CONSULTANCY SERVICE FOR CLIMATE CHANGE SECTOR SYSTEM AND VULNERABILITY ANALYSIS IN THE PUBLIC HEALTH AND WASH SECTORS, LAO PDR At Plan International

Terms of Reference

CLIMATE CHANGE SECTOR SYSTEM AND VULNERABILITY ANALYSIS IN THE PUBLIC HEALTH AND WASH SECTORS, LAO PDR

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About Plan International

Plan International is an independent development and humanitarian organization that advances children’s rights and equality for girls in developing countries and around the world. We connect committed people with powerful ideas in order to find solutions and trigger change that makes a real difference for children, especially girls. For over 80 years, Plan International has supported girls and boys and their communities around the world to claim their rights, free themselves of poverty and live positive fulfilling lives. Plan International has no religious or political affiliations.

About the WIN Project

Since 2019 Plan International Laos and Plan International Australia have been implementing the Water, Sanitation, and Hygiene (WASH) Integrated Nutrition (WIN) project. The overall goal of the project, which is in its third phase (fiscal years 2020 to 2022), is the reduction in stunting of girls and boys aged 0-23 months and a progressive movement towards gender transformative maternal and child health (MCH)-WASH outcomes in 114 communities in Saravan and Oudomxay Provinces. The project also contributes to achieving the objective of Plan International Laos’s Country Strategy under the Public Health and Nutrition Program (PHNP).

The WIN project is a renewed, direct response to the negative long-term development implications of under-nutrition in Lao PDR, which continues to record the highest national rate of under-nutrition in South-East Asia. Approximately 44% of children under 5 demonstrate moderate to severe undernutrition (stunting). Within Laos, there are substantial variations between provinces, with those targeted by this project recording rates of stunting significantly higher than the national average. The main part of the project is the implementation of the Community-led Total Sanitation (CLTS) Plus model that comprises seven components of public health and WASH. The components are:

1. First 1000 Days of life promotion by Social Behaviour Change Communication materials
2. Menstrual hygiene management.
3. Hygiene and environmental sanitation promotion and provision of community water systems.
4. Food intake for children under 2 years old.
5. Stimulation children under 2 years old.
6. Inclusion and child protection integrated into target communities.
7. Gender and WASH monitoring tools are used to engage target communities to promote gender equality.

Besides the CLTS Plus model, the WIN Project has a clinical component that aims to improve mother and child health services through Puern Tae or True Friend approach. This component consists of capacity strengthening of health care workers to conduct outreach activities targeting communities and health centres in raising awareness on maternal and child health services. The clinical component of the WIN Project has three main targets, which are to increase the number of (1) women and girls who consume at least 4 of the 6 food groups daily, (2) children aged 0-6 months who receive early and exclusive breastfeeding, and (3) children aged 6-23 months who receive a minimum acceptable diet.

By June 2021, the combination of CLTS Plus and the clinical component of the WIN Project has resulted in various outcomes at the community level. Rates of wasting, stunting, and malnourishment are gradually reduced in one of the project’s districts where CLTS Plus was implemented. The malnutrition level of children aged 0-2 years was decreased by 8.40%, indicating that the combination of exclusive breastfeeding practice, nutrition intake, and dietary standard at the village level has improved. There are also notable improvements in communities’ hygiene behaviours in all project locations. These are indicated by the significant addition of community members who have access to basic sanitation and handwashing facilities. In the locations where community water systems are constructed and rehabilitated, women and girls are able to reduce their burden of carrying out household roles due to improved access to clean water.

Background: Climate Change in Laos PDR

Climate change directly impacts water resources and water services for all economic, social, and environmental functions that water supports. As the global water cycle is directly affected by climate change, people’s access to food and nutrition, safe water, sanitation, and hygiene solutions can be significantly affected by extreme events such as floods and droughts, as well as growing water scarcity. The global climate change model[1] has predicted that Laos PDR will experience an increase in temperature, the intensity of rainfall that will increase the risk of floods and droughts and extended dry seasons. Annual precipitation overall has decreased by two to three percent across all of Laos PDR over the last century. In several provinces in Laos PDR, climate change exacerbation has resulted in water scarcity in many areas.

Women and girls are increasingly being seen as more vulnerable than men and boys to the impacts of climate change, mainly because they represent the majority of the world’s poor and are proportionally more dependent on the threatened environment. Globally, including in Laos PDR, women and girls represent a high percentage of poor communities that are highly dependent on local natural resources for their health and well-being, particularly in rural areas where they shoulder the major responsibility for household water supply, family care, and food security[2]. The difference between men and women can also be seen in their differential roles, responsibilities, decision-making, access to land and natural resources, and opportunities and needs. Women and girls have less access than men and boys to resources such as land, water, healthcare, nutritious foods, technology, training, and extension services that would enhance their capacity to cope with climate change impacts[3]. Furthermore, women and girls have negligible participation in decision-making and are not involved in the distribution of environment management benefits. Consequently, women are less able to confront climate change.

