Program Shift in CARE Peru: why, how, and implications for CARE UK November, 2009

I.One key idea II.How we have developed programs III.Lessons IV.Implications for CARE UK

I. Key to the Program Shift… A project is a MEANS to BIGGER IMPACT, NOT an END in itself

Take a pearl…FEMME Met need for emergency obstetric care (use of EmOC services), Obstetric case fatality rate (quality of EmOC services),

But reached only 2% of women of reproductive age in Peru So need a new role to leverage greater impact

Means, not End… …means that at end of project, build on it… Generate evidence of impact Instrumentalization and costing Advocacy and coalition building Convert into public investment projects, with budget Technical assistance Visibility (national and international) Replication Complementary & additional components..through… Retaining key staff Flexible funding Resource mobilisation for new projects

II. How we have done it 8 steps: 1. 1.Underlying causes of poverty 2. 2.Priority impact population 3. 3.Determine organizing logic (sector, geographic, UCP or impact population) 4. 4.Theory of change and hypotheses 5. 5.Strategy 6. 6.M&E system 7. 7.Annual operating plans 8. 8.Accountability and learning

Based on 3 strategic roles Generation, validation and dissemination of new models and strategies Support Government and others to adapt, replicate and scale up evidence based strategies Advocacy for public policy change or implementation

1. Underlying Causes of Poverty

Five underlying causes of poverty in Peru Inadequate or poorly implemented public policy Weak exercise of citizenship Exclusionary and unsustainable development model Lack of a shared national vision for development and poverty reduction High levels of discrimination, by gender, race and social class

UCPs and Unifying Framework

2. Priority impact population

1. A clearly defined goal for impact on the lives of a specific group, realized at broad scale The program must define what broad scale means, but, in general, we mean at least at national scale or for a whole marginalized population group. Impact should occur across three areas of unifying framework (human conditions, social position, enabling environment). Impact should be seen and evaluated over an extended period of time. Defining Characteristics of a CARE program….

CARE Peru considers poverty a multidimensional concept, within a human rights framework, and not just as economic poverty, and so we take a broad range of international and national commitments as a basis for setting the goals and targets to whose fulfillment our programs seek to contribute. These goals include: The Millennium Development Goals The Fourth World Conference on Women (Beijing) The Intergovernmental Panel on Climate Change The Hyogo Framework for Action The National Agreement (Acuerdo Nacional) The Multianual Macroeconomic Framework (MMM) The Multianual Social Framework (MSM) The National Plan for Equality of Opportunities between Men and Women The Multisectoral Strategic Plan in response to Tuberculosis, and the Multisectoral Strategic Plan for the Prevention and Control of Sexually Transmitted Diseases and HIV/AIDS The National Plan for Disaster Prevention and Response The UN Declaration on the Rights of Indigenous Peoples Paris Declaration on Aid Effectiveness

Criteria for defining priority impact group, within framework of anti discrimination, rights and equity... Which sector of the population is furthest from seeing its rights fulfilled in the impact area relevant for each program? Population group (rural, urban, indigenous) Geographical location (Coast, Highlands, Jungle, or departments) Sex (men, women) Economic groups (extreme poor, poor, non poor) Age (children, women of reproductive age, older people) Occupational groups (mining communities, workers in agro-exporting) Most vulnerable groups (MSM, SW, Trans, prison population)

Poverty in Peru is concentrated in Rural Highlands (Sierra Rural), and the Amazonian Indigenous population (Nativo)

Priority Impact Group for CARE Peru Programs: Families living below or near the poverty and extreme poverty lines In the Andean Highlands and in Amazonian Indigenous Communities Women (including youth) Men (including youth) Girls and female adolescentsBoys and male adolescents Sustainable Economic Development Sustainable Economic Development Nutrition Education Gender Health HIV & TB Climate Change Integrated Water Resource Management Governance & Extractive Industries Emergencies & Disaster Risk Reduction

CARE PERU PROGRAM PARTICIPANTS Priority Impact Group The population group in whose lives CARE Peru's programs seek to generate significant and sustainable impacts, in terms of poverty and social injustice, at broad scale Stakeholder Group Key actors who facilitate our interventions and advocacy, and who can affect (positively or negatively) or be affected by the program, but are not our impact group Secondary Objective Group The group with whom we work as a means to generate the impact in the priority impact group. Although we may generate positive impacts in the lives of this group, this is a means rather than an end in itself Direct Impact Subgroup The subset of the priority impact group with whom we work directly in our projects National Poverty Line National Extreme Poverty Line Population with whom a project will work directly to generate positive impacts – including the direct impact subgroup and members of the secondary target group Program Impact Goals The international and national goals and targets to which the program contributes, in the framework of the MDGs, international Conventions, and national strategies or frameworks (such as the Multianual Macroeconomic Framework or the Multianual Social Framework)

