"reconstruction must not be at the expense of transformation"

El Salvador
National Reconstruction Program
"transforming the country to reduce vulnerabilities"

Introduction

I:  Status of the Country, its Achievements and Challenges

1. Sociopolitical and economic achievements
2. Challenges: rural poverty and environmental deterioration
3. The situation of Salvadorian women

II:  Hurricane Mitch, Recurring Disasters and Vulnerability to Them

1. Immediate consequences
2. Threats, risks and vulnerabilities

III:  National Transformation Plan: To Establish Rings of Security

IV:  Sector Programs

1. National system of preparation and response to disasters
2. Health
3. Housing
4. Reconstruction and expansion of the local infrastructure
5. Promotion of micro and small enterprises in the rural areas
6. Environmental measures

V:  Macroeconomic Coherence and Improvement of the Financial Situation

1. Macroeconomic reactivation dimension
2. Local financial structure, especially in the rural areas

VI:  Transversal Focus

1. Education for development
2. Gender dimension for reconstruction
3. Promoting participation, transparency and responsibility

Annexes

Introduction

In order to promote increased citizen participation, El Salvador recently created a Commission for National Development. The mandate of this commission was to identify thematic priorities and propose a methodology for the preparation of a National Development Plan. The group’s recommendations are presented in the document "Basis for the Nation's Plan". Arising from this proposal and also to generate a social dynamism in support of national agreements made, a comprehensive information and consultation process was conducted at the national level throughout 1998. This exercise had been completed when Hurricane Mitch occurred.

One of the components of the process was consultation with Salvadorian professionals of different academic disciplines who analyzed and made proposals in 19 different specialized topics. The results were recorded in the publication "Key Themes for the Nation's Plan: Specialized Consultation" dated January 1999, widely quoted in this document.

The consultation process for the preparation of the National Reconstruction and Transformation Plan

In accordance with the criteria on the importance of participation as a requisite for the design of National Reconstruction Plans which were agreed upon during the Advisory Group’s preparatory meeting in Washington on December 10 and 11, 1998, the government of El Salvador (GOES) has promoted an extensive consultation process.

To implement this process, and with the support of the United Nations’ Agency System in the country as facilitator, a wide spectrum of participants was invited to join nine (9) working committees to provide responses in the thematic areas previously identified in the document presented by GOES at the Washington meeting. These areas were developed based on the suggestions received during the initial phase of the exchange.

The working committees met over a period of three weeks during which the participants dealt with the following: 1) identification of strategic guidelines to delineate each theme; 2) analysis of vulnerabilities and capacities of specific responses; and 3) input generation for program and project portfolio.

Document content and structure

The present Reconstruction and Transformation Plan has been structured in the following manner:

Section I presents El Salvador’s achievements in the 90's through the implementation of social, economic and political reforms for the country’s modernization. An outline is given of what remains to be done, taking into account the analysis of the country’s primary areas of vulnerability such as poverty - in its different manifestations and particularly in the cross-section represented by the rural area of the country's average in all the key variables of human indigence -, the environmental crisis and the situation of the Salvadorian women. A balance is made of the difficulties to be overcome as well as of the progress already achieved.

Section II deals with the damages caused by Mitch, quoting from CEPAL's report. The notion of reconstruction is introduced as a means to reduce weaknesses, at the same time, underlining the urgency to mitigate additional susceptibility caused by disaster to break the cycle of poverty - vulnerability - disasters - impoverishment.

In Section III, the structure of the transformation plan is explained, based on the concept of "Construction of Security Rings" which are used as foundations for the pillars of sustainable human development, understood as security, equity, productivity, sustainability and participation. Transversal axles are introduced on which the coherence of the plan is guaranteed: in economical terms, the strengthening of the local financial mechanisms as well as the macroeconomic consistency and in the social area, the strengthening of the educational system in the development of a culture of local participation together with care of the environment. In addition, the social valorization of equal gender participation is also included as a target in all the aspects of economic and social life.

Section IV contains the definitions per sector in the following order: 1. System of prevention of and preparation for disasters; 2. Health; 3. Housing - understood as habitat; 4. Reconstruction of the local infrastructure for water supply, sanitation, roads and electricity; 5. Promotion of micro and small rural, agricultural enterprise; and 6. the Environment.

Section V deals with aspects of economic consistency which implies the continuation of reforms aimed at the achievement of macroeconomic balance as well as at financial stability through the development and strengthening of the local financial structures.

Section VI puts forward the themes that build the social consistency of long-term actions such as the improvement of the educational system to form the human capital and culture, in accordance with the reconstruction plan’s activities; the empowerment of women to the point of having equal opportunities and the strengthening of the institutionalization for participation, transparency and responsibility.

Section I
Status of the country, its achievements and challenges

Seven years ago, El Salvador began an extensive and exemplary transformation when the civil war came to an end through a process of negotiations. The Peace Agreements laid the foundation for a significant historical change demanded by the war, that of an important transformation in the structures of the national political power, thereby permitting the establishment of a new scenario for the consolidation of democracy in the country.

1. Sociopolitical and economic achievements

In the area of social and political modernization, the fundamental inputs of the Peace Accords "are intimately related to the structure and the functioning of the political power in the country. An intensive military reform was undertaken and a new and modern policing structure of civil character was created; the institutional surveillance with respect to human rights was strengthened and the first rehabilitation works for the administration of an effective and trustworthy court system were also made". Through the reconciliation process, democracy has been reinforced and important room made for citizen participation.

In economic terms, ambitious reforms were undertaken aimed at the establishment of the basis to attain important rates of economic growth. The first stage of these reforms was directed at stabilizing the economy, decreasing state intervention and establishing clear rules for the private sector. In parallel, the signature of the Peace Agreements in 1992 was fundamental to the improvement of the business climate in El Salvador.

These factors produced an increase in the private sector investment that sustained an average growth rate of 5.5% between 1992 and 1997. The foreign investment and the repatriation of capital also made a significant contribution by assisting with the recuperation of a high level of credibility for receiving international credit. The country was qualified as one of the countries with the highest economic freedom in the world. During this same period, family remittances in foreign exchange from Salvadorians abroad increased substantially even during the times of conflict. Due to this multiple flow of resources, a high level of economic growth has been achieved with macrofinancial stability, in spite of a growing gap in the balance of goods and services.

• The public finances show an average deficit equivalent to 1.8% of GDP from 1993. This reflects a strong financial discipline in spite of the substantial demands for the reconstruction of the country and the fulfillment of the Peace Agreements, in addition to the efforts to increase the social expenditure and the human resources investment. The financial result achieved has permitted a prudent administration of the external public debt, estimated at less than 23% of the GDP.

• The external sector of the economy registers a current account average deficit of only 1.2% of GDP during the same five years. This resulted from an increase in exports at an average annual rate of above 23%, as well as from the increase of the family remittances from the Salvadorians resident in the United States equivalent to 11% of the GDP per year. This situation has permitted the financing of the required import goods that have been required by the agile Salvadorian economy.

• In 1998, the economy grew approximately 3.5% with an inflation rate of 4.2%. For the same year, there was a fiscal deficit close to 2% of the GDP. The current deficit in the balance of payments is estimated at 1.6% of the GDP, with an export growth of 4% and family remittances of 7.6% with relation to last year. For 1999, it is expected that the economic growth will be maintained in spite of the tensions caused by damages (fluctuating supply) and the reconstruction process itself (excess demand).

The Salvadorian reform process is internationally recognized because it has liberated the economy, as well as the production capacity of the private sector, and established the democratic institutions required by the Peace Agreements. It has also improved and extended the social program while maintaining a careful macroeconomic administration.

Recently, GOES adopted a series of measures to create an institutional and normative framework which will improve the implementation of a participative and sustainable development process. This includes reform of the FODES law (6% of the National Budget for the social and economic development of municipalities) and the approval of the General Environmental Law. On the other hand, it is important to highlight that El Salvador already ratified a series of international agreements with regard to the environment which constitute important tools that could promote the adoption of socioeconomic and institutional measures to lead to the sustainable administration of natural resources and the corresponding procurement of funds for this purpose.

2. Challenges: rural poverty and environmental deterioration

In spite of these achievements and the continuous effort in all the sectors, the process has not produced sufficient results to undo the Gordian Knot represented by the structural poverty which still hinders the possibilities of reaching higher levels of sustainable human development within a harmonious relationship with the environment. Consequently, the existing situation poses a threat to the achievements already attained.

The existent poverty is based on a very profound reality - the sociocultural marginalization. There is still a lot to be done to remove the deeply-rooted exclusion mechanisms and to create real, effective conditions for the eradication of the structural poverty within our society. The logic of this historical stage of the transition towards full democracy demands that poverty be eradicated from the entire country, substituting the marginalization pattern for one of participation.

