Ref. no. (to be filled out by the Project Advice and … › PubliceredeDokumenter › {AED2A9EF...THE PROJECT FUND – Large-scale development projects (DKK 1 to 5 million) 0 1. Cover

THE PROJECT FUND – Large-scale development projects (DKK 1 to 5 million) 0

1. Cover page

LARGE-SCALE DEVELOPMENT PROJECT

Project title: “Farming, Health and Environment - Nepal 2013-15” Danish applicant organization: Dialogos Other Danish partner(s), if any:

Danish Society of Occupational and Environmental Medicine through its international committee International Centre for Occupational, Environmental and Public Health (ICOEPH)

Local partner organization(s): Nepal Public Health Foundation Country(-ies):

Nepal Country’s GDI per capita: USD 490

Project commencement date: 01-01-2013

Project completion date: 31-12-2015

Number of months: 36 months

Contact person for the project: Name: Anshu Varma Email address: [email protected] Amount requested from the Project Fund: DKK 2.446.876

Annual cost level: DKK 815.625

Is this a re-submission? (To the Project Fund or Danish Ministry of Foreign Affairs)? [X] No [ ] Yes, previous date of application: Synthesis Forgiftninger og forurening pga. et øget forbrug af pesticider er et problem især i udviklingslande med millioner af tilfælde årligt. Dialogos og ICOEPH har nu gennem 8 år med succes arbejdet med forebyggelse og fortalervirksomhed i Bolivia og Uganda. I Nepal har en teknisk indsats for sprøjtesvage dyrkningsmetoder været afprøvet gennem et årti, men der mangler fortalervirksom-hed og folkeoplysning som kan udbrede en bæredygtig og ”grøn” fødevareproduktion. Aktuelle projekt fokuserer på awareness raising og advocacy blandt forbrugere, religiøse grupper og beslutningstagere for at fremme et sundere og bæredygtigt landbrug; på undervisning af sundhedspersonaler i forebyggelse, diagnostik og behandling af forgiftninger; og af bønder og pesticidsælgere i korrekt håndtering af sprøjtemidler, sprøjtesvage og økologiske metoder. Der samarbejdes bredt med Bondekooperativer, Røde Kors, læreanstalter, WHO og myndigheder. Date 17/09 2012 Person responsible (signature)

Place Odense

Person responsible and position (block letters) PROJECT HEAD: ERIK JØRS, VICE-PRESIDENT OF DIALOGOS, PRESIDENT OF ICOEPH, MEDICAL SPECIALIST IN OCCUPATIONAL AND ENVIRONMENTAL MEDICINE, MASTER OF INTERNATIONAL HEALTH. PROJECT CO-ORDINATOR IN DENMARK: ANSHU VARMA, CANDIDATE IN PUBLIC HEALTH WITH SPECIALTY IN OCCUPATIONAL HEALTH FIELD PROJECT CO-ORDINATOR IN NEPAL: DINESH NEUPANE, CANDIDATE IN PUBLIC HEALTH WITH MASTER DEGREE IN OCCUPATIONAL HEALTH FROM SDU

Ref. no. (to be filled out by the Project Advice and Training Centre)


2. Application text A. THE PARTNERS

A.1 The Danish organization The organization’s experience of working in the particular field addressed by this project proposal. Since its establishment in 1994 Dialogos has been committed to a) assist populations in low-income countries on their self-chosen way out of poverty, b) work for democracy and just resource distribution, c) involve and activate large resources in the close network of associations, institutions and companies in Denmark. The frame of work is to strengthen partners from the civil society in low-income countries to become able to advocate for a better health of the population by improving alternative and ecologically friendly methods for health care and food production. While carrying out projects in Bolivia and Uganda on prevention of pesticide intoxications Dialogos has proven its ability to work together with local and international NGOs, local agencies and authorities (universities and ministries) as well as international organizations like the World Health Organization (WHO), and the International Commission on Occupational Health (ICOH). These projects are seen as innovative in their fields, which has evoked national and international interest. The main successes of these projects apart from organizing and training target groups, has been elaboration and distribution of teaching materials for farmers and health care workers on prevention of pesticide intoxications, a healthier food production and environmental friendly pest control methods. Moreover, changes of curriculums in public schools and universities have taken place, and the project strategy and materials have been incorporated into governmental and NGO programs showing a high degree of sustainability potential. The budgets of these projects have been handled to the satisfaction of Danida and Civil Society in Development (CISU). (Evaluation reports and list of materials and contributions on international meetings can be forwarded on request). The consistency between the organization’s field of activity in Denmark and the work to be carried out in the project applied for. As a volunteer based Danish NGO, Dialogos is used to organizing and coordinating activities for their members and activate Danish and international professional networks to help conduct activities in projects. The individual members of Dialogos have a strong network of relevance to the projects carried out by Dialogos, as for example ICOEPH, a network of professional Occupational and Public Health specialists. These networks are a strong and a necessary part of the Dialogos projects. The organization’s cooperative relations with other organizations or stakeholders in the recipient country. Since 1999, Dialogos has conducted projects in Solokhumbu placed in the Northeastern part of Nepal with the Nepali NGO Young Star Club. The projects have focused on basic health needs, nutrition, education of females and creating communication media to retain and complement discussions and activities in the project area. Dialogos Youth has been sending volunteers to the area in and around the capital of Nepal, Kathmandu during the last five years to work on projects about children either placed at children's home or the street. Hence, Dialogos has a very solid local knowledge about and network in Nepal. Dialogos with yhid profound knowledge from Nepal, has decided to open a new area in Nepal with a focus on its successful experiences in the fields of occupational and environmental health from the pesticide projects in Bolivia and Uganda. This focus has made it necessary to change local partner to a professional and skilled NGO in this field, the Nepal Public Health Foundation (NPHF), as described below. Qualifications of relevant staff/members/volunteers. The working group for this project, consisting of specialists in occupational and environmental medicine, agronomy, journalism and public health science, has extensive experience with the project activities from their normal jobs in Denmark and from the Dialogos projects in Nepal, Bolivia and Uganda. Moreover, two of the project group members have a Nepali and Indian background and therefore knowledge of local culture, language and personal contacts into the civil society and governmental institutions in Nepal.


A.2 Other Danish partners Indicate the organization’s year of foundation and briefly describe its history, mission and main activities. DASAM was founded in 1980 and hosts a membership of 165 specialists in occupational and environmental health. In 2004, the international committee of the association called ICOEPH was created. The mission of the committee is to facilitate low-income countries in ensuring occupational and environmental health by means of advice and promotion of focus on occupational and environmental health issues. What experience does the organization have of working with development projects in general? Please see the next section. Apart from that, ICOEPH and Dialogos are collaborating on the Philippines to reduce mercury-pollution due to small-scale mining. What experience does the organization have of working in the particular field addressed by this project? Dialogos and ICOEPH have been working closely together for the last 8 years on development projects about “Pesticide Use, Health and Environment” in Bolivia and Uganda. ICOEPH helped with elaboration of adequate teaching materials, informative materials and programs, the revision of curricula in relevant training courses, educational programs, scientific studies documenting the magnitude of the challenge and the effect of interventions etc. Results of the work have been presented at international conferences where other studies have been documenting the obvious need for activities to prevent pesticide poisonings of humans and pollution of the environment in low-income countries. ICOEPH has been involved in public awareness rising in Denmark about occupational and environmental health issues in low-income countries for example by advocacy on conferences and also by awareness raising in the Danish society by means of the media. media cases were based on pesticide production in India by Cheminova, pesticide use on Danish owned plantations in Indonesia and Kenya, ship scrapping on the Alang Beach in India, Maersk container factory in Goudong China and the work environment in Ericsson and Telenor factories in Sri Lanka among others. What is the value of incorporating this additional partner? ICOEPH is not only a valuable partner because of its expertise in technicality, research and education but also because of its international relations. ICOEPH is a member of ICOH and forming part of ICOH’s group on agricultural health, whereby substantial influence on ICOH policies regarding pesticides is at reach. Based on the experiences made with Dialogos in Bolivia WHO requested ICOEPH to join WHO’s group of international specialists on Occupational Health and Safety (OHS) working to develop strategies and materials to improve the health of workers at a global level. In other words, incorporating ICOEPH into this project as an additional partner will prepare ground for global impact of the project results. A working agreement is signed between Dialogos and ICOEPH stating that Dialogos will be the overall responsible for the administration of funds and advocacy activities, while ICOEPH will deliver and coordinate the technical input concerning guidance of the local partner in the elaboration of teaching materials, documentation studies, evaluations and student supervision. Other collaborators in Denmark which we have contact to and are coordinating with are institutes and students from Danish Universities. By example, from the Faculty of Science KU Life agronomists, will be consulted on specific matters and students enrolled in research studies and thesis writing. Moreover, consultants from the companies "Better spraying" will be used to supervise on effective spraying techniques minimizing pesticide use, while we have contacts to "Biopesticides Tappernøje" that can advise on the biological means of killing pests. A.3 The local organization NPHF established in 2010 is a democratic organization with almost 50 members and yearly celebration of general assembly with election of board members. NPHF, as an organization with technical skills and contacts to Nepali organizations and government, is trying to articulate the needs of Nepali people in collaboration with its civil society organizations that not necessarily has got the knowledge or contacts to improve their own situation substantially. The organization is working for the civil society to ensure public health advocacy and community based action to


empower people at community level, and NPHF must be seen as a facilitator of changes in Nepal in the area of public health including workers health and a healthy environment. NPHF has implemented the following activities among others: Urban Health Program on School Health Screening, Skilled Birth Attendants Project in Bajhang, Dailekh and Kanchanpur district, District Investment Case project in Udayapur and Dadeldhura districts, Climate Change project in Kathmandu Valley and Research Methodology Training etc. NPHF works together with community based organizations, people's health movements, the government, other NGOs and private sector. Currently, Ministry of Health & Population (MoHP), WHO, Nepal Health Research Council (NHRC) and Epidemiology and Disease Control Division are partners with NPHF. NPHF has solid knowledge on health issues in local conditions. Although, farming projects have not been conducted directly, the fact that more than half of Nepal’s population is working in farming, this sector has been reached by the activities of NPHF. NPHF consists of a critical mass of highly experienced experts and activists in an apex body that has full autonomy exercised by its governing board and general body. The organization is established by experienced public health experts who already worked as senior government officers, employees of national and international organizations, professors of universities, leaders of consumer groups, environmentalists and human right activists. Furthermore, the good experience of NPHF in working with other civil society actors such as Nepal Red Cross Society (NRCS) and Female Community Health Workers and organizations such as foreign donors and WHO also emphasize the vast amount of experience that NPHF has. In addition to this, many of the employees in NPHF have already served as government policy which increases their lobbying capacity with governmental institutions in Nepal in order to have make policy level changes. Qualifications of relevant staff/members/volunteers. NPHF has a highly skilled and experienced personnel consisting of medical doctors and public health specialists with great motivation shown to take a leading role in the implementation of projects and has good international relations. NPHF is regarded as a crucial partner for further OHS and environment activities in Nepal. Thus, NPHF has great potential to implement this project, and fill a gap of knowledge on occupational health and environemtal health in Nepal. A working agreement has been signed between Dialogos and NPHF and information about status, annual report, governing body members and CVs of core personnel can forwarded on request. A.4 The cooperative relationship and its prospects How long have the partners been in contact for and what type of cooperation has taken place so far? Dialogos/ICOEPH has been in contact with NPHF since the establishment of NPHF by means of a Nepali public health student currently conducting his master thesis in a field related to this project. The contact was initiated through e-mail and telephone with the perspective of developing a potential collaboration. In April 2012 meetings and collaboration on the celebration of workshops between representatives from Dialogos/ICOEPH and NPHF took place in Nepal. During this process the partnership was agreed upon. In the preparation of the project proposal a constant and constructive dialogue via e-mail has taken place. How will the project applied for develop the partnership? By working together in the planning of the project, elaboration of the project proposal, and on workshops with other collaborators the partnership has already been developed to some extent by exchanging opinions and experiences. Now in the project this will be further developed, NPHF has the local knowledge and network without which the project cannot be realized. Dialogos/ICOEPH posses the administrative skills and an updated Scandinavian model for OHS organization that will be passed on to NPHF who will become one of the leading players in building OHS services and knowledge network on OHS in Nepal together with national authorities on OHS. Most likely, staff from NPHF will be invited to attend courses in administration and OHS in Denmark, as well as participating in international events on OHS presenting their experiences from Nepal in relevant forums like ICOH and WHO. What does each partner contribute (in addition to money) to the project concerned? As seen from above the partners have their networks and professional skills to contribute to the project. In brief, Dialogos has a broad Danish civil society network, experience from similar projects in Uganda and Bolivia and project work in Nepal; DASAM/ICOEPH has experience from working


