UNFPA Country Programme Evaluation: Nepal...UNFPA Country Programme Evaluation: Nepal 2013‐16...

UNFPA Country Programme Evaluation: Nepal 2013‐16

Final Evaluation Report

February 3rd 2017

Chairperson,ChiefGuestandallpresenthere,Iextendgreetings,allwarmandpleasant.

Hopingtobepardonedandalsobeadvisedincaseofanerror,IthinkIknow,uponchildmarriage,afewwordstodeliver.

Theyhadnoknowledgeaboutitinthepast,

Peopleheldthebelief‘tisthereligionintheirgrasp.

It’sacrimestraight,notapiousdeed,It’sasinwhovowsitasacreed.

Themaincauseisconsidered,povertyandilliteracy,

Onthataccountachildgirlconceivesababy.

Lifehastosufferandoffspringtorise,Motherandbabyfallill‘nthatcausesuntimelydemise.

Spiritualleaders,preachers,prophetsandpriests,Let’sgetunitedtofightagainstthisevilpractice.

Politicians,socialworkers,ladiesandgentleman,Let’sworkactivelytofightagainstthisill‐tradition.

Manythanksareduetotheorganizerandtherest,Letmebidyougoodbye,wishingallthebest.

PoemComposedbyMrHariPrasadJoshi,SecretaryofPrestigiousPriestGroup,Baitadi,

andRecitedonOccasionofCPEFocusGroupDiscussiononSeptember11th2016(translatedfromNepali)

MapofNepal*WithUNFPA‐supporteddistricts

Evaluation Team

Team leader Ms Alison King

Sexual and reproductive health expert Dr Bhimsen Devkota

Gender equality expert Dr Ava Darshan Shrestha

Population dynamics expert Mr Sunil Acharya

Acknowledgements

Theindependentevaluationteamwouldliketothankallwhocontributedtothisevaluation.TheevaluationwasmanagedbyMsKristineBlokhus,DeputyRepresentativeattheUNFPANepalCountryOffice.LedbyMsAlisonKing(www.kingzollinger.ch),theevaluationteamwascomposedofDrBhimsenDevkota,DrAvaDarshanShresthaandMrSunilAcharya.WewouldliketothankthestaffoftheUNFPAcountryofficeinNepal,andespeciallyMsBobbyRawal‐Basnet,UNFPANepal’sM&EOfficer,fortheirhospitality,invaluableinputsandpatiencethroughouttheevaluationprocess.WearemostgratefultocolleaguesintheUNFPARegionalSupportOfficesandUNFPADistrictProgrammeOfficersfortheircontributionstoorganizingthefieldphase.Wewouldliketoexpressspecialthankstoallthestakeholdersandbeneficiarieswhowereconsultedduringtheevaluation,givingfreelyoftheirtimeandsharingopenlytheirviewsontheUNFPAcountryprogramme2013‐17.WealsothanktheUNFPARegionalOfficeforAsiaandthePacificandmembersoftheEvaluationReferenceGroupfortheirguidanceandsuggestions.

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TableofContents

Map of Nepal .......................................................................................................................................... 2

Acknowledgements ................................................................................................................................. 3

Table of Contents .................................................................................................................................... 4

Abbreviations and Acronyms .................................................................................................................. 7

List of Boxes, Figures & Tables ................................................................................................................ 9

Key Facts: Federal Democratic Republic of Nepal ................................................................................ 10

Structure of the Country Programme Evaluation Report ..................................................................... 12

Executive Summary ............................................................................................................................... 13

Chapter 1: Introduction ........................................................................................................................ 18

1.1 Purpose and objectives of the country programme evaluation ................................................. 18

1.2 Scope of the country programme evaluation ............................................................................. 18

1.3 Evaluation methodology and process ......................................................................................... 19

1.3.1 Evaluation criteria and evaluation questions ...................................................................... 19

1.3.2 Methods for data collection and analysis ............................................................................ 20

1.3.3 Stakeholder and district sampling ....................................................................................... 21

1.3.4 Limitations ............................................................................................................................ 22

1.3.5 Evaluation process ............................................................................................................... 23

Chapter 2: Country Context .................................................................................................................. 24

2.1 Development challenges and national responses ...................................................................... 24

2.1.1 Political and socio‐economic context .................................................................................. 24

2.1.2 Vulnerability ......................................................................................................................... 24

2.1.3 SRH including HIV/AIDS: achievements, challenges and government policies ................... 25

2.1.4 Population and development: achievements, challenges and government policies .......... 26

2.1.5 Gender equality and women’s empowerment: achievements, challenges and government

policies .......................................................................................................................................... 27

2.2 The role of external assistance ................................................................................................... 28

Chapter 3: UNFPA Programmatic Response ......................................................................................... 29

3.1 The UNFPA Nepal country programme 2013‐17 ........................................................................ 31

3.1.1 Sexual and reproductive health and rights .......................................................................... 31

3.1.2 Gender equality and reproductive rights ............................................................................. 32

3.1.3 Population dynamics ............................................................................................................ 32

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3.1.4 Emergency preparedness and response .............................................................................. 33

3.2 The country programme financial structure ............................................................................... 34

Chapter 4: Findings ............................................................................................................................... 35

4.1 Relevance of the UNFPA 7th Country Programme ...................................................................... 35

A.1.1Alignment and responsiveness of CP7 to government priorities at national and district levels

...................................................................................................................................................... 35

A.1.2Alignment of CP7 with the needs of young people and vulnerable/marginalized women .... 37

A.1.3Alignment of CP7 with the UNFPA Strategic Plan and UNDAF ................................................ 39

A.2.1CP7 reflection of Nepal’s vulnerability to disasters and emergencies .................................... 43

A.2.2CP7 alignment with UNFPA corporate emergency preparedness and response objectives ... 44

4.2 Effectiveness and Sustainability .................................................................................................. 44

A.3.1Availability and use of quality comprehensive SRH services ................................................... 44

A.3.2Adolescent‐friendly health services ........................................................................................ 50

A.3.3Comprehensive sexuality education ........................................................................................ 53

A.3.3SRH/HIV information, education and behaviour change communication .............................. 56

A.4.1Strengthened health system response to GBV ........................................................................ 58

A.4.2Prevention of GBV and child marriage .................................................................................... 62

A.5.1Data availability and analyses on population, SRH, youth and GBV ....................................... 66

A.5.2Policy making and planning at national level .......................................................................... 69

A.5.2Policy making and planning at district level ............................................................................ 71

A.5.3Participation of young people and vulnerable women in policy making and planning .......... 72

A.6.1UNFPA’s contribution to enhanced emergency preparedness in Nepal ................................. 75

A.6.2UNFPA’s response to humanitarian crises, particularly the April 2015 earthquake ............... 79

4.3 Efficiency ..................................................................................................................................... 82

A.7.1Financial resources and CP7 implementation ......................................................................... 82

A.7.2UNFPA priority districts and decentralized programming....................................................... 84

A.7.3UNFPA organizational structure, rules and procedures .......................................................... 85

A.7.4Use of results‐based management .......................................................................................... 87

A.7.5UNFPA’s internal emergency preparedness and response ..................................................... 88

4.4 UNFPA Contribution to UNCT Coordination in Nepal ................................................................. 89

A.8.1&A.8.2UN country team coordination and joint programming/programmes ............................ 90

4.5 Added Value of UNFPA in Development Cooperation and Humanitarian Assistance ................ 91

A.9.1UNFPA’s added value in development cooperation ................................................................ 91

A.9.2UNFPA’s added value in emergency preparedness and response .......................................... 91

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Chapter 5: Conclusions and Recommendations ................................................................................... 92

5.1 Strategic Conclusions .................................................................................................................. 93

5.2 Programmatic Conclusions ......................................................................................................... 94

Chapter 6: Recommendations .............................................................................................................. 96

5.1 Strategic Recommendations ....................................................................................................... 96

5.2 Programmatic Recommendations .............................................................................................. 97

Annexes

Annex 1: Country Programme Evaluation – Terms of Reference: Country programme evaluation of the 7th GoN/UNFPA programme cycle ‐ Nepal CO, July 2016 Annex 2: Evaluation Matrix Annex 3: Documents Consulted Annex 4: Financial Analysis Annex 5: Interview Guides Annex 6: Stakeholder Map by Programme Components, SP Outcomes, CP Outcomes and CP Outputs Annex 7: Persons Consulted Annex 8: National Policies and Surveys Annex 9: Evaluation Team Comments on CP7 Regular Programme Results and Indicators Annex 10: CO monitoring information

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AbbreviationsandAcronymsAFHS Adolescent‐friendly health services ANM Auxiliary Nurse Midwife APRO UNFPA Regional Office for Asia and the Pacific ASRH Adolescent sexual and reproductive health AWP Annual Work Plan BPKIHS B.P. Koirala Institute of Health Sciences CAC Citizens’ Awareness Centre CBS Central Bureau of Statistics CDPS/TU Central Department of Population Studies of the Tribhuvan University CCPE Clustered country programme evaluation of UNFPA’s engagement in highly‐

vulnerable situations CEDAW Convention on the Elimination of all Forms of Discrimination against Women CERF UN Central Emergency Response Fund CMR Clinical Management of Rape CO UNFPA country office CP Country programme CPAP Country programme action plan CPD Country programme document CPE Country programme evaluation CPR Contraceptive prevalence rate CP7 UNFPA Nepal 7th country programme of assistance CRR Centre for Reproductive Rights CRVS Civil Registration and Vital Statistics CSE Comprehensive sexuality education CVICT Centre for Victims of Torture Nepal DDC District Development Committee DDRC District Disaster Relief Committee DEO District Education Office DEX UNFPA direct execution DHO District Health Office DHS Demographic and Health Survey DoE Department of Education DPMAS District Planning, Monitoring and Analysis System DPRP District Disaster Preparedness and Response Plan DWC Department of Women and Children EDCD Epidemiology and Disease Control Division EO Evaluation Office ERF UNFPA Emergency Response Fund ERG Evaluation Reference Group EQ Evaluation question FBARHCS Facility‐based Assessment for Reproductive Health Commodities and Services FCHV Female Community Health Volunteer FFS Female‐friendly Space FHD Family Health Division FP Family planning FSW Female Sex Worker FY Fiscal Year GBV Gender‐based violence GBVEGEDCC GBV Elimination and Gender Empowerment District Coordination Committees GBVIMS Gender‐Based Violence Information Management System GDP Gross Domestic Product GE Gender equality GoN Government of Nepal

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GPRHCS Global Programme to Enhance Reproductive Health Commodity Security HACT Harmonized Approach to Cash Transfer HCT Humanitarian Country Team HFOMC Health Facilities Operation and Management Committee HMIS Health Management Information System HQ UNFPA headquarters ICPD International Conference on Population and Development INFORM Index for Risk Management IRF UNFPA Integrated Results Framework JMMS Jagriti Mahila Mahasang National Network of Female Sex Workers LARC Long‐Acting Reversible Contraception LDMC Local Disaster Management Committee LGCDP Local Governance and Community Development Programme 2013‐17 LMD Logistics Management Division LMIS Logistics Management Information System MICS Multiple Indicator Cluster Survey MIDSON Midwifery Society of Nepal MISP Minimum Initial Service Package MMR Maternal Mortality Ratio MoE Ministry of Education MoF Ministry of Finance MoFALD Ministry of Federal Affairs and Local Development MoH Ministry of Health MoHP Ministry of Health and Population (until 2015) MoPE Ministry of Population and Environment (since 2015) MoWCSW Ministry of Women, Children and Social Welfare MoYS Ministry of Youth and Sports MPAs Minimum Preparedness Actions MTR Mid‐term Review M&E Monitoring and Evaluation NDRF National Disaster Response Framework NEX National execution NFEC Non‐formal Education Centre NFPPD National Forum for Parliamentarians on Population and Development NGO Non‐governmental Organization NHEICC National Health Education, Information and Communication Centre NHSP National Health Sector Programme 2010‐2015 NHSS National Health Sector Strategy 2016‐2021 NHTC National Health Training Centre NLSS Nepal Living Standards Survey NNC Nepal Nursing Council NPC National Planning Commission NPR Nepali Rupees NRCS Nepal Red Cross Society NWC National Women’s Commission OCMC One‐stop Crisis Management Centre ODA Official Development Assistance OF Obstetric fistula OR UNFPA Other Resources PD Population dynamics PDNA Post‐Disaster Needs Assessment RH Reproductive health RR UNFPA Regular Resources RRF Results and Resources Framework RRT Rapid Response Team RSO UNFPA Regional Support Office SBA Skilled Birth Attendant

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SFSP Social and Financial Skills Package SP UNFPA Strategic Plan SRH Sexual and reproductive health ToR Terms of reference UNCT UN country team UNDAF UN Development Assistance Framework UNDP UN Development Programme UNFPA UN Population Fund UNICEF United Nations Children’s Fund UNYAP UN Youth Advisory Panel VAW Violence against women VDC Village Development Committee WCF Ward Citizen Forum WCO Women and Children Office

ListofBoxes,Figures&TablesBox 1: Adolescents and Youth Definition Box 2: Appreciation of UNFPA‐supported ASRH Trainings Box 3: UNFPA Support for CBS and MoH Surveys and Analyses 2013‐16 Box 4: UNFPA Support for UNYAP Influence on National Policies and Plans Box 5: Good Examples and Lessons Learned from UNFPA Earthquake Response

Figure 1: CPE criteria Figure 2: Data Analysis and Validation Figure 3: Population Demographics of Nepal, 2011 Figure 4: ODA Flow Trends FY 2010/11‐FY 2014/15 Figure 5: UNFPA’s “Bull’s Eye” Figure 6: Nepal CP7 SRH Outcome, Outputs and Indicators Figure 7: Nepal CP7 GE Outcome, Outputs and Indicators Figure 8: Nepal CP7 PD Outcome, Output and Indicators Figure 9: Nepal CP7 SRH Outcome & Outputs Aligned with NHSP II Figure 10: Nepal CP7 GE Outcome & Outputs Aligned with NHSP II Figure 11: Nepal CP7 PD Outcome & Outputs Aligned with NHSP II Figure 12: Linkages between CP7 and UNFPA’s SP 2014‐17

Table 1: CPE Nepal Evaluation Questions Table 2: Relationship between EQs and Evaluation Criteria Table 3: Number of Kathmandu‐based Stakeholder Consulted Table 4: Number of Meetings along Key Topics Table 5: CPE Activities, Outputs and Work Days Table 6: Modes of UNFPA Engagement by Country Classification Table 7: Indicative Commitments by Programmatic Area 2013‐17 Table 8: Training on FP/RH Morbidities Supported by UNFPA Table 9: Change in Contraceptive Prevalence Rate in UNFPA Priority Districts Table 10: Change in % of Births Attended by SBAs in UNFPA Priority Districts Table 11: # of Ministries/Line Agencies Implementing Programmes on Population, SRH, Youth and GBV and % of National Budget Allocated Table 12: % of DDC Budgets for Population, RH, Youth and GBV in UNFPA‐supported Districts Table 13: % of Youth Network Member Participation in District Planning Table 14: Annual RR Ceilings 2013‐17

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KeyFacts:FederalDemocraticRepublicofNepal

1 http://data.un.org/Data.aspx?q=nepal&d=MDG&f=seriesRowID%3A557%3BcountryID%3A524.

Indicators Facts SourceLand Geographical location Latitude 260 22' N to 300

27' N ‐ longitude 800 4' E to 880 12' E

CBS (2014), Statistical Pocket Book of Nepal

Land area 147181 Sq.km. CBS (2014), Statistical Pocket Book of Nepal

Terrain Altitude ranges from aminimum of 70 meters to a maximum of 8,848 meters

CBS (2014), Statistical Pocket Book of Nepal

People

Population 26.5m (2011) CBS (2014), Population Monograph of Nepal, Vol. 1

Urban population 27.2% (2014) CBS (2014), Population Monograph of Nepal, Vol. 1

Annual population growth rate 1.35% (2011) CBS (2014), Population Monograph of Nepal, Vol. 1

Government

Government type Parliamentarian (in process to federal system)

% of seats held by women in national parliament

29.5 (2015) Millennium Development Goals Database: United Nations Statistics Division (24 February 2016): Seats held by women in national parliament1

Economy

Per capita GDP USD 752 (p*) (2016) GoN/MoF (2016), Economic Survey FY 2015‐16 (p=preliminary estimates)

GDP growth rate (real GDP at basic prices)

0.77 (p*) (2016) GoN/MoF (2016), Economic Survey FY 2015‐16 (p=preliminary estimates)

Main industries Tourism, carpet, textiles and agro‐based industries

Social Indicators

Human Development Index .490 GoN/UNDP (2014), Nepal Human Development Report 2014

Unemployment rate 2.1% (2008) ILO (2014), Nepal Labour Market Update

Life expectancy at birth 66.6 years CBS (2014), Statistical Pocket Book of Nepal

Under‐5 mortality (per 1,000 live births)

52.9 CBS (2014), Population Monograph of Nepal, Vol. 1

Maternal mortality ratio (deaths of women per 100,000 live births)

258 WHO, UNICEF, UNFPA, World Bank Group (2015). Trends in Maternal Mortality: 1990‐2015

Health expenditure (% of GDP) 5.3 (2014) WHO, UNICEF, UNFPA, World Bank Group (2015). Trends in Maternal Mortality: 1990‐2015

Births attended by skilled health personnel

55.6 CBS, MICS 2014, Key Findings. Kathmandu: Central Bureau of Statistics and UNICEF Nepal

Adolescent fertility rate (births per 1,000 women aged 15‐19)

71 CBS, MICS 2014, Key Findings. Kathmandu: Central Bureau of Statistics and UNICEF Nepal

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Note: Numbers in brackets denote reference period

2 http://www.unicef.org/infobycountry/nepal_nepal_statistics.html. 3 http://hdr.undp.org/en/composite/GD.

Proportion of demand for contraception satisfied

66.3% MICS 2014

Contraceptive prevalence rate (all methods)

49.6% CBS, MICS 2014, Key Findings. Kathmandu: Central Bureau of Statistics and UNICEF Nepal

Contraceptive prevalence rate (modern methods)

47.1% CBS, MICS 2014, Key Findings. Kathmandu: Central Bureau of Statistics and UNICEF Nepal

Unmet need for family planning 25.2 CBS, MICS 2014, Key Findings. Kathmandu: Central Bureau of Statistics and UNICEF Nepal

% of people living with HIV, 15‐24 years old

0.03% NCASC EPI Fact Sheet, 2015

% of people living with HIV, 15‐49 years old

0.2% NCASC EPI Fact Sheet, 2015

Adult literacy (% aged 15 and above)

57.4 (2008‐2012) UNICEF Nepal2

Primary gross enrolment ratio (m/f per 100)

38.06/40.23 (2011) Ministry of Education, Government of Nepal (2015). Nepal Education in Figures: At A Glance

Gross enrolment ratio (m/f per 100)

97.6/91.0 (2007‐2013) World Statistics Pocketbook | United Nations Statistics Division: Nepal.

Gender Inequality Index (GDI) 0.908 (2014) UNDP Human Development Report3

Gender‐based violence (% women aged 15‐49) Physical violence Sexual violence

22% 12%

Population Division Ministry of Health and Population Government of Nepal Kathmandu, Nepal. New ERA Kathmandu, Nepal and ICF International Calverton, Maryland, U.S.A. (March 2012) Nepal Demographic and Health Survey 2011

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StructureoftheCountryProgrammeEvaluationReport

Thepresentreportcomprisesanexecutivesummary,fivechaptersandannexes.

Chapter1,theIntroduction,providesthebackgroundtotheevaluation,objectivesandscope,themethodologyused,includinglimitationsencountered,andtheevaluationprocess.

ThesecondchapterdescribestheNepalcountrycontext,includingthechallengesitfacesintheUNFPA‐mandatedareas.

ThethirdchapteroutlinesUNFPA’sresponsetonationalchallengesinsexualandreproductivehealth,genderequalityandpopulationdynamics,aswellasinviewofNepal’shighvulnerabilitytonaturalandotherdisasters.

Chapter4presentsthefindingsoftheevaluationforeachoftheevaluationquestions,assumptionsforassessmentandindicatorsspecifiedintheevaluationmatrix.

Chapter5discussesconclusionsandrecommendationsatthestrategicandprogrammaticlevel.

Annexes(presentedseparately)roundoffthereport.

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ExecutiveSummary

Purpose,ObjectivesandScopeoftheCountryProgrammeEvaluationThisevaluationofUNFPA’s7thcountryprogramme(CP7)ofassistancetotheGovernmentofNepal2013‐17wascommissionedasperthe2013UNFPAEvaluationPolicyandtheUNFPATransitionalBiennialBudgetedEvaluationPlan2014‐15.Evaluationresultsareintendedtodemonstrateaccountability.Theyaremeanttosupportevidence‐baseddecisiontaking.AndtheyshouldcontributetoUNFPA’sknowledgebase.Thespecificobjectivesare:(i) ToevaluatetheprogrammaticresultsofCP7aswellasUNFPA’sstrategicpositioninginNepal;(ii) TodrawlessonsontherelevanceandperformanceofUNFPA‐supportedinterventions;(iii) Toproposeasetofrecommendationswithregardtoprogrammingstrategiesandoperational

approachesforthe8thcountryprogrammeofassistanceandthenextUNDAFcycle;(iv) TofeeddataandfindingsintotheclusteredcountryprogrammeevaluationofUNFPA

engagementinhighly‐vulnerablecontexts.

TheintendedaudienceareUNFPA(atcountry,regionalandgloballevel)andtheUNFPAExecutiveBoard.Additionally,counterpartswithintheGovernmentofNepal(GoN)andotherdevelopmentpartnersareexpectedtobenefitfromevaluationresults.ThesubjectoftheCPEareallinterventionsundertheUNFPANepalCountryProgrammeActionPlan(CPAP)2013‐17implementedbetweenJanuary2013andSeptember2016.

TheUNFPANepalCountryProgramme2013‐17AccordingtoUNFPA’sBusinessModel,Nepalisclassifiedas“red”becauseofitshighneedsandinabilitytofinance.Theinitialproposedindicativecommitmentwas$30.5m,coveringSRH($12.2m);populationdynamics($8.9m);andgenderequality($8.2m).Anamountof$1.2mwasallocatedtoprogrammecoordinationandassistance.However,RegularResources(RR)annualspendingceilingshavedroppedsignificantlyfrom$4.6min2014to4.05mand3.43min2016.TheimportanceofOtherResources(OR)hasthereforegrown and theCOhasincreasinglybeenrewardedforitsresourcemobilizationefforts.CP7wasimplementedwiththesupportofover40ImplementingPartners,including18districtauthorities.TheCPD2013‐17wasapprovedbytheUNFPAExecutiveBoardin2012andoperationalizedthroughaCPAP.Duringthepreviouscountryprogramme,UNFPAhadexpandeditscoveragefromsixto18districtsthatweremakingslowprogressinachievingICPDgoalsinthreegeographicclusters.UNFPA’slocalrepresentationisthroughDistrictProgrammeOfficersandthreeRegionalSupportOffices.TheearthquakeinApril2015ledtoatemporaryshiftinprioritiesandresourcesto14severely‐affecteddistricts.CP7pursuesthreeoutcomes: Outcome1:ImprovedaccesstoSRHservicesandsexualityeducation Outcome2:Genderequalityandreproductiverightsadvanced Outcome3:Populationdynamicsanditsinterlinkageswiththeneedsofyoungpeople,SRH(including

familyplanning),genderequalityandpovertyreductionaddressed

Outcome1consistsofsupply‐sideinterventionsinmaternalhealthandfamilyplanningwithaparticularfocusonadolescentSRH;italsobuildsonbehaviourchangeanddemandcreation.Outcome2isverystronglyfocusedonGBVandchildmarriage.Outcome3supportsthegenerationofdataandanalysesandtheiruseinpolicymakingandplanning;ithasaspecificcomponentonyouthempowermentandparticipation.EmergencypreparednessandresponseismainstreamedthroughoutCP7.

MethodologyTheevaluationprocesswasdividedintodesign,datacollection,andanalysisandreportingphases,amountingto200workdays.TheCPEwasstructuredaroundtwocategoriesofevaluationcriteria:(i)relevance,effectiveness,sustainabilityandefficiency;and(ii)coordinationandaddedvalue.Datacollectionmethodsincludeddocumentreview;financialdataanalysis;monitoringdataanalysis;semi‐structuredinterviewswithUNFPAstaff,

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ImplementingPartners,donorsandUNagenciesinKathmandu;semi‐structuredinterviewsandgroupdiscussionswithdistrictofficials,districtserviceprovidersandbeneficiariesinfourpurposivelyselecteddistricts(Baitadi,Sunsari,SindhuliandDang);andtelephoneinterviewswithofficialsintwoearthquake‐affecteddistrictsGorkhaandSindulpalchowk.Theevaluationmatrixwaskeyfortriangulatinginformationandformulatingevidence‐basedfindings.

MainFindingsCP7iswellalignedwithrelevantnationallegislation,policies,strategiesandprogrammes.ItsdesignundertheNationalHealthSectorProgrammeIIandannualplanningwereajointeffort.CP7isclearlyalsoanintegralpartofdistrictdevelopmentplans.UNFPAwasresponsive:itadaptedCP7inresponsetotheviolentearthquakeinApril2015.AdolescentsandyouthparticipatedinCP7designandUNFPAhasmadeaconsciousefforttoconsultandinvolvetheminimplementation;theywerelesssystematicallyrepresentedinannualplanning.Deliberateinvolvementofvulnerableandmarginalizedwomenindesignandplanninghasbeenless.Nepal’shighvulnerabilitytonaturaldisastersandUNFPA’sactualsupportforemergencyresponsepreparednessareinsufficientlyreflectedintheCPAPanditsResultsandResourcesFramework(RRF).CP7waslogicallyconnectedtotheMid‐termReviewoftheUNFPAStrategicPlan2008‐13andalignswellwiththeStrategicPlan2014‐17outcomeareas.There‐alignedRRFisaverygoodreflectionoftheSP2014‐17IntegratedResultsFrameworkintheareaofemergencypreparednessandresponse,butonlysincethe2015earthquake.CP7andtheUNDevelopmentAssistanceFrameworkareinsyncexceptfortheareaofemergencyresponsepreparedness.GenderequalityisatthecentreofCP7.UNFPAhasmadeapointtoengagemenandboysandotherlikelygatekeepers;ithasappliedarights‐basedapproach,atprogrammeandpolicylevels.UNFPAhasclearlytargetedvulnerablewomenandgirlsofreproductiveage,mostprominentlyGBVsurvivorsandwomenatriskofbeingmarriedearly.Ithasnottargetedthespecificneedsofveryyoungadolescents(10‐14)whoareacorporatestrategicpriority.UNFPAhasinfluencedmajorpolicies,strategiesandstandards.TheConstitutionandtheNationalPopulationPolicyaretwohighlights.UNFPAalsocontributedtoinstitutingahumanrights‐basedapproachtofamilyplanning;itcanclaimcreditforimportantdevelopmentsinmidwifery,obstetricfistula,ASRH,CSEandyouthdevelopment.UNFPA’scontributiontothelegal,policyandprogrammeframeworkregardingGBVandendingchildmarriageisevident‐e.g.,ClinicalProtocolonGBV,NationalStrategyonEndingChildMarriageand“Rupantaran”.WithUNFPAcontribution,selectedclinicaltraininginstitutionshavestartedtoprovidecompetency‐basedtrainingtoimprovefamilyplanningservicesandreducereproductivehealthmorbidities.UseoftheUNFPA‐supportedLMISformonitoringstock‐outshasincreased,butthesystemisnotfullyoperational,andisalreadybeingrevamped.UNFPAplayedapositiverole,butfactorssuchasnaturaldisastersandrestrictionsonmobilityneedtobeconsidered.Implantstock‐outsseemtohavebeenanissue.UNFPAhascontributedtosuccessfulinterventionstoprovideservicesforvulnerablewomenfromlowCPRpocketsandsufferingfromobstetricfistula.Togetherwithpartners,itcanclaimcreditfortheveryrecentintroductionofmidwiferyeducation.FPmicro‐planningandsatelliteclinicsareconsideredaneffectiveapproach.ThankstocollaborationbetweenUNFPAandthegovernment,moreandmorehealthserviceprovidersarebeingtrainedonASRHatsixgovernment‐certifiedclinicaltrainingsites.Trainingsitesareprovidingcompetency‐basedASRHtrainingsbasedonarevisedandclearlyrelevanttrainingpackage.UNFPAalsoplayedacrucialroleinrevisitingthequalitycriteriaandcertificationprocessforAFHScentres.Already24healthfacilitiesintenUNFPAprioritydistrictsarecertifiedAFHScentres,thankstoUNFPA,andothersareinthepipeline.Makingavailableadedicatedconsultationroomthatensuresprivacyisaproblem.ThenumberofadolescentsutilizingtheAFHShasincreased,butcoverageremainslow.Recording,reportingandanalysisofASRHserviceutilizationdataisabottlenecktoeffectiveplanning,monitoring

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anddecision‐making.TherevisedHMISdoesnotseparatelycaptureASRHservices;itonlyoffersdataforthebroadagecohort15‐49.UNFPAisontracktostrengthentheinclusionofCSEtopicsingrades1to10.However,subordinatetoformalcurriculumreviewcycles,itwillnotcompletelybeabletoachieveitsobjectives.UNFPAisalsosupportingtheMinistryofEducationtoincludeCSEteachertraininginitsin‐servicetrainingprogramme.UNFPAfacilitatedpolicyrecommendationsforimprovingCSEforout‐of‐schooladolescentsandyouth.Plansareinthemakingfortargetingtheirspecificinformationandeducationneeds.UNFPAhasmovedawayfromsomewhatscatteredIEC/BCCactivitiestoaprogrammaticapproachthatpromisesgreatereffectiveness.UNFPAhascontributedtobetterqualitypublichealthservicesforGBVsurvivors,butsofarmainlyonlyinsixdistricts.Ithasalsoprovidedlimitedsupportforsafehouses,butthoseobservedfacedproblems.DatacollectedwithUNFPAsupportthroughtheGBVInformationManagementSystem,whilenotcomprehensiveorrepresentative,areexpectedtobeapowerfuladvocacytool.UNFPAhasbeenprominentlyinvolvedinpreventingchildmarriagethroughlocal‐levelmechanisms;lesssotoreduceotherdiscriminatoryandharmfulpractises.UNFPAhassuccessfullyused“Rupantaran”toempoweradolescentgirlstospeakouttotheirpeersandeldersagainstviolenceandchildmarriage.UNFPAoutreachhashadanimmediateeffectontheattitudesoftargetedmenandboystowardsVAW;however,itisdoubtfulthatUNFPAhasinfluencedmaleattitudesonalargerscale.UNFPAfacilitatedfurtherdisseminationof2011censusresultsthroughthreePopulationMonographs.ItenabledtheCentralBureauofStatisticsandtheMinistryofHealthtoconductandpublishnational‐levelsurveysandanalyses,includingfurtheranalysisofthe2011DHS.Progressinsettingupnewdatabaseshasbeenmodest.Theweb‐basedCensusInfoisnew,butnotwellknown.Moregovernmentagenciesareimplementingprogrammesthatrespondtopopulation,SRH,youthand/orGE.However,notallwereinfluencedbyUNFPA.DespiteUNFPA’sefforts,thepercentageofnationalbudgetallocatedforpopulation,SRH,youthandGEdeclinedconsiderablyfrom10.5%inFY2012‐13to3.1%in2015‐16insteadofincreasingtothetargeted15%.Ontheotherhand,thepercentageofbudgetallocationshasincreasedconsiderablyacrossUNFPA’sprioritydistricts,withUNFPAcontribution.ThenumberofdistrictsusingUNFPA‐supportedcensusandnationalsurveysintheirplanningprocesseshasincreasedconsiderably,butisstillratherlow.Moreover,useisonlypartial.NeitherhaveauthoritiesinUNFPAprioritydistrictsreportedonICPDindicatorsinacomprehensivemanner.Collaborationwithyouth‐ledNGOsandtheMinistryofYouthandSportshasfacilitatedparticipationofyouthincentral‐levelpolicymakingandplanning.UNFPAhasalsoorganizedyouthinitsprioritydistricts.Mainlymaleyouthareincreasinglyvocalindistrictdevelopmentprocessesthroughyouthnetworkmembers.Contrarytooriginalintentions,UNFPAhasnotworkedwithvulnerablewomeninanorganizedmannersimilartoyouthnetworks.UNFPAcontributedtotheNationalDisasterResponseFramework.IthasbeenplayingaleadroleinemergencypreparednessintheareasofRHandGBV,withintheclustersystemandtheHumanitarianCountryTeam.MoreUNFPAprioritydistrictshaveincorporatedMISPintheirDisasterResponsePlans,includingthankstoUNFPA.UNFPAhasalsocontributedtodistrict‐levelclustercoordinationinhealthandprotection.IthasbeenpartofjointeffortstoscaleupprepositioneddignitykitsandhasprepositionedRHkits.UNFPAparticipatedinthePost‐DisasterNeedsAssessment,whichinfluencedtheofficialearthquakeresponse.UNFPAsuccessfullyledtheRHandGBVsub‐clusters.Itwasakeyactorforprovidingpost‐disasterA/SRHservicesandinformation.Aconsiderablenumberofvulnerablewomenandgirlswerereached,includingthroughmobileRHcamps.UNFPA’ssupportforprotectingwomenandgirlswentbeyondsupportforthehealthsystem.Althoughsomeopenquestionsremaininviewoffutureemergencies,female‐friendlyspacesanddignitykitsweremuchappreciated.

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UNFPAappliesarisk‐basedapproachtofinancialmanagement.UNFPAImplementingPartnershavereceivedfundsinatimelymanner.Despitedifficultcircumstancesanduncoordinatedfiscalyears,implementationhasbeenhigh–92.2%.UNFPANepalhascompliedwithcorporatepolicies,guidance,rulesandregulations.Insomeinstances,ithashelpedcreateandimprovethemandhassuccessfullylobbiedfortheiradaptation.ResourcemobilizationhasbecomeincreasinglyimportantinviewofplungingannualRRspendingceilings.UNFPAhasmobilizedconsiderableORfromabroadrangeofsources,includingUNFPATrustFunds,particularlyforSRHandGE.CP7hasbeendeliveredwithaninsufficientnumberoffixed‐termstaffandunsatisfactorystaffinglevels.Additionalhumanresourcecapacitiesforimplementingandmonitoringprojectshavehadtorelyonexternalfunding.TheplacementofUNFPADistrictProgrammeOfficersisclearlyameaningfulandadvantageousinvestment. Decentralizedprogramminghasitsbenefits,butUNFPAmayhaveinterpreteditsfocuson18prioritydistrictstoorigidly.Lookingahead,UNFPAmightconsiderdownscalingbeforedefinitivelyexitingprioritydistricts.Futuredecentralizedprogrammingwillhavetoalignwithlocal‐levelreformsandrestructuring;itshouldbemorefocusedongreatestneeds.MonitoringisaregularfeatureofCP7implementation,especiallyattheactivitiesandoutputlevel.Forlackofdistrict‐leveldata,theRRFisoftennotagoodbasisforresults‐orientedplanning,monitoringandreportingattheoutcomelevel.UNFPAhumanitarianprogrammingintheearthquake‐affecteddistrictshadadedicatedandfunctioningresults‐basedmonitoringandreportingsystem.UNFPANepalhumanitarianpreparednessplansfortheCOandthethreeRegionalSupportOfficesareavailableandup‐to‐date.Withsomeimportantexceptionsrelatedtoemergencyoperationsplanning,staffcapacities,procurement,andinformationmanagement,UNFPANepalfareswellontheMinimumPreparednessActionsDashboard.UNFPAhasbeenanactiveleaderandcontributortoUNCTcoordinationmechanisms.Evidencerevealedanumberofgoodexamplesofjointprogrammingandjointprogrammes,aboveallintheareasofchildmarriage,GBVandadolescenthealth.Examplesoffactorscontributingtosuccessfulrelationshipsarecredibility;trustandmutualunderstanding;commonissues/interests;andcapablestaff.NationalandinternationalpartnersalikevoicedpositiveopinionsonUNFPA’saddedvalue.

ConclusionsConclusionshavebeenmadeagainstthebackgroundofplungingRegularResourcesandnoimprovementsinthestaffingsituation.Theyalsoassumecontinuedhighlevelsofpoliticalinstabilityandvulnerabilitytonaturaldisasters.Theyarebasedontheassumptionthatstaterestructuringwillremaindelayed.ThisExecutiveSummarylistsstrategicconclusionsandrecommendations.TheGoNhasaconstitutionalcommitmenttofederaliseNepal.However,thetimeframeandroadmapforthereformsandespeciallythefutureofthecurrent75districtsunderthenewfederalprovinceshavenotyetbeenestablished.ReformswillrequirechangestoUNFPA’sorganizationalstructureandtothewayithasbeenco‐operatingwithitsgovernmentcounterparts,especiallyatthelocallevel;theywillgenerateaneedfornewdatasetsandanalysesaswellasforinstitutionalcapacitybuilding.UNFPAneedstoanticipatechangesinthestatestructures.UNFPAhasinvestedalotindatagenerationanddatabases,buttheavailabilityofup‐to‐dateandadequately‐disaggregateddataisstillachallenge,especiallyforthesub‐nationallevel.ThiswillaffectGoNandUNFPApriority‐setting,planning,monitoring,trendsanalysisandprojections.Moreneedstobedonetobridgethedatagap.CP7wasnotrealignedtotargetthespecificneedsofveryyoungadolescents(10‐14),aUNFPAcorporatepriorityandhighlightedintheNationalPlanofActionontheHolisticDevelopmentofAdolescents.Specialeffortsshouldbeconsideredtoensurethatveryyoungadolescentsbenefit.

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UNFPAhasbeenanactivehumanitarianactor.However,thisimportantworkwasinsufficientlyreflectedintheCPDorCPAP2013‐17andnotreportedandaccountedfor,alsobecausetheSP2014‐17IRFisonlyapartialreflectionofwhatUNFPAcontributes.UNFPAshouldbemoreexplicitonitstypesofandexpectedcontributionstoemergencypreparedness.UNFPA’sregionalanddistrictpresenceallowsforfocusandsynergies;itgeneratesconcretelocalexperienceforfeedingintonationalpolicydialogueandsystemsstrengthening.However,afterhavingincreasedthenumberofprogrammedistrictsfromsixto12to18,theUNFPANepalCOisrightlyreconsideringitsdecentralizedprogrammingmodality.UNFPAshouldreduceitsnumberofprioritydistrictsandconcentratemore.Youthparticipationinpoliticalprocesseshasincreased,alsothankstoUNFPA.However,itisnotclearwhatUNFPAsupporttostrengthenyouthparticipationhasresultedinandtowhatextentithasdrawnattentiontoandinvestmentsinSRH.TheUNFPACOshouldbecleareronitsexpectationsofadolescentsandyouthparticipationandtheoutcomeofitsefforts.AnimportantchallengehasbeenidentifiedconcerningtheselectionofandlevelatwhichtopitchRRFoutcomeindicators.Thecurrentpractisetopitchsomeatnationallevelandothersatthelevelofthe18prioritydistrictsisunsatisfactory.WhileinmostcasesUNFPAcontributionismostlikelyandeasiertoestablishatdistrictlevel,dataonarangeoftopicshavebeenunevenlyavailable.However,inacountrylikeNepal,andwiththeCO’slimitedresources,thegapbetweenUNFPAoutputsandnationaloutcomesisoften(too)big.Outcome‐levelmonitoringshouldbestrengthened.

StrategicRecommendations Inviewofuncertaintiesaroundstaterestructuring,UNFPACOseniormanagementshould

initiateaninternalscenarioplanningprocess.

ThePDcomponentofCP8shouldprioritizesupportforthe2021PopulationandHousingCensus.

TheUNFPACOshouldexploreoptionsforadvancinganalysisanduseofCRVS‐generatedvitalstatisticsinlocalplanninganddecision‐making.

TheUNFPACOshouldadvocatewiththeMoHandprovidetechnicalsupport,includingtrainingatalllevels,forincorporatingdisaggregatedASRHindicatorsanddatainthegovernmentreportingsystem.

UNFPANepalCOshouldcommission/useanalysesandexploreopportunitiestostrengthentheparticipationandtargetingofveryyoungadolescents(10‐14).

TheclusteredcountryprogrammeevaluationofUNFPA’sengagementinhighly‐vulnerablesituationsshouldreviewemergency‐relatedIRFindictors.

UNFPANepalseniormanagementshouldensurethattheCPDandCPAP2018‐22speakmoretoNepal’svulnerabilityandthattheRRFbetterreflectsoutputsthatareexpectedtocontributetoimprovedemergencypreparedness.

UNFPACOseniormanagementshouldreviewprioritydistrictsagainstICPDgoalsandplanitscompleteorpartialexitfromindividualdistricts.UNFPAshouldbemoreopentoselectiveprogramminginotherdisadvantageddistrictspendingavailableOR,butnotcontractfurtherDDCs.

CP8shouldbemoreclearlytargetedtowardsandtrackthecontributionofitssupportforadolescentandyouthparticipationtoadvancingUNFPA’smandateandICPDpriorities.

CP8RRFoutcomeindicatorsshouldbelocatedatthenationalordistrict‐leveldependingonthescaleofUNFPA’sassistanceanddataavailability.Whilethecontributionofawidergroupofpartnersisusuallyessential,outcomesneedtobeseenashavingasignificantandcrediblerelationshipwithUNFPAoutputs.

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Chapter1:IntroductionThischapterprovidesintroductoryinformationforthereadertounderstandthepurposeandobjectives(Section1.1)oftheNepalcountryprogrammeevaluation(CPE),itsscope(Section1.2),andthestructureofthepresentreport(Section1.3).

1.1PurposeandobjectivesofthecountryprogrammeevaluationInJuly2016,theUNFPANepalcountryoffice(CO)commissionedanexternalevaluationofits7thcountryprogramme(CP7)ofassistancetotheGovernmentofNepal2013‐17asperthe2013UNFPAEvaluationPolicyandtheUNFPATransitionalBiennialBudgetedEvaluationPlan2014‐15.4TheCPEassesseshowUNFPAcontributedtoimprovingsexualandreproductivehealth(SRH)andgenderequality(GE),andhowitaddressedpopulationdynamics(PD)inNepal.TheNepalCPEwasselectedfortheclusteredcountryprogrammeevaluation(CCPE)ofUNFPAengagementinhighly‐vulnerablecontexts,ledbytheUNFPAEvaluationOffice.ItthusalsoassessestheeffectivenessofUNFPA’shumanitarianpreparednessplanningandresponse.5ThepurposeoftheCPEisthreefold:Evaluationresultsareintendedtodemonstrateaccountability.Theyaremeanttosupportevidence‐baseddecisiontaking,particularlyinviewofformulatingthe8thUNFPAcountryprogramme.AndtheyshouldcontributetoUNFPA’sknowledgebase.ThespecificobjectivesoftheCPEare:(v) ToevaluatetheprogrammaticresultsofCP7aswellasUNFPA’sstrategicpositioninginNepal;(vi) TodrawlessonsontherelevanceandperformanceofUNFPA‐supportedinterventionsinthe

areasofSRH,youngpeople’sneeds,genderequalityandpopulationdynamics;(vii) Toproposeasetofrecommendationswithregardtoprogrammingstrategiesandoperational

approachesforthe8thcountryprogrammeofassistanceandthenextUNDAFcycle;(viii) TofeeddataandfindingsintotheclusteredcountryprogrammeevaluationofUNFPA

engagementinhighly‐vulnerablecontexts.

TheintendedprimaryusersoftheevaluationareUNFPA(atcountry,regionalandgloballevel)andtheUNFPAExecutiveBoard.Additionally,counterpartswithintheGovernmentofNepal(GoN)andotherdevelopmentpartnersareexpectedtobenefitfromevaluationresults.

1.2ScopeofthecountryprogrammeevaluationThesubjectoftheCPEistheUNFPANepalcountryprogrammeactionplan(CPAP)2013‐17,whoseResultsandResourcesFramework(RRF)wasre‐alignedwiththeUNFPAStrategicPlan(SP)2014‐17IntegratedResultsFramework(IRF),andfurtheralignedfollowingtheviolentearthquakeonApril25th2015.6TheevaluationcoversallinterventionsplannedorimplementedbyUNFPAanditsImplementingPartnersatcentrallevelandinthe18focusdistricts7withinthefourareasoftheorganization’sSP2014‐17:(i)sexualandreproductivehealth;(ii)gender;(iii)populationdynamics;and(iv)adolescentsandyouth.Additionally,itfocusesonUNFPA’sresponsetotheApril2015earthquakeinthe14most‐affecteddistricts.8TheevaluationteamwasnotrequiredtopayequalattentiontootherinstancesofemergencysituationsthroughoutCP7suchascivildisturbances,floodsorlandslides.TheevaluationcoverstheperiodbetweenthebeginningoftheCPAPinJanuary2013andthethree‐weekfieldmissioninAugust/September2016.Somefactualinformationonfinancesand

4 DP/FPA/2013/5 and DP/FPA/2014/2. 5 Due to its larger than normal scope, the CPE report exceeds the number of pages suggested by the Handbook. 6 See “Results and Resources Framework (RRF) for Nepal (aligned with new UNFPA Strategic Plan 2014‐2017) (aligned with 2015 earthquake)”. 7 The 18 districts for UNFPA regular programming are: Achham, Arghakhanchi, Baitadi, Bajhang, Bajura, Dadeldhura, Dang, Kapilvastu, Mahottari, Pyuthan, Rautahat, Rolpa, Rukum, Saptari, Sarlahi, Sindhuli, Sunsari, and Udayapur. Kanchanpur and Surkhet were districts from the previous CP cycle but had some activities carried over to the first half of 2013. They are excluded from this evaluation. 8 14 emergency‐affected districts for UNFPA humanitarian programming were: Bhaktapur, Dhading, Dolakha, Gorkha, Kabhrepalanchok, Kathmandu, Lalitpur, Makawanpur, Nuwakot, Okhaldhunga, Ramechhap, Rasuwa, Sindhuli and Sindhupalchok. Only one of UNFPA’s regular districts was also earthquake‐affected – i.e., Sindhuli.

