annual report 2017
annual report 2017
Graphic design Heads Collective Layout Publistampa Arti grafiche Photography Cover photo Nicola Berti Inside photos: Alessandro Froio pp. 4, 7, 28, 38 Matteo De Mayda pp. 12, 13, 33, 35, 48, 49, 50, 70, 76 Ilaria Onida pp. 18, 42 Nicola Berti pp. 20, 24, 26, 40, 46, 51, 60, 61 Simone Candorin p. 30 Manuel Pieretto p. 45 Images not credited are from the Doctors with Africa CUAMM archive. Editorial staff Andrea Atzori Andrea Borgato Dante Carraro Chiara Cavagna Andrea Iannetti Valentina Isidoris Fabio Manenti Francesca Papais Giovanni Putoto Bettina Simoncini Jacopo Soranzo Anna Talami Mario Zangrando Printed by Grafica Veneta Via Malcanton, 1 Trebaseleghe (PD) Finished printing June 2018 Supplement no. 1 to èAfrica magazine no. 4/2018 – Court of Padua authorization. Print register no. 633 of 19.01,1999
Thanks to: Grafica Veneta for the complimentary printing of this report
Angola Angola headquarters: Rua Sizenando Marques n.22 Bairro Alvalade - Maianga Luanda Caixa Postal 16624 t. 00244,923351224 Focal point: Joaquim Tomàs Ethiopia Sub city Bole Kebele 03/05 House nr. 4040 P.O. Box 12777 Addis Ababa t. 00251,116612712 t. 00251.116620360 f. 00251.116620847 ethiopia@cuamm.org Country manager: Matteo Bottecchia Mozambique Av. Patrice Lumumba 424 Bairro Central Maputo t. 00258.21302660 f. 00258.21312924 mozambico@cuamm.org Country manager: Giovanna De Meneghi Sierra Leone 22, Wilkinson Road Freetown t. 00232.76653457 sierraleone@cuamm.org Country manager: Simona Ponte Sud Sudan c/o TM Lion HotelBrowker Blvd, Juba100 Meters from the US Embassy JUBA sudsudan@cuamm.org Country manager: Giorgia Gelfi Tanzania New Bagamoyo Road plot nr. 14 Regent Estate P.O. Box 23447 Dar Es Salaam t. 00255.222775227 f. 00255.222775928 tanzania@cuamm.org Country manager: Matteo Capuzzo Uganda Gaba Road “Kansanga” Plot nr. 3297 P.O. Box 7214 Kampala t. 00256.414.267508 t. 00256.414.267585 f. 00256.414.267543 uganda@cuamm.org Country manager: Peter Lochoro United Kingdom 10 Queen Street Place London EC4R 1BE t. +447864076372
CONTENTS
04 INTRODUCTION
32 MATERNAL AND CHILD HEALTH
05 A YEAR OF STRUGGLE AND HOPE
36 NUTRITION
O6 ABOUT US
39 INFECTIOUS DISEASES
08 WHERE WE WORK
44 CHRONIC DISEASES
10 POSTCARDS FROM 2017
46 TRAINING
12 AFRICA REPORT
48 MONITORING, EVALUATION, AND RESEARCH
14 INSIDE THE NUMBERS: FACES, STORIES, AND DIALOGUE
51 FOCUS ON THE HOSPITALS
16 FOCUS ON SOUTH SUDAN: A REGIONAL CRISIS
58 HUMAN RESOURCE MANAGEMENT
18 ANGOLA
61 COMMUNICATION AND EVENTS
20 ETHIOPIA
62 SUPPORT GROUPS
22 MOZAMBIQUE
63 EDUCATION AND PUBLIC AWARNESS
24 SIERRA LEONE
64 ORGANIZATION AND STAFF
26 SOUTH SUDAN
66 BUDGET
28 TANZANIA
71 THANK YOU TO OUR DONORS
30 UGANDA
04
Doctors with Africa CUAMM
Annual report 2017
A YEAR OF STRUGGLE AND HOPE
by don Dante Carraro Director of Doctors with Africa Cuamm
Looking back over a year is about remembering so many things: the projects, initiatives, and activities that we experienced together, and the struggles, worries, and hopes we went through “with” Africa and its people, too often forgotten, yet always courageous and vibrant; it is about remembering the patients and local health workers that we work with and our volunteers and their families. And it is about the friends, volunteers in Italy and everyone, who generously gave of themselves, supporting in so many different ways our services to the most vulnerable, neglected groups. It was a year of struggle in South Sudan, Africa’s youngest country that went through a major crisis. We shared the insecurity, difficulty, and uncertainty of local populations, often depleted. Poverty is severe and widespread, and many parts of the country are still unstable and beyond control. We, nevertheless, persevered every day to give practical responses to the basic health needs of mothers and children, knowing that this is the only way to build a different, better future. At the Lui Hospital, on a national holiday, we started a new intervention for women and children by going into villages and communities to provide primary care, food, and vaccines, and to educate and train. Many health posts and centers have been refurbished and re-equipped, and personnel has been trained and mobilized. We work together to build up rather than tear down. At the hospital in Rumbeck and Nyal, the areas most afflicted by hunger, we worked to treat and prevent illnesses by providing food and medicine. In all the other countries and areas of intervention, our efforts and commitment grew as well, as this Annual Report shows, a testament to our efforts that documents our results in the field. We also brought our message to new worlds. In March at the UN headquarters in New York, as part of the CSW (Commission on the Status of Women), we offered an opportunity for focusing on adolescent health, called “Leaving no one behind: Healthy adolescents, smart, connected, sustainable practices.” The work we do today is deeply rooted in the hard work and dedication of many who came before us. In April, at the University of Padua, we presented the book, “Dove Comincia la Strada per l’Africa,” [Where the road to Africa starts] about professor Anacleto Dal Lago, the first CUAMM doctor who went to Africa, a major, long-standing figure in CUAMM’s scientific and planning community. Another especially moving moment was the dedication of the Aula Magna/ Auditorium of the Wolisso Hospital, in Ethiopia to Don Luigi Mazzucato in recognition of how much he put into this hospital, created entirely by CUAMM, an effort supported by the Italian and Ethiopian Catholic Churches. Another exciting moment was the opening of the High Dependency Unit at the Princess Christian Maternity Hospital in Freetown, Sierra Leone, recovering from its severe Ebola crisis. The completely refurbished and equipped unit for intensive care for patients in the most critical post-partum conditions Throughout the year, with hundreds of initiatives and events, we have traveled through Italy’s cities and regions to broadcast the words of Don Dante Carraro, Director of Doctors with Africa
CUAMM about the need to do more and better with Africa. We have also explored new forms for our work, such as a “special” initiative, “The Health Train” organized by jointly with the association “Ferrovieri con l’Africa,” with the Region of Veneto’s involvement. We traveled to Veneto’s major cities in November and December to bring attention to the issue of health and care for the most vulnerable groups in Africa and in Italy. We also met in November at our Annual Meeting in Assago. There were many of us from throughout Italy: from Palermo, Potenza, and Naples to Trieste, Trento, and Aosta. We were of all ages: from Giuditta’s 15 months to Grandma Ida’s 87 years. Some were there in person, others watched from afar live on TV2000, and some were there in spirit. We reported the results of our “The First 1,000 Days for Mothers and Children.” The faces, stories, emotions, and moods are still very vivid. At the Teatro della Luna in Assago, Niccolò Fabi, Gian Antonio Stella, Paolo Rumiz, Stefania Chiale, and Beppe Severgnini joined us to tell us about their experiences with CUAMM volunteers. Special guests included Mario Draghi, President of the ECB, and Italian Prime Minister Paolo Gentiloni. The recurring sentiment threading through all of these moments was one of gratitude. And I would like to send it on to each of you, with all my heart. Only together, joined in the same passionate struggle, can we overcome hardships and difficulties. We want this heartfelt gratitude to keep on being turned into concrete action, supporting the most vulnerable groups, so we can “do more and better with Africa.” Each of us, from where we are, taking courage by our numbers, we persevere together in building a more just world for all.
Annual Meeting in Assago, November 11, 2017: Romano Prodi, Don Dante Carraro, and Niccolò Fabi 05
ABOUT US www.doctorswithafrica.org
MISSION Doctors with Africa CUAMM was the first NGO working in the international health field to be recognized in Italy and is the largest Italian organization for the promotion and protection of health in Africa. We work with a long-term development perspective. In Italy and in Africa, we engage our human resources in training and in researching and disseminating scientific knowledge, affirming the fundamental human right to health. Learn more at doctorswithafrica.org
STRENGTHENING HEALTH SYSTEMS Doctors with Africa CUAMM affirms that strengthening health systems is our key strategy to meet health needs and fulfill the right to health of poor groups in Africa. Strategic Plan 2016–2030 p. 16
AREAS OF FOCUS “The priority issues define which health issues are addressed with which actions (what)”. Strategic Plan 2016–2030 p. 21
MATERNAL AND CHILD HEALTH
Care for mothers and children is at the heart of what we do, providing and distributing effective services in the community, peripheral health centers, and in hospitals. For instance, the “Mothers and Children First” program involved four countries (Angola, Ethiopia, Tanzania, Uganda) and ended in 2016 with results surpassing expectations. In all the countries where we work we strive to raise awareness about the importance of pre- and postnatal visits and make sure pregnant women have free access to safe, attended births in health centers and hospitals through an effective ambulance and transport system. Together, we aim for continuity and quality of care for infants and children.
NUTRITION
We focus on nutrition education for both women during pregnancy
06
Doctors with Africa CUAMM
Annual report 2017
and for children in the delicate early stage of their lives. We support the period of exclusive breastfeeding up to six months, and we monitor children’s growth at birth and during their early months. We also focus on fighting acute and chronic malnutrition.
INFECTIOUS DISEASES
We support local health services to raise awareness among families and communities about major diseases. We provide support and quality treatment for malaria and tuberculosis in particular — so-called diseases of poverty — which can be fatal if not treated. We implement actions to fight HIV/AIDS, for which we have treatments that are effective, but difficult to provide over patients’ entire life spans.
TRAINING
We support several schools and universities that train qualified health workers (midwives and nurses) and universities (doctors and specialists) with teachers and training material. We also provide ongoing
training working side by side with health personnel in the hospitals, health centers, and public health departments.
MONITORING, EVALUATION, AND RESEARCH
We always want to understand what impact our actions have, which is why we collect and analyze the data available and work to improve quality when needed. We also conduct full operational studies on specific aspects to guide and improve our strategy and modes of action.
CHRONIC DISEASES
We support national policies, plans, and programs to treat infectious diseases by implementing costeffective public health interventions on a district and regional level for prevention (screening), control, and treatment of cervical cancer, hypertension, and treatment of diabets.
About us
07
WHERE WE WORK www.doctorswithafrica.org/en/where-we-work/
ETHIOPIA 3
Doctors with Africa CUAMM is currently active in 7 countries with:
hospitals (Turmi, Wolisso, Gambella)
SOUTH SUDAN
school for nurses and midwives (Wolisso)
5
human resources
1
100
hospitals (Cueibet, Lui, Rumbek, Yirol, Maridi)
23 hospitals
1
64 malaria and training
189
midwifery school (Lui) human resources
programs for public health, maternal and child care, combating AIDS tuberculosis and malaria, and HIV/ AIDS
3schools for nurses
and midwives (Lui, Matany, Wolisso)
1University (Beira) 2,233 staff members, of which
1,461
human resources
SIERRA LEONE 6
UGANDA
hospitals (SJOG Lunsar, PCMH Freetown, Pujehun CMI, Bonthe, Makeni, Bo)
2
human resources
110
hospitals (Aber, Matany)
1
school for nurses and midwives (Matany)
84
human resources
264 international
TANZANIA
European
2
MOZAMBIQUE hospitals (Beira, Montepuez, Palma, Pemba)
1
university (Beira)
106
human resources
Doctors with Africa CUAMM
Annual report 2017
141
human resources
4
08
hospitals (Songambele, Tosamaganga)
Africa Report
Tunisia
Marocco
Algeria
Libya
EgyptSouth Africa
Sahara Western
Mauritania Mali
Niger Sudan
Senegal The Gambia Guinea Bissau Guinea
SIERRA LEONE
Eritrea
Ciad
Liberia
Burkina Faso
ETHIOPIA
Benin Ivory Coast
Togo
Nigeria
Gibuti
SOUTH SUDAN
Ghana
Republic of Central Africa Camerun Somalia Guinea Gabon
UGANDA
Congo
Rwanda
Democratic Republic of in the Congo
ANGOLA
Kenya
Burundi
TANZANIA
1
hospital (Chiulo)
42
human resources
ANGOLA
Malawi
Zambia
MOZAMBIQUE Madagascar Zimbabwe
Namibia
Botswana
Swaziland
Key Lesotho
Hospitals Schools
South Africa
Universities 09
POSTCARDS FROM 2017
July 6
April 8
November 11
March 23
April 27
July 6, 2017 In Juba, South Sudan’s capital city, the first 20 students graduated from the midwifery school of Lui, supported by CUAMM for the three previous years. With the country in a state of instability, it was a vibrant celebration full of hope for the future. Magdalen Awor,
10
Doctors with Africa CUAMM
teacher of the class of 12 young women and 8 young men who went between Lui and Juba for three years to study, escaping conflict and overcoming many challenges, reminded everyone present, which included the Minister of Health of South Sudan: “Nothing is impossible!”
Annual report 2017
March 23, 2017, New York Event organized in New York within the CSW (Commission Status of Women) about adolescent health called “Leaving no one behind: Healthy adolescents, smart, connected, sustainable practices.”
April 8, 2017, Padua Book presentation for “Dove comincia la strada per l’Africa,” in the Aula Magna del Bo’, dedicated to professor Anacleto Dal Lago, the first doctor who went with CUAMM for Africa and a key, long-time figure in our scientific and planning community.
Watch videos on Doctors with Africa CUAMM’s YouTube channel to re-experience the gatherings, events, and excitement of 2017: www.youtube.com/mediciconlafrica
August 31
Alberto Barcellan
November 26
April 27, 2017, Wolisso The Aula Magna/Auditorium was inaugurated at the Wolisso Hospital, in Ethiopia, dedicated to Don Luigi Mazzucato, CUAMM’s former director, who had a great love for this hospital, built fully by CUAMM, in an effort shared with the Italian and Ethiopian Catholic Church.
Postcards from 2017
August 31, 2017, Freetown In a country still severely afflicted by Ebola at the time, the High Dependency Unit at the Princess Christian Maternity Hospital (PCMH) was opened in Freetown, Sierra Leone, a completely refurbished and equipped room for intensive care for patients in the most critical postpartum conditions.
November 11, 2017, Milan At the Teatro della Luna in Assago, Niccolò Fabi, Gian Antonio Stella, Paolo Rumiz, Stefania Chiale, and Beppe Severgnini told us about their experiences with CUAMM volunteers. Special guests included Mario Draghi, President of the ECB, and Italian Prime Minister Paolo Gentiloni.
November 26, 2017, Rome End of the tour celebrating Niccolò Fabi’s 20-year career, where volunteers from CUAMM’s Rome group told visitors about how they can support CUAMM.
11
AFRICA REPORT DOCTORS WITH AFRICA CUAMM’S ACTION IN AFRICA IS AT THE CENTER OF WHAT WE DO. SINCE 1950, WE HAVE BEEN STRIVING TO CREATE RESPECT FOR THE BASIC HUMAN RIGHT TO HEALTH AND TO MAKE HEALTH SERVICES AVAILABLE TO ALL, ESPECIALLY THE POOREST AND MOST MARGINALIZED GROUPS. WE CREATE LONG-TERM HEALTH SERVICE PROJECTS: IN HOSPITALS, IN SMALL HEALTH CENTERS, VILLAGES, AND UNIVERSITIES. CUAMM WORKS TOGETHER WITH AFRICA TO WORK, BUILD, AND GROW WITH ITS PEOPLE, EVEN DURING EMERGENCIES.