with Dialogos and international professional networks on OHS, teaching and scientific experiences on OHS, along with profound knowledge of a unique Scandinavian model for OHS. NHPF has a well functioning organization on Public Health, and experiences from coordinating activities in the Nepali society including farmers and experience in handling donations from UN, Government of Nepal (GoN) and others. Describe how the project helps raise the partners’ profile and role as civil society actors locally and/or internationally (e.g. advocacy both North and South, networking or in other ways). NPHF is a part of the civil society in terms of its status as a civil society organization. This project supports the civil society by giving NPHF the main responsibility of carrying the project through while involving two important and essential influential civil society actors, NRCS and Farmers’ Cooperatives, representing the crucial sectors that this project will work in, namely the health and farming sector. These actors were not elected as main collaborator Farmers cooperatives due to lack of professional and administrative skills and with another focus of their organization. NRCS due to primarily a health focus in their activities and not as good possibilities for advocacy at central level in the government system. But they will be very much involved in the project and they are as civil society actors seen as fundamental pillars of this project. As a new NGO, NPHF needs to strengthen and further develop its organization. Through NPHFs deep involvement in implementing this project, carrying it through on a day-to-day basis, participating in seminars on organizational development and collaborating with other local stakeholders on the project are all factors that will help raise the profile of NPHF in Nepal. Also, expanding NPHFs professional expertise to a new area with its focus on Public Health but including environment and Occupational Health and Safety will enable NPHF to inspire and spearhead the evolution of a modern Nepal farming and industry with respect for health and environment. With a profile raised locally, the fact that NPFH already has good relations to WHO, and if feasible one or two NPHF staff members will participate in Danida courses for partner NGO’s from abroad, there are good opportunities for raising NPHFs profile internationally. With NPHF already having a role as a civil society actor this project will help NPHF make this role even stronger. As already described the project strengthens NPHFs organizational foundation. Such a foundation is necessary for a civil society actor interested in continuing working for the betterment of citizens in the longer run. Also, through this project NPHF will work with other civil society actors in Nepal and get the opportunity to share experiences, be inspired by each other’s work and develop future relations all that will reinforce the Nepali civil society community. At last, this project enables NPHF to reach a broader part of the Nepali citizens with its activities making the actions of this civil society organization more exposed and helpful. B. PROJECT ANALYSIS

B.1 In what context is the project placed? Relevant geographic, political, social and cultural conditions. Nepal is situated between India and China with an area of 147,181 sq. km (209 persons per sq. km of land area) populated by 30 million persons of whom the majority lives in rural areas. At the moment the annual population growth is nearly 2%. The subtropical climate in the southern lowlands, temperate climate in the middle mountainous zone and alpine climate up north covers elevation ranges from 66 to 8.848 meters above sea level. Although Nepali is the official language of the country over 100 languages are spoken in the approximately equivalent amount of ethnic groups, the most common ones being Maithili (12%), Bhojpuri (7%), Tharu (6%), Tamang (5%) and Newar (4%)(GoN). Main religions are Hinduism and Buddhism. The gross domestic product (GDP) of Nepal is 15 US$ billion structured by the service (48%), farming (36%) and industrial (15%) sectors. Per capita the gross national income (GNI) is US$ 490 and 30% of the population is living below the national poverty line. Around 59 % of the adult Nepali population is illiterate and the male adult population accounts for 72% of this. The fertility rate per woman is three children and life expectancy at birth is 68 years. The majority of the population has reasonable access to an adequate amount of water from an improved source. Democracy was introduced in 1990 and ever since the Nepali state has been characterized by political instability passing through a momentous and prolonged political transition after the end of a 10-year violent conflict in 2006. The country is still emerging from the conflict with some aftershocks. In the past five years the Nepali population


has been witnessing signing of a peace agreement between the former Maoists and the state, a new Interim Constitution, the election of a Constituent Assembly, the abolition of monarchy, five governments, and the rise of strong ethnic identity movements. The new constitution is intended to lead to major restructuring of the state. As it is now Nepal is divided into five development regions and 14 administrative zones subdivided into 75 districts (Nepal World Bank; GoN). All though the political situation of Nepal is very fragile, there are many optimistic aspects convincing us of implementing this project. The 10-year armed-conflict between the state and Maoist party has come to a conclusive end. The process of rehabilitation and integration of former Maoist rebels is almost completed. We do not see immediate start of any conflict soon. Representatives from the Danish Embassy in a meeting in Katmandu expressed their interest and support to our effort because they saw the pesticide challenge as highly compelling to deserve attention and especially since Danida will target one of its main development aid areas towards the Nepali farming sector starting from 2014. Also, the embassy expressed that this project could be kind of a pilot project and might be seen as complementary to the embassy’s future effort in Nepali farming sector. Another important aspect is that our project site is the least affected by ethnicity movements compared to all other districts with plain area. In what main area/sector is the project operating? How are local conditions within this sector? Health Health services are provided in government and non-government run hospitals, primary health care centers, health posts, sub-health posts, private nursing homes, and hospitals run by NGOs and international NGOs. There are eight central hospitals, three regional hospitals, two sub-regional hospitals, ten zonal hospitals, 65 district hospitals, 208 primary health care/health centers, 675 health posts and 3127 sub-health posts. There are 5600 hospital beds (approx: 4000:1) and only 1457 doctors who are working in the government health sector. Mid-level health professionals including 7491 health assistant/auxiliary health workers, 11637 nurses, 3190 maternal and child health workers and 3985 Village Health Workers and round 48,000 Female Community Health Volunteers working at community level run the health system. There are 2.1 per 10.000 physicians and 4.6 per 10.000 nurses and midwives. According to Nepal Demographic Health Survey 2011, 29% of children (under five years) are malnourished. The prevalence of stunting and wasting is 42% and 2%, respectively. The under five-year mortality and infant mortality are 54 and 46 per 1000 live birth, respectively. The contraceptive prevalence rate is 50% and about 63% of all deliveries occur at home. According to the Annual Report of Department of Health Services, the immunization coverage for Bacillus Calmette–Guérin (BCG), diphtheria, pertussis, and tetanus (DPT), polio and measles is more than 80%. The incidence of acute respiratory infections (ARI) among children under the age of five is 882 per 1000 persons, whereas severe pneumonia accounts for 0.48%. Similarly, the incidence of diarrhea among under the age of five was 598 per 1000 population. Clinical malaria incidence is 5.41 among 1000 tested slides. The prevalence of leprosy is 0.77 per 10,000 persons. Farming Providing employment opportunities to around 66% of the population and contributing to more than one third of the GDP, the farming sector is considered to be the backbone of Nepali economy and the main source of food and income. Cultivated and uncultivated farming areas in Nepal occupy about 3.1 and 1 million hectares, respectively. Among Nepali farmers most are subsistence/small-scale farmers and therefore dependent on farming related activities for their livelihood. Most of the crops that are sold throughout Nepal are from the Terai region. The 10 most important commodities produced ranked by international commodity price values (int $ 1000) in 2010 was: rice (1040644), vegetables (566043), buffalo meat (435846), buffalo milk (425544), potatoes (391184), fruit freshness (229071), maize (219709), wheat (185682), ginger (142754) and cow milk (133884) (Ministry of Agriculture and Cooperatives (MoAC); FAO). Pesticides form an important part in increasing farming production for controlling any pest in plants and diseases in animals. The highest average percentage of Nepali land using pesticides is the Terai (12%), then the hills (5%) and Himalayan region (0,7 %). Pesticides introduced in Nepal are organ chlorines- 1950’s, organophosphates- 1960’s, carbamates- 1970’s and synthetic pyrethroids- 1980’s, and due to international agreements and high toxicity GoN has banned fourteen pesticides. The import of pesticides in active ingredients has increased from 108427.19 kg in 1999 compared to the most


recently available data in 2008 and 2009 where the quantity was 312740.50 and 211079.34, respectively. On average the use of pesticides is 142g/ha. However, the use is higher in areas with intensive commercial farming of cotton (2560g/ha), tea (2100g/ha) and vegetables (1400g/ha) like the Terai region. In the import of pesticides the most common pesticide of the total pesticide import is fungicide (61%) and the second major component is insecticide (30%), where the very toxic organophosphates account for the highest amount. For the rest herbicide, rodenticides and bio-pesticides cover 7%, 1% and 0.7 %, respectively. Worth noting is that most of the pesticides used in Nepal are imported from India and as there is an open and porous border with India, there is a considerable, but unknown quantity of trade between farmers close to the border that is not reflected in the presently available data. Hence, the quantification of pesticides could be seriously underreported (Journal of the Plant Protection Society Nepal; MoAC). What interventions are carried out by local authorities and other organizations (e.g. Danida) in the sector? Legislative interventions From a health sector perspective, in Nepal, a fair amount of health policies, strategies and plans have been in place since 1991 where the National Health Policy was established with the main objective of extending the primary health care system to the rural population by means of health infrastructure development, community participation, multi-sectoral coordination, mobilizing local resources and decentralized planning and management. To reduce infant and child mortality has been a priority. Following the adoption of the National Health Policy the Nepali health care sector has made significant progress in both public and private sectors. Primary health care services are provided at district level through sub health posts, health posts, primary health care centers and district hospitals. Secondary and tertiary care is provided by regional hospitals and specialized tertiary facilities. The Second Long Term Health Plan was developed for the period of 1997-2017 with the aim to guide health sector development for overall improvement of the health of the population. The main objective of this plan is to improve the health status of the most vulnerable population groups whose needs are often not met such as women, children, the rural population and the poor. The Nepal Health Sector Implementation Policy was formulated with the objective to improve nationwide health outcomes by expanding access to and increasing the use of Essential Health Care Services, especially among the poor. From a farming sector perspective Pesticides Act 2048 was established in 1991 and rules in the act were framed by means of Pesticide Rules 2050 in 1993. The act and rules have been effective since 1994 aiming at the implementation of national and international rules and regulations on pesticides. By means of the act, pesticides are registered and regulated covering import, production, sale, distribution, marketing and use of pesticides for management and prevention of pesticide risk. The act established a Pesticide Registration and Management Division to partly register pesticides and issue certification upon receiving application and partly ascertain the criteria for rational and appropriate use of pesticides. Registration is required for each formulation and even brand of a single technical compound and pesticides are registered in the name of the trade product for five years with or without provision/condition. Also, the act established a Pesticide Committee composed of members from various ministries, the Pesticide Association of Nepal (PAN), scientists and consumer groups. The overall committee is mandated to 1) advise GoN in the formulation of national policy regarding pesticides, 2) co-ordinate between private and government sectors in the production and distribution of pesticides, 3) encourage private sector investment in the pesticide industry, 4) control the quality of industry produced pesticides operated under private or government sectors, 5) set standards for pesticide quality. Most recently the Plant Protection Act 2064 from 2007 was enacted establishing a Plant Quarantine Committee with the responsibility of making advise and suggestions to GoN on policies about quarantine of plants or plant products. Furthermore, Nepal is a signatory country of international conventions related to pesticides such as Stockholm Convention, Basel Convention, Rotterdam Convention and Montreal Protocol (MoAC). What is lacking is putting these conventions and control mechanisms into practice and make them function in the farming districts. Here knowledge is lacking among farmers and consumers thus little interest is given to these issues, and on the other hand GoN has not got the public pressure or advocacy to make these toxicological and environmental problems created by pesticides an issue of importance – awareness is missing.


