29 July 2005

DPRK RC & International Federation

Operations

Final Report

Strategic Review 2005 Chris Hurford, consultant and team leader

Dr Munawar Sher Khan, consultant

Knud Falk, Danish RC

In full cooperation with the Red Cross of the Democratic People’s Republic of Korea.

JULY 2005

contents executive summary context 1. introduction 2. the wider context the review 3. health 4. water/sanitation 5. disaster management 6. organisational development 7. International Federation and partner National Society support towards a future strategy 8. key issues 9. overall strategic framework 10. achieving the objectives 11. programme strategies and recommendations 12. next steps for the DPRK RC/Int Federation operation 13. towards a CAS process annexes A. source documents B. people consulted C. medical supply components of the health programme D. the water/sanitation programme by province E. the disaster management programme by province F. abbreviations and glossary G. inter-agency sectoral strategies H. terms of reference

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29 July 2005 Executive Summary

Background Humanitarian overview Although there have been significant improvements since the famine and flood conditions of 1995, DPRK is still considered to be suffering an ongoing humanitarian emergency. All recent assessments have substantiated this view. There are chronic food shortages for much of the population. Malnutrition in children has fallen since 1998, but this is still at a worryingly high rate. Diarrhoeal disease and respiratory infections are the major cause s of childhood illness and death – and here there have been little or no improvements over the past decade. State health and welfare provision continues to suffer from significant under-investment, with chronic shortages of pharmaceuticals and medical equipment. Poor water and sanitation is becoming recognised as perhaps the major cause of ill health and childhood malnutrition. Drought, rapid water run-off and poor retention have led to decreased supply, whilst the absence of major investment in the infrastructure has led to major water loss within the system. Sewerage pipe leakage and poor latrine design and maintenance are causing contamination and poor vector control. There is inadequate hygiene promotion and good practice. Disasters in DPRK (mainly floods and storm surges) affected 187,000 people in 2001, 66,000 in 2002 and over 200,000 in 2004. Agricultural outputs are affected, contributing to the food shortage. The train explosion in Ryongchon was a reminder that technological disasters are also a key hazard. Economic losses due to disasters range from 1 to 15 billion USD per year. The DPRK RC The DPRK RC is the only indigenous organisation with national coverage that is formally distinct from government. As such it offers unique opportunities as a national counterpart for international humanitarian actors. Founded as an independent voluntary humanitarian organization in 1946, the DPRK RC has 10 provincial and 200 city/county level branches. It is the largest humanitarian organization in the country, with a network of 330,000 volunteers and 371,000 Red Cross youth at the community level and over one million members. The International Federation The Int Federation is one of the three most significant international humanitarian actors in DPRK (together with WFP and UNICEF). Its operation in DPRK has been one of its largest country operations anywhere in the world. Together with the DPRK RC, the Int Federation provides basic medicines for around one third of the population, has implemented over 150 wa ter and sanitation projects benefiting up to 400,000 people, and supports the country’s largest non-governmental health promotion and disaster management programmes. It also supports the organisational development of the DPRK RC. There are currently nine delegates supervising a programme with a 13.5 million CHF budget. Purpose of the Strategic Review According to the Terms of Reference, the purpose is to analyse the strengths and challenges of the DPRK RC/Int Federation operation over the past four years and

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make clear recommendations for the future scope and direction of international assistance in the next 3-5 years. Findings Despite the constraints of a complex working environment, the DPRK RC and its Red Cross partners have provided consistent and appropriate levels of assistance over the past four years. The overall impact of the operation on vulnerability in DPRK appears to be significant, and the Red Cross has become a major and well-respected provider of humanitarian assistance in the country. The International Federation has correctly pursued a policy of engagement and solidarity with the DPRK RC at a time of increasing complexity within the international political sphere. The joint programmes under review (Health, Water/Sanitation, Disaster Management and Organisation Development) have been well-targeted and focused, and have as far as possible aimed at principles of capacity building and community-based action. There have also been significant improvements in the structure, capacities and competencies of the DPRK RC, partly as a result of the support it has received through this operation. In general, the International Federation has managed its implementing and coordination functions well. Support from the DPRK RC’s partners, and from back donors (particularly ECHO) has been consistent and of high quality. However, the focus on ensuring delivery of the programmes has led to the operation becoming somewhat mechanistic. Strategic and analytical capacity in the overall management of the programmes could be improved, particularly by the Int Federation . This threatens the continued success of the operation for two main reasons: the programmes may lose their focus on providing services to the most vulnerable in the most efficient way; and the funding and strategic positioning of the operation may lack an ability to negotiate and adapt to any future changes in the operating environment. Given the scale and significance of the operation, it is important that the Int Federation’s Secretariat and its regional delegations, together with partner NS, help the delegation and the DPRK RC in a concerted effort to better integrate, position and sustain the programmes for the future. It is hoped that this review might act as a focus and a foundation for a revised joint strategy to ensure the continued strengths of the operation. The Health Programme • The Int Federation and partner National Societies have provided extensive and

consistent coverage of drugs and essential health items that has impacted on the health needs of the vulnerable in around one third of the population of DPRK.

• This review concurs with the recent ECHO Review that health sector programming (including the RC programme) is “relevant, efficient and effective”.

• Timeliness and consistency of supp ly is also good (particularly when considering the eight month period from initial order to final delivery).

• The quality of the supplies appears to be good, with no major problems reported to the review team.

• Despite the risks and exposure that comes with providing large amounts of drugs over a long period, especially in a complex operating environment, there have been no serious proven instances of misuse or diversion of RCRC aid.

• CBFA is a strong element of the NS´ activities.

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• There has been a significant level of health and hygiene promotion, which has probably led to positive behaviour change and helped improve local health levels.

However: • The phasing out of the supplementary kits to secondary care institutions has left a

large and possibly critical gap in the coverage of basic medicines in the operational area , and should be reconsidered.

• The programme’s strategic qualities could be improved. Design, implementation, monitoring and reporting has become somewhat mechanistic.

• Vertical programming rema ins a problem. Despite repeated findings of previous reviews, activities need to be better integrated with other programmes.

• There is a need to improve inter-agency programming and strategies. There is little cooperation on joint strategies, policies and lobbying approaches to MoPH regarding DPRK’s priority health issues nationally.

• A more strategic dialogue between agencies would also help address key operational issues, such as harmonizing medical supply programmes across different operational areas.

• Coherence within the CBFA training could be improved . Courses tend to overlap and repeat information.

• The DPRK RC’s position on its role in HIV/AIDS awareness could be more robust. • Reproductive health is not fully incorporated into primary health care

• It is difficult to gain a complete and coherent picture of the entire programme and the strategy that drives it. In this sense, the programme is not well communicated .

Water Sanitation • This review concurs with previous studies that the programme has made a

significant impact on improving health in the targeted rural communities. • Interventions are relevant and appropriate to the needs of rural communities, and

adequate selection criteria for this target group have been applied. • Overall the programme seems to have been effective in reducing health risks in

the communities or households that it has served. • There is a high degree of involvement and ownership by the beneficiary

communities and local and national government in the implementation of projects. • The DPRK RC offered added value and unique opportunities through its branch

structure: it was effective in reaching the target population. • There appear to be high levels of beneficiary satisfaction. • The programme has added significant technical capacity in th e NS, and has

enhanced DPRK RC’s image, particularly within beneficiary communities and provincial and central Government departments.

However: • Whilst largely successful within its original objectives, the programme may not be

adapting to emerging priorities in water-related disease: that is: a) sanitation, and b) vulnerabilities in less rural communities.

• A focus on delivery to individual homes in small rural communities has limited beneficiary numbers. Cost efficiency has also been reduced. This would have been improved through more interventions in institutions and larger communities.

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• The focus on relatively time- and cost-intensive sanitation interventions has limited the number of people benefiting from improved sanitation facilities.

• There has been no assessment to gauge the comparative benefits of a range of domestic and collective water and sanitation solutions.

• The application of innovations and lessons learnt by other agencies and NGOs is not evident in the RC’s wat/san programme.

• Issues of gender are not evident in site selection, implementation or reporting. • Project hand-over arrangements with local authorities/communities are unclear. • Hygiene promotion components are not evident in programme reports. L inks with

the health programme should be better communicated. • Analysis of each intervention’s impact upon local health levels should be

improved, using a wider, more innovative range of indicators. Disaster Management • The DPRK RC is progressively building national response capacity. • The DP activities carried out by the DPRK RC proved relevant and very useful. • The DPRK RC has gained a high profile by being the first to respond to a number

of disasters. Red Cross volunteers have played pivotal roles, with regional and HQ stocks and coordination capacities also proving invaluable.

• Efforts put into training a large number of people have been effective . • The NS has improved national capacity and inter-agency collaboration by setting

up the Disaster Preparedness Working Groups and the National Disaster Response Teams.

• The NS has successfully moved into Community-Based Disaster Preparedness. 19 communities have successfully implemented small-scale mitigation measures.

• The DM capacity of the NS has developed steadily over the past 4 years. However: • The Disaster Preparedness Working Groups and National Disaster Response

Teams need time to become integral components of the NS’ capacity. Their role need to be better understood by stakeholders at provincial and county levels.

• DPRK RC contingency planning at national level need improvement, as do coordination procedures with the delegation during sudden-onset emergencies.

• There is room for the Red Cross to encourage better local contingency plans and early warning systems with other stakeholders.

• Some of the CBDP mitigation projects are major infrastructure rehabilitation projects that are outside the scope of RC intervention.

• Communities need regular follow-up support after a CBDP project to maintain readiness in the long term.

• Current plans for roll-out of CBDP are too ambitious in wanting to reaching 100 Ris by 2007, and do not reflect branch capacity.

• The RC’s position is unclear on road safety – a growing issue . • The process of integrating the CBDP training curriculum with Community-Based

First Aid Training has slowed, and no concrete outputs are yet in place.

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Organisational Development • The OD programme has added capacity in the NS’ restructuring process, in its

expertise in the four programme areas, in developing headquarters staff programming and management abilities, and in the adaptation of global Red Cross and other best practices and innovations.

• The OD process has been internally driven by the DPRK RC, and the OD programme has appropriately supported this process.

• The DRPK RC’s highly strategic and planned design and evolution of its own OD process provides a ‘model’ example for other NS.

• The restructure of the NS happened efficiently and effectively. • The training centres in pilot branches offer considerable opportunities for training,

dissemination and staff and volunteer motivation. • The NS is conscious of the main challenges within the OD process, and has

repeatedly made strategic attempts to address weaker areas such as branch development, finance management, and communications.

• The Int Federation has played a valuable role in specialised knowledge sharing. However, • While capacity has clearly increased overall, there is little coherent analysis or

documentation on the impact of OD inputs over the past 4 years. • The extent of cross-learning of OD initiatives between branches is unclear. • There has been relatively little emphasis on issues around the concept,

mobilisation, development and retention of volunteers. • The approach to resource mobilisation is too narrowly focused on micro-business

income generation projects. • There would appear to be deep and institutional blockages to progress on

modernising the DPRK RC’s financial management systems. • There has been little attention to the NS’ youth activities and structures. • As with the health programme, the OD programme lacks updates, summaries of

progress and reporting against original objectives. • Similar objectives appear in successive Int Federation appeals, but with no

analysis of constraints to make the case for repeated funding requests. • The flow of ad hoc, spontaneous or small-scale technical support has been

limited. Management of the Operation

• Overall, the Int Federation delegation has performed well over the past four years, particularly given the size of the operation, the complexities of the operating environment and limitations on delegate numbers. It has overseen largely successful programmes in terms of delivery.

• The resources of the joint NS/Fed operation seem to have been well managed.

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• Good relationships with other humanitarian actors and with authorities have been developed and maintained.

• A core group of partner National Societies have been committed partners of the DPRK RC and the delegation over the past four years.

However:

• The operation appears to be caught between the intense demands of programme implementation and the need for higher level, more strategic operational management, analysis and quality reporting.

• Balancing quality programme delivery, capacity building within the NS and satisfying donor accountability demands has been a major challenge.

• The Int Federation has not been able to solve the long-running problem of vertical programming. A lack of managerial expectation, structural changes within the delegation and procedural changes to programme management has meant that there has been no definitive solution.

• Despite the size and impact of the operation, the delegation is somewhat isolated in terms of strategic and operational management oversight and support from Geneva and the Beijing Regional Delegation.

• On the other hand, the delegation’s focus appears to be very ‘locked in’ to DPRK. There is insufficient management reporting to the Regional Delegation in Beijing or to Geneva.

• With some exceptions, there is limited strategic engagement between the delegation/DPRK RC and partner NS supporting the operation, outside of programming concerns that affect partner NS’ ability to report to back donors.

Recommendations Overall Strategic Framework Suggested Goals • Ensuring that the needs of most vulnerab le are addressed by the appropriate

authorities and agencies, and by the Red Cross as necessary

• A well-functioning NS, with core focused services that are sustainable nationally Objective 1: Improve quality of programming Continue to consolidate DPRK RC’s aid-related programming

• The joint DPRK RC/Int Federation programmes are currently of an appropriate scale and are appropriately targeted. There should be no overall change in the current portfolio unless there are significant changes to vulnerability in DPRK.

Greater focus on targeting the most vulnerable

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• The larger-scale programmes should be more flexible to local needs through, for example, a wider range of wat/san solutions.

• This will also entail building the capacities of volunteers and staff through existing programmes to have common capacities in conducting vulnerability assessments

Programmes to adopt a clearer, more systematic capacity building strategy

• The adoption of common approaches to branch development, information management, finance development etc in each programme will contribute to better programme design, implementation, integration and reporting.

• The long term sustainability of the OD gains achieved in recent years through the DPRK RC/Int Federation operation will be enhanced if capacity building elements at all levels are incorporated into programming.

Improve capacities whilst meeting donor monitoring and reporting demands

• A more robust engagement with back donors is needed to lobby for acceptance of the validity of DPRK RC’s role in monitoring and reporting. This will require coordinated lobbying from the Secretariat, Liaison Bureau and partner NS.

• Consider opening a sub-office to improve field access, either with a programme representative, or a revolving delegate presence from Pyongyang.

• Innovative solutions to the monitoring issue should be explored, such as the use by DPRK RC monitors of photographic evidence.

Identify and apply both qualitative and quantitative impact indicators

• Existing data and observations that indicate impact should be better collated and communicated through programme reports.

• A specific impact study document for donors and other stakeholders would improve the business case for continued donor support.

• Demonstrating impact should be linked to increased support for improved reporting skills within DPRK RC. Reporting workshops should be increased.

Objective 2: Strategic phasing out of externally-funded aid programmes

• It is vital that there is regular and robust dialogue between Red Cross partners

and back donors on their medium-long term support strategies for DPRK.

• Seek to hand over the medical supply and wat/san programmes to development agencies and Government as soon as situation allows.

• Develop criteria and indicators that will allow programmes to be down-scaled according to reductions in vulnerability or increased provision from other actors.

• If the operating environment improves, increase bilateral programming, but in careful alignment to the growth of DPRK RC’s capacities (particularly in financial management, monitoring and reporting ) and its Development Plan.

Objective 3: Develop DPRK RC’s long term services and capacities

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• Continue and increase the development of DPRK RC’s core long term activities that can be sustained from national and community resources – particularly social welfare, youth, health promotion and disaster management.

• Better align OD initiatives to the assistance programmes at branch level.

• Continue to invest in key individuals at all levels.

• Ensure the sustainability of the DPRK RC’s core long term services by improving its legal base, and a more strategic approach to resource development.

Objective 4: Ensure continued back donor support:

• Improve the communication of how the programmes are structured, how they

function and more analytical reporting of progress against objectives and constraints.

• Increase the transparency and analysis of constraints to progress in reporting.

• The Secretariat should lead on a coordinated approach with partner NS to increase awareness-raising of the humanitarian situation in DPRK to counter possible future politicisation of aid funding.

Objective 5: Continued and improved quality of Int Federation support

• The significance of the Federation’s operation in DPRK demands higher levels of attention and support at regional delegation, Secretariat and supporting NS.

• This support should ensure that programmes are consistently able to adapt and maintain direction in the face of a complex and fluid operating environment.

• Coordinate a predominantly multi-lateral operation for the foreseeable future .

• Carefully align the speed of handover of programming responsibilities to the DPRK RC’s capacities.

• Strengthen the strategic/analytical role and capacities of the delegation , with increased support from regional delegations and the Secretariat.

• The current number of delegates should be at least maintained to provide adequate capacity to DPRK RC programming.

• Resolve the issue of vertical programming within the delegation. Clearly identify cross-cutting statistical analysis and impact indicators.

• The Int Federation should better utilise cross-agency sectoral meetings to debate joint strategies, policies and technical lesson learning.

• The delegation should instigate more focused tripartite meetings with the NS and ICRC on pre-identified issues.

Objective 6: Consistent and increasing support from partner NS • Develop a CAS process to ensure appropriate and long term support to DPRK

RC by the PNS, IFRC, ICRC and other actors.

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• Encourage PNS to identify their level of commitment to the DPRK NS (whether this is through financial or technical support) and to change donor government’s donor thinking by advocating on identified issues.

Programme Strategies Health Strategy

• Maintain the basic scale and logistics systems of the medical supply programme, with one exception – – if lobbying of other agencies fails to ensure basic secondary health supplies are covered, reintroduce the provision of supplementary kits.

• Focus on improving quality of analysis, programme integration, impact assessment, reporting and technical support to the DPRK RC.

• Aim to make medical supply more closely linked and tailored to priority needs, rates of consumption and health level patterns through better access and analysis of qualitative and quantitative data.

• Develop joint inter-agency policies/strategies concerning national health problems and operating issues with which to approach both the MoPH and donors. Redesign the programme if inter-agency discussions lead to changes in the way national coverage is achieved.

• Focus on the full integration of the health and wat/san programmes: increase management demands for closer linkages and enforce integration through programme appeal, management and reporting systems.

• Lobby for continued donor support for the medical supply programme at its current level (with the addition of supplementary kits) but phase out as soon as adequate provision is possible through the DPRK Government or other agencies.

• DPRK RC should define sustainable community-based health promotion and delivery activities that will become core NS services for the very long term as externally-funded aid -related health programmes diminish. These may include: first aid, hygiene promotion, HIV/AIDS awareness, and possibly a greater role in volunteer-based social welfare services.

