Country Assistance Strategy 2000 - 2001
DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA

1. National context

1.1 Socio-Economic Analysis

Many of the achievements of the Democratic People's Republic of Korea have been eroded in recent years by a number of factors. There has been a rapid decline in per capita income over the last 10 years from US$ 1,005 to US$ 481, largely due to a massive contraction in the economy of nearly 30%. It is estimated that from 1990-1994 domestic food production fell by 14%, seriously affecting the population's ability to cope.

Economic decline and environmental disasters have led to a persistent energy crisis, reduction of industrial production, deterioration of roads and the transport system, ongoing food shortages, deforestation, and a lack of resources for health and social services. The situation is further complicated by a complex regional and international geopolitical environment.

Mining, manufacturing, transport and agriculture have all been particularly hard hit by rapid and serious declines. Much of the growth and development of past decades has either been significantly eroded or completely eradicated in recent years. Mining production is at levels experienced during the early Seventies; factories are either closed or remain idle for lack of raw materials; maintaining city and community infrastructures has become problematic, and there is a notable deterioration in the supply and maintenance of water, electricity, fuel and transport systems. While agricultural production has improved following the most recent environmental disasters, food shortages are still projected and most experts agree that the country cannot be totally self-sufficient in food production for at least the next year.

As is the case in many areas experiencing similar challenges, these events have resulted in a rapid increase in vulnerable populations at a time when financial support to health and social welfare institutions is often significantly reduced.

While it is fair to say that the country has demonstrated a high resilience and impressive coping mechanisms regarding these social and economic issues, there is no doubt that there has been a rapid decline in the provision of quality health care and other social services. The population growth rate fell 0.9% during 1998, while the death rate rose to 9.3% compared with 5.68% in 1996. Infant mortality, which showed a historical decline from 204/1000 births in 1945 to a low of 9.2/1000 in 1990, experienced a significant increase during the following eight years, and the rate now stands at 23/1000 births (Source DPRK Government).

The tragic effects of the recent famine and natural disasters on the nutritional status of the population is well documented. UNICEF/WFP/ECHO surveys conducted in 1998 provided statistical confirmation that 60% of children below the age of seven were underweight, while over 62% were classified as stunted and nearly 16% as wasted. There was also a recorded increase in the incidence of low birth weight, representing 22% of all births in 1998. Combined with this, there was a rapid decline in immunisation coverage during the five years 1993-1998, with protection rates falling to as low as 64% (BCG), 37% (DPT3), 34% (measles) and even five percent (TT2).

The potential for improvement does however exist. The Democratic People's Republic of Korea has a large workforce which is hard working, skilled and motivated, effective mechanisms for mobilising resources, an extremely low crime rate and an almost non-existent juvenile delinquency rate. Combined with a well-organised and extensive social and industrial infrastructure, this lays a solid foundation for growth and development, as long as there is the right economic environment.

Table 1. Selected human development indicators in East Asia (UNDP, 1998, UNICEF, 1999 UNDP figures refer to 1995, which means that recent deterioration in some indicators in countries affected by the economic crisis in DPRK, have not been registered).

1.2 Vulnerability Analysis

A number of conclusions can be drawn concerning the major challenges which must be tackled if the international community and local officials are to overcome many of the problems the country faces.

Stability of Food Supplies

This factor will continue to have a major effect on the future economic, social and health status of the nation, and food security remains high on the agenda of government leaders. UNDP data indicates that agricultural production has steadily declined by four percent a year since 1989, and this trend is set to continue.

Government reports show that cereal production has declined from eight million metric tons during the 1980s to a low of 3.5 million metric tons in 1998. While production in 1999 is expected to be equal to the previous period, it is clear that this will still result in a shortfall of over one million metric tons of rice and cereal commodities.

In a concerted effort to cope with this critical shortage, a number of strategies were adopted which, while providing for intervention in the immediate and short-term, have had negative effects. A reliance on 'alternative food sources' such as edible plants, acorns and grasses, has resulted in a marked increase in intestinal disorders, while over-cultivation and fertilisation have led to serious land erosion, and bleaching and deforestation will have negative implications for years to come.

