COMMISSION DECISION. of [.. ] on the financing of humanitarian actions in Sierra Leone from the 10th European Development Fund (EDF)

EUROPEAN COMMISSION Brussels C(2010) XXX final COMMISSION DECISION of [.. ] on the financing of humanitarian actions in Sierra Leone from the 10th European Development Fund (EDF) (ECHO/SLE/EDF/2010/01000) EN EN

COMMISSION DECISION of [..] on the financing of humanitarian actions in Sierra Leone from the 10th European Development Fund (EDF) (ECHO/SLE/EDF/2010/01000) THE EUROPEAN COMMISSION, Having regard to the Treaty on the Functioning of the European Union, Having regard to the ACP-EC Partnership Agreement signed in Cotonou on 23 June 2000 1, and in particular Article 72 thereof, Having regard to Council Regulation (EC) No 617/2007 of 14 May 2007 on the implementation of the 10th European Development Fund under the ACP-EC Partnership Agreement 2, and in particular Articles 5.4 and 8 thereof; Whereas: (1) Since the end of the civil war in 2001, Sierra Leone faces major challenges in the health sector being unable to cope with the rapidly increasing rates of malnutrition and mortality. Infant mortality rates in particular have reached an alarming rate well above the threshold for emergency assistance and constitute an unforeseeable sudden and serious humanitarian difficulty of an exceptional nature requiring humanitarian aid in addition to other aid instruments; (2) In order to address the high mortality in the vulnerable population, free access to primary healthcare for children under five, pregnant women and lactating mothers has been introduced on 27 April 2010 by the government of Sierra Leone; (3) Supporting the supply of essential drugs and therapeutic feeding inputs is one of the key parameters for the success of this free health care scheme at this crucial juncture and considering the massive needs; (4) To reach populations in need, aid should be channelled through international organisations including United Nations (UN) agencies. Therefore the European Commission should implement the budget by joint management; (5) An assessment of the humanitarian situation leads to the conclusion that humanitarian aid actions should be financed by the European Union for a period of 18 months; (6) The use of the 10th European Development Fund is necessary as all the funds for ACP countries in the general budget are entirely allocated; (7) It is estimated that an amount of EUR 6,600,000 from Sierra Leone's Allocation for unforeseen needs (B-envelope) of the 10th European Development Fund is necessary to provide humanitarian assistance to the most vulnerable population groups 1 2 OJ L 317 of 15.12.2000, p.3. OJ L152 of 13.06.2007, p.1. EN 2 EN

concerned. Although as a general rule actions funded by this Decision should be cofinanced, the Authorising Officer, in accordance with Article 103.3 of the Financial Regulation applicable to the 10th EDF 3, together with Article 253 of the Implementing Rules of the Financial Regulation applicable to the general budget of the European Union 4, may agree to the full financing of actions; (8) The Commission will inform the EDF Committee within one month of the adoption of the Decision and this in conformity with Article 8 of Council Regulation (EC) No 617/2007. HAS DECIDED AS FOLLOWS: Article 1 1. In accordance with the objectives and general principles of humanitarian aid, the Commission hereby approves a total amount of EUR 6,600,000 from the 10th European Development Fund for humanitarian aid actions to directly benefit vulnerable populations in Sierra Leone. 2. In accordance with Article 72 of the ACP-EC Partnership Agreement, the principal objective of this Decision is to support vulnerable populations affected by the breakdown of essential health services in Sierra Leone. The humanitarian aid actions shall be implemented in pursuance of the following specific objective: - To contribute to the recovery of essential health services for children under five, pregnant women and lactating mothers by supporting the provision of essential drugs and therapeutic feeding inputs. The full amount of this Decision is allocated to this specific objective. Article 2 1. The period for the implementation of the actions financed under this Decision shall start on 1 October 2010 and shall run for 18 months. Eligible expenditure shall be committed during the implementing period of the Decision. 2. If the implementation of individual actions is suspended owing to force majeure or other exceptional circumstances, the period of suspension shall not be taken into account in the implementing period of the Decision in respect of the action suspended. 3. In accordance with the contractual provisions ruling the Agreements financed under this Decision, the Commission may consider eligible those costs arising and incurred after the end of the implementing period of the action which are necessary for its winding-up. Article 3 1. As a general rule, actions funded by this Decision should be co-financed. The Authorising Officer by delegation, in accordance with Article 103.3 of the Financial Regulation applicable to the 10th EDF, together with Article 253 of the 3 4 OJ L 78 of 19.03.2008, p.1. OJ L 357 of 31.12.2002, p.1. EN 3 EN

