IPP381
GPAI Avian and Human Influenza Control and Preparedness Emergency Project
Indigenous Peoples Planning Framework
Phnom Penh, May 27, 2008
Introduction
1.
Cambodia was among the first countries in Southeast Asia to experience Avian and Human
Influenza (AHI) with the first case reported in Jan 2004 (for animals) and in 1005 (for humans).
The series of repeated outbreaks and associated loss of human life highlight the country’s need to
improve the disease surveillance system and limited capacity to control the disease.
2.
Consistent with the Global Program for Avian Influenza and Human Pandemic Preparedness
and Response (GPAI), this Cambodia Avian and Human Influenza Control and Preparedness
Emergency Project supports the implementation of a comprehensive national plan to minimize the
threat posed to humans and the poultry sector by AHI infection. There are three main aspects to this
project: (i) an Animal Health Component; (ii) a Health Systems preparedness to tackle possible
human infections; and (iii) an Inter- ministerial Cooperation for Pandemic Preparedness and Project
Coordination.
3.
Since the project will take place in areas with substantial ethnic diversity, and because ethnic
minorities are often among the poorer and more vulnerable sections of the population, this
Indigenous people Framework outlines principles to apply in project areas where indigenous
peoples are located. This Framework – which will be used to develop site specific plans1 –
emphasizes the importance of developing a communications strategy which (i) purposefully reaches
out to indigenous people groups in their local languages; (ii) tailors AHI messages according to
cultural contexts respecting the likelihood that minority communities may not share the worldviews
of the majority population. In the case of this project, they may have very different perceptions of
animal/human disease. In line with the Ministry of Health’s Action Plan for Avian Influenza
(2005), this Indigenous Peoples Framework includes guidelines for raising awareness and involving
minority communities in AHI surveillance.
Ethnic Minorities in Cambodia
4.
The population of Cambodia is 13.7 million of which 90-95% are Khmer. The remaining 510 percent is composed of ethnic minorities such as the Muslim Cham, Chinese and Vietnamese,
and seventeen indigenous ethnic minority groups also called “Khmer Loeu” or “hill tribes” who are
ethnically non-khmer. These groups are estimated to comprise around 120,000 persons and
constitute about 1 percent of the Cambodian population. There are seventeen indigenous minority
groups which range from 300 to 19,000 members and include Tampuan, Kui, Jarai, Phnong,
Kreung, Kavaet, Brou, Stieng, Lun and others.2 Under this Bank supported AHI project, only the
indigenous peoples belonging to the “Khmer Loeu” or “hill tribes” will be covered under the
Bank’s Policy.
5.
These groups are distributed throughout the country, but concentrated in the northeast. The
hill tribes are considered the most disadvantaged Cambodian population in that they live in isolated
areas and have poor access to services including communication. Rapid social change, especially
for the hill tribe communities is resulting in the loss of traditional livelihoods systems (swiddening,
1
According to the World Bank Policy on Indigenous Peoples (OP 4.10), an Indigenous people Framework is prepared
when all programs or subprojects are yet to be fully identified. When all programs, subprojects are known and the
presence of ethnic minorities in project locations is determined, then Indigenous Peoples Plans (IPPs) have to be
prepared in advance of individual program or subproject implementation and in accordance to the Bank’s Policy.
2
Pathways to Justice: Access to Justice with a Focus on Poor, Women and Indigenous People. Ministry of Justice,
UNDP, September 2005.
2
forest harvesting) with changes in land rights shifting towards the production of commercial crops
including for rubber, coffee and cashew nuts. Education levels are low among the hill tribes and
access to health services extremely poor.
Legal framework and policies
6.
The Cambodian Constitution respects the rights of ethnic minorities, Article 31.2 states
“Khmer citizens shall be equal before the law and shall enjoy the same rights, freedom and duties,
regardless of their race, color, sex, language, beliefs, religions, political tendencies, birth of origin,
social status, resources, and any position.”
7.
The definition of Khmer citizens is however controversial. The National Assembly's
interpretation in 1995 restricted the term [Khmer] to include some of the country's ethnic minorities,
including the hill tribes and Cham, but excluded others such as the Chinese. The country's signature
to several human rights conventions however means Cambodia is legally obliged to protect and
respect the rights (as covered by the various conventions) of all peoples.
General health status and access to public health services
8.
There is little comprehensive information on the health status of ethnic minorities, their
health seeking behavior and use of health services. Government health information is not
disaggregated by ethnicity. Health information available on ethnic minorities is mainly drawn from
NGOs that have been working with specific ethnic groups. Since ethnic minorities typically live in
remote areas making access to services (including information and health care) expensive and
physically difficult, they may face special risks vis a vis AHI. These risks are compounded by:

