MULTI-SECTORAL EDUCATION

AND WASH PROGRAMMING IN

THE LAO PDR

A CASE STUDY OF PLAN’S ECCD

AND WASH PROGRAMS IN BOKEO

PROVINCE

FUNDED BY AUSTRALIAN AID

May 2014

ACKNOWLEDGEMENTS

Thanks are due to all those people too numerous to name who gave their time to be interviewed and

answer my many questions, particularly the WASH and ECCD Team members in Meung and Pha

Oudom Districts. Thanks are also due to the Heads of Department in each participating sector at

provincial and district levels who shared their perspectives and suggestions regarding multi-sectoral

collaboration, as well as relevant Plan staff at all levels who provided a wealth of background information

and documentation. While many people have contributed to this study, any mistakes or

misunderstandings found in this report are solely the responsibility of the author.

W. John Howe

Director

Asia-Oceania Development Network

www.asiaoceania.net May 2014 Cover Photo: ECCD Village Volunteer Trainers prepare to give parenting training in their own villages. Longphabath Village, Meung District, April 2014

i

Table of Contents

Terms and Abbreviations ......................................................................................................................... ii

1. EXECUTIVE SUMMARY ................................................................................................................ 1

2. INTRODUCTION .......................................................................................................................... 3

3. MULTI-SECTORAL PARTNERSHIPS - AN OVERVIEW ...................................................................... 4

3.1 Global Research .......................................................................................................................... 4

3.2 Multi-Sectoral Programming in the Lao PDR ................................................................................ 5

3.3 Food and Nutrition Security Action Plan (FNSAP) ........................................................................ 6

4. CASE STUDY FINDINGS ................................................................................................................ 7

4.1 The WASH Program .................................................................................................................... 8

4.2 The ECCD Program .................................................................................................................... 10

4.3 WASH and ECCD Programs – Success Factors ............................................................................ 11

5. LESSONS LEARNED AND RECOMMENDATIONS ......................................................................... 13

6. CONCLUSIONS .......................................................................................................................... 14

Appendices

Appendix 1. Terms of Reference

Appendix 2. Bibliography

ii

Terms and Abbreviations

BEP : Basic Education Programme

CLTS : Community Led Total Sanitation

DESB : District Education and Sports Bureau

DHO : District Health Office

DWT : District WASH Team

ECCD : Early Childhood Care and Development

ECE : Early Childhood Education

FNSAP : Food and Nutrition Security Action Plan

INGO : International Non Government Organisation

LWU : Lao Women's Union

LYU : Lao Youth Union

MDGs : Millennium Development Goals

MNCHN : Maternal, Newborn and Child Health and Nutrition

MoES : Ministry of Education and Sports

MoH : Ministry of Health

MoU : Memorandum of Understanding

NGPES : National Growth and Poverty Eradication Strategy

ODF : Open Defecation Free

PESS : Provincial Education and Sports Service

PHD : Provincial Health Department

PMC : Program Management Committee

TOR : Terms of Reference

UNICEF : United Nations International Children‟s Fund

WASH : Water, Sanitation and Hygiene

1

1. EXECUTIVE SUMMARY

Multi-sectoral programming is not a new phenomenon, but has been receiving increased attention in

more recent years, particularly in addressing malnutrition which requires a more comprehensive multi-

sectoral approach in order to be effective. Implementing multi-sectoral programs can also be

challenging, with different sectors having different priorities, perspectives and ways of working.

In the Lao PDR, recent efforts to work multi-sectorally have included the response to avian influenza

and the UN supported REACH program. Planning is currently underway to implement the National

Food and Nutrition Security Action Plan (FNSAP) and there has been significant discussion regarding

how the agriculture, health and education sectors might work together effectively to achieve MDG 1, at

national, provincial and particularly at district levels.

At the same time, INGOs working in the Lao PDR, working with their Lao Government counterparts,

have significant experience in programming at district level involving more than one sector. This case

study involves a review of both the global literature on multi-sectoral partnerships as well as of two

programs supported by Plan in three districts in Bokeo Province - the WASH and ECCD programs -

which primarily involve the education and health sectors working together at district and village level.

The literature on multi-sectoral programming highlights a number of 'success factors' that should ideally

be present if this type of programming is to be effective. These inter-related 'success factors'1 include:

recognising and accepting the need for partnership; developing clarity and realism of purpose; ensuring

commitment and ownership; developing and maintaining trust; creating clear and robust partnership

arrangements; and monitoring, measuring and learning. Implicit in these factors is the need to ensure that

adequate time and effort are spent initially on planning and preparation so that all stakeholders are clear

on the purpose and benefits of the partnership, that effective management arrangements are in place,

and that the right people are selected for the implementation teams.

While there are a number of different models of multi-sectoral partnerships, the 'convergence model' of

multi-sectoral partnerships is increasingly being seen both globally and in the Lao PDR as an effective

way in which various sectors can work together despite their differences. This model involves multiple

sectors working together in planning and monitoring, with implementation being largely carried out

individually by each sector, sometimes referred to as 'think multi-sectorally, act sectorally'.2

INGOs in the Lao PDR have experience working multi-sectorally using under a number of different

arrangements, including seconding staff from different sectors to work in multi-sectoral teams, working

primarily with one sector but involving other sectors on a part-time basis, and more 'sector neutral'

arrangements - for example, working through the Committee for Rural Development and Poverty

Eradication under the leadership of District Governor's offices. While each arrangement has its

strengths and weaknesses, all generally involve an oversight committee, usually at district level with

some provincial level involvement.

The WASH and ECCD programs supported by Plan both provide examples of effective, though evolving,

multi-sectoral programs involving largely the education and health sectors at district level. The WASH

1 Adapted from Hardy, Hudson and Waddington, Assessing Strategic Partnership - The Partnership Assessment Tool,

2003 and other sources (see Annex 2. Bibliography). 2 Improving Nutrition through Multi-sectoral Approaches, World Bank. 2013

2

program provides school WASH infrastructure, associated community water supplies and hygiene

promotion, with a special focus on schools, while the ECCD program consists of two main components

- a community based multi-sectoral component focussed on parents (and parents to be) and children

between the ages of 0 - 5 years, and a sectoral ECE component focussed on pre-schools.

