FACTS - recent articles

Innovations in community physiotherapy

2009-03-02T18:57:57+01:00

Innovations in community physiotherapy
M. Ellangovin
Field. Actions Sci. Rep., 2, 93-100, doi:10.5194/facts-2-93-2009, 2009

Background
In the last 35 years, Bangladesh has produced only 415 physiotherapists to meet the demands of a total population of 150 million. Most of them practice in the capital city of Dhaka because of better business prospects. The need to formulate an innovative strategy to meet the huge demand is obvious.

According to a World Bank report (2005), 44% (poor) and 33% (very poor) people approach local pharmacists or medicine sellers for their ailments due to poor accessibility to healthcare facilities and also to avoid consultation fees.

Methods
Due to scarcity in the number of professionals, community physiotherapists have become popular with rural patients. They use innovative treatment approaches, which combines traditional Physiotherapy and ancient Ayurvedic massage. Targeting equitable access to all, Gonoshasthaya Kendra (GK) has its own health insurance policy. The fee is determined by the socio-economic status of the patient.

Results
Experienced paramedics are now able to administer treatment without direct supervision all the time. The number of patients seen by them is multiplying at a fascinating rate every year due to the growing recognition of their work.

Conclusion
Gonoshasthaya Kendra (GK) was established in 1972 and provides primary health care to a rural population of over 1.08 million across 629 villages in Bangladesh. The strategies and methods adopted by Gonoshasthaya Kendra in bridging the gap and promoting community physiotherapy by training health workers or "paramedics'' in Bangladesh, has been successful. Even though training of many more paramedics is required, success is guaranteed.

Access to microcredit for women living with, or vulnerable to, HIV in Haiti

2009-02-23T18:57:57+01:00

Access to microcredit for women living with, or vulnerable to, HIV in Haiti
C. Longuet, J. L. Machuron, M. M. Deschamps, R. Sinior, E. Brignoli, J. W. Pape, and B. Miribel
Field. Actions Sci. Rep., 2, 85-91, doi:10.5194/facts-2-85-2009, 2009
Haiti is the poorest country on the American continent. It is also the Caribbean nation where HIV prevalence is the highest: 2.2% of the adults carry the virus.

In 2005, GHESKIO, a centre for the care of people living with HIV/AIDS; ACME, Association for Cooperation with Micro Enterprise; and Fondation Mérieux launched a microcredit programme to help women living with HIV/AIDS. The programme was subsequently extended to vulnerable women who had consulted at GHESKIO.

In 2006, an impact assessment of the programme among the first 66 women benefiting from a loan showed better living conditions compared to a control group of 30 women with similar initial medical and socioeconomic status but no loan. By mid-2008, 1061 women were the beneficiaries of 1538 loans totalling 11 373 000 gourdes, i.e. approximately 216 000 €. Of these, 247 received several loans (up to seven loans to date).

Although the women are very poorly educated and live in arduous economic circumstances, the loan repayment records are excellent – around 94% as of mid 2008. There is no difference between HIV-negative women and those living with HIV.

Combined with antiretroviral treatment, micro-financing is certainly one of the major instruments for reducing the impact of HIV on the infected populations in countries with limited resources. This programme in Haiti is a demonstration of the feasibility of microcredit in a difficult environment. The great professionalism of the institutions implementing the programme is a key factor in its success.

Emergence of an environmental citizenship in Senegalese rural areas: local development initiatives by the Fannabara association in Missirah (Fatick, Senegal)

2009-02-13T18:57:57+01:00

Emergence of an environmental citizenship in Senegalese rural areas: local development initiatives by the Fannabara association in Missirah (Fatick, Senegal)
M. Fall, M. N. Dimé, and C. O. Sarr
Field. Actions Sci. Rep., 2, 79-84, doi:10.5194/facts-2-79-2009, 2009
In Missirah, a village in Senegal, a group of young ecologists who are part of an association called {Fannabara}, developed initiatives with the objective of restoring deteriorating ecosystems and promoting local culture. Along with the many numerous to their credit, in cooperation with partners such as the IUCN and the Global Environment Facility (GEF), Fannabara is trying to establish itself as a framework within which the interests of the Missirah communities can be defended. The projects undertaken are in line with a perspective that promotes public-awareness, education and actions for a sustainable development. The project is dependent on obtaining the necessary resources to meet the ecological, economic, social and cultural challenges faced in Missirah. This research shows that the decentralization and accountability context for community-level players – associated with the changes taking place in rural areas, namely as they relate to the participation of populations in the governance of biodiversity – has greatly contributed to the promotion of new local development dynamics.

