NGO Another Way (Stichting Bakens Verzet), 1018 AM
01. E-course : Diploma in
Integrated Development (Dip. Int. Dev.)
Edition 01: 25 November, 2009
SECTION B : SOLUTIONS TO THE
PROBLEMS.
Value: 06
points out of 18 .
Expected work
load: 186 hours out of 504.
The points
are finally awarded only on passing the consolidated exam for Section B :
Solutions to the Problems.
Fourth
block: The structures to be created.
Value : 03 points out of 18
Expected work load: 96 hours
out of 504
The points are
finally awarded only on passing the consolidated exam for Section B :
Solutions to the Problems.
Fourth
block: The structures to be created.
Section 5: Services structures. [24
hours]
20.00 hours : Service structures.
04.00 hours : Preparation report.
Fourth block : Exam. [ 4 hours per
attempt]
20.00 hours : Service structures.
01. Drinking water structures : organisation.
02. Drinking water structures : technique.
03. Sanitation structures : organisation.
04. Sanitation structures : technique.
05. Waste recycling structures : organisation.
06. Waste recycling structures : technique.
07. Photovoltaic lighting structures.
08. Structures for the elimination of smoke in and
around homes.
04.00
hours : Preparation
report.
20.00 hours : Service structures.
10. Health structures. (At least 2 hours)
Preventive and curative health.
This
integrated development project covers structural measures for the prevention
of health problems in the beneficiary community. Most of the necessary steps
can be taken and paid for by the people themselves under the framework of the
local money systems set up without causing financial leakage from the project
area.
The social
and financial structures set up in the project area during project execution
also support, by their very nature and size , the formation of a mature
three-level curative health system as well. Solutions to curative health problems which
cause financial leakage from the project
area are, however, excluded.
The
following paragraphs describe what the project can do for public health in the
project area and what it cannot.
Introduction.
Good health is a major
factor for our quality of life. However, it is a development fallacy that good
health depends mostly on vaccination campaigns and medicines. Diseases are consequences,
not causes. A promise by an American
president to grant 18 billion dollars to the “fight against AIDS” is not in
itself negative, but it has little if anything to do with local economic
development for the world’s poor. Most of the money goes into the pockets
of the pharmaceuticals companies who
supply the medicines. Some of the rest of it goes into the hands of NGO organisations who pay their staff to
organise and control their distribution. It is possible that not a single
dollar of direct contribution be made to the development of the local economies
in the areas where the AIDS medicines are distributed.
Mass vaccination
campaigns are another example of
activities where large amounts of money are invested with the declared
intention of helping the poor in less-developed nations. Yet there is, with the
possible exception of polio, little real evidence that the introduction of mass
vaccination campaigns has reduced the rate of death amongst children either in
industrialised or in developing countries. Some reports indicate that more
children may have died as a result of being vaccinated than would have been the
case had they not been vaccinated. The negative, wide-spread effects of the use of mercury in vaccination campaigns
are only now becoming public. The continued use of mercury, now banned in many
industrialised countries, is believed to be continuing in developing countries.
Had the money spent on vaccines been used for basic
services such as hygiene education, the improvement of basic water management,
better drainage, and improved cooking stoves, much of the poverty in the world
could have been eliminated and the quality of life of children and their parents guaranteed. The
problem is that such basic services do not put profits into the pockets of
multinationals or supply work for expatriate “health specialists” from
industrialised countries.
Better health for all.
In reality health
improvement necessary for a good quality of life in project areas in poor
countries can best be achieved by following low technology, locally executed
non-industrialised initiatives. Examples, all of which are brought under the
Model, are hygiene education courses for women and in schools, clean drinking
water supply, a varied food supply, proper sanitation facilities and recycling
of wastes, proper aeration of homes and the elimination of smoke through the
use of better cooking facilities, drainage and the elimination of stagnant
waters, the use of simple, intelligent locally applied means to combat flies
and mosquitoes.
In industrialised
countries, the rate of occurrence of traditional infectious diseases had, with
the possible exception of polio, decreased to present levels BEFORE mass
vaccination campaigns were introduced. The improvements which had already been
registered are generally attributed to better food, better quality
accommodation, and better hygiene in homes and in public places. Logic would
suggest similar principles be applied to rural and poor urban areas in less
developed countries. This can be done locally, without the need for any
financial leakage. Especially if some basic medicines can be locally prepared
using locally grown medicinal plants.
Health and local development.
