Director,
T.E.(Terry)
Manning,
Schoener
50,
1771 ED
Wieringerwerf,
The
Tel:
0031-227-604128
Homepage:
http://www.flowman.nl
E-mail:
(nameatendofline)@xs4all.nl : bakensverzet
Incorporating innovative
social, financial, economic, local administrative and productive structures,
numerous renewable energy applications, with an important role for women in
poverty alleviation in rural and poor urban environments.
"Money is not the key that
opens the gates of the market but the bolt that bars them"
Gesell, Silvio The Natural
Economic Order
Revised English edition, Peter
Owen, London 1958, page 228
Edition 15:
Good health is a major factor for our quality of life. However, it is a development fallacy that good health depends mostly on vaccination campaigns and medicines. Diseases are consequences, not causes. A promise by an American president to grant 18 billion dollars to the “fight against AIDS” is not in itself negative, but it has little if anything to do with local economic development for the world’s poor. Most of the money goes into the pockets of the pharmaceuticals companies who supply the medicines. Some of the rest of it goes into the hands of NGO organisations who pay their staff to organise and control their distribution. It is possible that not a single dollar of direct contribution be made to the development of the local economies in the areas where the AIDS medicines are distributed.
Mass
vaccination campaigns are another example of activities where large amounts of money
are invested with the declared intention of helping the poor in less-developed
nations. Yet there is, with the possible exception of polio, little real
evidence that the introduction of mass vaccination campaigns has reduced the
rate of death amongst children either in industrialised or in developing
countries. Some reports indicate that more children may have died as a result of
being vaccinated than would have been the case had they not been vaccinated. The
negative, wide-spread effects of
the use of mercury in vaccination campaigns are only now becoming public.
The continued use of mercury, now banned in many industrialised countries, is
believed to be continuing in developing countries.
Had the money spent on vaccines been used for basic services such as hygiene education, the improvement of basic water management, better drainage, and improved cooking stoves, much of the poverty in the world could have been eliminated and the quality of life of children and their parents guaranteed. The problem is that such basic services do not put profits into the pockets of multinationals or supply work for expatriate “health specialists” from industrialised countries.
In
reality health improvement necessary for a good quality of life in project areas
in poor countries can best be achieved by following low technology, locally
executed non-industrialised initiatives. Examples, all of which are brought
under the Model, are hygiene education courses for women and in schools, clean
drinking water supply, a varied food supply, proper sanitation facilities and
recycling of wastes, proper aeration of homes and the elimination of smoke
through the use of better cooking facilities, drainage and the elimination of
stagnant waters, the use of simple, intelligent locally applied means to combat
flies and mosquitoes.
In
industrialised countries, the rate of occurrence of traditional infectious
diseases had, with the possible exception of polio, decreased to present levels
BEFORE mass vaccination campaigns were introduced. The improvements which had
already been registered are generally attributed to better food, better quality
accommodation, and better hygiene in homes and in public places. Logic would
suggest similar principles be applied to rural and poor urban areas in less
developed countries. This can be done locally, without the need for any
financial leakage. Especially if some basic medicines can be locally prepared
using locally grown medicinal plants.
The
Model tries to distinguish between the major, the preventive, part of health
services which can be supplied within a local development area, and a
second-level of specialised curative services which cannot. A local development
project cannot substitute the state for construction and running of hospitals or
the training and payment of medical personnel, with the exception of the
salaries of doctors and trained nurses willing to work under the local money
LETS systems set up during project execution.
Where
residents in a given local development area must pay for medical services of any
kind originating outside the development area serious financial leakage occurs,
which reduces the amount of formal money in circulation available for other
purposes in the project area and restricts possibility of productivity
development there.
Viewed
inversely, funds supplied by donor nations in the form of grants or loans for
health improvement purposes is subtracted from their annual general development
aid quota, thereby reducing the funds available for integrated local development
in favour of the world’s poorest.
While
in many industrialised countries solidarity in favour of the weakest is often
reflected in health legislation, this is seldom the case in developing countries
where users often have to pay directly in cash for the services they receive.
