Finance Proposal
Community-based Health System
1. Objectives and Principles
The Community Organization and Development Project (PODC) proposes, based on the community survey done in 2010[1] as one of the main priority fields of intervention for rapid life quality and livelihood improvement, the introduction of a Community-Based Health System in 15 PODC pilot project villages, that consists of an integration of traditional and modern methods for health care[2].
The implementation of this Health System must be done in line with other working principles and strategies of the PODC, like:
- Reinforcement of community-based organizational structures
- Improve organizational capacities and institutional access to solve their community problems
- Promote and preserve their traditional knowledge and their natural and cultural environment
- Scientific, efficient and constructive management of the project, more and more involving the
- Local community
2. Background and Reasons
We propose a Community-based Health System with 5 pillars on which Health depends:
a) Quality and availability of drinkable water
b) Varied, well conserved and prepared food
c) Hygiene for prevention of biological or chemical contamination of food and water.
d) Healthy environment, clean water, air and soil, prevention of pollution
e) Availability of Medical treatment, traditional or modern.
The first four elements Water, Food, Hygiene and Environment reinforce health, fitness, and are preventive, while medicine is a corrective when the first four elements do not or insufficiently exist. For all work, the PODC will strictly follow the principle of combining best available scientific knowledge and existing traditional and local ways, that are well integrated into the local context and have been developed by a trial-error over generations and centuries. A concept of development that does not integrate locally available knowledge and potentials will not bring sustainable change, for it is not a process that has been interiorized and appropriated.
For medicine, the potentials of combining Tradition and Modernity can be easily perceived[3]: Traditional Healing has been very widespread in rural Central Africa and is still today the last resort for a poor population that can not afford modern medicine. This rich contextualized knowledge and knowhow about specific diagnostics, the effects of plants, therapeutic treatments and ritualistic practices, whose application relies on the natural environment, the tropical rainforest, is available in all communities the project works with. It treats virtually all known diseases, including Malaria, AIDS, Cancer, Arthritis and other difficult or almost incurable diseases. Unfortunately, for several decades, with the beginning of colonial times, traditional healing has been marginalized, made notorious and brought close to bad-intended occult practices and witch-craft. Today, the population neglects traditional healing methods, their carriers are ridiculed, systematically marginalized by State Authorities, therefore, it is difficult for them to hand over to the next generation their precious knowledge that has been accumulated during centuries.
On the other hand, the enthusiastic acceptance of modern medicine by the population has not been met by a corresponding modern health infrastructure. Available health structures are very often precarious, badly equipped, with untrained or unmotivated personal, with difficult access and, nevertheless, very expensive, unaffordable for most people.
Today, the population has turned its back to tradition and stepped towards modernity. It is a modernity that does not accomplish its promises. Between neglecting traditions and the unfulfilled dreams of modernity, the population is suffering innumerous diseases, with an increasing mortality, mostly caused by diseases that are not mortal and are treatable with traditional as well as with modern medicine.
An integrated community-based Health System must use both ways for the benefit of a suffering population and as a showcase for a humanistic project, empowering communities for preserving their human and natural resources and using them sustainably.
3. Expected Results
A. For the Community / Indicator / Outcome1) Community Health System with a locality and human resources available / · Community Health Center (CHC) built and functioning
· Community Health Responsibles (CR) working
· Traditional Healers (TH) practicing
· Health Agents (HA) being trained in a health profession / 15 CHC
30 HR
15 TH min.
30 HA
2) Traditional Healing used for community health care / · Inventory of traditional healing methods / 15 inventories
3) Efficient Cooking and improved kitchen introduced / · Practicable cooking models tested on their efficiency and indoor air pollution
· Community trainings on improved kitchen and efficient cooking / Test report
6 Trainings
4) Training on Basic Health, Water Hygiene, Food preparation, conservation and healthy nutrition / · Regular lessons and good participation for adults, youth and children
· Follow-up activities organized by participants together with Health Responsibles / 4 lessons per comm.
2 activities per comm.