• Continue to explore possibilities of in -country drug procurement if international standards can be ensured.

Water/sanitation strategy

• Re-emphasise the key criteria of vulnerability, cost efficiency and maximising resources for the greatest impact possible when deciding interventions.

• Therefore, widen the scope of the programme to include more densely populated (semi-rural) communities.

• Also consider increasing the number of collective water and sanitation interventions in institutions such as schools and hospitals.

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• Continue to seek developmental and sustainable solutions to wat/san problems, but develop a wider portfolio of technical options and clearer criteria for their use.

• High-impact interventions on mains water systems should be also considered.

• Int Federation wat/san delegates should focus on adding technical capacity for NS counterparts to oversee projects.

Disaster Management Strategy

• Consolidate the many new initiatives and expand more slowly in future, ensuring that lesson learnt inform future developments.

• Decrease reliance on HQ and improve the capacity of the branches in establishing skills for continued expansion of the CBDP approach.

• Ensure the quality and appropriateness of CBDP mitigation measures, including relevant use of reforestation as a targeted DM tool.

• Clarify and adjust the roles of the NS in relation to government agencies and other players, particularly in early warning systems, contingency plans, local response capacity, and coord ination regarding mitigation measures.

• As response capacity becomes mores rooted at the provincial level, refine the network of DM volunteer teams by targeting the county level, prioritising key counties and towns/cities.

• Explore how to move into traffic safety as a cross-sectoral activity of the NS.

• Maintain close collaboration with other departments so that all of DPRK RC’s long term activities follow a coherent risk reduction approach.

Organisational Development Strategy

• Continue in the direction laid out by the NS’ revised OD plan. Guide the programme using the DPRK RC’s Development Plan, and the Int Federation’s Framework for Capacity Building.

• The NS should focus on making a stronger business case for continued partner support through improved programme reporting, progress against objectives and constraints and analysis of impact on wider programming and vulnerability.

• Increase the integration of the OD programme with other programmes through better geographic and sectoral targeting of inputs, and through personal capacity-building of key management and governance.

• Increase attention on developing the volunteer base and RC youth, and their engagement in the NS’ assistance programmes.

• Revise the resource mobilisation strategy to include a broader approach to RM, a deeper contextual analysis and more realistic timeframes.

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• Prioritise requests for external support on the key areas requiring progress, such as financial management, resource development and branch support.

• Aim for sustainability of the programme by opening up the availability of OD support and lessons through more direct communications with the DPRK RC’s partners and through targeted peer support, facilitated by a CAS process.

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Context

1.1 Purpose of the Review The core purpose of the review can be defined as: laying the foundation for a joint DPRK RC/IFRC Strategy, and for a possible CAS process. According to the TOR,1 this strategic review should: • “analyse the strengths and challenges of the international programming

undertaken in the past four years” • “make clear recommendations for the future scope and direction of international

assistance in the next 3-5 years.” • be in line with the NS’ stated priorities, as defined in its Development Plan 2010. • find a joint way forward, with more integrated programming, future partner NS

involvement in the operation, and “new partnership principles and approaches”. 1.2 Structure After a brief contextual overview, the report is divided into two sections: The Review section consists of:

• a brief description of each programme, and the main findings given as strengths and challenges.

The Future Strategy section consists of:

• a discussion of key strategic issues;

• a suggested overall framework;

• strategies and recommendations for each programme;

• principles of Int Federation support and a CAS process. Thus, suggested strategies and specific programme recommendations are consolidated in the final section for easier reference when prioritising management decisions and delegating actions in the follow-up to this review. 1.3 Scope

• The review period is from 2001 to 2005, with a planning horizon to 2008-2010.

• The focus is on the areas of DPRK RC/Int Federation cooperation: that is, the four programmes within the Int Federation Appeals (Health, Wat/san, Disaster Management and Organisational Development).

• The wider activities of the DPRK RC are not reviewed, but are considered when looking at opp ortunities for future joint action .

• The review is not designed to review bilateral or ICRC cooperation in any detail. However, lessons that seemed valuable are incorporated into recommendations.

1 See Annex H

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• This was a joint DPRK RC/Int Federation exercise. It is therefore not an external or independent evaluation.

• This report can only lay the foundations for a joint DPRK RC/Int Federation strategy. The recommendations should be formally accepted or rejected by the operational partners in a management note. Only then can a definitive final strategy be drafted by the operational partners themselves.

1.4 Methodology There are well-documented difficulties in accessing and verifying even basic information in DPRK, let alone assessing the impact, effectiveness and efficiency of humanitarian interventions. Where specific and verifiable evidence of achievement or impact was not available, the team attempted to gain a view through processes of observation, deduction and triangulating a wide variety of interviewee comments and the findings of previous reviews. Where qualitative evidence was strong but quantitative proof was insufficient to be a definitive statement, conclusions are qualified by the words “appear to” or “probably”. Some of the limitations in reviewing impact and effectiveness were balanced by the fact that this review is the first to include a member of the host National Society. This enabled access to perspectives and knowledge unavailable to previous reviews. Moreover, the seniority of the DPRK RC team member enabled the NS to be fully represented in all the team’s findings and recommendations. The review methodology included:

• Extensive document review (see Annex A);

• Semi-formal interviews with the main RC and external stakeholders, as well as programme beneficiaries and branch staff and volunteers (see Annex B);

• Two weeks travel in DPRK, within the Int Federation ‘operational areas’ in North Pyongan, South Pyongan and Kaesong;

• An intensively participatory approach in discussing and agreeing findings. Extensive feedback sessions conducted with Federation and NS counterparts;

• Presentation/consultation of the draft findings and recommendations at the Int Federation East Asia Partnership Meeting in Ulan Baatar, May 2005. This allowed partner NS perspectives to be incorporated into the report.

1.5 Acknowledgements The degree of organisation and facilitation required to ensure that a strategic review runs smoothly in DPRK cannot be underestimated. We would like to extend our sincere gratitude for their assistance and generous hospitality to Mr Paek Yong Ho (Vice Chairman of DPRK RC), Mr Min Byong Gwan (Secretary General of DPRK RC), and Mr Choe Jung Gang (Head of the International Dept.) Many thanks to Alistair Henley (Head of Regional Delegation Beijing), to Jaap Timmer (Head of DPRK Delegation), and their teams for their commitment to this review, and the time and energy they expended in helping the team understand something of the operation. Finally our appreciation to Ewa Eriksson, Desk Officer in the Secretariat, for her support in all aspects of this review.

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2. The Wider Context 2.1 Socio-political In some ways, the situation in DPRK is similar to that of so-called ‘transition’ countries – particularly those affected by the collapse of Soviet Union or by the market reforms in China . For example, DPRK enjoyed a high level of development and prosperity in the 60s and 70s, but has recently suffered substantial economic decline, with chronic under-investment in the country’s infrastructure, power supply, social services and the modernisation of industry and agriculture . But, as the recent ECHO Review points out, DPRK “continues to pursue policies that no longer have parallels anywhere else in the world”.2 Given increasing international tensions on the Korean peninsula over the nuclear issue as well as a very specific socio-political system, DPRK is a wholly unique context for national and international humanitarian action. However, there are signs that the Government is aware of the need to improve the provision of social services whilst enhancing economic growth. In 2002 it introduced price and wage reforms which turned DPRK towards a more monetary, market-oriented economy. There have been experiments with economic zones (most recently the Kaesong Industrial Zone on the border with South Korea ) and official approval of limited private markets where an increasing range of items can be bought. Whilst this again could be seen to have parallels with change processes in China and elsewhere, it is difficult to gauge the strategies and long term plans that inform these developments. It is therefore very hard to predict how vulnerability, development assistance and the need for continued aid assistance will evolve in the medium-long term. Given that DPRK officially remains on a war footing, and that the government’s stated priority is military defence, it is likely that vulnerability, and the way in which it can be addressed, is ultimately dependent on wider political developments. 2.2 Humanitarian overview Although there have been significant improvements since the famine and flood conditions of 1995, DPRK is still considered to be suffering an ongoing humanitarian emergency. All recent assessments have substantiated this view. There are chronic food shortages for much of the population. 70% of households rely on the Government’s Public Distribution System, which delivers only around 50% of people’s daily energy requirements. Households spend 70% of income on food, but despite this and the use of various coping strategies, they are still not able to cover basic household requirements. Whilst overall crop production has recently increased by 3%, there is still not enough food to provide an adequate quantity of basic cereals for the population.

2 ECHO’s Actions in DPRK 2001-4 (Agua Consult, Jan 2005)

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In terms of health, there have been some improvements. Malnutrition in children fell from 64% stunting/20% wasting in 1998 to 35.9%/7% in 2004.3 But this is still a worryingly high figu re. Diarrhoeal disease and respiratory infections are the major causes of childhood illness and death – and here there have been little or no improvements over the past decade. State health and welfare provision continues to suffer from significant under-investment, with chronic shortages of pharmaceuticals and medical equipment. Finally, the limited economic reforms appear to have reduced purchasing power for the most vulnerable and have more generally placed great “strains on the livelihoods of the population”4 2.3 The international humanitarian response The call for international emergency assistance following the natural disasters in the mid-90s marked the beginning of substantive international aid operations in DPRK. In the following decade, agencies and NGOs saw a gradual improvement of their relations with the authorities, and some signs that their significant levels of assistance were contributing to reducing vulnerability in certain sectors. The importance of international assistance DPRK depends on external assistance for many of its basic food and health needs. WFP, the main provider of food aid in DPRK, had 6.5 million beneficiaries in 2004 (about a third of the population). An estimated 70% of the nation’s basic medicine requirements and 100% of vaccine immunisation requirements are provided by international agencies, predominantly by the Red Cross, UNICEF and WHO.5 It would appear that there have been gains in nutrition, localised water and sanitation, immunisation, blood quality, and controlling overall rates of morbidity and mortality. However, the diminishing quality of social services threatens gains made by Government and international agencies over the past few years. International presence In October 2004 there were 21 international humanitarian organisations with residency status in DPRK, including 7 UN agencies, 10 NGOs, the Int Federation, ICRC and the Swiss Development Agency. Two NGOs requesting permission to start operations in 2004 were refused. Despite the scale and significance of the international assistance to DPRK, there is a very small expatriate presence permitted by the authorities to work in country, and a lack of counterpart staff or organisations to work through. By late 2004, just 115 international and 199 national staff were implementing the overall humanitarian effort. Access Although geographical and information -related access had been improving since 2002, in September 2004 the Government announced tighter restrictions on the presence and access of humanitarian agencies, and did not support the Consolidated Appeals Process (CAP) for 2005. In January 2005 an interagency ‘Framework for International Cooperation’ was produced in lieu of the CAP.

3 According to the 2004 National Nutrition Assessment, prepared by the Central Bureau of Statistics and Institute of Child Nutrition (Feb 2005) 4 Interagency Framework for International Cooperation 2005 p.4 5 Report of the Interagency Mission to DPRK, October 2004

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Whilst the implications of the September 15th statement are perhaps not as draconian or restrictive as they first appeared, it is clear that the operating environment for humanitarian actors in DPRK remains extremely complex and susceptible to further change according to wider, largely political, factors. Donor trends Although most donors have maintained funding levels over the review period , and have continued to try to separate politics from international assistance, a deterioration of the external political environment can always threaten the level of support to the country. The DPRK authorities are increasingly stressing the need for developmental funding rather than aid assistance . However, the political climate and the difficulties in establishing dialogue with government counterparts in Pyongyang means that any significant development assistance from the World Bank, Asian Development Bank or governmental partners is unlikely in the near future.6 Meanwhile, humanitarian actors in DPRK continue to adopt whatever developmental approaches are possible within the parameters of their aid programming – predominantly through a focus on building the capacity of their counterparts. An inter-agency mission of October 2004 saw capacity building as “paving the way for longer term development”, especially in terms of technical expertise and strengthening the involvement of counterparts in programme design and implementation . 2.4 The DPRK RC Founded as an independent voluntary humanitarian organization in 1946, the DPRK RC has 10 provincial and 200 city/county level branches. It is the largest humanitarian organization in the country, with a nationwide network of 330,000 volunteers, 371,000 Red Cross youth and over one million members. The DPRK RC’s unique value has been highlighted by various external reports – particularly the recent ECHO Review which points out that DPRK Red Cross has: “a degree of autonomy…and comes closest to being a local ‘NGO’ - moreover one with considerable capacity. Its collaboration with the IFRC…has produced exceptional opportunities. IFRC’s counterparts…often have relevant sectoral skills or stay long enough to acquire them. The DPRKRC is also linked to a national network. The dividends…are enormous.” (p.18) Whilst this review would concur, it is important to also point out that the NS is operating in very specific circumstances in which concepts of autonomy, independence, accountability, community, and even volunteerism are complicated and nuanced. Distinctions between the individual, state and non-state spheres of action may not be well represented in standard international reporting and measurements of progress. But progress is nevertheless entirely possible. It is more a question of designing appropriate indicators to show impacts that occur in ways unfamiliar elsewhere. The notion of volunteerism is quite different in a society which can mobilise several thousand farm workers to dig a RC pipeline. Whilst they may not have volunteered, in a Western sense, the necessity and benefits to the community are recognised and 6 The Swiss Agency for Development and Cooperation is the only development agency currently in DPRK.

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therefore the labour is committed to it. This type of collective or social volunteerism (rather than the more common, Western individualistic notion of volunteerism) can be highly effective in terms of receiving and acting upon RC messages, implementing projects and delivering services. For example, Red Cross volunteers are able to attend the regular summing up meetings of farm work parties at the start or end of each working day, where key messages can be transmitted (such as: ‘drink boiled water, take a bottle of water to the fields, don’t drink from the irrigation pipe’). While there may not be a civil society as others would recognise it, the DPRK RC can, within its own context, play an important part in reducing vulnerability by working at a very local level. 2.5 The International Red Cross The Int Federation is one of the three most significant international humanitarian actors in DPRK (together with WFP and UNICEF). Its operation has been, year on year, one of its largest country operations anywhere in the world. Together with the DPRK RC, the Int Federation provides basic medicines for around one third of the population, has implemented over 150 water and sanitation projects benefiting up to 400,000 people, and supports the country’s largest non-governmental health promotion and disaster management programmes. It also supports the organisational development of the DPRK RC. There are currently nine delegates supervising a programme with a 13.5 million CHF budget, including a head of delegation, 3 health delegates, 2 wat/san delegates and DM, logistics, finance/admin functions. The delegation is within the region covered by the Beijing Regional Delegation. The Regional Finance Unit in Kuala Lumpur has offered some training services to the NS . In the absence of a Federation regional OD delegate in East Asia, the Asia Pacific Service Centre in KL provides support to DPRK through the Asia Pacific OD Coordinator. The delegation implements and coordinates the Int Federation’s operation on behalf of its members, specifically those National Societies with a history of support to DPRK, including the Australian, British, Canadian, Danish, Finnish, German, Norwegian, and Swedish RCs. The Danish and Netherlands RCs have also implemented large ECHO contracts through the Int Federation delegation. In addition, the Netherlands RC has a bilateral branch support programme with two provincial branches of the DPRK RC, and the Norwegian RC has a bilateral relationship that has included a tree-planting project and other activities. Some partner NS provide support for OD priorities in DPRK RC as integrated aspects of their programme funding, which results in such support not being “visible” as specific contributions to the Federation OD appeal. Nevertheless these funds enable DPRK RC to undertake a broader set of OD activities and are managed by the NS as part of the wider collective Movement resources. The ICRC have a small delegation in Pyongyang, and have established a large orthopaedic workshop, with a second workshop in development. They are also assisting the DPRK RC in some statutory issues, as well as exploring the possibilities of disseminating International Humanitarian Law within DPRK.

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Programme Review

This section examines the four programmes within the DPRK RC/Int Federation operation, and discusses the review team’s main findings. Specific recommendations for each programme are included in the Future Strategy (section 11, below).

3. Health programme 3.1 Context A large and relatively sophisticated state health service delivering all of population’s needs was developed in the 1960s and 70s. The system is now suffering an acute lack of investment, steady deterioration of its infrastructure, an under-supply of basic drugs and equipment, and a need for professional skills development. Most hospitals have irregular electricity, and it seems that many have inadequate water supply, heating, hygiene facilities and basic drugs. According to the inter-agency Framework for International Cooperation 2005, international assistance has had a significant impact on reducing morbidity and mortality. However: “the extent and depth of the problems in the health and nutrition sector are vast” (p13). WHO is the primary international interlocutor for the Ministry of Health on policy-level discussions. It also provides injectable drugs, IV fluids, hospital and laboratory equipment and various training courses for doctors. They are also active in anti-malaria and anti-TB campaigns and drug supplies. UNICEF works directly with the MoPH and covers the whole country with its vaccination (EPI) programme. Its drug distribution to health institutions, whilst similar to the Red Cross’, occurs in different ‘operational areas’. There are differences in the amounts and nature of drugs provided, with more of a focus on child-related medical care. UNFPA is engaged in reproductive health and safe delivery and also provides essential drugs in the clinics they support. Handicap International (Belgium), ADRA Premiere Urgence and SCF UK are all involved in various smaller health initiatives. 3.2 Red Cross Action Medical Supply The medical supply programme is the largest in the country, supporting 2,279 Health institutions in 65 cities and counties in the 5 provinces of the Int Federation’s ‘operational area’. See Annex C for a full table of kit distributions. Community-Based First Aid (CBFA) This consists of first aid during accidents and disasters, health promotion for prevention of most common diseases, first aid services mainly through local first aid posts, and the training of volunteers. The Int Federation has supported 650 DPRK RC FA posts with FA kits and training .

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Health Promotion This is conducted in cooperation with the MoPH. Household doctors attend workshops organised by the NS on rational drug use, infectious disease control such as acute respiratory infections (including tuberculosis), malaria, HIV/AIDS and water borne diseases. Workshops on aseptic techniques are organised for nurses and midwives. The Int Federation has supported the programme, the NS’ training centres where training takes place, and the publication of drug manuals and other health promotion materials. Health Promotion activities are also carried out on water borne diseases in conjunction with the wat/san programme. 3.3 Strengths 3.3.1 The programme has had a substantial impact on the health needs of the most vulnerable in around one third of the population of DPRK. Access to official health statistics is limited, and therefore qualitative impact analysis is problematic. However, disparate indicators, the cumulative findings of previous reviews and a process of deduction suggest that impact is significant.7 This review concurs with the recent ECHO Review that health sector programming (including the Red Cross programme) is largely “relevant, efficient and effective ” (p.19).