From research to field action: example of the fight against cholera in the Democratic Republic of Congo

2009-02-12T18:57:57+01:00

From research to field action: example of the fight against cholera in the Democratic Republic of Congo
R. Piarroux, D. Bompangue, P.-Y. Oger, F. Haaser, A. Boinet, and T. Vandevelde
Field. Actions Sci. Rep., 2, 69-77, doi:10.5194/facts-2-69-2009, 2009
The Democratic Republic of Congo (DRC) is the country in the world which reported the highest number of cholera cases to WHO from 2002 to 2007 (128 936 cases out of a worldwide 902 071 cases). We, therefore, implemented research work which intends to understand the epidemiology of cholera in the DRC and to ensure improvements in the strategy to fight against cholera. This broad study enabled us to accurately determine the cholera epidemic's mechanisms on different scales; to identify the source zones of the disease, and the groups of populations acting as vectors of the spread. It was then possible to demonstrate the role of "sanctuary'', played by some suburbs of lakeside cities. A collaborative network, including several scientific institutions in Europe and in the DRC, local and national government administrations in the field of public health and sanitation, international agencies, NGOs and private foundations, was progressively set up. Following the conclusions of our epidemiological studies, a drastic change of strategy was proposed: the limited curative approach on the one hand, the few existing water/sanitation programs on the other hand, have been merged in a global approach involving a larger scale water and sanitation infrastructure improvement, environmental protection, hygiene awareness and medical surveys targeting a few focus areas playing a central role in the epidemics. In conclusion, by better targeting intervention zones, one can gather human and technical resources previously scattered on the vast territory of the DRC. The strategy presented here revives the hope to eliminate cholera in the DRC.

Using climate information in the health sector

2009-02-09T18:57:57+01:00

Using climate information in the health sector
T. A. Ghebreyesus, Z. Tadesse, D. Jima, E. Bekele, A. Mihretie, Y. Y. Yihdego, T. Dinku, S. J. Connor, and D. P. Rogers
Field. Actions Sci. Rep., 2, 63-67, doi:10.5194/facts-2-63-2009, 2009
Many infectious and chronic diseases are either directly or indirectly sensitive to the climate. Managing this climate sensitivity more effectively requires new working relationships between the health sector and the providers of climate data and information. In Africa, where communities are particularly vulnerable, Ministries of Health and National Meteorological Services need to collaborate to reduce the burden of climate-related ill health.

The Ministry of Health and the National Meteorological Agency of Ethiopia have made significant progress towards the development of a climate-informed early warning and response system for diseases such as malaria and other climate-sensitive diseases. An important enabling mechanism is a Climate and Health Working Group, which is a multi-sectoral partnership created to spearhead the use of climate information for health interventions. While this is a work in progress, the key ingredients necessary to sustain such a joint venture are described to encourage similar activities in other countries faced with a growing climate-sensitive disease burden, to facilitate networking and to increase the return from the investment.