Both programs largely fit within the convergence model in that planning and monitoring are largely done

jointly, though implementation is sometimes sectoral, sometimes done together. While the MoUs for

both programs specify a provincial level Implementation Management Committee (IMC), these have not

functioned and oversight is provided by district level Steering Committees comprised of senior staff

from the relevant sectors and chaired by the District Governor's Office.

Originally, both programs did not have clearly documented roles and responsibilities for each sector

involved. This is now being addressed in the new WASH program MoU with the Ministry of Health.

However, the ECCD program has yet to develop this. While teams in both programs have been trained

in gender awareness and are addressing gender and inclusion related issues within their programs, they

would also benefit from a more comprehensive gender 'audit' by Plan in order to identify additional

practical ways in which gender could be mainstreamed more effectively into the program. Plan also

needs to ensure that equipment being provided to the program is shared equitably between the two

main sectors involved in order to avoid any negative impact on team morale.

The case study of the multi-sectoral WASH and ECCD programs as well as the review of relevant

literature documenting experience elsewhere, demonstrates the importance of ensuring that multi-

sectoral teams are well prepared with a shared understanding of purpose, are provided with effective

leadership and that clear organisational arrangements are in place. Teams need to be supported to 'think

multi-sectorally but act sectorally', with multi-sectoral program coordination mechanisms based at

district level rather than at provincial level. Multi-sectoral team members should also be provided with

equitable access to resources to do their work to avoid any negative impact on morale and

effectiveness.

While multi-sectoral approaches can be challenging, the literature and the findings from this case study

demonstrate that these kinds of partnerships can work, and are working in both the Plan WASH and

ECCD programs, contributing to more comprehensive and sustainable change than is perhaps normally

the case with single sectoral approaches.

3

2. INTRODUCTION

Multi-sectoral partnerships take different forms but share the expectation that objectives can be

achieved more effectively and efficiently through working together rather than working alone.

Developing effective multi-sectoral collaboration is challenging in any country, with different sectors

bringing their own perspectives, priorities and approaches to the partnership.

In the Lao PDR, development programs and projects are largely sectoral in nature, with donors and

development organisations signing MoUs with a single Ministry or Mass Organisation and then working

with and through their representative Departments or Offices at provincial and district levels. Inter-

sectoral collaboration has mostly involved one sector with overall responsibility for planning,

implementing, monitoring and reporting, inviting technical staff from other departments/organisations to

assist with implementation of specific activities only, rather than as partners.

As a number of recent case studies have shown3, developing a multi-sectoral approach to development

is a more effective and efficient way of achieving Millenium Development Goals (MDGs). Multi-sectoral

collaboration has been used in the Lao PDR in the recent past. For example, the global outbreak of

avian influenza saw the establishment of an inter-ministerial office4 to lead the response to the outbreak.

The UN REACH program 5 has brought together various UN agencies as well as several Lao

Government Ministries to address problems related to malnutrition and accelerate the scale-up of food

and nutrition actions. More recently, there have been discussions among Lao Government

representatives and Development Partners (donors and international organisations), particularly in

relation to the MDGs, several of which require a multi-sectoral approach if they are to be achieved.

This has led to the development of the National Food and Nutrition Security Action Plan (FNSAP) in

2013 and the establishment of the National Nutrition Committee, and has stimulated significant

discussion regarding how the agriculture, health and education sectors might work together effectively

to achieve MDG 1, at national, provincial and particularly at district levels.

There is also evidence on how multi-sectoral approaches can be implemented at provincial and district

levels. Several INGOs are supporting different forms of multi-sectoral collaboration at this level,

including Plan International, who, together with the Provincial Education and Sports Service (PESS),

District Education and Sports Bureau (DESB), Provincial Health Department (PHD) and District Health

Offices (DHO), have developed multi-sectoral collaboration for their ECCD and WASH programs in

three districts in Bokeo Province, funded by Australian Aid. This report documents this collaboration in

the form of a case study to identify lessons which could inform future multi-sectoral programming.

Development of this case study involved a literature review on multi-sectoral partnerships as well as

Plan's WASH and ECCD program documentation, key informant interviews, small group discussions and

observation of some ECCD and WASH activities in target districts.

3 e.g. Harmann, R., Pienaar, S., Boulogne, F., and Kranz, N. What makes cross-sector partnerships successful? Working

Paper, University of Capetown. 2007; Levinson, F. J. and Yarlini Balarajan, Addressing malnutrition multi-sectorally.

What have we learned from recent international experience? United Nations, 2013 4 Initially known as National Avian Influenza Coordination Office which later became the National Emerging

Infectious Diseases Coordination Office. 5 Renewed Efforts Against Child Hunger (REACH) is a joint United Nations initiative to address Millennium

Development Goal (MDG) 1, Target 3 - to halve the proportion of underweight children under 5 years old by

2015.

4

3. MULTI-SECTORAL PARTNERSHIPS - AN OVERVIEW

3.1 Global Research

There has been a significant amount of research into multi-sectoral partnerships in countries other than

the Lao PDR. While a comprehensive literature review is beyond the scope of this case study, the

'success factors' identified from other research involving case studies, as well as lessons learned from

implementing multi-sectoral nutrition related interventions in other countries, provide a useful context

against which the Plan supported ECCD and WASH programs as well as possible future multi-sectoral

partnerships can be reviewed.

Success Factors: Although much of the research into success factors in multi-sectoral partnerships

has taken place in developed economies with more of a focus on collaboration between Government

and the private sector, the general findings of this research have been largely supported by research

involving case studies in emerging economies as well. 6 While different studies of multi-sectoral

partnerships have emphasised different elements as contributing towards successful partnerships, they

generally fall within the scope of six inter-related factors7.

