Annual Report 2005 english

ANNUAL REPORT DOCTORS WITH AFRICA CUAMM

Onlus / Ong Via S. Francesco 126 35121 Padova Italy tel. +39 049 8751279 fax +39 049 8751279 www.doctorswithafrica.org

ANNUAL REPORT DOCTORS WITH AFRICA CUAMM

2005

2005

Annual Report 2005

INDEX

The NGO

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Projects Sector Angola ......................................................................................................................................................................................................................................

Ethiopia ..................................................................................................................................................................................................................................

Kenya ........................................................................................................................................................................................................................................

Mozambique ...................................................................................................................................................................................................................

Rwanda ..................................................................................................................................................................................................................................

Tanzania ................................................................................................................................................................................................................................

Uganda ...................................................................................................................................................................................................................................

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7 40 53 56 67 69 77

Human Resources Sector General Framework .............................................................................................................................................................................................

Working Personnel ................................................................................................................................................................................................

Recruting and Selection ...............................................................................................................................................................................

Training and Preparation ..............................................................................................................................................................................

Monitorino and Evalutation ......................................................................................................................................................................

Documentation Center ...................................................................................................................................................................................

Associative Life ..........................................................................................................................................................................................................

Students College .....................................................................................................................................................................................................

Information Sessions .........................................................................................................................................................................................

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101 101 103 104 113 114 116 116 117

Communication and information Sector Communication and information .....................................................................................................................................................

Sensitisation campaigns and Public Relations .........................................................................................................

The year’s products .............................................................................................................................................................................................

The year’s principal events ......................................................................................................................................................................

Publications .....................................................................................................................................................................................................................

Sensitisation material ........................................................................................................................................................................................

Educating for developement .................................................................................................................................................................

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121 121 123 125 126 128 129

Groups Sector The Groups ......................................................................................................................................................................................................................

Doctors with Africa Cuamm Groups .........................................................................................................................................

Partner groups of Doctors with Africa Cuamm ........................................................................................................

Friends of Doctors with Africa Cuamm groups ........................................................................................................

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133 134 150 153

Other Activities

pg. 157

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Doctors with Africa Cuamm

International College for Health Cooperation in Developing Countries Doctors with Africa Cuamm was founded in 1950.

It is one of the channels of the ‘Work of St. Francis Xavier’, agency with legal personality civilly recognized with DPR 18/01/60, nr.55.

Non governmental organisation (NGO) for health cooperation, recognized suitable to the senses of the Law nr. 49/87.

Foreign relations: Member of: Medicus Mundi International (MMI), Volunteers in the World – FOCSIV, Comitè de Liaison (UE).

Correspondent of: UNICEF, WHO. Adheres to : the Red Cross International code of conduct.

Head Office: via S. Francesco nr.126, 35121 Padova tel. 049.8751649-279; fax 049.8754738 e-mail: cuamm@cuamm.org Actual Member: On 31.12.2005: nr.306.

Director and legal representative: Luigi Mazzucato Director Assistants Andrea Borgato (Head of Administration Department) Egidio Bosisio (Projects Department) Dante Carraro (Vice-Director, Head of Human Ressources Department and of the College) Serena Foresi (Partners Department) Anacleto Dal Lago (Projects Department) Valerio Mecenero (Head of Projects Department) Anna Talami (Head of Communication&Marketing Department)

PROJECTS SECTOR

ANGOLA ETHIOPIA KENYA MOZAMBIQUE RWANDA TANZANIA UGANDA

ANGOLA

1 COUNTRY PROFILE Angola is one of the largest African producers of crude oil, second only to Nigeria. On 11 April 2002 the government and the UNITA rebel faction signed a ceasefire and peace agreement. After signing the ceasefire the decision to reach an agreement came after the killing, in February of the same year, of the historic leader of UNITA, Jonas Savimbi, during a skirmish in a UNITA controlled area near the border with Zambia.

The ceasefire may well be the first step towards lasting peace, in a country that, since the time of its independence in 1975, has been bloodied by constant warfare. The ongoing conflicts have left the country in a ruinous state. It is estimated that there are more than 10 million landmines spread over the vast national territory. The capital, Luanda, has a population of around 5 million, most of whom living in very poor conditions. The healthcare system is extremely out of date, not just because of the lack of equipment and facilities, but also and perhaps above all due to the persistent application of inappropriate political strategies. Angola’s healthcare indicators are among the worst in the world.

The 5th Congress of the Popular Movement for the Liberation of Angola (MPLA) which was held last December, ended with a vote of confidence in the current president, José Eduardo dos Santos, who was confirmed for the office of the party leader and natural candidate for the future presidential elections.

The total surface area of Angola is around 1,246,700 sq km. The most recent census dates back to 1970. It is estimated that the current population is in the region of 14 million.

Life expectancy at birth is 45 years for men and 48 years for women. The infant mortality rate is 125 per 1,000 live births. The maternal mortality rate is estimated at 1,500 for every 100 thousand live births. In its latest report on human development, the United Nations Development Programme (Undp) ranks Angola in the 164th place out of a total of 175 countries. > > > > > > > > > > > > > > >

>

Full name of the country: Republic of Angola Area: 1,246,700 sq km Population: 13,978,552 Capital city: Luanda (2,297,200 inhabitants) Ethnic groups: Ovimbundu 37%, Kimbundu 25%, Bakongo 13%, Mestico (mixed European and native African) 2%, European 1%, other 22% Languages: Portuguese (official), Bantu and other African languages Religion: indigenous beliefs (47%), Roman Catholic (38%), Protestant (15%) Government type: parliamentary republic President: José Eduardo dos Santos (1979) Prime Minister: Fernando de Piedade Dias dos Santos (2003) GDP: $ 20.5 billion GDP per capita: $ 1,490 Annual growth rate: 7.1% Inflation: 18% Main sectors/products: petroleum-chemicals, minerals (diamonds, bauxite, phosphates, uranium and gold), food and fish products, tobacco products, sugar, textiles Economic partners: USA, EU, China, South Korea, South Africa, Brazil.

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2 HISTORY OF DOCTORS WITH AFRICA CUAMM IN ANGOLA The Angola project started in 1997 and was initially concentrated in the province of Uige, expanding later to include the provinces of Luanda and Cunene.

From 1997 to 1999 Doctors with Africa CUAMM pursued its commitment with the Uige hospital also during the fiercest fighting of the civil war, subsequently extending its activity to include the hospital of Negage with a project funded by ECHO, the European Commission’s Humanitarian Aid Department.

In 2000 Doctors with Africa CUAMM consolidated its presence in Luanda and, further to an invitation from the bishop of Kunene, an intervention was planned that would subsequently be developed as the southern platform of Doctors with Africa CUAMM in the country.

With the peace agreements of 2002 the provincial territory was opened up thanks to a careful implementation of a relief, refurbishment and development strategy, Doctors with Africa CUAMM reopened five of the six hospitals in the province of Uige, subsequently focusing in 2006 on the two most isolated municipal areas: Damba and Maquela do Zombo.

In the other provinces the interventions were consolidated in both the area of tuberculosis treatment, which expanded in 2005 to embrace 11 provinces, and in Kunene where the organisation started supporting the provincial HIV treatment program.

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3 SOCIAL HEALTH INDICATORS HUMAN DEVELOPMENT INDICATORS Life expectancy Literacy rate at birth rate (gross) 40.1 years

42%

DEMOGRAPHIC INDICATORS Total Annual population population growth rate 13,978,552 2.9 HEALTH INDICATORS Maternal Infant mortality mortality

1700 /100,000 live births

154 / 1000

30%

Schooling development index ranking 164 out of 177

Human Human development index 0.381

Urban population

Fertility rate

48%

7.2

Deliveries assisted by qualified personnel 45%

Mean Doctors per prevalence of 100,000 persons HIV on study of pregnant women 5.1% 5

INDICATORS OF ACCESS TO WATER AND FOOD Population with Undernourished Underweight Underheight access to an population infants in infants in improved water relation to age source to age 38% 49% 31% 45%

Underweight infants at birth relation 12%

4 INTERVENTION PLATFORMS OF DOCTORS WITH AFRICA CUAMM IN ANGOLA The intervention platforms of Doctors with Africa CUAMM involve the provinces of Uige, Kunene and Luanda.

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4.1 Province of Uige 4.1.1 Maquela do Zombo SUPPORT OF THE MUNICIPAL HOSPITAL OF MAQUELA DO ZOMBO: PRESTAÇÃO DE CUIDADOS MATERNOS INFANTIS AS POPULAÇÕES DESLOCADAS DO MUNICÍPIO DA MAQUELA DO ZOMBO. LOCATION BENEFICIARY POPULATION BUDGET DONORS PARTNERS EXPATRIATE PERSONNEL LOCAL PERSONNEL AUXILIARY PERSONNEL PROJECT STARTING DATE PROJECT ENDING DATE

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> > > > > > > >

Municipality of Maquela do Zombo 229,681 269,231 EU in situ funding PTAPD PROVINCIAL HEALTH DIRECTORATE 1 doctor 1 nurse 1 logistician

> > > >

1 driver 1 storeman JUNE 05 DEC 05

Introduction The ECHO 12 month project, which started on 1.4.2004, reached its conclusion on 31.3.2005 without obtaining an extension for closure of ECHO activities in Angola.

On 1.6.2005 a transition project was started (8.ACP.ANG.11/30), funded by the EU Luanda office, in the framework of a national programme designed to support internal displaced persons (PTAPD) which terminated on 31.12.2005 and allowed the optimal transition with the activities of the project co-financed by Doctors with Africa CUAMM and the EU, lasting two years and starting on 1.1.2006.

In the period from 1.4.2004 to 31.5.2005 the activities in Maquela continued uninterrupted, using residual funds of the ECHO project and private resources of Doctors with Africa CUAMM. Main activities in hospitals > The epidemic of Marburg Hemorrhagic Fever that dominated the health scene in the province of Uige in 2005, did not impact on activities in Maquela; only two positive cases and one suspected case were recorded, all of which treated with appropriate safety measures and in close collaboration with the provincial epidemic control commission. > The flow of patients to the hospital increased steadily, probably due to the greater confidence of the population in the healthcare service and gradual population increase of the municipality caused by the gradual return of Angolan refugees from the neighbouring Democratic Republic of the Congo. > The total number of admissions recorded in 2005 was 11,581 of which 1,725 adults, 1,572 in the Obstetrics and Gynaecology department, 286 in the Respiratory Medicine Department and 7,998 in the Paediatrics Department, making this the second most important hospital in the province in terms of utilisation. > The Transfusions Centre was upgraded with the installation of a solar panel powered refrigerator for storage of blood: during the dry season the average number of paediatric transfusions is 8 /day, and the HIV and EP screening test is performed for all transfusions. > The number of assisted deliveries was 828, of which 61 by caesarean section and 33 by vacuum extractor. Surgery was reserved only for emergencies, for a total of 102 operations. The senior surgeon who was to join the team was unable to reach Maquela due to health problems. > Significant efforts have been made to improve the hospital’s information system, with the introduction of a computer in the statistical data room and the training of local personal in the basics of information technology. The information currently generated is reliable, in line with national plans, and updated in real time.

> The training of paramedical and auxiliary staff in security measures to be applied in hospital work has been improved, and a series of therapeutic and diagnostic protocols have been introduced for the main paediatric diseases and emergencies. > The supply of drugs was constant during the year without any significant stock breaking; the integration of drugs of Doctors with Africa CUAMM with those of the local government is proceeding slowly but surely; medicine stocks and distribution to wards are managed by a single function and efforts are being made to facilitate purchases by the hospital at the IDA to increase the effectiveness of the state investment, which is currently significant in economic terms although only mediocre in terms of the effective supply of drugs.

Main activities in the territory Construction is now almost complete of the Nzadi health post, 30 km east of Maquela, in one of the most densely populated areas and the main trading centre in the entire municipality.

The Health Post of Quibocolo on the road for Damba, and Ntaia on the road for the DRC have been renovated, refurnished, and provided with equipment.

Main logistical activities > The electrical installation of the hospital has been renovated and a new 40 kWA generator installed which, in addition to serving the hospital, will also feed power to the offices of the hospital management and the residential quarters of Doctors with Africa CUAMM personnel.

A parallel lighting system has been installed. Powered by batteries and solar panels, the parallel system will allow the continuous use of 16 light fixtures throughout all hours of darkness. > The hospital water supply system, which has been out of service since 1998, has now been restored thanks to the reactivation of the captation borehole with the installation of a submersible pump and the physical refurbishment of the storage and distribution systems: currently water is supplied for several hours each day to 10 external standpipes and several strategic areas of the hospital, including the maternity ward, laboratory, operating theatre and emergency room. > A new rational and protected structure has been constructed for the disposal of sorted hospital waste. This activity resulted in a radical improvement in the environmental hygiene of the hospital. > The hospital has also been painted throughout; renovation of the new maternity ward has been completed (in the original hospital management quarters), and also renovation of the kitchens, the laboratory, the respiratory medicine department and the mortuary.

4.1.2 Damba SUPPORT OF THE MUNICIPAL HOSPITAL OF DAMBA: PRESTAÇÃO DE CUIDADOS MATERNOS INFANTIS AS POPULAÇÕES DESLOCADAS DO MUNICÍPIO DA MAQUELA DO ZOMBO. LOCATION BENEFICIARY POPULATION BUDGET DONORS FOR COMPLEMENTARY ACTIVITIES PARTNERS EXPATRIATE PERSONNEL LOCAL PERSONNEL AUXILIARY PERSONNEL PROJECT STARTING DATE PROJECT ENDING DATE

> > > >

Municipality of Damba 141,820 569,775 euro Private donors and Groups, Doctors with Africa CUAMM > PROVINCIAL HEALTH DIRECTORATE > 2 doctors > 1 nurse > > > >

1 logistician 1 driver JULY 04 DEC 05

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Further to an ECHO project for reopening the hospital which was concluded successfully, a transition project (8.ACP.ANG.11/24) was started, financed by the Luanda office of the EU, in the framework of a national programme designed to support internal displaced persons (PTAPD) which terminated on 31.12.2005 after a 2-month extension, as a bridging solution before the start of the new project on 1.1.2006, lasting 2 years (ONGPVD/2005/112-761). The EU project, which started on 07.7.2004, featured the general objectives of reducing the infant-maternal mortality rate and providing a good level of medical-surgical healthcare assistance in the Damba hospital by means of: 1.

2.

3.

4.

5.

6.

7.

8.

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Improvement of paediatric care; Improvement of obstetric care; Improvement of auxiliary services; Improvement of PHC services; Constant training of nursing staff serving in the hospital; Improvement of the information system; Constant supply of pharmaceutical medicines; Construction of new infrastructure and refurbishment of existing plant.

The end of the project, which was initially scheduled for 05.11.2005, was delayed until 31.12.2005 in order to provide continuity pending activation of the new project, which will start on 01.01.2006.

In the paediatrics department a 24-hour service supporting the more complex cases has been put in place. During the course of 2005 the hospital saw 2,767 admissions of which 1,658 paediatric. All the children in the hospital were examined every day, thus allowing on-the-job training of the nursing staff accompanying the doctor. This approach made it possible to restrict overall infant mortality to 4.1% (mortality > 48 hours: 1.7%). In the obstetrics department a significant increase was achieved in the number of assisted deliveries (up by 50% over the previous year; 199 in 2004, 308 in 2005), reflecting the increased confidence in the level of healthcare provided. Maternal mortality was 332/100,000. However, it is our belief that many women die in the villages because of the disastrous situation of the roads and transport services that effectively make a trip to the hospital all but impossible; in this context we do not have any reliable data to confirm or refute this hypothesis. For this reason (transport difficulty), the number of women coming to the hospital to give birth has increased significantly, including those arriving from relatively distant locations (100 km). This situation has led to overcrowding on the maternity ward (25 hospitalised women with 4 beds, and an average bed occupancy rate of 350.5%), which calls for the future construction of a facility to be used as a “pre-delivery ward� like the one created by Doctors with Africa CUAMM at Negage. Another important requirement is the construction of a new delivery/maternity room: the existing room has just one delivery bed (with no possibility of installing a second bed because of the confined space). Clearly this is wholly inadequate when more than one delivery is in progress at the same time.

For this purpose construction activities of peripheral maternity facilities have been planned, together with the training of midwives, which will be developed also throughout the project scheduled to start on 01.01.2006.

Also the medicine and surgery ward have been entirely managed by Doctors with Africa CUAMM in terms of human resources and materials/drugs, even though this is not specifically envisaged by the project in progress. Surgical activities in 2005, after having started elective surgery, doubled with respect to 2004 when exclusively emergency surgery was performed (132 operations in 2005 versus 56 in 2004).

The laboratory/transfusion centre has been constantly supplied with reagents and test kits (HIV and HbsAg) for the execution of safe transfusions.

Primary Health Care is the main obstacle due to the size of the municipality and the poor condition of the roads (closed to traffic 8 months each year). Constant supervision is vir-

tually impossible and the activity performed this year has been that of providing twomonthly kits of essential drugs to the health posts with sporadic supervision; in addition, the extended vaccination programme (PAV) was supported.

Training of personnel was performed in three forms: > Daily on-the-job training, introducing standardised protocols and treatment plans. > Training by means of weekly lessons on the most frequently encountered illnesses and on topics requested by the nurses. > Execution of a “doenças comunas e partogramma” (common diseases and labour and delivery chart) with the production of a manual for continuous personnel training.

This allowed an improvement in the knowledge of personnel and the use of standardised treatment plans. The labour and delivery chart is now currently utilised for the assistance of all deliveries. The Marburg Hemorrhagic Fever epidemic in the province of Uige raised awareness of an improvement in the standards of bio protection, which are today observed by all health practitioners in the hospital.

The hospital information system has been improved thanks to the supply of a portable computer to the counterparty and the constant assistance in the collection of statistical data. Currently the municipality of Damba is the only one in the entire province to be equipped with a digital file containing all the statistical data required by MINSA for the year 2005.

Almost the entire quantity of drugs was supplied by Doctors with Africa CUAMM; the local counterparty, despite having access to government funding for the purchase of drugs, diesel fuel, and materials, instead proceeded with the totally haphazard purchase of drugs the majority of which are of no use, with only a small proportion that were subsequently utilised within the hospital. The diesel fuel for the generator was entirely supplied by Doctors with Africa CUAMM, despite repeated requests to the counterparty to contribute to this expense.

During the year two new constructions were started, involving the transfer of a skilled technician for three months. Subsequently the constructions fell under the remit of the project logistician: a new respiratory ward (currently women suffering from tuberculosis are accommodated in the general medicine ward) and a building for the auxiliary radiology service. Both buildings are scheduled for completion in February. The Marburg epidemic also called for upgrading of the organic waste disposal system with the construction of a specific area of the “lixo” in compliance with international safety standards (MSFWHO standard). In the hospital kitchen, in view of the constant saturation of smoke due to the use of traditional cooking systems (fires on the floor), which resulted in a highly noxious environment, a fireplace and chimney were constructed resulting in a significant improvement in conditions; also patient’s cooking for dinners was extended. The entire hospital was repainted (inside and outside).

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4.1.3 Uige and Songo SUPPORT OF THE PROVINCIAL HOSPITAL OF UIGE AND THE MUNICIPAL HOSPITAL OF SONGO: PROVIDING SECONDARY MATERNAL AND CHILD CARE TO DISPLACED PEOPLE IN UIGE PROVINCE (Uige, Songo e Negage Municipalities) LOCATION BENEFICIARY POPULATION BUDGET DONORS FOR COMPLEMENTARY ACTIVITIES

PARTNERS EXPATRIATE PERSONNEL

LOCAL PERSONNEL

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AUXILIARY PERSONNEL PROJECT STARTING DATE PROJECT ENDING DATE

> > > >

UIGE and Municipality of Songo 450,000 999,983 euro Private donors and Groups, Doctors with Africa CUAMM > Trentino Alto Adige Regional Administration > Cordar Consortium > > > > > > > > > > > >

LUANDA 1 administrator UIGE 1 doctor for maternity ward 3 doctors for paediatric ward SONGO 2 doctors 1 logistician 2 drivers 1 logistician SEPT 2002 AUG 2005

This project, which is funded by the EU (Project no. 8 ACP ANG 011/01), with the additional contribution of private supporters and local authorities involved support in paediatrics, maternity, nutritional services and health posts, with reference to the Hospitals of Uige, Negage and Songo.

The intervention in the municipal hospital of Negage terminated in September 2004.

In effect, since this is a continuation of previous global interventions in the same hospitals, the project involved total support for the municipal hospital of Songo, and support for paediatrics and obstetrics in the provincial hospital. In addition, it was planned to improve the information system at all levels and award priority to the training of local personnel. A special commitment concerned the supply of essential drugs and the refurbishment of several infrastructure facilities.

The project under way was an 11-month extension presented to the EU in July in order to provide continuity to activities in Uige and Songo.

Further to a joint meeting with the provincial health delegation, the management of Doctors with Africa CUAMM and local authorities, it was decided (after the 11 month project extension) not to continue with an intervention of the replacement clinical type in the provincial hospital of Uige and the municipal hospital of Songo, but instead to focus on activities of training support to healthcare middle management on a provincewide level.

The decision to terminate the intervention, which was a significant disappointment from many different standpoints, was taken further to decisions taken with the counterparty in the above meeting and due to various contingent situations including: the arrival en masse of North Korean healthcare practitioners (16 at Uige alone), with whom collaboration in the provincial hospital has proved difficult; the award to the Uige and Songo hospitals of substantial finances for recurring expenses in an amount that is sufficient, if properly managed, to cover the requirements for drugs, consumables and food of the hospital;

the presence in the province of situations that are far more difficult and widespread than those of Uige and Songo, in which, all things considered, government activities are significant and radical; the lack of CUAMM doctors willing to work in complex situations such as those typical of municipal hospitals.

Considerable difficulties were in fact encountered in assuring the constant presence of two doctors at the Songo hospital, where the high staff turnover also prevented the arrival at stable results in the management of the work.

The Songo hospital therefore saw a fall in its utilisation rates and requires significant input, so this facility has been included in the extension for 2005.

In the Uige paediatrics department work proceeded in a positive manner for almost the entire twelve-month period; the stable presence of skilled specialists allowed the consolidation of several work routines that are particularly effective in the management of emergencies. The number of admissions rose to more than 11,000 and the mortality rate fell to just below 10%. Unfortunately here too, the arrival en masse towards the end of the year of Asian medical practitioners and the transfer of the paediatrics department to the new installations built by the government has resulted in a period of instability and confusion from which it will be difficult to emerge.

In the Uige maternity department the utilisation rates increased still further and in the current year assisted deliveries were 6,285, with a rate of caesarean sections of 6.3%, for an average of 17 deliveries/day. Training of paramedical personnel arrived at after 7 years of working together, plus the continuous availability of drugs made it possible to restrict maternal mortality rates to 451/100,000, which is equivalent to one third of the rate normally recorded in similar provincial hospitals in Angola. Here too the arrival towards the end of the year of Asian doctors resulted in confusion in terms of management rather than a tangible reduction of the workload of Doctors with Africa CUAMM personnel, also because the final destination of many of these Asian doctors is still uncertain, so the integration process proceeds rather slowly.

The laboratory service with the transfusion centre (the number of paediatric transfusions required is high due to the seriousness of malarial disease) remains one of the most demanding sectors with all the problems associated with the transmission of HIV and the clinical and purely logistical workload that this involves.

The Nutritional Rehabilitation Centre continues to manage serious cases and provide support for the supply of milk and drugs. Now that the war is over reduction of the nutritional problem connected to the displacement of large numbers of the population has diminished while access from peripheral municipalities and villages has increased so the utilisation of the Uige Nutritional Centre has started to increase again; the cessation of Unicef supplies of therapeutic milk has led to a greater level of commitment in the management of the Uige Centre in the effort to adopt therapeutic protocols that use elements that are available on the local market.

The supply of drugs to the supported facilities continued on a high level, since the increase in the financial commitment of the government is as yet unable to translate into an increased availability of drugs due to the lack of a national pharmaceutical policy and due to the relative inexperience of several of the figures in local key management positions responsible for this activity.

The training activity was focused on the obstetrics aspect for hospital staff (introduction of the labour and deliveries chart) and, above all, on the peripheral level, for midwives.

An initial seminar on the management of health information was held in November with representatives from all the peripheral municipalities with the aim of starting the refurbishment of the provincial information system, which is currently in an extremely retrograde condition.

Logistical and infrastructure refurbishment requirements were covered by a specifically created local team assisted by expatriate personnel.

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4.1.4 Vertical interventions PILOT PROJECT FOR CONTROL OF NEGLECTED DISEASES LOCATION BENEFICIARY POPULATION BUDGET DONORS PARTNERS EXPATRIATE PERSONNEL LOCAL PERSONNEL AUXILIARY PERSONNEL PROJECT STARTING DATE PROJECT ENDING DATE

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> > > > > > > > > >

Municipality of Damba 141,820 USD 174,000 WHO PROVINCIAL HEALTH DIRECTORATE 1 doctor (non-employee) 0 1 health promoter JULY 05 DEC 06

The Neglected Diseases control project is financed by the W.H.O. and envisages an initial study of the prevalence of helmenithics, intestinal parasitosis and filariae and subsequently a mass treatment if this is justified by the presence of high prevalence. In addition a major training activity is planned (meetings, conventions, seminars) to be executed in villages (schools, churches, committee rooms, etc.) concerning the methods of transmission and prevention of these diseases. The project was officially opened on 1 September but the W.H.O. provided funds only in mid November. Therefore only the training of the health promoter envisaged by the project was carried out (this figure will be responsible for all training activities in the villages) and the implementation of tests in all schools in the municipalities for the identification of areas in which helmenithcs and schistosomiasis are most endemic (as recommended by the W.H.O.). When the material is available a survey will be carried out for the analysis of the prevalence of these diseases. In the framework of this project in December the refurbishment was started of a building that will function as an office of public health and the construction of a new laboratory within the hospital complex.

REFURBISHMENT OF THE DAMBA MUNICIPAL PRIMARY SCHOOL Education in the Municipality of Damba is currently in the launch phase thanks to the arrival of a large number of teachers. However the level of schooling remains a matter of concern at the present. The war resulted in a large number of young people without any level of education. This is the reason for the current mass enrolments, including many adult pupils. A state school was recently (2004) refurbished by local government, but it is wholly insufficient in relation to the need to provide education for all beneficiaries. The Catholic mission (Cappuccino monks and Misericordia nuns) provides primary education in the mission facilities. In 2004 the mission registered the admission of 797 children.

The project, which is funded privately and by Doctors with Africa CUAMM groups, is designed to renovate primary schools owned by the Catholic mission of Damba (two schools) and started after the end of the school year (end of November) and hence it is at the start of its development.

Work was started in November.

In this initial phase Doctors with Africa CUAMM received 50% of the planned budget for total refurbishment. Therefore, after a market survey the NGO acquired all the materials required for the refurbishment project and, through its logistics structure, it shipped them all to the Municipality of Damba.

The Logistics component impacted significantly on execution times because, since once the rainy season starts the Municipality of Damba is almost entirely cut off for days at a stretch from the rest of the province and from the capital.

Despite the difficulties, the materials, which are available only in the capital, were shipped and after several days they were delivered and the works were started.

Situation at present: > Renewal of the roof of one of the buildings in such a way as to prevent water ingress resulting in serious damage to suspended ceilings and walls. > Construction of doors and windows has been started. > Internal refurbishment work started including walls, tiling, and floors. > Refurbishment work on the external structure was started.

The programme envisages continuous work throughout December and January and probably the renovation works will be completed in time for the start of the school year (February 2005).

INSTALLATION OF SOLAR PANELS IN THE MUNICIPAL HOSPITAL OF DAMBA Italian cooperation has also financed the installation of 48 solar panels for the supply of electrical power 24 hours/day, contracting the work to a private company of Luanda, although the system is not yet running due to initial damage caused by a lightning strike on the system and the difficulty of finding qualified technical personnel for the necessary repair work. In view of the inefficiency of the local contractor Doctors with Africa CUAMM, which supplied exclusively logistical support for this project, decided to officially take possession of the entire plant in such a way as to return it to operation as soon as a Doctors with Africa technician is available. Finally, in the Municipality of Damba as in the entire province of Uige, Doctors with Africa is supporting the national programme for the control of tuberculosis, following the national protocol.

CONTROL OF THE MARBURG EPIDEMIC IN THE PROVINCE OF UIGE Towards the 7th week of 2005, following tests conducted by the Atlanta CDC, it was recognised that the Marburg virus was responsible for the Hemorrhagic Fever epidemic currently afflicting the province of Uige. Many embassies urged their citizens to leave the area, and there was talk of a health cordon being created around the Uige province, closure of border crossings and cancellation of international flights. Doctors with Africa CUAMM responded with the evacuation of personnel employed in Songo and Uige.

Unfortunately, for dr Maria Bonino, working in the Uige paediatric department, this measure came too late. She contracted the virus and died on 24 March 2005 in a Luanda clinic. This tragic death announced the start of a series of fatalities among Angolan healthcare personnel.

From the start of the epidemic the province of Uige was identified as the primary outbreak area of the infection. The provincial capital was given several funding awards.

Government personnel, international agencies and NGOs arrived on the scene. This activity is all in the framework of a strategy of combating the epidemic that started out as a national plan and was subsequently redefined as a local plan in the province of Uige.

The initial phases of response to the epidemic were chaotic: international experience with Marburg is limited and both in Uige and Songo attempts were made to apply standard models for the control of hemorrhagic fever, the creation of triage areas, and isolation. But in view of the high mortality of isolated patients and the cultural shock of such a radical intervention, the population started to lose faith in the hospital authorities. This heralded the transition to a second intervention strategy. Three areas of isolation were created in the hospital: maternity, paediatrics, and adult ward, with an information campaign orchestrated by the Angolan government. This saw the start of a visible mediation campaign by the health minister with local political and traditional authorities and the various agencies present in the area.

On the project level Doctors with Africa CUAMM defined three strategies: > To guarantee the activities envisaged in the projects currently underway in Damba and Maquela, with minimisation of the activities in the hospitals of Uige and Songo. > Logistical support to the Provincial health directorate in terms of acquisition and management of the stock of bio-safety materials.

17

> Implementation of the ECHO Marburg project (N. 3-076) signed on 06.01.03 and lasting for three months, with a budget of USD 200,000. The project includes: protective materials, creation of protected areas in Maquela, Damba, Songo and Uige, and management of hospital waste.

To support the Marburg emergency Doctors with Africa CUAMM launched a special appeal for the collection of funds that saw the involvement of numerous private donors, the Doctors with Africa CUAMM Groups and the Fondazione Cassa di Risparmio di Padova e Rovigo.

REFURBISHMENT OF THE WATER SYSTEM OF THE MUNICIPAL HOSPITAL OF SONGO

18

The municipal hospital of Songo is the sole second level healthcare in the west of the province of Uige. In addition to serving the population of the city of Songo, the hospital is the reference healthcare structure for the municipalities of Songo, Bembe, Ambuile and, in part, for the municipality of Mucaba.

The total number of patients admitted in 2004 was 4,514, of which 2,203 children, with an average of 111 patients/day of whom 44 children. This means that, calculating the mothers that accompany their children and service personnel, and average of around 170 persons sleep in or in the immediate vicinity of the hospital structure.

Before the implementation of this project the Songo municipal hospital did not dispose of its own water supply. The needs of the hospital were satisfied in part by a 1000 litre tank provided by Doctors with Africa, which was towed to the spring each day and filled by means of a diesel engine pump. This system was clearly insufficient for the total requirements of the hospital, so the intervention of support groups and private parties was requested for the implementation of the water supply project.

The project was implemented thanks to the support of Doctors with Africa CUAMM groups, private parties, and the Cordar Consortium.

Specific goals of the project 1. To create an independent water supply network at Songo hospital.

2. To improve the access conditions to water within the Songo hospital.

Activities performed > Refurbishment of the building housing the pump unit located next to the water source In the vicinity of the spring a house containing the new pump unit was renovated, and a metal grille door with a lock was installed to prevent possible theft or vandalism. > Installation of a new pump unit A new pump unit, shipped from Italy, was assembled and connected to the water system that supplies the Songo city water tank. The installed and tested pump is able to overcome a level difference of around 70 m and the 2000 m distance between spring and tank.

The Songo city tank has a capacity of around 125,000 litres. With the daily filling cycle it is possible to supply the entire city with running water, despite the large number of leaks in the city water distribution system, which dates back to colonial times. > Purchase and installation of a dedicated network for hospital water supplies A dedicated network for the hospital water supply was created with the purchase of 1500 m of high strength PVC piping and a 40 cm deep 20 cm wide trench of a length of 1500 m for laying the pipeline.

A system of gate valves was created in such a way as to fill the hospital tank in a selective manner. Once the city water tank is full the hospital supply line can be opened so that the city water tank fills the hospital tank by gravity.

> Renovation of the hospital water tank Once the supply system had been created, already from the initial tests serious leaks from the hospital tank were found, reducing the total capacity and the autonomy of the supply.

This realisation led to an intensive period of renovation works. The interior of the tank was renovated to ensure a good level of insulation, while the hospital outlet pipes were systematically either plugged or repaired. > Creation of a water distribution network inside the hospital.

Once the tank had been renovated attention was focused on the distribution system inside the hospital. The condition of the original system (Colonial period) was such that it was impossible to repair existing structures, so a new high-strength PVC pipe was installed between the tank and the hospital and the distribution areas (around 300 m).

Two distribution systems (drinking fountains) were created in the hospital’s external courtyard.

This system, since it avoids the dispersal associated with the original system, concentrates and optimises collecting of water by hospital staff and patients.

Conclusions The renovated system proved to be extremely efficient and easy to use, the pump unit fills the city tank and thanks to the system of gate valves the city supply is interrupted three times a week for several hours while the hospital tank is filled.

A local engineer, who was previously responsible for running and servicing the original pump unit, was trained in the operation of the new system both in relation to the new pump unit and the system of gate valves that serves to fill the hospital tank.

Thanks also to the stock of diesel fuel purchased by means of the project and managed by the Misericordia nuns of Songo, the city tank will be filled on a daily basis to respond to the population’s water requirements. For many citizens of Songo this means the elimination of a walk of several kilometres to the spring and the return journey carrying heavy water jugs on their heads.

The hospital supply system was proven to be efficient thanks to a dedicated pipeline and the altitude difference between the two tanks which, once the gate valve in the distribution well has been opened, allows the water to flow by gravity from the city tank to the hospital tank.

This operation makes it possible to fill the hospital tank with approximately 35,000 litres in around 6 hours, and when performed 3 times a week it responds fully to the needs of the hospital.

The project had a significant impact on the population of the city of Songo and on all the hospital staff and patients. The presence of running water made it possible to improve the hygiene and care provided by the hospital structure and, in general, improve the healthcare facilities at the Songo municipal hospital.

4.1.5 Francesco Canova Training Centre The Francesco Canova training centre was built in 1998 in the Dunga district of the city of Uige; the centre is located within the Caritas diocesan compound and is equipped with a generator, water, a secretary’s office, a library, and a classroom with seating for 60 plus.

All the most common teaching aids are available and in recent years the centre has become a point of reference for the Provincial health directorate and international agencies working in the province of Uige.

The project obtained a grant from the Trentino Alto Adige regional administration, which financed the project “Support of the Canova Training Centre for continuous training of

19

healthcare personnel in the Province of Uige - Angola”, presented to the Region by the Trentino CUAMM Doctors with Africa Group. The Group also contributed to funding of part of the project.

In 2005 the following courses / seminars were held: N. DAY SEMINAR No. PARTICIPANTS 1º 21-23/02/05 North Region Seminar 45 persons from various NGOs 2° 09-11/2/05 TB - HIV 20 HP nurses 3°

5°

28/2-5/3 05 Labour and delivery chart and obstetric dystocia 13.03.05 New regulations on National Programme for the control of Tuberculosis and Leprosy 14.07.05 Update courses

6°

22.11.05

7°

23-30/11/05 Theoretical basis of HIV/Aids infection 5.12.05 Training workshop on HIV/Aids

4°

Programme of vertical transmission of HIV in the province of Uige

20

8°

9°

6.12.05

Training workshop on HIV/Aids

10° 7.12.06

Training workshop on HIV/Aids

Health 11° 8.12.05

12° 9.12.05

18 institutional obstetricians from municipalities 9 nurses from Uige and Municipalities

TRAINERS EU personnel Doctors with Africa CUAMM Doctors with Africa CUAMM Doctors with Africa CUAMM + Provincial health directorate

70 midwives from Songo Doctors with Africa CUAMM + Health Department 30 healthcare personnel Brazilian (doctors-nurses, cooperation obstetricians, health technicians) 14 HPU doctors Brazilian cooperation 10 “sobas” Red Cross + and “regedores” Department of Health 10 police forces and Red Cross + armed forces Department of Health 10 women from Red Cross + “PROMAICA” Department of

Training workshop on HIV/Aids

10 health delegates

Training workshop on HIV/Aids

10 “IMNE” students

Red Cross + Department of Health Red Cross + Department of Health

During the Marburg epidemic the Francesco Canova centre played a key role in training personnel on awareness of the virus and on the hospital rules for bio safety and infection control.