Educative interventions From a health sector perspective, traditionally the majority of NGOs are involved in health education, family planning, maternal and child health, nutrition and prevention of major infectious diseases. Knowledge on toxicology depends on the academic qualifications of Nepali health personnel and the length of training they have received and there is no provision of training on toxicological effects of pesticides for health cadres in districts. The National Health Education, Information and Communication Center is acting as a center for MoHP with an integrated approach and one door system for advocacy, community mobilization, behavior change communication and health service and program promotion activities. The center is providing planning, implementation, monitoring and evaluation at the different levels and strengthens and encourages people individually and in groups, use participatory methods to develop positive attitude and practice healthy behavior through health education, promotion and appropriate treatment of disease prevention, control and rehabilitation to encourage full utilization of health services and program. From a farming sector perspective, MoAC has the overall responsibility of executing the UN promoted Integrated Pest Management (IPM) strategy introduced in 1997. IPM is understood as an effective, economically sound and environmentally sensitive approach to pest management that relies on a combination of common-sense practices that enhances, rather than destroys, natural controls. In IPM, pesticides are used sparingly and selectively always using the less toxic options and promoting the use of appropriate personal protection to minimize negative health effects. IPM was introduced through a Technical Cooperation Program of FAO under the “Implementation of IPM in Rice” followed by Nepal’s participation in the FAO “Regional Program on Community IPM in Asia” between 1998 and 2002. Upon phase out of the latter program, the Norwegian Government bilaterally funded the project “Support to the National IPM program” from 2004 to 2007; the first phase of IPM. In this phase the objective was to train human resources (technicians and farmers) focused in crops of rice and vegetables. In order to continue the IPM program activities the Norwegian Government granted financial assistance to support the consolidation, up scaling and institutionalization of the National IPM Program from 2008 to 2012. Achievements have been made and impacts observed with the existing implementation of IPM in Nepal. Approximately 72.957 farmers have been trained, 1.010 Farmer Field School (FFS) have been implemented (50 % in rice and 50 % in vegetables) and plant protection officers exist in each of the 75 districts. Other impacts observed are reduction in pesticide use by 40% in FFS areas, increase in crop yield from 15 –25% in rice and 32-48% in vegetable as compared to farmers’ adopted practice. However, it is estimated that only 20% of the farmers are aware of IPM practices and major challenges still faced are: 1) development of alternative means of pest control 2) up-scaling IPM technology based production systems through implementation of FFS 3) the field impact in terms of the use of IPM tools as an alternative to pesticides should be measured because the criteria of increasing the number of IPM trainers and trainees and FFS sites alone may not be a satisfactory answer to the success of IPM 4) the trend of pesticide import and use has not changed much even after a decade of IPM implementation 5) lacks in adequate knowledge of trainers 6) low level of participants in intensive district level trainings 7) delayed supply of economic and technical support 8) delayed quality seeds supply (MoAC). Farmers’ Cooperatives provide training related to improving technical farming production skills with assistance from MoAC. Most of the training is based on increase of food production and marketing. However, the training programs have not been adequate and most of the farmers have not received any training from their respective Farmers’ Cooperative or technicians. Foreign interventions From a health sector perspective, during the last fiscal year of 2010/2011, the World Bank provided 22.9 million US dollars, UK Aid from the Department for International Development 11.2 million US dollars and Australian Government Overseas Aid Program provided USD 5.6 million in a pooled funding to support the MoHP/GoN via Sector wide approaches. The major partners contributing to the health sector of Nepal are United Nations Population Fund, Unicef, WHO, United States Agency for International Development, Action Aid International, ADRA Nepal, Care International Nepal, Center Plan International, Oxfam etc. The major interventions supported by the donor agencies are focused on maternal health, child health, family planning, nutrition and HIV/AIDS. Danida does currently not support the health sector in Nepal.


From a farming sector perspective, generally this sector has not been much favored for donor support in the past and the foreign aid has remained almost stagnant at a very low level in the last two decades (Ministry of Finance (MoF). The donors’ share in foreign aid for farming through the MoAC in the period of 2003-2007 was as follows: Asian Development Bank 54%, World Bank 15%, UK Aid from the Department for International Development 13%, Development Aid from Japan 6%, Swiss Agency for Development Cooperation 5%, International Fund for Agricultural Development 4%, others 2% and Norwegian Agency for Development Cooperation 1%. International financial institutions have concentrated mainly on enlarging growth opportunities through infrastructures and commercialization whereas bilateral donors have supported mostly livelihoods improvement and natural resource sustainability. US Aid’s program activities in farming in Nepal in recent years included Small Holder Market Initiative, Business Development Services-Marketing and Production Service, Tea Coffee Smallholder Mobilization through Improved Governance, Ujyalo (Light) and IPM (MoAC). Danida does not have programs in the field of farming in Nepal. However, through the local grant authority two small-scale projects are taking place on the topics of “Livelihood improvement of women through innovative agricultural program and market linkages” and ”Water and farming for livelihood of rural women programme” in the period of 2012-2015 in Kavrepalanchowk and Dhading, respectively. Specific context for this project The project will operate in the district of Chitwan one of the most pesticide intensive areas in Nepal specifically in the following five villages of highly intensified farming production in the district: Mangalpur, Jagatpur, Bhandara, Shukranagar and Geetanagar. Chitwan has been selected because an unpublished study undertaken by Dinehs Neupane (SDU/ICOEPH/Dialogos) among farmers in this intensive farming production district largely distributing vegetables to the local market and market in Kathmandu shows an urgent need for action. See appendix for an abstract on the unpublished study. Chitwan has a total population of around 566,661 (census 2011) with relatively equal gender distribution. Chitwan is one of the inner Terai districts in the central development region of Nepal. The total number of households is 92863 with an average family size of 5.08 and a population density of 213 persons/km2. About 73% of the population lives in rural areas. Among many ethnic groups living in Chitwan, the top five ethnic communities are Brahmin (29%), Chhetri (11%), Tharu (13%), Tamang (7%), Newar (5%), Gurung (7%), Kami (4%) and Damai (2%). The first two belong to upper caste groups and the last two belong to the Dalits (the untouchables).The indigenous inhabitants of the district belong to “Tharu” ethnicity, but due to the migration the district is occupied mostly by so called upper caste ethnic groups. During the political conflict time, Chitwan was among one of the most unaffected districts of Nepal making it a rather politically stable project area. Chitwan district has one regional hospital, one eye hospital, one tertiary level cancer hospital, four primary health care centers, six health posts, 31 sub-health posts and a few private hospitals and nursing homes. The top five diseases in Chitwan are skin diseases, respiratory diseases, fever of unknown origin, diarrhea and injuries. Chitwan was a largely uncultivated dense forest before GoN started a project of spraying DDT for Malaria Eradication in 1950. Immediately, Chitwan became a major farming region, and services and infrastructure expanded across the area. Farming is the primary source of income for 75% of population of the district. Out of total 46,894 ha of arable land, 44,291 ha land is used for agricultural purpose. More than 80% of the total population in this district depends on farming. As of September 03, 2012, there were 630 registered Farmers’ Cooperatives in Chitwan. Among them, 147 were related with milk production, 77 were related to crop production, 15 were related to vegetable and fruit production and 13 were related with consumer groups. Though there is a strong network of Farmers’ Cooperatives in this district, they hardly receive training on pesticide and other production issues. The cooperatives in Chitwan have shown great willingness to be a part of this project creating a good point of departure to anchor this project among farmers. B.2 How has the project been prepared? Who has taken part in the planning, and what has been the role of the local organization and of the Danish organization, respectively? Besides the one-year contact between Dialogos/ICOEPH and NPHF the research collaboration on the topic of “Negative Health Effects of Pesticide Exposure among Vegetable Farmers in Chitwan”


settled the choice of specifically Nepal as a setting for this project. The collaboration led to a 10-day visit to Nepal in the end of April 2012 by two representatives from Dialogos/ ICOEPH where the scope of this project was explored. During the visit, meetings were held with local authorities (MoAC, MoHP, Ministry of Labor, Transport & Management (MoLTM) and the Danish Embassy), national and international NGOs (NPHF, Red Cross and Hellen Keller International), a local occupational and environmental medicine physician from the Department of Community Medicine at Katmandu Medical College, vegetable farmers, pesticide dealers and a Buddhist monastery. The visit brought about two workshops conducted in Katmandu and Chitwan with representatives from all the meetings attended by the two representatives from Dialogos/ICOEPH during the visit in April 2012. In addition, representatives from NARC, National Health Education, Information and Communication Center, Department of Community Medicine and Family Health, Tribhuvan University, District Public Health Office, District Farming Office, District Education Office and Farmers Cooperatives attended the workshops. At the workshops a draft proposal of this project was discussed to ensure development of a project suitable for the Nepali context based on a local multidisciplinary expertise team. Both workshops indicated that the project has a bright future and will give real impact in the society, there will be a strong collaboration between government and non-governmental organizations and that the project will get enough attention and priority from different stakeholders. Hence, to the extent that it was feasible the views of all representatives at the workshops were incorporated into the project proposal. However, the main planners have naturally been Dialogos/ICOEPH and NPHF. How have the target groups and participants been involved in preparing the project, including the participation of women, men, children and young people? The research study has directly ensured that perspectives of the target groups have been included in preparing the project, also from a gender and age perspective. The farmers have been visited in their homes and villages, and farmers cooperatives has been part of the workshops celebrated in Chitwan to discuss the problem and possible solutions. Indicate whether local and/or national authorities have expressed their consent to the project’s implementation Apart from the very positive consent from the Danish Embassy described earlier, MoAC, MoHP and MoLTM are national authorities that have all expressed consent and strong motivation to the project’s implementation. Relevant authorities and NGO’s did participate in a seminar and later a workshop in Kathmandu on the topic expressing their commitment to a initiative on farmers health with a focus on pesticides, where although a lot has been done to a certain level on IPM issues, as mentioned above, there is a need to make this settle in the villages and almost nothing has been done in the health care system on pesticides and intoxications. Have specific analyses been carried out (including gender-specific ones)? If so, how have these fed into the project’s design? The study on pesticides is forming a base for the project revealing a need among farmers and health care workers to improve their handling of pesticides and alternatives, and treatment and prevention of intoxications. Except from having taken the gender and age perspectives of the target group into consideration to be described in section B.3 no further specific gender analyses have been carried out. If an appraisal has been carried out prior to this application: What were its main conclusions? During the visit of Dialogos/ICOEPH to Nepal the representatives of Dialogos/ICOEPH were welcomed with a very positive interest in developing a project on the topic of “Farming, Health and Environment” by all representatives met in Nepal be that ministries, NGO’s or the farmers themselves - everyone considered the issue to be targeted urgently. The main conclusions were:

• Courses and materials in toxicology with emphasis on pesticides for health care workers and volunteer health educators to improve diagnosis and treatment, registration and prevention of intoxications in the health care system are lacking.

• Very few farmers have actually received any training or advice in IPM, and improper handling, storage and symptoms of intoxication after spraying are frequent.

• Pesticide dealers do not receive training and lack knowledge on pesticides and precautions, and do not provide personal protective equipment for sale.


• There is a great interest among farmers, in the health care system, among dealers and NGO’s to start collaborating on training and awareness rising on the subject.

• There are substantial resources that can be mobilized on the subject of preserving the environment, as e.g. the lamas in the monasteries having the focus of their leaders on this issue.