Recognising and accepting the need for partnership: This includes the need for all sectors involved8

to understand the need for a partnership and the policy context in which it will take place, as

well as identifying potential barriers and ways of addressing these.

Developing clear and realistic goals and objectives: Members of the multi-sectoral partnership need

to develop realistic interrelated or shared goals, objectives, and outcomes, and focus initially on

those areas where there is more likelihood of success in order to encourage and motivate team

members.

Ensuring commitment and ownership: This is particularly important among senior management and

heads of each sector (as well as among technical staff responsible for implementation), as limited

support at higher levels within each sector will impact negatively on multi-sectoral collaboration.

Developing and maintaining trust: Ensuring fairness and equity across sectors both in terms of

participation as well as distribution of resources is also important. This also relates to ensuring

the right people are selected for front line and leadership positions.

Creating clear and robust partnership arrangements: Clear and straightforward organisational

arrangements need to be in place as well as clarity regarding roles and responsibilities and

financial transparency.

Monitoring, measuring and learning: There needs to be agreement on a range of success criteria

as well as arrangements for monitoring and reviewing how well the partnership‟s aims and

objectives are being met. Periodic reviews looking at how well the multi-sectoral team is

working and what changes might be needed to improve their effectiveness are also important.

6 Harmann, R. et al. What makes cross sectoral partnerships successful? A comparative case study analysis of diverse partnership types in an emerging economy context. 2007

7 Adapted from Hardy, Hudson and Waddington, Assessing Strategic Partnership - The Partnership Assessment Tool, 2003.

8 Research has looked at different sectoral arrangements - e.g. among Government sectors, between public and

private sectors, and also civil society.

5

Planning and preparation are critical factors in setting up an effective multi-sectoral partnership. Time

and effort are needed at the outset to ensure that all stakeholders are clear on the purpose and benefits

of the partnership, that effective management arrangements are in place, and that the right people are

selected for the implementation teams.

The 'Convergence' Model: The convergence model requires multiple sectors to work together in

planning and monitoring, with implementation undertaken sectorally. This is sometimes referred to as

'think multi-sectorally, act sectorally'.9 This approach has been promoted by UN agencies and is now

regarded as an effective way in which different sectors can work both multi-sectorally as well as

sectorally to achieve common objectives.

The convergence approach developed out of an acknowledged failure of many earlier multi-sectoral or

integrated nutrition programs (particularly in the 1970s and 1980s) to achieve their goals and the

realisation that it is extremely challenging for sectors to work in a fully integrated way given differing

budget allocations as well as governance and accountability structures.10 A recent set of case studies of

multi-sectoral nutrition programs in Peru, Brazil and Bangladesh, 11 have provided evidence that a

convergence approach can work, and identified this approach as one of the main elements contributing

to successful multi-sectoral collaboration. This study also identified the importance of results-based

incentives for sub-national governments to encourage greater accountability for results, as well as

sustained civil society advocacy at the policy level and 'quality control' at the implementation level to

ensure effective multi-sectoral implementation.

3.2 Multi-Sectoral Programming in the Lao PDR

INGOs have significant experience implementing multi-sectoral projects and programs in the Lao PDR

which involve a variety of institutional arrangements with government.

Type 1. The 'Sub-Contracting' model: While not really a multi-sectoral model, this is the most

common type which involves a largely single sector program with an MoU signed between the

supporting organisation and the relevant line ministry or mass organisation. Funding and resources are

channelled through one sector with staff from other sectors being invited to implement specific

activities, on a 'sub-contracted' basis. For example, an education project may ask the District Health

Office to assist with water supply and sanitation in schools. This model is relatively simple to implement,

but does not necessarily result in sustainable change.

Type 2. The 'Seconded Staff' model: Technical staff from different district level departments are

seconded full time to a project or program for a specific time period, normally three years (the typical

donor funding timeframe), under the leadership of one sector whose line ministry has signed an MoU

with the donor and/or international organisation which is providing the funding and technical support.

While this model helps to ensure a more coordinated and comprehensive multi-sectoral approach to

implementation, it does take staff away from departments which are already under resourced in terms

of personnel, and can also contribute to discord between the seconded staff member and others within

9 Improving Nutrition through Multi-sectoral Approaches, World Bank. 2013 10 Ibid. Pg 32 11 Levinson, F. J. and Yarlini Balarajan, Addressing malnutrition multi-sectorally. What have we learned from recent

international experience? United Nations, 2013.

6

their own department due to 'resource envy'. Also, the multi-sectoral collaboration is unlikely to

continue once the project funding period ends.

Type 3. The 'Part-time Multi-Sectoral' Team model. This involves an MoU between one sector

and the supporting international organisation, but with technical staff from other sectors being involved

in a project/program on a part-time basis and involved in varying degrees in planning, implementation,

monitoring and reporting. This is the model being used by the Plan supported WASH and ECCD

programs in Bokeo Province and will be discussed in more detail later in this report.

Type 4. Non-sectoral 'Neutral Leadership' model: Perhaps less common, this type of multi-

sectoral engagement involves an MoU with a central non-sectoral body, typically the National

Committee for Rural Development and Poverty Eradication under the Prime Minister's Office. At

district level, this Committee is part of the District Governor's Office and thus has the authority to

oversee multi-sectoral implementation. This model is used for community development programs and

projects involving multiple sectors and enables a 'level playing field' in terms of sectoral dominance. It

also enables greater program flexibility in terms of the addition of new components to the program

even after the MoU has been signed, as all sectors are covered in some way. However, this model also

presents some challenges - for example, staff capacity of the Committee for Rural Development and

Poverty Eradication at provincial and particularly district levels is often limited, both in terms of numbers

of staff as well as previous experience and skills in coordinating, planning and reporting on larger multi-

sectoral programs and projects. Thus the funding organisation usually finds it necessary to have support

staff based at the district level in order to ensure that coordination among sectors is managed

effectively. Also, being further removed from a specific sector may make advocacy at Ministry level much

more difficult as there is less likely to be strong working relationships in place at that level when there is

no MoU in place with the ministry concerned.