12
Doctors with Africa CUAMM
Annual report 2017
Africa Report
13
NUMBERS, FACES, AND STORIES SCOPE AND COMPARISON
Numbers can tell us many truths, but they can become too abstract without proper interpretation and contextualization. Let’s compare the statistics of some countries where we work with those of Italy. These comparisons can give us a frame of reference to help us understand what the people we help need and remind us there is a face and a story behind every number. The countries where Doctors with Africa CUAMM works are highly diverse, including in geography. Their areas range from Sierra Leone’s 72,000 km² to Angola’s 1,200,000 km². Italy has an area of 300,000 km², a quarter of that of Angola, less than half that of Mozambique; but in Italy has more than twice the population of either of these two countries. Working on the furthest outposts means moving across these vast, sparsely populated lands to support hospitals and health centers in the remotest areas and getting to villages that aid has trouble reaching. Moving personnel, medicine, and materials is often part of what makes it complex. While in some parts of Ethiopia, it takes an hour and a half to get across 100 km — not much different than in Western countries — but covering the same distance in South Sudan takes more than three hours, which becomes endless during the rainy season (which can lasts up to six months) and in the areas most affected by insecurity and instability due to factional fighting. Health numbers are the hardest to compare, and they are the statistics most recurrent in this report. The lyrics of “La Strada per l’Africa,” a performance made to address the issue of unequal health, inspired by the stories of Doctors with Africa CUAMM workers. A piece of one song: “83: life expectancy in Italy, 50: if you’re born in Sierra Leone. When we lose a friend at 50 years old, we say that he died young and his life was cut short. And that’s true. Or at least that’s true in our world. Because, in another world, dying at 50 years old is the norm. 44: the average age of the population in Italy, 16 in Uganda, 17 in Mozambique, 19 South Sudan. Imagine two cafés: one whose regulars are quiet fifty-year-olds and another with a bunch of kids. We’re getting older and older, and they’re getting younger and younger.
Leone. The pain of those 4 out of 100,000 is no different than that of those 1,360. But the numbers tell of two different worlds. In one, these are terrible, but extremely rare events, and in the other, a tragedy on a massive scale”. This report seeks to provide an account of the results achieved by the many people who work every day to strengthen the health systems of the countries where we are active. For instance, what does it mean that CUAMM made 92,025 attended births possible in Uganda in 2017? It means that CUAMM helped achieve a number of attended births very close to those in the region of Veneto, according to Italian Ministry of Health data. In Ethiopia, we made 12,718 attended births possible, roughly equivalent to those the Marche in Italy. And so forth: Mozambique is like Tuscany, South Sudan like Liguria. Similarly, we can look at Italian statistics to help us understand hospital data. The San Pietro Fatebenefratelli Hospital is one of Rome’s leading hospitals and attends about 4,400 births per year (source: CedAP). The Princess Christian Maternity Hospital is the largest maternity hospital in Freetown, Sierra Leone’s capital, and had 6,861 births in 2017. The hospital in Wolisso, Ethiopia, counted 4,311, almost the same number as that in the Gemelli Clinic, also in Rome. How many doctors are there to attend the births as well as everything else? In Italy, 1 for every 253 inhabitants; in Sierra Leone, 1 for every 41,600 inhabitants; in Angola, 1 for every 7,000; in Uganda, 1 for every 8,300; in Mozambique, 1 for every 18,100; in Tanzania, 1 for every 33,000; and in Ethiopia, 1 for every 40,000. The situation in South Sudan is so unstable that it is impossible to gather any statistics. For Doctors with Africa CUAMM, this is what it means to work at the furthest outposts with passion and tenacity to strengthen all levels of the African health system.
35 out of 1,000, the mortality rate in Italy, 157 out of a thousand in Angola. 3.5 compared to 157. The news for mothers is no better. Four mothers out of 100,000 die in childbirth in Italy, 480 out of a hundred thousand in Mozambique, 789 in South Sudan, 1,360 in Sierra
14
Doctors with Africa CUAMM
Annual report 2017
Africa Report
AREA
AVERAGE AGE OF THE POPULATION
Angola
1,247,000 km²
Ethiopia
1,104,300 km²
Uganda
15.9
Tanzania
947,300 km²
Angola
16.3
Mozambique
799,380 km²
Mozambique
17.3
South Sudan
644,330 km²
Tanzania
17.6
Ethiopia
18.6
Italy
301,338 km²
South Sudan
Uganda Sierra Leone
241,550 km² 72,300 km²
Sierra Leone
18.9 19.3
Italy
44,3 10
0
20
30
40
50
MORTALITY OF CHILDREN UNDER 5 YEARS
MATERNAL MORTALITY of 100,000 live births
of 1,000 live births
Italy
Italy
4
Uganda
343
Tanzania
Ethiopia
353
Uganda
Tanzania
3,5 48 54
Ethiopia
398
59
Angola
477
Mozambique
Mozambique
480
South Sudan
South Sudan Sierra Leone
1,360 300
600
900
92
Sierra Leone
789
0
79
1,200
120
Angola
1,500
157 0
50
NEONATAL MORTALITY
NUMBER OF DOCTORS
Italy
Italy 1:253
of 1,000 live births
1
Tanzania
Angola 1:7,000
Uganda 1:8,300
100
150
Mozambique 1:18,100
200
Tanzania 1:33,000
35
Uganda
37
Ethiopia
41
Mozambique
Ethiopia 1:40,000
56
South Sudan
60
Sierra Leone
Sierra Leone 1:41,600
87
Angola
96 0
20
40
60
80
100
15
FOCUS ON SOUTH SUDAN: A REGIONAL CRISIS
2017 SNAPSHOT Intervention in Nyal:
1
operating unit
www.doctorswithafrica.org/en/southsudan
4
emergency care locations
The humanitarian crisis in South Sudan, which has been ongoing since 2013, considered “the largest refugee crisis in Africa,” continued in 2017 when food crises in the central part of the country were added to the the recent armed conflict between the government and the opposition in 2016. The result was massive internal and external migrations driven by the need for safety. As a result, not only were there “internally displaced persons,” there were migratory movements to the neighboring countries such
as Ethiopia, especially in the region of Gambella, and Uganda in the northern regions. It is currently estimated that there are over 1 million South Sudanese refugees in Uganda and 530,000 in Ethiopia; this means that about a quarter of the country’s population has fled and another large swath (1.76 million) has left their villages for safer areas. This was the context in which CUAMM’s interventions in the Nyal area, the Gambella Region (Ethiopia), and Uganda’s West Nile area.
Gambella interventions:
1
Nguenyyiel camp
80,000 people
Interventions in West Nile:
257
facilities
1,000,000
refugees Juba
4,000,000 DISPLACED PERSONS 1 INHABITANT OUT OF 3 LEFT THEIR HOME
SOUTH SUDAN Moyo
CENTRAL AFRICAN REPUBLIC
Nile River
SUDAN
Koboko
Adjumani
ETHIOPIA Arua
GAMBELLA NYAL
MAPER CUEIBET RUMBEK CENTRAL AFRICAN REPUBLIC
UGANDA
530,000
YIROL
REFUGEES IN ETHIOPIA Nebbi
LUI Juba
MARIDI DEM. REP. OF THE CONGO West Nile
SOUTH SUDAN: THE CRISIS’S NUMBERS 16
Doctors with Africa CUAMM
UGANDA
KENYA
1,000,000
REFUGEES IN UGANDA
Annual report 2017
REFUGEE CAMPS IN WEST NILE, UGANDA Africa Report
Nile River
INTERVENTION IN NYAL After the declaration of famine in the former Unity State in South Sudan, CUAMM took action in the County of Panyijar, in Payam of Nyal, one of the areas hardest hit by the flow of displaced persons fleeing the conflict and seeking food. Services here were inadequate to meet the needs of these families and of the resident communities that hosted them that had to bear responsibility for supporting them. Our efforts focused on giving access to basic health care to the now extremely vulnerable population and spread out over an area made almost entirely inaccessible by marshland, and responding
INTERVENTION IN THE GAMBELLA REGION In latter part of 2017, CUAMM initiated an intervention to support the health system of the largest and most recent of the region’s 7 refugee camps, in Nguenyyiel and has more than 80,000 people, mostly women and children. The camps have become full-fledged de facto cities. Basic health services have been set up by the authorities, but they need support to operate effectively and provide quality services. We have acted to do so on several fronts, with special attention to maternal and child health and
INTERVENTION IN THE WEST NILE In mid 2017, CUAMM launched an intervention to support the health system of 6 districts in the north of the country most affected by the influx of South Sudanese refugees (more than 800,000 out of a total population of 2,180,000). The situation in these areas, which was already difficult, with health indicators below the national standard, was compounded in recent years by these districts’ health services bearing the brunt of a major increase in the population served, especially mothers and children. The project that CUAMM initiated strives for better maternal and child health in the region, adopting the ReHope Strategy launched by Uganda’s government, with which everything
to, managing, and referring emergencies, especially obstetric emergencies. We built 4 first aid stations in 4 remote villages, set in the marshy inland. A mobile health team was formed to provide previously-isolated communities with regular access to prevention, diagnosis, and treatment of the most common diseases. Construction was started on the operating unit of Nyal’s health center to be able to address obstetric and surgical emergencies without having to transfer them elsewhere, also impossible much of the year due to flooding and insecurity on the roads. Vehicles were purchased that could cross marshes and streams, taking both health workers to villages needing care and seriously ill patients referred to the health center.
nutrition. While continuing to train and support the existing health staff, the health infrastructure was improved to ensure access to water and solar power as well as medicine and materials; we also improved the integration of the camps’ health system with the regional one, supporting the referral system for health emergencies. Improving the referral system entails also supporting the regional health system, specifically the Gambella Regional Hospital. CUAMM, therefore, supplemented its action specifically for the refugee population by further strengthening the health system in the three districts, in order to ensure quality services that can be equally accessed by the entire population, especially mothers and children.
done in the refugee areas must be integrated and provided both to the resident communities (Ugandan population) and the hosted populations (refugees). A total of 257 health facilities are involved in the intervention at different levels (hospitals, health centers, dispensaries, supported with small infrastructural projects, training, and mentorship of health personnel through a technical project team, equipment, and medicine, and strengthening of the referral system and community work. The project also has a significant component of supporting local authorities in order to progressively improve the delivery of integrated social services, working on the coordination of actions and careful monitoring of project activities and results.
17
ANGOLA
2017 SNAPSHOT
www.doctorswithafrica.org/angola
human resources
42 37
health facilities supported
1,044,493 ¤
invested in projects
IN 2017
OUR HISTORY
The country saw a very weak economic recovery, after oil prices had collapsed, and, after 38 years, a new president from the MPLA, the ruling party, João Lourenço, was elected. In this context, we developed a new undertaking in Luanda, having completed the intervention to improve diabetes and hypertension diagnoses in tuberculosis patients(TB). In the latter part of the year, also in Luanda, we started providing technical support for the national tuberculosis program preparing for the start of a pilot project of community-based DOTs (DirectlyObserved Therapy) in 5 municipalities in 2018.
1997 With the country in the midst of civil war, CUAMM implemented its first emergency actions in the province of Uige.
Efforts in the municipality of Ombadja continued in latter part of the year, supporting maternal and child health, with special focus on nutritional health, continued at the Chiulo hospital and throughout the Cunene province.
18
Doctors with Africa CUAMM
Country profile
2004 Support for the health system in the difficult process of moving from emergency to development with interventions in Luanda and in the provinces of Uige and Cunene. 2012 Started the “Mothers and Children First” program to ensure access to safe birth and newborn care in four African countries. 2014 Started an innovative intervention in Luanda to improve the diagnosis of diabetes, hypertension, and tuberculosis. 2016 “Mothers and Children First 1,000 Days” program started. period from the beginning of pregnancy up to 2 years of age.
Annual report 2017
Africa Report
Luanda Capital 25 million Population 1,247,000 km² area 16.3 years Average age of the population 51/54 years Life expectancy (m/f) 6,2 Average number of children per woman 150th of 188 countries Human Development Index
477 of every 100,000 live births Maternal mortality
156.9 of 1,000 live births Mortality of children under 5 years
96 of 1,000 live births Neonatal mortality
WHERE WE WORK Technical support to the National Tuberculosis Program
DEM. REP. OF CONGO
PROVINCE OF CUNENE
Luanda
PROVINCE OF LUANDA
Municipality of Ombadja 1 hospital Chiulo 36 health centers 323,957 population served
Atlantic Ocean
3 awarenessraising events about diabetes and hypertension. 2,500 participants in events
ZAMBIA Cunene
Municipality of Ombadja
CHIULO NAMIBIA
0
125
250 km
RESULTS ACHIEVED MATERNAL AND CHILD HEALTH NUTRITION
2,650
antenatal visits
12
transfers for obstetric emergencies
2,180
attended births
6,740
visits for children under 5 years
18,151
vaccinations
285
children treated for severe acute malnutrition
Angola
INFECTIOUS DISEASES
5,128
CONTINUING TRAINING
52
patients treated for malaria community agents and 120 traditional
267
patients treated for tuberculosis
707
patients in antiretroviral treatment
133
nurses
3
doctors
3
other
19
ETHIOPIA
2017 SNAPSHOT
www.doctorswithafrica.org/ethiopia
human resources
100 38
health facilities supported
3,201,793 ¤
invested in projects
IN 2017
OUR HISTORY
In a country beset by upheaval, our support for the Wolisso hospital continued, sending staff, aid for medicine and local staff, rehabilitation projects, and waste disposal systems. In the region of South Omo, we continued interventions for maternal and child health, the prevention and treatment of cervical cancer, HIV/ AIDS, tuberculosis, and hepatitis B. In April, a three-year project launched in the region of Gambella supporting maternal and child health and nutrition in the three reasons and reduce unequal access to health services. In Gambella, on the border of South Sudan, where about 500,000 refugees came, in August, we started an action to support the refugee camp in Nguenyyiel to compensate for effects on the local health system, improving infrastructure and equipment, and training health personnel, and urgent transportation to the regional hospital of Gambella, whose maternity ward was refurbished.
1980 First doctor sent to the Gambo leper colony.
20
Annual report 2017
Doctors with Africa CUAMM
Country profile
1997 An agreement signed with the Ethiopian Bishops’ Conference, leading to the construction of St. Luke’s Hospital of Wolisso with an attached school for midwives and nurses. 2012 Started the “Mothers and Children First” program to ensure access to safe birth and newborn care in four African countries.
Addis Abeba Capital 99.4 million Population 1,104,300 km² area 18.2 years Average age of the population 63/67 years Life expectancy (m/f)
2014 Started intervention in South Omo.
4.6 Average number of children per woman
2016 “Mothers and Children First 1,000 Days” program started. period from the beginning of pregnancy up to 2 years of age.