One of the results of the stable economic growth period experienced by the country is that "the urban population has been favored with better job and income opportunities while the rural homes have not had the same advantages nor experienced substantial improvements in the quality of life". The challenges in terms of education, health and housing are still very significant and the progress achieved to date is insufficient vis-a-vis the additional demand generated by the population growth.

In addition and given the urgent need for: (1) harmonizing the different programs and projects with internal and external funds directed at the promotion of different productive activities, to address poverty and the environmental deterioration, (2) formulating plans and local initiative with the strategies and national development programs; and (3) guaranteeing the social participation and transparency of the public administration, the GOES through the Ministry of Foreign Affairs has decided to promote mechanisms that facilitate the coordination of the external cooperation to assist in overcoming the three above-mentioned challenges. A good example is the recent approval of Nation-21, a technical, external support tool that leads the way in the correct direction and could use the assistance of the Advisory Stockholm Group to promote its effective and full implementation. This would mean a qualitative leap towards the creation and institutionalization of coordination mechanisms at the local and national levels between the State, the civil society, the productive sector and the international community in its effort to overcome specific local development problems.

2.1 Rural Poverty

The challenges are particularly evident in the rural ambient and are present not only in the limited scope of basic services but also in the insufficiency of the markets providing them. The rural impoverishment continues to form the hard core of the country's poverty.

In spite of the fact that the farmers are the main producers of basic foods, "the insecurity of food availability is a chronic problem at the level of the poor rural homes, given the fact that their access to the quantity and quality of the necessary food stuff to assure a healthy and productive life is limited by the indigent conditions.

The landless families of small farmers whose incomes depend basically on agriculture represent the most impoverished segment of the population. The departments most affected by the past civil war present elevated poverty indices, higher rates of economic dependency, less capacity to acquire basic services, greater deterioration of the natural resources and a marked existence of dwarf holdings.

This situation of the Salvadorian countryside is not a sector problem but rather a national one. If the population transformation, migration to the USA and growing urbanization had been accompanied by a demographic transition manifested by a population growth rate reduction from 3.7% (in the middle of the 60's) down to 2.2% at present, this transcendental fact does not itself guarantee the possibility of finding a path to harmonious development with a consequent reduction of the inequalities.

In fact, the birth rate in the poor rural departments at the northern edge of the country is still twice that of the urban departments. If the lack of opportunities in these departments is compensated by the migrations, causing a very low net rate (sometimes negative) of population growth, the pressure on the urban medium and the demand for more social services makes it progressively more difficult to continue absorbing the excess of rural population. Moreover, given the insufficient investment level in human resources in the rural areas, this has to do with a population with little capacity not only to contribute to increasing the global productivity but also to the generation of additional income to finance their necessities for social services.

2.2 Crisis and environmental deterioration

The country experiences a socioenvironmental crisis that "is manifested in the poverty and deterioration of living conditions of large groups of population, degradation and exhaustion of natural renewable resources, in addition to enormous territorial imbalances, in a vicious circle that needs to be broken. The socio environmental crisis expresses the highly-conflictive relationship established between the situation of underdevelopment and the environment, typified by urbanization patterns, production and consumption that, when linked, progressively damage the human, natural, social, cultural and economic heritage".

The imbalances threaten the possibilities of economic growth and the eradication of poverty, thereby risking the consolidation of the democratic governability in the immediate future. The social impact, in economic and environmental terms of hurricane Mitch are an evident example of the country's vulnerability in its fight against poverty. The latter and the environmental deterioration require concentrated efforts to avoid increasing the imbalances and to mitigate the impact of future disasters.

As a consequence of this socioenvironmental crisis, the indices of deforestation, soil erosion, loss of biodiversity and aquifer contamination reach levels that are among the highest in the American continent.

3. The situation of Salvadorian women

Women in El Salvador represent a little over half of a heavily concentrated population (the most densely populated in the continent: some 250 inhabitants per square kilometer). Half of the population is rural and the other portion urban, even though the female population is slightly more urban than the male; it is still fundamentally young and the majority, poor, especially in the country areas.

The Salvadorian women still have the tendencies to take mates and have pregnancies at a very early age, after which a high proportion assumes the role of head of the household (close to one-third of Salvadorian families are sustained by women). Recently, there has been a considerable reduction in the number of children borne during the women’s fertile life: the current global birth rate is 3.5% as against 5% of fifteen (15) years ago. This average figure reveals sharp differences depending on the zone of residence: 2.5% in the cities and 5.5% in the country areas.

As is valid in almost all countries of the region, the educational progress of the Salvadorian women has been considerable during the recent decades, in spite of the differences found at the various levels. Based on the Population Census of 1992, UNESCO concludes that currently one-fourth of the population is illiterate, a proportion that is higher for women. A tendency towards the reduction of this percentage has been recently noted.

In terms of primary education, the Salvadorian women and men participate in equal percentages. The proportion of women is higher in secondary schools but decreases in the higher education system.

Sanitary conditions reveal serious deficiencies especially among the rural population where it is the women who are particularly affected. This is evident in the maternal mortality which presents increased levels in the rural areas where there is also a high incidence of cancer in the reproductive system of the women.

The life expectancy in El Salvador is approximately 68 years, one of the lowest in the region. Life expectancy for women increased substantially during the past two decades even though it has been explained as a direct consequence of the high male mortality due to external traumatisms mainly homicides, labor and traffic accidents.

The economic participation of Salvadorian women is one of the highest in the region, with a rate of over 40% which represents 44% of the Active Economic Population (AEP). These figures are lower in the rural areas (a rate of 26%), resulting from a lack of civil registration and the factor of 'invisibility' of the female labor. In spite of this, the limited scope of public services in the urban periphery and especially in the country areas place the survival effort mainly on the women, a fact that was characteristic of the years of the civil war.

El Salvador still has a marked androcentric society in terms of power and genocentric when related to survival. In fact, women constitute a reduced minority in the realm of the social and political power.

Nevertheless, beginning from around the middle of the 80's, a movement promoting gender equality began in the country within the civil society, as well as in the public service. From 1991, and particularly since the Peace Agreements of 1992, the activity in favor of women has experienced a considerable increase. Today, there is a significant number of different types of women's organizations that have adopted several forms of coordination.

After the Beijeng conference and with the women's movements receiving full approval of the government, it was decided to approve a law to create a national mechanism, the Instituto Salvadoreno para el Desarrollo de la Mujer (the Salvadorian Institute for Women’s Development-SDEMU) linked from its origin to the need to formulate public policies for gender equality and with the specific purpose to "Design, direct, execute, advise and monitor to ensure the fulfillment of the National Policy for Women".

Section II
Hurricane Mitch, recurring disasters and vulnerability

According to CEPAL’s report, the climatic effect of Hurricane Mitch in El Salvador was mainly of an indirect nature. That is to say it resulted from the rains produced by both Mitch and a tropical disturbances existing on the Pacific coast of Nicaragua. The levels of rainfall reached their maximum point on November 1.

This precipitation – abnormally high – fell on the Pacific slopes of the Central American mountains after deluges during October. The already-saturated soils of the hydraulic watersheds could not hold the excess humidity and the main rivers of the country became seriously flooded. In addition, because of the over-saturation of the soil, the slopes failed and landslides occurred causing many rivers to overflow their banks resulting in the flooding of the adjacent areas.

1. Immediate consequences

a. Affected population

Even though the entire country was declared a disaster area (and all Salvadorians suffered the anguish and uncertainty of the hurricane), only part of the population was seriously affected. The majority of the victims was located in the low coastal areas of the region.

The orographic conditions of the country and the water flow from the rivers produced considerable flooding that covered the countryside. This isolated many areas and forced the population to evacuate their homes. The magnitude of the floods surpassed the levels predicted to such an extent that, in spite of the alert and strong solidarity of the inhabitants, many victims could not be evacuated. Deaths reached a number of 240.

According to COEN, the number of victims was 84,000. This figure was reduced when calculations were made of possible beneficiaries. The National Secretariat for the Family registered 10,384 families that could qualify as beneficiaries. Almost all the families were from the rural area and this information is consistent with the figure of 60,000 estimated beneficiaries identified by the World Food Program (WFP).

b. Mitch’s impact from the gender point of view

The analysis of Mitch’s effects presents a significant problem if taken from the gender perspective. This is due to the unavailability of basic statistics segregated by gender and has resulted in serious consequences that surfaced not only during the emergency phase but also during the rehabilitation and reconstruction stage.

A National Secretariat for the Family (SNF) poll shows and it was later confirmed in interviews with the inhabitants that 35% of the homes in the affected areas are headed by women. This inclination does not necessarily coincide with the ownership of land or house and could consequently conceal a certain element of over-representation of males among the victims.

In COEN’s first damage evaluation, it shows that women have required more hospital and pre-hospital attention. In terms of the former, out of a total of 448 people, 54.5% are women and 45.5% are men. Of this sample, 35.5% is less than 15 years of age. Official sources state that among the women, the floods produced a substantial increase in gynecological infections in addition to traumatisms and different diseases (respiratory, diarrhoeic, conjunctivitis and skin infections).