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donorsasperNovember2016wasincludedduringthereportingphase.Theevaluationwasthereforenotabletoassessfinalachievements.Eachprogrammecomponent(CP7outcomearea)wasevaluatedbasedontheOECD/DACcriteriarelevance,effectiveness,sustainabilityandefficiency.Inaddition,CP7wasalsoassessedagainstthetwocriteriaUNCT(UNcountryteam)coordinationandaddedvalueaspertheUNFPACPEHandbook.

1.3Evaluationmethodologyandprocess1.3.1EvaluationcriteriaandevaluationquestionsThisCPEhastwostandardcomponents:(i)analysisofUNFPAprogrammaticareas;and(ii)analysisofUNFPA’sstrategicpositioning.TheUNFPACPEHandbookprescribesthesetofevaluationcriteriaforeachofthesetwocomponents(Figure1).TheanalysisofUNFPAprogrammaticareasisconductedalongfourstandardOECD‐DACevaluationcriteria:relevance,efficiency,effectivenessandsustainability.ThetwocriteriaappliedtotheanalysisofUNFPA’sstrategicpositioningarecoordinationwiththeUNCT9andtheaddedvalueofUNFPA10.

Figure1:CPEcriteria

Source:UNFPACPEHandbook

Whileevaluationcriteriaencompassawiderangeofaspectsandfeatures,evaluationquestions(EQs)areusedtofocustheevaluationonspecificaspects,enablingtheevaluationteamtofocusonalimitednumberofkeypoints.EstablishingasetofEQsallowsformoretargeteddatacollection,amoreconcentratedandin‐depthanalysisandamorefocusedandusefulevaluationreport.TheCPEHandbookrecommendsselectingeighttotenevaluationquestions.Duringthepreparatoryphase,UNFPAincluded19EQsintheCPENepalToR(Annex1).Fromthose19questionstheevaluationteamwasmeanttodistilnotmorethanten.11TheevaluationteamthusfurtherrefinedtheEQs,inconsultationwithUNFPAandtheERG,andconsideringtheapproachpaperfortheclusteredcountryprogrammeevaluationofUNFPAengagementinhighly‐vulnerablecontexts(CCPE).Table1setsoutthenineEQsthatguideddatacollectionandanalysis.Table2givesanoverviewofhowtheEQsrelatetotheevaluationcriteria.

Table 1: CPE Nepal Evaluation Questions

Component 1: Analysis of programmatic areas

EQ1 [alignment]: To what extent was CP7 design, planning and implementation: (1) aligned with government priorities; (2) consistent with the needs of the population, in particular young people and marginalized/vulnerable groups; and (3) aligned to relevant UN system and UNFPA policies and strategies?

EQ2 [vulnerability]: How did UNFPA take into account the country’s vulnerability to disasters and emergencies in planning and implementing its interventions?

EQ3 [SRH services/information and CSE]: To what extent has UNFPA contributed to sustainably improving the availability of and use of quality comprehensive SRH services, in particular for and by young people and

9 Coordination within the UNCT is defined as the extent to which UNFPA has been an active member of, and contributor to, existing coordination mechanisms of the United Nations country team. 10 Added value is defined as the extent to which the UNFPA country programme adds benefits to what would have resulted from other development actors’ interventions only. 11 CPE Nepal Terms of Reference, p5.

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vulnerable/marginalized women? To what extent has UNFPA contributed to increased availability of CSE and SRH/HIV information to promote utilization of SRH services?

EQ4 [GBV services and harmful practices]: To what extent has UNFPA contributed to improving the availability of and access to quality GBV services in a sustainable manner? To what extent has it contributed to preventing GBV, child marriages and other discriminating and harmful practices?

EQ5 [policies & planning]: To what extent has UNFPA sustainably contributed to a stronger emphasis of national and sub‐national policies, plans and budgets on population, SRH, youth and GBV issues in an evidence‐based and participatory manner, informed by population dynamics?

EQ6 (emergency preparedness & response]: To what extent was (is) UNFPA, along with its partners, likely and able to respond to crises?

EQ7 [financial & human resources]: To what extent has UNFPA made good use of human and financial resources to pursue the achievement of CP7 outputs and outcomes?

Component 2: Analysis of strategic positioning

EQ8 [UNCT coordination]: To what extent has UNFPA contributed to the functioning and consolidation of UNCT coordination mechanisms?

EQ9 [UNFPA added value]: To what extent has UNFPA made good use of its comparative strengths?

Table 2: Relationship between EQs and Evaluation Criteria

Relevance Effectiveness Efficiency Sustainability Coordination Added Value

EQ1 x

EQ2 x

EQ3 x x

EQ4 x x

EQ5 x x

EQ6 x

EQ7 x

EQ8 x

EQ9 x

Asrequired,anevaluationmatrix(Annex2)wasprepared.Thematrixdisplaysthecoreelementsoftheevaluation:(a)whatwillbeevaluated(evaluationcriteria,evaluationquestionsandrelatedissuestobeexamined‐i.e.,“assumptionstobeassessed”andqualitative/quantitativeindicators);and(b)howtoevaluate(sourcesofinformationanddatacollectionmethods).Evaluationquestions,assumptionsforassessmentandindicatorsarecloselylinkedtotheCP7logicthroughtheCPAPRRF,includingearthquake‐relatedindicators.12

1.3.2Methodsfordatacollectionandanalysis

Thecollectionofevaluationdatawascarriedoutthroughavarietyofmethods: Analysisofdocumentsandwebsites(Annex3) Analysisoffinancialdata(Annex4) AnalysisofCOmonitoringinformation(Annex10) Briefing(s)fromanddiscussionswithUNFPACOstaffmembers Semi‐structuredinterviewswithrepresentativesofUNFPAImplementingPartners; Semi‐structuredinterviewswithrepresentativesofselectedotherpartnersandstakeholders Semi‐structuredinterviewswithCP7donors Interviewsandfocusgroupdiscussionswithbeneficiariesatinstitutionalandcommunitylevels DirectobservationofUNFPA‐targetedinstitutionsandareas

Interviewswereconductedwiththehelpofinterviewguides(Annex5).Interviewlogswerekeptbyeachevaluator.Theevaluationmatrixtemplatewasusedtoconsolidatekeydataandinformationassembledfromthedifferentstrandsofdatacollectionefforts.

12 Footnotes in the evaluation matrix indicate specific linkages.

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TeammemberscloselyadheredtotheUNEGEthicalGuidelinesforEvaluationandtheUNCodeofConductforEvaluationsintheUNSystem.13Allintervieweeswereassuredofconfidentiality.Dataanalysis(Figure2)builtontriangulatinginformationobtainedthroughinterviews,focusgroupdiscussions,documentanalysisanddirectobservationalongthelinesoftheassumptionsforassessmentandindicators.Totheextentpossible,availableandrelevant,datawereconsidereddisaggregatedatthelevelofgender,ageanddistricts.Theconsolidatedinformationwasthestartingpointfortriangulationandarrivingatevidence‐basedevaluationfindingsandsubsequentlyformulatingconclusionsasabasisforrecommendations.

Figure 2: Data Analysis and Validation

1.3.3StakeholderanddistrictsamplingStakeholdermapsweredevelopedbytheCOforeachprogrammaticarea(Annex6).TheyformedthebasisforselectingthesampleofstakeholdersandbeneficiariestobemetduringthedatacollectionphaseinthecapitalcityKathmanduandsampledistricts.Annex7providesdetailedinformationaboutpersonsconsulted.AccordingtotheCPEHandbook“theevaluatorsshouldnotaimatobtainingastatisticallyrepresentativesample,butratheranillustrativesample”.InKathmandu,prioritywasgiventointerviewingUNFPAstaff,UNFPAImplementingPartners,UNagenciesfamiliarwithCP7andCP7donors.Table3indicatesthenumberofpeoplemetalongdifferenttypesofstakeholders;Table4alongthemaintopicscovered.

Table 3: Number of Kathmandu‐based Stakeholders Consulted

UNFPA staff GoN IPs NGO IPs UN entities CP7 donors Others

17 PAX 14 PAX from 11 IPs

18 PAX from 13 IPs

8 PAX from 5 entities

2 PAX from 2 donors

13 PAX from 11 other organizations

Table 4: Number of Meetings along Key Topics

SRH ASRH GE PD Emergency

18 11 16 10 12

District‐levelitinerarieswerethesamewithsomeadaptationstoallowfordistrict‐levelspecificitiesanddependingonfeasibilityandavailabilities.PrioritywasgiventomeetingUNFPARSOstaffandDistrictProgrammeOfficersaswellasDistrictDisasterReliefCommittee(DDRC)membersandDistrictDevelopmentCommittee(DDC),DistrictHealthOffice(DHO),WomenandChildrenOffice(WCO)andDistrictEducationOffice(DEO)officials.Totheextent

13 http://www.unevaluation.org/document/detail/102 and http://www.unevaluation.org/document/detail/100.

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possible,teammembersalsometwithhealthserviceproviders,teachers,womencooperativemembersandendbeneficiaries,includingadolescentgirls,mothers,parents,menandboys.TheuniverseofdistrictscoveredwasUNFPA’s18prioritydistrictswhereUNFPA’sregularprogrammeisbeingimplemented,aswellasthe14severelyearthquake‐affecteddistricts.Ineachdistrict,UNFPAimplements“mini‐UNFPAprogrammes”coveringallthreeprogrammaticareas.OnlyoneofUNFPA’sprioritydistrictswasearthquake‐affected–i.e.,Sindhuli.AccordingtotheCPEToR,theevaluationteam,incollaborationwiththeUNFPACO,wasexpectedtoselect3‐6districtsforfieldvisits.ThesampleofdistrictstovisitwasmadeonthebasisofcriteriaagreeduponwiththeUNFPACOandtheEvaluationReferenceGroup(ERG)–i.e. Beillustrativeofallprogrammaticareas Beillustrativeofespeciallyfinancially‐largeandfinancially‐modestinvestments EnsureanillustrativecoverageofUNFPA’sworkingdistrictsandgeographicinequalitiesand

variationsbyreflectingthefivedevelopmentregionsandthethreeeco‐developmentregionsofNepal CoveratleastonedistrictfromeachofUNFPA’sthreeregionalclusterswhereUNFPAhasaregional

supportoffice(RSO) Coverdistrictsfromdifferentexpansionperiods(2004,2010,2011) Coveratleastoneearthquake‐affecteddistrict Allowademonstrationofsuccessesandchallenges Logisticalfeasibilityandsecurityconsiderations

Ofthe18UNFPA‐supporteddistricts,theCOconsideredeightdistrictsineligibleforsitevisits:anumberofdistrictsintheCentralandEasternregionswereandstillareconsiderablyaffectedbystrikesandgovernmentstaffchanges,affectingUNFPAactivitiesandpotentiallytheevaluationteam’smobility.OthersintheMid‐andFar‐westernregionsaredifficulttoaccess.Inothers,UNFPAhasmadecomparativelyverylowinvestments.Ofthetenremainingdistricts,theevaluationteamsubmittedapreliminaryproposaltovisitBaitadi,Dang,SindhuliandSunsari,recognisingthatfurtherplanningwouldshowwhatispossible,andwhethertogivemoreweighttoassessinglessdistrictscomprehensivelyormoredistrictspartially.Attheoutsetofthedatacollectionphase,theteamandUNFPACOconfirmedthefourdistricts,acknowledgingthatcoveringthemallwouldnotbepossiblewithinthegiventimeframeandthusaddingadditionaldaysforthenationalconsultantstocoverDangafterthedepartureoftheinternationalteamleader.Inaddition,ERGmemberssuggestedaddinganearthquake‐affecteddistrictwhereUNFPAhadnopriorpresence,contrarytoSindhuli.ThedecisionwastakentocoverGorkhaandSindupalchowkwhereUNFPAhad“hubs”duringtheearthquakeresponse.InterviewswithconcernedDHOandWCOofficialswereconductedbyphone.14

1.3.4LimitationsTheevaluationteamencounteredsomelimitations,whichweremitigatedasbestaspossible. Timerestrictions:Thedesignreportwarnedthatthestandardthree‐weekfieldmissionisshortfora

programmeascomplexasNepalthatisimplementedwithover40ImplementingPartnersinKathmandu,requiringtheevaluationteamtospendagoodweekinthecapital.Inaddition,thedatacollectionmissiontoBaitadiintheFar‐westabsorbedfivedays.Theteamwasthereforeonlyabletotraveltogethertothreedistricts.Dangwascoveredafterthedepartureoftheteamleader.Anadditionalfivedayswereaddedtotheconsultants’contractstomitigateworkloadimplications.

Limitedcoverageofearthquakeresponse:ItwasnotpossibletocoverUNFPA’searthquakeresponsein‐depth.Onlyoneaffecteddistrict(Sindhuli)wasvisited.Tomitigatethislimitation,telephoneinterviewswereconductedwiththeDHOsandWCOsinGorkhaandSindupalchowk.

Absences:Oneevaluatorwasnotgivenleaveofabsencefromhisemployertojointhedistrict‐leveldatagathering.Tomitigatethislimitation,PD‐relatedinterviewswereconductedbytelephone.

Stakeholderunavailability:NumerousstakeholdersinKathmanduwerenotavailableatatimeconvenienttothemandtheevaluationteam,mostimportantlyfromtheFamilyHealthDivision(FHD)oftheMoH.Forlackoftime,itwasnotpossibletorectifythisomissionlateronintheevaluationprocess.Totheextentpossible,theevaluationteambridgedthisgapwithdocumentanalysis.

14 See CPE Design Report for further details on district sampling.

23

Datagaps:ThedesignphaseconcludedthatdataavailabilityandreliabilitywasofsufficientqualitytofacilitateacredibleevaluationofCP7.Duringtheanalysisandreportingphase,theevaluationteamrealizedthatanassessmentofUNFPA’scontributiontonational‐levelprogresswasnotalwayspossibleduetomissingdatafortheperiodunderinvestigationandthe18prioritydistrictsforhigher‐level(outcome)results.

Languageconstraints:Especiallydistrict‐levelstakeholdersandbeneficiariesdidnotspeakorunderstandEnglish.Tomitigatetheabsenceofaninterpreter,nationalevaluatorsagreedtointerpretfortheinternationalteamleader,however,thiswasnotalwayspossibleinanoptimalmanner.

1.3.5EvaluationprocessAsoutlinedintheCPEHandbookandtheCPENepalToR(Annex1),theevaluationprocesswasdividedintothreephases:design,datacollection,andanalysisandreporting.15Table5liststheassociatedactivities,outputsandnumberofworkdays.

Table 5: CPE Activities, Outputs and Work Days

Design Phase (July‐August 2016)

Activities Outputs Work Days

Home‐based desk review Stakeholder mapping and sampling

District sampling

List of Atlas projects

Collection of latest monitoring data

Financial analysis

CP7 effects diagrams

Evaluation matrix

CPE field visit work plan

Draft design report

45

Consultations with UNFPA CO and EO

Draft design report

Finalize design report in consultation with UNFPA CO, APRO, EO and ERG

Data Collection Phase (August‐September 2016)

ERG briefing Final design report

Interview logs

List of persons met

Updated CPE field visit work plan

Presentation of preliminary findings

85

Finalize design report

Conduct data gathering

Compile key information from different strands of data collection in evaluation matrix

Present preliminary findings and conclusions to UNFPA CO, APRO and ERG

Analysis and Reporting Phase (September‐December 2016)

Conduct any missing data collection Completed evaluation matrix

1st and 2nd draft evaluation reports

Draft final and final evaluation reports

70

Analyse data

Draft 1st draft final evaluation report

Draft 2nd draft final evaluation report

Finalize and submit draft final evaluation report

Submit final evaluation report

TheCPEwasanexternal,independentexerciseundertakenbyfourindependentevaluators,inclosecooperationwiththeUNFPACOandundertheoverallguidanceoftheUNFPAAsiaandPacificRegionalOfficeandUNFPAEvaluationOffice.TheUNFPADeputyRepresentativewasUNFPA’sEvaluationManagerandmainpointofcontactfortheevaluationteamandtheERG.Theevaluationteamwassupportedinitsday‐to‐dayworkbytheUNFPACOM&EOfficer.AnEvaluationReferenceGroup(ERG)wasconstitutedbyUNFPAtoprovideoversightandtoensuretheoverallqualityoftheevaluationprocessandproducts.ItwascomposedofrepresentativesfromtheMinistryofFinance(MoF),NationalPlanningCommission(NPC),UNDAFM&EGroup,IPsandselectedUNFPAstaff.AUNYouthAdvisoryPanel(UNYAP)representativewasalsoincluded.

15 The CPE ToR did not envisage an in‐country scoping mission.

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Chapter2:CountryContextThispartoftheevaluationreportprovidesbackgroundinformationforthereadertounderstandthecountrycontextinwhichUNFPAhasworkedinNepal.

2.1Developmentchallengesandnationalresponses2.1.1Politicalandsocio‐economiccontextTheFederalDemocraticRepublicofNepalisa land‐lockedleastdevelopedcountry.Nepalhastremendousgeographicdiversity.FromSouthtoNorth,itcanbedividedintothreeeco‐systemregions:Terai,HillandMountain.Nepalischaracterizedbysloweconomicgrowthandalowlevelofhumandevelopment.Itsdevelopmentstagestemsfromapoliticallyandsocially‐fragilepost‐conflict situation, weak governance structures, poverty, deeply‐entrenched forms of socialexclusion,andhighvulnerabilitytonaturaldisasters.Theeconomyhasbeenseverelyimpacted:Fromfiscalyear(FY)2012‐13toFY2014‐15,GDPgrowthdwindledataround3‐5%peryear.For2016thepreliminarygrowthestimateisat0.7%.16Unemploymentwas2.1%in2008.17AfterthepopularPeople'sMovementIIof2006andtheConstituentAssemblyelectionsof2008and2013,apoliticalsystemofaseculardemocraticrepublicstatewasenshrinedinNepal'snewconstitution,whichcameintoeffectasrecentlyasSeptember20th2015,replacingtheInterimConstitutionof2007.However,immediatelyfollowingthepromulgationoftheconstitution,tensionandunrestbrokeoutintheTeraiintheSouthernpartofthecountryresultinginborderrestrictionsandseverelylimitingtheavailabilityoffuelandothernecessitiessuchasmedicinesandearthquakereliefmaterialcomingthroughandfromIndia.WidespreadprotestsandstrikesforcedUNFPAoperationsinatleastsixprogrammedistricts18tocloseentirelyforseveralmonthsandseverelyaffectedtherestofthecountry.Theborderrestrictionswereofficiallyliftedinmid‐February2016.Implementationandmonitoringofdevelopmentprogrammeshavealsobeenaffectedbythepoliticaltransitionwithaccompanyingsocio‐politicalinstability.Atthedistrictlevel,theprotractedabsenceoflocally‐electedbodieshasresultedinpoorgovernanceofdecentralizedservicedeliveryandpoorpublicaccountability.

2.1.2VulnerabilityNepalexperiencedadecade‐longarmedconflict,whichcametoanendonNovember21st2006withthesigningofaComprehensivePeaceAgreement.Despitegreatachievementsinbuildingandmaintainingpeace,thecountryisstillundergoingacomplextransitionphase.Besidesthisman‐madeconflict,UNDPranksNepalasthe11thmostat‐riskcountryforearthquakesandthe30thmostat‐riskforfloods.19In2014anumberofdistricts20sufferedseverefloods.In2015,thecountry’sdevelopmentwasseriouslyjoltedwhen,onApril25th,amassive7.8magnitudeearthquakeandsubsequentaftershocksaffectedalmostathirdofthepopulation,killednearly9,000people,injurednearly23,000andresultedinmorethan700billionNepaliRupees(NPR)ofdamagetohumansettlements,infrastructureandarchaeologicalsites.Recordsofpasteventsshowthat,onaverage,thereareonedisasterandtwodeathsperday.21Accordingtothe2016INFORM(IndexforRiskManagement),whichUNFPAhasusedsince2014forinformingtheimportanceofandcontextualizingitshumanitarianactionandemergencypreparednessinitsprogrammecountries,Nepalfacesahighriskofhumanitariancrisesanddisastersoccurring,withaveryhighriskoffurthernaturalhazards(physicalexposuretoearthquakes).Dataforthepastthreeyearsindicateanincreasingrisk.22The

16 GoN/Ministry of Finance (2016), Economic Survey FY 2015‐16. 17 ILO (2014), Nepal Labour Market Update. 18 Rautahat, Mahottari, Sarlahi, Sunsari, Saptari in the Eastern development region and Kapilvastu in the Mid‐western region. The two RSOs in Dang and Janakpur were also badly affected. 19 UNDAF 2013‐17. 20 Including Banke, Bardia, Dang and Surkhet. Dang is a UNFPA‐supported district. 21 Nepal Disaster Report 2011. 22 INFORM Results Report 2016, p3.

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HumanitarianCountryTeam(HCT),includingUNFPA,inconsultationwiththeGoN,recentlypreparedacontingencyplanforearthquakes.Theworst‐casescenariodescribesamagnitudeof8.6ontheRichterscalewithitsepicentreinFar‐westernNepalgeneratinghigh‐shakingintensitiesacrossanareafromtheTeraitotheHimalayarangeintheNorth.Suchanearthquakewouldlikelyleadtowidespreaddestruction.Possiblehumanitarianconsequencesincludeover280,000peoplelikelykilled,3.5minjuredand7.8mdisplaced.

2.1.3SRHincludingHIV/AIDS:achievements,challengesandgovernmentpoliciesThe2013MDGprogressreportshowedamaternalmortalityratio(MMR)of850per100,000livebirthsin1990.23Inordertoreducethishighrate,theGoNsetanambitiousnationaltargetof213for2015.Whilemissingthetarget,Nepalisontrack:theestimatedMMRdeclinedto539in199624and258in201525.Similarly,thepercentageofwomenwhomadetherecommendedfourantenatalvisitsincreasedfrom14%in1990to59.5%in2014.26However,thissuggeststhatNepalfellshortofits80%goalby2015.27Moreover,thereisahugegapinuseofantenatalcareservicesbetweenurbanandruralwomen:88%ofurbanmothersreceivedantenatalcarefromaskilledprovidercomparedwithonly55%ofruralmothers.Furthermore,theproportionofwomendeliveringwiththehelpofskilledbirthattendants(SBAs)increasednearlyeight‐foldinthelast25yearsfrom7%in1990to55.6%in2014.28ThelargereductioninMMRhasbeenpartlyattributedtoincreaseduseoffamilyplanning(FP)servicesbutalsobyanincreaseindeliveriesbySBAsandFemaleCommunityHealthVolunteers(FCHVs).Thecontraceptiveprevalencerate(CPR)formodernmethodsincreasedfrom24%in1990to47.1%in2014;thetotalfertilityratedecreasedfrom5.329to2.330duringthesameperiod.However,theunmetneedforFPisstill25.2%.31The2011PopulationandHousingCensusreportedthattheadolescentpopulation(10‐19years)accountsforapproximately24%ofthetotalpopulation.This,togetherwithearlymarriages,hasresultedinahighadolescentfertilityrate‐i.e.,71%.32Accordingtoothersources,39%ofgirlsbeartheirfirstchildbytheageof19.33MostofNepal’spublichealthfacilitiesdonotprovidespecializedSRHservicesandinformationtoyoungpeople.Astudyundertakenin2014onAdolescent‐FriendlyHealthServices(AFHS),initiatedbyUNFPAjointlywiththeFHDoftheMoHandUNICEF,concludedthatadolescentsfaceanumberofbarrierstoaccessingAFHS.34In2008,theMinistryofEducation(MoE)introducedsexualityeducationinschoolcurricula,particularlyforgrades6to10.35However,manyteachersarereluctantandnotadequatelytrainedtoruncomprehensivesexualityeducation(CSE)classes.SomebasicinformationsuchasonmodesofHIVtransmissionandpreventionhavebeenincludedinnon‐formaleducationandgirls’educationcurricula.InNepal,HIVprevalenceinthegeneralpopulation(ages15‐49)is0.03%,withaprevalenceofHIVamongpeoplewhoinjectdrugs(2.8%‐8.3%),menhavingsexwithmenandtransgender

23 NPC/UNDP (2013): Nepal Millennium Development Goals. 24NPC (2013): Nepal Millennium Development Goals: Progress Report. 25WHO, UNICEF, UNFPA, World Bank Group (2015): Trends in Maternal Mortality: 1990‐2015.26NPC (2015): Sustainable Development Goals 2016‐2030, National (Preliminary) Report. 27 NPC (2013): Nepal Millennium Development Goals: Progress Report. 28NPC (2015): Sustainable Development Goals 2016‐2030, National (Preliminary) Report.29MoH, 1991. 30CBS: MICS 2014, Key Findings. Kathmandu: Central Bureau of Statistics and UNICEF Nepal. 31 CBS, MICS 2014, Key Findings. Kathmandu: Central Bureau of Statistics and UNICEF Nepal. 32 CBS: MICS 2014, Key Findings. Kathmandu: Central Bureau of Statistics and UNICEF Nepal. 33Khatiwada N, Silwal P, Bhadra R, Tamang T. Sexual and reproductive health of adolescents and youth in Nepal: trends and determinants. Further analysis of the 2011 Nepal Demographic and Health Survey. Kathmandu: Population Division, Ministry of Health and Population, GIZ/GFA, Jhpiego, United Nations Population Fund, 2013.

34FHD/MoHP, UNFPA Nepal & UNICEF Nepal (2014): Assessing Supply Side Constraints Affecting the Quality of Adolescent Friendly Health Services (AFHS) and the Barriers for Service Utilization.

35 UNFPA (2014): Operational Guidance for Comprehensive Sexuality Education: A Focus on Human Rights and Gender.

26

(2.4%),andfemalesexworkers(2%).Onlyaquarterofadolescentsaged15‐24yearshavecomprehensiveknowledgeofHIV.36TheApril2015earthquakeseverelyaffectedhealthinfrastructureinover40districtsofNepal.Atotalof446publichealthfacilitiesweredamaged.37Intheprivatesector,includingnon‐governmentalandcommunityinstitutions,16healthfacilitieswerecompletelydestroyed.Inthe14most‐severelyaffecteddistricts,389publichealthfacilitieswerecompletelydestroyedand403partlydamaged.About32%ofhealthfacilitiesprovidingspecializedmaternalandneonatalservicesweredamaged.UNFPAestimatedthat1.4mwomenofreproductiveagewereaffected,includinganestimated93,000pregnantwomen(andupto10,000deliveringeachmonth). TheGoNhasintroducedanumberofSRH‐relatedlaws,policies,strategiesandprogrammes.ThecentralonesarelistedinAnnex8.

2.1.4Populationanddevelopment:achievements,challengesandgovernmentpoliciesNepal,likemanyoftheSouthAsiancountries,hasbeenundergoingrapiddemographicchange.Thetotalpopulation,asofJune2011,was26.5mwithadecadalincreaseof14.4%from2001(23.2m).Theaverageannualgrowthrateofthepopulationfrom2001to2011was1.35%,asharpdeclinefromthe2.25%ofthepreviousdecade1991‐2001.Thedeclineisattributedtoadeclineinfertilityandanincreasingtrendofyouthemigration.In2011thepercentageoffemalepopulationwasslightlyhigher(51.5%)thanmale(48.5%)withasexratioof94.2menper100women.Broadlybyagegroups,nearly35%ofthepopulationwasbelow15years,57%wasintheworking‐agegroupof15‐59yearsand8%was60yearsoldandabove.AccordingtotheUNdefinition(Box1),theyouthpopulationaged15‐24was20%in2011.TheNationalYouthPolicy,however,definesyouthas“women,menandthirdgender”personsaged16‐40yearsold. Basedonthisdefinition,theyouthpopulationinNepalin2011wascloseto40%.

Box 1: Adolescents and Youth Definition

The United Nations understands adolescents to include persons aged 10 to 19 years and youth as those between 15 and 24 years for statistical purposes without prejudice to other definitions by Member States. Together, adolescents and youth are referred to as young people, encompassing the ages of 10 to 24 years.38 In addition, distinctions are sometimes made between the age groups of the very young adolescents (10‐14) and the slightly older ones (15‐19). Nepal’s 2015 National Youth Policy defines youth as “citizens aged 16 to 40 years old. The Youth Vision 2025 of Nepal also adopted the same definition but divided youth into two groups: youth aged 16‐24 (to be targeted for education, health, trainings, leadership development and employment) and youth aged 25‐40 (to be targeted for employment, leadership development, management development, youth investment, policy formulation and implementation)3940. Various GoN policies define adolescents as 10 to 19 years.

The2011censusclearlyindicatedashiftingtrendofthepopulation.Thepyramidbase(Figure3)isshrinking,resultinginayouthbulgeandopeningawindowofopportunityfordemographicdividendforthenexttwotofourdecades.Ageingisexpectedtosetinafter2050.Lifeexpectancyatbirthincreasedfromabout41intheearly1970sto67in2011.Suchasignificantchangeinlifeexpectancywasduetoincreasinglymodernhealthfacilitiesthatreduceddeathrates,especiallyinfantandchilddeathrates,especiallyduringrecentyears.Thecountrysawarapidfallintheinfantmortalityrate,fromabout117per1,000livebirthsinthe1980stoabout41in2011.41Thetargetofthecurrent13thPlan(2013/14‐2015/16)istoachieveanincreaseinlifeexpectancyatbirthto71years.42

36 NCASC (2015): EPI Fact Sheet. 37 NPC (2015): Nepal earthquake 2015: Post Disaster Needs Assessment Vol. B: sector reports. 38 https://www.unfpa.org/sites/default/files/resource‐pdf/One%20pager%20on%20youth%20demographics%20GF.pdf. 39 MoYS/GoN (2015): National Youth Policy. 40 MoYS/GoN (2015): Youth Vision‐2025 and 10 Year Strategic Plan. 41 CBS (2014): Population Monograph of Nepal, Vol. I. 42 NPC: 13th Plan, 2013/14‐2015/16.

27

Lackofemploymentandeconomicopportunitiesresultingfromthe10‐yeararmedconflictandprolongedpoliticalinstabilityprevailandhasbeenamajorreasonforanincreasingtrendofmigrationinNepaloverthelastdecade.Asreportedinthe2010‐11NepalLivingStandardsSurvey(NLSS),53%ofhouseholdsinNepalhaveatleastoneabsenteelivingwithinoroutsidethecountry.Especiallytheabsenteepopulationlivingoutsidethecountryhassignificantlyincreased:accordingtocensusdata,therewasmorethanatwo‐foldincreaseinthenumberofNepalislivingawayfromthecountrybetween2001and201143,ofwhich87.6%weremen.6.3%werebetween15and34yearsofageatdeparture;18%between35and54.AlargepercentageofabsenteesemigratedtoASEANmemberstatecountriesandtheMiddleEast;41.7%toIndia.44 Theimplicationsaresignificant‐theaverageannualgrowthrateofNepal’sabsenteepopulationbetween2001and2011was9.2%.Shouldthiscontinue,theabsenteepopulationwouldbeapproximately4.4mby2020and7mby2025.With1,600individualsleavingforforeignemploymenteverydayandremittancesestimatedtobe29.1%oftotalGDP,foreignlabourmigrationhasbecomeanintrinsicpartoflife.45Themostrecentandreliablepopulationdataisbasedonthe2011PopulationandHousingCensus.Disaggregatedcensusdatabyage,gender,ethnicity,religionetc.areavailableatthenationalthroughdistrictandcommunitylevels.Furtheranalysisofselecteddemographic,socialandeconomicdatafromthisdatabaseisavailableinPopulationMonographVolumesI‐III.Othersourcesofreliablepopulationandrelateddatasourcesaremainlysamplesurveysconductedduringthelastfiveyears,interaliawithUNFPAsupport.However,suchsurveysoftenonlyprovidedataatnationaland/orregionallevels.Thus,theydonotservedistrict‐levelplanningormonitoring.NepalalsohasaCivilRegistrationandVitalStatistics(CRVS)systemthatoperatesatmunicipalityandVillageDevelopmentCommittee(VDC)levels.However,ithasonlypartialcoverageinthatcitizensmayormaynotregistereventsdependingontheirindividualneedsandrequirements.Datafromthissourcearethereforeconsideredunreliable.TheGoNhasintroducedanumberofPD‐relatedlaws,policies,strategiesandprogrammes,ofwhichthecentralonesarelistedinAnnex8;ishasalsoconductedanumberofsurveysandassessmentsrelatedtoPD(Annex8).

2.1.5Genderequalityandwomen’sempowerment:achievements,challengesandgovernmentpoliciesNepalratifiedtheCEDAWin1991andthe2015constitutionaffirmsequalrightsforwomen;butthestatusofwomenislowcomparedtothatofmen. Thoughgenderdiscriminationis

43 Table 9.3: Population Monograph of Nepal Vol.1, p223: total absentee population in 2001: 762,181; 2011: 1,921,494. 44 Data on absentee population is regarded as grossly under reported. Total absentee population reported by the 2011 Census is 1,921,494. Source: CBS (2014): Population Monograph of Nepal, Vol. I. 45 ILO/GIZ (2015): Analysis of Labour Market and Migration Trends in Nepal.

Figure 3: Population Demographics of Nepal, 2011 Source:CBS,2014

8 6 4 2 0 2 4 6 8

0‐45‐9

10‐1415‐1920‐2425‐2930‐3435‐3940‐4445‐4950‐5455‐5960‐6465‐6970‐7475‐7980+

Population in Percentage

Age

Group

Mal Femal

28

formallyprohibited,discriminatorysocialnormsandharmfulculturalpracticescontinueinmanypartsofthecountry.46Disparitiespersistamongdifferentagegroups,gender,castes,ethnicitiesandgeographicallocations.Issuesrelatedtodiscrimination,impunity,GBVandexclusionpreventtherealizationoftherightsandpotentialofwomen.In2014Nepalranked108thof188countriesontheGenderInequalityIndex.47Nepalhasnarrowedthegendergapintheimportantareasofeducation,health,employmentandpoliticaldecision‐making.Genderparityhasbeenachievedatprimaryandsecondarylevels.Evenso,theeducationalattainmentofwomenremainslowerthanthatofmen:inthe15‐49agegroupover40%ofwomenversus14%ofmenhaveneverbeentoschool.48Intermsofgenderparityinthelabourforceandthepoliticalempowermentofwomen,Nepalwasin112thposition(outof142countries)ontherankingfortheGlobalGenderGapin2014and61stonitspoliticalempowermentsub‐index.TheGlobalGenderGapreportputNepalat88thonitshealthandsurvivalsub‐index.49Adolescentgirls(aged10to19)areparticularlyvulnerable.AlthoughtheCivilCodedefinesthelegalageofmarriageas20,childmarriageisprevalentinNepal.Accordingtothe2011DemographicandHealthSurvey(DHS),twoineveryfiveNepalesewomen(40.7%)betweentheageof20and24weremarried/inunionby18years.Amongwomenaged25to49,55%weremarriedbyage18and74%by20.Themedianagethatgirlsmarryis17.8years.However,theproportionofwomenalreadymarriedbyage15declinesfrom24%amongthoseaged45to49to5%among15‐19yearoldsindicatingarisingageatfirstmarriage.Childmarriageoccursmorefrequentlyamonggirlswhoaretheleasteducated,poorestandlivinginruralareas.Despitesignificantimprovements,violenceagainstwomenandgirlscontinues.Domesticviolencepredominates,followedbygirltrafficking,physicalandsexualabuse,socialabusesandmalpracticessuchasallegationsofwitchcraft,chhaupadi(exclusionfromthefamilyduringmenstruation)anddowry.Morethanoneinfivewomenage15‐49(22%)haveexperiencedphysicalviolencesinceage15.28%ofever‐marriedworkersaged15‐49yearshaveexperiencedphysicalorsexualviolencecommittedbytheirhusband/partner.Oneinfivewomenreportedbeingthevictimofphysicalviolenceandmorethanoneintenreportedexperiencingsexualviolence.Onlyoneinfourwomenwhoexperiencedanyformofphysicalorsexualviolencesoughthelpfromanysource.50Addedtothis,accordingtothe2008‐09NepalMaternalMortalityandMorbidityStudy,theleadingcauseofdeathamongwomenofreproductiveageissuicide.Suicidescomprise16%ofalldeathsamongwomenand21%amongwomenaged15‐19.Violenceisasignificantfactorinmanysuicides.51 Toaddressthemanifoldchallenges,aGBVUnit(nowcalledtheGenderEmpowermentandCoordinationUnit)wassetupatthePrimeMinister’sOfficeandtheNationalStrategyonGenderEmpowermentandEndingGBV(2013‐17)launched.GBVEliminationandGenderEmpowermentDistrictCoordinationCommittees(GBVEGEDCC)havebeensetupinallthe75districts.One‐stopCrisisManagementCentres(OCMCs)andsafehouseshavebeensetupin21districts.TheGoNhasintroducedanumberofGE‐relatedlaws,policies,strategiesandprogrammes,ofwhichthecentralonesarelistedinAnnex8.

2.2TheroleofexternalassistanceNepalhasbeenreceivingdevelopmentassistanceformorethansixdecadesandaidcontinuestoplaysanimportantroleinthesocio‐economicdevelopmentofthecountry.52OfficialDevelopmentAssistance(ODA)representedonaverageabout20%ofthenationalbudgetoverthelastfiveyears.ThehighestamountofODAwasobservedinFY2010‐11;itdeclinedthereafter,reacheditslowestinFY2012‐13andstartedincreasingagain.InFY2014‐15,total 46 https://www.humanitarianresponse.info/en/operations/nepal/document/nepal‐gender‐profile. 47 http://hdr.undp.org/en/composite/GII. 48https://www.humanitarianresponse.info/en/operations/nepal/document/nepal‐gender‐profile. 49 https://www.weforum.org/reports/global‐gender‐gap‐report‐2014/. 50 Nepal 2011 Demographic Health Survey, MoHP, 2011. 51 http://nhsp.org.np/Document/nepal‐maternal‐mortality‐and‐morbidity‐study‐200809/. 52 Unless stated otherwise, this whole section is based on GoN/MoF (2016): Development Cooperation Report FY 2014‐15.

29

ODAflowwasslightlyover$1,026m(Figure4).TheoveralltrendofODAflowsinrelationtodisbursements(around$1billionannually)remainedconstantovertheperiodoffiveyears.ThevolumeofaiddisbursementinFY2014‐15reachedatotalof$1.13billion,ofwhichODAcontributionwas$1,020.75m(90%)andINGOcontribution$116.89m(10%).DespitethedevastatingearthquakeinApril2015,ODAdisbursementstoodatalmostthesimilarlevelascomparedtothepreviousFY.OftotalODAcontributions,about45%wasprovidedbymultilateraland55%bybilateral

donors.ThetopfivemultilateraldevelopmentpartnersinFY2014‐15weretheWorldBankGroup,theAsianDevelopmentBank,theUNCT,theEuropeanUnion,andtheGlobalFundtoFightAIDS,TuberculosisandMalaria.Theycontributedapproximately43%ofODA.ThetopfivebilateraldonorsweretheUnitedKingdom,USAID,Japan,ChinaandSwitzerland.Theycontributedapproximately40%.InFY2014‐15,thehealthsectordisbursedthelargestamountofODA(17.4%)followedbylocaldevelopment,education,roadtransportationandenergy.Thesetopfivesectorsreceivedapproximately60%oftotalODA.TheWorldBankGrouphasbeentheleaddonorineducation,economicreformandagriculture;theAsianDevelopmentBankforroad,energy,urbandevelopmentanddrinkingwater.TheUNCThasbeentheleadpartnerforremainingsocialsectorareassuchasSRH,GEandsocialinclusion,GBVandhumanrights.Similarly,USAIDhasledinthehealthsector,theEuropeanUnioninlocaldevelopmentandtheUnitedKingdominhomeaffairs.AccordingtotheMoF,NPR410billionwerepledgedforrespondingtothe2015earthquake.AsofMarch2016,almost30%hadbeenrealizedwiththeremainingNPR290billionexpectedoverthefollowingthreeyearsforachievingrecoveryandreconstructiongoals.53TheUNCTdeliveredapproximately$188.2m,ofwhich$130.7mwasfordevelopmentassistanceand$57.5mwasforhumanitarianassistancein2015.54

Chapter3:UNFPAProgrammaticResponseThischapterprovidesinformationforthereadertounderstandthecurrentUNFPACP,thesubjectofthepresentevaluation.ThefollowingsectionsfocusonUNFPA’sprogrammaticresponse(Section4.1)andfinancialresources(Section4.2).UNFPAsupporttoNepalbeganin1971.Duringthe6thUNFPAcountryprogramme(2008‐12)UNFPAexpandeditscoveragefromsixto18districtsthatweremakingslowprogressinachievingthegoalsoftheICPDinthreegeographicclusters.55UNFPA’slocalrepresentationisthroughRSOsinDangfortheMid‐westerntoWesternregions,DhangadifortheFar‐westernregionandJanakpurfortheCentraltoEasternregions.

53 GoN (2016): Post Disaster Recovery Framework (PDRF) 2016‐2020. 54 UN Resident Coordinator’s Annual Report 2015; http://un.org.np/sites/default/files/20160215_annualreport_2015.pdf. 55 Source: CPAP 2013‐17.

Figure 4: ODA Flow Trends FY 2010/11 – FY 2014/15 Source:GoN/MoF:DevelopmentCooperationReport2016

1079.71

1045.3

995.95

1036.65

1020.76

940

960

980

1000

1020

1040

1060

1080

1100

2010/11 2011/12 2012/13 2013/14 2014/15

Amount in M

illion US $

Fiscal Year

30

UNFPAisimplementingits7thCP.TheCPD2013‐17wasapprovedbytheUNFPAExecutiveBoardinSeptember2012andoperationalizedthroughtheCPAP2013‐17,signedinFebruary

2013.Atthehighestlevel,CP7intendstocontributetoUNFPA’scorporategoaldepictedinFigure5–i.e.,toachieveuniversalaccesstoSRH,topromotereproductiverights,toreducematernalmortality,andtoaccelerateprogressontheInternationalConferenceonPopulationandDevelopment(ICPD)agendaandMDGs5Aand5B,inordertoempowerandimprovethelivesofunderservedpopulations,especiallywomenandyoungpeople(includingadolescents),enabledbyanunderstandingofpopulationdynamics,humanrightsandgenderequality,anddrivenbycountryneedsandtailoredtothecountrycontext.CP7wasdevelopeddrawingonlessonslearnedandaseriesofnationalanddistrictlevelconsultations.Inparticular,anevaluationofCP6notedprogresstowardsnationalownership,strategicalignmentofthe

programmetoenhancesustainability,accountabilityandnationalsystemstrengtheningandanumberofachievementsinprogrammeresults.Itfoundthattheprogrammehadhelpedto:(a)positionUNFPAwithinthehealth‐sectorprogramme;(b)enhancethenationalresponsetoGBVbyworkingwithUNorganizationsandotherdonors;and(c)implementthepopulationandhousingcensus.56Lessonslearnedpointedtotheneedto: sharpenthefocusonevidence‐basedFPadvocacyeffortsandpolicies,includingresearchonthe

reasonsforthestagnantcontraceptiveprevalencerate; increaseaccesstoyouth‐friendlysexualandreproductivehealthservices,includingbyaddressing

socialbarrierstoaccess; paygreaterattentiontoinvolvingmeninviolence‐preventionefforts; addressthegenderdimensionofhealthsystemsandservices; conductresearchonmigration,urbanizationandageing;and providecontinuedsupporttodatamanagementsystems.

TheApril2015earthquakeledtoatemporaryshiftinprioritiesandresourcesto14severely‐affecteddistricts(withonlyoneUNFPAdistrictundertheregularprogrammebeingamongstdistrictsthe14mostaffecteddistricts).UNFPArespondedundertheumbrellaoftheNepalFlashAppealaspartofthehealthandprotectionclusters.UNFPA’sBusinessModel57,introducedin2014,determinedfourmodesofengagementforcountry‐levelinterventionsdependingonacountry’sparticularneedsandabilitytofinance–i.e.,advocacyandpolicydialogue,capacitydevelopment,knowledgemanagementandservicedelivery(Table6).Nepalwasclassifiedas“red”whereUNFPAisexpectedtomakefulluseofallmodesofengagementtoachieveitsobjectives.

Table 6: Modes of UNFPA Engagement by Country Classification

NeedAbilitytofinance Highest High Medium Low

Low A/P,KM,CD,SD A/P,KM,CD,SD A/P,KM,CD A/P,KMLower‐middle A/P,KM,CD,SD A/P,KM,CD A/P,KM A/PUpper‐middle A/P,KM,CD A/P,KM A/P A/P

High A/P A/P A/P A/P

56 CPD. 57 UNFPA SP 2014‐17 Annex 3.

Figure 5 UNFPA’s “Bull’s Eye”

Source:UNFPASP2014‐17

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A/P=Advocacyandpolicydialogue/advice CD=Capacitydevelopment

KM=Knowledgemanagement SD=Servicedelivery

Source:UNFPASP2014‐17

3.1TheUNFPANepalcountryprogramme2013‐173.1.1SexualandreproductivehealthandrightsOutcome1ofCP7“Improvedaccesstosexualandreproductivehealthservicesandsexualityeducationforyoungpeople,includingadolescents”contributesprimarilytoUNDAFOutcome1:“Vulnerableanddisadvantagedgroupsobtainimprovedaccesstobasicessentialsocialservicesandprogrammesinanequitablemanner”.Outcome1ultimatelycontributestoachievingthenationaldevelopmentgoal“increasedaccesstoandutilizationofhigh‐qualityessentialhealthcareservices”asputforwardintheNHSPIIanditsImplementationPlan.UndertheSRHprogrammaticarea,UNFPAsupportsnationaleffortstoimprovetheSRHofwomenofreproductiveagewithaspecialfocusonadolescentsandyouthaswellasmarginalizedwomen.Toachievethisgoal,theprogrammefocusesonboththesupplyanddemandsidesofSRH.