The public health and WASH sectors in Laos PDR are already affected in many ways by climate-related events (such as natural disasters, climate variability, and extreme events). This translates into negative impacts on food security, drinking water availability and quality, and in a negative performance of sanitation and hygiene services. Climate-related events can compromise health infrastructure and WASH service delivery, in which this interruption of health and WASH services can increase the number of affected people beyond the area of direct impact. During extreme weather periods, rural communities tend to stop their hygiene practices due to the unavailability of or difficulty in access to sanitation and hygiene facilities. Future climate change will put additional stress on delivering and sustaining health and well-being related outcomes.

A changing climate brings with it uncertainties that compound those that are already inherent in the public health and WASH sector, especially in developing countries that are the most vulnerable to these negative impacts. In developing countries, including Laos PDR, the incidence of diarrhoea is expected to increase by around 5% for every 1°C increase in temperature[4]. Furthermore, it has been predicted that in Laos PDR and other countries in Southeast Asia, climate change will lead to a relative increase in moderate stunting of 1-29% in 2050 compared with a future without climate change and an even greater impact on rates of severe stunting, which is estimated will increase by 62%[5].

There is also a growing concern by institutions such as the WHO and the G8 that global changes in the atmosphere, terrestrial ecosystems, and climate, to which environmental pollutants such as air pollution contribute, have the greatest impact on children’s growth and development as well as the wellbeing of pregnant and fetuses[6]; “…hundreds of millions of today’s children live in areas that are most exposed to climate change.” In fact, an estimated 710 million children live in the 45 countries, including in the Lao PDR, that are at the highest risk of suffering the impact of climate change such as food shortages, diseases, droughts, and/or rising sea levels.

Objective and Scope of the Assignment

Plan International Laos observes that climate change is likely to impact the progress and deliverables of the WIN project. It is also observed that the health, nutrition, and WASH outcomes that have been achieved at the community level would be negatively impacted by climate change. So that the outcomes and gains secured by the WIN project can be retained, Plan International Laos holds seeks to deepen its understanding by conducting a study that aims to answer the following questions:

1. What are the climate change impacts that have occurred in the project locations?
2. How do the impacts affect the communities, particularly concerning the project outcomes?
3. What are the potential strategies to adapt to the impacts?

In addition to the three questions, and to inform current and future phases of the WIN project and other programs, Plan International Laos wishes to understand the wider dimensions of climate change in Laos PDR including its social, sector system, and economic dimension. Therefore, consulting services are sought to gather, use, and analyse data and information on the occurrence and impacts of climate change on public health and WASH systems and the wider climate change sector ‘system’ in Laos PDR. The analysis to be undertaken is to cover but is not limited to:

· Recent data on climate extremes and potential hazards

· Vulnerability and adaptive capacity of communities,

· Water resources management and availability amidst climate uncertainty

· Climate change stakeholders and their mandates, influence, and motivations

· Climate-related public health and WASH risks.

In the end, the consultant will provide guidance and recommendations to Plan International Laos regarding options and priorities to guide the program direction and interventions of Plan International Laos’ Public Health and Nutrition Program including the WIN project.

Proposed analytical framework

The climate change sector system analysis is required to identify specific barriers and opportunities related to climate change occurrence and its impact on public health and WASH in Laos PDR. The sector system analysis is useful for explaining a specific climate change policy or programmatic issue regarding the nexus of climate change, public health, and WASH. Through the sector system analysis, the consultant will be able to identify and analyse climate change stakeholder networks, institutional arrangements, and opportunities for potential engagement for Plan International Laos. The sector system analysis will also identify and analyse the gender and social inclusion (GESI) dimensions of the nexus of climate change, public health, and WASH.

Based on the Australia Department of Foreign Affairs and Trade’s (DFAT) guidance[7], the ‘problem-driven approach is particularly appropriate for conducting the climate change sector system analysis. The guidance uses the example of the World Bank’s problem-driven framework that has four steps to help ensure the analysis is relevant and is used (see Figure 1). Plan International Laos expects the consultant to perform the steps tailored to the nexus of climate change, public health, and WASH. However, the consultant may perform a more comprehensive sector system analytical approach whenever possible.