In terms of housing, SNF’s assistance process included criteria for household heads but did not consider elements of ownership during the distribution of the emergency assistance. The Vice-Ministry of Housing and Urban Development will be responsible for continuing the reconstruction process. In keeping with a survey carried out among women in the affected areas, it is strongly felt that the procedure stipulating that the property be registered in the women’s name should be maintained, during the emergency period, and that only upon her request, should the registration be made out to the couple.

c. Damage summary

Estimates taken from an analysis of the information show that the damages caused by Mitch in El Salvador reached the level of US$ 388 million. Of this amount, US$169 million (45%) represents direct damage to property, whereas US$219 million (55%) relate to indirect damages affecting the economic flows. The figure of the damages is equivalent to 6.4% of the Salvadorian GDP.

Mitch mainly affected the productive activities and to a lesser degree, property. It also caused a cost increase in services, especially with regard to land transportation. The other expenditures were those related to meeting the needs of the emergency.

In the first place, property damages represent 36% of the construction sector’s internal product. This indicates that the effort required for reconstruction may not be out of reach of the national installed capacity and that it could be carried out in a relatively short period of two years or a little longer. In the second instance, losses in production are equivalent to 4% of the GDP.

The productive sectors were the ones hardest hit (69% of the total damages). This was followed by infrastructure (19%), the social sectors (10%) and the environment.

The damages to the social sector even though of minor importance in monetary terms, acquire more significance because the lower-income social strata is directly affected and their already inadequate well-being is even further reduced. These social groups consisting mainly of farmers or inhabitants of marginal urban areas have lost not only their scarce assets but also fallen into a situation characterized by the absence or reduction of their incomes.

In conclusion, the impact of the meteorological phenomenon has been:

• Of relatively small importance on the macroeconomic level.
• Serious at the level of certain local rural economies in that it has completely affected the country’s main hydrographic watersheds.
• Differential in the social sectors and with regard to gender.

2. Threats, risks and vulnerabilities

Even though in aggregated terms, Mitch has not seriously interfered with the national economy, the phenomenon has not only had local, important effects on several rural areas but also different social impacts. Both types of impacts reveal what has been characterized in the last section in the two dimensions (social and geographical) as the fragility when confronted by disasters: human poverty, in general, and the rural situation, in particular, in terms of economic equity and well-being.

The disaster has a more marked impact on the population living in precarious conditions whether it is seen from the point of view of the environment (greater susceptibility to excessive changes in the parameters of the ecosystem), economic (less recuperation capacity when faced with the loss of productive assets), human (less individual reaction capacity) or social (deficient organized response capacity from the social group).

Mitch has thus constituted an opportunity to reveal these vulnerabilities and to put the existing fragility into perspective when it comes to the country’s economic life and the effect of natural disasters, regardless of their origin and predictability. As with the rest of Central America, Mitch served to highlight the existing fragility of the region’s societies to confront disasters.

a. Principal vulnerabilities revealed by Mitch

These weaknesses have been identified based on the national challenges identified by the Nation’s Plan working committees, as well as on the analysis of the recurrent relations established in the time between these challenges and the vulnerability to disasters. These are:

• The need to strengthen a modern national system for prevention and immediate response to disasters based on an adequate cooperation between the local and central levels.
• An epidemiological situation characterized by infectious/contagious diseases linked to the water and endemic malnutrition that are activated when an extreme environmental situation is added to normal conditions of insufficient habitat and lack of sufficient services.
• A deficit of adequate housing for healthy family life in addition to the concentration of fragile housing under high-risk environmental conditions.
• Lack of access in many rural areas due to the inexistence of roads or lack of maintenance to the present ones. These factors render them vulnerable to rainfall and surface runoff.
• Depressed family and rural economy blocked not only by a deficient infrastructure network and lack of production services but also limited by fragmented and oligopsonistic markets.
• A damaged environment caused by the improper utilization of the watershed slopes incompatible with the sustainable use of the soil and forestry resources.
• A financial structure insufficiently developed at the local level to respond to the requirements of the small farmers.
• A framework of economic policies emphasizing the macrofinancing balances but less flexible when contracyclic tools are needed.
• An educational system in which the administrative reform has not been accompanied by an extensive modernization of the contents, methods and quality to meet the challenges to reduce the long-term national vulnerabilities.

b. A fragility accentuated by Mitch

Even though the damages caused by Mitch never reached catastrophic magnitude in spite of the fragility before-mentioned, it is evident that the storm’s main consequence has been an intensification of the poverty of families that were already living under critical conditions. It also undermined the circumstances of other families that were managing to live just above the critical poverty limit.

This additional social impact also has a gender dimension: many victims are women and children and, since the men had to leave the area to look for jobs, more women had to assume the role of household head, a fact that has reduced their capacity to generate income. Evidently, the solution of these social problems demand primary attention.

The fragility of the country is seen by the working committees in the following principal themes:

• Some outbreaks of infectious/contagious diseases affected the installed capacity of the health system.
• The damages to the rural schools decreased the capacity of the educational system to meet the inhabitants’ needs.
• The total or partial damages to housing, concentrated in the more precarious areas, have worsened the existing deficit and caused an additional demand in areas considered less risky but already overpopulated.
• The worsening state of roads in several rural areas in the mountains as well as on the plains and the failing of some bridges seriously affected the immediate recuperation of the local agricultural economy and aggravated the already-difficult connection to the markets.
• An impoverishment of rural families who lost their harvests and/or their traditional job opportunities during the summer months which caused an irreversible gap in the already-fragile financial cycle, making it difficult to encounter possibilities to continue as part-time producers for the next agricultural cycle.
• The loss of soil, if not precisely quantified, is evident in the profusion of sediments and rocks moved by the floods. To this must be added the loss of soil by erosion on slopes as well as the formation of gullies which urgently require stabilization. Mitch has affected the banking and non-banking financial portfolios working at the local level and will continue to affect their expansion capacity while simultaneously threatening the macrofinancial balances.

Section III
National Transformation Plan: establishing security rings

The direct and indirect damages caused by storms such as Mitch constitute important fragility factors since they define a new vulnerability concept. At the same time, the search for new solutions to mitigate the damages and to establish the basis for an improved, qualitative form of development is limited by the existing insufficient institutional capacity. For this reason, the Reconstruction and Transformation Plan is not limited to the repair of the direct damages nor to the prevention of short-term indirect damages but targets long-term solution of the vulnerability revealed by Mitch.

The reconstruction oriented towards transformation should be based on the following principles:

• Considering the reconstruction as a target for development is equivalent to introducing on the short-term, indispensable long-term components that reduce the human, social, economic and environmental vulnerability and joined together form an ‘insurance policy’ against future threats.
• Observing an agile calendar - paying attention to the natural and economical seasons - in the rehabilitation and reconstruction, is particularly important to minimize the accumulation of secondary, negative effects of the disaster, as well as to reduce the situation of additional impoverishment which continues manifesting themselves long after the phenomenon.
• The reconstruction should not be limited to repair of the damaged infrastructure: the cooperation for development will be more consistent if the international community supports the national priorities for the country’s transformation and serves to improve the general economy, thus incrementing the population’s security. The aspects of participation and shared responsibility should be strengthened and kept within a harmonious relationship with the environment.
• The reconstruction should take advantage of the opportunity to increase the regional consciousness on interdependent environmental, epidemiological and commercial elements of the Central American countries to promote regional strategic projects in all the relevant sectors. This process would also enhance the sustainable, increasingly integrated development of the region.

Using these four principles as a base, the plan’s strategy is developed around the concept of the construction of security rings.

These rings are concentric and incorporate the five pillars for Sustainable Human Development:

1. An adequate culture of organization to increase the human security in the face of disasters.
2. Equal opportunity for the population to have access to health and suitable habitat.
3. The expansion of opportunities for the poor to increase their productivity through strategic alliances to improve the functioning of the markets.
4. A human utilization of the environment in harmony with its sustainability to guarantee the social welfare of future generations.
5. A government system based on everyone’s participation. To implement this strategy, the transformation should mobilize and strengthen the social capital, taking advantage of the synergies between central and local levels through new public-private association mechanisms in which all the social sectors are invited to join and where both have equal opportunities for participation and for decision in the national, local and community organization.

If the breach between government and population can be closed, incentives will be generated to improve the performance of the public action and the efficient utilization of public resources. Simultaneously, the creative energy of the population will be taken advantage of when these inhabitants accept responsibility for their own development and actively participate in the monitoring mechanisms and evaluation of the corresponding results.

