What is the Encouragement Training for
Community Health Empowerment (ETCHE) Project?
1.0. Introduction & Background
Despite the original introduction of the Akosombo-based Onipanua Medical Services Vessel, as a means to increase health service accessibility to inhabitants along the Volta basin, complications have been identified as contributing to limited effectiveness in recent years. Currently, the Onipanua has been moored in Akosombo Port for the past two years as solutions have been explored by the health services department of the Authority. Our outline analysis of the previous project has identified specific hindrances to the effective utilization of the vessel, resulting in the current severance of activity, including:
- A lack of suitable beaching/mooring places for the vessel, resulting in repeated damages to its hull/props/engines during navigation and attempts to beach at lakeside communities;
- High project costs related to fuel consumption and labour. The vessel was kept in almost constant motion as it travelled the lake on a 14 day rotation, consuming 75+ litres of fuel per hour. The method resulted in a high fuel demand scenario, necessitating regular returns to port, during which time the health activities were not in progress.
- The limited ability of the project’s focus on treatment to provide adequate care in rural areas. The environment aboard the vessel is not conducive to performing surgery, despite the presence of a surgical theatre. Additionally, consequent treatment of wounds or illnesses post-vessel tend to be less effective when the patient returns to their community, where potential for re-infection, non-compliance in medication and dressings are rampant.
- The method and project activity necessitated a crew of 18 on 14 day turnaround. It seems as though some of the health professionals were not being maximized in their field potential due to the method and conditions on board. The financing and opportunity of such a crew requirement appears to be a factor in cost-effectiveness appraisal of the precedent project.
The potential for the Onipanua health care vessel to effectively reach and impact the majority of residents of the Volta Lake shoreline appears, therefore, not yet to have been achieved. The vessel’s assets appear to have not been maximised due to project costs and repairs, nor has it been able to meet its directives regarding health improvements through project activities, lack of community identification and related access.
2.0. MoM Objectives & Assets
In comparison to the previous VRA project, Medicine on the Move (MoM) believes that the MoM 10 point Encouragement Training for Community Health Empowerment (ETCHE) project has identified key, pertinent differences in its operations and goals. Details regarding operations will be described in the following section. Distinctly in contrast to previous efforts, MoM is preparing to work on a multi-prong-health education and encouragement based approach to changing the community approach/outcomes in relation to health, raising the base-line health quotient.
With the vast number of communities around the Volta, it is clear that it would take years to reach them all physically, and in fact many are simply going to be ‘practically-impossible’ to reach on a safe and/or regular basis.
Therefore, by working on a ‘air and water combined base’ approached to reaching the communities, and to ensure that EVERY community can be accessed, if not in person by regular aerial supply of educational materials and supplies related to health.
MoM and WAASPS have worked together to establish a functional low-cost supply drop system with accurate and repeatable methods. Such drops can be used to provide first contact, regular supply and ‘invitations’ to training sessions, etc. For the physical contacts it would be done principally via a series of purpose built, low operating and maintenance cost water vessels, leading ultimately to a catamaran barge which would primarily be used as a floating health education centre with capabilities as a First Responder Unit through Advanced First Aid. All such vessels are hereafter referred to as Health Education Vessel(s) or H.E.V. (s)
In the lead up to financing the catamaran barge H.E.V. the ETCHE team would continue to use float planes and other smaller H.E.V.s to establish contacts where possible, but within a more limited geographical range.
Community demand-led health education training will be at the forefront of the ETCHE project. Furthermore, in the event that a community has members needing critical care, stabilization of the patient may be able to be provided. The HEVs may also be used as amphibian ambulance aircraft docking points, enabling evacuation in extreme but transportable cases.
Critical care services will only be those within a broad Basic Trauma Life Support (BTLS) framework, with a focus on stabilization rather than specialist care on the HEV itself, as well as identification of disease and subsequent risk assessment.
Collaboration between MoM and other partner organizations that are expected to participate as the project commences (see our links in the Integrated National Schistosomiasis Control Initiative) will provide alternative strategies and multi-faceted support of the rural communities to promote long-term results in community-led efforts.
In response to community-identified needs, MoM will utilize the air drops and HEVs to further support the MoM 10 point ETCHE plan which includes Millennium Development Goals 4-6 as follows:
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MDG 4 - Reduce child mortality MDG5 - Improve maternal health |
Improved community and personal hygiene and nutrition through improving local understanding of the cause and effects of environmental factors in the harbouring, propagation and spreading of diseases related to child mortality and maternal health. |
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MDG6 - combating HIV/AIDS, Malaria, and Other Diseases |
Due to the unique environment around the Volta Basin a focused programme related to the active reduction and ultimate eradication of Bilharzia and associated lake/open water body specific disease risk areas. Particular focus will be placed upon preventable parasitic diseases such as Bilharzia, hookworm, malaria, etc… |
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Improve the over-all community health |
Through targeted capacity building aimed at disease reduction through improved self-awareness and self-initiated actions for community improvement. |
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Promote capacity building |
Through the encouragement of, and training towards sustainable community-led and where possible, community initiated, projects resulting in overall community health empowerment. |
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Sustainable community development. |
Through long term contact and encouragement visits. Contacts may be as frequent as weekly, monthly, quarterly and eventually bi-annually or annually to ensure, through evaluation and monitoring that the ‘MoM 10 point ETCHE plan’ remain in place and sustained. |
The ETCHE project has established the following socio-developmental formula to describe organizational and community efforts in relation to achieving the above objectives:
(Encouragement + Training) x (community commitment) = Community Health Empowerment
(E+T) x (CC) = CHE
In this formula, the effects of appropriate encouragement and training on community health empowerment are directly related to the status of the community’s commitment within the ongoing monitoring and evaluation cycle. This long-term encouragement and supplemental training process is inversely proportional in visit frequency to the resulting empowerment growth within the target communities to improve their own health status.