Implementing Rules of the Financial Regulation applicable to the general budget of the European Union, may agree to the full financing of actions when this will be necessary to achieve the objectives of this Decision and with due consideration to the nature of the activities to be undertaken, the availability of other donors and other relevant operational circumstances. 2. Actions supported by this Decision will be implemented by international organisations. 3. The Commission shall implement the budget by joint management with international organisations that are signatories to the Framework Partnership Agreements (FPA) or the Financial Administrative Framework Agreement with the UN (FAFA) and which were subject to the four pillar assessment in line with Article 29 of the Financial Regulation applicable to the 10th EDF. Article 4 The Decision shall take effect on the date of its adoption. Done at Brussels, For the Commission [..] Member of the Commission EN 4 EN

EUROPEAN COMMISSION DIRECTORATE-GENERAL HUMANITARIAN AID AND CIVIL PROTECTION - ECHO Humanitarian Aid Decision F10 (FED 10) Title: Commission Decision on the financing of humanitarian Actions in Sierra Leone from the 10th European Development Fund (EDF) Description: Humanitarian aid to provide essential drugs and therapeutic feeding inputs for children under five, pregnant women and lactating mothers in Sierra Leone Location of action: Sierra Leone Amount of Decision: EUR 6,600,000 Decision reference number: ECHO/SLE/EDF/2010/01000 Supporting document 1 Humanitarian context, needs and risks 1.1 Situation and context Despite two successful conclusions of elections, since the end of the civil war in 2001, Sierra Leone faces major challenges in development and good governance. Almost 70 % of the 5.7 million population live below the poverty line. Sierra Leone remains at the bottom of the Human Development Index (HDI) table in position 180 out of 182. High unemployment, especially of youth, lack of basic service delivery and corruption bear a risk of renewed conflict. Drug trafficking with its links to international criminal networks poses a further threat to stability. Progress in rehabilitating the economy and building up basic health and education services has been slow. Life expectancy in Sierra Leone is 48/50, or just over half of the life expectancy in the top 20 ranked countries. Access to healthcare in Sierra Leone has been constrained by a complex mix of factors, including limited availability of staff and drugs, traditional beliefs, lack of transport and affordability. The authorities have a limited capacity to deal with the health problems. The ECHO/SLE/EDF/2010/01000 1

health budget for the Government of Sierra Leone (GOSL) is a small percentage of the total national budget. (Ministry of Health budget 2010: USD 12.5 million) The European Commission's Directorate General for Humanitarian Aid and Civil Protection (DG ECHO) phased out of Sierra Leone in 2005 in the framework of linking relief, rehabilitation and development (LRRD) with EU Delegation/Commission's European Aid Office. The support to the health sector under the 9 th EDF has been scaled down at the end of 2007. Very little health sector support has been foreseen under the 10 th EDF, as in the division of labour between donors, the health sector has been mainly attributed to the United Kingdom's Department for International Development (DFID). A vast gap remains in basic service delivery with child and maternal health care and nutrition being key areas of concern. In order to address the high mortality in the vulnerable population, free access to primary healthcare for children under five, pregnant women and lactating mothers has been introduced on 27 April 2010 (on Independence Day, which underlines the political significance and will by the GOSL). This introduction was the conclusion of a long process led by DFID and the United Nations Children's Fund (UNICEF) and supported by several other donors. Supporting human resources and the supply of drugs are the key parameters for the success of this free health care scheme at this crucial juncture and considering the massive needs. The National Drug System has not been functional for some time. UNICEF, with funding from DIFID, purchased (one year supply) and distributed essential drugs to the health centres. In order to address the issue of human resources in terms of both motivation and red-tape/corruption mitigation salaries of the Ministry of Health and medical staff have been increased up to fivefold with initial funding from DFID. 1.2 Identified humanitarian needs The humanitarian needs can be best summarised as follows: Health The few health indicators available in Sierra Leone convey an alarming health status: - Infant mortality rate is currently (Demographic and Health Survey,2008) estimated at 123/1000 live births, under five mortality rate at 194/1000 live births. - In 2008, the maternal mortality ratio was estimated by the MOH at 860/100,000 live births, one of the highest in the world. - Malaria: Sierra Leone is a stable malaria endemic country, and the disease has been a leading cause of morbidity and mortality. In 2008, 30% of the children under 5 received malaria treatment. - Acute respiratory infections (ARI): prevalence among children 0-59 months is very high and is the leading cause for mortality (28% of all under 5 years old mortality). Malnutrition The results of the most recent national nutritional survey (2008) conducted by the World Food Programme (WFP)/Unicef indicate that approximately 10.2 % of children under five are wasted and 40% are stunted. These nutrition rates did certainly not improve in 2010, and are considered as an emergency. WFP stopped giving treatment for the moderately malnourished because of lack of funding. However, part of the moderately malnourished will be treated in the community based management of acute malnutrition (CMAM) programme because of the use of the new World Health Organisation (WHO) growth standards. ECHO/SLE/EDF/2010/01000 2

