Annual Report 2005 english

ANN

UAL REPORT DOCTORS W

ITH AFRICA CU

AMM

2005

2005

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

ANNUAL REPORTDOCTORS WITH AFRICA CUAMM

Annual Report 2005

INDEX

The NGO ............................................................................................................................................................................................................................. pg. 3

Projects SectorAngola ...................................................................................................................................................................................................................................... pg. 7Ethiopia .................................................................................................................................................................................................................................. pg. 40Kenya ........................................................................................................................................................................................................................................ pg. 53Mozambique ................................................................................................................................................................................................................... pg. 56Rwanda .................................................................................................................................................................................................................................. pg. 67Tanzania ................................................................................................................................................................................................................................ pg. 69Uganda ................................................................................................................................................................................................................................... pg. 77

Human Resources SectorGeneral Framework ............................................................................................................................................................................................. pg. 101Working Personnel ................................................................................................................................................................................................ pg. 101Recruting and Selection ............................................................................................................................................................................... pg. 103Training and Preparation .............................................................................................................................................................................. pg. 104Monitorino and Evalutation ...................................................................................................................................................................... pg. 113Documentation Center ................................................................................................................................................................................... pg. 114Associative Life .......................................................................................................................................................................................................... pg. 116Students College ..................................................................................................................................................................................................... pg. 116Information Sessions ......................................................................................................................................................................................... pg. 117

Communication and information SectorCommunication and information ..................................................................................................................................................... pg. 121Sensitisation campaigns and Public Relations ......................................................................................................... pg. 121The year’s products ............................................................................................................................................................................................. pg. 123The year’s principal events ...................................................................................................................................................................... pg. 125Publications ..................................................................................................................................................................................................................... pg. 126Sensitisation material ........................................................................................................................................................................................ pg. 128Educating for developement ................................................................................................................................................................. pg. 129

Groups SectorThe Groups ...................................................................................................................................................................................................................... pg. 133Doctors with Africa Cuamm Groups ......................................................................................................................................... pg. 134Partner groups of Doctors with Africa Cuamm ........................................................................................................ pg. 150Friends of Doctors with Africa Cuamm groups ........................................................................................................ pg. 153

Other Activities ....................................................................................................................................................................................................... pg. 157

Doctors with Africa Cuamm

International College for Health Cooperation in Developing Countries

Doctors with Africa Cuamm was founded in 1950.It is one of the channels of the ‘Work of St. Francis Xavier’, agency with legal personalitycivilly recognized with DPR 18/01/60, nr.55.Non governmental organisation (NGO) for health cooperation, recognized suitable to thesenses of the Law nr. 49/87.

Foreign relations:Member of: Medicus Mundi International (MMI), Volunteers in the World – FOCSIV,

Comitè de Liaison (UE).Correspondent of: UNICEF, WHO.Adheres to : the Red Cross International code of conduct.

Head Office:via S. Francesco nr.126, 35121 Padovatel. 049.8751649-279; fax 049.8754738e-mail: [email protected]

Actual Member:On 31.12.2005: nr.306.

Director and legal representative: Luigi Mazzucato

Director AssistantsAndrea Borgato (Head of Administration Department)Egidio Bosisio (Projects Department)Dante Carraro (Vice-Director, Head of Human Ressources Department and of the

College)Serena Foresi (Partners Department)Anacleto Dal Lago (Projects Department)Valerio Mecenero (Head of Projects Department)Anna Talami (Head of Communication&Marketing Department)

PROJECTS SECTOR

ANGOLA

ETHIOPIA

KENYA

MOZAMBIQUE

RWANDA

TANZANIA

UGANDA

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ANGOLA

1 COUNTRY PROFILE

Angola is one of the largest African producers of crude oil, second only to Nigeria. On 11April 2002 the government and the UNITA rebel faction signed a ceasefire and peaceagreement. After signing the ceasefire the decision to reach an agreement came after thekilling, in February of the same year, of the historic leader of UNITA, Jonas Savimbi, dur-ing a skirmish in a UNITA controlled area near the border with Zambia. The ceasefire may well be the first step towards lasting peace, in a country that, sincethe time of its independence in 1975, has been bloodied by constant warfare. Theongoing conflicts have left the country in a ruinous state. It is estimated that there aremore than 10 million landmines spread over the vast national territory. The capital,Luanda, has a population of around 5 million, most of whom living in very poor condi-tions. The healthcare system is extremely out of date, not just because of the lack ofequipment and facilities, but also and perhaps above all due to the persistent applica-tion of inappropriate political strategies. Angola’s healthcare indicators are among theworst in the world.The 5th Congress of the Popular Movement for the Liberation of Angola (MPLA) whichwas held last December, ended with a vote of confidence in the current president, JoséEduardo dos Santos, who was confirmed for the office of the party leader and naturalcandidate for the future presidential elections.The total surface area of Angola is around 1,246,700 sq km. The most recent censusdates back to 1970. It is estimated that the current population is in the region of 14 mil-lion. Life expectancy at birth is 45 years for men and 48 years for women. The infant mortali-ty rate is 125 per 1,000 live births. The maternal mortality rate is estimated at 1,500 forevery 100 thousand live births. In its latest report on human development, the UnitedNations Development Programme (Undp) ranks Angola in the 164th place out of a total of175 countries.

> Full name of the country: Republic of Angola > Area: 1,246,700 sq km > Population: 13,978,552 > Capital city: Luanda (2,297,200 inhabitants) > Ethnic groups: Ovimbundu 37%, Kimbundu 25%, Bakongo 13%, Mestico (mixed

European and native African) 2%, European 1%, other 22% > Languages: Portuguese (official), Bantu and other African languages > Religion: indigenous beliefs (47%), Roman Catholic (38%), Protestant (15%) > Government type: parliamentary republic > President: José Eduardo dos Santos (1979) > Prime Minister: Fernando de Piedade Dias dos Santos (2003)> GDP: $ 20.5 billion > GDP per capita: $ 1,490 > Annual growth rate: 7.1% > Inflation: 18% > Main sectors/products: petroleum-chemicals, minerals (diamonds, bauxite,

phosphates, uranium and gold), food and fish products, tobacco products, sugar,textiles

> Economic partners: USA, EU, China, South Korea, South Africa, Brazil.

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2 HISTORY OF DOCTORS WITH AFRICA CUAMM IN ANGOLA

The Angola project started in 1997 and was initially concentrated in the province of Uige,expanding later to include the provinces of Luanda and Cunene.From 1997 to 1999 Doctors with Africa CUAMM pursued its commitment with the Uigehospital also during the fiercest fighting of the civil war, subsequently extending its activ-ity to include the hospital of Negage with a project funded by ECHO, the EuropeanCommission’s Humanitarian Aid Department.In 2000 Doctors with Africa CUAMM consolidated its presence in Luanda and, further toan invitation from the bishop of Kunene, an intervention was planned that would subse-quently be developed as the southern platform of Doctors with Africa CUAMM in thecountry.With the peace agreements of 2002 the provincial territory was opened up thanks to acareful implementation of a relief, refurbishment and development strategy, Doctors withAfrica CUAMM reopened five of the six hospitals in the province of Uige, subsequentlyfocusing in 2006 on the two most isolated municipal areas: Damba and Maquela doZombo.In the other provinces the interventions were consolidated in both the area of tuberculo-sis treatment, which expanded in 2005 to embrace 11 provinces, and in Kunene wherethe organisation started supporting the provincial HIV treatment program.

3 SOCIAL HEALTH INDICATORS

HUMAN DEVELOPMENT INDICATORSLife expectancy Literacy rate Schooling Human Human at birth rate (gross) development development

index ranking index40.1 years 42% 30% 164 out of 177 0.381

DEMOGRAPHIC INDICATORSTotal Annual Urban Fertility rate population population population

growth rate13,978,552 2.9 48% 7.2

HEALTH INDICATORSMaternal Infant Deliveries Mean Doctors per mortality mortality assisted prevalence of 100,000 persons

by qualified HIV on study of personnel pregnant women

1700 /100,000 154 / 1000 45% 5.1% 5live births

INDICATORS OF ACCESS TO WATER AND FOODPopulation with Undernourished Underweight Underheight Underweight access to an population infants in infants in infants at birthimproved water relation to age relation source to age38% 49% 31% 45% 12%

4 INTERVENTION PLATFORMS OF DOCTORS WITH AFRICA CUAMM IN ANGOLA

The intervention platforms of Doctors with Africa CUAMM involve the provinces of Uige,Kunene and Luanda.

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10

4.1 Province of Uige

4.1.1 Maquela do Zombo

SUPPORT OF THE MUNICIPAL HOSPITAL OF MAQUELA DO ZOMBO: PRESTAÇÃODE CUIDADOS MATERNOS INFANTIS AS POPULAÇÕES DESLOCADAS DOMUNICÍPIO DA MAQUELA DO ZOMBO.

LOCATION > Municipality of Maquela do Zombo BENEFICIARY POPULATION > 229,681BUDGET > 269,231DONORS > EU in situ funding PTAPDPARTNERS > PROVINCIAL HEALTH DIRECTORATEEXPATRIATE PERSONNEL > 1 doctor

> 1 nurse> 1 logistician

LOCAL PERSONNELAUXILIARY PERSONNEL > 1 driver

> 1 storemanPROJECT STARTING DATE > JUNE 05PROJECT ENDING DATE > DEC 05

IntroductionThe ECHO 12 month project, which started on 1.4.2004, reached its conclusion on31.3.2005 without obtaining an extension for closure of ECHO activities in Angola. On 1.6.2005 a transition project was started (8.ACP.ANG.11/30), funded by the EULuanda office, in the framework of a national programme designed to support internal dis-placed persons (PTAPD) which terminated on 31.12.2005 and allowed the optimal transi-tion with the activities of the project co-financed by Doctors with Africa CUAMM and theEU, lasting two years and starting on 1.1.2006.In the period from 1.4.2004 to 31.5.2005 the activities in Maquela continued uninterrupted,using residual funds of the ECHO project and private resources of Doctors with Africa CUAMM.

Main activities in hospitals> The epidemic of Marburg Hemorrhagic Fever that dominated the health scene in the pro-

vince of Uige in 2005, did not impact on activities in Maquela; only two positive cases andone suspected case were recorded, all of which treated with appropriate safety measuresand in close collaboration with the provincial epidemic control commission.

> The flow of patients to the hospital increased steadily, probably due to the greater con-fidence of the population in the healthcare service and gradual population increase ofthe municipality caused by the gradual return of Angolan refugees from the neighbou-ring Democratic Republic of the Congo.

> The total number of admissions recorded in 2005 was 11,581 of which 1,725 adults,1,572 in the Obstetrics and Gynaecology department, 286 in the Respiratory MedicineDepartment and 7,998 in the Paediatrics Department, making this the second mostimportant hospital in the province in terms of utilisation.

> The Transfusions Centre was upgraded with the installation of a solar panel powered refri-gerator for storage of blood: during the dry season the average number of paediatric tran-sfusions is 8 /day, and the HIV and EP screening test is performed for all transfusions.

> The number of assisted deliveries was 828, of which 61 by caesarean section and 33by vacuum extractor. Surgery was reserved only for emergencies, for a total of 102operations. The senior surgeon who was to join the team was unable to reach Maqueladue to health problems.

> Significant efforts have been made to improve the hospital’s information system, withthe introduction of a computer in the statistical data room and the training of local per-sonal in the basics of information technology. The information currently generated isreliable, in line with national plans, and updated in real time.

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> The training of paramedical and auxiliary staff in security measures to be applied inhospital work has been improved, and a series of therapeutic and diagnostic protocolshave been introduced for the main paediatric diseases and emergencies.

> The supply of drugs was constant during the year without any significant stock breaking;the integration of drugs of Doctors with Africa CUAMM with those of the local governmentis proceeding slowly but surely; medicine stocks and distribution to wards are managed bya single function and efforts are being made to facilitate purchases by the hospital at theIDA to increase the effectiveness of the state investment, which is currently significant ineconomic terms although only mediocre in terms of the effective supply of drugs.

Main activities in the territoryConstruction is now almost complete of the Nzadi health post, 30 km east of Maquela, in oneof the most densely populated areas and the main trading centre in the entire municipality.The Health Post of Quibocolo on the road for Damba, and Ntaia on the road for the DRChave been renovated, refurnished, and provided with equipment.

Main logistical activities> The electrical installation of the hospital has been renovated and a new 40 kWA generator

installed which, in addition to serving the hospital, will also feed power to the offices of thehospital management and the residential quarters of Doctors with Africa CUAMM personnel.A parallel lighting system has been installed. Powered by batteries and solar panels, the paral-lel system will allow the continuous use of 16 light fixtures throughout all hours of darkness.

> The hospital water supply system, which has been out of service since 1998, has nowbeen restored thanks to the reactivation of the captation borehole with the installationof a submersible pump and the physical refurbishment of the storage and distributionsystems: currently water is supplied for several hours each day to 10 external standpi-pes and several strategic areas of the hospital, including the maternity ward, laborato-ry, operating theatre and emergency room.

> A new rational and protected structure has been constructed for the disposal of sortedhospital waste. This activity resulted in a radical improvement in the environmentalhygiene of the hospital.

> The hospital has also been painted throughout; renovation of the new maternity ward hasbeen completed (in the original hospital management quarters), and also renovation of thekitchens, the laboratory, the respiratory medicine department and the mortuary.

