Some Lessons in Development Management - Places Visited (Kenya)

Kenya visit - August 2015

 2 weeks' clinical shadowing!  Set at a PCEA Kikuyu district hospital, as well as the Kivuli medical clinic, Miliki Afya clinic, Mid Hills hospital and a health project operating with HIV/AIDS patients.

Health data: Major health problems faced: diarrhoea, malaria, HIV/AIDS (5.6% prevalence), TB, other respiratory problems.  Major exports are coffee / tea / cut flowers / refined petroleum.  There are approx 1 doctor per 10,000 people (compared to 30x that number in the UK), under 5 mortality is 71 per 1000 live births.  User fees have been levied for healthcare, since 1989 ?structural adjustment.  50% of doctors practice in the capital, and only 10% of doctors across the country work in the public sector.  Per capita expenditure on healthcare is $72 (as compared to $3,400 in the UK). 

Health facilities: Vary from the very upmarket (Gertrude's, Aga Khan) through smaller hospitals (including some mission hospitals), to local poorly regulated clinics.  Word of mouth reputation is important as clinical excellence data is not routinely collected.

Kenya is a financial centre for East Africa; strong trade links with India, China, UK as well as its Ugandan / Tanzanian neighbours.

Cost effectiveness of basic medical interventions in the developing world

Vaccination programme

Figures provided are per DALY (2001 data).  I've highlighted up the areas I've thought of working in, both pre-medicine and now I'm in medicine (latest view in bold).

·        Vaccination (e.g. diphtheria, polio, pertussis, river blindness, measles & deworming) ($3-6)
·        Hygiene promotion against diarrhoeal disease ($5)

·        Emergency medical care by training first aiders ($6)

·        Identification/treatment/control of leishmaniasis (~$10)

·        Malaria bednet provision and residual spraying ($6-11)

·        Acute MI management with aspirin and beta-blockers ($14)

·        Malaria treatment ($19)

·        RTA reduction interventions, e.g. speed bumps, media campaigns, speed penalties ($21)

·        Clean cookstoves - swapping out for LPG (~$50)          

·        Child nutrition / breastfeeding advice ($42)

·        Water sector regulation for clean water supplies ($47)
·        Integrated child health management (~$70)

·        HIV/AIDS education; routine counselling/testing; condom distribution ($37/$47/$82)

·        Ante/postnatal midwifery and obstetric emergency care ($87)
·        BCG vaccination against TB (~$100)

·        Epilepsy (Phenobarbital) & CHF (ACE + beta blocker + diuretic) basic treatment (~$100)

·        Family planning / contraception ($117)

·        Trauma surgery ($136)

·        Basic sanitation provision ($141)

·        Emergency medical care by training ambulance service (~$150)

·        TB treatment (~$150)

·        Cataract surgery ($183)

·        Vaccination (e.g. Chagas, Flu, HepB, diphtheria, pertussis, tetanus) ($300)

·        Alcohol & tobacco disincentivisation ($300-1000)
·        Oral rehydration therapy package for diarrhoeal disease ($1,000)

Source: http://www.ncbi.nlm.nih.gov/books/NBK11784/ 

Some lessons from OU MSc Development Management - Places Visited (Bangladesh)

Bangladesh visit - November 2009

Bangladesh - visited Nov 2009  I enjoyed a comfortable office life for my short time in Dhaka, and saw micocredit really working in the villages.  That said, also the tight press of bodies lining the roads, stringy rickshaw-pullers, and a lack of women in the traffic-choked city; in the country my food poisoning was desperate!

History/Economy/Society: Despite independence from Pakistan in 1971, 60% of the population remain landless, (cf ~30% UK), including the vast majority of women.  Water quality is a big problem (Weil's disease, diarrhoeal bacteria in water courses), and latrine usage only 16% in rural areas.  Fertility rate has dropped to 2.2 (from 7 in the 1970s).  Healthcare remains private, but education is free to 18.  Most workers in the largest industry (garments) are women - but with wages as low as $0.15 per hour.  There are 16.3m microcredit borrowers excluding Grameen (which has another 8m) i.e. about 5% of the population.  Transport infrastructure remains poor, and the quality of education is also very poor (high dropout rate).