In this sense, it is convenient to propose to the Salvadorian society as well as to the international community that the strategic objective of this effort be to promote the construction and implementation of a participative policy for the local sustainable development with a territorial order focus that would incorporate, from the very beginning, the prevention and mitigation of natural disasters. Given the interdependency of the countries and the Central American societies, an additional element for the strategy is presented: the active search for greater coherence of the Plan’s actions at the regional level.

As can be expected of a plan that encompasses almost all the important development themes, the coherence among the objectives and actions in each sector has been a serious consideration, as well as the dependencies that exist among the sectors and the need for each sector’s objectives to be compatible with those of their counterparts. With this logic in mind, the principle is based on the following:

• If the prevention and mitigation of disasters requires an integral management (National Emergency System), the higher objective is to produce a country that is better prepared and less vulnerable to the threats posed by disasters. These results should also be a product of development in its social, economic and environmental dimensions.
• The progress in the health area results from the achievements in terms of habitat (housing and basic infrastructure), of the income level increase of the population to enable them to pay for better health and an improved environment. At the same time, the investment in health is a condition to increase productivity and therefore ensure economic development.
• The investments in housing and basic infrastructure are conditions for economic development through its health impact, both indirectly and directly because employment generation is considered as an investment of productive capital in order to increase the opportunities for income generation through a better participation in the markets. This is especially true of the informal economy of the small and micro enterprises.
• The economic development at the level of the small and micro enterprise requires specific support through policies related to services for production and marketing, extension, financial services and training of human capital. It is also the result of energizing the local economic network to promote the investment programs in social, productive and environmental infrastructure together with the investment in health and education.
• The administration of the environment in harmony with the reproduction of its resources requires effective regulations as well as public investment in infrastructure. This also implies the need for local private entities that will not misuse the natural resources and, in this manner, to be able to bring together private interest and public well-being.

In addition, the intrinsic coherence of the security rings among themselves to facilitate their development requires certain factors which act as transversal axes while contributing to reinforce this relationship. These are:

In the economic optic, the consolidation of the economic stability should be monitored at the micro and macro levels through the following aspects:

1. The consolidation of functioning financial mechanisms with the proposed actions which supposes the promotion of new technologies of financial intermediatory nature to extend the access of the small and micro enterprises to the financial services in the rural area.
2. The preservation of the coherence between the reconstruction requirements and the macroeconomic balances by means of long-term economic stability necessary for savings and investment growth.

In the sociopolitical area, the consistencies are based on three main elements that intervene in each of the sector themes:

1. The educational system as an opportunity generator through the construction of a participative culture that engenders respect for the environment together with the formation of professional and technical human capital, consistent with transformation requirements, particularly at the local level where the lack of qualified human resources is a hindrance to effective local development.
2. The consolidation of women’s participation in conditions of equal opportunities as a social norm in order to better benefit from the qualified human resources for development.
3. The promotion of local participation in development management and the social control of public activities, supported by a progressive decentralization of government management. In addition to having the local governments strengthened, this will also require that the community learn to undertake responsibility.

Section IV
Sector Programs

1.  National system for preparation and response to disasters

The progressive importance being assumed by the necessity to cope with natural phenomena to avoid the occurrence of disasters (or at least to reduce their effects) is forcing us to consider the prevention, preparation and response as an indispensable part of the reconstruction and transformation activities.

There is an abundance of historic data on the incidence of disasters in the country, as well as in the Central American region. Beginning in 1976, the need was considered for a strategy to reduce the impact of man-made or natural disasters. In this context, the civil defense law was prepared and approved. This further resulted in the creation of the National Committee for Civil Defense with its executive dependency to enforce the mandates of the law.

However, the dynamics in this respect have become progressively evident with the proliferation of small disasters whose combined effects of human and economic losses provoke damages comparable to those occurrences of greater magnitude. The development of the disaster dynamics is closely related to the way in which society has evolved: there are characteristic underdevelopment elements that explain the extensive impact of disasters such as the type of housing, the environmental deterioration and the level of poverty. The natural phenomena in themselves do not result in disasters. It is rather their interaction with a vulnerable social, environmental ambient.

From the time of the formation of the National Committee for Civil Defense, now the National Committee for Emergencies, a substantial amount of work has been invested to broaden the institutional and geographic scope of the process to react to disasters. This task has been carried out through an intensive, inter-institutional exercise of coordination and training in the execution of specialized and general procedures concerning emergency plans and basic equipment. However, there is the need to strengthen the specific actions detailed in the disaster cycle’s outline and thereby increase the quality and quantity of preparation for emergency situations to lessen the disaster’s impact.

A multi-factoral analysis reveals the need to confront the problem from a new perspective, in at least in two fundamental respects: a) the need to modify the judicial framework to improve the system and to extend its scope to include all the disaster cycle’s phases; b) the convenience of reorienting the actions towards the local area and community participation, in addition to all the different phases of the disaster cycle (prevention, preparation, response, mitigation).

1.1 Vulnerability

From an analysis of the lessons learnt and the vulnerabilities evidenced by Mitch, an evaluation of priority elements is detailed hereunder:

• The inter-institutional coordination of the public sector and the organizations of humanitarian aid at the central level demonstrated efficiency but, at the departmental and local levels, the coordination requires strengthening and involvement of all the persons concerned.
• In accordance with the OCHA report, the efficient activities by COEN and other institutions were undertaken with very little equipment and resources and that makes it difficult to provide proper follow-up.
• The National Emergency Plan needs to be complemented or have the scope widened to integrate the different phases of the disaster cycle.
• Due to COEN’s organization at the local level, the potential for high human losses was considerably reduced. It is however necessary to improve and extend the coverage of the local early alert systems.
• The data collection system showed progress as well as weaknesses. Several organizations have pointed out that there is a lack of processed data especially with regard to information based on gender desegregation. Comments have also been made on the fact that the information on the victims (SNF) prioritize the head of the household and property as a reference which can eventually serve as a ‘veil’ to the presence of women.
• The actual judicial framework does not correspond to the current development of the more modern civil protection basis which involves: a) the integral protection of the population and its realm against natural threats and b) the necessity to fully include all the disaster cycle’s phases and stages.

1.2  Strategic guidelines

These are presented for the improvement of prevention, response, preparation and mitigation of disasters. They have been organized based on the following criteria:

1. General strategic orientation
2. Specific strategies
3. Strategic guidelines for gender issues
4. General criteria for the strengthening and modernization of the National Emergency System.

a.  General strategic orientation

• Strengthen and modernize the information system, early alert and communication on disasters with special emphasis on the opportune communication at the local levels.
• Integration of equipment of communal advisory to orient the communities on disaster prevention through the improvement of the educational, health and housing conditions.
• Guarantee female participation in the strategies for civil protection against disasters through training, availability of information, promotion of women’s capacities, etc.
• Promote the formation of local emergency committees that can act in cases of disasters.
• Design local emergency plans to address the effects of the disasters.
• Incorporate the prevention of disasters in the development policies through focusing on prevention. As an example, preparation of studies and plans of development; location, design and construction of safe structures; improvements in the feasibility analysis of projects (new or in execution), taking into account the standards of security and the environmental impact of disasters.
• To promote an increase of the budget specifically assigned to the prevention of disasters in each dependency of the government directly related to the subject.
• At the COEN level, the integration of a scientific-technological committee for the research and preparation of evaluations on threats, vulnerability and risk factors, as well as for the formation of possible prevention strategies, mitigation and attention to emergencies. In addition, the committee will be responsible for the diffusion of protection technologies with regard to disasters.
• To coordinate the efforts for restoration of the environment to reduce the natural risks in the badly-deteriorated areas of the country.
• Together with government agencies or with the civil society, prepare information and develop communication strategies for the prevention and mitigation to be applied to those projects that could have a bearing on the risk and vulnerability.
• To promote the integration of the relevant elements and mechanisms in a National Emergency System. The system should include aspects of the citizen participation and room for decentralized decisions and responsibilities.

b.  Specific Strategies

Previous phase: National Coordination

• Strengthen coordination at the level of emergency committees, departmental, municipal and local including the civil society institutions.
• Expand and strengthen the support of the previous actions to deal with emergency situations and disasters.
• Increase support of the processes of emergency/disaster training and education to increase the scope of action at the departmental, municipal and local levels.
• Strengthen the disaster planning system and include all the phases and stages of the disaster cycle.
• Continue the preparation activities for emergencies and disasters at the different levels with the involvement of other health sector institutions.

Response phase: Management and Control of Operations

• Based on the lessons learnt, complete the management model and control of operations.
• Promote and intensify the use of management and control of operations at the departmental, municipal and local levels.
• Periodically update the emergency plans and distribute them to the different sectors involved in responding to emergency and disaster situations.
• Maintain and develop mechanisms to coordinate the actions of institutions, humanitarian organizations, private enterprise to administer the international and national aid.
• Assure both the existence of well-trained personnel for the management of the supplies and of the required equipment for the logistics of the operations.
• Define local control mechanisms with the municipalities and communities to monitor the delivery of assistance to the beneficiaries.
• Promote the exchange of experiences with other countries in prevention and mitigation of disasters affairs.