4.1.2 Damba

SUPPORT OF THE MUNICIPAL HOSPITAL OF DAMBA: PRESTAÇÃO DE CUIDADOSMATERNOS INFANTIS AS POPULAÇÕES DESLOCADAS DO MUNICÍPIO DAMAQUELA DO ZOMBO.

LOCATION > Municipality of Damba BENEFICIARY POPULATION > 141,820BUDGET > 569,775 euroDONORS FOR COMPLEMENTARY > Private donors and Groups, ACTIVITIES Doctors with Africa CUAMMPARTNERS > PROVINCIAL HEALTH DIRECTORATEEXPATRIATE PERSONNEL > 2 doctors

> 1 nurseLOCAL PERSONNELAUXILIARY PERSONNEL > 1 logistician

> 1 driverPROJECT STARTING DATE > JULY 04PROJECT ENDING DATE > DEC 05

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

1. Improvement of paediatric care;2. Improvement of obstetric care;3. Improvement of auxiliary services;4. Improvement of PHC services;5. Constant training of nursing staff serving in the hospital;6. Improvement of the information system;7. Constant supply of pharmaceutical medicines;8. Construction of new infrastructure and refurbishment of existing plant.

The end of the project, which was initially scheduled for 05.11.2005, was delayed until31.12.2005 in order to provide continuity pending activation of the new project, which willstart on 01.01.2006.In the paediatrics department a 24-hour service supporting the more complex cases hasbeen put in place. During the course of 2005 the hospital saw 2,767 admissions of which1,658 paediatric. All the children in the hospital were examined every day, thus allowingon-the-job training of the nursing staff accompanying the doctor. This approach made itpossible to restrict overall infant mortality to 4.1% (mortality > 48 hours: 1.7%). In theobstetrics department a significant increase was achieved in the number of assisteddeliveries (up by 50% over the previous year; 199 in 2004, 308 in 2005), reflecting theincreased confidence in the level of healthcare provided. Maternal mortality was332/100,000. However, it is our belief that many women die in the villages because of thedisastrous situation of the roads and transport services that effectively make a trip to thehospital all but impossible; in this context we do not have any reliable data to confirm orrefute this hypothesis. For this reason (transport difficulty), the number of women comingto the hospital to give birth has increased significantly, including those arriving from rela-tively distant locations (100 km). This situation has led to overcrowding on the maternityward (25 hospitalised women with 4 beds, and an average bed occupancy rate of350.5%), which calls for the future construction of a facility to be used as a “pre-deliveryward” like the one created by Doctors with Africa CUAMM at Negage. Another importantrequirement is the construction of a new delivery/maternity room: the existing room hasjust one delivery bed (with no possibility of installing a second bed because of the con-fined space). Clearly this is wholly inadequate when more than one delivery is in progressat the same time. For this purpose construction activities of peripheral maternity facilities have beenplanned, together with the training of midwives, which will be developed also throughoutthe project scheduled to start on 01.01.2006.Also the medicine and surgery ward have been entirely managed by Doctors with AfricaCUAMM in terms of human resources and materials/drugs, even though this is not specif-ically envisaged by the project in progress. Surgical activities in 2005, after having start-ed elective surgery, doubled with respect to 2004 when exclusively emergency surgerywas performed (132 operations in 2005 versus 56 in 2004).The laboratory/transfusion centre has been constantly supplied with reagents and testkits (HIV and HbsAg) for the execution of safe transfusions. Primary Health Care is the main obstacle due to the size of the municipality and the poorcondition of the roads (closed to traffic 8 months each year). Constant supervision is vir-

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tually impossible and the activity performed this year has been that of providing two-monthly kits of essential drugs to the health posts with sporadic supervision; in addition,the extended vaccination programme (PAV) was supported. Training of personnel was performed in three forms:> Daily on-the-job training, introducing standardised protocols and treatment plans.> Training by means of weekly lessons on the most frequently encountered illnesses and

on topics requested by the nurses.> Execution of a “doenças comunas e partogramma” (common diseases and labour and

delivery chart) with the production of a manual for continuous personnel training.This allowed an improvement in the knowledge of personnel and the use of standardisedtreatment plans. The labour and delivery chart is now currently utilised for the assistanceof all deliveries. The Marburg Hemorrhagic Fever epidemic in the province of Uige raisedawareness of an improvement in the standards of bio protection, which are todayobserved by all health practitioners in the hospital.The hospital information system has been improved thanks to the supply of a portablecomputer to the counterparty and the constant assistance in the collection of statisticaldata. Currently the municipality of Damba is the only one in the entire province to beequipped with a digital file containing all the statistical data required by MINSA for theyear 2005. Almost the entire quantity of drugs was supplied by Doctors with Africa CUAMM; the localcounterparty, despite having access to government funding for the purchase of drugs,diesel fuel, and materials, instead proceeded with the totally haphazard purchase of drugsthe majority of which are of no use, with only a small proportion that were subsequentlyutilised within the hospital. The diesel fuel for the generator was entirely supplied byDoctors with Africa CUAMM, despite repeated requests to the counterparty to contributeto this expense.During the year two new constructions were started, involving the transfer of a skilledtechnician for three months. Subsequently the constructions fell under the remit of theproject logistician: a new respiratory ward (currently women suffering from tuberculosisare accommodated in the general medicine ward) and a building for the auxiliary radiolo-gy service. Both buildings are scheduled for completion in February. The Marburg epi-demic also called for upgrading of the organic waste disposal system with the construc-tion of a specific area of the “lixo” in compliance with international safety standards (MSF-WHO standard). In the hospital kitchen, in view of the constant saturation of smoke dueto the use of traditional cooking systems (fires on the floor), which resulted in a highly nox-ious environment, a fireplace and chimney were constructed resulting in a significantimprovement in conditions; also patient’s cooking for dinners was extended. The entirehospital was repainted (inside and outside).

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4.1.3 Uige and Songo

SUPPORT OF THE PROVINCIAL HOSPITAL OF UIGE AND THE MUNICIPAL HOSPI-TAL OF SONGO: PROVIDING SECONDARY MATERNAL AND CHILD CARE TO DIS-PLACED PEOPLE IN UIGE PROVINCE (Uige, Songo e Negage Municipalities)

LOCATION > UIGE and Municipality of Songo BENEFICIARY POPULATION > 450,000BUDGET > 999,983 euroDONORS FOR COMPLEMENTARY > Private donors and Groups, ACTIVITIES Doctors with Africa CUAMM

> Trentino Alto Adige Regional Administration> Cordar Consortium

PARTNERSEXPATRIATE PERSONNEL > LUANDA

> 1 administrator> UIGE> 1 doctor for maternity ward> 3 doctors for paediatric ward> SONGO> 2 doctors

LOCAL PERSONNEL > 1 logistician> 2 drivers

AUXILIARY PERSONNEL > 1 logisticianPROJECT STARTING DATE > SEPT 2002PROJECT ENDING DATE > AUG 2005

This project, which is funded by the EU (Project no. 8 ACP ANG 011/01), with the addi-tional contribution of private supporters and local authorities involved support in pae-diatrics, maternity, nutritional services and health posts, with reference to the Hospitalsof Uige, Negage and Songo. The intervention in the municipal hospital of Negage terminated in September 2004.In effect, since this is a continuation of previous global interventions in the same hos-pitals, the project involved total support for the municipal hospital of Songo, and sup-port for paediatrics and obstetrics in the provincial hospital. In addition, it was plannedto improve the information system at all levels and award priority to the training of localpersonnel. A special commitment concerned the supply of essential drugs and therefurbishment of several infrastructure facilities.The project under way was an 11-month extension presented to the EU in July in orderto provide continuity to activities in Uige and Songo.Further to a joint meeting with the provincial health delegation, the management ofDoctors with Africa CUAMM and local authorities, it was decided (after the 11 monthproject extension) not to continue with an intervention of the replacement clinical typein the provincial hospital of Uige and the municipal hospital of Songo, but instead tofocus on activities of training support to healthcare middle management on a province-wide level.The decision to terminate the intervention, which was a significant disappointment frommany different standpoints, was taken further to decisions taken with the counterpartyin the above meeting and due to various contingent situations including:the arrival en masse of North Korean healthcare practitioners (16 at Uige alone), withwhom collaboration in the provincial hospital has proved difficult;the award to the Uige and Songo hospitals of substantial finances for recurring expens-es in an amount that is sufficient, if properly managed, to cover the requirements fordrugs, consumables and food of the hospital;

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the presence in the province of situations that are far more difficult and widespread thanthose of Uige and Songo, in which, all things considered, government activities are sig-nificant and radical;the lack of CUAMM doctors willing to work in complex situations such as those typicalof municipal hospitals.Considerable difficulties were in fact encountered in assuring the constant presence oftwo doctors at the Songo hospital, where the high staff turnover also prevented thearrival at stable results in the management of the work.The Songo hospital therefore saw a fall in its utilisation rates and requires significantinput, so this facility has been included in the extension for 2005.In the Uige paediatrics department work proceeded in a positive manner for almost theentire twelve-month period; the stable presence of skilled specialists allowed the con-solidation of several work routines that are particularly effective in the management ofemergencies. The number of admissions rose to more than 11,000 and the mortalityrate fell to just below 10%. Unfortunately here too, the arrival en masse towards the endof the year of Asian medical practitioners and the transfer of the paediatrics departmentto the new installations built by the government has resulted in a period of instabilityand confusion from which it will be difficult to emerge.In the Uige maternity department the utilisation rates increased still further and in thecurrent year assisted deliveries were 6,285, with a rate of caesarean sections of 6.3%,for an average of 17 deliveries/day. Training of paramedical personnel arrived at after 7years of working together, plus the continuous availability of drugs made it possible torestrict maternal mortality rates to 451/100,000, which is equivalent to one third of therate normally recorded in similar provincial hospitals in Angola. Here too the arrivaltowards the end of the year of Asian doctors resulted in confusion in terms of manage-ment rather than a tangible reduction of the workload of Doctors with Africa CUAMMpersonnel, also because the final destination of many of these Asian doctors is stilluncertain, so the integration process proceeds rather slowly.The laboratory service with the transfusion centre (the number of paediatric transfu-sions required is high due to the seriousness of malarial disease) remains one of themost demanding sectors with all the problems associated with the transmission of HIVand the clinical and purely logistical workload that this involves.The Nutritional Rehabilitation Centre continues to manage serious cases and providesupport for the supply of milk and drugs. Now that the war is over reduction of the nutri-tional problem connected to the displacement of large numbers of the population hasdiminished while access from peripheral municipalities and villages has increased sothe utilisation of the Uige Nutritional Centre has started to increase again; the cessationof Unicef supplies of therapeutic milk has led to a greater level of commitment in themanagement of the Uige Centre in the effort to adopt therapeutic protocols that useelements that are available on the local market.The supply of drugs to the supported facilities continued on a high level, since theincrease in the financial commitment of the government is as yet unable to translate intoan increased availability of drugs due to the lack of a national pharmaceutical policyand due to the relative inexperience of several of the figures in local key managementpositions responsible for this activity.The training activity was focused on the obstetrics aspect for hospital staff (introduc-tion of the labour and deliveries chart) and, above all, on the peripheral level, for mid-wives.An initial seminar on the management of health information was held in November withrepresentatives from all the peripheral municipalities with the aim of starting the refur-bishment of the provincial information system, which is currently in an extremely retro-grade condition.Logistical and infrastructure refurbishment requirements were covered by a specificallycreated local team assisted by expatriate personnel.

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4.1.4 Vertical interventions

PILOT PROJECT FOR CONTROL OF NEGLECTED DISEASES

LOCATION > Municipality of Damba BENEFICIARY POPULATION > 141,820BUDGET > USD 174,000DONORS > WHOPARTNERS > PROVINCIAL HEALTH DIRECTORATEEXPATRIATE PERSONNEL > 1 doctor (non-employee)LOCAL PERSONNEL > 0AUXILIARY PERSONNEL > 1 health promoterPROJECT STARTING DATE > JULY 05PROJECT ENDING DATE > DEC 06

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

REFURBISHMENT OF THE DAMBA MUNICIPAL PRIMARY SCHOOL

Education in the Municipality of Damba is currently in the launch phase thanks to thearrival of a large number of teachers. However the level of schooling remains a matter ofconcern at the present. The war resulted in a large number of young people without anylevel of education. This is the reason for the current mass enrolments, including manyadult pupils. A state school was recently (2004) refurbished by local government, but it iswholly insufficient in relation to the need to provide education for all beneficiaries. TheCatholic mission (Cappuccino monks and Misericordia nuns) provides primary educationin the mission facilities. In 2004 the mission registered the admission of 797 children.The project, which is funded privately and by Doctors with Africa CUAMM groups, isdesigned to renovate primary schools owned by the Catholic mission of Damba (twoschools) and started after the end of the school year (end of November) and hence it is atthe start of its development.Work was started in November. In this initial phase Doctors with Africa CUAMM received 50% of the planned budget fortotal refurbishment. Therefore, after a market survey the NGO acquired all the materialsrequired for the refurbishment project and, through its logistics structure, it shipped themall to the Municipality of Damba.The Logistics component impacted significantly on execution times because, since oncethe rainy season starts the Municipality of Damba is almost entirely cut off for days at astretch from the rest of the province and from the capital.Despite the difficulties, the materials, which are available only in the capital, were shippedand after several days they were delivered and the works were started.