During the period the following courses/seminars were held:

N. DAYS 1 12/04/2005

SEMINAR PARTICIPANTS Hospital control 70 nurses regulations for Marburg infection Hospital control 50 cleaning staff regulations for Marburg infection Hospital control 50 hospital workers regulations for Marburg infection Marburg haemorrhagic 60 persons fever Marburg 50 persons haemorrhagic fever Marburg 70 persons haemorrhagic fever Marburg 80 “IMNE” students haemorrhagic fever

2

13/04/2005

3

14/04/2005

4

18/04/2005

5

19/04/2005

6

21/04/2005

7

28/04/2005

8

29/04/2005

Marburg haemorrhagic fever

80 “IMNE” students

9

4/05/2005

Marburg haemorrhagic fever

42 catechists

10 26/05/2005

Marburg haemorrhagic fever

30 healthcare staff

11 07/06/2005

Hospital control regulations for Marburg infection Hospital control regulations for Marburg infection Biology of Marburg Virus National seminar on malaria

36 personnel from “Angotrip” of Uige

12 15/06/2005

13 16/06/2005 14 18-19-20 06-2005

40 personnel from “Angotrip” of Negage 70 persons 60 healthcare staff

TUTORS Dr. Enzo Pisani Dr. Mike Bell Dr. Enzo Pisani Dr. Mike Bell Dr. Enzo Pisani Dr. Mike Bell Permanent training corps Permanent training corps Dr. Adriano Duse WHO Dr. Enzo Pisani Doctors with Africa CUAMM Dr. Enzo Pisani Doctors with Africa CUAMM Dr. Enzo Pisani Doctors with Africa CUAMM Dr. Emanuela Medici Doctors with Africa CUAMM Dr. Enzo Pisani Doctors with Africa CUAMM Dr. Enzo Pisani Doctors with Africa CUAMM WHO Department of Health

4.1.6 Supply of bio-protection material for expatriate personnel in the province of Uige The province of Uige, i.e. the centre of the Marburg haemorrhagic fever epidemic, requested the urgent supply of protective material for all expatriate personnel in the province of Uige in order to reduce transmission of the virus.

For this purpose the Italian embassy allocated USD 22,000 for an emergency intervention in the province of Uige in order to purchase bio-protection devices.

The Molfetta CUAMM Doctors with Africa Group participated with a special collection of hygiene-healthcare material for the Marburg emergency with the collaboration of the Puglia region and the Civil Defence Corps.

The Veneto Region sent bio-protection material supplied by local hospitals.

21

Market research In view of the situation of the utmost urgency, a brief market survey was carried out in order to ensure the best quality-price ratio of the articles purchased.

In the initial days of the epidemic very little protective material was available on the market in quantities commensurate with the requirements of the project. As time progressed and the demand increased, additional suppliers started to offer competitive prices (also by extending their ranges) for articles such as lab gowns, facemasks, and other disposable healthcare protective devices.

The market survey was conducted in relation to all the items listed in the contract, while quantities were adapted in relation to the demand from Uige and the best purchase price found on the Luanda market.

Material purchased > 100 pairs of boots > 2500 single-use gowns > 500 facemasks > 25,00 pairs of single-use latex gloves > 780 bottles of bleach (1 litre) > 400 pairs of rubber gloves and cleaning cloths > 50 pairs of protective spectacles

22

Conclusions The speed with which the Italian cooperation delivered the funds required and Doctors with Africa CUAMM’s detailed knowledge of the Luanda market enabled the rapid purchase and shipment of healthcare material for the protection of expatriate personnel in Uige.

The bio-protection materials were the first that expatriate personnel received in the province of Uige, bridging the period from the start of the epidemic to the time of arrival of additional aid.

Despite this situation it’s worth emphasising that the material purchased offered a minimal level of protection that was not sufficient for clinical activities, merely enough to protect operators who were occasionally in contact with potentially infected patients or areas.

4.1.7 Uige Provincial health directorate “post Marburg” support project This project, presented in May 2005, was financed by Italian cooperation on 30 November 2005. The total project budget was USD 139,000 and it envisages the support of the Uige Provincial health directorate in the post Marburg phase.

In the initial phase of the Marburg epidemic Italian cooperation, in response to a request from Uige Provincial health directorate, had already purchased and donated, by means of Doctors with Africa CUAMM, a four-wheel drive truck for logistics involved in the activities of combating the epidemic.

The aim is the creation of a network of epidemiological supervision with suitable communication systems, the supply of kits for health posts to ensure distribution in the municipalities because, due to the epidemic, the Provincial health directorate was unable to purchase the kits, and several purchases of material for the Uige permanent training centre.

The project envisages a series of one-off actions for the purchase of: > 4 VSAT satellite systems for rapid Internet communication and telemedicine > 110 kits for health posts > 1 generator for the permanent training centre > Stationery, a projector, and several per-diem allowances for trainers.

In 2005 the satellite systems and kits for health posts were purchased. Both purchases are currently in the stage of authorisation for importation and transport to Luanda.

Additional funds for completion of the planned activities should be allocated within the first quarter of 2006.

4.2 Province of Kunene

4.2.1 Chiulo

23

SUPPORT OF THE DIOCESAN HOSPITAL OF THE ROMAN CATHOLIC MISSION OF CHIULO: PROTECTION OF HEALTH AND CONSOLIDATION OF PEACE IN THE PROVINCE OF KUNENE. LOCATION BENEFICIARY POPULATION BUDGET DONORS

PARTNERS EXPATRIATE PERSONNEL LOCAL PERSONNEL AUXILIARY PERSONNEL PROJECT STARTING DATE PROJECT ENDING DATE

> > > > > > > > >

Diocesan hospital of Chiulo 204,766 743,436 euro MAE – CEI Private donors and Doctors with Africa CUAMM Groups Province of Trento ONDJIVA DIOCESE and PROVINCIAL HEALTH DIRECTORATE 3 doctors 1 logistician

> 2 drivers > OCT 03 > JAN O7

Introduction During 2003 MAE financed a hospital support having a duration of three years. This project envisages the provision of aid in the form of drugs, healthcare equipment, refurbishment of structures, and the provision of doctors for clinical management. In 2004-05 Doctors with Africa CUAMM performed the following hospital refurbishment works: > The new generator was hooked up to the hospital electrical system, which was refurbished by replacing wiring, lighting fixtures, and socket outlets.

> The laboratory was renovated, with the provision of running water, power supplies, toilet services, and by ordering new materials to ensure proper execution of analyses. > A hospital maintenance unit was created with young people from Chiulo who are learning the basics of plumbing, electrical wiring, structural engineering, mechanical engineering, in such a way as to assure proper maintenance of the hospital also in the future > A hospital internal workshop was set up in order to carry out the necessary maintenance work. > The plumbing material was purchased and has already reached Chiulo for the complete overhaul of the water distribution system. > New beds, mattresses, and material for the operating theatre were ordered. > In 2006 the complete overhaul of the plumbing system and water supply system is planned: a new water collection tank will be constructed and all the pipelines will be replaced. At this time the hospital will be entirely refurbished with replacement of doors and windows, painting of the walls, and the construction of bathrooms for each ward.

24

Financial situation Examinations are performed free of charge in the hospital, but patients pay a small amount for the purchase of drugs, for analyses, X-rays, and surgery.

The income from the sale of drugs is insufficient to cover the management costs. Without the assistance of the provincial government, which pays the salaries of nurses and the majority of auxiliary personnel, the hospital would be unable to remain operative.

In 2005 the government finally accepted that the hospital was entitled to government subsidies: this news was greeted with much enthusiasm.

The grant for 2005 was USD 59,000 p.a. For 2006 an increase is envisaged up to approximately USD 70,000. These amounts are clearly an important source of aid for the hospital, but they are unable to cover expenses, which exceeded USD 160,000 this year alone.

It is hoped that the government will choose to increase the funding in 2007 to the point in which the hospital can function without any outside aid.

The hospital administrative staff, with extremely limited capabilities to the point where the assistance of Doctors with Africa CUAMM is indispensable in order to maintain transparency of accounts, was this year strengthened with a skilled young person who is currently undergoing field training and, after a suitable period of apprenticeship at the provincial hospital administration, will assume the role of hospital administrator.

Personnel and nursing school Since it is located in the savannah in an isolated position the Chiulo hospital has always suffered from a lack of suitably trained nursing staff.

The nurses, because of the isolation and because of the difficulty in proceeding with their studies, usually request a transfer after a few years. The main shortfall is the presence of new personnel who are willing to live and work in isolated conditions.

With the possibility provided by the government of reopening the auxiliary nursing school (auxiliary nurse being a new denomination for general nurse) with a two-year course, the probability of finding personnel willing to work long-term in the Chiulo hospital is far higher.

Two nurses with superior qualifications have been contacted. The nurses in question collaborate with the Regional School of Lubango for training of medical technicians: this team has agreed to open the school in Chiulo in February 2006. It is hoped that it will be possible to create a reference training centre, not just of auxiliary nurses but also for medical technicians.

Clinical Activities Clinical activities have gradually increased over the years, especially because of the distribution by the government of ambulances to peripheral health posts. This leads to more visits since Chiulo is the reference hospital serving the entire northern area of Kunene. A

steady increase has been observed in outpatient visits, together with a reduction in the gross mortality rate. The percentage of the occupancy rate was extremely high, due to an increase in the number of patient admissions.

At the end of 2005, during the course of an inspection by the Provincial Statistics Department, the number of hospital beds was increased from 153 to 200. This led to a reduction in the occupancy rate.

Year 2002 2003 2004 2005 2005

Outpatient examinations 10,674 14,793 16,849 (153 beds) 17,979 (200 beds) 17,979

Admitted patients 5,142 5,906 5,868 7,267 7,267

Gross mortality % 4.7 3.8 3.4 3.2 3.2

Bed occupation rate % 86 96 128 151 115

Outpatient examinations The number of examinations performed during the year are relatively few in relation to the potential of the hospital, although this is explained by the geographical location of Chiulo in the middle of the savannah and the fact that the population tends to be dispersed throughout the area rather than being concentrated in urban centres. In all cases a significant increase can be observed each year (10,674 in 2002, 17,979 in 2005) The majority of non-urgent examinations are concentrated on Mondays, Wednesdays and Fridays, because Tuesdays and Thursdays are dedicated to elective surgery.

Paediatrics This is the ward with the highest number of admissions during the year, with peaks during April and May corresponding to the rainy season and the time of proliferation of malarial mosquitoes.

The gross mortality rate in 2005 was 2.9%, which is lower than in previous years (5.9% in 2002, 4.7% in 2003 and 3.2% in 2004). The most frequent cause of death among hospitalised children is malaria with the associated critical anaemia followed by respiratory infections and enteritis.

In order to combat infant malnutrition which, although rarely present in extreme forms such as marasmus or Kwashiorkor, is anyway more frequent than initially apparent, there is a small kitchen in the paediatrics department that makes it possible to provide at least four meals a day (milk, rice, high protein babyfoods and high calorie biscuits).

Obstetrics On the maternity ward the number of deliveries is low considering the potential, although the rate has increased constantly over the years. The rate of caesarean sections was 3.8% in 2002, 3% in 2003, 5.1% in 2004, and 5.3% in 2005.

The increase in the percentage of caesarean sections corresponds to an increase in the number of births with complications due to arrivals by ambulance from nearby health posts.

The maternal mortality rate has fallen to 0.3%.

The trend of prenatal examinations is shown below: 2002 (last 8 months) 1st examination 619 1357 Check 386 835 TOTAL 1005 2192

2003 1168 710 1878

2004 1158 639 1797

2005

Respiratory medicine Diagnosis is performed by testing sputum for BK, with clinical examinations and medical histories, and at times with a chest X-ray.

25

Greater attention is paid to the diagnosis of BK positive cases because it is these that propagate the disease. The increase in the number of HIV cases makes diagnosis of tuberculosis more difficult because a large number of HIV cases are associated with tuberculosis with negative BK. Suffers are hospitalised for two months and they continue their treatment at home for 6 months, in accordance with the plans of the Angola Ministry of Health 239 new cases of tuberculosis were treated in 2005 with a mortality rate of 2.5%.

In 2002 the number of cases were 175 with a mortality rate of 4%, and 163 and 284 in 2003 and 2004 respectively, with mortality rates of 2.7% and 5.3%.

A survey conducted in November 2005 among hospitalised patients on the respiratory medicine ward showed a prevalence of HIV positive cases of 16.3%.

Surgical unit From January 2002 the presence of a specialist surgeon made it possible to increase the number of major operations, making it possible also to perform elective surgery.

The majority of operations concern obstetric-gynaecological and urological disorders and also inguinal hernia. Until now general anaesthetics have been used with intravenous ketamine, while spinal anaesthesia is less frequently adopted.

Minor surgery includes wound sutures, lancing of abscesses, plaster casts for fractures, open reductions of dislocations, removal of small lymphomas or cutaneous cysts performed in the main by the operating theatre nursing staff.

The number of major operations rose, from 2002 to 2005, as follows: 212, 229, 231, 344.

26

Laboratory The laboratory performs the essential analysis routines for a rural hospital: Hb, blood group, white blood cells and white blood picture, red blood cells sedimentation rate, urine culture, analysis of faeces, urine, sputum, liquor analysis, tests for HIV, HBV and syphilis.

The number of transfusions increased from 442 in 2002, to 604 in 2004 and 1049 in 2005.

Laboratorio

Transfus천es Escarros

Jan

Feb

Mar Abr

29 75 124 55 39 46 (10p) (53p) (0p)

237 27 (3p)

Mayo Jun 179 63 (6p)

Julh Ago Set

106 68 44 50 128 69 (3p) (10p) (0p)

Out

33 68 77 115 (6p) (8p)

Nov Dez Tot 04 46 40 1049 64 65 798 (3p) (2p) (2p)

All blood donors have always been tested for HIV, and, in 2005, also for HBV. New registers have been created for collection of data.

The percentage of HIV carriers among blood donors was 3.52% 2005 BLOOD DONORS REGISTER Month total M F HIV jan feb mar apr may jun jul aug sep oct nov dec total

32 79 129 248 185 107 69 47 37 80 54 41 1108

38 48 100 70 42 37 25 24 42 33 27 486

37 76 145 101 62 28 22 13 37 21 14 556

32 71 121 232 162 104 65 45 37 74 52 40 1035

HIV+ M HIV + F % HIV+ HBV+

Missing data

3 2 5 5 0 0 0 0 2 1 0 18

1

4 5 3 14 3 4

3 8 5 2 20

0 1 0 0 34

1 1 8 4 0 0 2 0 3 1 1 21

5.06 2.33 5.24 4.86 0.00 0.00 4.26 0.00 6.25 3.70 2.44 3.52 %

1

In 2005 during prenatal examinations all women were tested for HIV, HBV and syphilis.

In 2005 the number of pregnant women who agreed to the HIV test was 983, of whom 43 were positive (4.37%).

Nยบ pregnant women 983

Testes indeterm.

HIV+

HIV-

% HIV+ HBV+

%HBV+ RPR+

%RPR+

11

43

929

4.37 % 182

18.5 % 67

6.8 %

Radiology The majority of X-rays: approx. 300 in 2003, 600 in 2004 and approx. 490 in 2005, were performed to investigate suspected fractures.

Ultrasound scans Ultrasound scans performed were as follows: 499 in 2003, 229 in 2004, and 620 in 2005.

Most of the examinations were obstetric and gynaecological scans. Renal and hepatic scans are less frequently performed.

Odontostomatology Tooth extractions are performed by one of the nurses. As yet the hospital has no facilities to perform fillings.

Public health 15,302 children were vaccinated in 2003 against BCG, DPT, polio, measles, yellow fever and tetanus.

Vaccinations performed in 2004 numbered 21,843. In November 04 a vaccination campaign was carried out in the municipality of Mucope against meningococcal meningitis in which 19,658 individuals of all ages were vaccinated.

The total number of persons vaccinated in 2005 was 14,997.

This year a situation was achieved at last in which only sporadic cases of meningitis were encountered.

Procurement of medication As from 2002 drugs were almost entirely supplied by the Doctors with Africa CUAMM NGO. Only at the end of 2004 emergency drugs were purchased using funds deriving from hospital revenues.

A total amount of USD 38,000 was spent on pharmaceutical products in 2004.

In 2005 the government contributed with a grant of 876,000 Kwanzas (equivalent to approximately 8,700 euro): In this expense item the real consumption of the hospital, with the support of Doctors for Africa CUAMM, totalled 4,114,745.00 Kwanzas (approximately 41,000 euro).

In 2006 the state subsidy will be increased up to a total of 2,000,000.00 Kwanzas. In 2007 it is hoped that the hospital will receive a higher level of funding in order to provide a response to the increasingly high numbers of patients.

27

4.2.2 Vertical interventions HIV EPIDEMIC CONTROL IN THE PROVINCE OF KUNENE

28

LOCATION BENEFICIARY POPULATION BUDGET DONOR PARTNERS

> > > > >

EXPATRIATE PERSONNEL LOCAL PERSONNEL AUXILIARY PERSONNEL PROJECT STARTING DATE PROJECT ENDING DATE

> > > > >

Province of Kunene 204,766 74,970 UNICEF PROVINCIAL HEALTH DIRECTORATE ONDJIVA DIOCESE 1 doctor 0 0 JULY 05 APRIL 06 with possible 6-month extension

The project developed and co-financed by UNICEF, PROVINCIAL HEALTH DIRECTORATE (DPS) of the province of Kunene and Doctors with Africa CUAMM, envisages: > The opening of two counselling and voluntary testing centres for HIV and STDs (sexually transmitted diseases) in the municipalities of Ombandja and Namakunde (one in Chiulo hospital and the other in Namakunde hospital). > Supply of a camper equipped for voluntary counselling and testing for HIV and STD for the population resident in the more isolated areas near the border with Namibia. > Opening of three centres for the prevention of vertical transmission at the infantile maternity centres of the hospitals of Chiulo, Xangongo and Namakunde (the national protocol envisages the intravenous administration of AZT to the mother during delivery and of AZT syrup to the newly-born infant in the first six weeks of life). > Activities of information, education, and communication (IEC) addressed to the sexually active population with the aim of achieving a reduction in the risk of the transmission of HIV and STDs and access to the voluntary counselling and test centres.

The project duration is eight months: from September 2005 to April 2006; it is probable that an extension will be awarded because all the material due to be supplied by Unicef has not yet been delivered.

Planned activities 1. Assignment of a doctor.

2. Staff training 3. Opening of three voluntary counselling and test centres for HIV and STDs: two fixed centres (in Namakunde and Chiulo) and one mobile centre; for the fixed centres Unicef will supply two pre-equipped containers for the planned activities; Doctors with Africa CUAMM will be required to assure the supply of material for correct operation of the centres, while the DPS will assume responsibility for supervision.

4. Opening of 3 centres for the prevention of vertical transmission.

5. Promotion of IEC activities.

Activities performed from September to December 2005 1. assignment of a doctor Dr Elena Nonini arrived in Luanda on 14 September 2005 and in Chiulo on 24 September 2005; she attended the Ondjiva voluntary counselling and test and antiretroviral treatment centre during the first two weeks of October to gain an understanding of the documents in use and the national treatment protocols

2. training activities Training activities addressed to Chiulo personnel were articulated as follows: > two courses for personnel of the voluntary counselling and test clinics, executed in Chiulo in March 2005 in collaboration with the W.H.O., and in September 2005 in collaboration with the private enterprise Odebrecht, which has many years of experience in the support of training projects concerning AIDS-related topics; training was provided for a total of 25 nurses, also from other centres (Xangongo, Ondjiva, Kahama, Xangalala) > a training course for “educator agents� (for IEC activities) carried out in Chiulo in September in collaboration with Odebrecht; training was provided for a total of 23 persons of different professions and various origins > from 19 to 23 September two nurses from the Chiulo hospital, already trained for voluntary counselling and HIV testing, attended the Ondjiva centre for on-the-job training > from 3 to 7 October 2005 two obstetricians from the Chiulo hospital, already trained for counselling and voluntary HIV testing, attended the centre for the prevention of vertical transmission of HIV at the Ondjiva hospital for on-the-job training > from 24 to 28 October 2005 two nurses from the hospital of Chiulo, already trained for counselling and voluntary HIV testing, participated in a course on the home treatment of AIDS sufferers at the Ongjiva hospital > training course, at the hospital of Chiulo, from 24 to 28 October 2005, for ten midwives from the municipality of Mukope (Chiulo) > training courses for all obstetricians from the hospital of Chiulo held (in two modules) in the Chiulo hospital in November 2005 > in December 2005 a laboratory technician from the Chiulo hospital attended a threeweek session at the laboratory of the Ondjiva centre to learn how to use the instruments for CD4 counts which will be supplied by UNICEF to the Chiulo hospital Training of personnel of the centres of Xangongo and Namakunde was supervised by the Provincial Health Directorate 3. Opening of three voluntary counselling and HIV test centres In October and November Doctors with Africa CUAMM personnel laid the foundations for the containers that UNICEF has pledged to supply, equipped for voluntary counselling and testing; Doctors with Africa CUAMM personnel have already prepared all the necessary roofing material for the containers.

The activity of voluntary counselling and testing with material supplied by Doctors With Africa CUAMM and through donations pending the arrival of the material pledged by UNICEF started in mid August at the Chiulo hospital.

4. Opening of 3 centres for the prevention of vertical transmission.

These centres have not yet been opened because of the absence of material (delivery kits), which is to be supplied by UNICEF. 5. Promotion of IEC activities.

With regard to the Chiulo area: since August 2005 information-education meetings have been held at the hospital with all women undergoing prenatal examinations. further meetings were arranged for the general population (markets, youth groups, churches, etc.).

With regard to the other areas of the municipality of Ombanja and Namakunde the organisers were selected and a meeting was held for the organisation and planning of the work that they will be required to perform in their respective areas. Also the implementation of these activities is impaired by the lack of information and educational material, which has yet to be supplied by UNICEF, and by the lack of condoms (which should be supplied by Doctors with Africa CUAMM).

29

Considerations The implementation of the activities envisaged has been greatly delayed because of failure of UNICEF to supply the entirety of the material it has pledged, therefore an extension of at least six months must be provided.

In the first 6 months of 2005 a project between Doctors with Africa CUAMM and the W.H.O. was signed, which enabled the following activities: > Renovation of the laboratory > Execution of a course for counselling and for laboratory technicians, utilising specialised personnel from Luanda as tutors. > Testing of all blood donors for HIV and HBV > Testing of all pregnant women for HIV, HBV and syphilis

30

In July 2005 a project was signed between Doctors with Africa CUAMM and UNICEF in collaboration with the Provincial Health Directorate, for: > Opening of 2 fixed CATVs (counselling centres) in the Chiulo and Namakunde hospitals. > Utilisation of a camper equipped as a mobile CATV for areas on the border with Namibia. > Opening of 3 centres for antiretroviral treatment for the interruption of mother-child transmission: one in Xangongo, one in Namakunde and one in Chiulo. > training of organisers and personnel for counselling. > Coordination of IEC (Information, education, and communication) activities in the worst affected municipalities.

The various activities have not yet commenced because the arrival of the material required for the CATVs and for execution of the tests has been delayed: the current forecast arrival date is January 2006.

For this reason a 6-month project extension is currently being prepared to offset the time lost due to the late arrival of materials.

In this period the hospital has anyway started to deliver voluntary counselling using its own resources: 2005 VOLUNTARY COUNSELLING HIV (+) MALE HIV (+) FEMALE HIV undetermined tests HIV (-) TOTAL

71 83 7 313 474

The number of cases tested is still small and we should also specify that the test group is highly selective because most of the volunteers are already hospitalised, i.e. persons already presenting symptoms who have been invited by the doctor to attend the counselling centre: the percentage of HIV positive patients is 32.4%.

Modernisation of the Chiulo diocesan hospital Thanks to funds allocated by the province of Trento in the amount of 53,151 euro, a project was launched for the modernisation of much of the healthcare equipment of the Chiulo diocesan hospital. The necessary materials, beds, wardrobes, nightstands, etc. have been identified and thanks to an order placed with a South African company all the material should be delivered and installed before the end of January 2006.

4.3 Province of Luanda TUBERCULOSIS CONTROL PROGRAM IN THE PROVINCES OF LUANDA AND UIGE LOCATION BENEFICIARIES BUDGET DONORS

> > > > > >

PARTNERS

>

EXPATRIATE PERSONNEL

> >

LOCAL PERSONNEL AUXILIARY PERSONNEL PROJECT STARTING DATE PROJECT ENDING DATE

> > > > > > > >

Provinces of Luanda e Uige 4,450,000 1,299,272 euro MAE Private donors and Doctors with Africa CUAMM Groups Province of Treviso and Public Health Units (ASL) 7, 8, 9 National tuberculosis and leprosy programme and Provincial Health Directorates of Luanda and Uige 1 doctor (Luanda), consultant at PNTL 1 doctor (Uige), consultant at Provincial Health Directorate 1 doctor (Uige), clinical activity at Uige hospital 1 laboratory technician 1 logistician - administrator 0 2 logisticians 2 drivers DEC. 03 APR. 07

Introduction The Tuberculosis control programme in the provinces of Luanda and Uige started in December 2003 in response to the pressing need to reorganise and implement the DOT strategy in the provinces.

The project funded by MAE will terminate in April 2007. In support of the project the Africa Chiama Amici Group of Doctors with Africa assumed the role of promoter of the “HARAMBEE� decentralised cooperation project. The three-year project, which will terminate in December 2006, envisages the participation of the Province of Treviso with the three local health units with their relative administrative Conferences of Mayors, for a total of 95 Italian municipalities.

Activities performed Technical consultancy The technical consultancy support of the Provincial Directorate of the Tuberculoses Control Programme (PPCT) proceeded. The doctor participated in the planning, execution, and assessment phase of all the activities performed in the field of tuberculosis in the province.

Special attention was devoted to the management of drugs.

Participation in drafting of the GF project for the TB component.

Training The following were executed in the framework of the project: > Quarterly meetings with the mangers of the treatment rooms and respiratory medicine laboratories. > A meeting with municipal public health managers concerning the problems of tuberculosis in the province. > An update seminar for nurses who have recently joined the diagnostic and treatment units > Training in IT for program personnel

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Supervisions Regular supervisions of all the centres, with priority awarded to newly opened centres, were performed throughout the year.

Drugs, reagents and diagnostic material During the entire year the quantitative and qualitative supply of drugs, reagents, and diagnostic material for the DOTS treatment was guaranteed.

Collaboration was provided to guarantee sufficient and prompt supplies to peripheral centres and no stock breakages were reported Peripheral expansion of the DOT service.

The service was launched in two new diagnosis and treatment centres, one of which after the refurbishment equipping of the relative treatment rooms.

The activity of inspection of health centres currently lacking a respiratory medicine service continued with the aim of assessing the possible activation of the service.

Microbaterial culture Reagents were purchased for mycoculture and antibiotic assays performed at the national Institute of Public Health.

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Activities in the province of Uige The Hemorrhagic Fever epidemic prevented the regular execution of the activities planned in the province. In the second and third quarters technical consultancy support originally provided by the two assigned doctors and laboratory technician was discontinued. The closure of the laboratories for reasons of biosecurity effectively curtailed the work of laboratory reorganisation. Patient care was still provided, basing diagnosis on clinical evidence and radiological examinations. The safety standards applied included the destruction of furniture and other material, thus effectively eliminating the benefits of previous purchases and refurbishment work. The paediatric respiratory medicine department, which is included among the areas allocated for isolation, called for additional maintenance work before resuming its original functionality.

Technical assistance At the level of the Uige Provincial Health Directorate the planning, realisation, and assessment of the activities envisaged in the framework of the Tuberculosis Control Program were guaranteed. Participation was assured at the meetings of the Provincial Health Directorate Advisory Council, consultancy of the statistics cabinet and planning of the Provincial Health Directorate and participation in the workgroup for preparation of the Provincial strategic HIV/SIDA plan.

Clinical Activities Clinical assistance in the adult and paediatric respiratory medicine service of the Uige hospital was guaranteed in the first and fourth quarters.

Training The following activities were performed in the context of training activities in Uige: > A seminar on the diagnosis and clinical treatment of TB and TB/HIV patients, addressed to clinical personnel ward supervisors of the provincial hospital of Uige. > A seminar on clinical statistics for officers of the health units. > IT training for program personnel. > Supervision for all DOTS centres in the province. > Quarterly supervision for municipal centres and the Uige hospital. > Supervision of laboratories was performed exclusively in the first and fourth quarters. > Visits to the municipalities of Quitexe, Ambula and Bembe to assess the possibility of opening new diagnosis and treatment units.

Drugs, reagents and materials The regular and sufficient supply of drugs was assured, both on the provincial and munic-

ipal levels, minor equipment for the laboratories was purchased and reagents, diagnostic and treatment materials were supplied to cover the entire needs of 2005.

Refurbishments Furniture purchased for the Provincial endemic diseases laboratory and the supervision office. Refurbishment of the respiratory medicine clinic of Negage, and the paediatric respiratory medicine clinic and the bacilloscopy laboratory of the Uige hospital

IMPLEMENTATION PROJECT OF DOTS STRATEGY IN 11 PROVINCES OF ANGOLA: SUPPORT TO THE NATIONAL TUBERCULOSIS PROGRAMME LOCATION BENEFICIARIES BUDGET DONORS PARTNERS EXPATRIATE PERSONNEL

LOCAL PERSONNEL AUXILIARY PERSONNEL

PROJECT STARTING DATE PROJECT ENDING DATE

> > > >

Luanda and 11 provinces of Angola 14,456,167 USD 4,086,956 Global Fund via UNDP Angola

> 1 doctor as project leader > 1 doctor > 1 logistician > 1 administrator > 4 consultants at PNTL > 12 logisticians > 1 administrator > 1 driver > 1 secretary > JULY 05 JUNE 07

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Introduction The “Support to the National Tuberculosis Control Programme� is a biennial project financed by the ATM Global Fund through UNDP. The project was officially opened on 01.01.2005 and will end on 30.07.2007.

The general objective of the project is to implement the DOT strategy in 11 provinces of the country with technical assistance to the Management of the PNCTL, and it involves the realisation of numerous activities in the following main areas of intervention: Recruitment and training of personnel for the PNCT Management and for the Provinces.

Training for healthcare staff (laboratory technicians and nurses).

Refurbishment of infrastructure.

IEC activities.

Main activities performed The following activities were undertaken in the first six months of the project:

34

Organisation of the project team The majority of the local personnel required by the project were selected and recruited: At the level of the National Management of the Tuberculosis Control Programme: > 1 head of epidemiological activities and data management; > 1 head of logistical activities; > 1 head of IEC activities; > 2 secretaries.

In the provinces: > 4 logisticians were recruited and started work in the same number of provinces; > 7 logisticians were selected and will start work before the end of January 2006 for the remaining provinces.

Each of these positions was defined by drafting the relative Job Description sheets.

Training activities Training courses were organised for the following: > Tuberculosis control program Provincial Supervisors (11). > Laboratory Technicians - Provincial Supervisors (11). > Municipal Laboratory Technicians (13). > Tuberculosis control programme Municipal managers (14). > General Nurses (25).

Specific didactic material was produced for each course.

Refurbishment of infrastructure. > Inspections were carried out in all 11 provinces included in the project and intervention plans were drawn up with the local authorities. > For the Provinces of Luanda and Bengo the first 8 interventions to be carried out in the first half of 2006 were set up and agreed.

Supervision > A supervisory visit was carried out in each of the 11 provinces. > Activity data were gathered and the database of services available and active in tuberculosis diagnosis and treatment was updated. > A calendar was prepared for supervisory visits to be performed during 2006.

Information system > Activity data of the national Tuberculosis Control Programme were gathered and several data processing routines and analyses were performed in relation to 2004 and the first nine months of 2005. The material produced (tables and graphics) was utilised in preparing didactic material for training courses.

IEC (information, education and communication) > The first two theatre performances envisaged by the project were staged on an experimental basis.

> An international consultant was contacted for the execution of a KAP study in 5 provinces. The study will be conducted in the first half of 2006.

Purchase of equipment and logistical activities > All the forms required for the activities of the tuberculosis treatment and diagnosis were produced for an estimated period of 12 months. > An initial shipment of drugs and other consumables was made by air freight in one of the provinces included in the project. The procedure will be utilised on a regular basis starting from the first quarter of 2006 in all the provinces in the project.

Partnership with local and international NGOs > Contacts were entered into with the various international NGOs that operate in the field of tuberculosis to promote a greater level of coordination with the National Management of the Tuberculosis Control Programme, in line with the objectives of the Project.

4.3.1 Vertical interventions ITALIAN COOPERATION EMERGENCY PROGRAMME Thanks to an emergency programme of Italian cooperation various material was distributed to the Tuberculosis Control Programme units. The Italian cooperation donated this material in respect of the MAE tuberculosis control programme in the provinces of Luanda and Uige and Doctors with Africa CUAMM provided assistance by identifying the centres with the greatest needs.

The material distributed was as follows: 10 desks with chairs, 7 microscopes with stools, 20 cabinets, 15 tables, 50 chairs, 15 examination beds.

SUPPORT OF THE TUBERCULOSIS CONTROL PROGRAMME IN THE PROVINCES OF LUANDA AND UIGE Support of the tuberculosis control programme in Luanda and Uige provinces The project, which was funded by USAID for a total amount of USD 98,148, involves the support of Tuberculoses Control Programme units in the provinces of Luanda and Uige for 2005. Because of the Marburg fever epidemic it was not possible to execute the activities within the time limits, making it necessary to seek an extension, which was subsequently granted until 30 June 2006.

The project involves a training portion and the purchase of various material for furnishing of the Tuberculosis Control Programme units.

Plans exist for the purchase of furniture for 7 treatment rooms and 12 laboratories and also 12 microscopes, while training initiatives envisage: > An international training course for the provincial coordinator. > 10 seminars for nurses of the health centre consultancy services. > A meeting with doctors from the Uige provincial hospital. > A meeting with Luanda health centre clinical managers. > Incentives for the supervision of treatment centres and laboratories.

The following initiatives were carried out in 2005: > International training course for the provincial coordinator. > 3 seminars for nurses of the health centre consultancy services. > A meeting with doctors from the Uige provincial hospital > Incentives for the supervision of the treatment centres and laboratories of the two provinces. > Purchase of a part of the furniture.

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5 PROJECTS COORDINATION Changes occurring in recent years led to the indispensable presence of a representative of Doctors with Africa CUAMM in the Luanda capital. This representation allowed Doctors with Africa CUAMM to participate actively in the dynamics of the MINSA and other bodies, including the Global Fund, the European Union, and other donors.

Also the following activities were carried out: > Logistical support of the provinces. > Local and international purchases. > Customs clearance. > Human resources management. > Guesthouse. > Projects administrative management.

5.1 Logistical support of the provinces.

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Logistics have always been a major problem for Doctors with Africa CUAMM in Angola because of the difficulties of transport and in the purchase of the material needed to support the various projects underway in the provinces. These difficulties are compounded by the intensive rehabilitative and substitutional nature of several of the initiatives of Doctors with Africa CUAMM in Angola. In 2005 approximately 99,341 kg of material was cleared through customs for a total of approximately 140,000 kg of material of various types shipped to the provinces. During the Marburg emergency two special aircraft transported a total of 30 tonnes of biosecurity material, which was received and distributed in the epidemic primary outbreak areas.

5.2 Human resources management In 2005 around 30 expatriates were processed through all the embassy registration procedures, visas, and flights, in addition also visits by family members and friends of the serving volunteers were organised.

5.3 Guesthouse The Doctors with Africa CUAMM guesthouse was extended, in 2005 a total of 116 persons stayed in the guesthouse at various times for a total number of nights in excess of 352.

REGISTER OF GUESTHOUSE VISITORS IN 2005

ospiti = guests notti = nights

5.4 Administrative management Project administrative-accounting management was another challenge in 2005: the large number of funding parties (graph 4) and the administrative variables of each funding body resulted in extreme complexity of project administration and accounting.

The volume of funds managed in 2005 (by Padova and by the Luanda coordination team) exceeded 3.5 million euro (graph 5).

37 GRAPH 4

GRAPH 5 Funding 1997 - 2007 * Projection based on current funding at 31 January 2005

6 RESEARCH ACTIVITIES No research activities were carried out in 2005 although the groundwork was carried out for the implementation of 1 focus group and 5 KAP studies in the provinces of Luanda, Uige, Huambo, Moxico and Benguela.

The planned KAP studies should start in the first quarter of 2006 and they envisage the use of a team of Angolan interviewers who would be required to produce 7500 forms (total interviews).

This study also has a dual purpose because the KAP study should provide the basis for a nationwide IEC campaign.

7 HUMAN RESOURCES In Angola the interventions of Doctors with Africa have been implemented by a large number of expatriates for the following reasons: Lack of qualified Angolan personnel.

The small number of qualified Angolan personnel available tend to be concentrated in the capital city of Luanda.

Emergency and post-emergency situation in progress.

Projects (such as ECHO, UNHCR) often characterised by rapid implementation and short duration.

38

During 2005 human resources were negatively affected by numerous external events due to the Marburg fever epidemic which claimed the life of one of our most dearly loved and valued volunteers, Dr Maria Bonino.

Many other staff members were repatriated and placed in quarantine at the Spallanzani Institute in Rome.

This situation, combined with the conclusion of the Mother and Child Health project and the start of the Global Fund TB project, characterised the presence of expatriate personnel in Angola in two separate phases which, for practical reporting reasons were designated MCH project (graph 1) and post-MCH project (graph 2) In practice, at the beginning of 2006 a project funded for 3 years by CEI with co-financing from the EU at least for the first 12 months is scheduled to start, involving the arrival of a further 2 healthcare workers and one logistician (graph 3).

Further outlooks for the future point to the increased use of African professionals, with the first due to start work on 15 January 2006 with the role of general physician in the municipal hospital of Maquela do Zombo in the framework of the EU funded project.

GRAPH 1 - MCH PROJECT EXPATRIATE PERSONNEL BY LOCATION EXP. HEALTHCARE EXP. SUPPORT LOC. HEALTHCARE LOC. SUPPORT

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GRAPH 2 - POST MCH PROJECT EXPATRIATE PERSONNEL BY LOCATION EXP. HEALTHCARE EXP. SUPPORT LOC. HEALTHCARE LOC. SUPPORT

GRAPH 3 - EXPATRIATE PERSONNEL BY LOCATION - 2006 PROJECTION EXP. HEALTHCARE EXP. SUPPORT LOC. HEALTHCARE LOC. SUPPORT

ETHIOPIA

40

Non Governmental Organisations (NGOs) in Ethiopia must be registered at the competent office of the Ministry of Justice and are required to sign a General Agreement with the Disaster Prevention and Preparedness Commission (DPPC).