Damage Evaluation and Analysis of Necessities (EDAN)

• Revision and adjustments of EDAN’s tools to facilitate their use.
• Development of an information system to be used with a data base to manage EDAN data.
• Training processes should include implementation practice as well as EDAN’s procedures.
• The departmental, municipal and local levels should be integrated into EDAN’s methodology.

National and International Humanitarian Assistance

• Develop permanent mechanisms for the administration of the national and international assistance in situations of disaster. These should not only take the national lessons learnt into account but also include room for an interchange of experiences with other countries.
• Promote the formation of human resources to be able to administer the supplies during the emergencies.
• Supply sufficient and adequate equipment to improve the logistic handling of the supplies.
• Define local control mechanisms to monitor the delivery of assistance to the beneficiaries.

Administration and Management of Temporary Shelters

• Previously identify the sites to be utilized as temporary lodging during emergencies and equip them to satisfy the basic requirements.
• Strengthen the local capacity for collecting data on the victims and keep such information updated to facilitate the estimations and calculations of the requirements for the supplies and shelters during the emergency.
• Establish a shelter management system using the emergency committees in accordance with their areas of responsibility.

Current Judicial Framework

The present judicial framework should be updated to make it coherent with the different phases of the disaster cycles, thereby guaranteeing the population’s full protection in emergency situations.

c.  Strategic guidelines in gender issues

Considering that disasters affect men and women differently, a gender dimension should be included in the various action phases not only to improve the quality of the response but also to open ways to progress towards greater gender equality. This perspective should guide the national system’s process for prevention, preparation and response in times of disasters. The following would be the strategies:

• Integrate training on gender and disaster as part of the formation process of the national system as well as in its subsequent operation. This applies to the public institutions as well as to the social organizations supporting the system.
• Prepare the necessary designs for the diagnostic, statistical, risk maps and every action to gather populational or territorial information, collect the information, segregated by sex and, if possible, by age.
• Damage estimates should also be segregated according to sex to facilitate that the first response actions are taken with the necessary focus on gender.
• Take into account women’s capacity in the disaster response process in terms of their ability to coordinate lodging, health committees, aid distribution, etc.
• Take into account the necessity to differentiate between the sexes for purposes of psychosocial assistance.
• Define, as a prevention measure, the specific attention to the female population which is in a particularly vulnerable situation (pregnancy, nursing mothers, elderly, children and adolescents).
• Take into consideration the need to prevent violence against women such as rapes and sexual abuse that sometimes occur in the shelters during emergency situations.
• Promote the inclusion of women in the rehabilitation works and those pertaining to the infrastructure especially where there is remuneration.

d.  Criteria for the progressive strengthening and modernization of the National Emergency System

The system is the result of an expansion process of COEN’s (National Emergency Committee) institutional functions. It is coordinated by the Ministry of the Interior.

Organizational aspects

• The National Prevention System is civil in character, multi-sectoral (with participation of the State and civil society), participative, highly-decentralized, modern and operates on two (2) planes: a) prevention and mitigation and b) response to emergency.

Dimension and scope

• The civil protection is not only viewed in its capacity to react to emergencies but also in its involvement in the rescue of victims and the supply of lodging and food. It also undertakes related actions with regard to the social reinsertion of victims, citizen participation and the decentralization in the decision process for disaster prevention.
• It also provides for the population’s full participation in the process of seeking and arriving at responses and solutions to their problems, bearing in mind the predominance of horizontal relations of respect among the different sectors and genders.

Regulatory framework

• It is imperative for a national emergency system to have the back-up of a legal body to provide the framework of effective action for the fulfillment of its targets. The modernization of the Civil Defense Law of 1976 permitted the contemplation of disaster prevention activities to cope with the consequences, promote reconstruction and reinsert the victims after the occurrence. In like manner, it would define the role of the institutions involved in the different stages of the process and assign responsibilities for different functions to each institution.

Decentralization and participation

The system will have a participative, decentralized character which implies the setting-up of an organizational network linked at all levels starting at the community and passing through the government and local instances, departmental and microregional, up to the centralized and specialized bodies such as the hydrologic and meteorological services, the geotechnical research center, the Salvadorian armed forces, the National Civil Police, as well as other dependencies of the Ministries of Agriculture, Environment and Natural Resources, Public Works, Economy, etc.

Education

Education is the means by which it is hoped to achieve the sensitization, organization and planning of effective actions to reduce vulnerability while, at the same time, strengthen the capacities for disaster prevention. Although these efforts will be developed in the areas of formal and non-formal education, attention will also be paid to those sectors that, by reason of physical location or socioeconomic profile, are more likely to be affected by the disasters.

Information and communication

Information must be reliable, opportune and accessible to all members of the system, as well as to the population at risk. This implies counting on at least one national center for information on disasters which should be equipped with modern technology and qualified technical personnel to conduct the following functions: acquire and process information, diffuse it in a timely manner through corresponding channels and design and activate it with that purpose. All these will guarantee the proper functioning of the National Emergency System.

Social equality and gender focus

Disasters affect the different social sectors and genders in distinct ways - all with different conditions, positions, vulnerabilities and capacities that should be taken into account when designing the prevention measures, response, rehabilitation and reconstruction to obtain effective and integrated solutions. These aspects must include a transversal element in every process, plan, program and project to be addressed to contribute not only to the reconstruction but also to development.

Regional dimension

The system anticipates the exchange of knowledge, strategies and resources with similar facilities in the rest of the Central American countries in an effort to improve effectiveness in prevention and attention to disasters.

2.  Health

2.1  Mitch’s effects

a. Direct damage to health

The Salvadorian health system underwent extraordinary pressure due to Hurricane Mitch. During the first stage, the demands were centered on emergency attention in the areas more gravely affected. Subsequently, the results were felt in the intensification of preventive works around the country in an effort to minimize the epidemiological risks. In the specific case of cholera, new cases were reported. The fact that the disease was not present in the country two years before the disaster testifies as to the epidemiological threats that resulted from damages to the water supply system, as well as to the human settlements.

In total, it is estimated that the indirect and direct damages caused by Mitch in the health sector reached the level of 101 million Colons (US$11.6 million). For details of the damages and their geographic location, see Annex 1.

b. Risk factors and additional threats produced by Mitch

The indirect and direct damages to the health sector do not themselves reflect the influence of Mitch on the country’s social health process. This exercise, still in evolution, is linked to several environmental and socioeconomic factors, as well as to the scope of service that the modern epidemiological science defines as an integral profile of health together with its tendencies in a determined dimension/population scenario. In keeping with this focus, risk factors produced by Mitch will have to be considered in terms of its possible effect on the social health process.

Risks

Aftermath

Immediate aftermath resulting from the emergency: skin diseases and gynecological infections caused by the flood waters.

Environmental, access and habitat conditions

• The extension of areas and environmental conditions favorable to the reproduction of infectious disease vectors.
• Surface environmental pollution in large areas of the country by fecal matter, solid and liquid wastes, animal corpses and organic material. Contamination of the superficial water sources as well as of the deep wells and other phreatic sources added to the difficulties of access to the victim populations to potable water, increasing the risks for diseases such as cholera.
• Lack of access of the population in affected areas to waste disposal systems; this occurred at the family as well as the community levels.
• Increment of the housing deficit in the affected areas.

Human and populational situation

• Weakness of the nutritional conditions in terms of quantity and quality in the affected population, particularly among the more vulnerable groups, thus increasing the susceptibility to endemic diseases and epidemics including those ailments of an infectious-contagious and transmittable nature.
• States of stress and anxiety, rupture of links and psychosocial factors related to family and community due to population displacement in the affected areas.
• Increase of internal migrations.

While also taking the previous elements into account, there are some areas that, in addition to having been seriously affected by Mitch, coincide with settlements of populations that were moved at the end of the civil war, among them, those benefiting from the land transference program. In these communities, the social, economic and environmental settlement process and the development is still fragile and in its initial stages.

Threats

• The possible increase of the more frequent infectious-contagious diseases within the high-risk groups.
• Possible interference with the epidemiological balance of the vector-transmissible diseases.
• Possible disturbances in the eradication and control of the immuno-preventable diseases.
• Possible recurrence of epidemics at the national level of water-related diseases (cholera).
• Possible permeability to epidemics of transmissible diseases existing in neighboring countries.
• Possible increment of the psychosocial problems associated with material and human losses in the affected areas.

2.2  Health situation in El Salvador: achievements and vulnerabilities

a.  Advances and achievements of the health system

The document "Measurement of the Targets of Half a Decade, 1996" published by UNICEF, indicates that the efforts carried out during the current decade have permitted the attainment of important targets in preventive activities, such as the coverage of immunizations which, in accordance with the available data, surpass 90% for Poliomyelitis, Diphtheria, Whooping Cough and Tetanus in children less than 1 year old. This coverage level has allowed the eradication of Poliomyelitis and reduced the mortality caused by Measles. In addition, an important decrease of the mortality rate in infants has been achieved, 31 children for every 1,000 born alive.

