INTEGRATEDSAFEGUARDSDATASHEET APPRAISAL STAGE I. Basic Information Date prepared/updated: 12/30/2013 R~portNo.: 84082 1• BaSIC ' Data . Pro.iect ., Country: Timor-Leste I Proiect ID: P145491 ' Proiect Name: Community Driven Nutrition Improvement Project Task Team Leader: Eileen Brainne Sullivan Estimated Aooraisal Date: January 8, 2014 Estimated Board Date: N/A Managing Unit: EASHH Lending Instrument: Trust Fund Sector: Health (50%), General Agriculture, Fishing, and Forestry (25%); General Water, Sanitation, and Flood Protection (Z5%) Theme: Nutrition and Food Security (1 00%) IBRD Amount (US$m.):. 0 IDA Amount (US$m.): 0 GEF Amount (US$m.): 0 PCF Amount (US$m.): 0 Other financing amounts by source: BORROWER/RECIPIENT 0.00 JSDFTF 2.71 Financing Ga12 0.00 2.71 Environmental Category: B I Simplified Processing Simple fl Repeater fl Is this project processed under OP 8.50 (Emergency Recovery) Yes [] No [X] or OP 8.00 (Rapid Resoonse to Crises and Emergencies) 2. Project Objectives The proposed Project Development Objective (PDO) is to improve nutrition practices targeted to children under the age of two and pregnant and lactating women In targeted least developed communities. 1 In order to acheive this, the project will address the key underlying causes through: (i) community mobilization, awareness raising and participatory planning (about malnutrition, its causes and consequences); (ii) community led delivery of nutrition-specific interventions (focusing on the four interventions 2 identified. by the Lancet series that encourage changes in behavior to improve nutrition) ; and (iii) community led delivery of nutrition-sensitive interventions.3 By linking both 1 TimC?r teste has 13 districts, 66 sub-districts, 442 sucos (villages) and 2336 aldeias (hamlets). Community in !his CN refers to aldeias 2 Raew, Kathryn et al. (2012). A Life Free From Hunger: Tackling Child Malnutrition. STC. London. 3 As defined wilhin the Scaling Up Nutrition (SUN) framework, nutrition-specific interventions are programs and plans !hat are designed to address the direct causes of malnutrition and to have a specific impact on nutrition outcomes, These Include: support for eKclusive breastfeedlng; appropriate complementary feeding; micronutrient fortification and supplementation; and treatment of acute mainutrition. Nutrition-sensitive approaches are strategies and plans that address !he underlying and basic 1 nutrition specific and sensitive interventions through·. multi-sectoral approaches, the proposed project will achieve wider and more sustainable improvement in the nutrition status of target populations. 3. Project Description Component 1: Community Mobilization. Awareness Raising and Participatory !>Janning (USD 0.34 million). The objective of this component is to increase community's understanding and participation in identifYing and addressing malnutrition. The Component 1 objective will be achieved through the following strategies: (i) district and sub-district level orientation of project objective and identification of target communities; (ii) orientation of project objective at suco level in consultation with suco councils; (iii) participatory mapping of key issues in child malnutrition at community level (e.g. types, causes and impact as well as options to address to malnutrition based on gender analysis to understand the roles of women and men in decision making); (iv) community-led participatory planning including nutrition-specific and sensitive intetvehtions a,nd selection of community volunteers to be members of each Care Group.4 Expected outputs under this component will include: (i) finalized detailed implementation plans; (ii) a complete list of district-endorsed target communities; (iii) completed participatory appraisal/assessment events by all target communities; (iv) a list of Care Group volunteers and existing community health volunteers/workers (e.g., Promotor Saude Familia (PSF)) from each community; and (v) action plans for community led interventions to be carried out under Components 2 and 3. Under this component, the implementing agency, Catholic Relief Services (CRS) and its local partners (e.g., Civil Society Organizations5, etc.) will be responsible for facilitating project orientation, coordination and participatory planning processes at the national, district, suco, and aldeia levels. This component will take into account the roles and responsibilities of all actors and institutions at the different levels and leverage strengths of various actors to sustain the delivery mechanisms. The project wilr work in close consultation with the different entities including newly formed Council for Food and Nutrition Security and Sovereignty to compliment other initiatives addressing malnutrition; and the Nutrition Working Group at national level and district health and agriculture departments at district level. causes of malnutrition and take into consideration the cross-sector impact of nutrition including those related poverty reduction, education, agriculture and improved sanitation. 4 A Care Group is part of a cascading health promotion model made up of beneficiaries (i.e., caregivers), care group volunteers (from target communities), community facilitators (from local partners) and overall supervisors (from local partners). Under the overall technical support of the Implementing agency, communities facilitators trained in key health promotion messages will meet with care group volunteers twice a month to share a set of heaiU1 promotion messages. In tum, each care group volunteer promotes · positive behaviors to the target mothers/ caregivers the volunteer is responsible; In order to minintlze turnover, care group volunteers will be selected by community leaders/beneficiaries: About IS-20% more volunteers will be trained to compensate turnover. 