The need for improved nutrition and a stable food supply will present challenges to the government and participating aid agencies for the foreseeable future. Population groups most affected will continue to include children, lactating mothers, and elderly people with little or no family support. The need for supplementary feeding programmes is an ongoing concern, and it is questionable whether the real needs have been clearly assessed and identified.

Additionally, as unemployment increases in the absence of growth in the manufacturing and production sectors of the economy, more welfare and food support will be needed for affected families. Failure to address these issues will mean that the consequences of food shortages on vulnerable populations will steadily increase.

Occurrence of Disasters

The Democratic People's Republic of Korea is exposed to a variety of natural occurrences that can cause severe damage and destruction. These include floods, drought, intense winters, landslides, typhoons, and earthquakes. The most recent occurrence of floods and tidal waves, at a time of drought conditions, had a disastrous effect on an economy already deteriorating, and it focused world attention on the challenges the nation was facing. It can be argued that it was the combination of these events that forced a more open dialogue with the international community and led to the provision of emergency assistance.

The probability of a reoccurrence of the potential risks the country faces continues to be present. The impact on vulnerable groups may be even greater than before, due to the continued demise of social, health and economic conditions. While there is now a recognition of the potential magnitude and impact that disasters may have, there is an apparent lack of initiatives to institute a nation wide policy, planning and response system.

The Red Cross is viewed as a primary player in this regard, although it is obvious that it should not be expected to take sole responsibility for a national response to a major disaster. The establishment of early-warning systems, appropriate training programmes, stockpiles of emergency supplies, and the creation of national management and control systems are essential steps in the preparation process. While communities may have an improved capacity to respond to disasters, no formal attempt has been made so far to document or identify the extent of vulnerability versus capacity, nor to specify the target populations considered most at risk from a particular type of disaster.

Some initiatives have been introduced which focus on disaster prevention measures, such as the construction of dykes to minimise the impact of flooding. However, these are not part of a comprehensive disaster preparedness and response system.

A Deterioration of the Health and Social Welfare Systems

The absence of quality health care is evident throughout the operational areas of the Federation, and there is no reason to assume that conditions are any different elsewhere. In fact, it is likely that given the restricted access and the inability of the aid community to complete comprehensive assessments and provide medical relief supplies, the situation may be even worse.

While there are no available statistics concerning hospital admission and discharge rates, observations by monitors clearly indicate that occupancy is low. This has been attributed to a number of variables, including the absence of drugs and other medicaments, poor water supply, and the wish of many patients to remain at home and be cared for by family members. In the winter, occupancy is even further reduced due to a lack of adequate heating in hospitals.

Community health authorities make every effort to maintain acceptable levels but the general conditions in many facilities can only be regarded as very poor. Major repairs wait to be carried out to, for example, broken windows and doors temporarily patched up months ago. The lack of maintenance has a particularly dramatic effect on essential services such as a clean and dependable water supply. Not only is the plumbing system in hospitals in need of major repair and new parts, but connections to water sources in many institutions are in a dangerous state of disintegration. Sanitation, including the disposal of dirty water and other materials, requires significant rehabilitation.

The infrastructure of the hospitals, like that of the major cities and communities, is rapidly deteriorating, and laboratory and diagnostic equipment is almost unknown outside major centres. Many smaller hospitals have attempted as best they can to construct their own equipment (such as radiology), and they struggle on with outdated and unreliable machines. In many hospitals, most if not all departments are said to be under-resourced, and in some cases they are no longer able to provide an acceptable level of patient care.

A number of assessment missions have suggested that the DPRK has a well-structured primary health care system. While it is true that there is a substantial health care system, consisting of provincial, industrial and county hospitals, polyclinics and ri level clinics throughout the country, it remains to be determined whether these resources and the distribution of beds have been based on an established service development strategy or have simply evolved over a period of time in response to political and community expectations. There is a need to re-examine whether or not the country has a rationale for the distribution of health care facilities and if their current structure is viable from an economic and effective service delivery perspective.