174th of 188 countries Human Development Index
2017 Started three-year project in the region of Gambella.
Africa Report
353 of every 100,000 live births Maternal mortality
59 of 1,000 live births Mortality of children under 5 years
41.4 of 1,000 live births Neonatal mortality
WHERE WE WORK
SOUTH WEST SHOA ZONE
ERITREA YEMEN SUDAN DJIBOUTI Gulf of Aden
South West Shoa Zone
GAMBELLA 1 hospital Gambella 3 districts 7 health centers 90,953 population served 1 refugee camp Nguenyyiel 82,631 refugees
Addis Abeba
WOLISSO
GAMBELLA Gambella
SOUTH SUDAN
1 hospital Wolisso St. Luke Hospital 1 school for nurses and midwives 4 districts 20 health centers 1.240.333 population served
SOUTH OMO 1 hospital Turmi 3 districts Indian 8 health centers Ocean 218.993 population served
South Omo
TURMI HC
SOMALIA KENYA 0
125
250 km
RESULTS ACHIEVED MATERNAL AND CHILD HEALTH NUTRITION
25,169
antenatal visits
2,258
transfers for obstetric emergencies
15,307
attended births
141,012
visits for children under 5 years
6,533
vaccinations
445
children treated for severe acute malnutrition
INFECTIOUS DISEASES
96,263
1,516
1,533
CONTINUING TRAINING
624
389
75
24
CHRONIC DISEASES
1,510
2,408
165
75
SURGERY SERVICES
3,431
4,935
HUMANITARIAN
6,951
356
patients treated for malaria community agents
patients diagnosed with diabetes
nurses and midwives
patients diagnosed with hypertension
major surgery, including 636 orthopedic surgeries visits for children under 5 years
Ethiopia
patients treated for tuberculosis
patients in antiretroviral treatment doctors
patients with heart disease
midwives graduated from the school for midwives
other
patients with cerebral ischemia
minor surgeries, including 338 orthopedic surgeries attended births
241
3,050
physiotherapy
29
emergencies transferred to the hospital 21
MOZAMBIQUE
2017 SNAPSHOT
www.doctorswithafrica.org/mozambique
human resources
106 27
health facilities supported
2,617,787 ¤
invested in projects
IN 2017
OUR HISTORY
With the country beset with conflict, in Beira, CUAMM reinforced its action for adolescent health and HIV/AIDS with 6 counseling and testing centers, training health personnel and activists. After completing the neonatal unit, we continued providing technical assistance to the central hospital and in health centers and teaching support at the Catholic University. In the Province of Cabo Delgado, we equipped the hospitals in Pemba and Montepuez with neonatal units and expanded the maternity ward in Ocua; in the districts of Balama and Montepuez, we started a project to prevent, diagnose, and treat malaria. In the Province of Tete we started an action for adolescent health and to fight HIV/AIDS with 11 counseling and testing centers. In the Provinces of Maputo, Beira, Nampula and Quelimane, we started screening, early diagnosis, and combating non-communicable diseases and chronic diseases (diabetes and hypertension) in the Provinces of Cabo Delgado, Sofala and Maputo
1978 Started health cooperation interventions, first in the post-war emergency period, and then in the development phase of the health service.
22
Annual report 2017
Doctors with Africa CUAMM
Country profile
2002 Interventions in Beira with technical support to hospitals and health centers.
Maputo Capital 27.9 million Population 799,380 km² area 17.3 years Average age of the population
2004 Started collaboration with the Catholic University of Mozambique in Beira.
56/59 years Life expectancy (m/f)
2013 Support extended to the district of Palma, one of the country’s most remote areas.
5.6 Average number of children per woman
2014 Started intervention in the Province of Cabo Delgado.
181st of 188 countries Human Development Index
2016 Started “Mothers and Children First 1,000 Days” program, from pregnancy through the first two years of the child’s life.
Africa Report
480 of every 100,000 live births Maternal mortality
79 of 1,000 live births Mortality of children under 5 years
56.7 of 1,000 live births Neonatal mortality
WHERE WE WORK
PROVINCE OF TETE
TANZANIA
3 districts 15 counseling for teenagers 200,000 population served
PALMA Cabo Delgado
MONTEPUEZ
ZAMBIA
PEMBA Nampula
Nampula
Tete
MALAWI
Tete
Zambézia
PROVINCE OF CABO DELGADO 3 hospitals Montepuez, Palma, Pemba 2 health centers 6 districts 1,235,844 population served
Quelimane Sofala
ZIMBABWE BEIRA
Indian Ocean
PROVINCE OF SOFALA 1 Central Hospital of Beira 1 Catholic University of Mozambique 6 health centers 463,442 population served
HEALTH DEPARTMENT Technical support on diabetes and chronic diseases. Support to the hospitals in Maputo, Beira, Quelimane, Nampula, Pemba
SOUTH AFRICA
Maputo
Maputo
SWAZILAND
0
125
250 km
RESULTS ACHIEVED CHILD HEALTH LESOTHO 19,370
17,732
43,840
561
78,224
61,084
988
76,761
1,149
753
26
6
antenatal visits
DISEASES
adolescents educated about HIV/AIDS
TRAINING
community agents
attended births
adolescents tested for HIV
nurses
101
midwives
Mozambique
visits for children
adolescents with positive test results
students graduated from the University of Beira
vaccinations
patients treated for malaria 40,260 < 5 years
teachers sent for short teaching programs
212
doctors
23
SIERRA LEONE
2017 SNAPSHOT
www.doctorswithafrica.org/sierra-leone
human resources
110
370
health facilities supported
2,333,736 ¤
invested in projects
IN 2017
OUR HISTORY
In this country, which is showing signs of recovery after the extreme Ebola epidemic, CUAMM continued to support the maternal-child complex of Pujehun and in the district, achieving substantial results in reducing child mortality and increasing access to care. Maternal mortality was significantly reduced in the maternal hospital in Freetown, the capital city, where we started the country’s first maternal intensive care unit. CUAMM expanded its work to two other regional hospitals (Makeni and Bo) and two hospitals in the district of Bonthe. Here, we started training community agents on the basic treatment of malaria, pneumonia, and diarrhea. We continued our work in the Lunsar hospital, extending it to specialist surgical missions in the area’s health centers, where an ambulance service for obstetric emergencies was started.
2012 CUAMM started working in the Pujehun district of Sierra Leone.
24
Annual report 2017
Doctors with Africa CUAMM
Country profile
2014 Sierra Leone was the country most affected by the worst outbreak of Ebola in history. CUAMM stayed in Pujehun and ensured the presence of an expatriate staff and the continuity of essential services. 2015 Started support to the hospital in Lunsar which had been forced to close during the epidemic. 2016 Started “Mothers and Children First 1,000 Days” program, from pregnancy through the first two years of the child’s life.
Africa Report
Freetown Capital 6.5 million Population 72,300 km² area 19 years Average age of the population 49/51 years Life expectancy (m/f) 4.83 Average number of children per woman 179th of 188 countries Human Development Index
1,360 of every 100,000 live births Maternal mortality
120.4 of 1,000 live births Mortality of children under 5 years
87.1 of 1,000 live births Neonatal mortality
WHERE WE WORK
FREETOWN WESTERN AREA
PORT LOKO DISTRICT
1 hospital Princess Christian Maternity Hospital - Freetown 1,573,109 population served
1 hospital St. John of God Hospital - Lunsar 140,970 population served
BOMBALI DISTRICT 1 hospital Makeni 107 health centers 636,000 population served
BO DISTRICT 1 hospital Bo 124 health centers 603,716 population served
GUINEA
BONTHE DISTRICT
Bombali
2 hospitals 55 health centers 210,531 population served
Port Loko
PUJEHUN DISTRICT
MAKENI LUNSAR
1 hospital Pujehun CMI 77 health centers 384,864 population served
FREETOWN
Freetown Western Area Atlantic Ocean
Bo
BO
Bonthe
BONTHE
Pujehun
PUJEHUN 0
40
LIBERIA
80 km
RESULTS ACHIEVED MATERNAL AND CHILD HEALTH
136,629
NUTRITION
395
antenatal visits
5,040
transfers for obstetric emergencies
attended births
31,482
2,226
4
638
visits for children under 5 years
children treated for severe acute malnutrition
INFECTIOUS DISEASES
209,892
CONTINUING TRAINING
174
10
CHRONIC DISEASES
2,234
21
Sierra Leone
patients treated for malaria
nurses
tests for gestational diabetes
midwives
doctors
pregnant women identified with gestational diabetes
other
207
pregnant women diagnosed with hypertension in pregnancy 25
SOUTH SUDAN
2017 SNAPSHOT
www.doctorswithafrica.org/south-sudan
human resources
189
95
1,461
7,659,808 ¤
extraordinary
IN 2017
OUR HISTORY
As the crisis deepened, CUAMM enhanced its support for 8 county health offices, 4 hospitals, 92 peripheral health facilities with missions in the communities, vaccinations, and ambulance service. Our support for the Lui midwifery school led 20 students to complete their degrees. Our interventions together affected over a million people. CUAMM focused its assistance in the area of Nyal (former Unity State), which was the most unstable area, with thousands of displaced persons in an almost inaccessible area, by building an operating room in the health center to ensure access to Cesarean section and by creating a healthcare network in the most remote locations. We built and stocked with medicine 4 first aid posts where the health staff permanently provided basic services and formed a mobile team to serve most of the wetland area. In December, we extended the program to include 4 new county health offices, 72 peripheral health facilities and a hospital.
2006 Started renovation and reopening of the Yirol Hospital.
26
Annual report 2017
Doctors with Africa CUAMM
health facilities supported invested in projects
Country profile
2008 Our action extended to the Lui Hospital. 2013 Conflict in the country made CUAMM face a severe humanitarian emergency. 2014 CUAMM aided displaced persons, opened a school for midwives in Lui and started the intervention in Cueibet. 2016 Started “Mothers and Children First 1,000 Days” program, from pregnancy through the first two years of the child’s life.
Africa Report
Juba Capital 12.3 million Population 644,330 km² area 18.9 years Average age of the population 56/59 years Life expectancy (m/f) 5.2 Average number of children per woman 181st of 188 countries Human Development Index
789 of every 100,000 live births Maternal mortality
92.5 of 1,000 live births Mortality of children under 5 years
60.3 of 1,000 live births Neonatal mortality
WHERE WE WORK
WESTERN LAKE STATE
EASTERN LAKE STATE
1 hospital Rumbek 4 counties 53 health centers 545,545 population served
1 hospital Yirol 3 counties 26 health centers 329,644 population served
0
100
200 km
SOUTH LIECH STATE 1 health center Nyal 1 county 4 health posts
AMADI STATE
SUDAN
1 hospital Lui 1 school for nurses and midwives of Lui 3 counties 48 health centers 169,489 population served
South Liech State
CENTRAL AFRICAN REPUBLIC
NYAL
ETHIOPIA
Gok State
GOK STATE
CUEIBET RUMBEK
1 hospital Cueibet 1 county 13 health centers 177,987 population served
Western Lake State Amadi Maridi State State
MARIDI
YIROL Eastern
LUI
Juba
MARIDI STATE KENYA
DEM. REP. OF CONGO
1 hospital Maridi (since 12/2017)
UGANDA
1 county 24 health centers 106,834 population served
RESULTS ACHIEVED MATERNAL AND CHILD HEALTH
64,742
NUTRITION
774
antenatal visits
221
transfers for obstetric emergencies (Yirol)
16,890
377,544
2.975
attended births
visits for children under 5 years
505,856
vaccinations
children treated for severe acute malnutrition
INFECTIOUS DISEASES
304,503
70
1,580
CONTINUING TRAINING
94
56
22
HUMANITARIAN RESPONSE
4,823
South Sudan
patients treated for malaria
community agents
patients treated for tuberculosis
nurses and midwives
patients in antiretroviral treatment
patients treated for the cholera epidemic in Eastern Lake State
doctors
outpatient visits + 102 antenatal visits for displaced people in the County of Nyal
27
TANZANIA
2017 SNAPSHOT
www.doctorswithafrica.org/tanzania
human resources
141
107
health facilities supported
4,420,468 ¤
invested in projects
IN 2017
OUR HISTORY
In Tanzania, recently suffering tensions, CUAMM strengthened the national health service, expanding its intervention to the 7 regions of Tanzania in 25 of its districts. We gave special attention in rural areas to the health of mothers and children, attended births, and newborn care. In the Dodoma region, we launched a project to improve water quality and the nutrition of children. Prevention measures in the community promoted adequate, sustainable eating habits to fight chronic malnutrition and provide medical treatment for severely malnourished children. We continued universal treatment for HIV in the areas of the 4 health centers of the dioceses and completed the awareness and treatment campaigns for cervical cancer and non-communicable diseases, such as diabetes and hypertension in the Kilosa district.
1968 Started intervention to strengthen the health system.
28
Annual report 2017
Doctors with Africa CUAMM
Country profile
1977 Implemented the first health cooperation program under the technical cooperation agreement between Italy and Tanzania. 1990 Inauguration of hospital in Iringa. 2012 Started the “Mothers and Children First” program to ensure access to safe birth and newborn care in four African countries. 2014 Started the project in the regions of Iringa and Njombe to treat child malnutrition. 2016 Started “Mothers and Children First 1,000 Days” program, from pregnancy through the first two years of the child’s life.
Africa Report
Dodoma Capital 53.5 million Population 947,300 km² area 17.6 years Average age of the population 60/64 years Life expectancy (m/f) 5.5 Average number of children per woman 151st of 188 countries Human Development Index
398 of every 100,000 live births Maternal mortality
48.7 of 1,000 live births Mortality of children under 5 years
35.2 of 1,000 live births Neonatal mortality
WHERE WE WORK
REGION OF SHINYANGA
REGION OF SIMIYU
2 health centers 2 districts 495,808 population served
1 hospital Songambele 12 health centers 3 districts 1,175,199 population served
UGANDA KENYA
RWANDA
Region of Simiyu
BURUNDI
SONGAMBELE Region of Shinyanga
REGION OF DODOMA
Region of Dodoma
Dodoma Region of Iringa
DEM. REP. OF CONGO
REGION OF IRINGA 1 hospital Tosamaganga 8 health centers 5 districts 827,519 population served
0
150
Region of Morogoro
Indian Ocean
TOSAMAGANGA Region of Njombe
ZAMBIA
REGION OF NJOMBE
REGION OF MOROGORO
Region of Ruvuma
49 health centers 6 districts 724,771 population served
MALAWI
2 districts 715,942 population served
6 health centers 1 Kilosa district 438,175 population served
REGION MOZAMBIQUE OF RUVUMA 28 health centers 6 districts 1,530,409 population served
300 km
RESULTS ACHIEVED MATERNAL AND CHILD HEALTH
18,418
118
NUTRITION
1,265
98,396
INFECTIOUS DISEASES
884
278
4,350
CONTINUING TRAINING
661
20
22
antenatal visits
children treated for severe acute malnutrition
Tanzania
patients treated for malaria
community agents trained to treat severe acute malnutrition
transfers for obstetric emergencies
11,956
attended births
children under 2 years screened for stunting in the regions of Symiu and Ruvuma
patients treated for tuberculosis
nurses
18,008
visits for children under 5 years
21,574
vaccinations
43,266
children under 2 years of age diagnosed with chronic malnutrition in the Regions of Symiu and Ruvuma, and 74,007 in the regions of Iringa and Njombe.
patients in antiretroviral therapy doctors
67
midwives 29
UGANDA
2017 SNAPSHOT
www.doctorswithafrica.org/uganda
human resources
84
409
health facilities supported
2,676,329 ¤
invested in projects
IN 2017
OUR HISTORY
Uganda felt the impact of the crisis in neighboring South Sudan. CUAMM focused on the health of mothers and children in the region of Karamoja and the Oyam district, in the villages and in health centers.and hospitals, Matany and Aber promoting education, antenatal visits, attended births, and emergency transport. In Karamoja, we gave focused especially on preventing HIV transmission from mother to child and treating tuberculosis. We intensified our efforts to fight chronic and acute malnutrition in the Oyam and Napak districts. After the conclusion in the West Nile region of the project to improve management of children suffering from acute malnutrition, an emergency intervention was launched in 5 districts of the region, and in the district of Kiriandongo, to support the South Sudanese refugees (more than a 1,000,000 people) and the host population to strengthen the health care system to help cope with the almost doubled population. .
1958 First doctor sent to the Angal Hospital.
30
Annual report 2017
Doctors with Africa CUAMM
Country profile
1979 Implemented the bilateral cooperation between Italy and Uganda in the health field. The first doctors started working in the national health system. 1990s Rebuilt the Aber Hospital and rehabilitated the hospitals of Maracha, Angal, Aber, and Matany. 2012 Started the “Mothers and Children First” program to ensure access to safe birth and newborn care in four African countries. 2016 Started “Mothers and Children First 1,000 Days” program, from pregnancy through the first two years of the child’s life.