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Fewer availability of health facilities near indigenous populations
Scarcity of village animal health worker and village health worker
Lack of trained health workers from local indigenous groups,
Low levels of understanding that indigenous people may not share the worldviews of the
majority groups, including on perceptions regarding human/animal disease
Program to Assist Indigenous Peoples
9.
To enable indigenous communities to better address both the animal and human health risks
of AHI, an indigenous people focused communications strategy will be developed which
emphasizes:



Learning about AHI via face to face meetings
Having exposure to culturally appropriate forms of media that is gender sensitive, intergeneration ally inclusive; sensitive to varying levels of education (thus creative use of
marching, radio, songs, posters, discussions,)
Hearing from respected indigenous people leaders to reinforce the credibility of AHI
messages
10. Considerable work has been done in Cambodia to develop AHI communications materials.
FAO and AED developed AHI materials to increase public awareness on the animal side whereas
UNICEF has developed the human IEC materials. For example, a Bird Flu IEC Committee was
3
established in 20053 to harmonize AHI communications materials. In addition, an AHI IEC
strategy and program is being drafted by UNICEF with input from IEC committee members.
11. Little attention, however, has been given to the production of indigenous specific AHI
communications materials. The Indigenous People’s Plans that will be developed using this
Framework as a basis will leverage existing AHI IEC materials and re-craft them to ensure their
suitability/appropriateness for the indigenous hill tribes. If possible, the Bank-supported AHI
project’s indigenous peoples plan will be folded as part of the IEC strategy based on discussions
with the Government and other stakeholders under the coordination of NCDM.
12.The cornerstone of any plan to reach indigenous peoples is to invite their participation and
consultation as well to incorporate their views into the design of AHI outreach materials (for
example: brochures, booklets, radio messages, plays, songs, posters) and to seek their advice
regarding the design of an effective communication strategy (unit of engagement, institutional
arrangements, time frame). Using health workers (for both the animal and human side) or
facilitators from indigenous communities or NGOs accustomed to working in indigenous is a
further step to ensure effectiveness. Elements of this framework which will guide the design of
plans once project locations are identified are presented in an attached Annex I.
Institutional Arrangements
Level
Entity
Responsibility
Central/National
 Ministry of Agriculture, Forestry and  Overall implementation
Fisheries (MAFF)
responsibility for IP
 Ministry of Health (MoH)
framework
 National Committee for Disaster  NCDM will coordinate
Management (NCDM)
as necessary
Provincial level
 Provincial
Animal
Health
and  Implement Annex I
Production Office
 Provincial Health Department
District level
 District of Animal Health and
 Implement Annex I
Production Office
 Operational Health District
Village level
 Village Animal Health Worker
 Implement Annex I
 Village Health Worker
13. This project will work with existing relevant AHI structures. For example, a Bird Flu IEC
Committee was established in 20054 to harmonize AHI communications materials. This committee
- which meets on an ad-hoc basis - briefs the AHI Partnership Meeting. Since it is a requirement
that all AHI materials are passed through this committee, using this committee to assess the
availability of IEC materials and to harmonize efforts in this area is crucial.
14. The services of special agencies (Ministry of Culture, ethnology institutes or other) that are able
3
This IEC Committee is comprised of the following Ministries: Health, Agriculture, and Information. It also includes
UNICEF, FAO, WHO and the UN Resident Coordination Body.
4
This IEC Committee is comprised of the following Ministries: Health, Agriculture, and Information. It also includes
UNICEF, FAO, WHO and the UN Resident Coordination Body.
4
to provide key input and advice regarding the design of communications tools (oral, visual, written
using an array of media forms) in minority languages will be developed.
Disclosure of documents
15. This IPPF (Indigenous Peoples Framework) will be made available to the indigenous people
communities in the appropriate, form, manner and language.
Monitoring and Evaluation
16. The National Committee for Disaster Management (NCDM) will coordinate with MOH and
MAFF to establish and maintain an M&E system for the Indigenous People’s Plan. The Dept of
Animal Health and Production (DAHP) and CDC from MOH will establish M&E indigenous
indicators to assess progress of outreach to indigenous people areas.
Budget
17. All activities (ultimately through Indigenous Peoples Plans – or IPPs) will be financed
from the training/workshop expenditure categories of under Components A & B (Animal
and Human Health). The disbursement arrangements for these funds are through the
Ministry of Economy and Finance to be channeled to designated accounts under the
Implementation Agencies (IAs). Details of budgets needed; allocation measures and
entity responsible for implementation of the principles of this IPPF will be detailed in
IPPs that will be developed once specific indigenous people project locations are known.
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ANNEX I: Indigenous People’s Framework
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Language is a barrier that excludes ethnic minorities from participating in development processes and the lack of information and
educational materials in the languages of ethnic minorities would be a major impediment towards effective outreach on AHI
prevention communication. Thus carrying out all training, awareness raising and development of media products must be in the
local language and in a form and manner that is accessible to the local communities
This framework will build on the AHI-IEC developed by the Government in partnership with international donors (UNICEF,
FAO, WHO etc). The framework will work with the Bird Flu IEC Committee developed (2005) to harmonize AHI IEC efforts
This framework will also build on, support, or complement the on-going IEC strategy being drafted by UNICEF with input from
IEC Committee members. This new AHI project will seek to influence this strategy by ensuring there are indigenous specific
strategies included in it.
Indigenous Peoples Plan for the Avian and Human Influenza Project
IDENTIFY THE TARGET AUDIENCE TO IMPLEMENT THE INDIGENOUS PEOPLE’S FRAMEWORK
Target
PRIMARY AUDIENCE
Implementer at PRIMARY LEVEL
Audience
 Indigenous people leaders (formal and informal): screen for their presence in all project