Type 5. 'Dual Partner' model: This model is less common and involves joint MoUs with two

partners at the national level who then mobilise staff at provincial and district levels to implement the

program. This model is challenging, as sectors at national level (i.e. Ministries and mass organisations)

are not accustomed to working multi-sectorally and often have different ways of working and different

priorities. There may also be competition for resources provided by the donor or supporting

organisation, and coordination at implementation level is often limited or non-existent.

Each of these models involves an oversight committee, either at district level or provincial level (or

both). For Type 1, this is only multi-sectoral to the point that other sectors are invited to meetings,

perhaps held quarterly, six monthly or annually. For other models, committees may be more involved in

reviewing and providing input and support to multi-sectoral implementation teams, particularly if the

committee is established at district rather than provincial level.

3.3 Food and Nutrition Security Action Plan (FNSAP)

The FNSAP was developed in the second half of 2013 in response to a growing awareness that the

country was off track to meet its nutrition related targets under MDG 1. This was confirmed by the

2013 MDG Report which highlighted an increase in food poverty as well as high rates of malnutrition

and stunted growth among children12. In mid-2013, the Prime Minister signed a decree establishing the

12 MDG Progress Report for the Lao PDR 2013, Chapter 1.5.

7

National Nutrition Committee and Secretariat (now based within the Ministry of Health), and the Multi-

sectoral Food and Nutrition Security Action Plan (FNSAP) was finalised with responsibility for

coordination placed with the National Nutrition Committee.

Since late 2013, there has been a commitment to improving coordination and alignment by both

Government as well as Development Partners, in addressing chronic malnutrition. A 'road map' for

implementation was developed and agreement reached on starting implementation in six districts in

three provinces - Luang Namtha, Saravanh and Oudomxay. At the time of writing this report, micro-

planning had commenced in Oudomxay Province, including the education, health and agricultural

sectors.

In terms of institutional arrangements at sub-national level13, it has been suggested that this could involve

the establishment of a Program Management Committee (PMC) in each province under the Office of the

Vice Governor. The PMC would be comprised of senior staff from each of the relevant sectors, with a

small administrative staff. The PMC would be responsible for coordinating joint planning and monitoring,

while each sector would be responsible for implementation of the agreed on interventions. Each sector

would be responsible for communicating directly with their district level departments who will be

responsible for implementation.

Given the less than satisfactory experience of Plan and other organisations with provincial level

committees and implementation (and conversely, the more positive experience of multi-sectoral

programming and management at target district level), consideration could be given to shifting the focus

of multi-sectoral program management from the province to the district level, with a reduced level of

provincial involvement. This suggestion is supported by both the literature on success factors in multi-

sectoral partnerships as well as the experience of Plan and other organisations involved in multi-sectoral

collaboration, and will be discussed in more detail later in this report.

The research identifies that multi-sectoral teams must be well prepared with a shared understanding of

purpose, be provided with effective leadership, and clear organisational arrangements. Teams need to be

supported to 'think multi-sectorally but act sectorally', and be provided with equitable access to

resources to do their work, if multi-sectoral partnerships are to achieve their goals.

4. CASE STUDY FINDINGS14

This section outlines Plan‟s multi-sectoral programs in WASH and ECCD in three districts - Meung, Pak

Tha and Pha Oudom - in Bokeo Province. It examines the nature of multi-sectoral collaboration,

primarily between the education and health sectors at district level, based on findings from two of these

districts. This section goes on to examine how the teams are structured and organised as well as how

they work together, particularly in terms of planning, implementation, monitoring and reporting, and the

extent to which gender equality has been mainstreamed in each of the programs. Some

recommendations are also made related to improving the current multi-sectoral programs.

13 Recommendations for Multisectoral Food and Nutrition Security Action Plan, UN Development Partners. November

2013 14 Note: This section is an abbreviated summary of the findings and recommendations from a fuller assessment of

the WASH and ECCD programs which was provided for Plan's internal use.

8

WASH Team members, teachers and students celebrate their

school become a 'Model Health and Hygiene School' in

Meung District

4.1 The WASH Program

Background: Plan began working in the WASH sector in 2010, piloting Community Led Total Sanitation

(CLTS)15 in three communities, initially in Pha Oudom District. This has now expanded to 87 schools

and communities in three districts - Pha Oudom, Paktha, and Mueng. Multi-sectoral teams known as

District WASH Teams (DWTs), comprised of technical staff from DESB and DHO, were established in

each district with formal letters of support from each District Governor assigning staff to the teams.

The DWTs are responsible for providing school WASH infrastructure, associated community water

supplies and hygiene promotion, with a special focus on schools. Previously implemented as part of a

wider Basic Education Program under an MoU with the Ministry of Education and Sports (MoES), the

WASH program came under a new MoU with the Ministry of Health (MoH) in 2014. The new program

phase design was developed in a

workshop in 2012 involving

Government stakeholders where

it was agreed that the multi-

sectoral approach to

implementation was effective and

would be continued. Accordingly,

the new MoU makes specific

reference to the multi-sectoral

partnerships and broadly defines

the roles and responsibilities of

each of the four sectors involved

(i.e. DHO, DESB, LWU and LYU),

as well as leadership

arrangements. This is currently

being introduced

Implementation Arrangements: The District WASH Teams (DWTs) are comprised of up to eight

members, with an equal number from the DESB and the DHO, with additional members coming from

the Lao Women's Union and Lao Youth Union. At least until recently (with the signing of the MoU

which broadly defines the role of each sector), the roles and responsibilities of each sector/team

member had not been documented, and the teams have been led by a member of the DESB supported

by a Plan staff member (though this may change under the new MoU arrangements). A District level

steering committee, chaired by the District Governor's Office, provides oversight, meeting six monthly

to review implementation of all Plan supported programs in the District, including WASH. While

program documents specify a provincial level Implementation Management Committee (IMC), it appears

that this has not functioned as intended, perhaps due to sectoral differences being more firmly

entrenched at higher levels as well as the fact provincial level departments are relatively distant from

implementation in the field.