3.3.2 Timeliness of the medical supply programme Timeliness and consistency of supply is also good (particularly when considering the eight month period from initial order to final delivery). The recent ECHO review found the Red Cross programme was more substantial, consistent and less dependent on donor fluctuations than the UNICEF programme.

3.3.3 Quality of contents distributed is appropriate In general the quality of the supplies appears to be good , with no major problems reported to the review team. Interestingly, quality control is carried out by the MoPH at time of delivery to warehouses. Boxes are opened at random and medicines taken and sent to laboratories. Some Int Federation medicines have, in the past, been recalled due to poor quality and wrong labelling . The infrequency of this event would suggest both that MoPH’s quality control has been active, and that the Int Federation’s supplies are of sufficient quality to be passed by the MoPH on practically every shipment.

3.3.4 CBFA is a strong element of the NS´ activities In 2004, the NS conducted professional training for 20 FA specialists, training and refresher courses for 407 trainers (51 trainers with Federation support). In addition training and refresher courses for 3,500 volunteers were organized to strengthen their capacities and roles in the community activities. And measures were taken to enhance activities and service quality of 2,500 FA posts. Reports from RC branches indicate that they provided services and health education to 497,000 people at community level.

7 A study on the impact of drugs provided by the Red Cross at the primary level was conducted by the Public Health Administration Institute of DPRK between May 2002 and April 2003. This suggested that cure rates increased and the number of days of illness decreased when Red Cross drugs were used and no other drugs were available.

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3.3.5 Health/Hygiene Promotion It would appear that there is a significant level of Red Cross activity in this field. In 2004 380 RC health volunteers were trained to support household doctors, and 19 workshops on waterborne diseases were he ld. Volunteers also give lectures on hygiene and health promotion to the farm workers, and the DPRK RC has been engaged by other agencies to conduct hygiene promotion. The recent ECHO review found that the RC “have come furthest” (p.46) in promoting hygiene awareness, and recommended that “hygiene promotion continues to be prioritised .” (p .8)

3.3.6 Inter-agency cooperation on a technical level is generally good. The sectoral inter-agency forum appears to work well, encouraging cooperation at a technical level. For example, UNICEF is implementing a maternal and child health project in collaboration with IFRC, WHO and UNFPA. The DPRK RC and Int Federation are also participating in UNICEF’s Integrated Management of Childhood Illnesses project. However there is scope for further coordination and collaboration particularly in drug distribution, reproductive health and promotional materials, as well as on more strategic issues (see 3.4.4 below). 3.4 Challenges 3.4.1 The phasing out of the supplementary kits needs to be reconsidered The 2003 Int Federation Health Review recommended a slow phasing out of drug supplies to secondary care institutions. Supplementary kits were discontinued on the assumption (or hope) that the MoPH or another agency would resume supplies,8 and on the grounds that the Int Federation’s core focus globally is on primary health care . The cessation of supplementary kits does not appear to have been prompted by a decrease in the availability of international funding. However, the Review Team found that drug supply to secondary hospitals has not been resumed by the MoPH or by any other agency to any meaningful degree. WHO reports “no increase in proportion of drugs supplied by the MOPH in last two years”9 despite the phasing out of the Red Cross supply. It is likely that the phasing out of the supplementary kits has simply left a large and possibly critical gap in the coverage of basic medicines in the operational area. Primary level clinics may now be better supplied than the hospitals to which patients with more serious conditions requiring specialist treatment are referred. In the words of one interviewee, it is possible that many patients are being “referred to nothing”.

3.4.2 The programme lacks a strategic approach. Design, implementation, monitoring and reporting has become somewhat mechanistic. Opportunities for integration with other programmes (particularly regarding the sharing of data and the development of impact indicators) have not always been taken. Higher level strategic and analytical qualities within the programme have been constrained by its heavy logistical element, a certain amount of institutional thinking caused by its longevity, and the workload created by ECHO monitoring targets.10 8 Though there does not appear to have been a written agreement, or even a clear verbal understanding behind this assumption. 9 The Evaluation of ECHO’s Actions In the Democratic People’s Republic Of Korea 2001-4, p.19 10 For example, that expatriates should visit 10% of all institutions supplied . In 2004 this mea nt delegates had to visit 228 clinics or hospitals .

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3.4.3 Vertical programming remains a problem Despite repeated findings of previous reviews, activities within the health programme still need to be better integrated with other Red Cross programmes. For example, reporting and impact studies on joint action with the wat/san programme on hygiene promotion and training is lacking. There is also no combined syllabus for CBFA and health promotion.

3.4.4 A need to improve inter-agency programming and strategies Despite the small number of international actors in this sector and their significance in national health care provision, there is little cooperation on forming joint strategies, policies and lobbying approaches to MoPH regarding DPRK’s priority health issues. These include the development of primary health care and the prevention of communicable and hygiene-related disease. A more strategic dialogue between agencies would also help address key operational issues, such as; • harmonizing the levels and quality of medical supply programmes across

different operational areas. There has been some progress in achieving consistency in the quantity and quality of various agencies’ health interventions. Most notably, UNICEF has now increased the number of medicines in their kits in order to better harmonise them with those supplied by Federation. However, many issues remain, and require further discussion. For example, UNICEF supplies supplementary kits to paediatric hospitals in its areas of operation, whereas the RC has phased out supplementary kits, does not specifically target paediatric hospitals, but has a more extensive range of kits to primary facilities, with generally greater quantities of supplies within them.

• developing joint approaches to donors, In particular ECHO, which is the main

donor of health and wat/san projects in DPRK.

• progressing joint initiatives on accessing basic health data. Joint approaches to the MoPH may encourage further trust and openness in deciding what information can be shared with no threat to national security.

• harmonizing training curricula and health promotion materials. A formal inter-agency review of overall provision by humanitarian agencies within the health sector, as recommended by the recent ECHO Review, would help identify both technical and strategic areas where inter-agency cooperation could improve.

3.4.5 There is a lack of coherence in CBFA training CBFA curricula and training sessions do not follow a set pattern, and courses tend to overlap and repeat information. There is no system for tracking the effectiveness of the training on individual participants, and little sense of a progression towards milestones that mark achievement and increasing competence. Recent discussions regarding aligning the curricu lum with that of the Community-Based Disaster Preparedness programme have not yet led to practical revision of curricula.

3.4.6 Unclear RC position on its role in HiV/AIDS awareness HIV/AIDS is becoming an area of focus for the MoPH even though there have been no officially confirmed cases in DPRK. However, as with other subjects related to

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sexual behaviour, HIV/AIDS is seen as a sensitive issue, particularly in the way it is disseminated to the public. The DPRK RC is understandably cautious about its role in raising HiV/AIDS awareness, though health promotion materials include some messages about HiV/AIDS within the subject of STDs. However, as a signatory to the RC/RC Manila Action Plan, the DPRK RC should determine a clearer position on its approach and the extent of its role in raising awareness in the future.

3.4.7 Reproductive health is not fully incorporated into primary health care The recent ECHO Review found support by agencies in DPRK for reproductive health was limited, but what there was appeared “to be particularly relevant” (p 6). Within the DPRK/Int Federation programmes, specific attention to reproductive health, and to gender-specific health issues is thin. Although the DPRK RC’s health policy stresses the importance of maternal and child care, a holistic reproductive health approach is not well understood by the National Society or the Int Federation delegation . (In discussion it was interpreted as anything from simple family planning to gynaecological complaints requiring surgery, rather than as a core aspect of primary health care.) 3.4.8 The RC’s role during an epidemic is unclear. The State Emergency Committee work with WHO regarding diseases such as SARS and avian flu, and these partners would have the lead role in combating a sudden outbreak. However, it is not clear if DPRK RC HQ, branches and volunteers know what their role should be (if any) as an auxiliary to government during a large scale emergency of this type. This issue is linked to the DPRK RC’s search for a clearer Legal Base and positioning vis-à-vis the State authorities as already articulated in the next phase its organisational development priorities. An upgraded Legal Base could, if well framed, also provide a clearer mandate for the NS in a wider Civil Defence Plan spanning role in disaster preparedness and relief, and health in emergencies roles. 3.4.9 The programme is not well communicated The health programme’s long evolution and various additions and modifications means that it is difficult to gain a complete and coherent picture of the entire programme and the strategy that drives it. It lacks a clear, schematic document to illustrate how the various components interact, what impact they have, and what are the key messages for donors and other stakeholders.

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4. Water & sanitation 4.1 Context Poor water and sanitation is becoming recognised as perhaps the major cause of ill health and childhood malnutrition within the population of DPRK. Problems in this sector have been well documented, and include: • Absence of major new investment in the wat/san infrastructure; • Power supply problems; • Major water loss within the system (estimated at over 50%); • Droughts coupled with rapid water run-off and poor retention due to deforestation ; • High levels of contamination through sewerage pipe leakage; • Inadequate latrine design and maintenance is causing both contamination and

poor vector control; • Improper treatment of human and animal waste for agricultural fertiliser; • Insufficient public health awareness, practice and national hygiene promotion; • Limited interest from authorities and communities on the issue of sanitation –

though this seems to be improving. UNICEF provides ministries with technical assistance, and conducts projects in cities and counties in the east and north of DPRK. It is now focusing on an integrated approach to the communities it supports, combining health, nutrition, education services alongside wat/san. NGOS (including GAA, Concern, Triangle and SCF UK) conduct community-based projects, particularly for institutions such as schools and hospitals. Projects mostly consist of rehabilitating or constructing water supply systems, bore holes and water treatment and pumping stations. 4.2 RC Action From 1999-2001 a programme supported by the Int Federation rehabilitated water and sanitation systems in 147 health institutions, particularly those affected by the floods and tidal inundations of 1995 and 1997. In 2001 a new three-year programme was designed to improve wat/san in 100 communities for 600,000 beneficiaries, in the North Pyongan, Chagang and South Pyongan provinces. The target group was the rural population living in Ri-villages or Dong-settlements adjacent to towns. The main types of intervention were rehabilitation or replacement of small pumps, tanks and pipelines, with delivery at domestic level. Ecosan latrines were attempted, but latrines with biogas components became increasingly favoured. The RC’s focus since 2001 on domestic sanitation is unusual. As the Framework for International Cooperation notes: “only the RC has a wastewater management component at household level incorporated into their programmes.” (p40) During implementation of the water systems, there are workshops to train local technicians to operate and maintain the installations. A hygiene education campaign was also added to the programme. In addition to supporting the DPRK RC’s wat/san department at HQ (3 staff), there are 6 technicians (of which 3 are Field Technicians) and 8 Water Quality Monitors. There are currently two Int Federation wat/san delegates. Technical wat/san reviews took place in 2002 and 2004.

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4.3 Strengths

4.3.1 This review concurs with previous studies that the programme has made a significant impact on improving health in targeted rural communities;11

4.3.2 Interventions are relevant to the needs of rural communities, and adequate selection criteria for this target group have been applied;

4.3.3 Overall the programme seems to have been effective in many of its original objectives. Water in all projects visited by the 2004 Review Team appeared to be of good quality, and water was no longer a factor negatively affecting health in the communities served ;

4.3.4 There is a high degree of involvement and ownership by the community and local and national government in the implementation of the projects;

4.3.5 The DPRK RC offered added value and unique opportunities through its branch structure: it was effective in reaching the target population;

4.3.6 There appear to be high levels of beneficiary satisfaction (though the general difficulties of accessing communal and personal feedback in DPRK apply); 4.3.7 The programme has added significant technical capacity in the NS, which has already been of benefit to other humanitarian agencies and NGOs, and may well be a resource for the state water sanitation sector in future . According to the ECHO Review, national counterparts of Int Federation delegates have developed appropriate technical competencies, unlike those of most agencies and NGOs. Indeed, other NGOs reportedly used DPRK RC staff to conduct training for their own national staff; 4.3.8 The programme has enhanced DPRK RC’s image , particularly within beneficiary communities and provincial and central Government departments 4.3.9 Previous reviews suggest that the project “appears to have been well managed financially” with “Tested expenditure being able to be reconciled with documentation”12 4.4 Challenges

4.4.1 Whilst largely successful within the original objectives as determined in 2002, it is possible that the programme is in danger of drifting away from addressing the emerging priorities in water-related disease: that is: a) sanitation, and b) vulnerabilities in less rural communities.

11 Particularly the Int Federation technical review of 2004, and the ECHO Review of January 2005 12 ECHO 6’s External Audit of the Danish RC Contract 2004 (p. 3-4). It was beyond the scope of the present review to make its own audit or detailed investigation into the programme’s financial management.

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4.4.2 The balance of the programme’s focus (and expenditure) is on the provision of water supply, although sanitation is possibly the biggest factor in poor health within the population. This should be reviewed in more depth to ensure that the achievement of programme’s purpose (of improving health) is best maintained. 4.4.3 The programme was originally designed to target groups within rural communities. However, recent reviews suggest that the priority vulnerabilities are located in small rural townships, larger towns and cities. While there is a slight increase in projects in 2005 that address less rural communities, there is no policy shift as a result of re -examining vulnerabilities 4.4.4 There is a question about the programme’s overall efficiency. There has been a focus on delivery to beneficiaries’ homes in small rural communities). This has limited beneficiary numbers. Of the 600,000 planned beneficiaries, only about 190,000 are likely to be reached in this way by the end of 2005 .13 4.4.5 Cost efficiency has also been reduced. According to Int Federation delegation figures, cost per capita is likely to be 22.73 euro, or 113.65 euro per household. Whilst this is apparently within generally accepted financial unit-cost criteria for improvement of piped rural water supplies,14 improved cost efficiency would have been possible through larger scale projects, more interventions in schools and other institutions, and in larger communities. However, in the absence of a clear definition of what is a beneficiary and what degree of assistance they receive, caution is needed when comparing numbers of beneficiaries, and thus of cost efficiency. 15 4.4.6 The NS, together with Federation delegates, has introduced a latrine model with bio-gas digesters to replace the less successful ecosan latrine model. This is in line with the Int Federation’s global policy to design wat/san programmes as “an effective evolution from relief to development.” However, the focus on relatively time- and cost-intensive sanitation interventions, which have included domestic ecosan or biogas components, has limited the number of people benefiting from improved sanitation facilities. 4.4.7 This Review agrees with ECHO Review 2005 that: “There is a need for a hardheaded look at whether the development of improved latrine models can be sustained from local resources in the short to medium-term.” (p.45) Such sanitation models, whilst popular with the few beneficiaries lucky enough to receive them, are “not affordable to other householders”, nor to international agencies aiming to make a significant regional or national impact on reducing vulnerability. 4.4.8 There has been no independent technical review to establish the efficiency and effectiveness of domestic latrines incorporating biogas systems in improving the situation of the most vulnerable. In particular, how the production on fuel has benefited health levels (through, for example, reducing household spending on energy, thus increasing cash available for food, clothes, hygiene or medical items).

13 Interestingly, an additional 150,000 people benefited through a single repair to a mains pipeline to a small city, though to a lesser degree than the beneficiaries of the domestic water supply programme. 14 Review of RC Water and Sanitation Programme in DPRK, Int Federation 2004 (p.ii) 15 An example given by an Int Fed wat/san delegate in DPRK: when UNICEF donate spare parts and disinfectant to water treatment stations, all who receive water from those stations is classified as a beneficiary. Several million beneficiaries are thus possible under this definition, but it cannot be compared with a Red Cross beneficiary of an individual tap or latrine.

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Factors effecting fuel bi-product, such as availability of sufficient amounts of waste and climactic variations have also not been formally evaluated within the programme. 4.4.9 There has been no assessment to gauge the comparative benefits of various domestic and collective water and sanitation solutions. Other ECHO-funded sanitation programmes in DPRK showed that “Institutional sanitation is relevant and effective” and had impacted on “demonstrating health benefits, especially in schools”16 4.4.10 The application of innovations and lessons learnt by other agencies and NGOs is not evident in the RC’s wat/san programme, despite functional interagency dialogue via a sectoral working group . 4.4.11 Issues of gender aren ’t evident in site selection, implementation or reporting. 4.4.12 Project hand-over arrangements with local authorities and communities are unclear: particularly the formal end of the project period, the handover of maintenance, monitoring and repair responsibilities and liability/grievance procedures. 4.4.13 The health education and hygiene promotion component is not very evident in programme reports, and the linkages with the health programme need to be better communicated. The 2004 wat/san review recommendations on this issue need further follow up. 4.4.14 Analysis of each intervention’s impact upon local health levels should be improved, using a wider, more innovative range of indicators where access to statistical data is restricted. 4.4.15 The structure and the programming of the Federation delegation’s Wat/San Department lacks integration with other departments. 4.4.16 The role of the DPRK NS’ Water Quality Field Monitors has been unclear, and was a cause for urgent review within the programme in Spring 2005 .

16 ECHO Review 2005, p.47

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5. Disaster management 5.1 Context Disasters in DPRK (mainly floods and storm surges) affected 187,000 people in 2001, and 66,000 in 2002.17 The latest recorded floods occurred in August-September 2004, with 24 people killed and 200,000 affected18. The 2004 train explosion in Ryongchon was a reminder that technological disasters are also a key hazard in DPRK. In addition, traffic accidents appear to cause a large number of casualties despite the relatively small numbers of cars on the road, and this will be exacerbated by any future increase in car ownership.19 In addition to the direct loss of life, droughts, slope erosion and floods (aggravated by widespread deforestation ) are factors affecting agricultural outputs and contributing to the food shortage.20 Economic losses due to disasters reach into millions of USD each year. The Flood Damage Rehabilitation Committee (FDRC) is responsible for all areas of disaster management, with a particular role in the co-ordination of international humanitarian organisations. It appears to have limited involvement in disaster preparedness activities. 21 The Ministry of Environmental Protection (MoEP) is the main agency involved in mitigating disaster risks, and managing river embankments, coastal protection, land use and reforestation. There appear to be comprehensive disaster contingency plans at various levels, although it is possible that “a majority of these plans are… drawn up ad hoc after the occurrence of a disaster”22. It was not clear whether there were linked to branch development frameworks and human resource development objectives. Although many agencies support post-disaster relief and the ongoing emergency operations, few are active in disaster preparedness. UNDP is supporting FDRC and MoEP in building capacity in national-level mapping and risk planning. 5.2 RC Action Prior to the major flood disasters in 1995, DPRK RC had no specific department responsible for disaster management. By 1998 the DM Department was established, and its capacity has now grown to 4 staff, with training and support from the Int Federation. The first 4 years’ focus was on establishing NS resp onse and preparedness systems, capacities, and community-based projects.