05..62.05 Health
education.
The (200) health clubs for women and
on-going hygiene education courses in the (40) schools in the project area are
sustainably run under the local
money systems set up. They include
household hygiene, the need for
keeping clean water clean, germ
theory, water-borne diseases, skin infections, worms, malaria, the sanitation
ladder and nutrition. It is the intention of the project that aspects relating
to AIDS prevention, anti-conception and family planning in general also be
introduced and discussed. Course material can also be extended to discussion of
circumcision practices, household violence, and the physical abuse of women and
children, and child labour. Some of these health related topics are taboo in
some project areas. Since the local people are themselves directly involved in
project planning and execution, there is little point in extending the courses
to cover subjects they do not wish to discuss. Sensitive cultural issues needing
very careful and patient management may be involved.
05..62.06 Health aspects relating to drinking
water supply.
The
organisational workshops for water supply will establish a network for the
systematic control of water quality. The following are some possible
indications:
01
Organising systematic water sampling to keep a close check on water quality in
the wells and in the tank installations.
02 Hygiene education. Cooperation
through the established Health Clubs with locally operating health workers and
the Regional Department of Health to spread information and training of the
users in the correct use of clean household utensils, washing of hands before
eating.
03 Equipment for water testing will be supplied to one of the local
clinics and paid for by the users on condition that water testing within the
project area be carried out free of charge.
04 Organisation of regular water
sampling.
05 Water testing programme.
06 Hygiene education courses in
schools.
07 Rules concerning special industrial and medical waste products.
Special
attention will be paid to keeping the clean drinking water supplied by the
project clean once it leaves the dedicated water tank in a tank commission area,
and in particular how to keep water recipients clean, how to store the water
safely, and how to use the water without contaminating recipients and the
water which is left over.
05..62.07
Health and sanitation.
The
introduction of a complete ecological sanitation system in the project area
should also have a profound effect on the health of the people there. Risk of
contamination of surface and ground-waters is eliminated. Stagnant surface
waters will be drained. Organic and
inorganic waste products will be usefully recycled and pests eliminated from the
environment. Relationships between (ethical and ecological) animal husbandry and
humans may over time be reviewed. The review is expected to cover slaughtering
practices and safe food storage and its safe conservation for local
consumption.
05..62.08
Insects.
Once
the local money system is in place in the project area, initiatives will be taken for the local
production of mosquito nets, fly-catching devices and similar and for the
natural biological elimination of harmful insects from homes and villages.
Stagnant
surface waters offering breeding places for disease-bearing vectors will be
eliminated by improving drainage from them.
05..62.09
Health and smoke elimination.
The
adoption of high efficiency cookers
and the elimination of wood- and charcoal-burning will eliminate smoke hazards
in and around users’ homes. Smoke-related respiratory illnesses, the largest
single cause of illness and death amongst children and women in developing
countries, should be eliminated altogether. This is the first, and the most
important, step towards improved housing quality.
05..62.10
Health and nutrition.
Improved
nutritional sufficiency and dietary variation can be expected to increase
resistance to illness throughout the project area. The fitter the people the
higher their work capacity and productivity.
05..62.11
Curative Health structures.
This
project is about the general improvement of the health of the inhabitants in the
project area by prevention of diseases through the elimination of their main
causes.
The
proposed social and service structures set up by the project are also optimally
sized to receive doctors and nurses willing to work within the framework of the
local money systems once they are in operation. Doctors and nurses paid
(reasonable) formal money salaries by regional or government health authorities may
wish to return to the areas they come from and contribute to the local
integrated development under way there. Where necessary and legally possible,
they can supplement their formal money salaries by charging for their services
under the local money systems set up. “Unemployed” or “underemployed” doctors
and nurses originating in the project area may accept to work entirely within
the local money systems in operation there.
The
following paragraphs on possible future medical structures describe target
sustainable health services for the project area. The realisation of these
services is not formally a part of this project, but the services must be
included in any integrated development vision for the area. It may take many
years for the required services to become a reality. It remains a task of the
project to use all of the social, financial, and productive structures it sets
up in the project area to promote their realisation. These structures include
the local money system which enables inhabitants to pay nurses and doctors fully or partly for
their services without their needing to have formal money for the
purpose.