The Ministry of Justice is the judicial body of reference for all international and national NGOs. Once the foregoing agreements have been signed an NGO can undertake cooperation initiatives on all levels, also signing specific projects with the competent Ministries or Bureaus.

NGOs in Ethiopia operate with specific agreements and with projects arranged beforehand in which the relative organisations are normally required to guarantee the contribution of their own financial resources, i.e. without having to recourse to funds of bilateral cooperation between Ethiopia and donor countries.

Doctors with Africa CUAMM has been working in the country since 1987, initially under the auspices of the Ethiopian Catholic Church and, since 1994, with a full registration as an international NGO engaged primarily in the healthcare sector.

The organisation is active in three regions of the country (Oromia, Tigray and the South Region) and it collaborates mainly with diocesan counterparties and local NGOs. The reference body and government counterparty is the Regional Health Bureau.

Doctors with Africa CUAMM, together with the Ethiopian Roman Catholic Church, have signed a letter of collaboration with the regional health authorities for the hospital and nursing school of Wolisso. This fact is of considerable political value because it is the first time that a partnership agreement has been forged in Ethiopia between a private nonprofit organisation (NGO) and the state public service.

The Oromia authorities have guaranteed a contribution, over the past five years, to cover the cost of part of the healthcare personnel employed in the hospital, facilitations for the purchase of medicines and several study grants for students from the Nursing School sent by the Regional Authorities. Also the maternity facility of Dubbo was upgraded from Maternal-Infant Clinic to Small General Hospital, obtaining in the process a measure of support in the form of clinical personnel. These recognitions, which on the one hand confirm the decentralisation policy adopted by the Ethiopian government, on the other hand also point to the high consideration of the Authorities of the usefulness and quality of services that are offered to the population. Exploiting the above situation Doctors with Africa CUAMM chose to consider the Wolisso hospital and nursing school as a valid “platform�. In view of the large-scale investment and the excellent results obtained recently, the objective is that of further qualifying the structure both in terms of equality of opportunities and accessibility and in terms of quality and specialist training and, above all, to perform a consolidated public health intervention in the territory.

Also the line of dialogue must be pursued with the government and the other organisations of the Ethiopian Catholic Church in order to arrive at collaboration agreements between the public sector and the private non-profit sector.

1 COUNTRY PROFILE Ethiopian tradition and culture date back more than 3000 years. With a population of approximately 77 million, the country is home to a vast assortment of ethnic groups (more than 80), each with specific languages, culture, and traditions, even though there are also high levels of intermixing, affinity, and assimilation. The two main religions are Christianity and Islam.

The average population density is 70.4 inhabitants per square km. The annual population increase stands at 2.7% and life expectancy is 48 years. More recent data point to a reduction of life expectancy to 40 years because of the AIDS pandemic.

Ethiopia has immense natural and human resources. The territory extends from mountain ranges with peaks at more than 4000 metres to low-lying areas as much as 300 metres below sea level. This explains the enormous variety of flora and fauna with a large number of indigenous and exclusive species. Despite its long history of civilisation in the country, most of the population currently live in conditions of extreme poverty and in the past two decades the country has been repeatedly afflicted by serious famines. The main causes for the famines are recurrent droughts and the wars that have devastated the country. Other major negative factors include the lack of effective administration, the rapid population growth, overgrazing and deforestation, and extremely primitive farming methods. The seriousness of the economic situation is clearly evident from a cursory examination of statistical data, but it is also evident to all who visit the country, particularly in various heavily disadvantaged rural areas and in suburban ghettoes. After several years of peace and the improvement in living conditions associated with the process of democratisation that started in 1994, the latest two-year war with Eritrea has reversed a large proportion of the results previously achieved. It is hard to evaluate the human and material cost of this latest conflict. The repercussions on the organisational level are still evident in the dysfunctions of services, which have worsened, particularly in the education and healthcare sectors. External aid, which had been all but completely frozen, has started to return with agreed and large-scale intervention programmes.

Elections were held in May 2005, attracting a turnout of more than 26% of the electorate. The result of the elections, leaving aside the lack of transparency of the voting process, vindicated the coalition currently in power, with a majority secured by the Federal Parliament. This result was followed by numerous disturbances with the arrest of various opposition leaders.

Following these incidents a portion of external aid packages was once more suspended.

2 SOCIAL-HEALTHCARE CONTEXT AND DEVELOPMENTS OF HEALTHCARE POLICIES In 1993 the National health system was subjected to structural and organisational changes on various levels. The healthcare policy was configured in relation to the following guidelines: > democratisation and decentralisation of healthcare services; > empowerment of district resources; > increased mobilisation and involvement on the community level.

The system of distribution of healthcare services is organised in accordance with a pyramid structure that calls for strong connections and excellent coordination between the various levels. The Health Posts are at the base of the pyramid. On average every five Health Posts are connected to a Health Centre. In turn, the Health Centres are associated with a District Hospital. The higher level is composed of Area Hospitals and Specialised Hospitals.

2.1 Indicators Population density Population <1 year Population <3 years Population <5 years Population <15 years Population between 15 and 49 years Maternal mortality Infant mortality Mortality under 5 years Healthcare services coverage Prevalence of HIV in 15-49 year olds

70.4 persons/ km2 3.4% 6.8% 16.8% 44% 51.9% 870/100,00 live births 96.8/1000 140.1/ 1000 48% 3.8%

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3 PROJECTS AND ACTIVITIES IN 2005 42

During 2005 Doctors with Africa CUAMM in Ethiopia supported various activities thanks also to the commitment and financing of various institutional and private donors.

Project title Technical and financial support of San Luca hospital and nursing school in Wolisso

Technical support of St Mary rural hospital of Dubbo Support of physical rehabilitation services

Agency and/or donor Geographical Region Fondazione Cassa di Oromia Region Risparmio di Padova e Rovigo Fondazione Cassa di Risparmio di Verona, Vicenza, Belluno e Ancona Dgcs â&#x20AC;&#x201C; M.aa.ee. exclusively for reasons of compliance Doctors with Africa Southern Nations CUAMM Private donors Nationalities and Peoples Region Dgcs - M.aa.ee Tigray Region Doctors with Africa CUAMM Private donors

3.1 Oromia Region, South West Showa 3.1.1 Wolisso Hospital and Nursing School HOSPITAL AND NURSING SCHOOL Building of the San Luca hospital with nursing school of Wolisso was terminated in 2000, subsequently opening the hospital service in January 2001. The building is owned by the Ethiopian Catholic Church. Together with Doctors for Africa CUAMM, in 2003 the Church

signed a letter of understanding and a five-year project with the Regional Authorities. Doctors with Africa CUAMM has been involved in the project since the start of the initiative, thus including all the initial activities of construction and start-up of the hospital and training activities.

Location Beneficiary population Total budget Doctors with Africa CUAMM budget Donors

Government counterparty Counterparty Expatriate personnel Local Personnel Auxiliary Personnel Project duration

Wolisso Woreda, South West Zone, Oromia Region 1,057,000 approx. 720,000/year 100,000 Euro/year + 3 expatriate doctors CARIPARO foundation CARIVERONA foundation DGCS â&#x20AC;&#x201C; M.A.A.EE. Private donors and Doctors with Africa CUAMM Groups Oromia Regional Health Bureau Ethiopia Catholic Church 3 1 public health expert 0 5 years (2003 -2008)

General objectives Protection of the health of the population, ensuring accessible services and guaranteeing a quality level of healthcare for all and mainly for the most needy and vulnerable members of the community: women and children.

43 Specific goal To regulate the operation of the hospital and the school in conditions of economic stability and offering adequate quality standards.

Target results 1. Guarantee high quality standards in the services provided; 2. Increased utilisation of the hospital, with bed occupancy rates of more than 70%; 3. Availability of specialist ophthalmological and orthopaedic services; 4. Availability in the hospital and extension to the surrounding territory of mother and child health services (MHC) and community medicine; 5. Training of competent and motivated nursing staff; 6. Acquisition of organisational and financial stability of the institution; Activities in 2005 High quality standards guaranteed in the services provided > OPD examinations: 57,159 > Major operations : 1,841 > Minor operations : 1,567 > Normal deliveries: 956 > Deliveries with complications: 653 Bed occupation rate over 100% Specialist ophthalmological and orthopaedic service provided > Major orthopaedic operations : 215 > Minor orthopaedic operations : 107 > Major ophthalmological operations 353 > Minor ophthalmological operations 372

MCH and community medicine services guaranteed in the hospital and surrounding area: > Prenatal clinic : 7,710 examinations > Vaccination activities: 9,809 children vaccinated Training of competent and motivated nursing personnel > 20 qualified nurses : 128

Assured presence of a Medical Director capable of contributing to the achievement of adequate levels of efficiency and quality of the services.

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Number of beds Total Number of Doctors Number of Expatriate Doctors Number of Medical Officers Number of Nursing Staff Number of Support Staff Total Number of Staff Number of Healthcare Staff per 100 beds Total Number of Admissions Number of Paediatric Admissions Paediatric Admissions % Number of hospitalisation days Number of Deliveries Number of Caesarean sections Caesarean sections on total deliveries % Number of Major surgical operations Outpatient examinations ANC Vaccinations SUO (op) Total Income (€) Income from User Fees (€) Income from Donors (€) Income from Government (€) Other income (€) Total Expenses (€) SUO (op) / Staff member Total Expenses /SUO (op) (€) Income from User Fees/SUO (op) (€)

138 9 4 2 115 120 246 1.26 7985 2427 30.4 % 50809 1554 428 27.5 % 1701 57268 7710 11918 184,592 594,850 264,376 136,051 83,657 110,766 678,901 750 3.6 1.4

Specifically, in 2005 Doctors with Africa CUAMM provided: > Qualified healthcare personnel with experience not available in Ethiopia. > An orthopaedic service by means of periodic visits of expatriate orthopaedic surgeons. > Partial coverage of day-to-day hospital running costs.

With the coordination of the Ortho-Cuamm group, Doctors with Africa CUAMM collaborates with the Faculty of Medicine of the Addis Ababa and Padova Universities in the sector of Orthopaedic Surgery, thus guaranteeing technical support for students from both universities.

Moreover, for 2006 Doctors with Africa CUAMM must consolidate the laboratory service for HIV cases and guarantee, in collaboration with regional health authorities, the supply of antiretroviral drugs. In this context a project document was presented to the Global Fund to seek possible financing.

PUBLIC HEALTHCARE ACTIVITIES IN THE TERRITORY The Public Health Department performs preventive activities in the territory including nine “kebeles” (urban dwellers’ associations). In addition, nine manually operated wells were bored and seven springs were protected in several villages in the district. In order to facilitate the strengthening of basic peripheral services in the territory Doctors with Africa CUAMM submitted to the Ministry for Foreign Affairs a public healthcare project approved by the DGCS Directorate in October 2005, which envisages a series of interventions based on Primary Healthcare criteria in the Wolisso district.

The main beneficiaries of the project will be the inhabitants of the Wolisso Woreda (approx. 220,000), in particular those of the three selected kebeles, and specifically children up to the age of five (4,067, or 18.11 %) and women of childbearing age (5,335 or 23.76 %).

The construction of three new Health Posts is envisaged together with the provision of furniture and equipment and the regular supply of drugs in accordance with local standards. These are local government structures that will take over control of the facilities at the end of the initiative.

In each of the three sites a well will be bored to assure a safe supply of water to the Health Post and to the population in the surrounding area. In addition “VIP latrines” will be built in the villages as a model to persuade local families to follow suit.

The training of 20 healthcare workers will increase the number of users assisted by suitably skilled personnel. Six of these will be assigned to the three new dispensaries while the remainder will be placed at the disposal of local health services.

The refurbishment of the Wolisso Health Centre is designed to promote its full operation and the establishment of an appropriate relationship with our Hospital.

The project will be implemented in close collaboration with local counterparties at various levels (Woreda, zone, and regional state). The project counterparty is the Oromia Health Bureau, which is responsible for health management of the Region, the Oromia Disaster Prevention and Preparedness Commission and the Ethiopian Catholic Church, proprietor and party responsible for management of the Hospital and the Nursing School.

3.1 SNNP Region, Guraghe 3.2.1 Burat Dispensary/Maternity clinic in the Geto area In August 2003 the management and responsibility of the Burat clinic project were left entirely to the Catholic Church, which as the proprietor of the Doctors with Africa CUAMM structure and thanks to its representation on the Board of Directors with one member, annually guarantees financial support to cover the running costs of the Clinic.

In 2005 Doctors with Africa CUAMM Ethiopia covered costs for a total amount of USD 30,000.

The clinic guarantees an outpatients service and prevention service in the territory including the eight districts assigned by the health authorities of the zone.

The agreement with the Catholic Church, which expired at the end of 2005, was renewed for a further three-year period, guaranteeing, through Doctors with Africa CUAMM, support of the three-year running costs through the contribution of 20,000 euro per annum.

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Location Beneficiary population Budget Doctors with Africa CUAMM budget Donors Government counterparty Counterparty Expatriate personnel Local personnel Auxiliary Personnel Project duration

Burat, Gumer Woreda, Guraghe Zone SNNP Region 109,740 36,000 euro/year USD 30,000 in 2005 and 60,000.00 euros (2006-2008) Private donors and Doctors with Africa CUAMM Groups Zonal Health Desk Emdibir eparchy 0 0 0 6 years (2003 -2008)

General objectives Protection of the health of the population, ensuring accessible services and guaranteeing a quality level of healthcare for all and mainly for the most needy and vulnerable members of the community: women and children.

46

Specific goals To improve treatment services on the outpatient level (OPD); To improve prenatal coverage and the postnatal service To strengthen the system of reference between the clinic and the Attat reference hospital; To provide vaccination coverage of children and pregnant women; To improve the service for outpatient deliveries.

Target results 1. Guarantee of high quality standards in the services provided; 2. Availability in the clinic and extension to the surrounding territory of mother and child health services (MHC) and community medicine; Activities in 2005 High quality standards provided in services distributed in 2005 > New OPD examinations: 5,315 > Children examinations: 1,466 > Normal deliveries: 78 > Deliveries referred: 36 MCH services and community medicine provided in the hospital and in the surroundings > Prenatal clinic : 8,567 examinations > Vaccination activities: 2,555 vaccinations > Health Education 24,428 persons contacted

3.3 SNNP Region, Wolaita 3.3.1 St. Mary of Dubbo Rural Hospital The St. Mary of Dubbo rural hospital is a non-profit institution managed by the Ethiopian Catholic Church in collaboration with Doctors with Africa CUAMM and the government of the Southern Nations Nationalities and Peoples Region. The hospital was opened in July 2002. The primary aim is to deliver therapeutic and preventive healthcare services to the

local population with special regard to the accessibility to services by the most needy and disadvantaged members of the community.

The hospital is located in the Bolosso Sore Woreda Wolaita Zone in the Southern Nations Nationalities and Peoples region. It is approximately 30 km from the city of Wolaita Soddo, on the road to the west leading to the city of Hosanna. Since the start of the Hospital activities Doctors with Africa CUAMM has been providing specialist doctors to ensure the provision of a multidisciplinary and comprehensive service.

The hospital, which has 62 beds, provides outpatient services, hospitalisation and treatment. With the opening of the paediatric ward in June 2003 the hospital can guarantee a comprehensive service for local mothers and children. The hospital is also responsible for 9 sites in the territory where vaccination sessions are held once a month.

Location Beneficiary population Doctors with Africa CUAMM budget Donors Government counterparty Counterparty Expatriate personnel Local personnel Auxiliary Personnel Project duration

Dubbo, Boloso Sore Woreda, WolytaZone SNNP Region 494,000 Cost of 1 Medical Director and 1 Matron (expatriated) Private donors and Doctors with Africa CUAMM Groups SNNP Regional Health Bureau Soddo Hosanna Vicarship office 2 0 0 5 years (2003 -2007)

General objectives Protection of the health of the population, ensuring accessible services to guarantee quality healthcare for all and mainly for the most needy and vulnerable members of the community: women and children.

Specific goal Regular operation of the hospital in conditions of economic stability and offering adequate quality standards.

Target results 1. Guarantee of high quality standards in the services provided; 2. Increased utilisation of the hospital, with bed occupancy rates of more than 70%; 3. Availability in the hospital and extension to the surrounding territory of mother and child health services (MHC) and community medicine; 4. Acquisition of organisational and financial stability of the institution; Activities in 2005 High quality standard provided in services in 2005 > OPD examinations: 27,600 > Major operations : 730 > Minor operations : 797 > Normal deliveries: 323 > Deliveries with complications: 227 Bed occupation rate over 100%

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MCH services and community medicine provided in the hospital and in the surroundings > Prenatal clinic : 3,745 examinations > Vaccination activities: 28,749 children vaccinated Presence of a government body that meets periodically and ensures the continuous presence of a Medical Director and a Matron in the hospital Management team, able to contribute to the arrival at adequate levels of efficiency and quality of the service and also preparing a three-year programme of hospital activities complete with relative financial plan.

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Number of beds Total Number of Doctors Number of Expatriate Doctors Number of Medical Officers Number of Nursing Staff Number of Support Staff Total Number of Staff No. of Healthcare Staff per 100 beds Total Number of Admissions Number of Paediatric Admissions Paediatric Admissions % Number of hospitalisation days Number of deliveries Number of Caesarean sections Caesarean sections on total deliveries % Number of Major surgical operations Outpatient examinations ANC Vaccinations SUO (op) Total Income (€) Income from User Fees (€) Income from Donors (€) Income from Government (€) Other income (€) Total Expenses (€) SUO (op)/ Staff member Total Expenses /SUO (op) (€) Income from User Fees/SUO (op) (€)

62 5 1 0 73 45 123 126 5,959 2,602 44 550 181 33 730 27,600 3,745 28,749 127,357 412,182 194,426 19,845 2,825 195,086 258,799 1.633 2.03 1.53

For 2006 Doctors with Africa CUAMM intends to continue supporting the hospital with qualified medical and paramedical personnel in order to strengthen management, preventive, diagnostic, and treatment capabilities of the hospital and throughout the territory.

In addition, in order to facilitate the strengthening of basic peripheral services in the territory Doctors with Africa CUAMM intends to submit to the Ministry for Foreign Affairs a public healthcare project aimed at boosting basic peripheral services and strengthening the hospital’s public health department.

Specifically, plans exist to build and equip three peripheral health centres and refurbish two existing centres in order to guarantee preventive medicine services with prenatal examinations, vaccination of children, and health education activities.

The project envisages the boring of manually operated wells and the strengthening of the district health office.

3.4 Tigray Region, Mekele 3.4.1 Support of the Mekele Physical rehabilitation Centre The project aims to strengthen and improve the assistance activities of the Mekele Physical rehabilitation centre to assist the disabled population, with special attention focused on the civil population of disabled persons, in the Tigray Region.

The present project originates from a repeated request of the regional authorities to Doctors with Africa CUAMM for the continuation of additional support collaboration for facilities and activities executed using the funds of a Special MAEE Programme. This intervention was implemented in the period from 1993 to 1998, taking account of both the feasibility study and the development of the project, with handover of the structure and equipment to the counterpart represented by a Board composed of the regional health Authorities, Social Affairs, Ethiopian Red Cross, and the Tigray Disabled Veterans Association (TDVA).

At the closure of the project the regional authorities of the sector and the regional Bureau of Labour and of Social Affairs (MOLSA) assigned the physiotherapy centre to the management of TDVA. The Technical Unit of Italian Cooperation in Addis Ababa, further to a mission of valuation of the terminated project, informed Doctors with Africa CUAMM of the request of TDVA for additional support of their activities and hence invited the organisation to consider generating a study for a proposal of the promoted project.

For this purpose Doctors with Africa CUAMM executed two feasibility missions in October 1999 and in May-June 2000 and presented a proposal to the DGCS in March 2001.

The facility is currently managed by the TDVA jointly with the mechanical-orthopaedic workshop set up by the International Committee of the Red Cross (ICRC) in the early 1990s and it is still supported by this organisation today. Currently the two centres offer integrated assistance for disabled members of the population of Tigray.

The project presented to the DGCS was approved by the Directorate meeting of July 2003 and the project leader started work in Mekele in July 2004.

In the past three years the context surrounding the project has altered partially and therefore contacts have been entered into with the counterparty, the Tigray Disabled Veterans Association (TDVA), in such a way as to update the activities in relation to the planned objectives.

In October 2004 a 4-month extension was requested of the first yearly period, requesting an update of the project because it was drafted in 2001 but, following the procedures of approval and registration of the accounting commitment by M.AA.EE., it was possible to commence the works only in March 2004.

In November 2004 we received approval for the modification from the DGCS and in December 2004 an agreement for implementation of the project was signed with the local counterparty and the regional Authorities of the sector.

Location Beneficiary population Total budget Donors

Government counterparty Counterparty Expatriate personnel Local personnel Auxiliary Personnel Project duration

Mekele Woreda, Eastern Zone, Tigray Region 30,490 disabled persons 913,893 euro Dgcs â&#x20AC;&#x201C; M.aa.ee Private donors and Doctors with Africa CUAMM Groups Caritas Antoniana Tigray Regional Health Bureau Tigray Disabled Veterans Association (TDVA) 2 0 4 3 years (2004 -2007)

49

General objective > To improve the living conditions and healthcare assistance for the disabled population – Eastern Zone – Region 1 – Tigray.

Specific goals > To support the Mekele prosthetics-physiotherapy centre and improve the quality of the physical rehabilitation sector, with a special focus on the surgical and orthopaedic services, through integration with the Regional healthcare system. > To boost sensitisation and information on a community level of the problem of physical disabilities and promote initiatives of economic sustainability of the Mekele Centre.

Target results 1. Improved and enhanced accessibility of the civil population to the prosthetics and physiotherapy services.

2. Increased number of qualified personnel at the Centre.

3. Improved quality of the physical rehabilitation and orthopaedic surgery services in the zone.

4. Creation of a reference network on the zone level and activities of sensitisation on the community level.

5. Identification of systems for the self-sustainability of the Centre.

Activities in 2005 50

Improved and enhanced accessibility of the civil population to the Prosthetics and physiotherapy services. > Construction work was started on • a residential block for 5 disabled users plus 5 assistants (with external latrines and shower units and a traditional kitchen) for a total of 120 square metres; • a wing for fee-paying users of 90 sq. m annexed to the Centre but with a separate entrance, toilet facilities and storeroom; • a classroom for theoretical training of the Centre’s staff, for the activity of training and updating of healthcare workers of the territory and work meetings; > The Centre was supplied with material, equipment and furniture for the new dwellings, assuring the completion of the building works described above and the execution of training initiatives and assistance activities.

Increase of the number of qualified personnel at the Centre > Strengthening of the staff of the Physiotherapy centre with the presence of two physiotherapists. > Preparation of a plan of studies for assistant physiotherapists to be trained on the job > On-the-job training was provided for 5 physiotherapists of whom 2 will be assigned to the Centre for internal assistance activities and 3 for the activities envisaged in the regional hospitals. > In accordance with the Counterparty and the regional healthcare authorities, the project personnel collaborated in organising the plan of studies for a two-year course for qualified physiotherapists addressed to persons with experience in the field and qualified nurses interested and motivated to work in the sector. The proposal forwarded by the Mekele nursing school and the Tigray Health Bureau will achieve recognition at a regional level. > Payment guaranteed of 2 study grants for the current academic year for the degree course at the university of Gondar. > An operative was trained to ensure the collection of data and creation of a database documenting the activities performed by the centre

Improved quality of the physical rehabilitation and orthopaedic surgery services in the zone > Three missions arranged for visits of an orthopaedic physician to the Mekele hospital and the Centre. > Introduction of assistance protocols and standardisation of treatments > Start of data collection and relative processing.

Creation of a reference network on the zone level and activities of sensitisation on the community level > Commencement of updating of personnel of the healthcare facilities in the zone, disabled members of the TDVA, and social workers. > The updating activities, already partially undertaken to support the operators of the peripheral services of the region, were continued. The operators will receive training targeted for the creation of knowledge to transmit to the community heads and for the sensitisation of the latter in relation to the problem of physical disability, early identification, and reference to the appropriate facilities for specific treatment campaigns.

Specifically, the operators will be informed and trained in relation to the following aspects: 1. the procedures to follow for referring disabled users to the Mekele centre; 2. the follow-up to be implemented for disabled patients who have returned to their homes; 3. the mechanisms of sensitisation of the community on the subject of physical disabilities.

Identification of systems for self-sustainability of the Centre > Commencement of building works of a bakery to assure income-generating activities to cover the centreâ&#x20AC;&#x2122;s management costs. > Purchase of material for 100 prams/wheelchairs to ensure the implementation of income generating activities. > In order to allow access to physical rehabilitation services for all disabled users, including those who are unable to make any measure of contribution to the assistance costs, it is planned to promote the identification of criteria and forms for the creation of a social fund for their welfare. A study into the accessibility of the centre and its economic situation was terminated in November. The parties involved, including government authorities and donors, have planned various meetings at the start of 2006 to define future strategies of the centre in order to guarantee a service that is accessible to all disabled users of the centre.

Description Total number of patients treated Total number of infant diseases Infant diseases % Total Number of treatments Patients from the Mekelle zone Patients from other areas of Tigray Neurological disorders Orthopaedic disorders

Numbers 746 116 15.54 % 3,304 563 183 248 498

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4 HUMAN RESOURCES IN ETHIOPIA IN 2005-2006

52

EXPATRIATE PERSONNEL N. Name Location 1.

Fabio Manenti Wolisso 2.

Barbara Secco Wolisso 3.

Elisabetta Marastoni Wolisso 4.

Ciro Bedin Wolisso 5.

Giovanni Cecchini Dubbo 6.

Luciano David Dubbo 7.

Mario Battocletti Dubbo 8.

Elisabetta Lovato Dubbo 9.

Mattia Morri Mekele 10. Leopolda Bortolani Mekele 11. Massimo Maroli A.A.

Project Hospital Hospital Hospital Hospital Hospital Hospital Hospital Hospital Physiotherapy Physiotherapy Coordination

LOCAL PERSONNEL N. Name 12. Gebre Madebo 13. Hanna Hailesellassie 14. Mulu Asrat 15. Bellette Tadesse

Project Hospital - Coord.

Coordination Coordination Coordination

Location Wolisso -AA Addis Ababa Addis Ababa Addis Ababa

Role Public Health expert Accountant Secretary Driver

KENYA 1 NATIONAL CONTEXT The Republic of Kenya has a population of approximately 32 million. The country is located in East Africa and is bordered by Sudan, Ethiopia, Somalia, Tanzania, Uganda, and the Indian Ocean to the southeast. The territory is bisected by the Great Rift Valley, which forms the bed for lake Turkana. The main activities are activities are arable and livestock farming, while the industrial sector is gradually gathering pace. There are several important tourist resorts on the coast. In December 2002 a new government came to power, proclaiming that it intended to turn the country around by focusing on the fight against corruption, universal access to primary education, basic healthcare, roads and railways, and partnership agreements with neighbouring countries.

The climate of change also touches on the health sector, where the situation of the public health service and the conditions of accessibility appear to be precarious. The country is preparing for elections in 2007.

2 REGIONAL CONTEXT The diocese of Nyahururu, in which Doctors with Africa CUAMM is present, is of recent construction and has a population of approximately 860,000; the territory covers two government districts: Nyandarua, site of the North Kinangop hospital, and West Laikipya (East Laikipya is in the diocese of Nyeri), site of the bishopric and the city of Nyahururu. > Nyandarua District > West Laikipya District

Area: 3,520 sq km Area: 4,940 sq km

Population: 500,000 Population: 360,000

Population: 31,987,000 Life expectancy at birth m/f (years): 50.0/49.0 Infant mortality m/f (per 1000): 126/120 Adult mortality m/f (1000): 495/521 Total per capita healthcare costs (Intl $, 2002): 70 Healthcare spending as % of GDP (2002): 4.9 Source: The world health report 2005

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3 DOCTORS WITH AFRICA CUAMM IN KENYA Doctors with Africa CUAMM has a long tradition of engagement in Kenya, assigning the first doctor in 1956 and continuing its work up to 1993, mainly in the facilities of local churches and missionary congregations.

After the conclusion of the Nkubu and North Kinangop projects, Doctors with Africa CUAMM continued to maintain contacts with local institutions, in particular with institutions controlled by the Church, thanks also to the ties existing with the priests of the Diocese of Padova working in Kenya.

At the end of October 1999 contacts were established with the St. Martin Association in the Nyahururu area, which is in charge of various initiatives including a rehabilitation project on a community level for disabled children.

This contact gave rise to a collaboration undertaking, signed in August 2000, for which a three-year project was presented to CEI (approved for conformity by MAAEESC/052/CUAMM/KEN); the project is currently financed with private funds.

Missionary structures in Kenya cover 40% of assistance needs and constitute an essential resource for the healthcare system; despite formal endorsement, the Kenyan government does not offer any form of financial support to the missionary structures. A broadbased series of meetings is currently under way in order to develop regulations governing the cooperation between private non-profit organisations and government bodies.

Pending the definition of general policies, agreements with government authorities must be sought on a peripheral level, maintaining good relations with District Medical Officers.

54

The Saint Martin Catholic Social Apostolate (CSA) is a religiously oriented organisation that bases its action on a community approach, involved in the provision of aid for the most disadvantaged members of society. The Saint Martin mission operates in the district of Nyandarua and West Laikipya. All the programmes derive from grassroots initiatives and are managed by committees representing the various communities. In this manner it is the community itself that seeks solutions for the problems of its members and establishes the methods of execution of the programmes. It is the conviction of the Saint Martin mission that solutions must arrive from the community as far as possible, and must be developed in harmony with the community context (table 1).

Table 1: Vision and Saint Martin Mission - CSA

Vision of Saint Martin CSA: A fair society where the community employs and involves needy persons through a spirit of love and solidarity, in such a way as to assure complete human realisation and development for all.

Saint Martin CSA Mission: To generate substantial capabilities within communities irrespective of creed, such as to allow the communities to assume responsibility in relation to the more disadvantaged members, ensuring the practical implementation of the social teachings of the Church.

The Saint Martin mission is dedicated to caring for the most needy members of the community without any form of discrimination on the basis of creed, sex, or ethic origin. The work is organised in specific programmes, each dealing with the problems of a specific group (e.g. street children, disabled children, etc.). The programmes are reciprocally integrated in order to make complementary use of the available resources. The Saint Martin mission makes use of a large number of volunteers from the Catholic and Protestant

Churches, active both on the managerial level (the Programme Management Committees: currently 85 staff), and in the field, in addition to its salaried personnel. Other community members have been involved in the programme through the distribution of material goods or the provision of professional services free of charge or with reduced charges (doctors, nurses, lawyers, teachers); this approach supported the creation of a community support network for the most needy individuals.

COMMUNITY DEVELOPMENT PROJECT FOR DISABLED PERSONS (NYAHURURU) The Project (2004-2007) is fully supported with private funds OPSA-Padova, JengaInsieme Doctors with Africa Group, Atantemani Association and Fontana Foundation.

The work is articulated in the framework of various social and assistance initiatives of the local St. Martin association (Diocese of Nyahururu). The scope of the project is the strengthening of the services network (composed of professional and voluntary operators), involvement of families in the rehabilitation of disabled children, improvement of prevention (by supporting midwives and forging links with the local health services), consolidation of activities undertaken over the past three years, and a more systematic approach to data collection.

The project has strong community roots and looks highly likely to be able to proceed almost independently with only limited external support. The main challenges are constituted by the difficult prospectives of adult disabled persons, by the enrolment of the younger disabled children in schools, and by the frequent changes of local agents.

55 Human resources Luca Ramigni (physiotherapist)

26/07/2004

31/12/05

MOZAMBIQUE

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1 HISTORY August 1977:

Signing of technical cooperation agreements between Italy and Mozambique.

1978:

First mission of voluntary doctors.

Objective: to contribute to the development of the Mozambican healthcare system based on “prevention” and “decentralisation”.

Presence of doctors in numerous hospitals in provinces of the Central and Northern regions.

Organisation of a course for medical technicians.

From 1978 to 1985:Staff employed: 50 volunteers and 10 experts.

From 1986 to 1992:A programme in the Gaza province was launched: Support guaranteed to Chokwe, Chibuto and Chicumbane hospitals.

Staff employed: 15 volunteers.

4 OCTOBER 1992: SIGNING OF PEACE AGREEMENT IN MOZAMBIQUE. End of 1992:

Presence in Sofala Province begins with emergency activities followed by rehabilitation of the structures and healthcare system.

From 1992 to 1997:Doctors with Africa Cuamm operate in districts of: Nhamatanda, Marromeu, Gorongosa, Inhaminga and Maringue.

Staff employed: 37 volunteers.

1997:

Padua and Beira become twin towns and Doctors with Africa Cuamm participate in opening of a health centre: The city of Padua helps build a school and the Padua hospital authority provides support to the Beira hospital.

From 1997 to 2001:Staff employed: 34 volunteers.

Continuity is given to the Sofala initiative through a programme to support the Provincial Health Management and various districts (Sofala 2000 Programme).

Organisation of a training programme for medical technicians in Chicumbane (Gaza province).

Development of a project to support three districts in the Zambezia province.

The current stage began in 2002 with the projects in the Sofala, Nampula and Inhambane provinces.

2 COUNTRY PROFILE Mozambique is a sub-Saharan country with an estimated population of 18 million people.

According to the UNDP report, it is one of the 10 poorest countries in the world. The 1997 census found a life expectancy at birth of 42.3 years, but subsequent projections indicate that at the end of 2005 the figure may be as low as 35.2 years due to the impact of AIDS. By 2001 life expectancy had already fallen to 39.2 years. Official figures show that almost 70% of the population lives in extreme poverty1. However, figures vary considerably from one province to another: the Sofala Province has an absolute poverty rate of 88% of the population and Tete and Inhambane of 82-83%, while the figure for Maputo is 48%. The literacy rate is 45.2% and average annual per capita income $ 1,140. Only 57% of the population has access to potable water. Births assisted by healthcare staff account for just 50% of the total.

The main causes of disease and mortality are malaria, diarrhoea, respiratory infections, tuberculosis and HIV/AIDS. Figures from 1997 show that 15% of registered illnesses are malarial in nature and that tuberculosis is the major cause of hospitalisation in rural areas.

The mother-child health indicators in Mozambique are amongst the worst in the world, with a maternal mortality rate of almost 1,000 per 100,000 live births. The infant mortality rate varies from 183/1000 births in the Zambezia Province to 60/1000 in Maputo.

The national health service (SNS – Servico Nacional de Saúde) effectively provides healthcare to just 50% of the population, partly because the majority of the population in rural areas still use traditional medicine. The national health service operates on four levels: Levels I and II, Health Stations and Centres, are responsible for primary healthcare and have important preventive functions, whereas Levels III and IV, clinics and hospitals, have more specialised treatment functions within the institutional structure of the national health service. There are about 1,100 primary level units with an average of about 15,000 inhabitants per basic healthcare unit. Although the national health indicators continue to cause concern, the healthcare sector has improved significantly since 1993.

In 2000, the Mozambican government presented its Action plan for reducing absolute poverty 2001–2005 (PARPA).

The primary aspects of poverty reduction that are relevant to the healthcare sector are: > Primary healthcare (beneficiaries: women, children, adolescents) and nutrition. > Fight against fatal diseases (diarrhoea, malaria, tuberculosis, HIV/AIDS). > Improvement of peripheral healthcare network. > Development of human resources. > Improvement in healthcare sector planning and management. > The strategic healthcare plan places particular emphasis on improving quality and providing equal accessibility to healthcare. It also refers to closer links between the healthcare sector and civil society, in particular cooperation with other institutions and NGOs, the creation of partnerships and the participation of traditional medicine.

1 The National Household Survey on Living Conditions, 1997 (in “Understanding Poverty and Well-Being in Mozambique, the First National Assessment”, 1998)

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3 OVERVIEW OF PROJECTS AND SOURCES OF FUNDING FOR YEAR 2005 PROJECT TITLE Sofala Province Improvement in laboratory and paediatric services at Beira central hospital (Sofala Province)

Training of high-level healthcare managers: support programme for the medicine faculty of the Catholic University of Mozambique

Strengthening of healthcare systems in the Beira and Dondo districts

58 Reinforcement of HIV-AIDS paediatric services in the Beira central hospital HIV-AIDS and malnutrition in children: an integrated response in the Sofala province Nampula Province Reopening and consolidation of elementary obstetrics training centre in Alua

SOURCES OF FUNDING 2005 The total cost of the project is € 591,560 for the period October 2002 - February 2006. The following contributed: Italian Ministry of Foreign Affairs, Hospital of Padua, Doctors with Africa Cuamm Groups and private individuals.

The total cost of the project is € 334,003.60 for the period August 2004 - August 2007.

The following contributed: Italian Ministry of Foreign Affairs, Doctors with Africa Cuamm Groups and private individuals.

The total cost of the project is € 830,807 for the period December 2004 - November 2006.

The following contributed: Italian Ministry of Foreign Affairs, Doctors with Africa Cuamm Groups and private individuals.

Clinton Foundation € 29,154 (100%) UNICEF € 37,044 (100%)

The total cost of the project is € 472,002 for the period September 2004 - February 2007.

