Zimbabwe. Projektbeskrivelse. Udarbejdet af: Frank Thisgaard Udgave: 1 Sider i alt: 12 inkl. forside

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1 Projektbeskrivelse Udarbejdet af: Frank Thisgaard Udgave: 1 Sider i alt: 12 inkl. forside Redder af Verden Engvej 32 DK-7700 Thisted CVR: DK

2 Indhold Indledning... 3 Formål... 3 Mål... 3 Zimbabwe... 3 Forberedelse... 4 Gennemførelse... 4 Vedligeholdelse... 4 Budget... 5 Evaluering... 5 Involverede RAV medlemmer... Fejl! Bogmærke er ikke defineret. Bilag Side 2 af 12

3 Indledning Projektet i Zimbabwe er opstået på baggrund af en forespørgsel fra NGO Care4People og formand Morten Helmø, se evt. Formål At hjælpe Ambulancemandskabet og det på sygehusene modtagne personale i Matabeleland, North Region, Zimbabwe med at udvikle viden og færdigheder i behandling, optagelse, transport og overlevering på lokalt modtagerafdeling på sygehus/lægeklinik ved målrettet undervisning af ambulancepersonale samt sygeplejersker. De 2 Falck-donerede ambulancer skal implementeres samt gerne 2 lokale ambulancer. Undervisning og instruktion af nævnte personalegrupper on site foretages af Redder af Verden Danmark (RAV) i samarbejde med Care4People, som har den lokale forankring og dermed viden om de lokale forhold. Mål At gennemføre undervisning og uddannelse i basal ambulancetjeneste. Udsendelsesholdene skal bestå af 2-4 erfarne sundhedsfaglige personer fra RAV (ambulancepersonel, sygeplejesker eller lignende). Samt at gøre områdets ambulancetjeneste bæredygtigt ved at iværksætte årlige øvelser superviseret af lokal supervisor og yderligere undervisningshold fra RAV. Målet på sigt er at det lokale sundhedsfaglige personale, herunder ambulance redderne og det modtagne personale sikres en grundlæggende viden som de selvstændigt kan holde ajour, for derved at sikre at den egentlige uddannelse og repetition kan finde sted lokalt i region eller kommune fremadrettet. Zimbabwe Republikken Zimbabwe, tidligere Sydrhodesia, Rhodesia og Zimbabwe-Rhodesia, er en republik i det sydlige Afrika. Zimbabwe grænser op mod Zambia, Mozambique, Sydafrika og Botswana. Landet har sit navn efter Great Zimbabwe, en oldtidsby i det sydlige Afrika, som var centrum for et stort rige kendt som Munhumutapaimperiet. "Zimbabwe" kommer af Dzimbadzemabwe, der betyder "stort stenhus" på shonasproget. Landet løsrev sig fra Storbritannien i På det tidspunkt var landet ledet af den hvide farmer Ian Smith. Da landet blev anerkendt som Zimbabwe i 1980, var det med den sorte socialist Robert Mugabe ved magten. Da Mugabe blev præsident, udgjorde de hvide ca. 4 procent af befolkningen, men de ejede 70 procent af landets landbrugsjord, herunder alle de mest frugtbare områder. I Zimbabwe er der jernbanenet på totalt km. Vejnettet har en total længde på km, hvoraf 19% er asfalteret, og der er bygget 7 lufthavne med regulær trafik. Vigtige eksportvarer er tobak, guld, nikkel, bomuld, asbest, sukker, majs, frugt og grøntsager. Vigtige importvarer er maskiner og transportudstyr, brændstof, tekstiler, Side 3 af 12