If either quotient [(E+T) or (CC)] is absent, the objective (CHE) is correspondingly less likely to be achieved. MoM’s ETCHE project maintains its position of non-invasive stimulation of community self-awareness, and subsequent self-maintained developmental activities, both during and posts the active-collaboration phase of ETCHE.
Prior successes support the use of alternative strategies to meet the previously stated objectives. Utilizing assets within MoM, improvements in community-led projects have already been identified in a rural Fulani camp as well as in Battorkope, following the recent flooding. Within the Fulani camp, an education centre was identified by the community as a need, resulting in a structure being built by its residents to invest in basic education for both adults and pre-school aged children. A part-time teacher is provided by MoM, confirming the commitment of both parties. In addition, MoM has collaborated with the people at Battorkope to help them recover from health risks they faced after their community was flooded. Health education was provided to minimize continued risks, encouraging resident participation towards a community hygiene approach. As a result of collaboration with the authorities, it has been demonstrated that WAASPS, the organisation that supports and operates MoM’s humanitarian aviation logistics operations, has the ability and approval for aerial supply systems to provide resources such as medications in the event of emergencies and especially for times that either an aircraft cannot land, or it is more advantageous to not land the machine.
The collaboration of WAASPS / MoM presents a unique ability to reach rural areas along Lake Volta in a way that has not been done before. The availability of air-drops and HEVs will significantly increase the already indicated ability of MoM to partner with the communities. WAASPS has available a fleet of light aircraft, including an amphibian aircraft and a soon-to-be completed 4-seater amphibian air-ambulance, able to carry a medical stretcher as well as provide crew transfers/urgent supply runs. Furthermore, MoM has recruited Michaela Hayes an MPH (Master of Public Health) (commences full-time on 4th Feb 2012) as well as teachers, IT specialists, and a biochemist with experience in health education to assist in the development, training, implementation, and evaluation aspects of the proposed project. They have experience in operational logistics, rural community need assessment, community motivation, health and basic education. Three of the four MoM recruits have extensive backgrounds in Ghana and its unique cultures. With the addition of the air drops and HEVs, MoM will be able to expand and deepen its health and education services to the Volta basin Infrastructurally Isolated Communities (IIC’s) in a way distinct to the needs of those communities.
3.0. Proposed Mode of Operations
3.1. Project Establishment Activities
MoM has identified the pilot area within the Afram area and the lower half of the main lake below 7°15’. This area was chosen for a number of factors, including the fact that the furthest point is only 100kilometers from Kpong airfield (MoM HQ) which is the equivalent of one days travel by vessel and less than an hour by aircraft. This makes material supply drops, crew changes, resupplying, and potential emergencies management much more realistic. In addition, this region lies almost completely within the Eastern Region, which limits inter-region complications. Potential target communities have already been identified within the pilot area using hi-res aerial photographs and logarithms have been developed to establish location, travel times, dependency relationships, and other identifying factors.
Prior to the catamaran barge HEV operations, MoM would have initiated exploratory visits to target communities (by air supply and smaller HEV access) to assess community interest and invite participation. Participating communities would each identify community-elected representatives (CERs) to participate in training exercises aboard the HEV and to lead the in-community training and implementation activities. An established formal contract with each of the participating communities would be obtained which expresses their invitation for MoM to provide health education and capacity building services in collaboration with the CERs.
This method of assessing interest and acquiring a formal invitation ensures that the project is elective and non-invasive to the communities. MoM maintains that development must be self-initiated by individuals and communities, rather than imposed, to ensure relevant and sustainable developments within the communities. There is neither desire nor aim to change culture or faith, but simply to enhance quality of life through increased socio-economic self-sustainability via improved health education/awareness at a personal and community level.
3.2. Phased Operations
Upon ETCHE operations commencement, educational material and invitation drops will be made to communities. Health programmes would be established based on the ‘take-up’ from the outreaches. Smaller HEVs may visit some communities, others may be visited by road or aircraft (land or sea plane). Long term the catamaran barge HEV will dock at strategically located mooring buoys that will have been set up in the lake relative to the targeted communities. Such buoys will have been placed in order to ideally serve several communities which are geographically/accessibility relevant. The catamaran barge HEV would be moored at the buoy for between 2 and 14 days before moving to the next location buoy. Mooring the HEV will allow for a reduction in the cost of maintaining the vessel as it will not be traveling full-time. Furthermore, mooring to a buoy ‘at large’ avoids the collateral risks associated with bank-side navigation and beaching. Length of time at each location will be determined by the current needs and training schedule of the communities. The catamaran barge HEV would have docking points for the smaller HEV vessels and the amphibious aircraft.