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Situation at present:> Renewal of the roof of one of the buildings in such a way as to prevent water ingress

resulting in serious damage to suspended ceilings and walls.> Construction of doors and windows has been started.> Internal refurbishment work started including walls, tiling, and floors.> Refurbishment work on the external structure was started.The programme envisages continuous work throughout December and January and prob-ably the renovation works will be completed in time for the start of the school year(February 2005).

INSTALLATION OF SOLAR PANELS IN THE MUNICIPAL HOSPITAL OF DAMBA

Italian cooperation has also financed the installation of 48 solar panels for the supply ofelectrical power 24 hours/day, contracting the work to a private company of Luanda,although the system is not yet running due to initial damage caused by a lightning strikeon the system and the difficulty of finding qualified technical personnel for the necessaryrepair work. In view of the inefficiency of the local contractor Doctors with Africa CUAMM,which supplied exclusively logistical support for this project, decided to officially takepossession of the entire plant in such a way as to return it to operation as soon as aDoctors with Africa technician is available. Finally, in the Municipality of Damba as in theentire province of Uige, Doctors with Africa is supporting the national programme for thecontrol of tuberculosis, following the national protocol.

CONTROL OF THE MARBURG EPIDEMIC IN THE PROVINCE OF UIGE

Towards the 7th week of 2005, following tests conducted by the Atlanta CDC, it was recog-nised that the Marburg virus was responsible for the Hemorrhagic Fever epidemic cur-rently afflicting the province of Uige. Many embassies urged their citizens to leave thearea, and there was talk of a health cordon being created around the Uige province, clo-sure of border crossings and cancellation of international flights. Doctors with AfricaCUAMM responded with the evacuation of personnel employed in Songo and Uige.Unfortunately, for dr Maria Bonino, working in the Uige paediatric department, this meas-ure came too late. She contracted the virus and died on 24 March 2005 in a Luanda clin-ic. This tragic death announced the start of a series of fatalities among Angolan health-care personnel.From the start of the epidemic the province of Uige was identified as the primary outbreakarea of the infection. The provincial capital was given several funding awards.Government personnel, international agencies and NGOs arrived on the scene. This activ-ity is all in the framework of a strategy of combating the epidemic that started out as anational plan and was subsequently redefined as a local plan in the province of Uige.The initial phases of response to the epidemic were chaotic: international experience withMarburg is limited and both in Uige and Songo attempts were made to apply standard mod-els for the control of hemorrhagic fever, the creation of triage areas, and isolation. But in viewof the high mortality of isolated patients and the cultural shock of such a radical intervention,the population started to lose faith in the hospital authorities. This heralded the transition toa second intervention strategy. Three areas of isolation were created in the hospital: mater-nity, paediatrics, and adult ward, with an information campaign orchestrated by the Angolangovernment. This saw the start of a visible mediation campaign by the health minister withlocal political and traditional authorities and the various agencies present in the area.On the project level Doctors with Africa CUAMM defined three strategies:> To guarantee the activities envisaged in the projects currently underway in Damba and

Maquela, with minimisation of the activities in the hospitals of Uige and Songo.> Logistical support to the Provincial health directorate in terms of acquisition and mana-

gement of the stock of bio-safety materials.

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

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

REFURBISHMENT OF THE WATER SYSTEM OF THE MUNICIPAL HOSPITAL OF SONGO

The municipal hospital of Songo is the sole second level healthcare in the west of theprovince of Uige. In addition to serving the population of the city of Songo, the hospital isthe reference healthcare structure for the municipalities of Songo, Bembe, Ambuile and,in part, for the municipality of Mucaba.The total number of patients admitted in 2004 was 4,514, of which 2,203 children, with anaverage of 111 patients/day of whom 44 children. This means that, calculating the moth-ers that accompany their children and service personnel, and average of around 170 per-sons sleep in or in the immediate vicinity of the hospital structure.Before the implementation of this project the Songo municipal hospital did not dispose ofits own water supply. The needs of the hospital were satisfied in part by a 1000 litre tankprovided by Doctors with Africa, which was towed to the spring each day and filled bymeans of a diesel engine pump. This system was clearly insufficient for the total require-ments of the hospital, so the intervention of support groups and private parties wasrequested for the implementation of the water supply project.The project was implemented thanks to the support of Doctors with Africa CUAMMgroups, private parties, and the Cordar Consortium.

Specific goals of the project1. To create an independent water supply network at Songo hospital.2. To improve the access conditions to water within the Songo hospital.

Activities performed> Refurbishment of the building housing the pump unit located next to the water source

In the vicinity of the spring a house containing the new pump unit was renovated, anda metal grille door with a lock was installed to prevent possible theft or vandalism.

> Installation of a new pump unit A new pump unit, shipped from Italy, was assembled and connected to the watersystem that supplies the Songo city water tank. The installed and tested pump is ableto overcome a level difference of around 70 m and the 2000 m distance between springand tank.The Songo city tank has a capacity of around 125,000 litres. With the daily filling cycleit is possible to supply the entire city with running water, despite the large number ofleaks in the city water distribution system, which dates back to colonial times.

> Purchase and installation of a dedicated network for hospital water suppliesA dedicated network for the hospital water supply was created with the purchase of1500 m of high strength PVC piping and a 40 cm deep 20 cm wide trench of a lengthof 1500 m for laying the pipeline. A system of gate valves was created in such a way as to fill the hospital tank in a selec-tive manner. Once the city water tank is full the hospital supply line can be opened sothat the city water tank fills the hospital tank by gravity.

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> Renovation of the hospital water tankOnce the supply system had been created, already from the initial tests serious leaksfrom the hospital tank were found, reducing the total capacity and the autonomy of thesupply.This realisation led to an intensive period of renovation works. The interior of the tankwas renovated to ensure a good level of insulation, while the hospital outlet pipes weresystematically either plugged or repaired.

> Creation of a water distribution network inside the hospital.Once the tank had been renovated attention was focused on the distribution systeminside the hospital. The condition of the original system (Colonial period) was such thatit was impossible to repair existing structures, so a new high-strength PVC pipe wasinstalled between the tank and the hospital and the distribution areas (around 300 m).Two distribution systems (drinking fountains) were created in the hospital’s externalcourtyard.This system, since it avoids the dispersal associated with the original system, concen-trates and optimises collecting of water by hospital staff and patients.

ConclusionsThe renovated system proved to be extremely efficient and easy to use, the pump unit fillsthe city tank and thanks to the system of gate valves the city supply is interrupted threetimes a week for several hours while the hospital tank is filled. A local engineer, who was previously responsible for running and servicing the originalpump unit, was trained in the operation of the new system both in relation to the newpump unit and the system of gate valves that serves to fill the hospital tank.Thanks also to the stock of diesel fuel purchased by means of the project and managedby the Misericordia nuns of Songo, the city tank will be filled on a daily basis to respondto the population’s water requirements. For many citizens of Songo this means the elim-ination of a walk of several kilometres to the spring and the return journey carrying heavywater jugs on their heads.The hospital supply system was proven to be efficient thanks to a dedicated pipeline andthe altitude difference between the two tanks which, once the gate valve in the distribu-tion well has been opened, allows the water to flow by gravity from the city tank to thehospital tank.This operation makes it possible to fill the hospital tank with approximately 35,000 litresin around 6 hours, and when performed 3 times a week it responds fully to the needs ofthe hospital.The project had a significant impact on the population of the city of Songo and on all thehospital staff and patients. The presence of running water made it possible to improve thehygiene and care provided by the hospital structure and, in general, improve the health-care facilities at the Songo municipal hospital.

4.1.5 Francesco Canova Training Centre

The Francesco Canova training centre was built in 1998 in the Dunga district of the cityof Uige; the centre is located within the Caritas diocesan compound and is equipped witha generator, water, a secretary’s office, a library, and a classroom with seating for 60 plus.All the most common teaching aids are available and in recent years the centre hasbecome a point of reference for the Provincial health directorate and international agen-cies working in the province of Uige.The project obtained a grant from the Trentino Alto Adige regional administration, whichfinanced the project “Support of the Canova Training Centre for continuous training of

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

In 2005 the following courses / seminars were held:

N. DAY SEMINAR No. PARTICIPANTS TRAINERS1º 21-23/02/05 North Region Seminar 45 persons from EU personnel

various NGOs2° 09-11/2/05 TB - HIV 20 HP nurses Doctors with

Africa CUAMM3° 28/2-5/3 05 Labour and delivery 18 institutional Doctors with

chart and obstetric obstetricians Africa CUAMMdystocia from municipalities

4° 13.03.05 New regulations on 9 nurses from Uige Doctors with National Programme and Municipalities Africa CUAMM + for the control of Provincial health Tuberculosis and directorateLeprosy

5° 14.07.05 Update courses 70 midwives from Songo Doctors with Africa CUAMM + Health Department

6° 22.11.05 Programme of vertical 30 healthcare personnel Braziliantransmission of HIV in (doctors-nurses, cooperationthe province of Uige obstetricians, health

technicians)7° 23-30/11/05 Theoretical basis of 14 HPU doctors Brazilian

HIV/Aids infection cooperation8° 5.12.05 Training workshop 10 “sobas” Red Cross +

on HIV/Aids and “regedores” Department of Health

9° 6.12.05 Training workshop 10 police forces and Red Cross + on HIV/Aids armed forces Department of

Health10° 7.12.06 Training workshop 10 women from Red Cross +

on HIV/Aids “PROMAICA” Department of Health11° 8.12.05 Training workshop 10 health delegates Red Cross +

on HIV/Aids Department of Health

12° 9.12.05 Training workshop 10 “IMNE” students Red Cross + on HIV/Aids Department of

Health

During the Marburg epidemic the Francesco Canova centre played a key role in trainingpersonnel on awareness of the virus and on the hospital rules for bio safety and infectioncontrol.During the period the following courses/seminars were held:

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N. DAYS SEMINAR PARTICIPANTS TUTORS1 12/04/2005 Hospital control 70 nurses Dr. Enzo Pisani

regulations for Marburg Dr. Mike Bellinfection

2 13/04/2005 Hospital control 50 cleaning staff Dr. Enzo Pisani regulations for Marburg Dr. Mike Bellinfection

3 14/04/2005 Hospital control 50 hospital workers Dr. Enzo Pisaniregulations for Marburg Dr. Mike Bellinfection

4 18/04/2005 Marburg haemorrhagic 60 persons Permanent fever training corps

5 19/04/2005 Marburg 50 persons Permanent haemorrhagic fever training corps

6 21/04/2005 Marburg 70 persons Dr. Adriano haemorrhagic fever Duse WHO

7 28/04/2005 Marburg 80 “IMNE” students Dr. Enzo Pisani haemorrhagic fever Doctors with

Africa CUAMM8 29/04/2005 Marburg 80 “IMNE” students Dr. Enzo Pisani

haemorrhagic fever Doctors with Africa CUAMM

9 4/05/2005 Marburg 42 catechists Dr. Enzo Pisani haemorrhagic fever Doctors with

Africa CUAMM10 26/05/2005 Marburg 30 healthcare staff Dr. Emanuela

haemorrhagic fever Medici Doctorswith Africa CUAMM

11 07/06/2005 Hospital control 36 personnel from Dr. Enzo Pisani regulations for “Angotrip” of Uige Doctors with Marburg infection Africa CUAMM

12 15/06/2005 Hospital control 40 personnel from Dr. Enzo Pisani regulations for “Angotrip” of Negage Doctors with Marburg infection Africa CUAMM

13 16/06/2005 Biology of Marburg 70 persons WHOVirus

14 18-19-20 National seminar 60 healthcare staff Department of 06-2005 on malaria Health

4.1.6 Supply of bio-protection material for expatriate personnel in the province ofUige

The province of Uige, i.e. the centre of the Marburg haemorrhagic fever epidemic,requested the urgent supply of protective material for all expatriate personnel in theprovince of Uige in order to reduce transmission of the virus.For this purpose the Italian embassy allocated USD 22,000 for an emergency interventionin the province of Uige in order to purchase bio-protection devices.The Molfetta CUAMM Doctors with Africa Group participated with a special collection ofhygiene-healthcare material for the Marburg emergency with the collaboration of thePuglia region and the Civil Defence Corps. The Veneto Region sent bio-protection material supplied by local hospitals.

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Market researchIn view of the situation of the utmost urgency, a brief market survey was carried out inorder to ensure the best quality-price ratio of the articles purchased.In the initial days of the epidemic very little protective material was available on the mar-ket in quantities commensurate with the requirements of the project. As time progressedand the demand increased, additional suppliers started to offer competitive prices (alsoby extending their ranges) for articles such as lab gowns, facemasks, and other dispos-able healthcare protective devices.The market survey was conducted in relation to all the items listed in the contract, whilequantities were adapted in relation to the demand from Uige and the best purchase pricefound on the Luanda market.

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

ConclusionsThe speed with which the Italian cooperation delivered the funds required and Doctorswith Africa CUAMM’s detailed knowledge of the Luanda market enabled the rapid pur-chase and shipment of healthcare material for the protection of expatriate personnel inUige. The bio-protection materials were the first that expatriate personnel received in theprovince of Uige, bridging the period from the start of the epidemic to the time of arrivalof additional aid.Despite this situation it’s worth emphasising that the material purchased offered a mini-mal level of protection that was not sufficient for clinical activities, merely enough to pro-tect operators who were occasionally in contact with potentially infected patients orareas.