4 garn, madvarer og levende dyr. Vigtige handelspartnere er Sydafrika, Storbritannien, Japan, Tyskland og USA. Ifølge FN's Verdenssundhedsorganisation er forventet levealder for mænd 37 år og for kvinder 34 år, det laveste i verden i En forening af læger i Zimbabwe har opfordret præsident Mugabe til at hjælpe til med at styrke helsetjenesten. Et stort helseproblem er AIDS. I 2001 regnede en med at mere end 30 % af den voksne befolkning er smittet og frem til samme år havde mennesker mistet livet af sygdommen. Gennemsnitsalder: 18,9 år (2002) Spedbarnsdødelighed: 6,6 % (2002) Etniske grupper: shona 82 %, ndebele 14 %, andre afrikanere 2 %, andre 2 % (hvide omkring 1 % (afrikaanere og englændere) Matabeleland North, Regionen har en befolkning på godt mennesker på et areal knapt dobbelt så stort som Danmark ( km2) De berørte distrikter hedder Lupane og Binga, som kan ses i bilag 1. Forberedelse Forberedelserne går ud på at RAV forbereder et koncentreret uddannelsesforløb over 14 dage, i hvert af byerne der skal have tilknyttet en ambulance. NGO Care4People er i gang med at undersøge, hvor mange deltagere der bliver tilknyttet bilerne. Derefter vil Care4People og Redder af Verden via DMR o.a. søge om 2 ekspertrejser til instruktører fra RAV. Derefter skal planlægges og ansøges om følgende: Der udpeges en holdleder/koordinator fra RAV. Indsamling af supplerende udstyr til ambulancerne og måske uniformer. Udarbejdelse/kontrol af uddannelsesplan. Og plan for repetition. Udvælgelse af øvrigt personale. Forberedelse og briefing af personale. Kontrol af vaccinationer. Ansøge om økonomi til diverse udgifter, kost og logi, tøj m.m. Overnatnings- og undervisningslokalitet måske indledningsvist på ambulancestationen/sygehuset. Briefing og status inden afgang. Forum på nettet. Ambassadens hjælp ved nødprocedure. Gennemførelse Projektet iværksættes efter NGO Care4People og dens samarbejdspartneres anvisninger. Vedligeholdelse Uddannelsesmæssig vedligeholdelse af faglige færdigheder ved evt. præ-fabrikerede øvelser ca. 10 gange om året, evt. også ved hjælp af supplerende udsendelseshold fra RAV. Side 4 af 12

5 Budget Foreløbigt budget for rejse til Zimbabwe for 2 personer. Post Beløb 2 x Lokal transport i Zimbabwe ,- Overnatning 14 á 530,- kr. Dobbeltværelse Harare 7.420,- 2 x Flybillet x 2 Billund - Harare t/r ,- Visa og lokale skatter x 2 personer 2.400,- Kommunikation, telefon og internet 1.500,- Vaccination, og malariaprofylakse x 2 i 14 dage 3.800,- I alt ,- Alle beløb er angivet i DKK Evaluering Når projektet er iværksat kan de involverede instruktører følge projektet på hjemmesiden, hvor de kan beskrive den røde tråd og at alle således har ansvar for at følge med og udvikle projektet. Holdleder/koordinatoren er ansvarlig for projektet over for samarbejdspartnerne, donorerne og RAV. Dermed også ansvaret for at beskrive projektet i en afsluttende rapport og oplysning i diverse medier. Rapporten skal være offentligt tilgængelig på Indholdet i RAVs evalueringsforum skal som minimum indeholde: Egen sikring, farlige forhold og adfærd på lokaliteten. Code of conduct. Behov og mangler. Uddannelsesmæssig status, uddannelseshjælpemidler og nyt. Vedligeholdsmæssig status. Kontakter og forhold ved nødsituationer. Rekognosceringshold Morten Helmø, formand Care4People Simon Wonsild, RAV Mette Ladefoged, RAV Ejnar K. Nielsen, RAV Side 5 af 12

6 Bilag 1 AMBULANCES PROPOSAL FOR MATABELELAND NORTH PROVINCE SUBMITTED TO: CARE 4 PEOPLE IMPLEMENTING OFFICES: CHRISTIAN YOUTH VOLUNTEERS ASSOCIATION TRUST AND CHRISTIAN CARE BULAWAYO PROJECT TITLE: PROVISION OF AMBULANCES TO MOST RESOURCE POOR MATABELELAND NORTH REGION TARGET POPULATION: ZIMBABWE IN BINGA & LUPANE DISTRICTS CURRENTLY COVERED BY CARE 4 PEOPLE DENMARK SUBMITTED BY: Meck Sibanda Director Christian Youth Volunteers Association Trust Emil: cyvtrust@gmil.com Mobile: HISTORY a) BINGA DISTRICT Side 6 af 12