B.3 Problem analysis Describe the main problem that the project is expected to address. Ill health is a factor that contributes to the continuation of poverty because when poor people become ill or injured, their entire household can become trapped in a downward spiral of lost income and high healthcare costs. This project is targeting the health of farmers and consumers by promoting a healthy and sustainable food production and therefore contributing to poverty reduction in one of the poorest countries of the world. On a yearly basis three million cases of pesticide poisoning are estimated to occur. Farmers confront a particularly high risk of pesticide poisoning due to the added risk from their occupational exposure through pesticide management when mixing, applying, spraying, transporting, storing, taking care of equipment, reentering into the field, spillage and careless disposal. Not only the farmers but also the general population confronts a risk of pesticide poisoning being the food consumers. Aside from acute poisoning chronic diseases like cancer, fertility issues and injuries on fetus are other serious negative health effects of pesticide use. Over the years with the introduction of high-yielding varieties expansion of areas of rice, maize, wheat and vegetables, Nepal has experienced increasing tendencies in the use of pesticides. Compared to other farming countries pesticides are not used extensively in Nepal in terms of the ratio of active ingredients used per hectare of cropland. However, the characteristics of Nepali pesticide use in terms of location, target crops, intensity, types of chemicals and trends are disturbing. The use of pesticide is intensive in the Terai part of the country and Katmandu Valley where farming is mainly commercialized in crops such as vegetables, mustard and cotton (Plant Protection Society). This increase in pesticide use with lacking knowledge among farmers and dealers on proper protection, safe storage, spraying interval before harvest etc. leads to an increase in poisonings occupational, accidental as well as self-harm. And chronic intoxications among consumers might develop due to the presumably high level of pesticide residues on especially vegetables and in drinking water. In the health care system and among volunteer health educators no information or education on pesticide toxicity is given although more than half of the Nepali population lives in the countryside being possibly exposed to pesticides especially in the low lands. Set out the causes giving rise to this main problem. At a structural level, there are several causes to a poor management of pesticides in Nepal. There is no controlling mechanism for application of expired pesticides, the quality of imported as well as locally produced pesticides and consumer safety. Illegal trading due to open borders, especially to India, is also an important matter as is the low import of alternative pesticides and if such are available they are not readily available. Systematic disposal mechanisms are non-existing and therefore storage of obsolete pesticides is not always obvious posing serious if carelessly managed. Due to a poor monitoring system, adequate enforcement of pesticide regulations is not taking place and several misuses of pesticides could be happening (Plant Protection Society). At a health care system level, prevention and treatment of pesticide poisoning cases whether intentional or unintentional is poor in Nepal due to a strong lack of relevant skills among health personnel. The majority of pesticides poisoning cases are handled at peripheral levels of health care units such as health post and district hospitals where treatment of poisoning cases is based on individual level. There are no standard protocols for handling such cases immediately after arriving in the emergency ward. Also, the existing health care education is not effectively managing poisoning making it difficult for health personnel to recognize and manage pesticide poisonings as well as providing an actual picture of the prevalence of pesticide poisonings and their characteristics. At a practical level, inappropriate pesticide behavior among farmers and pesticide dealers are unfavorable for the management of pesticides. The majority of farmers in Nepal still apply highly


toxic pesticides because they feel that more is better in the sense that more toxic pesticides are more effective in killing pests. Other issues are overdoses, frequent use, not following pre harvest waiting periods, combining a broad spectrum of especially insecticides and treat it like human medicine. Moreover, usually the farmers do not have or apply personal protective equipment (PPE) either due to lack of awareness or discomfort. Also, the farmers are exposed to pesticide dealers and retailers leading aggressive marketing strategies (Plant Protection Society). Prioritization: which of the causes does this project give priority to addressing, and why?

• Challenges at the structural level are approached by raising awareness and strengthening advocacy for a healthy and sustainable food production in the civil society because a common voice will be promoted that can force political powers to take action.

• Challenges at the health care system level are approached by improving health personnel’s ability to prevent and treat pesticide poisonings because their skills are crucial in reducing pesticide use and treating poisoning cases.

• Challenges at the practical level are approached by promoting effective IPM and ecological alternatives among farmers and pesticide dealers because these actors are undeniably directly managing pesticides.

How did the issue of women’s and men’s (girls’ and boys’) needs, roles, particular starting points and interests enter into the problem analysis? The majority of Nepali communities are patriarchal. The status of women is determined by the patriarchal social system, values, and women’s right preserved and protected by the state and state policy for the development of women. The economic contribution of women is substantial, but largely unnoticed because their traditional role is taken as for granted. A large part of women’s work is not considered as economic activity. Woman’s situation is very poor in health, education, participation, income generation, self-confidence, decision-making, access to policymaking, and human rights. The health status of Nepali women is one of the lowest in South Asian region. One fifth of women get married in the early age of 15-19 years. The involvement of Nepali women in professional work, politics, bureaucracy and judiciary is very small. Women are almost excluded economically, socially and politically in Nepal. This is mostly because of their neglected role in decision making and strong socially gender discrimination attitudes of the society. A majority of men will naturally be targeted in this project because mostly male farmers manage pesticides. However, women can be seen performing spraying operations and often working next to spraying areas. Thus pesticides can affect them. In some cases women’s work in farming activities is significantly higher than men’s. The involvement of women in pesticide handling, harvesting, spraying and disposal of outdated pesticides put them at a serious health risk, especially if they are pregnant because pesticides are also hazardous to fetus. Also, working in parent farming is very common for children and they are often involved in the whole process of farming. It is in the interest of both sexes along with adults as well as children that fewer pesticides and less toxic pesticides are used and that pesticides are safely handled, stored and disposed. B.4 Stakeholder analysis NRCS established in 1962 provides aid to the areas of disaster management, health care, promotion of fundamental principles and humanitarian values, and organizational development. NRCS has district level networks in all 75 districts of Nepal. NRCS can support the project by providing a platform through their own network to the implementation activities and establishment of collaboration with health care facilities at district level. Strengths of NRCS are their good reputation, strong role in community awareness activities, solid and extensive network in all districts at community and school level. Also, NRCS has established facilities (own office space, vehicle, executive committee, general member, staff and board members). The major weakness is that being a humanitarian organization pesticide issues may not get high priority. NRCS did participate in elaboration of this proposal and will be a key collaborator in Chitwan where agreement of collaboration with local NRCS chapter is signed. Farmers’ Cooperatives came into life by means of the cooperative act of 1992 giving farmers the opportunity to organize and establish cooperative societies. The cooperatives are formed and governed by farmers to increase farming production, add value to farming produce, enhance marketing of farming commodities and develop technologies and practices related to farming production. As of July 2007, 9362 cooperatives exist in Nepal and out of them 3056 cooperatives are formed by farmers’ group (GoN,


2007). Farmers’ Cooperatives can support the project by means of making contact to farmers, organizing educative and informative sessions at local level and provide educative material for this project’s inspiration. Strengths of Farmers’ Cooperatives are that they consist of civil society organizations formed by the farmers who will benefit directly from this project and therefore be motivated to participate. In addition to this, the cooperatives also have a strong nationwide network, which can be utilized to make a broad out reach for farmers in general. The major weakness of the cooperatives is that farmers form them, a group that cannot be expected to have strong managerial and administrative capacities. Additionally, usually farmers are busy in their work, making it difficult to recruit them for the project activities. Farmers cooperatives has been active in workshopsand village meetings in Chitwan were proposal was discussed. Agreement of collaboration with Farmers cooperatives will be signed MoAC established in 1961 bears the overall responsibility for the growth and development of the farming sector in Nepal. Their work consists of developing national level policy, planning and administration in farming and allied areas. MoAC can support this project in the development of educational material, getting contact to farmers at district level through IPM district level program officers, training of farmers and pesticide dealers, revision of laws and regulations concerning pesticides, revision of curricula in educational institutes. Strengths of MoAC are their experiences in implementing IPM, established contact to farmers and trainers and their influence on pesticide monitoring and revision of laws. Weaknesses of MoAC lie in their political nature; seeing that change in government staff is very frequent in Nepal a frequent change in the chief of district farming office can be expected making continuity a challenge. MoLTM established in 1971 has the obligation to secure OHS in Nepal. The department mainly has two activity areas: 1) a training program (14 days) for government officials, employers and workers in all industries aiming at providing tools to build up an OHS system, 2) creating awareness on OHS. MoLTM can support this project with documentation studies of negative health effects of pesticide use and the effect of IPM, revision of laws and regulations concerning pesticides, revision of curricula in educational institutes and their labor inspectorate. Strengths of MoLTM are that they have expertise on labor rights and are in touch with different people through their training programs. Their weakness is that they have not been involved in the field of farming and health before. NRHC under MoHP established in 1982 has the aim of conducting health research, making health research applicable, setting priorities for health research topics, promoting international perspectives on Nepali health research, evaluating health research and defining national health policy. NHRC can support this project with student research activities, contact to health personnel, revision of laws and regulations concerning pesticides and revision of curricula in educational institutes. Strengths of NRHC are their strong community-based relation to health personnel and establishment of tertiary level regional and cancer hospitals. Weaknesses are that pesticides are not given much attention in regular public health programs and therefore the pesticide issue may not get high priority by district public health offices because they may consider pesticide as an issue belonging to the farming sector. IAAS originated as a school of farming established in 1957 in Kathmandu to train Junior Technical Assistant becoming an agricultural institute under Tribhuvan University for college level training in farming and animal sciences. The institute offers a Bachelor, Master and PhD in Farming. IAAS can support this project with technical expertise, development of IPM and alternative farming methods, monitoring of farming related interventions, documenting research studies and implementing IPM in the curricula of the agronomic education. The strength of IAAS its that it is situated in the project implementation district where staff and students have been enriched in the farming sector. Weaknesses of IAAS are that being the only agricultural academic institution in Nepal, they may not be available as per our need; they may only be interested in more scientific studies rather than programs focusing on community awareness. Hellen Keller an international NGO from 1989 has a program that develops village model farms improving farming through malnutrition with a special focus on women and children. The organization believes in IPM and organic farming. Hellen Keller can support this project with their experience in the field of training farmers in relation to IPM principles. Strengths of Hellen Keller are that it is among one of the few international organizations in Nepal working in both the health


and farming sector and they have existing tools in IPM to the inspiration of this project. The weakness of Hellen Keller is that it is an international NGO typically involving complex bureaucracy making it difficult to include the organization more directly in this project aside from being a discussing partner. PAN, a newly established association working for the interest of pesticide dealers can support this project with the organization and participation of pesticide dealers and advocacy towards farmers. The opposition in having PAN as a stakeholder is that this association has an obvious interest in promoting pesticide sales whereas this project is interested in reducing pesticide sales. The strength of PAN is that it is a union of common interest groups involved in district pesticide sales making PAN an efficient and effective knowledge transferor to pesticide dealers and farmers. Weaknesses of PAN are that the organization has recently been formed and some pesticide dealers may only be interested in their own profit and not have an interest in taking social responsibility. Katmandu Medical College, Department of Community Medicine has existed for more than fifteen years and is doing preventive health work, documenting studies and providing medicine and public health science education. This educational institution can support this project with documentation studies of negative health effects of pesticide use. Strengths of this institution are the expertise in conducting field studies and field training along with expertise on OHS issues. The weakness is that Kathmandu Medical College is a private institution and mostly has faculties in clinical sciences, which is not a focus in this project. C. PROJECT DESCRIPTION

C.1 Target group and participants Objective 1: STRUCTURAL ACTORS Direct beneficiaries - Representatives from local key stakeholders (farmers union, farmers cooperatives, PAN, health authorities, NRCS, MoAC, MoLTM and MoHP) will be trained and form a pesticide management committee in Chitwan. A project steering committee will be formed consisting of key participants in the project from NPHF, Farmers cooperatives, NRCS, NHRC, Kathmandu Medical College, Department of Community Medicine and MoLT, Environment Conservation Committee Rumtek Monastery, Buddhist Monastery Khoryug Network. MoAC and MoHP. University students will participate in documentation studies in the field. The project can be expected to influence hundreds of students in teaching sessions at the university and students will benefit from participating in field studies. Religious leaders will be trained in advocacy on Farmers health and sustainable food production and spread this knowledge in their communities all over Nepal. Two hundred professionals and farmers will be participating in a conference on ‘pesticides, health and environment’ in Nepal the second and third project year. Core staff of NPHF will be trained in Occupational Health and Safety, project management and administration. The structural actors are expected to have the following gender distribution 60 % male and 40 % female. Indirect beneficiaries - Through improvement of control measures taken by the district pesticide committee regarding local import, sale, stocking and use of pesticides a larger population in the districts will benefit. Expected female-male ratio is 1-1, and expected adult-child ratio 1:1. The project will reach a considerable number of people from the general population within and outside the districts by means of pamphlets, posters, radio and television with general information about the harms and benefits of pesticides and the use of preventive measures. Expected female-male ratio is 1-1, and expected adult-child ratio 1:1. Objective 2: HEALTH PERSONNEL Direct beneficiaries - The project will train 60 health personnel (30 curative health care workers and 30 female community health volunteers) in prevention, diagnosis and treatment of acute and chronic pesticide poisonings due to farming, spraying, suicidal attempts and accidents. Indirect beneficiaries - The preventative health personnel will in turn pass their acquired knowledge on to the villagers in the districts in out-reach Information, Education and Communication (IEC) activities, while the curative health personnel will share acquired knowledge with their colleagues.