Africa Report
Kampala Capital 39 million Population 241,550 km² area 15.9 years Average age of the population 60/64 years Life expectancy (m/f) 5.9 Average number of children per woman 163rd of 188 countries Human Development Index
343 of every 100,000 live births Maternal mortality
54.6 of 1,000 live births Mortality of children under 5 years
37.7 of 1,000 live births Neonatal mortality
WHERE WE WORK
REGION OF WEST NILE 5 districts + Kiryandongo district 257 health centers 2.297.000 population served 881.341 refugee population
SOUTH SUDAN
REGION OF KARAMOJA
West Nile
DEM. REP. OF CONGO
Karamoja
1 hospital Matany 1 school for nurses and midwives Matany 7 districts 121 health centers 1.067.400 population served
MATANY
ABER Mid Northen
MID NORTHEN DISTRICTS Oyam district 1 hospital Aber 29 health centers 414.800 population served
KENYA
Kampala
Vittoria lake
RWANDA
TANZANIA 0
60
120 km
RESULTS ACHIEVED MATERNAL AND CHILD HEALTH NUTRITION
219,526
antenatal visits
1,908
92,025
transfers for obstetric emergencies
attended births
1,152,627
visits for children under 5 years
8,614
children treated for severe acute malnutrition
Uganda
INFECTIOUS DISEASES
1,823,831
2,688
7,408
CONTINUING TRAINING
3,872
6
7
patients treated for malaria
community agents
patients treated for tuberculosis
nurses
patients in antiretroviral therapy midwives
1
doctor
11
other
31
MATERNAL AND CHILD HEALTH www.doctorswithafrica.org/en/where-we-work/the-first-1000-days-for-mothers-and-children/
THE FIRST 1,000 DAYS FOR MOTHERS AND CHILDREN Maternal and child health is a priority action area for Doctors with Africa CUAMM. In sub-Saharan Africa, too many mothers still die from treatable diseases. Distances from hospitals, facilities, and insufficient staff, as well as a lack of information, put at risk the lives of the most fragile, vulnerable groups. After the end of the 5-year program “Mothers and Children First” in 4 districts of 4 African countries, a new program was launched to provide continuity and to expand the efforts to support women and their children. We expanded our focus to include nutrition during the mother’s pregnancy and newborn care for the first two years of life in the 7 countries in the program.
The new 5-year program “The First 1,000 Days for Women and Children” supports and trains local personnel to increase the number of women with access to safe, attended births and provides nutritional interventions to combat chronic and acute malnutrition in mothers and children. The key interventions, in addition to those part of the earlier program, are for nutritional support for the developing fetus, the newborn, and children up to two years old, with support for antenatal visits, promoting exclusive breastfeeding, weaning, and monitoring child growth, as well as the earlier identification of acute malnutrition and its treatment. The hospitals involved, increasing from 4 to 10, were: Chiulo (Angola), Wolisso (Ethiopia), Montepuez (Mozambico), Songambele, Tosamaganga (Tanzania), Aber, Matany (Uganda), Pujehun (Sierra Leone), Yirol, and Lui (South Sudan).
FIRST YEAR RESULTS Goal: 320,000 attended births in 5 years
Objective: 10,000 acutelymalnourished children treated in 5 years
Goal: 50,000 children supported in their growth over 5 years
CHILDREN TREATED FOR SEVERE ACUTE MALNUTRITION IN 2017
ATTENDED BIRTHS IN 2017
2,410
CHILDREN TREATED FOR SEVERE ACUTE MALNUTRITION
17,167
17%
24%
34%
This is a good start and in line with expectations. In some districts where we work, we have recently started engaging communities, which therefore did not already know about the services available and new assistance to access them.
Acute malnutrition is caused by inadequate access to food, such as that caused by famine or economic problems. This is the most dangerous form and can lead to death. It requires treatment in hospitals or health centers.
Chronic malnutrition means delayed growth caused by a continuous food shortage or a limited use of available resources. It causes permanent deficits in children in their physical, psychological, and intellectual growth, compromising the rest of their lives. CUAMM implements actions for women and children that can reduce the impact of chronic malnutrition.
55,209
OF GOAL MET
32
Doctors with Africa CUAMM
OF GOAL MET
OF GOAL MET
Annual report 2017
Africa Report
OTHER DIFFICULT SETTINGS CUAMM’s action went beyond these 10 districts and hospitals, affecting another 13 in the seven countries where we work. In 2017, our intervention at the hospital of Palma, Mozambique, came to end and fully given over to district authorities, with 1,469 attended births and 189 Cesareans. In Sierra Leone, our action extended to maternal health in the hospitals of Makeni, Bo, and two hospitals in the District of Bonte (one governmental hospital on the island, and a non-profit private hospital on the mainland). The intervention’s goal is to address major obstetric complications, support the emergency and referral system with ambulances and improve the quality of hospital care. The table shows the major obstetric complications treated in Sierra Leone and compares them with other places where CUAMM works. We can see that only in a single site (Tosamaganga), the percentage of attended births is over 50%, evidence that, though we have done a great deal in treating major obstetric complications that contribute to maternal mortality, there is still a great deal to do in order to decisively reduce maternal mortality. In South Sudan, despite the country’s difficulties, our work continued and, indeed, expanded in support of the hospitals of Yirol, Lui, and Cueibet, as well as Rumbek, though guerrilla warfare and insecurity made operations and movement in the area difficult. In 2017, in the 7 countries where we work, Doctors with Africa CUAMM has provided a total of 187,928 attended births, 48,019 of which were in the 22 hospitals where we operate.
HOSPITAL AND AREA SERVED
NO. ATTENDED BIRTHS
% MDOC ON THE BIRTHS EXPECTED IN AREA SERVED
PCMH
6,871
38.9%
Makeni
2,219
27.8%
Bo
2,778
38.1%
Bonte
722
18.0%
Pujehun
940
32.6%
ANGOLA
Chiulo
2,180
23.8%
ETHIOPIA
Wolisso
2,311
49.0%
MOZAMBIQUE
Montepuez
4,048
45.3%
SOUTH SUDAN
Yirol
1,398
27.6%
Cuibet
1,208
24.9%
Lui
557
26.9%
SIERRA LEONE
TANZANIA
Tosamaganga 3,010
67.5%
UGANDA
Aber
2,338
22.3%
Matany
1,161
28.3%
*Note: data pertains to 22 hospitals. For the most recent hospital, opened in Maridi in South Sudan at the end of 2017, the data are not available.
Maternal and child health
33
COVERAGE OF ATTENDED BIRTHS IN ACTIVE*
* The data refers to attended births only in the districts where Doctors with Africa CUAMM operates on all three levels of the health system (community, peripheral health centers, and hospitals) for which we can calculate the coverage rate more accurately. ** data refers only to the hospital
COUNTRY
REGION
DISTRICT
EXPECTED BIRTHS
ATTENDED BIRTHS IN HOSPITALS AND HEALTH CENTERS
COVERAGE IN PERCENTAGE 2017
VARIATION OF COVERAGE COMPARED TO 2016
ANGOLA
Cunene
Ombadja
16,198
2,180**
13%
+4%
ETHIOPIA
South Omo Dassenech
2,316
1,497
65%
14%
Male
1,350
1,752
130%
34%
Omorate
2,621
911
35%
5%
Goro
2,137
1,661
78%
8%
Wolisso urban 8,856 and rural
5,097
58%
11%
Wonchi
4,351
2,209
51%
-12%
Cabo Delgado
Palma
2,710
1,469
54%
15%
Montepuez
10,695
7,666
72%
SIERRA LEONE
Pujehun
Pujehun
16,934
12,595
74%
4%
SOUTH SUDAN
GOK
Cueibet
9,825
4,225
43%
34%
Western Lakes
Wulu
3,377
925
27%
14%
Rumbek Center
12,786
2,774
22%
8%
Rumbek East
10,228
2,709
26%
-2%
Rumbek North 3,615
989
27%
0%
Yirol West
8,852
2,578
29%
-6%
Yirol East
5,612
1,725
31%
Awerial
3,917
408
10%
Mundri
Amadi
2,557
557
22%
-5%
TANZANIA
Iringa
Iringa District 9,975 Council
8,639
87%
-6%
UGANDA
Karamoja
Abim
6,254
3,102
50%
-5%
Amudat
5,820
2,049
35%
-2%
Kaabong
8,539
5,512
65%
9%
Kotido
9,679
5,689
59%
1%
Moroto
5,386
2,238
42%
0%
Nakapiripirit
8,697
3,463
40%
-4%
Napak
7,392
4,622
63%
-2%
Oyam
20,188
14,562
72%
1%
210,867
103,803
49%
3%
Southwest Shoa
MOZAMBIQUE
Eastern Lakes
Lango
TOTAL 34
Doctors with Africa CUAMM
Annual report 2017
Africa Report
TWIN GIRL PREEMIES For the baby girls from Tumaini, I set the goal of a minimum of 1400 grams. Think that Italian neonatal units are unlikely to discharge children under 1700 grams! Of course, Italian premature babies go to homes with heating and every convenience, and they have nutritional supplements and a family pediatrician that will take care of them after they go home. When I discharge these tiny babies, I’m sending them to homes that have almost nothing in them. Continuous contact with the mother’s skin (the “kangaroo mother” treatment) is the only way to keep these children warm during
Maternal and child health
Anna Berti Pediatrician at Tosamaganga, Tanzania with Doctors with Africa CUAMM
the cold storms of the rainy season, and the pediatrician will see them again only if the mother takes them to the follow-up appointment. And yet...they come back! And most of the time their weight and health have improved. The smallest of the twin babies in Tumaini will be the first newborn weighing under a kilo to have survived here in Tosamaganga. And, now, on the very same day another pair of twins has been born, boys this time: 1050 and 950 grams! It looks hopeful at the moment, but I don’t want to assume anything because it is too early to tell.
35
NUTRITION
READ THE DATA
ENSURING GOOD NUTRITION
The mortality index is generally below 10%, indicating a good standard of care, except in the hospitals in the regions of Njombe, Iringa and Rumuva, where we need to better understand the impact on the relatively few patients treated in each nutritional unit. Tanzania has many very decentralized treatment units, closer to the population but with very low workloads by problem type with the resulting risk of low quality (for example, the problem of the plethora of delivery sites). For example, the 7 hospitals of Iringa and Njombe treat only 24% more than the cases treated in the hospital of Wolisso, and the 4 nutritional units in Simiyu that have the highest mortality rate, together handle 62% of the cases treated in Wolisso. The problem of high dropout rates seems considerably improved since 2017, reduced in hospitals from 27% to 6% on average, and throughout the area from 33% to 25%.
The importance of good nutrition, especially during pregnancy and early childhood, is a top priority on the Agenda 2030 for Sustainable Development, signed by 193 UN member states. CUAMM addresses the issue of nutrition by supporting national programs and policies, facilitating practical nutritional education or pregnant women in the communities, dispensaries, and health centers, raising awareness among mothers about the advantages of exclusive breastfeeding for the first six months, and monitoring childrenâ&#x20AC;&#x2122;s growth during the early years. We also handle acute and chronic malnutrition cases, still widespread in Africa, particularly during droughts and resulting famines. Worldwide, malnutrition contributes to 45% of all deaths of children under five years of age (Lancet 2013) because it worsens and complicates all illnesses. Every health intervention, both in hospital and health centers, must address this difficult situation.
FIGHTING ACUTE MALNUTRITION
We must further investigate whether this is due to better data collection or to actual improvement in our ability to manage patients and family members to avoid drop outs.
Acute malnutrition is a result of rapid weight loss or the inability to gain weight. It happens when a person generally has insufficient access to food, such as in cases of famine or economic hardship. It may be moderate or severe, in which case, the child is at risk for death. CUAMM supports nutritional units for the intensive care of severe, acute and complicated malnutrition in several hospitals in the countries where it operates, to which the nutritional units were added in 2017 in Tanzania in the regions of Njombe, Iringa, Simyu, and Ruvuma. Here and in Karamoja, a region of Uganda that includes 7 districts, we are continuing our support of care in hospitals and health centers for both severe acute malnutrition and moderate malnutrition. The table shows the 2017 data for hospital treatments:
36
Doctors with Africa CUAMM
Annual report 2017
Africa Report
TREATMENTS FOR ACUTE MALNUTRITION IN HOSPITALS 2017 COUNTRY
HOSPITAL
PATIENTS PATIENTS RATE OF PATIENTS RATE OF NUMBER OF RATE OF NUMBER DISCHARGED RECOVERED HEALING DEATHS MORTALITY DROPOUT DROPOUT TRANSFERS TO OTHER FACILITIES TO COMPLETE TREATMENT
ANGOLA
Chiulo
285
220
77%
29
10.2%
36
12.6%
0
ETHIOPIA
Wolisso
445
353
79%
35
7.9%
24
5.4%
33
SIERRA LEONE SOUTH SUDAN
Pujehun CMI
395
217
55%
6
1.5%
6
1.5%
166
Cueibet
386
345
89%
4
1.0%
5
1.3%
2
Lui
148
104
70%
4
2.7%
33
22.3%
7
Yirol
240
225
94%
7
2.9%
8
3.3%
0
Tosamaganga 119
94
79%
8
6.7%
17
14.3%
0
Songambele
73
55
75%
12
16.4%
4
5.5%
2
7 hospitals in Iringa and Njombe
543
446
82%
67
12.3%
27
5.0%
3
Simyu
276
195
71%
52
18.8%
29
10.5%
0
Ruvuma
254
213
84%
22
8.7%
16
6.3%
3
MOZAMBIQUE Montepuez
127
109
86%
18
14.2%
n.d
n.d
n.d
UGANDA
Aber
342
239
70%
58
10.2%
35
10.3%
7
Matany
236
165
70%
8
3.4%
7
3.0%
56
3,869
2,980 77% 330
8.5%
247
6.4% 279
TANZANIA
TOTAL TREATED
The data in this table are for Tanzania and Karamoja (Uganda) where the interventions pertain to the entire region not only the hospital.
ACTIONS TO COMBAT ACUTE MALNUTRITION IN THE COMMUNITY 2017 COUNTRY
REGION
TANZANIA
Ruvuma 2,601 and Simyu
2,190
TANZANIA
Iringa and 1,431 Njombe
UGANDA
Karamoja 8,036
TOTAL TREATED Nutrition
PATIENTS PATIENTS RATE OF DISCHARGED RECOVERED HEALING
12,068
PATIENT DEATHS
RATE OF NUMBER OF RATE OF MORTALITY DROPOUTS DROPOUT
NUMBER TRANSFERRED TO OTHER FACILITIES TO COMPLETE TREATMENT
84.2%
26
1.0%
363
14.0%
22
1,221
85.3%
1
0.1%
59
4.1%
150
5,342
66.5%
49
0.6%
2,315
28.8%
330
8,753
72.5% 76
0.6%
2,737
22.6% 502 37
FIGHTING CHRONIC MALNUTRITION
IN TANZANIA In Tanzania, specific interventions are fighting chronic and acute malnutrition, combined with the diagnosis and treatment of acute malnutrition, when possible. In 2017, in the regions of Iringa and Njombe, 1,053 community agents and supervisors were involved, 450 meetings were organized in communities, and 74,007 children under two were identified
Chronic malnutrition leads to stunted growth, detectable in a low height/age ratio. It is due to a regular shortage of food or a limited use of potential resources, starting in the early days of a fetus’s life. It causes permanent deficits for children in terms of physical, psychological, and intellectual growth, compromising their futures. Unfortunately, there is no true treatment, but CUAMM’s targeted programs include educational interventions for mothers and providing supplements to pregnant women and children, which can reduce the impact and damage of stunting. One of our main interventions is treating anemia in pregnancy, providing folic acid and other minerals like iodine, preventing malaria in pregnancy, supporting good nutrition for the mother and exclusive breastfeeding, and treating intestinal parasitosis in children.
