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.
Role
of Women's Organizations in Revitalizing Communities:
The Case of the Gujarat Disaster
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.
Towards
a Community Based Disaster Risk Reduction Approach
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.