The following contributed: Italian Ministry of Foreign Affairs, Doctors with Africa Cuamm Groups and private individuals General strengthening of public healthcare system Clinton Foundation in Moma district including treatment of HIV-AIDS € 19,500 (100%) Inhambane Province Support for HIV-AIDS services in Inhambane Doctors with Africa Cuamm with the province contribution of private individuals and Doctors with Africa Cuamm Groups, € 31,485 (68%) UNICEF € 4,390 (10%) GTZ v 10,000 (22%) Specific and vertical projects Mapping of lymphatic filariasis in the country

Liverpool School of Tropical Medicine € 25,000 (100%)

4 DETAILS OF PROJECTS 4.1 Sofala Province

59

IMPROVEMENT IN LABORATORY AND PAEDIATRIC SERVICES AT CENTRAL HOSPITAL IN BEIRA Location Beira Central Total budget Donors

Partners Expatriate staff Local staff Support staff Duration of project

60

> Beneficiary population Child population of city of Beira (500,000 people) and the Sofala province > € 591,560 > Italian Ministry of Foreign Affairs > Doctors with Africa Cuamm, with the contribution of private individuals and Groups > Padua hospital authority > Hospital management > 1 paediatrician > 1 nurse (at the service of Padua hospital authority) > 9 nurses and 4 auxiliary workers > 7 activists > 3 guards > 3 years, ending in February 2006

Main results achieved > Improvement in quality of healthcare provided to inpatient children through the technical support of the paediatrician, training of paramedical staff, supply of materials and standardisation of procedures. > Laboratory (biochemical and haematological sections) operational as a result of technical support, purchase and maintenance of automated equipment, supply of reagents and introduction of a quality control system. > Commission set up for prevention and control of hospital infections.

TRAINING OF HIGH-LEVEL HEALTHCARE MANAGERS: SUPPORT PROGRAMME FOR THE MEDICINE FACULTY OF THE CATHOLIC UNIVERSITY OF MOZAMBIQUE Location Beneficiary population Total budget Donors Partners Expatriate staff Local staff Support staff Duration of project

> Beira > The approximately 200 students at the university and the entire teaching staff of the faculty > € 334,003 > Doctors with Africa Cuamm (with the contribution of private individuals and Groups) > Faculty of Medicine of Catholic University of Beira > 1 doctor in surgical department > 1 doctor in infectious diseases department > 3 years, ending in July 2007

Main results achieved > Guaranteed coverage of theoretical and practical teaching of students in the fields of anatomy/surgery and internal medicine/infectious diseases. > Improved access to study by providing textbooks for the Faculty’s library and 6 study grants for students from the north of the country.

STRENGTHENING OF HEALTHCARE SYSTEMS IN THE BEIRA AND DONDO DISTRICTS Location Beneficiary population Total budget Donors

> > > > >

Partners

> > > > > > > > > > > >

Expatriate staff Local staff Support staff

Duration of project

Beira and Dondo districts Population of Dondo district and the Beira city district â&#x201A;Ź 830,807 Italian Ministry of Foreign Affairs Doctors with Africa Cuamm (with the contribution of private individuals and Groups) Provincial health management Beira district management Dondo district management 2 public health doctors 1 paediatrician 10 nurses 15 auxiliary workers 1 accountant 1 logistician 2 drivers 3 guards 3 years, ending in November 2006

Main results achieved > Improvement in overall management of the two districts through constant technical support for the managements. > Higher quality and more effective services provided through training of local staff, adequate equipping of health centres, structural rehabilitation and the availability of transport (materials and supervision).

STRENGTHENING OF HIV-AIDS PAEDIATRIC SERVICES IN BEIRA CENTRAL HOSPITAL Location Beneficiary population Total budget Donors Partners Expatriate staff Local staff

Support staff Duration of project

> > > > > > > > > > > > > >

Central hospital in Beira Child population of the city (total population 500,000) â&#x201A;Ź 51,666 Clinton Foundation Hospital management 1 laboratory biologist 1 paediatrician in partnership with UNICEF project 3 activists 3 auxiliary social workers 1 pharmacy technician 1 day hospital nurse 2 auxiliary workers 1 secretary 1 year ending in May 2006

Main results achieved > Setting up of paediatric day hospital service for HIV-AIDS (250 children registered at the end of 2005 including 120 undergoing antiretroviral treatment). > Improved diagnostics and treatment of opportunistic infections and HIV-AIDS in inpatient children in the four paediatric department wards.

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> Guaranteed laboratory quality in diagnosing HIV-AIDS and the most common opportunistic infections.

HIV-AIDS AND MALNUTRITION IN CHILDREN: AN INTEGRATED RESPONSE IN THE SOFALA PROVINCE Location Beneficiary population Total budget Donors Partners Expatriate staff Local staff Support staff

Duration of project

62

> Sofala Province > Child population of the province (total population 1,600,000) > â&#x201A;Ź 300,833 > UNICEF > Provincial health management > 1 paediatrician > 1 nutritionist nurse > 1 data entry worker for day hospital > 1 accountant > 1 logistician > 1 driver > 17 months ending in December 2006

Main results achieved Improved healthcare for children in malnutrition ward of central hospital through training and increase in number of paramedical staff.

Protocols introduced for early diagnosis and treatment of malnourished and/or HIV-AIDS infected children in peripheral health centres.

Connection and support network set up between paediatric department, paediatric day hospital, peripheral health centres and communities for malnourished and/or HIV-AIDS infected children.

4.2 Nampula Province

63

REOPENING AND STRENGTHENING OF ELEMENTARY OBSTETRICS TRAINING CENTRE IN ALUA Location Beneficiary population Total budget

Partners Expatriate staff Local staff - Support staff

Duration of project

> > > > > > > > > > > >

Alua, Erati district Population of Nampula province 60 obstetricians â&#x201A;Ź 472,000 Donors Italian Ministry of Foreign Affairs Doctors with Africa Cuamm (with the contribution of private individuals and Groups) Provincial health department 1 obstetrician 1 nurse 1 driver 1 surveyor/logistician 2 guards 2 years and 6 months, ending in February 2007

Main results achieved > Training centre reopened and operational through the construction of new buildings (kitchen/refectory, practice room/library, 5 houses for teachers), supply of books and teaching materials, technical support for management, teaching and practical training of students. > Two courses organised and completed for a total of 54 qualified obstetricians.

GENERAL STRENGTHENING OF PUBLIC HEALTHCARE SYSTEM IN MOMA DISTRICT INCLUDING TREATMENT OF HIV-AIDS Location Beneficiary population Total budget Donors Partners

Expatriate staff Local staff

Support staff 64 Duration of project

> > > > > > > > > > > > > > >

Moma, Nampula Province Inhabitants of Moma district (300,000 people) â&#x201A;Ź 452,075 Clinton Foundation Provincial Health Management District Health Management Vida Positiva local NGO 1 doctor 1 obstetrician 18 nurses, obstetricians and auxiliary workers (8 in hospital + 10 in district) 2 social workers 1 logistician 1 driver 1 accountant 2 years, ending in October 2007

Main results achieved > project began in November 2005

4.3 Inhambane Province

65

SUPPORT FOR HIV-AIDS SERVICES IN INHAMBANE PROVINCE Location Beneficiary population Total budget Donors

Partners

Expatriate staff Local staff Support staff Duration of project

> Homoine, Chicuque and Inhambane > Inhabitants of the Inhambane province served by these 3 centres (about 600,000 people). > â&#x201A;Ź 150,000 > Doctors with Africa Cuamm (with the contribution of private individuals and Groups) > UNICEF > GTZ > Homoine District Health Department > Chicuque District Health Department > Inhambane District Health Department > Provincial Health Department > 1 doctor > 10 nurses, social workers and auxiliary workers > 2 years

Main results achieved > Improved access to treatment of opportunistic infections and antiretroviral treatment in the Homoine district. > Increased coverage of prevention of mother-to-child transmission in the area of Homoine, Chicuque and Inhambane.

5 RESEARCH ACTIVITIES

66

In 2005 Doctors with Africa Cuamm in Mozambique conducted an epidemiological mapping of lymphatic filariasis across the country. The project was carried out in cooperation with the WHO and the Mozambican Ministry of Health. Doctors with Africa Cuamm contributed through ? 25,000 funding donated by the Liverpool School of Tropical Medicine and through the technical support of a public health doctor who personally led the project for 4 months (paid through a contract with the WHO of Geneva).

In 2005, an attempt was made to launch an ambitious national-level survey of the equity of antiretroviral treatment programmes across the country. The project was presented to the Ministry of Health as a combined proposal by Doctors with Africa Cuamm, Italian Cooperation and Equinet. The Ministry of Health approved the initiative and appointed its own researcher. In July, two researchers developed the detailed protocol of the research project and the operational stage was scheduled to start at the end of September following approval by the national ethical committee. However, the study did not begin within the established timeframes as the researcher designated by the Ministry was promoted and was therefore no longer able to work on the research project (which involved at least two months full-time work). As roles are currently in a state of flux, it was decided to postpone the start of the project to the first quarter of 2006. The consequences of this research project in terms of decision-making for the Ministry and partners (donors and NGOs) in the field of HIV-AIDS are potentially significant.

6 FIGURES FOR EMPLOYED STAFF Expatriate staff: > 11 specialist doctors > 4 postgraduate doctors > 1 biologist laboratory technician > 3 nurses > 3 specialist doctors on short-term missions > 1 social science expert Local staff: > 80 nurses, auxiliary workers and social workers engaged through the Ministry of Health > 18 accountants, logisticians, drivers

RWANDA Rwanda is now seeing a slow and difficult return to normality in spite of the lingering wounds in the country’s social and political life. The policy of “iron reconciliation” promised by the hard-line president Paul Kagame has not proved sufficient to achieve pacification of the country, which still today sees episodes of violence and intimidation between members of different cultural groups. Furthermore, Rwanda is located in the Great Lakes region, an extremely volatile geopolitical area subject to continuous conflicts and clashes involving numerous African countries, with severe consequences for the lives of the civilian populations. After the 1994 genocide, new balances of power began to emerge and although these did not achieve any real redistribution of resources they generated further imbalances in terms of access.

Doctors with Africa CUAMM has been operating in Rwanda since June 1994. It has concentrated its activities in the Umutara province through actions aimed at developing the healthcare system and in particular providing support to basic health services. After implementing two projects funded by UNDP and the European Union (concluded respectively in 2000 and 2001), a project assigned by the Italian Ministry of Foreign Affairs (MAE) allowed the organisation to capitalise on its past experience and provide continuity to a country programme aiming to promote and improve the state of health of the population.

In June 2004, in spite of the difficulties in interacting with the local institutions, the Rwandan Ministry of Health approved the request to extend the MAE assigned programme, which thus obtained an extension of 36 months to July 2007.

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Population: 8,387,000 Life expectancy at birth m/f (years): 43.0/46.0 Child mortality m/f (per 1000): 213/193 Adult mortality m/f (1000): 541/455 Total per capita healthcare expenditure (Intl $, 2002): 48 Total healthcare expenditure as % of GDP (2002): 5.3 Source: The world health report 2005

PROJECT TO SUPPORT HEALTHCARE DEVELOPMENT IN THE UMUTARA PROVINCE This is a project assigned by the MAE (Conv. No. 1075 of 19/11/1999) which involves strengthening the basic services and supporting the organisation and supervision of the services themselves, thereby contributing to greater coverage and improved quality of the services provided in the Umutara province. The project was extended on 06/12/04 until 31.07.07. It is coordinated with the local partner and strongly sustained by the UTC. The project involves various activities ranging from healthcare building work to health education campaigns. The main components of the programme are: > support for Nyagatare Nursing School > construction of two health centres > promoting public awareness and supporting the fight against HIV-AIDS. In spite of difficulties deriving from the changes in management of local structures, the project continued to carry out the planned activities during the first few months of 2005.

However, due to administrative difficulties deriving from failure on the part of the MAE to provide the necessary funds, the activities gradually slowed down and the project was suspended at the beginning of July 2005, as communicated with a note on 17.05.05 (prot. no. 102/PG/2005) and on 07/12/05 (prot. no. 303/PG/2005).

Staff employed: Benelli Maura: 01/01/05 - 30/06/05 Andreucci Sergio: 01/01/05 - 09/08/05 68

TANZANIA

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1 COUNTRY PROFILE The country has a surface area of 945,050 sq. km including 59,050 sq. km of inland lakes.

There are two wet seasons: the long wet season between March and May and the short wet season between November and January. There are four separate topographical zones in the country. The coastal tableland that extends from the coast to about 150 km inland with an average altitude of 300 m is a wet area with temperatures of between 20째C and 30째C. The central Plateau has a large diurnal temperature variation and a semiarid climate. The area of the large lakes (Victoria and Tanganyika) has relatively high temperatures and higher rainfall than the central plateau. The plateaux around Mount Kilimanjaro in the north and the mountain ranges in the south generally have a temperate climate and high rainfall.

1.1 Historical background The mainland territory of the Republic (Tanganyika) and the islands of Zanzibar obtained independence respectively in December 1961 and December 1963. In 1964 the two areas were unified into the United Republic of Tanzania. The President of Tanganyika, Mwalimu Julius Nyerere, became the first president of the Union.

After the Arusha declaration in 1967, Tanzania pursued a centrally-controlled socialist type development programme. In 1986 the newly elected President Ally Mwinyi launched the Economic Recovery Programme with the support of the International Monetary Fund (IMF) and the World Bank. In 1989 the programme was reinforced by the Economic and Social Action Programme. After being elected in November 1995, President Mkapa pressed on with the process of privatisation and adherence to the IMFâ&#x20AC;&#x2122;s fiscal programme. Tanzania has continued to enjoy political stability since independence and has acquired an important role at a sub-regional level.

1.3 Administrative divisions In 1972 the government initiated a gradual process of decentralisation to promote popular participation in decision-making processes. Mainland Tanzania has 20 regions and 114 local councils (City, Municipal, Town and District). Each council is divided into 4-5 divisions, in turn divided into 3-4 wards. Each ward consists of about 5-7 villages. A total of 10,045 villages have been counted in the country.

Zanzibar has 5 regions and 10 districts. The councils are the most important administrative authorities and are responsible for social services. The Ministry of Health (MoH) is currently attempting to strengthen the district health services.

1.4 Economy

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Per capita income is estimated at around $ 270 a year. The most important sector of the economy is agriculture (principally coffee, cotton, tea, cashew, sisal, maize, rice, wheat, cassava and tobacco), which accounts for 50% of GDP and 85% of exports. For topographical and climatic reasons, arable land area is very limited. Industry accounts for 14% of GDP and is restricted to the processing of agricultural produce and limited ranges of articles for mass consumption. The mining sector, gold in particular, has undergone considerable expansion in recent years and has attracted foreign investment. The tertiary sector and the informal sector are also important areas of employment. Tourism has seen significant growth in recent years. GDP has risen on average by 5.3% over the last four years. Inflation has dropped from 30% (1995) to less than 5%. However, the high rate of population growth means that Tanzania is unable to benefit from its good economic performance and the figures for the level of poverty have remained unchanged over the last decade.

1.5 Population Tanzania has a population of 33.8 million people (1999 estimates) and an annual growth rate of 2.8%. About 75% of the population lives in rural communities. About 20% of the population is under 5 years of age and 27% between 5 and 15. About 20% consists of women of childbearing age (between 15 and 49). The national census was carried out in August 2002.

The infant mortality and under-5 child mortality rates are respectively 99 and 152 per 1,000 live births. Maternal mortality is around 529 cases per 100,000.

Life expectancy is 45 years.

2. OVERVIEW OF SECTOR 2.1 Healthcare The providers of healthcare services in Tanzania are the government and the private profit and non-profit sectors. The health system is organised into three levels: primary (dispensaries), secondary (health centres) and tertiary (hospitals).

The two Ministries of Health (Tanzania and Zanzibar) and the Presidentâ&#x20AC;&#x2122;s Office Regional Administration and Local Government (PORALG) are responsible for providing healthcare.

The specialist Consultant hospitals and the area training centres are controlled by the Ministry of Health. The PORALG in turn is responsible for managing district and regional services.

A dispensary generally serves about 6-10,000 users, a health centre about 50-80,000 and a district hospital 250,000. The regional hospital serves 4-8 districts and the consultant hospitals serve numerous regions.

2.2 Health conditions in the country The main health indicators in Tanzania reveal that the general conditions of the population are in line with the average of other African countries: > Low life expectancy at birth (46 years). > High levels of under-5 child mortality (150-160 per 1,000 live births).

The government spends about 12% of its budget on healthcare. Some 40% of the healthcare budget is financed by donors.

2.3 The healthcare development policy in Tanzania THE NATIONAL DEVELOPMENT PLAN The objective of social policy within the National Development Plan dating from 2000/01 is to improve the performance of social services (health, education and water). The specific objectives for healthcare are: > To improve the quality of services. > To encourage the participation of communities, NGOs and the private sector. > To introduce measures for increasing the availability of resources at a local level. > To introduce alternative funding for the provision of services. > Prevention and control of infectious diseases.

POVERTY REDUCTION STRATEGY (HEALTHCARE COMPONENT) For the healthcare sector, the PRS aims to achieve the following short and medium-term goals: > Reduction in infant mortality rate from 99 to 85 per 1,000 live births by 2003. > Reduction in under-5 child mortality rate from 147 to 127 per 1000 live births by 2003. > Reduction in maternal mortality rate from 529 to 450 per 100,000 live births by 2003. > Reduction in malaria lethality rate from 12.8% to 10% by 2010. > Increase in proportion of rural population with access to potable water from 48.5% in 2000 to 55% in 2003.

3. DOCTORS WITH AFRICA CUAMM IN TANZANIA Doctors with Africa has been working in Tanzania since 1979, initially in missionary hospitals and since 1979 in close cooperation with the Tanzanian Ministry of Health.

A total of 280 doctors and other paramedical staff have worked in Tanzania for periods no shorter than two years.

The organisation is based in Dar es Salaam, where it has its offices and a house for accommodating Doctors with Africa Cuamm staff in transit and their families.

It has another office in Iringa, not far from the regional hospital.

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At Tosamaganga (Iringa region) there is a training centre that can host up to 20 people for seminars and study courses.

Staff currently employed in Tanzania by Doctors with Africa Cuamm (December 2005): > 6 doctors (5 Italians, 1 Tanzanian) > 1 Italian administrator > 1 Italian nurse/ward sister

4. OVERALL STRATEGY OF DOCTORS WITH AFRICA CUAMM IN TANZANIA TO PROMOTE HEALTH FOR EVERYONE > Equity in health system financing: to favour the weak segments of the population, to develop solidarity type local funding systems (Community Health Funds). > Accessibility to services: to contribute to coverage of recurrent costs to keep charges low and to guarantee access to treatment for the poor, setting up of the flat rate system.

TO INTEGRATE HOSPITAL SERVICES WITH TERRITORIAL SERVICES

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> Training staff at peripheral units (Dispensaries and Health Centres) both at a clinical level and with regard to public health (domiciliary care, community participation, preventive medicine). > Supervision/support of peripheral units. > Use of a referral system between hospital and peripheral units. > Use of a simple but effective monitoring and evaluation system based on the government model.

TO INTEGRATE AND SUPPORT THE MEDIUM AND LONG-TERM GOVERNMENT HEALTHCARE PROGRAMMES > To encourage the involvement of local and national public health authorities in the stages of planning and implementation of projects. > To be as active as possible in the Council Health Management Teams and the District Health Management Teams. > To follow the ministerial guidelines, where present. > To avoid overlapping with the government programmes and those of private agencies with consequent wastage of resources.

LOCAL STAFF TRAINING > Study grants. > Formal training for staff at hospitals and peripheral units. > On-the-job training.

5. PROJECTS IMPLEMENTED IN 2005

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5.1 PROJECT TO “SUPPORT HEALTHCARE SERVICES IN FOUR AREAS OF TANZANIA” (KNOWN AS “FOUR AREAS” PROJECT) The project concerns three hospitals, Mikumi, Tosamaganga and Lugarawa, and their respective areas of referral plus the maternity wards in the Dar es Salaam Diocese.

Staff employed Budget: Donors:

> 5 Italian doctors > € 1,448,296 > Italian Ministry of Foreign Affairs – CEI – Doctors with Africa Cuamm – Local partners Donors for complementary activities: > Doctors with Africa Cuamm Groups, private donors, Centro pastorale per la cooperazione missionaria tra le Chiese di Roma, Province of Bolzano, Trentino Alto Adige Region through Gruppo Medici dell’Alto Adige per il Terzo Mondo.

Main components: 1. Retraining and on-the-job training for staff.

2. Adaptation of infrastructures.

3. Support for healthcare activities for pregnant women and children.

4. Start-up/support of activities to control HIV infection and AIDS. 5. Supply of drugs and consumable materials to keep charges low enough to assure access to treatment for the entire population.

6. Support for peripheral units for the referral areas.

In the Lugarawa hospital the new flat rate for charging was introduced just a few months ago so it is still too early to assess its impact.

However, charges for the Paediatric and Maternity wards have been kept very low for at least two years (even prior to the project) through the direct and autonomous action of Doctors with Africa which provided drugs and consumable materials for these two wards.

At the Tosamaganga hospital a flat rate system will be adopted at the beginning of 2006.

In 2005, the policy of reducing charges for patients has only concerned the Paediatric and Maternity wards. The increase in admissions to the Paediatric and Maternity wards of these two hospitals confirms that cost is a factor that restricts access to treatment, at least in rural areas.

5.2 THE GLOBAL FUND PROJECT TO FIGHT AIDS, TB AND MALARIA (ROUND 3)

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The project officially began on 01.06.2005 and has a duration of 5 years. In 2005 it focused on the Iringa Urban district. In 2006 the activities will be carried out not only in Iringa Urban district but also in the Iringa Rural and Ludewa districts.

Staff employed

Budget for 2005: Donors:

> 1 Tanzanian doctor, 1 Tanzanian A.M.O. (Assistant Medical Officer), two secretaries and one accountant, both Tanzanian > 47,635 USD > Global Fund. Doctors with Africa Cuamm, together with another eleven NGOs, is a subrecipient of AMREF, in turn the principal recipient of the Global Fund. Each of the eleven NGOs has to submit an action plan and budget to AMREF and thus the Global Fund in Geneva in agreement with the other NGOs.

Main components of project for 2005: 1. Construction or refurbishment of outpatient clinics for Voluntary Counselling and Testing (VCT sites) and for Prevention of Mother-To-Child Transmission of HIV (PMTCT).

2. Training of VCT and PMTCT Counsellors.

3. Supply of consumable materials and reagents for HIV test.

4. Training of Maternity staff in Post Exposure Prophylaxis (PEP).

5. Community health education on PMTCT in the areas involved (Community mobilization).

5.3 SUPPORT FOR NATIONAL PROGRAMME TO FIGHT MALARIA AND INTEGRATED APPROACH IN DODOMA AND IRINGA REGIONS The project was funded by the Italian Ministry of Foreign Affairs. In 2005 a non-onerous extension of 9 months was requested and obtained to allow the activities to be carried out.

Staff employed 1 Italian voluntary doctor, 1 Tanzanian doctor.

Budget for 2005: € 860,000 Donors: Italian Ministry of Foreign Affairs The main components of the Project were: 1. Improvement in clinical management of patients affected by malaria both in the referral hospitals and in the peripheral centres.

2. Improvement in personal protection against malaria, particularly for children and pregnant women through the distribution of mosquito nets impregnated with longlasting insecticide.

3. Sponsorship of a study grant in public health management for a Tanzanian doctor.

4. Improvement in epidemiological approach to malaria.

5. Improvement to the Council Health Management Team in planning and implementing initiatives to fight malaria.

This project is part of a broader initiative by the Italian government to support the Tanzanian National Malaria Control Programme called Roll Back Malaria.

75 5.4 BORN WITHOUT AIDS Staff employed 1 Italian doctor Budget for 2005: € 200,000 Donor: Caritas Antoniana The project, concluded on 31.12.2005, was carried out in the area of the city of Dar es Salaam, with the aim of reducing perinatal transmission of HIV infection in the population served by PASADA (Pastoral Activities and Services for Aids People Dar es Salaam Archdiocese), within the framework of the Tanzanian national protocol for prevention of perinatal HIV transmission (PMTCT) through chemoprophylaxis with Nevirapina.

The main components were: 1. Introduction of protocols for prevention of mother-to-child transmission of HIV (PMTCT) in the 18 maternity wards in the Diocese of Dar es Salaam.

2. Training of obstetric and nursing staff in PMTCT. 3. Improvement in information and data collection system in the maternity wards in the Diocese.

4. Support for diocesan HBC activities.

5.5 MAPATO PROJECT Three-year project funded by Caritas Antoniana with a budget of € 200,000.

The aim of the project was to reduce poverty through empowerment of poor or lowincome women in the depressed districts of Dar es Salaam. This would be achieved through microcredit activities, i.e. granting loans to women to allow them to start up small business or production activities capable of generating income. The loans were granted after an analysis of the woman’s situations and their real need for and ability to use the

loans. Before the loans were granted, a 4-day seminar on the basic principles of commerce and budget management systems was held.

The main components of the Project were: > Empowerment of 2,000 poor or low-income women by increasing their income through access to credit, training and investment. > Improvement in the capacity of Caritas in Dar es Salaam to manage the project. > Strengthening of cooperation between PASADA (Pastoral Activities and Services for Aids People Dar es Salaam Archidiocese) and Caritas of Dar es Salaam through mutual referral of their customers.

6. ACTION ON AIDS The fights against AIDS has an important role in the “Four areas” project:

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1. For the hospitals in Tosamaganga, Lugarawa and Mikumi, Doctors with Africa Cuamm had an official evaluation performed by the auditors of the National Aids Control Programme (NACP).

Tosamaganga and Lugarawa thus gained accreditation to officially join the NACP’s national programme. Healthcare staff will receive specific free training from the NACP and the hospitals will subsequently obtain ARV drugs (again provided free through government channels) and therapy will begin. It is very important that by then the “Four areas” project is operational to provide training to the VCT Counsellors and the HBC workers, otherwise the therapy alone will be pointless.

During the next few months, as soon as the upgrade from a Health Centre to a hospital has been officially recognised, Mikumi should also be able to join the list of accredited health units.

2. Benefiting from a study grant provided by the support group Doctors with Africa Cuamm of Modena, the Lugarawa doctor, Dr. Giuseppe Iozzelli, attended the course in Tropical Medicine and AIDS at the Swiss Institute of Tropical Medicine in Ifakara (Tanzania) in June 2005.

The Global Fund Project is entirely devoted to AIDS. In the action plan submitted by Doctors with Africa Cuamm for 2006, the specific issues addressed are: a. Early recognition of infection and illness through VCT. b. Prevention of mother-to-child transmission (PMTCT) in the mother/child clinics and maternity wards. c. Prevention of infection subsequent to accidental exposure to potentially infected material in hospitals and dispensaries (PEP). d. Promoting an awareness of the problem of discrimination against HIV-positive people or AIDS sufferers within the communities in the areas concerned.

Planned activities include masonry work on the VCT PMTCT outpatient clinic, staff training, supply of consumable materials and reagents, and support for small, well-established local NGOs for the purposes of awareness promotion and health education of the communities living in the areas concerned (Iringa Urban, Iringa Rural and Ludewa districts, about 500,000 people).

UGANDA 1 INTRODUCTION As mentioned in the 2004 annual report, the activities of Doctors with Africa CUAMM in Uganda have reached a critical watershed. The projects in progress are nearing completion and there are no programmes due for imminent implementation that either may be seen as the natural continuation of those under way or are likely to become a springboard for new areas of action. This situation stems from a number of factors, particularly the following 3: 1. Effective reliance on only one large institutional donor, Italian Cooperation, which is no longer able to provide financial and strategic support to programmes as in the past.

2. The fact that the organisation’s historic approach has been to support “healthcare systems” (specifically those of the government and missionary groups) rather than specific sectors (e.g. AIDS, vulnerable groups), while the latter are at present the areas of greatest interest both for the Ugandan government and for the major donors operating in Uganda (UNICEF, European Community, DANIDA).

3. Operation in regions that are distant from the critical areas of international interest/attention (the areas of the Acholi conflict) where almost all outside aid is being channelled and where international attention is focused.

Unlike other sub-Saharan African countries which are either still in a stage of emergency, generally due to conflicts or natural disasters, or in a stage of development, Uganda is in a “schizophrenic” situation in which the two aspects (emergency and development) have coexisted chronically for more than twenty years. While part of the country is embroiled in a tragic and chronic state of conflict, recognised worldwide as one of the worst contemporary humanitarian catastrophes (in terms of the victims of the civil war in the Acholi and Lango region), the rest of the country is undergoing gradual development and economic growth but with severely insufficient economic resources and administrative capacities and with health and development indicators that are amongst the worst in the world. The result of the simultaneous presence of two equally strong needs means that the most dramatic of the two draws almost all the attention and resources, leaving very little for the rest of the country. This phenomenon has become particularly evident in the last 5 years, during which time the brutal and inhumane actions by the groups of rebels in the Acholi region has made the refugee problem dramatic. Almost 95% of the population of 5 districts lives in refugee camps in sub-human conditions and with shocking mortality rates simply to escape from the attacks and violence that occur in the villages on an almost daily basis.

The other factor that distinguishes Uganda is its historic fight against AIDS. Uganda was effectively the first African country to launch and implement an extensive national policy to fight the diffusion of HIV infection and has achieved extraordinary results. In 20 years, the prevalence of the infection has fallen from values close to 27% to 6.4% (epidemiological surveillance of 2005). However, the number of people infected remains high and the secondary social impact of the pandemic is severe (almost 2 million orphans, thousands of deaths in productive age with severe damage to the country’s already poor economic resources). For these reasons, the strategic national healthcare programme still envisages a major commitment in this area with substantial investments on the part of the government and the major donors. This is a second factor behind the severe polarisation of economic aid.

There is also a third element of national and international economic policy that should not be underestimating when evaluating the prospects for intervention of an NGO in Uganda

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and the possibility of gaining access to funding for its projects. Uganda was also one of the first countries to embrace the SWAP policy towards international donors, a policy that was sustained and initially appreciated by the international community as a result of strategies promoted by the World Bank and the International Monetary Fund. Bilateral external development funding goes almost entirely into a single national fund which is then redistributed by the government to the various area of intervention according to national policies and programmes. With all its limitations and potential, the system has effectively minimised funds available to projects proposed or implemented directly by NGOs. For example, until just a few years ago the Danish cooperation agency DANIDA provided considerable funding to projects in a variety of sectors, but in the last two years it has concentrated its activities in just a few areas and almost entirely through the governmental budget support policy. The SWAP policy also affected the funds of the Global Fund initiative which were collected directly by ministerial offices and their national programmes.

From what we have said, it is clear that the action strategies hitherto followed by Doctors with Africa CUAMM, in spite of meeting important real needs of the population, are difficult to reconcile with the strategies currently pursued by the government and the international aid agencies.

The longstanding presence of Doctors with Africa CUAMM in Uganda, with its excellent quality actions and evident results, is well known and highly esteemed in the districts where it operates or has operated in the past but has little or no impact at a central level where for several years now the decisions have been taken and the actions and partnerships established.

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As was suggested in the previous annual reports, it is necessary to rethink the model of cooperation proposed by Doctors with Africa CUAMM to make it more suitable for the governmentâ&#x20AC;&#x2122;s top-priority healthcare policies and the sectors considered significant by donors. This is a difficult process that requires time and must be carried out without neglecting the inspiring principles of Doctors with Africa CUAMM and the real needs of people. It is probably necessary to review the image and positioning profile of Doctors with Africa in the context of NGOs in Uganda, particularly at a central level in the capital, where there are a large number of players, several of which have a high profile, good capabilities and excellent credentials, where competition is fierce and where contacts and introductions play a crucial role.

Likewise in the relations between Doctors with Africa CUAMM and Italian Cooperation it is important to bear in mind the considerable limitations displayed by the latter in recent years in terms of financial capacity and operational and strategic capabilities, but without forgetting the link that must or should exist between an Italian NGO and its national cooperation body.

To try to find a way out of this impasse, a process of renewing the strategies of Doctors with Africa CUAMM in Uganda was initiated in 2005: > New areas of intervention were sought (e.g. participating in healthcare initiatives in the Acholi Lango region). > Sectors more consistent with the priorities identified at a national and international level were developed or expanded (e.g. greater involvement and visibility in the HIV AIDS programmes). > New sources of funding were sought (contacts initiated or reopened with the large international agencies: ECHO, EU, USAID, DANIDA, SIDA, WHO).

At the same time, efforts were made to enhance the visibility of Doctors with Africa CUAMM at the institutional levels at which the various humanitarian agencies and NGOs meet, while also guaranteeing greater participation at the meetings that address the countryâ&#x20AC;&#x2122;s most important healthcare issues (AIDS, disability, healthcare in the conflict areas) and initiating a process of accreditation as members of the health commissions (Development partners, HSSP committee, etc.).

The results of this process will probably not be visible in the short term.

2 COUNTRY PROFILE The political situation in Uganda remained stable during 2005.

In the Acholi region, guerrilla actions and attacks on civilians by the LRA rebels continued throughout 2005, albeit discontinuously during the various months of the year. This year for the first time vehicles of humanitarian organisations were attacked, resulting in the deaths of both expatriate and Ugandan staff.

There critical Karamoja area has also seen a deterioration in security compared to 2004 with a fresh upsurge of intertribal cattle raids, bandit attacks on villages and transiting vehicles, and clashes with military and militia detachments located in the region. There have been numerous deaths and injuries amongst civilians. The episodes have continued intermittently throughout the year.

At the present time solutions do not appear close to being reached in either of the internal conflicts, which have very different natures and dynamics.

On 23 February 2006, the first multiparty presidential elections will be held, an event that is causing some concern and uncertainty regarding the future of the country and may create problems of security and stability.

The key events in the field of healthcare in 2005 were: > Presentation of the new five-year national health sector strategic plan (HSSP 2005-2010). > The national epidemiological survey for HIV-AIDS. > Completion of the first stage of administrative decentralisation with the creation of 12 new districts. > Freezing of Global Fund Initiative funds following suspected fraud and shortages of funds. > A significant reduction of much of the international aid from various European countries due to the country’s corruption and failure to respect human rights.

The two key documents for development of healthcare policies in the country are the Poverty Eradication Action Plan 2004-2008 of the Ministry of Finance and Economy and the Health Sector Strategic Plan 2005-2010 of the Ministry of Health.

The first takes account of the UN’s MDGs and is based on 5 principles: Better economic management in order to increase growth in gross domestic product from 6 to 7%.

Improvement in production, competitiveness and profitability.

Consolidation of internal security, conflict solving and disaster management.

Good governance.

Human development (where there is a health component that takes account of MDG indicators).

The second document addresses the health component of the PEAP. Amongst other things, it devotes particular attention to developing the concepts of decentralisation, public-private partnership and community participation in order to provide a better response to the specific needs of the various situations. The key tool is effective delivery of the Uganda National Minimum Health Care Package (a set of standard services and treatments in the various areas of healthcare) to reach specific targets and obtain precise outputs (see Boxes).

At present, the sectors considered to be strategic to Uganda’s development policies and which impact on the activities of Doctors with Africa CUAMM are the following: > Reinforcing and accelerating the decentralisation process. > Support for the public-private partnership policy. > Introduction of effective actions to assure the greatest degree of equity, with special attention to the most vulnerable groups (including the disabled and people displaced by the Acholi – IDP conflict). > Fight against AIDS, TB and Malaria. > Reinforcement of action to reduce maternal mortality rate. > Increase in efficiency to offset the effects of lack of resources (including human resources).

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Box 1.1 Targets for the PEAP health related outcomes by 2009 > > > > > > >

Reduce Infant Mortality Rate from 88 to 68 per 1,000 live births Reduce Under-5 Child Mortality from 152 to 103 per 1,000 live births Reduce Maternal Mortality Ratio from 505 to 354 per 100,000 live births Reduce Total Fertility Rate from 6.9 to 5.4 Increase Contraceptive Prevalence Rate from 23% to 40% Reduce HIV prevalence at ANC sentinel sites from 6.2% to 5%; Reduce stunting in children under 5 years from 38.5% to 28%

Base year 2000

Box 1.2: HSSP II key output targets by 2009/10

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> Percentage of children <1yr receiving 3 doses of DPT/Pentavalent vaccine according to schedule by district from 87% to 93% > Total (GoU and PNFP) per capita OPD utilization from 0.72 to 1.0 > Percentage of deliveries taking place in a health facility (GoU and NGO) from 24.4% to 50% > Proportion of approved posts (HSSP I norms) that are filled by trained health personnel from 68% to 90% > Percentage of health facilities without any stockouts of first line antimalarial drugs, Fansidar, measles vaccine, Depo Provera, ORS and cotrimoxazole from 40% to 100% > Couple Years of Protection from 223,686 to 494,908 > Reduce the Case Fatality Ratio among malaria inpatients aged less than 5 years from 4% to 2% > Proportion of TB cases that are cured from 62% to 85% Base year 2003/04

3 STRATEGY OF DOCTORS WITH AFRICA CUAMM In July 2005, the first Technical Workshop for CUAMM executive was held in Kampala, during which the following strategic country guidelines were established. These were confirmed by the board and management of Doctors with Africa during the meeting with country representatives held in Padua in November 2005: > Support for districts and subdistricts with limited public medicine resources, data collection and actions in the strategic sectors of TB, HIV, Malaria. > Support for diocesan health structures in the context of the public-private partnership policy. > Development and support for training activities for health staff with management capacities in cooperation with the science faculty of the UMU University, Nkozi. > Development of activities and research areas in the field of public medicine, HIV, TB and Malaria, and health administration (Health Management and Financial Health). > Development and reinforcement of actions in strategic sectors of HIV, TB and Malaria. > Consolidation and development of actions in favour of the most vulnerable groups (disabled, epileptics, etc.). > Reinforcement and development of cooperation with other international and national NGOs. > Identification of potential local financers (e.g. decentralised negotiation with UNICEF, WHO, EU) to reduce the share of projects funded by Italian Cooperation to less than 40%.