JASMINE Jasmine, 16 months, was admitted with the worst form of severe acute malnutrition, accompanied by edema. You must be patient with them. You must not overdo their calorie intake and need to evaluate the progress of the edema every day. Two weeks after hospitalization, undressing the child to check her, I realize that she was getting worse. It is the most feared complication and requires starting the treatment over. Then a fever and cough appear and her weight
38
Doctors with Africa CUAMM
Luca Brasili Doctor specializing in pediatrics, in Tosamaganga with Doctors with Africa CUAMM
was dropping. We started an anti-TB treatment. The risk we were taking was high given how thin and skeletal her little body now was. With our hearts full of fear, we started the treatment: the next 48 hours would be decisive. Well, Jasmine is still with us! She was discharged with a smile that you couldn’t even imagine. Many times, Tosamaganga has taken me, but when it gives back, it always pays back with interest.
Annual report 2017
Africa Report
as suffering from chronic malnutrition. In the regions of Symiu and Ruvuma, 30,510 community meetings have been organized, involving 1,675,361 participants, including 1,300 trained community agents who educated the community about good nutritional practices and evaluated 98,396 children under two years old, identifying 43,266 cases of chronic malnutrition.
INFECTIOUS DISEASES
INSIDIOUS ENEMIES In recent years, international cooperation has helped achieve significant results in the fight against major infectious diseases, including malaria, tuberculosis, and HIV/AIDS. In Africa, there are now fewer people infected, fewer deaths, and more patients in treatment. Nonetheless, much of the African population continues to
suffer disproportionately, compared to other continents, from preventable premature death and disability caused mostly by major epidemic diseases. These diseases affect poor people and groups and those at risk for poverty, especially pregnant women, children, adolescents, and adults living in disadvantaged social conditions who have problems accessing, using, and adhering to prevention and treatment services.
FIGHTING MALARIA
As we can see, the overall mortality rate remains quite low, although this still means that of the almost 2.5 million cases of malaria
In every hospital, many dozens of cases of malaria are treated every day, especially in children under five years of age. Since last year, we have started more accurately recording how many cases are diagnosed and treated in hospitals and health centers supported by CUAMM, as seen for each country in the following table.
treated (67.3% of which were laboratoryconfirmed), there have been almost than 1,500 deaths, of which almost 700 are children under 5 years.
MALARIA
ANGOLA
ETHIOPIA
MOZAMBIQUE SIERRA LEONE
SOUTH SUDAN
TANZANIA
UGANDA
TOTAL
No. malaria diagnoses
5,128
96,293
76,761
209,892
304,503
884
1,823,831
2,517,292
No. diagnoses of malaria confirmed by laboratory
n.d
56,285
5,983
60,615
129,181
790
1,441,885
1,694,739
% of diagnoses confirmed in laboratory
n.d
58.5%
7.8%
28.9%
42.4%
89.5%
79.1%
67.3%
No. deaths
43
18
41
144
215
n.d
991
1.452
Mortality from malaria
0.8%
0.0%
0.1%
0.1%
0.1%
0.0%
0.1%
0.1%
No. diagnoses of malaria <5 years
n.d
13,065
40,260
118,584
117,239
161
540,153
829,462
No. of deaths <5 years
26
7
n.d
130
137
n.d
385
685
Mortality from malaria <5 years
n.d
0.1%
0.0%
0.1%
0.1%
0.0%
0.1%
0.1%
Infectious diseases
39
FIGHTING TUBERCULOSIS There were slightly fewer tuberculosis patients, but diagnosis is still difficult, especially in children, even with new technology like GeneXpert which can detect tuberculosis and possible resistance to rifampicin, indicating possible “MDR or multidrug resistance.” In 2017, we expanded our diagnostic efforts with GeneXpert, in addition to the hospitals in Wolisso (Ethiopia) and Matany (Uganda), to include Chiulo (Angola), as shown in this table:
Note that, starting in 2017, the sputum test is no longer the national diagnostic protocol, but all patients that produce a sputum are tested with Xpert. We can see that the apparent rate of resistance is
2.9% in Wolisso, 6.7% in in Matany, and up to 10.4% in Chiulo, where the intervention was only recently started, making it probable that only patients most at risk for resistance are sent for testing.
Hospitals (country)
PATIENTS NO. TESTS DIAGNOSED WITH GENEXPERT WITH TUBERCULOSIS FOR MDR TB
NO. TESTS WITH GENEXPERT POSITIVE RESULTS
PATIENTS WHO TESTED AS RIFAMPINRESISTANT (MDR)
Wolisso, Ethiopia
368
2.206
235
7
Matany, Uganda
718
1.802
355
24
Chiulo, Angola
267
185
86
9
40
Doctors with Africa CUAMM
Annual report 2017
Africa Report
FIGHTING HIV/AIDS
certain number. Only pregnant women who were HIV-positive started treatment in all cases. With the test-and-treat approach, all infected patients start treatment, regardless of their lymphocyte count. The aim is to stop the spread of the virus by reducing the chance that each individual HIV-positive patient could pass on the virus. The table shows results from anti-retroviral clinics that we oversaw directly:
For HIV/AIDS, in 2017, we continued the new strategy to reduce the pandemic through the testandtreat approach. Until a few years ago, patients who were infected had been treated only if the counts of their T4 lymphocyte, our immune systemsâ&#x20AC;&#x2122; infection-fighting agents, fell below a
RESULTS FROM ANTI-RETROVIRAL CLINICS DIRECTLY OVERSEEN COUNTRY
ANTIRETROVIRAL AL CLINICS
TESTED FOR HIV*
POSITIVE FOR HIV
% POSITIVE
NEW PATIENTS WHO STARTED TREATMENT IN 2017
TOTAL PATIENTS IN ART TREATMENT
ANGOLA
Chiulo
2,856
164
5.74%
141
707
ETHIOPIA
Wolisso
2,187
40
1.83%
39
1,533
MOZAMBIQUE
Beira
61,084
988
1.62%
427
174
SOUTH SUDAN
Lui
1,174
53
4.51%
53
331
Yirol
2,398
409
17.06%
450
1,056
Cuibet
1,194
383
32.08%
193
193
Bugisi
14,570
570
3.91%
476
2,112
Mwamapalala
2,201
45
2.04%
76
387
Ngokolo
2,186
134
6.13%
204
307
Songambele
2,251
164
7.29%
94
83
Tosamaganga
3,320
466
14.04%
119
1,461
Aber
32,707
918
2.81%
850
5,163
Matany
7,933
62
0.78%
79
2,245
3.2%
3,201
15,752
TANZANIA
UGANDA
TOTAL
136,061 4,396 Data on the total number of patients receiving antiretroviral treatment (ART) also includes patients who were waiting for treatment and started it when the test and treat approach was implemented. * Includes individuals who tested voluntarily, patients, and women during antenatal visits.
Infectious diseases
The table shows that the number of patients put on antiretroviral therapy has increased by 3,201 people (+25.5%).
41
IN MOZAMBIQUE While these activities are integrated in hospitals and peripheral clinics, in some cases, projects were targeted to specific groups in high HIV/AIDS settings. This was the case of Mozambique and activities in Beira targeted at adolescents, a particularly at risk group for contracting the virus in high prevalence situations, a particularly at risk group for contracting the virus in high prevalence situations. In Beira, prevalence is estimated at 25%. The project involved establishing youth centers in some urban areas; dedicated clinics were organized in schools and in some health centers to encourage voluntary testing and educate young people about safer behavior to avoid contracting the disease. This type of action was also started in the second half of the year, in the city of Tete and in two districts of the province, with the
LIGHTS IN ANGOLA At the Chiulo Hospital, we work to prevent and treat HIV, tuberculosis, and malaria and help children suffering from malnutrition. Of the problems faced in this facility, the one that affects us most is the lack of electric power. This is why we rely on generators, which, like worker bees though they are machines, can go into the hive.
42
Doctors with Africa CUAMM
training of personnel and activities put in charge of counseling. In 2017, 61,084 adolescents were tested and 988 were positive, with an apparent HIV prevalence even lower than last year. Considering the high prevalence in the population, there is a doubt about how access to testing is actually effective at identifying HIV-positive people who, only suspecting it, may have â&#x20AC;&#x153;avoidedâ&#x20AC;? testing. Another issue is access and ensuring that treatment is continued, especially in urban settings where patients may not come back to the center to continue treatment, either because they feel well and think there is no need, or because of economic problems and the resulting isolation and social issues that result from pursuing this treatment.
FEMALES
MALES
Adolescents given counselling
50,796
27,428
Tested for HIV
49,691
11,393
Positive for HIV
746
242
% positive
1.50%
2.12%
Mozambique
Domenico Maddaloni, Pediatrician working in Angola with Doctors with Africa CUAMM
At times, in the dark heralded by the beauty of the African sunset we can glimpse many small lights, and, if you look more closely, they are the aid workers who came with CUAMM. Chiulo keeps on living, even in the dark. We must not give into the darkness and give space for bitter or black thoughts, but only those thoughts illuminated by the will to live.
Annual report 2017
BEIRA
Africa Report
ACUTE RESPIRATORY INFECTIONS
Especially in hospitals or health systems in peripheral areas, the data refers to places where there is support and available data. The outcome for this disease depends on antibiotics and oxygen being available for severe forms, especially in children under five. Specific mortality rates remain very low.
Acute respiratory illnesses, along with malaria and diarrhea, are the three major causes of death in children under five. The table shows the cases treated in the hospitals and districts where CUAMM works.
ANGOLA ETHIOPIA MOZAMBIQUE SIERRA SOUTH TANZANIA UGANDA TOTAL LEONE SUDAN NO. DIAGNOSES OF PNEUMONIA
-
23,926
-
80,859
-
8,074
117,348
230,207
NO. DEATHS FROM PNEUMONIA
42
29
-
118
-
36
324
549
MORTALITY FROM PNEUMONIA
-
0.1%
-
0.1%
-
0.4%
0.3%
0.2%
NO. DIAGNOSES CHILDREN <5 YEARS
300
12,653
-
54,737
6,555
2,468
57,875
134,588
NO. DEATHS CHILDREN <5 YEARS
11
25
-
99
-
84
182
401
0.2%
-
0.2%
0.0%
3.4%
0,3%
0.3%
3.7% MORTALITY FROM PNEUMONIA <5 YEARS
DIARRHEAL DISEASES
Here, as for acute respiratory infections, Uganda reports the most cases due to the high quality of its information system that can quickly collect all data, including epidemiological, from all health facilities. This is not possible in South Sudan, even though the intervention is broader and reaches more beneficiaries.
Diarrheal diseases, especially in its most common form (without blood), are one of the main causes of death from severe dehydration. This is particularly true for children who are at risk if they are not adequately treated with ongoing re-hydration, including oral if possible. The table shows the cases treated in settings where CUAMM works and specific data is reported.
DIARRHEA
ANGOLA ETHIOPIA MOZAMBIQUE SIERRA SOUTH TANZANIA UGANDA TOTALI LEONE SUDAN
NO. DIAGNOSIS OF DIARRHEA
-
26,151
-
20,585
-
6,888
224,829
278,453
NO. DEATHS FROM DIARRHEA
11
18
-
18
-
8
42
97
MORTALITY FROM DIARRHEA
-
0.1%
-
0.1%
-
0.1%
0.0%
0.03%
NO. DIAGNOSIS OF DIARRHEA < 5 YEARS
384
13,336
-
15,571
7,864
27,449
122,179
186,783
NO. DEATHS FROM 4 DIARRHEA < 5 YEARS
9
-
17
-
1
27
58
1.0% MORTALITY FROM DIARRHEA < 5 YEARS
0.1%
-
0.1%
0.0%
0.0%
0.0%
0.03%
Infectious diseases
43
CHRONIC DISEASES
infectious diseases as the leading cause of death in Africa as well. Ninety percent of deaths from traffic accidents are in countries with middle and low income. Focus on preventing and treating this group of emerging diseases in low-income countries has become a key target of the Sustainable Development Goals.
According to the “Global Report on Non Communicable Diseases (NCD) (WHO, 2014) 38 million people lose their lives prematurely every year due to non-communicable diseases (NCDs), and the majority of these deaths (about 28 million) are in low- and middle-income countries. By 2030, chronic diseases are forecast to pass
As we can see, the Wolisso Hospital has higher numbers because there has long been an outpatient clinic here where all diagnosed cases are referred and overseen, including by recording clinical data for every visit. This will soon give us a more accurate picture, including of these patients’ epidemiological situations, their adherence to
DIABETES, HYPERTENSION, AND HEART DISEASE In the hospitals where CUAMM works, we have always diagnosed and treated these patients, but due to the large numbers, they have been poorly documented. But in certain settings, special outpatient clinics have been organized to help integrate the patients and reduce the stigma around AIDS patients by terming them all “chronic patients.” The table shows the data from hospitals where there are dedicated outpatient clinics and where admissions have started to be documented.
treatment, and its effectiveness. In Beira, though data collection still needs improvement, this service has started within a project supported by the Ministry of the Republic of Mozambique for developing diagnostic and treatment guidelines for chronic diseases and to support the four hospitals.
WOLISSO TOSAMAGANGA MATANY ABER
BEIRA
TOTAL
PCMH*
N. VISITS FOR WITH DIABETES
3,596
1,512
5,267
122
N. ADMISSIONS FOR DIABETES
188
45
21
105
426
21
N. VISITS FOR HEART DISEASE
1,236
228
179
N. ADMISSIONS FOR HEART DISEASE
165
103
163
2
2,408 N. PATIENTS WITH HYPERTENSION
178
40
85
7,396
10,107
N. ADMISSIONS FOR STROKES
4
22
35
85
221
75
119
40
67
1,643
* screening for gestational diabetes
44
Doctors with Africa CUAMM
Annual report 2017
Africa Report
433
UTERINE CERVICAL CANCER Uterine cervical cancer is the second most common cancer in women in Africa and can be prevented with vaccination against the papillomavirus and through earlier screening and diagnosis. For several years, we have been implementing projects to improve community awareness about this problem to offer cervical cancer screening. The strategy adopted is â&#x20AC;&#x153;see & treatâ&#x20AC;? in which, after the cervix is colored with acetic acid it is inspected
(VIA) for lesions, which might be malignant and then are immediately treated with cryotherapy. Testing and treatment are done by trained nursing staff with the goal of evaluating 20% of eligible women every year. By treating all small lesions, including inflammatory ones, we seek to prevent their becoming malignant. This means that it is a secondary prevention rather than actual treatment. More advanced tumors are surgically treated in the hospital, though the actual effectiveness is limited because most tumors are seen in advanced/inoperable stages. The table shows the data from 2017, in Ethiopia (Wolisso, Turmi, and Omorate), Tanzania (Tosamaganga and the District of Kilosa) and in Uganda (Matany).
WOLISSO TURMI E TOSAMAGANGA DISTRICT OMORATE OF KILOSA
MATANY
TOTAL
NO. WOMEN ASSESSED WITH VIA
5,327
916
361
11,548
703
18,855
NO. VIA +
249
66
17
184
99
712
% VIA POSITIVE
4.7%
7.2%
4.7%
1.6%
14.1%
3.8%
NO. VIA + TREATED WITH CRYOTHERAPY
238
66
12
171
-
597
NO. WOMEN ASSESSED WITH LEEP
6
-
1
13
35
55
Chronic diseases
45
TRAINING
THE CRITICAL ROLE OF TRAINING
The focus of the training is on maternal and child health, integrated treatment of newborn and childhood diseases, treating acute and chronic malnutrition, and information and data collecting systems.