Drinking water: a need met for the people of the commune of Bantè, Benin

2009-02-04T18:57:57+01:00

Drinking water: a need met for the people of the commune of Bantè, Benin
T. R. Fousseni
Field. Actions Sci. Rep., 2, 57-62, doi:10.5194/facts-2-57-2009, 2009
RACINES (Recherches, Actions Communautaires, Initiatives pour un Nouvel ESpoir) is a Beninese non-governmental organization established in 1999 following the initiatives of young Beninese executives. A case study undertaken in 2003 in the villages of Galata and Agbon in the commune of Bantè identified the need for drinking water as the most urgent need. In response to this need, and with the financial support of Oxfam Québec, RACINES initiated a project for the installation of manual water pumps in the two villages. The development of this project involved three major phases: the mobilization of communities around this project, the installation of water pumps and the organization of socio-sanitary educational activities. Twenty months into the execution of the project, a local management committee was established and strengthened, a hand-operated water pump was installed and water-themed public awareness activities, such as water use, water sanitation and the dangers of drinking dirty or contaminated water, were organized every month or so in each of the two communities. Overall, this project has introduced a new type of leadership in the commune of Bantè, involving a high level of participation by young people working alongside the elders in the local management committees and ensuring the perpetuation of the systems installed.

Rice-fish farming in Guinée Forestière – outcome of a rural development project

2009-02-02T18:57:57+01:00

Rice-fish farming in Guinée Forestière – outcome of a rural development project
D. Simon and J. F. Benhamou
Field. Actions Sci. Rep., 2, 49-56, doi:10.5194/facts-2-49-2009, 2009
The rice-fish farming project in Guinée Forestière launched in 2000 was, at the outset, a pilot project for the purpose of testing the introduction of a new production technique in an impoverished and landlocked region. It aimed to improve food security for people living in the region and to promote the creation of income through a diversification of activity and better land use. The intervention strategy followed the template used in Côte d'Ivoire for a similar project. It consisted in supporting groups of voluntary producers who were ready to accept the risk of financing lowland developments to produce fish and rice. The project was supported by a small group, mainly composed of volunteers (expatriates) and local facilitators recruited as the project activities progressed. A €1.8 million grant was donated by the Agence Française de Développement, raised between 2000 and 2008, to cover technical assistance and training expenditures.

The project gave precedence to the concept of actor autonomy for the development of lowlands and ponds.

Investments were financed and implemented by the producers themselves depending on their available resources in funds and labour. Animal husbandry methods, based on extensive mixed cropping, used no other inputs than those available on the farm itself. The fish farmers themselves supplied alevins.

To ensure the sustainability of rice-fish farming activities after the project ended, special emphasis was given to providing a structure for the profession in the future by encouraging the members of the groups to sponsor and train new candidates.

Although results exceeded the initial targets since, by the end of the project, 350 farmers and 500 ponds were active, lowland rice and fish production is still limited. It does provide, however, regular supplies of fish to approximately 6000 people, calculated according to the low level of local consumption (10 kg/per year/per person).

The impact of the project is considerable. In economic terms, lowland development is an excellent profit opportunity since it multiplies farmers' incomes by six, two thirds of which are from fish farming and the remaining third by rice. The lowland development technique reduces the time required to cultivate rice by 30%. As a result, these benefits are attracting a large number of new potential entrants.

The impact on the environment is also positive, in particular due to the improvement of soil fertility and the beneficial effects of ponds on the natural environment.

Finally, these good results have led to plans for new projects to prolong and consolidate existing benefits and to repeat the system in other countries.

WÉGOUBRI, the sahelian bocage: an integrate approach for environment preservation and social development in sahelian agriculture (Burkina Faso)

2009-01-27T18:57:57+01:00

WÉGOUBRI, the sahelian bocage: an integrate approach for environment preservation and social development in sahelian agriculture (Burkina Faso)
H. Girard
Field. Actions Sci. Rep., 2, 33-39, doi:10.5194/facts-2-33-2009, 2009
The NGO Terre Verte pursues the realisation of bocage perimeters (wégoubri in the mooré language) in Burkina Faso. They are an innovative concept of rural development that has been established in the 1990s in the experimental farm of Guiè and is now adopted in other experimental farms in Burkina Faso.

The deterioration of the rural landscape in the Sahel region has worsened in the last decades, endangering local populations. The creation of bocage perimeters in this rural landscape is a way to remediate problems linked to overly extensive agriculture.