15

Community-led total sanitation (CLTS) is an methodology for mobilising communities to completely eliminate

open defecation (OD) with a high level of community participation.

9

The Parenting Orientation component of the ECCD

program provides a good example of how different

sectors can work together effectively to achieve more

comprehensive outcomes. The training observed in

Longpabath Village, Meung District, for 20 village

volunteer trainers from several surrounding villages, half

of whom were women, took place over three days and

focussed on one of the modules in the parenting training

(Module 2 – „Our traditions and child-rearing practices') that

the village volunteers would be presenting in their villages

(and in their own languages, of which there were at least

five) later. The trainers, members of the ECCD multi-

sectoral team, were from both the education and health

sectors as well as Plan, and had worked together to

prepare the sessions, dividing up responsibility for each

session according to the content . The sessions involved

a mix of interactive presentations by the trainers, small

group work and village volunteer presentations of what

had been discussed in their group discussions, and the

village volunteers were clearly relaxed and enjoying the

training. Following the training, the ECCD team members

develop an action plan so that they (at least one

education and one health member) can visit each village

when the volunteers are giving training to parents in

order to both support and monitor them. They also

make home visits at this time to monitor the changes

brought about by the training received by the parents.

During home visits, team members also address a gender

issue related to the small number of men attending

parenting orientation sessions a perception among many

men that parenting is a woman's responsibility. the visits,

the team members encourage fathers to attend these

sessions and play a greater role in parenting.

WASH Program and 'Convergence':

This case study finds the WASH

program largely follows the convergence

model, in that planning, monitoring and

reporting are done by the multi-sectoral

team, though implementation is a mix of

sectoral and multi-sectoral activities - for

example, hygiene education in schools is

done by a combined team while latrine

construction is overseen by members

from the DHO. Most team members

have been trained in gender awareness

and could highlight aspects of the

program where they had taken gender

equity into account. A new gender and

WASH toolkit will be piloted in the

program in mid 2014.

Achievements and Challenges: The

WASH program is multi-sectoral and has

made a significant impact. To date it has

reached 87 communities and schools

across the three target districts. The

final evaluation of the first phase in 2012

found that there had been significant

progress in improving sanitation and

hygiene in schools, with an increase in

schools achieving the 5 star rating 16

increasing from 7.3% at the start of the

program to 76% by mid-2012.

Community latrine coverage had

increased from 42% to 68% during the

same period. The WASH program has

contributed significantly to developing

local capacity particularly in training all

DWT members in CLTS.

At the same time, it has been

constrained by frequent turnover of

staff, particularly from the DHOs as well

as Plan, and the limited orientation of

new staff. While little can be done to

16 The Five Star system includes 1) Open Defecation Free (ODF) status, 2) hand washing with soap, 3) safe

drinking water, 4) environmental cleanliness and 5) school and village WASH committees established.

10

limit turnover of staff on the DWTs beyond requesting heads of sectors to allow the same staff to

remain, more attention will be given to ensuring a more thorough induction of new staff, including the

development of job descriptions for each DWT member.

The program has ensured that DWT members have received training in gender equity and child rights,

and staff have given particular attention to ensuring the inclusion of girls and women in program

activities.

4.2 The ECCD Program

Background: Plan‟s ECCD program started in 2010 and has evolved from a focus initially on early

childhood education (ECE) and 3-5 year old children, with implementation the responsibility of the

DESB, to a multi-sectoral program focussed on children 0-6 years, as well as pregnant women. ECCD

teams comprising both education and health technical staff were established in all three target districts.

While there were no formal written agreements, an orientation meeting on parenting education was

held with each ECCD team at the beginning, and regular steering committee meetings involving all

relevant sectors are held to discuss progress of the multi-sectoral teams. The ECCD program now

consists of two main components - a community based multi-sectoral component focussed on parents

(and parents to be) and small children between the ages of 0 - 5 years, and an ECE component focussed

on pre-schools (including the pre-primary preparation year or hong giam). It is currently implemented

under an MoU between Plan and MoES which, unlike the WASH MoU, does not specify the nature of

the multi-sectoral team.

Implementation Arrangements: The teams are comprised of eight to 10 members primarily from the

DESB and the DHO. Leadership of the team is shared between two representatives, one from the DESB

and the other from the DHO. However, as the MoU is with education, this tends to be the more

dominant sector in terms of planning, implementation and reporting, as well as in the number of team

members. While Plan has its own reporting requirements (and thus its own set of forms for Plan staff

to use), the ECCD program team uses Government forms for planning and reporting.

As with the WASH Program, ECCD team members report to the same district level Steering

Committee chaired by the District Governor's Office with representatives from all relevant

Departments. The MoU refers to a provincial level IMC but this does not include Provincial Health

Department (PHD) representation and does not appear to be functioning, probably for similar reasons

as those outlined above for the WASH program.

The ECCD Program and 'Convergence': As with the WASH program, the ECCD program fits largely

with the convergence model, with joint multi-sectoral planning, 17 monitoring, and reporting.

Implementation of activities related to the ECE component of the program (i.e. pre-schools) are

implemented sectorally by staff from the DESB, while those related to the parenting orientation - namely

the training and support of village volunteer trainers - are done jointly, with support for pre-schools

being implemented sectorally .

Achievements and Challenges: The biggest achievement of the ECCD program so far is that it has

ensured more comprehensive coverage of child development, nutrition, and health than would be the

17 Of the two districts visited, joint planning was happening in one while in the other, education team members

drafted the monthly plan and then sent it to the health members for review.

11

case in a sectoral program ensuring more comprehensive coverage of child development, nutrition, and

health than would be the case in a sectoral program through enabling the education and health sectors

to work together on parenting orientation for parents of young children. While many organisations

supporting ECCD tend to limit themselves to a sectoral approach to ECE by focussing on pre-schools,

Plan‟s ECCD program ECCD team members from the education and health sectors plan and

implement training of village volunteer trainers together, supporting the trainers when they give training

in their communities in their own languages, and then work jointly on home visits to assess the

effectiveness of the training as well as to provide individual support to families as required.