ODA: $89bn since 1971.  Gradual increase in HDI underpinned by birth control, microcredit, agricultural efficiency (up 3x since 1971), anti-poverty social safety nets (12% of govt spending), and largely the power of the huge NGO BRAC, which has made strides for the population in health, education and other areas.  Bangladesh is a bit of a benchmark for good NGO work.

Some lessons from OU MSc Development Management - Places Visited (Ghana)

Ghana visit - spring/summer 2000

Ghana - visited Apr-Aug 2000  Vivid recollections of hip-life music, muslim drivers + ablutions, colourful batik makers; but polio, beaches w/open sewage, animal cruelty: tiny crocodile on show in an oil can, and kids without schools to go to.

Economy/History: First half of the colonial period 1867-1902 significant conflict between Ashanti and colonists, which previously had included Swedes, Dutch, Germans, Danish, Portuguese and British.  From then till independence in 1957 was initially a traditional export-oriented colonial economy (gold, ores, timber, ivory and later significantly cocoa), with legislative councils in the cities (Accra, Cape Coast, Sekondi), and tribal chiefs with absolute power backed by the colonists in the regions.  Post-independence, the economy suffered at the whims of the markets, experiencing no per-capita growth between 1960 and 2000.  Recent industrialisation, oil finds, automotive and digital manufacturing have pulled the country forward, with consistent rapid growth since 2000.

Social: Since 2003, pay-before-care 'cash and carry' healthcare was replaced by basic universal health coverage, provided by a tax-funded national health insurance scheme.  Since the 1980s, education up to age 14 has been free (though school meals and uniform paid for).  2012 election manifestos sought to provide free education including ancilliary costs up to age 18.

ODA: Broadly ineffective 1960-2000, despite $21bn aid (1960-2000) and $15bn aid (2000-2010), and a current debt of $11bn.  Growth was significantly hindered by the structural adjustment conditions on loans from 1988-, leading to unemployment and health sector cutbacks.  NGOs were enacting projects in many areas: WASH, HIV, education projects, environment, transport, agriculture, public sector reform.  Unclear what influence these had on the country.

Some lessons from OU MSc Development Management - Interventions

1) 'International Development' with its modern meaning came about since the mid 1950s, following post-war Marshall Plan reconstruction, intensive trade with the African colonies and decolonialisation.  It's really a post-colonial phenomenon.

2) Microcredit may well be on the wane.  Drop in # of borrowers shown in India between 2010 and 2012 and both Roodman, 2011, and Duvendack et al, 2011 indicate that there is no consistent concomitant reduction in poverty from microcredit programmes.  It's particularly difficult to find annual spend ODA figures for investment in microcredit - there is at least $6bn in revolving microfinance funds, and Grameen indicate an asset base of >$1bn. 


3) While there were competing capitalist and communist models post-WW2, MSc has a clear message - 'capitalism has won'.  Mainstream social development interventions exist in a paradigm of 'ameliorating the disordered faults of progress' (Cowen & Shenton, 1996).  

4) 'The Sphere Project' provides minimum standards for humanitarian intervention, very widely used.  The UN 'cluster approach' provides an administrative framework within which to co-ordinate intervention, with various agencies taking the lead of, for example, shelter (IFRC) or WASH (UNICEF).

5) Logframes form the standard basis for application for development donor funding.

6) The right-based approach underpins much practice by development NGOs - building the capacity of beneficiaries to realise their 'inalienable' rights (such as those broadly agreed upon under international law). This is broad enough to be widely accepted, although it involves educating individuals about their rights and may cause problems for donors looking for immediate social welfare outputs.

Informative NGO animations

Creative input to NGOs has led to some great explanatory animations on the websites

Transparency International (anti-corruption)
http://www.transparency.org/whatwedo

Generic Medicines Patent Pool (sharing pharma information)
http://www.youtube.com/watch?v=Vj0dbFgjoh4

Triodos Bank (social investment)
http://www.youtube.com/watch?v=devgHqVS14k

NHS Primary health service choice
http://www.youtube.com/watch?v=ffT1orYXdcI