Participating communities would be visited by MoM teams for in-community monitoring and to invite previously identified community-elected representatives for health education and first aid training (at a venue or aboard the catamaran barge). Where possible, in-community monitoring will assist the community in identifying individual needs and will serve as an evaluation method to assess community commitment/development. Representatives may travel by local canoe or smaller HEVs to the catamaran barge HEV in order to ensure an environment conducive to learning by being free from community distractions, as well as being suitably equipped with teaching aids. Those residents requiring more than in-community care would also be able to embark the catamaran barge HEV to access the consulting room and potentially receive care in the on-board ward. Upon completion of training sessions/primary care treatments, the catamaran barge HEV would travel to the next mooring buoy and begin services and assessments with the subsequent communities.
A potential rotation would follow the shoreline beginning on the south side of the Afram, traveling up towards Adowso, and beyond. Returning via the north side of the Afram, the proposed route would lead into the lower half of the mid-lake section and continue on down the lower eastern side of the lake. Once all the communities have been visited, the HEV would continue the rotation. We have identified nearly 400 potential communities along the nominal Afram leg and nearly 550 potential communities along the nominal mid-section south of 7°15’ parallel. (Thus, with a total of ±950 potential communities in the lower lake, we postulate that there are in excess of 3,000 communities in total around the lake edge, the majority of which exhibit infrastructural isolation.)
Crews and supplies can be rotated to the catamaran barge HEV by smaller HEVs or by air, improving time effectiveness and cost-effectiveness of the facility. Located behind the HEV there will be an aircraft docking pontoon, with two smaller HEVs, to allow for mooring of the amphibian aircraft, as well as being part of the HEV’s dedicated beachable launch system for in-community visits/transport. In addition, diesel and fresh water are available at Adowso and Kpando, which are conveniently located at the points close to where the catamaran barge HEV would eventually change directions. Such moorings are also convenient for crew rotation as they are in possession of proper docking ramps and associated facilities.
3.3. Evaluation Criteria
As each community approaches MoM, evaluation of each target community will occur continuously, beginning with a baseline assessment according to ten established points developed by the MoM team of experienced community facilitators. These criteria will identify the level of need, commitment and resources within each community and our response options. Once these criteria have been met, the community will be considered at the level of “maintenance only” indicating that they have obtained the training and resources necessary to be sustainably independent in their community.
MoM considers the end goal for each community is to require only periodic encouragement from outside sources. MoM will assess the:
- Commitment to community health empowerment through the establishment of mutual trust;
- Community-led development of personal and environmental hygiene;
- Achievement of sufficient health literacy for self-enlightenment (e.g. to be able to interpret posted health messages and medication instructions by a suitable number of community members;
- Completion of basic First Aid training and determine the need for further medical attention;
- Attainment of an appropriate level of literacy within the community through an education centre;
- Encouragement of the community to send all children, male and female including those with disabilities to school;
- Understanding of the relationship between improved health and the stimulation of potential economic stability and community growth;
- Support for the current registration and maintenance of NHIS cards and other essential paperwork;
- Stimulation, development and maintenance of sustainable potable water solutions for all community members;
- Development and maintenance of suitable power solutions to promote learning.
4.0. Proposed Inter-Organizational Collaboration
In addition to these regular activities, MoM would be available for partnering with other organizations involved with reaching the communities for health and education activities. Research from the WHO and Schistosomiasis Control Initiative (SCI) indicates that there are often co-infections among communities, particularly in the case of Malaria, HIV/AIDS, and parasitic diseases. It has been shown to be more cost-effective to promote co-administration of certain drugs when there are diseases showing overlap. The services and infrastructure of the ETCHE project utilizing the HEV would provide a platform for those needing to distribute nets, polio vaccinations, etc… to the area. MoM would encourage NHIS compliance by encouraging the NHIS agencies to register residents in-community or on board the HEV. By collaborating with organizations with common interests and goals, MoM can assist the rural communities to empower themselves to improve their capacity building in ways that make sense for them, which leads to long-term sustainability and development within the area.
SUMMARY:
Based upon the above project outline, we believe that, post the INSCI conference, we should be in a position to commence aerial supply of health education materials and invitations to participate in ETCHE before the middle of 2012. WE see the construction and entry to service of two smaller HEVs and the lead up to the catamaran barge Health Education Vessel in the coming year will provide exponential growth potential to our outreach activities and promotion of increased health education towards community growth through Encouragement Training for Community Health Empowerment.
To discuss this further please contact:
Captain Yaw
Medicine on the Move
Tel +233 (0) 28 5018028
e-mail This email address is being protected from spambots. You need JavaScript enabled to view it.
web medicineonthemove.org