SUSTAINABLE ECONOMIC DEVELOPMENT PROGRAM PARTICIPANTS Priority Impact Group Women and men below or near the poverty and extreme poverty lines, in the Andean Highlands and Amazonian Indigenous Communities Stakeholder Group Key actors that facilitate our interventions and advocacy work: Local government, Ministry of Agriculture, research bodies, private sector, technical assistance providers, NGOs, etc. Secondary Objective Group Non-poor entrepreneurial small farmers in the communities where we work, for whom our projects generate positive impacts as a means (force of example, leaders of change, etc.) to generate impacts for the priority impact groups Direct Impact Subgroup Poor women and men with whom we work directly in our projects, in Ancash, Ayacucho, Cajamarca, Huancavelica & Puno National Poverty Line National Extreme Poverty Line Population with whom a specific project works directly: for example, Alli Allpa in Ancash – includes those below the poverty line (88%) as well as non- poor (12%) Program Impact Goals MDG1: 50% reduction in poverty and extreme poverty, reduction in poverty gap, and increase in share of national income of poorest 20%. MMM: poverty from 48.7% to 30%, and rural poverty from 70.9% to 45% ( ). MSM: Improve income distribution to halve the gap between the richest 20% and the poorest 50%.

Program Priority Impact Group Direct Impact Subgroup Secondary Objective Group Stakeholder Group Sustainable Economic Development Women and men below or near the poverty and extreme poverty lines, in the Andean Highlands and Amazonian Indigenous Communities Poor women and men with whom we work directly in our projects Entrepreneurial non--poor Institutions, private sector, etc. Nutrition Poor women, girls and boys in Highlands and Amazonian indigenous communities Poor women, girls and boys in communities where we work… Community authorities, men, health volunteers, health staff, local governments, etc. Ministries, Mayors, national government, JUNTOS, etc. Education Indigenous boys and girls, and women, from rural highlands and jungle Boys and girls in schools/women in communities where… Teachers, parents, community leaders, local education specialists, etc. Ministry of Education, Ministry of Economics & Finance, local government Gender Women and girls from rural highlands and jungle Women and girls in communities where… Men and boys from communities where we work, community leaders, etc. National government, local government, women´s movement, etc. Health Reproductive age women and newborns in rural highlands and jungle Direct participants in our projects Health staff, community authorities, health volunteers, men & mothers in law in project communities, etc. National and local government, women´s movement, Finance ministry, etc. HIV & TB MSM, SW, Trans, prison population, reproductive age women and their newborn children, adolescents, rural poor Vulnerable groups with which projects work directly Health staff, school children, networks of PLWHA National and local government, NGOs, etc. IWRM Families in or near poverty lines in rural highlands/ jungle Families in communities where we work directly Local government staff, health promoters, community leaders… National and local government, etc. OthersTo be completed…

3. Determine organizing logic

How to organize and focus programs Sector Peru/Ecuador: Health, education etc. Geographical ??? UCP Peru/LAC: Gender equity. Impact population Bangladesh: Women´s Empowerment/Extreme Rural Poor, Sri Lanka: Plantation workers

4. Theory of Change

1st step Identify desired impact and change 3rd step What does Government, private sector, civil society etc. need to do to achieve the desired change? 4th step What will be CARE´s strategies to contribute most significantly to these actors achieving the desired change? Based on what hypotheses have we chosen these rather than other strategies? 5th step Building the Theory of Change 2nd step Identifying contributory factors Identify the core problem Underlying Causes of Poverty for CARE Peru 1. High levels of discrimination, by gender, race and social class 2. Inadequate or poorly implemented public policy 3. Weak exercise of citizenship 4. Exclusionary and unsustainable development model 5. Lack of a shared national vision for development and poverty reduction