4.1.7 Uige Provincial health directorate “post Marburg” support project

This project, presented in May 2005, was financed by Italian cooperation on 30 November2005. The total project budget was USD 139,000 and it envisages the support of the UigeProvincial health directorate in the post Marburg phase.In the initial phase of the Marburg epidemic Italian cooperation, in response to a requestfrom Uige Provincial health directorate, had already purchased and donated, by means ofDoctors with Africa CUAMM, a four-wheel drive truck for logistics involved in the activi-ties of combating the epidemic.The aim is the creation of a network of epidemiological supervision with suitable commu-nication systems, the supply of kits for health posts to ensure distribution in the munici-palities because, due to the epidemic, the Provincial health directorate was unable to pur-chase the kits, and several purchases of material for the Uige permanent training centre.

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

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In 2005 the satellite systems and kits for health posts were purchased. Both purchasesare currently in the stage of authorisation for importation and transport to Luanda.Additional funds for completion of the planned activities should be allocated within thefirst quarter of 2006.

4.2 Province of Kunene

4.2.1 Chiulo

SUPPORT OF THE DIOCESAN HOSPITAL OF THE ROMAN CATHOLIC MISSION OFCHIULO: PROTECTION OF HEALTH AND CONSOLIDATION OF PEACE IN THEPROVINCE OF KUNENE.

LOCATION > Diocesan hospital of ChiuloBENEFICIARY POPULATION > 204,766BUDGET > 743,436 euroDONORS > MAE – CEI

> Private donors and Doctors with Africa CUAMM Groups

> Province of TrentoPARTNERS > ONDJIVA DIOCESE and

PROVINCIAL HEALTH DIRECTORATEEXPATRIATE PERSONNEL > 3 doctors

> 1 logisticianLOCAL PERSONNELAUXILIARY PERSONNEL > 2 driversPROJECT STARTING DATE > OCT 03PROJECT ENDING DATE > JAN O7

IntroductionDuring 2003 MAE financed a hospital support having a duration of three years. This proj-ect envisages the provision of aid in the form of drugs, healthcare equipment, refurbish-ment of structures, and the provision of doctors for clinical management. In 2004-05Doctors with Africa CUAMM performed the following hospital refurbishment works:> The new generator was hooked up to the hospital electrical system, which was refur-

bished by replacing wiring, lighting fixtures, and socket outlets.

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> The laboratory was renovated, with the provision of running water, power supplies, toi-let services, and by ordering new materials to ensure proper execution of analyses.

> A hospital maintenance unit was created with young people from Chiulo who are learningthe basics of plumbing, electrical wiring, structural engineering, mechanical engineering,in such a way as to assure proper maintenance of the hospital also in the future

> A hospital internal workshop was set up in order to carry out the necessary maintenan-ce work.

> The plumbing material was purchased and has already reached Chiulo for the comple-te overhaul of the water distribution system.

> New beds, mattresses, and material for the operating theatre were ordered. > In 2006 the complete overhaul of the plumbing system and water supply system is

planned: a new water collection tank will be constructed and all the pipelines will bereplaced. At this time the hospital will be entirely refurbished with replacement of doorsand windows, painting of the walls, and the construction of bathrooms for each ward.

Financial situationExaminations are performed free of charge in the hospital, but patients pay a smallamount for the purchase of drugs, for analyses, X-rays, and surgery.The income from the sale of drugs is insufficient to cover the management costs. Withoutthe assistance of the provincial government, which pays the salaries of nurses and themajority of auxiliary personnel, the hospital would be unable to remain operative. In 2005 the government finally accepted that the hospital was entitled to government sub-sidies: this news was greeted with much enthusiasm.The grant for 2005 was USD 59,000 p.a. For 2006 an increase is envisaged up to approx-imately USD 70,000. These amounts are clearly an important source of aid for the hospi-tal, but they are unable to cover expenses, which exceeded USD 160,000 this year alone.It is hoped that the government will choose to increase the funding in 2007 to the pointin which the hospital can function without any outside aid.The hospital administrative staff, with extremely limited capabilities to the point where theassistance of Doctors with Africa CUAMM is indispensable in order to maintain trans-parency of accounts, was this year strengthened with a skilled young person who is cur-rently undergoing field training and, after a suitable period of apprenticeship at the provin-cial hospital administration, will assume the role of hospital administrator.

Personnel and nursing schoolSince it is located in the savannah in an isolated position the Chiulo hospital has alwayssuffered from a lack of suitably trained nursing staff. The nurses, because of the isolation and because of the difficulty in proceeding with theirstudies, usually request a transfer after a few years. The main shortfall is the presence ofnew personnel who are willing to live and work in isolated conditions. With the possibility provided by the government of reopening the auxiliary nursing school(auxiliary nurse being a new denomination for general nurse) with a two-year course, theprobability of finding personnel willing to work long-term in the Chiulo hospital is far high-er.Two nurses with superior qualifications have been contacted. The nurses in question col-laborate with the Regional School of Lubango for training of medical technicians: thisteam has agreed to open the school in Chiulo in February 2006. It is hoped that it will bepossible to create a reference training centre, not just of auxiliary nurses but also for med-ical technicians.

Clinical ActivitiesClinical activities have gradually increased over the years, especially because of the dis-tribution by the government of ambulances to peripheral health posts. This leads to morevisits since Chiulo is the reference hospital serving the entire northern area of Kunene. A

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steady increase has been observed in outpatient visits, together with a reduction in thegross mortality rate. The percentage of the occupancy rate was extremely high, due to anincrease in the number of patient admissions.At the end of 2005, during the course of an inspection by the Provincial StatisticsDepartment, the number of hospital beds was increased from 153 to 200. This led to areduction in the occupancy rate.

Year Outpatient Admitted Gross Bed occupationexaminations patients mortality % rate %

2002 10,674 5,142 4.7 862003 14,793 5,906 3.8 962004 16,849 5,868 3.4 1282005 (153 beds) 17,979 7,267 3.2 1512005 (200 beds) 17,979 7,267 3.2 115

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

PaediatricsThis is the ward with the highest number of admissions during the year, with peaks dur-ing April and May corresponding to the rainy season and the time of proliferation of malar-ial mosquitoes.The gross mortality rate in 2005 was 2.9%, which is lower than in previous years (5.9% in2002, 4.7% in 2003 and 3.2% in 2004). The most frequent cause of death among hospi-talised children is malaria with the associated critical anaemia followed by respiratoryinfections and enteritis.In order to combat infant malnutrition which, although rarely present in extreme formssuch as marasmus or Kwashiorkor, is anyway more frequent than initially apparent, thereis a small kitchen in the paediatrics department that makes it possible to provide at leastfour meals a day (milk, rice, high protein babyfoods and high calorie biscuits).

ObstetricsOn the maternity ward the number of deliveries is low considering the potential, althoughthe rate has increased constantly over the years. The rate of caesarean sections was3.8% in 2002, 3% in 2003, 5.1% in 2004, and 5.3% in 2005.The increase in the percentage of caesarean sections corresponds to an increase in the num-ber of births with complications due to arrivals by ambulance from nearby health posts.The maternal mortality rate has fallen to 0.3%.The trend of prenatal examinations is shown below:

2002 (last 8 months) 2003 2004 20051st examination 619 1357 1168 1158Check 386 835 710 639TOTAL 1005 2192 1878 1797

Respiratory medicineDiagnosis is performed by testing sputum for BK, with clinical examinations and medicalhistories, and at times with a chest X-ray.

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Greater attention is paid to the diagnosis of BK positive cases because it is these that prop-agate the disease. The increase in the number of HIV cases makes diagnosis of tuberculosismore difficult because a large number of HIV cases are associated with tuberculosis withnegative BK. Suffers are hospitalised for two months and they continue their treatment athome for 6 months, in accordance with the plans of the Angola Ministry of Health239 new cases of tuberculosis were treated in 2005 with a mortality rate of 2.5%.In 2002 the number of cases were 175 with a mortality rate of 4%, and 163 and 284 in2003 and 2004 respectively, with mortality rates of 2.7% and 5.3%.A survey conducted in November 2005 among hospitalised patients on the respiratorymedicine ward showed a prevalence of HIV positive cases of 16.3%.

Surgical unitFrom January 2002 the presence of a specialist surgeon made it possible to increase thenumber of major operations, making it possible also to perform elective surgery.The majority of operations concern obstetric-gynaecological and urological disorders andalso inguinal hernia. Until now general anaesthetics have been used with intravenous ket-amine, while spinal anaesthesia is less frequently adopted.Minor surgery includes wound sutures, lancing of abscesses, plaster casts for fractures,open reductions of dislocations, removal of small lymphomas or cutaneous cysts per-formed in the main by the operating theatre nursing staff.The number of major operations rose, from 2002 to 2005, as follows: 212, 229, 231, 344.

LaboratoryThe laboratory performs the essential analysis routines for a rural hospital: Hb, bloodgroup, white blood cells and white blood picture, red blood cells sedimentation rate, urineculture, analysis of faeces, urine, sputum, liquor analysis, tests for HIV, HBV and syphilis.The number of transfusions increased from 442 in 2002, to 604 in 2004 and 1049 in 2005.

Laboratorio Jan Feb Mar Abr Mayo Jun Julh Ago Set Out Nov Dez Tot04

Transfusões 29 75 124 237 179 106 68 44 33 68 46 40 1049Escarros 55 39 46 27 63 50 128 69 77 115 64 65 798

(10p) (53p) (0p) (3p) (6p) (3p) (10p) (0p) (6p) (8p) (3p) (2p) (2p)

All blood donors have always been tested for HIV, and, in 2005, also for HBV. New regis-ters have been created for collection of data. The percentage of HIV carriers among blood donors was 3.52%

2005 BLOOD DONORS REGISTERMonth total M F HIV - HIV+ M HIV + F % HIV+ HBV+ Missing

data jan 32 32feb 79 38 37 71 3 1 5.06 4mar 129 48 76 121 2 1 2.33 5apr 248 100 145 232 5 8 5.24 1 3may 185 70 101 162 5 4 4.86 14jun 107 42 62 104 0 0 0.00 3jul 69 37 28 65 0 0 0.00 1 4aug 47 25 22 45 0 2 4.26sep 37 24 13 37 0 0 0.00 3 0oct 80 42 37 74 2 3 6.25 8 1nov 54 33 21 52 1 1 3.70 5 0dec 41 27 14 40 0 1 2.44 2 0total 1108 486 556 1035 18 21 3.52 % 20 34

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In 2005 during prenatal examinations all women were tested for HIV, HBV and syphilis.In 2005 the number of pregnant women who agreed to the HIV test was 983, of whom 43were positive (4.37%).

Nº Testes HIV+ HIV- % HIV+ HBV+ %HBV+ RPR+ %RPR+pregnant indeterm.women983 11 43 929 4.37 % 182 18.5 % 67 6.8 %

RadiologyThe majority of X-rays: approx. 300 in 2003, 600 in 2004 and approx. 490 in 2005, wereperformed to investigate suspected fractures.

Ultrasound scansUltrasound scans performed were as follows: 499 in 2003, 229 in 2004, and 620 in 2005.Most of the examinations were obstetric and gynaecological scans. Renal and hepaticscans are less frequently performed.

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

Public health15,302 children were vaccinated in 2003 against BCG, DPT, polio, measles, yellow feverand tetanus.Vaccinations performed in 2004 numbered 21,843. In November 04 a vaccination cam-paign was carried out in the municipality of Mucope against meningococcal meningitis inwhich 19,658 individuals of all ages were vaccinated.The total number of persons vaccinated in 2005 was 14,997.This year a situation was achieved at last in which only sporadic cases of meningitis wereencountered.

Procurement of medicationAs from 2002 drugs were almost entirely supplied by the Doctors with Africa CUAMMNGO. Only at the end of 2004 emergency drugs were purchased using funds derivingfrom hospital revenues. A total amount of USD 38,000 was spent on pharmaceutical products in 2004.In 2005 the government contributed with a grant of 876,000 Kwanzas (equivalent toapproximately 8,700 euro): In this expense item the real consumption of the hospital, withthe support of Doctors for Africa CUAMM, totalled 4,114,745.00 Kwanzas (approximate-ly 41,000 euro).In 2006 the state subsidy will be increased up to a total of 2,000,000.00 Kwanzas. In 2007it is hoped that the hospital will receive a higher level of funding in order to provide aresponse to the increasingly high numbers of patients.

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HIV EPIDEMIC CONTROL IN THE PROVINCE OF KUNENE

LOCATION > Province of Kunene BENEFICIARY POPULATION > 204,766BUDGET > 74,970DONOR > UNICEFPARTNERS > PROVINCIAL HEALTH DIRECTORATE -

ONDJIVA DIOCESEEXPATRIATE PERSONNEL > 1 doctorLOCAL PERSONNEL > 0AUXILIARY PERSONNEL > 0PROJECT STARTING DATE > JULY 05PROJECT ENDING DATE > APRIL 06 with possible 6-month extension

The project developed and co-financed by UNICEF, PROVINCIAL HEALTH DIREC-TORATE (DPS) of the province of Kunene and Doctors with Africa CUAMM, envisages:> The opening of two counselling and voluntary testing centres for HIV and STDs (sexual-

ly transmitted diseases) in the municipalities of Ombandja and Namakunde (one inChiulo hospital and the other in Namakunde hospital).