The health personnel are expected to have the following gender distribution 70% females and 30% male. Objective 3: FARMERS AND DEALERS Primary target group - The project will train 40 farmers and 20 pesticide dealers in IPM strategies and the use of PPE. The farmers will be elected from their cooperatives to participate in the training sessions. The gender distribution is expected to be 75 % male and 10 % female. Secondary target group - The trained farmers and pesticide dealers will be expected to pass their knowledge on to the other farmers and customers. Several hundreds to thousand of farmers will be reached this way. The materials and strategies for training of pesticide dealers developed in the project might be of use in other districts in Nepal, and to other countries through the WHO and ICOH at global level. We intend to have an equal gender, caste and ethnic representation in all layers of the project but given the traditions in Nepal we may not succeed. However, we will try to empower male and females, all castes and ethnicities in the respective target groups. Account for the local partner’s legitimacy vis-à-vis the target group (e.g. the partner’s relation to the project’s target groups, roots in the local community - or communities – where the intervention will take place). NPHF has been legally registered, as an NGO in Nepal that can implement community-welfare activities across the nation by helping the government, general population and civil society in Public Health matters. NPHF has strong roots in the local communities and the work of this organization in broad geographical areas of the country means that they have ensured good relations with farmers, health workers, community people and government staff. Through a close local collaboration with the chitwan chapter of NRCS and Chitwan Farmers cooperatives the local knowledge and roots are further strengthened. C.2 The project’s objectives and success criteria (indicators) Indicate the overall development objective towards which the project sets out to contribute. To improve the health of farmers and consumers by promoting a healthy and sustainable food production in Nepal. Indicate the project’s immediate objectives (no more than three in total). Objective 1: To strengthen the capacity of civil society actors to advocate for a healthy and sustainable friendly food production. Objective 2:To improve prevention and treatment of pesticide poisonings in the health care system and among actors from the civil society. Objective 3: To reduce the health risks and pollution due to pesticides by promoting safer handling and ecological alternatives for pest control among farmers and pesticide dealers. Indicate the success criteria/indicators used to measure the achievement of each immediate objective and state by which means of verification information regarding the indicators will be collected.


Indicators

Means of Verification

Objective 1 (Organization and advocacy) 1.1 A pesticide management committee (PMC) representing local stakeholders is established in Chitwan and has taken at least three major actions to control pesticide intoxications and pollution e.g.: a. A positive list of pesticides for use in IPM-farming in Chitwan is available to farmers and dealers b. Storage and sale of pesticides in Chitwan is supervised and monitored by the pesticide management committee. c. Awareness rising in the District have been undertaken by the pesticide management committee to increase the knowledge of the general population about pesticides, health and environment. 1.2 Forty farm leaders and 30 religious leaders are advocating for a proper use of pesticides and promotion of IPM. 1.3 NPHF has strengthened its capability to conduct OHS activities within their work frame of public health.

1.1 Revision of statutes of the PMC, minutes from committee meetings and activity reports. 1.2 Report of activities from focus group discussions in the villages and key informant interview with the pesticide management committee members, farmers and religious leaders. 1.3 Registration of NPHF administrative procedures and number of new working agreements.

Objective 2 (Health activities) 2.1 Thirty health care workers are capable of diagnosing and treating acute pesticide poisoning. 2.2 Thirty volunteer health educators, farm leaders and religious leaders are educating villagers about prevention of intoxications with pesticides. 2.3 Materials for diagnosis, treatment and prevention of pesticide intoxications are available and in use by health institutions and NGOs inside and outside the project area.

2.1 Revision of clinical stories in health posts. 2.2 Focus group discussion and interviews with target group on activities and knowledge improvements. 2.3 Inspection of materials produced by means of qualitative assessment.

Objective 3 (Farming activities) 3.1 Farmers have fewer symptoms of pesticide poisoning after pesticide handling sessions. 3.2 Forty trained farmers use IPM methods e.g. use less toxic pesticides and ecological methods, use proper protection and hygienic procedures when handling pesticides, use proper storage of pesticides etc. 3.3 Twenty trained pesticide dealers are giving advice to farmers and other pesticide users on the use of less toxic pesticides, promoting the use of PPE and proper storage of pesticides. 3.4 Materials in IPM are available and in use by farmers and pesticide dealers inside and outside the project area.

3.1 to 3.3 Baseline and follow up surveys 3.2 and 3.3 Interviews with target groups. 3.4 Inspection of materials produced by means of qualitative assessment.


C.3 Outputs and activities

Activities Expected outputs

Objective 1 (Organization and advocacy) 1.1 Organize meetings to form a pesticide management committee in Chitwan district with the participation of local key stakeholders. 1.2 Organize 4 training sessions for the pesticide management committee members in Chitwan district. 1.3 Organize quarterly meetings of the pesticide management committee in Chitwan district. 1.4 Organize and train religious leaders to advocate for a healthy and sustainable food production in Nepal. 1.5 Produce, print and publish 10 articles about IPM and pesticide, health and environment in newspapers and other written medias. 1.6 Produce thirty radio spots for transmission in the whole country. 1.7 Conduct 120 village meetings in Chitwan district to inform the population about the project, IPM and pesticides, health and environment. 1.8 Strengthen Farmers Cooperatives in Chitwan to promote production and marketing of IPM products by advocating for healthier

1.1 A pesticide management committee is formed in Chitwan by the end of year one. 1.2 and 1.3 The pesticide management committee is advocating for sustainable farming production in the Ministries of Agriculture and Health, among local authorities and in the civil society.

1.4 Religious leaders are spreading information and advocating for a healthy and sustainable food production and a cleaner environment in Nepal. 1.5, 1.6 and 1.7 Awareness has been raised in the general population about pesticides, health and environment.

1.8 Farmer’s Cooperatives using IPM for food production exists in the district from year three.

foods and offering this for sale on the markets. 1.9 Organize an annual conference in Chitwan district about pesticides, health and environment, where experiences can be shared with other partners and entities to advocate for healthy and sustainable solutions. 1.10 Conduct studies through Nepali and Danish university collaboration on pesticides, farming and health related issues by students and lecturers. 1.11 NPHF and project staff has been trained in project management once a year.

1.8 A strategy on how to promote IPM products at the market is developed by the project and endorsed by the PMC. 1.9 Interest groups in IPM and sustainable farming are getting to know each other and are collaborating. 1.10 Five research studies have been published in international journals, presented on scientific conferences for advocacy purposes towards decision makers in Nepal. 1.11 NPHF is complying with international standards on project management as promoted by the UN.


Objective 2 (Health activities) 2.1 Conduct a baseline study and later follow up survey to get an overview of the number and reasons for acute illness among farming families. 2.2 Review of existing IEC materials and development and distribution of new IEC materials. 2.3 Conduct five training courses for 30 health care workers in registration, diagnosis and treatment of pesticide poisonings. 2.4 Conduct five training courses for 30 female community health personnel in the district about prevention, places for diagnosis, treatment and registration of pesticide poisonings. 2.5 Introduce a registration system for pesticide poisonings and testing in Chitwan district.

2.1 Information on the incidence of farmers’ ill health in Chitwan will be explored focusing on pesticide poisonings from the baseline survey during the first year of the project. 2.2 IEC materials, and a book about pesticide poisoning, diagnosis and treatment for the use of health personnel are available and distributed by two years of project period. 2.2 Five types of pamphlets, posters and one flip-chart about prevention, diagnosis and treatment of pesticide poisonings for IEC activities will be printed and distributed in the villages by two years of project period. 2.3 Proper registration, diagnosis and treatment of acute pesticide poisonings are taking place by year three. 2.3 A model for training health personnel in prevention, diagnosis and treatment of pesticide poisonings exists at the end of the project period. 2.4 IEC about prevention of illness and pesticide

poisonings is taking place in the in the villages by year two.

2.5 A registration system for poisonings is developed and in use by the end of the project period.

Objective 3 (Farming activities) 3.1 Conduct a baseline survey and later follow up survey among farmers about their use of pesticides, knowledge and practice in pesticide handling and symptoms of poisoning. 3.2 Gather existing information materials about IPM, PPE and safe storage of pesticides and produce and distribute new IEC materials. 3.3 Conduct 10-15 theoretical and practical courses for 40 farmers on knowledge sharing, IPM, use of PPE and safe storage of pesticides. 3.4 Conduct five theoretical and practical courses on knowledge sharing, PPE, hygiene when handling pesticides and safe storage for 20 pesticide dealers in Chitwan.

3.1 A report having information about use of pesticides, knowledge and practice in pesticide handling and symptoms of poisoning among small scale farmers exists at the end of the first project year. 3.2 Five booklets, pamphlets, posters and one flip-chart about IPM and safe storage will be developed and distributed in the district at the end of the second year of the project. 3.3 Forty IPM farmers will have obtained knowledge and will adopt IPM strategies and safe storage technique by the third project year. 3.3 Forty IPM farmers will pass their acquired IPM knowledge and informative materials on to 500 fellow farmers in their villages by the second project year. 3.4 Twenty pesticides dealers are passing on information about PPE, hygiene and safe storage of pesticides to their customers. 3.1-3.4 A model for training of farmers and dealers in IPM issues and safe storage exists at the end of the project period.

C.4 Strategy: how does the project cohere? What methods and modus operandi will be employed by the project and why. Pesticide use and associated problems is complex; on one hand pesticides increase yields, and on the other pesticides lead to human poisoning and environmental pollution. At the moment we do not believe that pesticide use can be avoided in most of farming productions because it is practically impossible to eradicate the usage of pesticides with a single announcement and still achieve the agricultural requirement of Nepal. However, it does not mean that pesticides without further should be allowed to harm health and environment but that the approach taken needs to be realistic because there is no doubt that pesticide use can and must be minimized. This is where IPM and the exploration of new methods in organic farming after all are internationally recognized methods with


great potential of responding to the challenge of minimizing the use of pesticides. Naturally, the success of such implementation depends on many factors in a given setting which Nepal is an example of. Despite the fact that pesticide use in farming has already been addressed by MoAC for some years serious challenges remain in making the implementation efficient and effective; at the moment impossible without further funding. Including pesticide dealers and health personnel makes the project innovative in its field besides trying to include religious leaders from the Buddhist monastery in awareness raising as they have a big network in the villages and are willing to teach the farmers, especially on ecological methods and green technologies as their spiritual leaders see the conservation of the nature as a very important issue. Interdisciplinary collaboration Many entities are involved in exports, imports, sale, use, legislation, information, teaching etc. Therefore efficient solutions have to be elaborated in a broad collaboration among authorities from various professional fields, farmers and consumers. The project is an interdisciplinary project, which will be reflected by coordination and mutual activities realized with the corresponding entities and by employing staff with the relevant skills. We can definitely take advantage of the experience already accumulated where especially the university and MoAC have experience in training farmers and where MoHP and NRCS have experience in training health personnel. As the pesticide dealers are the ones having almost a daily and direct contact with the farmers as pesticide customers we want to include this group in the training sessions. We know that there is a contradiction in the interest of the pesticide dealers and the IPM strategy, but on some points the project and the pesticide dealers could have the same interest e.g. minimizing poisonings due to promotion of PPE, the use of less toxic pesticides, a correct identification of the pest, to be able to choose and administer the pesticides effectively. Consumers groups are hardly seen in Nepal, but will likely be created in the years to come, with knowledge, such groups might also be able to advocate for safer products and a cleaner environment. Religious leaders from the monasteries can advocate in a bigger area due to their monasteries all over Nepal. It can be claimed that the number of collaborators seems to be high. However, this number clearly demonstrates that the pesticides safety problem is not a simple one, and therefore it should not be seen as having a quick fix solution. Instead, for the first time many key stakeholders in Nepal will be brought together functionally, to address the single problem from the various angles. The project bears in mind not to set up parallel structures but to build on existing ones, but in Chitwan a local pesticide committee with participation of different stakeholders is started to coordinate efforts and to advocate beyond the villages where most of the educational activities will take place.