4 PROJECTS IN PROGRESS At present Doctors with Africa CUAMM operates in 6 districts located in 3 geographical areas: > The West Nile region > The Central region > The Karamoja region In the Mpiji district it also cooperates with the ’Uganda Martyrs University’ of Nkozi.

4.1 Coordination of non-profit and public-private partnership health services in Uganda This three-year project funded by the Italian Ministry of Foreign Affairs (MAE) and the Italian Episcopal Conference (CEI) began in June 2002 and ended on 26 June 2005. It therefore completed the last six months of its activity during 2005.

The project consisted of two components: 1. Support for processes of reorganisation of health services in the Arua and Nebbi Dioceses through technical assistance for the diocesan health coordination offices.

2. Support for the activities of the Uganda Catholic Medical Bureau (a body responsible for policy, coordination and representation at the Ministry of Health for all health services of the Catholic Church in Uganda) by appointing a doctor to the position of Assistant Executive Secretary.

The project is part of the national public-private partnership healthcare policy to promote integration of diocesan healthcare services in district health systems.

81 Staff of Doctors with Africa CUAMM employed: > Dr Paolo Giambelli (in Arua, project leader). > Dr Peter Lochoro (in Kampala, at UCMB). > Antonio Sebben (in Arua, a technician not formally engaged in the project but involved in building activities).

Summary of activities carried out: The various activities established by the project and initiated in previous years were completed in the period January-June.

The following objectives were achieved during the three years of the project: > The Ugandan doctor provided support to the executive secretary of the UCMB for activities relating to development of the national public-private partnership policy, coordination between the diocesan health offices and the district health offices, and all initiatives to improve the quality of services provided by the Catholic Diocese’s health facilities. > Technical support and coverage of the management costs of the Healthcare Coordination Offices of the Diocese of Arua and Nebbi were assured. The Diocesan Coordinators regularly attended the periodic meetings for programming and monitoring the activities in the District Health Offices. > The Health Councils of the two dioceses were set up with their own articles and regulations. > In each diocese, a diocesan policy document was approved; and the control and policy organisations, their members and their mandate were established. > The procedure for annual presentation of an action plan, a budget of expenditure, an annual financial and activity report and balance sheet approval was regulated. > The boards of directors were rendered operative in all hospitals and the governing bodies and their members and mandates were established. The same was done for the peripheral health units. > Articles and regulations were established for all the structures.

The following policies/strategies were introduced at the level of peripheral structures: • a unified employment and salary policy for all healthcare staff employed • unified financial statement procedures • unified activity report procedures • unified procedures for planning expenses and activities • unified drug procurement procedures • unified data collection procedures • census and monitoring of human resources at a national level • introduction of minimum accreditation criteria on the basis of efficiency and quality of services • unification of services provided and their quality • unification of articles and governing bodies in peripheral units, including definition of responsibilities and roles • representativeness of PNFP at the level of local and national authorities and institutes (respectively, districts and subdistricts, and Ministry of Health and Education).

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> A regular supply of drugs, consumable materials and basic equipment was assured to all facilities. > 5 health centres were rehabilitated to different degrees. > 49 health operators were trained in various qualifications through the assignment of study grants. > On-the-job training of healthcare staff was guaranteed during the three years of the project through a calendar of seminars and theme courses. > All the units were regularly supervised every three months through an on-site training programme. Special attention was given to correct prescription of therapies and use of drugs, the hospital disease control procedures (sterilisation, aseptic procedures, disposal of infected materials), patient management, quality of laboratory tests, data collection. > The diocesan coordinators took part in all the peripheral unit board meetings to assure correct application of the employment procedures and to provide support in management of resources and finances.

Chart 1: time series of assisted deliveries in the peripheral units in the Arua and Nebbi dioceses

4.2. Support for diocesan coordination offices in Arua and Nebbi This is a small project based on local resources with the objective of guaranteeing sufficient funds to allow the two diocesan health coordination offices of Arua and Nebbi to continue their activities of supervising, monitoring and coordinating the health units and liaising with the UCMB central offices.

Staff of Doctors with Africa CUAMM employed: > none Summary of activities carried out Funds were guaranteed to cover the following: > The salaries of the two diocesan coordinators, a secretary and a driver. > The basic management costs of the two offices. > The expenses of the essential supervision programme. > Organisation and transport at cost price of drugs for the peripheral units and the assurance of a vehicle at the Nebbi office. > The offices of Doctors with Africa CUAMM of Arua, Nebbi and the central coordination in Kampala assured logistic support for the two diocesan coordinating offices.

4.3 Support and expansion of medical rehabilitation services in Northern Uganda This is a three-year consortium project (AVSI, Doctors with Africa CUAMM and CCM) carried out by Doctors with Africa CUAMM in the Arua and Nebbi districts. The project received financial contributions from the Italian Ministry of Foreign Affairs (MAE), private individuals and Doctors with Africa CUAMM Groups. It began in September 2003. The project is made up of three components: 1. Development and support for orthopaedic workshops and physiotherapy departments at the Arua and Nebbi district hospitals.

2. Reactivation and expansion of the Community-Based Rehabilitation activities.

3. Reactivation and support of clinics for treatment of epilepsy and provision of drugs.

In 2005 it entered its second year of activity. The initiatives in progress were consolidated and initial information was analysed with a view to developing a potential future project currently at the first draft stage. The project was very well received in the districts by the political authorities, the health administration and the hospitals of the two districts.

Staff of Doctors with Africa CUAMM employed: > Stefano Vida (project leader, physiotherapist) > Patrick Pariyo (project assistant in Arua) > Francis Abdekane (project assistant in Nebbi) > Silvio Delle Vedove (physiotherapist on 3-month mission) > Dr Antonio Loro (orthopaedist, evaluation mission 20-28 February 2005) Summary of activities carried out: > The regular convening of district coordination committees for disabilities was facilitated. > Construction and rehabilitation work on orthopaedic workshops and physiotherapy units of the hospitals of Arua and Nebbi was completed. The structures complete with requisite equipment were handed over to the local authorities at an opening ceremony held in May 2005 and attended by a delegation from the Italian Embassy in Uganda. > The work of organising and setting up equipment in the orthopaedic workshop in Arua, which will be the regional hub for the production of prostheses, artificial limbs and orthopaedic aids, was performed under the technical expertise of physiotherapist Silvio delle Vedove on assignment from January to March 2005.

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> The first artificial limbs were produced and fitted during the second half of the year. > Dr. Loro went to the hospital in Arua on assignment from 20 to 28 February to evaluate the technical and logistic capabilities and the availability of instruments and equipment in the hospital with a view to starting up specialist orthopaedic surgery activities with a high level of excellence. > 53 healthcare workers were trained in disability rehabilitation at various professional levels. > Data collection was completed for the study of the prevalence of the various forms of disability in the districts of Arua and Nebbi and the data were processed. More than 10,000 people affected by disability were identified, a prevalence of about 5% of the population. At the same time, the referral system for patients affected by forms of motor disability was consolidated at the two district hospitals’ therapy and rehabilitation centres. > The orthopaedic operations performed in 2005 at the Arua hospital were facilitated, coordinated and organised. > 20 community rehabilitation workers were trained in the use of appropriate technologies and instruments for rehabilitation and support of the disabled at a village level. > Equipment was distributed to community rehabilitation workers to help them carry out their work. > Supervision was carried out regularly at health centres and at the sites where the community rehabilitation workers operate and where mobile physiotherapy clinics are organised. > A peripheral centre for basic physiotherapy and rehabilitation was set up in the hospitals of Maracha (Arua district) and Angal (Nebbi district). > Meetings were organised with the local authorities and radio programmes and messages planned to promote an awareness of the problem of disability within the community. > 11 clinics were opened for epileptic patients in the districts of Arua and Nebbi and supplied with drugs for the treatment of more than a thousand patients. > A register was drawn up for epileptic patients and the initial data gathered on the illness in the two districts, revealing an incidence of 0.5%.

4.4 MAE-UNICEF project: “Support to the Health Sector Strategic Plan (HSSP) of the Government of Uganda 2000-2005” The project to support the UNICEF country programme has completed its second year of activity. It is a multibilateral project comprising 3 action components: 1. Support with state budget funding (contribution to the Poverty Alleviation Fund).

2. A direct management component through the presence of an expert at the Uganda Ministry of Health.

3. Support for UNICEF’s national programme in Uganda.

This last component involves support for 8 districts with the cooperation of 3 Italian NGOs. Doctors with Africa CUAMM operates in 4 of these districts: Arua, Nebbi, Yumbe and Moroto.

The project entails direct funding for the district administrations and a technical support role provided by the NGO. The sectors of activity include: HIV/AIDS, TB, Malaria, Immunisation, Birth registration. The activities for each district are carried out only in some counties. The only exceptions are the vaccination campaign actions which have district-wide coverage. Alongside these specific areas of activity, there is an undertaking to provide Technical Support for the district health offices, particularly in the processes of programming and monitoring of healthcare information activities and systems.

The planned activities are those established by the UNICEF country programme which will end in December 2006.

Staff of Doctors with Africa CUAMM employed: > Antonio Sebben (technician) in Arua > Dr Luigi Cicciò in Arua > Innocent Komakech in Yumbe > Dr Elisabetta Fusco in Moroto > Dr Enrico Tagliaferri in Nebbi Summary of activities carried out: > Technical support was guaranteed for the district health offices of Arua, Nebbi, Yumbe and Moroto through participation in the planning sessions for all district healthcare activities (setting out of action strategies, drafting of annual plans and budgets) and drafting of activity reports. > Technical support was guaranteed in management of the vaccination programme in the community and collection and processing of vaccination coverage data. Constant technical and logistic support was assured for the national mass vaccination campaigns against tetanus and measles and distribution of vitamin A amongst the child population. > Survey support was provided for vaccination coverage conducted by the WHO and the Ugandan ministry of health. > The Technical Advisers took part regularly in supervision of the peripheral units and the subdistrict bases. > Actions were performed to support the VCT and PMTCT services (training of healthcare staff and promoting an awareness within the community of the use of the services), assuring coordination with similar activities conducted by other programmes. A process of expanding these services at a district and subdistrict level was initiated. > Training courses for birth registration (BDR) staff were organised and facilitated. The number of counties involved in the programme was extended and a computerised data collection system was introduced. > Computerisation of the national information system (HIMS) was further developed at both district and subdistrict levels through active participation in the staff training and supervision of peripheral units and organisation and analysis of data. > Control of domiciliary malaria treatment activities was guaranteed, with special attention to correct distribution of drugs and drafting of the monthly reports. > Support was provided to the Subdistricts to increase access for adolescents to Reproductive Health services. > Help was given to the district offices to develop the national CB-DOTS policy for control and treatment of TB.

4.5 HIV/AIDS and TB Control in West Nile - Expansion of PMTCT services and strengthening of DOT strategy in Arua and Yumbe Districts The project began at the end of October 2004 and ended on 31.12.2005. Funded by the agency AIM (The AIDS/HIV Integrated Model District Programme) with USAID funds, it involved activities in the West Nile region in the Yumbe district and in the Marcha and Koboko health subdistricts of the Arua district. Continuation is not planned as the agency AIM closed down its activities in Uganda at the end of 2005.

It consisted of 2 components: a. Setting up 3 PMTCT centres (prevention of mother-to-child transmission of HIV) at the Maracha and Yumbe hospitals and the Koboko Health Centre.

B. Support with implementation of the DOT (Directly Observed Treatment) Strategy in TB control in the entire Yumbe district and the Maracha and Koboko health subdistricts of the Arua district.

The activities are integrated with those carried out through the UNICEF project and with those of the project funded by Caritas Antoniana.

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Staff of Doctors with Africa CUAMM employed: > The same staff as the UNICEF project in the West Nile region.

Summary of activities carried out: > In the two districts of Arua and Yumbe the activities were planned and coordinated with the district committees for HIV-AIDS. > In the Yumbe district, the local NGOs and CBOs (Community Based Organisations) were supported in promoting VCT awareness within the community. > In the Yumbe and Maracha hospitals and in the Koboko health centre, seminars on the themes of PMTCT and TB were organised for healthcare staff. > Training on the themes of PMTCT and TB and on the means for assuring effective referral of patients to the diagnosis and treatment centres was provided for staff in the peripheral units in the Yumbe district and the Maracha and Koboko subdistricts. > Training was organised for the TB control programme managers at a subcounty level and for laboratory technicians in the TB diagnosis referral centres in the two Maracha and Koboko subdistricts. > Seminars on TB-CB DOTs treatment criteria were organised for village healthcare workers. > Campaigns were organised to promote awareness of the issues of AIDS and TB amongst the population and to provide information on available services through radio messages and informative material. > Equipment and furnishings were provided for the laboratories and HIV-AIDS clinics at the Maracha and Yumbe hospitals and the Koboko subdistrict health centre.

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4.6 Activities of prevention and support in HIV/AIDS and TB services at Angal and Maracha hospitals in Uganda This is a small two-year project funded with a ? 20,000 budget by Caritas Antoniana as an initiative to complement the AIM and UNICEF projects. Here too there are two components, one in the HIV/AIDS sector and one in the TB sector. For both these sectors, in agreement with the hospital managements, attention was focused on actions to foster the provision of healthcare services at a community level in villages.

Staff of Doctors with Africa CUAMM employed: > The same that follow the UNICEF and AIM projects.

Summary of activities carried out: > Follow-up support for mothers included in the PMTCT programme in the Maracha and Angal hospitals. > Organisation and strengthening of domiciliary visits to AIDS sufferers in the Maracha subdistrict and in the Padyere county and supply of drugs for control of opportunistic diseases. > Support for supply and distribution of antitubercular drugs in domiciliary treatment (DOTs).

4.7 Construction of new Health Centre III at Moyo in the Arua Diocese This is a project funded by the government of Navarra in Spain through Medicus Mundi Navarra. It comprises a single structural component: construction of the new diocesan health centre in the city of Moyo.

The project was officially concluded with the handing-over ceremony for the buildings in November this year. The work began in mid 2004.

Staff of Doctors with Africa CUAMM employed: > Antonio Sebben (in service in UNICEF project) Summary of activities carried out: > Construction of the level III health centre in Moyo was completed, including: > Outpatient clinics including laboratory, pharmacy with warehouse, medication and therapy room, mother/child centre. > Inpatient and maternity ward with delivery room. > Toilets and bathrooms. > An incinerator. > Two buildings for housing staff with kitchens, toilets and bathrooms. > Complete enclosure around the complex. > Solar electrical system. > Plumbing system for collection of rainwater.

4.8 Lugazi initiative The â&#x20AC;&#x153;Lugazi initiativeâ&#x20AC;? is a commitment to long-term cooperation with the Lugazi Diocese in the reorganisation and revitalisation of diocesan healthcare services (3 hospitals and 7 peripheral health units). A number of different projects with various forms and sources of funding co-participate with this aim.

The initiative was started up in January 2001 principally as support for the Naggalama hospital. Over time it was joined by other more structured and traditional projects (the project funded by Fondazione Cassa di Risparmio di Padova e Rovigo began in 2002 and the project promoted and co-funded by the Italian Ministry of Foreign Affairs (MAE) and CEI began in 2004) and saw greater involvement on the part of the health administrations of the two districts of Mukono and Kayunga, where the Lugazi diocese is located.

At the beginning of 2005, a major new partnership will begin with Mildmay Clinic, the largest institute in Uganda for AIDS treatment and prevention, for the purpose of consolidating the HIV AIDS clinic at the Naggalama hospital through funds from CDC of Atlanta.

In addition to MAE, CEI and Fondazione Cassa di Risparmio di Padova e Rovigo, funding was provided by the following: > Doctors with Africa CUAMM and private donations (for the salaries of Italian medical staff and other items of current expenditure). > Doctors with Africa CUAMM Groups. > Private resources obtained in Uganda (Camilliani). > Tuscany region decentralised cooperation.

Staff of Doctors with Africa CUAMM employed: > Dr. Elisabetta Ruckstuhl > Dr. Monica Imi Summary of activities carried out: > Staff housing was completed, handed over and opened in May 2005. > The HIV-AIDS clinic in the Naggalama hospital was revitalised and the community services for sufferers were initiated. > Cooperation began with the Austrian NGO DKA for adaptation of the plumbing, electrical and sewage systems at the Naggalama hospital. > The HIV-AIDS clinic at the Nyenga hospital was revitalised, antiretroviral therapy services introduced and territorial and domiciliary care activities strengthened. Drugs were procured for antiretroviral therapy and for treatment of opportunistic diseases. > Technical support was assured for the three hospitals and 7 peripheral health units of

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> > > > > >

the diocese and regular visits guaranteed for supervision, monitoring and support of the respective management bodies.

Drugs, equipment and essential consumable materials were procured for the three hospitals.

Mobile radiological equipment was procured for the Naggalama hospital.

A € 12,000 contribution was given for the purchase of an ambulance for the Nkokonjeru hospital.

Healthcare support was strengthened in the Buvuma Islands with the presence of a qualified obstetrician.

Technical support was guaranteed to the district supervisors for TB and Leprosy in Mukono and Kayunga.

An Italian doctor specialising in surgery provided voluntary service for 15 days in the Naggalama hospital in June.

4.9 Strengthening of health services in the Lugazi Diocese – Project for the Naggalama Hospital – Stage 1

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This is a project funded by Fondazione Cassa di Risparmio di Padova e Rovigo (total commitment of € 516,450,000) which involves a radical reorganisation of the Naggalama hospital and construction of new buildings. The goal is to improve accessibility, effectiveness and quality of services provided by the Naggalama hospital, particularly in the surgical and mother/child areas. The first stage ended in 2005 with completion of all the civil works, which were handed over and opened at an official ceremony in May. A second restructure stage has already received funding and the activities began in the last quarter of 2005.

Staff of Doctors with Africa CUAMM employed: > Dr Italo Nessi (project leader provided through other Doctors with Africa CUAMM projects) > Engineer Jimmy Araba Parata (director of works) > Engineer Silver Martin Oucul (site manager) Summary of activities carried out: > Construction of a new adult ward (male and female sections) which will hold a total of 70 beds. > Remodelling of an existing building to create two apartments for senior hospital staff. > Construction of a new block of 5 apartments for hospital staff. > Purchases have been made to supplement equipment and consumable materials for inpatient wards. > Coordination has been assured with Austrian NGO DKA engaged to perform building work on the hospital’s new sewage system. > Opening of new buildings and handover to diocese authorities and hospital administration.

4.10 Strengthening of health services in the Lugazi Diocese – Project for the Naggalama Hospital – Stage 2 This is the second stage of the project funded by Fondazione Cassa di Risparmio di Padova e Rovigo (funding for € 280,000). This stage likewise involves remodelling work and the construction of new buildings in the Naggalama hospital over a period of 2 years to complete the refurbishing work carried out during the first stage. The work comprises remodelling of the paediatric ward, construction of covered connecting walkways

between the various hospital wards and services, construction of staff housing, and remodelling of the hostel for junior hospital staff. The project is coordinated with the Austrian NGO DKA for rehabilitation of the sewage, electrical and plumbing systems which will be followed by the director of works of Doctors with Africa CUAMM under the supervision of DKA technicians.

Staff of Doctors with Africa CUAMM employed: > Dr Italo Nessi (project leader provided through other Doctors with Africa CUAMM projects). > Engineer Silver Martin Oucul (works director).

Summary of activities carried out: > Completion of plans for civil works and submission to hospital administration for approval. > Planning calendar of works. > Start-up of procurement of materials and organisation of site, warehouses and recruitment of teams of workers. > The building work will begin in January 2006.

4.11 Strengthening of health service offerings in the Lugazi Diocese – Uganda – Improvement in quality and optimisation of costs of services This is a three-year project (total funding € 952,425) funded by the Italian Ministry of Foreign Affairs, CEI, private donors and Doctors with Africa CUAMM Groups. It began on 1 April 2004. It involves support for processes of reorganisation of health services in the Lugazi Diocese through support for the diocesan healthcare coordination office. This project, like the analogous project to support the Arua and Nebbi Dioceses, is part of the national public-private partnership healthcare policy and promotes integration of diocesan healthcare services in district health systems.

Staff of Doctors with Africa CUAMM employed: > Dr. Italo Nessi (project leader) > Dr. Nathan Onyachi (surgeon, currently assigned to Naggalama Hospital) > Engineer Jimmy Araba Parata > Engineer Silver Martin Oucul (responsible for building activities in this project and those funded by other projects in Lugazi Diocese as of May 2005) Summary of activities carried out: > The project-leader doctor and the diocesan healthcare coordinator regularly took part in all activities of programming and coordinating the healthcare activities in the Mukono and Kayunga districts, particularly those concerning mother/child health, HIV/AIDS, information flow management and review of charge systems in the diocesan health units. > Technical and material support was assured to the diocesan healthcare coordination office (supply of equipment, consumable materials, transport vehicles for the supervision activities). > Support was guaranteed for the activities of coordinating the entire private non-profit health sector. > Technical consulting was guaranteed to the Diocesan Health Council and the Diocesan Health Assembly. > The Diocesan Health Plan for the new financial year and the Five-Year Diocesan Health Plan were drawn up. > Financial management based on cost centres was introduced in the three hospitals together with a manual on staff employment procedures in the peripheral units.

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> All health units were given their own articles of association, management bodies with terms of reference and mandates for individual members. > Financial backing was guaranteed for pay rises of staff in health units as part of the harmonisation of pay policies and improvement of qualifications of operating staff. > IT equipment (computers and printers) was provided to hospital administrations and to the diocesan coordination office to assure full operativeness and to improve data collection and processing. > Materials and equipment were purchased for the activities of on-the-job training of healthcare staff. > Clinical and diagnostic equipment was purchased for the three hospitals and the supply of drugs, consumable materials and essential equipment for the peripheral health units was guaranteed. > Remodelling of the Nkokonjeru hospital outpatient building was completed. > 19 courses, seminars and meetings for diocesan and district healthcare staff were organised during the year. > 18 study grants for various clinical or management/administrative training courses were guaranteed for staff of diocesan health facilities.

4.12 Veneto region health authority project – Naggalama hospital

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The arrival of an obstetric specialist marked the beginning of the cooperation project between Naggalama hospital and the Este and Rovigo area health authorities (Italy).

This mainly involves support for obstetric-gynaecological activities in the hospital, improvement in referral systems between the community and the hospital in the mother/child sector, and strengthening of the clinical and surgical areas of the hospital by sending specialist staff (with tasks that include training). The project officially began at the end of October 2005 with the arrival of the specialist gynaecological doctor (project leader).

Staff of Doctors with Africa CUAMM employed: > Dr. Luciano David (project leader, a doctor specialising in gynaecology and obstetrics).

Summary of activities carried out: > The activities of reorganising the hospital’s obstetric/gynaecological department have begun. > The first on-site training activities of staff involved in maternity treatment have begun.

4.13 Uganda Martyrs University (UMU) project: Working for a New Generation of Health Managers Doctors with Africa CUAMM began cooperating with the Catholic University of Nkozi (Uganda Martyrs University) in 2000, providing technical support, teaching staff and material resources for the Department of Health Sciences courses. In 2005 the Department was upgraded to Faculty in view of the quality of the courses offered and the volume of the cooperation activities and research carried out. A second stage of support for the faculty by Doctors with Africa CUAMM is under way with a project covering a period of 3 years, up until December 2006. The total funding for the new stage is ?

882,280.00, of which ? 523,300.00 is provided by the Italian Episcopal Conference (CEI) and ? 358,980.00 by Doctors with Africa CUAMM. The project also received funding from the Cariplo Foundation through Gruppo Medici con l’Africa Como Onlus and from several municipalities in the province of Vicenza through Gruppo Cuamm con Sara per l’Africa Onlus.

In 2005 the final proposal of the project was submitted to Italian Cooperation for co-funding, which successfully concluded the preliminary stage. Once approved, the project will assure continued support for the new faculty.

The areas of activity of the current project include: 1. Support for courses and teaching activities (teaching staff salaries, study grants, purchase of teaching materials).

2. Scientific research and publication activities (operational research, consulting, publication of a scientific journal).

Staff of Doctors with Africa CUAMM employed: > Dr Bikaitwaha Maniple, project leader and head of faculty > Dr John Odaga, lecturer and researcher > Dr Vincent Bwete, lecturer and researcher > Dr Maurizio Murru, visiting lecturer > Dr Luigi Cicciò, visiting lecturer Summary of activities carried out: > In January the Science department was raised to the level of faculty and Dr Maniple was appointed dean. > The Science faculty received recognition in 2005 as the best university department for its various activities and services. > 79 students have received diplomas and certificates in the various courses offered.

Table 1: Students completing the various courses during academic year 2004-2005 Course Diplomas awarded in 2005 1. Certificate in Health Services Management 20 2. Diploma in Health Services Management 4 3. Diploma in Health Promotion and Education 3 4. Advanced Diploma in Health Services Management 21 5. Advanced Diploma in Health Promotion and Education 20 6. Master of Science in Health Services Management 11 Total 79 > A new Certificate in Health Promotion and Education course has been opened. > The following numbers of students have enrolled on the various courses in the academic year 2005-2006: Course Enrolled in 2005 1. Certificate in Health Promotion and Education 15 2. Certificate in Health Services Management 19 3. Diploma/Advanced Diploma in Health Services Management 15 4. Diploma/Advanced Diploma in Health Promotion and Education 42 5. Master of Science in Health Services Management 15 Total 102 > The faculty has engaged a doctor from the Public Medicine School of the University of Modena to participate in the Primary Health Care, Health Policy, and Planning and Management modules of the Public Health Masters Degree. > Doctors with Africa CUAMM has provided study grants for the following 9 candidates

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Course 1. Diploma/Advanced Diploma in Health Services Management 2. Diploma/Advanced Diploma in Health Promotion and Education 3. Master of Science in Health Services Management Total

Candidates sponsored in 2005 6 1 2 9

> The annual faculty conference entitled “Reducing maternal mortality in Uganda” was held in November 2005 with the support of CUAMM. > 14 laptop computers have been obtained for masters course students. > Textbooks have been provided free of charge to masters course students. > Expenses have been covered for field research and data collection activities for the purposes of writing theses for the various courses. > Research studies on the organisation of human resources in hospital wards and the attitude of healthcare workers towards the issues of HIV-AIDS have been funded. > Expenses have been covered for participation in meetings and seminars by faculty staff. > Publication of the faculty’s journal “Health policy & development” has continued to be published. It is now online on the website www.umu.ac.ug/hpdjournal and is affiliated to Bioline. > The faculty received the Makerere University’s Vice Chancellor’s Innovative Academic Excellence Award with a cash prize of $ 8,000.

92 4.14 Primary Eye Care Project The Primary Eye Care Project began in 2001 and is funded by an Italian organisation (MAC – Movimento Apostolico Ciechi) engaged in providing support to the blind. The aim of the project is to guarantee basic eye treatment to the population in the dioceses of Arua and Nebbi (West Nile region), Lugazi (central region), and Moroto and Kotido (Karamoja region). 2005 will be the last year in the first 5-year period of cooperation between Doctors with Africa CUAMM and MAC and a second extension of funding and activities is already planned for a further 5 years. Funding for each year is about ? 26,000 established according to the plan of activities.

The project covers 7 hospitals and 36 rural dispensaries.

Doctors with Africa CUAMM’s contribution to the project comprises the activity of technical support, supervision and control through Doctors with Africa CUAMM’s staff working in the same areas on other projects.

The project has the following components: > Organisation of mobile eye clinics. > Material, financial and logistic support for eye surgery sessions. > Production and sale of glasses at subsidised prices. > Supply of ophthalmic drugs to all diocesan health units. > Prevention of neonatal ophthalmic diseases.

Staff of Doctors with Africa CUAMM employed: > The same as those working at the various diocesan and district sites on other projects.

Summary of activities carried out: > Support for activities of 27 eye surgeries with more than 7,000 examinations. > Purchase and distribution of ophthalmic drugs for all 7 hospitals and 36 dispensaries in the 5 dioceses. More than 11,000 eye infections have been treated.

> Purchase of lenses and consumable materials for the Ediofe optical laboratory (Arua district, West Nile). > Financial backing for payment of salaries of Ediofe optical laboratory technicians. > Financial backing for payment of incentives for obstetricians involved in activities of preventing neonatal eye infections. > Production and sale of glasses at subsidised prices (more than 700 pairs). > Financial and material support for eye surgery sessions (a total of 575 patients underwent operations in Matany, Maracha and Arua hospitals).

4.15 Conformity Project “Support for diocesan hospital services in sectors of mother-child health and correlated HIV/AIDS activities – Arua, Lugazi, Nebbi and Moroto Dioceses, Uganda” This is a conformity project approved by the Italian Ministry of Foreign Affairs that allows volunteer doctors to be sent out from Italy with a registered contract. The project ended in November 2005 but has been extended to May 2006.

The resources required for the activities come from private donors: Fondazione Cassa di Risparmio di Padova e Rovigo, Doctors with Africa CUAMM Groups and other private contributions.

Staff of Doctors with Africa CUAMM employed: > Dr Stefano Santini (Kampala, until February 2005) > Dr Paolo Giambelli (Kampala, from February 2005) > Dr Stefano Vicentini (Matany Hospital) > Dr Italo Nessi (Naggalama Hospital) > Dr Julian Kiwala (Nyenga Hospital) > Dr Enrico Tagliaferri (Angal and Nyapea Hospitals) > Dr Marina Anghileri (Maracha Hospital) In addition to the above-mentioned Italian doctors, Dr Mario Marsiaj and Mrs Claudia Marsiaj worked in the Angal hospital without registered contracts for two periods of time to a total of 6 months.

Summary of activities carried out: Lugazi Diocese Hospitals (Naggalama, Nkokonjeru and Nyenga) > Support was provided to hospitals for pay rises and incentives for obstetric staff. > In cooperation with the Ugandan organisation TASO, the first module of the counselling course was organised, attended by 15 staff members from the 3 hospitals. > 1 obstetrician from the Naggalama hospital was trained in communication/counselling with paediatric patients at the Mildmay International Study Center. > The MCH services and paediatric and maternity wards received supplementary drugs and consumable materials, particularly for prevention of opportunistic diseases. > A doctor was sent to Nyenga hospital to coordinate the activities of the HIV-AIDS clinic, to improve data collection, the registration system and patient follow-up, and to begin antiretroviral therapies. > VCT and PMTCT services were further expanded in all three hospitals. > The HIV-AIDS clinic at Naggalama hospital was reorganised and support with drugs and consumable materials was provided. > Cooperation with the community organisations for the fight against AIDS was also strengthened. > 2 seminars for village health workers were organised to promote relations between the hospital and the community.

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> Support for the HIV-AIDS clinic at the Nkonjeru hospital was guaranteed through the support of Intercare (UK). > A project was started up at the Naggalama hospital in October with the aim of fostering and developing intra-hospital obstetric services and its links with the community through the presence of a specialist Italian obstetrician.

Arua and Nebbi Diocese Hospitals in West Nile (Maracha, Angal and Nyapea) > Short refresher courses on the most significant mother/child and HIV/AIDS related pathologies have been organised for nursing staff. > Drugs and other consumable materials have been purchased to supplement supplies to MCH services and paediatric and maternity wards. > The PMTCT and VCT services have been further expanded. > HIV/AIDS clinics operate in all three hospitals. They offer services of counselling, psychological support and treatment of opportunistic infections. Angal hospital also offers a service to support orphan children whose parents have died from AIDS. > In all three hospitals a programme has been launched for domiciliary (communitybased) treatment of fever and malaria within the areas they serve. > At all three hospitals audit processes are in operation for cases of maternal mortality. > At all three hospitals staff have been trained in management of antiretroviral drugs and in patient treatment guidelines. > At all three hospitals the first antiretroviral treatments have begun.

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Moroto Diocese Hospital in Karamoja (Matany Hospital) > Refresher courses have been organised for nursing staff. The themes covered have included the principal mother-child pathologies. > The PMTCT and VCT services are operative at the Matany hospital. > Staff have been trained in management of antiretroviral drugs and in patient treatment guidelines. > The first patients have been admitted to the AIDS clinic for antiretroviral treatment. > Cooperation with traditional midwives has been further developed.

Summary of PMTCT activities at the 7 hospitals in the project in 2004 PMTCT Mothers receiving pre-test counselling Mothers tested for HIV Mothers found HIV+ % mothers HIV + Mothers given ARV Mothers HIV+ who delivered Babies given ARV

Maracha

Angal

Nyapea

Naggalama Nyenga

Nkokonjeru Matany

Total

891

2,182

1,067

1,644

858

1,886

1,126

9,654

891 14 2 7 12

1,020 29 3 7 12

484 21 4 21 5

1,188 76 6 36 41

786 56 7 14 17

1,657 148 9 26 32

717 17 1 9 9

6,743 361 5 120 128

11

11

0

36

14

25

18

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Comparison between paediatric admissions and deliveries in the 7 diocesan hospitals in financial years 2003-04 and 2004-05

Hospital Angal Nyapea Maracha Naggalama Nyenga Nkokonjeru Matany Total

N. paediatric admissions Year Year Variation 03 - 04 04 - 05 % 6,962 7,052 1.3 3,250 3,922 20.6 3,632 4,181 15.1 2,955 3,620 22.5 2,289 3,747 63.7 1,615 1,475 -9 6,939 6,672 -4 27,642 30,669 10.9

No. deliveries Year Year 03 - 04 04 - 05 1,489 1,675 860 1,101 732 779 1,299 1,612 402 572 729 840 687 1,085 6,198 7,664

Variation % 12.5 28 6.4 24 42.2 15.2 57.9 23.6

Chart 2: Variation in paediatric admissions over period 2001-2005

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Chart 3: Variation in assisted deliveries over period 2001-2005

4.16 Technical support in Nakapiripirit District From March 2003, Doctors with Africa CUAMM assured the presence of a Technical Adviser (TA) at the District Health Office of Nakapiripirit in Karamoja through funding by the Danish cooperation agency DANIDA. The support project ended in April 2005.

Staff of Doctors with Africa CUAMM employed: > Dr John Mudusu Summary of activities carried out: > The Doctors with Africa Technical Adviser cooperated with the District Health Office in preparing the activity and budget plan for the new financial year and helped with the Office organisation and management processes. > Technical support was provided to all Health Centres in preparing annual action plans. > Consolidation of activity of the District Health Assembly, which draws together the various public and private partners and the international NGOs engaged in the healthcare sector in the Nakapiripirit District. > The Doctors with Africa Technical Adviser assisted the District Health Office in implementing its activities and in seeking new forms of collaboration and financing with various cooperation agencies (UPHOLD, HSPS, CHDC, UNICEF, AMREF). > The study document on the potential new healthcare strategies for the specific context of Karamoja was officially presented with a view to defining concrete action policies. > Support was given to the district for organisation and implementation of the vaccination campaigns, the national programme for the fight against TB and the development of HIV-AIDS services.

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5 NATIONAL COORDINATION - KAMPALA The National Coordination in Kampala serves to represent Doctors with Africa CUAMM in all the institutional offices in Uganda, towards the international and national cooperation and development agencies and towards other Italian and foreign NGOs operating in the country.

It plays a role of liaising and coordinating between the various projects, promoting activities and developing new initiatives, projects and partnerships and seeking funds and resources for implementing the various initiatives. It also has important administrative and management functions for the projects under way, for human and instrumental resources and for the logistic structures present in the various areas of the country. In 2005 the Guest House building underwent radical refurbishing as well as operations of routine and reactive maintenance.

Other work was carried out in order to transfer the offices from the old location to the twofloor building behind the headquarters of Doctors with Africa CUAMM. A process of upgrading the communication systems was initiated. These operations were necessary to adequately accommodate the increase in staff in the projects sector and the administration and accounting sector. Maintenance and restoration work on the former office building is planned in 2006 to transform it into accommodation for the country representative TA. The coordination in Kampala acquired two new figures in 2005 to strengthen cooperation and to design projects and to revitalise the network of contacts and relationships with the Ugandan institutions, other international agencies and NGOs. Staff of Doctors with Africa CUAMM employed: > Dr Paolo Giambelli (Country Representative) > Dr Peter Lochoro (TA for Country Representative) > Simona Schiava (Project Assistant) > Tito Dal Lago (Administrator/logistician) > Nicoletta Cavaliere (Assistant accountant)

Summary of activities carried out: Representation activities and External partnerships > Relations with various partners, cooperation and development agencies and local and international NGOs have been looked after and maintained. The following are the most representative: Italian Embassy, Nunziatura Apostolica, UTL (Local Technical Unit) of Italian Cooperation, Ugandan Ministry of Health, Uganda Catholic Medical Bureau, European Union, ECHO, DANIDA, SIDA, Japanese Embassy, Irish Embassy, USAID, WHO, OCHA, UNDP, UN Human Rights Commissions, International Red Cross, MSF, MMN, AVSI, COOPI, CESVI, ISP, SVI, District Authorities, Dioceses, Uganda Martyrs University. > Meetings called by the following were regularly attended: • ECHO • EU • OCHA • Development Partners • UCMB • UTL • WHO > The country representative regularly took part in the meetings of the following: • Uganda Stop TB Partnership of which Doctors with Africa CUAMM is a member.

• The Uganda Aids Commission.

• The Joint Review Mission of Development Partners.

Logistic/administrative activities > Accounting of all projects was assured on a quarterly basis. The funds were used properly without residual shares. Irregularities and delays in provision of funding were experienced throughout the year, and this had consequences for the overall management of accounting and for the coverage of management costs of the planned activities. > Logistic and administrative support was assured to all Doctors with Africa CUAMM projects in progress, to the district offices where Doctors with Africa operates, to the national TB programme, to the diocesan hospitals that are partners of Doctors with Africa CUAMM, and to missionary institutes. > Logistic and accommodation support was provided to voluntary staff and to the missions sent by the Padua health authority to evaluate cooperation projects with the Nsambia-Kampala hospital. > The employment manual and regulations for local staff was reviewed, the job descriptions written for each position and the responsibilities of all figures regulated. > The records of expatriate and local staff of Doctors with Africa CUAMM were reorganised.