Through a holistic approach to the problem, the experimental farm of Guiè has been able to integrate environmental preservation into the Sahel agriculture thanks to three axes of intervention: applied research, education and direct help to the peasants. An experimental farm relies on five technical teams, each supervised by a coordinator.

The concept is based on the creation of bocage perimeters in a mixed propriety regime, comprising individually owned plots and common grounds, managed by an association of beneficiaries. The result is a restored environment, in which agriculture is no longer tantamount to erosion and livestock farming to overgrazing, where trees and bushes are harmoniously integrated into the environment.

The increase in agricultural yields observed after a few years of soil restoration leads to the conclusion that those projects will be economically viable. A system of credits for farmers could allow the implementation of such a system, which represents the only solution for the millions of hectares of degraded soil in the Sahel region.

Living City: community mobilization to build active transport policies and programs in Santiago, Chile

2009-01-27T18:57:57+01:00

Living City: community mobilization to build active transport policies and programs in Santiago, Chile
L. Sagaris
Field. Actions Sci. Rep., 2, 41-48, doi:10.5194/facts-2-41-2009, 2009
Although the usefulness of walking and cycling to promote health is increasingly recognized, the importance of civil society leadership in developing new policies and activities is often overlooked. This case study, of Living City (Ciudad Viva) a community-based organization in Santiago, Chile, examines how several communities used knowledge about transport's impact on the environment and health, gained through opposition to a major highway project, to build effective sustainable urban transport initiatives.

Inspired by urban reforms in Bogotá, Living City now focuses mainly on "active transport" (formerly non-motorized), building the policies, attitudes and infrastructure necessary to encourage walking and cycling, and the inclusion of the differently abled. It has won two major awards for innovation and now partners with NGOs in The Netherlands and elsewhere in Chile and Latin America.

Moreover, Living City now organizes cycling-inclusive training programs, design charrettes and participatory processes in cooperation with Santiago's regional and national authorities. Its publication, La Voz de La Chimba, distributed free throughout the city by volunteers, has helped to open people's eyes to the implications of active transport for social equality and health, and provided support to other citizens' initiatives, struggling to get off the ground.

This experience illustrates how citizens' and community organizations acquire important knowledge and practical experience in learning by doing situations, and how they can learn to reach out to ordinary people and key policymakers, building bridges across the citizen-policy divide to produce innovative, win-win programs that simultaneously bring change at micro- and macro-levels.

Health logistics is a profession: improving the performance of health in developing countries

2009-01-22T18:57:57+01:00

Health logistics is a profession: improving the performance of health in developing countries
B. Silve
Field. Actions Sci. Rep., 2, 19-25, doi:10.5194/facts-2-19-2009, 2009
"We can now prevent or treat most illnesses by using known and inexpensive techniques, the problem lies elsewhere: it consists in providing personnel, medicines, vaccines and information to those in need, at the appropriate time, in sufficient quantity, reliable and sustainable manner, and at a cost acceptable''.
WHO's report "Health and MDGs for development''

"Given the recognized need for health logistics officers and the present lack of such officers in the countries, WHO/AFRO, UNICEF, Bioforce and partners should urge countries to create positions of health logistics officers in health management teams, coordinate their efforts and mobilize necessary resources to initiate adequate training in logistics for health in support of present move toward greater integration of public health interventions''.
Task Force on Immunization Meeting, Maputo, 2006

Biogas production using water hyacinths to meet collective energy needs in a sahelian country

2009-01-22T18:57:57+01:00

Biogas production using water hyacinths to meet collective energy needs in a sahelian country
O. Almoustapha, S. Kenfack, and J. Millogo-Rasolodimby
Field. Actions Sci. Rep., 2, 27-32, doi:10.5194/facts-2-27-2009, 2009
This paper presents a pilot project that investigates the possibility of producing biogas from a mixture of water hyacinth and fresh rumen residue – replacing firewood as a source of fuel – to meet the energy needs of a maternity facility in Niamey (Niger). The discontinuous-type installation (batch reactors) is made up of six digesters measuring 5 m³ each. The output during hot and cool seasons, 0.52 m³ and 0.29 m³ respectively of biogas per m³ of digester per day, has met the energy needs of the maternity facility, estimated at 8 m³ of biogas per day. The study revealed strong seasonal variations: output during the hot season is approximatively 1.8 times greater than it is during the cool season. Large quantities of water hyacinth, an invasive plant present in Niger since 1986, are manually harvested in aquatic environments. The project is run by a local NGO, the Groupe d'Initiative pour les Energies Renouvelables (GIER), and supported by UNICEF and the Niger Basin Authority. The duration of the project is 8 months.