Village Health Volunteer (VHVs) for
locations
human disease
 School teachers

Village Animal Health Worker
 Poultry traders
(VAHW) for animal disease
SECONDARY TARGETS
 Health based NGOs
 Government health units
 News media sources
 Veterinarians
 Agency and individuals concerned with indigenous people affairs
 Teachers
 Poultry traders
DEVELOP A TRAINING PROGRAM INDIGENOUS PEOPLES AND AHI
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PHD: Provincial Health Department, OD: Operational District
Implementer at SECONDARY LEVEL

PHD and OD5 CDC Offices – for
human health

District Animal Health and Production
Office (DAHPO) for animal health
PHD and OD
training

Training to District Veterinary/Health Staff on communicating with, learning from, and
how best to effectively reach out to indigenous communities
Village level
training

Train village-based VAHWs and VHVs on AHI and on cultural practices of indigenous
communities
Try to include indigenous peoples as the local animal and human health workers when
possible
Train important people from indigenous peoples’ communities who can best help with
outreach of AHI materials. These include:
- Children of IPs who can speak Khmer and also indigenous language
- IP formal and informal leaders
- Village Chief (appointed by Ministry of Interior)
- Informal/traditional IP leaders
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
DEVELOP A VILLAGE CAMPAIGN OF SPECIFIC ACTIVITIES
Start the AHI
 “Marching” through villages with loudspeakers in indigenous languages
Campaign
 Teach children in school about animal and human dimensions of AHI
 Include “Open Forums, Open Q&A on AHI” in indigenous languages
 Develop community forums on AHI
 Community contest on AHI
Responsible entity
 Animal side: NaVRI
 Human side: PHD and OD, monitored
by CDC
Note: organizations such as the Institutes of
Ethnology, Ministry of Culture and academics
working on IP issues should help in developing
this training module
Cascade training on Communicable Disease
Control (CDC) on human side
District Animal Health and Production
Office – animal side
Responsible entity
 Animal side: NaVRI
 Human side: PHD and OD, monitored
by CDC
Note: organizations such as the Institutes of
Ethnology, Ministry of Culture and academics
working on IP issues should help in developing
this training module
MONITOR AND EVALUATE EFFECTIVENESS OF REACHING INDIGENOUS COMMUNITIES ON AHI-IEC
Monitor and
 Develop indicators of outreach
Responsible entities are Project Directors of:
Evaluate
 Develop M&E Framework
 Ministry of Agriculture, Forestry and
Activities
Fisheries (MAFF)
 Ministry of Health (MoH)
 National Committee for Disaster
Management (NCDM)
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