5 CSOs include local NGOs, faith-based organl2ations (FBOs), etc currently operating in the target areas. Local partners will be selected per the simplified World Bank Procurement/Consultant Guidelines for · Fragile and Small States (FCS). 2 ·component 2: Community Led Delivery of Nutrition Specific Interventions (USD 0.76 million). The objective of this component is to improve accessibility of community driveri nutrition specific interventions by the target households. While the Integrated Community Health Services (SISCa) and clinic-based initiatives to address malnutrition in Timor-Leste have made some progress they have not been able to reach the outlying households. Most of these households do not have frequent contact with pro.yiders of health services. 6 This project will incorporate aspects of the Care Group modbl that is able to multiply efforts through the use of community based volunteers that have shown promising results to improve .the level of global under-nutrition scale at a low cost in Africa. 7 CRS has experience in Timor Leste to reach large number of colJllllunities with high level of engagement from community facilitators/volunteers. This will be a mixed approach that will blend a volunteer-based strategy with the provision of incentives for CNE. The Component 2 objective will be achieved by: (i) providing Community Nutrition Coordinators (CNC's) with training of trainers (ToT) on nutrition and hygiene counseling and facilitating community led learning sessions; (ii) CNC's will train Community Nutrition Educators (CNE's) on nutrition and hygiene counseling and conducting home visits ana small group discussions; and (iii) CNE's will build relationships with households· and provide ongoing, individualized, dynamic counseling. Nationally, CRS will engage with the Technical Working Group for Nutrition within the Ministry of Health (MOH) so that training materials and Behavior Change and Communication (BCC) materials used in the field are aligned with the national nutrition strategy and existing initiatives. Based upon this consultation, CRS will create/adapt training materials for the ToT provided to CNC's and training for CNE's1 CNE's will be part of groups that meet monthly at the suco level for the nutritional learning sessions. They will also conduct home visits and small group sessions to provide promotion/counseling sessions, building awareness and inducing behavior changes around optimal infant and young child care and feeding, appropriate hygiene especially hand-washing, proper food preparation, disease prevention and treatment. A local partner implementing agency, will be contracted to lead training of CNE's, with technical support provided from CRS in close collaboration with the MOH. The volunteers will also be responsible for encouraging households to attend monthly SISCa events and work to support and collaborate with existing community health promoters (PSF's). Expected outputs include: (i) training plan and finalized curriculum/manual for training of trainers; (ii) approximately 500 CNE trained on nutrition and hygiene promotion and facilitating counseling sessions; (iii) Community Nutrition Learning Sessions conducted in 50 sucos; and (iv) 70% of targeted households receive counseling either via home visits or small group sessions. Component 3: Community Led Delivery ofNutrition-Sensitiye Interyentions (YSD 1.14 million). The objective of this component is to improve accessibility of selected nutrition 6 TLSLS 2007 1 Davis, Thomas P. et al. Reducing child global undernutrition at scale in Sofala Province, Mozambique, using Care Group Volunteers to communicate health messages to mothers, Global Health: Science and Practice 2013. 3 sensitive activities that address the underlying causes of malnutrition and create an enabling environment for households and communities to engage in the behavior change for improved nutritional outcomes. Under this component, communities will implement their community action plans. The communities select one of three options that best address their needs, interests and natural resources. These three nutrition sensitive interventions have been identified as having the most promising effects on leducing maternal and child malnutrition8• CRS Timor-Leste experience with commmiity based projects has shown increased participation and better outcomes when the community is provided with limited number of interventions to select from that address the community prioritized problems. A recent review of nutrition sensitive agriculture interventions of Timor-Leste9 identified the following as having positive impacts on nutritional outcomes at the.household level: (a) increasing the availability and production ofbio-fortified foods such as orange flesh sweet potato; (b) increasing vegetable production and homestead gardening combined with nutrition education; and (c) increasing aquaculture production, post-harvest handling and storage. This information was used to create the three nutrition sensitive intervention options for this component. The three options are 1) increased availability of nutritious staple and minor crops; 2) increased availability of vitamins and diversified food through homestead gar~ens; 3) increased availability of protein and Omega 3 through creation of household level fish ponds. Each of these interventions will contribute to dietary diversity (measured. as number of food groups from which individuals consume) and increased meal frequency. They will increase the availability of carbohydrates, micronutrients, proteins, and essential fats. Additionally, these options contribute to two of the five objectives of the Strategic Development Plan of the Ministry of Agriculture: Objective! - sustainbble increase in the production and productivity of selected crops, livestock species, fisheries and forestry; and