IHD messages from an aged and dusty book
By Tyler Weber
Uganda
The means of conducting high quality and successful work in the field
international health and development (IHD) have long been discovered.
Currently I am at the MIHV site in Sembabule with Anna and Sarah. This
past week I have been assisting on a variety of projects including the
reorganizing of the sites' library. It is full of MIHV documents and
papers, brochures, reports, books, and magazines about IHD. This was a
tedious task full of aged dust that pairs lovingly with an already
heinous cough. It was a lovely experience. During a state of boredom I
happened to randomly flip open a book and word for word below is what
I found.
Key Messages from (p. 7)
- The need for dialogue and sharing with the community
- We already know far more than is required for the implementation of
PHC--the main issue is implementation
- Community work must not be based on externally formulated resolutions
- Approach to communities must be based on respect and acknowledgement
of the fact that communities know what they want
- Communities are already mobilized and organized and know their
problems are as they have often prioritized them
- Communication with communities must be based on simple understandable messages
- "Harambee" is an example of a community mobilized to respond to its
own needs in a voluntary manner and it should remain voluntary
- Government financial resources will remain at their current level
for the next five years and health budgets will always be constrained
- We must focus more on prevention- it should have been our emphasis long ago
- it is a myth that people are difficult to organize
Ways of Improving the chances of Sustainability (p. 123)
A programme is more likely to be sustained then there is adequate
training, continuing education, supervision, and good management.
Monitoring and operations research also ensure the most efficient and
effective activities and thus promote sustainability. Capacity
building, the solidity of start-up training and orientation, the
degree of real community participation and ownership lead to
sustainability--but these are slow processes which require a lot of
time. The identification of effective leadership and training in
management is important. Information, education and communication
which change attitudes and behavior will help ensure that an activity
continues. If mothers understand and want immunization for their
children then their demand will help ensure sustainability.
What have been some of the reasons for collapse of Programmes (p.124)
Hasty initiation without adequate community involvement and with
unrealistic donor-determined targets has been the cause of many
failures. Lack of use of existing structures is also a cause of
collapse. How many communities are littered with the skeletons of
defunct communities imposed from outside?
The creation of dependency on external resources is in itself a
failure of initiation of PHC. Planning from outside seldom forsees the
repercussion of donations; for example, a one-time gift of bicycles
for CHWs might prejudice future training. IF planning was done by, or
jointly with, the community then sustainability can be considered from
every aspect.
Did I mention that the book was published in 1992! I was 7 years old.
Here is the bibliography that I apologize for as I don't have a
reference guide...
Ochola, P. A. & Kisubi, W. K. (1992). All from Primary Health Care"
Experiences in Eastern and Southern Africa: based on the proceedings
of a conference organized by the African Medical and Research
Foundation. Nairobi, Kenya. African Medical and Research Foundation.
Everything above should be very self explanatory, but I am learning
that it isn't. For example, in the key messages it states that
community work must not be based on externally formulated resolutions.
Of course they shouldn't! Then why, as Anna discovered, did UNICEF
come to Sembabule, set up a wonderful birth registration system for
orphans and vulnerable children (OVC), and then leave. The project
completely collapsed. Donor money was completely wasted except for the
fact that it contributed to the dependency on western efforts. It's
not fair to place all the blame on the west, as you will find in my
next blog, but, really, what were we doing?
The key messages above are lessons that should have been learned and
taught long ago. Sadly they are lessons that I am just learning from
this field experience. It would have been nice to discover this book
before my mosquito net project. I will be sure to read over the
messages I posted from the book several more times in order to take
them to heart as I hope anyone who reads my blog will do as well. We
owe it to the individuals, communities, and populations we, as public
health professionals, are working to improve to do so.
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