Training health personnel is essential for improving and strengthening the quality of care and the ability to provide health services. In addition to what Doctors with Africa CUAMM accomplishes working every day alongside local personnel and local authorities, we organize professional development courses, and work in the field, involving some 11,623 people, including community agents, nurses, obstetricians, doctors, and paramedics.
Training was also provided for managerial and administrative positions, starting with those in management roles in the hospitals, including Chiulo, Wolisso, Tosamaganga, Aber, Pujehun, Freetown, Yirol, Cueibet, and Lui. Particularly significant in a situation of major crisis, 20 young students earned their diplomas from the school in Lui: 12 women and 8 men became “seeds” for the future of the local health system.
24 MIDWIVES AT WOLISSO Saturday, August 12, 24 new midwives graduated from St. Luke’s College of the Wolisso Hospital, here in Ethiopia. This is the fifteenth year since the school opened. It was a big celebration with civil and religious authorities in attendance. This is a step forward for training midwives and gradually lessening the still enormous shortfall:
46
Doctors with Africa CUAMM
Carlo Resti, doctor and public health expert, Ethiopia with Doctors with Africa CUAMM
in the Oromia region, there is currently one midwife for every 50,000 people, whereas the desirable ratio is 1 per 5,000. Training new midwives is essential for the country. Attended births and antenatal and postpartum care provided by professional midwives are key factors for improving maternal and child health.
Annual report 2017
Africa Report
TRAINING WITH SHORT COURSES OR RESIDENCIES COUNTRY
COMMUNITY AGENTS
NURSES
MIDWIVES
GENERAL DOCTORS
OTHER
TOTAL BY COUNTRY
ANGOLA
172
133
0
3
3
311
ETHIOPIA
624
316
73
75
241
1,329
MOZAMBIQUE
1,149
753
101
212
0
2,215
SIERRA LEONE
2,129
174
10
4
638
2,955
SOUTH SUDAN
94
45
11
22
0
172
TANZANIA
611
20
67
22
4
724
UGANDA
3,872
12
15
7
11
3,917
TOTAL
8,651
1,453
277
345
897
11,623
BY CATEGORY
PROFESSIONAL AND UNIVERSITY TRAINING In 2017, we continued to support several schools for professional and university training, graduating the following professional figures:
COUNTRY
ORGANIZATION
MIDWIVES GRADUATED
NURSES GRADUATED
STUDENT MIDWIVES
NURSE STUDENTS
DOCTORS GRADUATED
ETHIOPIA
Wolisso
24
0
62
16
-
MOZAMBIQUE
Faculty University of Beira
-
-
-
-
26
SOUTH SUDAN
Lui
20
-
-
-
-
UGANDA
Matany
13
14
46
45
-
57
14
108
61
26
TOTAL
BY CATEGORY
Training
47
MONITORING, EVALUATION, AND RESEARCH www.doctorswithafrica.org/en/fieldresearch/
MONITORING OUR PROJECTS, MEASURING OUR SYSTEMS
DOING RESEARCH IN THE GLOBAL SOUTH
CUAMM’s monitoring and assessment go beyond those required for individual projects. The impact we want to measure is about strengthening health systems and not just individual project indicators, though they are necessary to provide donors with transparency and accountability. That is why the hospitals we support are evaluated for their overall performance and why we focus a section on each one. Likewise, whenever possible, the districts and areas of intervention are evaluated in terms of overall impact, with measurements of how beneficiaries are reached for each service compared to expectations. Within our diverse areas of intervention, both geographically and by issue, we perform operational research with a variety of methods and focus on expanding knowledge and the quality and effectiveness of our services.
48
Doctors with Africa CUAMM
Annual report 2017
Eighty percent of the world population lives in developing countries where healthcare and research are severely limited due to scarce financial resources and the lack of adequate infrastructure. Operational research in these contexts can help answer questions about risk factors and possible treatments and guide us in the design and developing efficient, effective and preferably
Africa Report
low-cost health policies. Promoting research in the Global South plays an extremely important role in improving understanding of local problems and priorities and to achieve effective, lasting benefits for the people’s health. This is why CUAMM supports a type of research that supports these populations, using “frugal” tools with a low economic impact to help improve that health of the most vulnerable groups and build strong, quality health cooperation in even these most remote corners of Africa.
OPERATIONAL RESEARCH IN THE FIELD Within our diverse areas of intervention, both geographically and by issue, we perform operational research with different methods and focuses to expand our knowledge, the quality and effectiveness of our services health. In 2017, CUAMM had 19 publications in international scientific journals, twelve posters and three oral presentations at Italian and international conferences. These numbers speak to CUAMMâ&#x20AC;&#x2122;s commitment every year to conducting operational research in the field to improve the quality of our health interventions, promoting research that can fill the gap between quality research and the social settings where we are active, with respect for the local culture. This is a long process that begins first with training local personnel in collaboration with the authorities of the countries involved. Doctors with Africa CUAMMâ&#x20AC;&#x2122;s research is also increasingly involved on the international scientific world by creating networks with international research institutes. This is why, in 2017, CUAMM continued to collaborate with experts and academic partners, such as the Universities of Bari, Padua, Palermo, and Rome, the Fondazione Bruno Kessler in Trento, the Burlo Garofolo of Trieste, and others. Doctors with Africa CUAMM sees scientific research as the foundation for improving health and health care and, particularly in the developing countries, and is a fundamental step towards guaranteeing health as a universal right.
2017 RESULTS 5
Issue areas:
main issue areas
19
studies published
3
oral presentations
12
posters and presentations at international congresses
30
More than Italian, African, and international partners working together to build quality health cooperation
MATERNAL AND CHILD HEALTH INFECTIOUS AND TROPICAL DISEASES UNIVERSAL HEALTH COVERAGE AND EQUITY NUTRITION
CHRONIC DISEASES
Every year, Doctors with Africa CUAMM brings together in a single publication the scientific articles, abstracts, and posters that it has presented at international congresses. The collections can be downloaded free of cost
49
50
Doctors with Africa CUAMM
Annual report 2017
Africa Report
FOCUS ON THE HOSPITALS
2017 SNAPSHOT 23
Hospitals managed by Doctors with Africa CUAMM
1
Angola
3
Ethiopia In 2017, Doctors with Africa CUAMM was involved in managing 23 hospitals in Africa: one in Angola, three in Ethiopia, four in Mozambique, six in Sierra Leone, five in South Sudan, two in Tanzania, and two in Uganda. As is true throughout Africa, hospitals are the main facilities providing healthcare in these countries, especially complex services like surgery. This makes it important for CUAMM to evaluate our work as we see access to care as a basic right of every human being, especially important for the poorest parts of a population. We can measure the volume of health services provided by a hospital using an aggregate indicator called Standard Unit for Output (SUO), which takes as a unit of measurement a visit to an outpatient clinic and provides its relative impact in terms of cost to other major hospital healthcare (admissions, births, vaccinations, and ante- and post-natal visits).
Focus on the hospitals
The use of this indicator allows hospital managers and board of directors to plan rationally, make evidence-based decisions aligned with the institution’s mission, and explain choices that had successful or unsuccessful results. We can use this measurement system to form four indicators:
- PRODUCTIVITY
To measure the total volume of a hospital’s activity;
4
Mozambique
6
Sierra Leone
5
South Sudan
2
Tanzania
2
Uganda
- EQUITY
To evaluate if its services are accessible to everyone, especially the most vulnerable groups;
- STAFF EFFICIENCY
To evaluate the management of human resources;
- MANAGEMENT EFFICIENCY
The formula for calculating SUO shows the relative importance of a hospital’s different services: SUO-op = (15xadmissions) + (1x outpatient visits) + (5xbirths) + (0.2xvaccinations) + (0.5xpre-postnatal visits)
To evaluate financial resource optimization.
51
PRODUCTIVITY Overall performance is evaluated by averaging the results of the eight hospitals, which are the ones for which continuous data are available for the last five years. These differ from the hospitals in the 2016 report, because Mikumi (Tanzania), where cooperation stopped early last year, was replaced by Pujheun (Sierra Leone). We, therefore, cannot compare the trend data to 2016, which refer to the average of 8 other hospitals.
The trend is towards progressive improvement with stabilization between 2016 and 2017. There was significant growth of 2016 (+12.4%), mainly from the increase in pediatric admissions in Aber (Uganda), where a major malaria epidemic doubled admissions, and in Wolisso (Ethiopia) due to a measles epidemic. The total volume of activity differs for each facility and does not correspond to the number of beds, though there was a general growth trend in 2017, rising in four of the eight hospitals monitored, with considerable stability for the other three. Only Aber Hospital saw a considerable decrease with a return to the values of years prior to 2016.
TOTAL AVERAGE VOLUME (SUO) IN 8 HOSPITALS
Average
200,000 190,000
181,559
181,908
180,000 170,000
156,274
160,000
158,562
161,577
150,000 140,000 2013
2014
EQUITY The service cost borne by patients is calculated based on the ratio of revenues from the users and the total cost. In the hospitals considered, it has been essentially stable in the last five years, never going above 30%. The Wolisso Hospital had the highest level (40%) with an average of 37% in the last five years. The Matany Hospital had the lowest level with 18% and an average of 12%, with a considerable increase in the last two years, which shows that in Ugandaâ&#x20AC;&#x2122;s poorest region, Karamoja, the ability to contribute
2015
2016
2017
to costs is increasing at the same time that the ability to attract external resources is decreasing. It should be noted that the rise in costs paid by patients means less equality, caused by growing, widespread difficulty in finding financial resources to fund hospitals, both within and outside of the countries. The desired effect of our presence, especially where we make the greatest political impact, is to balance the continuous request for greater sustainability and the need to ensure access, which means the lowest possible costs borne by the patients.
% OF THE SERVICE COST PAID BY PATIENT 30% 25%
Average
27%
24%
25%
27%
23%
20% 15% 10% 5% 0% 2013
52
Doctors with Africa CUAMM
2014
Annual report 2017
2015
Africa Report
2016
2017
STAFF EFFICIENCY In terms of staff efficiency (ratio between total SUO and qualified staff), we see that after a substantial drop in 2015, due to the reduction of volume in Yirol Hospital (South Sudan), there was a major increase in 2016, which continued
in 2017, due to the widespread increase of access (and therefore volume) without a real increase in the number of qualified staff. It should, however, be noted that Yirol Hospital still has very high productivity levels (9,742), compared to the average of the others, due to the low number of qualified personnel.
UNITS DISPENSED BY ONE HEALTH WORKER Average
4,000 3,500
3,707 3,214
3,000
2,702
2,899
2,906
2015
2016
2017
2,500 2,000 1,500 1,000 500 0 2013
2014
MANAGEMENT EFFICIENCY As for the service cost per SUO (ratio between total cost and total SUO), we see a growth trend starting in 2013. This trend was affected by the rise in prices caused by the international economic crisis and resulting adjustment of labor cost, rising in all countries. Though there was a slight drop in 2015, in the seven hospitals, the service cost per SUO rose by 17% in 2017 over the
previous year. This is a sign that costs are continuing to rise even though activity is increasing. This is, however, an average statistic that pertains to different countries, meaning that they have both different production costs and different inflation rates, with a variable local currency exchange rate to the euro. As such, these statistics cannot be considered comprehensive and should be taken with circumspection.
COST PER UNIT PROVIDED BY THE SERVICE
Average
6€
5.6 €
5.5 € 5€
4.7 € 4.4 €
4.5 € 4€
4.6 €
3.9 €
3.5 € 3€ 2013
Focus on Hospitals
2014
2015
2016
2017
53
QUALITY OF HOSPITAL SERVICES In limited resource settings, such as in the parts of subSaharan Africa where Doctors with Africa CUAMM works, hospital performance must be monitored in terms of accessibility, equity, and efficiency, while also evaluating the quality of services provided to the population; offering lowcost services is not enough in itself if they are of inadequate quality. Though it is difficult to measure a hospital’s performance in general — and it is even harder to measure the quality of its services — we introduced some indicators in 2012 to evaluate the quality of obstetric assistance.
RATE OF STILLBIRTHS PER 1,000 LIVE BIRTHS This indicator pertains specifically to how the birth is managed during the labor and expulsion stages. The statistic helps determine how correctly and timely services were provided and do not consider stillbirths that were already inevitable before labor. In 2017, there was a clear increase in averages, due primarily to the results of the two most recent hospitals where we
work; Songambele (Tanzania) with 89, Montepuez and Palma (Mozambique) with 77 and 80, respectively. This result is, however, difficult to interpret accurately because of problems in collecting reliable data. It could reflect CUAMM’s still limited impact in improving quality, such as in the hospitals of Sierra Leone where the still birth rate per 1,000 live births still varies between 30 and 50.
Maximum
90
Minimum
89
80 70 60
59
60
50
46
40
51 31.1
30 20
18.3
14.7
20.3 10.2
10 0
3 2013
54
Doctors with Africa CUAMM
4 2014
Annual report 2017
3,5 2015
Africa Report
1 2016
2 2017
Average
RATE OF CESAREAN SECTIONS OUT OF TOTAL BIRTHS The Cesarean section rate can vary a great deal between hospitals and depends on numerous factors. Women in different countries, for instance, may differ in their body shapes and may need Cesareans more or less frequently. If the hospital is the only place to go for complicated cases, there tends to be a higher concentration of complicated births and, therefore, more Cesareans, depending on the efficiency of the referral system. In different settings, surgeons and gynecologists may have different habits regarding Cesareans. However, within each hospital, we can see considerable stability over the years, with the exception of Pujehun (Sierra Leone), where the rate rose considerably (43%). The explanation for this is the much work was done on
the referral system, which means a growing number of complicated cases are brought to the hospital that may need Cesarean sections. The PCMH, also in Sierra Leone, has a fairly high rate as well, but it is a referral hospital for the Western Area of Freetown and serves over a million and a half people, increasing its likelihood of handling complicated cases. The same applies to Bo Hospital (36%). At Songambele and Lunsar, which are dioceses hospitals, the rate is high because of the low number of total births. The percentage of Cesareans is higher because, unfortunately, those who come most often to the hospital are the few complicated cases that manage to overcome the many barriers to access, such as the costs of traveling long distances and paying hospital fees (though eliminated at Lunsar and lowered only this year in Songambele). Maximum
Minimum
Average
50% 40%
43%
19%
18%
20%
5%
3%
3%
43
39%
34%
30% 20%
40%
21
16%
10% 0
2013
2014
RATE OF MATERNAL DEATHS FOR MAJOR OBSTETRIC COMPLICATION OUT OF THE TOTAL NUMBER OF MAJOR OBSTETRIC COMPLICATIONS WHO sets a target of less than 1% for good care for major obstetric complications. However, the data given for the hospitals do not necessarily mean there is a low quality of care. The data are quite likely overestimated due to the information systemâ&#x20AC;&#x2122;s inadequacy, preventing it from precisely track all major obstetric complications treated. The frequent changes in registration criteria can be tied to the succession of different doctors who do not provide continuity and uniformity in applying diagnostic criteria. A more precise definition of diagnostic criteria must be developed in order to get data that is uniform and comparable. Generally, in the last five years, a majority of the hospitals have shown an improvement trend, and better attention over the last two years to data gathering will lead to data being more easily compared over time.
