Page 1 REPUBLIC OF CONGO HIV/AIDS AND HEALTH PROJECT ADDITIONAL FINANCING Indigenous People’s Planning Framework (IPPF) 1. The HIV/AIDS project, like the IDA-supported Health sector project (PDSS) is countrywide and includes support for the Pygmies. OP 4.10 was therefore been triggered for the PDSS and the IPPF prepared. Although the PLVSS originally did not trigger OP4.10, it has been done for additional funding and will build on ongoing activities under the health sector project. 2. The Pygmies were the first settlers in Congo and reside mainly in three Departments – Likuala, Sangha and Cuvette. They reside in rural forested areas where health care access is poor. There is general lack of health infrastructure in these departments, and the Pygmies rely predominantly on Traditional Medicine. Although specific data on Pygmies is lacking, the Demographic Health Survey (2005) confirmed higher maternal and child mortality in rural areas. This and the very low literacy levels and poor access to health services point to higher mortality rates among Pygmies than in the rest of the population. They are also more vulnerable to most common diseases and have a shorter life expectancy. HIV/AIDS is not yet an epidemic amongst the Pygmies, and the groups of people living with HIV/AIDS are supporting prevention activities. In addition, the Ministry of Health (MSASF) is currently organizing outreach activities, supported by specific disease initiatives. For example, leprosy is more common in Pygmies leading to a special focus on this population by the national program. This project had already initiated preventive activities for HIV/AIDS and intends to build on existing interventions in order to expand access to quality of services and reduce morbidity and mortality in this group. The PDSS PSE has been specially adapted to suit their special circumstances, with emphasis on voluntary participation, ownership and sensitivity to local cultures. 3. In this project, the Pygmies are identified as potentially vulnerable and therefore given special attention in the planned interventions. This is in line with the Government of Congo’s policy to promote their issues and respect their rights within the Congolese society. A draft law for Pygmy protection and integration is under discussion in Parliament. The PDO specifically targets vulnerable groups and takes this to the next level in Components 1, 2 and 3 to ensure equitable access to services to vulnerable and undeserved groups, such as the Pygmies, youth, commercial sex workers and uniformed personnel. Building on work already done under PVLSS and initiated by PDSS, additional effort will be made to identify barriers to service delivery, participation and equity for these groups, including the Pygmies. The findings will strengthen delivery of effective interventions for the Pygmies. Component 3 aims to build local ownership and community participation in prevention and delivery of services. Under this component, local NGOs working with the Pygmies, and with support from UNICEF, will be contracted to build the capacity of the Pygmies to participate in articulating their special needs. This will include improving capacity of health facilities to manage HIV/AIDS and opportunistic infections, establishment of outreach services and strengthening of prevention programs, health education and behavior change communication. Finally, the project has identified specific indicators that will be monitored on a continuous basis by the SEP/CNLS, MSASF’s M&E unit and specific IPP360 Page 2 Departmental Management teams (UDLS) to inform on progress among the Pygmies and other vulnerable groups. 4. During project preparation of PDSS, consultations were held with UNICEF and groups of NGOs (Medicins Afrique) that are already working with Pygmies. UNICEF is the lead agency on Pygmies and health in Congo and the project will work closely with them. They had prepared a document on Pygmies health. These were followed by special meeting with Pygmy groups in the three Departments, building on the process that had been initiated under the HIV/AIDS and Health Project. Some of the concerns addressed included Pygmy inclusion in decision making during project planning and execution, identification of change agents among Pygmies, utilization of schools as an entry points for health education, training of Pygmy community health workers as part of the Community subcomponent and provision of health care, especially MCH to mobile groups. The concerns are addressed in the project design, especially in components 3 and 4 of this project and PDSS respectively 5. The Pygmy leaders met during the preparation of PDSS and the implementation of PLVSS are: Guillaume Daloté Pygmy chief Enyelle (Likouala) Likaka Pygmy Imphondo (Likouala) Nzakama Pygmy chief Mimbelly (Likouala) Bolombo Propriétaire terrien Enyelle (Likouala) Mabonda Pygmy living in Brazzaville Bobianga Pygmy living in Brazzaville Fernand Nuki Pygmy living in Brazzaville Page 3 Action Plan Activities Responsible Costs in CFA Time frame Indicator Rapid assessment of Pygmies awareness, health status and access to information and services MSASF/DD S/DGAS/CN LS.UDLS 10 000 000 1st year Assessment report Consultations with Pygmy communities MSASF/DD S/DGAS/Pre fects/UDLS 50 000 000 Appraisal, & Annually Consultation reports and consensus Capacity building of Pygmy leaders and Health and HIV/AIDS committees MSASF/DD S/DGAS/UD LS 100 000 000 1st, 2nd and 3rd year # of leaders and groups trained Training of Pygmy Community Health Workers (CHW) MSASF/DD S/DGAS/UD LS 100 000 000 1st, 2nd year # Pygmy CHW trained Development of IEC and BCC materials for Pygmies on PSE MSASF/DD S/DGAS/CN LS 50 000 000 1st, 2nd year # IEC/BCC materials developed Monitoring at national, regional and local level MSASF/DD S/DGAS/CN LS 20 000 000 During project Project Mid-term monitoring and final evaluation Consultant 10 000 000 3rd and 5th year Project Total of costs 340 000 000 (CFA)