Figure 6: Nepal CP7 SRH Outcome, Outputs & Indicators

Source: Evaluation Team based on Re‐aligned RRF

Outcome1isexpectedtobeachievedthroughstrengtheningthecapacityofhealthinstitutionsandserviceproviderstoplan,implementandmonitorhigh‐qualitycomprehensiveSRHservices(OP1.1)andincreasingthecapacityofwomenandyouthtoaccesshighqualitySRHservices(OP1.2).InterventionsunderOP1.1includecapacitybuilding/training,FPandcommoditysecurity,maternalhealth,ASRHservices,emergencypreparednessandresponse;whileOP1.2comprisesSRHinformation/education,particularlyCSEandHIVeducation.ProjectactivitiesunderOP1.1arebyfarmorenumerousandweighty.Inadditiontonational‐levelpartnershipswithgovernmentdepartments,UNFPAhasenteredintoagreementswiththeDDCsoftheUNFPA‐supporteddistrictswiththeaimtoimplementprojectinterventionsdesignedandagreeduponbynationallevelbodiesthroughtheirrespectivedistrictunits.SRHinterventionshavebeenfundedthroughUNFPARegularResources(RR),variousUNFPAThematicFunds(includingUNFPASuppliesandMaternalHealthThematicFund),theUNFPAEmergencyResponseFund(ERF)aswellasGIZ,the

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GovernmentofAustralia,Japan,GAVI,UBRAF,theUNCentralEmergencyResponseFund(CERF)andUNFIP.58TheCPEdesignreportprovidesmoredetails.

3.1.2GenderequalityandreproductiverightsThisprogrammaticarea(CPOutcome2)focusesonbuildingnationalcapacityinthehealthsectortopreventandaddressGBVaspartofmulti‐sectoraleffortsandonenhancingtheknowledgeandcapacityofmen,womenandcommunitiestopreventGBV,childmarriageandotherharmfulpractises(Figure7).

Figure 7: Nepal CP7 GE Outcome, Outputs & Indicators


UnderCP7,GEinterventionsweredesignedtocontributetoUNDAFOutcome3thatseekstoensurethatvulnerableandstigmatizedgroupsexperiencegreaterself‐confidence,respectanddignity.CPOutcome2intendsforGEandRRtobeadvancedparticularlythroughadvocacyandimplementationofpolicies.ThethreeoutputsstipulatedtoachieveOC2are: OP2.1:Strengthenednationalandsubnationalhealthsystemcapacitywithinthecoordinatedmulti‐

sectoralresponsetosexualandgender‐basedviolence OP2.2:Enhancedcapacityofmenandwomentopreventgender‐basedviolenceandsupportwomen

seekingmulti‐sectoralservicesongender‐basedviolence OP2.3:Communitiesareengagedinpreventingchildmarriageandotherpracticesthatdiscriminate

againstwomenandharmyoungwomen

BesidesusingUNFPARRandUNFPAERF,Outcome2‐relatedactivitieswerefundedthrougharangeofexternalsources–i.e.,SwissAgencyforDevelopmentandCooperation(SDC),GovernmentofJapan,GovernmentofAustralia,GIZ,DFID,theUNPeaceFund,theUNCentralResponseFund,OCHA,GlobalGivingGrantand,asofAugust2016,Norway.TheCPEdesignreportprovidesmoredetails.

3.1.3PopulationdynamicsCPOutcome3contributestoUNDAFOutcome5“Institutions,systemsandprocessesofdemocraticgovernancearemademoreaccountable,effective,efficientandinclusive”.Itincludesthreeoutputs.Itfocusesonensuringthatnational,sectoralanddecentralizedpoliciesandplansareresponsivetopopulationdynamicsandtheirinter‐linkageswithGE,povertyreduction,andtheRHneedsofyoungpeopleincludingFP.Moreover,itincludessupportforbuildingnationalcapacitiesindatageneration,processing,analysis,disseminationandusefor

58 Resources for CSE are also expected from KOICA through UNESCO as soon as agreement is signed.

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inclusivedevelopmentplanningandprogrammemonitoring;andonenhancingcivilparticipationinpolicyformulation,planningandmonitoring(Figure8).

Figure 8: Nepal CP7 PD Outcome, Outputs & Indicators


Inthecontextoflowgovernmentcapacityforplanningandprogrammingactivitiesonpopulationissues,OP3.1isconcernedwithcapacitybuildingoflineagenciesatnationalanddistrictlevelstoincorporatepopulation,SRH,youthandGBVissuesintheirannualplansandutilizedataandinformationinactivityplanningandreporting.SinceconsiderablePD‐relateddisaggregatedandupdateddatasetsarenotavailable,OP3.2interventionsareaimedatimprovingdataavailabilityandanalysis,developingdatabasesaswellascapacitybuildingofnationalauthoritiestoanalyseandusedisaggregateddata.InthecontextoflowparticipationofA&Yandvulnerablewomeninpolicymakingandplanningprocesses,OP3.3aimsatstrengtheningthecapacityofA&Yandvulnerablewomennetworksatcentralandlocallevelstoinfluencedevelopmentpolicies,plansandbudgets.ThePDprogrammaticareaismostlyfundedthroughUNFPARR.IthasbeenimplementedthroughthePopulationDivisionoftheMinistryofHealthandPopulationMoHP59,theCentralDepartmentofPopulationStudiesoftheTribhuvanUniversity(CDPS/TU),theMinistryofYouthandSports(MoYS),theLocalGovernanceandCommunityDevelopmentProgramme2013‐17(LGCDP60)oftheMinistryofFederalAffairsandLocalDevelopment(MOFALD),theCentralBureauofStatistics(CBS),theyouth‐ledorganizationRestlessDevelopmentandDDCs.TheCPEdesignreportprovidesmoredetails.

3.1.4EmergencypreparednessandresponseEmergencypreparednessandresponseismainstreamedthroughoutCP7.AreadingoftheCPDandCPAPrevealsanoverarchingintentionforUNFPAtointegrateriskreductioninprogramming.TheCPAPconcretizedemergencypreparedness–i.e.,bywayof technicalsupportforincorporatingMISPcomponents,includingSRH,GBVandA&Y,indistrict

contingencyplans advocacyforincorporatingMISPintoexistingpre‐andin‐servicehealthtrainingcurricula

59 Since 2015, the Population & Environment Management Division of the Ministry of Population & Environment (MoPE). 60 LGCDP 2016 Annual Report: The purpose of LGCDP is to improve local governance for effective service delivery and citizen empowerment. The programme has adopted a framework to strengthen decentralization, devolution and accountable local governance system which makes basic service delivery effective and efficient and empowers citizens mainly women, children and disadvantaged groups.

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buildingcapacitiesofserviceprovidersatnational,regionalanddistrictlevelsonhumanitarianpreparednessandresponse

makingavailableRHkitsfortheeventofanemergency

IntheaftermathoftheApril2015earthquake,theCPAPRRFwasmodifiedtoincludeUNFPA’semergencyresponseconsistingofsupportfor MISPimplementation; emergencyGBVpreventionandresponseservices,includingthecreationofFemaleFriendlySpaces; coordinationaroundRHandGBV; evidence‐basedassessmentsforhumanitarianassistance;and monitoringandevaluationofhumanitarianresponse

Essentially,emergencypreparednessandhumanitarianassistancehasfallenunderthefollowingCPoutputs:OP1.1,OP2.1,OP3.1,OP3.2andOP3.3.FundsforrespondingtotheApril2015earthquakewereredirectedfromUNFPA’sbudgetedRR;theywerereceivedfromtheGovernmentofAustralia(allocatedtoSRHandGE),theUnitedKingdom(GE),theGovernmentofJapan(SRHandGE),GIZ(SRHandGE),theGovernmentofSwitzerland(GE),theUNFPAERF(SRH,GEandPD)andtheUNCERF(SRHandGE).UNFPAalsoreceivedadditionalRHkitsfromtheUNFPASuppliesProgramme(inkindforanapproximateamountof$500,000),additionalsupportthroughtheRegionalProgramme(fromAustralia)topurchaseadditionaldignitykits,aswellassmallandin‐kindcontributionsfromdifferentsources.HumanitarianassistanceImplementingPartnerswereJhpiego(GE),theMidwiferySocietyofNepal(SRH),theCentreforVictimsofTorture(GE),theEpidemiologyandDiseaseControlDivision(EDCD)(SRH),CARENepal(SRHandGE),ADRA(SRH),FPAN(SRHandGE)andtheNepalRedCrossSociety(SRH,GE).UNFPAalsosupportedasocio‐demographicimpactstudyinthe14earthquake‐affecteddistrictsimplementedthroughCDPS/TU(PD)andayouth‐ledinitiativethroughRestlessDevelopmentandthreeyouthorganizations(Yuwa,Y‐PeerandYuwalaya).PDactivitieswerefundedthroughtheUNFPAERF.

3.2ThecountryprogrammefinancialstructureTheinitialproposedindicativecommitmentofUNFPAaspertheCPD(Table7)is$30.5m:$23mfromRRand$7.5mthroughco‐financingmodalitiesand/orotherincludingRR.Thisamountwastobedividedamongthreecoreprogrammeareas:SRH$12.2($9.2mfromRR);followedbyPD$8.9m($6.9mfromRR);andGE$8.2m($5.7mfromRR);aswellasprogrammecoordinationandassistance$1.2mfromRR.

Table 7: Indicative Commitments by Programmatic Area 2013‐17 (in millions of US$)

Programmatic Area Regular Resources

Other Resources

Total %

Young people’s SRH and SE 9.2 3.0 12.2 40.0%

GE and RR 5.7 2.5 8.2 26.9%

Population dynamics 6.9 2.0 8.9 29.2%

Programme Coordination and Assistance (PCA) 1.2 ‐ 1.2 3.9%

Total 23.0 7.5 30.5 100%

Source: CPD 2013‐17

Attherequestoftheevaluationteam,theUNFPACOundertookananalysisofthecountryprogrammefinances.61Table1inAnnex4showstheannualRegularResourcespendingceilingsandavailableOtherResources(OR)andTable2utilizationfigures.2015wasapeakintermsofincome($8.75m)andexpenditure($8.63m).AsofNovember2016,UNFPAhadutilized92.2%oftotalfunds:95.2%ofRRand86.1%ofOR.Similarly,Table3indicatesannualexpendituresperprogrammaticarea.SRHisthelargestprogrammecomponentinmonetaryterms.Contrary

61 Financial tables are included in Annex 4. The amounts for 2016 are provisional and as of November 2016 only.

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toindicativecommitments,itisfollowedbyGEandthenPD.Inallinstances,actualORbudgetsarealreadylargerthanoriginallyplannedforthewholeCPcycle.Table4providesinformationabouttheoriginofORbyprogrammaticarea.Donorsarenumerousandincludebilateraldonors(firstandforemostSwitzerland,DFIDandJapan),UNFPATrustFunds,theUNFPAERF,UNTrustFunds,othermultilateralorganizationsandsmallcontributions–mainlyforSRHandGE‐relatedinterventions.Tables5‐6providedataontheextenttowhichCP7wasimplementedusingtheDEXandNEXmodalities–byyearandprogrammaticarea.NEXwashighestinabsoluteterms($3.41m)in2015,theyearofthedevastatingearthquake.NEXamountsto45.6%ofallexpendituresbetween2013andNovember2016.TheGEprogrammaticcomponenthasmadeleastuseofNEXascomparedtoDEX.Table7showsNEXutilizationbyImplementingPartner.ThenumberofUNFPAImplementingPartnersishigh(46)andincludesgovernmental(centralanddistrict‐level)andnon‐governmentalentities.ThelargestamountreceivedbyanindividualImplementingAgencyforthefouryearsunderevaluationis$1.05m(ADRA),followedbyJhpiego($0.86m)andFPAN($0.42m).Duringtheperiodunderreview,theCOreceivedasignificantamountofcontraceptionassistanceworth$5.48mdirectlyfromtheUNFPACommoditySecurityBranch(CSB)forfurtherdistributiontotheGoNandNGOs(Table8).62CSBfundingcontributestothenationalFPprogrammetomeettheshortfallincommodityrequirementsduetodelaysinthenationalprocurementsystem.

Chapter4:FindingsThispartoftheevaluationreportprovidesanassessmentoftheperformanceoftheUNFPA3rdCP2013‐17three‐and‐a‐halfyearsintoitsimplementationagainstindicatorsofachievementdevelopedbytheevaluationteamconsideringtheCPAPRRFandconsultedwiththeUNFPACO.Itisstructuredalongtheevaluationcriteriaandcorrespondingevaluationquestions.

4.1RelevanceoftheUNFPA7thCountryProgramme

EQ1Alignment:TowhatextentwasCP7design,planningandimplementation:(1)alignedwithgovernmentpriorities;(2)consistentwiththeneedsofthepopulation,inparticularyoungpeopleandmarginalized/vulnerablegroups;and(3)alignedtorelevantUNsystemandUNFPApoliciesandstrategies?

A.1.1Alignment and responsiveness of CP7 to government priorities at national and district levels

IND1.1.1&IND1.1.2CP7iswellalignedwithrelevantnationallegislation,policies,strategiesandprogrammes.ItsdesignundertheNationalHealthSectorProgrammeIIandannualplanningwereajointeffort.UNFPAwasresponsiveatthestrategiclevel.ItadaptedCP7inresponsetotheviolentearthquakeinApril2015.ConsistencywithGoNprioritieswasensuredthroughtheCPAP2013‐17,co‐signedbyUNFPAandtheMoF.Overtime,alignmentofCP7planningwassoughtthroughcontractsandAnnualWorkPlans(AWPs)withselectedcentral‐governmentImplementingPartners,particularlyinSRHandPD.Furthermore,evidenceofsafeguardingalignmentatnationallevelisfoundinjointmonitoringmissionsandannualreviewmeetings.TheRRFexplicitlylinksoutputsandoutcomestotheNationalHealthSectorProgramme2010‐15(NHSPII)(Figures9‐11).Moreover,CP7isconsideredconsistentwithanumberofkeynationalandsectoralpoliciesandprogrammes.Theyarereferredtothroughoutthisreport.

62 Not part of the spending ceiling or expenditures of UNFPA Nepal but provided in kind to the GoN and NGOs.

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Accordingtotwokeyinformants,alignmentwasfacilitatedbytheexistenceofacomprehensivelegalandpolicyframework,forwhichUNFPAfrequentlyconductedadvocacyandprovidedpolicyadvice.

Figure 9: Nepal CP7 SRH Outcome & Outputs Aligned with NHSP II

Source: Evaluation Team

TheSRHprogrammeshouldcontributetothenationalgoaltoincreaseaccesstoandutilizationofhigh‐qualityessentialhealthcareservices.UNFPAhasgotitsprioritiesright.IntervieweesemphasizedUNFPAsupportforGoNprioritieswheredataandanalysesaswellasdomesticskillsandfundingareinsufficienttosatisfyneeds–i.e.,reproductivehealthcommoditysecurity;FPandinparticularLong‐ActingReversibleContraception(LARC)anddistrict‐levelFPmicro‐planning;RHmorbidities;andASRH.TheyappreciatedUNFPA’ssupportforinitiatingmidwiferyeducationaswellasforobstetricfistula(OF).

Figure 10: Nepal CP7 GE Outcome & Outputs Aligned with NHSP II


TheGBVprogrammeshouldcontributetothenationalgoaltoreduceculturalandeconomicbarrierstoaccessinghealthcareservicesandharmfulculturalpractices.StakeholdersespeciallyemphasizedUNFPA’ssupportforOCMCsandsafehouses,psycho‐socialcounselling,inter‐generationaldialogue,andtheSocialandFinancialSkillsPackage(SFSP).Furthermore,UNFPA’sworkintheareaofchildmarriagewasspecifiedasessential.ItssupportforintegratingpriestsandastrologersinpreventingGBV,childmarriageandotherharmfulpractiseswascommendedastacticalandaninnovativeapproach.

Figure 11: Nepal CP7 PD Outcome & Outputs Aligned with NHSP II

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ThePDprogrammeshouldcontributetothenationalgoaltocreateafavourableenvironmentforintegratinggenderandsocialinclusioninthehealthsectorthroughpolicies,strategies,plansandprogrammes.GoNstakeholdersemphasizedtherelevanceofpolicy‐levelandprogrammesupportprovidedbyUNFPAonyouthdevelopment.Intervieweeswereparticularlyclearthatsupportforyouthempowermentwasalsoverymuchinlinewithgovernmentprioritiesasembodied,forinstance,inthe13thPlanandthe14thPlanApproachPaper,theYouthVision2025,theNationalYouthPolicyandtheLGCDP.Aswillbeelaborated(IND9.2.1),UNFPAhasplayedaleadingroleintheclustersysteminsupportoftheGoNNationalDisasterResponseFramework(NDRF).FollowingtheearthquakeinApril2015,theUNFPARRFwasadaptedandresourcesmobilized/shiftedinsupportoftheGoN’sresponseeffortsinthe14most‐affecteddistricts,onlyoneofwhichwasaUNFPAprioritydistrict.Despitesomedelaysencounteredinitsregularprogrammingbecauseoftheurgentattentiongiventoearthquakesurvivors,nointervieweethoughttoquestionthisdecision.

IND1.1.1&1.1.2CP7isclearlyanintegralpartofimplementingdistrictdevelopmentplans.ThegreatestneedforflexibilitywasinresponsetotheApril2015earthquakeinSindhuliwheretheAnnualWorkPlanwassuccessfullyre‐orientatedtomeeturgentSRHandGBVneeds.Asthisevaluationrevealed,thepercentageofdistrict‐levelbudgetallocationsforpopulation,SRH,youthandGBV/women’sempowermenthasincreasedconsiderablyacrossUNFPA’sprioritydistricts.UNFPAnotonlyinfluencedperiodicandannualdistrictdevelopmentplanning(IND5.2.6),italsoclearlyengagedintheirimplementation.ItdidsobyprovidingtechnicalexpertiseaswellasearmarkedfundingthroughDDCsasUNFPAImplementingPartners.Aspartofimplementation,UNFPAalsoparticipatedinjointmonitoring.Inallfourvisiteddistricts,localgovernmentrepresentativesconfirmedthatUNFPAsupportwasalignedthroughtheregulargovernmentplanningprocess.Supportwasdescribedas“appropriate”,“aligned”,“crucial”,“inline”,“highlyrelevant”,“synchronized”,“responsive”,and“close”.UNFPArepresentativesintheregionsanddistrictsperceivethemselvestobebridgingimportantcapacityandfinancialgapsconsistentwithUNFPA’smandateandCP7.Aswillbeexplainedbelow(IND7.3.1),stakeholdersconsideredthephysicalpresenceofUNFPAstaffpertinentintermsofoptimizingconsistency,integrationandgovernmentownership.ThegreatestneedforresponsivenessandflexibilitythattheevaluationteamnotedwasinSindhulidistrictbecauseofthedevastatingearthquakeinApril2015.Withinreasonabletime,UNFPAandtheDDCrevisedtheir2014‐15AWPtore‐programmeremainingfundsforSRHandGBVtohelpimplementtheMISP,includingestablishingmobileRHcampsandprovidingdignitykitsandsanitarypadstotheelevenmost‐affectedVDCs.Lateron,additionalin‐kindsupportwasgivenandextraemergencyfundingchannelledtothedistrictthroughthe2015‐16AWP.

A.1.2Alignment of CP7 with the needs of young people and vulnerable/marginalized women

IND1.2.1&IND1.2.2Youngpeoplearenotonlytargetbeneficiaries;theyarealsopartnersinaction.AdolescentsandyouthparticipatedinCP7design;theyhavebeenless

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systematicallyrepresentedinannualplanning.UNFPAhasmadeaconsciousefforttoconsultandinvolveyoungpeopleinCP7implementation.DeliberateinvolvementofvulnerableandmarginalizedwomeninCP7designandplanning,toensurealignmentwiththeirparticularneeds,hasbeenless.UNFPAstaffconfirmedthatyoungpeopleparticipatedinnationalanddistrict‐levelconsultationsleadinguptoCP7,andthattheintentionistoensuretheirrenewedinvolvementinCP8design.AnnualplanningbuildsonAnnualReviewMeetingsinKathmandu;inthedistricts,itbuildsonmulti‐stakeholderconsultations.YoungpeoplewerenotrepresentedatAnnualReviewMeetingsapartfromtheyouth‐ledorganizationRestlessDevelopment,anImplementingPartner.Inthedistricts,thereseemtohavebeendifferentapproachestoA&YparticipationinUNFPAannualplanning.IntermsofCP7implementation,themostobviousstrategiccollaborationwithA&YisinthePDprogrammaticareawhereUNFPAhasworkedwithyouth‐ledorganizationsandstakeholdersatthecentralleveltoinfluenceyouthpolicies,actionplansandprogrammes,andwhereithasfacilitatedtheformation,strengtheningandinstitutionalizationofyouthnetworksinitsprioritydistrictstoinfluencelocal‐levelpolicyandplanningprocesses.Equallyimportantiscollaborationwithgirls’circleswithintheGEprogrammetoempoweradolescentgirlstoleverageUNFPA’seffortstoinformandeducatecommunitiesaboutSRH,GBVandchildmarriage.Moreover,A&Ywereconsultedforthe“BarrierStudy”andthe“CSEReview”.Theywerepartofabottom‐upprocesstodeveloptheUNFPA/NHEICCBCCStrategyandImplementationPlan.A&YwerealsoinvolvedindevelopingtheASRHtrainingpackageforhealthserviceproviders;andAFHScentreclientsareheardaspartoffinaldecisionstocertifyAFHScentres.Intheaftermathofthe2015earthquake,UNFPAtrainedA&YvolunteersaspeereducatorsandenumeratorsinthecontextofthePost‐DisasterNeedsAssessment(PDNA),fundedbytheWorldBankandUNDP.WhileUNFPAhasclearlytargetedvulnerableandmarginalizedwomensuchasFSWsandGBVsurvivorsasbeneficiaries(IND1.3.3),theevaluationteamdidnotcomeacrossevidencethatUNFPAhadpurposefullyinvitedrepresentativestoparticipateinCP7designandplanning.Reasonsstatedforthiswerelackoftimeandcapacities,andtheneedtofirstidentifyandbuildworkingrelationshipswithlocalstakeholdergroups/organizations.

IND1.2.3CP7hasbeenwellinformedbydata,analysesandknowledgeproducts;someassessmentsofCP7performancewereconducted.UNFPAhascreatedandutilizedmultipledatasetsandanalysestoinformCP7planningandimplementation.In2012,itcommissionedabaselinestudytoinformOutcome3(PD)planning.Follow‐updatacollectionstudieswereundertakenyearly.In2013,UNFPAconductedaperceptionsurveytogatherbaselinedataforGEandSRH‐relatedperception‐basedindicators.63Anexternally‐commissionedstrategyvalidatedtheCPAPfocustoengagemenandboys,parentsandcommunities,includingreligiousleaders,toaddresstheissueofchildmarriageandharmfulpractises.64Obviously,UNFPAalsosupportedandusedCBS,DHS,MultipleIndicatorClusterSurvey(MICS)andHealthManagementInformationSystem(HMIS)dataandrelatedanalysestoinformitswork.Ineachofthedistrictsvisitedbytheevaluationteam,assessmentshadbeenconductedtoidentifylowCPRVDCsandinformFPmicro‐planning.AftertheApril2015earthquake,theCOparticipatedinandusedthefindingsofthePost‐DisasterNeedsAssessment(PDNA).Togetherwithpartners,UNFPAalsoproducedanumberofknowledgeproducts.InSRH,forinstance,itconductedstudiesonselectedRHmorbiditiesandonhealth‐relatedqualityoflifeofwomensufferingfrompelvicorganprolapsebeforeandaftersurgery.TheCO,fulfillingaGPRHCSrequirementandharmonizedwiththeNationalHealthFacilitySurvey,also

63 An end‐line perception survey is planned for 2017. 64 International Centre for Research on Women (ICRW): “Engaging Men and Boys, Communities and Parents to End Violence against Women, Child Marriage and Other Harmful Practices in Nepal”, January 2014; http://nepal.unfpa.org/publications/engaging‐men‐and‐boys‐communities‐and‐parents‐end‐violence‐against‐women‐child‐marriage (English).

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commissionedtheannual“Facility‐basedAssessmentforReproductiveHealthCommoditiesandServices”.ASRHworkwasverymuchdirectedbythefindingsandrecommendationsofthe“BarrierStudy”andthe“CSEReview”.InGBV,UNFPAsupportedanassessmentbytheNepalHealthSectorProgrammeoftheOCMCsandorganizedmeetingstosharethefindings.65Furthermore,astudyandpolicybriefwerepreparedon“TrackingCasesofGender‐basedViolenceinNepal:Individual,Institutional,LegalandPolicyAnalysis”66,andtheCOparticipatedinaregionalstudyon“SexWork,ViolenceandHIVinAsia–fromEvidencetoSafety”.Intheareaofdataavailabilityandanalysis,UNFPAmobilizedsupportforpublishingthePopulationMonographsofNepal;itsupportedfurtheranalysisofthe2011DHS.Aspartofitssupportforyouthempowerment,UNFPAprovidedfinancialandtechnicalsupporttotheMoYSforresearchingandpublishingthereport“NepaliYouthinFigures”67;itsupportedRestlessDevelopmenttoproducea“MediaMonitoringReportonYouthEngagementinPost‐EarthquakeReliefCampaign”.Aftertheearthquake,UNFPA,incollaborationwithInternationalOfficeofMigration,supportedastudyentitled“Socio‐demographicImpactoftheEarthquake2015”.SomeassessmentsofUNFPA’sperformancewereconducted,mainlyearlyonintheCP7cycle.In2013,UNFPAconductedanassessmentofitsflagshipadolescentgirls'programmeChooseYourFuture.FindingsandrecommendationsfedintothecontentanddesignoftheSFSP.68IncollaborationwithUNWomenandUNICEF,UNFPAcommissionedafinalevaluationoftheTrustFundproject“Multi‐SectoralGender‐basedViolenceResponseattheDistrictLevelinNepal”.In2014DFIDassessedUNFPA’sinterventionsaspartofitsGPRHCSAnnualReview.Mostrecently,inMay2016,UNFPAsupportedanevaluationoftheMISPforReproductiveHealthServicesinPost‐earthquakeNepalbytheWomenRefugeeCouncil.

A.1.3Alignment of CP7 with the UNFPA Strategic Plan and UNDAF

IND1.3.1CP7waslogicallyconnectedtotheMid‐termReviewoftheUNFPAStrategicPlan2008‐13andalignswellwiththeStrategicPlan2014‐17outcomeareas.CP7wasoriginallydesignedundertheMid‐termReview(MTR)oftheUNFPASP2008‐13andmodifieddevelopmentresultsframework.Initsregularprogramming,UNFPAhaspursuedeightoutputsacrossthreeprogrammaticareas.ThethreeCPAPoutcomestatements(oneforeachprogrammaticarea)wereidenticaltoselectSPMTR2008‐13outcomeareas–i.e., SPMTROutcome1:PDanditsinterlinkageswithyoungpeople’sneeds,SRHandGBVaddressedin

nationalandsectoraldevelopmentplansandstrategies

SPMTROutcome5:GenderequalityandRRadvanced,particularlythroughadvocacyandimplementationoflawsandpolicy

SPMTROutcome6:ImprovedaccesstoSRHservicesandsexualityeducationforyoungpeople,includingadolescents

TheRRFwaslaterre‐alignedtotheUNFPASP2014‐17IRF.Thisre‐alignmentbroughtnochangestothenumberorformulationofCPoutcomesoroutputs;itdidatthelevelofoutcomeandoutputindicators.Existingresultsstatementswereprogrammaticallyre‐connectedtothefournewSPoutcomesasdepictedinFigure12.NoseparateA&Yprogrammecomponentwascreated.69Outcome1wasalignedtobothSP2014‐17Outcomes1(SRH)and2(A&Y).

Figure 12: Linkages between CP7 and UNFPA’s SP 2014‐17

65 MoH: Assessment of the Performance of Hospital‐Based One Stop Crisis Management Centres, 2013. 66 2013. UNFPA, DFID and UN Women. 67 December 2014. 68 Later, the MoWCSW allocated regular funds to scale‐up the programme, renamed Kishori Bikash Karyakram, in all 75 districts. Source: Evaluation of UNFPA Support to Adolescents and Youth 2008‐2015. 69 This was not a corporate requirement.

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IND1.3.2ProgrammaticsynergiesandcollaborationbetweentheCP7programmecomponentsareevident,bothinUNFPA’sregularprogrammeandearthquakeresponse,butcouldbefurtherexplored.UNFPA’s“bull’seye”requiresthateachCOpoolsitsforcesandresourcesandworksinasynergisticfashionratherthanoperatinginsilos.ThisCPErevealedgeneralsatisfactionandsomegoodexamplesofoffice‐widecollaboration.Atthesametime,twokeyinformantsfeltthattherewasroomformorecollaborativeeffortsandthatinformationflowwasimportanttoidentifyadditionalopportunities.SupportforGBVsurvivorsisonesuchgoodexample.Aspartofitsregularprogramming,UNFPAhasworkedwiththehealthsectortostrengthenOCMCsindistricthospitals;aspartofthereferralsystem,ithassupportedsafehouses,forwhichWCOsareresponsible.Thishasprovenagoodentrypointforcollaborationbetweenhealthsectorandprotectionactors.AnotherexampleofworkingacrossoutcomeareasareUNFPA’spublicoutreachandBCCactivitiestoaddressissuesrelatedtotheinter‐connectedareasofSRH,includingpregnancydangersignsandHIVprevention,aswellasGBVpreventionandchildmarriage.Similarly,boththeSRHandtheGEprogrammecomponentsaremakinguseoftheSFSP,locallyknownas“Rupantaran”.Rupantaran70,co‐designedbyUNICEFandUNFPA,aimstoprovidecomprehensivesocialandfinancialskillstoA&Yaged10‐19.Itincludesmodulesonself‐awareness,genderandsocialinclusion,civicengagement,GBVandSRH.TheUNFPACOhasalsoengagedatthepolicylevelthroughadvocacyandpolicydialogue/advice.WorktoimprovedataavailabilityandanalysesonPD,SRH,youthandGBVinordertoinfluencethenationalpolicyframeworkanditsimplementationhasbeenacommonundertaking,within‐housetechnicalsupportfordatagatheringandresearchfromthePDcomponent.Forthebenefitoftheentirecountryprogramme,thePDcomponentisthemaincounterpartfortheNationalForumforParliamentariansonPopulationandDevelopment(NFPPD)andco‐leadstheUNCTSDGWorkingGroup.ProgrammaticcollaborationandsynergybetweenthethreeCP7programmecomponentswasalsowelldemonstratedduringthe2015earthquakeresponse.MobilizationofyouthasvoluntarypeereducatorsandenumeratorsandprovisionofmobileRHcampsandfemale‐friendlyspaces(FFSs)thatprovidedcontraceptivesanddignitykitsaregoodexamples.

IND1.3.3UNFPAhasclearlytargetedwomenandgirlsofreproductiveagewhoarevulnerableandmarginalized,mostprominentlyGBVsurvivorsandwomenatriskofbeingmarriedearly.Ithasnotspecificallytargetedtheparticularneedsofveryyoungadolescents(10‐14)whoareacorporatestrategicpriorityfor2014‐17.TheoverallgoalofCP7istosupportnationaleffortstoimprovetheSRHofthemostmarginalizedadolescentgirls

70 “Transformation” in English.

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andwomen.Whilenotexplicit,furtheranalysisoftheCPDandCPAPsuggestsmarginalizedandvulnerablegirlsbetween15and24andwomenupto49yearsofage.Theagegroup15to24correlatesexactlywiththeUN’sdefinitionofyouthandlargelywithNepal’sdefinitionofyouthaspertheYouthVision2025–i.e.,16to24.WhileinlinewiththetargetpopulationsoftheUNFPASP2014‐1771,theevaluationteamnotedthatCP7wasnotre‐alignedtoreflecttheincreasedcorporatefocusonveryyoungadolescentgirlsaged10‐14.72Whileinterventionsatpolicyandprogrammelevel‐suchasregardsthe2013NationalPlanofActionontheHolisticDevelopmentofAdolescents73andAFHS‐havealsobenefitedveryyoungadolescents,theonlysupportwithatargetedcomponentbenefitingthisagegroup(althoughnotyetimplemented)isthroughCSEinprimaryschool.IntervieweesvoicinganopinionnotedthattherewasverylittleguidanceforthcomingfromUNFPAheadquarters(HQ);thattherewasapaucityofdata;thatengagingwithveryyoungadolescentswasdifficult;andthattheyweretooyoungforSRHservices.CP7haslargelybeenimplementedin18districtsthatweremakingslowprogresstowardsthegoalsoftheICPD.74Thisinitselfspeaksforanappropriatetargetingofvulnerablegroups.Withindistricts,theevaluationteamwasfrequentlytoldthattargetcommunitieswereselectedbasedonvulnerabilitiessuchaslowCPRpockets‐e.g.,forsatelliteclinics;presenceofethnic/religiousgroupsandcastes‐e.g.,forBCCactivities;disaster‐pronecommunities‐e.g.,fordignitykits;andgeographicalremoteness‐e.g.,formobileRHcamps.Ontheotherhand,theevaluationteamnotedthatCSEinterventionshavetodatelargelysupportedgirls(andboys)withintheformaleducationsystemratherthannon‐formalprogrammesforthebenefitofA&Ywhoarenotinschoolandgenerallyhardertoreach(A.3.3).GBVsurvivorsandthoseatriskofGBVareprominenttargetbeneficiariesofUNFPA’sworkinNepal,bothinitsregularprogrammingandearthquakeresponse,asareyoungwomenatriskofbeingmarriedearly–i.e.,beforetheminimumlegalageformarriage,whichisnow20.TheentireOutcome2(GE)revolvesaroundtheissuesofGBV,childmarriageandotherharmfulpractisessuchaschhaupadi.KeyinterventionswereGBVandpsycho‐socialcounsellingtraining,supportforOCMCsandsafehousesandFFSs,thelatterduringtheearthquakeresponse.Moreover,underOutcome1,UNFPAhasadvocatedforandsupportedtargetedtreatmentandrehabilitationservicesforwomensufferingfromobstetricfistula(OF),whoareunderserved,andmanyofwhomsufferfrommultiplevulnerabilities:theyarepoor,marginalizedandliveinisolation.Asalsowillbeseen,UNFPAhasraisedawarenessandbuiltcapacitiestosafeguardthehealthandrightsofFSWs,aparticularlymostatriskpopulationgroup,althoughsupporthasbeenselectiveandmodest.

IND1.3.4&IND1.3.5GenderequalityisatthecentreofCP7asagoalinitselfandameanstoanend.UNFPAhasmadeapointtoengagemenandboysandotherlikelygatekeepers.Ithasappliedarights‐basedapproachtoSRH,includingGBV,atprogrammeandpolicylevels.GenderequalityisanimportanthumanrightsprincipleunderlyingUNFPA’scorporatemandateand“bull’seye”;itisalsoagoalinitself.TheCPEofCP6foundthatUNFPAhadincreasinglyendeavouredtomainstreamgenderequality.75StakeholdersinterviewedduringthedatacollectionphaseforthecurrentCPEwerealsopositiveinthisrespect.WithinCP7thereisaseparateprogrammecomponentaimingtoadvancegenderequality(Outcome2),especiallyinUNFPA’sprioritydistricts.ItisclearlyfocusedonVAWandchild 71 In terms of target population groups, the 2014‐17 Strategic Plan calls for reaching those farthest behind by giving priority to the most vulnerable and marginalized, particularly adolescent girls, as well as to indigenous people, ethnic minorities, migrants, sex workers, persons living with HIV and persons with disabilities. Source: UNFPA SP 2014‐17, p5. 72 Outcome 2 of the 2014‐17 SP reads as follows: “Outcome 2: Increased priority on adolescents, especially on very young adolescent girls, in national development policies and programmes, particularly increased availability of comprehensive sexuality education and sexual and reproductive health services”. The title of the 2016 State of the World Population is “10: How Our Future Depends on a Girl at This Decisive Age”. 73 http://nepal.unfpa.org/publications/national‐plan‐action‐holistic‐development‐adolescents. Only in Nepali. 74 CPAP, p7. 75 CPE CP6, p20.

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marriage.Alongwithsupplyanddemand‐sideinterventionstoincreaseaccesstoSRH,improvematernalhealthandpromotesafesexualbehaviour,thesearemajorbarrierstoachievingGE.Outcome3hasplayedanenablingrolebyimprovingdataavailabilityandanalysisforpolicy‐makingonGEandbysupportingyouthofbothsexestovoicetheirneeds.Atthecommunitylevel,UNFPAhasusedstructurestobuildnetworksofgenderequalitychampionssuchasgirls’circles/groups,womencooperativesandFCHVs.Ithasalsostrivedtobringaboutchangeindiscriminatorysocietalgendernormsandattitudesamonglikelygatekeeperstogenderequalityinhealth.CP7addressedgenderrolesandattitudes;itsensitizedandbuiltthecapacitiesofparents,menandboys,andreligiousleadersaswellasteachersandpoliceofficers76tobepartofthesolution,althoughinasomewhatunorganizedmanner.Allintervieweesexpressinganopinionconfirmedthathumanrightsprinciplesandwomen’shumanrightshavepurposefullyguidedUNFPA’sworkinallthreeprogrammecomponents.Documentanalysisconfirmsthisfinding.TheUNFPACOhasconsciouslyworkedtostrengthenandbuildthecapacitiesofdutybearers‐e.g.,healthandprotectionprofessionals‐toprovidequalityservicesandmeettheirobligations.Atthesametime,ithasreachedouttoanddevelopedthecapacitiesofrightsholders‐e.g.,adolescentgirlsandyouth‐tomakedemandsandtoclaimtheirrights.Asevidencedabove,UNFPAprogrammeshavetargetedthemarginalizedandvulnerable,aimingtoreducedisparities.Moreover,UNFPAhasrecognizedyoungpeopleandwomenaskeyactorsintheirowndevelopment,ratherthanonlypassiverecipientsofservicesandcommodities.GoodexamplesareUNFPA’ssupportforyouthparticipationintheearthquakeresponseanddistrict‐levelplanning;empowermentofgirlsaspeereducatorsthroughtheSFSP;andtrainingofwomencooperativemembersaspsycho‐socialcouncillorsforGBVsurvivorsandwomenatrisk.UNFPAhasnotonlybeenabletobuildonandfurthertherightsofwomenandgirlsinitsoperationalactivities,butalsoinitsupstreampolicywork.Accordingtotwokeyinformants,thiswasfacilitatedbythefactthatGoNrepresentativesaregenerallyaccessibleandsympathetictoUNFPA’smandate.“Choices,notchance”isUNFPA’sFPslogan.77Inthisregard,twocentralachievementswerehighlightedbytheCO,namelythe2015NationalPopulationPolicyandthe2015ConstitutionwhereUNFPAreportedlysucceededinincludingnewreproductivehealthandrightslanguagebasedonthenotionofchoiceinsteadofcontrol.TheFPStrategy2020andthecostedImplementationPlanforFP2015‐20aswellastheNationalHealthSectorStrategy2015‐21(NHSS),developedwiththesupportofUNFPAandotherdevelopmentpartners,areothersuchaccomplishmentsthathaverespectedreproductivehealthandrightsofwomen.Otherexamplesofrights‐basednormativeworkcanbefoundthroughoutthisreport.

IND1.3.6CP7andtheUNDevelopmentAssistanceFrameworkareinsyncexceptfortheareaofemergencyresponsepreparednesswhereUNFPAdoesnotappearasacontributingagency.Asmentioned,UNFPAisexpectedtocontributetoOutcomes1,3and5oftheNepalUNDevelopmentAssistanceFramework(UNDAF)2013‐17.CP7resultsandindicatorsarereflectedintheUNDAFResultsMatrixundertheseoutcomeareas.Theperceptionsurvey,conductedbyUNFPAin2013,alsocoveredperception‐basedindicatorsintheUNDAF.TheCOhasparticipatedinandledpertinentUNDAFCoordinationGroups;ithasfedintoUNDAFAnnualReports,andhelpedtomonitorprogress.CP7andtheUNDAFarenotinsyncinemergencyresponsepreparedness.GivenNepal’shighvulnerabilitytonaturaldisasters,UNDAFOutcome7envisagesthatpeoplelivinginareasvulnerabletoclimatechangeanddisastersshouldbenefitfromimprovedriskmanagementandbemoreresilienttohazard‐relatedshocks(“protectingdevelopmentgains”).BesidesageneralfocusofOutcome7ondisasterriskmanagementandclimatechange,Output7.4reads:“nationalpreparednessandemergencysystemsareabletoeffectivelyprepareforandrespond 76 Collaboration with the police force as part of the UNTF‐funded Joint Programme “Multi‐sectoral GBV Response at the District Level in Nepal”. 77 Choices not Chance – UNFPA Family Planning Strategy 2012‐2020.

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tohazard‐relateddisasters”,whichfitsnicelywithUNFPA’sworktopreparecentralanddistrict‐levelpartnersanditstargetpopulationstocopewithemergenciesintheareasofGBVandRH.However,UNFPAdoesnotappearasacontributingagency.78Accordingtokeyinformants,theUNDAFisverybroadandagencies,forpracticalpurposes,hadtobeselective.

EQ2Vulnerability:HowdidUNFPAtakeintoaccountthecountry’svulnerabilitytodisastersandemergenciesinplanningandimplementingitsinterventions?

A.2.1CP7 reflection of Nepal’s vulnerability to disasters and emergencies

IND2.1.1Nepal’shighvulnerabilitytonaturaldisastersandUNFPA’sactualsupportforemergencyresponsepreparednessareinsufficientlyreflectedintheCPAPanditsRRF.TheCPD2013‐17startsthesituationanalysisbyexplainingthattheNepalpeaceprocessisgraduallymovingforward.AccordingtotheCPAP2013‐17,CP7contributestoconsolidatingpeaceandsustainingdevelopment.NeitherdocumentdiscussesNepal’shighvulnerabilitytonaturaldisasterssuchasearthquakes,floodsorlandslides,ordrawsconclusionsforUNFPA’sstrategicpositioning.TheonlyreferencesintheCPDnarrativetoemergencypreparednessandresponseareinthePDprogrammaticarea.79TheCPAPisonlyslightlymoreexplicit:besidesplannedPD‐relatedinterventionstoaugmentdataavailabilityandincreasecapacities,italsolistsplannedSRHandGBVinterventions.OnlytwooriginalCPAPoutputsandindicatorsmeasureUNFPA’scontributiontoemergencypreparedness: #ofkeysectoralministriesthathaveimplementedtheirannualworkplansandbudgetsresponding

topopulation,ASRH,youthandGBV,includinginemergencies80;and #ofUNFPA‐supporteddistrictswithdistrictcontingencyplansthatincorporatetheMISP,response

toGBVandASRHservices81.

InterviewedUNFPAstaffagreedthatvulnerabilitywasinsufficientlyreflectedinCP7,especiallyinviewofitsincreasedprioritizationbytheorganizationtoday,andthatCP8shouldpaymoreattentiontoemergencyresponsepreparedness.Theyexplainedthatnoassessmentsorriskanalyseswerecommissionedatthetime82,butthatCP7consultationshadalsoincludedhumanitarianaspects.Inactualfact,UNFPAhasgonebeyondtheoutputsstipulatedintheCP7RRF.Interalia,theCOprepositionedRHanddignitykitsaswellastents,provideddiverseemergencypreparednesstrainings,andcontributedtonationalandsub‐national‐levelcoordinationandcontingencyplanning.

IND2.1.2BasedontheUNFPA‐supportedPost‐DisasterNeedsAssessment,CP7wastemporarilyre‐programmedafterthedramaticearthquakein2015.Ultimately,thedeadlyearthquakein2015seemstohavebeenaneye‐openerintermsofNepal’svulnerabilities.UNFPAhumanitarianassistancewasmainstreamed.Toreflectthechangedsituation,theRRFandcertainImplementingPartnerWPswererevised.NewImplementingPartners–e.g.,CARENepal83andWOREC–werecontractedtohelpimplementUNFPA’searthquakeresponse.CP7

78 Alongside OCHA, UNICEF, OHCHR and WHO. 79 CPD 2013‐17, p4: “Interventions will support: (a) the development of tools and methodologies to integrate indicators on gender, youth and adolescent sexual and reproductive health, as well as humanitarian concerns, into national, sectoral and local plans and budgets; …” (Source: CPD 2013‐17, p4). “Interventions will support: (b) the strengthening of information management systems on health and gender‐based violence and the sub‐national capacity to use data in emergency preparedness and response; …”. 80 CPAP Outcome 3 Output 1 Indicator 1. According to the RRF, aligned with SP 2014‐17 Outcome 4 Output 14. 81 CPAP Outcome 3 Output 2 Indicator 1. According to the RRF, aligned with SP 2014‐17 Outcome 1 Output 5 Indicator 5.2. 82 A risk analysis was not mandatory according to Policy and Procedures for Development and Approval of the Country Programme Action Plan (CPAP), June 2012. 83 Guided by a pre‐existing global understanding between CARE International and UNFPA.

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wasnotonlyre‐programmedintermsofscaleandtypesofinterventions;financialandhumanresourceswerealsoredirectedtocompletelydifferentdistricts.84

A.2.2CP7 alignment with UNFPA corporate emergency preparedness and response objectives

TheUNFPASP2014‐17recognizedtheneedforanexpandedroleforUNFPAinhumanitariansettings.In2015,theNepalCOrealignedtheCP7RRFwiththeSP2014‐17IRF;laterwithitsearthquakeresponse.

IND2.2.1There‐alignedRRFisaverygoodreflectionoftheSP2014‐17IntegratedResultsFrameworkintheareaofemergencypreparednessandresponse,butonlysincethe2015earthquake.SP2014‐17SRHOutput5,Indicator5.2regardingcontingencyplanswasalreadypartoftheoriginalCP7RRF.GEOutput10,Indicator10.2regardinginter‐agencyGBVcoordinationbodieswasaddedduringtheSP2014‐17re‐alignmentexercise.AlignmentwiththeremainingpertinentIRFoutputsandindicators–i.e.,regardingcapacitiestoimplementMISP(Indicator5.1),datainemergencies(Indicator12.1),andM&Eforinterventionsinhumanitariansettings(Indicator15.1)‐onlyhappenedaftertheearthquake.TheSP2014‐17MTRmeanwhileaddedfourindicatorstostrengthenmeasurementandreportinginkeyareasofUNFPAworkinthehumanitarianfield.85However,theevaluationteamdonotdeemthemrelevantforCP7.