Training, documentation and coverage As a small project we do not expect to cover large areas with trained farmers, dealers, or health personnel, although we do expect that the strategy of ‘training of trainers’ will result in knowledge being passed on to more people than the project’s direct beneficiaries. The project must be seen as a project in a local area where the work with farmers and health personnel will create strategies and materials that can be distributed to a larger number of people and other geographical areas. Radio and television programs are also making it possible to get the information out to a much larger number of people, and through the WHO, these materials, strategies and experiences might be of world-wide interest. In the district 40 farmers will be elected by the Farmers’ Cooperatives from the different villages to take part in 10-15 theoretical and practical courses about IPM, health and environment. The trained farmers will then be supported in passing their acquired knowledge on to their fellow farmers, and act as a kind of local consultant on pesticide matters in their villages. The pesticide dealers will be trained and later participate in the education of the farmers to strengthen their knowledge of IPM, making them able to continuously supervise and educate the farmers’ groups in the districts. The trained farmers are all directly attached to the Farmers Union. Likewise a group of health personnel will be selected by the health authorities for training in the district, and five courses will be conducted on prevention, diagnose and treatment of pesticide poisonings. The training will be for both extension workers doing preventive work in the villages and curative personnel from the health care units, so each group gets an idea of both areas treatment and prevention of poisonings. For advocacy purposes an in-depth documentation of the actual situation concerning e.g. number of acute poisonings and severity, amount and types of pesticides involved, reasons for poisonings, handling and storage of pesticides among small scale farmers, residues of pesticides in food, soil and water etc will be documented. A knowledge that is useful not only to the project in its strategy and for evaluation purposes, but also of utmost importance for advocacy towards the entities and politicians dealing with pesticides, particularly the illegitimate use of non-registered compounds to make the responsible parties aware of the magnitude of the problem and take appropriate action to find sustainable solutions. An evaluation of the effects of the interventions performed and materials produced is valuable, if the experiences shall be of use for a wider range of institutions and farmers nationally and regionally, thus giving the project the possibility of a larger coverage than normally should be expected for the size of the project. The project personnel will have an office at the NPHF office in Kathmandu, and a local presence through an office in the district from where the employees will operate. The per diem and consultancies are used for collaborators when they go into the districts to collaborate in the project. A 4x4 vehicle for transport is necessary as no public transport is available and flexible enough to cover the transport needs. Teaching materials and general information Materials developed in Bolivia and Uganda will serve as an example and be translated to Nepali when producing materials for Nepal. It is foreseen to develop booklets for the farmers and dealers with themes like “The different classes of pests and how they attack different crops”, “The different classes of pesticides, proper mixing and spraying”, “Dangers to health and environment, how to protect man and nature, the use of personal preventive measures”, “Organic methods and the preparation of natural pesticides”, “Protection of non-cropping areas” etc. A common theme in the courses will be “How to pass on acquired knowledge on to others, - pedagogic methods!”, as many farmers do not have this knowledge. For the health personnel, a pocket book about symptoms of poisoning, classes of poisonings and their treatment will be produced and distributed, as well as educative materials about prevention of poisonings and first aid for teaching in the villages. Awareness will be raised outside the primary target area with the help of various media. Radios will be used to get the messages out to a wide audience in talk shows, radio spots etc. This is a good media for mass communication as most Nepalis have a radio. Radios cater even for those who cannot read or write. TV and newspapers may also be used if the project is able to come up with appealing information or news in the interest of a wider audience. This has been shown to be possible by lobbying among local journalists. Free SMS messages of interest to the general public can be sent by telephone companies, and the project will try out this methodology to reach great parts of the population. The content would be about IPM, poisoning of humans and nature,


preventive measures etc. By establishing communication facilities the project will open web pages in the adequate languages where distribution of articles and radio programs via the Internet to all interested parties is possible. The cost of this added perspective is extremely low. Materials produced and experiences will be systematized and disseminated at a national and international level through the collaborators in the project. The means will be international and national conferences, publications, Internet etc. – the key issue is to have an experience that has proven its worth and materials of high quality and that there is a big interest and ‘market for distribution’. Students training and collaboration between universities and professionals North-South Students in the medical, public health and agricultural training institutions will be encouraged and supported by the project to write their final thesis in matters of interest for the project, e.g. it could be: a. documentation of the number of poisonings, b. document the causes for poisonings, c. show the value of preventive measures when spraying, d. do a comparison of the yields using conventional farming, IPM farming and organic farming, e. environmental analyses etc. Studies like these have proven to be of value for promotion and dissemination of the strategy and ideas of the project. The results from studies can be disseminated at Nepal Scientific Conferences and in other scientific and public circles. The collaboration with Danish universities and ICOEPH provides a platform for using the project experience in teaching, e.g. SDU Global Health, Department of International Health, Immunology and Microbiology and Department of Farming and Ecology Life Sciences from Copenhagen University provides input to Danish and international students each year in the field of public health, international health, global health, organic farming, IPM etc. A couple of Danish students will be given the possibility to participate in the project by doing research in Nepal collecting and analyzing data from the project. An exchange of lessons learned will be possible as the Department of International Health, Immunology and Microbiology is responsible for several pesticide poisonings projects in India and Sri Lanka focusing on prevention through improved national registration process, improved safe sales practices and improved safe storage in households. Collaboration is expected to start between universities in the field of pesticide research promoted through this project and through ICOEPH linking it up to the WHO. Whether the project is divided into certain sequences or stages. The following time plan over activities provides an overview of how the project is divided in to sequences.

Objective 1 (Organization and advocacy) Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Q12 Organize a project steering committee with the participation of key stakeholders.

X X

Organize and train a pesticide management committee in Chitwan.

X X X X X X

Organize quarterly meetings of the pesticide management committee.

X X X X X

Organize and train religious leaders to advocate for a healthy and sustainable food production in Nepal.

X X X X X

Establish and sustain collaboration with MoAC and MoHP at local level farming.

X X X X X X X X X X X X

Produce, print and publish articles about IPM and pesticide, health and environment in newspapers


Produce radio programs for transmission in the whole country.


Conduct village meetings in Chitwan to inform the population about the project, IPM and pesticides, health and environment.


Strengthen Farmers Cooperatives in Chitwan to promote production and marketing of IPM products.

X X X X X X X


Organize a conference annually about pesticides, health and environment, where experiences can be shared with other partners and entities to advocate for healthy and sustainable solutions.

X X X

Conduct studies through Nepali and Danish university collaboration on pesticides and health related issues.

X X X X

X

X

X

X

X X X

Objective 2 (Health activities) Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Q12 Conduct a baseline study and later follow up survey to get an overview of the number and reasons for acute illness among farming families including pesticide poisonings through Nepali and Danish university collaboration.

X X X X

Review of existing IEC materials. X X X Development and distribution of new IEC materials.

X X X X X X X X

Conduct five training courses for 60 health care workers in diagnosis, treatment and prevention of pesticide poisonings.

X X X X X X X X

Introduce a registration system for pesticide poisonings and testing in Chitwan.

X X X X X X

Objective 3 (Farming activities) Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Q12 Conduct a baseline survey and later follow up survey among small-scale farmers about their use of pesticides, knowledge and practice in pesticide handling and symptoms of poisoning through Nepali and Danish university collaboration.

X X X X

Gather and analyze existing information materials about IPM, PPE and safe storage of pesticides.

X X

Production, distribution and evaluation of new IEC materials.

X X X X X X X X

Conduct 10-15 theoretical and practical courses for 40 farmers in Chitwan on IPM, use of PPE and safe storage of pesticides.

X X X X X X X X

Conduct five theoretical and practical courses on IPM, PPE and safe storage for 20 pesticide dealers in Chitwan.

X X X X X X X X

Field based supervision of Farmer’s Cooperative members on how to pass their acquired knowledge to fellow farmers.

X X X X X X X X

Field based supervision to pesticide dealers on how to pass their acquired knowledge to the farmers.

X X X X X X X X

OTHER ACTIVITIES Project Management

Q 1

Q 2

Q 3

Q 4

Q 5

Q 6

Q 7

Q 8

Q 9

Q 10

Q 11

Q 12

Project Steering Committee meetings X X X X X X X X X X X X Monthly planning/evaluation meetings NPHF


Internal evaluation X X Investments X X


Audit X X X Project visits from Denmark according to needs

X X X X X X

How women’s and men’s equal participation and gain from the project will be secured. Equal gender participation is in its nature difficult dealing with target groups with gender dominance of one or the other kind. When participants are selected by the community to participate in courses a wish to have an equal gender distribution is emphasized. It must however make sense, e.g. it is males who are doing the bulk of spraying operations, so it makes good sense to accept more males in the group of farmers to be trained, and on the other hand Volunteer Health Educators and Health Care workers are with female dominance, so in this case a female dominance is given. Is crucial that both genders receive a relevant knowledge from the project which relies on making the target groups pass on their knowledge to colleagues, farmers, families and neighborhoods in both genders. Hence, the project implementers will have to be aware of systematically emphasizing the importance of including an outnumbered participant whenever possible and also making the target groups spread their knowledge gender sensitively. As most families consist of both sexes and children, they all will benefit from knowledge although it might only be passed to one family member. How coherence and balance between capacity building, advocacy and possible strategic deliveries form part of the project strategy (see the Guidelines p.28-29). The project is primarily a capacity building project raising awareness through sharing of knowledge among partners and target groups. The knowledge in the primary target groups is shared by working together, through seminars and courses, and it is expected that these groups will pass on their knowledge to colleagues and farmers, as a sort of ‘training of trainers’ principle. Broader more general information directed at secondary target groups is given by folders, pamphlets, radio and newspapers. Based on our experience we assume that bringing new knowledge through teaching and information to farmers, health personnel and others will help them to alter their current practices and lead to a change in behavior in relation to pesticides handling and the prevention and treatment of pesticide poisoning. It is our experience that this is a sound assumption if the new knowledge is understood and if it can help to improve performance and income of the target groups. As advocacy towards decision makers and politicians is crucial, it is part of the project especially through the work with Farmers’ Cooperatives who based on their newly acquired knowledge and experience will be given the possibility of promoting sustainable agricultural production through participation in District Pesticide Committee and National Agricultural Chemical Board, together with NFHP, NRCS and the University among others. Advocacy should be directed at more education and control with import and sale, better extension services especially on IPM, more focus on pesticide toxicity in foods and environment, and improved registration and treatment of poisonings. Strategic deliveries such as implementation of infrastructure or attending patients is not part of the project, but education of farmers which should be part of the responsibility of the MoAC through its extension service can be seen as a strategic delivery. Given the limited ability of the MoAC, mainly due to restriction of funds, this education is however seen as necessary to justify the activities and create support from the farmers to project activities in general. How the project strengthens the local partner’s and/or target groups’ capacity and role as part of civil society. Please see section A.4 for a description on how the project helps raise NPHF’s role as a civil society actor locally and internationally. To be an active part in the civil society ‘knowledge’ is a must, and that is what this project is about – spreading knowledge on how to advocate for a sustainable food production in a health and environment perspective, how to plan, organize and celebrate activities in the civil society, and how to get the collaboration and secure local ownership from the civil society. NHPF has experiences in this field already, and with international experiences from this project their abilities will be further developed. The farmers, pesticide dealers and health personnel will with their newly acquired knowledge through training have gained capacity to advocate and advice the civil society and discuss with governmental institutions on how