Urban agriculture: multi-dimensional tools for social development in poor neibourghoods

2009-01-16T18:57:57+01:00

Urban agriculture: multi-dimensional tools for social development in poor neibourghoods
E. Duchemin, F. Wegmuller, and A.-M. Legault
Field. Actions Sci. Rep., 2, 1-8, doi:10.5194/facts-2-1-2009, 2009
For over 30 years, different urban agriculture (UA) experiments have been undertaken in Montreal (Quebec, Canada). The Community Gardening Program, managed by the City, and 6 collective gardens, managed by community organizations, are discussed in this article. These experiments have different objectives, including food security, socialization and education. Although these have changed over time, they have also differed depending on geographic location (neighbourhood). The UA initiatives in Montreal have resulted in the development of a centre with a significant vegetable production and a socialization and education environment that fosters individual and collective social development in districts with a significant economically disadvantaged population. The various approaches attain the established objectives and these are multi-dimensional tools used for the social development of disadvantaged populations.

Technical support by Solthis for health-care workers in order to decentralise medical treatment for people living with HIV in the Ségou region of Mali

2009-01-16T18:57:57+01:00

Technical support by Solthis for health-care workers in order to decentralise medical treatment for people living with HIV in the Ségou region of Mali
P. Teisseire, A. Akonde, C. Pizzocolo, S. Calmettes, N. Bodo, and L. Pizarro
Field. Actions Sci. Rep., 2, 9-17, doi:10.5194/facts-2-9-2009, 2009
Medical treatment for people living with HIV/AIDS started in Mali as early as 1997 thanks to civil society. The national response was officialised by the adoption of the Malian Initiative for Access to Antiretroviral Therapy (Initiative Malienne d'Accès aux Antirétroviraux IMAARV). In 2004 ART, drugs against opportunistic infections and basic biological monitoring were made available free of charge by decree. In 2005, decentralisation of health-care to regions and circles became one of the main thrusts of the national strategy for the fight against the pandemic.

Sub-Saharan African countries are making significant efforts to provide full geographical coverage of their national territory.

It is in this "scaling-up" context that the Solthis NGO (Solidarité Thérapeutique et Initiatives contre le Sida) began cooperating with Malian actors to extend access to quality treatment for patients living with HIV/AIDS in the city and region of Ségou. Based on a developmental approach, Solthis opted for continuing in situ technical support for national actors in the fight against AIDS. Thanks to the daily presence of a team "in the field" Solthis devotes a large part of its activities to capacity-building for health-care workers through an exchange of medical and scientific expertise.

Efforts were also made to improve health-care workers' working conditions and to make various tests and drugs accessible to patients infected with HIV.

The initial aim was to encourage universal access to ART. Today, the Ségou programme supported by Solthis has developed over 1500 new treatments in the region. In addition, every PMTCT centre in the region offers prevention and treatment services to mothers and children. Today, the Ségou region is an integral part of the IMAARV initiative as a decentralisation pilot project.