4.2EffectivenessandSustainability

EQ3SRHServices,CSE&BCC:TowhatextenthasUNFPAcontributedtosustainablyimprovingtheavailabilityofanduseofqualitycomprehensiveSRHservices,inparticularforandbyyoungpeopleandvulnerable/marginalizedwomen?TowhatextenthasUNFPAcontributedtoincreasedavailabilityofCSEandSRH/HIVBCCtopromoteutilizationofSRHservices?

A.3.1Availability and use of quality comprehensive SRH services

IND3.1.1UNFPAhascontributedtoinstitutingahumanrights‐basedapproachtofamilyplanninginNepal.Itcanclaimcreditforimportantpolicydevelopmentsinmidwiferyandobstetricfistula.DuringCP7,UNFPAtechnicalsupportfortheFHDwasconsideredtohaveinfluencedthedirectionandemphasisoftheFPStrategy2020andthefirst‐evernationalcostedImplementationPlanforFP(2015‐20).86TheStrategyandImplementationPlanaddressexistinginequitiesinaccessingFPservicesandarepartofauniversally‐accreditedrights‐basedstrategytomeetingunmetneedforcontraceptivesinsteadofadoptinganapproachthatlargelydefinesfertilityratesandchoicesaboutfamilysize.UNFPA,alongwithotherdevelopmentpartnerssuchasUNICEF,DFIDandWHO,wasalsoamemberoftheteamfordevelopingtheNHSS.ContrarytoNHSPII,theNHSSwasdevelopedbasedontheprinciplesofuniversalhealthcoverageandahumanrights‐basedapproachtohealth.Moreover,UNFPAcontributedtotherevision,endorsementanddisseminationoftheNationalRHCommoditySecurityStrategy2015.ItprovidedsupporttoFHDforconductingastudythatpinpointedalackoftimelyprocurementofessentialcommoditiesresultingintheirunavailability.Intheareaofmaternalhealth,UNFPA’spersistentadvocacyresultedinhavingmidwiferyeducationincludedinthe2014NationalHealthPolicy.ThankstoUNFPA’scontinuouslobbying,togetherwiththeMidwiferySocietyofNepal(MIDSON),theMoHdevelopedMidwifery

84 With the exception of Sindhuli district. 85 UNFPA: Integrated midterm review and progress report on implementation of the UNFPA strategic plan, 2014‐2017 ‐ Report of the Executive Director. DP/FPA/2016/2 (Part I), 25 April 2016. 86 MoHP/DoHS: National Family Planning Costed Implementation Plan 2015‐2020, 2015.

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Guidelinesandacareerladderformidwives.Inaddition,UNFPAstartedlobbyingtheMoHtoaddresstheproblemofobstetricfistula(OF)atthepolicylevelandinparticulartoincludeOFscreeninginitsbasichealthpackage.IncollaborationwithUNFPA,theNationalHealthTrainingCentre(NHTC)andJhpiegodevelopedacompetency‐basedtrainingpackageonOF;theB.P.KoiralaInstituteofHealthSciences(BPKIHS)wasaccreditedasaOFtrainingsite.However,asofnow,stakeholdersconsidertheallocatedbudgetforOFinadequate.

IND3.1.2&3.1.3&3.1.4WithUNFPAcontribution,selectedclinicaltraininginstitutionshavestartedtoprovidecompetency‐basedtrainingtoimprovefamilyplanningservicesandreducereproductivehealthmorbidities.UNFPAhasplayedamajorroleinpromotingLARC.HealthprovidersweresatisfiedwithUNFPA‐supportedFPandRHmorbiditiestraining.CP7intendedforUNFPAtoestablishfourhealthtrainingsitesforcompetency‐basedtraininginFPandRHmorbidities.87ThistargetwasfullyachievedincollaborationwithFHDandtheNHTC,withtechnicalsupportfromJphiego.88AtthebeginningofCP7,nosuchtrainingsitesexistedinNepal.89Thenewly‐establishedcomprehensivetrainingsitesareprovidingadvanced‐levelcompetency‐basedtrainingtomedicalstaffondifferentaspectsrelatedtoRHandFP.UNFPAalsosupportedandhasworkedthroughtheNHTCtoimproveFPuptakeandreduceRHmorbidities–e.g.,MISPandRapidResponseTeamtrainings–coveringUNFPApriorityandearthquake‐affecteddistricts.90Inaddition,trainingsforhealthprofessionalswereorganizedatthelevelofUNFPA’s18prioritydistricts–e.g.,onthefivemethodsofFP(pills,condom,DPMA,implantandIUCD)andonevidence‐basedFPmicro‐planning.IntervieweesparticularlyhighlightedUNFPAsupportfortrainingserviceprovidersonLARCgivenhighdemand.Monitoringdata(Table8)onFP‐relatedtrainingsshowthatUNFPA‐supportedtrainingsonimplant,IUCD,minilap,NSVandPPIUCDwerereceivedby248,152,56,26and16healthserviceprovidersrespectivelysince2014.Trainingdatashowthatthenumberoftraineesonimplantincreasedovertheyears;PPIUCDwasonlyofferedin2014.AsregardsRHmorbidities,thenumberofhealthprofessionalstrainedoncervicalcancerjumpedto91in2016comparedtoteneachin2014and2015.OFandPOPtrainings,usingthecompetency‐basedtrainingmanual,startedin2014.ThenumberofpersonstrainedonSBAandASBAsofarismodest.

Table 8: Training on FP/RH Morbidities Supported by UNFPA 2014‐16

FP training No.

Implant 248

IUCD 152

Minilap 56

NSV 26

PPIUCD 16

Training on RH morbidities No.

POP 121

Cervical cancer 111

OF 7

SBA 15

ASBA 4

Source: UNFPA CO, Training Data 2016

NosurveyshavebeenundertakentoascertaintraineesatisfactionwithUNFPA‐supportedtrainings.Non‐representativeinterviewsandFGDs,includingwithFCHVs,revealedthat,overall,

87 CPAP Outcome 1 Output 1 Indicator 3. 88 The four comprehensive training sites are Seti Zonal Hospital, Bheri Zonal Hospital, Western Regional Hospital, and Paropakar Maternity and Women’s Hospital in Kathmandu. 89 Baseline for CPAP Outcome 1 Output 1.1 Indicator 3. 90 Emergency preparedness trainings are discussed more in‐depth under EQ6.

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trainingparticipantsweresatisfiedwiththecontentsofthetrainingsaswellaswiththefacilitationskillsofthetrainers.InSindhuli,trainingoninsertionofIUCDandimplantwasconsideredparticularlyhelpfulforprovidingemergencyFPservicesaftertheearthquake.Specificallyforthenewcomprehensivetrainingsites,acomparisonofpre‐andpost‐trainingtestresultsindicatesthathealthprofessionalsgainedknowledgefromthetrainings.

IND3.1.5&3.1.6District‐levelusersappreciatetheUNFPA‐supportedweb‐basedLMIS.Itsuseformonitoringstock‐outshasincreased,butitisnotfullyoperational,andthesystemisalreadybeingrevamped.ItwasonlyafterthecorporateshifttoUNFPA’sSP2014‐1791thattheCOaddedanindicatortotheCP7RRF:“#ofdistrictsthatuseweb‐basedLMISforregularreportingformonitoringstock‐outsituations…”.Thebaselinewaszero;thetargetwasforall18prioritydistrictstousetheweb‐basedLogisticsManagementInformationSystem(LMIS)bytheendof2017.92Accordingtolatestmonitoringdata,thistargethasalreadybeenmet.KeyinformantsinKathmandurecognizedUNFPA’sfinancialandtechnicalsupportfortransformingthepaper‐basedLMIStoaweb‐basedsystem,incollaborationwithUSAID.Anumberofintervieweesconfirmedthatthesystemisbeingused,evenifitisnotfullyoperational.93EvaluationteamvisitstodistricthospitalsinBaitadi,SunsariandDangrevealedthattheLMISwasfunctionalandbeingused.However,inDang,irregularinternetconnectionhadregularlyledtointerruptions.InSindhuli,thesystemhadnotstartedpendingtrainingoftheDHOstatistician.DHOstatisticalofficersandstorekeepersinDang,BaitadiandSunsarisuggestedthatrecordingandreportingwasuser‐friendly.However,whilehavingafunctioningLMIShelpsmonitorstockandtakeprecautionstoavertstock‐out,itdoesnotpersepreventstock‐outs.Thereareotherfactors.Sunsari,forinstance,benefittedfromeasyroadaccess;BaitadiintheFar‐west,sufferedfromscarcityofthepopularimplantsintheregionalmedicalstore.InUdayapurandKapilvastudistricts,UNFPAhasalsosupportedtheLogisticsManagementDivision(LMD)topilotapublic‐privatepartnershipforimprovingthesupplychainusingthepullsystemtoaddresshighstock‐outsituations.Outsourcingofsuppliestransportationatsub‐districtlevelisshowingfirstpromisingresults.Meanwhile,theGoNandUSAIDareworkingonanewsupplychainmanagementprogramme.UNFPAissupportingthiseffort.TheCOissupportinganonlineinventorysystemtoreplacetheweb‐basedsystem.DHOrepresentativesinvisiteddistrictswereawareofthepotentialbenefitsofonlineLMISreportingversusweb‐basedreportingsystem.

IND3.1.7&3.1.8AccordingtotheUNFPA‐supportedFacility‐basedAssessmentforReproductiveHealthCommoditiesandServicesSurvey,thenumberofservicedeliverypointswithnostock‐outofcontraceptiveshasslightlyincreased;ontheotherhand,thenumberofservicedeliverypointswith7maternal/RHmedicineshassignificantlydeclined.Yet,dataarenotrepresentativeofUNFPA‐supporteddistricts.UNFPAhasplayedapositiverole,butotherfactorsneedtobeconsideredsuchasnaturaldisastersandrestrictionsonmobility.Especiallyimplantstock‐outsseemtohavebeenanissue.CP7intendsforUNFPA’sinterventionstocontributetoanincreasednumberofdeliverypointswithnostock‐outofcontraceptives.94TheRRFisnotexplicit,but,intheeyesoftheevaluationteam,thetheorywouldbethatUNFPA’sadvocacy/policyadviceandtechnicalsupportfortheLMISwouldbethemaincontributortothisoutcome.ItwouldalsobeachievedbyimprovingthecapacitiesofFPhealthserviceprovidersand,indirectly,bycreatingchoiceandgeneratingmoredemandforFPcontraceptives.ThelogicwouldimplythatperformancebetrackedandmeasuredforUNFPA’sprioritydistrictswheretheorganization’scontributionisgreatest.

91 Aligned with Strategic Plan IRF Outcome 1 Output 2 Indicator 2.1. 92 CPAP 2013‐17 Outcome 1 Output 1.1 Indicator 5. 93 The UNFPA‐supported Nepal Health Facility Survey 2015 found that 94% of all facilities compiled an LMIS report (with considerable variations between the different levels). Only 61% had a designated focal person, of which only 60% had received the necessary training. 94 CPAP Outcome 1 Indicator 7, added later together with Outcome 1 Output 1 Indicator 5 (LMIS).

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UNFPAhasindeedfocusedonimprovingthesupplyanddemandforcontraceptives,andparticularlyprocurementandsupplyofLARC,mainlyinUNFPA’sprioritydistricts,butalsoatthelevelofthehealthsystem:establishmentofcomprehensiveRHtrainingsites;FPtrainingforhealthserviceproviders;technicalsupportforLMISandsupplychainmanagement;central‐levelRHpolicy‐making;andBCCactivities.95Interviewedserviceprovidersfromallfourdistrictsvisitedbytheevaluationteaminformedthatcontraceptiveshadnotbeenstockedout,withtheexceptionofimplants.Implantstock‐outswereexperiencedbecauseoflargerthanexpecteddemandandduetointerruptionsinsupplycausedbytheearthquakeandsouthernborderrestrictionsin2015.NoneofthehealthfacilitiesvisitedinBaitadidistricthadanyimplantsbecauseofscarcityintheregionalstores.Increasingthepercentageofservicedeliverypointsthathavesevenlife‐savingmaternal/RHmedicinesfromtheWHOprioritylist96alsolinksbacktoUNFPA’sinvolvementinsupplychainmanagement.InBaitadi,theevaluationteamwasinformedthatalllife‐savingmaternalmedicineswereregularlyavailable,exceptforduringtheborderrestrictionswhenoxytocinbecamescarce.However,UNFPAwasabletofillthesupplygap.Sunsarireportedaregularsupplyofthesevenlife‐savingmedicines;similarlyDang.TheUNFPA‐supported2013Facility‐basedAssessmentforReproductiveHealthCommoditiesandServices(FBARHCS)Surveyshowedthat80%ofprimary,secondaryandtertiaryservicedeliverypointshadnostock‐outofcontraceptivesinthelast6months.97Thetargetwas60%,whichwouldequalanincreaseinstockoutsratherthanadeclineandisthereforenotausefulbenchmark.The2015FBARHCSSurveyrevealedthatslightlymore–i.e.,82.7%ofhealthfacilities‐hadnostock‐outofcontraceptives.98Furthermore,itindicatedthat41%ofhealthfacilitieshadsevenlife‐savingmaternal/RHmedicines.ThisnotonlyclearlymissestheCP7target‐i.e.,95%;itislessthanthe2013baselineof60.7%.99However,theFBARHCSSurveyonlycovers15districtsofNepal,ofwhichonlyfour100areUNFPA‐prioritydistricts.DataincludedthereinthereforedonotservetoassessUNFPA’sperformanceandcontribution.

IND3.1.9Contraceptiveprevalencerateisontheincreasein11of18UNFPA‐supporteddistricts.Micro‐planningandsatelliteclinicsareconsideredaneffectiveapproach.Goingastepfurtheralongtheimpactpathway,CP7oughttocontributetoanincreaseintheCPR,throughincreasedandmorereliableavailabilityofandgreaterdemandforcontraceptives.101Again,thelogicimpliesthatanincreaseintheCPRwouldbegreatestinUNFPA’sprioritydistricts.AccordingtoUNFPAbaselinedata,theCPRin2013wasalow43.0%nationally.102LatestUNFPAmonitoringdata,basedonthe2014MICS,revealanationalCPRof49.7%,justmeetingthetargetof50%.LatestavailableofficialdataforUNFPAprioritydistricts(Table9)revealthatCPRhasincreasedagainst2013data(range1to9%)in11districts;ithasdecreasedinfivedistricts.

Table 9: Change in Contraceptive Prevalence Rate in UNFPA Priority Districts 2013‐16

Districts with Increased CPR (Increased %) Districts with Decreased CPR (Decreased %)

Kapilvastu (5%) Rolpa (9%)

Bajura (1%) Pyuthan (9%)

Dang (9%) Udayapur (5%)

Achham (4%) Dadeldhura (3%)

95 With UNFPA Implementing Partners LMD, NHTC, ADRA Nepal, FPAN. 96 CPAP Outcome1 Indicator 4. Added in context of re‐alignment exercise. 97 FBARHCS Survey 2013; CPAP 2013‐17 RRF Outcome 1 Indicator 7 baseline data. 98 FBARHCS Survey 2015; UNFPA August 2016 monitoring data. 99 Sources: FBARHCS Survey 2013; FBARHCS Survey 2015; UNFPA August 2016 monitoring data. UNFPA monitoring data also indicate that 94.4% of hospitals; 85.7% of PHCCs; 53.8% of HPs; and 24.5% of SHPs had stock of seven life‐saving maternal/RH medicines. 100 Baitadi, Kapilvastu, Rautahat and Saptari. 101 CPAP 2013‐17 Outcome 1 Indicator 5. Added as part of re‐alignment exercise in 2014. 102 CPAP RRF Outcome 1 IND5 baseline data; baseline source: 2013 FBARHCS Survey.

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Baitadi (5%) Arghakachi (2%)

Bajhang (7%)

Rukum (2%)

Rautahat (5%)

Sunsari (2%)

Saptari (2%)

Sindhuli (0.63%)

Sarlahi (3%)

Mahottari (1%)

Source: UNFPA CO Monitoring Data (based on DoHS Data 2013‐14 & 2015‐16)

Besidesinterventionsdiscussedabove,intervieweeshighlightedtheeffectivenessofFPmicro‐planningforidentifyingVDCswithlowCPRwherepoor,marginalizedandhard‐to‐reachcommunitiesliveandforincreasingtheiruptake,althoughhardevidencestillneedstobecollected.UNFPAhassuccessfullysupportedallitprioritydistrictstoidentifyVDCsorpocketswithlowCPRbasedonreviewsofavailabledataandrapidassessmentswheresubsequentlysatelliteclinicswereorganized.MainreasonsprovidedbyintervieweesfordecreasingCPRarelackofawareness,equipmentandFPcontraceptives;poorrecordinganduseofprivatesectordata;andhighseasonalmigration.IntervieweesconsideredmissinganalysesofcausesforlowCPRproblematicforfutureprogramming.

IND3.1.10&3.1.11&3.1.12&3.1.13UNFPAanditspartnerscanclaimcreditfortheintroductionofmidwiferyeducation,whichhasjustkickedoff.UNFPAconsidersthatmidwiferyeducationisoneoftheuniqueachievementsoftheUNFPAcountryprogramme.WorkonmidwiferywascarriedoverfromCP6.CP7envisagedanewmidwiferytrainingcurriculumbeingtaughtbyfourtraininginstitutionsbytheendof2017.103DuringCP7,UNFPAworkedatthepolicyandprogrammelevel.TheCObuilttheadvocacycapacitiesofMIDSONtolobbywiththeMoHtodevelopamidwiferycurriculum.Asaresult,UNFPAandMIDSONwereabletosupporttheMoHtodevelopacurriculumframeworkforBachelorofMidwiferyasperICM‐WHOstandards;theyadvocatedfortheprovisionofmidwiferyeducationaswellasforensuringacareerladderforthemidwives.Central‐levelstakeholdershighlightedthescopeofmidwivestoprovidecomprehensivematernalcareandreducematernalmortalityandmorbidityinfuture.Threeuniversitiesthatrunpre‐servicemedicaleducation,namelyKathmanduUniversity(KU),theNationalAcademyofMedicalScience(NAMS)andBPKIHSwereassessedbyajointteamconsistingofMIDSON,NNC,MoHandUNFPAandwerefoundtomeetminimumrequirements.TheirmidwiferycurriculaweresubsequentlyapprovedbytheNNC.Bythetimeofreportfinalization,KUhadstartedmidwiferyeducationandNAMShadannouncednewadmissionsforBachelorinMidwiferySciences.

IND3.1.14UNFPAhascontributedtosuccessfulinterventionstoprovidetargetedservicesforvulnerablewomenfromlowCPRpocketsandforwomensufferingfromobstetricfistula.UNFPAstaffaswellasserviceprovidersfromKathmanduandthevisiteddistrictsreportedthatUNFPA‐supportedSRHserviceshavenotonlyreachedwomenofreproductiveageingeneral,butthattheysuccessfullytargetedpoor,vulnerableandhardtoreachcommunities,particularlythosefromareaswithlowaccess.Forexample,UNFPAfocusedonwomenfromlowCPRpocketsforundertakingFPmicro‐planning.UNFPAhasalsosupportedwomenwithOFtoavailSRHservices.UNFPA’scontributionwasprominentinprovidingpreventionandtreatmentservicesforOF,notonlytoaffectedwomenfromtheEasternregionwherethepublichospitalBPKIHSissituated,buttowomenfromalloverthecountry.Consequently,thenumberofwomenwithOFseekinghelphasincreased,from20‐25peryearonaverageto50‐60annually.350womenunderwentsurgeryduringthepastfiveyears.UNFPArecentlystartedsupportingBPKIHStorehabilitateandreintegratewomenwithOFintheirfamiliesandcommunities.

103 CPAP 2013‐17 Outcome 1 Output 1 Indicator 2.

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IND3.1.15TheevaluationteamwasunabletodetermineclientsatisfactionwithUNFPA‐supportedSRHservices.DataforassessingUNFPA’scontributiontoimprovingtheproportionofclientswithdemandforcontraceptionsatisfiedinitsprioritydistrictsarealsounavailable.PriortotheCPE,UNFPAhadnotgathereddataonclientsatisfaction.InterviewedserviceprovidersandUNFPAstaffclaimedthatclientsweresatisfiedwithUNFPA‐supportedSRHservices.Theevaluationteam,however,wasunabletoconfirmthisperceptionwithservicerecipients.Forlackoftimeandavailabilityofbeneficiaries,itwasunabletoorganizeFGDs.AnexpectedoutcomeofUNFPA‐supportedSRHservices,addedaspartofthere‐alignmentexercise,istoincreasetheproportionofdemandforcontraceptionsatisfied.104Ascomparedtothe2011nationalbaseline(65%),onlyonepercentagepointincrease(66.3%)wasrecordedin2014,thelatestavailabledata105,comparedtotheNHSStargetof72%.Thisisonlyaminorchange.Butavailabledataareoutdated;theydonotservetoascertainchangeovertheperiodofinvestigation2013‐16.Furthermore,theperformanceindicatorispositionedatthenationallevel.GrantedthatUNFPAisalsoengagedinpolicydialogueandcapacitybuildingatthenationallevel,buttheimpactpathway,intheprofessionalopinionoftheevaluationteam,seemstoolongandcomplextobeabletoassessUNFPA’scontribution.

3.1.16Thepercentageofwomenaged15to24withunmetneedforfamilyplanninginUNFPA‐supporteddistrictshasincreased.Re‐analysisofDHSdatabytheUNFPACOshowsthatinUNFPA‐supporteddistrictstheunmetneedforFPamongyoungwomenaged15‐24was36.5%in2011.Thispercentageincreasedto43.3%‐i.e.,progressdecreasedbysixpercentagepoints‐accordingtoare‐analysisofthe2014MICS.106Thesefiguresalsopossessweaknesses:firstandforemost,theyarenotrepresentativeoftheperiodunderinvestigation.Secondly,thetargetvalueincludedintheRRFdoesnotdifferfromthebaseline.ItisthereforeunclearagainstwhattoassessUNFPA’sperformanceandcontribution.Lookingahead,itisworthnotingthattherecentlyintroducedHMISonlycollectsandreportsondataforthebroadreproductiveagegroup(15‐49years).InterviewsconductedinthefourvisiteddistrictsrevealedthatUNFPAhascontributedtoaddressingunmetneedforFP,inparticularbysupportingauthoritiesinchargetoprocureandsupplyLARC:“ThegreatestachievementofUNFPAlieswithitssupportforlong‐actingreversiblecontraceptives(implants)incollaborationwithDHO”,asoneintervieweesaid.InBaitadi,aGoNpilottointegrateFPandroutineimmunizationprogrammeshasshownencouragingresultsandwasrecommendedbyakeyinformantforextensiontootherRHissuesandreplicationinotherdistricts.

IND3.1.17Halfofallbirthstowomenaged15‐24areattendedbyskilledbirthattendants,anincreaseover2011,butstillcomparativelylow.UNFPA’scontributionwasmodest.In2011,42%ofbirthsamongwomenaged15to24inNepalwereattendedbySBAs.InUNFPA’s18prioritydistrictsitwasevenless–i.e.,anestimated34.1%.107Thetargetfor2017is60%nationally,whichisyettobeachieved(50%in2015).108TheRRFdoesnotindicateatargetforthe18districtssupportedbyUNFPA.Officialdatafor2016(Table10)showthatthepercentageofbirthsattendedbySBAshaveincreasedin12districts(range1.5%to16%)since2013;ithasdecreasedinfivedistricts(range1.5to16%),andremainedstagnantintheremainingdistrict.

Table 10: Change in % of Births Attended by SBAs in UNFPA Priority Districts 2013‐16

Districts with Increased SBA (Increased %)

Districts with Decreased SBA(Decreased %)

SBA Rate Stagnant

Rautahat (10%) Arghakachi (3%) Sarlahi (33%)

Pyuthan (6%) Kapilvastu (3%)

104 CPAP 2013‐17 Outcome 1 Indicator 6. 105 MICS 2014; UNFPA August 2016 monitoring data. 106 CPAP 2013‐17 Outcome 1 Indicator 1. UNFPA CO August 2016 monitoring data. 107 CPAP 2013‐17 Outcome 1 Indicator 2. 2011 DHS; UNFPA re‐analysis of 2011 DHS. 108 DoHS, Annual Report 2015.

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Rukum (5.5%) Rolpa (1.5%)

Sunsari (4%) Saptari (16%)

Dang (1.5%) Mahottari (6%)

Bajura (15%)

Baitadi (11%)

Dadeldhura (12%)

Achham (14%)

Bajhang (16%)

Sindhuli (2%)

Udayapur (5%)

Source: UNFPA CO Monitoring Data based on DoHS Data 2013‐14 & 2015‐16

UNFPA’ssupportforassisteddeliveryhasbeenmanifold,includingsupportforSBAtrainings;orientationsforFCHVs,mothersandpregnantwomen;andBCConpregnancydangersigns.However,coveragewaslimited.Onlyfewhealthserviceprovidersweretrained(IND3.1.3)andIEC/BCCactivitiesweresomewhatscattered(IND3.3.5).

IND3.1.18UNFPA‐supportedinstitutionsandSRHservicesaresustainable.UNFPAhassupporteditscentralanddistrict‐levelpartnersinthehealthsectortostrengthentheircapacitythroughknowledge,skillsandresources;tobuildownershipandstrengthennationalsystems;andtoimplementSRHservicesatthedistrictlevel.IthasprovidedsupportinareaswheretheGoNhadnoorlimitedcapacity.Sustainabilityofcomprehensivetrainingsites,servicesforOFpatients,supplychainmanagementandmidwiferyeducationislikely,butremainstobeseenthroughouttheremainderofCP7andthenextprogrammecycle.

A.3.2Adolescent‐friendly health services

IND3.2.1The“BarrierStudy”hasclearlyinfluencednationalcommitmentsandqualitystandardsintheareaofadolescentsexualandreproductivehealth.WhilecontinuingtosupporttheimplementationoftheNHSPII2010‐15andthe2010NationalAdolescentSexualandReproductiveHealthProgramme,UNFPA,togetherwithUNICEF,andincollaborationwiththeFHD,conductedanational‐levelassessmentofsupply‐anddemand‐sideconstraintstoprovidingandutilizingqualityAFHS.Therecommendationsofthe2015“BarrierStudy”109promptedtheGoNtoreviewexistingcertificationcriteriafortherisingnumber110ofpublicAFHScentresandtorevisethenationalASRHtrainingpackageforhealthserviceproviders.111

IND3.1.2&3.1.3ThankstocollaborationbetweenUNFPAandthegovernment,moreandmorehealthserviceprovidersarebeingtrainedonASRHatsixgovernment‐certifiedclinicaltrainingsites,surpassingthetargetoffoursites.Trainingsitesareprovidingcompetency‐basedASRHtrainingsbasedonarevisedandclearlyrelevantandimminently‐effectivetrainingpackage.During2015‐16,UNFPAsupportedtheFHDandNHTCtoestablishASRHtrainingsitesatsixgovernmenthospitalsacrossNepal.112Basedonthesamemodel,a7thtrainingsiteisreportedlyplannedbyNHTCinPokharainKaskidistrict,withsupportfromSavetheChildren.Certificationofthesixtrainingsiteshappenedbasedonajointly‐developedandimplementedfive‐stepstandardizedprocess,includingqualityassessment,whole‐siteorientation,availabilityofmastertrainers,andexistenceofanon‐site

109 “Assessing Supply Side Constraints Affecting the Quality of Adolescent Friendly Services (AFS) and the Barriers for Service Utilization”, January 2015. Also see Policy Brief prepared by UNFPA, UNICEF and FHD. 110 1,000 AFHS centres were established in health facilities by the end of 2015. Barrier Study Policy Brief; Burnet Institute. 111 The Barrier Study was specifically referenced by the Evaluation of UNFPA Support to Adolescents and Youth 2008‐2015 as a specific example of well‐utilised adolescents and youth needs assessments. 112 Seti Zonal Hospital in Kailali district in the Far‐west development region, Bheri Zonal Hospital in Banke district in the Mid‐west, Western Regional Hospital in Kaski district in the Western development region, Paropakar Maternity and Women’s Hospital in Kathmandu in the Central development region, Bharatpur Hospital in Chitwan district in the Central development region and Koshi Zonal Hospital in Sunsari district in the East.

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AFHScentrefordemonstrationpurposes.TherevisedASRHtrainingpackage,developedincollaborationbetweenUNFPA,FHDandNHTC,withsupportfromSISoNepal,includesatrainer’sguide,aparticipant’shandbookandreferencematerials.ItwasendorsedbytheGoNinApril2015andofficiallylaunchedthroughmastertrainertrainingsinJuly2015afterpre‐testsinFebruaryandMarch.Consideringfindingsofthe“BarrierStudy”,thefive‐dayin‐servicetrainingsputastrongeremphasisonskills‐building,sensitization,empathyandattitude/behaviourchangeforbetterandnon‐discriminatorycommunicationandcounsellingofadolescents.Trainingdatafor2013‐16indicatethat74mastertrainerswereinstructedonthenewASRHtrainingpackage.113UndertheNHSPII2010‐15,theGoNplannedtoestablishover1,000AFHScentresinhealthfacilitiesacrossNepal;iteventuallyestablished1,134.However,therewerequalityissues,includinginadequatelytrainedhealthserviceproviders,asalsofoundbytheBarrierStudy.Hence,asalsoreflectedintheNHSS,CP7emphasizedcertificationandqualityratherthansupportforexpansionofservicesites.114ThescopeofCP7istotrainatleastthreehealthserviceprovidersfromselectedAFHScentresinthe18UNFPAprioritydistrictsasapreconditionfortheircertification.During2015‐16,UNFPAfundedthetrainingof755healthserviceproviders.115TheevaluationteamnotedthatUNFPA’sinitiativemotivatedotherinternationaldevelopmentpartners–i.e.,UNICEFandSavetheChildren‐apartfromtheMoHitself‐tofundadditionalASRHtrainingsforotherplannedAFHScentresfromwithinandoutsideUNFPAprioritydistricts.Ananalysisofpre‐andpost‐trainingtestsrevealedanimminentknowledgeimprovement:Whileonaveragetraineesstartedoffwithascoreoflessthan40%,learninghadincreasedtoabovethenecessary80%bytheendofthetrainings.InterviewedstakeholdersaswellastrainedhealthprofessionalsinKathmanduandthevisiteddistrictsclearlyacknowledgedtheneedforandappreciatedthenewtrainingmethodologyandcontents(Box2).VisitedAFHScentresinSunsariandSindhuliexplainedthattrainingsweresomewhatrushedandmoretimewouldhavebeenhelpful.

Box 2: Appreciation of UNFPA‐supported ASRH Trainings

“EvenserviceprovidersareunfamiliarwithsomeASRHissues;theyarehesitanttotalkaboutthem–e.g.,unwantedpregnancies.SPsneedsensitizing…Theywerefamiliarizedwithnewtopicsand

droppedsomeoftheirshyness…”FGDinKathmandu

“Welearntaboutgenderissues;abouttheH.E.A.D.S.Sassessmentmethodforinterviewingadolescents…Itisnoweasiertodealwithadolescentsandtotalkopenlyaboutsensitiveissues…Very

muchappreciated”FGDinSindhuli


IND3.2.2&3.2.3UNFPAplayedacrucialroleinrevisitingthequalitycriteriaandcertificationprocessforAFHScentres.Already24healthfacilitiesintenUNFPAprioritydistrictsarecertifiedAFHScentres,thankstoUNFPA,andothersareinthepipeline.CertificationnolongersolelydependsonUNFPA’ssupport.Makingavailableadedicatedconsultationroomthatensuresprivacyisapracticalproblem.The“BarrierStudy”resultedinareviewofAFHScentrestandards,forwhichUNFPAprovidedtechnical116andfinancialsupport,andwhichresultedintheendorsementbyFHDofanewAFHScentrequalityimprovementandcertificationtoolinJuly2015.117TheevaluationteamnotedandobservedthatthetoolwasbeingusedforcertifyingAFHScentres,basedonhealthfacilityself‐assessmentsandworkplans,jointDHOandUNFPApre‐certificationvisitsandjointFHD,UNFPA,DHOandADRAcertificationmissions(includingclientexitinterviews).Askedaboutthecertificationcriteria,

113 UNFPA: Outcome 1 Training Data, received November 15th 2016. 114 The ultimate goal of the National Health Sector Strategy is to scale up of adolescent‐friendly services throughout the country in all approximately 4,000 public health facilities. 115 Source: Manju Karmacharya: ASRH Services for Adolescent in Nepal: ASRH Training and Certification, September 2016. 116 Including with the support of SISo Nepal. 117 Available in Nepali only.

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healthofficialsandserviceprovidersinthevisiteddistrictsandKathmanduexpresseddifficultiesmakingspaceavailablethatensuresprivacyandconfidentiality.

Atthetimeofevaluationdatagathering,threeUNFPA‐supportedAFHScentresinSindhulidistrict,twoinPyuthan,twoinAchham,twoinBajhangandtwoinSunsarihadbeencertified.118BytheendofNovember2016,anadditional13hadjoinedthegroup.119 WhiletheRRFtargetofatleastonecertifiedcentreperUNFPAprioritydistricthasnotyetbeenmet,intervieweesweresatisfiedwithprogressmadewithinnotquite12monthsandconfidentthatthe

targetwillbemetbytheendofCP7.120Moreover,healthfacilitieshavebeencertifiedwithoutUNFPA’sdirectinvolvement–i.e.,inKapilvastusupportedbySavetheChildren,andthisnumberisalsoexpectedtogrowgiventheadditionalsupportfromotherinternationaldevelopmentpartnersfortheAFHSprogrammeandfromtheGoNbudget.

IND3.2.5&3.2.6ThenumberofadolescentsutilizingtheservicesofAFHScentresinUNFPA‐supporteddistrictshasincreasedsince2014,butcoverageoftheadolescentpopulationremainslow.Morepublicitywouldhelp.IEC/BCCmaterialsplayacrucialroleinsatisfyingadolescents’informationneeds.In2014,UNFPAreportedthat102,302adolescentsaged10‐19hadutilizedASRHservicesintenUNFPA‐supporteddistricts,correspondingtoapproximately10%ofthetotaladolescentpopulationof982,695.Thisfigureincreasedto300,476inelevendistrictsin2015;itincreasedfurtherto350,752in18districtsin2016.Dataaredisaggregatedbygender:In2015,159,876maleand140,600female;in2016,166,917maleand350,752female.UNFPAmonitoringprovidesnofurtherbreakdown.InterviewsinBaitadi,SunsariandSindhuliconfirmedthatthenumberofvisitstoAFHScentreswasincreasing,andthatmoregirlsthanboyswereseekingcounsellingandservices.WhileinBaitadimostclientswerereportedlyalreadymarried,thiswasnotthecaseinSunsariandSindhuli.Askedaboutveryyoungadolescents,theevaluationteamwasinformedthatonlyveryfewwerebelowtheageof14;themajoritywerearound15‐16.Asoneintervieweesaid:“theydonotyetunderstandsexuality…theyhavenotyetstartedexperiencingchanges”.MorepublicityforAFHScentreswouldbeimportantforgreateruptakeasremarkedbyseveralinterviewees.AnumberofconversationspinpointedthatknowledgeaboutandfamiliaritywithAFHScentreswereinsufficient:amongadolescents,amongparticularlyvulnerableadolescents,andamongofficialsandserviceprovidersoutsidethehealthsector.Visitingnearbyschools,promotingASRHservicesthroughFCHVs,participatingingirls’circles,andinvitingdistrict‐levelDEOandWCOofficialsandteacherstoseeAFHScentreswiththeirowneyeswerementionedasgoodoutreachexamples.TheevaluationteamwasabletoconducttwoFGDswithAFHSclients.Onegroupofaroundtenschool‐going,unmarriedgirlsbetweentheageof12and16wasverysatisfiedwithinformationandservicesreceived,whichtheyclaimedhadimprovedoverthelast12months.TheywereparticularlykeentovisitthecentretoreadanddiscussthesetofeightIECbookletsonissuesrelatedtoadolescents’SRHandrightsproducedanddistributedearlierbyUNFPA,GIZ,NHEICCandtheNepalRedCrossSociety(NRCS)throughUNFPA.ConcernedserviceprovidersinallvisiteddistrictsrequestedformoreandnewIEC/BCCmaterials‐bothprintandmulti‐media.

118 CO monitoring data September 26th 2016. 119 Kapilvastu (2), Mahottari (2), Rautahat (3), Rukum (3), and Sarlahi (3). Plus one AFHS centre in Kapilvastu supported through Save the Children. 120 Three more districts (Baitadi, Bajhang and Arghakanchi) are in the pipeline for certification in December 2016.

AFHS Centre Beneficiaries in Sindhuli District

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IND3.2.4Recording,reportingandanalysisofASRHserviceutilizationdataisabottlenecktoeffectiveplanning,monitoringanddecision‐making,especiallytherevisedHMIS.Healthfacilitiesareexpectedtorecordvisitsbyadolescentsandreporttothedistrict‐levelDHOonamonthlybasisforonwardtransfertotheMoHandtheHMIS.Monthlyreportingisnotyetthenorm.Moreover,observationsrevealeddifferent‐manual‐recordingformatsasconcernsagegroups,gender,maritalstatus,in‐orout‐of‐school,andtypesofservices.TheevaluationteamnotedthatultimatelytherevisedHMISdoesnotcaptureASRHservicesasaseparateprogrammecomponent,andthatitonlyoffersdataforthebroadagecohort15‐49.Thisrendersanyplanning,monitoringanddecision‐takingdifficult,ifnotimpossible,forthe10‐19yearolds,oreven10‐14(earlyadolescence)and15‐19(lateadolescence)yearolds.

IND3.2.7Politicalcommitmentsareconsiderable,butsustainingqualityandtakingcertifiedAFHScentrestoscalewillrequireextraefforts.Asalreadyseen,adolescents’health,includingSRH,hasbeenincreasinglyreflectedinGoNpoliciesandprogrammesoverrecentyears,andpoliticalcommitmentsareconsiderable.The“BarrierStudy”providedanadditionalpush.ThisbodeswellforthefutureofASRHtrainingsandcertificationofAFHScentres.However,accordingtoseveralintervieweesinKathmanduandthevisiteddistricts,moneycouldwellbeanissueforsustainingbenefitsandtakingtheprogrammetotheplannedambitiousscale,despite“RedBook”governmentanddonor‐includingUNFPA,UNICEFandSavetheChildren–funding.Asonekeyinformantsaid:“AFHScentresarenotcertifiedforever”:OneareaofconcernarisingfrominterviewsishowtoassurethequalityofAFHScentresaftertheircertification.Qualitycriteriaareavailableandqualityassurancemechanismsinplaceathealthfacility(HFOMCs)anddistrict(DHO)levels.However,somestakeholdersfearlackofcapacityandfundsforseriousmonitoringandfollow‐upofanincreasingnumberofAFHScentres.

A.3.3Comprehensive sexuality education

IND3.3.1Althoughnotdirectlyengagingintheeducationsector,UNFPAsuccessfullypushedforinclusionofCSEintheNepalSchoolSectorDevelopmentPlan2016/17‐2022/23.UnderCP5andCP6,UNFPAhadsupportedvariousASRHIECactivitiesaspartofitseffortstofurthersexualityeducationandHIVprevention.Takingtheorganization’sengagementastepfurther,CP7committedUNFPAtosupportthereviewandrevisionoftheexistingCSEcurriculumtomakeitage‐appropriateandgender‐sensitive.121In2013,theCOinitiatedareviewoftheformalschoolcurricula(grades1to10),teachertrainingcurriculaaswellasnon‐formalcurriculaandtrainingmaterialstoidentifygapsinsexualityeducationcontentanddelivery.ItdidsoagainsttheUNESCO2009InternationalTechnicalGuidelinesonSexualityEducation.122A“ComprehensiveSexualityEducationReview”waspublishedin2014.123APolicyBrief124wasdevelopedandused,withUNICEFsupport,foradvocacyvis‐à‐vistheMoEandeducationsectorpartnersaswellasparliamentarians.Withsomedelaybecauseoftheearthquake,aCSEtechnicalworkinggroupwasformedwiththeparticipationofthethreeconcernedMoEdepartments125;workplansforstrengtheningCSEweredeveloped.AccordingtoUNFPAstaff,itisalsothankstoUNFPAanalysisandadvocacythattheSchoolSector

121 CPAP 2013‐17, p10. 122 UNESCO: International Technical Guidance on Sexuality Education – An evidence‐informed approach for schools, teachers and health educators – Volume I: The rationale for sexuality education, December 2009. 123 “Review of Curricula in the Context of Comprehensive Sexuality Education in Nepal – A Review of Formal Curricula (Grade 1‐10), Non‐formal Curricula, Teacher’s Training Curricula (Pre and In‐service) and Training Materials in Line with Comprehensive Sexuality Education against UNESCO 2009 International Technical Guidelines on Sexuality Education (ITGSE)‐II”, August 2014. 124 UNFPA/MoE: Review of Curricula in the Context of Comprehensive Sexuality Education (CSE) in Nepal, 2014. 125 Curriculum Development Centre (CDC); National Centre for Education and Development (NCED); Non‐formal Education Centre (NFEC).

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DevelopmentPlan2016/17‐2022/23126,theGoN’smajoreducationinitiative,includesCSEunderresult2.2.1:“%ofschoolsthatprovidelifeskills‐basedhealthandsexualityeducation”.

IND3.3.2&3.3.3UNFPAisontracktostrengthentheinclusionofCSEtopicsingrades1to10.However,subordinatetoformalcurriculumreviewcycles,itwillnotcompletelyachieveitsobjectivesforCP7.UNFPACSEinterventionsunderCP7Outcome1tookoffwiththe“CSEReview”mentionedabove.127CSEinterventionshavebeenimplementedalongseveraltracks.Attheinstitutionallevel,theonlyexpectedoutputincludedintheRRFisOutput1.1Indicator3,whichwasaddedinthecontextofre‐alignmentwiththeSP2014‐17.Itreadsasfollows:“NationalCSEcurriculaareinplacealignedwithinternationalstandards(ITGSE)”.Thebaselinewasdeterminedtobezero.128BytheendofCP7in2017,UNFPAexpectedtohavesupportedtheinclusionofCSEinthecurriculaforschoolgrades1to10andtheassociatedtextbooksandteachertrainingmanuals.Workisongoing.Atthetimeofevaluationdatacollection,theCurriculumDevelopmentCentre(CDC)hadstrengthenedthecomprehensivenessofsexualityeducationfor9thand10thgraders(secondaryeducation).Forlackoftime,theevaluationteamwasnotinapositiontoassesshowwellCSEtopicshavebeenstrengthenedandarealignedwithinternationalstandards.UNFPAhadprovidedthree‐dayCSEtrainingfor15MoEofficials,teachersandtextbookwriters.129Asfortheothergrades,UNFPAisexpectedtobeinvolvedduringthe2017inreviewingCSErevisioncycleinprimaryeducation(grades1‐3,4and5).GivenCDC’snewresponsibilityforgrades11and12(highersecondaryeducation),newopportunitiesforcollaborationmayarise.

IND3.3.2Seekinggreaterscale,UNFPAissupportingtheMinistryofEducationtoincludeCSEteachertraininginitsregularin‐servicetrainingprogramme.UNFPAalsosupportedthedesignofandishelpingtoimplementajointMoH/MoEmenstrualhygienemanagementstrategy.InCP5,UNFPAprovidedmodestsupporttobuildthecapacitiesofteachersinitsprioritydistrictstotalktostudentsaboutASRH.Intheabsenceofin‐serviceCSEtrainingforteachersithascontinuedtodosounderCP7.DEOintervieweesinthefourvisiteddistrictsweresatisfiedwithUNFPA‐sponsoredteachertrainingsandrequestedgreatercoverage.However,hesitancetoteachcomprehensivesexualityeducationinschoolsisstillamajorconcernandremainsasystemicchallenge.Consequently,besidesfollowinguponrecommendationstoimproveandmakemorecomprehensivetheschoolsexualityeducationcontent,UNFPArecentlystartedtopartnerwiththeGoNtoimprovesexualityeducationdeliverythroughoutthecountry’spublicschools.WithfundingfromtheGovernmentofAustraliaandincollaborationwiththeNationalCentreforEducationandDevelopment(NCED),UNFPAthroughSISoNepalissupportingthedevelopmentofanin‐serviceCSEteachertrainingpackage,withtechnicaloversightbytheCSEtechnicalworkinggroup.Atthetimeofevaluationdatagathering,SISowaspreparinga1stdraftofthetrainingpackageandresourcematerials,whichwereexpectedtobeavailableforMoEendorsementbyDecember2016.ThemenstruationcycleandmenstruationhygieneispartofCSEandalearningobjectiveforadolescentsaged9andupwards.130UNFPAprovidedtechnicalsupportforelaboratingand,startingin2016,implementingajointMoH/MoEmenstrualhygienemanagementstrategyandtrainingpackage.WithfundingfromtheAustralianGovernment,SISohasstartedtoconductmenstrualhygienemanagementtrainingsforselectededucationandhealthprofessionalsinfiveUNFPAprioritydistricts.131

126 http://www.moe.gov.np/article/535/school‐sector‐development‐plan.html. SSDP exists in Nepali only. 127 Outcome 1 in fact does not use the term “comprehensive sexuality education”, but “sexuality education”. 128 August 2016 monitoring data. 129 The evaluation team was unable to assess trainee satisfaction (evaluation matrix IND3.3.3: Trainee satisfaction with CSE curricula and capacity building). Only one trainee was interviewed who was “happy” with the knowledge, information and CSE materials received. 130 UNESCO: International Technical Guidance on Sexuality Education – An evidence‐informed approach for schools, teachers and health educators – Volume I: The rationale for sexuality education, December 2009. 131 Sindhuli, Udaipur, Bajang, Baitadi and Rukum districts.