to manage pesticides safely and handle pesticide poisonings, respectively, and if they are interested in promoting such knowledge to other colleagues, families and neighborhoods they are becoming strengthened civil society actors. How the project will secure support from important stakeholders (cf. B.4) The point of departure for securing support from important stakeholders is solid for several reasons. The ten-day visit to Nepal from Dialogos/ICOEPH established good initiative relations with key stakeholders. Especially, the very successful workshops with representatives of all key stakeholders held in Chitwan and Kathmandu after the ten-day visit show that the important stakeholders are highly motivated to implement this project and create sustainable solutions together. In particular, NPHF and NRCS have collaborated in the past, both organizations have similar goals of improving the public health and during the workshops they happily expressed their willingness to work together on this project. Furthermore, working agreements will strengthen these relations. In general, the purposed project field coordinator in Nepal for this project has studied in Denmark for two years and has excellent experience in working with civil society organizations in Nepal both creating an invaluable basis for an effective and efficient ongoing communication. Furthermore, by prioritizing an open, including, regular and motivational communication forum with each important stakeholder and NPHF it is expected that support will be gained from the relevant stakeholders. Regular visits from Dialogos/ICOEPH to the project site providing constructive feedback will certainly help with this. In other words, if the process is considered as open, effective, efficient, and beneficial to all stakeholders based on a common ground than most likely this project will secure support and participation from important stakeholders. C.5 Phase-out and sustainability Phase-out: Describe how best to ensure that local partners or target groups are not left in an unfortunate position of dependency when the implementation period expires. The project, mainly concerned with advocacy and a strengthened civil society, will not create infrastructure that puts demand on maintenance and thus funds from the target groups and partners. The project is not donating food, paying locals to participate in the project or creating a lot of well-paid jobs that will disappear when the project ends. Hence, local partners and target groups are not expected to be left in an unfortunate position of dependency when the implementation period expires. Rather, the project will leave local partners with awareness, knowledge and skills to continue potential efforts independently. Sustainability: Indicate the results or positive changes, which are expected to endure after the project has been completed. Relations created between stakeholders at a local and national level provides a collaborative framework for future projects about farming, health and environment. A systematic overview provided of the prevalence, reasons and consequences of pesticide use by means of registers along with documentation studies have raised awareness among the general population and a well-founded case for political discussion on the future pesticide issue in Nepal and its alarming consequences. NPHF is the one Nepali partner in this project whose core interest, and permanent mandate, is to promote the health and safety of persons in their living and working environment, wherever they may be living and whatever work they may be doing. Farmers forming the majority of community members and the majority of workers in Nepal are naturally NPHF’s leading target beneficiaries, which will ensure a focus on this group. NPHF’s extensive governmental expertise have created good possibilities for continuous lobbying, negation and information sharing with policy makers on the topic of farming, health and environment and thereby bring it on the agenda and make this project sustainable and scalable. Farmers have improved their production by implementing healthier and more sustainable IPM production methods not only affecting their own helath but also the health of consumers in Nepal. In the future, more emphasis will be put on the production of agricultural products containing minimal residues of pesticides certain to be able to export and also to sell on the home market, this will force the farmers to use pesticides in a proper way and to seek ecological alternatives. Health personnel are preventing and threating pesticide posinings, which in the long run will minimize the dangers of pesticides together with the above mentioned changes. Actual discussions at the MoHP promised an interest and thereby possible sustainability - “as the


project is offering training of staff, improvement of registration, documentation of health problems and improvement in food safety all in the interest of the health system” expressed by the senior health officer. See also results and indicators above! Describe how the project is expected to become socially, politically and economically sustainable The project is expected to become socially sustainable if a. farmers see an economic and health advantage in IPM or organic farming, b. pesticide dealers embrace the economic and human aspect in selling and guiding appropriately and c. health personnel experience an increasing number of pesticide poisoning cases forcing them to take action. By producing strategies and materials of high quality we have experienced other organizations (including Farmer’s Cooperatives), operative branches of ministries, teaching institutions and other NGO’s adopt the theme, our teaching materials and they themselves ask and pay for courses, which is a reflection of the necessity of the intervention and therefore potential natural sustainability to the benefit of the general population. The project is expected to become politically sustainable if decision makers after advocacy and documentation of the magnitude of the problem considers the problem big and serious enough to take action on. Also, if the capacity of awareness raising and advocacy in the civil society organizations of Nepal is improved then some legal and institutional changes might be realized leading to sustainability of actions taken to fulfill the development objective of the project. The materials and experiences from the project are expected to get substantial influence through the channels of WHO and ICOH because of ICOEPH’s international relations to these organizations after having caught their interest with the previous projects in Bolivia and Uganda. The project is expected to become economically sustainable if both the farmers and pesticide dealers can see the economic advantage in IPM or organic farming. In our previous experience IPM farming has shown to be economically beneficial and some farmers changed their farming to organic farming because of the economic benefits. Systematization and dissemination of experiences: Account for how the project’s experiences will be gathered, systematized and passed on.

• The information and teaching materials will be printed for distribution and sale, as well as made accessible on the web for downloading.

• The project will have an evaluation that will be publicly accessible in print as well as on the web. • The different results of documentation studies will be published in the press and technical

publications. • Radio and television will be used in Nepal.

How do you expect the systematized experiences to be used and by whom? The experiences will mainly be used in the health care system and among farmers and pesticide dealers in Nepal. It can be of inspiration to the state institutions working with health, education and farming as well. As it will be presented at an international level it can be used and for inspiration by the same groups in other developing countries. Indicate who will be responsible for systematizing the experiences. The main responsibility for elaboration, printing and uploading of teaching materials will be that of NPHF with technical support from Dialogos/ICOEPH and other collaborators. Furthermore, local collaborators will be responsible for sharing experiences through radio and television while Dialogos/ICOEPH and NPHF for the international promotion. C.6 Assumptions and risks Main assumptions • The GoN and stakeholders will support the project promotion and be open for collaboration at

both national and local level regardless of change in the direction of national policies. The project will attempt to take this factor into account by effectively raising awareness, knowledge and understanding of project issues among the target groups, and thereby foster an environment in which the public demand their rights and seek due accountability from governments and providers.

• The GoN and all stakeholders will support the project promotion and be open for collaboration at both national and local level regardless of caste/ethnic differences. Caste/ethnicity issues are not considered as major seeing that regardless of the Chitwan population’s


caste/ethnicities, most of the people are directly or indirectly involved and collaborating in farming and using pesticides. However, this project will attempt to include representatives from all castes/ethnicities in the different target groups where possible.

• Different stakeholders are able and willing to work together. The project will attempt to take this factor into account by ensuring effective communication forums and motivational efforts for each collaborator to contribute.

• Farmers, pesticides dealers and religious leaders are interested in training in IPM and they are ready to share acquired knowledge with other farmers. The project will attempt to take this factor into account by ensuring motivational efforts that will make the target groups participate.

• The health personnel is interested in training in diagnosis, prevention and treatment of pesticide poisonings and they are ready to share acquired knowledge with other health workers. The project will attempt to take this factor into account by ensuring motivational efforts that will make the target groups participate.

• Bringing new knowledge through teaching and information is assumed to promote changes in behavior and practices, if the target groups can see a benefit. The project will attempt to take this factor into account by ensuring motivational efforts for the respective target groups to see the benefits.

• Funds for the project are administered in a sound way to avoid misuse and corruption. The project will attempt to take this factor into account by effective monitoring and documentation of the budget and process evaluation.

• No corruption will take place. By means of the use of Danish social auditing to ensure budget and activity transparency this project will attempt to prevent corruption from taking place.

Risks • Major political unrest in the country will hamper the activities of the project. • Unstable currency that can minimize the project funds. D. PROJECT ORGANISATION AND FOLLOW-UP

D.1 Division of roles in project implementation NPHF is responsible for the day to day activities in Nepal, activities that from the start will be discussed, planned and executed with the local partners and beneficiaries. NPHF is responsible for employing core project personnel and consultants ensuring that the project is run on a day-to-day basis, implemented and evaluated. The core project personnel employed by NPHF are the following: a local project part time leader (from NPHF), a field coordinator specialized in OHS (Occupational Health and Safety) and responsible for health activities, a responsible for agricultural activities (specialized in agronomy and IPM), and a media-PR responsible/secretary in one person. To support the core project personnel, consultants from the following collaborating partners will be involved in special tasks:

• NRCS Chitwan is involved in teaching farmers, health personnel, and religious leaders in diagnosis and prevention of pesticide poisonings, negative health and environmental consequences.

• NRHC, Kathmandu Medical College, Dept of Community Medicine, MoHP, MoLTM are involved in documentation of negative health and environmental effects of pesticide use.

• MoAC is involved in teaching of IPM methods, practical training and elaboration of teaching materials for farmers, pesticide dealers and religious leaders.

• MoAC and MoLTM are involved in documentation studies on the effect of IPM methods. Monthly planning and evaluation meetings will be celebrated among NPHF, the personnel and project consultants. A project steering committee will be formed representing NPHF, Farmers Cooperatives, NRCS, NRHC, MoAC, MoLTM and Dialogos when present in the country. The Committee will meet every trimester to evaluate project performance and plans for the coming trimester, evaluations and revision of accounts. Trimester reports, trimester accountability reports and annual reports are forwarded to the steering committee by the project personnel before the meetings; these reports


will be corrected on the meetings and then forwarded to other partners in Nepal and Dialogos. A yearly auditing of local expenditures will be made by a local auditing firm and send to Dialogos in Denmark. Dialogos has the project administration expertise and will handle the overall economic administration of the project being the responsible referent to CISU. Dialogos’ board is the maximum authority in the execution of the project, and has to take the final decision according to Working Agreement signed between Dialogos, ICOEPH and NPHF if doubts about project issues arises in course of the project that can not be solved within the project steering comittee in Nepal or project steering group in Denmark. In Denmark a project steering group is formed consisting of members from Dialogos and ICOEPH with project management capacity, experience from Nepal, and from similar projects in Bolivia and Uganda. The steering group will meet 5-6 times a year and visit the project 2-3 times a year to evaluate project performance on spot, and bring technical input on administration, accountability, occupational health and safety (OHS) in agriculture with a focus on pesticides and input on Integrated Pest Management (IPM) strategies. Moreover the group will assist and evaluate in the production of teaching materials, and studies to document the present situation and the impact of the project activities. Dialogos and ICOEPH has the relevant technical knowledge on the subject of pesticides from both the health and agricultural side, which has been of great value in the projects in Bolivia and Uganda, where the quality of the materials elaborated and of the results has assured that these materials and methods have been adopted by other civil society organisations and governmental institutions. The distribution of roles among the Danish and local partners has been tried out with good results hitherto. The role of Dialogos has been to secure the administrative skills among our local partners to make them able to plan, execute, evaluate and report of activities and handle funds in a reliable and standardized manner complying with donor requirements. It has been necessary to strengthen the administrative capacity of our local partners to meet these requirements and this has been done by establishing reporting accountability formats, by supervision of these on visits to the project sites, by celebrating courses on administration and accountability in a local or international settings and reading and commenting on quarterly financial and activity reports from our local partners. After the first phase of the project these administrative and accountability procedures are most often established and the need of assistance for administration is less frequent. Regarding the technical skills like elaborating and executing strategies for democratic development of organizations, advocacy towards decision takers, design of adequate pedagogic teaching materials, technical input to OHS and IPM, etc. Dialogos and ICOEPH have significant experience to share with partners. This sharing of experiences is done in a dialogue where partners are able to contribute significantly with their local and professional knowledge. It is our experience that the Danish input has its strengths in democratic procedures, open and permissible administrative and accountability procedures, pedagogic in knowledge sharing, strategies in planning, stringency in documentation of project impacts, OHS and farming were the Scandinavian countries have unique experiences to offer to most other places in the world. It is obvious that with the years of collaborating the knowledge and technical skills shared will raise the ability of both partners to perform projects strengthening the civil society and promote technical solutions to solve OHS problems in farming, thereby improving the lives of the target groups. How are implementation responsibilities to be distributed within the Danish organization? Also detail who is expected to be directly involved in implementation of the project. The Danish steering group will consist of volunteers from Dialogos, ICOEPH and the universities. As can be seen from CV’s that can be requested from Dialogos, the Danish partners will use experts with relevant knowledge and experience to guide the project whether it is on awareness raising and advocacy matters, OHS, farming and pesticides, research, education, information or administration. Dialogos secretary will help manage the funds, and a Danish auditor will do audits every year of the overall expenditures. ICOEPH and Danish universities will engage in documentation involving students and researchers in collaboration with Nepali colleagues.