Accommodation activities (Guest House) > The Doctors with Africa CUAMM Guest House accommodated 316 guests in 2005 with a total of 1,235 days’ accommodation. > The staff shifts were reorganised and rationalised.

Project supervision activity > Regular supervision visits to all projects were assured. In particular, regular supervisions of the Naggalama hospital works sites were carried out.

Planning activities > The following projects were drafted and presented: > The project for post exposure prevention (PEP) of AIDS in a hospital environment in the Nsambia and Nebbi hospitals was drafted and submitted to the Veneto region’s decentralised cooperation agency as a consortium with the hospital of Padua.

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> Completion and review of the project promoted for the West Nile diocese currently at the preliminary stage. > Completion and review of the project for the UMU University in Nkozi currently at the preliminary stage. > Drafting of the project proposed to the EU in a consortium with AISPO and UMU for PEP in all health facilities of 4 West Nile districts: not approved. > Drafting of project proposed to ECHO for support to health facilities in the Oyam county, Apac district: reviewed in accordance with EU funding policy. > Drafting of project to propose to Japanese embassy to support orthopaedic workshop at the Arua regional hospital. > Review and redrafting of project promoted to support the Moroto and Kotido dioceses for submission to Italian Cooperation. > Participation in completion of drafting of the project proposed to the decentralised cooperation agency of the province of Trento for support to the Moroto diocese.

Cooperation with WHO and Stop TB Partnership was also finalised and negotiated for technical support for 6 districts in developing TB-DOTS strategies, a project that began in the last quarter of 2005.

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Training and research activities > A research study was initiated on the impact of AIDS mother-child contagion prevention services in cooperation with AVSI for submission to the AIDS 2006 world congress to be held in Canada. > Feasibility study and initial data collection for the study of operational research on TB with just two expectorate samples in cooperation with WHO. > In July 2005 the first Technical Workshop was organised for Doctors with Africa CUAMM staff with management functions operating in Uganda. > The periods of participation of the JPOs in Doctors with Africa CUAMM projects in the West Nile region and in the Matany hospital were organised, as was participation of the JPOs in health management course modules held at the UMU university in Nkozi.

HUMAN RESOURCES SECTOR

GENERAL FRAMEWORK Working Personnel Recruiting and Selection Training and Preparation Monitoring and Evaluation Documentation Center

ASSOCIATIVE LIFE Student college Information Meetings

GENERAL FRAMEWORK Working in Africa is today a difficult and complex challenge, requiring answers as much difficult and complex, in terms of general strategies, analysis, research, knowledge of the reality and of the problems, organizations, motivations and passion.

This implies that Doctors with Africa Cuamm counts mainly on human capital, the most important investment the organization can make. The future of Doctors with Africa Cuamm is intimately linked to this kind of investment that, as we know, gives fruit in long or medium term.

In the 2000 Political Document we state: â&#x20AC;&#x153;In health care, the development of professional expertise and managerial skills is one of the necessary ways to strengthen systems and turn them towards sustainability. The best result cooperation can achieve is when itâ&#x20AC;&#x2122;s not necessary anymore. This result will be possible if cooperation is considered mainly as an improvement of local resources, particularly human resources.

This is a difficult, as well as fascinating and stimulating task.

For this reason we tried to make a significant and far-sighted investment in all the phases of Human Resources Management (Recruiting, Training, Selection, Preparation, Monitoring and Development) both with locals and foreigners. Recruiting has been broadened, training has always been constant and updated, selection and preparation, from the moment of departure for service, have become more accurate and precise. We have organized a monitoring system for the performance of single workers that, being still in fieri, allow us to have good control of the staffing situation, with the ability to timely face problems as they emerge.

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1. WORKING PERSONNEL In Pic. 1 we can observe the number and the status of the individuals working in our projects during 2005. The total number has further grown as regards to the previous years.

Together with health care positions, administrative and logistic roles are becoming more important.

Pic. 1

In Pic. 2 we can see the Personnel distribution for each country. The number of our workers has decreased mainly in Angola, as some projects came to an end, while it has consistently increased in Mozambique because of new projects.

Fig. 2

102 Pic. 3 emphasizes that the countries with the biggest number of workers at the first experience are Angola and Mozambique: this is due both to some JPO â&#x20AC;&#x201C; Junior Project Officer (Mozambique) and the type of on-going projects (Angola); Uganda instead is the country with the greatest number of African professionals. The africanization process has started and is gradually bearing fruit. It has contributed to make our work increasingly appreciated by our local counterpart; it has facilitated the fruitful exchange of experience and skills among our local and expatriated personnel and the organism itself has been enriched.

Pic. 3

In Pic. 4 we can observe how the majority of our workers is made up of expatriate personnel with prior experience on the field (redeployed); the personnel at first experience also include specialising doctors (5 in 2005) who have not been involved in projects, rather have supported senior doctors, as doctors in training.

The number of African professionals in our projects has maintained steady.

Pic. 4

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2 RECRUITING AND SELECTION Together with our ordinary recruiting methods, we have tried to undertake, with greater determination and method, the path of active recruiting of strongly needed professional specializations. New channels have been activated, through which to make our Organisation better known, as well our proposal of training and our commitment for Africa: among others, deserve mentioning the contacts with some Medical Associations, the Federazione Nazionale Ordine dei Medici (FNOMCEO), Postgraduate Schools of Medicine, Health, and Hospital Centers, Associations and Societies of Doctors and scientific journals usually addressed to experts who are the most sought for the on-going projects.

A process of focused recruiting has been started, by publishing vacancies on the Italian portals dedicated to the development cooperation and forwarding the vacancies to the Associations of Doctors identified on the basis of the professional profiles required (e.g.

Italian Society of Paediatrics).

The web-site of the Organisation, renewed and re-launched in 2005, has become the main point of contact for those approaching Doctors with Africa Cuamm: beyond the overview of the inspiring principles, the working modalities, the on-going projects, it has proved a useful tool to provide basic indications for those willing to leave for the projects; it also functions as filter, as it highlight the professional profiles required for the projects.

Furthermore, on the web-site a form is available for those who are interested, to be filled in in order to receive the useful information on the recruitment procedure.

During the current year 534 individuals interested in our work have contacted us, 134 sent the personal form and â&#x20AC;&#x201C; after a first screening of the candidates based on the information gleaned from the form â&#x20AC;&#x201C; 92 people have been invited for an orientation interview in order to start the training process.

Thirty-four candidates were admitted to the introductory week and 25 of them have then continued the training path proposed by the Doctors with Africa Cuamm, participating to the Basic Course for health operators (Pic. 5) Pic. 5

104 With regard to selection, an internal process has been initiated to improve the selection criteria and expand the selection tools in order to achieve an overall evaluation of the applicants that emphasizes each individual’s skills and expertise to best identify and select the most qualified people for each project.

The desired output is a more accurate and comprehensive selection process that examines all the different qualities necessary to carry out a professional activity in Africa.

In addition to the usual learning evaluation tools and the personal monitoring of candidates during the Basic Course, this year a psychological questionnaire was introduced, which is administered at the end of the basic course, under the supervision of a psychologist, it is presented to those who are interested and discussed individually during the final interview.

Moreover, the evaluation group, composed of educators, recently returned volunteers and psychologists, continues to concentrate on the identification of new evaluation tools and to the formulation of the course final evaluation (see section on the Basic Course).

In the case of experienced candidates coming from other organizations, we try to implement an accurate selection process, organizing several meetings and interviews in order to facilitate a reciprocal understanding between the individual and Doctors with Africa Cuamm as deeply as possible. Required references, of good quality and judiciously, are very important and seriously examined.

3 TRAINING AND PREPARATION In order to respond to the various formative demands of the actors on the field, Doctor with Africa Cuamm’s training proposal has been expanded and diversified. Together with the Basic Course, which embodies the “heart” of our education commitment, there are several other Courses that we carry out together with other Universities, both Italian and African.

Twenty-seven health operators (chosen after the Introductory Week) participated to the Basic Course 2004/05 (ended in May 2004).

Among these, five left as specialized physicians, five as a specializing physician accepted in the Junior Project Officer project and one physiotherapist.

Twenty-five people participated in the 2005/2006 Basic Course: 19 physicians, 5 nurses, 1 physiotherapist. (Pic. 6) Pic. 6

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This year, besides maintaining our commitment to the several Postgraduate Courses in which we are involved and that are useful for “positioning” and qualifying the image of Doctors with Africa Cuamm, we have undertaken an important initiative regarding the training of trained candidates departing for a period of service, which led to the preparation of a CD “Guide for departing for a period of service and rules of behaviour’, including information on the destination countries and useful details for the departure.

We have had 33 departures and 33 re-entries (Pic. 7), which have ensured a continuous presence in the field.

Pic. 7

The specific training offered by Doctors with Africa Cuamm (Basic Course, Postgraduate Course in health services management, Master in health services management in Nkozi) surely improves the candidate’s theoretical preparation and is important in developing an understanding of the Doctors with Africa Cuamm intervention philosophy. However, it doesn’t completely satisfy the required professional standards, especially in the management field, both for clinical and public health. There are several workers who possess the requirement of strong training in the field of health management, and the number is still growing.

As many projects in progress require more detailed and targeted expertise, a large percentage of our personnel is composed of “re-entries”, operators with working experience acquired in poor countries.

Out of 33 recent departures, 16 have been individuals beginning their first experience (of whom 5 are JPO - specializing doctors) and 17 were personnel with prior experience. The distribution among the different roles is shown in the chart below. (Pic. 8) Pic.8

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Pic.9

This is the reason for the intensification of efforts and activities directed towards “young” doctors through the Junior Project Officer (JPO) project.

This project aims to offer first experience operators, under the guidance of a “senior” expatriated doctor, a theoretical and practical preparation as adequate as possible in order to satisfy required professional standards. Such “field training”, economically supported by a scholarship that the specializing student maintains, could allow, at a later time, a successful placement of the same doctor within the Health Cooperation Project.

During the year five specializing doctors, engaged in hospitals or in Public Health projects in Mozambique and Uganda, have departed. These experiences – still on-going – involve the University of Modena – Reggio Emilia and the University of Torino for the Specialization in Public Health, the University of Florence for the Specialization in Gynaecology and Obstetrics, and the University of Padua for the Specialization in Internal Medicine.

In October 2005, a doctor student in Public Health of the University of Padua returned, after eleven months of theoretical – practical training in Beira district (Mozambique) in a project for the strengthening of the District Health System under the supervision of a project leader.

During the year, we maintained contacts with several Italian Universities and ad hoc promotional material have been prepared and distributed in the Universities of Bologna, Florence, Milano Bicocca, Modena, Siena and Turin, where the year before we organized meetings to inform them of the initiative of the Graduate School Directors and its specialists.

The initiative of Junior Professional Officer has also been promoted through the portals dedicated to the specialists and has been presented to the Italian specialists in Pediatrics in the frame of the Italian Symposium of ONSP (Osservatorio Nazionale Specializzandi Pediatria), held in Sciacca (Agrigento) from 27 to 29 May 2005. The training value of the initiative has been also recognized with the publishing of the training proposal in n. 3/2005 of the ONSP Bulletin.

Moreover, in the second half of the year, the basis for the collaboration of the Pediatric Clinic and the School of Specialisation in Pediatrics of the University of Padova, aimed at offering some specialist the opportunity of a period of theoretical – practical training in Africa to some specialists. Agreeing on the need for a tailored training for those who are willing to participate to the initiative, we have decided to organize a training course to provide some tools to understand the context where the specialists may be sent to, as well as some basic elements for the treatment of the main pediatric pathologies of the developing countries (see later on).

3.1 Training Courses detailed presentation Pic. 10

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TRAINING â&#x20AC;&#x153;BASIC COURSEâ&#x20AC;? FOR HEALTH OPERATORS IN DEVELOPING COUNTRIES In 2005 the training course has been carried out, following an active methodology and constituted of four weeks modules and a conclusive seminar. Apart from the issues related to the health cooperation programmes, specific topics related to anthropology, ethics etc have been included.

The course has dealt issues mainly on public health, the organisation and the management of health services, both at the local level and at the hospital level.

The course has training purposes as well as aims related to recruitment and knowledge of the candidates: the first step in the recruitment is represented by the interview (and by the psychological test), which is preceding the step from the introductory week, broader and more general, to the following weeks, more specific, while the second important step in the recruitment is the exam at the end of the course, together with the second psychological test and the final interview. > Weeks modules:

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Course 2004/2005: 17-21 January 2005 07-11 March 2005 13-14 May 2005

second week of the Basic Course third week of Course Conclusive Seminar

27 participants 27 participants 27 participants

Course 2005-2006: 12-16 September 2005 15-19 November 2005

Introductory week First week of Basic Course

35 participants 25 participants

Thirty-one trainers of Doctors with Africa Cuamm have been involved in activities of the Course in 2005. A month before the lectures, some preliminary information material is sent to the participants for each week course in order to allow a thorough reading, while the remaining material is distributed during the courses or sent afterwards.

Upon completion of the course, all material is filed in a cd, which is provided to the trainers and to the Country representatives. > Evaluation In itinere evaluation sessions have been introduced this year: a written exam is envisaged each week with multiple choice questions that relate to the topics dealt in the previous week.

Moreover, a written exam has been prepared, at the end of the course, with open questions aimed at evaluating the knowledge as well as the skills to organise the knowledge to solve a problematic situation.

Beyond the evaluation and recruitment ordinary tools, this year a second psychological test has been introduced, which highlights relevant personal characteristics (communication skills, flexibility, leading skills etc): the test is filled in by participants at the end of the course, evaluated by a psychologist and discussed individually during the final interview. > Language skill test In replacement of the test, a certificate attesting the knowledge of English or Portuguese is now requested to the candidates.

3.2 Week modules – course Doctors with Africa Cuamm COURSE TIMETABLE: 9 AM – 1 PM, 2 PM – 6 PM 17-21 January 2005 second week Course 2004-2005

7-11 March 2005 Third week Course 2004-2005

12-16 September 2005 14-19 November 2005 Introductory Week First week 2005-2006 Course 2005-2006

“Planning at district level” Carlo Resti

“General principles of health management” Alessandra Gatta Roberto Gnesotto

“Planning an Intervention” Cinzia Montagna Valerio Mecenero “ Planning activities at local level” Alessandro Bavcar

“The Hospital” Gavino Maciocco Rita Polo

“Development and Povery” Massimo La Raja Alessandra Gatta Mara Mabilia “State of health in the world” Roberto Turra Marina Spaccini “Globalisation, market and health policies” Giorgio Pellis Adriano Cattaneo

“Origin, evolution and transformation of health systems” Gavino Maciocco “Primary Health Care.

Conceptual basis” Carlo Frizzi Marco Pratesi

“The concept of health in a comparative view” Mara Mabilia Annamaria Dal Lago

“Primary Health Care.

Organisation models.

Health and child health” Patrizia Morganti

“Integration hospital / territory: the management of the delivery room” Patrizia Morganti

project implementation” “Integration hospital / Massimo La Raja territory: primary surgery” Giorgio Pellis “Economic evaluations “Integration hospital / for planning” territory: Intra and Roberto Gnesotto extra hospital IMCI” Marina Spaccini Major Public Health Fanelli Carmelo Problems: malaria Giampietro Pellizer “Working group, team work” Luigi Ranzato “HIV and AIDS: impact “Supervision” on health, society Marco Pratesi and economy” Marzia Franzetti “The territory: drugs Vinicio Manfrin and pharmacies” Mara Mabilia Adriano Cattaneo

“Health systems in Africa: definition and historical notes” Adriano Cattaneo

“Immunization” Luca Scali

“The proposal of Doctors with Africa Cuamm” Luigi Mazzucato Dante Carraro Valerio Mecenero Anna Talami

“Health Information system” Luca Scali “Psychological opportunities and risks in the work of health personnel” Luigi Ranzato

3.3 Conclusive seminar BASIC COURSE DOCTORS WITH AFRICA CUAMM 13-14 MAY 2005 Thursday 13/05 “Sustainability of international cooperation interventions” Bianca Nucci Carlo Frizzi Friday 14/05 “Learning from past experiences” Luigi Ranzato Maria Teresa Fenoglio

3.4 Other training initiatives In 2005, Doctors with Africa Cuamm has collaborated with various Universities in order to realize Postgraduate Courses aimed at the promotion of Health and International cooperation in the Health field:

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> “Postgraduate Course in Tropical Medicine and International Health”, activated by the Clinic of Infectious and Tropical Diseases at the University of Brescia in collaboration with Doctors with Africa Cuamm, the Tropical Diseases Centre of the Negrar Hospital, the Burlo Garofolo Institute of Trieste, and the Doctors Without Borders, completed its seventh iteration in 2005.

The Course – addressed to health personnel interested in committing to cooperation activities – is recognized as Basic-Course for the International Health Master in the TropEdEurope circuit, subscribed to by all the main European Schools of International Medicine.

The lessons took place at the Clinic of Infectious and Tropical Diseases at the University of Brescia from February 7 to May 13 2005, with the participation of 30 candidates. Twelve Doctors with Africa Cuamm trainers were involved. > “Postgraduate Course in Anaesthesia in Developing Countries”, activated by the Department of Pharmacology and Anaesthesiology of the University of Padova in collaboration with Doctors with Africa and the Bethania Hospital, has finished its ninth iteration in 2005 and took place from April 4 to April 8 2005, with the participation of 5 students and 4 Doctors with Africa Cuamm trainers.

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> “Postgraduate course on Human Development and Management of Health Services in Countries with Limited Resources”: the Course is organised by Doctors with Africa Cuamm in partnership with the Department of International Studies of the University of Padova. It reached the fourth edition in 2005 and it took place from January 10th to October 8th 2005, for a total of 160 hours. > As in the previous edition, the course was constituted of four weeks, in order to favour the participation of foreign lecturers and ensure the didactical continuity to the participants. The thematic modules have been: • Module 1 - human development and health in Africa (10-15 January 2005) • Module 2 – Elements of health policy, planning and management (4-9 April 2005) • Module 3 – Health Economics and financing in the health services (20-25 June 2005) • Module 4 – The major public health challenges in Africa (3-8 October 2005) The course was intended for health professionals and other professionals approaching to international health cooperation, as well as updating for those who have already participated to health cooperation projects, with particular focus on experienced Doctors with Africa Cuamm staff.

Twenty-three people participated to the 2005 edition and a fourth of the participants was of experienced Doctors with Africa Cuamm staff, who has taken the opportunity to refresh also with the view of the new departure in the future; moreover, the number of professional health and non health staff who have participated to the course even without having previously contacted the Organisation has increased. The overall picture of the participants (fig. 11) seems to evidence the effectiveness of the communication and promotion strategies started, including the preparation of ad hoc material and publication of advertisements in sectoral portals and press and specifically addressed to universities, ASLs and hospitals, Italian NGOs working in the health domain. > The 2005 Course, as the two previous editions, has been accredited within the Continuing Medical education programme following the accreditation procedures of the Veneto Region.

Pic. 11

Among the twenty-four trainers who have contributed to the course in 2005, there has been four lecturers of the Faculty of Health Sciences of Uganda Martyrs University, a UNICEF officer coming from New York, two FAO officers, a consultant of the Ministry of Health of Uganda, two consultants who mainly work in Mozambique, an NGO staff working in North Uganda and South Sudan; of the thirteen professionals working in Italy, six are university lecturers and six are Doctors with Africa Cuamm’ trainers According to the aims stated, the 2005 course has confirmed the links with the University of Padova, it has allowed to strengthen the collaboration with the University of Bologna and the Course on Development Cooperation, the University of Pavia and the International Master in Cooperation and Development, the Inter-departmental Centre for Human Rights of the University of Padova, the Faculty of Health Sciences of Uganda Martyrs University and AVSI. > “Training Course in health assistance in complex emergency”: the idea of the course came from the presence, among the trainers in the Postgraduate course on Human Development and Management of Health Services in Countries with Limited Resources in 2004, of a consultant who collaborates with the WHO Health Action in Crises Department.

The commitment in countries that are now facing emergency situations and the interest to get into more details in said topics, which are dramatically present, led the Organisation to decide to organise an intensive course aimed at suggesting an overall view on the current conflicts, their consequences on the health of the population, the responses of the health systems, and the re-organisation and restoration process of the health system after the prolonged conflict.

The course, mainly addressed to the experienced Medici con l’Africa Cuamm staff and also promoted outside the Organisation, has taken place from 11th to 16th April and registered the participation of 30 health professionals, 24 of whom with previous experiences in health international cooperation projects or in emergency projects; the Cuamm experienced staff represented half of the participants (fig.12).

All the four trainers engaged in the course have a consolidated experience in complex emergency contexts, who work for Non Governmental Organisations or as WHO consultants.

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The Course was accredited by the Ministry of Health within the Continuing Medical Education Programme.

Pic. 12

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Apart from the above mentioned training courses and postgraduate courses, some optional courses have been organised for the students of Faculty of Medicine: > Optional Course for Students of the Faculty of Medicine of the University of Padova “Health and Healthiness”: the Course, organised by Doctors with Africa Cuamm in collaboration with the Faculty of Medicine of the University of Padova, has been held from 7th to 11th November 2005 with the participation of five Doctors with Africa Cuamm’ s trainers, among whom Doctors with Africa Country Representative in Mozambique. The course has envisaged the assignment of university credits to the students of the fifth year of the course in Medicine. The participants were 120 for each session. > Optional Course for Students of the Faculty of Medicine of the University of Trieste “The great epidemics of the new millennium”: the Course has been organised by Doctors with Africa Cuamm in collaboration with the association Doctors with Africa – Blood Bank of Trieste and the Desk of Microbiology of the Faculty of Medicine of Trieste, under the sponsorship of SISM. Sessions were held on 18, 20, 25 and 27 January 2005, with the participation of 50 students and a trainer of Doctors with Africa Cuamm. The course has envisaged the assignment of university credits to the students from the third to the fifth year of the course in Medicine.

3.5 Education Meetings for the managerial staff There has been a commitment aimed at maintaining a high level of knowledge, expertise, and performance for the Organization as well as the people working in it. A continuing education at all levels has been supported as sign of Cuamm’s interest towards its members.

Workshop on Problem Based Learning and its application in the Faculty of Medicine of Beira: the meeting held on 2nd April 2005 with the participation of 20 experienced Cuamm staff in Mozambique and Angola. The trainers were the Dean and the Course

Coordinator of the Faculty of Medicine of Beira (Mozambique), who presented the reality of the Faculty of Medicine of Beira, the distinctive features of its courses and the of the learning method applied in the Faculty (Problem Based Learning), which has also tested by the participants with a simulation.

The training proposal took origin from the need to create a group of trainers available to teach – according to the specialisation needed – in the various modules of the course of the Faculty of Medicine in Beira or to support the development of the Faculty curricula with their skills. The achievement of the objective has been evidenced by the departure of two experts who participated to the meeting and carried out training activities at the University of Beira in autumn 2005.

Meeting for Trainers The various initiatives involved not just trainers, who have collaborated with care and dedication to the activities proposed by Doctors with Africa Cuamm, but also “occasional” trainers who we would like to involve more actively and in a more coordinated and harmonious way.

In 2005 a meeting with the trainers engaged in the various training courses organised by Doctors with Africa Cuamm has been organised: a presentation of the training activities has been done, an update on the on-going projects, with the relating human resources involved and an overview of the Basic Course.

Pic. 13 shows the number of trainers involved in the different courses.

Pic. 13 113

4 MONITORING AND EVALUATION Monitoring and evaluation are crucial activities in the management of human resources.

Through these processes, we receive indispensable inputs that serve to confirm or improve all the processes regarding working personnel: training, selection, preparation and in loco support. We have started to work on this aspect but we need to improve in terms of composition and method.

MONITORING The elements considered in monitoring are: â&#x20AC;&#x153;job descriptionâ&#x20AC;?, language, interpersonal relationships with locals and expatriates, relations with the Cuamm, logistic and contractual problems, personal motivations and difficulties, and suggestions for improvement.

Tools At Single Operator level Biannual report by the operator.

Interview with the operator in Padova coinciding with vacations or in loco during visits.

Any other kind of informal or friendly communication (letters, etc.)

At the Organization level In loco visit by Doctors with Africa Cuamm/Padova, at least once a year.

Update (see biannual/annual report) by the Project-leader or Country Representative.

FINAL ASSESSMENT The elements considered in the assessment are: professional adequacy, language skill, relational aptitude with locals and expatriates, sense of belonging to the Cuamm organization, and future prospects.

Tools For each Operator a Final Assessment is drawn up; a report is written by Doctors with Africa Cuamm/Padova, one by the Operator and another one by the Project-leader or Country Representative.

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5 DOCUMENTATION CENTER Objectives - To be up to date in the International news in the Tropical Medicine field (to spread serious and specialized culture).

- To improve the professional qualification of candidates at their departure, of working doctors, and of partners (Training and Updating Courses).

-To encourage contacts and exchange of research at the International level in the health cooperation field with Developing Countries (enhancement of acquired, and under way experience).

The Documentation Center offers a series of cultural and scientific publications, as broad and up-to-date as possible, on the issues regarding Developing Countries and International cooperation. It includes over 3,000 books and scientific journals, periodicals and various publications, often not available in other libraries or bookstores in Italy.

Part of the Center is a General Medicine library with more than 3,800 books, annually updated, and representing an important support for the medical professionals.

5.1 Carried out activities International and Tropical Medicine Collaboration Prof. Giovanni Baruffa (Pelotas/Rio Grande do Sul, Brasile); from 28 March to 18 June 2005.

Updating of the Specialized Library in Tropical Medicine New acquisitions (n. 15), purchase of training texts (n. 120), subscriptions to Italian and specialized foreign journals (see Table 1).

Documentation Center Access The consultation of available material is possible in agreement with the Training Official.

Along with books and journals, slide sets from TALC, assembled in 15 areas are also available: Public Health, Ginaecology and Obstetrics, Infectious Diseases, Stomatology, Endocrinology, Ematology and Immunology, Radiology, Diagnostic Tecnichs, Feeding, Pediatrics, Opthalmology, General Surgery, Rehabilitation and Orthopedics, Anaesthesia, Microbiology and Parasitology.

Videotapes Videotapes are available for public information events and awareness campaigns. They are divided by subject: Health, Doctors with Africa Cuamm Programs, Training, and Various subjects.

Libraries Updating for coordination groups in Africa > For the coordination offices in Africa and for the personnel, distribution of the Cd of the training course on organisation, management and health services in Africa” > For the coordination office in Uganda: 4 books (Tb and HiV, Tropical Medicine, Medical Laboratory 1/2) Subscriptions for coordination groups Tropical Doctor (see Table 2) 2005 Subscriptions for Nkozi Martyrs University “International Journal of Health Planning and Management” 115 Subscriptions for Doctors with Africa Cuamm library New subscriptions for the year 2005 have been eight. Concerning other journals an exchange with our journal “Salute e Sviluppo” has been achieved.

Table 1 JOURNALS OF TROPICAL HEALTH CENTER 2005 AIM Reports Mozambique Appropriate technology Bulletin WHO Contact (CMC Churches) Health Policy and Planning Journal of Tropical Pediatrics Tropical Doctor Weekly Epidemiological Record

Table 2 SUBSCRIPTION FOR HOSPITALS AND AFRICAN HEADQUARTERS: 2005 Tropical Doctors for Cuamm DAR ES SALAAM (TANZANIA) Cuamm MAPUTO (MOZAMBICO) Cuamm KAMPALA (UGANDA) Cuamm ADDIS ABABA (ETIOPIA) Cuamm LUANDA (ANGOLA)

ASSOCIATION LIFE 1 STUDENTS COLLEGE 1.1 Aims Doctors with Africa Cuamm was born as boarding school for the training of the students of the Faculty of Medicine, oriented to rendering their voluntary services in the developing countries and engaged in sensitisation activities in Italy.

According to art. 2 of the code, “Cuamm proposes the aim to contribute, in the spirit of Gospel and as not-for-profit , to the redemption and growth of each person, mainly the most in need and the suffering, to the independent and autonomous development of the populations of the third countries, to the assertion of values of international solidarity, of justice and peace” To share these aims, an accurate professional training within a serious and regular training path is required.

1.2 Activities

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The students hosted by the College in 2005: 50 Indian religious people, students of the Faculty of Medicine, hosted in institutes in Padova thanks to Doctors with Africa Cuamm: 4 Students graduated in 2005: 4 The training path of the college is articulated in three domains: > Spirituality > Culture > Sensitisation and solidarity

1.3 Spirituality > A day of spirituality in Advent: 19th November > End of week in Lent: 30th April > Weekly Eucharist

1.4 Culture For the internal students, various sessions are proposed for their knowledge: a. participation to the Optional Course “Health and Healthiness in Africa”. Topics dealt: > Health and health services in Africa (dr. Roberto Gnesotto); > Health and the territory: public health interventions (dr. Claudio Beltramello); > Primary Surgery: referring surgical cases (dr. Rita Polo); > Child health: hospital and primary health care services (dr. Marzia Franzetti); > Mother health care (dr. Patrizia Morganti) b. participation to Saturday Cuamm c. meetings with expert Doctors with Africa Cuamm staff

1.5 Sensitisation and solidarity The college is integral part of the NGO Doctors with Africa Cuamm and is requested to contribute, according to its capacities and possibilities, to the health development projects that are on-going in Africa. It is a concrete activity that is rendered explicit through: a. sensitisation activities and fundraising in the parishes or associations where they come from; b. sensitisation activities and fundraising designed and managed in the College, mainly addressed to the university and the town of Padova.

Among them, deserve mentioning: > collaboration with radio programmes of the Radio of the Diocese > cineforum, discussions after films, in collaboration with the Diocese Centre for Social Communication; > a music party for the university students > update of Doctors with Africa Cuamm web-site (www.doctorswithafrica.org) ; > active participation during “Saturday Cuamm” > support various activities of Doctors with Africa Cuamm in the area, including the preparation of small works.

2. INFORMATION SESSIONS These meetings take place, every two months, on Saturday morning, at the Doctros with Africa Cuamm headquarter. They intend to present and discuss issues concerning International health, cooperation, and development.

It is an initiative of awareness, information, and discussion addressed to health operators mainly, but also to a broader audience.

The invitation reaches in particular the Padova area and it is sent to those “in contact” with the organization (around 600 addresses).

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COMMUNICATION AND INFORMATION SECTOR

COMMUCATION AND INFORMATION Sensitisation campaigns and Public Relations The year’s products The year’s principal events Publications Sensitisation material Educating for developement

COMUNICATION AND INFORMATION Overall, in addition to its traditional activities, the year has seen a series of specific actions carried out by the Communications sector, concentrated in three main areas: > Co-ordinated Identity Restyling The restyling of the organisation’s co-ordinated identity has led to a decisive improvement in image and reputation. This has involved a careful and profound rethinking of all the various instruments of communication in Italy and Africa, intended to promote a betterdefined and more incisive perception of Doctors with Africa Cuamm and clearly distinguish it from other and larger organisations in the same field. > Communication Plan Our aim has been to improve our performance in proposal, debate and information on themes concerning Healthcare Co-operation. As a consequence, we have carried out a methodical and integrated media campaign (in the press, TV, radio, at local and national levels), to publicise Doctors with Africa Cuamm’s aims and activities via the creation of a specific sensitisation campaign on the theme of “with Africa”. > Integrated Communication Strategy We have pursued the objective of rationalising in a unified and coherent manner the content, form and means of communication, through the creation of an Image Manual.

Our integrated communication strategy has been applied on two different levels: integration and homogeneity of all Doctors with Africa Cuamm’s communication instruments and actions; integration and homogeneity of the instruments produced by Doctors with Africa Cuamm groups or by single areas.

1 SENSITISATION CAMPAIGNS AND PUBLIC RELATIONS 1.1 The “With Africa” Campaign 2005’s most significant project has been the launch of the “with Africa” campaign.

Presented to the public on the 18th of November in the Sala del Carroccio in the seat of Rome’s municipal government, its aim is to promote public sensitisation of the concept of the African people’s right to health. The predominant message is the theme of sharing.

Doctors with Africa Cuamm’s bond with the African continent is made up of over fifty years’ field work inspired by that one key word: “with”. Doctors with Africa (and not “for Africa”) is an expression of the choice of sharing with others, signifying profound participation, exchange, joint effort, working and suffering together with African mothers and children, with people infected by Aids, tuberculosis and malaria, with all those in need of medical treatment.

In order to give voice to the real Africa, whose daily struggle is shared by Doctors with Africa, the “with Africa” campaign is the first communications project by a non-government organisation to make use of internationally recognised and successful African artists: in the press campaign and in radio and TV commercials it is Africa and the Africans who speak about themselves, their potentials and their needs. Thus art becomes a potent universal instrument for the transmission of a message of social responsibility…. “because we have to affirm in a radical but not merely provocative way that we are neither Westerners nor Africans, but simply human beings”, as the artist Pacale Marthine Tayou underlined at the presentation, “and as such, at home and citizens everywhere”.

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> The “with Africa” press campaign develops the theme of the encounter with otherness and of mutual sharing, involving for the first time some of the best-known contemporary African artists whose work speaks of their continent: Myriam Mihindou, Pascale Marthine Tayou, and Outtara Watts. > The subject of the TV commercial is “Hands”: it focuses on the unbandaging of an African man’s hands, metaphor for healing but also for the release of Africa’s expressive potential. The commercial is by the African director Mohammed Soudani, with music

by Lokua Kanza, collaborator of Peter Gabriel. > In the radio commercial, the speaker evokes the idea that encounter and sharing with otherness is an occasion for enrichment and growth. The soundtrack is by the African musician Lokua Kanza.

Press advertising and TV and radio commercials have begun appearing at national and local levels, thanks mainly to the unpaid collaboration of broadcasters and publishers.

The campaign has specifically involved the main national weekly magazines, magazine supplements published with the major national daily newspapers, some national radio stations and many local TV stations. In 2006 this process will be extended to the principal national TV networks.

1.2 Other activities

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In parallel to the “with Africa” Campaign, we have pursued our other activities connected with press-releases, press dossiers and documental archives in connection with the year’s most important events (see calendar of the year’s principal events). Also important has been the organising of appearances and interviews on radio and TV. External communication activities have particularly concerned Study Days, local exhibitions, the days dedicated worldwide to specific diseases, and making known the organisation’s position on various topical subjects.

2 THE YEAR’S PRODUCTS PUBLICATIONS DESCRIPTION Health and Developement > Issue n° 2. 2004 > Issue n° 3. 2004 > Issue n° 1. 2005 > Health and Development 2004 Cuamm Solidarity > Two issues in 2004 and five issues in 2005, one every two months The Four Winds Two issues, one in June one in December SENSITISATION MATERIALS Project brochures for sensitisation

Promotional Accessories in Africa and Italy

Sympathiser Fidelity Materials MATERIALS FOR EVENTS Open Day, Study Days, Cuamm Saturday Notebooks

Material for Doctors with Africa Cuamm Party, 18/06/2005

DESCRIPTION > > > > > > > > > > > > > > > >

Ethiopia Orthopedic Brochure Advanced Training courses Brochure Vocational Training Poster Post-cards and posters Institutional Brochure Personalised Diaries Visiting Cards Press Kits Personalised Pencils (reprint) Pens Personalised T-shirts for adults and children Cloth bags Choker Key-rings Badges Stickers Africa Kit (backpack, belt-bag, T-shirt, doctor’s coat, cap, sleeveless jacket) > Sensitisation Campaigns Campaign Cards and > Envelopes > Pre-printed Post Office payment forms > Press Advertising > Headed writing paper and envelopes for Thank You letters > 2005 Special Aids Appeal > Christmas Cards 2004 DESCRIPTION > 2 PVC banners, color-printed on both sides, 100x200cms > 10 PVC banners, colour-printed on one side, 78x150 cms > 2 Forex panels with coloured vinyl adhesive stickers 240x200 cms > 1 Giant Poster 200x300 cms > Leaflets for Study Days 2004-2005 (1,500) > Invitation Postcards for Study Days 2004-2005 (2,500) > Leaflets for Open Day (1,500) Invitation Postcards for Open Days (2,500) > Study Day Records > 1 PVC banner, presenting Countries and Cuamm > Projects 10m x 3 m > 1 PVC banner 2m x 3m > Cuamm Party Postcards (3,000 copies) > 50 copies DVD “Roads” > 2 hand-painted panels

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Civitas 6-7-8 /05/2005 Terrafutura (Futureland) 8-9-10/04/2005 Caorle Exhibition 16/7 - 01/8 Educating for Developement Perugia-Assisi March 11/09/2005 Mozambique Donors Conference 19/09/2005 “with Africa” Campaign 18/11/2005

> 1 PVC banner, one side color-printed, 400x250 cms > 1 PVC banner, one side color-printed, 400x250 cms > > > > > >

50 posters 33x47 cms 250 single-leaf invitations 16.5x10.5 cms 3,000 metal-bound “A day with Mazengo” dossiers, 15x20 cms, closed format 400 copies of slides “A day with Mazengo” 1 PVC banner 250x100 cms

> 250 folded invitations 10.5x22 cms > 1,500 folded invitations 21x10.5 cms > 200 folded invitations (in English) 21x10.5 cms

2.1 Website and Digital Newsletter

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Doctors with Africa Cuamm’s new website (www.mediciconlafrica.org) has been online since April 2005. The result of a complete renewal in graphic design, programming and content, this operation has created an instrument for presenting the organisation and its activities aimed at projecting the image of Doctors with Africa through Internet. An extremely simple graphic layout helps navigators quickly find the different sections and easily search for the information that interests them. The site is further enriched by numerous service instruments, including the possibility of consulting the complete online archive of Health and Development from 1999, as well as the latest issues of Cuamm Solidarity and Quattroventi (Four Winds).