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IND3.3.2Students‐teachers‐parentsdialogue;healthworkervisitstoschoolclasses;andadolescentinformationcornersinschoolsarecomplementaryandwelcomewaystostrengthenCSEinschoolsettings.UNFPAanddistrict‐levelpartnershaveexploredandareexploringotherwaystopromoteandsupportCSEinschoolsettings.InBaitadiandDang,forinstance,UNFPAsupportfordialoguebetweenstudents,teachersandparentsonASRHtopicswasfoundtobeveryrelevantandmuchappreciated.Equally,intervieweesinBaitadi,SunsariandSindhulidistrictswerelargelyinfavourofhealthworkeroutreachandvisitstoschoolclasses,thuslinkinguptheeducationandhealthsectors.InSindhuli,theDEOorganizedASRHorientationsforsecondaryschoolgirlstudents,forteacher/parentassociationsandschoolmanagementcommittees,andeventuallyforboys,afterrealizingtheywerebeingneglected.Moreover,atthetimeofdatacollection,theestablishmentofadolescentinformationcornersinschoolswereplannedundertheAustralian‐fundedprojectaswellasundertheevenmorerecentUNESCO/UNFPA/UNWomenjointprogramme“EmpoweringAdolescentGirlsandYoungWomenthroughtheProvisionofCSEandaSafeLearningEnvironmentinNepal”.132

IND3.3.2&3.3.4UNFPAfacilitatedpolicyrecommendationsforimprovingCSEforout‐of‐schooladolescentsandyouth.Untilnow,whilenotexcludingout‐of‐schoolyoungpeopleasbeneficiaries,theorganizationhasnottargetedtheirspecificSRHinformationandeducationneeds.Plansareinthemaking.CP7committedUNFPAto“mobilizepeereducatorsformessagedisseminationonSTIandHIV/AIDStoadolescentsandyouth,includingunmarried,out‐of‐schooladolescentsandFSWs”;furthermoreto“supportgovernmenttoassess,refineandstrengthentheout‐of‐school/adolescents’lifeskillsprogrammes”.133The“CSEReview”,ledbyUNFPA,discussednon‐formalCSEforout‐of‐schooladolescentsandyouth.ItrecommendedaligningtheMoENon‐FormalEducationCentre(NFEC)“FlexibleSchoolingProgramme”withtheformalschoolcurriculumcyclesandCSErevisionsasperITGSEstandards,aswellasensuringthatout‐of‐schoolchildrenbenefitfromRupantaran.134Rupantaranisimplementedininformalsettings.ItsdesignwasledbyUNICEFwiththesupportofUNFPAandotherstohelpimplementtheNationalPlanofActionfortheHolisticDevelopmentofAdolescents,initselfacollectiveeffort.UNFPAwasinstrumentalindesigningtheGBVandSRHmodules.ThefinalpackageisbeingusedbytheMoWCSWandMoYS.RupantarancutsacrossandcontributestoboththeCP7SRHandGEprogrammecomponents.Todate,UNFPAhasgatheredexperiencewithRupantaranintheGEcomponentforthebenefitofgirls’circle/groupmembers,withoutdifferentiatingbetweenin‐andout‐of‐schoolgirls.Lookingahead,UNFPAalsoplanstousethepackageinacomprehensivemannerinitsASRHprogramme,aspartoftheJointProgramme“EmpoweringAdolescentGirlsandYoungWomenthroughtheProvisionofCSEandaSafeLearningEnvironment”andintheAustralia‐fundedprojectwhere,togetherwiththeNFEC135andRestlessDevelopment,itintendstointroduceRupantaranspecificallyforout‐of‐schooleducationinearly2017.Theevaluationteamwasalsoinformedaboutasoon‐to‐be‐launchedmobileapponASRH.

IND3.3.7EducationsectorCSEwillcontinuetodependonexternaladvocacy,technicalsupportandfundingforthenearfuture.Asrevealedabove,CSEisnowanchoredinthe 132 This five‐year joint programme, funded by KOICA, will be implemented in five UNFPA priority districts (Saptari, Sunsari, Sarlahi, Rautat) with a total budget of $5m (UNFPA: $500,000). 133 CPAP 2013‐17, p10 & p12. 134 “CSE Review” policy brief. 135 The evaluation team was unable to meet NFEC representatives.

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SchoolSectorDevelopmentPlan2016/17‐2022/23;itisgraduallystrengtheningitspositioningwithintheformalschoolcurriculumandshouldbeincludedinnationalteachertraining.However,CSEwithitssixcomponentsisanewconcept,itisnotconsideredatoppriority136,anddedicateddomesticfundingisinsufficient.137Frequentgovernmentstaffrotationhasimpedednationalownership.Asonekeyinformantsaid:“CSEisstillverynew…woulddieifexternalsupportweretobediscontinued”.

A.3.3SRH/HIV information, education and behaviour change communication

UNFPAIEC/BCCactivitiesandtrainingshavecutacrossCP7Outcomes1(SRH)and2(GE),contributingtoRRFoutputs1.2,2.2and2.3.Activitieshaverevolvedaroundtheissuesofpregnancycomplications,HIV,GBVandchildmarriageinanattempttocontributetoimprovedhealthandwell‐beingofwomen,mothersandadolescentgirlsbyinforming,educatingandpromotingpositivebehavioursappropriatetocommunitysettings.Inaddition,HIVoutreachworkhastargetedFSWs.138Activities,incollaborationwiththeNationalHealthEducation,InformationandCommunicationCentre(NHEICC),DDCsanddistrictlineagencies,aswellasotherpartnershavebeenmanifold.Theevaluationteamwasunabletograspormapthemall.Althoughattimesdifficulttodisentangle,thissectionspeakstoSRH/HIVoutreachunderOutcome1.UNFPAoutreachintheareasofGBVandchildmarriageisdiscussedunderEQ4.

IND3.3.5UNFPAandtheNHEICChavemovedawayfromsomewhatscatteredIEC/BCCactivitiesinsupportofOutcome1objectivestoaprogrammaticapproachthatpromisesgreatereffectiveness.Printmaterialsandtoolswerenotsufficientlyavailabletosatisfyneeds.Aspartofitsregularprogramming,theUNFPACOhassupportedtheairingofradioandTVPSAs,dramasandtalkshowsacrossallNepalidistricts.Ithasinvestedadditionalresourcesinitsprioritydistricts.TheevaluationteamwasabletointerviewtworepresentativesoflocalFMradios,withwhomUNFPAcollaboratedtoairjinglesandmini‐dramas,includingaftertheearthquake.ItenquiredwithotherstakeholdersandbeneficiariesaboutthevalueaddedofFMbroadcastingfordisseminatinginformationandmessages.Reactionswereallfavourable.WidepopulationcoverageandtheimportanceofFMradiointheabsenceoftheinternetwerementionedaspluses.ItwassuggestedthatFMradiocouldbeusedtoincreaseknowledgeaboutnewly‐introducedhealthservicessuchasOCMCsandAFHScentres.UNFPAhasalsosupportedtheproductionofprintmaterialsandcommunicationtoolsandorganizedorientationsandtrainings.InterviewedSRHstakeholdersandbeneficiariesverymuchappreciatedtheproductionofsuchmaterials,butworriedthattheywerenotsufficientlyavailabletosatisfytheirneeds.Thiswasalsoobservedbytheevaluationteam.AnothermainmessageconveyedtotheteamwastheimportanceoflocalizingbroadcastingandothertypesofIEC/BCCactivities:localstories;locally‐adaptedmessages;andlocallanguages.OnekeyinformantlaudedUNFPA’sexpertiseandclearunderstandingofthesubjectmatters,butregrettedthatonlylittlefundingwasavailablecomparedtoneeds,limitingUNFPA’scontribution.Stakeholderopinionsgenerallyseemedtodifferonwhethertocontinueusinglimitedfundingtocoverasmuchgroundaspossible,evenifsomewhatsuperficially,orwhethertoconcentrateandtargetparticulargeographicalareas.AnotheraspectthathaspotentiallyaffectedUNFPA’seffectivenessandcontributiontochangesinattitudesandbehavioursrelatestocoordination:firstbetweenthecentreanddistricts;secondbetweendifferentministries.Asitseems,interventionsinUNFPA‐supporteddistrictshavebeenimplementedinanuncoordinatedmanner,especiallywithoutinvolvementfromthecentre.Furthermore,itwasrealizedthatbettercollaborationbetweenUNFPA’sGoNpartnersinchargeofinformingandeducatingA&Y‐i.e.,MoH,MoE,MoWCSWandMoFALD,couldhaveproducedvaluablesynergies.

136 Stakeholders mentioned lack of vocational skills as well as teacher and student absenteeism as burning issues. 137 There is no separate budget line for CSE in the “Red Book”; rather, it is included in the curriculum as part of the regular teaching learning process. 138 Discussed further below as separate aspect of CP7.

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Inearly2016,UNFPAandtheNHEICCagreeduponatwo‐yearBCCStrategyandImplementationPlanfor2016‐17withatotalestimatedbudgetofapproximately$1.9m.139Implementationatnationalanddistrictlevelhasstarted,withsomemonths’delay.140Sixinter‐relatedissueswereidentifiedbasedondataandabottom‐upconsultationprocess,againcoveringbothCP7Outcomes1and2:pregnancydangersigns;HIV;condomuseamongmaleclientsofFSWs;accesstocarefollowingsexualviolence;violenceagainstwomenandgirls;delaymarriageuntilage20.AcommunicationmixconsistingofradioandTVPSAs,billboardsandposters,inter‐personalcommunicationtools,IECgive‐aways,capacitybuilding,andcommunitymobilizationactivitieswaschosen.Agoodattemptwasmadetodevelopprocessandoutcomeindicatorsandmonitoringmethodologies.

IND3.3.5UNFPAhasraisedawarenessandbuiltcapacitiestosafeguardthehealthandrightsoffemalesexworkers,goingbeyondHIVpreventionandaccesstoSRHservices,butsupportandUNFPA’scontributiontochangehasbeenmodest.CP7aimstoincreasetheknowledgeofFSWsinUNFPAprioritydistrictsaboutHIVprevention,increasecondomusewithclients,andfacilitateaccesstoSRHandHIVservices.Tomeasuretheorganization’sperformance,theRRFincludedtheoutcome‐levelindicator“%ofFSWsinUNFPA‐supporteddistrictsreportingtheuseofacondomwiththeirmostrecentclient”.141UNFPAworkwithandforFSWswascarriedoverfromCP6whenUNFPAsupportedtheGoNtodevelopatoolkitforHIVpreventioninsex‐worksettingsandsupportedcapacitybuildingforFSWnetworks.142UnderCP7,supporthasbeenmodestinmonetaryterms;itwaslimitedtoonlyfewdistricts.143ExplanationsprovidedbykeyinformantsforthisdecisionwerethatnotasignificantnumberofUNFPAprioritydistrictsfallintheHIVepidemiczonesofNepalasdeclaredbytheGoN;thatotherpartnersweremoreinvested;thatHIVprevalenceamongFSWsasper2015estimateremainsat2%only;andthatotherissuesmustenjoygreaterpriority.ActivitieswereimplementedwithsupportfromFPANandJMMS.TheywentbeyondHIVpreventiontoaddressSRHandGBVandincludedresearchandanalysis144;campaignsanddisseminationofIEC/BCCmessages;trainingfordistrictofficialsandserviceproviders;trainingofFSWsaspeereducators;trainingforFSWs;inter‐actionsbetweenFSWsandserviceproviders;andvocationalskillstrainingforFSWs.In2012‐13UNFPAestimatedthepercentageofFSWsinUNFPA‐supporteddistrictshavingusedacondomwiththeirmostrecentclienttobe64.5%.145TheGoNnationaltargetfor2017wassetat80%.146Latestmonitoringdatarevealthat85.5%ofFSWsreportedhavingusedacondomwiththeirmostrecentclientin2015.However,thisfigureisnotmeaningfulsinceitrelatestostreet‐basedFSWsinKathmanduValley147andnotdistrictswithUNFPAinterventions.Evenifitwere,theevaluationteam,basedonevidencecollectedandanalysedabove,wouldhesitatetoattributeamajorcontributiontoUNFPA.

139 “Creating Courage for Change in Nepal – A Comprehensive Behaviour Change Communication Strategic Implementation Plan”, June 2015. “Creating Courage for Change (CCC) – A Behaviour Change Intervention of GoN/UNFPA 7th CPAP – Behaviour Change Communication (BCC) Materials Prototypes and Costed Implementation Plan and Monitoring Framework”, February 2016. 140 First activities were envisaged for February/March 2016 according to the Implementation Plan. 141 CPAP 2013‐17 Outcome 2 Indicator 3. 142 CPE CP6, p24 & p45. 143 E.g., Sindhuli, Dang, Sunsari, Sarlahi, Pokhara, Baitadi, Kapilvastu, Saptari, Mahottari. 144 E.g., JMMS involvement during 2013 and 2014 in regional study entitled “Sex Work, Violence and HIV in Asia – from Evidence to Safety”. 145 Based on national‐level data. In 2013, FSW Terai highway districts Integrated Bio‐Behavioural Surveillance Survey (IBBS) data was 75%. The GoN target for condom use was 80%. UNFPA further analysed the 2013 IBBS data for UNFPA‐supported districts and the target was set at 64.5%. 146 National HIV Strategic Plan target. UNFPA did not set a target for its priority districts. 147 UNFPA August 2016 monitoring data. IBBS Round V – 2015: Integrated Biological and Behavioural Surveillance (IBBS) Survey among Female Sex Workers (FSWs) in Kathmandu Valley.

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TheevaluationteamwasabletoconsultwithbeneficiaryFSWsinSunsariandDangdistrictswhowereappreciativeofUNFPA’sengagementandsuggestedthatmoresupportwasrequired,includingrefreshertrainings,reachingoutto“hidden”sexworkers,facilitatingunbiasedaccessto(adolescent‐friendly)healthandGBVservices,sensitizingpoliceofficers,andofferingalternativeincomegenerationactivities.Theabove‐mentionedUNFPA/NHEICCBCCStrategyandImplementationPlanfor2016‐17envisagesactivitiesforincreasingcondomuseamongFSWsandtheirclientsacrossallUNFPA‐supporteddistricts;itnotedtheneedtoprimarilychangethebehavioursofFSWclientsandtheirhusbands/regularpartners.Lookingfurtherahead,interviewedstakeholdersagreedthatFSWsarevulnerabletoHIVandviolence;thattheyarediscriminatedagainst;thatprotectingandempoweringFSWswasnotagovernmentpriority;andthatUNFPAcouldhavearoletoplayduringCP8.However,givenlimitedandincreasinglyearmarkedUNFPAresources,thecomparativelylowanddecreasingprevalencerateamongFSWsasakeyHIVpopulation148,andmajorHIV/AIDSfundingfromotherdonors149,itsparticularnichewasnotimmediatelyevident.

EQ4GBVandharmfulpractices:TowhatextenthasUNFPAcontributedtoimprovingtheavailabilityofandaccesstoqualityGBVservicesinasustainablemanner?TowhatextenthasitcontributedtopreventingGBV,childmarriageandotherdiscriminatingandharmfulpractices?

A.4.1Strengthened health system response to GBV

IND4.1.1UNFPA’scontributiontothelegal,policyandprogrammeframeworkregardingGBVandendingchildmarriageisevident.TheClinicalProtocolonGBV,theNationalStrategyonEndingChildMarriageand“Rupantaran”arethreesuchhighlights.DuringCP7,UNFPAhasworkedinclosecollaborationwiththeGoNandotherpartnerstodevelopnationalstrategiesonGBVandchildmarriage.WithUNFPAtechnicalandfinancialassistance,andwiththesupportofJhpiego,aClinicalProtocolonGender‐basedViolencewasdevelopedbytheMoHandendorsedbytheGoNin2015.TheprotocolisthefirstnationalguidelineforhealthcareprovidersonGBVmanagementinNepal.Basedontheprotocol,acompetency‐basedtrainingpackagewasdevelopedwithUNFPA’ssupportundertheleadershipoftheNHTC.150Furthermore,UNFPAandtheCentreforReproductiveRights(CRR)haveco‐operatedcloselytopromotealegalpolicyframeworkthatalignswithNepal'scommitmentsasregardschildmarriage.BasedonCRRresearchinSouthAsia151,abriefingpaperwithrecommendationsforlegalreformstostrengthenprotectionagainstchildmarriageandaccountabilityforviolationsofnationallawsthatprohibitchildmarriagewaspublished.IncollaborationwithUNICEF,UNFPAalsoactivelyparticipatedintheNationalSteeringCommitteefordevelopingaNationalStrategyonEndingChildMarriage2015.InlinewiththeNationalPlanofActionfortheHolisticDevelopmentofAdolescents,UNFPAsupportedUNICEFtodevelop,testandfinalizetheSFSPforadolescents,alsocalled“Rupantaran”,whichincludes,interalia,modulesonGBV,childmarriageandotherharmfulpractices.Rupantaranisnowagovernment‐ownedtrainingpackage:itwasendorsedbytheMoWCSWandMoYS.AccordingtotheUNFPACO,itshouldalsobeimplementedthroughthePresident’sProgrammetoEmpowerWomenandGirlsthatwaslaunchedduringtheNepalGirlSummitinMarch2016.

148 EPI Fact Sheet 1 2014: FSWs prevalence rate 2%; EPI Fact Sheet 2013: FSWs prevalence rate 2%. 149 Japan, the Global Fund and USAID were mentioned. 150 http://nepal.unfpa.org/publications/clinical‐protocol‐gender‐based‐violence. Only available in Nepali. 151https://www.reproductiverights.org/sites/crr.civicactions.net/files/documents/ChildMarriage_BriefingPaper_Web.pdf.

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IND4.1.2&4.1.3UNFPAhascontributedtobetterqualitypublichealthservicesforGBVsurvivors,butsofarmainlyonlyinsixdistricts.UNFPAhasnotonlysupportedthehealthresponsetoGBV.Referralserviceshavebeenstrengthened,butobservedsafehousesfacedproblems.Trainedserviceprovidersweregenerallysatisfied.Since2011,theMoHhasestablished21One‐stopCrisisManagementCentres(OCMCs)forGBVsurvivorsinpublichospitalsacrossNepalindistrictsthathavesafehomesforGBVsurvivors.152During2013‐16UNFPAhassupportedOCMCs,alongwithDFIDandWHO.CP7committedUNFPAtoworkwiththeGoNtoincreasethenumberofOCMCsthatcomplywithMoHguidelinesfromabaselineofzerotooneeachintenofitsprioritydistricts.153ThistargetwasincreasedtoonepublicsectorhospitalineachofUNFPA’s18programmedistricts.Thistargetisnotlikelytobemet:monitoringdatarevealsixOCMCsinUNFPAprioritydistrictsthatareconsideredtobeapplyingMoHguidelines–i.e.,inDang,Pyuthan,Rautahat,Saptari,SarlahiandSunsari.

UNFPAsupportforOCMCshasbeenmanifold:itbeganwithanassessment154ofexistingOCMCsin2013incollaborationwiththeMoHandDFID.TheassessmentrevealedaneedtodevelopthecapacitiesofhealthserviceprovidersworkingatOCMCstorespondtoGBVandtoenhancereferralmechanisms.155Itfoundaclearconsensusamongcentralanddistrict‐levelstakeholders,aswellasamongGBVsurvivorsthemselvesandtheirfamilies,

thatOCMCsareaworthwhileandpositivegovernment‐ledinitiative.156Consequently,UNFPAsupportedtwoannualreviewmeetings,14daysofmedico‐legaltrainingforselectedOCMCdoctors,sixmonths’trainingforselectedOCMCfocalpoints/staffnursesonpsycho‐socialcounselling,trainingof102healthserviceprovidersintheOCMCsinDang,Sarlahi,SunsariandPyuthanonGBVandclinicalmanagementofrape(CMR)157,provisionofpost‐rapetreatmentkits(Kit3)toallOCMCsfordeliveringregularservices,andanobservationvisittoSriLankaforMoH,OPMCM158andDepartmentofWomenandChildren(DWC)staff.TheevaluationteamvisitedtheOCMCsinSunsariandDangdistricts.Itobservedthattheywereworkingwell.TheyprovidedanintegratedpackageofservicesforGBVsurvivorsandfollowedthecoreprinciplesofensuringthesecurityandsafetyofGBVsurvivors,maintainingcaseconfidentiality,andrespectingthedignity,rightsandwishesofsurvivors.ThevisitedOCMCshavereportedlyreferredsurvivorstootherhospitalsforadvancedtreatment,tosafehomesundertheresponsibilityofWCOs159,tothepoliceforprosecutingcases,andtoNGOsforrehabilitationandlivelihood‐relatedskillstraining;theyalsoputsurvivorsincontactwithlawyers.ThededicationandinterestoftrainedOCMCfocalpersonswereclearlyevident.TheAuxiliaryNurseMidwife(ANM)inSunsarihadbeenawardedtheBestCounsellorAwardfromtheCDOasrecognitionofherservices.Likewise,inDang,theANMhasbeenawardedseveral

152 Established 2011/12: Makwanpur, Kanchanpur, Doti, Panchthar, Baglung, Sunsari (UNFPA priority district), Bardiya; 2012/13: Kathmandu, Tanahun, Nawalparasi, Dang (UNFPA priority district), Solukhumbu, Sarlahi (UNFPA priority district), Saptari (UNFPA priority district), Kabhre Palanchowk; 2013/14: Jumla; 2015/16: Pyuthan (UNFPA priority district), Rautahat (UNFPA priority district). GoN/NHSSP and UKAID: INNOVATIVE GOOD PRACTICES IN NEPAL’S HEALTH SECTOR 3. Hospital‐based One‐Stop Crisis Management Centres, February 2016; http://www.nhssp.org.np/pulse/Pulse_OCMC_good_practices_february2016.pdf. 153 CPAP 2013‐17 Outcome 2 Output 1 Indicator 1. At the time, four OCMCs already existed, but were not considered to comply with the MoH guidelines. 154 MoH: Assessment of the Performance of Hospital‐Based One Stop Crisis Management Centres, 2013. 155 Assessment of the Performance of the Hospital‐based OCMCs. Population Division, MoHP. 156 MoH: Assessment of the Performance of Hospital‐Based One Stop Crisis Management Centres, 2013. 157 Outcome 2‐ training compiled by UNFPA, November 2016. OCMCs in Pyuthan and Rautahat were set up in 2015/16. 158 Office of the Prime Minister and Council of Ministers. 159 Generally run on their behalf by women’s cooperatives.

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timesinappreciationforherwork.TheANMssuggestedthattheyrequiredrefreshertrainingsonGBVandrecommendedthatalldoctorsandnursesshouldbetrainedonpost‐rapetreatment.OtherhealthserviceprovidersconsultedbytheevaluationteamreportedhighsatisfactionwithtrainingsreceivedfromtheNHTCthroughtheCentreforVictimsofTortureNepal(CVICT).Theyappreciatedthatclinicalandpracticaltrainingusedanon‐the‐jobtrainingapproachtofocusspecificallyoncompetencies.Insteadofrelyingonthetraditionalwayoftrainingwhereparticipantsaresimplygivenknowledge,thisnoveltrainingmodelhelpedthemtoacquireskillsthroughinteractivemethodsthatencourageddialogue,discussionandlearningbydoing.Likewise,healthcareprovidersinBaitadiandSunsariattendedtrainingonpsycho‐socialcounsellingandorientationregardingGBVandmulti‐sectoralservices.Withregardstocounsellingtraining,theystatedtheirsatisfaction.However,staffinBaitadispecifiedthattheorientationonGBVandmulti‐sectoralservicesandreferralwastooshort.Itwassuggestedthatrefresherandupgradedtrainingwouldbebeneficialtoworkbetter.UNFPA’ssupportforGBVsurvivorsandvulnerablewomenandgirlshasgonebeyondhealthservicedelivery.AssafehousesareanationalprerequisiteforsettingupOCMCs,andanimportantelementofthereferralsystem,UNFPAhasalsoadvocatedforandprovidedlimitedsupportfortheestablishmentandrunningofsafehousesinanumberofitsprioritydistricts–interaliabyprovidinglogisticssupportandtrainingsafehouseandWCOstaffonGBVandpsycho‐socialcounselling.160ThiswasnotoriginallyenvisagedintheRRF.Theevaluationteamvisitedthreesafehouses,onlyoneofwhich(Sindhuli)hadreceived(logistics)supportfromUNFPA,ObservationofthesafehousesinSunsariandSindhuligavecauseforconcern.InDang,safehousesintheVDCsreportedlyhavelimitedfundsandGBVsurvivorsareoftenhousedprivatelyuntilatransfertothedistrictsafehousebecomespossible.Thedistrictsafehouseseemedtoberunningwell;in2016itcateredto131cases.TheothertwoinSunsariandSindhulididnotappearpromising.Bothfacefinancial,staffingandsecurityproblems;intheeyesoftheevaluationteamtheywereinsufficientlyequippedtooffersurvivorscomfortandstructure.

IND4.1.4&4.1.5ThenumberofGBVsurvivorscaredforbyUNFPA‐supportedOCMCsdiffersconsiderablyfromdistricttodistrict.GBVsurvivorsseekinghelpfromOCMCsandsafehousesareoverwhelminglyfemale.Overall,OCMCshadprovidedsupportandservicesto4,420GBVsurvivorsasofmid‐November2015,94%ofwhichwerefemale.161GBVcaseshavingreceivedcareinUNFPA‐supportedOCMCswere300inDang,18inPyuthan,312inSunsari,96inSarlahi,632inSaptariand7inRautahat.162GBVsurvivorsstayedintheOCMCsupto15days,butthereisapparentlynoguidanceastohowlongtheycanstay.OCMCsreferredcasestothesafehouseswhenthesurvivorshadnoplacetogo.GBVsurvivorswerehousedinsafehousesupto45days.MostrecentdataofGBVsurvivorsreceivingsupportinUNFPA‐supportedsafehouses,allofwhomwerefemale,are1,116.163Inthedistrictsvisited,theevaluationteamheardthatknowledgeabouttheexistenceofUNFPA‐supportedGBVserviceshasincreased,butthatitvaried.TheteamwasinformedthatawarenessaboutOCMCshasgrownashospitalstaff,policeandlocalgovernmentofficialshavebeenorientatedonthepurposeandroleofOCMCs.Alowlevelofknowledgewasespeciallythecaseindistantandremotecommunities.LanguageproblemswereanotherfactoraffectingknowledgeaboutGBVservices.Also,GBVsurvivorsandvulnerablewomenandgirlswerenot

160 Outcome 2‐ training compiled by UNFPA, November 2016. UNFPA is supporting safe houses in Sindhuli, Udaypur, Argakhanchi, Rolpa, Rukum, Dadeldhura, Accham, Bajhang, Baitadi, Bajura and Kapilvastu. Additionally, the DWC is supporting safe houses in Saptari, Sunsari, Sarlahi, Rautahat, Pyuthan and Dang. 161 Latest available data. GoN/NHSSP and UKAID: INNOVATIVE GOOD PRACTICES IN NEPAL’S HEALTH SECTOR 3. Hospital‐based One‐Stop Crisis Management Centres, February 2016. 162 Outcome 2‐training compiled by UNFPA, November 2016. Pyuthan and Rautahat OCMCs were only recently opened. Figures for Saptari and Rautahat also include GBV cases catered for by the district hospital. 163 Outcome 2‐training compiled by UNFPA, November 2016.

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alwaysawareaboutthetypesofservicesprovidedbyUNFPA‐supportedOCMCsandsafehouses.Consequently,theyarrivedlateorwerehesitanttoseekforhelp.Inadditiontoitscapacity‐buildingsupportforOCMCsandsafehouses,andinordertostrengthenreferrals,UNFPAhastrainedotherserviceproviderstoaddressGBV‐e.g.,trainingforcommunitypsycho‐socialworkersandpolicepersonnelonGBV.GBVsurvivorsseemedtoresortprimarilytoWCOsforadviceandhelp,fromwheretheyhavebeenconnectedtoasafehouseoranOCMC.Safehomes,NGOs,thepolice,psycho‐socialcounsellorsandFCHVshavelikewisehavereferredsurvivorstoOCMCs.TheevaluationteamwasunabletointerviewGBVsurvivorstoevaluatetheirresponsesregardingUNFPA‐supportedGBVservices.164However,mothers’groupsandwomencooperativemembersexpressedtheirsatisfactionwiththesysteminplaceandtheservicesprovided.ItwasarguedthatGBVsurvivorsmaintainprivacyandoftenareunwillingtoopenlyseekforcare,butthatthishaschangedinrecentyearsandmoresurvivorsarecomingforthtoseekforcareasknowledgeofavailabilityofGBVserviceshasincreased.

IND4.1.6TheextenttowhichGBVEliminationandGenderEmpowermentDistrictCoordinationCommitteesarereallyfunctionalisquestionable.GBVEliminationandGenderEmpowermentDistrictCoordinationCommittees(GBVEGEDCC)existinalldistrictsforanimprovedmulti‐sectoralresponsetotheneedsofGBVsurvivorsandimprovedreferralamongvariousagencies.AccordingtotheirToR,GBVEGEDCCsareresponsiblefordevelopingstrategicplanstoaddressGBV;theyalsoallocateresources(providedbytheDDC)toimplementlocal‐levelawarenessraisingactivities,tosupportGBVsurvivors,andtoholdcoordinationmeetings.Underitsregularprogramme,CP7committedUNFPAtoincreasingthefunctionality165oftheGBVEGEDCCsinits18prioritydistricts.166LatestmonitoringdatarevealthatGBVEGEDCCsarefunctionalinalldistricts.167UNFPAhassupportedthestrengtheningofGBVEGECDDs.However,contradictorytoUNFPAmonitoringdata,responsesregardingtheirperformancevariedinthedistrictsvisitedbytheevaluationteam.InDang,BaitadiandSunsari,itwasreportedthattheGBVEGEDCCsmetonaquarterlybasis,butthattheywerenotveryeffective.InSindhuli,theGBVEGEDDCwasreportedtohavebeenactiveandeffective;itapparentlymetseveraltimesinresponsetotheearthquake.Weaknesses,withwhichGBVEGEDDCsareconfronted,arefluctuatingmembers,lackofaclearagendaanddependenceontheleadershipoftheCDOwhoisthechairperson.

IND4.1.7UNFPAresumeditssupportforimprovedGBVdatamanagement.DatacollectedthroughtheGBVInformationManagementSystem,whilenotcomprehensiveorrepresentative,areexpectedtobeapowerfultoolforadvocacyandlobbying.SupportedatgloballevelbyaSteeringCommitteecomprisingofUNFPA,theInternationalRescueCommittee,UNHCR,UNICEFandtheInternationalMedicalCorps,theGender‐BasedViolenceInformationManagementSystem(GBVIMS)wasfirstrolledoutinNepalinSeptember2011.168CP7intendedtouseGBVIMSdataasameansofverification,butdidnotexplicitlyenvisagesupportforimprovingit.However,continuedlackofdataforfutureGBVinterventionswasrepeatedlypointedoutinvariousforums.TheGBVIMSwasthereforere‐launchedinNovember

164 GBV survivors were not present at visited OCMCs and safe houses; it was difficult to organize FGDs with former clients for reasons of privacy, but also distances and heavy workloads of beneficiaries. 165 “Functional” means holding regular meetings, documenting meeting outcomes and carrying out planned activities. 166 CPAP 2013‐17 Outcome 2 Output 1 Indicator 2. This indicator and target were added to align with UNFPA 2014‐17 SP Outcome 2 Output 10 “Increased capacity to prevent gender‐based violence and harmful practices and enable delivery of multi‐sectoral services, including in humanitarian settings”. 167 Outcome 2‐training compiled by UNFPA, November 2016. UNFPA August 2016 monitoring data confirm this information for 16 of the 18 priority districts. 168 http://www.gbvims.com/. http://nepal.unfpa.org/news/towards‐data‐uniformity‐gbv‐gbvims‐nepal.

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2014byeightNGOs169,theNWCandUNFPA.Theinitiative,whichtwootherNGOsjoinedin2015,isledandcoordinatedbytheNationalWomen’sCommission(NWC)andsupportedfinanciallyandtechnicallybyUNFPA.Since2015,CVICThasbeenprovidingtechnicalassistance,includingtraining,totheNWCtocollect,analyseanddisseminateGBVdata.UNFPAhassupportedtheparticipatingNGOstorecordGBVsurvivorsandreportmonthlytotheNWCfollowingastandardformat.InterviewedstakeholdersgenerallyconsideredUNFPA’ssupportworthy.Datawerepublishedin2016170andshouldserveasapowerfuladvocacyandlobbyingtool.However,onekeyinformant,whilewelcomingtheGBVIMS,spokeoutforasingleconsolidated,government‐ownedGBVdatasetrepresentingtheentirecountry.

IND4.1.8GBVservicesthroughexistingOCMCsappearsustainable,evenwithoutfurtherexternalfunding.Thesamecannotbesaidofsafehouses.AvailabilityofqualifiedhumanresourcesforrespondingtoGBVcouldbecomeanissue.UNFPA’sassistancehasdevelopedtheindividualcapacitiesofpsycho‐socialcounsellorsandinstitutionalcapacitiesofsafehousesandOCMCs,allofwhichcatertodifferentneedsofGBVsurvivorsandthoseatriskofviolence.UNFPAhasworkedwithinexistingstructuresoftheGoN;ithasnotcreatedparallelstructures.Thisbodeswellforownershipandpolicysupport.Interviewsconductedbytheevaluationteamregardingfinancialsustainabilityrevealthefollowing:OCMCsarestipulatedintheRedBookandUNFPA’sadditionalsupportishighlyappreciated.InterviewedhealthprofessionalsinDangandSunsariwereconfidentthat“their”OCMCshavethecapacityandthemeansandresourcestooperatewellevenifexternalsupportweretocontinue.However,refreshertrainingsandcapacitybuildingofnewstaffarerequiredforOCMCstocontinuetheirwork.Availabilityofqualifiedhumanresourcescouldalsobecomeanissueintheareaofcommunity‐basedpsycho‐socialcounselling:thereisnoguaranteethatpsycho‐socialcounsellorstrainedonGBVwillcontinueworkingsincetheyareinhighdemand.Newcounsellorswillthereforeneedtobetrainedonacontinualbasis.Howeverdomesticfundingforrefreshercoursesandtrainingnewcounsellorsislacking.Inthedistrictsvisitedbytheevaluationteam,safehouses,asopposedtoOCMCs,areclearlyunsustainablewithoutcontinuedexternalsupport,althoughtheyarealsostipulatedintheRedBook.Safehousesexistedinalldistrictsvisitedbytheevaluationteam.However,domesticfundingonthepartoftheWCOsforrunningthesafehousesonaday‐to‐daybasisisinadequate.

A.4.2Prevention of GBV and child marriage

IND4.2.1UNFPAhasstrengtheneddifferentnetworkstomobilizecommunitiesagainstGBVandchildmarriage.Initsprioritydistricts,UNFPAhascapacitateddifferenttypesofcommunitymobilizerstopreventGBV,supportGBVsurvivorsandpreventchildmarriagesandotherharmfulpractisesthroughdistrict‐leveltrainingsandorientations.Theyrangefromreligiousleaders,LGCDPsocialmobilizers,membersofgirls’circles,womencooperativemembersandmembersofwomen’sgroups.NoassessmentsorperceptionsurveysareavailabletodocumentthesatisfactionofsuchcommunitymobilizerssupportedbyUNFPAwithtrainingsandsensitizationworkshops.Henceitisdifficulttogaugeopinions.Interviewsanddiscussionsprovidedabroadsenseoffeedbackandviews,andoverallsuggeststrongappreciationandsatisfaction,aswellasafeltvitalneedforcontinuationandexpansiontomoreVDCs.Forinstance,priestsandJyotishis(astrologers)inBaitadiweresatisfiedwiththesensitizationtrainingtheyhadattended;theyandotherstakeholdersfeltthattheirinvolvementinpreventingchildmarriageandchhaupadiwasagoodstrategy.Membersofgirls’circles/groupsinBaitadiandSunsariwereappreciativeofRupantarantraining.TheystatedthattheirawarenessandknowledgeonGBVandchildmarriagehadincreased,thattheyhadbenefitedpersonally,andthattheywereabletoshareinformationintheirfamiliesandcommunitiesand

169 The eight signatories to the GBVIMS are: Women Rehabilitation Centre (WOREC), Centre for Victims of Torture Nepal (CVICT), Women Forum for Women in Nepal (WOFWON), Nepal Disabled Women Association (NDWA), Action Works Nepal, SAATHI, AWAAZ and Transcultural Psychosocial Organization Nepal (TPO). 170 http://www.cvict.org.np/index.php?page=publications.

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hadsuccessfullystoppedchildmarriages.InterviewedwomencooperativemembersandsocialmobilizerswerealsosatisfiedwithorientationsonGEandGBVtheyhadattended.

IND4.2.2&4.2.5UNFPAoutreachhashadanimmediateeffectontheattitudesoftargetedmenandboystowardsVAW;however,itisdoubtfulthatUNFPAhasinfluencedmaleattitudesandconsequentlybehavioursonalargerscale.CP7committedUNFPAtoincreasingthepercentageofmenandboysinitsprioritydistrictswhobelievethatviolenceagainstwomen(VAW)isnotacceptable.171AperceptionsurveyconductedbyUNFPAin2013showedthat

only32.6%ofmenandboysinitsprioritydistrictsagreed–i.e.,thattwo‐thirdsthoughtviolencewasacceptable.172Thisattitudeisreinforcedbywomen’sperceptions:2014MICSdatashowedthatthepercentageofwomenwhothinkthatahusband/partnerisjustifiedinhittingorbeatinghiswife/partnerundercertaincircumstanceswas42.9%.Thus,inthecourseofthere‐alignmentexercise,UNFPAalsocommitteditselftoreducingthepercentageofwomenaged15‐24and15‐49whothinkthatahusband/partnerisjustifiedinhittingorbeatinghiswife/partnertozero.173TopreventGBVandtocreateanenablingenvironmentforsurvivorstoseeksupport,UNFPAanditspartnersdirectlyreachedouttothousandsofmenandboysintheircommunities.ItorganizedorientationsformalemembersofWardCitizenForums(WCFs).174Insomedistricts,includingthankstoUNFPA’soutreach,ward‐levelactionplanstoreduceviolenceweredeveloped.UNFPAalsotrainedselectedmenandboystobecome“champions”committedtobreakingthesilenceonGBV.In2015,itlaunchedthepilotMen’sInitiativeforLifelongActionandPartnership(MILAP)infour175ofitsprioritydistrictstoengagemen,boysandwomeninmonthlydiscussionsaboutGBV.InformationonwhetherlessmenandboysinUNFPA‐supporteddistrictsbelievethatVAWisacceptablewasnotavailableatthetimeoftheevaluation,pendingaplannedend‐lineperceptionsurvey.SomeindicationofachangeinattitudesthankstoUNFPAcanbegaugedfrom2015pre‐andpost‐trainingdata:70%of3,339participantssecuredthe80%passingscore.InterviewsanddiscussionsconductedbytheevaluationteamgavethesensethatmenandboyswhohadbenefitedfromUNFPA’soutreachactivitieswereindeedmoresensitive,butthatmoreeffortsarerequiredtocovermoreandremoteVDCsandtobringaboutactualbehaviouralchange.

IND4.2.3Incontinuationofitsearlierworktosupportadolescentgirlstochoosetheirownfutures,UNFPAhassuccessfullyused“Rupantaran”toempoweradolescentgirlstospeakouttotheirpeersandeldersagainstviolenceandchildmarriage.Rupantaranhashadacascadingeffectoncommunities,thusbenefitingawidercircleofgirls.In2013,UNFPAsupportedWCOsinUNFPA‐supporteddistrictstoempoweradolescentgirls.Morethan500girls–graduatesoftheKishoriBikashKaryakramprogramme–wereorientatedonGBVandharmfulpractisesincludingchildmarriage.Theywentontoformadolescentgirls’circlesintheirvillages.Inthemeantime,44girls’circleshavebeenformedinUNFPAprioritydistricts.

171 CPAP 2013‐17 Outcome 2 Output 2 Indicator 2. 172 Annual Review Meeting 2015; UNFPA August 2016 monitoring data. 173 CPAP 2013‐17 Outcome 2 Indicator 3. Added as part of re‐alignment exercise. 174 There is one Ward Citizen Forum in every ward of every VDC and municipality, established by the LGCDP. WCFs have 24 members represented by various groups of local communities who sit regularly to discuss their needs and priorities and send them to VDC Council Meetings. 175 In two VDCs each in Pyuthan, Achham, Dang and Sindhui districts.

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In2014,UNFPAsupportedthetestingandcontributedtorollingoutthenewly‐developedSFSP(“Rupantaran”).TheinitiativewaspilotedbyUNFPAthroughtheWCOinDangandlaterrolledouttoBaitadi,Bajhang,Accham,KapilvastuandRolpa;itwasimplementedthroughtheNationalMuslimWomenWelfareSocietyandMadrasateachersinRautahat,KapilvastuandSarlahi.Giventheinitiative’searlydays,noformalassessmentofRupantaranhasbeenconducted.Interviewsgeneratedpositivefeedback:GBVstakeholdersinKathmanduaswellasofficialsandbeneficiariesinBaitadiandDangconfirmedthatthepackagehasincreasedtheknowledgeandenhancedthecapacitiesofgirls’circlestoaddressSRHissuessuchasGBV,HIV,childmarriageandmenstrualhygieneintheirfamiliesandcommunities.UNFPAalsodirectlytargetedwomenandgirlsthroughothermeansandchannelswiththeintentiontoinformthemaboutGBVandchildmarriage,tochangebehavioursandgeneratedemandforservices: IEC/BCCmaterials MediacampaignsandFMradiojinglesandmini‐dramas Orientationsformothers’groups Intergenerationaldialogues Streetdramas

Messagesweredisseminatedthroughwallpaintings,posters,postcards,stickersregardingGBV,childmarriageandotherharmfulpractices.TheevaluationteamsawonlyfewoftheseintheOCMCs,WCOsandsafehouses.Governmentoffices,NGOs,womencooperativemembers,girls’circles,andreligiousleadersdistributedtheseproducts.However,revisingandlocalizingthecontentofthemessagesandproductionofmessagesinlocallanguageswasfeltnecessary.

IND4.2.4WomensurvivorsofviolencegenerallyfirstseektheadviceofWomenandChildrenOffices.UNFPAexpectstoincreasetheproportionofwomenandgirlsaged15‐24inits18prioritydistrictswhoknowwhenandwheretoseekhealthservicesfollowingsexualviolencefromaverylow11.7%in2013to60%in2017.176AcombinationofactivitiesundertheGEandSRHprogrammesshouldhelpachievethisoutcome:activitiesthatimmediatelytargetwomenandadolescentgirlssuchasRupantaran,CSEandIEC/BCCactivities,butalsothoseintendedtobuildsupply‐sidecapacities,suchasclinicaltrainingonGBVforhealthserviceprovidersandthecertificationofAFHScentres.Forlackofup‐to‐datestatistics,theevaluationteamwasunabletoassessprogress.Anend‐lineperceptionsurveyisplannedfor2017.EvaluationteaminvestigationsrevealedthatwomenandadolescentgirlsbenefittingfromCP7inwhicheverwaygenerallyknewtheiroptionsforseekingcare.Beforetakinganycourseofaction,manybeneficiarieswouldgenerallyfirstseektheadvicefromWCOs.Thisisalsoaccordingtothelawandprocessesstipulatedbythestate.177Of3,202womenandadolescentgirlsacrossallprioritydistrictswhowerespecificallyorientedbyUNFPAonthehealthresponsetoGBVin2015,80%securedthe80%passingscore.

IND4.2.6&4.2.7&4.2.8UNFPAhasbeenprominentlyinvolvedinpreventingchildmarriagethroughlocal‐levelmechanisms;lesssotoreduceotherdiscriminatoryandharmfulpractises.Alreadyin2013,averyhigh93.3%ofsurveyedparentsdidnotwanttheirdaughterstomarryearly.Thisupwardtrendisexpectedtocontinue,includingthanksto

176 CPAP 2013‐17 Outcome 2 Output 2 Indicator 1. 177 http://nepal.unfpa.org/sites/asiapacific/files/pub‐pdf/TrackingCasesofGBV.pdf.

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UNFPA’sinvolvementontheground.Despitealleffortstoeducatecommunitiesandgenerallyfavourableparentalattitudes,childmarriageisstillachallenge,althoughseeminglyalessandlesscommonphenomenon.InUNFPAprioritydistricts,CP7intendstoincreaseawarenessofchildmarriageasaharmfulpractise178asacontributiontoreducingchildmarriages.179Forthispurpose,theCOhasbeensupportingexistingandcreatingnewcommunity‐basedmechanismstoengagethepopulationinpreventingchildmarriageandotherdiscriminatoryandharmfulpractisessuchaschhaupadi,dowry,witchhuntingandsonpreference.180Atotalof137suchcommunity‐basedmechanismswerereportedtohaveexistedatdistrictandcommunitylevelsin17UNFPA‐supporteddistricts(exceptforRukum181)in2015,anaverageofeightmechanismsperdistrict.AtthebeginningofCP7,childmarriagepreventionmechanismshadonlyexistedonlyintwodistricts,KapilvastuandMahottari.182UNFPAhassupportedseveraldifferenttypesofcommunity‐basedmechanismstoaddresschildmarriageandotherharmfulpractises.TheyincludeexistingmechanismssuchasWCFs,Citizens’AwarenessCentres(CACs),mothers’groups,girls’circles,religiousleaders,GBVWatchGroupsandinter‐generationaldialogue,aswellasnewly‐createdonessuchasGBV‐freeVDCsandchild‐marriagefreeVDCs.