The Model tries to
distinguish between the major, the preventive, part of health services which
can be supplied within a local development area, and a second-level of
specialised curative services which cannot. A local development project cannot
substitute the state for construction and running of hospitals or the training
and payment of medical personnel, with the exception of the salaries of doctors
and trained nurses willing to work under the local money LETS systems set up
during project execution.
Where residents in
a given local development area must pay for medical services of any kind
originating outside the development area serious financial leakage occurs,
which reduces the amount of formal money in circulation available for other
purposes in the project area and restricts possibility of productivity
development there.
Viewed inversely,
funds supplied by donor nations in the form of grants or loans for health
improvement purposes is subtracted from their annual general development aid
quota, thereby reducing the funds available for integrated local development in
favour of the world’s poorest.
While in many
industrialised countries solidarity in favour of the weakest is often reflected
in health legislation, this is seldom the case in developing countries where
users often have to pay directly in cash for the services they receive.
Health education.
The (200)
health clubs for women and on-going hygiene education courses in the (40)
schools in the project area are sustainably
run under the local money systems set up. They include household hygiene, the need for keeping clean water clean, germ theory, water-borne diseases, skin
infections, worms, malaria, the sanitation ladder and nutrition. It is the
intention of the project that aspects relating to AIDS prevention, anti-conception
and family planning in general also be introduced and discussed. Course
material can also be extended to discussion of circumcision practices,
household violence, and the physical abuse of women and children, and child
labour. Some of these health related topics are taboo in some project areas.
Since the local people are themselves directly involved in project planning and
execution, there is little point in extending the courses to cover subjects
they do not wish to discuss. Sensitive cultural issues needing very careful and
patient management may be involved.
Health aspects
relating to drinking water supply.
The organisational workshops
for water supply will establish a network for the systematic control of water
quality. The following are some possible indications:
01
Organising systematic water sampling to keep a close check on water quality in
the wells and in the tank installations.
02 Hygiene education. Cooperation through the established Health Clubs with
locally operating health workers and the Regional Department of Health to
spread information and training of the users in the correct use of clean
household utensils, washing of hands before eating.
03 Equipment for water testing will be supplied to one of the local clinics and
paid for by the users on condition that water testing within the project area
be carried out free of charge.
04 Organisation of regular water sampling.
05 Water testing programme.
06 Hygiene education courses in schools.
07 Rules concerning special industrial and medical waste products.
Special
attention will be paid to keeping the clean drinking water supplied by the
project clean once it leaves the dedicated water tank in a tank commission
area, and in particular how to keep water recipients clean, how to store the
water safely, and how to use the water without contaminating recipients and the
water which is left over.
Health
and sanitation.
The introduction of a complete ecological sanitation system in the
project area should also have a profound effect on the health of the people
there. Risk of contamination of surface and ground-waters is eliminated.
Stagnant surface waters will be drained.
Organic and inorganic waste products will be usefully recycled and pests
eliminated from the environment. Relationships between (ethical and ecological)
animal husbandry and humans may over time be reviewed. The review is expected
to cover slaughtering practices and safe food storage and its safe conservation
for local consumption.
Insects.
Once
the local money system is in place in the project area, initiatives will be taken for the local
production of mosquito nets, fly-catching devices and similar and for the
natural biological elimination of harmful insects from homes and villages.
Stagnant
surface waters offering breeding places for disease-bearing vectors will be
eliminated by improving drainage from them.
Health
and smoke elimination.
The
adoption of high efficiency cookers and
the elimination of wood- and charcoal-burning will eliminate smoke hazards in
and around users’ homes. Smoke-related respiratory illnesses, the largest
single cause of illness and death amongst children and women in developing
countries, should be eliminated altogether. This is the first, and the most
important, step towards improved housing quality.
Health
and nutrition.
Improved
nutritional sufficiency and dietary variation can be expected to increase
resistance to illness throughout the project area. The fitter the people the
higher their work capacity and productivity.
Curative
Health structures.
This project is about the general improvement of the health of the
inhabitants in the project area by prevention of diseases through the
elimination of their main causes.
The proposed social and service structures set up by the project are
also optimally sized to receive doctors and nurses willing to work within the
framework of the local money systems once they are in operation. Doctors and
nurses paid (reasonable) formal money salaries by regional or government health authorities may wish to
return to the areas they come from and contribute to the local integrated
development under way there. Where necessary and legally possible, they can
supplement their formal money salaries by charging for their services under the
local money systems set up. “Unemployed” or “underemployed” doctors and nurses
originating in the project area may accept to work entirely within the local
money systems in operation there.