7 The BaTonga people living in the Zimbabwean side belong to the same ethnic group as Zambian BaTonga. The two were one people just separated by the then Zambezi River up until the 1950s when the Kariba dam was constructed. The people claim that in the valley life was good and much better than it is today. They always had plenty of food and never went hungry or experienced any hunger. They always had clean water and the variety of wild fruits throughout the year. The fertile alluvial soils in the banks were cultivated throughout the year. In August 1955, the District Administrator (DA), Ivor Cockcroft, referred to by the locals as Sikanyana, which means small man, together with his messengers informed them that they have to move away from the river as the entire area was going to be flooded. They were to abandon their homes and burial grounds and leave part of their livelihoods behind. The BaTonga were soon to learn that this resettlement was going to happen without their consent, and in areas with poor soils for farming and with no water. Some chiefs are said to have resisted the move until the flooding water forced them out. Life in the new area was difficult for them as they tried to establish themselves. Many are reported to have died of starvation though the then government distributed food during the first two years. The government of the day promised that water will follow them, but till today nothing has happened. This problem of water is always a big challenge for the BaTonga, especially during the drought years and most of the people are left desperate for the much needed water. The BaTonga people today still remain the most marginalised community in an independent Zimbabwe. Uprooted from their traditional lands and the great river, separated form their lands on the other side of Lake Kariba were forced to surrender much of their collective freedom and way of life by the river. The ritual involvement with their ancestors when those who had inherited great spirits cannot unite with others on the other side for rituals is a severe loss for them. Their river goddess, the Nyaminyami was a tying force to the water. Today there are still beliefs that the Nyaminyami will avenge the forcible relocation of her people from the river to make way for their return to the water. A look t the name Tong shows the importance of the river to the people. One explanation comes from the verb kutonga, which means to rule or judge. The Tonga people were originally known as Balonga, or the people of the river mulonga means a river. In time the I changed to d and they became known as BaTonga, or the people of the great river. As the d and the t sounds are similar, BaDonga became BaTonga (source: The People of the Great River- A publication of Silveria House) Side 7 af 12

8 Fig 1. MAP OF BINGA AND THE AVAILABLE HOPISTALS AND HEALTH FACILITIES DISTRICT PROFILE Item Description Location Matabeleland North Province Population (projected 2002 Census) Natural Region 4 and 5 Rainfall pattern 450 mm(low and erratic) Soil Type Sandy with poor structure Traditional Crops Small grains (sorghum & millet) Land areas 1, 316,388 ha Health 1 District hospital, 2 rural Hospitals & 11 Health Centres/Clinics Education 120 Primary schools and 20 secondary schools Water and Sanitation 77% below the government standards CROP PRODUCTION & SUSTENANCE Traditionally the BaTonga people have practiced subsistence farming, with focus on small grain crops. As a result, the District is a crop deficit area, with 85%-95% of the households not being cereal sufficient even in a normal year. Historical data indicates that sorghum and millet production have been much more important than maize. Thus in Binga, considerable average levels for the 1990s, the hectarage under small grain cultivation amounted to over 60% of the total area under cereals, with maize accounting for the balance 40%. It is estimated that about 70% of the District maize output is grown in areas around Lusulu, which receives much higher rainfall levels. Lusulu area is the part of the district that falls under region natural region 4. Crop Side 8 af 12