> Supply of a camper equipped for voluntary counselling and testing for HIV and STD forthe population resident in the more isolated areas near the border with Namibia.

> Opening of three centres for the prevention of vertical transmission at the infantilematernity centres of the hospitals of Chiulo, Xangongo and Namakunde (the nationalprotocol envisages the intravenous administration of AZT to the mother during delive-ry and of AZT syrup to the newly-born infant in the first six weeks of life).

> Activities of information, education, and communication (IEC) addressed to the sexual-ly active population with the aim of achieving a reduction in the risk of the transmissionof HIV and STDs and access to the voluntary counselling and test centres.

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

Planned activities1. Assignment of a doctor.2. Staff training3. Opening of three voluntary counselling and test centres for HIV and STDs: two fixed

centres (in Namakunde and Chiulo) and one mobile centre; for the fixed centres Unicefwill supply two pre-equipped containers for the planned activities; Doctors with AfricaCUAMM will be required to assure the supply of material for correct operation of thecentres, while the DPS will assume responsibility for supervision.

4. Opening of 3 centres for the prevention of vertical transmission. 5. Promotion of IEC activities.

Activities performed from September to December 20051. assignment of a doctorDr Elena Nonini arrived in Luanda on 14 September 2005 and in Chiulo on 24 September2005; she attended the Ondjiva voluntary counselling and test and antiretroviral treatmentcentre during the first two weeks of October to gain an understanding of the documentsin use and the national treatment protocols

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2. training activitiesTraining activities addressed to Chiulo personnel were articulated as follows:> two courses for personnel of the voluntary counselling and test clinics, executed in

Chiulo in March 2005 in collaboration with the W.H.O., and in September 2005 in col-laboration with the private enterprise Odebrecht, which has many years of experiencein the support of training projects concerning AIDS-related topics; training was provi-ded for a total of 25 nurses, also from other centres (Xangongo, Ondjiva, Kahama,Xangalala)

> a training course for “educator agents” (for IEC activities) carried out in Chiulo inSeptember in collaboration with Odebrecht; training was provided for a total of 23 per-sons of different professions and various origins

> from 19 to 23 September two nurses from the Chiulo hospital, already trained for volun-tary counselling and HIV testing, attended the Ondjiva centre for on-the-job training

> from 3 to 7 October 2005 two obstetricians from the Chiulo hospital, already trained forcounselling and voluntary HIV testing, attended the centre for the prevention of verticaltransmission of HIV at the Ondjiva hospital for on-the-job training

> from 24 to 28 October 2005 two nurses from the hospital of Chiulo, already trained forcounselling and voluntary HIV testing, participated in a course on the home treatmentof AIDS sufferers at the Ongjiva hospital

> training course, at the hospital of Chiulo, from 24 to 28 October 2005, for ten midwivesfrom the municipality of Mukope (Chiulo)

> training courses for all obstetricians from the hospital of Chiulo held (in two modules)in the Chiulo hospital in November 2005

> in December 2005 a laboratory technician from the Chiulo hospital attended a three-week session at the laboratory of the Ondjiva centre to learn how to use the instru-ments for CD4 counts which will be supplied by UNICEF to the Chiulo hospital

Training of personnel of the centres of Xangongo and Namakunde was supervised by theProvincial Health Directorate

3. Opening of three voluntary counselling and HIV test centresIn October and November Doctors with Africa CUAMM personnel laid the foundations forthe containers that UNICEF has pledged to supply, equipped for voluntary counsellingand testing; Doctors with Africa CUAMM personnel have already prepared all the neces-sary roofing material for the containers. The activity of voluntary counselling and testing with material supplied by Doctors WithAfrica CUAMM and through donations pending the arrival of the material pledged byUNICEF started in mid August at the Chiulo hospital.

4. Opening of 3 centres for the prevention of vertical transmission. These centres have not yet been opened because of the absence of material (deliverykits), which is to be supplied by UNICEF.

5. Promotion of IEC activities.With regard to the Chiulo area:since August 2005 information-education meetings have been held at the hospital with allwomen undergoing prenatal examinations.further meetings were arranged for the general population (markets, youth groups,churches, etc.).With regard to the other areas of the municipality of Ombanja and Namakunde the organ-isers were selected and a meeting was held for the organisation and planning of the workthat they will be required to perform in their respective areas. Also the implementation ofthese activities is impaired by the lack of information and educational material, which hasyet to be supplied by UNICEF, and by the lack of condoms (which should be supplied byDoctors with Africa CUAMM).

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ConsiderationsThe implementation of the activities envisaged has been greatly delayed because of fail-ure of UNICEF to supply the entirety of the material it has pledged, therefore an extensionof at least six months must be provided.In the first 6 months of 2005 a project between Doctors with Africa CUAMM and theW.H.O. was signed, which enabled the following activities:> Renovation of the laboratory> Execution of a course for counselling and for laboratory technicians, utilising speciali-

sed personnel from Luanda as tutors. > Testing of all blood donors for HIV and HBV> Testing of all pregnant women for HIV, HBV and syphilis

In July 2005 a project was signed between Doctors with Africa CUAMM and UNICEF incollaboration with the Provincial Health Directorate, for:> Opening of 2 fixed CATVs (counselling centres) in the Chiulo and Namakunde hospi-

tals.> Utilisation of a camper equipped as a mobile CATV for areas on the border with

Namibia.> Opening of 3 centres for antiretroviral treatment for the interruption of mother-child

transmission: one in Xangongo, one in Namakunde and one in Chiulo.> training of organisers and personnel for counselling.> Coordination of IEC (Information, education, and communication) activities in the worst

affected municipalities.The various activities have not yet commenced because the arrival of the materialrequired for the CATVs and for execution of the tests has been delayed: the current fore-cast arrival date is January 2006.For this reason a 6-month project extension is currently being prepared to offset the timelost due to the late arrival of materials.

In this period the hospital has anyway started to deliver voluntary counselling using itsown resources:

2005 VOLUNTARY COUNSELLINGHIV (+) MALE 71HIV (+) FEMALE 83HIV undetermined tests 7HIV (-) 313TOTAL 474

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

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

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4.3 Province of Luanda

TUBERCULOSIS CONTROL PROGRAM IN THE PROVINCES OF LUANDA AND UIGE

LOCATION > Provinces of Luanda e UigeBENEFICIARIES > 4,450,000BUDGET > 1,299,272 euroDONORS > MAE

> Private donors and Doctors with Africa CUAMM Groups

> Province of Treviso and Public Health Units (ASL) 7, 8, 9

PARTNERS > National tuberculosis and leprosy programme and Provincial Health Directorates of Luanda and Uige

EXPATRIATE PERSONNEL > 1 doctor (Luanda), consultant at PNTL> 1 doctor (Uige), consultant at Provincial

Health Directorate> 1 doctor (Uige), clinical activity at Uige hospital> 1 laboratory technician> 1 logistician - administrator

LOCAL PERSONNEL > 0AUXILIARY PERSONNEL > 2 logisticians

> 2 driversPROJECT STARTING DATE > DEC. 03PROJECT ENDING DATE > APR. 07

IntroductionThe Tuberculosis control programme in the provinces of Luanda and Uige started inDecember 2003 in response to the pressing need to reorganise and implement the DOTstrategy in the provinces.The project funded by MAE will terminate in April 2007. In support of the project the AfricaChiama Amici Group of Doctors with Africa assumed the role of promoter of the “HARAM-BEE” decentralised cooperation project. The three-year project, which will terminate inDecember 2006, envisages the participation of the Province of Treviso with the three localhealth units with their relative administrative Conferences of Mayors, for a total of 95Italian municipalities.

Activities performedTechnical consultancyThe technical consultancy support of the Provincial Directorate of the Tuberculoses ControlProgramme (PPCT) proceeded. The doctor participated in the planning, execution, andassessment phase of all the activities performed in the field of tuberculosis in the province.Special attention was devoted to the management of drugs.Participation in drafting of the GF project for the TB component.

TrainingThe following were executed in the framework of the project:> Quarterly meetings with the mangers of the treatment rooms and respiratory medicine

laboratories. > A meeting with municipal public health managers concerning the problems of tubercu-

losis in the province.> An update seminar for nurses who have recently joined the diagnostic and treatment units > Training in IT for program personnel

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

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

Collaboration was provided to guarantee sufficient and prompt supplies to peripheralcentres and no stock breakages were reported

Peripheral expansion of the DOT service.The service was launched in two new diagnosis and treatment centres, one of which afterthe refurbishment equipping of the relative treatment rooms.The activity of inspection of health centres currently lacking a respiratory medicine serv-ice continued with the aim of assessing the possible activation of the service.

Microbaterial cultureReagents were purchased for mycoculture and antibiotic assays performed at the nation-al Institute of Public Health.

Activities in the province of UigeThe Hemorrhagic Fever epidemic prevented the regular execution of the activitiesplanned in the province. In the second and third quarters technical consultancy supportoriginally provided by the two assigned doctors and laboratory technician was discontin-ued. The closure of the laboratories for reasons of biosecurity effectively curtailed thework of laboratory reorganisation. Patient care was still provided, basing diagnosis onclinical evidence and radiological examinations. The safety standards applied includedthe destruction of furniture and other material, thus effectively eliminating the benefits ofprevious purchases and refurbishment work. The paediatric respiratory medicine depart-ment, which is included among the areas allocated for isolation, called for additionalmaintenance work before resuming its original functionality.

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

Clinical ActivitiesClinical assistance in the adult and paediatric respiratory medicine service of the Uigehospital was guaranteed in the first and fourth quarters.

TrainingThe following activities were performed in the context of training activities in Uige:> A seminar on the diagnosis and clinical treatment of TB and TB/HIV patients, addres-

sed to clinical personnel ward supervisors of the provincial hospital of Uige.> A seminar on clinical statistics for officers of the health units.> IT training for program personnel.> Supervision for all DOTS centres in the province.> Quarterly supervision for municipal centres and the Uige hospital. > Supervision of laboratories was performed exclusively in the first and fourth quarters.> Visits to the municipalities of Quitexe, Ambula and Bembe to assess the possibility of

opening new diagnosis and treatment units.

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

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

RefurbishmentsFurniture purchased for the Provincial endemic diseases laboratory and the supervisionoffice. Refurbishment of the respiratory medicine clinic of Negage, and the paediatric res-piratory medicine clinic and the bacilloscopy laboratory of the Uige hospital

IMPLEMENTATION PROJECT OF DOTS STRATEGY IN 11 PROVINCES OF ANGOLA:SUPPORT TO THE NATIONAL TUBERCULOSIS PROGRAMME

LOCATION > Luanda and 11 provinces of AngolaBENEFICIARIES > 14,456,167BUDGET > USD 4,086,956DONORS > Global Fund via UNDP AngolaPARTNERSEXPATRIATE PERSONNEL > 1 doctor as project leader

> 1 doctor> 1 logistician> 1 administrator

LOCAL PERSONNEL > 4 consultants at PNTLAUXILIARY PERSONNEL > 12 logisticians

> 1 administrator> 1 driver> 1 secretary

PROJECT STARTING DATE > JULY 05PROJECT ENDING DATE JUNE 07

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IntroductionThe “Support to the National Tuberculosis Control Programme” is a biennial projectfinanced by the ATM Global Fund through UNDP. The project was officially opened on 01.01.2005 and will end on 30.07.2007. The general objective of the project is to implement the DOT strategy in 11 provinces ofthe country with technical assistance to the Management of the PNCTL, and it involvesthe realisation of numerous activities in the following main areas of intervention:Recruitment and training of personnel for the PNCT Management and for the Provinces.Training for healthcare staff (laboratory technicians and nurses).Refurbishment of infrastructure.IEC activities.

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

Organisation of the project team The majority of the local personnel required by the project were selected and recruited:At the level of the National Management of the Tuberculosis Control Programme:> 1 head of epidemiological activities and data management;> 1 head of logistical activities;> 1 head of IEC activities;> 2 secretaries.In the provinces:> 4 logisticians were recruited and started work in the same number of provinces;> 7 logisticians were selected and will start work before the end of January 2006 for the

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

Training activitiesTraining courses were organised for the following:> Tuberculosis control program Provincial Supervisors (11).> Laboratory Technicians - Provincial Supervisors (11).> Municipal Laboratory Technicians (13).> Tuberculosis control programme Municipal managers (14).> General Nurses (25).Specific didactic material was produced for each course.

Refurbishment of infrastructure.> Inspections were carried out in all 11 provinces included in the project and intervention

plans were drawn up with the local authorities.> For the Provinces of Luanda and Bengo the first 8 interventions to be carried out in the

first half of 2006 were set up and agreed.

Supervision> A supervisory visit was carried out in each of the 11 provinces.> Activity data were gathered and the database of services available and active in tuber-

culosis diagnosis and treatment was updated. > A calendar was prepared for supervisory visits to be performed during 2006.

Information system> Activity data of the national Tuberculosis Control Programme were gathered and seve-

ral data processing routines and analyses were performed in relation to 2004 and thefirst nine months of 2005. The material produced (tables and graphics) was utilised inpreparing didactic material for training courses.

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

rimental basis.

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

Purchase of equipment and logistical activities> All the forms required for the activities of the tuberculosis treatment and diagnosis were

produced for an estimated period of 12 months.> An initial shipment of drugs and other consumables was made by air freight in one of

the provinces included in the project. The procedure will be utilised on a regular basisstarting from the first quarter of 2006 in all the provinces in the project.