Focus on Hospitals
4%
2015
2
2016
2017
HOSPITALS
2015
2016
2017
Aber
0.4%
1.2%
1.2%
Chiulo
1.6%
2.4%
2.0%
Cueibet
2.9%
1.4%
0.8%
Lui
4.0%
2.0%
0.0%
Lunsar
1.7%
4.7%
0.6%
Matany
0.9%
0.4%
0.9%
Pujehun
0.9%
1.3%
1.9%
PCMH
-
2.4%
1.3%
Tosamaganga
0.2%
0.3%
0.5%
Wolisso
0.8%
0.1%
0.5%
Yirol
0.4%
1.6%
1.6%
55
HOSPITAL DATA * 2017 COUNTRY
HOSPITAL
BEDS
VISITS OUTPATIENT
ADMISSIONS PRENATAL VISITS
BIRTHS
CESAREANS VACCINATIONS
ANGOLA
Chiulo
234
33,021
6,613
6,798
2,180
115
ETHIOPIA
Gambella RH*
2,302
1,937
271
MOZAMBIQUE
SIERRA LEONE
SOUTH SUDAN
Turmi
20
10,608
179
1,480
534
12
5,217
Wolisso
200
93,538
15,047
9,583
4,311
597
6,533
Beira
644
204,639
27,642
5,960
2,267
Montepuez
134
58,518
10,624
604
4,048
709
Palma
64
89,022
2,592
1,596
1,469
189
1,159
Pemba
273
5,095
14,084
2,194
2,637
858
561
Bo*
40
3,950
27,017
2,778
996
258
44
Bonte "isola"* 12
337
Lunsar
100
1,043
1,282
721
279
Makeni*
38
2,881
18,824
2,219
486
PCMH*
129
16,704
9,973
13,661
6,861
2,028
Puejhun CMI
50
1,189
4,073
940
400
Cueibet
98
29,461
6,246
3,707
1,208
42
6,618
Lui
98
32,663
4,559
1,811
557
73
4,940
Rumbek
40
62,304
4,795
6,009
1,136
22
6,543
Yirol
103
58,278
12,609
5,542
1,398
25
29,246
Songambele
63
5,752
1,742
1,274
348
119
8,985
Tosamaganga
165
24,050
6,359
1,458
3,010
1,053
12,616
Aber
178
31,620
9,622
6,607
2,338
495
26,651
Matany
250
23,520
9,903
5,031
1,161
324
46,141
(only maternity and pediatric)
TANZANIA UGANDA TOTALI 56
18,151
2,933 779,982 Doctors with Africa CUAMM
Annual report 2017
154,873 116,780 48,019 11,404 173,361 Africa Report
* hospitals where intervention is only for maternity
INCOME FROM USER FEES
ETOTAL INCOME FOR RECURRING EXPENSES
69,394
609,617
1,595,194
RECURRENT EXPENSES
TOTAL STAFF
QUALIFIED STAFF
1,284,087
207
113
27
22
385
225
1,570
994
139
91
115
65
710
469
118
84
390
212
94
71
607,017
104
28
625,452
132
40
88,344
113
53
700,814
123
35
53
36
1,529,577
359,771
1,113,157
1,206,962
210
150
253,329
1,271,063
1,157,230
173
124
102,390
637,520
565,480
234
135
1,394,501
4,616,934
7,764,963
4,897
2,947
Focus on Hospitals
57
HUMAN RESOURCE MANAGEMENT HUMAN RESOURCES IN AFRICA
SUPPORTING THE HEALTH CARE SYSTEM IN SOUTH SUDAN
Countries undergoing rapid change in increasingly complex political, religious, and cultural contexts — this is the Africa where the staff of Doctors with Africa CUAMM is active on many different levels. CUAMM recruits and selects human resources to fill the positions needed for our projects: - international Europeans; - international Africans, from countries neighboring those where we operate; - nationals, from the country of action.
South Sudan is still very fragile and cannot manage and support its own health services. As such, Doctors with Africa CUAMM was designated as the organization to support the country’s health care system in 12 counties and five hospitals, contributing directly to their management and the salaries of the personnel of peripheral health facilities and hospitals. We will continue this “extraordinary management” until the government has the ability and resources to manage the staff of its health facilities itself.
In 2017, in the seven countries where we are active, we managed 2,233 human resources, and 1,461 of these were under “extraordinary management” in South Sudan (see details). Out of the 772 human resources involved in the projects, 552 are qualified professionals (not just health workers, this includes administrative, logistics and community experts), and 220 support staff, such as drivers and guards.
STAFF IN 2017
772 human resources involved in projects:
552
qualified professionals, including
2,233
233
African nationals
human resources
55
international Africans
264
1,461 human resources
international Europeans
“extraordinary management” South Sudan
58
Doctors with Africa CUAMM
220
support
Annual report 2017
Africa Report
STAFF PROFILE Significantly, 88% of physicians are international and European, while 60% of the non-medical health staff is national. These numbers show that Doctors with Africa CUAMM gives priority to investing in national staff in terms of capacity building while sending international staff to fill positions for which the African country still lacks available national professionals.
RECRUITMENT, SELECTION, AND TRAINING The staff must demonstrate solid professional training and motivation, essential for honing skills of analysis, research, context knowledge, planning, and organization. In 2017, in Italy, we gave 574 interviews with international and European staff to fill 140 positions. After being selected, the aid workers receive information and specific documents to prepare them for the job and the setting. They are then sent to CUAMM’s offices (international Europeans in Italy, and international and national Africans, on site) to complete their training. Throughout the year, in Italy, 83 pre-departure training days were organized, and a week of training was given for young administrators. 151 international European professionals went to Africa, joining the human resources already active in the field.
JUNIOR PROJECT OFFICER (JPO) INITIATIVE In in its sixteenth year, the initiative gives medical residents an opportunity for theoretical and practical training in Africa, supported by a medical specialist who serves as a mentor. Since its start, 146 residents have come from universities throughout Italy; in 2017, alone 26 residents participated. Many completed their specialization theses in the field by contributing to CUAMM’s operational research. Though JPO initiative is the most structured example, it is not only in-the-field training for young people who would like to work in international cooperation in the future. In 2017 we sent another 12 young people who joined our professionals in the field for a shorter training period. To find out more about opportunities for young people, see the “Education and Awareness Raising” section on p. 59 and visit our website www.mediciconlafrica.org.
THE ORTHOPEDIC GROUP The orthopedic group, founded in 2002, brings together professional specialists (orthopedists, physiotherapists, and nurses) who support ongoing projects with fundraising, technical support, and consulting. The orthopedic project is carried out at the Saint Luke Hospital in Wolisso (Ethiopia) where an Ethiopian orthopedic doctor works with two orthopedic residents from the University of Addis Ababa (Ethiopia). Orthopedic and physiotherapy services in 2017: major surgery: 636; minor surgery: 338, outpatient visits 6,016, physiotherapy treatments, 3,050. There were three missions in 2017 by orthopedic doctors and one by a physiotherapist. Luigi Conforti is the group’s president.
PROFESSIONAL PROFILES AND ORIGINS OF SKILLED PERSONNEL 200 175 150
161
42%
125
48%
100 75
73
62
4
4
Administrator
Doctor
0
Human resource management
10
20 0
6
0 2
Country representatives
24
11 17
10%
36
36
Nondoctor health workers
25
43
Other
43
Logistics
50
International European staff
International African staff National staff
59
60
Doctors with Africa CUAMM
Annual report 2017
Italy Report Repor
COMMUNICATION
In 2017 we continued our work to raise CUAMM’s visibility in Italy and Africa through print and digital publications, involving spokespeople, producing videos, materials, and receiving considerable press coverage. More than 2,600 publications, print and web, recount the hard work of our doctors and, most importantly, tell about the projects underway in Africa. In 2017, special attention was given to the crisis in South Sudan and its repercussions on neighboring countries, such as Ethiopia and Uganda. In the Corriere della Sera, a report was published by Gian Antonio Stella “With the 530,000 refugees in the megacamp without a hospital,” and in La Repubblica, Pietro del Re, wrote, “Ethiopia, with the victims of the famine fleeing South Sudan.” Corriere della Sera’s weekly insert, 7, published Stefania Chiale’s report “Why a young doctor chooses Africa?” explored the stories of residents who go with the Junior
Project Officer project. “Ciao mamma, vado in Africa” (Bye, Mom. I’m going to Africa.) the project exclusively about the stories of CUAMM’s young doctors and volunteers; in 2017, a series of five episodes was produced, which aired twice on TV2000 (in February and in October), and a web series that is still online on the La Repubblica website. In terms of publications, we continue to inform and engage with our bimonthly èAfrica magazine and Health and Development , published in Italian and English, focusing on issues of cooperation and international health policy. Online communication is of growing importance because it lets us give regular updates about what we are doing in Africa and Italy and involves the many people who follow us, including through social networks where engagements are growing monthly.
EVENTS In 2017, we put on 304 events in Italy (compared to 293 in 2016), moderate but consistent growth, reflecting the hard work of the entire organization and especially that of our volunteers in Italy. Among most significant of these events was our Annual Meeting in Assago (Milan) on November 11, in which over 1,700 people participated, including important people like the European Central Bank director Mario Draghi, and the Prime Minister, Paolo Gentiloni. This year the event was another excellent chance to take stock of what we have achieved with our projects thanks to the help of so many people, and an opportunity to involve the highest level of institutions trying to put Africa and its people in the center of their political agendas. In addition to this special event, a series of 25 events took place in Lombardy and Piedmont, attended by illustrious friends, such as Gian Antonio Stella, Pietro del Re, Diamante d’Alessio, Ferruccio de Bortoli, Pietro Suber, and Federico Taddia, whose participation amplified our message and efforts.
SPECIAL PROJECTS IN ITALY CUAMM also turned its attention to Italy in support of the most vulnerable groups. The Bari group of Doctors with Africa CUAMM continued its “Mobile clinics for laborers” project in the province of Foggia. During its second year, about 1,500 people were seen by medical staff and the “ex Pista” support area
was started. We have growing relationships with the Region of Puglia and the interim commissioner to strengthen the Casa Sankara reception center. With the Region of Marche, the Municipality of Arquata, and the local health agency, we built a clinic to provide visits by general physicians, pediatricians, and gynecologists.
61
SUPPORT GROUPS
Trento Asiago
Lecco
Conegliano Bassano Vicenza del Grappa Rho Milano Verona Campagna Padova Lupia Cremona
Varese Biella
Bergamo
Reggio Emilia
Trieste
Ferrara Modena
Firenze
Ancona
Siena
CUAMMâ&#x20AC;&#x2122;s support groups are made up of friends who choose to combine their energy and enthusiasm to make the voice of Africa heard throughout Italy. Among their many activities, they work particularly hard to supporting the organizationâ&#x20AC;&#x2122;s awareness-raising initiatives and taking part in fundraising to support specific projects. CUAMM can now count on 2,910 active volunteers, key resources to support our work. In 2017 a new group was formed, Doctors with Africa CUAMM Rho, joining the others throughout Italy for a total of 27 support groups.In October in Palermo, we held a training weekend for group members, in which Agostino Lessio received a special acknowledgment for having completed his service as president of the group committee.
Chieti
Roma Bari Potenza
Cagliari
Palermo
62
Doctors with Africa CUAMM
Annual report 2017
Italy Report
Torre Santa Susanna
EDUCATION AND AWARENESS RAISING We work for the right to health through education and awareness raising. We believe that engaging young people, doctors and health professionals in development and cooperation issues can help create a fairer world and the more responsible exercise of the medical profession. This is why we organize a residential training course every year in our Padua offices to introduce young people to health cooperation. The 110-hour course is for residents and doctors from throughout Italy who want to learn more about health issues in developing countries — public health, infectious diseases, gynecology, and pediatrics — and possibly prepare to go to those countries. We also work with a network of Italian universities and with the FNOMCeO (National Federation of Physicians, Surgeons and Dentists) to offer workshops, courses, and conferences on issues of global health and health cooperation. In 2017, about 250 health professionals attended courses offered by the Orders of Doctors and Hospitals, and about 15 courses were organized about international health cooperation in Italian universities.
Varese Milano
Brescia
Pavia Torino
SISM: STUDENTS SINCE 2006 278
Udine
Monza Novara
We also offer students and residents training in the field in Africa. Working with SISM – Italian Secretariat of Medical Students, we offer four students each month a chance to spend a period of training in Ethiopia or in Tanzania to give them an early experience in international health cooperation. For residents, since 2002, CUAMM has a Junior Project Officer (JPO) program. Jointly with CRUI – Conference of Deans of Italian Universities, we offer a period of field training lasting 6–12 months that is recognized by the home university as part of the educational program. By the end of 2017, 278 students from all over Italy had gone to the field, as well as 146 residents from 25 universities. During the year, the first mission for the Senior Medical Officer (SMO) project was completed. The program is for “senior” health professionals who want to learn firsthand about CUAMM’s approach and its activities in Africa and Italy. In October, seven health professionals and one doctor with long experience in Africa came to Uganda to learn about CUAMM’s operational context and to find paths to be of service.
Verona
Trieste
Padova
Parma
Ferrara
Modena
Bologna
Genova Pisa
Firenze Ancona
Siena
residents participating so far:
69
51
209
Chieti Roma Campobasso
to Wolisso, Ethiopia Foggia
Napoli
Sassari
Students who participated so far: to Tosamaganga, Tanzania
Perugia
RESIDENTS WITH CUAMM SINCE 2002 146
in pediatrics
13
in gynecology
26
in internal medicine
Bari
28
Salerno
in public health
21
in surgery
Catanzaro
Palermo
Medical students SISM (Italian Secretariat for Medical Students) locations from which students go to Africa with CUAMM Education and awareness raising
7
Messina Catania
in infectious diseases Resident doctors Universities from which they go to Africa with CUAMM
63
ORGANIZATION AND STAFF
Doctors with Africa CUAMM is legally part of the “Opera San Francesco Saverio” foundation. Though it is a single foundation, it consists of three branches of activity:
STAFF IN 2017
- FOUNDATION - DOCTORS WITH AFRICA CUAMM NGO-NPO - UNIVERSITY COLLEGE
53
employees
15
The Foundation is governed by a Board of Directors. The Director of Doctors with Africa CUAMM NGO-NPO is responsible for the organization and management of all activities. He or she is appointed by the Board of Directors with a three-year, renewable term.
32%
68%
men
38
women
Country Representatives are the legal representatives in the country where they operate and have local programming and management functions.
AGE GROUPS
The coordinating committee for the solidarity groups consists of five members, elected by the internal chairperson of the groups, with the task of coordinating the activities of groups and connecting them with those of the head office.
12%
Under 30 years
26%
30–35 years
The assembly consists of active members and aims to contribute to defining strategic guidelines, operational plans and initiatives, and formulating instructions and proposals.
36 - 40 years
18%
41 - 45 years
18%
In 2017, a total of 72 students from the College (37 males and 35 females) went, including 38 in the biology-health department, 13 engineering, 4 law, 8 psychology and 9 in humanities.
Over 46 years
26% 0
3
6
9
12
15
YEARS OF SERVICE 42%
Less than 5 years
20%
5 to 10 years
24%
11 to 15 years
12%
More than 15 years 0
64
Doctors with Africa CUAMM
Annual report 2017
Italy Report Repor
5
10
15
20
25
ORGANIZATIONAL CHART Angola Country representative
Board of Directors
Ethiopia Country representative Mozambique Country representative College
Director
Coordination in Africa
Tanzania Country representative Uganda Country representative South Sudan Country representative Sierra Leone Country representative
Management, finance, and auditing
Directorâ&#x20AC;&#x2122;s secretariat
Planning
Administration area
Project area
General Secretariat
Communication & fundraising
International relations
Monitoring and evaluation
Human resources
Community relations area and fundraising
Communications
Angola Desk
Secretariat
Northeast
Publications and material
Information technology
Ethiopia and Uganda Desk
Training
Northwest
Media relations
Personnel management
Mozambique Desk
Selection and management
Central south area
Website, visibility, and new media
Project management
Sierra Leone Desk
Accounting
South Sudan Desk
Education and public awareness area
Events
Tanzania Desk
Active member assembly
Organization and staff In service
Committee of groups
65
BUDGET 2017 Report by independent auditors of financial statements
Tel: +39 049 78.00.999 Fax: +39 049 83.14.767 www.bdo.it
Piazza G. Zanellato, 5 35131 Padova
Report on the audit of the financial statements To the Chairman of Fondazione “Opera San Francesco Saverio” – C.U.A.M.M.