A
three-tiered system is foreseen. It incorporates nursing services at tank
commission level, doctors’ services at well-commission level, and a hospital
facility at project level. These are described in the following
paragraphs.
05.62.12
Nursing services at tank commission level.
The
(200) tank commission areas provided for in this project each serve 40-50
families, or about 250-350 people. In principle, each tank commission area
should provide work for one (qualified) specialist nurse. Suitable accommodation and a reception
area for the nurse can be organised and built by the local tank commission as
soon as the local money system is in place. The project management will try to
mediate with the Ministry of Health in support of each local tank commission’s
efforts to identify and attract a nurse to its tank commission area.
As
each tank commission organises nursing assistance, all of the members served by
the tank commission will pay a small monthly formal money contribution into a
Cooperative Health Fund (nursing section) run by the project along the same
lines as the Cooperative Local Development Fund. The population will decide how
much they pay into the Cooperative Health Fund (nursing section), taking
eventual contributions by state and national Health Authorities into
consideration. Where nurses are
required to serve people in more than one tank commission area, the associated
costs will be divided amongst the tank commission areas served and the monthly
formal money contributions of families into the Cooperative Health Fund (nursing
section) adapted accordingly.
Local
money contributions to nursing costs will be paid by the local populations under
the local money systems in the normal way. They may take the form of a monthly
retainer payment debited in equal shares to all of the adults in a tank
commission area; eventually together with a specific (limited) local money
charge to the patient for each consultation. Formal money costs of medicines and
equipment are paid out of the Cooperative Health Fund (nursing section). The
sick are therefore collectively
insured by all adult tank commission members for the formal money costs of their
(basic) medicines. Purchases of
(basic) medicines are pooled at project level to reduce costs.
One
nurse for each tank commission area is a target to be reached over a number of years, and may depend
on improvement in local education levels and training of nurses from the project
area.
The
nurse will be equipped with basic equipment and materials necessary for (her/his) nursing activities. Lists of
very basic medical supplies for the nursing posts would be chosen on advice from
health service specialists from the World Health Organisation's model list of essential
medicines.
Special
priority will be given to the treatment of (list of particularly common
area-specific illnesses) which are common in the project
area.
05.62.13
Doctors’ services at well commission level.
The
(40) well commission areas provided for in this project each serve 350 families,
or about 1750-2500 people. In principle, each well commission area should
provide work for one (qualified) doctor.
Suitable accommodation and a reception area for the doctor can be
organised by the local well commission as soon as the local money system is in
place. The project management will
try to mediate with the Ministry of Health in support of each well commission’s
efforts to identify and attract a doctor to the area.
As
each well commission organises qualified doctor’s assistance, all of the members
served by the well commission will pay a small monthly formal money contribution
into a Cooperative Health Fund (doctors’ section) run by the project along the
same lines as the Cooperative Local Development Fund. The population will decide
how much they pay into the Cooperative Health Fund (doctors’ section), taking
eventual contributions by state and national Health Authorities into
consideration.
Local
money contributions to doctors’ costs will be paid by the local populations
under the local money systems in the normal way. They may take the form of a
monthly retainer payment debited in equal shares to all of the adults in a tank
commission area; eventually together with a specific (limited) local money
charge to the patient for each consultation. Formal money costs of medicines and
equipment are paid out of the Cooperative Health Fund (doctors’ section). The
sick are therefore collectively
insured by all adult well commission members for the formal money costs of the
(basic) medicines prescribed by their doctor. Purchases of (basic) medicines are pooled at project
level to reduce costs.
One
doctor for each well commission area is a target to be reached over many years, and may depend on
improvement in local education levels and training of doctors from the project
area. The target ratio of doctors
to inhabitants is in line with that currently widely accepted in industrialised
countries.
The
doctor’ post will be equipped with basic equipment and materials necessary
for (her/his) professional
activities. Supplies of medicines for the doctors’ posts would be chosen by the
doctors themselves, where requested on advice from health service specialists,
from the World Health Organisation's
model list of
essential medicines.