Partnership with local and international NGOs> Contacts were entered into with the various international NGOs that operate in the

field of tuberculosis to promote a greater level of coordination with the NationalManagement of the Tuberculosis Control Programme, in line with the objectives ofthe Project.


ITALIAN COOPERATION EMERGENCY PROGRAMME

Thanks to an emergency programme of Italian cooperation various material was distrib-uted to the Tuberculosis Control Programme units. The Italian cooperation donated thismaterial in respect of the MAE tuberculosis control programme in the provinces of Luandaand Uige and Doctors with Africa CUAMM provided assistance by identifying the centreswith the greatest needs.The material distributed was as follows: 10 desks with chairs, 7 microscopes with stools,20 cabinets, 15 tables, 50 chairs, 15 examination beds.

SUPPORT OF THE TUBERCULOSIS CONTROL PROGRAMME IN THE PROVINCESOF LUANDA AND UIGESupport of the tuberculosis control programme in Luanda and Uige provinces

The project, which was funded by USAID for a total amount of USD 98,148, involves thesupport of Tuberculoses Control Programme units in the provinces of Luanda and Uigefor 2005. Because of the Marburg fever epidemic it was not possible to execute the activ-ities within the time limits, making it necessary to seek an extension, which was subse-quently granted until 30 June 2006.The project involves a training portion and the purchase of various material for furnishingof the Tuberculosis Control Programme units.Plans exist for the purchase of furniture for 7 treatment rooms and 12 laboratories andalso 12 microscopes, while training initiatives envisage:> An international training course for the provincial coordinator.> 10 seminars for nurses of the health centre consultancy services.> A meeting with doctors from the Uige provincial hospital.> A meeting with Luanda health centre clinical managers.> Incentives for the supervision of treatment centres and laboratories.

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

vinces.> Purchase of a part of the furniture.

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5 PROJECTS COORDINATION

Changes occurring in recent years led to the indispensable presence of a representativeof Doctors with Africa CUAMM in the Luanda capital. This representation allowed Doctorswith Africa CUAMM to participate actively in the dynamics of the MINSA and other bod-ies, including the Global Fund, the European Union, and other donors.Also the following activities were carried out:> Logistical support of the provinces.> Local and international purchases.> Customs clearance.> Human resources management.> Guesthouse.> Projects administrative management.

5.1 Logistical support of the provinces.

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

5.2 Human resources management

In 2005 around 30 expatriates were processed through all the embassy registration pro-cedures, visas, and flights, in addition also visits by family members and friends of theserving volunteers were organised.

5.3 Guesthouse

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

REGISTER OF GUESTHOUSE VISITORS IN 2005

ospiti = guestsnotti = nights

5.4 Administrative management

Project administrative-accounting management was another challenge in 2005: the largenumber of funding parties (graph 4) and the administrative variables of each funding bodyresulted in extreme complexity of project administration and accounting.The volume of funds managed in 2005 (by Padova and by the Luanda coordination team)exceeded 3.5 million euro (graph 5).

GRAPH 4

GRAPH 5Funding 1997 - 2007

* Projection based on current funding at 31 January 2005

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6 RESEARCH ACTIVITIES

No research activities were carried out in 2005 although the groundwork was carried outfor the implementation of 1 focus group and 5 KAP studies in the provinces of Luanda,Uige, Huambo, Moxico and Benguela.The planned KAP studies should start in the first quarter of 2006 and they envisage theuse of a team of Angolan interviewers who would be required to produce 7500 forms (totalinterviews).This study also has a dual purpose because the KAP study should provide the basis fora nationwide IEC campaign.

7 HUMAN RESOURCES

In Angola the interventions of Doctors with Africa have been implemented by a large num-ber of expatriates for the following reasons:Lack of qualified Angolan personnel.The small number of qualified Angolan personnel available tend to be concentrated in thecapital city of Luanda.Emergency and post-emergency situation in progress.Projects (such as ECHO, UNHCR) often characterised by rapid implementation and shortduration.

During 2005 human resources were negatively affected by numerous external events dueto the Marburg fever epidemic which claimed the life of one of our most dearly loved andvalued volunteers, Dr Maria Bonino.Many other staff members were repatriated and placed in quarantine at the SpallanzaniInstitute in Rome.This situation, combined with the conclusion of the Mother and Child Health project andthe start of the Global Fund TB project, characterised the presence of expatriate person-nel in Angola in two separate phases which, for practical reporting reasons were desig-nated MCH project (graph 1) and post-MCH project (graph 2)In practice, at the beginning of 2006 a project funded for 3 years by CEI with co-financ-ing from the EU at least for the first 12 months is scheduled to start, involving the arrivalof a further 2 healthcare workers and one logistician (graph 3).Further outlooks for the future point to the increased use of African professionals, with thefirst due to start work on 15 January 2006 with the role of general physician in the munic-ipal hospital of Maquela do Zombo in the framework of the EU funded project.

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GRAPH 1 - MCH PROJECT EXPATRIATE PERSONNEL BY LOCATIONEXP. HEALTHCAREEXP. SUPPORTLOC. HEALTHCARELOC. SUPPORT

GRAPH 2 - POST MCH PROJECT EXPATRIATE PERSONNEL BY LOCATIONEXP. HEALTHCAREEXP. SUPPORTLOC. HEALTHCARELOC. SUPPORT

GRAPH 3 - EXPATRIATE PERSONNEL BY LOCATION - 2006 PROJECTIONEXP. HEALTHCAREEXP. SUPPORTLOC. HEALTHCARELOC. SUPPORT

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ETHIOPIA

Non Governmental Organisations (NGOs) in Ethiopia must be registered at the competentoffice of the Ministry of Justice and are required to sign a General Agreement with theDisaster Prevention and Preparedness Commission (DPPC).The Ministry of Justice is the judicial body of reference for all international and national NGOs.Once the foregoing agreements have been signed an NGO can undertake cooperation initia-tives on all levels, also signing specific projects with the competent Ministries or Bureaus.NGOs in Ethiopia operate with specific agreements and with projects arranged before-hand in which the relative organisations are normally required to guarantee the contribu-tion of their own financial resources, i.e. without having to recourse to funds of bilateralcooperation between Ethiopia and donor countries.Doctors with Africa CUAMM has been working in the country since 1987, initially underthe auspices of the Ethiopian Catholic Church and, since 1994, with a full registration asan international NGO engaged primarily in the healthcare sector.The organisation is active in three regions of the country (Oromia, Tigray and the SouthRegion) and it collaborates mainly with diocesan counterparties and local NGOs. The ref-erence body and government counterparty is the Regional Health Bureau.Doctors with Africa CUAMM, together with the Ethiopian Roman Catholic Church, havesigned a letter of collaboration with the regional health authorities for the hospital andnursing school of Wolisso. This fact is of considerable political value because it is the firsttime that a partnership agreement has been forged in Ethiopia between a private non-profit organisation (NGO) and the state public service. The Oromia authorities have guaranteed a contribution, over the past five years, to coverthe cost of part of the healthcare personnel employed in the hospital, facilitations for thepurchase of medicines and several study grants for students from the Nursing Schoolsent by the Regional Authorities. Also the maternity facility of Dubbo was upgraded fromMaternal-Infant Clinic to Small General Hospital, obtaining in the process a measure ofsupport in the form of clinical personnel. These recognitions, which on the one hand con-firm the decentralisation policy adopted by the Ethiopian government, on the other handalso point to the high consideration of the Authorities of the usefulness and quality ofservices that are offered to the population. Exploiting the above situation Doctors withAfrica CUAMM chose to consider the Wolisso hospital and nursing school as a valid “plat-form”. In view of the large-scale investment and the excellent results obtained recently,the objective is that of further qualifying the structure both in terms of equality of oppor-tunities and accessibility and in terms of quality and specialist training and, above all, toperform a consolidated public health intervention in the territory.Also the line of dialogue must be pursued with the government and the other organisa-tions of the Ethiopian Catholic Church in order to arrive at collaboration agreementsbetween the public sector and the private non-profit sector.

1 COUNTRY PROFILE

Ethiopian tradition and culture date back more than 3000 years. With a population of approx-imately 77 million, the country is home to a vast assortment of ethnic groups (more than 80),each with specific languages, culture, and traditions, even though there are also high levelsof intermixing, affinity, and assimilation. The two main religions are Christianity and Islam.The average population density is 70.4 inhabitants per square km. The annual populationincrease stands at 2.7% and life expectancy is 48 years. More recent data point to areduction of life expectancy to 40 years because of the AIDS pandemic.

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Ethiopia has immense natural and human resources. The territory extends from mountainranges with peaks at more than 4000 metres to low-lying areas as much as 300 metres belowsea level. This explains the enormous variety of flora and fauna with a large number of indige-nous and exclusive species. Despite its long history of civilisation in the country, most of thepopulation currently live in conditions of extreme poverty and in the past two decades thecountry has been repeatedly afflicted by serious famines. The main causes for the faminesare recurrent droughts and the wars that have devastated the country. Other major negativefactors include the lack of effective administration, the rapid population growth, overgrazingand deforestation, and extremely primitive farming methods. The seriousness of the econom-ic situation is clearly evident from a cursory examination of statistical data, but it is also evi-dent to all who visit the country, particularly in various heavily disadvantaged rural areas andin suburban ghettoes. After several years of peace and the improvement in living conditionsassociated with the process of democratisation that started in 1994, the latest two-year warwith Eritrea has reversed a large proportion of the results previously achieved. It is hard toevaluate the human and material cost of this latest conflict. The repercussions on the organ-isational level are still evident in the dysfunctions of services, which have worsened, particu-larly in the education and healthcare sectors. External aid, which had been all but complete-ly frozen, has started to return with agreed and large-scale intervention programmes.Elections were held in May 2005, attracting a turnout of more than 26% of the electorate. Theresult of the elections, leaving aside the lack of transparency of the voting process, vindicat-ed the coalition currently in power, with a majority secured by the Federal Parliament. Thisresult was followed by numerous disturbances with the arrest of various opposition leaders.Following these incidents a portion of external aid packages was once more suspended.

2 SOCIAL-HEALTHCARE CONTEXT AND DEVELOPMENTS OF HEALTHCARE POLICIES

In 1993 the National health system was subjected to structural and organisational changeson various levels. The healthcare policy was configured in relation to the following guidelines:> democratisation and decentralisation of healthcare services;> empowerment of district resources;> increased mobilisation and involvement on the community level.

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

2.1 Indicators

Population density 70.4 persons/ km2 Population <1 year 3.4%Population <3 years 6.8%Population <5 years 16.8%Population <15 years 44%Population between 15 and 49 years 51.9%Maternal mortality 870/100,00 live birthsInfant mortality 96.8/1000Mortality under 5 years 140.1/ 1000Healthcare services coverage 48%Prevalence of HIV in 15-49 year olds 3.8%

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3 PROJECTS AND ACTIVITIES IN 2005

During 2005 Doctors with Africa CUAMM in Ethiopia supported various activitiesthanks also to the commitment and financing of various institutional and privatedonors.

Project title Agency and/or donor Geographical RegionTechnical and financial Fondazione Cassa di Oromia Regionsupport of San Luca Risparmio di Padova e hospital and nursing Rovigo Fondazione Cassa school in Wolisso di Risparmio di Verona,

Vicenza, Belluno e AnconaDgcs – M.aa.ee. exclusively for reasons of compliance

Technical support of Doctors with Africa Southern Nations St Mary rural hospital CUAMM Private donors Nationalities and Peoples of Dubbo Region Support of physical Dgcs - M.aa.ee Tigray Region

Doctors with Africa rehabilitation services CUAMM Private donors

3.1 Oromia Region, South West Showa

3.1.1 Wolisso Hospital and Nursing School

HOSPITAL AND NURSING SCHOOL

Building of the San Luca hospital with nursing school of Wolisso was terminated in 2000, sub-sequently opening the hospital service in January 2001. The building is owned by theEthiopian Catholic Church. Together with Doctors for Africa CUAMM, in 2003 the Church

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

Location Wolisso Woreda, South West Zone, Oromia Region

Beneficiary population 1,057,000Total budget approx. 720,000/yearDoctors with Africa CUAMM budget 100,000 Euro/year + 3 expatriate doctors Donors CARIPARO foundation

CARIVERONA foundationDGCS – M.A.A.EE.Private donors and Doctors with Africa CUAMM Groups

Government counterparty Oromia Regional Health BureauCounterparty Ethiopia Catholic ChurchExpatriate personnel 3Local Personnel 1 public health expertAuxiliary Personnel 0Project duration 5 years (2003 -2008)

General objectivesProtection of the health of the population, ensuring accessible services and guaranteeinga quality level of healthcare for all and mainly for the most needy and vulnerable membersof the community: women and children.

Specific goalTo regulate the operation of the hospital and the school in conditions of economic stabil-ity and offering adequate quality standards.