Independent Auditor’s report Opinion We have audited the financial statements of Fondazione “Opera San Francesco Saverio” – C.U.A.M.M. (the Company), which comprise the balance sheet as 12/31/2017, the income statement and the cash flow statement for the year then ended and the explanatory notes. Such Financial Statements, although not specifically required by law, has been prepared in accordance with the Italian Civil Code, except for non disclosing the cash flow statement. In our opinion, the financial statements give a true and fair view of the financial position of the Company as at 12/31/2017, and of the result of its operations and its cash flows for the year then ended in accordance with the Italian regulations and accounting principles governing financial statements except for cash flow statement Basis of opinion We conducted our audit in accordance with International Standards on Auditing (ISA Italia). Our responsibilities under those standards are further described in the Auditor’s Responsibilities for the audit of the Financial Statements section of this report. We are independent of the company in accordance with ethical requirements and standards applicable in Italy that are relevant to the audit of financial statements. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion. Other matters This report is not issue under any legal requirement, since for the year ended as December 31, 2017 the audit pursuant to article 2477 of the Italian Civil Code has been performed by a subject other than this audit firm. Responsibilities of management and those charged with governance for the financial statements Management is responsible for the preparation of financial statements that give a true and fair view in accordance with the Italian regulations and accounting principles governing financial statements and, within the limits of the law, for such internal control as management determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error. In preparing the financial statements, management is responsible for assessing the Company’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless management either intends to liquidate the Company or to cease operations, or has no realistic alternative but to do so. Those charged with governance are responsible for overseeing the Company’s financial reporting process. Bari, Bergamo, Bologna, Brescia, Cagliari, Firenze, Genova, Milano, Napoli, Padova, Palermo, Pescara, Roma, Torino, Treviso, Trieste, Verona, Vicenza
BDO Italia S.p.A. – Sede Legale: Viale Abruzzi, 94 – 20131 Milano – Capitale Sociale Euro 1.000.000 i.v. Codice Fiscale, Partita IVA e Registro Imprese di Milano n. 07722780967 - R.E.A. Milano 1977842 Iscritta al Registro dei Revisori Legali al n. 167911 con D.M. del 15/03/2013 G.U. n. 26 del 02/04/2013 BDO Italia S.p.A., società per azioni italiana, è membro di BDO International Limited, società di diritto inglese (company limited by guarantee), e fa parte Pag. 1 di 2 della rete internazionale BDO, network di società indipendenti.
66
Doctors with Africa CUAMM
Annual report 2017
Italy Report Repor
Auditor’s Responsibilities for the Audit of the Financial Statements Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with International Standards on Auditing (ISA Italia) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these financial statements. As part of the audit in accordance with International Standards on Auditing (ISA Italia), we exercise professional judgment and maintain professional scepticism throughout the audit. We also:
Identify and assess the risk of material misstatement of the financial statements, whether due to fraud or error; design and perform audit procedures in response to those risks, and obtain audit evidence that is sufficient and appropriate to provide a basis for our opinion. The risk of non detecting a material misstatement resulting from fraud is higher than for one resulting from error, as fraud may involve collusion, forgery, intentional omissions, misrepresentations or the override of internal control;
Obtain and understanding of internal control relevant to the audit in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the Company’s internal control;
Evaluate the appropriateness of accounting principles used and the reasonableness of accounting estimates and related disclosures made management;
Conclude on the appropriateness of management’s use of the going concern and, based on the audit evidence obtained, whether a material uncertainty exists related to events or conditions that may cast significant doubt on the Company’s ability to continue as a going concern. If we conclude that a material uncertainty exists, we are required to draw attention in our auditor’s report to the related disclosures in the financial statements or, if such disclosures are inadequate, to modify our opinion. Our conclusions are based on the audit evidence obtained up to the date of our auditor’s report. However, future events or conditions may cause the Company to cease to continue as a going concern;
Evaluate the overall presentation, structure and content of the financial statements, including the disclosures, and whether the financial statements represent the underlying transactions in a manner that achieves fair presentation.
We communicate with those charged with governance, identified at the appropriate level as required by the ISA Italia, among other matters, the planned scope and timing of the audit and significant audit findings, including any significant deficiencies in internal control that we identify during our audit. Padova, 24 April 2018 BDO Italia S.p.A. Stefano Bianchi Partner This report has been translated into English from the original, which was prepared in Italian and represents the only authentic copy, solely for the convenience of international readers.
Fondazione “Opera San Francesco Saverio” – C.U.A.M.M. | Relazione della società di revisione indipendente Pag. 2 di 2
Budget 2017
67
In 2017, Doctors with Africa CUAMM NGO-NPO’s expenses totaled €28,076,451. Out of this, 90.8% (€25,475,380) were invested in prevention, treatment, and training projects in the countries where we operate.Operating costs accounted for 4.1% and include the overall management of the organization, staff personnel, financing fees, taxes, and duties.
Communication, awareness raising, and fundraising costs accounted for 5.1% including event organization in Italy, publications, media relations, development education, donor engagement, new campaigns, and staff for the communications, local relations and fundraising.
HOW WE RAISED FUNDS IN 2017 TOTAL 28,416,353 ¤
100%
PRIVATE FUNDING
INSTITUTIONAL FUNDING
PRIVATE FUNDING
INSTITUTIONAL FUNDING
15,179,184 ¤ 53.4%
13,237,069 ¤ 46.6%
11 mln
10,402,753 € 68.6%
10 mln 9 mln
8 mln
8 mln
7 mln
7 mln
6 mln
5,381,369 €
4,820,822 €
5 mln
6 mln
40.7%
36.4%
5 mln
4 mln
4 mln
3,458,664 € 22.8%
3 mln
3 mln
1,956,874 €
€ 166,512 € 16,914 € 399,005 2.6%
4.8%
1.1%
0
Medici con l’Africa Cuamm
Annual report 2017
Italy Repor
Local agencies
Italian cooperation
C.E.I.
Individual donors
Groups
Foundations
Corporate
0
5x1000 nonprofit designation on Italian tax 68
735,436 €
1 mln
4%
4.2%
0.1%
Other institutions
525,112 €
552,892 €
International agencies
1 mln
2 mln
14.7%
European Union
2 mln
HOW WE USED THE FUNDS
TOTAL 28,076,451 ¤
PROJECTS: TREATMENT, PREVENTION, AND TRAINING
100%
25,475,380 ¤ 90.8%
COMMUNICATION, AWARENESS RAISING, AND FUNDRAISING
OPERATINGCOSTS 1,160,551 ¤ 4.1%
1,440,520 ¤ 5.1%
Communication, awareness raising, and fundraising: costs for services in communication, community relations, and fundraising, costs for publications, media relations, event organization and communication, education about development, relationship building, new campaigns, costs for personnel in communication, community relations, and fundraising.
Projects to treat, prevent, and train: costs for implementing projects on site, costs for project services, other project-related expenses, project personnel costs. Operating costs: costs for personnel for general management of the facility, for purchasing materials, facility management services, amortizations, other facility management costs, financial fees, taxes, and duties.
OPERATIONAL COSTS IMPACT ON BUDGET € 28,076,451 25 mln
9%
€ 23,275,897 22 mln
8.5%
8.7%
€ 21,711,666
8%
7.7% 19 mln
7%
€ 16,724,132 16 mln
6%
6% € 12,947,905
13 mln
€ 11,296,831
5%
€ 12,111,059 4.9%
4.2%
2015
2016
4.1%
10 mln
4% 2011
2012
2013
The chart shows trends for total costs and impact of operating costs for the period 2011–2017.
Budget 2017
2014
Total cost (expressed in euros)
2017
Operating Impact ratio(expressed as a percentage)
69
70
Doctors with Africa CUAMM
Annual report 2017
Italy Report
THANK YOU FOR BEING “WITH AFRICA” ON THIS INCREDIBLE JOURNEY Institutions Action Medeor The Italian Development Cooperation Agency Embassy of Japan The University Hospital Health-Siena Azienda Ospedaliera Cremona Azienda Ulss 8 Berica Caritas Italiana Azienda Sanitaria Locale To5 Collegio Ipasvi Municipality of Dueville Municipality of Vicenza The Italian Episcopal Conference Echo Federazione Nazionale Collegi Ostetriche Global Fund Government of Flanders Health Pooled Fund Iom Kofih Ocha Autonomous Province of Trento Veneto Region Region of Tuscany UNFPA Unicef WFP Foundations 3Ie African Innovation Foundation Becton & Dickinson Bristol Meyer Squibb Foundation Charities Aid Foundation Ejaf (Elton John Aids Foundation) Elma Philanthropies Eni Foundation Fondation Assistance Internationale Fondazione Mons. Camillo Faresin Fondazione Maria Bonino Fondazione Prosolidar Fondazione Cariparo Fondazione Cariplo Fondazione Cariverona Fondazione Crt Fondazione Cassa di Risparmio di Biella Fondazione Compagnia San Paolo Fondazione Comunitaria del Lecchese Fondo Emanuela Spreafico Fondazione Flavio Filipponi Fondazione Giuseppe Maestri Onlus Fondazione Happy Child Fondazione Intesa Sanpaolo Onlus Fondazione Martino E Silvana Gesuato Fondazione Nando e Elsa Peretti Fondazione Prima Spes Fondazione Rachelina Ambrosini Fondazione Rizzato Cerino-Canova Fondazione Un Raggio Di Luce Onlus Fondazione Zanetti Onlus Kofih Manos Unidas
Symphasis Foundation Pink Ribbon Red Ribbon Viiv Healthcare Vitol Charitable Foundation World Diabetes Foundation We Care Solar Ciff Children’s Investment Fund Foundation Groups and associations Volunteer and Solidarity Associations Associazione Quetzal Associazione Amici dei Bambini Contagiati da Hiv/ Aids-Onlus Associazione Amici del Graticolato Associazione Arianna Associazione Ho Avuto Sete Associazione Nico I Frutti del Chicco Associazione Operazione Mato Grosso Associazione Tumaini Bambini Del Danubio Onlus Bush Global Health Initiative Associazione Operazione Occhi Dolci Comic Relief Comitato Per La Lotta Contro La Fame Nel Mondo Dioceses of Lund Dioceses of Padua Dioceses of Vicenza FIPAV Comitato Provinciale di Padova Stadio Euganeo Group supporting the Matany hospital NGO Missionary Group, San Martino di Lupari Missionary Group Mejaniga Manos Unidas Doctors With Africa Como Onlus, Opera San Francesco per i Poveri NGO Parish of S. Pietro in Vincoli Limidi Soliera Parish of San Pietro Apostolo Parrocchia Esaltazione della Santa Croce Parish of S. Lorenzo di Ardenno Patriarcato di Venezia Pink Ribbon Red Ribbon Santuario della Beata Vergine del Covolo Unità Pastorale Arcella Women and Children First Women’s Hope International Zeropiù Medicina Per Lo Sviluppo Onlus Casa Accoglienza alla Vita Padre Angelo Onlus Aziende Alì Spa Azienda Vitivinicola Paolo Scavino di Erico Scavino Banca Intesa San Paolo Bettiol Srl Casa di Cura Parco dei Tigli Casa di Cura Privata Lorenzo Spa
Cercato e Associati Srl Desk Srl Eurizon Capital Sgr Fratelli Mazzon G.M.T. Spa Gilead Sciences Glaxosmithkline Grafica Veneta Spa Italpizza Spa Laboratorio Chimico Farmaceutico A. Sella Srl Leoncini Srl Mafin Srl Midac Spa Morellato Spa Msd Italia Srl Ospedale Pediatrico Bambin Gesù Società di MutuoSoccorso Cesare Pozzo Studio legale La Scala We would also like to thank: Tembo Srl Dual Sanitaly Spa Gandelli Group Opi Provincia diBiella Cascina Candiana Associazione Casa Accoglienza Padre Angelo Varesevive Trenitalia Veneto Direzione Prevenzione, Sicurezza Alimentare, Veterinaria del Veneto Caritas del Veneto Ulss Padova FederazioneTriveneto Cuore Onlus Infermeria Caritas Mestrino Onlus Infermeria di Padre Daniele Hechic O.F.M. Associazione Musicale Summertime Insieme per l’Africa Onlus Comune di Masi Comitato Provinciale Vigili del Fuoco Padova Soleto Spa Azienda Agricola Rovasenda Comune di Rho Municipality of Assago Pontificio Istituto Missioni Estere Municipality of Arquata del Tronto Architect Giovanni De Angelis - Studio degli Architetti Marchetti Rossi Ingegneria Michieli Zanatta Architetti Giuseppe Virgili Costruzioni&Restauri Municiaplity of Castelleone Municipality of Rivolta D’adda We also wish to thank the many parishes, associations and Rotary, Lions and Soroptimis clubs through the country that help us, and, very importantly, the over 2,910 volunteers with CUAMM groups that give a voice to Africa and to our mission.
71
THE JOURNEY CONTINUES. HELP US ON THE WAY! You can contribute to: Post office account no. no. 17101353 to the order of: Doctors with Africa CUAMM Via San Francesco, 126 35121 Padova Bank transfer. Bank transfer to Banca Popolare, Padua IBAN: IT32C0501812101000011078904 Ongoing donation. Adopt a mother and her child for the first 1,000 days. It only costs â&#x201A;Ź6 per month. www.mediciconlafrica.org/ donazione-continuativa 5 per mille. Give your 5x1000 to Doctorswith Africa CUAMM indicating on your Italian tax return the tax code 00677540288 Bequests. A bequest in the form of money or property will be a lasting special sign of your support of the African peoplewith whom we work Solidarity products. Wedding gifts, colorful t-shirts, books, cups, cotton bags, and many other items to choose for yourself or give as gifts to share your support for us with your friends and relatives Businesses with Africa. Customizable gifts, calendars, and cards: Your business can choose to make a (great) small gesture to give your employees, customers, or suppliers a gift of hope for many African mothers and children Online donations Go to www.mediciconlafrica.org to make a donation online and find all the up-to-date information on what we are doing
To ensure the right to health, it takes help from everyone, including you. Together we can make the difference for many mothers and children in Africa. Find out about all the ways to support us. Join in and help! Your contribution is deductible for tax purposes.And, most importantly, it is needed.
www.mediciconlafrica.org postal bank account 17101353
MEDICI CON L’AFRICA CUAMM ANNUAL REPORT 07
OUR COMMITMENT TO ACCOUNTABILITY, YEAR AFTER YEAR.
REPORT ANGOLA ETHIOPIA KENYA MOZAMBIQUE SUDAN TANZANIA UGANDA
ANNUAL REPORT 2010 - DOCTORS WITH AFRICA CUAMM
Doctors with Africa
ITALIANO — ENGLISH
ANNUAL REPORT 2010 - MEDICI CON L'AFRICA CUAMM
DOING MORE AND DOING BETTER WITH AFRICA AND ITS COURAGEOUS, VIBRANT PEOPLE, WHO ARE NOT JUST NUMBERS.
Doctors with Africa CUAMM via San Francesco, 126 35121 Padova tel. 049 8751279
7 COUNTRIES 23 HOSPITALS 1,083 HEALTH FACILITIES 2,233 HUMAN RESOURCES 187,928 ATTENDED BIRTHS 9,586 TRANSFERS FOR OBSTETRIC EMERGENCIES AND BIRTHS 16,222 CHILDREN TREATED FOR ACUTE MALNUTRITION 15,752 PATIENTS ON ANTIRETROVIRAL THERAPY 11,623 HEALTH WORKERS TRAINED
cuamm@cuamm.org www.mediciconlafrica.org