5) General Health Survey / · General Health Check up
· Medical Report on Health Situation / 80 % of households
6) Medical Assistance / · Regular presence of qualified medical personal in all communities
· Health Service Contract with local hospitals
· Modern medicaments available for treatment / One per month
3 conventions
4. Activities
4.1. Community Health System
As one of the first actions that has been discussed and agreed is that any Health System needs a locality where healing can happen. The communities have already chosen their places and are ready to start building the Community Health Centers. These CHCs will be simple, modest but clean and functional houses with at least 3 rooms – a waiting room, a room for traditional healing and room for modern medicine. Greenpeace Germany has offered highly efficient solar-powered refrigerators, called «solar-chills» to store in the CHC some heat-sensitive drugs, vaccines and snakebite serums.
In each community, two Health Responsibles have already been chosen, the Traditional Healers have already given their agreement to work for the benefit of their community, two Health Agents (a woman and a man) have already been appointed by the community to go for a 1 to 3-years professional medical training. For these trainings, they will get a scholarship that they can pay off by working several years in their community. With regular knowledge exchange meetings, cohesion and knowledge among the Health Agents will be improved.
4.2. Traditional Healing Methods
An inventory of Healing methods known by the community will be done in each community, conducted by a mixed team of the project and a respected community member and supervised by a mixed commission of traditional chieftaincy, elders and project coordination. This inventory is intellectual property of the community, is entirely available for the community’s benefit and health and will only be accessible for others in part or entirely by their prior informed consent[4].
4.3. Efficient Cooking / Improved Kitchen
Research on lung functions of the village population[5] has shown, that permanent exposure to smoke in kitchens is a main cause for the degradation of respiratory and eye health particularly for women and children. Since the project can count on a large implementation experience with improved stoves[6] that are wood-efficient and emit less or no smoke, the project has already trained 60 community members for the construction of efficient clay stoves, in July 2011. These people have partially already applied their knowledge in their own communities. The project will organize a follow-up to that training and execute with those trained community members workshops in their community to assess potentials for improving working and living conditions in kitchens as well as for the construction of efficient clay stoves[7].
4.4. Training on Basic Health, Hygiene, Food and Water
Information and training session with different community groups (all together, men, women, youth, children) will be held to discuss health issues and understand better what contributes to good health or to sickness, what is the influence of lack of hygiene, contaminated food and water, of pollution, and what are simple measures to improve that situation. These trainings and information sessions will be held in the solar-powered[8] community centers or schools using also audiovisual material and adapted didactical methods for each group. They will be run by the project Workgroup «Education» together with the elected Education Responsibles of the communities.
These sessions also prepare for in-depth discussions, trainings and implementation of a community-based water-management, as well as for concrete simple actions on hygiene, behavioral changes in food and water treatment, that will be accompanied by the communities Health Responsibles.
4.5. General Health Survey
A general Health Survey will give a real picture of the health situation in all project communities. This survey will be conducted at the beginning of the Health phase and periodically after two years to monitor the health situation of the population and be able to measure impacts through project or otherwise triggered changes. A report on the general health situation and a database will help to orient any future medical interventions in the project communities, and serves as well as scientific argument for the implication of the public health services.
4.6. Medical Assistance
To ease the almost total absence of modern health services, the project organizes a regular presence of medical professionals at least once every month with cheap treatment based on the regular payment of small contributions to a community-based health insurance system (very common in many places) as well as service contracts with several regional health centers for an improved treatment for project community members. The first trained Community Health Agents with diploma will be contracted by the community and be regularly present or easily accessible in their community assuring a good quality modern health care.
5. Budget and Finance Plan
See also Budget Overview in Annex.
First year, CHF 256’000.- are foreseen, in the second year CHF 131’000.-, comprising household expenses per year of CHF 256.- or 131.-.
For a sustainable Finance Modell, we will discuss some issues with the participating communities, and fix them in a cooperation contract:
- Benchmark for self-financing by the benefitting communities: 120.- per household and year, or CHF 10.- per household and month, making the Health System here proposed self-sustainable from the third year of existence on.
- Contribution scalable for average incomes, for poor incomes and for large incomes, or just one contribution, proportional for household size?
- Financial Management within communities: To be organized in cooperation with the traditional chieftaincies (like for the Energy Phase), by health associations (“mutuelle de santé”, existing in some communities) or by an external agency (who? Needs to be indicated and approved by community assembly)
- Income-generating activities: As part of the activities of a health association, members work together, managing a communal cash crop field, to have a financial base for their association. This idea can be promoted within the project communities.