The ECCD program team members have also received training in gender awareness and they are trying

to address some gender related issues that have arisen in the program. For example, fathers are often

reluctant to attend the parenting orientation sessions, as they regard it as 'a woman's responsibility'.

ECCD team members are trying to address this by encouraging fathers to attend the parenting training

through approaching them individually and encouraging their participation, particularly during the home

visits. As with the WASH program, a comprehensive gender 'audit' of the ECCD program would build

on the work already done and provide team members with practical ways of enhancing gender equity

within the program.

The ECCD teams have only recently been established and thus have only limited experience in working

multi-sectorally. They also face the challenge of staff turnover, especially from the health sector. They

need to continue to strengthen the district teams by documenting the roles and responsibilities of multi-

sectoral team members and ensuring these are agreed and shared with all relevant staff, as well as

ensuring that multi-sectoral planning takes place in all target districts. The earlier provision of

equipment to the DESB members of the team has perhaps reinforced feelings that the program 'belongs'

to the education sector, and more sectorally equitable distribution of equipment and other resources

will need to occur in future to address this issue.

4.3 WASH and ECCD Programs – Success Factors

The Plan WASH and ECCD programs have achieved a significant degree of effective multi-sectoral

collaboration by applying several of the principles outlined in the „success factors‟ described earlier:

Recognising and accepting the need for partnership: At the district level, the need for staff from

different sectors to work together appears to largely understood and accepted by the heads of

departments and, in Pha Oudom District, particularly by the District Governor who is very

supportive of both programs. The team members also understand the need for a multi-sectoral

approach to ECCD and WASH, though as was mentioned earlier, new members being appointed to

the teams will need a thorough orientation to the program, the reasons for the multi-sectoral

partnership and the methodologies being used.

While the importance of multi-sectoral collaboration appears to be largely accepted at the district

level, this does not appear to be the case at provincial level. The IMC's referred to in the MoUs

have never really functioned, perhaps because they are too far removed from implementation of

the programs and thus see little benefit in giving a priority to these management arrangements.

Developing clear and realistic goals and objectives: The goals and objectives of each program are

realistic and achievable. Activities required to achieve the objectives are relatively straightforward

and within the capacity of the technical teams assigned to implement the program.

12

Ensuring commitment and ownership: While there is commitment and ownership within the

implementation teams, the extent to which this exists among more senior staff in each sector is

questionable. This is particularly the case at provincial level, where both ECCD and WASH have

been regarded in the past as 'belonging' to the education sector. This was also reflected at district

level in one target district in the ECCD program where planning is done initially by the DESB team

coordinator and then passed on to the DHO team members for comment and feedback, rather

than undertaking joint planning.

Developing and maintaining trust: In terms of participation, there is perhaps a stronger sense of

equity within the WASH program which has been running for a longer period of time. However,

even with this program, there is a sense, at least prior to 2014 when the new MoU was signed, that

it is an 'education program' and that the DESB has benefitted most in terms of equipment and other

resources.

Creating clear and robust partnership arrangements: Until now, there have not been 'clear and

robust' partnership arrangements, but more informal and verbally agreed arrangements. The roles

and responsibilities of each sector involved have not yet been clearly defined and documented in

the case of the ECCD program. The WASH MoU addresses this by defining the roles of each

sector, but these need to be further defined in the form of job descriptions if they are to be

effective.

Monitoring, measuring and learning: Both programs have put in place effective mechanisms for

monitoring the effectiveness of the program, with these being more highly developed in the WASH

program as they utilise the CLTS. However, these mechanisms do not specifically provide an

assessment of the working of the multi-sectoral teams themselves, which could be helpful to both

improve team functioning as well as build a stronger sense of membership in a multi-sectoral team.

As noted in the literature review earlier, Levinson, F. J. and Yarlini Balarajan (2013) in their study on

addressing malnutrition multi-sectorally, also identified the importance of sustained civil society advocacy

at the policy level and 'quality control' at the implementation level in ensuring effective multi-sectoral

implementation. In the case of the Lao PDR, the space for civil society is limited and it is largely

international organisations who fulfill this role. Plan is an active member of the Informal ECCD Working

Group and the WASH Technical Working Group (TWG) which also includes representatives from the

Lao Government as well as other development organisations, founder and host of the Scaling Up

Nutrition (SUN) Civil Society Alliance, and Chair of the NGO Health and Nutrition Working Group.

Through these mechanisms, Plan is well placed to have some degree of influence at the policy level. At

the implementation level, Plan has played the main role ".... to ensure adequate budgeting, well-designed and

implemented programmes and programme impact that addresses the needs of the population."18

18 Levinson, F. James and Balarajan, Yarlini. 2013, Page vi.

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5. LESSONS LEARNED AND RECOMMENDATIONS

Plan‟s WASH and ECCD programs in Bokeo Province, together with the findings from the literature on

other case studies, provide a number of important lessons for integrated multi-sectoral programming

and the implementation of the convergence model in the Lao PDR.

• Multi-sectoral program coordination mechanisms are more effective if they are based at

district level: While the MoUs between Plan and MoES (for the ECCD program) and MoH (for the

WASH program) specify an Implementation Management Committee (IMC) at provincial level, these

have not functioned as planned. Sectoral administrative and management structures (e.g. different

priorities, ways of working, administrative demands, etc.) are more firmly entrenched further up

within the hierarchy, and provincial level departments are also further removed from implementation

and thus an appreciation of the direct benefits for communities within their geographic area. They

also face time and budget constraints which limit the extent to which they can engage with districts.