Efforts have been made by the MSPAS to intensify the service network in terms of infrastructure, hours of hospital attention to the public and equipment. If, to the installed capacity of the social security, the offer is added from the private sector, in general terms, it can be said that the country possesses a service network that could satisfy the demand of the national population with the provision that the latter should be endowed with adequate and sustainable technical, human and managerial technical resources.

b.  Epidemiological profile

The epidemiological profile of the country presents different characteristics: on the one hand, some of the features of a developing country persist (infectious-contagious, vector diseases linked to poverty; limitations of access to potable water; lack of sewerage and education). On the other hand, the increase in the life expectancy of the population has pushed up the proportion of adults whose sickness profile varies in relation with a population that although is largely made up of young people, reports chronic-degenerative and heart diseases, as well as incidence of cancer, diabetes, etc., in addition to ailments associated with the environment in crowded societies such as traffic accidents, violence and mental illness.

The achievements in other sectors of the society especially the increase in the educational levels, the peace culture, the presence of democracy and the macroeconomic stability increases the demands of the population for health services within the public sector, as well as from the private institutions for social security which causes a greater pressure on the content and quality of the services in terms of equity, efficiency and quality of the attention.

c.  Context of the risks and threats

The majority of the Salvadorian population is young: 50% is not more than 20 years of age. It has a decreasing birth and mortality rates whereas life expectancy is growing. For every 100 productive persons, there are also 72 dependents. There is a high internal migration index basically towards the urban areas. Crime and violence, mainly when children and women are affected, have a negative impact on the public health.

In the epidemiological profile of the hospital mortality, some chronic, degenerative diseases are significant which is the result of an increase in life expectancy. The data indicates that children, pregnant women and elderly people constitute the groups of high-risk especially in the rural and marginal, urban areas. There is a considerable advance in the coverage of immunization of the population with the corresponding decrease in related diseases.

In the past years, the diseases transmitted by vectors have been kept at the endemic levels. The intense human and commercial exchange among the countries of the area – that have been affected by Mitch – increases the permeability to regional epidemics.

In this context, the direct damages and especially the magnitude and intensity of the risk and threat factors identified as possible consequences on the long-term on the public health, constitute the basis for a higher vulnerability in the sanitary situation of the victim population, as well as of the population in general due to the fact that the infectious-contagious and transmissible diseases – cholera, dengue, malaria, sexual, etc. – could reach levels of epidemic incidence.

2.3  Vulnerabilities of the Health System

Besides of the problems linked to the epidemiological health profile and in spite of the achievements already mentioned, there are still matters pending that indicate the necessity to continue to reforming and adapt the health system to the new context and problems that exist in the country. Hurricane Mitch has not only intensified these problems but also revealed the vulnerabilities while indicating the way to the necessary responses and transformations.

With the subject of public health, the disaster has revealed the greater vulnerability in the rural and urban marginal areas in terms of water-related diseases and lack of sewage: cholera, transmissible diseases and in general in the lack of access to primary health and hospital services.

The obstacles to the access to the services have different characteristics which include economic, geographic and cultural factors in addition to the lack of trust of the population towards the quality of the services. For a substantial part of the population, especially those in extreme poverty, the expenses for the health recuperation are way beyond their reach.

In geographic terms, it is not necessarily distance that is the limiting factor but the specific conditions of the streets, lack of bridges and high transportation costs.

On the other hand, the inequality in the geographic distribution of the population, the lack of medical supplies as well as material and equipment does not permit the institutions to fulfill their corresponding functions, especially the ones of the first level of attention.

Due to aspects such as centralization, lack of trained personnel, deficient administration information systems and overloading with activities that are not of priority, the form of management of the health resources (financial and physical: human and technical) results in over-lapping and losses.

The modernization of the Health Sector and the necessities for changes are not facilitated by the existing framework that establishes a health system structure in need of modification with regard to the responsibilities of various institutions that must redefine their mission to meet the health challenges of the next millenium.

The MSPAS faces serious financial difficulties partially due to the low national budget of which a high percentage is used to pay salaries, basic services and other fixed expenditures. This generates a deficit in the ability to cope with the health necessities of the population.

The law and regulations of the ISSS that makes this institution autonomous in terms of management and financing links it to the Ministry of Work and Social Security but it fails to establish both the connection between the health program and that of the ISSS and the MSPAS. Relations with the other institutions of the health sector are also not stated. There are still other institutions related to the social security that had been created independently without coherence with the principles of social security and without mechanisms of coordination with the MSPAS.

It is necessary to develop the human resources of the health sector at the institutional, local and community levels to improve the training output as well as the formation in the aspects related to prevention, preparation and mitigation with regard to disasters.

2.4  Strategic axles of response

The strategic focus for public health is based on a double key response: a) minimize the additional risks and threats caused by Mitch, on the short-term, and b) begin the long-term actions to reduce vulnerabilities.

This focus integrates the actions of the anti-epidemiological fight, reconstruction and improvement of the damaged infrastructure, the extension of the coverage and quality of the integral primary assistance oriented to lessen the problems of more vulnerable groups. It will also foster the National Process for Reform and Modernization of the Sector through which the decentralization process will have to be focussed on the more vulnerable and affected areas to promote a high degree of social participation, as well as the regional coordination in the field of disaster preparation and prevention.

The health sector reform process began in the country since 1993/94. In this respect, there is a general agreement on the fact that the process "is urgent, has great priority and cannot be postponed, requiring profound, judicial and structural changes in: a) the attention health model to the population; b) in the method of administering and financing the services, and c) in the political will and leadership to carry out these changes."

The challenge and the opportunity contained in the response to Mitch impact is based on the reduction of the vulnerability and disparity of the rural and urban marginal population in the face of higher environmental risks, characterized by insufficient coverage and epidemiological disease. The strategy is to strengthen and modernize the public health system and basic services in order to maintain and increase the progress in public health achieved on the national scale during the last decade.

The ordering of the strategic axles that are detailed in the following paragraph is a response to the necessity to confront the more immediate threats in order to reduce the vulnerabilities and epidemiological weaknesses.

Short-term axles

a.  Attention to the population

• Attention to diseases caused by poverty and lack of water as well as the infectious/contagious, EDA, malnutrition, etc.
• Nutrition programs with an emphasis on the more vulnerable groups.
• Educational programs and promotion at the institutional and community level of health to women, adolescents, the disabled and elderly persons in poor rural areas and urban marginal zones.

b.  To improve the basic services and primary attention

• Provision of water supply and sewerage in the urban and rural areas.
• Improvement of basic health in the urban and rural communities.
• Rehabilitation of roads and provision of electricity to rural areas.
• Administrative decentralization of the basic services at the municipal and community level, at the same time supplying organizational skills and promoting communal participation.
• Reconstruction of the MSPAS infrastructure for the primary attention, considering the relocation of damaged units in high-risk situations.
• Prevention and promotion of health with the full participation of schools, the civil society, promotion networks, women and other participants.
• Epidemiological monitoring system based in the community to cover the marginal and more susceptible areas for the decision-taking process in health at the local level both in ‘normal’ and emergency situations.

c.  Prevention and preparation for disasters

• Information and early alert plan.
• Training and organization for the prevention and response when confronting disasters locally, with special emphasis on the capacities shown by the women.
• Community participation based on cultural and local organization.
• Epidemiological monitoring system as well as its plan for intervention in the frontier areas.

The participative decentralization enables the State to increase its effectiveness in the provision of public services. It also helps the State to better understand the population’s demands. Similarly, it enhances the development of social responsibility of all the local participants, allowing the users to benefit from improved services.