In parallel to the website, the digital newsletter “Voices from Africa” was inaugurated in October, and is a new communication instrument which broadens the organisation’s informative panorama. News and information, first-hand accounts, stories from Doctors with Africa Cuamm’s various projects and a selection of upcoming events, all helping the reader, wherever they may be, to be “with Africa”. Conceived as a more agile way of circulating information thanks to its electronic flexibility, the newsletter is structured in four main sections. Under “Focus” come the month’s most important news items, while “From Africa” carries first-hand accounts from volunteers in service, and “Appointments” lists important upcoming events. The section “Let’s make a network” (“Facciamo rete”) deserves a special mention. It is dedicated to initiatives and discussions on the theme of “being with Africa” in Italy. It lists activities organised all over the country and carries accounts of experiences from our partners, especially the Doctors with Africa Cuamm Groups, who are active at a local level in promoting being with Africa in Italy.

3 THE YEAR’S PRINCIPAL EVENTS EVENT Saturday 22.01.2005 12.03.2005 07.05.2005 22.10.2005

Terrafutura (Futureland) Florence 8-10 April 2005 Italy Africa Rome 21-28 May 2005 Civitas, Padua 6-8 May 2005 Cuamm Party 18 June 2005

DESCRIPTION > “Aids: an uphill road. Comparing experiences” > “Health objectives for the millennium. Commitments or wishes?” > “Margins at the centre. Forgotten illnesses in Angola and Mozambique”. > “A question of coherence: educating for development, the other side of co-operation.” > Promotional Stand and sale of material, run with help from volunteers from Tuscany. > Promotional Stand and sale of material, run with help from volunteers from Rome. Good attendance and excellent visibility.

Present in Civitas with a Promotional Stand

> Large-scale get-together of all the Doctors with Africa Cuamm who in the fifty five years of the organisation’s history have served in Africa. “with Africa” Campaign > Communication campaign (press campaign, radio and TV 18 November 2005 commercials) on the theme of Sharing, basic element of Doctors with Africa Cuamm’s identity.

Invisibile Africa > Good attendance, important opportunity for sensitisation on Exhibition the problems of co-operation and Doctors with Africa Caorle (Venice) Cuamm’s projects.

16 July - 01 August 2005

3.1 Participation in events in Italy > TERRA FUTURA (Future World) FLORENCE 8-10 April 2005 – promotional stand run with help by volunteers from Tuscany International Exhibition and Conference on viable sustainability practices under way in various fields: everyday life, social relations, the economic system, government practice…

“Terra Futura” (Future World), held in Florence, at the Fortezza da Basso, from the 8th to the 10th of April 2005, was an excellent opportunity for the presentation and promotion of all those initiatives that have been taken to try out and utilise in the fields of government, social relations and organisations, consumer behaviour, production, finance and sustainable commerce. Organised around five main themes: habitation, production, cultivation, action, government.

Doctors with Africa Cuamm was present at Terra Futuro with a promotional stand in the “Action” section. > ITALY AFRICA – ROME 21-28 May 2005 – Promotional Stand run with help from local volunteers The 28th of May was our NGO’s second showing at the Italy – Africa event. This year we again felt the need to participate in this event as a way of drawing sufficient attention to the injustices, the wars and the new kinds of slavery that still crush hundreds of millions of people, to reinforce the commitment to justice and to stress that our own future depends on the future of Africa.

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> CIVITAS 2005 Doctors with Africa Cuamm took part again in this year’s Civitas event, with a promotional stand that kept our volunteers busy over the non-profit fair’s three days. The high attendance at Civitas makes it an important opportunity for increasing Doctors with Africa Cuamm’s visibility. Above all it offers a chance to reach a young public, and to some extent the schools.

> STUDY DAYS AND CUAMM SATURDAY EVENTS During the first part of 2005 we were still using material planned at the beginning of the 2004-2005 “Cuamm Saturdays”. As we began on our new programme, new materials were established, and this was a useful contribution to what is an important sensitisation initiative greeted with growing interest and attention by school-age children and university students. In line with last year’s approach, we continued to explore themes not exclusively dealing with health, a method that offers interesting angles of reflection and at the same time broadens appeal.

4 PUBLICATIONS

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Once again, Doctors with Africa Cuamm’s publications offer their annual contribution to the panorama of Italian publishing with various intentions: to promote discussion of ideas, to compare different approaches, to provide information on new international policies, to provoke thought and dialogue and to evaluate the many kinds of possible means and ways of co-operation and sensitisation. They also aim to transmit first-hand accounts, to bear witness, to stimulate the growth of a co-operation culture through the example of people’s real experiences in the field. In particular they promote in-depth study of subjects connected to the idea of “health and development”, perspectives on international co-operation and volunteer contributions, and crucial issues in the health field and different approaches to the organisation of health services.

HEALTH AND DEVELOPEMENT This magazine began 16 years ago as a means of internal communication within the association and of providing news on its projects. It assumed its definitive title as “Health and Development” in 1999, and is published every four months in editions of 90-100 pages, with a print-run of 4,000.

Up to the first issue of 2001 the graphic design and internal structure introduced in 1999 remained constant. Each issue has eight sections: 1. In this issue: a single page listing the contents.

2. Dialogue: a series of brief editorials from various writers, offering points of reflection and discussion.

3. Health Politics: the transformations underway and the most important issues and debates.

4. Health Co-operation: institutional and NGO policies and strategies.

5. Afrinews: subdivided into three sections: Agenda (significant upcoming events), Focus (in-depth discussion of one issue), and “History” (aspects of Africa’s past).

6. Observatory: information from international sources.

7. Health Numbers: data and statistics of special interest.

8. Review: books, articles, conferences and events.

Today the magazine is increasingly in demand by research bodies, operators in the same field, and students preparing theses. A substantial restyling was introduced from the second issue of 2001, reflecting the desire to reach a wider public with an issue dedicated entirely to Aids. In subsequent issues, while returning to its usual structure it maintained the radically new graphic design and format, which consolidated itself over the course of the year 2002.

The first issue of 2003 saw the beginning of a new feature within the Health Co-operation section where, under the title Focus/Nation, each issue devotes itself to one of the countries where Doctors with Africa Cuamm operates, offering detailed information and analysis on budgetary data, the hospital situation, the project context, along with critical reflection: Issue N° 2.2004 N° 3.2004 N° 1.2005 N° in English Totale

Copies 3,900 3,800 3,800 1,000 12,500

CUAMM SOLIDARITY This news-sheet originally came into being as a supplement to Health and Development, with the idea of communicating the same subjects in simplified terms so as to reach a wider, more heterogeneous and non-specialised public. In 2001 it underwent a restyling in order to improve its achievement of these goals and doubled its number of pages so as to be able to treat issues in a more articulate way.

By 2003 its structure had become well established: the first two pages focussing on one topical subject, the two central pages devoted to current initiatives in Africa (statistics, needs, experiences and testimonies), and the last two dealing with events in Italy and descriptions of members’ experiences in the field.

Cuamm Solidarity is an increasingly important and well-received organ of communication within the organisation and between its supporters, with a print-run of over 43,000 copies, mostly sent by postal subscription. A few thousand copies are distributed in various Italian sensitisation events where the issue’s main subject is related to the theme promoted in the event.

2005 saw the publishing of two issues relating to 2004 and 5 issues relating to 2005:

Issue N° 5/04 6/05 1/05 2/05 3/05 4/05 5/05

Main Subject

Copies

Patience in sowing seeds/Vocational training in Africa Training, hospitals and territory/All the dimensions of caring Infinite Pain/Another disaster in Angola With Africa at heart/Exchanges of gifts and of life Doctors with Africa Cuamm/2005’s Projects An appeal from a poor country/Committment in Dubbo, Ethiopia.

Cradle of Hope/The Africa of dignity and courage

45,000 42,000 45,000 43,000 45,600 43,000 43,250

FOUR WINDS This is the traditional channel of communication within the association, renewed in many aspects in 2000. It too was restyled in 2001, and the graphic design of its articles and images enlivened. Published twice yearly in June and December, it carries updated news on the life of the Doctors with Africa Cuamm, using letters and personal reflections of the volunteer personnel, registering departures and returns, births and marriages, dates and events.

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Issue December 2004 June 2005 Total

Copies 1,100 1,200 2,300

RECORD OF STUDY DAYS A comprehensive record of all the contributions to the Study Days at Padua head office in 2004/2005 was published in one volume, of which 1,000 copies were printed.

5 SENSITISATION MATERIAL The year by year updating of our instruments of communication and information is intended to make Cuamm better known and to promote sensitivity and attention to Africa’s problems. In 2005 various brochures, posters, leaflets, and PVC panels were used to promote meetings. Already existing materials were also distributed and in some cases reprinted: BROCHURES ON SPECIFIC INFORMATION CAMPAIGNS

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Subject Ethiopia Orthopedic Brochure Aids Brochure Angola Brochure Total

Copies 1,500 44,000 800,000 845,500

To reach and mobilise new supporters, we carried out a major subscription-letter postal campaign, concentrated on the same themes. During the year over 800,000 fund-raising letters were sent out, each with a presentational brochure. This operation required a reorganisation of our contacts database and the subsequent sending out of thank you letters, all of which weighed heavily on the Communications Sector’s budget. 15,000 thank you letters and envelopes were printed and posted.

PROMOTIONAL ACCESSORIES As part of our communications campaign in Africa and Italy we made the following: Kinds of material Institutional Brochures Personalised Diaries Visiting Cards Press Kits Personalised Pencils (reprint) Pens Personalised T-shirts for adults and children Cloth bags Choker key-rings Badges Stickers Christmas Cards Africa Kit (Rucksack, belt-bag, T-shirt, doctor’s coat, cap, sleeveless jacket) Photoresists for visiting card reprints

Copies 20,00 170 2,900 500 1,000 1,500 1,000 2,000 1,000 500 5,000 800 200 400

6 EDUCATION FOR DEVELOPEMENT Some of the encounters organised in schools

Date 19/11/2004 26/11 3/12 10/12 7/1/2005 21/1 28/1 11/2 18/2 25/2 4/3 11/3 10/1/2005 17/1 24/1 31/1 21/2 28/2 7/3 14/3 21/3 11/4 18/4 2/5

School State Secondary School, First Year Students State Secondary School, First Year Students State Secondary School, First Year Students State Secondary School, First Year Students State Secondary School, First Year Students State Secondary School, First Year Students State Secondary School, First Year Students State Secondary School, First Year Students State Secondary School, First Year Students State Secondary School, First Year Students State Secondary School, First Year Students State Secondary School, First Year Students State Secondary School, Second Year Students State Secondary School, Second Year Students State Secondary School, Second Year Students State Secondary School, Second Year Students State Secondary School, Second Year Students State Secondary School, Second Year Students State Secondary School, Second Year Students State Secondary School, Second Year Students State Secondary School, Second Year Students State Secondary School, Second Year Students State Secondary School, Second Year Students State Secondary School, Second Year Students

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9/5 23/5 30/5 4/12/2004 11/12 18/12 22/1/2005 29/1 12/2 19/2 26/2 5/3 12/3 130 19/3 23/4 30/4 7/5 14/5 10/10/2005 17/10/2005 24/10/2005 7/11/2005 14/11/2005 21/11/2005 28/11/2005 5/12/2005 12/12/2005

State Secondary School, Second Year Students State Secondary School, Second Year Students State Secondary School, Second Year Students State Secondary School, Second Year Students State Secondary School, Second Year Students State Secondary School, Second Year Students State Secondary School, Second Year Students State Secondary School, Second Year Students State Secondary School, Second Year Students State Secondary School, Second Year Students State Secondary School, Second Year Students State Secondary School, Second Year Students State Secondary School, Second Year Students State Secondary School, Second Year Students State Secondary School, Second Year Students State Secondary School, Second Year Students State Secondary School, Second Year Students State Secondary School, Second Year Students State Secondary School, Third Year Students State Secondary School, Third Year Students State Secondary School, Third Year Students State Secondary School, Third Year Students State Secondary School, Third Year Students State Secondary School, Third Year Students State Secondary School, Third Year Students State Secondary School, Third Year Students State Secondary School, Third Year Students

Vigodarzere (Pd)

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GROUPS SECTOR

THE GROUPS Partner groups of doctors with Africa Cuamm Friends of doctors with Africa Cuamm groups

THE GROUPS As defined in the Doctors with Africa Cuamm internal regulations, “the Groups are legally constituted autonomous associations which within specific regions promote Cuamm’s ideals and support its initiatives. An Association becomes a Cuamm Group when, satisfying the essential requisites as specified in a relevant document, and undertaking to follow the guidelines set out in the appropriate protocol agreement and to participate in the co-ordinating organism as defined in the following article, they have been officially recognised as suitable by the Board of Directors. An Association ceases to be a Cuamm Group if it fails to engage in activities directly connected with Cuamm, or if it has been declared unsuitable by the Board of Directors.” (Article 8 of the Regulations) The Groups are recognised as being among the legitimate participants in the organisation (Article 4 of the Regulations) and actively contribute to carrying out its activities, both in Africa and Italy. The Groups’ main activities are: > offering support to Doctors with Africa Cuamm’s health co-operation projects in Africa; > promoting public sensitisation and educating for development in Italy.

Offering support to projects in Africa consists principally in recruiting human resources, fund-raising, planning relevant local co-operation projects and mobilising other donors.

Activities related to educating for development consist in information campaigns and sensitisation, involvement with the world of education (e.g. in schools), the organisation of local events, solidarity operations (e.g. involving immigrants), and are aimed at reviving interest and hope in Africa’s future among institutions and public opinion, on the one hand, and also at promoting values concerning solidarity and co-operation between peoples.

At present the Groups are organised in three categories: > Doctors with Africa Cuamm Groups, recognised by the Board of Directors (9 Groups) > Partner Groups of Doctors with Africa Cuamm, close to the organisation but not yet recognised by the Board of Directors (4 Groups) > Friends of Doctors with Africa Cuamm Groups, associations with a wider range of objectives and activities who regularly support some of the organisation’s projects (10 Groups) In May 2005, in order to promote and co-ordinate the activities of the various Groups in a more efficient and structured way, a Group Sector was set up at Doctors with Africa Cuamm’s head office. At present staffed and run by one person, this sector co-ordinated the organising of a workshop on the 29th of July 2005, open to all the Groups and dedicated to presenting and discussing proposals regarding the activity and organisation of this new Sector and its relations with the Groups. These proposals were further discussed with single Groups during a series of visits made by the Sector’s director to the following Groups: Medici con l’Africa Modena and Reggio Emilia (Modena, 4th October 2005), Medici con l’Africa Como Onlus (Como, 18th November 2005), Associazione Cuamm Lecco (Lecco, 21st November 2005), Santarcangelo Città del Mondo (SantarcangeloRimini, 22nd November 2005), Medici dell’Alto Adige per il Terzo Mondo Onlus (Bolzano, 3rd December 2005), Africa Chiama Associazione Amici dei Medici con l’Africa (Conegliano, 16th December 2005), and Jenga-Insieme Cuamm Medici con l’Africa Siena (Siena, 17th December 2005). The proposals will also be discussed by the Group Co-ordination Committee, whose job is to co-ordinate the activities of the various Groups and connect them with those of the head office, to promote the creation of new Groups, and to discuss and prepare proposals and opinions to be submitted to the Board of Directors and/or the Executive Director (Article 9 of the Regulations).

Here are a series of detailed accounts of activities carried out by single Groups during 2005…

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1. DOCTORS WITH AFRICA CUAMM GROUPS CUAMM MEDICI CON L’AFRICA - TRENTINO Address: Tel. Fax E-mail President

Via Valsugana, 51 - 38100 Trentino 0461 2397976 - cell. 340 7231600 0461 983929 adrianobertoldi@virgilio.it Adriano Bertoldi

N° members 50

Activities in support of Doctors with Africa Cuamm’s healthcare co-operation projects in Africa Countries supported: Angola - Ethiopia Projects supported: > Support for the Canova Vocational Training Centre for nursing personnel in the province of Uige, Angola. > Healthcare and peacekeeping in the province of Cunene, Angola.

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Initiatives carried out: In 2005 the Group promoted the following projects, financed respectively by Trentino Alto Adige Region and by the Province of Trento, in support of Doctors with Africa Cuamm projects in Angola: > Support for Permanent Vocational Training Centre for nursing personnel in the province of Uige. > Modernisation of medical facilities in the Chiulo Hospital In support of Doctors with Africa Cuamm projects in Ethiopia, the Group has also submitted the following projects for funding by the Provincial and Regional local governments in 2005: > Structural renovations to the Health Centre in Wolisso, submitted to the Trentino Alto Adige Region for financing. > Institution of a Department of Public Health in the hospital in Dubbo, submitted to the Province of Trento for financing.

During 2005 the Gruppo Cuamm Medici con l’Africa - Trentino also took part in the “Mozambique Consortium”, within the framework of the decentralized joint co-operation project between the Province of Trento and the Province of Caia in Mozambique, collaborating on a health care project which includes Aids prevention, the renovation of various Health Centres, and the “ante natal clinic”. The President of the Consortium is a doctor who works with Doctors with Africa Cuamm.

In the context of supporting the recruitment of medical personnel for African projects, in June a new volunteer of Doctors with Africa Cuamm, Dr. Mario Battocletti from Trentino, departed for Ethiopia with his family. Various solidarity initiatives and fund-raising events were organised in connection with this event, as briefly listed here: > May: an evening presenting Doctors with Africa Cuamm and the Battocletti family in the Mezzolombardo Theatre. > The Mezzolombardo Missionary Group committed itself to support the Dubbo hospital where Dr. Battocletti works. From the 8th to the 10th December it organised a small Missionary Market.

> On the 23rd December the little Oratory theatre and the Hosanna Choral group of Mezzolombardo presented the recital “The Legend of the Fourth King”. Doctors with Africa Cuamm promotional materials (T-shirts, bags, etc) were distributed in the foyer, and the box-office takings were donated to the Association. > In November there was a fund-raising concert featuring three local musical groups. A brief film of Dr. Battocletti’s work was shown and the box-office takings were donated to Doctors with Africa Cuamm. > Towards the end of December 700 calendars were printed, using photos taken in Ethiopia by Dr. Battocletti’s wife Miriam, to be distributed to various supporters and benefactors.

Local sensitisation activities and educating for development. > 2 March – Primary School, Canale di Pergine (Tn), educational and sensitisation encounter with the catechesis group preparing for their Confirmation. Representatives of Doctors with Africa Cuamm were Carmelo Fanelli and Laura Maldini. 18 children and 3 catechists attended. > 19 March – Oratory, Levico Terme (Tn), sensitisation encounter with 5 Primary school catechism groups, with catechists and parents, followed by frugal supper of boiled rice. Representatives of Doctors with Africa Cuamm were Carmelo Fanelli and Laura Maldini. Between adults and children, about 70 people attended. > 30 March – Nursery School, Pian dei Pradi (Tn), preparatory evening with parents of children attending the nursery school, in view of an encounter to take place with their children during school hours. Representatives of Doctors with Africa Cuamm were Carmelo Fanelli, Laura Maldini and Roberto Cappelletti. About 40 adults participated. > 25 May – Nursery School, Centa San Nicolò (Tn). During school hours Carmelo Fanelli introduced Africa to the children using a slide show and games made by African children. > 9 June – Public Encounter in the Auditorium, Vigolo Vattaro. Representatives of Doctors with Africa Cuamm were Carmelo Fanelli and Laura Maldini. About 25 people attended. > 24 October – Primary School, Vattaro (Tn). During school hours Carmelo Fanelli introduced Africa to the children using a slide show and games made by African children.

About 20 children took part. > 15 November – Primary School, Levico Terme (Tn). During school hours Carmelo Fanelli introduced Africa to the children using a slide show and games made by African children. About 70 children took part. > 20 November – Multifunctional Hall, Mattarello (Tn). Solidarity Concert “Children for the Children”, organised by the Torrefranca Chorus in collaboration with the Marzari Bakery. Performances by the Torrefranca Mini-chorus from Mattarello and the “Vogliam cantare” chorus from Trento. At the end of the concert Carmelo Fanelli gave a brief talk with slideshow on Doctors with Africa Cuamm’s mission. About 200 people attended. > 26 and 27 November – Multifunctional Hall, Romagnano (Tn). Solidarity Bazaar in favour of Doctors with Africa Cuamm, organised by the “Le Gnampe” Group from Trento. Various hand-made items were on sale (plates, vases, ornaments, clothes etc. decorated with decoupage). Over the two days Doctors with Africa Cuamm’s activities were illustrated with poster displays and other information. On the afternoon of the 27th of November Carmelo Fanelli gave a slideshow talk on the subject of Doctors with Africa Cuamm. > 30 November – Nursery School, Calceranica (Tn). During school hours Carmelo Fanelli introduced Africa to the children using a slide show and games made by African children. About 35 people took part. > 6 December – Primary School, Canale-Pergine Valsugana (Tn). During afternoon

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school hours Carmelo Fanelli introduced Africa to the children using a slide show and games made by African children. About 100 people took part.

8 December – Presentation of a project by the Vattaro Primary School’s Fifth Class, “From Brother to Brother”. The children and their teachers performed a play, attended by the mayors of Vattaro and Bosentino (Tn). Part of the items in the Christmas Bazaar organised by the children were sold in aid of Doctors with Africa Cuamm. The representative of Doctors with Africa Cuamm was Carmelo Fanelli.

13 December – Public Encounter in the Primary School of Canale-Pergine Valsugana (Tn). Representatives of Doctors with Africa Cuamm were Carmelo Fanelli and Laura Maldini. About 15 people took part.

15 December – Nursery school, Matterello (Tn). During school hours Carmelo Fanelli introduced Africa to the children using a slide show and games made by African children. About 120 people took part.

17 December – Susà-Pergine (Trento), at the Artigianelli Theatre, children from the Canale Primary school, together with the parish choirs of Canale, Santa Caterina and San Vito, organised a fund-raising Christmas Concert. Representatives of Doctors with Africa Cuamm were Carmelo Fanelli and Laura Maldini. About 350 people attended.

20 December – Primary School, Levico Terme (Tn). Christmas Bazaar in aid of Doctors with Africa Cuamm. The representative of Doctors with Africa Cuamm, Carmelo Fanelli.

23 December – Vigolo Vattaro (TN). Volunteers from Vigolo Vattaro’s S.A.T. group organised a Banquet to publicise Doctors with Africa Cuamm, the price of the meal being decided by each guest, and the proceeds going to Doctors with Africa Cuamm.

ASSOCIAZIONE CUAMM LECCO Address: Tel. Fax E-mail President

Viale Turati 22 - 23900 Lecco 0341 602961 - cell. 328 6163941 0341 350330 cuammlecco@tiscali.it Giovanni Molinari

N° members 80

Activities in support of Doctors with Africa Cuamm’s healthcare co-operation projects in Africa Countries supported: Ethiopia - Mozambique Projects supported: Reinforcement of the district healthcare system in the Beira Corridor (Sofala Province, Mozambique)Wolisso Hospital and Nursing School (Oromia Region, South West Showa, Ethiopia) Initiatives carried out: The Group carried out various fund-raising activities over the year 2005, receiving some donations on a regular basis from various members and sympathisers, and other donations on an occasional basis from participants in various events.

It also presented a micro-project in support of the Beira Project, participating in the competition organised by the Lecco Committee for Peace and Co-operation between peoples (financed by the Province of Lecco). Subject: public health (no prize won)

During the year two members, the orthopaedic doctors Marco Incerti and Riccardo Bonfanti, continued their collaboration with the activities of the Orthocuamm group, particularly in aid of the Wolisso hospital in Ethiopia.

Local sensitisation activities and educating for development.

One Ordinary and one Extraordinary Association Assemblies were organised, open also to the public: > in mid-May an Ordinary Assembly featured the first-hand testimony of Doctors with Africa Cuamm volunteer Dr. Cristina Pizzi, in service in Beira-Dondo, Mozambique (about 40 participants); > at the end of the year an Extraordinary Assembly heard Dr. Cristina Pizzi speak of the end of her service in Mozambique and her upcoming service in Ethiopia, as well as exvolunteer Dr. Marina Anghileri. Presentation of Doctors with Africa Cuamm’s new cultural project “with Africa” (about 40 participants).

The Group ran a Stand promoting the Association in these local events: > “Manifesta 2005”, a Province of Lecco’s voluntary workers’ Happening held in Osnago from the 20th to the 22nd of May; > “Festa Missionaria”, a parish initiative in Monte Marenzo from the 1st to the 5th of June.

The Group was also present at various occasions promoting the culture of solidarity organised by local committees or groups. Our councillor Dr. Riccardo Bonfanti continued to participate in the meetings of the Lecco Committee for Peace and Co-operation between Peoples.

From 20 November 2004 to 8 of January 2005 two Group members, Annapia and Paolo Moioli, visited Dr. Cristina Pizzi in Beira. Their experience and testimony was presented to a reunion of the Association’s Board of Directors. th

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Other initiatives of the Association: > Council Meetings, attended also by some members or sympathizers (about 15 people), held on average once a month; in the November Meeting the Group met Serena Foresi, the new director of the Doctors with Africa Cuamm Groups Sector. > The president of the Association attended the 29th of July workshop, in the Padua head office, for the presentation to the Groups of Doctors with Africa Cuamm’s new cultural project and a discussion of the various Groups’ role in it. > Some members participated in the activities for Active Members at the Doctors with Africa Cuamm head office.

AFRICA CHIAMA - ASSOCIAZIONE AMICI DEI MEDICI CON L’AFRICA Address: Tel. Fax e-mail President

Via Cavour, 23 - 31015 Conegliano (Treviso) 0438 450452 – cell. 340 6408309 0438 411164 africa.chiama@libero.it Rinaldo Bonadio

N° of members 98

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Activities in support of Doctors with Africa Cuamm’s healthcare co-operation projects in Africa Country supported: Angola Projects supported: Tuberculosis control in the provinces of Luanda and Uige.

Mother-and-child assistance in Damba and Maquela.

Providing Secondary Maternal and Child Care to displaced people in Uige Province (Uige, Songo and Negage Municipalities) Initiatives carried out: The Group-promoted decentralized co-operation project “HARAMBEE” continued to support the Tuberculosis Cure Project. This three year project concludes in December 2006 and is based on the Province of Treviso’s collaboration with the three ASL health service departments in its territory, each of which are overseen by their respective Mayors’ Conference, covering a total of 95 Municipalities. The project provides for an annual contribution of .19 ? for every citizen resident in the territories covered by the ULSS districts 7, 8 and 9. It is also supported by the Diocese and the Parishes of Vittorio Veneto for the initiative entitled “The Day of Rice”, as well as by other Associations operating in the social sector (the Fishing Sport Association “I Gabbiani” of San Fior, the Mareno Amateur Football Association, the Campologo Amateur Football Association, the Collabrigo Sports Group, the Santa Lucia di Piave Amateur Football Association).

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In support of the Songo hospital, the Water Supply project for the town and hospital of Songo, devised and run by the Group, arranged towards the end of the year for the acquisition in Italy, the transport, and the installing of a motor-pump and its relative water supply pipelines serving the hospital. The installation work was carried out by three technician volunteers from the Group, during a 15 day trip to Angola. Also involved in the project were: the Mato Grosso Group from Chiarano, the Vittorio Veneto USMI, the Municipality of Conegliano, the Province of Treviso, the Veneto Region, the writers Arturo Buzzat and Rita Musumeci, the Orafo Vicentino, the Orsago Banca della Marca, the Conegliano Corocastel, the “Tre Milioni” theatre company, the San Salvatore Choir, and numerous private citizens.

As its contribution to the mother-and-child care project in Damba and Maquela, the Group has contributed to the conversion and renovation of the Damba school, very close to the hospital. The G. Marconi and the Saint Francis Primary schools in Conegliano and the Sansovino Higher Institute for Surveyors and Accountants in Oderzo were both involved, on a fund-raising and sensitisation basis. Other schools have shown interest and will become involved in the near future.

Local sensitisation activities and educating for development.

Various encounters have been organised with Primary and Secondary schools, and two projects carried out: > “Thirst for Justice” on the theme of water as a fundamental human right, with special attention paid to the aspect of “water and health”. The encounters took place at the Marconi Primary school and the Saint Francis Primary school in Conegliano, on the 12th, 14th and 29th of April and the 6th and 11th of May, 2005. > “Africa goes to school”, a project stressing the link between education and health, on the 7th and 14th December 2005. This opened the possibility of involving the schools in support of the conversion and renovation of the school in Damba, and a Christmas

Bazaar was organised on the 22nd and 23rd of December, with a display of African games, instruments and objects. Further school encounters will take place in Spring 2006.

Two further encounters on the theme of voluntary work and the Doctors with Africa Cuamm’s aims and activities took place in High Schools, on the 10th of June in the Collegio Immacolata High School in Conegliano, and on the 7th of November in the Sansovino Higher Institute for Surveyors and Accountants in Oderzo. The second encounter concluded with a collection in aid of the Damba school.

The Group took part in the course entitled “Workshop, School, Volunteer work”, organised by the Province of Treviso.

On the 5th of March it participated in the Conference on volunteer work organised by the “Scuola delle Opere” in the ex-convent of Saint Francis, during which a film on the project for curing tuberculosis in Angola, “TB Angola”, was projected.

On the 17th of September, the “Conegliano for Water” event took place, organised by Africa Calls, with the patronage of the Veneto Region, the Province of Treviso and the Municipality of Conegliano. During the event there was the presentation of a book on the theme of African immigration “In viaggio dall’altopiano” (“The journey from the plateau”) (from Eritrea to Lampedusa) and a concert of traditional songs of Italian immigrants sung by the Corocastel Città di Conegliano choir.

“Queen of Africa and of the whole world” was an event dedicated to the lay missionary work of the Doctors with Africa Cuamm, held in the Follina Abbey from the 8th of October to the 4th of November. On the 23th of October, World Missionary day, the San Salvatore Choir gave a concert. A film made by the Group was shown, entitled “Motivations for a choice: Africa seen through the eyes of someone who has known it just a little, but loved it a lot”. The initiative received appreciative coverage both in the local press and on the Regional television news, and was sponsored by the Banca Prealpi, the Artisans’ Association and various local businesses.

Between the 30th of October and the 6th of November the Group collaborated in the “W Nairobi W” initiative, with school guided visits of the photographic exhibition and a conference on the 4th of November with the title “The right to health: from words to deeds”, in co-operation with the Zikomo Association and the G.Marconi Classical High school.

On the 17th of November 2005 the Group took part in the cycle of conferences entitled “Black Africa, cradle of humanity” organised by the Conegliano Municipality, the Forum on Immigration north of the Piave, and the social co-operative “A Home for Man” from Montebelluna, together with the Community of Sant’Egidio, on the theme “The other Africa of civil action and unofficial networks: the role of the Church and the NGO’s.”

CUAMM MEDICI CON L’AFRICA – GRUPPO DEL PIEMONTE Address: Tel. fax E-mail President

V. Morazzone 11 – 10132 Turin 011 8192193 – 339 5627232 011 8192193 gruppo.piemonte@cuamm.org Marco Pratesi

N° members 47 (concentrated in the Biella and Pinerolo districts and in and around Turin)

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Activities in support of Doctors with Africa Cuamm’s healthcare co-operation projects in Africa Country supported: Ethiopia Projects supported: Support for the Dubbo Hospital (SNNP Region, Wolaita) Support for Mekele Physical Rehabilitation Centre (Tigray Region, Mekele) Wolisso Hospital and Nursing School (Oromia Region, South West Showa) Initiatives carried out: Agreements were made with two parishes in the Biella area providing for them to raise funds during the year, and this resulted in a major financial contribution to our chosen aid projects. We also continued our “target mailing” activity; this was run by three couples among our members who carried out not only the traditional Christmas donation campaign but also two other campaigns aimed at private sector businesses in the Pinerolo and Biella areas.

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The Group participated directly in Doctors with Africa Cuamm’s healthcare co-operation projects in Africa. Some Orthopaedist members and a Turin colleague of theirs took part in the Ortho-Ethiopia project and undertook brief missions to Ethiopia within the ambit of the Wolisso and Makallé projects. A student from Turin specialising in Hygiene served in Beira (Mozambique) for 6 months, as part of the Junior Project Officer programme. A Group member participated in the first week of the basic course in Padua run for those wishing to serve in administrative roles in an African project. Our Association’s President is a member of the Doctors with Africa Cuamm’s main Board of Directors, representing all the Groups, and attended 7 board meetings in Padua.

Some Group members have taken part in various Doctors with Africa Cuamm assemblies in Padua, in the encounter with the African country representatives, in the “Trainers’ Pool” reunions, and in the Group Co-ordination meetings.

We were represented by a member as part of the Doctors with Africa Cuamm delegation on the Perugia-Assisi Peace March (11.09.05) Thanks to donations received, the Group was able to acquire and send various items of medical equipment to Africa: > 1 electro-coagulator (from the Biella hospital), 300 transfusion bags (through the Ivrea hospital), and 100 phials of hysterosalpingography contrast dye (through the Pinerolo hospital) for the Dubbo hospital; > various surgical and orthopaedic instruments (from the hospitals of Biella, Pinerolo and Chivasso), destined for the Wolisso hospital and the Makallè Rehabilitation Centre; > sanitary equipment (beds, gynaecological equipment etc.) received from the Biella hospital, to be checked and sent to projects in need of them; > a request for the acquisition of 3 oxygen concentrators and an obstetric cupping-glass was submitted to the Biverbanca Foundation. These will be sent to the hospitals in Dubbo and Wolisso.

Local sensitisation activities and educating for development.

During the year the Group participated in numerous meetings on the theme of volunteer work promoted by the Province of Biella (Round Table for Peace) and by the Municipalities of Pinerolo and Rivoli, as well as other meetings on the subject of Immigration.

In 2005 the Gruppo Piemonte was officially admitted to the Province of Biella’s Register of Voluntary Workers and was accredited by provincial Voluntary Work Service Centres (2 in Turin and 1 in Biella), being able therefore to take advantage of their facilities (loan of vehicles, vocational courses, printing resources etc.).

We also contacted the Piedmont NGO Consortium, with a view to becoming members, and the Onlus of the San Luigi Hospital in Orbassano, with a view to obtaining support for Doctors with Africa Cuamm projects.

One of our members is on the management committee of the Piedmont HPH Hospital Network, at present involved in improving medical care for immigrants.

As a Group we have organised a number of conferences (8 in the province of Torino: Torre Pellice, Pinerolo, Rivoli, Turin; 5 in the province of Biella: Biella, Cossato), and set up stands within various relevant public events (7 in the province of Torino and 9 in the province of Biella: Pinerolo, Rivoli, Cossato, Biella, Cumiana, Abano Terme). These initiatives were also intended to raise funds for projects in Africa. A special mention for the occasion on June the 2nd, in the context of the “Ciclolonga Cumiana-Erlagen” (or Cumiana-Erlagen Bicycle Outing), a collective bicycle ride to celebrate friendship between peoples, promoted by the Francesco Camuso Bicycle-lovers group of Cumiana to commemorate the 1944 civilian massacre in Cumiana. A number of our members took part in the ceremonies at the start of the ride, out of solidarity with the principles underlying an event which the Group had collaborated in organising. In Salussola the 22 cyclists from Cumiana later met up with a large delegation from the Biella area (co-ordinated by the ApertaMente Association and the Cuamm Medici con l’Africi – Gruppo del Piemonte) that wished to demonstrate friendship and moral support and which included the municipal and provincial councillor Luca Sciaretta and the councillor in charge of Peace Initiatives Davide Bazzini. In Piazza Duomo to greet the group’s arrival was Alberto Zola, Biella’s Councillor in charge of Peace Initiatives, and another group of sympathisers.

2005 marked the first time that the Group went “on the air”: in June on Radio Becwith Evangelica, broadcast in the Pinerolo area, to talk about the Association and advertise for the recruitment of volunteer workers for the National Volunteer Service, and on the 21st of July on the Biella local radio, talking on the Association and imminent events in the area. We were also mentioned in various articles in the Biella press related to initiatives we had organised or taken part in (e.g. the summer work project), and in the Pinerolo press in relation to social service volunteer recruitment.

The traditional biennial event entitled EquaMente was held from the 30th of September to the 9th of October in Ochieppo Inferiore (Biella), and the Group participated with a Doctors with Africa Cuamm photographic exhibition entitled “it’sAfrica”, as well as its usual Stand.

The Group carried out a number of Educating for Development schools initiatives. A total of 7 classes from 4 Primary schools from Luserna San Giovanni and Cossato were involved in a cycle of conferences run by Group members and integrated with projects organised by their respective teachers. A similar approach was taken with a High school class from Cossato. Informational and illustrational stands on Doctors with Africa Cuamm’s activities were on display for a week in two High schools in Pinerolo.

The Group has also carried out numerous activities connected with vocational training.

Several members have taught in vocational training courses, usually 1 or 2 intensive days, such as the Social Medicine course within the courses for Cultural Mediators in Pinerolo, “Primary Health Care” in the Paediatric department, the Doctors with Africa Cuamm basic course, in the Hygiene faculty in Turin, on “Buildings for Health care” in the Architectural faculty in Turin, “Continuous Training” in the Doctors with Africa Cuamm basic course, and “Travel precautions” with the Sportika theatre group from Pinerolo. One member organised a training course in inter-cultural relations and ethno-psychiatry for health workers in the Pinerolo national health service ASL. Other members participated in training courses run by various organisations (Fund Raising Course/Solidarity Idea/Turin and CSV/Biella, Course on

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administrative requirements to be observed by Voluntary work associations/VSSP/Turin, Course on CSV planning/Biella, Communications Course/CSV/Biella, Course on managing participants in the National Voluntary Service/Municipality of Turin and Solidarity Idea/Turin, Doctors with Africa Cuamm Course on humanitary emergencies/Padua, inter-cultural and ethno-psychiatric course/ASL 10/Pinerolo, Course on the inter-cultural approach to medical assistance/Piedmont HPH Hospital network/Turin).