In Dialogos/ICOEPH the following members are appointed to the steering group: Anshu Varma, Master of Public Health, researcher at the Bispebjerg Clinic of Occupational Medicine, speaks hindi. Dinesh Neupane, Master of Public Health, currently employed by Århus University, Nepali citizen, has working experience from Nepal University and Health authorities Erik Jørs, chief physician, Odense Clinic of Occupational Medicine, 27 years of experience working with health in developing countries Mette Jørgensen, agronomist, 30 years of working experience with spraying techniques to improve effects and minimize the use of pesticides. Currently working as an environmental advisor on a Danish development project. Jens Streibig, professor in agronomy, employed on KU-Life, specialist in weeds and as such several times employed as an external consultant by Danida on farming matters in African countries. Dan Larsen, journalist and web-designer, 20 years of experience from developing countries among these from Nepal. Janus Weidling, school teacher and filmmaker. 10 years of experience from Dialogos’ previous project in Nepal, and before that working experience from Africa. D.2 Monitoring and evaluation in project implementation Section D.1 describes how the project will be locally managed. The project personnel in Nepal will monitor the progress of the project on a monthly basis through staff meetings within NPHF. The project steering committee will meet quarterly and revise project plans, quarterly reports and accountability and provide technical input where needed. Relevant administration procedures are adapted to fit this project according to donors guidelines and local requirements. Also, a process evaluation document for each activity under each objective will be developed. In Denmark a project group is formed that will meet quarterly to revise project plans, quarterly reports and accountability and provide technical input and supervision to the project where needed. A person from this group will have the direct day-to-day communication with the project personnel. Ad hoc meetings will be held when found necessary. From this technical project group expertise will be provided from Denmark or during visits in Nepal when needed The regular meetings held by the project personnel and steering committees in Nepal and Denmark will ensure that relevant actions are taken if the conditions that the project is conducted under fail in one way or the other. In the beginning of the project period a baseline survey including health and agricultural matters of relevance to the project will be elaborated. When reviewing and evaluating the project this baseline survey will be repeated to document expected positive changes in knowledge and behavior as seen from indicators. Furthermore, in general information on the indicators will be gathered by means of questionnaires and interviews to be analyzed with sound quantitative and qualitative analytical methods. After one and a half year and internal evaluation will take place to decide whether to stop the project after the first phase or to prepare for a second phase. An external evaluation at the end of the project phase 1 is planned. E. INFORMATION WORK

E.1 Has project-related information work in Denmark been planned? Dialogos/ICOEPH plan to inform the Danish public about the intricacies of “Farming, Health and Environment - Nepal 2013-15”. News and background on the effort to improve food production from a health and environment perspective without excessive use of pesticides in farming will be published in general news outlets as well as the proprietary media of Dialogos (web page and newsletter). Also, the Danish language specialized web media www.organictoday.dk will receive content based on the project experience. The agricultural industry’s magazine and web will be contacted with offers of editorial content. A professional Danish journalist with 30+ years of experience in international affairs (a board member of Dialogos) will do the information work. The reporter has previously covered our


corresponding project in Bolivia for print, web, radio and video. He is familiar with the subject and has previously visited Nepal as a reporter for the national Danish media. This project has a very fine group of partners who may shed authoritative light on the real situation in Nepali farming and protection of health and environment. The aim is not exclusively to report on the project details but also put the entire work in a national Nepali context.

F. PHASED PROJECTS

F.1 The combined intervention divided into phases The complete intervention is expected to run over ten years divided into three phases of which the first and third phase would take three years each and the second phase four years. The annual budget will be approximately one million DKK distributed towards Nepali project costs and costs by the Danish partners in their administration, reporting and technical assistance given to the project in Nepal. Provided a successful first phase where the following interventions have been implemented the feasibility of a second phase will be internally evaluated: good and systematic working relations are created between stakeholders at a local and national level, a systematic overview is provided of the prevalence of pesticide poisonings with effective registers, farmers, pesticide dealers and health personnel have experienced successful training and are passing on their acquired knowledge, and at last the general population have become aware of pesticides, health and environment issues. Hence, a foundation for effective advocacy is created. In phase two the activities will be spread to cover a larger geographical area and experiences and working materials are refined and printed for distribution. Other pesticide using groups can be included in this phase such as vector spray men fighting malaria, dengue and vegetable farmers in green houses in higher altitudes. To improve sustainability advocacy for revision of curriculums in agricultural and health educations take place with relevant collaborators and ministries. Control with imports of pesticides, banning of the most toxic pesticides and revision of the handling of obsolete pesticides and containers will also be advocated for. A broader diffusion of experiences to neighboring countries in Asia will take place with the help from WHO, FAO and ICOH. In phase three a phase out will take place emphasizing on continuing the best experiences from the second phase possibly reviewing advocacy strategies and adding new future objectives. The results are consolidated and further disseminated in and outside Nepal, and finally the project is phased out in sustainable manner. What is the relative weight of strategic deliveries, capacity building and advocacy in the various phases, and why? Seeing that the project is mainly a capacity building and advocacy project no substantial strategic deliveries are expected except from donations of PPE to the farmers during training. In order to develop sound advocacy strategies with potential to alter the behavior of farmers, health personnel, pesticide dealers, politicians and the general population capacity building is a crucial step. Without capacity building advocacy strategies will not be structured, well organized and substantiated reducing their effectiveness in obtaining their goal. Hence, the first phase is mainly a capacity building project laying a strong foundation for advocacy strategies, a strategy proven its value in Bolivia, where a second phase managed to change curriculums and incorporate IPM strategies and training in Bolivia’s official policy. Mainly focused upon in the second phase is delivering the advocacy strategies because in this part of the intervention process solid relations have hopefully been created, trainings showed effectiveness and research documenting the seriousness of the farming, health and environmental issues, all important for ensuring effective advocacy strategies. In the third phase, continuous implementation of advocacy strategies is emphasized because they will be the key in maintaining future sustainability. How and when is advocacy developed and implemented in the project? Activities in the first phase will create a foundation for advocacy strategies by strengthening the voice of civil society organizations and the general population to put pressure on governmental institutions to take action in promoting a sustainable food production from a health and environment perspective. In the second phase, advocacy strategies will have a broader outreach in that the activities promoting advocacy in the first phase will be spread to a larger geographical area. Also,


supplementary channels of advocacy will be applied by involving revision of curriculums in agricultural and health educations, focusing on control of imports and banning of toxic pesticides with revision of the handling of obsolete pesticides and containers. At last reviewing the developed and implemented advocacy strategies in the two previous phases and adding new objectives will promote a foundation for future advocacy strategies taking an outset in the third phase. Are there any special factors in the context that may influence the combined intervention process? The success of the second and third phases is determined on the effectiveness of the first phase. Hence, process evaluations during each phase and final internal review by the end of each phase are highly necessary to plan and target realistic goals for the following phases.

3. Budget summary Budget summary Currency Indicate the total cost (i.e. including contributions from the Project Fund as well as other sources)

2.991.876 DKK

Of this, the Project Fund is to contribute

2.446.876 DKK

Of this, indicate the amount to be contributed by other sources of finance, including self-funding by the Danish organization or its local partner, if any

545.000

Indicate total cost in local currency (=subtotal of CISU contribution to be spent on activities in Nepal)

29.832.180 NRP

Indicate exchange rate applied

1 DKK 15.33 NRP

If relevant: Indicate the extent of project-specific consultancy assistance (spreadsheet 3 of the budget format), see also ‘Guide to budget preparation’

DKK

Main budget items: Financing plan Full amount Of this, from

Project Fund Of this, from

other sources 1. Activities 1.357.900 935.400 422.500 2. Investments 249.000 249.000 3. Expatriate staff - - 4. Local staff 587.000 587.000 5. Local administration 174.600 174.600 6. Project monitoring 231.300 118.800 112.500 7. Evaluation, included in project monitoring 8. Information in Denmark (max 2% of 1-7) 37.000 27.000 10.000 9. Budget margin (min 6% and max 10% of

1-8) 150.000 150.000

10. Project expenses in total (1-9) 2.786.800 2.241.800 545.000 11. Auditing in Denmark 45.000 45.000 12. Subtotal (10 + 11) 2.831.800 2.286.800 545.000 13. Administration in Denmark (max 7% of

12) 160.076 160.076

14. Total 2.991.876 2.446.876 545.000


4. ANNEXES OBLIGATORY ANNEXES The following annexes must be submitted both in print by post and electronically by email:

A. Basic information about the Danish applicant organization B. Fact sheet about the local organization C. Budget format

Annex B is filled in and signed by the local partner. It can also be submitted in a copied/scanned version. The following annexes about the Danish organization must be submitted in print by post:

D. The organization’s statutes E. The latest annual report F. The latest audited annual accounts

SUPPLEMENTARY ANNEXES (max 30 pages):

Annex no. Annex title G Report from appraisal mission H Working agreement Dialogos NPHF

I Pesticide exposure and its health effects among Farmers in Chitwan district of Nepal J Report workshop Chitwan K Jobdescriptions TA

Annexes that can be forwarded on request Report workshop Kathmandu Working agreement Dialogos-ICOEPH CV’s Danish volunteers and core personnel NPHF NPHFs statutes NPHF annual report Notice: All annexes should be submitted in print in three copies (no magazines, books, newspaper cuttings or ring binders, but copies of relevant excerpts thereof).

Abbreviation List

ARI Acute Respiratory Infection BCG Bacillus Calmette–Guérin CISU Civil Society in Development DASAM Danish Society for Occupational and Environmental Medicine DPT Diphtheria, Pertussis, and Tetanus FFS Farmer Field School GDP Gross Domestic Product GNI Gross National Income GoN Government of Nepal IAAS Institute of Farming and Animal Science ICOEPH Center for Occupational, Environmental & Public Health ICOH International Commission on Occupational Health IEC Information, Education and Communication IPM Integrated Pest Management MoAC Ministry of Farming and Cooperatives MoF Ministry of Finance


MoFSC Ministry of Forests & Soil Conservation MoHP Ministry of Health & Population MoICS Ministry of Industries, Commerce & Supplies MoLTM Ministry of Labor, Transport & Management NARC Nepal Farming Research Council NHRC Nepal Health Research Council NPHF Nepal Public Health Foundation NRCS Nepal Red Cross Society NR Nepali Rupee OHS Occupational Health and Safety PAN Pesticide Association of Nepal PPE Personal Protective Equipment WHO World Health Organization

The application form and all annexes must be submitted in three printed copies to: CISU – Civil Society in Development, Klosterport 4A, 3.sal, DK-8000 Aarhus C, Denmark In addition, the application form and Annexes A-C must be sent electronically to: [email protected]. Annexes D-F may also be submitted in an electronic format, although this is not required.

Documents

Ref. no. (to be filled out by the Project Advice and … › PubliceredeDokumenter › {AED2A9EF...THE PROJECT FUND – Large-scale development projects (DKK 1 to 5 million) 0 1. Cover