9 yields in the Poor Resource Kariba Valley food one (Save the Children UK Household Economy assessment report, 2006); average less than 50 kg/hector, an output level far below household requirements. This is further worsened by the problem of wild animals e.g. elephants, which lower the expected yields per given area. Part from food id interventions, the deficit in food requirement is met through income and food earning activities such s livestock sales, wild fruits, fishing and sale of crafts. According to the UNDP s Human Development REPORT (2000), the district had the third lowest Human Development Index (HDI), with its neighbour Kariba rural being the first. Both Districts have the highest Poverty Indices (HPI) in Zambbwe as well. The High HPI in these res is as a result of deprivation, high illiteracy and constrained access to clean water and health care. Although no indices re available t district level, the re round Binga and Nyaminyami re found to have the lowest Gender empowerment measure. The situation of the BaTonga communities has wide socio-moral divide in that they insist their relocation from the Zambezi River t the construction of the Kariba dam wall marked the beginning of their sorrowful life. They were moved from fertile alluvial soils in the river banks to be settled in the dry semi-rid res where soils re unproductive and rain fed crop production is almost meaningless. Other organisations like CADEC, Christian Care end Save the Children have also started Conservation agriculture. b) LUPANE DISTRICT Lupane District is located in Matabeleland North province. The District consists of 26 wards. Based on the 2006 population projections, the district has total population of , all of whom re rural based. Almost one third of households re female headed, whilst further 25% headed by either elderly or children. Approximately 7% of the District s population consists of children under the age of 5 years, with each household containing at lest two under 5 year olds. Around 4005 children in this age group (70%) come from vulnerable and food insecure households (2006 Christian Care base line survey) Lupane District is extremely poor in natural resources. Most of the district is semiarid, characterised by deep infertile Kalahari soils. Rainfalls are low and highly erratic, verging round mm per annum and there re few perennial water sources. The local population relies almost exclusively on rain fed, dry-land subsistence crop farming. Given the harsh agricultural conditions of the area, approximately 16% of the households experience food shortages every year. Infrastructure, services and sources of employment in the district are extremely limited, with labour migration and local small trade being the main sources of income generation. The socio-economic challenges facing the whole country broadly define the status of Lupne district. The deteriorating economic climate caused by the decline in investor confidence soon after the land reform programme, shortage of foreign currency, upsurge of unemployment and inflationary conditions premise the economic challenges of the country and district. On the other hand 3 consecutive droughts, general poverty and the impact of HIV and AIDS influence the social status of the communities, especially poor resourced populations like women and children. High rates of unemployment and high dependency on agriculture s the sole source of food and income re specific macro-economic challenges facing the district. Although the district is endowed with natural resources such as timber, these are under the State, which has monopoly over the harvest of timber and employ few locals. 3.0 PROJECT GOAL Disadvantaged communities of Binga and Lupane Districts secure their basic health rights through the provision of quality ambulance services. 3.1 PROJECT OBJECTIVES Side 9 af 12

10 i. To reduce unnecessary deaths of patients due to lack of transport during emergencies by at least 30% in the target districts. ii. To increase access to basic health services for children and women through mobile clinics with ambulances in the hard to reach communities. iii. To reduce incidences of deaths of pregnant mothers or accident victims which may be complicated and requiring referrals in the target Districts. 4.0 NEEDS ASSESSMENT Political: the political style which Zimbabwe has adopted presents major hurdles to community and family development as it is highly competitive and seldom tolerates divergent political views. This sometimes results in conflict and few flashes of sporadic violence. Given this context, communities find it difficult to claim their right to services form government. Economic: the country s economy is slowly stabilising but communities remain under the yoke of poverty as unemployment is rampant, partly due to a blind education system that continues to produce candidates for a jobless market. This has given way to brain drain especially in rural communities where the youth migrate to urban areas in search of employment. Social: health and educational facilities are now operational but there still remains the challenge of HIV infection in teenagers being very high. Also the mothers and babies are still suffering under the crumbled health system. The maternal and child mortality rates shot up. Eventually in 2011 the3 international community stepped in. Through a fund led by the Ministry of Health and UNICEF, a group of donors pledged $435 million USD to create a Health transition Fund (HTF). The fund goes towards maternity and child health and nutrition, essential medicines, vaccines, basic equipment and human resources, as well as health policy and financial planning. Essential drugs are now available through this initiative in almost all the rural clinics and health Centres. However, although the health delivery system has improved in terms of quality assurance, there is still challenge in accessing some of the health clinics and centres due to lack of transport. Most of the health centres and clinics do not have an ambulance. In cases of emergency, an ambulance has to be organised from the District hospital. This has posed a lot of challenges and most patients usually fail to get the most needed treatment in case of such emergencies. In Binga District, the current available ambulances are old and when in case of emergency for referrals or an accident/disaster, clinics and health centres have to phone the district or raise a radio wave message for attention and an ambulance. This has really affected the patients and most of them usually die while waiting for the ambulance that has to come from the District Hospital which is always far and in most cases the only available ambulance will be having a break down or gone for another similar call INTENDED BENEFITING HOPSITALS i) Binga District (Siabuwa Rural Hospital and Kariyangwe Mission Hospital) In Binga District, the most needed ambulances will serve Siabuwa and Kariyangwe Rural Hospitals and their catchment areas, clinics and heath centres. a) SIABUWA RURAL HOSPITAL Side 10 af 12