17 Int Federation World Disasters Report 2002, 2003, and 2004. 18 EM-DAT Emergency Disasters Data Base (www.em-dat.net) 19 According to the ICRC delegation in DPRK, more than 50% of all patients at their prosthetic workshop are victims of traffic accidents, and the remainder mainly suffer from work-related accidents. 20 North Korea’s Economic, Political and Social Situation (G. Helgesen & N.H. Christensen, Nordic Institute of Asian Studies , December 2004) 21 A more thorough summary of the DPRK Govern ment agencies’ roles in disaster management is provided in the Int. Federation Mission report 2000 by D. Peppiatt & A. Galperin. 22 Peppiatt and Galperin, 2000

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DPRK Red Cross has a Memorandum of Understanding with FDRC, outlining the Red Cross’ response preparedness through regional warehouses with pre -positioned stocks of non-food relief items for 17,000 families (85,000 people) at six locations across the country (see Annex E). In addition, the MoU specifies DPRK RC cooperation with the relevant government agencies in training. The Ryongchon train explosion “highlighted the vulnerability of the weak health services to cope with a disaster, major accidents or disease outbreaks.23” This, and the recommendations of previous reviews, have led DPRK RC to establish a range of response preparedness and coordinating entities: Disaster Preparedness Working Groups (DPWG) – an initiative to exchange information and coordinate preparedness activities across agencies. A national level DPWG was established in 2002, and expanded into the provinces in 2003. While the National DPWG meets 2-4 times annually, the groups at provincial level are at different stages of consolidation. The DPWGs do not appear to have a role in defining contingency plans or in coordination during emergencies – a responsibility that rests with FDRC. National Disaster Response Teams (NDRT) have been defined, and 28 Red Cross staff from around the country have been trained in December 2004. Trained staff will become the core of local response teams. The NDRT concept also includes plans for two national levels Emergency Rescue Teams (ERT) with more specialised capacity to intervene in marine and land-based disasters. DPRK RC initiated Community-based Disaster Preparedness (CBDP) in 2002 – starting with 9 pilot communities (Ris) and including 20 more by 2005. Site selection criteria for future projects have also been improved. Some basic disaster preparedness appears to exist in local communities – even without a Red Cross promotion of the concept – providing a foundation for the efficient implementation of small-scale pro jects. One outcome of the CBDP is “Micro” mitigation projects in communities; they have been implemented in all target communities, with an approximate average cost of 5-6 EURO per beneficiary. Micro projects include local river flood dikes, run -off ditches and erosion control. Reforestation: in hilly areas the risk of flash floods and landslides may often be exacerbated by deforestation. Tree-planting has traditionally been an annual event for DPRK RC, mainly as a RC Youth activity. However, in 2003 and 2004 tree -planting has been included as a specific mitigation activity in 18 of the 19 CBDP Ris, under the Ministry of Environmental Protection’s overall coordination. 5.3 Strengths

5.3.1 Recommendations of previous reviews in 2000 and 2002 have been systematically followed-up, and the DPRK RC is progressively building national response capacity.

23 Framework for International Cooperation in 2005, UNOCHA ( p 12)

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5.3.2 The DPRK RC has gained a high profile by being the first to respond to a number of disasters (notably Ryongchon). 5.3.3 This review concurs that “the DP activities carried out by the DPRK RC proved relevant and very useful.”24 5.3.4 Efforts put into training a large number of people (1 ,256 participants at 39 workshops since 1999) have been effective. DP officers are in place in 12 Provinces, and in the Ryongchon explosion local, trained Red Cross volunteers played a pivotal role in organising the initial response, with regional and HQ stocks and coordination capacities also proving invaluable. 5.3.5 International study tours and training for staff has paid off: Knowledge, lessons learnt and training materials have been successfully adapted to DPRK needs. 5.3.6 The NS has improved national capacity and inter-agency collaboration by setting up the Disaster Preparedness Working Groups and initiating the National Disaste r Response Teams. 5.3.7 The NS has successfully moved into Community-Based Disaster Preparedness, and the first 19 communities have successfully implemented small-scale mitigation measures.25 5.3.8 The DM Department has established systems to ensure lesson learn ing within the CBDP programme, and has revised its target area selection criteria to ensure the risk reduction focus of the interventions. 5.3.9 The DM capacity of the NS has developed appropriately and steadily over the past 4 years. The many new initiatives now need to be consolidated. 5.4 Challenges 5.4.1 The DPWG and NDRT initiatives are not yet fully operational, and need a few years to become integral components of the NS’ DM capacity, with roles recognised by all stakeholders. 5.4.2 There is a need for clearer description and communication of the DPWG and NDRTs’ roles at province/county levels. 5.4.3 At least some local branches have no clearly defined, pre-organised response teams and appear to react ad hoc, without access to proper gear etc. 5.4.4 DPRK RC contingency plans at national level need improvement. 26 Communication and coordination procedures between the NS and the IFRC Delegation during sudden-onset emergencies also need attention.27 24 Ibid. 25 See examples described in: BRCS Review May 2004, and DFID review October 2004

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5.4.5 Whilst there is a generally high level of DP awareness within all levels of DPRK as to the importance of early warning systems, there is considerable room for RC to prepare local contingency plans firmly coordinated with other stakeholders. 5.4.6 Some of the CBDP mitigation projects are far from “micro” and may rather be considered major “infrastructure rehabilitation” that are outside the scope of RC intervention (such as a proposed road bridge). 5.4.7 Some CBDP micro-projects are not always technically sound . There is still a need to improve quality assurance. 5.4.8 From a DM perspective the DPRK RC’s role in tree-planting is unclear. The RC’s role in identifying local risks and determining project sites within a DM framework appears to be secondary to its contribution to a much wider state reforestation plan which has various agendas, of which DM is only a part. 5.4.9 There is a tendency to consider that CBDP is “done” once a Ri has established some kind of mitigation measure. However, communities need regular follow-up support to maintain readiness in the long term through, for example, evacuation drills and re -motivation activities. 5.4.10 Current plans for roll-out of CBDP would appear to be too ambitious. The CBDP programme has been encouraged mainly by HQ staff support, which has the capacity to support new projects in around 10 Ris per year. Future plans are unrealistic in wanting to reaching 100 Ris by 2007 , and do not reflect branch capacity. 5.4.11 The RC’s position is unclear on road safety. This has previously been seen as the function of various Government departments. However, with increased car ownership and already poor road awareness by most sections of the population (especially children), road safety will become a significant public health and safety issue in the coming years. The number of traffic accident victims being treated by the ICRC orthopaedic clinic attests to the growing health issue – and one on which the RC should at least define a position and the extent of its role. 5.4.12 It has long been an aim to coordinate/integrate the CBDP training curriculum with Community-based First Aid Training. However, the process has slowed down . No concrete outputs are yet in place. 5.4.13 There is room for improvement in developing more user-friendly, pictorial training material to supplement the current more text-based material.

26 The 2000 review (Peppiatt & Galperin) noted that in DPRK RC “operational procedures for disaster response have not yet been formalised in any one document”. Four years later, a lack of procedures prevented HQ from rapidly deploying water cleaning equipment for use in the Ryongchon disaster. 27 Information was delayed during the first day of Ryongchon disaster

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6. Organisational development 6.1 Context As there is no absolutely independent civil society within DPRK, all international humanitarian actors except the Int Federation and Handicap International must work with government ministries and departments as their local counterparts. The DPRK RC is the only indigenous organisation with national coverage that is formally distinct from government. The DPRK RC’s OD process has been characterised by a highly strategic and phased approach. Decreasing government funding and several natural disasters in the 1990s led the NS to re -evaluate its structures, policies and capacities. An Extraordinary Congress in 1998 introduced the latest period of change, which began fully in 2001 (called ‘the Year of Preparation’) with an OD Assessment, a national OD Workshop and a SWOT. In 2002, an OD Committee was formed, and the NS began to restructure its branches, reducing numbers (from 30 to 14 in two years) and staff (by over 150). Major initiatives also occurred to begin the distinction of governance and management: The post of branch Executive Vice Chairman was dissolved, and the Branch Secretary position was created to strengthen formal management capacities throughout the organisation. By March 2004 all the Secretaries had been appointed. 2003 saw increasing focus on skills and competencies, with training on issues such as Characteristics of a Well-Functioning National Society, governance and management, volunteering, and managing budgets, plus workshops on the NS’ restructure. In addition, staff and members at all levels participated in mapping the Strategic Development Plan ” which would guide the NS’ work until 2010. 2004 marked, in the NS’ eyes, the end of the restructuring process. Its 7th Congress was a “historical milestone” which amended the Constitution, adopted a revision of its Statutes, and approved the Development Plan 2010. There was also an increasing focus on branch development (beginning with a Capacity and Performance Indicators self-assessment exercise), the development of strategies underpinning the Development Plan, and improving the NS’ legal base. In the first half of 2005, the fast pace of the OD process slowed as it began to tackle the intractable issues of financial management, resource mobilisation, legal base issues, branch development and the integration of OD and programming. 6.2 Int Federation Action In 2002, Int Federation OD support first appeared as a programme within an annual appeal. In 2003 there was more substantial support as the Capacity Building Fund ensured over 100% coverage of the programme, and the Netherlands Red Cross began their bilateral assistance to two provincial branches, initially providing refurbishment, English language training and various skills training. The Int Federation support via the Appeals have tended to focus on branch development, financial management, human resource management and

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communications. As mentioned in section 2.5, some partner NS provide support for OD priorities in DPRK RC as integrated aspects of their programme funding, which results in such support not being “visible” as specific contributions to the Federation OD appeal. Nevertheless these funds enable DPRK RC to undertake a broader set of OD activities and are managed by the NS as part of the wider collective Movement resources which have measurably helped the achievement of some key OD processes over the past 3-4 years. There has never been an OD delegate in DPRK: day-to-day support is tasked to the Head of Delegation . In the absence of a Federation regional OD delegate in East Asia, specialised advisory OD inputs (and two visits per year) have been made by the Federation’s Asia Pacific OD Coordinator based in the Asia Pacific Service Centre in Kuala Lumpur. The Asia Pacific Service Centre’s Finance Unit has also facilitated occasional financial training and development opportunities for DPRK RC. The Beijing regional delegation has provided some strategic and technical support: it encouraged initial thinking around a renewed CAS process, and stimulated the current Strategic Review. In 2004, the regional information delegate facilitated a national-level communication workshop together with a Danish RC expert. The regional reporting delegate also provided on -the-job training for key NS staff in Beijing. Support to the Int Federation programme has come from the Swedish, British, Canadian, Norwegian and Australian Red Cross Societies. Valuable bilateral cooperation continued with the Netherlands RC, as well as through study visits and exchanges with the German RC and others. 6.3 Strengths 6.3.1 The OD programme has added capacity in the NS’ restructuring process, in its expertise in the four programme areas, in developing headquarters staff programming and management abilities, and in the adaptation of global Red Cross and other best practices and innovations. 6.3.2 The OD process, supported by the Int Federation, has been largely internally driven by the DPRK RC. There is a desire to keep it that way, whilst diversifying the support it gets from the Movement and beyond. 6.3.3 The NS has rapidly and thoroughly absorbed and adapted Int Federation and other OD tools and methodologies. 6.3.4 In some respects the DRPK RC’s design and evolution of its own OD process provides a ‘model’ example for other NS. 6.3.5 The restructure of the NS happened efficiently and effectively, though it too early to ascertain the impact of the newly separated governance and management positions. 6.3.6 Int Federation support to rehabilitating branch premises and facilities has been seen by the branches themselves as contributing to their distinct identity in relation to the authorities.28 28 The Regional OD delegate mission report 2002: “Branches are vocal about their need for independent premises to reduce dependency on authorities.”

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6.3.7 The training centres in pilot branches offer considerable opportunities for training, dissemination and staff and volunteer motivation. 6.3.8 The NS is conscious of the main challenges within the OD process, and has repeatedly made strategic attempts to address weaker areas. 6.3.9 For example, the revised OD programme of April 2005 is an appropriate response to the need to concentrate efforts on improving in key areas (such as branch development, finance management, and communications). 6.3.10 The Int Federation has played an important role in knowledge sharing – the Asia Pacific OD Coordinators have provided tools, guidelines, lessons learned by other NS, encouraged exchange visits and included the DPRK RC in regional initiatives more latterly coordinated from KL. This form of support appears to be highly effective. 6.4 Challenges 6.4.1 While capacity has clearly increased overall, there is little coherent analysis or reporting on the impact of OD inputs over the past 4 years. 29 6.4.2 The extent of cross-learning of OD initiatives between the branches is unclear. In particular, the learning benefits stemming from the 6 Int Federation -supported and 2 Netherlands RC-supported ‘model’ provincial branches have not been clearly demonstrated.30 The DPRK RC’s OD Committee recently mandated a Branch Development Working Group to propose ways of responding to issues and development plans emerging from the Branches themselves. This should include the specific issue of cross-learning in future. 6.4.3 Even when the particular nature of volunteerism in DPRK is taken into account, there has been relatively little emphasis on issues around the concept, mobilisation, development and retention of volunteers. 6.4.4 The approach to resource mobilisation is too focused on micro-business income generation projects. The wider concept of RM is not fully developed, and lacks contextual analysis, the clear identification of constraints, the need for realistic timeframes, and the consideration of lessons learned (often the hard way!) by other RC National Societies. 6.4.5 There would appear to be deep and institutional blockages to progress on modernising the DPRK RC’s financial management systems. Despite Project Planning Process training, and on-the-job training from the Regional Finance Unit in KL, progress remains slow. One PNS’ view was that there has been a lack of interest, possibilities and capacity both within the DPRK RC and the Int Federation. While this

29 However, an initial step to address this was taken by DPRK RCS who participated actively in the Asia Pacific OD Forum in November 2004 to address the topic, together with 13 other NS. The NS assisted in developing a tool to help contextualise the contribution of OD work on making a measurable change, and have been using this tool to explanations to partners the importance of their OD process. The effect of this probably requires more time and effect the issue of general OD reporting. 30 The Revised OD Plan notes that, from the second half of 2005, there will be more focus on in–country knowledge sharing.

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is not entirely borne out by the attempts to achieve progress, it does indicate that partners are feeling a strong need for a concerted and focused effort in this area. 6.4.6 Linked to this are the issues of transparency and accountability, both financial and performance-related. Whilst the comments on the constraints of the wider context in DPRK is particularly relevant here (see 8.2 and 8.4), there are clear implications for the Int Federation -DPRK RC relationship, not least regarding the limits of bilateral action from partner NS that are currently possible. The experiences of the Netherlands RC would suggest that transparency and accountability are key issues in their work with the DPRK RC, and learning to mutually address these challenges is an integral part of the partnership. 6.4.7 There has been little attention to the NS’ youth activities and structures. Despite extensive responsibilities for youth development within the Ministry of Education and the national Youth League, the RC’s youth strategy and role has lacked clarity and ambition. 6.4.8 The visual presence of the Red Cross and its volunteers, especially at provincial and local levels, appears to be weak.31 6.4.9 As with the health programme, the OD programme lacks updates, summaries of progress and reporting against original objectives. Achievements can be obscured by a lack of clear reporting and analysis, particularly of constraints to progress.32 6.4.10 Similar objectives are repeated in successive Int Federation appeals, (especially resource development, human resource development and financial management). A lack of reporting of the progress made in each of these areas could lead external observers to assume that the repeated headings being used in the OD appeal each year is synonymous with lack of progress in each area , which may not necessarily be the case . There is no corresponding rationale that helps make the case for repeated funding requests for seemingly similar activities. 6.4.11 The flow of ad hoc, spontaneous or small-scale technical support has been limited . On-site OD support from the Head of Delegation is constrained by workload and wider management responsibilities. Support from the nearby Beijing Regional Delegation has also been limited. The Asia Pacific OD Coordinator position in Kuala Lumpur, whilst providing invaluable technical advice and twice yearly visits where possible , has 35 other National Societies to assist.

31 This confirms the findings of previous reports, as well as impressions of non-RC expatriate staff that travel within DPRK. 32 As a Regional OD delegate noted in 2004, “the NS has not been able to report …in a manner which enables others to appreciate the achievement to date”

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7. Int Federation and partner National Society support 7.1 Findings 7.1.1 Overall, the Int Federation delegation has performed well over the past four years, particularly given the size of the operation, the complexities of the operating environment and limitations on delegate numbers. It has overseen largely successful programmes in terms of delivery. 7.1.2 Good relations have been maintained between the Int Federation and the DPRK RC throughout review period. 7.1.3 The Int Federation has performed well as a coordinator of multilateral assistance whilst also accommodating a small number of bilateral interventions. Most partner NS, and the DPRK RC itself, currently prefer a predominantly multilatera l model. 7.1.4 The delegation has developed and maintained good relationships with other humanitarian actors and with authorities. 7.1.5 The Int Federation’s role in procurement and logistics appears to have been sound, within the constraints to applying international standards in DPRK. 7.1.6 No major problems in the Int Federation’s overall financial management of the programmes were noted , though it was beyond the scope of this review to investigate this fully. However, both ECHO and internal Federation audits have been largely positive.33 7.1.7 Other National Societies have shown a high degree of solidarity and commitment in their support to the joint DPRK RC/Int Federation operation. A core group of NS have participated in a number of ways – from securing significant ECHO contracts and governmental donor support for Annual Appeals, to the provision of delegates and complementing the programmes with study visits and other ad hoc bilateral inputs.

