Director,
T.E.(Terry)
Manning,
Schoener 50,
1771 ED
Wieringerwerf,
The Netherlands.
Tel:
0031-227-604128
Homepage:
http://www.flowman.nl
E-mail:
(nameatendofline)@xs4all.nl : bakensverzet
and
"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,
05..47 THE
PROJECT AND HEALTH AND 05.62 HEALTH ASPECTS
05.47.01
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.
05.47.02
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.
05.47.03
: 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.
05.47.04: 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.
05..47.05 Health education.
The 297 health clubs for women and on-going hygiene education courses in
the 60 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.
05..47.06 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.
05..47.07 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.
05..47.08 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.
05..47.09 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.
05..47.10 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.
05..47.11 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.
05.47.12 Nursing services at tank commission level.
The 297 tank commission areas provided for in
this project each serve 20-25 extended families, or about 200-350 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.
05.47.13 Doctors’ services at well commission
level.
The 66 well commission areas provided for in this project each serve
175-250 extended 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.
05.47.14 Points for the distribution of
medicines.
The 66 well commission areas provided for in this project each serve
175-250 extended families, or about 1750-2500 people.
Pending the establishment of doctors’ practices as foreseen in paragraph
05.47.13, suitable accommodation for points for the distribution of medicines
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 set the distribution points up.
The medicine distribution points will be operated, in cooperation where
possible, with the local medical
profession and the Ministry of Health. They should be open each day at times
offering a reasonable possibility for all members of the population to collect
their medicines there. The medicine distribution points are not intended to act
as pharmaceutical retail outlets. They offer a cooperative service for the
collection and distribution of patients’ prescriptions. They may also hold a
small stock of very basic medicines at the lowest level provided for in :
The Primary
Health Care Package for South Africa : a set of norms and standards.
Personnel serving the medical distribution points should have at least
some basic medical training. They must be willing partily or wholey to be paid
under the local money system.
Local money contributions to personnel 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 well commission area; eventually together with a
specific (limited) local money charge to the patient for each withdrawal of
medicines.
All of the members served by the well commission will pay a small
monthly formal money contribution into a Cooperative Health Fund (medicines
distribution section) run by the project along the same lines as the
Cooperative Local Development Fund. The population at well-commission level
will decide how much they pay into the Cooperative Health Fund (medicines
distribution section), taking eventual contributions by state and national Health
Authorities into account..
Formal money costs of medicines not paid by the
Health Department or other external organisation are paid out of the
Cooperative Health Fund (medicines distribution 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.
Special priority will be given to the treatment
of (list of particularly common area-specific illnesses) which are common in
the project area.
05.47.15
Project area hospital.
The size of the project area 80.000 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 297 tank
commissions. The local hospital unit should therefore be equipped with 297
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.
05.47.16
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.
05.47.17 Transport of patients.
The project foresees the construction and operation of 66 bicycle ambulance to be housed near the medicine distribution centres at well-coommission level throughout the project area. The ownership of them and supervsion of their activities falls under the duties of the well-commission where thebicyle ambulance is based.
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.
05.62.18 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. .
05.62.19 Mine clearance.
There are no parts in the project area which
are known to be mined.
05.62.20
Ecological hazards.
There are no known ecological hazards in the
project area.
05.62.21 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.
FROM 05.40 DESCRIPTION OF THE
PLANNED SERVICE STRUCTURES
Next file :
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FROM 05.60 SUMMARY OF
IMPROVEMENTS TO THE QUALITY OF LIFE OF THE INHABITANTS
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05.61 Institutional developments.