UNFPAexpectstocontributetoanincreaseintheproportionofparentsinitsprioritydistrictswhodonotwanttheirdaughterstomarryearly.183Alreadyin2013,theperceptionsurveyconductedbyUNFPArevealedthat93.3%ofparentsdidnotwanttheirdaughtertobemarriedbeforetheageof18,whichwasthenthelegalminimumageofmarriage.Pendingtheend‐lineperceptionsurveyin2017,nodataareavailableonthepresentsituation.Evenifitwere,theextenttowhichitwouldbecomparableisquestionablegiventheincreaseinthelegalageformarriagefrom18to20.TheevaluationteamwasthereforeunabletousetheRRFtoassessprogressandUNFPA’scontribution.Inallfourvisiteddistricts,theevaluationteamwasinformedthatmoreparentshaveknowledgeonthelegalageofmarriageandthatfeweryouthwerebeingmarriedearly,andthatthisisnowthetrend.TeammembersweregiventounderstandthatUNFPA‐supportedlocal‐levelmechanismswereinfluencingparents’attitudestowardschildmarriage.Whilenotrepresentingtheoveralldistricts’knowledgescenario,theevaluationteamnotedthatinterventionsfororienting15,119parentsonendingchildmarriageweresuccessful:ofthetotalnumberofparticipants,80%securedthe80%passingscorepost‐test.UNFPAhasprominentlyengagedinfightingchildmarriageatthecentralanddistrictlevels–atthelegal/policylevelandthroughitssupportontheground.UNFPAinterventionsweremeanttocontributetoattitudinalandbehaviourchangeamongpolicymakersandwithincommunities,consequentlycontributingtoareductioninchildmarriages,especiallyinUNFPA’s18prioritydistricts.184Accordingtothe2011DHS,thenationalfigureforwomenaged20to24whoweremarriedorinunionbeforeturning18wasahigh51%.Threeyearslater,theMICSrevealedaconsiderabledecreaseto36.6%,whichis,however,stilloneofthehighestinthe

178 CPAP 2013‐17 Outcome 2 Output 3 Indicator 2. 179 CPAP 2013‐17 Outcome 2 Indicator 2. 180 CPAP 2013‐17 Outcome 2 Output 3 Indicator 1. 181 By the time of writing, mechanisms were also in place in Rukum. 182 UNFPA August 2016 monitoring data. 183 CPAP 2013‐17 Outcome 2 Indicator 2. 184 CPAP 2013‐17 Outcome 2 Indicator 2.

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world.185Noupdateddataareavailablethatwouldpermitabetterunderstandingoftrendsthroughouttheperiodofinvestigation2013‐16.Basedonare‐analysisof2011DHSdatabytheCO,thepercentageofwomenaged20‐24whoweremarriedorinunionbeforeage18inUNFPA’sprioritydistrictswas48.7%,slightlybelowthenationalaverage.TheRRFdoesnotprovidea2017targetvalueforUNFPAdistricts,andnomonitoringdataareavailable.186

IND4.2.9EffortstopreventGBVandchildmarriagelargelydependonexternalfinancialsupport,includingfromUNFPA.Thedifferentinterventionsreferredtoabovetoempowerwomenandgirls–e.g.,Rupantaran‐andtoengagecommunities,directlyorthroughcommunitymobilizers,havebeenheavilydependentuponexternalexpertiseandfinancialsupportforDDCsanddistrictlineagencies.Sustainabilityofbehaviourchangecommunicationanddemandgenerationgreatlydependsontheextenttowhichdistrictsareopentoallocatingtheirownfunds.Astobeseenbelow(IND5.2.6),thepercentageofdistrict‐levelbudgetallocationsforpopulation,SRH,youthandGBV/women’sempowermenthasconsiderablyincreasedsince2012,alsothankstoUNFPA.However,theevaluationteamwasunabletodoanyin‐depthanalysistodeterminewhetherthishasbenefittedinformation,educationandcommunicationforpreventingGBVandchildmarriage.Atthenationallevel,politicalwillingnesstosensitizethepopulationonGBVandchildmarriageisthere.Asseenabove(IND3.3.5),UNFPAandNHEICChaveagreed,forthefirsttime,uponacostedBCCStrategyandImplementationPlan,which,interalia,coversGBVandchildmarriage.Fundingupuntiltheendof2017foractivitiesincludedinthePlanissecured.

EQ5Data,Policies&Planning:TowhatextenthasUNFPAsustainablycontributedtoastrongeremphasisofnationalandsub‐nationalpolicies,plansandbudgetsonpopulation,SRH,youthandGBVissuesinanevidence‐basedandparticipatorymanner,informedbypopulationdynamics?

A.5.1Data availability and analyses on population, SRH, youth and GBV

IND5.1.1UNFPAenabledtheCentralBureauofStatisticsandtheMinistryofHealthtoconductandpublishnational‐levelsurveysandanalysesonyouth,ageing,migrationandurbanization.Itprovidedinputsintothe2014MultipleIndicatorClusterSurveydesign.UNFPAintendedtoincreasethenumberofnationalhouseholdsurveysandcensusthatcollected,analysedandestimateddataforkeypopulationandRHindicators.187Thebaselinewasidentifiedasfour–i.e.,the2011NepalAdolescentandYouthSurvey,the2011DHS,the2011PopulationandHousingCensus,andtheNLSS2011.LatestUNFPAmonitoringdata188indicatethatonlyoneadditionalsurveyhasprovideddataandanalysisforkeypopulationandRHindicators,includingwithUNFPAsupport–i.e.,the2014MICSwhereUNFPAinputtedintoquestionnaireandsampledesign.Thetargetofsevensurveyshasnotbeenachieved.Thetwootheranticipatedsurveyswereconducted189,butdonotaddresskeypopulationandRHindicators.However,UNFPAhasprovidedtechnicalexpertiseandfundingforCBSandthePopulationDivisionoftheMoHtoconductothersurveysandanalysesofnational‐leveldata,includingfurtheranalysisofthe2011DHS,andnotablyonyouth,ageing,migrationandurbanization(Box3).190InterviewedstakeholderswereveryappreciativeofUNFPA’ssupport.Atthetimeofthis

185 http://www.girlsnotbrides.org/child‐marriage/nepal/. 186 UNFPA August 2016 monitoring data. 187 Outcome 3 Indicator 2 was added as part of the re‐alignment with the UNFPA 2014‐17 Strategic Plan. 188 Outcome 3: Round IV Data Collection Study, 2016. 189 These are the Nepal Household Survey 2012 and the National Accounts of Nepal 2012‐13. 190 UNFPA support for the Post‐Disaster Needs Assessment in 2015 is discussed under A.6.2.

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evaluation,theUNFPACOwasparticipatinginthe2016DHSTechnicalWorkingGroupandTechnicalAdvisoryCommittee.

Box 3: UNFPA Support for CBS and MoH Surveys and Analyses 2013‐16

In2013UNFPAsupportedtheMoHtofurtheranalyse2011DHSdata. In2013UNFPAprovidedtechnicalsupporttothePopulationDivisionoftheMoHtoidentifyfive

thematicareasforfurtheranalysisofthe2011NepalAdolescentandYouthSurveythroughaseriesofconsultationswithkeydatausersandresearchers.

OtherstudiesreceivingUNFPAtechnicalandfinancialsupportincludetheNationalAgeingSurveyandtheNationalMigrationSurvey.

In2015UNFPAinitiatedandprovidedfullfinancialsupporttoCBSforconductinganUrbanPopulationSurvey.Itsupportedsurveydesignandtools.AsofJuly2016,fieldworkfordatacollectionwascomplete.Thedraftstatisticalreportanddraftanalysisofdemographicindicatorsbasedonthissurveywillbeavailablebytheendof2016.

Sources: UNFPA, CBS

IND5.1.1UNFPAtechnicalandfinancialsupportfacilitatedfurtherdisseminationof2011censusresultsthroughthreePopulationMonographs.AlreadyunderCP6,UNFPAhadmadeavailabletechnicalandfinancialsupportforconductingtheNepalPopulationandHousingCensus2011andforpublishingthenationalreportVolumeIandothersubsequentvolumes.191UNFPAassistanceinpilotingthecensus,fieldwork,postenumerationsurveyanddataanalysiswasconsideredimportantfordataqualityassuranceandimprovedandsustaineddataavailabilityandanalysisinNepal.Towardstheendof2013,CBS,withUNFPAsupport,publishedadditionalvolumesofcensusresults.Theyincludeddisaggregatedinformationonhouseholds,fertility,migration,industry,occupation,education/literacyandgenderamongstotherthings.UNFPAalsoprovidedsupportfordisseminatingcensusresultsacrossUNFPAprogrammedistricts.DuringCP7,UNFPAwasabletofullyfundthepreparation,implementation,printinganddisseminationofPopulationMonographvolumesI,IIandIIIbytheCBSin2014.Thethreevolumescanbeaccessedonline.192VolumeIanalysesaspectsofpopulationdynamicssuchasNepal’spopulationsize;growth;distributionandstructure;ageandsexcomposition;marriageandfertility;aswellasmortality,includingmaternalmortalityandmigration.Specifically,asmemberofatechnicalcommittee,UNFPAprovidedtechnicalsupporttoCBSandthePopulationDivisionoftheMoHtoworkonnationalandsub‐nationalpopulationprojectionsbasedonthecensusresults,whichresultedintheinclusionofpopulationprojectionsfortheperiod2011‐31.UNFPAalsoenabledthemissionofaseniorM&EadvisortohelpCBSundertakeanestimationofthematernalmortalityratio(MMR),resultingintheinclusionofachapteronmaternalmortality.UNFPAprovidedthesamekindoftechnicalandfinancialsupportforVolumesIIandIIIofthePopulationMonograph.Sofartherehasbeennoformalattempttolookattheusefulnessandthequalityoftheinformationincludedinthethreemonographvolumes.However,theobservedwideuseoftheinformationcontainedinthesevolumesbyresearchers,academiaandplanners/policymakersassertsthequalityandusefulnessofthesepublications.

IND5.1.2&5.1.3Progressinsettingupnewdatabaseshasbeenmodest.InadditiontotheCDROM‐basedNepalInfo,theweb‐basedCensusInfoisanewimportantdatabaseforexpertsandotherinterestedpersonstoaccessandanalysecensus‐relateddata,butitisnotwellknown.Otheranticipateddatabasesarestillunderdevelopment.CP7envisagesanincreaseinthenumberofdatabaseswithpopulation‐baseddataaccessiblebyusersthroughweb‐basedplatforms.193Thetargetwastocreate/strengthenfournewdatabases:CensusInfo,

191 CBS 2012: National Population and Housing Census 2011, Vol. 1, National Report, p10. See http://unstats.un.org/unsd/demographic/sources/census/wphc/Nepal/Nepal‐Census‐2011‐Vol1.pdf. 192 See http://cbs.gov.np/sectoral_statistics/population/populationmonographnepa_2014. In English. 193 CPAP 2013‐17 Outcome 3 Output 2 Indicator 2.

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DistrictHealthInformationSystem(DHIS),PopulationManagementInformationSystem(PMIS)andtheDistrictPlanning,MonitoringandAnalysisSystem(DPMAS)194.Asofnow,progresshasbeenmodest.Onlyoneisfunctional,butnotwellknown.UNFPAcontinuedtosupportthepublicationofNepalInfoonCD‐ROMtofacilitateawiderdisseminationofdisaggregatedcensusdatabyreachingthosewhodonothaveaccesstotheinternet.195ThelatestreleaseofthisdatabaseisNepalInfo2014.Itisconsideredauser‐friendlydatabasethatcaneasilyproduceawidevarietyofdatatables,graphsandmaps.TheCD‐ROMcontainsdatafordifferenttimeperiodsthataredisaggregatedbysexandadministrativeandgeographicareaswhereverdataareavailable.WithUNFPAsupportatotalof150personsfromthedistrictsweretrainedonNepalInfo.In2013,UNFPAsupportedaweek‐longmastertrainingoftrainersforeightCBSofficialsontheCensusInfodatabasetool.In2014,andwithUNFPAsupport,CBSlaunchedtheCensusInfodatabasesoftwarepackagefordisseminating2001and2011censusresultsonCD‐ROMandontheweb.196Theuser’sperspectiveonthisdatabasehasnotbeenformallyassessed,butkeyintervieweesconsideredituser‐friendlyandconfirmedthatiteasilyproducesawidevarietyofdatatables,graphsandmaps.AsofAugust2016,270localusers/plannershadbeentrainedonitsuse.However,mostintervieweesatcentralanddistrictlevelwereunawareofthisnewdatabase.Theyhadnotuseditandwereunabletotalkaboutitsusefulness.Furthermore,thedevelopmentoftheDHISwasinitsfinalstageswithtechnicalandfinancialassistancefromUNFPA,WHOandtheUniversityofOslo,accommodatingNepalifeatures.Atthetimeoftheevaluation,preparationsforitsestablishmentwerenearlycomplete:thesoftware/databasewasreadyandtheGoNwasplanningitslaunch.197NotmuchprogresshasbeenreportedontheestablishmentorthefunctionalizationofthePMIS.

IND5.1.4UNFPAhasnothelpedmoreministerialstatisticsunitstoproduceevidence‐basedanalysesonA&Y,SRH,GBV,GEandsocialinclusionbeyondtheCentralBureauofStatisticsandtheMinistryofHealth.Aspartofthere‐alignmentexercise,UNFPAcommittedtoincreasingthenumberofnationalstatisticalauthoritiesthathavethecapacitiestoanalyseandusedisaggregateddataonA&Y,SRH,GBV,GEandsocialinclusion–upfromtwo(CBSandtheMoH)toseven–i.e.,CBS,MoH,MoFALD,MoWCSW,MoYS,MoPEandtheMinistryofScienceandTechnology.198LatestUNFPAmonitoringdatarevealnoprogress.However,whileUNFPAhasnotexpandeditssupporttootherministries,ithascontinuedtobuildthecapacitiesofCBSandtheMoHtoanalyseandusedisaggregateddataonA&Y,SRH,GBV,GEandsocialinclusion.AnumberofpublicationsandreportsbyMoHandCBS,includingthePopulationMonographs,areevidenceofthissupport.

IND5.1.5EspeciallyCBSisinabetterpositiontosustainitsoperations,butitstillrequiresexternalfinancialandtechnicalsupport.Upcomingadministrativereformsatsub‐nationallevelwillnecessitatestrongerdatagathering,analysisandmanagementinthepublicsector.InNepal,theneedfordatacollectionandanalysishasbeenincreasingandwideninginrecentyears;itwillcontinuetodoso,includingbecauseofnewdatabasesthatneedtobefedandbecauseoftheexpecteddecentralizedadministrativereforms.Despiteenhancedcapacities,CBScontinuestorequirefinancialandtechnicalsupportforfurthercensusanalysesandforsustainingthecensusdatabasesystem.CBS,andotherstatisticunits,alsodependoncontinuedsupportfromexternalsources,includingUNFPA,forotheractivitiessuchasconductingsurveys,dataanalysis,reportpreparationanddissemination,capacitybuilding/training,logisticssupportandtechnicalinputs.

194 DPMAS is discussed in detail below: Planning and reporting at district level. 195 Outcome 3: Round IV Data Collection Study, 2016. 196 Available at: http://dataforall.org/dashboard/nepalcensus/. 197 Outcome 3: Round IV Data Collection Study, 2016. 198 Outcome 3: Round IV Data Collection Study, 2016. CPAP Outcome 3 Output 2 Indicator 3.

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A.5.2Policy making and planning at national level

IND5.2.1UNFPA‐supporteddataanalysis,capacity‐buildinginitiativesandadvocacyeffortshaveinfluencedmajorpolicydocuments,strategypapersandplans,includingatthehighestlevel.ThenewConstitutionandthe2015NationalPopulationPolicyaretwosuchhighlights.WorkingwiththelegislativehasleveragedUNFPA’spositioning.SincethebeginningofCP7,UNFPAhasbeencontributingtopolicyandplanformulationprocessesatthenationallevel.Aspreviouslyseen(A.5.1),UNFPAhascontributedtodatagenerationandanalysesonpopulation,SRH,youthandGBVfornationalpolicymakingandplanning.Since2013theCOhasalso,onnumerousoccasions,builtthecapacitiesofnationalauthoritiestobetterintegrateUNFPA’smandateinNepalipoliciesandplans,includingthroughCDPS/TU.Capacitybuildingcontinuedin2016.KeyrecipientsofsuchsupportwerethePopulationDivisionoftheMoH,NPCandMoFALD.Capacitybuildingactivitiesincluded:provisionoftechnicalexpertise–e.g.,recruitmentofaseniordemographertofacilitatethenewNationalPopulationPolicyformulationprocessatMoH;studytoursandparticipationininternationalconferences‐e.g.,astudytourwasarrangedforPopulationDivision’sofficialstothePhilippines;facilitationofinter‐sectoralconsultations–e.g.,supportfortheNPCduringthepre‐consultationphasefordevelopingthe13thPlan;orientationsandtrainings;andorganizationofconferencesinNepal–e.g.,supportforMoHandCDPS/TUtoorganizethefirstNationalPopulationConferenceinKathmanduin2014.199UNFPAalsotargetedstakeholdersoutsidethebureaucracy.Forinstance,in2014,UNFPAtrained84nationaljournaliststobettercoverpopulationissues.In2014‐15,itprovidedfinancialandtechnicalsupportforestablishingandoperationalizingtheNationalForumofParliamentariansonPopulationandDevelopment(NFPPD),which,inpartnershipwithUNFPA,hassuccessfullyadvocatedforpopulationissueswithinandoutsidetheparliament.200There‐alignedRRFcommitsUNFPAtoincreasingthepercentageofnewnationaldevelopmentplansthataddressPDbyaccountingforpopulationtrendsandprojectionsinsettingdevelopmenttargets.201AttheoutsetofCP7,fournationaldevelopmentplansaddressedPD.AccordingtolatestUNFPAmonitoringdata,thetargetofsevenhasalreadybeensurpassed:anadditionalsixnewnationaldevelopmentplanshavebeenadoptedbytheGoN,withUNFPAcontribution.202TheyarethePopulationPerspectivePlan2010‐2031,the13thPlan2013/14‐2015/16,theNationalHealthPlan2014andtheNepalHealthSectorStrategy2015‐20203,theNationalPopulationPolicy2015,andthe2015ConstitutionofNepal.204Inparticular,UNFPAanditspartnerscontributedtotheformulationandendorsementbytheGoNofarights‐basedandinclusiveNationalPopulationPolicyin2015.ThedesignandformulationofthePopulationPolicywasbasedontheUNFPA‐supportedNationalPopulationPerspectivePlan2010‐31.Moreover,advocacywithnationalparliamentariansledtotheinclusionofsafemotherhoodandRHasafundamentalwomen'srightandofthetermpopulation“management”inthenewConstitutionofNepal.ThiswasthefirsttimeinthehistoryofconstitutionmakinginNepalthattheseissueswererecognizedasfundamentalrights.Basedondocumentanalysisandinterviews,theevaluationteamwouldliketoaddothers.InlinewiththeRRF,UNFPAsupportisalsoreflectedinothermajorpolicyandplans(Annex8),includingthe14thPlanApproachPaper

199 http://nepal.unfpa.org/publications/first‐national‐population‐conference‐2014‐post‐conference‐proceedings. 200 NFPPD has created four sub‐committees: Local Development and Accountable Governance, Gender Equality and Women Empowerment, Children and Youth Concern, and Senior Citizen Welfare Concern. Source: NFPPD Introductory Booklet. 201 CPAP 2013‐17 Outcome 3 Indicator 3. The following analysis is limited to the work under the PD component. Similar work under the other CP7 outcome areas is reflected elsewhere in the report. 202 One pre‐dates CP7. 203 This report talks to these health‐focused national policy documents under EQ3. 204 Source: UNFPA Outcome 3: Round IV Data Collection Study, 2016.

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2016/17‐2018/19,the2015NationalYouthPolicyandtheYouthVision2025and10‐YearStrategicPlan2015.

IND5.2.2&5.2.3Eightnational‐levelgovernmentagenciesareimplementingprogrammesthatrespondtopopulation,SRH,youthand/orGE,againstfiveatthebeginningofCP7.However,notallwereinfluencedbyUNFPA;thisisonlyaroundaquarterofallexistingagencies;andUNFPAisnotlikelytoreachitstarget.Atthesametime,despiteUNFPA’sefforts,thepercentageofthenationalbudgetallocatedforpopulation,SRH,youthandGEdeclinedconsiderablyfrom10.5%inFY2012‐13to3.1%inFY2015‐16insteadofincreasingtothetargeted15%.InFY2015‐16,theNepalicentralgovernancesystemconsistedof30ministriesandonelineagency(CBSundertheNPC).205Ofthose,eighthadimplementedpartoftheirannualworkplansandbudgetsrespondingtopopulation,SRH,youthandGBVissues–upfromfivein2012‐13(Table11).TheCP7targetforend2017is15.206ItcanbeassumedthatUNFPAfirstandforemostinfluencedsixofitsclosegovernmentpartnersastheevaluationteamdidnotcomeacrossevidenceofinfluenceontheothertwo.Theagenciesreportedlyimplementingprogrammesonpopulation,SRH,youthand/orGBV/women’sempowermentinFY2015‐16werefirstandforemostUNFPAclosegovernmentpartners–i.e.,MoH,MoWCSW,CBS,MoPE,MoYS,andMoFALD.UNFPAprogrammaticsupportfortheseagenciesmainlyfocusedonpolicydevelopment,coordination,capacitybuilding,youthparticipationanddevelopment,anddataandresearch.TheothertwoaretheMinistryofLandReformandManagementandtheMinistryofInformationandCommunication.207UNFPAintendstoinfluencethepercentageofnationalbudgetallocatedforpopulation,RH,youthandGBVissues.208AvailabledataindicatethatinthebaselineperiodpriortoCP7implementation,10.5%ofthenationalbudget(NPR35.6m)wasallocated.In2016,allocationsdecreasedto3.1%(NPR38.1m)(Table11).Nobreakdownisavailableforthedifferentissues.209NoplausibleexplanationexistsforthedeclineinthethirdyearofCP7implementation(FY2014‐15).TherearetwomainreasonsforthefurtherreductioninbudgetallocationsinFY2015‐16.First,duetothemassiveearthquakeinApril2015,plannedbudgetswerereallocatedtoemergency‐relatedprogrammes.Second,thereorganizationofsomeoftheministryandnationallineagencieslateronin2015resultedintherestructuringofprogrammesandbudgets.

Table 11: # of Ministries/Line Agencies Implementing Programmes on Population, SRH, Youth and GBV and % of National Budget Allocated

CP7 Indicators BaselineFY 2011/12

Nepali Fiscal Year CP7 Target2017 FY

2012/13 FY 2013/14

FY 2014/15

FY 2015/16

Total # of ministries/line agencies working at the national level

27 27 27 27 31 ‐

# of ministries/line agencies implementing programmes on population, SRH, youth and GBV at national level, with UNFPA contribution

5 5 7 7 8 15

205 In FY 2015‐16 the GoN initiated a ministerial restructuring process. As a result, the total number of national‐level ministries and line agencies increased from 27 at the beginning of CP7 to 31. 206 CPAP Outcome 3 Output 1 Indicator 1: # of key sectoral ministries that have implemented their annual work plans and budgets responding to population, ASRH, youth and GBV issues, including in emergencies. Sources: UNFPA Outcome 3: Round IV Data Collection Study, 2016; August 2016 monitoring data. 207 Sources: Outcome 3: Round IV Data Collection Study, 2016. 208 CPAP 2013‐17 Outcome 3 Indicator 1. 209 UNFPA Outcome 3: Round IV Data Collection Study, 2016.

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% of national budget allocated for population, RH, youth and GBV, with UNFPA contribution

10.5% 4.5% 9.1% 5.8% 3.1% 15%

Source: UNFPA: Outcome 3 Round IV Data Collection Study, 2016; August 2016 monitoring data

A.5.2Policy making and planning at district level

IND5.2.4ThenumberofdistrictsusingUNFPA‐supportedcensusandnationalsurveysintheirplanningprocesseshasincreasedconsiderably,butisstillratherlow.Moreover,useisonlypartial.UNFPAexpectstoincreasethenumberofitsprioritydistrictsthatusedatafromcensusandnationalsurveysintheirDistrictDevelopmentAnnualPlans.210LatestUNFPAmonitoringdatashowsthatonlysevenofthe18UNFPA‐supporteddistrictshadutilizeddata,andthisonlyforselectedkeyICPDindicators–i.e.,CPR,ANCvisits,andtotalHIVcases.211However,theevaluationteamnotedthatthisnumberwasupfromzero.DDCsalsodevelopfive‐yearPeriodicDistrictDevelopmentPlans.AsofOctober2016,10districtsoutof18weredevelopingtheirPeriodicPlans.DatafromUNFPA‐supportedcensusandnationalsurveyshavebeenonlypartiallyutilized.Interviewsrevealedconsiderableimportancegiventoevidence‐basedplanning.Unavailabilityofupdatedanddistrict‐disaggregateddatawasthemainreasonfornon‐utilizationofdataforallkeyindicatorsinplanningprocesses.212

IND5.2.6Contrarytothenationallevel,thepercentageofdistrict‐levelbudgetallocationsforpopulation,SRH,youthandGBV/women’sempowermenthasincreasedconsiderablyacrossUNFPA’sprioritydistricts,withUNFPAcontribution.Inparallel,UNFPAexpectedanincreaseinDDCbudgetsforpopulation,RH,youthandGBV.213Theevaluationteamnotedasteadyincrease‐fromanaggregatedverylow1.7%acrossUNFPAprioritydistrictsinFY2011‐12to6.4%in2016.Combinedannualbudgets(DDC,DHO,DEO,andWCO)reached12.8%,upconsiderablyfrom3.5%(Table12).UNFPAfinancialsupportandthepresenceofUNFPADistrictProgrammeOfficersareassumedtohaveplayedarole.Whilethetargetforcombinedbudgetsisinsight,thetargetforDDCbudgetsseemsoutofreachwithinthedurationofCP7.

Table 12: % of DDC Budgets for Population, RH, Youth and GBV in UNFPA‐supported Districts

CP7 Indicators BaselineFY 2011/12

Nepali Fiscal Year CP7 Target 2017

FY 2012/13

FY 2013/14

FY 2014/15

FY 2015/16

% of DDC budgets allocated for population, RH, youth and GBV issues in 18 UNFPA programme support districts214

1.7 3.8 4.3 6.2 6.4

18.0

% of district budgets (combined budgets of 4 government line agencies ‐ DDC, DHO, WCO and DEO) allocated for population, RH, youth and GBV issues in 18 UNFPA programme support districts

3.5 5.9 7.0 11.9 12.8 15.0

Source: UNFPA Outcome 3: Table 10, Round IV Data Collection Study, 2016

IND5.2.5AuthoritiesinUNFPAprioritydistrictshavenotreportedonICPDindicatorsinacomprehensivemanner.NonehavereportedbasedontheDistrictPlanning,Monitoring 210 CPAP 2013‐17 Outcome 3 Output 2 Indicator 1. 211 UNFPA August 2016 monitoring data; UNFPA Outcome 3 Round IV Data Collection Study 2016. 212 UNFPA Outcome 3 Round IV Data Collection Study 2016. 213 CPAP Outcome 3 Indicator 4. 214 UNFPA Outcome 3: Table 10, Round IV Data Collection Study, 2016, p28.

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andAnalysisSystem,revisedandre‐introducedwiththesupportofUNFPAandUNICEF.DuringCP6,preparatoryworkswerebeingcarriedouttorevisetheDistrictPlanning,MonitoringandAnalysisSystem(DPMAS).In2013and2014,arevisionofDPMASandanumberofactivitieswerecarriedouttorevitalizethesystem.WiththesupportofUNFPAandUNICEF,NPCandMoFALDrevisedtheDPMASguidelinesandsoftwareinconsultationwithotherlineministriesandbasedonfeedbackfromthedistricts.Therevisionresultedinbetterharmonizationoftheguidelinesandsoftwarewiththemonitoringindicatorsandreportingtoolsoflineministriesanddistrictlineagencies.UNFPADistrictProgrammeOfficersorganizedDPMASorientationsfordistrictofficialsinmostUNFPAprioritydistricts.Asaresult,theconcernedDDCswereabletosubmitDPMASfirstreportstoMoFALD.Orientationscontinuedin2015,butwereinterruptedbytheeffectsoftheearthquakeandadversepoliticalsituation.Irrespectiveoftheseefforts,DPMAShasnotbeenoperationalizedinthemajorityofUNFPAprioritydistrictsduetoseveralfactors,includingfrequentchangesofDPMASsoftwareandguidelinesbyMoFALD,lackofownershipbylineministries,lackoffollow‐upandsupervisionbyMoFALD,frequenttransferoftrainedstaff,andweaklogistics.TherehasbeengoodprogressinmakingDPMASfunctionalinSindhulidistrict.OrientationonnewsoftwarewasconductedinSindhulianddistrict‐leveldevelopment‐relateddataforathree‐yearperiodentered.Itwasalsoreportedthatdistrict‐leveljointmonitoringofdevelopmentactivitieswasinitiatedutilizingDPMASandthatthedistrictwasplanningtomakeDPMASaweb‐basedsysteminthenearfuture.215AspecialefforthasalsobeenmadetorevitalizeDPMASinUdayapurandMahottaridistricts.However,noneoftheDDCshavesofarreportedonkeyICPDindicatorsusingDPMASdataandinformation.216Ultimately,ananalysisofdistrictannualreportsrevealedthatnoUNFPAprioritydistricthasreportedonallkeyICPDindicators.217Ofthe18prioritydistricts,fivehadreportedonCPR,sevenonANCvisits,sixonSTI,andsevenonHIVcases.Furthermore,threedistrictshadcoveredotherindicatorssuchaswomenrepresentationindistrictcouncils,womenrepresentationinpublicserviceandGBVcases;onedistricthadreportedontheratioofboystogirlsinsecondaryleveleducation.218

IND5.2.7ThesustainabilityofimportantpolicyandplanningprocessesforadvancingtheICPDagendaisaffectedbypoliticaluncertainties.Thedevelopmentofthe2015NationalPopulationPolicyandthe13thNationalPlanwerebasedontheUNFPA‐supportedlong‐termPopulationPerspectivePlan2010‐31.The14thPlanApproachPaper(2016/17‐2018/19)andotherpolicy/plansweredrawnup,withUNFPAcontribution,basedonthePopulationPolicyandothersectoralpoliciessuchastheNationalHealthPlan,theNHSSandtheNationalYouthPolicy.In2015,theGoNinitiatedtheprocessofdevelopingaNationalPopulationAct,whichwasmeanttoprovidemoreclarityonvariousaspectsrelatedtopopulation,SRH,youthandGBV.Thisprocess,however,hasbeendelayedindefinitely,mostprobablyduetothecurrentpoliticalsituationandthenon‐clarityonwhenandhowthestaterestructuringprocesswillproceedandthetimingforthenewstructuretobeputinplace.

A.5.3Participation of young people and vulnerable women in policy making and planning

IND5.3.2Collaborationwithyouth‐ledNGOsandtheMinistryofYouthandSportshasfacilitatedparticipationofyouthincentral‐levelpolicymakingandplanning.UNFPAwasinstrumentalintherecentestablishmentofaNationalYouthCouncilanddistrictyouthcouncils.RRFOutcome3Output3reads“Strengthenedcapacityofnetworksforyouthandforvulnerablewomenatcentralandlocallevelstoinfluencedevelopmentpolicies,plansand

215 UNFPA Outcome 3 Round IV Data Collection Study, 2016. 216 CPAP 2013‐17 Outcome 3 Output 2 Indicator 2. Source: UNFPA August 2016 monitoring data. 217 CPR; ANC visits; SBA use; STI and HIV cases; women representation in district council and public services; total GBV cases; and ratio of girls to boys in secondary level education. Source: UNFPA Outcome 3 Round IV Data Collection Study, 2016. 218 Source: UNFPA Outcome 3 Round IV Data Collection Study, 2016.

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budgets”.UNFPAhassupportedyouthparticipationatcentrallevel.Butforlackofanindicator,ithasnottrackeditscontribution.UNFPAhascollaboratedwiththeGoNandcivilsocietytoincreaseyouthparticipationincentral‐levelpolicymakingandplanning,mainlywiththeUNYouthAdvisoryPanel(UNYAP),RestlessDevelopmentandtheMoYS.DuringCP7,UNFPAprovidedsupportonvariousoccasionsforUNYAPtobeheardandhaveaninfluence(Box4).

Box 4: UNFPA Support for UNYAP Influence on National Policies and Plans

SupportforadvocatingyouthissuesinotherUNagencies ConsultationwithUNagenciesonSDGlocalizationprocess Celebrationofinternationaldays Networkingwithnationalandinternationalyouthnetworks/groups Mappingofyouthnetworks/agenciescurrentlyworkinginNepal

Sources: UNYAP; UNFPA

Theyouth‐ledNGORestlessDevelopmententeredintopartnershipwithUNFPAin2012.WithUNFPAsupport,itcontributedtothereport“NepaliYouthinFigures”andestablishedayouthdatabase.ItintroducedtheYouthScoreCard,whichisregardedasaneffectivemechanismforassessingtheUNCT’sprogrammefromayouthperspectiveandasaneffectiveadvocacytool.219UNFPAhasworkedwiththeMoYSsincethebeginningofCP7.In2013,UNFPA,alongwithothers,providedtechnical,financialandmaterialsupportforelaboratingtheNationalPlanofActionfortheHolisticDevelopmentofAdolescents.Itfacilitatedtheconsultationof2,000adolescentsfromacrossthecountry.In2013‐14,UNFPAsupportedyouthparticipationintheMoYS‐ledprocesstoelaborateaNationalYouthPolicyandImplementationPlanaswellastheYouthVision2025.InOctober2016,theNationalYouthPolicyImplementationPlanwasfinalized.Intervieweesagreedthattheseweregoodachievementsthatpavedthewayforamorefocusedapproachtoyouthdevelopment.In2014,UNFPAprovidedsupporttoMoYSforfurtheranalysingcensusdataonadolescentandyouthpopulation.Thereportwaspublishedin2014as“NepaliYouthinFigures”.In2015,UNFPAinitiatedtheNationalAdolescentsandYouthMDGCharter,whichwaslaunchedaspartofthepost‐2015AgendaandsharedwiththeUNGeneralAssemblybytheMoYS.UNFPA,togetherwithUNICEFandRestlessDevelopment,hadconductedextensivedistrict‐levelconsultationswithover500A&Yacross41districtsbeginningin2013.TheCharterisconsideredareferencedocumentfordraftingpolicies,developmentplansandprogrammesthataffectyoungpeople’slives.In2015,UNFPAwasinstrumentalinsupportingtheestablishmentbytheMoYSofaNationalYouthCouncilinKathmanduandyouthcouncilsin64districtsofNepal.Status,functions,fundingandworkingmodalitiesarenotyetclear.Lastbutnotleast,UNFPAhasenabledanumberofgovernmentalandnon‐governmentalstakeholderstoparticipateininternationaltrainingsandforumsin‐andoutsidetheUNsuchastheSpecialSessionoftheCommissiononPopulationandDevelopmentonICPDbeyond2014inNewYork,thefirstGlobalForumonYouthPoliciesinAzerbaijan,theUNECOSOCYouthForumonTransitionfromtheMDGstotheSDGsinNewYork,andtheSAARCRegionalDialogueonPromotingYouthParticipationintheImplementationoftheSDGs.

IND5.3.1&IND5.3.3UNFPAhasorganizedyouthinitsprioritydistricts.Youthareincreasinglyvocalindistrictdevelopmentprocessesthroughyouthnetworkmembers.Youthrepresentativesweremainlymaleandnotmanywerefromdisadvantagedgroups;theirageisnotknown.UNFPAhasnotworkedwithvulnerablewomeninanorganizedmannersimilartoyouthnetworks.UnderCP7,UNFPAcommitteditselftoincreasingthepercentageofyouthfromdistrict‐levelyouthnetworksinitsprioritydistrictswhoparticipateinlocalgovernmentplanningprocesses–morepreciselyinDDCCouncilmeetingsandDistrict

219 Restless Development. UNCT Nepal, Youth Score Card, 2009: https://www.google.com/search?q=What+is+youth+score+card%3F&ie=utf‐8&oe=utf‐8&client=firefox‐b.

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IntegratedPlanningCommittee(DIPC)meetings.220Overall,accordingtoUNFPAmonitoringdata,youthwerehardlyvisibleindistrict‐levelplanningprocessesatthebeginningofCP7.Sincethattime,youthparticipationhasshownanincreasingtrend(Table13),andthetargetof20%islikelytobemet:inFY2015‐16youthnetworkmembersrepresented16.3%ofallDDCcouncilmeetingparticipantsand21.4%ofDIPCparticipants.Dataisavailablebysexandbydisadvantagedgroups:theyshowthatyouthwerelessrepresentedbyyoungwomenthanbyyoungmen.221Youthcategorizedasbelongingtodisadvantagedgroups222wereevenlesspresent.223Dataontheageofyouthnetworkmemberrepresentativesisnotavailable.

Table 13: % of Youth Network Member Participation in District Planning

CP7 Indicator BaselineFY 2011/12

Nepali Fiscal Year CP7 Target 2017

FY 2012/13

FY 2013/14

FY 2014/15

FY 2015/16

% of youth network member participation in DDC council meetings

1.4

2.1 5.2 16.7

16.3 20.0

% of youth network member participation in DIPC meetings

1.7

13.1 2.5

17.4 21.4

20.0

Source: UNFPA Outcome 3 Round IV Data Collection Study, 2016

Toincreaseyouthparticipation,UNFPAhasnotonlybuiltthecapacitiesandfacilitatedtheparticipationofexistingyouthnetworks comprisingvariouslocal‐levelyouthgroups.Beginningin2013,ithelpedinitiateandformnewyouthnetworksinitsprioritydistrictsandatthelevelofVDCs.AsofOctober2016,atotalof504youthnetworkshadbeenformedwithatotalmembershipof7,519youthinallUNFPAprioritydistricts.UNFPAcapacitybuildingforyouthnetworkshasbeenimplementedbyRestlessDevelopment.Youthnetworkmembershavebeentrainedonlocal‐levelplanningprocesses,results‐basedmanagement,monitoringandevaluation,andevidence‐basedadvocacy.Othergoodexamplesofyouthempowermentwerefoundinthedistrictsvisitedbytheevaluationteam.InDang,UNFPAsupportedtheestablishmentof“Illaka”levelYouthInformationCentres.224InSindhuli,youthnetworkrepresentativesarenowrepresentedonWCFs.UNFPA‐supportedyouthnetworksarealsobeingconsultedbydistrictstakeholdersotherthanDDCs‐forexample,youthnetworksinDangandRukumwereconsultedbylocallineagenciesanddevelopmentpartnerswhenplanningandreviewingtheirprogrammes.UNFPAhasnotworkedwithvulnerablewomeninanorganizedmannersimilartoyouthnetworks.CP7Outcome3Output3reads“Strengthenedcapacityofnetworksforyouthandforvulnerablewomenatcentralandlocallevelstoinfluencedevelopmentpolicies,plansandbudgets”.Asconcernscivicrepresentationofvulnerablewomen,theRRFcontainsnoperformanceindicator;therefore,nomonitoringdataisavailable.InterviewsanddocumentanalysisrevealedthatUNFPAhasnotimplementedaprogrammetostrengthenandcreatevulnerablewomennetworkssimilartoyouthnetworks.ThroughUNFPA’sparticipationinandsupportfortheLGCDP,itssupportforyouthnetworks,anditsempowermentactivitieswithcommunity(demand‐side)institutionssuchasWCFsandCACsonissuesaroundGBV,SRHandchildmarriage,ithas,however,indirectlycontributedtobottom‐uprepresentationofwomen’sinterestsinlocalgovernance.Accordingtothe2016LGCDPAnnualReport,“women'sinvolvementinlocal‐levelaffairs…seem[s]highlyencouraging”.

220 CPAP 2017 Outcome 3 Output 3 Indicator 1. 221 Young women accounted for 22% of youth network representatives in DDC council meetings and around 19% in DIPC meetings in 2015/16. 222 Defined as a group of people who are considered either socially and or economically deprived. http://daginfo.deprosc.org.np/StartPage.aspx. 223 Youth from disadvantaged groups accounted for 5.2% of youth network representatives in DDC council meetings and around 8.5% in DIPC meetings in 2015/16. There is no breakdown by gender. 224 “Illaka” is a sub‐district level electoral boundary that consists of several VDCs.

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IND5.3.4SustainabilityofUNFPA‐supportedyouthparticipationisnotsecured.UNFPA’sprimaryfocusfromthebeginningofCP7hasbeenatsub‐nationallevel.Youthnetworkmembershavebeencapacitatedtotheextentthattheyareabletoclaimparticipationindistrictdevelopmentprocesses.YouthparticipationinDDCandDIPCmeetingshasbeenformalizedwithDDC‐leveldecisions.Fromthispointofview,benefitsarelikelytobesustainable,atleastintheshortrun.However,youthnetworksarelooseforumswithnolegalbasis.Also,keyinformantsnotedthatworkingwithyoungpeoplecanbechallenging:individualsmoveinandoutoftheyouthagebracketandaremobile.Althoughyouthparticipationindistrictdevelopmentprocessescurrentlyshowsanincreasingtrend,includingthankstoUNFPA,theextenttowhichrepresentativesoffutureyouthgenerationswillbewillingandabletoparticipateisanunknown.

EQ6EmergencyPreparednessandResponse:Towhatextentwas(is)UNFPA,alongwithitspartners,likelyandabletorespondtocrises?

ThisevaluationquestiondelvesintotheeffectivenessofUNFPA’semergencypreparednessandresponse.Twoassumptionsassessthisquestion.ThefirstcoversUNFPA’seffectivenessinsupportingthecountrytoprepareforadisasteroremergency.ThesecondpresentsUNFPA’scontributiontohumanitarianactionin14districtsafterthemassiveearthquakeinApril2015.Emergencypreparednessandresponsearealsodiscussedundertheaddedvalueevaluationcriterionbelow(A.9.2).

A.6.1UNFPA’s contribution to enhanced emergency preparedness in Nepal

IND6.1.1MoreUNFPAprioritydistrictshaveincorporatedMISPintheirDisasterResponsePlans,includingthankstoUNFPA.TostrengthenNepal’semergencyresponsepreparedness,theCOhasinsomeinstancesevenfocusedonvillage‐leveldisasterpreparedness.OneoftheoriginalCP7targetsistoincreasethenumberofUNFPAprioritydistrictswithcontingencyplansthatincorporateMISP,GBVandASRHcomponents.225In2014,theUNFPACOhadreportedthatDistrictDisasterReliefCommittees(DDRCs)lackedcommitmentandfundstoprioritizeSRHandprotection.LatestCOmonitoringdatarevealthatDistrictDisasterPreparednessandResponsePlans(DPRPs)forall18UNFPAprioritydistrictsarenowsensitivetotheseissues.Interviewsinallfourdistrictsconfirmedthatthiswasindeedthecase.NumerousrepresentativesofconcerneddistrictauthoritiesconfirmedthatUNFPAsupport,includingfunding,technicaladviceandtrainingsforDDRCmembers,hascontributedtothisstrongeremphasisonMISP,GBVandASRHinDPRPs.InDang,UNFPAiseventheassignedDistrictLeadSupportAgencyinsupportoftheDDRC.226ConcernedUNFPAstaffascribedthisparticularstatustothepresenceoftheRSOinthedistrict,stronglocalstaffcompetenciesinemergencypreparednessandUNFPA’scomparativeadvantageinpopulationdynamics.However,theyfounditnotonlyanopportunitytostrengthentheorganization’sreputationasahumanitarianagency;itisalsoanadditionalburdenforstaff.AdeskreviewofthelatestandupdatedDPRPsforthesedistricts227revealedinclusionofissuesrelatedtoUNFPA’smandate:districtshaveincorporatedMISPandGBVintheirPlans;aswellashealthandnutrition,protection/emergencyshelterandASRH.SindhulihasincorporatedGBVandhealthandnutrition.UNFPAislistedasaplayerinallfour.DisasterresponsepreparednessinNepalisfour‐tiered:Besidesnational,regionalanddistrict‐levelstructures,VDCsarealsoresponsiblefordisasterpreparednessandresponseatlocallevel.228KeyinformantinterviewsinBaitadirevealedthatsub‐districtawarenessandcapacities

225 CP7 Outcome 1, Output 1, Indicator 4. 226 This is the only district where UNFPA has been appointed as DLSA. 227 DPRPs of Sindhuli (FY 2013‐14); Sunsari (FY 2014‐15); Dang (FY 2015/16); Baitadi (FY 2015‐16) 228 NDRF, July 2013.

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were“poor”,“lacking”,“low”,aparticularproblemgiventhegeographicalremotenessanddifficultaccessibilityofmanyVDCs.InSunsari,healthserviceproviderssuggestedtocreatemoreawarenessandcopingskillsamongcommunitiesandserviceprovidersin19flood‐proneVDCsadjacenttotheKoshiRiver.Inplaces,UNFPAhasrespondedtolocal‐levelneeds:inSindhuli,UNFPA‐supportedorientations/trainingsforLocalDisasterManagementCommittees(LDMCs)indisaster‐proneVDCsreportedlyledtoareactivationofemergencypreparednessactivities.InDang,UNFPAhelpedtoestablishCDRCsinoverhalfadozenVDCs;theyhavestartedpreparingLocalDisasterManagementPlans.AnexternalreviewoftheUNFPAGuidanceNoteonMinimumPreparedness,publishedin2015,foundthatworkingnotonlywithnationalauthoritiesbutalsowithlocalgovernmentstoincludeissuesrelatedtoUNFPA’smandateintheircontingencyplansisagoodpractice.229

IND6.1.1Besidessupportfordisasterresponseplanninginitsprioritydistricts,UNFPAhasalsocontributedtoclustercoordinationinhealthandprotection.Asonekeyinformantsaid,“onlyhavingaplanisnotsufficient”.Tofurtherstrengthenemergencypreparednessandresponse,UNFPAhasthereforealsoparticipatedinthehumanitarianclusterapproachatdistrictlevel.Initsprioritydistricts,UNFPAisamemberofWCO‐ledprotectionclustersandDHO‐ledhealthclusters.Apartfromprovidingtechnicaladvicefordevelopingclustercontingencyplans,ithasmadeavailablefundingtoregularizeclustermeetings.Contrarytoitsrolewithinthenationalprotectionandhealthclusters,UNFPAhasnotplayedaformalleadroleatdistrictlevel.However,thisisabouttochange:therecentlyendorsedNationalProtectionClusterStrategicPlanhasdefinedtheformalco‐leadroleofUNFPAindistrict‐levelprotectionclusterswhereithasaphysicalpresenceandthenecessarycapacities.