7.2 Challenges

7.2.1 There are relatively few delegates in comparison to the size of the appeal budget, and particularly given the complexity of the operating environment.34 Given government policies, increasing delegate numbers is currently problematic. 7.2.2 There are also limitations in the extent to which programme management and reporting can be handed over to the DPRK RC, for reasons of capacity and donor monitoring requirements.

33 See for example Report of the Risk Management and Audit Dept on the Internal Audit Review of the DPRK Delegation, Int Federation (May 2004) 34 The Int Federation’s Asia Pacific operations have an average budget/delegate ratio of 1 delegate per 0.9-1 million CHF, where there is no or low bilateral presence. From this crude but indicative equation, the DPRK delegation would appear to be understaffed by at least 2 delegate positions.

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7.2.3 Coping with these pressures has led to the Int Federation’s programme implementation becoming relatively mechanist ic in order that basic delivery is ensured. 7.2.4 The delegation appears to be caught between the intense demands of programme implementation and the need for higher level, more strategic operational management, analysis and quality reporting. In this context, balancing integrated and high-quality programme delivery, capacity building within the NS and satisfying donor accountability demands is a major challenge. 7.2.5 The Int Federation has not been able to solve the long-running problem of the need for greater integration between programmes. There have been numerous individual initiatives but a lack of managerial expectation, structural changes within the delegation and procedural changes to programme management has meant that there has been no definitive solution. Recommendations from previous reviews have not been sufficiently incorporated into an overall change initiative to ensure less vertical programming. 7.2.6 The delegation seems to be somewhat isolated in terms of ongoing strategic and operational management oversight and support. This is despite the fact that the size and significance of the DPRK RC/Int Federation operation is such that any decrease in its quality would be highly visible, and would damage the credibility of both organisations. 7.2.7 On one hand, the delegation’s focus appears to be very ‘locked in’ to DPRK – a tendency that the operating environment encourages. There is insufficient management reporting by the delegation to the Regional Delegation in Beijing or to Geneva . Four-monthly programme reporting is not a substitute for monthly reporting on strategic and management issues. 7.2.8 On the other hand, the delegation lacks external technical support in strategic advice, links to best practice, lesson learning from rest of Movement, and regional sectoral support. 7.2.9 The Beijing Regional delegation feels a long way away, despite being only two hours by plane . While the country delegation needs little technical support in health and wat/san, other regional resources are not readily available to the DPRK RC. Senior-level strategic advice has been affected by the HoRD’s focus on China - the last HoRD visit to DPRK was 12 months ago. The regional reporting delegate (and the regional HIV/AIDS delegate) are constrained from visiting DPRK by their nationalities. Regional information support has been limited for various internal and external reasons. Regional OD and finance support from KL, whilst of high quality, is inevitably very periodic and constrained by distance and the demands of the many other countries in that region. 7.2.10 With some exceptions, there is limited strategic engagement between the delegation /DPRK RC and partner NS supporting the operation , outside of programming concerns that affect partner NS’ ability to report to back donors. There is also limited dialogue between DPRK RC’s partner NS, who were largely unaware of their mutual strategies, approaches and intentions.

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7.2.11 Although study visits are reported by the DPRK RC to have been valuable, it has not always been clear as to the exact purpose and intended outcomes of such visits, and how these may fit with the stated priorities of the NS. 7.2.12 Despite strong and consistent support, there is little sense of equitable partnerships existing between partner NS and the DPRK RC. With a few exceptions, the partner NS interviewed could not easily communicate how they had learned or benefited from their relationship with DPRK RC. Despite expressions of long term commitment to addressing needs in DPRK, partner NS’ engagement with DPRK RC appears to be often predicated on funding (particularly governmental and ECHO funding) rather than strategic partnership. This may have important implications for a future CAS process (see Section 13).

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Towards a Future Strategy

This section comprises of the following sections: • analysis of some key strategic issues • a suggested overall framework; • programme strategies and detailed recommendations; • elements of a possible CAS process. It is important to note that what fo llows are suggested components of a strategy for joint operations 2005-2010. The final strategy, complete with timeframes and more management-oriented detail, should of course be drafted by the operational partners themselves. 8. Key strategic issues 8.1 Access There are various limitations of agency/NGO access to the vulnerable and to information relating to vulnerability. • International agencies/NGOs have only had access to 161 out of 203 counties. • Travel within DPRK is not possible for foreigners without prior consent from the

authorities. • There can be no unannounced or unaccompanied visits to beneficiary homes,

counterpart organisations or facilities such as warehouses, hospitals and schools. • There are limitations on the number of field visits made by international staff. • Access to data and statistics necessary for measuring impact of large -scale

programmes is limited. This includes national and regional health and social welfare statistics, crop yields and market prices.

The Int Federation relies on the Government’s Flood Damage Rehabilitation Committee (FDRC) for permission to access its operational areas. International delegates are currently restricted to three field visits per week per team, though there appears to be fewer restrictions on the size of each team. There are also restrictions on the number of visits of foreign delegates within the delegation, and ad hoc short term visits by international RC staff and consultants requires much pre-planning and negotiation. It would appear, however, that the visit of a team is counted in the same way as a visit by a single individual in the eyes of FDRC. 8.2 Accountability Limits on access have led to serious issues regarding the accountability of much of the programming in DPRK. Reduced monitoring, reporting and impact assessment opportunities have led to increased scrutiny by donors of programme rationale, delivery and accountability, and have limited the extent of donor and agency/NGO engagement in DPRK. This has important operational implications. In lieu of what donors regard as transparent governmental or non-governmental partners, monitoring by international agency staff has come to be seen as the primary method of ensuring accountability. But the effectiveness, and even meaningfulness, of fo rmal monitoring is constrained by the same issues of access and delegate presence. Various attempts to resolve

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this dilemma are being attempted: particularly around encouraging DPRK counterparts to give better access to information, to develop more transparency in reporting, and to align their working practices to international ‘norms and standards’. Given that for all agencies and NGOs (except the Red Cross and Handicap International) their national partners are government departments, this is inevitably a complex and gradual process requiring compromise, innovation and fostering a degree of trust on both sides. A related dimension of this issue is the need for all programmes to adopt a clearer and more systematic capacity building strategy so that a highly trained force of local volunteers and staff can use upgraded monitoring and reporting skills to play some of these roles and increasingly be depended upon for high quality information. 8.3 Issues for the Red Cross

The Red Cross has attempted to addre ss this issue through a simultaneous process of capacity building of the DPRK RC, whilst developing a case to demonstrate to donors (predominantly ECHO) that the National Society is a credible and accountable implementing partner. In April 2005, the Int Federation delegation circulated a draft Monitoring Framework. In essence, it proposes donor (predominantly ECHO) acceptance of an increased role of the DPRK RC in monitoring, which would free up delegate workload to help improve the quality of the NS’ technical capacities in programme delivery, as well as the strategic and analytical aspects of joint programming overall. It aims to negotiate the restrictions of delegate visits to the field by stressing that their role would not be to ‘monitor’ programmes (a concept disliked and suspected by FDRC), but to give technical advice and ‘quality assurance’. The DPRK RC and partner NS agreed with the principles underpinning the proposal, but ECHO have indicated that they will be unable to accept a higher monitoring role of non-international staff for the programmes it supports. 8.4 Perspectives of the Review Team This review supports the aim of increasing the NS’ capacity to monitor and report on externally-funded programmes. However, its analysis suggests that the proposed Monitoring Framework should be revised to take into account the following factors: • The distinction between ‘monitoring’ and ‘technical visits’ is not a critical issue for

FDRC, which is more concerned with the number of visits, whatever the purpose. • According to UN and NGO staff interviewed by the Review Team, NGOs and UN

agencies seem to be getting more access more easily than the Int Federation. This, however, should be verified by the delegation.

• Despite questioning the validity of the DPRK RC as objective and valid monitors,

ECHO accepts UN and NGO monitoring and reporting, which is primarily performed by DPRK governmental counterparts.35

• There could also be a wider issue, in that the Government may feel that the Int

Federation needs less field access as it has the DPRK RC as a counterpart – even though this is not accepted by ECHO.

35 Except WFP, which has some 40 international staff – another anomaly.

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• Those agencies and NGOs with regional sub-offices may enjoy better field

access and relations with local authorities than those with only a Pyongyang presence. This was also the perception of the recent ECHO Review.

If correct, this analysis suggests that the DPRK RC/Int Federation should adjust its strategy by: • More thoroughly analysing the access and monitoring arrangement of other agencies; • Using a more robust and strategic approach to lobbying donors on this issue – for

example, by pointing out back donor inconsistencies in their expectations of monitoring and reporting; and pointing out to the major back donors that they need the RC to fulfil their objectives in DPRK as much as the RC needs them;

• Consider opening a small regional sub-office linked to a DPRK RC branch; • Revising the Monitoring Framework in the light of the above, and incorporating the

feedback from ECHO and other stakeholders. 8.5 Sustainability Given that the DPRK RC/Int. Federation medical supply programme is effectively replacing a core state service, there is clearly no financial sustainability beyond ensuring continued donor support, and successfully handing back the responsibility for resourcing those services to the Government (or, conceivably, to international development agencies). Nevertheless, indicators and criteria for a well-managed exit of the RC from the programme at the earliest opportunity are essential for the credibility of its repeated requests for funding to ECHO and others. Opportunities for local procurement of items within the programme should also be actively monitored (see section 11.1.12 ) There is a sound argument for the wat/san programme to be considered as an aid programme to prevent serious human suffering – not least because of the evident and immediate impact of poor water and sanitation on mortality and morbidity. But this review agrees with the recent ECHO Review that the provision of relatively high-cost ecosan and biogas latrines to individual households is “inherently unsustainable and unreplicable” (p .47) when cheaper options are available . However, the joint Int Federation/DPRK RC operation do offer important and unique opportunities for sustainability, given the NS’ permanent status as an indigenous and distinct humanitarian organisation. Its community-based approaches to health promotion, CBFA, disaster management and organisational development are relatively low-cost volunteer-base activities which will continue in some form as long as the basic infrastructure of the DPRK RC is maintained. The Int Federation’s focus on developing DPRK RC’s capacities, its resource base and longer term bilateral support (for example, through a future CAS process) are essentially developmental measures to help sustain and expand these services for the long term. In addition, both the medical supply and wat/san programmes have created capacity in the course of their implementation which may well provide important resources for the Government once handed over, particularly given the NS’ exposure to international standards and approaches.

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9. Overall Strategic Framework In order to allow operational managers to apportion recommended actions, there is a progression in scale and priority from wider strategic considerations to more detailed programme recommendations. It should be stressed that these offer a foundation for a future strategy. They will require redrafting by operational managers within the DPRK RC and the Int Federation, according to the joint acceptance or rejection of the recommendations. There are various planning processes which may be useful when creating a DPRK RC/Int Federation strategy. For example, what follows may be easily adapted to the ‘5+1’ Objectives of the Secretariat, particularly as the country appeal planning is similarly linked.36 The precise structure is a decision for the joint operational management rather than this Review Team. It would be important that the NS can propose its own strategic framework, or adapt Secretariat planning models. Suggested Goals • Ensuring that the needs of most vulnerable are addressed by the appropriate

authorities and agencies, and by the Red Cross as necessary.

• A well-functioning NS, with core focused services that are sustainable nationally and in the long term.

Objectives 1. Continued delivery of the current set of high quality programmes to address

needs of most vulnerable for as long as needs persist.

2. A smooth phasing out of externally-funded medical supply and wat/san programmes as humanitarian needs decrease, and/or as soon as these sectors can be adequately resourced by the government and development agencies.

3. A planned transit from these larger externally-funded programmes to a clearly identified, indigenously sustainable set of core services that DPRK RC can implement in the long term, relying on sustainable communal resources and trained staff and volunteers in each Branch which will continue to conduct these core services.

4. Ensuring adequate back donor support to DPRK RC aid programmes, core services, and organisational strengthening and capacity building priorities in accordance with the NS’ Development Plan 2004-10.

5. Continued and improved quality of Int Federation technical support to the delivery of the joint programmes, and to longer term capacity building of DPRK RC within each programme but to common standards (for example in volunteering management, branch development, finance development standards etc).

6. Consistent and increasing bilateral support from DPRK RC’s partner National Societies, but delivered in a synergetic and collectively planned process through the planned CAS process.

36 The 5+1 framework consists of i) strengthening the NS, ii) cooperation, coordination and partnerships, iii) disaster management, iv) governance support, v) advocacy and PR, vi) efficient delegation management

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10. Achieving the Objectives Objective 1: Improve quality of programming Continue to consolidate DPRK RC’s aid-related programming

• The joint DPRK RC/Int Federation programmes are of an appropriate scale and are appropriately targeted. There should be no overall change in the current portfolio unless there are significant changes to vulnerability in DPRK.

Greater focus on targeting the most vulnerable

• The larger-scale programmes should refocus on addressing the most vulnerable groups within communities. This will also entail building the capacities of volunteers and staff in all Branches through the existing sectoral programmes to have common capacities in conducting vulnerability assessments to be able to contribute to needs-driven programme development processes in the future.

• Programmes should become more flexible to local needs through, for example, more tailored provision of medical kits and a wider range of wat/san solutions.

All programmes should adopt a clearer and more systematic capacity building strategy

• The adoption of common approaches to agreed minimum standards of branch development, information management, finance development etc in each programme will contribute to better programme design, implementation and reporting across DPRK.

• This will also improve integration across programmes.

• The long term sustainability of the OD gains achieved in recent years through the DPRK RC/Int Federation operation will be enhanced if capacity building elements at all levels are incorporated into programming.

Improve capacities of the DPRK RC whilst meeting donor’s monitoring and reporting demands

• A more robust engagement with ECHO and other back donors is needed to lobby for acceptance of the validity of DPRK RC’s role in monitoring and reporting . This will require coordinated top-level lobbying from the Secretariat, Liaison Bureau and partner NS. The delegation could gather experiences of agencies and NGOs to better analyse the RC’s own position and case for more flexible reporting.

• The current number of delegates should be at least maintained to provide adequate capacity to DPRK RC programming. The addition of a Programme Coordinator would help improve the overall strategic, analytical and integrated quality of the programmes.

• Consider opening a sub-office to improve field access, either with a programme representative, or a revolving delegate presence from Pyongyang.

• The Int Federation Monitoring Framework should be redrafted .

• Continue to emphasise the developmental and capacity-building nature of RC programmes, without relying on this to improve access.

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• Innovative solutions to the monitoring issue should be explored, such as the use by DPRK RC monitors of photographic evidence.

Identify and apply both qualitative and quantitative impact indicators

• Existing data and observations that indicate impact should be better collated and communicated through programme reports.

• A specific impact study document for donors and other stakeholders would improve the business case for continued donor support.

• A consultant specialising in developing innovative impact indicators may help DPRK RC and the delegation generate the above document as well as on-going impact monitoring and reporting systems.

• Demonstrating impact should be linked to increased support for improved reporting skills within DPRK RC. Reporting workshops should be increased. Financial and logistics reporting should be included.

Objective 2: Strategic phasing out of externally-funded aid programmes

• It is vital that there is regular and robust dialogue between the Int Federation Secretariat (and the Liaison Bureau and partner NS) and back dono rs on their funding and support strategies for DPRK. Obviously these will, to some extent, depend on political and other factors. But the RC should push the thinking beyond this standard fall-back position, and insist on the back donors’ obligations as formulated within the Good Donor initiative. The implications on the vulnerable of sudden drops in funding levels, or abrupt changes to the conditions attached to funding, should be communicated (particularly if the donors claim to be needs-driven).

• The deve lopment of joint strategies between back donors and the Int Federation that go beyond the annual funding cycle should be encouraged – particularly if back donors are aware of reasons why their funding may vary according to different scenarios over the longer term.

• The Int Federation and DPRK RC should develop technical criteria and indicators that will allow programmes to be down-scaled according to reductions in vulnerability and/or increased provision from other actors. This would be an important tool when convincing donors of the need for repeated year-on-year support if the funding situation becomes difficult, and pressure for demonstrable ‘exit strategies’ is intensified.

• In particular, seek to hand over the medical supply and hardware components of

the wat/san programme to development agencies and Government as soon as situation allows.

• If the operating environment improves, increase bilateral programming, but in careful alignment to the growth of DPRK RC’s capacities (particularly in financial management, monitoring and reporting ) and its Development Plan.

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Objective 3: Develop DPRK RC’s long term services and capacities

• Continue and increase the development of DPRK RC’s core long term activities

that can be sustained from national and community resources – particularly social welfare, youth, health promotion and disaster management.

• Better align OD initiatives to the assistance programmes at branch level.

• Continue to invest in key individuals at all levels.

• Ensure the sustainability of the DPRK RC’s core long term services through a focus on improving its legal base, and through a more strategic approach to resource development.

Objective 4: Ensure continued back donor support:

• Improve the communication of how the programmes are structured, how they

function and more analytical reporting of progress against objectives and constraints. Such clear messaging should include the existing experiences of integrated capacity building within programmes (such as the capacities successfully built amongst volunteers within health and hygiene promotion). Future strategies should improve this, and build donor understanding of the important link between the NS’s OD programme and its direct impact on improved services to the vulnerable.

• Increase the transparency and analysis of constraints to progress when reporting to donors.

• The Secretariat should lead on a coordinated approach with partner NS to increase awareness-raising of the humanitarian situation in DPRK to counter possible future politicisation on aid funding. The DPRK RC should be informed of discussions/initiatives being conducted on their behalf with donors and the public.

• Opportunities presented by the Seoul General Assembly in November 2005 should be maximised to raise awareness of the situation in DPRK and encourage engagement and even visits by high -level attendees of the Assembly.

• A key message to donors is that it is not acceptable to ‘drop’ DPRK funding for political or any other reasons. Use of the Good Donor principles should be included in Secretariat and partner NS lobbying.

• The impact study document (see above) should be utilised to argue for importance and effectiveness of RC programming, and the need for continued support.

Objective 5: Continued and improved quality of Int Federation support • Continue to uphold and reflect humanitarian principles of independence and

impartiality through the RC/RC Movement’s presence and solidarity with the DPRK RC despite the country’s international isolation.

• The significance of the Federation’s operation in DPRK demands higher levels of attention and support at regional delegation, Secretariat and supporting NS.

• This support should ensure that programmes are consistently able to adapt and maintain direction in the face of a complex and fluid operating environment.