5. Program strategy document

2. Taller(es) con el equipo programático para análisis conjunto y definición de productos de la estrategia: Presentación de la lógica de programas y el transito de proyectos a programas (reflexiones y retos)Presentación de la lógica de programas y el transito de proyectos a programas (reflexiones y retos) Presentación de problemática y brechas, Definición de población de impacto prioritario Presentación de problemática y brechas, Definición de población de impacto prioritario Construcción del FODA,Construcción del FODA, Ajuste y definición de teoría de cambio: identificación del problema central, factores contribuyentes (según causas subyacentes de la pobreza), cambio deseado, actores responsable del cambio, rol de CARE e identificación de objetivos estratégicos para la estrategia programaticaAjuste y definición de teoría de cambio: identificación del problema central, factores contribuyentes (según causas subyacentes de la pobreza), cambio deseado, actores responsable del cambio, rol de CARE e identificación de objetivos estratégicos para la estrategia programatica Reconstrucción de experiencia institucional y lecciones aprendidasReconstrucción de experiencia institucional y lecciones aprendidas Definición de la gestión de la estrategia: mapeo de socios y aliados, movilización de recursos, gestión de talentos y fortalecimiento de capacidades, monitoreo, evaluacion y aprendizajeDefinición de la gestión de la estrategia: mapeo de socios y aliados, movilización de recursos, gestión de talentos y fortalecimiento de capacidades, monitoreo, evaluacion y aprendizaje 2. Taller(es) con el equipo programático para análisis conjunto y definición de productos de la estrategia: Presentación de la lógica de programas y el transito de proyectos a programas (reflexiones y retos)Presentación de la lógica de programas y el transito de proyectos a programas (reflexiones y retos) Presentación de problemática y brechas, Definición de población de impacto prioritario Presentación de problemática y brechas, Definición de población de impacto prioritario Construcción del FODA,Construcción del FODA, Ajuste y definición de teoría de cambio: identificación del problema central, factores contribuyentes (según causas subyacentes de la pobreza), cambio deseado, actores responsable del cambio, rol de CARE e identificación de objetivos estratégicos para la estrategia programaticaAjuste y definición de teoría de cambio: identificación del problema central, factores contribuyentes (según causas subyacentes de la pobreza), cambio deseado, actores responsable del cambio, rol de CARE e identificación de objetivos estratégicos para la estrategia programatica Reconstrucción de experiencia institucional y lecciones aprendidasReconstrucción de experiencia institucional y lecciones aprendidas Definición de la gestión de la estrategia: mapeo de socios y aliados, movilización de recursos, gestión de talentos y fortalecimiento de capacidades, monitoreo, evaluacion y aprendizajeDefinición de la gestión de la estrategia: mapeo de socios y aliados, movilización de recursos, gestión de talentos y fortalecimiento de capacidades, monitoreo, evaluacion y aprendizaje Overview of process for developing program strategy document, with team and key partners 1. Initial preparation of inputs for workshop with Program Coordinator: - Review of context, problem analysis and gaps (figures, data), - Workshop with experts and partners to define problem, key advances already achieved, and recommendations to CARE - Develop draft Theory of Change - Suggest indicators (from national targets, MDGs and others) Time involved: depends on agenda of team and coordinator 2. Workshop(s) with program team for joint analysis and definition of key parts of the strategy: - Presentation of characteristics of programs, logic of program shift (reflections and challenges) - Presentation of problem and challenges - Definition of priority impact population for the program - SWOT analysis - Adjustment and definition of draft Theory of Change: identification of core problem, contributory factors (related to underlying causes of poverty), desired change, actors responsible for change, role of CARE and identification of strategic objectives for the program strategy - Review of institutional experience and lessons learned - Definition of strategy management: mapping of partners and allies, resource mobilization strategy, articulation with other strategies, talent management and capacity building requirements, monitoring, evaluation and learning 3. Meetings with core team and program coordinator: - Adjust inputs for each element - Structure strategy document following outline format - Map and select key indicators (impact, public policy, program strategy) - Write draft document 4. Share draft strategy document with program team for feedback and revision 5. Present program strategy to Program Coordination Team for feedback 6. Incorporate feedback and finalize strategy document