IND6.1.2UNFPAhascontributedtoaninclusionofdignitykitsinNepal’semergencyresponsepreparednessstrategy;ithasbeenpartofjointeffortstoscaleupprepositioneddignitykitstoensureeffectiveemergencyresponse.PrepositioningofRHkitsisalsopartofUNFPA’ssupportforemergencypreparedness.

“TheprepositioningofRHkitsanddignitykitsalongwithstrengtheningcoordinationmechanisms,contingencyplanningandcapacitydevelopmentispartofUNFPAsupporttotheGovernmentofNepal’sworkonemergencypreparedness”.GiuliaVallese,UNFPARepresentativeNepal:ReproductiveHealthKitsandDignityKitsAreanImportantComponentofDisasterPreparedness,August22nd2016230

TheimportanceofprepositioninginNepalwasemphasizedbymanyinterviewees.UnderCP7,UNFPAstartedtoprepositionRHkits,somethingithadnotdoneunderCP6.TheApril2015earthquake,however,seemstohavebeenabigwakeupcall,andUNFPAalsostartedprepositioningdignitykitsandotheremergencyreliefitems.Theneedforadequateandup‐scaledprepositioningofemergencysupplies,notjustbyUNFPA,wasunderscoredininterviews.Veryrecently,theprotectioncluster,co‐ledbyUNFPA,agreeduponminimumstandardsanddefinedthecontentsofdignitykitsinthe2016NationalProtectionClusterStrategicPlan.PrepositioningisthusajointundertakingoftheGoNandhumanitarianorganizations.UNFPAhascontributedaminimumamountofdignitykitsinsome,butnotall,ofitsprioritydistrictsforthecaseofsmall‐scaleemergenciessuchasfiresandlandslides.TheyarestoredattheWCOs.Forlarge‐scaleemergencies,theCOhasalsoprepositionedalimitedamountofdignityandRHkitsandothercommoditiesatstrategicpointsinKathmanduandthroughoutitsgeographicalclusters–i.e.,inUNFPARSOsandhospitalsmanagedbytheNRCS.231Fundinglimitationsaswellasinadequatestorage,logisticalandmanagementcapacities,includingexpiryissues,influenced

229 Guidance Note on Minimum Preparedness Review, Findings and Recommendations, Draft, December 2015, p12. 230 Press release downloaded from http://www.unfpa.org/transparency‐portal/unfpa‐nepal. 231 Giulia Vallese: Reproductive health kits and dignity kits are an important component of disaster preparedness, August 22nd 2016 (press release downloaded from http://www.unfpa.org/transparency‐portal/unfpa‐nepal).

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decisionsaboutwhereandhowmanykitstopreposition.Aprepositioningstrategy,includinginventory,ispreparedonayearlybasisforHQapproval.AccordingtothecorporateUNFPAdignitykitguidelines232,prepositioningdignitykitsisadvisableforcountriesfacingrecurringdisasters;maintaininga“safetystock”ofprepositionedkitsin‐countryhasbeenshowntogreatlyimprovethetimelinessoftheemergencyresponse.Inthefourvisiteddistricts,theevaluationteamobservedthatWCOofficeshadvaryingnumbersofdignitykits,fundedbyUNFPA,attheirdisposal,exceptforBaitadiwherenoneweretobefound.Variousdistrictofficialspointedoutthatmorekitswererequiredforeffectiveemergencyresponsepreparedness.ThisseemstogenerallybethecasethroughoutNepal.ThecontentofthedignitykitswasagreedwiththeGoNtakingintoaccountNepal’ssocio‐culturalcontext:thekitsincludeasari,petticoatandshawl,orkurta,aswellassanitarypads,otherhygieneitemsandaflashlightforprotectionpurposes.However,stakeholdersinSunsariandSindhulireportedthatsomeitemsshouldhavebeenbettercustomizedtolocalclimaticconditions.Safestoragespacewasalsohighlightedasaproblemastheevaluationteamalsoobservedfirst‐handinSindhuliwheresomehadbeendestroyedbyvermin.Ontheprosandcontrasofinvestinglimitedfundinginprocuringdignitykits,onekeyinformantsharedtheviewthatdignitykitsarenotjustsupplies,butanimportantentrypointforconversationswithvulnerablewomenandadolescentgirlsonGBVprevention.TheyalsohelpstrengthentheroleofWCOsasfirstrespondersinhumanitariansituations.UNFPAHQmaintainsastockof13differentessentialRHkits,designedtorespondtothreemonth’sneedforvariouspopulationsizes.TheUNFPANepalCOhasreportedlyprepositionedRHkitsinKathmanduandcleandeliverykits(Kit2A)initsRSOsinordertobeabletorespondrapidlytotheneedsofaffectedpopulationsincaseofanemergency.

IND6.1.3ProvisionismadeforStandardOperatingProceduresonGBVinhumanitariansettingsintheNationalProtectionClusterStrategicPlan.TheSOPsareinthemaking,fundedbyUNFPA.In2015,UNFPA,incollaborationwiththeMoWCSW,commissionedNRCStodevelopSOPsonGBVinhumanitariansettings.Atthetimeoftheevaluation,workwasstillpendingorratherpostponedbecauseofdifficultiesidentifyinganationalconsultant.Meanwhile,theNationalProtectionClusterStrategicPlan,whichwasrecentlyendorsedbytheMoWCSW,mentionstheprovisionofGBVSOPsinhumanitariansettings.

IND6.1.4&6.1.5&6.1.6&6.1.7Officials,serviceproviders,youthandNRCSvolunteersweretrainedonMISP,SRHandGBVinemergencysettings.Knowledgehasincreasedthankstosuchemergencypreparednesstrainings.MinistryofHealthRapidResponseTeamsatthecentralanddistrictlevelsarebetterabletocopewithRHissuesduringemergencies,thankstoUNFPA.ThegovernmenthasendorsedaNepaliversionoftheUNFPA/SavetheChildrenASRHtoolkitforhumanitariansettings.District‐levelorientationsandtrainingshavestartedtofamiliarizehealthprofessionals,butcoverageisasyetsmall.UNFPAhascontributedtodevelopingthecapacitiesofhealthserviceprovidersandotherstakeholderssuchascentralanddistrict‐levelDRCmemberstoensurequalitySRHservicesinemergenciesandtoimplementMISP.UndertheHealthCluster,RapidResponseTeams(RRTs)havebeenformedatnationalandregionallevels,inall75districtsofNepalandatthecommunitylevel.WithUNFPAtechnicalassistanceandfunding,EDCDdevelopedanintegratedRRTtrainingpackagewithasessiononMISP.UNFPAhassincesupportedEDCDtrainingsforRRTmembers.TheevaluationteamnotedthatparticipantswereselectedfromUNFPAprioritydistricts,but,atofficialrequest,alsofromotherdistricts.UNFPAalsoworkedwiththeNHTCtoadapttheMISPtrainingpackageinNepali.A3‐daytrainingpackagewasendorsedin2015androlledouttonearly400healthserviceprovidersandstakeholders.

232 UNFPA Dignity Kit Programming Guidelines, HFCB/PD, January 2013.

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UNFPA’sworktointroducethetoolkit“ASRHinHumanitarianSettings”233inNepalbeganin2013incollaborationwiththeEDCD,FHDandSavetheChildren,withthesupportofNRCS.FirstorientationsusingaNepalitranslationoftheASRHtoolkitwereconductedbyNRCSin2014.ThetoolkitwasformallyadoptedbyFHDin2015andhasbeenimplementedin12districts,includingearthquake‐affectedones.ParticipantswereDHOofficials,healthserviceprovidersincludingfromAFHScentres,FCHVsandHFOMCmembers.Besidessuchdedicatedtrainings,ASRHinhumanitariansettingsisalsoastandardcomponentofMISPtrainings.UNFPAhasworkedcloselywiththeDWCandNRCStotrainofficials,governmenthealthprofessionalsandothersinKathmanduandthe18prioritydistrictsonGBVinemergencysituations:In2014,withUNFPA’sfinancialandtechnicalsupport,20nationalprotectionclustermembersandNRCSvolunteersinKathmanduweretrainedbytheNRCSonprotectionandGBVissuesinemergencies.234.Thiswasconsideredcrucial.Asaresult,theleadershipoftheDWCintheprotectionclusterandcollaborationwiththeNRCSreportedlyimproved.Since2014,UNFPAhasalsostrengthenedthecapacitiesofhundredsofhealthserviceprovidersandotherstakeholdersfromDDCs,WCOsandlocalNRCSchapterstoplanforanddealwithGBVinemergencysituationsinitsprioritydistricts.InpartnershipwiththeDWCandNRCS,56personsfromWCOs,DDCsandNRCSfrom18districtsweretrainedinfour‐daytrainingoftrainersonprotectionissuesinemergencyandatotalof395protectionclustermembersandstakeholdersorientedonprotectioninemergenciesin18UNFPAprioritydistricts.Theevaluationteamwasunabletoexplorein‐depththeextenttowhichUNFPAemergencypreparednesstrainingshaveincreasedknowledgeandconfidenceorevenmadeadifferenceincasesofemergency.However,availablequantitativeandqualitativeevidencepaintsapositivepicture.KnowledgeoftrainedRRTmembersandotherhealthserviceprovidersonSRHinhumanitariansettingsandMISPhasincreased.Theyfeelincreasinglypreparedandconfidenttorespondtoemergencies.AsforexamplehealthserviceprovidersinSunsariremarked:“AfterparticipatinginRRTorientation,wearemorecapableofrespondingtodisasters”.Similarly,healthprofessionalsfromSindhulicommendedUNFPA‐supportedtrainingsforincreasingtheirunderstandingandskills.IntervieweesatthevisitedAFHScentresinBaitadiandSunsarihadbenefitedandweresatisfiedwiththeASRHtoolkittrainings,althoughtheywouldhaveappreciatedamorehands‐onapproachandwerenotinpossessionofthetoolkit.NostudieshavebeenconductedtogaugetheextentofknowledgegainthankstoUNFPA‐supportedtrainingsonGBVinhumanitariansettings.Pre‐andpost‐trainingresultsrevealimminentknowledgeimprovements.Interviewsalsopointedtoincreasedknowledge.

IND6.1.8TheimportanceofbeingabletocontinuedeliveringSRHandGBVservicesintimesofcrisesisgenerallyrecognizedandgovernmentsystemsandstrategiesareinplace.However,furtheradvocacyaswellassupportforcapacitybuildingandprepositioningisnecessary.UNFPA’semergencypreparednessprogrammehascutacrosstheSRHandGEprogrammecomponentstosupportplanning,coordination,capacitydevelopmentandprepositioning.UNFPA’ssupportwasembeddedingovernmentstructures,incollaborationwithgovernmentauthoritiesandinternationalandlocalorganizations.EvidencesuggeststhatSRHandGBVareintegralpartsofemergencypreparednessplanningandcoordinationinNepal,atcentral235anddistrictlevels–perhapslesssoatVDClevel.Assuch,sustainabilityofUNFPA’seffortsisensured,alsointheknowledgethattheCOdoesnotintendtowithdrawfromtheclustersystem.AsregardstrainingsandorientationsonMISP,A/SRHandGBVinhumanitariansettings,ahostofindividualshavebenefitedandshouldbeabletousetheirknowledgeandskillsshouldadisasteroccur.RRTandMISPtrainingshavebeeninstitutionalizedandaremanagedbythe

233 Save the Children & UNFPA: Adolescent Sexual and Reproductive Health Toolkit for Humanitarian Settings ‐ A Companion to the Inter‐Agency Field Manual on Reproductive Health in Humanitarian Settings, September 2009. 234 In 2014, 20 protection cluster members and Red Cross volunteers were trained in GBV in humanitarian settings through three‐day training. 235 For instance, the DWC has allocated a budget for protection cluster meetings.

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EDCDandNHTC,whichbodeswellfortheirsustainability.ButmostUNFPA‐supportedtrainingswereplanned,fundedandconductedinindividualdistrictsaspartofAWPswithUNFPAImplementingPartners,andarethereforeonamoreinsecurefooting.TheprocurementandprepositioningofsufficientdignityandRHkitsandreplenishmentofstocksrequiresacontinuousefforttobeabletoeffectivelyandrapidlyrespondtosmallandlarge‐scaleemergencies.AstheGoNcannotsustainthisactivityonitsown,procurementbyUNFPAandotherdevelopmentpartnerswillberequired.

A.6.2UNFPA’s response to humanitarian crises, particularly the April 2015 earthquake

IND6.2.1&6.2.2UNFPAwasakeyactorforprovidingpost‐disasterA/SRHservicesandinformationinthe14earthquake‐affecteddistricts.AconsiderablenumberofvulnerablewomenandgirlswerereachedthankstoUNFPA,includingthroughmobileRHcamps.In2015theRRFwasmodifiedtoincludeindicatorsandtargetsforUNFPA’searthquakeresponse.Amongstothers,indicatorswereaddedtotrackitssupportfortheimplementationofMISPinthe14most‐affecteddistricts236andthenumberofpersons,includingwomenandgirls,reachedthroughRHkitsandSRHservices237.MonitoringdatarevealthattheCOoutperformeditself,althoughsupportwasmodestcomparedwiththenumberofaffectedpersonsandthehugedemandsintheaffecteddistricts‐i.e.,estimated1.4mwomenofreproductiveage,ofwhich93,000werepregnant,10,300expectedtodelivereachmonthand1,500wereatriskofobstetriccomplications.238MonitoringdatarevealthatUNFPAdistributedatotalof1,331RHkitsandtrained163healthworkersontheircontentsanduse;anestimated143,686personsbenefittedfromdrugsandsuppliescontainedtherein.UNFPAalsoorganized132mobile(tent)RHcamps.Mobilecampslastedfor2‐3days.TheyprovidedSRHandGBVservices,information,drugsandcontraceptives,hygienearticles,psycho‐socialcounselling,andincludedspecialspacesforA&Ytoreceiveadviceandcommodities.8‐10youthvolunteerspercampweretrainedtodeliverinformationonASRHinsideandoutsidethecamps.Allinall,RHcampsreportedlycateredfor104,740persons,85%ofwhichwerewomenandadolescentgirls;10,293peopleutilizedUNFPA‐supportedFPservices.2395,000A&Yvisitedthecamps.UNFPAalsoestablishedtransitionhomes(tents)whereitreached1,127pregnantandpostpartumwomen;itsetupmaternitytentsandtentsasbirthingcentres.Furthermore,tofacilitatethecontinuationofcommunityhealthservices,UNFPAcontributedsome3,000motivationalpackagestoFCHVsinthreedistricts(Sindhuli,OkhaldhungaandKathmandu).Thecontentofthepackage‐includingasolarlamp,hygieneitems,clothes,medicinesandotherbasicsupplies–wasagreeduponintheRHsub‐cluster.240In2015,UNFPAalsoexpandedtrainingsonSRHinemergenciesandMISPtoearthquake‐affecteddistricts.Besides163healthworkersorientedonRHkits,100healthserviceprovidersweretrainedonMISP.241UNFPAhascontinuedtoprovidesuchtrainingsoutsideitsprioritydistricts,butatalimitedscale.InSindhulidistrict,UNFPAenabledtrainingforRRTmembersondisasterpreparednessandresponse,includingMISPanduseofRHkits.RHanddignitykitsweredistributedandRHkittrainingprovidedto90healthserviceprovidersfrom24healthfacilities.UNFPAandtheDHOconducted13RHcampsforthose25VDCsidentifiedbytheDDRCtohavebeenmostaffected,coveringnearly12,500persons,ofwhich70%werewomen.TheprovisionofFPservices(mainlyimplant,IUCDandcondoms)andsanitarypads,aswellaspsycho‐socialcounsellingalongwithmedicaltreatmentservicesprovedrelevantandeffective.Dignitykitswere

236 CPAP Outcome 1 Output 1 Indicator 4.1. 237 CPAP Outcome 1 Output 1 Indicator HFCB IRFI3.8. 238 Nepal Earthquake 100 Days into the Humanitarian Response, p5‐7. 239 Source: UNFPA August 2016 monitoring data. 240 http://nepal.unfpa.org/sites/asiapacific/files/pub‐pdf/UNFPANepalEQ_humanitarianresponsereport27August.pdf. 241 UNFPA monitoring data 2016.

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distributedtopregnantandpostpartumwomenaswellasmotherswithchildrenundertwoyears242.ASRHinformationandserviceswereprovided,includingonthetopicofhumantrafficking.UNFPAsupportwasreportedlyprovidedbeforeotherpartnersappearedonthescene.ItproveditselfasthemainorganizationtosupportthehealthsectoronRHandadolescent‐friendlyservices.InGorkha,asimilarpicturepresenteditselfwhereUNFPAwasconsideredthefront‐lineorganizationforsupportingSRHservices.RHcampswereconductedintendifferentlocations.IND6.2.3&6.2.5UNFPA’ssupportforprotectingwomenandgirlsaftertheearthquakewaslargelyintheformofcoordination,procurementandtrainings.ItwentbeyondsupportforthehealthsystemandhealthservicesforGBVsurvivors.Female‐friendlyspacesweremuchappreciated.Thedistributionof56,000dignitykitswasanotherimportantelementofUNFPA’searthquakeresponse,butsomecriticalvoiceswereraisedintermsofquantities,contentsanddistributionmechanisms.ThemodifiedRRFalsoincludedindicatorsandtargetstotrackUNFPA’ssupportforaneffectivehealthresponsetoGBVduringtheearthquake243andthenumberofpersons,includingwomenandgirls,reachedwithGBVservices244.UNFPA’sengagementintheemergencyGBVresponsewaslargelyintheformofcoordination,procurementandtrainings.Theevaluationteamnotedthattheorganization’ssupportforGBVservicestargetedwomen’shealthandwell‐beinginaholisticmanner,andnotonlythroughthehealthsector.Thus,UNFPAmadeavailable14FFSs(tents)toWCOs,oneforeachearthquake‐affecteddistrict,aswellas55,000dignitykitsand600winterizationpackagesfordistributionthroughlocalgovernments,mobileRHcampsandFFSs.245ThroughtheDHOitprovided53post‐rapetreatmentkitstoOCMCsandhealthfacilities.

InthecontextoftheaftermathoftheNepalearthquake,theDWCrequestedtenFFSsineachoftheaffecteddistricts.TheGBVsub‐clusteroftheProtectionClusterdevelopedguidelinesonFFSs,adaptedfromtheUNFPAFemaleFriendlySpacesguidelines.246UNFPA‐supportedFFSsprovidedamulti‐sectoralresponsetoGBVsurvivorsaswellasSRHservices,andintendedtosupporttheresilienceandwell‐beingofwomenandgirlsthroughcommunity‐organizedrecreationalactivitiesconductedinafriendlyandstimulatingenvironment.247Ultimately,theFFSsreachedatotalof124,720womenandadolescentgirls,anaverageofapproximately9,000perdistrict.248427GBVsurvivorswerereferredforvariousmulti‐sectoralservices.InterviewedWCOofficialsinSindhuli,GorkhaandSindhupalchowkhighlyappreciatedtheFFSs,whichtheyconsideredinnovativeandbeneficial.ItwassuggestedthatcoverageshouldbeforentiredistrictsandnotonlyselectedVDCs.TheevaluationteamvisitedthelocationoftheFFSinSindhuli.TheFFShadcateredformorethan750earthquake‐affectedwomenandadolescentgirls.TheWCOandbeneficiariesconfirmedthatithadmadeavailabledignitykitsandcounsellingservicesaswellasrecreationalspace.

242 Later reduced to below two months when the kits were limited. 243 CPAP Outcome 2 Output 1 Indicator 1. 244 CPAP Outcome 2 Output 1 Indicator HFCB IRFI10.6. 245 UNFPA August 2016 monitoring data. 246 Guidance on Female‐Friendly Spaces (FFS) – Nepal Earthquake Response (v.1). 247 http://nepal.unfpa.org/sites/asiapacific/files/pub‐pdf/UNFPANepalEQ_humanitarianresponsereport27August.pdf. 248 UNFPA August 2016 monitoring data.

FFS Beneficiaries in Sindhuli District

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UNFPAhashandedover12FFSs(tents)toWCOsandassociatedwomencooperatives,includinginSindhuli,SindhupalchowkandGorkha;in2016itcontinuedtosupporttenFFSsaspartoftransitionandrecoveryefforts.249InSindhuli,theevaluationteamnotedseveralproblems:thecooperativelacksthespaceforstoringthetent(s)andassociatedmaterials;membersdonotknowhowtosetupthetent;theywouldliketousethetent(s)beyondemergencysituations;theylackthecapacity,staffandthemeanstomanageandrunaFFSintheeventofadisaster.Similarly,theWCOinGorkhawasfacingstorageproblems.Meanwhile,FFSshavebeenincludedintheNationalProtectionClusterStrategicPlanasakeyresponseintervention.TheMoWCSWhasreportedlyrequestedUNFPAtosupportthedevelopmentofFFSoperationalguidelines.Theprocurementof56,000dignitykitswasanotherimportantelementofUNFPA’searthquakeresponse.Dignitykitsweredistributedtowomenwhowerepregnant,lactating,single,aged,disabledaswellaswomenofreproductiveagefrommorevulnerablegroups.PlanninganddistributionwereconductedincoordinationwiththeDWCandWCOs.250Onekeyinformantandlocalrespondentspointedoutthat,whiledignitykitsweregreatlyappreciated,thequantitydistributedduringtheearthquakewasinsufficient.Anotherexpressedconcernthatthekitsreachedearthquakesurvivorstoolateandthatthedistributionmechanismsneededevaluating.Indeed,withbarelyanyoptionstoprocurelocallyduetotheearthquake,astheevaluationteamwasinformedbytheUNFPACO,andintheabsenceofaLong‐termAgreement(LTA),UNFPAwasobligedtoprocuredignitykitsthroughaseriesofinternationalbids.This,alongwithlatereceiptofsomedonorfunds,indeedsomewhatdelayedprocurementanddistribution.DignitykitcontentshadbeendeterminedbasedonthedraftNationalProtectionClusterStrategicPlan.UNFPAsupportedNHTCandCVICTtoexpandGBV‐relatedorientationsandtrainings–i.e.,psycho‐socialcounsellingandCMR‐totheearthquake‐affecteddistricts.113psycho‐socialcounsellorsandotherserviceprovidersandoutreachworkersweretrainedbyCVICTtocounselGBVsurvivorsinmobileRHcamps,FFSsandthroughtheircommunity‐outreachwork.25114,011womenandadolescentgirlsbenefittedfromsuchcounsellingservices.252UNFPA‐supportedpsychosocialcouncillorshavehadalong‐termimpact;theyarestillprovidingservicesinthedistricts.Moreover,261healthworkers,designatedtoworkinOCMCsandmobileRHcamps,weretrainedtoimplementCMR.253Itwasestimatedthatmorethan28,000womenandadolescentgirlscouldrequirepost‐rapetreatment.254Lastbutnotleast,UNFPAIECplayedanimportantpartintheearthquakeresponsecuttingacrossSRHandGBV.EspeciallymobileRHcampsplayedanimportantroleinraisingthepopulation’sawarenessonFPandA/SRHthrough,forexample,flipchartsandposters:monitoringdatarevealthat56,496personswerereached.LocalFMradioswerealsousedtospreadawarenessamongsurvivors:intotal,7,803episodeswereairedtoprovidemessagesonSRH,GBVandASRH.

IND6.2.6UNFPAparticipatedinthePost‐DisasterNeedsAssessment,whichinfluencedtheofficialearthquakeresponse,includingintheareasofpopulation,SRHandGBV.AftertheApril2015earthquake,theRRFwasamendedtoincludetheindicator“#ofdistrictsexperiencingahumanitariancrisissituationinwhichUNFPAprovidedTAontheuseofpopulation‐relateddataandsupportforassessments”.255UNFPAcontributedtotwoimportantassessmentspost‐earthquake.Asintended,theCOprovidedsupporttotheNPCforconductinga

249 Dignity First – UNFPA Nepal 12 Month Earthquake Report, July 2016. 250 UNFPA August 2016 monitoring data; http://nepal.unfpa.org/sites/asiapacific/files/pub‐pdf/UNFPANepalEQ_humanitarianresponsereport27August.pdf. 251 20 Psychosocial Counsellors, 14 Case Managers and 79 Psychosocial First Aid volunteers. Source: http://nepal.unfpa.org/sites/asiapacific/files/pub‐pdf/UNFPANepalEQ_humanitarianresponsereport27August.pdf. 252 UNFPA August 2016 monitoring data. 253 UNFPA August 2016 monitoring data. The evaluation team was unable to meet trainees from the earthquake‐affected districts and thus unable to respond to IND6.2.4: Trainee satisfaction with training on GBV services, including CMR. 254 Nepal Earthquake 100 Days into the Humanitarian Response, p5‐7. 255 CPAP 2013‐17 Outcome 3 Output 2 Indicator 2.1.

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Post‐DisasterNeedsAssessment(PDNA),fundedbytheWorldBankandUNDP.Ascoreteammember,UNFPAcontributedtothePDNAinthreesectors:(1)healthandpopulation;(2)gender,elderly,personswithdisabilitiesandchildren’swelfare;and(3)HumanDevelopmentImpactAssessment.UNFPAmobilizedyouthtocollectprimarydataforthePDNAHumanDevelopmentImpactAssessmentfieldsurvey:itmobilized42youthinsixdistrictstocollectprimarydatafromaround400households.UNFPA’sinvolvementinthePDNA,theonlydocumentavailableforemergencyprogramming,contributedtotheintegrationofpopulation/migration/displacement,SRH,GBVandsocialprotectionissuesintheimmediateresponse,recoveryandreconstructionplansandstrategies.256Importantly,theGoNutilizedthePDNAinpreparingthePost‐DisasterReliefFramework.ItwasalsousedinternallybyUNFPAstaffforplanningearthquake‐relatedactivitiessuchasFFSsandcontraceptivesupplies.Similarly,UNFPA,incollaborationwiththeInternationalOfficeofMigration,supportedastudyentitled“Socio‐demographicImpactoftheEarthquake2015”.

4.3Efficiency

EQ7Financialandhumanresources:TowhatextenthasUNFPAmadegooduseofhumanandfinancialresourcestopursuetheachievementofCP7outputsandoutcomes?

A.7.1Financial resources and CP7 implementation

IND7.1.1UNFPAappliesarisk‐basedapproachtofinancialmanagement.In2011,theevaluationofCP6foundthat:“GivenUNFPA’srecentqualifiedaudits,managementandoperationsclearlyfeeltheneedtojustifyallexpendituresinatransparentmanner,anddemonstrateaccountabilityandvalueformoney…”257InterviewsinKathmandureaffirmedacontinuedalertnesstofinancialrisks.Thus,UNFPAinNepalhasintroducedpracticalmeasuressuchasannualCOassessments,HACTimplementationanddelegationofmorefinancialauthoritytoProgrammeManagerswhoareclosertoandmoreknowledgeableoftheirrespectiveprogrammeactivities.Inanenvironmentwherecorruptioninthepublicsectorisrampant258,theCOisalsoconsideringtheprosandconsofworkingwithNGOsinlieuofgovernmentcounterparts.259Mentionwasalsomadethatphysicalpresenceinthedistrictsisaneffectiveriskmitigationmeasure.Thoseintervieweesofferinganopinion,fromwithinandoutsidetheorganization,consideredUNFPAfinancestobemanagedtransparently.

IND7.1.3&7.1.4UNFPAImplementingPartnershavereceivedfundsinatimelymanner,thankstoUNFPA’sattentiontothematterandHQ’saccommodationoflocalneeds.Despitedifficultcircumstancesanduncoordinatedfiscalyearsatthecentrallevel,implementationhasbeenhigh–92.2%fortheperiod2013‐16.MajorfactorsthathaveininstancesdelayedthereleaseandreceiptofCP7fundsinNepalarelatereportingandplanning,CObottlenecks,channellingoffundstoGoNIPsthroughthe“RedBook”,andtheNepalibankingsystem.Inthisrespect,theUNFPACOhasintroducedseveralmeasurestofacilitatetimelyreleaseandreceipt.TheseincludeamorerapidprocessingofFundingAuthorizationand 256 Dignity First: UNFPA Nepal Earthquake 12 Month Progress Report 2016. 257 Evaluation of UNFPA’s Sixth Country Programme in Nepal (2008‐2012), Final Report, November 2011, p51. According to the CO, mention is of an unsatisfactory internal audit conducted in 2014. 258 Nepal further slipped on the Corruption Perception Index (CPI) 2015 of Transparency International, continuing its standing as one of the most corrupt states in the world. The annual survey placed Nepal in 130 positions with a score of 27 among 167 surveyed countries. Nepal failed to improve both country wise ranking and score. In 2014, it was placed 126th rank on the index among surveyed countries with 29 marks last year. The CPI measures the extent of corruption within a country on a scale ranging from zero to 100. Countries that score below 50 are perceived as highly corrupt and those that secure 100 are cleanest. Source: The Kathmandu Post (online edition), January 27th 2016. 259 During CP6, audit issues prompted UNFPA to turn to large national and international NGOs based in Nepal. CPE CP6, p8.

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CertificateofExpenditure(FACE)formsbydelegatingmoreauthoritytoProgrammeManagers.TheyalsoincludeHQ’spermissiontoreleasefundsforsixmonthsratherthanonthestandardcorporatequarterlybasisbecauseofpoorbankingservices,whichwasfoundtohavereducedimplementationdelays,tohavehelpedalignwiththeNepaliFYthatrunsfromJuly16th‐July15th,andtohavelessenedpaperwork.Furthermore,theCOhasworkedtowardsimprovingthetimelinessofreportingandplanning.IntheSRHprogrammaticcomponent,multi‐yearplanningwasfoundtohelpdecreasetimespentonplanning.AccordingtoUNFPAstaff,theCOalsoreducedcollaborationwithGoNIPsandincreasedco‐operationwithNGOsinordertocircumventthe“RedBook”,whichisacauseofdelaysinfundingauthorizationanddisbursements,andconsequentlyimplementation.Atlasdata(Annex4)revealthatthenumberofNGOIPshasindeedincreasedconsiderably;butthenumberofGoNIPsthatUNFPAdealswithdidnotdecrease.In2013UNFPApartneredwith4NGOIPs;thisrosetotwelvein2016,stilllessthanhalfthenumberofGoNIPs.In2016UNFPAwasdirectlycollaboratingwith29GoNIPs,threemorethanin2013(26).260Limitingthisanalysistocollaborationwithcentral‐levelIPs,UNFPAhad6GoNIPsin2013;in2016itdealtwith10.However,inmonetaryterms,collaborationwithNGOshasbecomealmostequallyimportant:CollaborationwiththeGoNincreasedslightly:GoNNEXexpendituresamountedto$1.42min2013and$1.57min2016.Atthesametime,NGONEXexpendituresamountedto$160,000in2013andmultipliedconsiderably(nearlyeight‐fold)to$1.23min2016.Tothesameintent–i.e.,tofacilitatetimelyreceiptoffundsbyDDCs‐theCOsuccessfullynegotiatedthepossibilityofdirectfundtransferstoDistrictDevelopmentFacilitiesbesidesthroughthe“RedBook”.Indeed,theoverwhelmingview,bothatcentralanddistrictlevels,wasthatfundsweregenerallybeenreleasedandreceivedontime.Nodifferentiationwasmadewhetherforregularprogrammingorforearthquakeassistance.Besidesdependingontimelyreceiptoffunds,implementationofCP7hasbeenaffectedbythecountry’spoliticalsituation,includingfrequentrotationofgovernmentofficials.Implementation–e.g.,ofCSEorDPMAS‐wasphysicallyhinderedbytheearthquake,borderrestrictionsandstrikesin2015.Regularprogrammesweretemporarilyde‐prioritizedduringthesecondhalfof2015inviewofurgenthumanitarianresponseandreliefneeds.DifferentFYcycles,especiallyoftheGoNandUNFPA,werealsofrequentlyandmostlycriticallymentionedinthecontextoftimelydelivery.Previously,theCPEofCP6hadalreadyfoundthisinconsistencytoaffectimplementation.261Apracticalandmuchappreciatedsolutionhassincebeenfoundatdistrictlevelwhere,since2014,AWPswithDDCsfollowtheGoNFY.Publicprocurement–e.g.,ofemergencysupportmaterials‐wasafurtherreasonforimplementationdelays.Despiteallchallenges,interviewsandAtlasdatarevealahighlevelofimplementation(Annex4).Inabsoluteterms,UNFPAutilizationroseconsiderablyfrom$3.8min2013to$5.5min2014and$8.63min2015.Therespectiveutilizationrateswere82.8%,96.5%and98.6%oranoverallutilizationrateof92.2%.

IND7.1.2ResourcemobilizationhasbecomeincreasinglyimportantinviewofplungingannualRRspendingceilings.TheRR/ORmixhaschanged.UNFPAhasmobilizedconsiderableOtherResourcesfromabroadrangeofsources,includingUNFPATrustFunds,andparticularlyforSRHandGE.UNFPAhasnotonlymobilizedOtherResourcesforitsownactivities;ithasleveragedadditionalfundingfromotherdevelopmentpartners.TheUNFPASP2014‐17classifiedNepalasa“redcountry”.Inredcountries,wherenationalneedisrecognizedtobehighestandabilitytofinancelow,COsareexpectedtomakeuseofallmodesofengagementtoachieveregularprogrammingandhumanitarianassistanceobjectives,includingservicedelivery.Asaredcountryandacountryatriskofhumanitarian 260 Between 2013 and 2016, two DDCs (Kanchanpur and Surkhet) were phased out. UNFPA reverted to partnering separately with FHD, LMD, NHIECC, NHCT and EDCD of the MoH instead of having DoHS consolidate the five. 261 “The different FY cycles of the GoN and UNFPA prevent adequate time for programme implementation by GoN, resulting in funds being under‐utilised.” CP6 CPE, p36.

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crises,theSPenvisagesthatNepalshouldbeallocatedahighershareofRR.262TheindicativeRRcommitment,accordingtotheCPD,was$23mfor2013‐17oraplanningfigureof$4.6mperyear.Withonlyonemoreyeartogo,totalRRspendingceilings,includingERF,haveamountedtoonly$16.62mandannualRRceilingshavedroppedsignificantly(Table14)fromapeakof$4.6min2014to4.05min2015and3.43min2016.Theprospectsfor2017areevenmoreprecariouswiththeindicativeceilingjustexceeding50%oftheoriginalplan.CorporateausteritymeasuresworryUNFPANepalstaff;theyputmorepressureontheCOtoraiseOR.

Table 14: Annual RR Spending Ceilings 2013‐17 (in millions of US$)

2013 2014 2015 2016 2017 Total

Planned RR 4.60 4.60 4.60 4.60 4.60 23.00

RR Ceiling 3.94 4.60 4.05 3.43 2.47263 18.49

Difference 0.66 0 0.55 1.17 1.75 4,13

Source: UNFPA Nepal CO

Annex4revealsthattheCOhasbeenrewardedforitsresourcemobilizationefforts,whichhavealreadyraisedmorethananticipatedintheCPD($7.5m).In2015,theyearoftheearthquake,OR($4.90m)evensurpassedtheRRannualceiling($4.05m).Overall,since2013,staffhavebeenabletoraise$8.8mforimplementingCP7,largelyinsupportofSRHandGEactivities.264OtherResourceshavebeenmobilizedfromarangeofsources:bilateralagencies(firstandforemostJapan,UKAIDandSwitzerland),UNTrustFunds,othermultilateralorganizationsandsmallcontributions.UNFPATrustFundsupportformaternalhealthandcontraceptivesupplies,aswellastheUNFPAERF,werefurtherimportantsources,amountingto$2.7m,athirdofallOR.Inaddition,theCOmobilizedin‐kindcontributions,mainlyFPcommodities.Theamountindollartermsvaried,but,forinstance,in2015aloneamountedto$2.58m.TheevaluationteamnotedthatORhavebeenmobilizedinlinewithCP7regularprogrammingandearthquakeassistance.Keyinformantsemphasizedthisfirmness,atthesametimeaddingthattheyhadconsequentlyhadtorejectopportunitiesoutsidetheprioritydistricts.BesidesmobilizingOR,whichfigureinUNFPA’sbudgetandfinancialreporting,CP7hasalsomotivatedotherdevelopmentpartnerstocontributetoachieveitsandtheGoN’sobjectives.ThiswasclearlythecasefortheASRHprogramme,whichhasleveragedsupportfromUNICEFandSavetheChildrenforASRHtrainingsites,healthserviceprovidertrainingsandAFHScentrecertifications.Equally,themidwiferyprogrammehasattractedtheattentionofotherdonors,includingGIZ,RealMedicineFoundationandInternationalMedicalCorps.

A.7.2UNFPA priority districts and decentralized programming

TheevaluationteamwasrequestedtogatheropinionsonUNFPA’sdistrictprioritizationanddistrict‐levelprogramming,especiallyinviewofCOconsiderationstoexitcertaindistricts.Itisworthnotingthat,duringCP6UNFPAexpandedthenumberofitprioritydistrictsfromsixto12(2010)and18(2011),withtheformalapprovaloftheGoN.Theselectionofdistrictswasguidedbydevelopmentindices265andthepresenceofotherUNagencies.266

IND7.2.1Decentralizedprogramminghasitsbenefits,butUNFPAmayhaveinterpreteditsfocuson18prioritydistrictstoorigidly.CP7hassupportedsystem‐levelinterventions267anddecentralizedprogrammesin18prioritydistricts.Decentralizedprogramminghasitsbenefits 262 Annex 4 of the SP 2014‐17 on funding arrangements. 263 Tentative figure for 2017. 264 PD is most reliant on Regular Resources. Only $200,000 were mobilized between 2013 and July 2016. 265 CPAP: Districts making slow progress in achieving the goals of the ICPD. 266 CPE CP6, pvii. 267 System‐level interventions have primarily, but not only, benefitted UNFPA’s 18 priority districts. For example, EDCD RRT trainings were provided to health professionals from the 18 districts, but also other districts. Similarly, UNFPA‐supported NHTC MISP trainings.

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intermsofsupportingdecentralizationandlocalgovernance,intermsofputtingthespotlightonspecificissues,andenablingUNFPAandtheGoNtodemonstratetangibleresults.WorkingthroughDDCsisauniquemodelthatmightbeheavy,butfostersownership.However,thequestionremainedunansweredastowhetherUNFPAwasspreadingitselftoothinly.268TheevaluationteamwasinformedthattheCOhasrigidlyrestricteditsregularprogrammeactivitiestothe18prioritydistricts;thatthishas,however,incertaininstancesprovedsomewhatdisadvantageous,intermsoffundraisingandjointprogramming.Incomparison,UNagenciesarenotrequiredtostrictlylimittheiractivitiestothe23UNDAFprioritydistricts;UNICEFalsotakesaflexibleapproachtoits15prioritydistricts.269Lookingahead,thoseUNFPAstaffmembersvoicinganopinionfeltthattheCOshouldfeelfreertoimplementactivitiesoutsideitsprioritydistrictsaftercarefulconsideration.Indeed,thisself‐perceptioniscertainlycorrectforUNFPA’sworkplanswith18DDCs.However,itdoesnotholdtrueforanumberofactivitiesimplementedinco‐operationwithcentral‐levelpartners.270Moreover,in2016,theCOcontinuedworkinginearthquake‐affecteddistricts.271

IND7.2.1Lookingahead,UNFPAmightconsiderdownscalingbeforedefinitivelyexitingprioritydistricts.Futuredecentralizedprogrammingwillhavetoalignwithlocal‐levelreformsandrestructuring;itshouldbemorefocusedongreatestneeds.UNFPAkeyinformantssuggestedthatexitingprioritydistricts–e.g.,DangandDadeldhura–shouldbeanoptionandshouldhappenbasedonanassessmentofrelevantindicatorsandlevelofnationalownershipandinstitutionalization.However,scalingdownmightbethepreferredwaytogotosustainbenefits.ThebiggestquestionmarksurroundingthefutureofUNFPA’sdecentralizedprogramminginNepalisthepaceandoutcomeoflocal‐levelgovernmentadministrativereformsandrestructuring.Allthingsequal,thereseemedtobeaconsensuswithinUNFPAthatCP8shouldnotenvisagecollaborationwithDDCsinmoredistricts,astheGoNmightprefer,butratherfewer.Furthermore,UNFPA/GoNdistrict‐levelprogrammescouldbemore“diversified”,“targeted”,“in‐depth”,“concentrated”and“context‐specific”,nolongernecessarilycoveringallfourSPoutcomeareas.

A.7.3UNFPA organizational structure, rules and procedures

IND7.3.1CP7hasbeendeliveredwithaninsufficientnumberoffixed‐termstaffandunsatisfactorystaffinglevels.Becauseofcorporatefinancialausteritymeasures,additionalhumanresourcecapacitiesforimplementingandmonitoringprojectshavehadtorelyonexternalfundingandsupport.InNepal,UNFPA’sperformancehasbeen,andstillis,considerablydependentuponservicecontractsholders,especiallyintheregionsanddistricts.272In2013,COmanagementrequestedfixed‐termpostsforselectedfunctionsperformedbynationalstaffonservicecontractsinKathmandu,whichHQapproved.273InconnectionwiththeUNFPASP2014‐17re‐alignmentexercise,UNFPANepalcommissionedaHumanResourcesAlignmentExercise.ThereportfoundaveryrealriskoflosinghumanresourceswhohadbeentrainedandwerefullyfamiliarwithUNFPA’smandateand

268 This question was already raised by CPE CP6. 269 According to the UNICEF Nepal CPAP 2013‐17 “…will prioritize at least 15 districts (and their municipalities and VDCs) considered to be the most vulnerable through a newly‐designed Child Deprivation Index… Pending availability of funds, another set of disadvantaged districts and municipalities will be supported through selective programming....” p26. 270 For instance, establishment of six ASRH training sites in six government hospitals across Nepal; ASRH trainings for health service providers from other districts; BCC activities with the NHEICC; distribution of post‐rape treatment kits to OCMCs. 271 For instance, trainings on ASRH toolkit in humanitarian settings in three earthquake‐affected districts Ramechhap, Dolakha and Okhaldhunga; GBV clinical management master training of trainings in Okhaldhunga. Support for female‐friendly spaces in Okhaldhunga, Dolakha and Sindhupalchowk. Also, the Swiss‐supported Gender‐based Violence and Response Project 2016‐18 is being implemented in Okhaldhunga (besides the priority districts Udayapur and Sindhuli). 272 As of July 2016: 35 service contract holders of a total of 78 staff members. Source: UNFPA Nepal Office Employee Status as of 1 July 2016. 273 UNFPA Nepal Request for Approval of Fixed‐term Posts for UNFPA Nepal CO, June 2013.

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programmaticinterventions;ariskofnotattractingtechnically‐qualifiedstaffduetonon‐competitivenessofUNFPAjoblevels,salaryandjobsecurity;andarealfiduciaryriskofnotadequatelyaddressingrecentauditfindingsparticularlywithrespecttoprogrammeandfinancialoversight.AlsoinviewofNepal’sstatusasa“redcountry”withthefullpackageofinterventions,thereportrecommendedanumberofnewnationalpostsandupgradestosomeexistingposts.274ArequestwassubmittedtotheUNFPAAsiaandPacificRegionalOfficeinAugust2014andfurthersubmittedtoHQinJune2015afterbeingaskedtoreducethescopeofthehumanresourcesalignment.275However,corporatefinancialausteritymeasureshaveputanyre‐alignmentonhold;proposedrealignmentswerenotapproved.Nevertheless,UNFPANepalwasabletocreatenewpoststhroughadditionalservicecontractsthatdonotrequireapprovalfromHQ‐e.g.,MidwiferyTechnicalOfficer,HarmfulPracticesTechnicalOfficer,CSETechnicalOfficerandseveralGBVpositions,allfundedthroughearmarkedfunds.276Itmobilizeddonor‐fundedUNVsandJPOs.Atthesametime‐asforewarned‐itwasnotabletoretainandlostvaluablestaffmembersduetounsatisfactorytermsandconditionsofemployment.MostoftheresponsestoquestionsaboutUNFPA’sorganizationalstructureinNepalrevolvedarounditsdecentralizedstructure,andespeciallythephysicalpresenceofDistrictProgrammeOfficersinthe18prioritydistricts,hostedbytheDDCs.IND7.3.1TheplacementofUNFPADistrictProgrammeOfficersisclearlyameaningfulandadvantageousinvestment. OneDistrictProgrammeOfficerperdistrictistheperceivedminimum,allthingsequal.AllinterviewedUNFPAstaffappreciatedthepresenceofDistrictProgrammeOfficersdespitesomequestionmarksbecauseofUNFPA’slimitedresources.Accordingtooneinterviewee,“DistrictProgrammeOfficersbringUNFPAclosertothepeopleinneedandtotheresponsiblelocal‐levelauthorities.”Morespecifically,UNFPAdistrict‐levelpresencehasservedto: Facilitatealignmentwithlocalpriorities; Strengthenadvocacyandpolicydialogue; StrengthenUNFPA’sroleinemergencypreparednessandresponse; Ensurefrequentmonitoringandimplementationsupport; Facilitateaccesstoinformation; Motivateandencouragelineagencyrepresentatives;and Mitigatefinancialrisks.

Allthingsequal‐i.e.,shouldUNFPAcontinuetoimplementdecentralized“mini‐programmes”coveringalloutcomeareas‐interviewssuggestthatoneUNFPAstaffmemberperdistrictisthebareminimum.IdeasrangefromrecruitingadministrativeassistantstounburdenDistrictProgrammeOfficersfromtheiradministrativeresponsibilitiesandtoimproveUNFPAofficepresencetoincludingdistrict‐levelprojectstaffinprojectproposals.DistrictProgrammeOfficersarebackstoppedbyoneofthreeUNFPARSOs.TheyworkunderthedirectsupervisionoftheconcernedRegionalDevelopmentCoordinator.CommentsontheworkandsupportofRSOswereonlyfew.TheysuggestthattheexistenceoftechnicalexpertisetoresorttoandofacoordinationmechanismbetweenthedistrictsontheonehandandbetweenthedistrictsandtheCOinKathmanduontheotherhandisimportant.However,itisimportanttoensurethatcoordinationfunctionsandthattechnicalexpertiseisavailableontimeandaddsvaluetothecompetencesoftheDistrictProgrammeOfficers.