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• Maintain the current scale and programme focus of Int Federation support until humanitarian needs and/or the provision of health and other services by the Government or other agencies increases.

• Coordinate a predominantly multi-lateral operation for the foreseeable future .

• Maintain delegation presence at the current or slightly increased level (if possible) so as to continue programme support whilst also adding more quality capacity building to the DPRK RC.

• Strengthen the strategic/analytical role and capacities of the delegation , with increased support from regional delegations and the Secretariat.

• Resolve the issue of vertical programming within the delegation. Clearly identify cross-cutting statistical analysis and impact indicators, and report on them.

• Structural changes within the delegation are limited by the apparent cap on overall delegate numbers permitted in DPRK. Whilst it is not the intention of a Strategic Review to focus too deeply on management issues, two main options would appear to be possible:

If an additional delegate position is possible, create a Programme Coordinator position to work on better strategic and programme integration, as well as releasing the HoD’s workload to allow for more in-country attention to the NS’ senior level and ad hoc OD needs.

If no additional post is available, consider incorporating the Wat/san Department into the Health Department to better reflect DPRK RC and Secretariat structures, and to improve programme integration. But a prerequisite for this would be a Health/WatSan Coordinator who implicitly understood and prioritised both Health and WatSan programmes equally. A specialist medic with no awareness or understanding of WatSan would be detrimental to this position.

• The Int Federation should better utilise cross-agency sectoral meetings to debate joint strategies, policies and technical lesson learning.

• The delegation and the DPRK RC should review their joint emergency coordination procedures in the event of a major sudden-onset disaster.

• The delegation should instigate more focused tripartite meetings with the NS and ICRC on pre -identified issues (such as legal base support, communications, emergency coordination arrangements, road safety, emblem and visibility issues).

• In line with standard Int Federation practice , the delegation should make monthly management reports to the Beijing Regional Delegation and Secretariat.

• Carefully align the speed of handover of programming responsibilities to the DPRK RC’s capacities particularly in financial management, monitoring and reporting and branch support.

Objective 6: Consistent and increasing support from partner NS • Develop a CAS process to ensure appropriate and long term support to DPRK

RC by the PNS, IFRC, ICRC and other actors (see Section 13 below)

• Encourage PNS to identify their level of commitment to the DPRK NS (whether this be through financial or technical support) and to change donor government’s donor thinking by advocating on identified issues.

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• Form peer support linkages with partner NS (and not just the wealthier ‘donor’ NS) on specific issues of OD (such as legal issues, resource mobilisation, financial management, etc) – ideally coordinated through the CAS. This would provide additional focus and consistency to the OD support available through the HoD, and the Beijing and KL Regional Delegations.

• An increase in directly bilateral programming support is not recommended for the short term, given the NS’ absorptive capacities and outstanding issues around financial management, transparency and accountability.

• However, increased bilateral actions in the medium to long term should be considered. These should absolutely be coordinated with the Delegation. One NS suggested that what it sees as a successful role of the East Asia Regional Delegation in coordinating bilateral activities in China may prove a useful model.

• The precise coordination mechanisms and the role of the Secretariat and its delegations could be usefully discussed and defined within a CAS process.

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11. Programme Strategies and Recommendations 11.1 Health

Short- medium term:

• Ensure the continued provision of essential medical supplies to primary and secondary level health facilities.

• Focus on improving quality of analysis, programme integration, impact assessment, reporting and technical support to the DPRK RC.

• Maintain the basic scale and logistics systems of the medical supply programme, with one exception – if lobbying of other agencies fails to ensure basic secondary health supplies are covered, reintroduce the provision of supplementary kits.

• Aim to make medical supply more closely linked and tailored to priority needs, rates of consumption and health level patterns through better access and analysis of qualitative and quantitative data.

• Harmonize the quality and quantity of medical supply programme with those of other agencies to ensure equitable national coverage.

• Develop joint inter-agency policies/strategies concerning national health problems and operating issues with which to approach both the MoPH and donors. Redesign the programme if inter-agency discussions lead to changes in the way national coverage is achieved.

• Address recent findings that sanitation/hygiene (and to a lesser extent water supply) interventions are crucial in improving overall health and nutrition levels.

• Therefore focus on the full integration of the health, wat/san and other programmes: increase management demands for closer linkages and enforce integration through programme appeal, management and reporting systems.

Longer term:

• Lobby for continued donor support for the medical supply programme at its current level (with the addition of supplementary kits) but phase out as soon as adequate provision is possible through the DPRK Government or other agencies.

• Develop a provisional strategy, criteria and indicators for phasing out and handing over medical supply responsibilities.

• DPRK RC to define clear roles and deve lop competencies in specific and sustainable community-based health promotion and delivery activities that will become core NS services as the aid -related health programmes diminish.

• These may include: first aid, hygiene promotion, HiV/AIDS awareness, and possibly a greater role in volunteer-based social welfare services.

• Maximise the capacity created in the CBFA programme (particularly regarding volunteers and mobilisation at the local level) as a foundation for the DPRK RC’s long term health programming.

• Continue to explore possibilities of in -country drug procurement if international standards can be ensured .

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Specific Recommendations 11.1.1 Lobby for UNICEF, WHO or another agency to fill the gap left by the RC’s phasing out of the supplementary kits. If this fails, additional donor support for resumption of supplementary kit distributions should be sought. The Int Federation’s global approach focuses on primary health care. Whilst providing a useful area of prioritisation and expertise, this should also be flexible to the highly specific situation in DPRK, where it is the only major international agency active in certain areas, and where it is providing possibly several times more drugs at secondary level than the government.37The issue of sustainability and exit strategy is an important one – but applies to the entire Int Federation-supported programme, and is not specific to the supplementary kits. There are also important issues around logistics and storage (particularly regarding temperature) which will need to be addressed. 11.1.2 NS and Int Federation to increase qualitative and strategic focus in programme design and management, in areas such as: consumption patterns in order to refine drug kit contents; analysis of statistical information in order to modify design and develop quantitative impact indicators; development of innovative, qualitative impact indicators; opportunities for integration with other programmes.

11.1.3 Engage other agencies in strategic discussions to harmonise the types, amounts and quality of health interventions across the country. Issues include: medical supply kits, a review of the strengths and weaknesses of geographical focus rather than sectoral focus, joint approaches to major donors. 11.1.4 Improve the quality of inter-agency approaches to national health problems, such as policies and initiatives on reproductive health issues, HIV/AIDS, the threat of SARS and avian flu, joint statistical analysis, the development of joint training curricula and materials, and joint strategies for eventual handover of medical supply programmes. The Int Federation/DPRK RC should consider leading an inter-agency engagement with the Government if WHO is not willing or able to lead on this. 11.1.5 Support the creation of a technical inter-agency review of drug/medical equipment distributions (as recommended by the recent ECHO Review), but widen this to include health policy and strategic issues. Ensure full MoPH participation . 11.1.6 The supply and usage of medical equipment should be reviewed by delegation and NS health staff. Redesign kits/distributions if necessary to avoid over-supply of some items and under-supply of others. Replacement or ‘refresher’ kits rather than re-supplying complete kits should also be considered. 11.1.7 Develop a modular CBFA training package , integrating CBDP and hygiene promotion. Ensure that all volunteers receive the total training package over a defined period through attending modules focused on particular topics. Include clarified refresher training and re -certification procedures. Delegates and CBFA

37 The need for flexibility of global Federation approaches within the unique environment of DPRK is also an issue within the wat/san programme – see section 11.2.

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trainers should reinforce the “Knowledge, Attitude and Skills (KAS)” approach of the first aid volunteers manning first aid posts.

11.1.8 Increase understanding of reproductive health within the NS and the Int Federation delegation, and integrate this core primary health care approach within all aspects of the programme. 11.1.9 DPRK RC to work towards defining its role and strategy re HIV/AIDS. 11.1.10 DPRK RC and the Int Federation to explore the development of a more substantial social welfare programme by 2010 – as prioritised within the NS’ own Development Plan. This could well become the key health delivery programme as the externally-funded medical supply programme phases out. 11.1.11 Maintain a watching brief on possibilities for local drug procurement, once international quality standards and cost effectiveness can be assured . Periodically review lessons learnt by WHO, UNICEF, and DIAKONI on progress on their local drug production project. It appears that the Pyongyang Jongsong Pharmaceutical Institute will soon be manufacturing basic medicines by late 2005. However, the Int Federation should maintain its policy of avoiding support for the import of raw materials for drug production. 11.1.12 A consolidated programme document with a 2 -5 year horizon should be created to better summarise and describe the strategic aims, approach and various components of the health programme. This will assist in donor understanding and marketing.

11.1.13 Ensure a common approach to integrated capacity building within all health-related programmes to strengthen branch structures and skilled volunteer and staff bases. In particular, strengthen the capacities of the local-level, volunteer-based CBFA programme as a platform for longer term health interventions.

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11.2 Water and sanitation Issues The wat/san programme is at a pivotal juncture. Two key trends have steadily emerged over recent reviews, which have important implications for its future : • “Urban areas…are at a significantly higher risk of water borne diseases than

rural populations”38 • Sanitation and hygiene interventions may be as effective a way of reducing

water-related disease as focusing on water supply.39 Interestingly for the Int Federation, this correlates to two of the five priority areas within the International Framework for Action , that is: “extending sanitation coverage” and “meeting the challenge of urbanization”.40 There may, however, be institutional and external reluctance to broaden the programme’s focus. The DPRK RC and the Int Federation delegation has been guided for many years by the priority objective of protecting water systems, rather than also addressing sanitation problems beyond relatively few ecosan and biogas installations. Whereas most of the Int Federation’s wat/san work (and global approach) is predicated on basic rural systems in developing countries, in DPRK the key vulnerabilities are found in more densely populated areas, in which communities rely on once-sophisticated but now decaying systems. The Int Federation’s global approach to wat/san may therefore need to adapt to the DPRK context if it wishes to address the needs of the most vulnerable. This need not necessarily imply massive, complex urban mains renovations. It is simply a question of setting clear parameters and criteria to avoid exceeding institutional technical competencies. 41 Additionally, in the context of DPRK, the phrase ‘semi-urban’ means an extended village, located near to urban conurbations but still primarily agricultural – in fact the phrase ‘semi-rural’ is more apposite. It should also be noted that the Int Federation’s wa t/san policy does not state any preference for working in rural contexts.

38 See The Interagency Framework for International Cooperation 2005, p.8, and the Report For The Evaluation of ECHO’s Actions In DPRK 2001-4, p.39 39 For example, the ECHO Review 2005, p.43: “There is widespread consensus amongst international observers that improving hygiene and sanitation would improve health to a greater extent than any other type of intervention.” 40 A greed upon during the second World Water Forum 2000, and used to guide global RC/RC policy 41 Similar issues arose in the Balkans and other post-Soviet ‘transition’ contexts, and were successfully negotiated by the Red Cross and other humanitarian organisations.

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Water/sanitation strategy

• Re-emphasise the key criteria of vulnerability, cost efficiency and maximising resources for the greatest impact possible when deciding interventions.

• Therefore, widen the scope of the programme to include more densely populated (semi-rural) communities.

• Also consider increasing the number of collective water and sanitation interventions in institutions such as schools and hospitals.

• Continue to seek developmental and sustainable solutions to wat/san problems, whilst develop ing a wider portfolio of technical options and clearer criteria for the ir application.

• Single, high -impact interventions on mains water systems (such as the Sinuiju pipeline repair) should be also considered.

• With a greater emphasis on larger projects, the aim should be to reduce the numbers of interventions whilst increasing the number of beneficiaries of the programme. This should aid programme management and supervision by the Int Federation delegates, given travel restrictions within DPRK.

• Int Federation wat/san delegates should focus on adding technical capacity for NS counterparts to oversee projects.

• Form stronger, more integrated links with the RC health programme, and with the wat/san programmes of other actors in DPRK.

• The DPRK RC, with Federation support, should develop a long term exit strategy for the eventual handover of its wat/san activities to the Government, except possibly water- and hygiene-related health promotion activities to be decided by the DPRK RC.

Specific Recommendations 11.2.1 A technical feasibility study of domestic and collective sanitation solutions applicable in DPRK should be commissioned – preferably as an inter-agency exercise. The study should identify a portfolio of interventions suitable for various vulnerable groups. It should include a cost benefit analysis, and recommended sets of impact indicators. If possible, it should include a technical specialist from outside of DPRK in order to provide access to global lessons and innovations.

11.2.2 Criteria for what constitutes a ‘semi-rural’ community - and parameters for RC intervention in such areas - should be developed. These should broadly define a ´step-up´ in scale of the existing rural wat/san projects, and should ensure that interventions do not go beyond the technical capacities of the NS and the delegation. Lessons learned by other agencies should be incorporated. The direction recommended by the wat/san planning workshop of August 2004 should be continued through the 15 semi-rural projects in the current ECHO programme, and

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the work to be implemented in the South Hamgyong province.42 The inclusion of semi-rural as well as rural communities in the programme does not on its own imply increases in future financial requests to donors, but re-prioritisation of the types of work to be undertaken within whatever budget is defined.

11.2.3 Criteria for single high-impact interventions on mains systems should also be drafted. Particular attention should be paid to defining a ‘beneficiary’ and assessing improvements in water quality and availability where a single contribution is made to a much larger overall mains supply.

11.2.4 The refinement of site selection criteria should include whether the necessary conditions for effective fuel production via biogas technology are present. Biogas and other systems with fuel bi-products may be more effective when applied to collective latrines in public institutions such as schools and hospitals.

11.2.5 While hand-over mechanisms currently exist, there should be a review of the formal processes by which post-project responsibilities are agreed . This should include criteria determining the formal end of the project, timeframes for handover, grievance and liability arrangements, and the Int Federation’s position in the formal handover process. It is recommended that all responsibilities for maintenance, water testing and repair are handed over to the community/local authorities as soon as possible after completion.

11.2.6 The technical capacities and training needs of delegates and NS staff should be reviewed if larger semi-rural projects form an increasing part of the intervention options.

11.2.7 If a wider Programme Coordinator position is not possible within the delegation, the Federation Wat/San Department should be incorporated into the Health Department, in order help improve integration of programming . However, this would only be effective if the head of the combined health/watsan department gave both sectors equal value, and did not allow personal technical specialism to neglect or interfere with the smooth running of joint department.

11.2.8 The role of the DPRK RC’s Water Quality Monitors should be reviewed , particularly in the light of their recent additional duties in wat/san-related health promotion. Issues requiring urgent clarification include: their integration with the health programme; their additional training needs; reporting ; the accountability of their performance and adjustments to their job descriptions.

11.2.9 The focus of the Int Federation delegates should increasingly be on:

• improving technical, monitoring, reporting and analytical capacities within the DPRK RC,

• analysis of project data in relation to impact on overall health levels in vulnerable communities,

• liaising with other international actors in the sector to better harmonise technical and policy approaches to national wat/san issues, and to create shared learning for application through ongoing programmes

• creating a more integrated approach at community level with the health programme.

11.2.10 An exit strategy should be drafted by the DPRK RC and the Int Federation. This should include: criteria for phasing out the programme, handover arrangements 42 Report of the Planning Workshop of the wat/san program in DPRK, Int Federation, Aug 2004, p.12.

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of staff and know-how to appropriate authorities or development agencies, and contingency plans in the event of a reduction of ECHO or other funding. The DPRK RC should define its projected future role in wat/san beyond the Federation-funded programme. This may well include water and hygiene-related health promotion (linking with the NS’ health activities).

11.3 Disaster management

Short- medium term:

• Consolidate the many new initiatives and expand mo re slowly in future, ensuring that lesson learnt inform future developments.

• Decrease reliance on HQ and improve the capacity of the branches in establishing skills for continued expansion of the CBDP approach.

• Ensure the quality and appropriateness of CBDP mitigation measures, including relevant use of reforestation as a targeted DM tool.

In the longer term:

• Ensure that DM is consolidated as a core activity for the DPRK RC.

• Clarify and adjust the roles of the NS in relation to government agencies and other players, particularly in early warning systems, contingency plans, local response capacity, and coordination regarding mitigation measures.

• As response capacity becomes mores rooted at the provincial level, refine the network of DM volunteer teams by targeting the county level, prioritising key counties and towns/cities.

• Explore how to move into traffic safety as a cross-sectoral activity of the NS.

• Maintain and improve close collaboration between the DM Department and other departments so that all of DPRK RC’s long term ‘development-oriented’ activities will follow a coherent risk reduction approach.

Specific Recommendations 11.3.1 At Headquarter level, the DPRK RC needs to define, document and train their internal contingency plans for various disaster scenarios, including 24/7 on -call rosters, communication lines and response procedures. Coordination procedures with the Int Federation delegation also need to be improved. 11.3.2 Define the roles and responsibilities of the provincial Disaster Preparedness Working Groups, and support their capacity to form contingency plans with relevant local stakeholders. 11.3.3 Define clear roles and follow-up support, contingency planning and drill exercises for the National Disaster Response Teams at the province level.

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11.3.4 Define the mandate and operational conditions for the planned Emergency Response Teams. 11.3.5 Maximise the potential of the “factory sub-branches” by developing a specific RC role in wo rk-place accident prevention and response to small-medium scale industrial or technological disasters. 11.3.6 Expand the coverage of the CBDP programme by 10 Ris per year for the near future , while improving p rovincial capacities for faster roll-out from 2006 or 2007. 11.3.7 Strengthen the criteria for micro-project selection and approval to ensure that the focus remains on local risks for the most vulnerable , and not contributions to local general infrastructure projects. 11.3.8 HQ and branches need to define a viable plan for follow-up support to the CBDP Ris after the first implementation phase; this includes coaching in revising the communities’ DP plans and adjusting and rehearsing contingency plans. HQ needs to support branches with training material, technical visits and joint lesson-learning. 11.3.9 When acting within the Int Federation DM programme, DPRK RC should clarify its role in tree -planting. Tree-planting should occur as CBDP micro-projects only when aimed at minimising localised and clearly defined risks. The RC should support wider government-led tree-planting campaigns as a Youth activity. Tree nurseries should be considered outside Red Cross areas of focus and expertise . 11.3.10 Continue to develop indicators on the effects of DM interventions elements (in line with pre vious reviews). 11.3.11 Finalise the process of aligning DM training curriculum with CBFA . 11.3.12 DPRK RC should consider its strategic positioning regarding road safety, the prevention of road accidents and emergency first aid. It should define its role in respect of the role of various Government ministries. A tripartite approach with the Int Federation and ICRC (given its work with road accident victims) should be explored. Opportunities for integrating DM, first aid, youth programmes, branch deve lopment and the activities of other agencies should be explored to avoid vertical programming.