Projet Organisation et Développement Communautaire, s/c Association Jeunesse Verte Cameroun AJVC 2
Annex: Budget Overview
Activity / Observations (all costs in CHF) / 1st year / 2nd year / Other necessary contributions1. Community Health System / Building Health Center: 15 villages * 4'000.- (incl. Solar installation and fridge) / 60'000.- / 0 / Community: Local materials and labor, payment for consultations
Greenpeace: 70 % reduction for Fridges
Health Agents Scholarships: 30 HA * 2'000.- * 2 years / 60'000.- / 60'000.- / PODC: Guest House in Yaoundé
2. Traditional Healing Methods / Compilation and archive of Inventory: 15 villages * 600.- / 9'000.- / Community and PODC: Data collection
3. Efficient Cooking / Improved Kitchen / Community Workshops: 10 workshops * 6 days * 300.- per day / 18’000.-
Efficiency and pollution tests for stoves: 6 months * 400.- per month for material / 2’400.- / PODC: Workshop area already available
4. Training on Basic Health, Hygiene, Food and Water / Training sessions preparation and execution: 15 villages * (2 * 4 days per village) * 300.- per day / 36’000.-
5. General Health Survey / Field work, materials: 2 * 24 days * 400.- per day / 9’600.- / 9’600.- / PODC: Getting university partners for long-term health study
General Health Report: 2 * 6’000.- for compilation / 6’000.- / 6’000.-
6. Medical Assistance / Monthly medical visit: 12 months * 8 days per visit * 200.- per day for transport, food, material / 19’200.- / 19’200.- / See community-based finance system, and individual payment
Medicaments: 12 months * 1000.- per month / 12’000.- / 12’000.-
Contractual treatments: 12 months * 2’000.- per month / 24’000.- / 24’000.- / Public: long-term health programs funding
Total / 256’200.- / 130’800.-
- per community (ø) / 15 communities / 17’900.- / 8’700.-
- per household (ø) / Approx. 1’000 households / 256.- / 131.-
- per inhabitant (ø) / Approx. 5 to 7 inhabitants per household / 45.- / 22.- / See community-based finance system
Projet Organisation et Développement Communautaire, s/c Association Jeunesse Verte Cameroun AJVC 2
[1] See the Survey documents that have been elaborated by a team of 30 Cameroonian and Congolese students during the 1st Training Cours on Psychosociocultural Methodology for Community Development, given in Yaoundé between April and September 2010, in: PODC Archive/Pré-Diagnostique et Diagnostique. PODC Office, Yaoundé, and the Survey analyzes by Scientist and Trainer Guilherme dos Santos Barboza, in: Rapport Ethnologique Technique-Scientifique RETS, dos Santos Barboza. CABEPEC - AIWO-CAN – Greenpeace, Yaoundé, 2010.
[2] According to specific objective 3 of the Global Project: «Amélioration de la condition de santé, d’hygiène et de l’eau potable dans la communauté».
[3] It is the World Health Organization (WHO) that has, in its beginning, promoted combined traditional-modern health care, a concept that has been abandoned after some years, in favour of an exclusively modern medicine. The project will re-animate this idea. See Discours de Programmation dans les communautés, January-March 2012, Guilherme dos Santos Barboza.
[4] Through contracts and by applying modern intellectual property rights regulation, eventual benefits from publishing or using these methods outside community and project will be assured for the community.
[5] In cooperation with the University of Lübeck, Germany, a study on respiratory health has been conducted in 2012 in all project communities. The research report is being prepared, as part of a Doctor Thesis.
[6] Based on the research of the Aprovecho Research Center (www.aprovecho.org) and the publication „Design Principles for Wood Burning Cook Stoves, Larry Winiarski. Partnership for Clean Indoor Air (PCIA), Oregon, 2005», the project has, since 2009 in Cameroon, Togo, Senegal, Congo and Kenya, developed, built and trained wood-efficient clay stoves as well as metallic stoves that consume 60 to 80 % less wood or charcoal than a traditional open fire. Visual documents as well as construction manuals are available.