Lao People’s Democratic Republic
Peace Independence Democracy Unity Prosperity
***************
Ministry of Health
Community Nutrition Project
Ethnic Group Development Plan
Supported by: The World Bank
22 January 2012
Table of Content
1. Overview
1.1 The Community Nutrition Project
1.2 Compliance with World Bank Operational Policy 4.10
2. Background Information
2.1 Ethnic Groups in Lao PDR
2.2 Legal and Institutional Frameworks applicable for Ethnic Groups in Lao PDR
2.3 Baseline information on ethnic groups in project areas
3. The Ethnic Group Development Plan
3.1 Summary of the HSIP Social Impact Assessment
3.2 Summary of free, prior, and informed consultations during project preparation
3.3 Framework for ensuring ethnic groups consultations during project implementation
4. Action Plan of Measures for the EGDP
5. Cost of financing the EGDP
6. Complaint monitoring and conflict resolution mechanisms
7. Monitoring and Evaluation
8. In-country disclosure
References
1. Overview
The Ethnic Group Development Plan (EGDP) provides a strategy and a programmatic approach to ensure and enhance the inclusion of different ethnic groups in the Community Nutrition Project (CNP). The EGDP also ensures compliance with policies of the Lao People’s Democratic Republic concerning ethnic groups, as well as the World Bank’s Operational Policy 4.10 on Indigenous Peoples.
The World Bank Operational Policy 4.10 on Indigenous Peoples aims to ensure that ethnic groups are afforded opportunities to participate in, and benefit from, the project in culturally appropriate ways. As the CNP will be targeting remote and rural areas, where many ethnic groups are concentrated, it has been designed in a manner that is fully consistent with Operational Policy 4.10 and is expected to positively impact ethnic groups. The EGDP will describe in detail the socioeconomic and demographic characteristics of ethnic groups in project areas and the manner in which the project’s core activities will be carried out to ensure ethnic groups benefit from the project.
Lao people’s Democratic Republic (Lao PDR) is one of the poorest and least developed countries in East Asia. With a population of 6,200,894 and a GDP per capita of US$1,208 in 2010, it is classified as a lower middle income country (WDI 2010). Poverty in the country has been reduced significantly, with the poverty headcount declining from 46 percent in 1992/93 to 34 percent in 2002/03 and to 28 percent by 2007/8, and expected to reach the related MDG target of 25 percent by 2015 (Lao DoS 2010).
However, considerable differences in poverty rates persist among different geographic areas and ethnic groups. The three major non Lao-Tai groups, who together constitute about 45 percent of the population (2005 Lao DoS), still record poverty rates above 42 percent, compared to 25 percent among Lao-Tai (considered the majority group). Lao PDR has 49 different ethnic groups, making it one of the most diverse countries.
The country has made good progress on health indicators over the last decade; under-5 mortality and maternal mortality have been reduced from 88 in 2000 to 54 in 2010 and from 790 in 2000 to 580 in 2008 respectively. However, less progress has been seen among ethnic groups. The total fertility rate has also been reduced from 4.3 in 2000 to 2.8 in 2009. Malnutrition however remains a problem and Lao PDR has one of the highest stunting rates in the region with 47.6 percent of children under-5 being stunted and 31.6 percent of children under-5 being underweight (MICS 2006). Furthermore, health indicators show high degree of variations amongst the Lao-speaking population and ethnic groups.
1.1 The Community Nutrition Project
The CNP project has been designed as a program of demand incentives, community-based nutritional education, and institutional capacity building needed to improve access to health care and raise knowledge and awareness regarding nutrition. The objective of the CNP is to improve coverage of essential maternal and child health services and improve mother and child caring practices among pregnant and lactating women and children less than two years old in seven southern and central provinces (Bolikhamxai, Khammoune, Savannakhet, Salavane, Xekong, Attapeu, and Champasak).
The CNP comprises two components:
1. CCTs to stimulate the uptake of key maternal and child health services;
2. A community-based health and nutrition program to affect behavior change and mobilize mutual support to improve nutrition;
In addition, the project provides resources for support and management, including capacity building to health staff through in-service training (5 Module Training), improved supervision, and increased availability of maternal and child care supplies in remote rural villages through community-based distributors (CBDs).
As a result of these activities, villagers, especially those living in remote rural communities, are expected to benefit from improved utilization of health services and increased knowledge and awareness of nutrition. Through the CCT component, the project is expected to help reduce financial barriers to accessing care, while the community nutrition component will improve knowledge of maternal and child health and nutrition, especially in remote villages where non-Lao speaking ethnic groups typically live. The community-based distributor program, in particular, is operational in communities considered too remote to be able to reliably depend on routine outreach of health services.