Until these issues are addressed in a constructive manner, it is considered that most of the population will remain vulnerable to major outbreaks of communicable diseases and will have to accept sub-standard health care services.

Manufacturing-Related Environmental Catastrophes

Disasters of this kind are becoming more frequent throughout the world. In view of the condition of manufacturing and production plants in the DPRK, due to poor maintenance and the lack of resources and spare parts, an assessment of the risk of such a disaster happening in the country should be made a priority.

1.3 Analysis of Funding and Operational Assistance Environment

During the initial operational period (1995-1997), when international attention was drawn to the terrible conditions being faced by the country as it attempted to deal with serious flooding made worse by unusual drought conditions, donors responded well to requests for material and financial support.

Funds were obtained for Red Cross activities, and the Federation played a prominent role in providing resources and assistance to the operating National Society. Projects were essentially for emergency relief, rather than long-term solutions.

Most aid agencies consider that fundraising will become more and more difficult toward the end of 1999 and into the new millennium. With this in mind, it is essential that the Federation and its partners draw up a communication and fundraising strategy to respond to this emerging trend.

Finally, the present approach to participating National Societies and donor organisations providing assistance through the Federation, which is well co-ordinated, should be encouraged and maintained.

2. National Society Context

The Federation's operating partner, the Red Cross Society of the Democratic People's Republic of Korea, has over 325,000 volunteers organised by nine provincial and three city branch committees. This is further divided into 200 city or county committees. The highest governing body is the Central Committee, to which the Secretary General reports.

Major programmes and services are directed towards protecting life, promoting health and providing first-aid services, with more than 8,000 first-aid posts across the country. In addition, the Society is actively involved in tracing services, youth activities and disseminating International Humanitarian Law.

Over the years, the National Society has acquired a significant level of operational knowledge concerning Federation-standard operating procedures, and it has incorporated many of these systems into its own practices. The Society is well structured, disciplined and highly motivated, demonstrating a keen interest in expanding its staff and the skills of volunteers. While it must be noted that the Federation continues to function under restrictions, an improvement in the situation is apparent and a greater openness.

The Society is determined to expand its profile and activities in regard to Red Cross activities, through the provision of emergency assistance and capacity-building opportunities. It is the only agency in the country to be allowed any degree of independence in its operations - all other activities are controlled by government agencies and representatives.

The Federation enjoys a positive and co-operative working relationship with other international and non-governmental agencies. Structures are in place to provide for inter-agency co-ordination and co-operation. This is seen as crucial in having an influence on the longer-term situation and sustainable forms of intervention.

3. Priorities and objectives for Federation assistance

The Federation intends to continue its support to the Red Cross Society of the DPRK in the years to come. The main objectives will be to continue to strengthen the National Society's operational and institutional capacities through various programmes and activities and to give further support to health institutions, in order to have a system at community level which can provide basic health services.

The Federation will continue to focus on the National Society's disaster preparedness programme through training and setting up effective and efficient disaster response systems.

The health programme will be maintained at the present level. It aims to improve health institutions and promote the prevention of communicable diseases, emphasising personal health.

4. Priority programmes for Federation assistance

Over the next two-year period (January 2000/December 2002), the Federation will undertake a number of relief and development activities with the National Society, in close partnership with participating Societies and other funding agencies.

These programmes will focus on two key areas:

4.1 Disaster Response and Preparedness will be addressed through the introduction/continuation of a comprehensive preparedness and response initiative. This includes an emergency drug distribution programme, emergency winterisation activities, food relief distribution to hospitals (under review), VAC training, establishment of a disaster-preparedness warehouse system, and disaster response skill training. These are all designed to achieve the following aims:

4.1.1 Strengthen the National Society's ability and capacity to respond in an effective and efficient manner to large and small-scale disasters.

4.1.2 Reduce community vulnerability to the effects of disasters through effective and appropriate preparedness activities and training opportunities.

4.1 .3 Facilitate the establishment of a national disaster-planning system through the Red Cross, providing national and community leadership as well as a significant response function.