Target results1. Guarantee high quality standards in the services provided;2. Increased utilisation of the hospital, with bed occupancy rates of more than 70%;3. Availability of specialist ophthalmological and orthopaedic services;4. Availability in the hospital and extension to the surrounding territory of mother and

child health services (MHC) and community medicine;5. Training of competent and motivated nursing staff;6. Acquisition of organisational and financial stability of the institution;

Activities in 2005High quality standards guaranteed in the services provided> OPD examinations: 57,159 > Major operations : 1,841 > Minor operations : 1,567 > Normal deliveries: 956 > Deliveries with complications: 653

Bed occupation rate over 100%

Specialist ophthalmological and orthopaedic service provided> Major orthopaedic operations : 215 > Minor orthopaedic operations : 107 > Major ophthalmological operations 353 > Minor ophthalmological operations 372

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MCH and community medicine services guaranteed in the hospital and surroundingarea:> Prenatal clinic : 7,710 examinations > Vaccination activities: 9,809 children vaccinated

Training of competent and motivated nursing personnel> 20 qualified nurses : 128

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

Number of beds 138Total Number of Doctors 9Number of Expatriate Doctors 4Number of Medical Officers 2Number of Nursing Staff 115Number of Support Staff 120Total Number of Staff 246Number of Healthcare Staff per 100 beds 1.26Total Number of Admissions 7985Number of Paediatric Admissions 2427Paediatric Admissions % 30.4 %Number of hospitalisation days 50809Number of Deliveries 1554Number of Caesarean sections 428Caesarean sections on total deliveries % 27.5 %Number of Major surgical operations 1701Outpatient examinations 57268ANC 7710Vaccinations 11918SUO (op) 184,592Total Income (€) 594,850 Income from User Fees (€) 264,376 Income from Donors (€) 136,051 Income from Government (€) 83,657

Other income (€) 110,766 Total Expenses (€) 678,901 SUO (op) / Staff member 750 Total Expenses /SUO (op) (€) 3.6 Income from User Fees/SUO (op) (€) 1.4

Specifically, in 2005 Doctors with Africa CUAMM provided:

> Qualified healthcare personnel with experience not available in Ethiopia.> An orthopaedic service by means of periodic visits of expatriate orthopaedic surge-

ons.> Partial coverage of day-to-day hospital running costs.

With the coordination of the Ortho-Cuamm group, Doctors with Africa CUAMM collabo-rates with the Faculty of Medicine of the Addis Ababa and Padova Universities in the sec-tor of Orthopaedic Surgery, thus guaranteeing technical support for students from bothuniversities.

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

PUBLIC HEALTHCARE ACTIVITIES IN THE TERRITORY

The Public Health Department performs preventive activities in the territory including nine“kebeles” (urban dwellers’ associations). In addition, nine manually operated wells werebored and seven springs were protected in several villages in the district. In order to facil-itate the strengthening of basic peripheral services in the territory Doctors with AfricaCUAMM submitted to the Ministry for Foreign Affairs a public healthcare project approvedby the DGCS Directorate in October 2005, which envisages a series of interventionsbased on Primary Healthcare criteria in the Wolisso district. The main beneficiaries of the project will be the inhabitants of the Wolisso Woreda(approx. 220,000), in particular those of the three selected kebeles, and specifically chil-dren up to the age of five (4,067, or 18.11 %) and women of childbearing age (5,335 or23.76 %).The construction of three new Health Posts is envisaged together with the provision offurniture and equipment and the regular supply of drugs in accordance with local stan-dards. These are local government structures that will take over control of the facilities atthe end of the initiative.In each of the three sites a well will be bored to assure a safe supply of water to the HealthPost and to the population in the surrounding area. In addition “VIP latrines” will be builtin the villages as a model to persuade local families to follow suit.The training of 20 healthcare workers will increase the number of users assisted by suit-ably skilled personnel. Six of these will be assigned to the three new dispensaries whilethe remainder will be placed at the disposal of local health services.The refurbishment of the Wolisso Health Centre is designed to promote its full operationand the establishment of an appropriate relationship with our Hospital.The project will be implemented in close collaboration with local counterparties at variouslevels (Woreda, zone, and regional state). The project counterparty is the Oromia HealthBureau, which is responsible for health management of the Region, the Oromia DisasterPrevention and Preparedness Commission and the Ethiopian Catholic Church, proprietorand party responsible for management of the Hospital and the Nursing School.

3.1 SNNP Region, Guraghe

3.2.1 Burat Dispensary/Maternity clinic in the Geto area

In August 2003 the management and responsibility of the Burat clinic project were leftentirely to the Catholic Church, which as the proprietor of the Doctors with AfricaCUAMM structure and thanks to its representation on the Board of Directors with onemember, annually guarantees financial support to cover the running costs of the Clinic.In 2005 Doctors with Africa CUAMM Ethiopia covered costs for a total amount of USD30,000.The clinic guarantees an outpatients service and prevention service in the territory includ-ing the eight districts assigned by the health authorities of the zone. The agreement with the Catholic Church, which expired at the end of 2005, wasrenewed for a further three-year period, guaranteeing, through Doctors with AfricaCUAMM, support of the three-year running costs through the contribution of 20,000euro per annum.

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Location Burat, Gumer Woreda, Guraghe Zone SNNP Region

Beneficiary population 109,740Budget 36,000 euro/yearDoctors with Africa CUAMM budget USD 30,000 in 2005 and

60,000.00 euros (2006-2008)Donors Private donors and Doctors with

Africa CUAMM GroupsGovernment counterparty Zonal Health DeskCounterparty Emdibir eparchyExpatriate personnel 0Local personnel 0Auxiliary Personnel 0Project duration 6 years (2003 -2008)

General objectivesProtection of the health of the population, ensuring accessible services and guaranteeinga quality level of healthcare for all and mainly for the most needy and vulnerable membersof the community: women and children.

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

Target results1. Guarantee of high quality standards in the services provided;2. Availability in the clinic and extension to the surrounding territory of mother and child

health services (MHC) and community medicine;

Activities in 2005High quality standards provided in services distributed in 2005> New OPD examinations: 5,315 > Children examinations: 1,466 > Normal deliveries: 78 > Deliveries referred: 36

MCH services and community medicine provided in the hospital and in the sur-roundings > Prenatal clinic : 8,567 examinations> Vaccination activities: 2,555 vaccinations> Health Education 24,428 persons contacted

3.3 SNNP Region, Wolaita

3.3.1 St. Mary of Dubbo Rural Hospital

The St. Mary of Dubbo rural hospital is a non-profit institution managed by the EthiopianCatholic Church in collaboration with Doctors with Africa CUAMM and the government ofthe Southern Nations Nationalities and Peoples Region. The hospital was opened in July2002. The primary aim is to deliver therapeutic and preventive healthcare services to the

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local population with special regard to the accessibility to services by the most needy anddisadvantaged members of the community.The hospital is located in the Bolosso Sore Woreda Wolaita Zone in the Southern NationsNationalities and Peoples region. It is approximately 30 km from the city of Wolaita Soddo,on the road to the west leading to the city of Hosanna. Since the start of the Hospitalactivities Doctors with Africa CUAMM has been providing specialist doctors to ensure theprovision of a multidisciplinary and comprehensive service. The hospital, which has 62 beds, provides outpatient services, hospitalisation and treat-ment. With the opening of the paediatric ward in June 2003 the hospital can guarantee acomprehensive service for local mothers and children. The hospital is also responsible for9 sites in the territory where vaccination sessions are held once a month.

Location Dubbo, Boloso Sore Woreda, WolytaZone SNNP Region

Beneficiary population 494,000Doctors with Africa CUAMM budget Cost of 1 Medical Director and 1

Matron (expatriated)Donors Private donors and Doctors with

Africa CUAMM GroupsGovernment counterparty SNNP Regional Health Bureau Counterparty Soddo Hosanna Vicarship officeExpatriate personnel 2Local personnel 0Auxiliary Personnel 0Project duration 5 years (2003 -2007)

General objectivesProtection of the health of the population, ensuring accessible services to guarantee qual-ity healthcare for all and mainly for the most needy and vulnerable members of the com-munity: women and children.

Specific goalRegular operation of the hospital in conditions of economic stability and offering adequatequality standards.

Target results1. Guarantee of high quality standards in the services provided;2. Increased utilisation of the hospital, with bed occupancy rates of more than 70%;3. Availability in the hospital and extension to the surrounding territory of mother and

child health services (MHC) and community medicine;4. Acquisition of organisational and financial stability of the institution;

Activities in 2005High quality standard provided in services in 2005> OPD examinations: 27,600 > Major operations : 730 > Minor operations : 797 > Normal deliveries: 323 > Deliveries with complications: 227

Bed occupation rate over 100%

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MCH services and community medicine provided in the hospital and in the sur-roundings> Prenatal clinic : 3,745 examinations > Vaccination activities: 28,749 children vaccinated

Presence of a government body that meets periodically and ensures the continuous pres-ence of a Medical Director and a Matron in the hospital Management team, able to con-tribute to the arrival at adequate levels of efficiency and quality of the service and alsopreparing a three-year programme of hospital activities complete with relative financialplan.

Number of beds 62Total Number of Doctors 5Number of Expatriate Doctors 1Number of Medical Officers 0Number of Nursing Staff 73Number of Support Staff 45Total Number of Staff 123No. of Healthcare Staff per 100 beds 126Total Number of Admissions 5,959Number of Paediatric Admissions 2,602Paediatric Admissions % 44Number of hospitalisation days Number of deliveries 550Number of Caesarean sections 181Caesarean sections on total deliveries % 33Number of Major surgical operations 730Outpatient examinations 27,600ANC 3,745Vaccinations 28,749SUO (op) 127,357Total Income (€) 412,182 Income from User Fees (€) 194,426 Income from Donors (€) 19,845 Income from Government (€) 2,825 Other income (€) 195,086

Total Expenses (€) 258,799 SUO (op)/ Staff member 1.633 Total Expenses /SUO (op) (€) 2.03 Income from User Fees/SUO (op) (€) 1.53

For 2006 Doctors with Africa CUAMM intends to continue supporting the hospital withqualified medical and paramedical personnel in order to strengthen management, pre-ventive, diagnostic, and treatment capabilities of the hospital and throughout the terri-tory.In addition, in order to facilitate the strengthening of basic peripheral services in the terri-tory Doctors with Africa CUAMM intends to submit to the Ministry for Foreign Affairs apublic healthcare project aimed at boosting basic peripheral services and strengtheningthe hospital’s public health department. Specifically, plans exist to build and equip three peripheral health centres and refurbishtwo existing centres in order to guarantee preventive medicine services with prenatalexaminations, vaccination of children, and health education activities.The project envisages the boring of manually operated wells and the strengthening of thedistrict health office.

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3.4 Tigray Region, Mekele

3.4.1 Support of the Mekele Physical rehabilitation Centre

The project aims to strengthen and improve the assistance activities of the MekelePhysical rehabilitation centre to assist the disabled population, with special attentionfocused on the civil population of disabled persons, in the Tigray Region.The present project originates from a repeated request of the regional authorities to Doctorswith Africa CUAMM for the continuation of additional support collaboration for facilities andactivities executed using the funds of a Special MAEE Programme. This intervention wasimplemented in the period from 1993 to 1998, taking account of both the feasibility study andthe development of the project, with handover of the structure and equipment to the coun-terpart represented by a Board composed of the regional health Authorities, Social Affairs,Ethiopian Red Cross, and the Tigray Disabled Veterans Association (TDVA).At the closure of the project the regional authorities of the sector and the regional Bureauof Labour and of Social Affairs (MOLSA) assigned the physiotherapy centre to the man-agement of TDVA.The Technical Unit of Italian Cooperation in Addis Ababa, further to a mission of valuationof the terminated project, informed Doctors with Africa CUAMM of the request of TDVAfor additional support of their activities and hence invited the organisation to considergenerating a study for a proposal of the promoted project.For this purpose Doctors with Africa CUAMM executed two feasibility missions in October1999 and in May-June 2000 and presented a proposal to the DGCS in March 2001. The facility is currently managed by the TDVA jointly with the mechanical-orthopaedicworkshop set up by the International Committee of the Red Cross (ICRC) in the early1990s and it is still supported by this organisation today. Currently the two centres offerintegrated assistance for disabled members of the population of Tigray.The project presented to the DGCS was approved by the Directorate meeting of July 2003and the project leader started work in Mekele in July 2004.In the past three years the context surrounding the project has altered partially and there-fore contacts have been entered into with the counterparty, the Tigray Disabled VeteransAssociation (TDVA), in such a way as to update the activities in relation to the plannedobjectives.In October 2004 a 4-month extension was requested of the first yearly period, requestingan update of the project because it was drafted in 2001 but, following the procedures ofapproval and registration of the accounting commitment by M.AA.EE., it was possible tocommence the works only in March 2004. In November 2004 we received approval for the modification from the DGCS and inDecember 2004 an agreement for implementation of the project was signed with the localcounterparty and the regional Authorities of the sector.

Location Mekele Woreda, Eastern Zone, Tigray RegionBeneficiary population 30,490 disabled personsTotal budget 913,893 euroDonors Dgcs – M.aa.ee

Private donors and Doctors with Africa CUAMM GroupsCaritas Antoniana

Government counterparty Tigray Regional Health BureauCounterparty Tigray Disabled Veterans Association (TDVA)Expatriate personnel 2Local personnel 0Auxiliary Personnel 4Project duration 3 years (2004 -2007)

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General objective> To improve the living conditions and healthcare assistance for the disabled population

– Eastern Zone – Region 1 – Tigray.

Specific goals> To support the Mekele prosthetics-physiotherapy centre and improve the quality of the

physical rehabilitation sector, with a special focus on the surgical and orthopaedic ser-vices, through integration with the Regional healthcare system.