1.3 Risk assessment and possible constraints The success of the program also depends on the success of the strengthening of the procurement and supply chain management and the capacity of the MoH to manage the free service delivery in a transparent way. 2 Proposed DG ECHO response 2.1 Rationale Drug supply The regular provision of essential drugs for free access for health care for the vulnerable population (children under 5 and pregnant and lactating mothers), is secured only until early 2011, whilst the procurement for the new 12-month supply, for which there is no funding at the moment, should be activated without delay. In order to support and boost the process at such a critical moment, as well as reduce the risk of a possible collapse of the whole system a few months only after the reform, and to contribute preventing the heavy toll in human lives that this would entail, the supply of essential drugs should be provided for one year. Nutrition In 2008, UNICEF introduced the CMAM or community therapeutic care (CTC) with a total of 14,000 admissions. In 2009, 105 outpatient therapeutic feeding (OTP) and 14 stabilisation centres based in secondary and tertiary hospitals were functional treating in total approximately 32,000 children. For 2010, UNICEF expects to treat 40,000 severely malnourished children and will increase to 195 OTP and 18 stabilisation centres. The rapid increase in the number of treated children had serious implications on the supply and funding of ready-to-use-therapeutic feeding (RUTF). In order to avoid stock-outs to treat the growing number of severely malnourished children additional funding is needed. 2.2 Objectives - Principal objective: To support vulnerable populations affected by the breakdown of essential health services in Sierra Leone - Specific objectives: To contribute to the recovery of essential health services for children under five, pregnant women and lactating mothers by supporting the provision of essential drugs and therapeutic feeding inputs 2.3 Components - Provision of essential medicines and medical supplies (including management and distribution). - Provision of RUTF for the treatment of severely malnourished children (including management and distribution). 2.4 Complementarity and coordination with other EU services, donors and institutions DFID, together with UNICEF, has been the lead donor to implement the free health care services for vulnerable groups. UNICEF will strengthen the procurement and supply chain ECHO/SLE/EDF/2010/01000 3