IND7.3.2UNFPANepalhascompliedwithcorporatepolicies,guidance,rulesandregulations.Insomeinstances,ithashelpedcreateandimprovethemandhassuccessfullylobbiedfortheiradaptationtolocalcircumstances.Forinstance,theCOpilotedtheMinimumPreparednessActions(MPAs)andcontributedtotheexternalreviewoftheGuidanceNoteonMinimumPreparedness(IND7.5.2).Afterthe2015earthquake,itprovidedwrittencommentsontheUNFPASOPsinHumanitarianSettings.Inotherinstances,itworkedtowardsadaptingthemtotheNepalisituation–e.g.,regardingthereleaseoffundstoIPseverysixmonthsor

274 Nepal CO HR Alignment Exercise 2014 Final Report, August 2014. 275 UNFPA interoffice memorandum, 8 June 2015. 276 UNFPA Nepal Office Employee Status as of 1 July 2016.

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synchronizingAWPswiththeGoNFYfordistrict‐levelIPs.Thefactthattherecently‐introducedGlobalProgrammingSystem(GPS)allowsformulti‐yearplanningaccommodatesvoicespromotinglonger‐termplanning.SpecificallyonNEXandDEX,onekeyinformantfoundbothimplementationmodalitiestobechallengingandtime‐consuming,suggestedthatprocedureswerenotveryclearandthattheCOneededaclearerstrategy.OnlyfewNGOImplementingPartnersprovidedaviewonUNFPA’sfinancialandadministrativerulesandregulations,includingNEX.Theirexperiencesdiffered.Theevaluationteamcouldfindnopatterns.

A.7.4Use of results‐based management277

IND7.4.1&7.4.2Themonitoringsystemhasbeenstrengthenedinresponsetotheevaluationofthe6thUNFPAcountryprogramme.MonitoringisaregularfeatureofCP7implementation,especiallyattheactivitiesandoutputlevel.Forlackofdistrict‐leveldata,theCPAPResultsandResourcesFrameworkisoftennotagoodbasisforresults‐orientedplanning,monitoringandreportingattheoutcomelevel.TheCPEofCP6concludedthatUNFPAinNepaloughttostrengthenitsM&Esystem.278Theevaluationteamisoftheviewthatprogresshasbeenmadeandthatarobustmonitoringsystem,withsomeweaknesses,isinplace.ThiswasechoedbyUNFPAstaff.TheevaluationteamconsiderstheRRFadecentbasisforresults‐orientedworkplanningandmonitoring.TheRRFwasmodifiedtwice:first,toalignwiththeSP2014‐17IRFandsecond,toincludeindicatorsforUNFPA’searthquakeresponse.Modificationsweremadetooutcomeandoutput‐levelindicators.Outcomeandoutputstatementsremainedthesame.Thelevelofexpectedfinancialresourceswasadaptedforeachoutcome.279Annex9offerssomecommentsontheCP7regularprogrammeresultsstatementsandindicators.Generallyspeaking,theevaluationteamnotedthat: Agoodattemptwasmadetolimitthenumberofoutputsandtoidentifybaselinesandtargets AnticipatedresultsarelinkedtotheUNDAFresultsframework Anumberofoutput‐levelindicatorsmeasurechangesattheoutcomelevel MostplannedoutputsandoutcomesarecorrectlylocatedatthelevelofUNFPA’s18prioritydistricts However,representativeoutcome‐leveldataforthe18districtsareoftenhardtocomeby Indicatorsaremainlyquantitativeinnature;theyhardlysayanythingaboutqualitativeaspects ThebulkofUNFPA’semergencypreparednesswork–e.g.,prepositioning‐isnotreflectedintheRRF

WiththesupportoftheCOM&EOfficer,andincollaborationwithImplementingPartners,evidence‐basedplanninghasbeendoneonanannualandevenmulti‐annualbasis;year‐wiseprocessindicatorsandmilestoneshavebeenprepared.Inprinciple,thelevelofavailablefundinghasbeenknownatthetimeofplanning,althoughUNFPAausteritymeasureshaveledtoretrospectivebudgetcutsinsomeinstances.Progressatthelevelofprojectactivitiesandoutputshasbeenregularlymonitoredandreported.Atamorestrategiclevel,internalprogrammereviewswereconductedonaquarterlyandannualbasis.AnnualreviewmeetingswereheldaroundNovember‐December.UNFPAhasbeenflexibleandtakencorrectivemeasures:monitoringdatawereconsideredduringplanningprocesses.Targetsandmilestoneswererevisedbasedonmonitoringvisits,researchstudiesandreviews.Monitoringattheoutcomelevelwaslessevidenttotheevaluationteam.Outcome‐levelmonitoringwashamperedbythelackofup‐to‐dateofficialdata,especiallyforselectedRRFindicatorsforSRHandGE,andinsufficientCOfundingtoinvestinadditionalsurveys.

277 Evaluation matrix A.7.4: CP7 made sufficient use of results‐based programming, management and monitoring to achieve expected results in the RRF. Unless otherwise mentioned, the analysis in this section is based on a group discussion on RBM with UNFPA CO staff members. 278 CPE of CP6, p64. 279 Annex 2: Results and Resources Framework (RRF) for Nepal (Aligned with New UNFPA Strategic Plan 2014‐2017) (Aligned with 2015 Earthquake Response).

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OneofthegreatestchallengesfacedduringplanningandmonitoringwithGoNImplementingPartnershasbeentheoffsetGoNandUNFPAplanningcycles.280.Asmentionedpreviously(IND7.1.4),apracticalandmuchappreciatedsolutionwasfoundatdistrictlevelwhere,since2014,AWPswithDDCsfollowtheGoNFY.

A.7.5UNFPA’s internal emergency preparedness and response

TheOrganizationalEffectivenessandEfficiency(OEE)sectionoftheSP2014‐17IRFcontainsmanagementelementsthatshouldenabletheattainmentofdevelopmentresults.OEEOutput1readsasfollows:“Enhancedprogrammeeffectivenessbyimprovingqualityassurance,monitoringandevaluation”.Indicator1.8relatestoUNFPA’scorporateemergencypreparedness:“PercentageofCountryOfficesinhigh‐riskcountriesthathaveup‐to‐datehumanitarianpreparednessplans”.

IND7.5.1UNFPANepalhumanitarianpreparednessplansfortheCOandthethreeRegionalSupportOfficesareavailableandup‐to‐date.“UNFPANepalContingencyPlans”havebeenavailablesince2013.Theyhavebeenupdatedeveryyearandareavailablefortheyears2014,2015and2016‐17.Since2014,inadditiontoearthquakesandfloods,UNFPANepalcontingencyplansarebasedonascenarioofcivildisturbances.Accordingtothemostrecentcontingencyplan,theobjectivesofUNFPA’semergencyresponseinNepalare:(1)Savelivesandalleviatesufferingbyprovidingand/orensuringaccesstoSRHservicestothosemostaffected,includingstrengtheningreferralsystems;(2)PreventandrespondtoGBVbyprovidingservices,includingpsychosocialcounselling/supportandstrengtheningmechanisms;(3)RestorecomprehensiveSRHandpsychologicalservicesbyintegratingdisasterriskreductionandimprovingresilience;and(4)Engageyouthandadolescentsforemergencyresponse.Amongstotherthings,the2016‐17plantalkstothenationallegislative,policyandinstitutionalframeworkandtoexistingcoordinationclusters.ItpresentstheUNFPACOinternalcoordinationmechanisms,staffrolesandresponsibilitiesaswellashumanandfinancialresourcemobilizationarrangements.Furthermore,itcommitsUNFPAtoprovidehumanitariantrainingstoitsstaffmembersanddetermineslogisticsandprepositioningofsupplies.GiventhediversityofNepal,UNFPARSOsareadditionallyexpectedtodevelopregion‐specificcontingencyplansbuildingonscenariosrelevanttothegeographyandspecificrisks.281Thosefor2015weremadeavailabletotheevaluationteam;theywerebeingupdatedatthetimeofdraftingthisreport.

IND7.5.2Withsomeimportantexceptionsrelatedtoemergencyoperationsplanning,staffcapacities,procurement,andinformationmanagement,UNFPANepalfareswellontheMinimumPreparednessActionsDashboard.TheMPAimplementationstatuswasrecentlyupdatedusingrevisedcorporateguidance.UNFPA’sMPAsweredevelopedbasedonapilotbytheUNFPARegionalOfficeforAsiaandthePacific(APRO)inthePhilippines,IndonesiaandNepalin2013.282TheyareasetoftenactionsthatestablishUNFPA’sminimumemergencypreparedness.TheevaluationteamwasprovidedwithanExcelsheetentitled“CountryDashboard–ImplementationMPAs”datedAugust2015.AccordingtotheDashboard,theCOhascontinuouslyimplementedtheMPAs,althoughsomeactions,especiallyunderMPA3(emergencyoperationsplan)andMPA10(capacitydevelopment),werestillinprocessandonehadnotstarted–i.e.,thepreparationofaLTAforprocuringdignitykits.283PendingrevisedMPAGuidancefromHQ,theCOhadnotupdateditsimplementationstatussinceAugust2015.However,therevisedguidelineswerereportedlyreceivedinAugust2016andawebinaronthe

280 The GoN planning cycle follows a Fiscal Year based on the Nepali calendar (mid‐July to mid‐July); UNFPA follows the UN calendar (January‐December). 281 UNFPA Nepal Contingency Plan 2016‐17. 282 UNFPA Programme Division/Humanitarian and Fragile Contexts Branch & and Asia Pacific Regional Office: Guidance Note on Minimum Preparedness, May 2014, p3. 283 It was due by July 2016, but information about a possible global LTA for dignity kits influenced action.

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subjectorganizedbyAPROinSeptember.TheCO’sMPAsweresubsequentlyupdatedandarereadytofeedintotheStrategicInformationSystem(SIS).AnexternalreviewoftheUNFPAGuidanceNoteonMinimumPreparednesswaspublishedin2015.284NepalCOstaffmembersparticipatedinasurveyandinterviews.Thereviewnotedsomegoodpracticesandlessonslearnedfromtheearthquakeemergency(Box5).Accordingtothem,furtheractionisrequiredtofamiliarizeandprepareallCOstaffwithhumanitarianissuesandtheirrespectiverolesandresponsibilities.Moreover,UNFPANepalneedstostepupitsprogrammeinformationmanagementandreportingcapacities.

Box 5: Good Practices and Lessons Learned from UNFPA Earthquake Response

In Nepal and Ecuador, UNFPA works not only with national authorities but also with local governments to support inclusion of issues related to UNFPA’s mandate in their contingency plans and increase capacities.

After participating in the inter‐agency contingency planning, some UNFPA COs ‐ among them Nepal and Ecuador ‐ developed a UNFPA internal contingency plan, which ensures UNFPA’s ability to deliver upon commitments with the inter‐agency group.

The inter‐agency group focused its contingency plan on flood risk. Preparedness efforts, although initially inspired by a different threat, proved very helpful in quickly providing humanitarian assistance to the earthquake victims. In particular, coordination agreements and supply lists were very useful at the onset of the crisis.

UNFPA had to respond in districts not targeted in its regular programme. Likely, UNFPA Nepal could quickly relocate field staff to initiate response in the new locations.

At the onset of the emergency, staff on the humanitarian team knew what to do, while many other staff were unprepared. All staff members, not only those with preparedness responsibilities, should be familiar with humanitarian issues. The office should define in advance the roles and responsibilities needed during an emergency and prepare the staff accordingly.

Programme information management and reporting quickly became a priority need that the CO was unprepared to meet.

Source: Guidance Note on Minimum Preparedness Review

IND7.5.3UNFPAhumanitarianprogrammingintheearthquake‐affecteddistrictshadadedicatedandfunctioningresults‐basedmonitoringandreportingsystem.AftertheApril2015earthquake,UNFPAmodifieditsRRFtoincludeearthquakeresponseindicatorsandtargetsacrossallthreeprogrammecomponents.Indicatorsweresetattheoutputlevel.TheywerealignedwithUNFPA’scorporateframeworkforhumanitarianwork.285UNFPAdevelopedmonitoringtoolsandanearthquakeresponsemonitoringframework,whichitimplementedduringsixmonths.Morethan100personsweretrainedtogeneratedata.Monitoringdatawerecollected,includingthroughjointmissions.A100‐daysresponsereportaswellas5‐monthand6‐monthreportswereprepared.A12‐monthprogressreportwaspublished.286Theevaluationteamhadtherespectivemonitoringdataatitsdisposal.

4.4UNFPAContributiontoUNCTCoordinationinNepal

EQ8UNCTcoordination:TowhatextenthasUNFPAcontributedtothefunctioningandconsolidationofUNCTcoordinationmechanisms?

284 Guidance Note on Minimum Preparedness Review, Findings and Recommendations, Draft, December 2015. 285 Latest version not yet available to the evaluation team. 286 UNFPA: Nepal Earthquake Response – 12 Month Progress Report 2016.

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A.8.1&A.8.2UN country team coordination and joint programming/programmes

IND8.1.1UNFPAhasbeenanactiveleaderandcontributortoUNCTcoordinationmechanismsrelevanttoitsmandate.InNepal,UNFPAleadstheUNCTYouthGroup.TogetherwithUNDP,theCOco‐leadstheSDGWorkingGroup.InthecontextofitsGBV‐relatedwork,itco‐leadswiththePrimeMinister’sOfficetheUNDAFOutcome3CoordinationGroup(“vulnerablegroupsexperiencegreaterself‐confidence,respectanddignity”).Furthermore,UNFPAhasparticipatedintheGenderThemeGroup,theUNHIVTeam,theConflict‐relatedSexualViolenceGroup,andthePeaceSupportWorkingGroup.InthecontextofitsSRHprogramme,itcontributestotheUNDAFOutcome1CoordinationGroup;inPDitparticipatesintheUNDAFOutcome5CoordinationGroup.287UNFPAisalsomemberoftheUNDAFM&EGroup.Ontheoperationsside,UNFPAparticipatesintheOperationsManagementTeamanditsrelatedworkinggroupsaswellastheHarmonizedApproachtoCashTransferGroup.QualitativeevidenceforUNFPA’scontributiontoUNCTcoordinationmechanismsisratherweak.288However,intervieweesvoicinganopinionwereconsistentlyoftheviewthatUNFPAhasplayedanactiveroleinUNCTcoordinationmechanisms,beitaschairorparticipant.ParticularmentionwasmadeofUNFPA’sroleintheUNCTYouthGroup,theSDGWorkingGroupandtheUNDAFOutcome1CoordinationGroup.Accordingtoonekeyinformant“UNFPAisoneoftheheavyweights…itgets10outof10pointsforinter‐agencycoordination”.

IND8.2.1&8.2.2Evidencerevealedanumberofgoodexamplesofjointprogrammingandjointprogrammes,aboveallintheareasofchildmarriage,GBVandadolescenthealth.UNFPAalsopartneredwithotherUNagenciestoinfluencepolicyframeworksandstandards.UNFPAhaspartneredwithUNICEFonanumberofoccasionsintheareasofchildmarriage,GBVandadolescenthealth.Amongstotherthings,theUNFPACOsupportedaUNICEF‐ledprocesstodevelopaNationalStrategytoEndChildMarriageby2020.UNFPAwasalsoinvolvedrightfromthebeginningindesigningandpromotingtheSFSP,ledbyUNICEF.UNFPAwasinchargeofdevelopingtheGBVandSRHcontents.Viceversa,UNICEFsupportedUNFPA’sinitiativetoconductthe“BarrierStudy”,publishedinJanuary2015,which,asseenabove,promptedtheGoNtoreviewexistingcertificationcriteriaforpublicAFHScentresandtorevisethenationalASRHtrainingpackageforhealthserviceproviders.UNICEFalsofacilitateddisseminationoffindingsandrecommendationsfromthe“CSEReview”amongeducationsectorpartners.UNESCOissinceveryrecentlyaclosepartnerinCSE.UNFPAhasstartedtocollaboratewithUNESCOandUNWomenundertheumbrellaoftheGlobalJointProgrammefortheEmpowermentofAdolescentGirlsandYoungWomenthroughEducation.Nepalisoneofthesixfirst‐phasecountriesoftheglobalJointProgramme.Thefive‐yearNepaliJointProgramme,ledbyUNESCO,isentitled“EmpoweringGirlsandYoungWomenthroughtheProvisionofCSEandaSafeLearningEnvironmentinNepal”.ImplementationisstartinginfiveofUNFPA’s18prioritydistricts.UNFPAisinchargeofCSE,particularlyinschools,includingtheestablishmentofadolescent‐friendlycorners.TheprogrammealsointendstoimplementtheSFSPmentionedabove.289Earlier,UNESCOhadsupportedtheCSEReview,conductedunderUNFPA’sleadership.TheUNFPACOhasgroundedimportantpartsofitsregularSRHworkonWHOstandards,notablyintheareasofsupplies(sevenlife‐savingmaternal/RHmedicinesfromtheWHOprioritylist)andmidwifery(ICM‐WHOstandards).ItcollaboratedcloselywithWHOtopilotNationalGuidelinesonthePreventionofCervicalCancer,todeveloptheDistrictHealthInformationSystem(DHIS),andinconnectionwithOCMCs.

287 Source: UN Interagency Coordination Groups 10062016. 288 The evaluation team was only able to meet representatives of three UN agencies and the RCO. 289 Information brochure “Empowering Adolescent Girls and Young Women through the Provision of CSE and a Safe Learning Environment in Nepal”, 2016.

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FourotherjointinitiativesareworthmentioningthatwereimplementedattheendofCP6andbeginningofCP7: FundedbytheUNPeaceFundforNepal(2011‐12),UNFPA,UNICEFandothersco‐implementeda

jointprogrammeentitled“EnsuringRecognitionofSexualViolenceasaToolofConflictintheNepalPeaceBuildingProcessthroughDocumentationandProvisionofComprehensiveServicestoWomenandGirlSurvivors”.Theinitiativecontinuedbeyond2012withadvocacyactivitiesandfurtherefforts.

FundedbytheUNTrustFundtoEndViolenceagainstWomen(2010‐13),UNFPAworkedwithUNICEFandUNWomeninfourdistrictstoimplementthejointprogrammeentitled“Multi‐sectoralGBVResponseattheDistrictLevelinNepal”.

In2013,UNFPAcollaboratedwithUNWomentoconductthestudyentitled“TrackingCasesofGBVinNepal:Individual,Institutional,LegalandPolicyAnalysis”.

Alsoin2013,UNFPAcollaborationwithUNICEF,UNESCO,UNWomenandothersresultedintheendorsementbytheNPCofaNationalPlanofActionfortheHolisticDevelopmentofAdolescents.

IND8.2.4Intervieweesweregenerallysatisfiedwithinter‐agencycollaboration.Examplesoffactorscontributingtosuccessfulrelationshipsarecredibilitybecauseevidence‐based;trustandmutualunderstanding;commonissues/interests;andcapablestaff.IND8.1.2&8.2.3Nobodywasabletopinpointanymissedopportunities.

4.5AddedValueofUNFPAinDevelopmentCooperationandHumanitarianAssistance

EQ9UNCTaddedvalue:TowhatextenthasUNFPAmadegooduseofitscomparativestrengthstoaddvaluetoNepal’sdevelopmentresults?

A.9.1UNFPA’s added value in development cooperation

IND9.1.1NationalandinternationalpartnersalikevoicedpositiveopinionsonUNFPA’saddedvalueinitsregularprogramminginallprogrammaticcomponents.Accordingtosome,UNFPA’stechnicalexpertiseinSRH,includingASRH,CSEandfamilyplanning,wasaclearcomparativestrengthtofurtherbuildon.OthershighlightedUNFPA’sleadingroleinintegratingGBVintothehealthsystembybringinghealthandprotectionactorstogether.YetagainothersappreciatedUNFPA’sin‐housestatisticalandanalyticalcompetencesanditsabilitytoarguebasedonevidence.Moreover,UNFPAwascommendedforitsstrongyouthfocuscomparedtootherdevelopmentpartners.Moregenerallyspeaking,intervieweesmentionedUNFPA’sgoodrelationshipswiththeauthorities,whichfacilitateownershipandincreasethelikelihoodofsustainability.Withoutprovidingdetails,theyidentifiedcomparativeadvantagesinIECandadvocacy.OnecloseUNCTpartneremphasizedthebenefitsofUNFPA’sdistrict‐levelpresenceforco‐operatinglocally.

A.9.2UNFPA’s added value in emergency preparedness and response

IND9.2.1Atthenationallevel,UNFPAcontributedtothe2013NationalDisasterResponseFramework.UNFPAhasbeenplayingaleadroleinemergencypreparednessintheareasofRHandGBV,withintheclustersystemandtheHumanitarianCountryTeam.2015provedthatearthquakesremainalarge‐scalehazardthroughoutNepalwiththecountrylocatedonanactiveseismicbelt;18districts(ofwhichsixarecurrentUNFPAprioritydistricts)areparticularlypronetofloods.290ReliefworkfollowingamajordisasterinNepalisguidedbythe1982NaturalCalamityReliefAct.TheJuly2013NationalDisasterResponseFramework(NDRF),towhichUNFPAalsocontributed,providesthestrategicdirectionforallphasesof

290 HCT Contingency Plan Nepal: Earthquake, February 2016; HCT Contingency Plan Nepal: Floods, August 2016.

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disastermanagement.Itclarifiestherolesandresponsibilitiesofgovernmentandnon‐governmentalagenciesinvolvedindisasterriskmanagementinNepal.UNFPAplaysakeyroleintwoofthe11clusters:UNFPA,togetherwithUNICEF,co‐leadstheprotectioncluster,whichisledbytheDWCoftheMoWCSPandtheNationalHumanRightsCommission(NHRC).WiththeDWC,itleadstheGBVsub‐cluster.InterviewedprotectionclustermembersareunanimousthattheprotectionclusterandGBVsub‐clusterarefunctional291,andthatUNFPAhasbeenplayinganactiverole.Mostrecently,UNFPAcontributedtotheelaborationofaNationalProtectionClusterStrategicPlaninlinewiththeNDRF,whichwasendorsedanddisseminatedinNovember2016.TogetherwithFHD,UNFPAisalsoco‐leadingtheRHsub‐clusterundertheHealthCluster,whichisledbytheMoHandco‐ledbyWHO.UNFPAisalsoanactiveplayerandwellpositionedintheHCT,whichisledbytheUNHumanitarianCoordinator.In2016,theHCTpreparedtwocontingencyplans–oneforearthquakesandanotherforfloods.292DocumentanalysisrevealedthatSRH,GBVandMISParewellreflectedinthestrategicobjectivesandindicatorsofbothdocuments.Togiveaflavour,somekeyresponseinterventionsincludeFFSs,psychologicalsupport,dignitykits,post‐rapetreatment,andprintandelectronicGBVpreventionmessages.

IND9.2.2&IND9.2.3UNFPAsuccessfullyledtheRHandGBVsub‐clustersaftertheearthquake.Itplayedanimportantcoordinationroleatthedistrictlevel.AfterthedevastatingearthquakeinApril2015,UNFPAsuccessfullyadvocatedformoresupport,resourcesandfundingtoaddressincreasedrisksofsexualandGBVoccurringcausedbytheongoingcrisis,andtoestablishareferralsystemtosupportGBVsurvivors’accesstoqualitycareincludingemergencycontraception.TheCOwasinstrumentalinensuringregularmeetingsoftheRHandGBVsub‐clustersanddocumentationofthosemeetings.Tofacilitatecoordinationduringtheacuteemergencysituation,itdeployedRHandGBVcoordinatorstothethreehumanitarianhubsinKathmandu,GorkhaandSindhupalchowkdistricts.293FeedbackfromRHstakeholdersonUNFPA’sperformancewasgenerallypositive.InterviewedhealthofficialsinGorkhaandSindhuliapplaudedUNFPA’sroleasafrontlineorganizationthatshowedstrongpresenceontheground,thathelpedtobuildnationalcopingcapacities,andthatprovideddirectsupporttosurvivorsofthedeadlyearthquake.OneNGOImplementingPartneremphasizeditssatisfactionwithUNFPA’sleadership,timelycommunication,andinformationsharing,butvoicedregretoverperceivedcompetitionbetweenUNFPA,UNICEFandWHO.

Chapter5:ConclusionsandRecommendationsThischapterpresentstheevaluationteam’sstrategicandprogrammaticconclusionsbasedontheassessmentaboveandinviewofdesigningthe8thUNFPAcountryprogrammeforNepal2018‐22.Strategicconclusionsareoverarchinginnature;programmaticconclusionsaddressindividualprogrammaticareasanddeallargelywiththeevaluationcriterioneffectiveness.Conclusionsreflecttheevaluationteam’sprofessionalopiniononselectedaspectsofUNFPA’sperformanceduringtheperiodunderevaluationandareforwardlooking,leadinguptorecommendationsforconsiderationbyUNFPA.ThefollowingprioritizedconclusionshavebeenmadeagainstthebackgroundofplungingRegularResourcesandnoimprovementsintheCOstaffingsituation.Theyalsoassumecontinuedhighlevelsofpoliticalinstabilityandvulnerabilitytodisasters.Theyarebasedontheassumptionthatthestaterestructuringprocesswillremaindelayed.

291 UNFPA has achieved its target: the re‐aligned CP7 RRF envisaged by the end of 2017 the GBV Working Group under the protection cluster would be functional (Outcome 2 Output 2.1 Indicator 2). 292 HCT Contingency Plan Nepal: Earthquake, February 2016; HCT Contingency Plan Nepal: Floods, August 2016. 293 CPAP 2013‐17 Outcome 1 Output 1 Indicator HFCB IRFI5 & CPAP 2013‐17 Outcome 2 Output 1 Indicator2. UNFPA August 2016 monitoring data.

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5.1StrategicConclusions

Conclusion1:TheUNFPACOneedstoanticipatechangesinthestatestructures.

In2015theparliamentratifiedanewconstitution.TheGoNhasaconstitutionalcommitmenttofederaliseNepal.Thisisexpectedtomakegovernmentmoreefficientandreceptivetotheneedsanddemandsofthepeople.Thelong‐awaitedreforms,whentheymaterialize,willrequirechangestoUNFPA’sorganizationalstructureandtothewayithasbeenco‐operatingwithitsgovernmentcounterpartsinNepal,especiallyatthelocallevel;theywillgenerateaneedfornewdatasetsandanalysesaswellasforinstitutionalcapacitybuilding.However,stakeholdershavedifferentviewsandopinionsandclarityhasnotyetbeenestablishedonthetimeframeandroadmapforthereformsandthefutureofthecurrent75districtsunderthenewfederalprovincesprovisionedbythe2015constitution:willthecurrentnumberandbordersofdistrictsbeleftintact?Willand,ifso,howwillcurrentDDCsanddistrictlineagenciessuchasDHOsandWCOsbereplaced?Howwillreformsaffectresponsibilitiesandmechanismsforpolicyandplanning,servicedeliveryandmonitoring?Origin:EQ1,EQ3,EQ4,EQ5andEQ6

Conclusion2:Moreneedstobedonetobridgethedatagap.

UNFPA,alongsideotherdevelopmentpartners,hasinvestedalotindatagenerationanddatabasesinallareasofitsmandate.Thankstoitsadvocacyandtechnical/financialassistance,consciousnessaboutthevalueofdataandevidence‐basedplanningisthere,buttheavailabilityofup‐to‐dateandadequately‐disaggregateddataisstillachallengeinallspheresofUNFPA’swork,especiallyforthesub‐nationallevel.ThiswillaffectGoNandUNFPApriority‐setting,planning,monitoring,trendsanalysisandprojections.Moreneedstobedonetobridgethedatagap,alsoinviewofachievingtheSDGs.Origin:EQ1,EQ3,EQ4andEQ5

Conclusion3:TheUNFPACOneedstoconsidertargetedeffortstobenefitandempowerveryyoungadolescentsaged10‐14.

AdolescentsandyouthhavebeenmainstreamedthroughoutCP7.However,CP7wasnotrealignedtotargetthespecificneedsofveryyoungadolescents(10‐14)andespeciallyveryyoungadolescentgirls,aUNFPAcorporateprioritysince2014andhighlightedinthe2013NationalPlanofActionontheHolisticDevelopmentofAdolescents.TheCOisnotalone:only6%and5%ofUNFPACOshaveidentifiedandsupportedveryyoungadolescentgirlsandboysrespectively.294Indeed,manyveryyoungadolescentgirlsinNepalarediscriminatedagainstbytheirownfamilies–e.g.,theyareforcedtodropoutofschool;theyaremarriedoffearly;theyareparticularlyvulnerableduringcrisesanddisasters.Thishasmulti‐dimensionaleffectsontheirhealthandwell‐being.Asadolescentsaged10‐14yearsareintheirformativeyears,thisistherightagetochallengetraditionalnormsthatcompromisetheirrightstohealthcare,education,recreationandtheirchoicesregardingmarriage,professionandfamilylife.Thereisneedforaction.Itisinsufficienttoassumethatveryyoungadolescentswillbenefit;specialeffortsarenecessary.Origin:EQ1,EQ3andEQ4

Conclusion4:UNFPAshouldbemoreexplicitontypesofandexpectedcontributionstoemergencypreparedness.

Nepalishighlyvulnerabletonaturaldisasters.Atthetimeofwriting,a5.5‐magnitudeaftershockstrucknearMountEverest.UNFPAhasbeenanactiveplayeratthecentreandinitsprioritydistrictswhereithasmadeadifferenceintermsofincorporatingMISP,A/SRHandGBVinDisasterPreparednessandResponsePlans,strengtheningcoordinationandtheclusterapproachinRHandGBV,buildingcapacitiesandprepositioningsuppliesand

294 Evaluation of UNFPA Support to Adolescents and Youth 2008‐2015.

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commodities.However,thisimportantworkwasnotsufficientlyreflectedintheCPDorCPAP2013‐17,especiallyintheRRF,andnotreportedandaccountedfor,alsobecausetheSP2014‐17IRFisonlyapartialreflectionofwhatUNFPAcontributes.Origin:EQ6

Conclusion5:UNFPANepalshouldreduceitsnumberofprioritydistrictsandconcentratemore.

UNFPA’sregionalanddistrictpresenceallowsforfocusandsynergies;itgeneratesconcretelocalexperienceforfeedingintonationalpolicydialogueandsystemsstrengthening.However,afterhavingincreasedthenumberofprogrammedistrictsfromsixto12to18,theUNFPANepalCOisrightlyreconsideringitsdecentralizedprogrammingmodality.Itisconsideringleavingdistrictsthathavereachedcertainbenchmarksandmorethematicconcentrationoflimitedfundswithintheremainingones.SomestaffareentertainingtheideaofmoreflexibilityintermsofacceptingdirelyneededOtherResourcesforactivitiesoutsideitsprioritydistricts.Origin:EQ7

Conclusion6:TheUNFPACOshouldbecleareronitsexpectationsofadolescentsandyouthparticipationandtheoutcomeofitsefforts.

YouthparticipationinDDCcouncilandDIPCmeetingshasshownapositivetrend–althoughaccordingtoavailabledatamainlyyoungmenandthosenotbelongingtodisadvantagedgroups.UNFPAcantakecredit.Whilethisincreaseperseconstitutesprogress,CP7isneitherexplicitonnordoesittracktheexpectedoutcomeofUNFPA‐supportedyouthparticipation.Isitincreasedattentiontoandinvestmentsinyoungpeople’sdevelopmentinabroadersenseorlimitedtoSRHissues,whicharespecificallyofinteresttoUNFPA,andwhichtheCOisalsoinfluencingthroughothermeansandchannels?TheCPlogicwouldsuggestthelatter.Origin:EQ1

Conclusion7:TheUNFPACOshouldstrengthenoutcomemonitoring.

TheUNFPACOhasgonetogreatlengthstohavearobustandworkableRRF.However,animportantchallengehasbeenidentifiedconcerningtheselectionofandlevelatwhichtopitchRRFoutcomeindicators.Selection:Dataneedtobecollectedfrequentlyenoughandatreasonablecostandefforttobeusefulfordecision‐makers;otherwiseanindicatorisnotappropriate.Foroutcomeindicators,thiswouldideallybeonanannualbasisinordertoalignwithannualreviews.Level:InNepal,UNFPAintendstomakeacountrywidedifference,withspecialemphasisonselecteddistricts.Thecurrentpractisetopitchsomeoutcomeindicatorsatnationallevelanddisaggregateothersatthelevelofthe18prioritydistrictsisunsatisfactoryandrequiresrefining.WhileinmostcasesUNFPAcontributionismostlikelyandeasiertoestablishatdistrictlevel,dataonarangeoftopicshavebeenunevenlyavailable.However,inacountrylikeNepal,andwiththeCO’slimitedresources,thegapbetweenUNFPAoutputsandnationaloutcomesisoften(too)big.Origin:EQ7

5.2ProgrammaticConclusions

Conclusion8:TheUNFPACOshouldbettercoordinateitsbehaviourchangeactivities.

Besidesreformingthepolicyframeworkandstrengtheningstatesystemsandtheircapacities,UNFPAhasrightlyworkedindifferentwaystopromotesocialandbehaviourchangeandbetterutilizationofservicesamongwomen,men,adolescentgirlsandboys,parentsandcommunities inordertoachievepositiveSRHoutcomes.Goodexperiencehasbeengainedthroughinter‐personalcommunication–e.g.,mobilizingadolescentgirls’circlesand

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orienting/trainingFCHVs,religiousleaders,LGCDPsocialmobilizersandwomencooperativemembers.UNFPAandtheNHEICCalsoproducedanddistributedBCCmaterials,albeitinsufficientinnumber.RecentlytheydevelopedaBCCStrategyandImplementationPlanfor2016‐17.Thissteptowardsamoreprogrammaticapproachispromising.However,itisunclearhowthestrategyandplanalignwithandsupportUNFPA‐supportedinter‐personalcommunicationactivitiestomaximizemessagepenetrationandsynergies.Origin:EQ3,EQ4

Conclusion9:TheUNFPACOshouldcontinuetoinvestinmidwifery.

CP7expectedtocontributetoanincreaseinbirthsattendedbySBAsinordertoimprovematernalhealth.Inactualfact,thisoutcomeendedupnotbeingamajorfocus.Atthesametime,butinthesamevein,theCOanditspartnerscontinuedtoconsiderablyinvesttimeinpromotingmidwifery–i.e.,aseparateeducationprogrammeandofficialrecognitionofmidwives‐whereitfinallyhasconcreteresultstoboastof.MidwiferyisnowformallyrecognizedbytheGoNasaseparateprofession. However,improvinginstitutionalandpersonalskillsofaprofessionrequiresalargeinvestmentoftimeandeffort.Origin:EQ3

Conclusion10:UNFPAshouldfocusitssupportforGBVservicesonhealthresponse.

TheGoNhascommitteditselftopromotinggenderequalityandempoweringwomenbyratifyingvariousconventionsattheinternationallevelandbyformulatingacts,policies,strategiesandactionplansatthenationallevel.RelevantgovernmentmechanismsforGEidentifywiththepolicies.YetwithinthewiderstructureoftheGoNonlylittlepriorityisgivenintermsofplanning,budgetingandimplementation.UNFPA’simplementationsupporthasbeenmulti‐sectoral:ithasworkedwithitstraditionalpartnersinthehealthsystemandextendeditsco‐operationtogenderequalitymechanisms.Thereisunfinishedbusinessonbothfronts:moreOCMCsandhealthprofessionalsthatprovidequalityservices;safehousesthatareprofessionallyrun;psycho‐socialcounsellorsthatworkinremoteanddistantareas;andqualityFFSsthatarelocally‐managedintimesofemergencies.Continuousdatageneration,evidence‐andrights‐basedadvocacyaswellasinstitutionalcapacitybuildingandtrainingforserviceprovidersarestillrequiredfortacklingGBVwithintheoverallGEandreproductiverightscontext.However,UNFPAcannotbeinallplacesatthesametime.Origin:EQ4

Conclusion11:UNFPAshouldcontinuetoprioritizethephenomenonofchildmarriage.

UNFPANepalhasheavilyengagedinfightingchildmarriage.Indeed,datashowarisingageatfirstmarriage,althoughlesssoamonggirlswhoareleasteducated,poorestandlivinginruralareas.Also,thereseemstobeagapbetweenattitudes(highawareness)andbehaviour(overathirdofNepaligirlsaremarriedbeforetheageof18).Toalesserextent,UNFPAhasalsosupportedcommunity‐basedmechanismstoaddressharmfulpractisessuchaschhaupadi(exclusionfromthefamilyduringmenstruation),dowry,witchhuntingandsonpreference.Activitiestothisendandoutcomeswerelessvisible.Whilescalingupworktoendotherharmfulpractiseswouldbeveryimportant,itwouldbeprematuretoshiftscarceresourcesandattentionawayfromchildmarriagewherethereisconsiderableunfinishedbusiness.Origin:EQ4

Conclusion12:UNFPAshouldfurtherstrengthenparliamentarians’commitmenttoandengagementinsexualandreproductivehealthandrights.

Parliamentshavearoletoplayinthedevelopmentagenda.TheUNFPACO,underCP7,initiatedco‐operationwiththeNationalForumforParliamentariansonPopulationandDevelopment(NFPPD),whichhasshownfirstimportantresults.Partneringnotonlywiththeexecutive,butalsowiththelegislativebranchcanbeofaddedvaluefortheentireUNFPA

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countryprogramme,especiallyintermsofinfluencingandleveragingnationalandsub‐nationallaws,policiesandthecurrentlyshrivellednationalbudgetforpopulation,SRH,youthandGBVthatgobeyondsingleministriesanddemandstrongerdomesticaccountability.Origin:EQ5

Chapter6:RecommendationsThischapterpresentstheevaluationteam’sstrategicandprogrammaticrecommendationsforCP8followingfromtheconclusionsdrawninthepreviouschapter.

5.1StrategicRecommendations Recommendation1onStateRestructuring:UNFPAwillneedtoanticipateandflexiblyrespondtothepoliticaltransitiontoensurecontinuedrelevanceandeffectiveness.Inviewofuncertaintiesaroundstaterestructuring,UNFPACOseniormanagementshouldinitiateaninternalscenarioplanningprocess,withtheparticipationofUNFPARegionalDevelopmentCoordinators,tothinkaboutthefuture,howthefuturemightunfold,andhowthismightaffectUNFPA’sorganizationalstructureandinfluenceitsprogrammepriorities,modesofengagementandpartnerships.Recommendation2ontheDataGap:InviewofUNFPA’srecognizedroleasakeyplayerinpopulationandhousingcensusesandSP2013‐17Outcome4Indicator1,thePDcomponentofCP8shouldprioritizesupportforGoNplanning,implementation,monitoring,disseminationanduseofthenextPopulationandHousingCensusin2021.InterventionsshouldtakeintoaccountfindingsandrecommendationsoftherecentevaluationofUNFPASupporttoPopulationandCensusDatatoInformDecision‐makingandPolicyFormulation2005‐2014.Recommendation3ontheDataGap:AsmemberoftheGlobalCivilRegistrationandVitalStatisticsGroupandinthecontextoftheGlobalCivilRegistrationandVitalStatisticsScalingUpInvestmentPlan2015‐2024295,theUNFPACO(PDTeam)shouldexploreopportunitieswithHQ,theGoNandinternationalpartnerssuchastheWorldBankforUNFPAtechnicalassistanceforstrengtheningtheCRVSsystem,particularlyforfacilitatingtheanalysisanduseofCRVS‐generatedvitalstatisticsforlocalplanninganddecision‐making.Recommendation4ontheDataGap:GoNandUNFPAplanning,monitoringanddecision‐takingregardingASRHhasbeenrendereddifficultbytherecently‐overhauledHMISthatonlyoffersdataalongindicatorsforthebroadagecohort15‐49.TheUNFPACO(SRHTeam)shouldadvocatewiththeMoHandprovidetechnicalsupport,includingtrainingatallgovernmentlevels,forincorporatingdisaggregatedASRHindicatorsanddatainthegovernmentreportingsystem.Revisedreportingshouldcapturethestatusandessentialhealthservicesprovidedtoveryyoungadolescents(10‐14)andolderadolescents(15‐19),maleandfemale.Recommendation5onVeryYoungAdolescents:AspartofCP8preparations,andinconsultationwithselectedpartnerssuchasUNICEF,UNFPANepalshouldcommission/useanalysesandexploreopportunitiestostrengthentheparticipationandtargetingofveryyoungadolescents.Recommendation6onEmergencyPreparedness:TheclusteredcountryprogrammeevaluationofUNFPA’sengagementinhighly‐vulnerablesituations(CCPE),ledbytheUNFPAEvaluationOffice,shouldreviewIRFindictorstobetterreflectthedifferenttypesofUNFPAcontributionstoemergencypreparednessinitsprogrammecountries.Recommendation7onEmergencyPreparedness:UNFPANepalseniormanagementshouldensurethattheCPDandCPAP2018‐22speakmoretoNepal’svulnerability,firstandforemosttoearthquakesandfloods,butalsototheconsequencesoffrequentcivildisturbancesthatdisruptservicesanddistributionofsupplies.TheRRFshouldbetterreflectoutputsinA/SRH,GEandPDthatareexpectedtocontributetoimprovedemergencypreparedness.

295 http://unstats.un.org/unsd/demographic/CRVS/GlobalCRVS.html; http://www.worldbank.org/en/topic/health/publication/global‐civil‐registration‐vital‐statistics‐scaling‐up‐investment.

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Recommendation8onDecentralizedProgramming:UNFPA’sdecentralizedprogrammecomponentshouldbemaintained.Butinviewofpositivedevelopmentoutcomesandlimitedresourcesitshouldbescaleddown.CP8shouldbeimplementedwithspecialemphasisonareducednumberofprioritydistrictswithinitscurrentgeographicalclusters.UNFPACOseniormanagementshouldreviewUNFPA’sprioritydistrictsagainstICPDandrelevantSDGgoalsandplanitscompleteorpartialexitfromindividualdistricts.Totheextentpossible,theCOshouldcontinuetodirectOtherResourcestoitsprioritydistricts.However,dependingondonors’ownstrategiesandpriorities,UNFPAshouldbemoreopenthaninthepasttoselectiveprogramminginotherdisadvantagedareas,withoutcontractingfurtherDDCsasImplementingPartners.Recommendation9onA&YParticipation:ItisnotclearwhatUNFPA’ssupportforyouthparticipationhasresultedin.CP8shouldbemoreclearlytargetedtowardsandtrackthecontributionofitssupportforyouthparticipationtoadvancingUNFPA’smandateandICPDprioritieswithintheSDGcontext.Recommendation10onMonitoring:CP8RRFoutcomeindicatorsshouldbelocatedatthenationalordistrict‐leveldependingontheimportanceandscaleofUNFPA’sassistanceandtheavailability/collectabilityofdata.Whilethecontributionofawidergroupofpartnersisusuallyessential,outcomesneedtobeseenashavingasignificantandcrediblerelationshipwithUNFPAoutputs,otherwisetheirdegreeofambitionneedstobelowered.

5.2ProgrammaticRecommendationsRecommendation11onBCC:UNFPANepalCOstaffinvolvedinknowledgegenerationandattitude/behaviourchange(SRHTeam,GETeam,Communication&AdvocacyOfficer)shouldformaninternalBCCworkinggrouptoensureoptimalcoordinationandintegrationofdifferentA/SRH,GBVandchildmarriage‐relatedBCCactivitiesandpartners.Recommendation12onMaternalHealth:Midwifery–i.e.,developingandcoachingacadreofprofessionalmidwiveswhoprovidecomprehensivematernityservicesandhelppreventemergenciesfromoccurring,eveninremoteareas,shouldcontinuetobeamajorUNFPApriorityinlinewiththeNationalHealthPolicy.InviewofdecliningRegularResources,UNFPANepal(SRHTeam)shouldconcentrateonconveningandcoordinatingstakeholdersandleveragingfinancialsupport.Recommendation13onGBVServices:Inviewofscarceresources,theCOoughttoconcentrateitsRegularResourcesonitsoriginalmandatewhereithasanaddedvalue.AsalreadyenvisagedintheCP7RRF,thisisthehealthresponse.UnderCP8,theUNFPANepalCO(GETeam)shouldcontinuetofocusonGBV,butwithastrongerandmoreuniquefocusonthepublichealthsystem’scontributiontoprotectingandcaringforGBVsurvivors,bothinitsregularprogramming,includingemergencypreparedness,andhumanitarianresponse.UNFPAshouldmobilizeothersandincreasethepoolofactorstofillgapsinviewofestablishingafunctioningreferralsystem.Basedonanassessmentofpsycho‐socialcounsellingandsafehouses,itshouldmobilizeandleverageOtherResourcesforstrengtheningthereferralsystem.Recommendation14onChildMarriage:TheUNFPANepalCO(GETeam)shouldcontinuetoemphasizethepreventionofchildmarriage,nowlegallydefinedasamarriageenteredintobyanindividualbeforereachingtheageof20(asopposedto18attheoutsetofCP7).CP8shouldbemoreexplicitonthedrivingfactorsthatoverrideknowledge,positiveattitudesandnationallegislation.Simultaneously,duringCP8,theCOshouldstrengthenthegroundworkforUNFPAandotherpartnerstotackleotherharmfulpractisesinanevidence‐basedandresults‐orientedmanner,andfromahuman‐rightspointofview.Recommendation15onLegislativeSupportforSRH:TheUNFPANepalCOshouldstrengthencollaborationwiththeNFPPDbyfacilitatingincreasedparticipationofparliamentariansinnationalandinternationaleventsandforumsoninterlinkagesbetweenpopulation,SRH,genderandGBVissues;andbuildingthecapacitiesofparliamentarianstofulfiltheirlegislativeandoversightroles.

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