6. Monitoring and evaluation

Design and build monitoring and evaluation strategy Determine Indicators for: Impact for the (priority) populationImpact for the (priority) population Impacts on public policyImpacts on public policy Strategic objectives in programStrategic objectives in program Strategy managementStrategy management Process (Program Principles, etc.)Process (Program Principles, etc.) With review of key hypotheses for selection of program strategies Education Program: Impact on access to and quality of education Impact on public policy 1.1 Tasa de cobertura en secundaria rural por sexo e idioma nativa (Aumentar cobertura secundaria del 77% al 90%, meta para 2011) 1.2 Tasa de inasistencia en primaria y secundaria, por sexo e idioma nativa 1.3 Reducir tasa de extra-edad en primaria, por sexo e idioma nativa (reducir atraso escolar del 60% al 40%, meta para 2011) 1.4 Tasa de extra-edad en secundaria, por sexo e idioma nativa (Reducir extra edad del 83% al 60%, meta para 2011) 1.5 Desempe ñ o suficiente en matem á ticas de los alumnos que concluyen el III ciclo de EBR (Segundo grado de primaria), por sexo e idioma natva 1.6 Desempe ñ o suficiente en comprensi ó n lectora de los alumnos que concluyen el III ciclo de EBR(Segundo grado de primaria), por sexo e idioma nativa 2.1 CNE - % de regiones con implementaci ó n adecuada de su PER 2.2a MEF - asignaci ó n presupuestal al sector educaci ó n (% del PBI) 2.2a MEF - inclusi ó n de productos, resultados, indicadores y metas relativos a la educaci ó n biling ü e e intercultural en el programa estrat é gico logros de aprendizaje al finalizar el 3°ciclo del Presupuesto Por Resultados 2.3 MINEDU - existencia de un sistema para informar de manera peri ó dica sobre el acceso a la EIB y los logros educativos de los y las estudiantes, y de las ni ñ as de á reas rurales. 2.4 Defensor í a del Pueblo - informe defensorial sobre la EIB, con acciones de seguimiento a recomendaciones dadas 2.5 Gobiernos Regionales - aumento en asignaci ó n presupuestal (recursos ordinarios, canon, PP, FONIPREL, etc.) a inversiones para mejorar la calidad y equidad de educaci ó n

Indicators of 6 Program Strategies Indicators of Strategy Management 3.1 N ú mero de propuestas participativas de educaci ó n intercultural biling ü e en zonas andinas y amaz ó nicas validadas 3.2 N ú mero de propuestas educaci ó n intercultural en zonas urbanas y en escuelas p ú blicas y privadas validadas 3.3 N ú mero de propuestas y estrategias validadas que han sido adoptadas y adaptadas a nuevos contextos y a mayor escala por parte del sector educaci ó n, gobierno local y regional 3.4.a N ú mero de espacios fortalecidos de participaci ó n de la sociedad civil, sector p ú blico y privado en la formulaci ó n, implementaci ó n y evaluaci ó n de pol í ticas educativas 3.4.b Ejemplos de logros de la incidencia de estos espacios 3.5 Ejemplos de logros de la incidencia para promover, crear e implementar pol í ticas de inversi ó n p ú blica para mejorar la calidad de la educaci ó n de los sectores m á s vulnerables. 3.6 Ejemplos de logros de la incidencia en el gobierno local, regional y nacional para la formulaci ó n y aplicaci ó n de pol í ticas y estrategias de interculturalidad que combatan la discriminaci ó n ling üí stica, social, racial é tnica, la inequidad de g é nero, adecuadas a las caracter í sticas del contexto. 4.1 Existencia de una estrategia program á tica revisada en los ú ltimos 12 meses, en el marco de la definici ó n de programas y sus caracter í sticas en el taller de Istanbul 4.2 N ú mero de estudios, investigaciones, pilotos, y productos de conocimiento, que han sido desarrollados con la participaci ó n proactiva de los y las integrantes del Equipo Program á tico de Educaci ó n 4.3 N ú mero de estrategias de incidencia pol í tica definidas y en implementaci ó n 4.4 Ejemplos de debates internos en el Equipo Program á tico sobre temas importantes y candentes 4.5 N ú mero de redes y alianzas en las cuales tenemos una participaci ó n efectiva y estrat é gica 4.6 N ú mero de espacios promovidos en los ú ltimos 12 meses para analizar los resultados de Desempe ñ o Organizacional y Aprendizaje para mejorar sistem á ticamente la calidad program á tica durante el ciclo de programas 4.7 % de propuestas y proyectos que incorporen su informaci ó n en el sistema gerencial de proyectos (SGP) 4.8 N ú mero (y $ presupuestal) de propuestas presentadas y aprobadas, frente a metas definidas

Process: incorporation of PPs in proposals

Annual aggregation of quantitative project effects and results

Qualitative impact measurement Health The Healthcare Services Law was introduced in Congress with the backing of more than 100,000 signatures to congress and approved by the Committee for Health, Population, Family and People with Disabilities. Its debate is pending. The bill containing the regulations for Law was put to Congress. The bill contains contributions from the Local Health Management Committee, which were gathered at macro-regional meetings held with the support of the European Commission. The National Health Council incorporated the proposals of ForoSalud in the bill amending Law 27813, which creates the coordination bodies of the National Health System. With the technical assistance of CARE and other institutions, the Ministry of Health (2007) has institutionalized the Clinical Practice Guidelines for Neonatal Care and the Clinical Practice Guidelines for Emergency Obstetric Care according to handling capabilities. 50 health professionals act as regional facilitators. IWRM Promotion of the promulgation of 21 regional bylaws which promote access to water and sanitation services, which contribute in a direct manner to improved health conditions.