The establishment of district level Steering Committees has provided oversight and support for

implementation in target villages. District level Steering Committee members are more likely to be

motivated to take an active interest in the work of the multi-sectoral implementation teams as they

live in the target district and are able to engage more closely with the multi-sectoral program as well

as better realise the potential benefits to be gained for their communities. Given the relative

ineffectiveness of provincial level oversight committees, it is suggested that sufficient resources are

made available to enable provincial representatives of the sectors involved to participate in district

level Steering Committee meetings.

• Multi-sectoral collaboration arrangements at District level are just as important, if not more

important than the sectoral MoU at national level: Related to the above point, it seems that it is

not so important which Ministry or Mass Organisation the MoU is signed with at central level - what

matters more are the actual arrangements at district level. There needs to be provision for a multi-

sectoral approach stated in the MoU (as with the WASH MoU between Plan and MoH), a clear

structure in place for multi-sectoral implementation that is equitable for each participating sector,

clear leadership, and equitable distribution of equipment and other resources across all sectors.

• Planning and preparation are critical: Three of the six 'success factors' identified - Recognising and

accepting the need for partnership; Developing clarity and realism of purpose; Ensuring commitment and

ownership - highlight the need for adequate preparation of all involved in the multi-sectoral

partnership before activities get underway. In the WASH program, there were introductory

meetings to enable internalisation of the program objectives and approach at provincial and district

levels and formal District Governor endorsement of the multi-sectoral teams. While the preparation

phase was perhaps limited for the first phase, this is currently being addressed with a strong focus on

preparation for the multi-sectoral approach for the new phase. This focus is essential in setting up

multi-sectoral programs, for the team members themselves, as well as for senior staff of each sector

at all levels - district, provincial and central.

• Clearly defined roles and responsibilities are required for multi-sectoral Team members: In the

case of the Plan supported programs in Bokeo, there was previously limited documentation relating

to roles and responsibilities of staff in each sector. The WASH MoU addresses this issue and it will

be further developed so that each multi-sectoral team member has a clear job description. This also

14

needs to be extended to the ECCD program. Given the reality of often high staff turnover, these job

descriptions are then an essential part of orienting new team members and institutionalizing

development programming (thus contributing to sustainability).

• Equitable access to resources: This was an issue raised by the multi-sectoral team members in both

the WASH and ECCD programs. It is essential that equipment and other resources provided are

shared equitably by all members in the multi-sectoral team. Even if the resources being provided are

minimal, equitable distribution and access to these can help ensure that the project or program is not

regarded as only 'belonging' to one sector. While not part of the Plan supported programs, nutrition

program case studies outlined earlier in this report suggest that results based incentives could also be

considered, though again the principle of equitable distribution across sectors needs to be kept in

mind.

• All multi-sectoral team members need to be involved in planning, and monitoring: The

convergence model does not require multi-sectoral implementation but focuses on inter-sectoral

planning and monitoring. This is largely happening within the WASH and ECCD programs and it is

essential that all multi-sectoral implementation team members are involved in planning and

monitoring for sustainable impact.

• Government planning, reporting and monitoring tools should be used: While it is highly unlikely

that existing official sectoral planning, monitoring and reporting tools will be able to meet the needs

of both the Government and donor/supporting organisation, an effort needs to be made to integrate

where possible. The use of Government formats for activity planning and reporting in both the

WASH and ECCD programs provides a practical example of this. This will avoid the creation of a

new set of tools for planning, monitoring and reporting purposes.

• District Government should make a commitment to change staff on the multi-sectoral team

as little as possible: During the preparation period, the importance of retaining the same staff on

the multi-sectoral team needs to be stressed, particularly to the heads of each sector at district level.

While some staff turnover is inevitable, commitment of staff for an extended period of time, albeit on

a part-time basis, should be sought from heads of sectors, and it is also important that there are

plans for handover and orientation of new staff members in place to avoid any disruption or negative

impact on program implementation.

6. CONCLUSIONS

While there is now a substantial body of literature on multi-sectoral partnerships - what has worked

and what has not worked - little has been documented about the benefits of working multi-sectorally in

the context of the Lao PDR, particularly at district level. With an increasing focus on working multi-

sectorally to support the achievement of nutrition related targets within MDG 1, the experience of

INGOs and others involved in supporting multi-sectoral initiatives within poor and often remote

districts is particularly relevant.

Multi-sectoral collaboration presents many challenges given sectoral differences in terms of budgets,

working approaches, human resource capacity and others, and several of these challenges have been

highlighted in this report - for example, ensuring cross-sectoral commitment at all levels, bringing

together people from different sectors with different capacities in terms of skills and knowledge, and

different ways of working. However, as the case study of the Plan supported WASH and ECCD

15

programs has demonstrated, when it does work, implementing collaboratively enables a more focussed,

coordinated and comprehensive approach than working in a sector-specific way, and ultimately brings

greater benefits to those communities that are the target of these development efforts.

The experience of Plan and their partners in Bokeo in developing these multi-sectoral approaches as

well as studies of multi-sectoral collaboration elsewhere, have provided some useful pointers for the

future development of similar partnerships elsewhere - including the importance of spending time at the

beginning to ensure that all involved fully understand the purpose of the program and effective ways of

working multi-sectorally, as well as the benefits that are to be gained. The experience has also

highlighted the importance of ensuring that management of these kinds of multi-sectoral programs that

aim to benefit rural communities, is located as much as possible at district level, where those involved,

from heads of sectors to technical staff assigned to a multi-sectoral team, understand the local context

and can appreciate directly the benefits that will result from their working in this way. Working

sectorally in an uncoordinated and fragmented way does not do justice to the potential gains that are to

be made from working multi-sectorally, and limits the benefits to those communities who need

assistance and support the most.

In addition to identifying some of the lessons to be learned, this brief case study has highlighted some of

the strengths and areas for improvement of the approaches to multi-sectoral collaboration being

supported by Plan in the WASH and ECCD programs in three target districts in Bokeo. These are not

presented as 'models of best practice' but rather approaches that are in the process of being developed

and further refined. They demonstrate that multi-sectoral partnerships can work, and are working in

both the Plan WASH and ECCD programs and contributing to more comprehensive impact than is

normally the case with sectoral programs. It is hoped that the experience gained within the WASH and

ECCD programs in Bokeo Province and the lessons learned from this experience, will contribute to

enhanced and more effective multi-sectoral programming in the future.