11.3.13 DPRK RC is encouraged to update its assessment as a “Well-prepared National Society”, using the Int Federation’s revised self-assessment tool. 11.3.14 The DPRK RC desires a ‘disaster fund’ to finance restocking during small-medium disaster response s. Donor support is unlikely. However, as part of the recommended ‘solidarity’ approach for the CAS process (see section 13), interested partner NS should express a commitment to consider well-designed proposals for small scale restocking and related expenditures after each response .43

43 It should be noted that ECHO are able to release such funding if it receives a request from a member state NS within 72 hours of a disaster. This could form a part of the partner NS’ commitment of interest in this areas of support to DPRK RC.

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11.4 Organisational Development Short-medium term

• Continue in the direction laid out by the NS’ revised OD plan.

• Guide the programme using the DPRK RC’s Development Plan, and the Int Federation’s Framework for Capacity Building.

• The NS should focus on making a stronger business case for continued partner support through improved programme reporting, progress against objectives and constraints and analysis of impact on wider programming and vulnerability.

• Increase the integration of the OD programme with other programmes through better geographic and sectoral targeting of inputs, and through personal capacity-building of key management and governance.

• Increase attention on developing the volunteer base and RC youth, and their engagement in the NS’ assistance programmes.

• Revise the resource mobilisation strategy to include a broader approach to RM, a deeper contextual analysis and more realistic timeframes.

• Improve the visibility of the DPRK RC.

• Phase in more focused levels of support from the Int Federation’s regional delegations in strategic advice, reporting, information, OD and finance.

Longer Term

• Extend the successful increase of human resource capacities at branch level via health volunteers into a wider capacity building strategy in future which has more conscious links to Branch development plans. This would result in stronger Branches with a wider number of community based skilled volunteers in the years to come who deliver self-sustaining health promotion at community level

• Increasingly prioritise requests for external support on the key areas requiring progress, such as financial management, resource development and branch support.

• Aim for sustainability of the programme by increasingly opening up the availability of OD support and lessons through more direct communications with the DPRK RC’s partners, facilitated by a CAS process.

• Conduct a major review of the Development P lan in 2009-10. Specific Recommendations

11.4.1 Decisive progress on improving DPRK RC’s financial management issue should be secured . The Federation (including partner NS) should push for improvement, whilst helping the NS explore software solutions for multi-reporting, investment in training of NS Financial Dept. staff, development of an NS finance manual and decentralised financial systems.

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11.4.2 Clarify and develop DPRK RC’s strategy and role in volunteerism, including a clear definition of volunteerism within the RC context in DPRK, a revision of the Volunteer Manual, and stronger incorporation within the delivery of other programmes – particularly those that will become core RC activities once the externally-funded programmes are phased out.

11.4.3 Clarify the RC’s strategy and role in youth. Consider greater incorporation of RC Youth in current and future programme delivery.

11.4.4 Revise the Resource Mobilisation strategy, adopting a broader approach to include human, financial and other resources, realistic objectives and timeframes, a more thorough analysis of the market and the business environment in DPRK, and a more strategic positioning of the NS to take advantage of emerging possibilities.

11.4.5 Focus income generation on core RC activities and services (such as commercial first aid). Emphasis should be on the provision of services where the RC can maximise its image or competencies. Consider an emphasis on contracted service provision (eg. first aid for learner drivers) rather than industrial production or retail of goods in competitive business sectors.

11.4.6 Explore pilot income generation initiatives selectively and strategically, rather than encouraging a proliferation of many diverse projects.

11.4.7 The Int Federation should provide consolidated lessons learnt on resource mobilisation (particularly income generation projects) by other NS, especially those in ex-Soviet transition countries.

11.4.8 Explore a provincial branch computer project, located in the training centres, to offer youth education opportunities, to modernise dissemination and training methods, programme management and reporting, and to position the branches for eventual commercial computer training initiatives.44

11.4.9 Increase Int Federation (and ICRC) support for basic visibility materials (vests, posters, etc) to enhance the NS’ visibility.

11.4.10 Create a report on the current status of the OD process. Include clearer progress reports against specific appeal objectives, a thorough analysis of achievements, constraints to progress and impact on the delivery of other programmes. Make a clearer business case for continued investment by donors.

11.4.11 Develop a more coherent system of updating and summarising the programme for future communication internally and to partners.

11.4.12 The Int Federation delegation, Beijing Regional Delegation and RFU and Asia Pacific OD Coordinator in KL should agree a scheduled annual programme of OD support according to appeal objectives.

11.4.13 The Int Federation country and regional delegations should be more proactive in enabling direct communication between DPRK RC and other parts of the Movement who may be able to offer lessons and experiences on specific issues. 44 This will depend on sufficiently regular mains power supplies which remain erratic. However, some improvements have been noticed by observers in the past year.

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12. The DPRK RC / Int Federation Operation: Next Steps In the Team’s experience, the effectiveness of many exercises similar to the present Review is reduced through a lack of clearly coordinated follow-up. Therefore, suggested follow-up actions are given below. At present, this is foreseen as a separate (but linked) process to a wider CAS (see Section 13) which has yet to take any concrete shape, and which would have a focus beyond the Int Federation/DPRK programmes reviewed here. However, if the CAS process takes root, the DPRK RC/Int Federation strategy should obviously become an increasingly integral part of the CAS.

a) An agreed position on this Review DPRK RC senior management, the Int Federation HoD, HoRD and Asia Pacific Dept Geneva produce reconciled management notes that formally accept, reject or modify the findings and recommendations of this Review.

b) A Redrafted Operational Strategy

The accepted or modified findings, recommendations and suggestions towards a strategy are converted into the objectives of a redrafted DPRK RC/Int Federation operational Strategy. This could then introduce more management-oriented considerations such as operational structures, delegation of tasks and overall timeframes. This is an opportunity to link the Strategy with 2010, the Secretariat’s ‘5+1’ framework, and the annual appeal cycle.

The operational Strategy will naturally include consultation with ICRC, partner NS and other stakeholders, on a range of issues from ECHO grants and peer support for OD to coherent advocacy, awareness and fundraising messages.

c) An Action Plan

This should underpin the Strategy, in which the actions required to achieve the strategic objectives are clearly recorded and reported against.

d) Guiding the Operational Strategy

It is suggested that there is a Strategic Steering Committee to act as an oversight body to maintain momentum and direction of the Strategy. Depending on how the CAS evolves, this role may be part of a wider CAS Steering Group.

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13. Towards a CAS process 13.1 Background A CAS paper was produced in 2001. However, it was interpreted as more of an alternative appeal document, and did not play a significant role in DPRK RC’s relationships with its partners. The National Society was obviously eager to revisit a CAS process (indeed, it has been an objective in every Annual Appeal since 2003). However, the second half of 2004 saw an increase in a momentum to finally re -engage with the process. This has coincided with the development of the ‘second-generation’ CAS concept across the Int Federation. This is defined as “the process through which a NS manages its cooperation in order to achieve its mission in favour of the community it serves.” It sees CAS less as an alternative appeal mechanism for directly raising funds, and more as a means of improving all aspects of the quality of a NS’ relationships.

DPRK RC has seen recent documentation of o ther CAS processes (including Nepal, Indonesia and East Africa). There was also a discussion on CAS with its NS partners at the 2005 regional Partnership Meeting in Ulan Baatar, where general interest in engaging in such a process was expressed by most (but not all) participants. This should be followed up by the Secretariat in the first instance. In a brief survey of the main NS partners of the joint operation,45 the majority were supportive of a CAS process, despite the fact that most wished to pursue a broadly multilateral form of support for the foreseeable future. Their interest was for various reasons, largely centring on the benefits they perceived for better coordination of joint strategy, multilateral funding, complementary bilateral inputs where possible, and a stronger joint platform to raise awareness and advocate for the vulnerable in DPRK. It is interesting to note that all of those partner NS questioned expressed a strong long term commitment to engage with the DPRK RC and the needs in the country. The ability of some to make concrete strategies is curtailed by their reliance on the fluctuations of their governmental donor’s thinking, but saw a CAS process as a way to be able to offer low (or no) cost support in a coordinated and prioritised way. Three were interested in engaging their branches and the public in awareness raising. 13.2 Rationale for a CAS process The motivation and decision to initiate a CAS must of course be determined by the partners of the process. However, the Review Team suggests that in the context of DPRK, a CAS may present opportunities to:

• Establish the principle of solidarity between DPRK RC and its partners, whatever the fluctuations in back donor funding to DPRK.

• Ensure that gains made in service delivery and DPRK RC’s development over the past 10 years is not lost, by maximising the financial and non-financial resources available within the RC Movement.

45 The DPRK RC has various other NS partners, particularly in the region, who are not engaged in supporting the joint operation, and whose support is strictly bilateral.

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• Ensure programming coherence with the DPRK RC’s Development Plan 2010 , (particularly if there is an increase in bilateral programming over the medium-long term).

• Align partnership principles – particularly important in a situation where partner NS are highly dependent on ultimately political funding bodies (such as government donors and ECHO).

• Provide a forum for the DPRK RC and its partners to understand their mutual constraints. This could be particularly valuable in DPRK, where the NS needs to be able to communicate its somewhat sensitive operating context in an informal, understanding and supportive environment.

• A CAS process could also be a useful forum to create a coordinated humanitarian lobbying strategy across a wide range of issues on behalf of the NS.

13.3 Issues specific to DPRK context • It is important to distinguish between a CAS process – which has relevance

wherever multiple partners are supporting an NS – and bilateral programming, which is a specific form of partnership . The 2003 East Asia Donor Partners Meeting noted the need for “a different approach [to bilateral work] for DPRK in view of the complex situation there”. As the mechanism for support, many PNS felt the multilateral approach was still most appropriate. Neither negates the need for a CAS process: indeed, the complex situation may make CAS of additional relevance.

• There are many inherent power imbalances between DPRK organisations and international organisations: including those related to donor agendas. To a large extent this is ultimately created by macro-political forces, but nevertheless may affect DPRK RC’s relations with its partners. For example, some European NS have very large contracts with ECHO to whom they are accountable: others are under pressure to answer to formulaic or reductive reporting demands by the ir governmental donors. Any CAS process must be robust enough to recognise power imbalances and deal with them openly but with sensitivity and mutual respect for the position of all sides.

• There are many conflicting donor agendas of bureaucratic control, accountability, one-way transparency and even of longer term change. On the other hand, there may be issues around a lack of transparency and access within DPRK. Either will fundamentally displace a true partnership environment, and would need careful and honest discussion.

• There will also be a need for sensitivity to the subtleties required in understanding and supporting DPRK RC to overcome constraints caused by its working context. Western management approaches used by many PNS’s are ill-tuned to the specific cultural, social and institutional context in DPRK.

• Partner NS (and the Federation) want to be accountable to the vulnerable and to the host NS, but are often in practice more accountable to their donors. Such issues have been seen elsewhere “a significant obstacle to effective partnership”.46 Within a CAS process, DPRK RC may well want their Movement partners to be more open about their organisational agendas, priorities and planning – particularly regarding their dialogue with donors.

46 A. Balpe: CAS: the Latest Thinking, Int Federation (Feb 2005), p.2

49

• On the other hand, the extent of openness of an NS to its partners has been identified elsewhere as a key aspect of a meaningful CAS process. This, as in all institutions in DPRK, may prove to be problematic for the DPRK RC, and will require careful and realistic exploration of the limits of expectation and what this means for partnerships.

• Given the above, the issue of whether a CAS process should engage non-RC partners will be an important and interesting one.

13.4 Timeframe

Although there is some interest within the DPRK RC to have initial Memoranda of Understanding signed at the General Assembly in November 2005, all previous learning suggests that establishing a strong CAS process takes time. However, its possible that partner NS could make a statement in Seoul of their commitment to provide solidarity and either financial or non-financial support to the DPRK RC over the longer term via a CAS process. It might be useful to integrate a CAS timeframe with that of the NS’ Development Plan 2004-2010 – that is, to review and revise the process as part of any similar exercises planned for the Development Plan. 13.5 Next steps towards a CAS process • The Secretariat, with the regional and country delegations, to lead on the

coordination of follow-up to the 2005 East Asia Partnership Meeting . This should include a meeting (by teleconference if necessary) of host and partner National Society stakeholders, the Secretariat and ICRC to ascertain levels of commitment, areas of interest and a road map for the CAS process;

• The possible formation of a NS taskforce or Learning Group to oversee the CAS process;

• The nomination of focal people with in the DPRK RC, the Int Federation and the partner NS group;

• The creation of consultation mechanisms (teleconferences, partnership meetings, a special meeting) including how branches/volunteers in the respective NS can be involved ;

• A relationship analysis and the development of principles of cooperation;

• A mapping of resources, mutual agendas and competencies;

• Plotting and scheduling the CAS process;

• The creation of a simple operational plan, with roles and responsibilities;

• The drafting of a CAS document and MoU.

29 July 2005 Annex A: Source Documents DPRK RC plans and policies • DPRK RC Development Plan 2004-2010 (May 2004) • MoU between the DPRK RC and the Int Federation (2005) • Disaster Preparedness Policy of the Red Cross Society of DPRK (adopted at the

7th General Assembly Session of the DPRK RCS, 19 May 2004) • Disaster Response Policy, Red Cross Society of DPRK (adopted at the 7th

General Assembly Session of the DPRK RCS, 19 May 2004) • 5-Year Strategic Work Plan for Disaster Management (2003-2007) • 3-Year DPRK RC Health and Care programme • DPRK Health Policy • Resource Mobilisation Strategic Work Plan (2005 -7 (draft) DPRK RC, International Federation and PNS documents General (Many of the documents were jointly owned with the DPRK RC) • Annual and Emergency Appeals and Reports for DPRK, 2001-2005 • Review of Monitoring Procedures, January 2005, by DPRK Int. Federation

Delegation • The Manila Action Plan 2002 • International Federation Health Policy • International Federation First Aid Policy • International Federation of Red Cross and Red Crescent Societies Strategy 2010

– Health and Care Review ( M. Michael and peer reviewers March 2005) • International Federation of Red Cross and Red Crescent Societies mid term

evaluation and review of Strategy 2010 • The John Hopkins and Red Cro ss/Red Crescent Public Health Guide for

Emergencies • Int Federation Water and Sanitation policy • Int Federation Emergency Response Policy • Int Federation Disaster Preparedness Policy • Minutes of the East Asia Donor Partners Meeting (June 2003) • Minutes of the East Asia Donor Partners Meeting (March 2004) • List of DPRK Appeal coverage, 1995-2004 • Strategic Framework for IFRC and its Partners, (version 5, June 2003) • Internal Audit Review of the DPRK Delegation, (May 2004) Health • Review of the Red Cross Health and Care Programme, DPRK by C. Dammers, A.

Cramer & G. Nedgård, March 2003. • DPRK RC Comments on the recommendations from the 2003 Review on the

IFRC’s Health and Care programme in the DPRK • Review of the Red Cross Health and Care Programme, DPRK by C. Dammers,

T.H. Kristiansen, M. Pelly, J. de la Peña, N. Juel, October 2001.

• Mission report: Health Programme Review DPRK Red Cross/Federation, 20 - 27 October 1998 by I. Hauglin & M. Tailhades.

• Int. Federation Health and Nutritional Support in DPRK, Mid-term Assessment Report, April 1998.

• Contents lists of: Supplementary Hospital Kit, Orthopaedic Kits June 2002, First Aid Refills July 2002, Delivery Kits June 2002, Household Doctor Kits June 2002, Basic Hospital List December 2001.

• DPRK appeal 2005-2006 for Health and Care • DPRK 2005 Health and Care Logical Framework • IFRC medical supply 1 basic kit/1000 population – quantity per quarter/per kit • Some Information on Health care in DPRK and the RC Health Programme - Ans

Groen 26/03/04 • Monitoring Analysis( by DPRK Fed Delegation) September 2004 – March 2005 • MOU for Collaboration between the WHO, South- East Asia regional Office and

the IFRC Disaster Management • Visit Report - DPRK Red Cross Disaster Management Programme, May 2004, by

A. Poulter, BRCS • Disaster Preparedness and Response Programme 2001 – 2002 review by H.

Lockwood for BRCS • IFRC Mission Report, DPRK RC Disaster Preparedness Programme, by D.

Peppiatt (BRCS) & A. Galperin (DP Consultant), September 2000 • Disaster Preparedness and Response Plan 2005/2007 (Draft Program Proposal,

May 2005) • Concept paper: Establishment of National Disaster Response Team (+ outline &

Terms of Reference) • Note: Rescue Team Project (idea presented to German Red Cross) • Tree planting activities conducted in CBDP areas (Internal list by DPRK DM

Dept.) • DP/DR workshops at various levels (Internal list by DPRK DM Dept.) • DM Dept.: Programme for Provincial DM Workshops • DM Dept.: Programme for Community-based Disaster Preparedness Workshop

(S. Hamgyong Prov. 2005) • CBDP Meeting Report (lessons learnt workshop for first 9 pilot Ris) Water and Sanitation • Int. Federation Review of the Red Cross Water and Sanitation Programme in

DPRK by W. Stöckl & W. Klaassen, June 2004 • Water & Sanitation Project Assessment in DPR of Korea, 15 - 22.08.2000 by U.

Jaspers & P. Fox. • Final evaluation of health institution Water & Sanitation Programme in DPR of

Korea 1999-2001, by P. Fox & T. Le • Review of the Red Cross Water and Sanitation Programme in the DPRK, by P.