Most significant change on UCPs

7. Annual operating plans

Develop Annual Operating Plan for program strategy: priority activities, alignment of ongoing projects, timeframe, resources, who responsible (at national and departmental/local levels)

8. Accountability and learning

Define process and system for Accountability: identify processes for accountability to stakeholders (in projects, offices, program overall, as part of institutional system) Six-monthly and/or annual review of AOP by team to identify advances and gaps. Annual review of context, and hypotheses. Updating opportunities, threats and review of program strategies and theory of change. Accountability and learning

Where are we? 10 programs developed or in process10 programs developed or in process Climate change Sustainable economic development Nutrition Education Emergencies, reconstruction and disaster risk reduction Integrated Water Resource Management Governance and Extractive Industries Gender equity Health (maternal and child) HIV & TB 73 projects between 2007 & projects between 2007 & 2008 Spending: US $ 46.6mSpending: US $ 46.6m

Program Coordination Team Ec. Dev Health Education IWRM GovernanceEmergencies MDG1 & MMM -Poverty -Inequality -Rural Highlands MDG2 & MMM -Chronic malnutrition -Rural Highlands MDG 4 & 5 & MMM -Maternal mortality -Newborn mortaliity -Rural Highlands & Jungle MDG 6 & National Strategy -HIV/AIDS -TB MDG 3 & MMM -Quality and equity in education -Rural highlands MDG 7 & MMM -Access to water -Sanitation -Rural highlands MDG12 & National Agreement - Surveillance -Transparency -Decentral- ization National impact (MDGs & national goals) Gender Equity * Economic model * Extractive industries -Peru -LAC -Signature Program - Peru - LAC -Signature Program -Peru -LAC -Peru -LAC -Peru -CARE Humanitarian Mandate -SPHERE -Accountability INNOVATION * Disaster risk reduction *IWRM MDG6 -Climate Change -Adaptation -Equity -Rural Highlands & Jungle 3 Program Strategies : 1.Generation, validation and dissemination of new models and strategies 2.Support Government and others to adapt, replicate and scale up evidence based strategies 3.Advocacy for public policy change or implementation 5 Underlying Causes of Poverty: High levels of discrimination, by gender, race and social class Inadequate or poorly implemented public policy Weak exercise of citizenship Exclusionary and unsustainable development model Lack of a shared national vision for development and poverty reduction Cross-cutting approaches: RBA & CI Program Principles (Accountability, Advocacy, Gender Equity, Governance, Inclusion, Interculturality)

III. Lessons Time and accompaniment - to help internalize logic, promote reflection, facilitate dialogue and generate resultsTime and accompaniment - to help internalize logic, promote reflection, facilitate dialogue and generate results Learning styles vary – so varied processes and timeframes and advances – enable this, rather than box into one approachLearning styles vary – so varied processes and timeframes and advances – enable this, rather than box into one approach Process needs time to developProcess needs time to develop Process more important than final outcome – though key to end up with that (document)!Process more important than final outcome – though key to end up with that (document)! Difficult to expect someone with full-time project agenda to have the time to lead on the development and implementation of a new program agendaDifficult to expect someone with full-time project agenda to have the time to lead on the development and implementation of a new program agenda Different teams/spaces for analysis and reflection – sectoral, RBA, gender, accountability, expanded SMT, Program Coordination Team, Project cycle course, etc.)Different teams/spaces for analysis and reflection – sectoral, RBA, gender, accountability, expanded SMT, Program Coordination Team, Project cycle course, etc.)

Flexible resources are critical (unrestricted, program investments, CARE UK PPA, studies, knowledge sharing funds) Key role of individuals – in teams and to facilitate Talent management (HR support) RMU support and leadership Build on pearls (CARE´s/partners´) Alliance building/strengthening niche Flexible funding – scale of EDYFICAR resources for CARE Peru allows 10 programs

Very proactive resource mobilization is key… and not just for big projects

IV. Implications for CARE UK Flexible funding key Beware SPC gaps Fund key initiatives in programs Get PPA4 Advocacy in North Engagement in program development and implementation process (governance, EEII, gender?) See the forest, not just your trees

DonorPartner Distant Engaged $ drain$ contributor Bureaucratic Agile Secretive Transparent Engage beyond your projects, and… see these as means, not ends

CARE Perú Av. Gral. Santa Cruz 659 Lima 11 - Perú Central: (511) :(511) Fax:(511)