Long-term axles

a.  Preparation, prevention and response to disasters with a local-level focus

• The National health system should function as a unit not fragmented and must therefore be established in an integral manner.
• The prevention and mitigation system for disasters must be based on the experiences of the affected communities, civil society and local sectors.
• Organized and interdisciplinary structures at the municipal level must be promoted.
• There must be a legal framework together with regulations to organize the responsibilities and participation of the municipalities, private development entities and the local civil society.
• Internal and external resources must be integrated to carry out actions in the community.
• Democratic spaces should be provided to facilitate the health construction process with an emphasis at the local level for the establishment of public health policies.

b.  Improvement of the scope of basic services in vulnerable rural and urban marginal areas

• Adequate and solid urban and rural housing programs.
• Reconstruction of basic hospitals as part of the health system incorporating risk and vulnerability criteria for natural disaster.
• Administrative decentralization of basic services at the municipal and communal level with strong organization.

c.  Strengthening of the structure and scope of primary attention in the public health services

• Substantially improve the quality and scope in the rural areas to achieve full equity.
• Integral transformation of the models and programs for the attention of more vulnerable people (pregnant women, handicapped persons, children, indigent, elderly, violence victims).
• Decentralization of the managerial processes to strengthen local planning for the health services with the target of efficacy and efficiency in the utilization of resources in the more vulnerable areas.
• Participation of municipalities in the health services underlining the water quality control, basic sewerage and disposal of wastes.
• Development of a monitoring and evaluation system of the process as well as of the results and impact of the interventions made at the local and community level with the civil society’s participation.
• To conduct programs that guarantee the universal access to the reproductive health services including birth control and sexual health. This will promote the rights of the couples and individuals to decide, freely and responsibly, on the number of children and the spacing among them.

d.  Strengthening of the human resources for disaster prevention and health sector reconstruction

University level

• Revision and transformation of the curricula for the technical and professional personnel in health.
• Strengthening of the master programs in public health.
• Development of specializations in natural disasters from the public health standpoint.
• Scientific and technological research to learn about the phenomena and effects of the prevention and mitigation systems for natural disasters.

Local level

• Training the local, intersectoral teams in financial and strategic administration.
• Network of community promoters trained to deal with disasters, in coordination with the local participating institutions.
• Rescue and valorization of the natural and cultural practices at the local and community levels.
• Continuous training in preparation and prevention of disasters as well as in all other aspects of promotion of social health at the local level, with a focus on: 1. teachers and students; 2. local personnel in public health; 3. municipal personnel; 4. civil society, local participants, health promoters and community personnel, with the full participation of women.

e.  Financial mechanisms and social equity

• Alternative and complementary ways of financing health at the local level with the participation of: municipalities, civil society, foreign corporations, private sector and associations.
• Higher budget and additional technical and professional technical resources in vulnerable areas.
• Municipal financial resources for primary attention, payment of health promoters with social monitoring mechanisms to increase the equity of the scope in public health programs in vulnerable areas.
• Decentralized financial mechanisms at the local level to enable the intersectoral teams to manage the investments and sustainability of health programs.
• Extension of the financing for "healthy municipality" programs as part of the application of the Public Health Policies.

f.  Judicial, institutional and regulatory framework

• Expanding the role and functions of the civil society’s health organizations with emphasis on the health promoters and on the integration of community personnel at the local level.
• Reforming the roles and responsibilities of the municipalities for the health regulations of the disaster emergencies.
• Democratic room for the "healthy" policies that could favor the integral development of the vulnerable areas and municipalities in the countryside as well as in the urban, marginal areas.
• To generate conditions of social, political consensus at the national level as well as adequate managerial conditions to promote the transformation and modernization process in the health sector.

3.  Housing

3.1  Damages caused by Mitch

According to COEN’s figures, 10,372 homes were destroyed. The damages were concentrated in the rural areas, especially in those located along the coast and the plains of the vulnerable watersheds. The impact of the loss of these houses has to be added to the high deficit levels of housing resulting in a situation that makes it imperative to initiate permanent solutions. In addition, and according to official data, 36,174 homes in high-risk urban and rural areas, represent a population that must receive attention within a period of not more than 4 years – 2001-2004 – in order to diminish their high susceptibility levels.

3.2  Key issues in the vulnerability of the housing sector

Mitch’s effect on the housing sector revealed, in its full magnitude, the progressive degree of vulnerability of the human settlements throughout the country. This situation is accompanied by a process of environmental degradation in which different factors are combined: deforestation – intense rainfall – agricultural soil losses – landslides – floods – lack of effective habitat planning and management mechanisms – high percentage of poorly-built housing and two-thirds of the population in conditions of poverty and extreme poverty.

The Working Committee for Housing of the Nation’s Plan has identified a set of economic, technical, territorial, regulatory and environmental factors that have a bearing on the problems faced by the housing sector. The following has been highlighted:

1. Lack of equity distribution of the public investment. The general budget for the housing sector has been reduced during the past six years. There have been occasional limited allocations of public resources to maintain a strategy of ‘contribution’ to housing by means of transferences to sectors in conditions of vulnerability, poverty and extreme poverty.
    
2. Insufficient investments in social infrastructure particularly in rural areas. Based on data from the "Homes and Multi-Purpose Poll (1997)", only 65.8% of homes at the national level had water supply, either through pipelines or by access to a public fountain. If this rural coverage is classified, the conclusion is that 16.2% have access to water through pipelines; a high percentage of the population settles in places without basic services.
    
3. A high percentage of human settlements located in high-risk areas that lack the possibilities of investment in infrastructure to reduce their vulnerability.
    
4. Financial strategies directed only towards the formal sector, absence of housing credit for the informal sector, high rates of interest decreases the purchasing capacity and the unemployment are limiting factors for the procurement of housing through the commercial banking system.
    
5. Lack of housing offers for families with incomes lower than 2 minimum salaries.
    
6. Lack of quality control for the inputs and construction products. Absence of regulations and knowledge on the potential utilization of quality control systems.
    
7. Laws for urban development that increase the costs or prevents the feasibility of housing solutions for populated areas.
    
8. Lack of territorial order plans at the national and municipal levels that could regulate and promote the location of human settlements, the social and economic activities of the population, as well as the spatial development that could achieve social security and stability through the optimum use of the natural resources.
    
9. Difficult access among the low-income families to housing areas. Inexistence of a regime for the utilization and ownership of the land in order to decrease the speculation, promote development and enable accessibility to housing.
    
10. A limited social policy which results from the reduced allocation of budgetary resources in this area. Under these circumstances, it is not possible to reach a solution to the progressive problem of vulnerability in the human settlements and it is also difficult to reduce the high housing deficit.
     
11. Little use of local traditional materials whose manufacture has improved for housing construction. High overseas dependency on elaborate and semi-elaborate inputs.

3.  Lines of strategy

1. The activities for rehabilitation and reconstruction of human settlements and housing affected by Mitch should be based on the application of a strategy that takes into account poverty mitigation, vulnerability reduction and the improvement of the local managerial capacities for territorial planning.
    
2. Housing and human settlement programs should be decentralized so that municipalities and populations become active parts in the perception of the demand, as well as in the execution of the programs for territorial order and housing construction. For this purpose, it is important to strengthen the municipalities’ technical units which will contribute to achieve higher levels of coherence between the territorial order plans and the development of human settlements.
    
3. The rehabilitation and reconstruction plans for housing and human settlements should create a balance between the quality of living conditions and the utilization and preservation of the resources and natural systems in each location.
    
4. Based on the sustainability, the large social and economic investments required for the construction of housing for the victims should be coordinated to facilitate participation, cooperation and consensus among the participants. This will be possible through the strengthening of a mechanism for coordination, dialogue and institutional cooperation among the different government organizations of the municipalities, housing sector and private entities specialized in human population settlements.
    
5. The programs and projects should be coordinated among the following institutions: Ministry of Foreign Affairs, Vice-Ministry of Housing and Urban Development, local governments, National Secretariat for the Family and civil society organizations.
    
6. Incorporate into the strategies for development and reconstruction of the human settlements, gender policies that take into consideration the different needs between women and men and their social and economic relationships. The purpose is to recognize the women’s role as a factor in the social promotion and stabilization for development, simultaneously providing the possibility of co-ownership of property.
    
7. Promote a housing and human settlement policy to strengthen the existing financial mechanisms and to implement others that could serve the population at high-risk.

4.  Specific recommendations

1. Updating and creation of an information system to facilitate the establishment of criteria and priorities for the beneficiaries.
    
2. Creation of an advisory committee with the participation of government organizations in the housing sector, municipalities, private entities and enterprises as well as community representatives. The objective would be to facilitate the coordination of efforts, the monitoring and coherence in the execution of programs for rehabilitation and reconstruction of human settlements.
    
3. Creation of a special fund with the participation of GOES/VMVDU/private development organizations/municipalities and private enterprises to assure the procurement and legalization of land in favorable conditions (rates and payments) addressed to those families living in high-risk regions for their relocation.
    
4. Creation of a fund to provide technical assistance to low-income families as well as to rehabilitate the 10,372 homes destroyed by Mitch.
    
5. Creation of a mechanism "credit-contribution" for access to financial resources addressed to 36,174 families that are currently in rural and urban areas of high-risk.
    
6. Promote a permanent mechanism for inter-institutional coordination in order to guarantee proper services to the human settlements.
    
7. Promote the execution of works according to the modality (mutual aid and self-help efforts) with the participation of private organizations, local governments, private enterprise and government institutions of the sector.
    
8. Promote and strengthen municipal capacities to apply the regulations, technical economic and social criteria required by the process of territorial order in the regions affected by Mitch.
    
9. In the intervention areas, develop a plan for the human settlement oriented towards the reduction of the vulnerability levels, allowing the full participation of the victims in coordination with municipalities, institutions of the sector and private enterprise.
    