4.1.4 Maintain minimal operational capacities for health care facilities within the Federation's operational area.

4.2 Health Education and Service activities focus on activities which aim to prevent communicable diseases and promote individual health and well-being. These include a series of educational interventions covering relevant community health issues, such as safe motherhood, diarrhoea prevention, effective use of medication and setting up comprehensive, first-aid services. The following programme objectives have been established for the next two-year period:

4.2.1 Reduce the prevalence and occurrence of communicable diseases.

4.2.2 Increase the knowledge and skills of health workers concerning water/ sanitation issues, disease treatment, and prevention and promotion of personal health and well-being.

4.2.3 Strengthen the profile of community-based, first-aid services.

4.2.4 Promote national self-sufficiency in the availability and provision of essential drugs and medicaments to the health care system.

4.2.5 Provide clean and dependable water systems to a selected number of health care facilities.

5. Resource mobilisation strategy

Most funding received so far has been generated through the Federation Appeals and the establishment of funding agreements for specific programmes. The Federation intends to enlarge its donor base to make the programmes more financially sustainable.

The potential at the present time for local funding opportunities remains extremely limited. The National Society recognises the importance of these activities and continues to generate revenue through its traditional means of collecting membership fees and government financial support. It should be noted that there has been a significant decrease in government funding due to current economic circumstances, and there appears to be increasing reliance on the Federation for material and programme support.

However, it is fair to say that there appears to be interest in identifying revenue projects which have the potential to generate both local and foreign currency.

6. Evaluation of assistance strategy

The absence of national statistical data as a means of establishing baseline measures for comparative purposes, and the severe restrictions placed on the collection of most measures necessary to determine the impact of a particular activity has, to say the least, hampered the introduction of normally-acceptable evaluation procedures. The Federation has had some success, introducing an elementary disease surveillance programme with limited scope and methodology, as well as data collection on the consumption of drugs provided through its emergency distribution programme.

Objectives, activities, expected outcomes and evaluation criteria have been established for all programmes, and will form the basis of any formal evaluation. In addition, the use of external evaluation teams will facilitate this process.

7. Budget Overview (2000)

(in CHF)

Project number	PKP001	PKP002	PKP003	PKP160
Name	National Coordination	Health	CBFA	DPP	Water Sanitation	TOTAL
Shelter & construction				96,000		96,000
Clothing & textiles				128,000		128,000
Food & Seeds
Water				62,083	82,000	144,083
Medical & first aid		5,598,560	174,400			5,772,960
Teaching materials
Utensils & tools				6,150		6,150
Other relief supplies					550,000	550,000
Sub total supplies		5,598,560	174,400	293,133	632,000	6,698,093
Land & Buildings
Vehicles
Computers & telecom	9,000					9,000
Medical equipment
Other capital expenses	7,000					7,000
Sub total capital	16,000					16,000
Programme management	37,844	468,502	34,991	40,474	63,504	645,315
Technical services	11,329	140,245	10,474	12,116	19,010	193,174
Professional services	12,563	155,530	11,616	13,436	21,082	214,228
Sub total programme support	61,736	764,277	57,081	66,027	103,596	1,052,717
Transport & shortage	49,500	121,760	5,940		8,430	185,630
Personnel (delegates)	308,052	302,088	101,101	95,636	109,236	916,113
Personnel (local staff)	47,610	101,842	142,837	114,440	58,961	465,689
Personnel (support costs)
Sub total personnel	355,662	403,930	243,938	210,076	168,197	1,381,802
Travel & related expenses	24,242	16,824	3,108	3,108	3,108	50,390
Information expenses	4,700	1,320				6,020
Sub total Travel& Communications	28,942	18,144	3,108	3,108	3,108	356,410
Admin & general expenses	49,400	41,300	34,450	27,900	26,450	179,500
External worksh./seminars
Subtotalgeneral & administration	49,400	41,300	34,450	27,900	26,450	179,500
Total budget	561,240	6,947,970	518,917	600,244	941,781	9,570,152
Total assistance sought	561,240	6,947,970	518,917	600,244	941,781	9,570,152