How can community-based health care be established in an area of a country where there are no roads, all transportation is on foot, and there are few people with even a primary level of education? ADRA South Sudan, under Robin Willison as Program Director, determined to develop a system which would be owned and largely operated by local people.

South Sudan has been subject to periodic civil war since the independence of Sudan 40 years ago. Since 1989 it has been in a constant state of civil war. This has led to the loss of all pre-existing infrastructure, and an ongoing civil war situation in which to work to reestablish some basic services.

ADRA South Sudan began with primary education as its first activity. Since training was held in English, the language of communication within UN and NGO relief efforts, the work began with training in English. This was particularly needed to get women to a high enough standard to be able to take advantage of the training for them to be teachers in their communities. A gradually extending primary education system is being developed with funding from the Danish government.

Once basic literacy has been achieved and teachers have been trained to begin new schools and to extend the primary education system, then training of community-based health workers can begin. Expanded Program of Immunization (EPI) facilitators were trained to assist in the immunization campaign to protect against childhood diseases, and traditional birth attendants were trained to assist in delivery of babies. A 12-bed field hospital and a four-bed maternity unit were built using the local materials of mud walls and grass roof, but with imported wood to make a more durable roof. Nursing attendants were trained, followed by community health workers. A full-time trainer was appointed to supervise all the training courses and to ensure their quality, funded as part of a major USAID project. Community health units were established in several villages up to a day's walk away.

At the same time the Netherlands government funded a well drilling program to enable local people to stay in their home areas instead of being driven from their homes in search of water every dry season. Even in the wet season, in this flat land, the sole source of water was the local swamps which was used by animals, by people for bathing, and then for drinking and cooking, leading to the propagation of serious diseases.

For this project, all supplies had to be flown to a roughly-cleared strip of land, which became unusable when any significant rain fell. In the beginning supplies were distributed by being carried. Later some specially-strengthened vehicles were used but wear and tear was high.

From the beginning of these projects the local community was involved. They were met with and surveyed to determine their needs on the first assessment mission. Groups, individuals and leaders were all involved to determine their community priorities and to help them understand respective responsibilities. Thereafter quarterly meetings were held for consultation as developments took place. Usually several hundred people attended and none were denied the opportunity to express themselves. Local community structures began to develop as projects were implemented, and responsibility was taken for the developments, particularly for ownership of all resources, for the effectiveness of their operation, and for security of facilities and supplies. Some lessons had to be learned when a local community did not maintain facilities or provide workers and facilities had to be closed, but new ones were opened in places where there was more interest.

Robin willison is the Director, Technical Services at Asian Disaster Preparedness Center. He can be contacted at rwillison@ait.ac.th. Robin has worked with PDRA in Sudan before joining ADPC.

In the wake of the devastating January 2001 Gujarat earthquake in India, women of Kutchch district have been severely affected. After the initial relief months during the transition phase, women were among the most vulnerable groups. Among the injured, 65% were women because many were inside their homes when the tremor occurred. Single woman-supported households were the most affected, as women's income earning opportunities were reduced as marketing channels were cut off. Women find it difficult to leave the village for wage work because constructing a proper shelter is the priority. Men are busy earning wages outside the village, especially in drought relief work. With the help of NGO and government interventions, house construction also consumes much of both women's and men's time, for which they are not remunerated since they contribute their labor as a provision of the housing package offered to people.

Medical services were disrupted for a few months, which has affected women's health. Similarly, village schools and childcare facilities have been affected. As a result, women's work burden has increased, as they have to look after children, engage in house construction and also seek income-earning means. Women normally suffer from malnutrition and this has been especially exacerbated after the relief phase. Trauma also affects women and is manifested in many ways, especially when there are slight tremors in Kutchch.

Self-Employed Women's Association (SEWA) and Kutchch Mahila Vikas Sangathan (KMVS) are two women's organizations working in Kutchch. The rehabilitation program strategy of both organizations aims at livelihood security, shelter restoration and reconstruction, and social protection services. Women were involved in relief distribution which gave them visibility. Women's participation was ensured in village rehabilitation meetings. Masonry training was provided for women on seismic-resistant house construction and building materials. Compensation was also jointly received by spouses.

Earthquakes have a differential and adverse impact on women in terms of casualties, injuries, trauma, insecurity, income earning and household responsibility. Women's participation in relief and rehabilitation can better address not only women's needs, but also the needs of communities in terms of prioritization, program implementation and monitoring, not to mention addressing equity and women-focused issues that are outside others' agenda.

Dr Smita Mishra Panda is an Assistant Professor at the Institute of Rural Management, Anand, Gujarat, India. She can be contacted at smita@fac.irm.ernet.in.

The Citizens' Disaster Response Center (CDRC) was organized in 1984 by several people's organizations who saw the need for an alternative approach to disaster management in the Philippines. CDRC's community based disaster management approach:

• Looks at disasters as a question of people's vulnerability.
• Recognizes and strengthens people's existing capacities.
• Addresses the roots of people's vulnerabilities to transform or remove structures generating inequity and underdevelopment.
• Considers people's participation as essential to disaster management.
• Places a premium on the organizational capacity of vulnerable sectors through the formation of grassroots disaster response organizations, and
• Mobilizes support from less to more vulnerable sectors.

These six principles are applied in CDRC programs and services, including emergency response and rehabilitation, disaster preparedness and mitigation, advocacy research, public information, and partnership development. Programs and services are geared towards helping at-risk communities themselves to become more disaster-resilient through a process of capacity-building supported by CDRC and its partners. This involves:

• Awareness-raising and skills development.
• Formulation of a Counter Disaster Plan (CDP).
• Formalizing Disaster Response Committees in existing people's organizations, the formal creation of a grassroots disaster response organization (GDRO).
• Identifying, selecting and implementing short- and long-term risk reduction measures, and
• Implementation of actions by the GDRO.

An external donor evaluation of CDRC's community based disaster management approach reported that:

• Community self confidence was enhanced through meaningful participation.
• Displacement time was shortened because of organized action.
• In communities with their own GDRO, relief assistance is usually in accordance with needs, and
• Partnerships between vulnerable and less vulnerable sectors facilitates not only relief operations but also other programs.

Adapted from an article by Odon A Morillo, Jr, Deputy Executive Director, Citizens' Disaster Response Center, Philippines.