10. Establish the conditions necessary to take into account the family preoccupations with regard to construction materials, design, size and access to basic services.
     
11. The Vice-Ministry of Housing and Urban Development will propose an execution plan for the rehabilitation and reconstruction projects of human settlements in accordance with the following agenda: 1999-2000, attention to 10,372 families that lost homes; 2001-2004, attention to 36,174 families located in high-risk areas.

4.  Reconstruction and expansion of the local infrastructure

4.1 Damage to the local infrastructure

The primary sectors for attention to the local infrastructure that act as catalyzers to start the process of recuperation in areas of extreme poverty hit by Mitch are as follows:

• Potable water and sewerage system to provide the primary necessity at the basic level whose provision directly sustains human health: water.
• Roads as a linking mechanism among all levels of society.
• Rural electrification: even though this is not a basic requirement, it is directly connected to the quality of human life in the promotion of the social and productive development.

In Annex III, the details of the damages for each sector can be found.

4.2  Sector vulnerabilities

4.2.1  Potable water and sewerage

In accordance with the "Homes and Multiple Purpose Poll (EHPM-97)", before Mitch, it was estimated that the coverage of water through pipelines at the rural level reached only 26.5% whereas in the urban zones, it was 71.1%. This has direct consequences on the health and living conditions of the population without water supply.

4.2.2  Access roads

The lack of access roads is a limiting factor already mentioned. This is particularly true of the small farmer who perceives a decrease in his operative margins and a lowering in his income level.

A FUSADES report has indicated that, before Mitch, the urgency for the rehabilitation of 1,737 km of rural roads to foster the development of 689,000 ha under cultivation or with some agricultural potential. On the other hand, the Ministry of Public Works states that it only has resources to maintain 50% of the existing road network.

4.2.3  Rural electrification

According to the EHPM–97, the scope of the electrical distribution in the country reaches 79.5% of the population. Even though, in the urban areas, it reaches 95.9%, in the rural zones it is very low, a little more than 55.7%. In the years to come it will be necessary to intensify rural electrification and, since the distribution enterprises will probably not be interested in supplying electricity to the rural areas, the government intervention supported by the international community becomes necessary.

It should be mentioned that at the level of electric generation, it will be necessary to monitor the sedimentary deposits in the reservoirs. In addition, it is important to incorporate into the monitoring, national programs focused on local management to help reduce the vulnerability of the reservoirs: integral management of watersheds, protection of the environment and land utilization order. All this has to be combined with a permanent alarm system to minimize the effects of floods such as the ones that occurred in the low-lying areas of Rio Lempa.

4.3  Institutional limitations to the provisions of basic services

In El Salvador, there are marked social and territorial imbalances that affect issues such as food and nutrition, inequalities in the quality of life, deterioration of the ecosystem, productive infrastructure, installed productive capacity, quality of human resources, etc.

The concentration of functions at the central level is the cause of this territorial imbalance. Until there is a solution to the current decentralization process, it will be very difficult to adequately deal with the regional, urban and rural imbalances.

A new balance between administration and territory is being sought in the country. The territorial organization of the administration does not fit the current requirements of the society which explains the deficit of rural public services. It is therefore apparent that the main institutional vulnerability is the excessive operative centralization.

This susceptibility is the responsibility of the government and, in order to overcome it, a commitment on national policy is required which will imply an ample consensus level.

4.3.1  Potable water and sewerage

Currently, 70% of the municipalities has centralized potable water and sewerage systems. The services are fully and excessively centralized within the metropolitan area of San Salvador (AMSS), with 80% of water supply resources and 79% of sewerage. There are 78 municipalities that manage the service together with their communities of which the more successful cases are found in communities between 1,700 and 3,000 inhabitants.

The current institutional model does not favor the extension of services at the rural level. It is also an indirect source of the deterioration of hydraulic resources and discourages the rational utilization of water. In addition, the projects under the present model have not included citizen participation in the management nor organizational and educational procedures that foster the effective participation of local communities. A law to create a new legal framework in the provision of water services has been recently presented to the legislative authorities.

4.3.2  Access roads

Within the Ministry of Public Works, a closer linkage is badly needed among its highly centralized maintenance services: it is necessary to coordinate the maintenance of the rural roads with similar activities developed by local governments.

The result is under-utilization of the already-scarce available resources for the maintenance of roads. There are no sustainable programs that take into account the roads’ integrity such as drainage systems, culverts, preservation of the right of way, etc. In addition, it is necessary to leave sufficient room for the participation of citizens to share responsibility for the maintenance of rural roads.

All these aspects of deficiency were highlighted by Mitch.

4.3.3  Rural electrification

The electrical distribution has been totally privatized and the control of the regulations and services falls under the responsibility of the Electrification and Telecommunication General Superintendency, SIGET. There are regional enterprises in charge of the operative aspects under the scheme of a quasi-monopolized government generation.

In some cases, there are initiatives for sub-distribution under the responsibility of smaller enterprises and social cooperatives. The economic situation of the latter is often critical due to the high prices of the energy sold "in blocks" by a larger company, which does not correspond to the purchasing capacity of the rural population.

In spite of the progress represented by a new legal and regulatory framework for the sector, the past public investments are still pending. In effect, for financial feasibility reasons, the new private enterprises will not expand with traditional solutions to provide the sectors without service. The public policy will therefore have to generate the technical requirements and absorb the investments required to carry the service to the rural areas.

In addition, there are no regulatory framework nor initiatives to create local enterprises to administer the service that could be managed with human resources and methodologies to guarantee their long-term subsistence.

4.4  Strategic focus

After a devastating phenomenon like Mitch, the reconstruction requires the adoption of new criteria with regard to mitigation to protect the population from exposure to similar damages.

The considerations on over-prioritizing, temporary profile and the changes required in regulations on design, construction and use of soil are important elements to be considered in agreement with the current legislation in the country. At any rate, a reconstruction will not be possible without an element of qualitative improvement with respect to the present situation.

Another aspect of the feasibility of every reconstruction process is the internal capacity to conduct the process at the required programming to avoid surpassing the natural absorption capacity. In the fragile balance between the urgent replacement of what was lost and the capacity to carry out the works required, El Salvador must recognize the situation in which it finds itself and prioritize its actions.

The main guidelines for reconstruction and reformation after Mitch are those that will efficiently absorb the direct and indirect effects of the phenomenon. Some examples reflect clearly this concept: it was verified that some structures were insecure and that several infrastructure works were located inadequately such as roads, bridges, electrical distribution systems, water systems, public buildings, etc. It was also noticeable that there is a lack of schemes for watershed management with its corresponding works and finally it is clear that there is a lack of prevention and disaster control works for floods, management and mitigation of its consequences.

On the other hand, the strategic vision to overcome the vulnerabilities will consider all macroeconomic principles to avoid unwanted consequences that sometimes occur when ambitious programs are undertaken without the required support of the communities and municipalities.

Strategic Vision: the Local Development Program (PDL)

The Local Development Program is the strategic vision of efforts to overcome the effects and poverty caused by Mitch. Conceptually, it is a process to generate the capacity at the municipal level and at the community to promote the economic, social and political growth of the population. This development is understood as a self-sustained, progressive and equitable process that also has aspects of gender and environment, based on the participation of local residents.

This focus considers the participation of the population in which gender equity plays a central role and in which the municipal governments acts as facilitator: the communities are the protagonists.

The primary objective is the development of a progressive process for the transference of power, competence, responsibilities and resources from the central government to local government in their role of politico-administrative units that form part of the national judicial system and also represents the communities’ interests. The following are the specific objectives:

1. Create strengthen and consolidate local processes for the improvement of the communities and municipal governments with the objective of promoting their own development, mainly in two areas:

• organized and democratic participation of the civil society in processes of planning, formulation, execution and operation of communal and municipal projects and,
• autonomy and capacity of management of the local development by the municipal governments by means of a process of decentralization.

2. Provide the municipal and community infrastructure works aimed at the provision of social services and support of the economic development (education, water, health, rural roads, electrification, etc.)

Guidelines and regulations

• Participation and shared responsibility: this implies the decision-taking process for local development shared with the population. The municipal governments is one of the more important elements of the PDL because only in this fashion, can the projects respond to the population’s necessities.
• Decentralization and promotion of the municipal governments: with this, the participative role of the governments will be supported and strengthened for the promotion of local development with the objective of an improved management of public resources.
• Operative co-financing: as a mechanism for the multiplication of the central government’s resources. It supposes allocations of a local nature from the beneficiary community and municipal governments.
• Through the anticipated procedures, the projects will last the projected period and the social organizations will have sustainable processes for their continuous operation.
• Economic and social equity: the entire population will have the opportunity to participate in the planning. In this way, from the very beginning, the local government will take into account the interests, necessities and concerns of the population (men and women) so that the planning is carried out in accordance with local reality. This will focus the projects on the populations with more disadvantages.