11 Sibauwa Rural Hospital is situated about 120 kilometres the Binga District Hospital. Within a radius of the same distance, there is only one health centre which is Mucheni health centre. Siabuwa Rural Hospital serves about two -thirds of the total Binga North constituency population. The furthest point from the hospital is Mujele which is about 60 kilometres making it about 160 kilometres away from the district hospital which is Binga District Hospital. All this area has gravel roads. If an emergency occurs at Mujele, it can take an ambulance over 8 hours to serve a patient from Binga district hospital but can be reduced to less than 3 hours if an ambulance is stationed at Siabuwa clinic. Because of the magnitude of the area, a minimum of two ambulances for the area would go a long way to serve a purpose. The ambulances will be used everyday to help emergencies and cases of women that have complications in giving birth. For Siabuwa, two ambulances will really help serve a great purpose. One ambulance will be situated at Siabuwa Rural Hospital and the other one at Mujele health centre. At Mujele the ambulance will take patients to Siabuwa Rural Hospital, while Siabuwa will further transport patients who are referred to the District hospital in Binga centre. b) KARIYANGWE MISSION HOSPITAL Kariyangwe Mission hospital was established in It is a 72 bedded hospital and has a catchment area that serves a wide catchment area. The Hospital is 80 kilometres from Binga District Hospital. It is also serving the rest of Binga south constituency and takes patients from as far as the Binga boundary to Lupane which is Lusulu. The hospital takes patients from the nearby health centres of Muchesu, Pashu, Chinego, Siadindi and Lusulu clinics. At present Kariyangwe hospital has an ambulance but it is not suitable for the Binga roads. The much needed ambulance for the situation should be hard body and four wheel drive. Since the rods re gravel roads and they are not maintained. During the rain season it is difficult for transporting patients especially with an ambulance without a four wheel drive. ii) LUPANE DISTRICT In Lupane District, the most needed ambulances will serve St Lukes Hospital, its clinics and heath centres. ST LUKES HOSPITAL The hospital is strategically positioned and serves patients from almost the whole Matabeleland North province. The hospital also gets referred patients from as far as Binga and also some patients come from Gokwe, which is in Mashonaland West province. This is due to its reputable health delivery system in the region. The current fleet of ambulances is old and is over whelmed by the demand since this is the busiest hospital in the province. Apart from referrals from outside Lupane District, the hospital gets patients referrals from 5 government Clinics, 5 council Clinics, one rural hospital and one District Hospital within Lupane. 6.0 ALLOCTION OF AMBULANCES S/N NAME OF HOSPITAL DISTRICT NO. OF AMBULANCES 1 SIABUWA BINGA 2 Side 11 af 12

12 2 KARIYANGWE BINGA 1 3 ST LUKES LUPANE 1 TOTAL WHO WILL RUN THE AMBULNCES Normally the Ministry of Health in the country employs ambulance drivers to be specifically responsible although the person in charge of clinic or hospital has overall responsibility. The people responsible for running the ambulances are those certified by the Ministry to be capable. The District Medical Officer who is a doctor has overall responsibility and is helped by a committee set up by the community. However, in each hospital there are drivers who are well trained and capable of driving the ambulances in the current road status. It is also envisioned that the trainers from Denmark will be able to orient the drivers on how to carefully drive and run the donated ambulances so that they can last longer. In each hospital there is a human resource department that supervises all the drivers and they keep up-to date log-books for the mileage of all the hospital vehicles. 8.0 MAINTENANCE AND SERVING OF THE AMBULANCES This project is expected to strengthen the capacities of the local drivers, enabling them to once again provide adequate maintenance and services. It is anticipated that advisory services and training measures provided by the project (trainers from Denmark) will enable the hospital professional staff and drivers to once again deliver and maintain these basic services. In Zimbabwe all vehicles that fall under a public service/ institution are serviced by the Central Mechanical Equipment Department (CMED) which services all government vehicles in Zimbabwe. The department has a depot at Binga Centre about a kilometre from the district hospital. The same service is also available in Lupne District. In Lupane CMED is 30km from St Lukes Hospital. If major service that cannot be done in Binga or Lupane, the vehicles are taken to Bulawayo, which is bout 450 kms from Binga and 170 km from Lupane Districts. For sustainability there is need for orientation of the operation of the vehicles, therefore, training from medical personnel from Denmark will be a noble and welcome idea. 9.0 CONCLUSION The socio-economic situation and the vulnerability of the population living in these two districts, where the ambulances are most needed, leaves a lot to be desired hence the desperate need for the proposed ambulances. The ambulances in all the benefiting hospitals will increase hospital staff outreach and mobile clinics to the community. Side 12 af 12