1.2 Compliance with World Bank Operational Policy 4.10
The CNP project has been designed to meet all the requirements of the World Bank’s Operational Policy 4.10 on Indigenous Peoples. The objective of this policy is to ensure that groups meeting the definition of “indigenous peoples” can receive culturally appropriate benefits from the project, and that any adverse socioeconomic and cultural impacts caused by the projects are identified, minimized and otherwise mitigated. The World Bank’s Operational Policy 4.10 requires that “indigenous peoples” be involved in a multi-step consultation process including a social impact assessment (SIA) of the proposed project and in a process of “free, prior, and informed consultations” during project design and preparation. The World Bank will only support projects involving such groups, if a consultation process demonstrates a pattern of broad community support for project objectives and activities.
2. Background Information
2.1 Ethnic Groups in the Lao PDR
Lao PDR is one of the most ethnically and culturally diverse countries. The official terminology, for describing the diverse population of the Lao PDR is ‘ethnic group’ and was introduced in the 1991 Constitution. The term “indigenous people” is not used in Lao PDR. Therefore the EGDP will use the official terminology of the Government of Lao PDR (GoL).
Despite the fact that the number of ethnic groups have changed over time, specialist agree on the ethnolinguistic classification of ethnic groups produced by the Lao Front for National Construction (LFNC) which contains 49 categories and over 160 subgroups.
According to the official categorization of the LFNC, ethnic groups in Lao PDR can be categorized into four ethnolingustic categories:
- The Lao-Tai (also referred to as ‘Tai-Kadai’) which includes the ‘ethnic Lao’ group and lowland Tai/Thay speaking groups;
- Mon-Khmer ethnic groups, which includes the Khumic, Palaungic, Kautic, Bhahnaric-Khmer and Vietic speaking groups;
- Hmong-Mien, including the Hmong and the Mien speaking groups.
- Sino-Tibetan (also referred to as Chine-Tibet), which includes Chinese Ho and Tibeto-Burman speaking groups.
It has been established that these groups meet the Bank’s definition of ‘indigenous people’, that is, they possess the following characteristics:
a) Self-identification as members of a distinct indigenous cultural group and recognition of this identity by others;
b) Collective attachment to geographically distinct habitats or ancestral territories in the project area and to the natural resources in these habitats and territories;
c) Customary, cultural, economic, social, or political institutions that separate them from those of the dominant society and culture; and
d) An indigenous language, often different from the official language of the country.
2.2 Legal and Institutional Frameworks on Ethnic Groups in Lao PDR
According to the 1991 Constitution, Lao PDR is defined as a multi-ethnic state, with “equality among all ethnic groups.” Article 8 of the Constitution reads:
“The State pursues the policy of promoting unity and equality among all ethnic groups. All ethnic groups have the rights to protect, preserve and promote the fine customs and cultures of their own tribes and of the nation. All acts of creating division and discrimination among ethnic groups are forbidden. The State implements every measure to gradually develop and upgrade the economic and social level of all ethnic groups”.
The intention of the Constitution is to grant equal status to all ethnic groups, and to this end no reference is made to distinctions between highlanders (Lao Soung) and lowlanders (Lao Loum) and midlanders (Lao Theung). That is, from this point on, the terms Lao Loum, Lao Theung, Lao Soung are no longer recognized as official terminology.
The 1992 ethnic minority policy, Resolution of the Party Central Organization Concerning Ethnic Minority Affairs in the New Era, focused on gradually improving the lives of ethnic minorities, while promoting their ethnic identity and cultural heritage. It is the cornerstone of current national ethnic minority policy. The general policy of the Party concerning ethnic minorities can be summarized as follows (Pholsena 2005):
· Build national sentiment (national identity).
· Realize equality between ethnic minorities.
· Increase the level of solidarity among ethnic minorities as members of the greater Lao family.
· Resolve problems of inflexible and vengeful thinking, as well as economic and cultural inequality.
· Improve the living conditions of the ethnic minorities step by step.
· Expand, to the greatest extent possible, the good and beautiful heritage and ethnic identity of each group as well as their capacity to participate in the affairs of the nation.
The implementation of the Party’s policy on ethnic minorities is tasked to the Lao Front for National Construction (known colloquially as Neo Hom).
In relation to health care, the policy calls for protection against and eradication of dangerous diseases and to allow ethnic groups to enjoy good health and long life. The Government, it states, should provide appropriate investments to enlarge the health care network by integrating modern and traditional medicine.