The following paragraphs on possible future medical structures describe
target sustainable health services for the project area. The realisation of
these services is not formally a part of this project, but the services must be
included in any integrated development vision for the area. It may take many
years for the required services to become a reality. It remains a task of the
project to use all of the social, financial, and productive structures it sets
up in the project area to promote their realisation. These structures include
the local money system which enables inhabitants to pay nurses and doctors fully or partly for their
services without their needing to have formal money for the purpose.
A three-tiered system is foreseen. It incorporates nursing services at
tank commission level, doctors’ services at well-commission level, and a
hospital facility at project level. These are described in the following
paragraphs.
Nursing
services at tank commission level.
The (200) tank commission areas provided for in this project each serve
40-50 families, or about 250-350 people. In principle, each tank commission
area should provide work for one (qualified) specialist nurse. Suitable accommodation and a reception area
for the nurse can be organised and built by the local tank commission as soon
as the local money system is in place.
The project management will try to mediate with the Ministry of Health
in support of each local tank commission’s efforts to identify and attract a
nurse to its tank commission area.
As each tank commission organises nursing assistance, all of the members
served by the tank commission will pay a small monthly formal money
contribution into a Cooperative Health Fund (nursing section) run by the
project along the same lines as the Cooperative Local Development Fund. The
population will decide how much they pay into the Cooperative Health Fund
(nursing section), taking eventual contributions by state and national Health
Authorities into consideration. Where nurses
are required to serve people in more than one tank commission area, the
associated costs will be divided amongst the tank commission areas served and
the monthly formal money contributions of families into the Cooperative Health
Fund (nursing section) adapted accordingly.
Local money contributions to nursing costs will be paid by the local
populations under the local money systems in the normal way. They may take the
form of a monthly retainer payment debited in equal shares to all of the adults
in a tank commission area; eventually together with a specific (limited) local
money charge to the patient for each consultation. Formal money costs of
medicines and equipment are paid out of the Cooperative Health Fund (nursing
section). The sick are therefore
collectively insured by all adult tank commission members for the formal money
costs of their (basic) medicines. Purchases of
(basic) medicines are pooled at project level to reduce costs.
One nurse for each tank commission area is a target to be reached over a number of years, and may depend on
improvement in local education levels and training of nurses from the project
area.
The nurse will be equipped with basic equipment and materials necessary
for (her/his) nursing activities. Lists
of very basic medical supplies for the nursing posts would be chosen on advice
from health service specialists from the World Health Organisation's model list of essential
medicines.
Special
priority will be given to the treatment of (list of particularly common
area-specific illnesses) which are common in the project area.
Doctors’ services at well
commission level.
The (40) well commission areas provided for in this project each serve
350 families, or about 1750-2500 people. In principle, each well commission
area should provide work for one (qualified) doctor. Suitable accommodation and a reception area
for the doctor can be organised by the local well commission as soon as the
local money system is in place. The
project management will try to mediate with the Ministry of Health in support
of each well commission’s efforts to identify and attract a doctor to the
area.
As each well commission organises qualified doctor’s assistance, all of
the members served by the well commission will pay a small monthly formal money
contribution into a Cooperative Health Fund (doctors’ section) run by the
project along the same lines as the Cooperative Local Development Fund. The
population will decide how much they pay into the Cooperative Health Fund (doctors’
section), taking eventual contributions by state and national Health
Authorities into consideration.
Local money contributions to doctors’ costs will be paid by the local
populations under the local money systems in the normal way. They may take the
form of a monthly retainer payment debited in equal shares to all of the adults
in a tank commission area; eventually together with a specific (limited) local
money charge to the patient for each consultation. Formal money costs of
medicines and equipment are paid out of the Cooperative Health Fund (doctors’
section). The sick are therefore
collectively insured by all adult well commission members for the formal money
costs of the (basic) medicines prescribed by their doctor. Purchases of (basic) medicines are pooled at project level
to reduce costs.
One doctor for each well commission area is a target to be reached over many years, and may depend on
improvement in local education levels and training of doctors from the project
area. The target ratio of doctors to
inhabitants is in line with that currently widely accepted in industrialised
countries.
The doctor’ post will be equipped with basic equipment and materials
necessary for (her/his) professional
activities. Supplies of medicines for the doctors’ posts would be chosen by the
doctors themselves, where requested on advice from health service specialists,
from the World Health Organisation's model list of essential
medicines.
Special priority will be given to the treatment
of (list of particularly common area-specific illnesses) which are common in
the project area.