Fox, T. Le & C. Dammers, November/December 2002. • Report of the Planning Workshop of the water & sanitation program in DPRK, by

W. Klaassen & W Stöckl, November 2004 • Programme proposal: Water and sanitation programme proposal for the

improvement of rural community health in DPRK, by P. Fox, J. de la Peña & E. Pleijel, 2001

• Int Federation Water & Sanitation Policy

Organisation Development and CAS • Field Trip Report, Regional OD Delegate (July 2002) • DPRK NS - Well-functioning NS Self Assessment Questionnaire: Preliminary

Findings of IFRC Evaluation Dept (Nov 2002) • PNS activities and Plans (matrix) • Concept Paper for Strategic Framework (draft) (2003) • Strategic Framework for IFRC and its Partners (5 th version, April 2003) • Field Trip Report, East Asia Regional Information Delegate, April 2003) • Discussion Paper: Partnerships and Power Relationships (Balpe, April 2004) • Field Mission Report, Asia Pacific Regional OD Delegate, June 2004) • Minutes of DPRK Visit to Service Centre, KL (September 2004) • CAS: the Latest Thinking (February 2005) • Sharing CAS Best Practice (Presentation, 2005) • East Africa CAS Learning Workshop (March 2005) • Revision of the OD Programme 2005 (April 05) • Draft Case Study and Draft Presentation: ‘Impact of OD and CB Work on

improving the lives of the most vulnerable’ (2005) • DRAFT Mission Report to DPRK RC and International Federation Delegation in

DPRK, 26 th April – 7th May 2005, by J. Gwynn Regional OD Delegate Non-RC • DPRK 2004 Nutrition Assessment, Report of Survey Results. DPRK Central

Bureau of Statistics, Institute of Child Nutrition (in collaboration with UNICEF and WFP). February 2005.

• Strengthening International Development Projects and Programs through Effective Cultural Collaboration: Lessons Learned (Centre for Intercultural learning, Canadian Foreign Service Institute, Oct 2003)

• UN Report of the Inter-agency Mission to the DPRK (Oct 2004) • Framework for International Cooperation in 2005 (UN/OCHA, 2004) • North Korea’s Economic, Political and Social Situation (NIAS, December 2004) • ECHO’s Actions in DPRK 2001-4 (Agua Consult, Jan 2005) • ECHO 6 Field Audit (of the Danish RC drugs programme component), (Oct 04) • Review of CHAD Support to the International Federation of Red Cross / Red

Crescent DPRK Red Cross Society. Monitoring Mission report, October 2004. Dfid (Draft copy only)

• UNICEF medical supply for Ri level/5000 population/1 quarter/ quantity per kit • WHO Model List for Essential Medicines

ANNEX B: Persons consulted DPRK RC Paek Yong Ho Executive vice president Min Byong Gwan Secretary General Ri Ho Rim Deputy Secretary General Choe Jung Gang Head of International Dept. Dr. Pak Eun Gyong Health Team desk officer Ho Gyong Chol Health (CBFA) Team desk officer Ryo Sung Chol DM Dept. Director Dr. Song Jiu Kuk HealthTeam desk officer Dr. Kim Chol Health Coordinator Pak Kwang Chol Head of WatSan team Kim Song Il Programme coordinator So Myong Sok Programme officer Pak Ok Ran DM Officer Ri Un Hye Int’l Dept., Desk Officer for European NS Ju Myong Il DP Officer, Anju City Branch Anju City Branch Sinuiju City Branch Sunchon City Branch Kaesong City Branch Ryongchon Branch

Int Fed Delegation DPRK Jaap Timmer Head of Delegation, IFRC DPRK Ahmed E. Suleman IFRC Disaster Management Coordinator, DPRK Ruben Margaryan IFRC Health Co-ordinator Ulla Nerenst IFRC Health Delegate, DPRK Mari Inger Dorum IFRC Health Delegate, DPRK Aengus Ryan IFRC WatSan Coordinator Alex Bor IFRC WatSan Delegate Bo Bakstrom IFRC Logistics Delegate Int Fed Regional Delegations Alistair Henley Head of Regional Delegation, IFRC, Beijing Gu Qiunghui Regional Disaster Management Senior Officer, IFRC,

Beijing Audrey Swift Regional HIV/AIDS Manager, Beijing Hope Weiner Regional Reporting Delegate, Beijing Marat Yunusov Regional Finance Delegate, Beijing John Sparrow Regional Information Delegate, Beijing John Gwynn

Regional OD Coordinator, Regional Delegation, KL

Int Fed Secretariat Bruce Eshaya-Chauvin Head, health & Care Dept. Aurelia Balpe CAS Coordinator Marcel Fortier Head of Donor Relations Ewa Eriksson Desk Officer, East Asia Graham Betts-Symonds DM Senior Officer

Grace Lo Senior Officer, Health & Care Dept Uli Jaspers Head Water and Sanitation Unit, Health & Care Dept Hakan Sandbladh Senior Officer, Public Health in Emergencies, Health &

Care Dept Partner NS Hellmut Giebel German Red Cross, Desk Officer Asia Lasse Melgaard Danish Red Cross, Desk Officer E Asia Anna Björnberg Finnish Red Cross, Desk Officer, E Asia Lena Hansson Swedish Red Cross, Desk Officer, E & SE Asia Wilma ter Heege Netherlands Red Cross, Desk Officer, E & SE Asia Arie Schuurmans Netherlands Red Cross, Regional Programme Manager,

Beijing Penny Harrison Acting Manager / Int’l Operations Dept, Australian RC Satoshi Sugai Japanese RC, Desk Officer Torben Henriksen Norwegian Red Cross Desk Officer Anne Bergh Norwegian Red Cross Special Advisor Alistair Burnett Desk Officer, British Red Cross Ruth Aggiss Desk Assistant, British Red Cross Moira Reddick Head of IPADD, British Red Cross Jhiyoung Yoon S Korea Red Cross ICRC Sandra Moretti Carr Head of Sector Asia & Pacific Cooperation , Geneva Paul-Henri Morard Head of Delegation The ICRC orthopaedic workshop, DPRK

Non-RC Interviewees

Mr. Jong Song Il, Director for Europe, Ministry Foreign affairs Mr. Pak Yo Liaison Officer, Flood Damage Rehabilitation Committee David Slinn Ambassador, British Embassy, Pyongyang Paul Beijer Ambassador, Swedish Embassy, Pyongyang Taufique Mujtaba Programme Coordinator, UNICEF, Pyongyang Pierette Vu Thi Representative, UNICEF, Pyongyang Dr. Eigil Sørensen WHO Representative, Pyongyang Abraham de Kock Deputy Country Director, UN WFP, Pyongyang George Murray Head of Office, UN OCHA, Pyongyang Thomas Pfeiffer ECHO Desk, Brussels David Hill Representative, EC ECHO, DPRK Laurence Bardon Programme Officer, EC ECHO, DPRK

Rose Dew Country Director, Concern, Pyongyang So Jun Ok Vice Director, Ministry of City Management Jory Kwon Nam Senior Officer, Ministry of City Management Ri Cha Dol Dept. External Cooperation, Ministry of Environmental

Protection

Annex C: Medical Supply Components within the Health Programme Provincial

hospital City/County/Industrial hospital

Primary level (ri clinic; ri hospital; polyclinic)

First aid post

Total

Number of Fed supported health facilities

3 (not 2005)

195 (from 2005, only household doctor depts supported)

2,081 650 posts, manned by 2 RC volunteers 10 in each city/county

2,279 hosps/clinics + 650 First Aid posts

Basic kit (medicine)

8,850 kits supplied quarterly to household doctor depts. city, county & industrial hospitals, and primary level institutions

Household doctor's kit (equipment)

1 or 2 kits for each health facility depending upon number of household doctors (annual)

intensive care kit

8,000 kits in 2005 (annually)

supplementary kit: medicines (tablets & injectables) syringes, etc

Twice yearly until end 2004

twice yearly until 2004

Orthopedic surgical kit

1 to each in 2004

23 hospitals (2004). 70 hospitals in 2005

Delivery kits (delivery and OB/GYN surgical instruments)

one kit being supplied to each hospital

Delivery kit (Midwives) kit

one kit being supplied to each institution

First Aid Kits one full kit to 150 FA posts annually and refill kits to 500 posts 6 monthly

ANNEX D: The Water Sanitation Programme

The three easternmost counties are target areas for 2005.

ANNEX E: The Disaster Management Programme

The five easternmost CBDP areas are target areas for 2005. x indicates counties where tree-planting has been used as a mitigation activity of the community-based disaster preparedness programme 2003-04.

ANNEX F: Abbreviations and Glossary

CAS Cooperation Agreement Strategy

CBDP Community Based Disaster Preparedness

CBFA Community Based First Aid

Delegation DPRK delegation of the IFRC

Reg Delegation IFRC regional delegation in Beijing

Dong Urban or peri-urban subdistrict in DPRK

DM Disaster Management

DP Disaster Preparedness

DR Disaster Response

DPRK Democratic Peoples’ Republic of Korea

DPRK RC DPRK Red Cross Society

ECHO European Community Humanitarian Office

EcoSan Here, a small-scale latrine system for safely treating human waste, with agricultural fertiliser as a by-product

Int Federation International Federation of Red Cross and Red Crescent Societies

FDRC Flood Damage Rehabilitation Committee

FPA Framework Partnership Agreement (w/ ECHO)

IFRC International Federation of Red Cross and Red Crescent Societies

MoCM Ministry of City Management

MoEP Ministry of Environmental Protection

MFA Ministry of Foreign Affairs

MoPH Ministry of Public Health

MoU Memorandum of Understanding

NGO Non-governmental organization

NS National Society (ie DPRK RC)

PHAST Participatory Hygiene and Sanitation Transformation

PP Programme Proposal

OD Organisational Development

RC Red Cross

Ri Rural subdistrict in DPRK

SWOT Strengths, Weaknesses, Opportunities and Threats (analytical tool)

ToT Training of Trainers

UNICEF United Nations Children’s Fund

WatSan Water and sanitation

WBD Water-borne disease

WFP World Food Programme

WHO World Health Organization

ANNEX G: Interagency Sectoral Strategies It is important that the Red Cross’ short-medium operational strategies are coherent with those of the wider humanitarian effort in DPRK. The sectoral strategies for health and wat/san are outlines in the Interagency Framework for Cooperation 2005, drafted by UNOCHA, and include: Health

• Provision of basic drugs, equipment and supplies

• Focus on nutritional needs of most vulnerable,

• Developing a strategy and building capacity to address outbreaks of disease

• Strengthen national immunisation system

• Building technical capacities especially primary health care, reproductive and child health and control of communicable diseases

• Advocacy on policy and strategy

Wat/san

• Acute prioritisation within a systemic, nation-wide problem that only major governmental investment can address;

• A move to address needs of whole communities, not just institutions or individual houses, for those agencies with enough capacity to do this;

• Continued emphasis on urban populations;

• Encourage improvement in water management;

• Piloting “low-cost community-based approaches” for eventual replication on a larger scale once large scale development funding becomes available;

• Emphasis on gravity-fed systems;

• Encouraging Government-led coordination and strategy.

Annex H: Terms of Reference 1. Introduction

After the holding of its National Congress in May 2004, the Red Cross Society of the Democratic People’s Republic of Korea (DPRK RC) has requested support from the Federation to set up a Cooperation Agreement Strategy (CAS) process. One important part of this exercise will be to carry out a holistic review of all the society’s current programmes in order to:

• analyse the strengths an d challenges of the international programming undertaken in the past four years, and

• make clear recommendations for the future scope and direction of international assistance in the next three to five year time frame to assist DPRK RC in implementing its Development Plan 2004 -2010.

This strategic review should be an inclusive process, involving DPRK RC at all levels, relevant DPRK government ministries and the society’s external partners from within the Red Cross Red Crescent Movement, as well as other relevant international actors within DPRK.

2. Background

a) Overview

Founded as an independent voluntary humanitarian organization in 1946, is organized as a network of 10 provincial branches (the number of provinces has decreased from 12 to 10 due to changes in the country’s administrative divisions); and 200 city/county level branches. The DPRK RC is the largest humanitarian organization in the country possessing a nationwide network of 330,000 volunteers and 371,730 Red Cross Youth at the community level, and over one million members.

The International Federation has been working closely with the DPRK RC since 1995 when it first intervened to help address the relief needs in the country following a series of disastrous floods. With support from a wide range of participating national societies (PNS), their back donors and ECHO, the focus of the Federation’s support has moved since the late 1990s from emergency relief to longer term health and water sanitation programmes, disaster management, and capacity building in order to bridge the gap between relief and development. A series of reviews of these individual sectoral programmes has been commissioned by the Federation over the past several years. The value of this international assistance programme totals some CHF 14 million (USD 11 million) per year.

The ICRC has supported DPRK RC with the dissemination of international humanitarian law and the fundamental principles. In 2002 ICRC established an orthopaedic workshop, providing modern prostheses to amputees, as well as training of orthopaedic surgeons in modern amputation techniques. ICRC is currently negotiating a second workshop to serve amputees from the armed forces.

In addition to international assistance managed by the Federation, some PNS have bilateral cooperation programmes with DPRK RC. The Republic of Korea National Red Cross (ROK RC) has provided various types of support to the society’s activities for several years. This

has included sometimes substantial volumes of relief assistance and an ongoing programme to support families separated during the Korean War.

In 2002, the Norwegian Red Cross commenced a tree planting programme which focused on the provision of seedlings and strengthening the capacity of five seedling nurseries. This programme includes a component of Red Cross youth activities, where members from the DPRK and ROK Red Cross Societies jointly conduct tree planting and other activities. The NRC also provides various disaster management and health related in-kind material. In 2003, the Netherlands Red Cross (NLRC) started a five-year bilateral capacity building programme targeting two provincial branches. This programme aims at increasing the capacity of the branches in human resource management and financial sustainability.

b) National Society Strategy/Programme Priorities:

The society’s current statutes were recently revised and adopted at the National Congress in order to adjust to the country’s changing environment. The Congress also approved the DPRK RC’s Development Plan 2004-2010. Of vital importance to the plan is the capacity building of branches to ensure the sustainable development of the national society. DPRK’s harsh economic situation is a constraint to domestic fundraising activities and it is anticipated that government subsidies will be further decreased.

The Development Plan defines three strategic directions for development and four core areas of concentration in line with the Federation’s Strategy 2010 and the Manila Action Plan. The three strategic directions for development as defined by the plan are as follows:

1. The Society will improve its emergency response capacity to provide timely and effective

assistance to the most vulnerable. 2. The Society will continue to market and develop specialised services and improve

resource mobilization for its sustainable development, by adopting an integrated approach of disaster management, social and health care, promotion of humanitarian values and organisational development.

3. The Society will raise national and international awareness of DPRK Red Cross activities by strengthening its legal base; increasing its public and media relations; and, improving partnership relations.

The National Society’s activities will focus on f our core areas:

• Disaster management • Community-based health care and social welfare services • Humanitarian services to alleviate sufferings and misfortunes caused by national

division • Promotion of the Movement’s principles and humanitarian values

3. Objectives

• Review achievements, constraints and future perspectives of each of the main

programmes in the international assistance activities that have been implemented over the past four years by DPRK RC/Federation (health, water and sanitation, and disaster management).

• Review progress and challenges in undertaking more integrated programming in these sectoral programmes in order to strengthen the capacities and resilience of specific communities in a more effective manner.

• Review progress and challenges made over the past four years in organisational development initiatives undertaken by DPRK RC on its own and in conjunction with international partners, and assess the needs and opportunities for further strengthening the society’s operational and organisational capacity.

• Analyse the strategies and future intentions of each of the society’s cooperation partners with regard to DPRK programming for international cooperation1, and assess the requirements for new partnership principles and approaches to ensure minimum capacity building standards are identified and adhered to by all partners supporting future programmes.

• Make recommendations for the future scope and direction of international assistance to DPRK in the next three to five year time frame in order to assist DPRK RC in implementing its Development Plan 2004 -2010.

4. Team Composition

The review will be carried out by a team consisting of a team leader representing the Federation, two members representing PNS, and one member representing DPRK RC as an in-country participant.

The team leader should be experienced in strategic planning issues and have a wide knowledge of the RCRC Movement. S/he should have prior experience in conducting evaluations of this nature and possess good writing skills.

The two people representing PNS should be specialists in on e or more of the main sectoral programme areas, preferably including capacity building/organisational development, and at least one of whom should have a good knowledge of the RCRC Movement.

The DPRK RC representative should have a good understanding of capacity building issues.

The Federation will invite all Movement partners listed below to submit candidates to serve as team members. The most suitably qualified will then be selected.

5. Methodology

- Review of key documents. The team members should study key documents including existing reviews, evaluations, other reports and DPRK RC development plans and strategies from the previous four years.

- Briefing. The team will visit Geneva and Beijing for briefing by relevant Federation departments.

- In-country mission. The team should visit DPRK for a period of not less than two weeks and conduct interviews with DPRK RC leadership and staff from HQ and selected branches, DPRK government ministries and the national Flood Disaster Relief Committee (FDRC), Federation and ICRC delegates and representatives from international organisations and donor representatives based in the country.

1 American RC, Australian RC, British RC, Canadian RC, Danish RC, Finnish RC, German RC, Japanese RC, Malaysian RC, Netherlands RC, Norwegian RC, Republic of Korea RC, Swedish RC, ICRC, International Federation.

- Interviews with RC/RC partners. The team should also gather information from all PNS cooperating with DPRK RC by telephone interviews and/or questionnaires, and with Federation representatives in Geneva and Beijing.

- Production of strategic review report. In order to build in a sense of ownership amongst all stakeholders into the review report and its recommendations, a first draft should be circulated by the team to all Movement partners. The final version of the report should then incorporate a synthesis of the feedback received.

The final report will be presented and discussed at the next East Asia partnership meeting which is foreseen to be held in May 2005. This will constitute one key input into the formulation of the DPRK CAS document.

6. Timelines

Dec 2004 – mid Jan 2005: Identification of review team members. Start visa process for DPRK and China.

Dec 2004 – end Jan 2005: Resource mobilisation for conducting the review.

14 – 15 April 2005: Team briefed in Geneva and formulates action plan. First round of interviews with PNS

18 – 20 April: Flight to Beijing and briefing at regional delegation

21 April – 16 May 2005: Team visits DPRK and collects in-country information.

Mid-May 2005: Findings presented at East Asia partnership meeting for consultation.

June 2005: Draft report circulated to partners for consultation

July 2005: Final report sent to partners