Figure 1. Sector system analysis guiding questions

Source: DFAT Guidance Note (https://www.dfat.gov.au/sites/default/files/political-economy-analysis-guidance-note.pdf)

In addition to the wider perspective of the sector system analysis, Plan International Laos aims to understand the climate change vulnerability of community-based public health and the WASH sector, specifically regarding the WIN project’s seven components of ‘CLTS Plus’ and Puern Tae clinical component as detailed earlier. Therefore, the consultant will analyse how the sector is/will become vulnerable to climate change and what the appropriate adaptation options are. The following matrix guides the vulnerability analysis, however, the consultant may use a more comprehensive approach or tool in doing so. Consistent with the sector systems analysis noted above, this vulnerability analysis will include consideration of gender and social inclusion (GESI) dimensions relevant to community-based public health and WASH at each step.

Figure 2. Vulnerability analysis framework

Step

Further explanation

· Identify the climate change impacts on a sector

Provide details on ‘Exposure’ or ‘Hazards’, i.e. describing the climatic stressors.

· Explain how this sector is/will become vulnerable to climate change

Provide details on ‘Sensitivity’ and the drivers of vulnerability. Indicate, where applicable, the assumption(s), framework(s), or perspective(s) underlying your explanations

· Describe current adaptation practices

Describe the existing adaptations adopted in practice (in-country practices if available, if not sector best practices from other locations)

· Indicate the strengths and weaknesses of these adaptations

Evaluate these adaptations. Be specific about the terms in which these adaptations are considered to be good or successful.

· Make some recommendations as to what needs to do more

Source: adapted from ODI’s climate change vulnerability analysis (https://cdn.odi.org/media/documents/odi_climate_change_conflict_and_fragility.pdf)

The consultant will work closely (including regular communication and collaborative working style) with Plan International Australia (PIA) WASH team and the Plan Laos Public Health team. Due to COVID-19 travel restrictions, regular and quality communication is needed between all parties involved in the assessment.**

Methodology and Deliverables

The study will be conducted through a qualitative approach based on a balanced combination of primary and secondary data. However, the consultant may also apply a simple quantitative approach and/or modeling approach if necessary. The consultant may conduct primary data collection in project locations with the support of Plan International Laos. The primary data collection methods that the consultant may need to conduct are field observation and interviews with community members, government officials, and other relevant stakeholders (with FGDs as an additional method if necessary). For qualitative interviews with participants at the community level, the purposive sampling method would be recommended, however, the consultant could perform another more appropriate qualitative sampling procedure if needed. The locations for primary data collection would be jointly decided by the consultant and Plan Laos, and would be reflective of the different environments of lowland, plateau and mountainous topography: potentially six villages across both Saravan and Oudomxay provinces

Secondary data collection can be done through desk study and data solicitation to relevant stakeholders. During the study preparation, data collection, and analysis phase, the consultant will seek and obtain regular feedback from related Plan International Laos staff members and other individuals appointed by Plan International Laos.

The final deliverables from the consultant under this assignment are:

1. A full study report of no more than 50 pages (plus annexes) that can be used as a program design and implementation guideline and which details:

o Outputs from sector system analysis

§ Key sectoral issues on the climate change, public health, and WASH nexus

§ Key GESI issues related to climate change impacts

§ Climate change stakeholder mapping

§ Climate change institutional analysis (i.e., policy, law, relevant programs, formal/informal factors)

§ Opportunities and critical areas for entry points and engagement for PIL

o Outputs from vulnerability analysis

§ Description of climatic stressors, exposure, and hazards

§ Climate change impacts at the community level in Laos PDR in general and in the project locations more specifically

§ The sensitivity of public health and WASH sector and the drivers of vulnerability

§ Analysis and evaluation of existing adaptation practice

§ Adaptation strategy and recommendation for PIL

1. A summary report of no more than 5 A4 pages providing a concise version of the findings from the study and the key programming recommendations for PIL.

Ethics and Safeguarding

Plan International is a children’s rights organization that focuses on the well-being of children. We require all those involved in our work to commit to our child protection guidelines and to treat children and young people in a way that respects their rights and dignity and pays equal attention to their best interests.

Timeline

The consultant has two to three month period to complete the study, with approximately 35 work days. It is scheduled to start in late 2021 and is to be completed no later than February 2022. Final timelines will be agreed upon between the consultant and Plan International Laos at the start of the consultancy.

Expected Qualifications

We are looking for a consultant or consultant team with the following qualifications and experience:

· Relevant academic qualifications, demonstrating an ability to undertake systems analysis based on secondary sources.

· At least five years of experience in WASH, environment or natural resources management sector

· Proven experience in analysis and interpretation of climate information in the Southeast Asia Region (preferably in the Lao PDR).

· Experience of working in partnership with Lao government agencies and an appreciation of their working modalities, drivers and challenges will be an asset.

· Demonstrated experience in producing study and research reports.

· Excellent spoken and written English, good interpersonal skills, and ability to communicate effectively with people from different backgrounds.