Objective 5 • enhance sustainable resource conservation, management and utilization. Community led delivery of nutrition-sensitive interventions chosen by the target communities will only be initiated after verifying that (i) targeted beneficiaries in the communities have been mapped; (ii) communities have selected volunteers and participating households under Component 2; (iii) selected volunteers have been trained; and (iv) communities have organized at least three CNEs sessions and at least 70% of participating households engaged in either home visits or small group sessions (for which multiple members of households are expected to attend). All Component 2 relevant activities will nonetheless continue upon triggering Component 3. Verification of successful completion of the conditional criteria set forth in Component 2 will be the responsibility of the implementing agency. The conditionality of this component is based on the premise that the proven interventions in Component 2 for improving nutrition are necessary and urgent during the first 1000 days of life. Since existing structures, incentives and health schemes have not been sufficient to adequately increase their 8 Tung, Curran and Fanzo (2013) "Nutrition Sensitive Agriculture for Timor-Leste: A Compendium of Resources" 9 Tung, Curran and Fanzo (2013) "Nutrition Sensitive Agriculture for Timor-Leste: A Compendium of Resources" 4 adoption at the household and community level, this project will pilot the effects of conditionality on community development initiatives that have shown to have a higher demand. Execution of the component will be done by community members encompassing all members of the households targeted, assisted by Agricultural Coordinators (AC), CNEs, consulted with suco councils 10 and facilitated by the local NGO with support from the Ministry of Agriculture (MAF), MOH (including District Health Teams) and others as needed. Expected outputs include: (i) technical specifications and guidelines for each option of interventions; (ii) 200 communities with necessary inputs, training and demonstrations provided; and (iii) 200 communities completed the intervention(s) per plan. Component 4: Monitoring, Evaluation. and Project Management (USD 0.48 million) The objectives of this component are to: (i) provide technical advisory services and other material support to facilitate implementation of nutrition specific and sensitive interventions by target communities; (ii) improve coordination among various actors through creation of communication flow map (e.g., ministerial counterparts, district teams, sucos, aldeias, etc.); and (iii) strengthen monitoring and evaluation activities associated with the verification and measurement of project results at the community level. Monitoring implementation plans, supervision, and verification of de!iverables lies with CRS. Expected outputs include: (i) a simple results framework to direct supportive supervision of project implementation and monitoring system to facilitate systematic data collection, project implementation, coordination of multiple local implementing agencies, and ensure beneficiary accountability through feedback mechanisms for. community use of monitoring data; (ii) quarterly progress reports including unaudited financial reports; and (iii) implementation completion and results report incorporating results of the final evaluation. The Monitoring and Evaluation (M&E) system will incorporate the community monitoring component to ensure beneficiary accountability and community ownership of information gathered and analyzed. The output indicators will be verified and finalized under Component 1 of this project, allowing communities to decide what information they want to record and monitor throughout the subsequent components of the project. CRS will be responsible for contracting services for carrying out baseline and end·line surveys to measure the effects of the intervention on the targeted communities and households. Secondary data from existing sources such as the Demographic and Health Survey as well as the National Nutrition Survey for Timor-Leste conducted by UNICEF will also be used in the analysis of project level data so as !ISSess the strategies to be scaled up after the completion of the pilot period . . -y 10 Suco Councils are made up of the Suco Chief, the Aldeia Chiefs, two women representatives, two youth repre,sentatives (one male and one female) and one representative of the Lia Naln, who are traditional authorities in each Suco. 5 4. Project Location and salient physical characteristics relevant to the safeguard analysis The project will target all communities (i.e. 287 aldeias) in 50 sucos that fall in the two lowest living standard groups 11 in the two eastern districts of Baucau and Viqueque. 12 These two districts have significantly higher proportion of sucos with the lowe"st living standard group. 13 The project will primarily benefit an estimated number of 4,470 children under the age of two and 5,503 14 pregnant and lactating women by increasing demand for and utilization of nutrition specific and sensitive interventions. The project will aim to achieve universal targeting of all children under the age of two and all pregnant and lactating women in targeted aldeias. Adding in the nutrition sensitive interventions, the project will benefit an estimated 70,000 people within those target communities, as well as 1,000 service providers 15 who will also benefit from a community driven interventions(s) indirectly improving nutritional status and training, respectively. S. Environmental and Social Safeguards Specialists Mr. Virza S. Sasrnitawidjaja (BASIS) Ms. Francisca Melia Setiawati (BASIS) 11 Asian Development Bank (2012). Timor-Leste's Least Developed Sucos 12 While Oecussi has the highest proportion of sucos in lowest living standards, the proposed Project will target Viqueque and Baucau given the fact that it is a pilot project requiring a lot oftechnical assistance by the implementing agency and travel time between Viqueque and Oecussi is substantial. 