Project area hospital.
The
size of the project area (50.000 inhabitants) is also designed to take a local
non-specialised centrally located hospital facility with optimal access from
all of the population centres in the project area. The hospital should have 1
bed for each tank commission area. This project provides for (200) tank
commissions. The local hospital unit should therefore be equipped with
(200-220) beds.
The
hospital unit should be able to handle the medical situations most commonly
arising in the project area. These include trauma and emergency services,
rehabilitation, maternity issues, the treatment of infectious and water-borne
diseases, and some basic surgical interventions. The hospital will provide active support for
hygiene education activities, drinking water quality control, and HIV/AIDS and
family planning campaigns in the project area.
It will support doctors’ posts with advice on nutrition matters, child
and youth care and mental health problems. It will provide a front office
filter service for the diagnosis of more complex conditions, and provide
liaison for their handling in specialised hospitals outside the project area.
Advanced
hospital services are the responsibility of the Department of Health of
(country).
The
project can facilitate hospital services and activities which can be carried out
under the local money system set up. These include non-specialist services,
such as the supply of guards, gardeners, cleaning services, washing services,
non-qualified kitchen services.
Non-specialised
individual care following release from hospital is covered under the local
money systems at well-commission (doctors) and tank commission (nurses) levels.
Simple
hospital construction can be carried out under the local money system, once
qualified design and specifications for buildings suitable for the project area
are available.
Other specialist medical and
paramedical activities.
There are many
other standard specialist medical and paramedical support activities which
should be made available in the project area, including dentists, physiotherapists,
optometrists, psychiatrists and psychologists.
The project can facilitate the introduction of such
services and activities where they can be carried out under the local money
system set up.
Improvements
in the general quality of life of the local inhabitants over the years should
gradually entice such specialists to (return to) the project area.
Transport of
patients.
As soon as the local money system to be set up is in place and drivers
willing to work under the local money system are available, the project
management may attempt to obtain national government support and/or separate
external seed funding for the purchase (where appropriate second hand) of up to
four four-wheel drive vehicles suitable for the transport of patients to the
project area hospital or from the project area to the hospitals nearest to the
project area.
As the project management brings an ambulance service to each ambulance
district (expressed as a cluster of well-commission areas), all of the members
served by the well commissions in question will pay a small monthly formal
money contribution into a Cooperative Health Fund (ambulance section) run by
the project along the same lines as the Cooperative Local Development Fund. The
population will decide how much they pay into the Cooperative Health Fund
(ambulance section), taking eventual contributions by state and national Health
Authorities into consideration. The formal money amount must be sufficient to
pay for fuel, spare parts and long-term vehicle replacement. Drivers’ salaries
will be paid under the local money systems. Long-term replacement reserves may
be loaned to the Cooperative Local Development Fund and recycled in the form of
interest-free micro-credit loans until they are needed.
Local manufacture
of health products.
Priority
will be given taken under the financial structures created in an early phase
of the project to initiatives for the
local manufacture for local use of devices and products for the rehabilitation
of the physically handicapped. These may
include basic assistance to individual
mobility such as wheelchairs and
artificial limbs. Steps may also be taken for the local production of
elementary medicines, including those using locally available medicinal plants,
and contact lenses. .
Mine clearance.
There are no parts in the project area which
are known to be mined.
Ecological hazards.
There are no known ecological hazards in the
project area.
A primary health care package.
For a general view of primary health
care suitable for the project area, refer to:
The Primary
Health Care Package for South Africa : a set of norms and standards.
1. Research.
Make a
one-page summary of the health services in your chosen project area, for each
of the categories listed above.
2. Opinion.
On one
page give a description of the potential effects of the introduction of
local money systems on health services in poor countries.
3. Research.
On one page,
describe how the three levels of structures pf integrated development projects
automatically adapt to the health structures considered necessary to a good
quality of life , both in industrialised and in poor countries.
4. Opinion.
On one page,
write a dialogue between the Chairperson of a well commission part of an
integrated development projects and a
doctor from the well commission area.
◄ Fourth block : Section 5: Services structures.
◄ Fourth block : The structures to
be created.
◄ Main index for the Diploma in
Integrated Development (Dip. Int. Dev.)
"Money is not
the key that opens the gates of the market but the bolt that bars them."
Gesell, Silvio, The
Natural Economic Order, revised English edition, Peter Owen,
“Poverty is created
scarcity”
Wahu Kaara, point 8
of the Global Call to Action Against Poverty, 58th annual NGO
Conference, United Nations,
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