management. Other important donors to support the process are the World Bank, African Development Bank, Irish Aid and Japan International Cooperation Agency (JICA). A Joint Financing Arrangement is under development to enable partners to channel funds in an efficient and transparent manner. Very little health sector support has been foreseen under the 10 th EDF, as in the division of labour between donors, the health sector has been mainly attributed to DFID. However, with EDF funding a central medical store and corresponding medical stores in all districts are under construction. The drug supply through DG ECHO would certainly complement the construction. There also seems to be a clear will to give health more prominence in the framework of the 11 th EDF. 2.5 Duration The duration for the implementation of this Decision shall be 18 months Humanitarian actions funded by this Decision must be implemented within this period. Expenditure under this Decision shall be eligible from 1 October 2010. Start Date : 1 October 2010 If the implementation of the actions envisaged in this Decision is suspended due to force majeure or any comparable circumstance, the period of suspension will not be taken into account for the calculation of the duration of the humanitarian aid actions. Depending on the evolution of the situation in the field, the Commission reserves the right to terminate the Agreements signed with the implementing humanitarian organisations where the suspension of activities is for a period of more than one third of the total planned duration of the action. In this respect, the procedure established in the general conditions of the specific agreement will be applied. 3 Evaluation Under Article 18 of Council Regulation (EC) No.1257/96 of 20 June 1996 concerning humanitarian aid the Commission is required to "regularly assess humanitarian aid actions financed by the Union in order to establish whether they have achieved their objectives and to produce guidelines for improving the effectiveness of subsequent actions." These evaluations are structured and organised in overarching and cross cutting issues forming part of DG ECHO's Annual Strategy such as child-related issues, the security of relief workers, respect for human rights, gender. Each year, an indicative Evaluation Programme is established after a consultative process. This programme is flexible and can be adapted to include evaluations not foreseen in the initial programme, in response to particular events or changing circumstances. More information can be obtained at: http://ec.europa.eu/echo/policies/evaluation/introduction_en.htm. ECHO/SLE/EDF/2010/01000 4

4 Management Issues Humanitarian aid actions funded by the European Union are implemented by NGOs and the Red Cross National Societies on the basis of Framework Partnership Agreements (FPA), by Specialised Agencies of the Member States and by United Nations agencies based on the Financial Administrative Framework Agreement with the UN (FAFA) in conformity with Article 103.3 of the Financial Regulation applicable to the 10th EDF, together with Article 163 of the Implementing Rules of the Financial Regulation applicable to the general budget of the European Union. These Framework agreements define the criteria for attributing grant agreements and contribution agreements and may be found at http://ec.europa.eu/echo/about/actors/partners_en.htm For NGOs, Specialised Agencies of the Member States, Red Cross National Societies and international organisations not complying with the requirements set up in the Financial Regulation applicable to the general budget of the European Union for joint management, actions will be managed by direct centralised management. For international organisations identified as potential partners for implementing the Decision, actions will be managed under joint management. Individual grants are awarded on the basis of the criteria enumerated in Article 7.2 of the Humanitarian Aid Regulation, such as the technical and financial capacity, readiness and experience, and results of previous interventions. 5 Annexes ECHO/SLE/EDF/2010/01000 5

Annex 1 - Summary decision matrix (table) Principal objective To support vulnerable populations affected by the breakdown of essential health services in Sierra Leone Specific objectives Allocated amount by specific objective (EUR) Geographical area of operation Activities Potential partners 1 To contribute to the recovery of essential health services for children under five, pregnant women and lactating mothers by supporting the provision of essential drugs and therapeutic feeding inputs 6,600,000 Sierra Leone Provision of essential medicines and medical supplies (including management and distribution). - Provision of RUTF (including management and distribution). UNICEF TOTAL 6,600,000 1 ECHO/SLE/EDF/2010/01000 6

Annex 2 - Overview table of the humanitarian donor contributions Donors in SIERRA LEONE over the last 12 months 1. EU Member States (*) 2. European Commission EUR EUR Germany 800,000 DG ECHO 0 Ireland 5,901,571 Other Services 86,000,000 United Kingdom 204,560 Subtotal 6,906,131 Subtotal 86,000,000 TOTAL 92,906,131 Date : 19/07/2010 (*) Source : DG ECHO 14 Points reports. https://webgate.ec.europa.eu/hac Empty cells : no information or no contribution. ECHO/SLE/EDF/2010/01000 7

Annex 3 - Map ECHO/SLE/EDF/2010/01000 8

Annex 4 - Statistics on humanitarian situations Vulnerability and Crisis index GNA 2007-08 Countries - GNA 2009-10 score HDI/HPI R+I+r / 2 U5 HMT Phis. Crisis Index (CI) Health + Inequality C/ND/R Co ND Ref+IDP Sierra Leone 3 3 1 3 2 3 2.8 0 0 0 0 Liberia 3 2 1.5 3 2 3 2.5 0 0 0 0 Guinea 3 3 1 3 2 3 2.5 0 0 0 0 Cote d'ivoire 3 3 2.5 3 2 3 2.5 3 0 0 3 ECHO/SLE/EDF/2010/01000 9