Special
priority will be given to the treatment of (list of particularly common
area-specific illnesses) which are common in the project area.
05.62.14 Project area hospital.
The
size of the project area (50.000 inhabitants) is also designed to take a local
non-specialised centrally located hospital facility with optimal access from all
of the population centres in the project area. The hospital should have 1 bed
for each tank commission area. This project provides for (200) tank commissions.
The local hospital unit should therefore be equipped with (200-220) beds.
The
hospital unit should be able to handle the medical situations most commonly
arising in the project area. These include trauma and emergency services,
rehabilitation, maternity issues, the treatment of infectious and water-borne
diseases, and some basic surgical interventions. The hospital will provide active support
for hygiene education activities, drinking water quality control, and HIV/AIDS
and family planning campaigns in the project area. It will support doctors’ posts with
advice on nutrition matters, child and youth care and mental health problems. It
will provide a front office filter service for the diagnosis of more complex
conditions, and provide liaison for their handling in specialised hospitals
outside the project area.
Advanced
hospital services are the responsibility of the Department of Health of
(country).
The
project can facilitate hospital services and activities which can be carried out
under the local money system set up. These include non-specialist services, such
as the supply of guards, gardeners, cleaning services, washing services,
non-qualified kitchen services.
Non-specialised
individual care following release from hospital is covered under the local money
systems at well-commission (doctors) and tank commission (nurses)
levels.
Simple
hospital construction can be carried out under the local money system, once
qualified design and specifications for buildings suitable for the project area
are available.
05.62.15 Other specialist medical and paramedical
activities.
There
are many other standard specialist medical and paramedical support activities
which should be made available in the project area, including dentists,
physiotherapists, optometrists, psychiatrists and psychologists. The
project can facilitate the introduction of such services and activities where
they can be carried out under the local money system set up.
Improvements
in the general quality of life of the local inhabitants over the years should
gradually entice such specialists to (return to) the project
area.
05.62.16
Transport of patients.
As
soon as the local money system to be set up is in place and drivers willing to
work under the local money system are available, the project management may
attempt to obtain national government support and/or separate external seed
funding for the purchase (where appropriate second hand) of up to four
four-wheel drive vehicles suitable for the transport of patients to the project
area hospital or from the project area to the hospitals nearest to the project
area.
As
the project management brings an ambulance service to each ambulance district
(expressed as a cluster of well-commission areas), all of the members served by
the well commissions in question will pay a small monthly formal money
contribution into a Cooperative Health Fund (ambulance section) run by the
project along the same lines as the Cooperative Local Development Fund. The
population will decide how much they pay into the Cooperative Health Fund
(ambulance section), taking eventual contributions by state and national Health
Authorities into consideration. The formal money amount must be sufficient to
pay for fuel, spare parts and long-term vehicle replacement. Drivers’ salaries
will be paid under the local money systems. Long-term replacement reserves may
be loaned to the Cooperative Local Development Fund and recycled in the form of
interest-free micro-credit loans until they are needed.
05.62.17
Local manufacture of health products.
Priority
will be given taken under the financial structures created in an early phase
of the project to initiatives for
the local manufacture for local use of devices and products for the
rehabilitation of the physically
handicapped. These may include basic assistance to individual mobility such as wheelchairs and artificial limbs. Steps may also be
taken for the local production of elementary medicines, including those using
locally available medicinal plants, and contact lenses. .
05.62.18
Mine clearance.
There
are no parts in the project area which are known to be
mined.
05.62.19 Ecological
hazards.
There
are no known ecological hazards in the project area.
05.62.20
A primary health care package.
For
a general view of primary health care suitable for the project area, refer
to:
The Primary
Health Care Package for South Africa : a set of norms and standards.
Forward:
Contributions of users and ongoing maintenance and administration costs.
Back:
Institutional developments.
List of drawings and
graphs.
Typical list of maps.
List of key
words.
List of
abbreviations used.
Documents for
funding applications.