The Ethnic Minorities Committee under the National Assembly holds the responsibility to draft and evaluate proposed legislation concerning ethnic minorities, lobby for its implementation as well as implementation of socioeconomic development plans. Research on ethnic groups is the responsibility of the Institute for Cultural Research under the Ministry of Information and Culture. The lead institution for ethnic affairs is the mass (political) organization, the Lao Front for National Construction (LFNC), which has an Ethnic Affairs Department.
2.3 Baseline information on ethnic groups in project areas
Lao PDR has a high degree of ethnic and linguistic heterogeneity. Based on data and analysis from the LECS4, the Lao-Tai groups make-up 66% percent of Lao’s population, followed by the Mon-Khmer (21.5%), the Hmong-Mien (8.8%) and the Sino-Tibetan (3.1%) (Lao DoS 2010).
Ethnic groups, especially those living in rural and remote areas, generally have a higher poverty incidence than the Lao-Tai group. The LECS4 survey analysis found that people belonging to the Mon-Khmer, Sino-Tibetan, and Hmong-Mien ethnic groups have a poverty incidence that is two-and-a-half times higher than the Lao-Tai (Table 1). Food poverty, the ability to ensure the supply of food to meet daily nutritional needs, is double the rate amongst ethnic groups, suggesting that ethnic groups are more vulnerable to food insecurity and malnutrition.
Table 1: Socio-economic indicators of Lao Ethnic Group at the National Level
Ethnic Group / Share of total population / Poverty Headcount / Food PovertyLao-Tai / 66% / 18.4% / 17.4%
Mon-Khmer / 21.5% / 47.3% / 39.3%
Sino-Tibetan / 3.1% / 42.2% / 32.5%
Hmong-Mien / 8.8% / 43.7% / 39.8%
Other / 0.6% / 22% / 34.9%
Source: Lao Department of Statistics, 2010
Furthermore, health indicators for non-Lao ethnic groups are low compared to the rest of the country, due to the fact that non-Lao ethnic groups typically face significant health-care-related disadvantages: they live in remote, isolated areas not readily accessible to the formal health system, they are often poorer, have a lower literacy rate in Lao language, and generally lack access to roads, schools, markets, and other services.
The CNP baseline study assesses the socio-economic and demographic characteristics in some of the districts where CNP will be implemented. CNP will pilot interventions in 62 target health centers in seven southern provinces. The baseline survey was administered to 1,317 households, in 87 villages, across 6 of the southern project provinces (Bolikhamxai, Khammouane, Savanakhet, Salavan, Champasak, and Attapu) in the catchment areas of 19 of the 62 intervention districts. The survey collected information on household, village, and health center characteristics as well as knowledge, practice, and attitudes relating to health status and health seeking behavior.
The districts, wherein the 19 sampled health centers are located, have a higher poverty rate compared to the national average. In addition, most of these districts are some of the most geographically remote and difficult to access, and almost all of them are identified as poor and as high priority by the GoL (Table 2 and Map 1).
Table 2: Poverty Rate and Priority Status of 19 Intervention Districts
Province / District / Poverty Rate / Poor and PriorityAttapeu / Phouvong / 61% / Poor and Priority
Attapeu / Xaysetha / 44% / Poor
Savannakhet / Thapangthong / 60% / Poor
Savannakhet / Xepon / 66% / Poor and Priority
Savannakhet / Xepon / 66% / Poor and Priority
Savannakhet / Nong / 75% / Poor and Priority
Savannakhet / Vilabouly / 62% / Poor and Priority
Salavane / Taoi / 71% / Poor and Priority
Salavane / Taoi / 71% / Poor and Priority
Khammouane / Nakai / 55% / Poor and Priority
Khammouane / Xaybouathong / 54% / Poor
Khammouane / Xaybouathong / 54% / Poor
Khammouane / Mahaxay / 45% / Poor
Champasak / Pathoomphone / 31% / Poor
Champasak / Bachiang / 41% / Poor and Priority
Bolikhamxay / Khamkheuth / 50% / Poor and Priority
Bolikhamxai / Borlikhan / 36% / Poor and Priority
Bolikhamxai / Borlikhan / 36% / Poor and Priority
Champasak / Sukhuma / 33% / Poor and Priority
National Average / 34%
Source: Epprecht M, Minot N, Dewina R, Messerli P, Heinimann A, 2008. The Geography of Poverty and Inequality in the Lao PDR. Swiss National
.