Children aged 12–59 months missed through the National Vitamin A Capsule Distribution Program in Bangladesh: findings of the Nutritional Surveillance Project

2008-12-08T18:57:57+01:00

Children aged 12–59 months missed through the National Vitamin A Capsule Distribution Program in Bangladesh: findings of the Nutritional Surveillance Project
N. Akhter, C. Witten, G. Stallkamp, V. Anderson, S. de Pee, and N. Haselow
Field. Actions Sci. Rep., 1, 19-25, doi:10.5194/facts-1-19-2008, 2008
From January 1990 to December 2006, Helen Keller International implemented the Nutritional Surveillance Project (NSP) in Bangladesh, which has been used to conduct regular surveillance and special surveys to provide information on health and nutritional status of children and mothers, and report on the coverage and impact of nutrition and health programs in Bangladesh. The Government of Bangladesh (GOB) distributes vitamin A Capsule (VAC) among children aged 12–59 months biannually. The NSP data was analyzed to assess VAC coverage and to explore which children were less likely to receive a VAC in order to help GOB identify necessary modifications aimed at higher coverage of VAC among all eligible children. Results showed that coverage among girls and boys was not different (P=0.970). However, coverage was consistently lower among children aged 12–23 months compared to older children (24–59 months) (P≤0.001) in each of the distribution rounds. Coverage among children from poorer households was lower than among children from wealthiest households (P<0.001), with the extent of this difference varying by round. Coverage was significantly higher if households had had contact with a government health assistant in the last month (P<0.001); and among households who owned a radio or a TV compared to those who did not. The VAC distribution campaign needs to be strengthened to cover the children who are currently not reached; especially younger children, children living in underserved regions, children from poorer households and from households with less contact with health service providers or mass media.

When will community management conserve biodiversity? Evidence from Malawi

2008-12-03T18:57:57+01:00

When will community management conserve biodiversity? Evidence from Malawi
Joy E. Hecht
Field. Actions Sci. Rep., 1, 9-17, doi:10.5194/facts-1-9-2008, 2008
Both development practitioners and conservation organizations are focused on community ownership and management of natural resources as a way to create incentives for the conservation of biodiversity. This has led to the implementation of a number of large community-based conservation projects in sub-Saharan Africa, in countries including Namibia, Zimbabwe, Malawi, Zambia, and Rwanda. While the concept is logical, and valuation studies may suggest that conservation is more valuable than other uses of the resources in some areas, there has been little detailed analysis of the financial costs and benefits to the communities, to determine whether they would actually have an incentive to conserve if they had more extensive legal rights to the resources. This paper assesses the conditions under which this approach may be viable, based on a valuation study of the resources of Mount Mulanje in southern Malawi.

Mobile laboratory to improve response to meningitis epidemics, Burkina Faso epidemic season 2004

2008-11-26T18:57:57+01:00

Mobile laboratory to improve response to meningitis epidemics, Burkina Faso epidemic season 2004
R. T. Ouedraogo, B.-M. Njanpop-Lafourcade, P. Jaillard, Y. Traoré, J. E. Mueller, J.-F. Aguilera, M. Dabal, S. R. Tiendrébéogo, W. Goehde, A. da Silva, B. D. Gessner, and P. Stoeckel
Field. Actions Sci. Rep., 1, 1-7, doi:10.5194/facts-1-1-2008, 2008
A Mobile Laboratory was developed for use primarily during the epidemic meningitis season in Burkina Faso. This report describes the Mobile Laboratory characteristics, its use to date, problems encountered and their resolution, and future directions. During 2004, the mobile laboratory intervention in three remote Burkina Faso districts experiencing meningitis epidemics led to more specific case management and led directly to vaccination of one district. However, in a second district, the intervention occurred too late to allow vaccination. During 2006, the Mobile Laboratory was used to conduct an emergency carriage study that for the first time occurred during the peak of a meningococcal serogroup A epidemic. This information is critical for the design of meningococcal conjugate vaccine schedules and vaccine approaches. During 2004-6, technicians in 11 district laboratories received training by Mobile Laboratory staff. Numerous problems with the initial prototype laboratory were identified, namely that the solar power cells could not provide enough energy to the refrigerator and incubator to maintain appropriate temperatures and having a single integrated unit required use of a separate vehicle for specimen transport. A second laboratory was developed during 2005-6 that used a generator or local energy source for power and that had a laboratory that could be detached from the vehicle. Currently the main limitation of the Mobile Laboratory is that it has not been integrated into routine Ministry of Health activities, limiting its use both during and between meningitis seasons.