13 The total number of population within the target area (i.e., sucos falling in the two lowest quintile in Baucau and Viqueque) Is 72,305. The estimated number of children under the age of two living in the target areas based on DHS 2009/2010 and the Asian Development Bank's analysis is 4,470, while Census 2010 shows a higher number of children under the age of two (-7,0000). 14 An average rate of women aged 15-49 currently pregnant in the lowest two wealth quintiles is 7.35% (DHS 2009/20 I0). Based on the population within those two quintiles in the target area, an additional I,033 pregnant and lactating women will be targeted, in addition to the 4,470 households with children under age two. Adolescent girls aged 15-19 within the targeted communities wilf also be encouraged to attend any nutrition education/counseling sessions. "Service providers include community health workers (PSFs), agricultural extension workers (SEOs), community facilitators from Implementing partner staff and Care Group volunteers. 6 6. Safetmard Policies Tri~.ttzered Yes .No Environmental Assessment (OP/BP 4.01) X Natural Habitats (OP/BP 4.04) X Forests (OP/BP 4.36) X Pest Mana~.tement (OP 4.09) X Physical Cultural Resources (OP/BP 4.11) X lndi~.tenous Peoples (OP/BP 4.10) X Involuntary Resettlement (OP/BP 4.12) X Safety of Dams (OP/BP 4.37) X Proiects on International Waterways (OP/BP 7.50) X Projects in Disputed Areas (OP/BP 7.60) X II. Key Safeguard Policy Issues and Their Management A. Summary ofKey Safeguard Issues 1. Describe any safeguard issues and impacts associated with the proposed project. IdentifY and describe any potentia/large scale, significant and/or irreversible impacts: The project focuses on community mobilization/awareness raising (Component 1), communit-based health and nutrition education and promotion (Component 2), and other interventions that will help the community members exercise practices that can eventually improve their nutritional status (Component 3 - i.e., nutrition sensitive interventions). The physical investment of the project will be in small scale or households scale type of ·agricultural activities to improve the nutritional content of the communities. The .likely types of investment that will be supported under Component 3 are promotion of organic and environmentally friendly garden farming, such as self-generating compost and organic pest control (integrated pest management); small garden size fish ponds and/or tank/used drums aquaculture in community lands. No pesticides or herbicide will be supported under the project; this and other activities that are not allowed by the project are listed in the project's negative list. The potential environmental impacts of the investments will be minimal, localized, and will be managed by adopting the best environmental practices, The implementing partner will prepare the ECOPs (environmental code of practices) as the environmental instrument, for each activity that will be promoted to the communities as a menu of options, upon which they will decide which one is more appropriate to their respective environmental conditions, as well as local livelihood practices. The ECOPs will be disclosed in both English and Tetum Language, and included in the Project Operation Manual (POM). Given that this is a CDD project no involuntary land acquisition and resettlement is envisioned. Thus the project does not trigger OP 4.12. Most of the physical investment of the project will be on household scale in the form of small scale homestead gardening or fish pond by utilizing the beneficiary's own land/home. garden to increase existing vegetable/livestock/aquaculture production. Any land acquisition, if needed, will be done on voluntary basis. If community demonstration plot is included in the final list of 7 interventions to be supported by the project, the project will use small pieces of government or community land, or if government land is not available, the project will temporarily rent voluntarily individual land for demonstration plots.. The process of determining land for community demonstration ·plots will be conducted through a participatory process to ensure that all stakeholders are involved. The project will document step-by step the consultation process in the Project Operation Manual (POM) to ensure any transactions are indeed voluntary. All consultation process~ will be documented. The project is triggering the Bank's Indigenous People Policy (OP 4.1 0), Ethnicity in Timor Leste is bound by language. Seventeen languages, derived from one of two broad language groups - Austronesian (Malaya - Polynesian) and Papuan (Melanesian) - are spoken across the country. The project will prepare a Social Assessment based on an existing, thorough and information Social Assessment carried out by ADB indicating that no significant difference of cultural and social identity exist among the people who speak different languages. Since· the project will have In~igenous People as overwhelming · beneficiaries, a separate Indigenous People's Plan (IPP)/Indigenous Peoples Policy Framework (IPPF) is not required. Since the overwhelming majority of the beneficiaries are IPs, the project design will incorporate the elements.ofpolicy requirements, such as in Project Operational Manual (POM). The project uses an existing ADB's social assessment that provides .thorough and informative social and economic profile of all districts in Timor Leste as a baseline. The project location is in the two Eastern Districts· of Baucau and Viqueque. ·The Macasae language is mother tongue of 70% of the population in Baucau