Two further “Committed Tourist” journeys were organised during 2005, to visit Doctors with Africa Cuamm projects in Ethiopia, at Wolisso (in October) and Dubbo (in November).

These journeys were first publicised, especially in medical circles, then became the object of numerous interviews with people interested, to verify their expectations and attitudes, and culminated in an encounter “for preparation and re-orientation” with the “tourists” before their departure. Unfortunately, one of the travellers had to interrupt her journey in Rome, due to a sudden death in the family, while the journey to Dubbo had to be indefinitely suspended due to the political violence in Ethiopia.

The Group has involved itself in a number of activities in support of immigrants. It was a participant in the ”Round table on Immigration” set up by the municipality of Pinerolo, and brought pressure to bear on the Regional Health Department and the relative Regional Taskforce to improve healthcare services for illegal immigrants. It organised courses on the subject for health workers in Pinerolo’s ASL and took part in the training of local Cultural Mediators. It participated in the Piedmont HPH Hospitals network, one of whose main short-term objects is the improvement of health services for immigrants, and promoted, organised and conducted, together with the local ASL services, two encounters with the area’s Chinese community.

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From the 24th to the 29th of July, in the context of “Operation Restitution” based in the Parish of Hope in Cossato, the Group’s local section promoted and organised a summer camp for the 18-22 age-group. Every day, participants alternated reflection and discussion sessions, manual work, and evening encounters with representatives from trade unions and local associations and co-operatives. Over the week, many of the talks were devoted to the theme of work today, particularly in relation to the non-profit sector.

Two volunteer workers from the National Volunteer Service entered service in Pinerolo in October, in premises lent by the “Solidarity Idea” CSV. On average they are committed to 25 hours work per 5-day week, and so we have counted on them to increase our Group’s activities. The project they are due to carry out includes sensitisation activities, but they have been active too in connection with the reception and integration of immigrants in the Pinerolo area. They also took part in the Doctors with Africa Cuamm meeting with African National Representatives in Padua. Among their other activities in 2005 was the preparation of a project plan for a series of events under the title “The other Africas”, submitted to the Fondazione Cassa di Risparmio di Torino. If financing is approved, in April 2006 the “it’sAfrica” photographic exhibition will come to Pinerolo, and a series of cultural events will take place in Pinerolo and the surrounding valleys (multicultural workshops in dance, music, cooking and other manual activities, as well as performances and conferences), all of which will make the Association better known throughout the area. The planning phase of this project, at the end of 2005, involved a series of reunions and agreements with other organisations and associations (Not just a foreigner, Dreams of Having More, the Fair Trade shop, cultural workers and councillors, social services personnel, the public works department, the society of authors, etc.), all of which will provide precious contacts for the future.

The Group held its two regular annual assemblies as planned, both of them opportunities for reflection, discussion and decision on our activities. The first was in Torre Pellice, the 19th of February, and the second in Cossato, on the 23rd of October. On the 21st of January in Turin we organised a meeting dedicated to health workers in general, and on the prospects for collaboration that Doctors with Africa Cuamm and its Gruppo Piemonte can offer them.

Various equipment has been acquired to facilitate the Group’s activities. The Banca di Biella e Vercelli donated a portable PC with printer, scanner and digital camera for the Biella section of the Group, the Turin “Solidarity Idea” Service Centre for voluntary work lent a PC and printer to the Pinerolo section, and the Biella Service Centre for voluntary work paid for various carpentry tools for use in the Cossato summer camp.

One activity which some of the Group’s members have carried out for a number of years, although substantially independent from other initiatives, has been a Solidarity Shopping Group, based in Turin, which has about 30 members, most of whom are not members of our association. At present this activity is going through a critical period due to the fatigue felt by those who have been its driving force, and their sense of lack of support from other members. In addition, there has been a reduction of reflection and discussion on the issues that underlie the creation of such a group, with the result that its activities now consist merely of group acquisition of biological and fair trade products. A meeting/assembly to decide on the destiny of the initiative is envisaged for the beginning of 2006.

CUAMM CON SARA PER L’AFRICA Address: Tel. E-mail President

Via Rossini n. 13, 36061 Bassano del Grappa (VI) 0424 567961 – 333 9066322 carlo_girardi@virgilio.it Carlo Girardi

N° members 85

Activities in support of Doctors with Africa Cuamm’s healthcare co-operation projects in Africa Country supported: Uganda Projects supported: Nkozi – Uganda Martyrs University Initiatives carried out: The Group’s principal activity, in aid of the University of Nkozi’s Department of Medical Sciences, has been fund-raising to support its academic activities (see below). Thanks to the contributions of many donors, in 2005 the University was able to reclassify its Department as a fully-fledged Faculty of Medical Sciences. Financial assistance for this project was further boosted by the involvement of a number of Municipalities and Associations in the Province of Vicenza, among them the Municipality of Rosà and the “Solidarity Market” Association of Bassano del Grappa.

Local sensitisation activities and educating for development.

In chronological order, these are the activities we have carried out during the year: > 03 February – In Memory of Marisa Ferrari, a year after her tragic death in Angola on the 1st of February 2004, don Dante Carraro, vice-director of Doctors with Africa Cuamm, celebrated a memorial Mass at 7pm in Marisa’s birthplace Valstagna, in the presence of her family and members of the Gruppo Cuamm con Sara per l’Africa. > February – Meeting in the Art Institute in Nove, to promote sensitisation of NGO acti-

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vities in the Third World and particularly in Africa. Main speaker was a doctor from Doctors with Africa Cuamm, Dr. Andrea Quarello.

February – Round Table in the J. Da Ponte Scientific High school in Bassano del Grappa. The participants were representatives of Doctors without Frontiers, the Banca Etica, Doctors with Africa Cuamm, and local voluntary workers, and the High school’s fifth year classes attended. It was an interesting encounter that revealed little-known realities, problems and aspects of solidarity which certainly provoked reflection among those present and helped them better understand the situation in underdeveloped countries. The representative of Doctors with Africa Cuamm was Dr. Alessandro Mecenero.

26 February – Solidarity with Africa Evening, held in the “P.G.FRASSATI” Oratory in the Santa Croce Parish and organised in order to create an opportunity for encounter between the members of the association, its sympathisers and all those sensitive to world poverty. It was also an occasion for explaining the Associazione Cuamm con Sara per l’Africa’s motives, activities and initiatives, as well as those of Doctors with Africa Cuamm. 150 people were present.

03 April – In collaboration with the “Alpini” organisations from the Bassano area, and particularly from Casoni, as well as the Municipality of Mussolente, the parish of Casoni, and the Pro-Loco association, we organised a Celebration Day for Professor Giovanni Baruffa’s 50 years with Doctors with Africa Cuamm. At 10.30am Mass was celebrated by Mons. Luigi Mazzuccato, director of Doctors with Africa Cuamm, followed by a ceremony in the church square where a plaque was presented to Prof. Baruffa in recognition of his commitment towards the poor of Africa and Brazil. Throughout the morning the Association displayed material promoting the activities of Doctors with Africa Cuamm, and those of the Association. About 200/250 people attended.

04 April – Encounter with Prof. Giovanni Baruffa in Casoni di Mussolente. The Professor gave a talk, and the Association displayed Doctors with Africa Cuamm promotional material on its projects and current activities. 90 to 100 people attended.

16 April – Encounter with the pupils of Cartigliano Seconday school on the subject of Sub-Sahara Africa, and particularly on the situation of children and their mothers.

The encounters were animated by Dr. Chiara Bertoncello and her husband Dr. Luca De Mattia, and by Orianna Ferracin, a nurse with a long experience of Africa, all three being Doctors with Africa Cuamm volunteers and connoisseurs of Africa. Participants: the first and second year classes, in separate encounters.

20 May - Meeting in Breganze organised by the mons. Camillo Faresin Foundation, entitled “A smile for the Mato Grosso: paths, experiences, projects”, in collaboration with Doctors with Africa Cuamm, the Alpini association, the Pro-Loco and with the patronage of the municipality of Breganze. Speakers were Don Dante Carraro (vicedirector of Doctors with Africa Cuamm), Prof. Giovanni Baruffa (friend and collaborator of mons. Camillo Faresin, bishop of Guiratinga in Mato Grosso, Brazil), Dr. Paolo Curry (chief doctor in the Santa Maria Bertilla Hospital founded by mons. Faresin in Guiratinga), and mons. Giacomo Prandina (parish priest of Breganze and member of the Foundation’s directors’ board.) Material was displayed promoting the initiatives of Doctors with Africa Cuamm, to whom the evening’s offerings were donated. 200 to 250 people attended.

27 May – Encounter at the ITC Einaudi in Bassano del Grappa with four second year classes on the subject of public health issues in African developing nations. Dr. Andrea Quarello, doctor from Doctors with Africa Cuamm was present.

29 May – Participation in the Associations’ Day organised by Macondo, in the Christian Brothers’ school in Romano d’Ezzelino. The Group was present with a stand (display of material on Doctors with Africa Cuamm and its projects, and sale of tickets, T-shirts and books). Objective: sensitisation on Doctors with Africa Cuamm, the Associazione Cuamm con Sara per l’Africa and the Nkozi project which the Group is committed to supporting.

> 12 June – Maestro Emanuele Bellò’s traditional Young Artists Concert was held in the Church in Solagna. During the concert the parish priest of Solagna, don Francesco, requested a testimony on Sara and her love for Africa, and this was delivered by the president of the Association. 100/150 people attended. > 24 July – Initiative with other voluntary work groups on the occasion of the Celebration of Saint Anne of Rosà. Stand with display of promotional material on Doctors with Africa Cuamm, the Associazione Cuamm con Sara per l’Africa and the Nkozi project. > 15 August - Doctors with Africa Cuamm Day, organised with the parish of Enego, thanks to the affectionate helpfulness of the parish priest, don Ruggero Ferrazzi.

Testimonies were read during the Masses, during some of which mons. Luigi Mazzuccato, director of Doctors with Africa Cuamm, was present. Association stand with promotional material, distribution of Doctors with Africa Cuamm material to the congregations and gathering of donations in aid of the Nkozi project in Uganda. > 28 October – Encounter meeting in the Chiesetta del Angelo in Bassano del Grappa, chaired by Dr. Massimo La Raja, doctor belonging to Doctors with Africa Cuamm and specialist in Haematology at the Trieste Hospital; theme “A fair share for all….health inequalities in the world”. 50/60 people attended. > 15 November – Gospel Concert in the parish church in Solagna, performed by the Bassano Blue Spiritual Band, consisting of 45 male and female singers, two soloists and a 12-man orchestra conducted by maestro Diego Brunelli. Sara Lessio was remembered by the parish priest, don Francesco, and by Dr. Maurizio Ferracin who served with Doctors with Africa Cuamm in Uganda for over six years and who described to the public the role and the presence of Doctors with Africa Cuamm on the African continent. The church was completely full, with standing room only. The proceeds from the collection were donated to Doctors with Africa Cuamm for the project in support of the Nkozi University in Uganda. > 4 December – Day in Piazza Libertà in Bassano del Grappa with the voluntary Associations united under the co-ordination of “Under the skies of the world”.

JENGA-INSIEME ONLUS - CUAMM MEDICI CON L’AFRICA SIENA Address: Tel. E-mail President

Via Lombardia 15, 53100 Siena 0577 349004 - 335 5411618 bsafrica@beactive.it Paolo Rossi

N° members 100

Activities in support of Doctors with Africa Cuamm’s healthcare co-operation projects in Africa Country supported: Kenya Projects supported: Programme of Community Developement for Disabled People in Nyahururu, Kenya Initiatives carried out: The Group is very directly involved in the realisation of the Nyahururu project, given that two of its members, Dr. Barbara Tomasini and Dr. Stefano Zani, are also the co-ordinators of the project. Both of them undertook a monitoring and evaluation mission to Kenya in June-July 2005, also with a view to the project’s continuation. Support for this project has been concentrated on the search for funds, often in collaboration with other entities.

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The Group’s activities in support of projects in Africa have also concerned the training and recruitment of healthcare personnel. Collaboration has continued with the Siena Hospital and the Faculty of Medicine, who have recognised Doctors with Africa Cuamm’s training course for doctors in the training curriculum of the Specialisation Schools (see below).

Local sensitisation activities and educating for development.

In the course of 2005 the Group has participated in the Tuscany Regional Government’s Meetings of the Africa Round Table, in the context of the Region’s decentralized cooperation activities. Other encounters were held in Siena, on the Decentralized Co-operation with the Province of Siena.

On the 20th April 2005 it ran a Training Encounter at the Saint Catherine’s Training High school, with displays of photographs and promotional material on the Kenya project.

In June the Group had a display stand in the Spring Festival in Pergine di Montalto (Arezzo), which for the last two years has treated the Association as a fixed and privileged guest.

From the 6th to 8th of October the Group took part in the “Africa on the March” event, organised by the Municipality of Siena in collaboration with the Tuscany Regional Government, presenting a stand with photographic and promotional material, and delivering a talk in the Sala delle Lupe in the Siena town hall on the activities of the Gruppo Jenga-Insieme Onlus - Cuamm Medici con l’Africa Siena.

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On the 28th of November the Group ran a Training Day in Health Co-operation for Development, entitled “International co-operation in support of humanitarian and healthcare development in countries with limited resources”, in collaboration with the Siena University Hospital, as part of a project recognised by the Tuscany Regional Government.

This consists of 4 days of training in international health co-operation, and follows the institution of a Committee on International Health Co-operation within the University hospital, on which some of our group members serve, as they also do on the Technical Scientific Committee. The Group was in charge of organising the day and inviting the training teachers, and also presented its promotional stand on Doctors with Africa Cuamm and produced presentation material including a CD-Rom with photos and music.

On the 4th of December the Group took part in the San Mamiliano in Valli Parish Solidarity Fair, displaying photos and promotional material and taking donations.

On the 10th of December we were invited by the Siena Galileo Galilei Scientific High school to an educational encounter on healthcare co-operation themes in Africa.

On the 17th of December Irene Stracciati’s Stranensemble Association (a dance ensemble made up of the able and the disabled) offered a Dance Theatre Performance where there was also the presentation of Doctors with Africa Cuamm promotional material, the production of a “A Mosaic of Love” CD-Rom with photos and music, as well as fund-raising activity.

On the 19th and 20th of December we displayed posters and photos in the Santa Marta Nursery School in Siena and organised a collection of pens, pencils and notebooks for the “Christmas Together with Africa” initiative.

On the 22nd of December the Group took part in the inauguration of a new mini-bus with the “Playing at clouds” group in Siena. We displayed Doctors with Africa Cuamm promotional material and collected donations.

NOI CON L’AFRICA - ZIMELLA Address: Tel. E-mail President

Via Molini 32, 37040 Verona 0429 82495 antonioloro@libero.it Antonio Loro

N° members 4

Activities in support of Doctors with Africa Cuamm’s healthcare co-operation projects in Africa Country supported: Ethiopia – Tanzania Projects supported: Wolisso Hospital and Nursing School (Oromia Region, South West Showa, Ethiopia) Prosthesic-Orthesic Centre in Adis Abeba, Ethiopia Orthopaedic Laboratory, Dodoma Regional Hospital, Tanzania Initiatives carried out: In 2005 the Group continued its financial support for the clinical activities of the San Luca catholic hospital in Wolisso and its Orthopaedic and Traumatology services. In particular we continued to sustain the Orthopaedic project, through Italian specialists who periodically visit the hospital on a purely voluntary basis. To this end we constituted a group of Doctors with Africa Cuamm othropaedic specialists, under the name Ortho-Cuamm, in which some of our members take part. Some members also participated in a 15-day working mission to the Wolisso hospital. The Group was active in supporting the Doctors with Africa Cuamm’s 2005 fund-raising campaign in aid of disabled children in Ethiopia.

The Group was also active in economically supporting the physically disabled patients who frequent the Dodoma Regional Hospital’s Orthopaedic Laboratory in Tanzania, the Faraja House for Homeless Children in Iringa, Tanzania, and the construction of low-cost housing for the Dodoma Disabled group, Tanzania.

During the year we worked in close collaboration with the Fair Trade network and with the Voluntary Work Associations operating in the southern part of the Verona region. In this context the Associations’ Joint Council granted us a financial contribution collected among the area’s voluntary workers, and the Municipality of Zimella gave a specific grant towards our Group’s activities.

Local sensitisation activities and educating for development.

Over the year our members were active in informing and sensitising on the healthcare problems (and other problems) afflicting countries in sub-Saharan Africa. Our sensitisation activities were directed especially towards schools, parishes around Zimella, and youth, always taking advantage of opportunities for contact with other organisations in the area. This involved the organisation of numerous sensitisation encounters in local schools, encounters with groups of children and adolescents in the parishes of Altavilla Vicentina and San Bonifacio, and participation in local sporting events and courses in the Trentino Third Age University.

On the 2nd and 3rd of December the Group took part in the “Doing is Living” exhibition organised by Verona’s ULSS 20, setting up and running a stand with information on

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Doctors with Africa Cuamm’s activities for the disabled. Many other associations and social or medical entities involved in work with the disabled took part in the exhibition.

The Group has also collaborated with Doctors with Africa Cuamm teaching activities (Basic Course, Course in Tropical Medicine and International Health) and provided two Doctors with Africa Cuamm contributions during the European Society of Osteo-articulatory Infections Congress in Ljubljana, Slovenia, last May. We have organised various fundraising birthday parties and an encounter on physical disabilities in Lonigo, Vicenza, taken part in church services in local parishes, sold Fair Trading products after Mass in some parish churches and on other occasions, and organised an evening on the disabled in Africa in Saletto, Padua.

SANTARCANGELO CITTÀ DEL MONDO Address: Tel. E-mail President

Via Emilia 384, 47821 S. Giustina di Rimini 0541 680016 – 335 8436758 stampriccardo@libero.it Patrizia Bettini

N° members 15

Activities in support of Doctors with Africa Cuamm’s healthcare co-operation projects in Africa 148

Country supported: Ethiopia Project supported: Aid project for the Dubbo hospital Initiatives carried out: The Group is closely connected to the project for healthcare co-operation with the Dubbo hospital, especially since our founding member works as a voluntary doctor in that hospital. Our activities in support of the 2005 project have specifically involved sending and repairing medical equipment for the hospital and collecting and sending financial aid.

Local sensitisation activities and educating for development.

Apart from fund-raising activities, no sensitisation or educating for development activities took place in 2005.

On the occasion of one of our medical volunteer in Dubbo’s periodic returns, we held our annual assembly, with an account of the situation in Ethiopia.

Our members are committed to promoting the Dubbo project as much as possible during their professional and business activities.

MEDICI CON L’AFRICA MODENA – REGGIO EMILIA Address: Tel E-mail President

Via U. Tirelli 211, 4100 Modena 0522 692202 – 333 4060790 lucasarti@tiscalinet.it Ruggero Urselli

N° members 22

Activities in support of Doctors with Africa Cuamm’s healthcare co-operation projects in Africa Country supported: Tanzania Project supported: Aid for health services in four areas of Tanzania Initiatives carried out: The Group’s financial support for the project in Tanzania has been channelled towards: > lowering the cost of medicines for the Maternal and Paediatric departments in the Lugarawa hospital; > paying the salary of one Public Health Nurse, in support of the Public Health activities of the Lugarawa hospital; > providing an aqueduct for Lugarawa (project for financing by the Province of Modena, presented 22/4/2004); > financing the cost of a course in tropical medicine at the Swiss Tropical Institute attended by Dr. Giuseppe Iozzelli, doctor with Doctors with Africa Cuamm serving at the Lugarawa hospital; > making a special donation to Doctors with Africa Cuamm for the Marburg emergency in Uige, Angola.

Fund-raising activities: > Charity Dinner, Saturday 11th of June in Cognento di Modena > Flower selling, Guastalla (Reggio Emilia), 8 May > Submission of a project and funding request to the Provincial Government of Modena, entitled “Completion of laboratory and provision of outpatient facilities, particularly for HIV/AIDS patients, at the Lugarawa hospital, Tanzania.” Submitted 9th November. > Written request presented to the management office of the Modena General Hospital on the 13th September, requesting eligibility for financing under the so-called Lunch Voucher Initiative. Details of project to be submitted in February 2006 in order to apply to be in line for benefits from the initiative programmed for November-December 2006.

If received, the grant would go to covering the recurrent costs of chemical reagents for the Lugarawa hospital laboratory. > CONAD Initiative, 14 November-31 December, “Help us support the Lugarawa hospital in Tanzania”. Presentational Press Conference Friday 11 November in the Modena Conad premises. > Charity Dinner in Guastalla (Reggio Emilia), 23 October > Dinner in Carpi, Friday 25 november > Subscription in memory of Cristiano Venturelli, with fund-raising in aid of the Nutrition Unit in the Lugarawa hospital, involving about 20 paediatricians, colleagues and friends of the deceased doctor.

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These initiatives have involved almost all of the 22 members of our association. The Dinners were attended by roughly 200 people, had groups of Boy Scouts serving at the tables, and cooks provided by the voluntary cooks organisation from Limidi di Soliera (Modena).

Local sensitisation activities and educating for development.

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> Report delivered by Dr. A. Foracchia in the “My future as a doctor” Conference, organised by Professor Masellis, director of the Obstetric and Gynaecological department in the Carpi hospital, at the Auditorium G.Fini in Modena. Title of the report: “Being an international co-operation doctor”. Audience: students and post-graduate students in Medicine and Surgery. > 23 January, Dr. A. Foracchia participated in the Reggio Emilia Voluntary Work Forum > Adhesion to the Provice of Modena Co-ordination Body for Associations involved in International Co-operation. Group member Dr. Zaynal Kahfian appointed delegate/contact person for relations with Medici con l’Africa Modena - Reggio Emila and relative co-ordination. > Adhesion to the “Flying in Carpi” initiative, aimed at sensitisation among Secondary school and High school pupils on the subject of voluntary work. Dr. Ruggero Urselli gave two talks in two different schools on the subject of international voluntary work. > Organisation of two “Committed Tourist” journeys to Tanzania. The first, from 27/8 to 11/9, comprising 8 people including two Group members, Gino Camellini, paediatrician from Guastalla and councillor, and Cleo Castagnoli Claudina, the other travellers being friends, nurses or colleagues and children. The second trip began on the 18/10 and for five travellers lasted until the 2/11, while two others stayed on until the 8/11. Among the party were two doctors (Dr. Emanuela Carossini, gynaecologist and Group member, and Dr. Gamberini, a non-member family doctor), plus one nurse (Annamaria Cavallaro, Group member), and friends. Also in the party were the Carpi Municipal Councillor responsible for social services, together with a colleague.

The Group is frequently in direct contact with the Faculty of Medicine and Surgery, with its students and with the director of the Specialisation School in Hygiene and Preventive Medicine. Some of the post-graduate students from this department are participants in the Doctors with Africa Cuamm Junior Project Officer programme.

2. PARTNER GROUPS OF DOCTORS WITH AFRICA CUAMM CUAMM MEDICI CON L’AFRICA MOLFETTA Address: Tel E-mail Co-ordinator

Via Cavallotti 26, 70056 Molfetta 080 3971376 – 338 2312998 Cuamm.molfetta@libero.it Giovanni Balacco

N° collaborators and sympathisers

16

Activities in support of Doctors with Africa Cuamm’s healthcare co-operation projects in Africa Country supported: Angola

Project supported: Tuberculosis control in the Provinces of Luanda and Uige, Angola Providing secondary Maternal and Child Care to displaced people in Uige Province (Uige, Songo e Negage Municipalities - Angola) Initiatives carried out: The Molfetta Group is a very small-scale affair which with perseverance has done its best to support Doctors with Africa Cuamm projects, especially in Angola, partly due to the presence there of two doctors from Molfetta. Little by little and with discretion, more by word of mouth than through public events, the Group has spread the word about Doctors with Africa Cuamm. Interest and support have grown, to the extent that in the case of many of the encounters and events in which the Group has taken part during 2005 it has been the host organisations that have chosen and invited Doctors with Africa Cuamm as funding beneficiary or partner in dialogue or discussion.

Among the initiatives carried out we would mention: > Special operation of gathering and sending hygienic and sanitary material for the Marburg emergency in Angola. In collaboration with the Apulia Regional Government and the Civil Defense. > Financial support for projects raised through systematic donations (monthly contributions) and occasional donations (funerals, graduations, birthdays and holidays are often moments when people renounce certain habitual expenditures and donate the equivalent sum to Doctors with Africa Cuamm projects.

Local sensitisation activities and educating for development.

In the course of 2005 the Group organised and promoted a number of school encounters (Primary, Secondary and High schools) and encounters with parochial or diocesan groups, and also took part in various charity events and occasions. For example, the charity basketball match between the local team at the top of the C1 league and a nearby team from the B1 leaugue, played on the 20th December in Molfetta and organised by the local team together with the ”don Cosmo Azzolini” Primary school, which has been supporting Doctors with Africa Cuamm projects for the last three years.

This initiative was conceived, carried out and organised with minimal involvement on the Group’s part; the children had their own ideas and made posters, drew Angolan flags, and put together displays using “institutional” materials effectively and imaginatively. The mothers, instead of giving Christmas presents to the teachers donated the equivalent sum to Doctors with Africa Cuamm. In December the Group also participated in the diocesan youth party, with music and moments of reflection. The entrance contributions were donated to Doctors with Africa Cuamm. At all such encounters the Group regularly distributes Doctors with Africa Cuamm promotional material and gadgets.

GRUPPO DI APPOGGIO TOSAMAGANGA HOSPITAL Address: Tel E-mail Co-ordinator

Via Timavo 9, 33077 Sacile 360 275617 niclapo2@tin.it Nicola La Porta

Activities in support of Doctors with Africa Cuamm’s healthcare co-operation projects in Africa Country supported: Tanzania

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Project supported: Aid for healthcare services in four areas of Tanzania Initiatives carried out: Our main activity in support of the project has been private fund-raising in aid of the administration of the Tosamaganga Hospital in Tanzania, and specifically for the two most important budgetary items: the paying of salaries and the buying of medicines. This in order to allow the administration to then charge lower and more accessable patient fees, especially for children and pregnant women.

Local sensitisation activities and educating for development.

Visits to the project sites in Tanzania have inspired the desire to promote future “committed tourist” journeys within the ambit of the Doctors with Africa Cuamm’s Welcome Project.

MEDICI CON L’AFRICA COMO ONLUS Address: Tel E-mail President 152

Via Dante Alighieri 127, 22100 Como 3031 3371052 – 339 3348051 mediciconafrica@interfree.it Giovanni Foglia Manzillo

N° members 35 Country supported: Uganda Projects supported: Broadening of healthcare services in the Diocese of Lugazi, Uganda Qualitative improvement and optimisation in cost of services.

Initiatives carried out: The Group has been active in fund-raising, both from institutions (in part through grant applications) and from from private citizens, businesses, associations and parishes, in aid of the Uganda project. The funds raised have been channelled to the project partly through the Doctors with Africa Cuamm head office and partly directly to Kampala in Uganda. In the course of the year some Group members visited the project site in Uganda.

Local sensitisation activities and educating for development.

The Group has carried out information campaigns and educating for development on health issues in southern hemisphere countries in numerous high schools in the Province of Como (course of 2-3 encounters of 2 hours each). These activities are part of the 200506 school year.

We also participated in the “Right to health” course within the ambit of the School of Human Rights organised by the Como Co-ordination for Peace, of which our Group is part.

This course is aimed mainly at pupils in their final years in High schools in the Province of Como and takes places outside school hours. It also includes evening classes for young people already employed. These activities are part of the 2005-06 school year.

The 2005 edition of the annual “The faces of Africa” event was held; a cycle of conferences open to the public, with African speakers, on problems inherent in the world of Africa (the 2005 edition treated the topic of multi-ethnic Africa). The event took place in October, in collaboration with the Como Diocesan Missionary Centre and the Guanelliano Missionary Centre.

Invited by parish groups, missionary groups and sporting associations, we also participated in various encounters and conferences on the subject of health problems on the African continent.

The Group collaborates with the Como province Caritas on healthcare assistance for immigrants.

GRUPPO LUGARAWA Address: Tel E-mail Co-ordinator

Via Breda 2, 35010 S. Giorgio delle Pertiche 049 5742356 Ometto@tele2.it Giancarlo Ometto

Activities in support of Doctors with Africa Cuamm’s healthcare co-operation projects in Africa Country supported: Tanzania Project supported: Aid for healthcare services in four areas of Tanzania Initiatives carried out: The Group has supported the Lugarawa hospital, sending funds for the hospital’s activities and for the Lugarawa district. The main source of funding has been through meetings with parish missionary groups and in the parish churches.

Local sensitisation activities and educating for development.

The Group is strongly committed to Doctors with Africa Cuamm’s educating for development activities, mainly through Group members’ participation in sensitisation and educational events in Primary and Secondary schools. Members of the Group have taken part in various educational and promotional initiatives in the area, sharing their testimony as volunteer doctors serving with Doctors with Africa Cuamm.

3. FRIENDS OF DOCTORS WITH AFRICA CUAMM GROUPS The Groups and Associations who come into this category are: Voluntary Work Association Doctors with Africa – Trieste Blood Bank: has raised funds to support Doctors with Africa Cuamm’s activities in the Uige Hospital in Angola.

Committe for children in Angola, Work group from Reggio Emilia’s 3rd district: > the solidarity campaign “Ten euros and….you save a life”, launched in 2003 to raise funds for Doctors with Africa Cuamm’s project for the control and cure of Tuberculosis

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in Angola, has recently come to an end, with great success. The donations have been used to buy medicines and equipment and have made it possible to reach over 6,000 children. The campaign was carried out with the active participation of Reggio Emilia’s 4th and 5th districts, numerous families, students, parishes, social centres and private businesses.

Association Friends of children infected by Hiv/Aids Onlus (Leghorn): has raised funds in aid of projects in Tanzania for the prevention and cure of HIV/AIDS, especially in children and mothers.

Association “Let’s save our brothers from poverty and leprosy” – Onlus (Bergamo): has raised funds in aid of the Doctors with Africa Cuamm’s project for physical rehabilitation in West Nile, Uganda.

Support group for the Matany Hospital – Onlus (Milan): has collaborated in financial support for the Doctors with Africa Cuamm project in the Matany Hospital, Uganda.

Donations have gone in particular to covering the cost of the Doctors with Africa Cuamm volunteer doctor in the hospital.

Association Toyai Onlus (Broni, PV): has supported the Doctors with Africa Cuamm project for the Matany Hospital in Uganda.

Solidarity Market (Bassano del Grappa): has raised funds for the Doctors with Africa Cuamm project in support of the Nkozi University in Uganda, together with the “ Gruppo Cuamm con Sara per l’Africa-Onlus”.

Association Alto Adige Doctors for the Third World (Bolzano): has presented two projects for funding to the Trentino Alto Adige Regional Government and the Province of Trento, in aid of the activities of Doctors with Africa Cuamm in Tanzania related to AIDS prevention and mother-and-child care. Both projects were approved.

Association “Friends of Angal”: has continued its support for the hospital in Angal, Uganda, by sending funds, medical equipment and medical personnel missions. It is also active locally in sensitisation, promotion and fund-raising for the hospital.

Asiago Missionary Group: has promoted fund-raising initiatives in favour of Doctors with Africa Cuamm projects in Angola.

OTHER ACTIVITIES

OTHER ACTIVITIES AND INITIATIVES ASSEMBLY OF ACTIVE MEMBERS These were held on the following dates: 15.01.2005, 23.04.2005, 17.09.2005 and 12.11.2005.

Assembly of 15.01.2005 On the agenda: > Report on the work carried out by the assembly’s Committe > Report on the work carried out by the Board of Directors > Report on the work carried out by the committee for Group co-ordination > Examination and approval of requests for admission by new active members > Role of active members in the life of the association > Approval of the new subscription fee > Report on Cuamm’s activities in various countries > Update on the financial situation Participants: 37.

Assembly of 23.04.2005 On the agenda: > Presentation, discussion and comparison on Cuamm’s “Planning Guidelines” > Approval of new requests for active membership of Doctors with Africa Cuamm > Approval of the financial statements > Various Participants: 62.

Assembly of 17.09.2005 On the agenda: > Approval of the minutes of the previous assembly > Constitution of theme study groups > Audit-report on the Marburg epidemy in Angola > Report on the financial situation > Communication Plan > President’s message Participants: 42.

Assembly of 12.11.2005 On the agenda: > Approval of the minutes of the previous assembly > Ratification of new active membership requests > Reports by Country Representatives > Discussions after each Country Represenatative’s report > Any other business Participants: 43.

BOARD OF DIRECTORS Met on the following dates: 07/01, 24/01, 23/04, 20/06, 26/09, 14/11, 21/12.

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BOARD OF AUDITORS Met on the following dates: 02/03, 01/06, 30/08, 24/11.

COUNTRY REPRESENTATIVES MEETING Held on the 07-14/11.

VIGIL OF THE SENDING On 14/10/04 the Bishop of Padua presided over the Vigil of the Sending (Veglia dell’Invio) in the Cathedral, during which crucifixes were presented to a number of Cuamm volunteers who were either departing, in service, or returned from Africa.

PARTICIPATION IN FOCSIV ASSEMBLIES, BOARD OF GOVERNORS MEETINGS AND ENCOUNTERS > > > > >

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19/02: 09-10/04: 18/06: 24/09: 03-04/12:

Focsiv Board Meeting (Dr. Giancarlo Ometto) Ordinary and Extraordinary Focsiv Assemblies (Dr. Giancarlo Ometto) Focsiv Board Meeting (Dr. Giancarlo Ometto) Focsiv General Assembly (Dr. Giancarlo Ometto) Focsiv Ordinary Assembly (Dr. Giancarlo Ometto)

OTHER ENCOUNTERS AND PARTICIPATIONS > 25/02: don Dante Carraro participates in the General Assembly of Medicus Mundi International, in Brussels, Belgium. > 11/03: Andrea Borgato participates in the Ordinary Assembly of Italian NGOs in Rome. > 16/06: Dr. Anna Talami participates in the Seminary Day on Educating for development organised by the Association of Italian ONGs, in Rome. > 22-23/06: Dr. Marzia Franzetti and Dr. Mara Mabilia partecipate in the AIDS Forum organised by the Aids Observatory, in Montecatini Terme.. > 16/09: Dr. Giorgio Pellis participates in the General Assembly of Medicus Mundi International, in Rome. > 02/12: dr. Giorgio Pellis participates in the Executive Board of Medicus Mundi International, in Brussels, Belgium.

BRIEF TECHNICAL MISSIONS > > > > > > > > > > > > > >

28/01-07/02: 04/02-04/03: 18/02-25/02: 09/03-19/03: 03/04-23/04: 07/04-23/05: 08/07-24/07: 24/07-21/08: 28/07-13/08: 27/08-12/09: 10/09-26/09: 18/09-06/10: 19/09-19/10: 24/09-09/10:

Tanzania (Dr. Giampietro Pellizzer).

Ethiopia, Wolisso (Dr. Silvio Pasquato and Dr.Silvia Pini).

Tanzania (Dr. Paolo Lanzoni).

Ethiopia, Wolisso (Dr. Maurizio Piazza).

Ethiopia, Wolisso (Dr. Nicola Vinassa).

Tanzania (Dr. Alessio Panza).

Ethiopia, Wolisso (Dr. Antonio Loro and Dr. Annamaria Dal Lago).

Ethiopia, Wolisso (Dr. Giorgio Pellis and Dr. Marina Spaccini).

Ethiopia, Wolisso (Dr. Renato Spadoni).

Mozambique, Beira (Dr. Alessandro Mecenero).

Mozambique, Beira (Dr. Giorgio Dalle Molle).

Ethiopia, Wolisso (Dr. Danilo Mellano).

Ethiopia, Dubbo (Dr. Rossella Peruzzi).

Angola (Francesco Beldì, Italo Bernardi and Giuseppe Marcon).

> > > > >

28/10-25/11: 02/11-19/12: 13/11-27/11: 04/12-21/12: 30/12-20/01:

Ethiopia, Ethiopia, Ethiopia, Ethiopia, Ethiopia,

Wolisso (Dr. Giovanni Cescato).

Wolisso (Dr. Claudio Pierandrei).

Mekele (Dr. Silvio Pasquato).

Wolisso (Dr. Giuliano Novaretti and Dr. Renato Sattin).

Wolisso (Dr. Luigi Conforti).

INSTITUTIONAL MISSIONS > 14/01-22/01: Ethiopia (don Luigi Mazzucato and Dr. Antonio Loro). > 18/01-01/02: Mozambique (don Dante Carraro, Dr. Egidio Bosisio and Dr. Alessandra Gatta). > 28/01-05/02: Angola (don Luigi Mazzucato and Dr. Rinaldo Bonadio). > 27/04-04/05: Angola (don Dante Carraro and il Dr. Giovanni Putoto). > 13/05-21/05: Uganda (don Luigi Mazzucato, Dr. Gianpaolo Braga and Dr. Roberto Saro). > 11/07-20/07: Tanzania (don Dante Carraro, Dr. Valerio Mecenero and Cristina Biason). > 05/08-17/08: Ethiopia (Dr. Ilaria Bianchi and Dr. Maurizio Murru). > 28/11-10/12: South Sudan (don Dante Carraro, Dr. Massimo La Raja, Dr. Monica Favot, and Antonio Sebben) > 05/12-14/12: Tanzania ( Andrea Borgato and Dr. Azzurra Rosa)

BENEVOLENCE WORK CUAMM â&#x20AC;&#x2DC;s life and activities depend fundamentally on voluntary work.

It would be impossible to formulate an exact valutation of the contributions offered in terms of human resources and material. We may mention some quantifiable elements: > Brief Missions: 422 days. > Unpaid work by teachers on training courses: approximately 600 hours. > Participation in training teacher encounters: 450 hours

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