municipalities across Osh, Jalal-Abad and Batken provinces. This may require some modification to respond to local contexts and needs. UNICEF Country Office has therefore conducted rapid assessments of the 55 municipalities, collected statistical data from each municipality which will be later graphically mapped to supplement the analysis. A cost benefit analysis of the project will also be carried out, providing a new perspective on the intervention logic and programme design. Additionally, a number of sector-specific data collection activities are under way, including a KAP study with youth, and awareness surveys on health and social protection. The results of these various assessments will be analyzed and appropriate tweaks to programme design will be incorporated as the project moves beyond the inception phase.
In the medium to long term, UNICEF is planning to work with the Kyrgyz Government and other partners to improve legislation and policies to benefit the most disadvantaged children and families and to ensure those policies are implemented at the local level. Meanwhile, UNICEF will continue to monitor the provision of existing services and their impact on achieving MDGs, and to support institutional reform with tailored capacity building activities to ensure the equitable inclusion of vulnerable and poor children and their families.