____________________

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APPENDIX 1. TERMS OF REFERENCE

Terms of Reference

Case study of best practice and lessons learned:

Multi-sectoral planning, coordination and monitoring

Background

Plan Laos has been working in three districts of Bokeo province since 2007, implementing four programs

- Early Childhood Care and Development (ECCD), Basic Education, Water, Sanitation and Hygiene

(WASH) and Maternal, Newborn and Child Health and Nutrition (MNCH+N).

The ECCD and WASH programs have both been coordinating with the District Education Bureaus and

the District Health Offices, whilst forming multi-sectoral teams that are involved in planning,

implementation and monitoring of their activities. These teams often involve other stakeholders such as

the Lao Women‟s Union, Lao Youth Union, Ministry of Labour and Social Welfare staff and others.

There is currently a lot of interest in multi-sectoral planning, coordination and monitoring in the context

of the new Government of Lao PDR National Food and Nutrition Security Action Plan (FNSAP), and the

“convergent model” proposed by the UN Country Team and accepted by the government and the high

level National Nutrition Committee.

The FNSAP calls for multi-sectoral planning, sectoral implementation, and multi-sectoral monitoring, and

specifically the creation of coordination mechanisms and multi-sectoral monitoring teams at district

level.

Purpose of this consultancy

To review, document and present the best practice approaches and lessons learned by Plan Laos in multi

sectoral planning, coordination and monitoring in a case study that can be presented to the National

Nutrition Committee and other partners (including key institutional donors) as an input to the “micro-

planning” process and implementation of the FNSAP at district and provincial level.

Expected Outputs

1. A written case study that outlines best practice and lessons learned, and details the mechanisms,

processes, multi-sectoral teams and committees etc. that have been trialed by Plan and DHO

and DESB partners in Bokeo province. The case study analysis should identify if Plan has

developed working models, mechanisms or tools that can be replicated and scaled up, and if so,

these should be clearly described. The analysis will capture how gender mainstreaming has been

addressed in current multi-sectoral planning and monitoring, and identify specific gaps, strengths

and recommendations. The case study document will include:

a. A brief, one page executive summary

b. References where appropriate

c. Brief (half to one page) description of the method in which data for the case study was

obtained.

d. Detailed description of Plan‟s working models, mechanisms or tools .

e. Recommendations for Plan and for government partners, with reference to the FNSAP.

17

f. Annexes of planning and monitoring tools that are currently used in Bokeo for multi-

sectoral planning and monitoring.

2. A power point presentation that outlines the main findings of the case study (Plan will translate

this to Lao language)

3. Testimonials from government officials in Bokeo, including high ranking officials such as

governors, deputy governors and DESB and DHO directors, which will be annexed or

integrated into the case study.

Key activities

1. Field visit to the three districts in Bokeo (Pak Tha, Meung and Pha Oudom)

2. Meet with Plan staff- particularly ECCD and WASH program teams

3. Meet with Bokeo and Pha Oudom, Pak Tha and Meung district government officials to discuss

the multi-sectoral collaboration

4. Accompany a multi- sectoral team (District WASH Team DWT, and/or Parenting Trainers

team) during implementation of an activity or monitoring of an activity

5. Meet with key education and health staff in UNICEF Laos, and key health staff in WHO Laos and

capture the lessons learned from their partnership with local government for provincial and

district planning.

6. Plan Laos‟ gender specialist will provide support if required, to undertake some analysis on

gender mainstreaming in the current planning and monitoring model used.

Processes

One Plan staff members will support the consultant on the field visits, most likely the District Team

Leader from each district. Translation support will be provided.

Profile of consultant

Extensive experience in Lao PDR of working with local government offices, especially District Education

and Sports Bureau‟s and District Health Offices

Excellent written and spoken English and very good Lao comprehension required

Experience and qualifications in both qualitative and quantitative research methodologies

Experience working in the target districts in Bokeo province and advantage

Applications

Interested candidates should submit their CV, a one page note on their understanding of the TOR and a

rough work plan including number of days required for the task, and a daily consultancy rate as well as

an estimation of international travel costs.

18

APPENDIX 2. BIBLIOGRAPHY

Drost, S and Pfistener, S. How to make cross-sectoral partnerships work? Critical success factors for partnering,

The Partnerships Resource Centre, Rotterdam, 2013

Government of the Lao PDR and the United Nations, The Millenium Development Goals Progress Report for

the Lao PDR 2013.

Hardy, Hudson and Waddington, Assessing Strategic Partnership - The Partnership Assessment Tool, 2003.

Harmann, R., Pienaar, S., Boulogne, F., and Kranz, N. What makes cross-sector partnerships successful?

Working Paper, University of Capetown. 2007

Kar, K., and Chambers, R. Handbook on Community-Led Total Sanitation, Plan UK and Institute of

Development Studies, University of Sussex, London. 2008

Levinson, F. J. and Yarlini Balarajan, Addressing malnutrition multi-sectorally. What have we learned from

recent international experience? United Nations, 2013.

Scaling Up Nutrition (Various authors), Effectively Engaging Multiple Stakeholders, Issue 1, January 2014

UN Development Partners, Recommendations for Multi-sectoral Food and Nutrition Security Action Plan, Lao

PDR, November 2013

UN REACH Progress Report January 2010 - June 2011 - Accelerating the scale up of food and nutrition

actions, http://www.reachpartnership.org/

World Bank, Improving Nutrition through Multi-sectoral Approaches, World Bank. 2013

Vargas-Baron, E., Achieving multi-sectoral integration and coordination, Paper presented at World

Conference on ECCD, UNESCO, Moscow, 2010

World Health Organisation, WHO Discussion Paper 2 - Lessons learned from existing multi-sectoral

partnerships that may inform the global response to NCDs, Geneva, 2012.