> To boost sensitisation and information on a community level of the problem of phy-sical disabilities and promote initiatives of economic sustainability of the MekeleCentre.

Target results1. Improved and enhanced accessibility of the civil population to the prosthetics and

physiotherapy services.2. Increased number of qualified personnel at the Centre.3. Improved quality of the physical rehabilitation and orthopaedic surgery services in the

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

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

Activities in 2005

Improved and enhanced accessibility of the civil population to the Prosthetics andphysiotherapy services.> Construction work was started on

• a residential block for 5 disabled users plus 5 assistants (with external latrines andshower units and a traditional kitchen) for a total of 120 square metres;

• a wing for fee-paying users of 90 sq. m annexed to the Centre but with a separateentrance, toilet facilities and storeroom;

• a classroom for theoretical training of the Centre’s staff, for the activity of training andupdating of healthcare workers of the territory and work meetings;

> The Centre was supplied with material, equipment and furniture for the new dwellings,assuring the completion of the building works described above and the execution oftraining initiatives and assistance activities.

Increase of the number of qualified personnel at the Centre> Strengthening of the staff of the Physiotherapy centre with the presence of two physio-

therapists.> Preparation of a plan of studies for assistant physiotherapists to be trained on the job> On-the-job training was provided for 5 physiotherapists of whom 2 will be assigned to

the Centre for internal assistance activities and 3 for the activities envisaged in theregional hospitals.

> In accordance with the Counterparty and the regional healthcare authorities, the pro-ject personnel collaborated in organising the plan of studies for a two-year course forqualified physiotherapists addressed to persons with experience in the field and quali-fied nurses interested and motivated to work in the sector. The proposal forwarded bythe Mekele nursing school and the Tigray Health Bureau will achieve recognition at aregional level.

> Payment guaranteed of 2 study grants for the current academic year for the degreecourse at the university of Gondar.

> An operative was trained to ensure the collection of data and creation of a databasedocumenting the activities performed by the centre

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Improved quality of the physical rehabilitation and orthopaedic surgery services inthe zone> Three missions arranged for visits of an orthopaedic physician to the Mekele hospital

and the Centre.> Introduction of assistance protocols and standardisation of treatments> Start of data collection and relative processing.

Creation of a reference network on the zone level and activities of sensitisation onthe community level> Commencement of updating of personnel of the healthcare facilities in the zone, disa-

bled members of the TDVA, and social workers.> The updating activities, already partially undertaken to support the operators of the

peripheral services of the region, were continued. The operators will receive trainingtargeted for the creation of knowledge to transmit to the community heads and for thesensitisation of the latter in relation to the problem of physical disability, early identifi-cation, and reference to the appropriate facilities for specific treatment campaigns.Specifically, the operators will be informed and trained in relation to the followingaspects:

1. the procedures to follow for referring disabled users to the Mekele centre;2. the follow-up to be implemented for disabled patients who have returned to their

homes;3. the mechanisms of sensitisation of the community on the subject of physical disabili-

ties.

Identification of systems for self-sustainability of the Centre> Commencement of building works of a bakery to assure income-generating activities

to cover the centre’s management costs.> Purchase of material for 100 prams/wheelchairs to ensure the implementation of inco-

me generating activities.> In order to allow access to physical rehabilitation services for all disabled users, inclu-

ding those who are unable to make any measure of contribution to the assistancecosts, it is planned to promote the identification of criteria and forms for the creation ofa social fund for their welfare. A study into the accessibility of the centre and its eco-nomic situation was terminated in November. The parties involved, including gover-nment authorities and donors, have planned various meetings at the start of 2006 todefine future strategies of the centre in order to guarantee a service that is accessibleto all disabled users of the centre.

Description NumbersTotal number of patients treated 746Total number of infant diseases 116Infant diseases % 15.54 %Total Number of treatments 3,304Patients from the Mekelle zone 563Patients from other areas of Tigray 183Neurological disorders 248Orthopaedic disorders 498

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4 HUMAN RESOURCES IN ETHIOPIA IN 2005-2006

EXPATRIATE PERSONNELN. Name Location Project1. Fabio Manenti Wolisso Hospital2. Barbara Secco Wolisso Hospital3. Elisabetta Marastoni Wolisso Hospital4. Ciro Bedin Wolisso Hospital5. Giovanni Cecchini Dubbo Hospital6. Luciano David Dubbo Hospital7. Mario Battocletti Dubbo Hospital8. Elisabetta Lovato Dubbo Hospital9. Mattia Morri Mekele Physiotherapy10. Leopolda Bortolani Mekele Physiotherapy11. Massimo Maroli A.A. Coordination

LOCAL PERSONNELN. Name Location Project Role12. Gebre Madebo Wolisso -AA Hospital - Coord. Public Health expert13. Hanna Hailesellassie Addis Ababa Coordination Accountant14. Mulu Asrat Addis Ababa Coordination Secretary15. Bellette Tadesse Addis Ababa Coordination Driver

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KENYA

1 NATIONAL CONTEXT

The Republic of Kenya has a population of approximately 32 million. The country is locat-ed in East Africa and is bordered by Sudan, Ethiopia, Somalia, Tanzania, Uganda, and theIndian Ocean to the southeast. The territory is bisected by the Great Rift Valley, whichforms the bed for lake Turkana. The main activities are activities are arable and livestockfarming, while the industrial sector is gradually gathering pace. There are several impor-tant tourist resorts on the coast. In December 2002 a new government came to power,proclaiming that it intended to turn the country around by focusing on the fight againstcorruption, universal access to primary education, basic healthcare, roads and railways,and partnership agreements with neighbouring countries.The climate of change also touches on the health sector, where the situation of the pub-lic health service and the conditions of accessibility appear to be precarious. The countryis preparing for elections in 2007.

2 REGIONAL CONTEXT

The diocese of Nyahururu, in which Doctors with Africa CUAMM is present, is of recentconstruction and has a population of approximately 860,000; the territory covers two gov-ernment districts: Nyandarua, site of the North Kinangop hospital, and West Laikipya(East Laikipya is in the diocese of Nyeri), site of the bishopric and the city of Nyahururu.

> Nyandarua District Area: 3,520 sq km Population: 500,000> West Laikipya District Area: 4,940 sq km Population: 360,000

Population: 31,987,000

Life expectancy at birth m/f (years): 50.0/49.0

Infant mortality m/f (per 1000): 126/120

Adult mortality m/f (1000): 495/521

Total per capita healthcarecosts (Intl $, 2002): 70

Healthcare spending as % of GDP (2002): 4.9

Source: The world health report 2005

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3 DOCTORS WITH AFRICA CUAMM IN KENYA

Doctors with Africa CUAMM has a long tradition of engagement in Kenya, assigning thefirst doctor in 1956 and continuing its work up to 1993, mainly in the facilities of localchurches and missionary congregations.After the conclusion of the Nkubu and North Kinangop projects, Doctors with AfricaCUAMM continued to maintain contacts with local institutions, in particular with institu-tions controlled by the Church, thanks also to the ties existing with the priests of theDiocese of Padova working in Kenya.At the end of October 1999 contacts were established with the St. Martin Association inthe Nyahururu area, which is in charge of various initiatives including a rehabilitation proj-ect on a community level for disabled children.This contact gave rise to a collaboration undertaking, signed in August 2000, for which athree-year project was presented to CEI (approved for conformity by MAAEE-SC/052/CUAMM/KEN); the project is currently financed with private funds.

Missionary structures in Kenya cover 40% of assistance needs and constitute an essen-tial resource for the healthcare system; despite formal endorsement, the Kenyan govern-ment does not offer any form of financial support to the missionary structures. A broad-based series of meetings is currently under way in order to develop regulations govern-ing the cooperation between private non-profit organisations and government bodies.Pending the definition of general policies, agreements with government authorities mustbe sought on a peripheral level, maintaining good relations with District Medical Officers.

The Saint Martin Catholic Social Apostolate (CSA) is a religiously oriented organisationthat bases its action on a community approach, involved in the provision of aid for themost disadvantaged members of society. The Saint Martin mission operates in the districtof Nyandarua and West Laikipya. All the programmes derive from grassroots initiativesand are managed by committees representing the various communities. In this manner itis the community itself that seeks solutions for the problems of its members and estab-lishes the methods of execution of the programmes. It is the conviction of the Saint Martinmission that solutions must arrive from the community as far as possible, and must bedeveloped in harmony with the community context (table 1).

Table 1: Vision and Saint Martin Mission - CSA

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

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

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

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

COMMUNITY DEVELOPMENT PROJECT FOR DISABLED PERSONS (NYAHURURU)

The Project (2004-2007) is fully supported with private funds OPSA-Padova, Jenga-Insieme Doctors with Africa Group, Atantemani Association and Fontana Foundation.

The work is articulated in the framework of various social and assistance initiatives of thelocal St. Martin association (Diocese of Nyahururu). The scope of the project is thestrengthening of the services network (composed of professional and voluntary opera-tors), involvement of families in the rehabilitation of disabled children, improvement of pre-vention (by supporting midwives and forging links with the local health services), consol-idation of activities undertaken over the past three years, and a more systematicapproach to data collection.

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

Human resourcesLuca Ramigni (physiotherapist) 26/07/2004 31/12/05

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MOZAMBIQUE

1 HISTORY August 1977: Signing of technical cooperation agreements between Italy and

Mozambique.

1978: First mission of voluntary doctors.Objective: to contribute to the development of the Mozambicanhealthcare system based on “prevention” and “decentralisation”.Presence of doctors in numerous hospitals in provinces of the Centraland Northern regions.Organisation of a course for medical technicians.

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

From 1986 to 1992:A programme in the Gaza province was launched:Support guaranteed to Chokwe, Chibuto and Chicumbane hospitals. Staff employed: 15 volunteers.4 OCTOBER 1992: SIGNING OF PEACE AGREEMENT IN MOZAMBIQUE.

End of 1992: Presence in Sofala Province begins with emergency activities followedby rehabilitation of the structures and healthcare system.

From 1992 to 1997:Doctors with Africa Cuamm operate in districts of:Nhamatanda, Marromeu, Gorongosa, Inhaminga and Maringue.Staff employed: 37 volunteers.

1997: Padua and Beira become twin towns and Doctors with Africa Cuammparticipate in opening of a health centre:The city of Padua helps build a school and the Padua hospital author-ity provides support to the Beira hospital.

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From 1997 to 2001:Staff employed: 34 volunteers.Continuity is given to the Sofala initiative through a programme to sup-port the Provincial Health Management and various districts (Sofala2000 Programme).Organisation of a training programme for medical technicians inChicumbane (Gaza province).Development of a project to support three districts in the Zambeziaprovince.

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

2 COUNTRY PROFILEMozambique is a sub-Saharan country with an estimated population of 18 million people.According to the UNDP report, it is one of the 10 poorest countries in the world. The 1997census found a life expectancy at birth of 42.3 years, but subsequent projections indicatethat at the end of 2005 the figure may be as low as 35.2 years due to the impact of AIDS. By2001 life expectancy had already fallen to 39.2 years. Official figures show that almost 70%of the population lives in extreme poverty1. However, figures vary considerably from oneprovince to another: the Sofala Province has an absolute poverty rate of 88% of the popula-tion and Tete and Inhambane of 82-83%, while the figure for Maputo is 48%. The literacy rateis 45.2% and average annual per capita income $ 1,140. Only 57% of the population hasaccess to potable water. Births assisted by healthcare staff account for just 50% of the total. The main causes of disease and mortality are malaria, diarrhoea, respiratory infections,tuberculosis and HIV/AIDS. Figures from 1997 show that 15% of registered illnesses aremalarial in nature and that tuberculosis is the major cause of hospitalisation in rural areas.The mother-child health indicators in Mozambique are amongst the worst in the world,with a maternal mortality rate of almost 1,000 per 100,000 live births. The infant mortali-ty rate varies from 183/1000 births in the Zambezia Province to 60/1000 in Maputo. The national health service (SNS – Servico Nacional de Saúde) effectively provides health-care to just 50% of the population, partly because the majority of the population in ruralareas still use traditional medicine. The national health service operates on four levels:Levels I and II, Health Stations and Centres, are responsible for primary healthcare andhave important preventive functions, whereas Levels III and IV, clinics and hospitals, havemore specialised treatment functions within the institutional structure of the nationalhealth service. There are about 1,100 primary level units with an average of about 15,000inhabitants per basic healthcare unit. Although the national health indicators continue tocause concern, the healthcare sector has improved significantly since 1993. In 2000, the Mozambican government presented its Action plan for reducing absolutepoverty 2001–2005 (PARPA). The primary aspects of poverty reduction that are relevant to the healthcare sector are: > Primary healthcare (beneficiaries: women, children, adolescents) and nutrition. > Fight against fatal diseases (diarrhoea, malaria, tuberculosis, HIV/AIDS).> Improvement of peripheral healthcare network.> Development of human resources.> Improvement in healthcare sector planning and management.> The strategic healthcare plan places particular emphasis on improving quality and pro-

viding equal accessibility to healthcare. It also refers to closer links between the heal-thcare sector and civil society, in particular cooperation with other institutions andNGOs, the creation of partnerships and the participation of traditional medicine.

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

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3 OVERVIEW OF PROJECTS AND SOURCES OF FUNDING FOR YEAR 2005

PROJECT TITLE SOURCES OF FUNDING 2005Sofala ProvinceImprovement in laboratory and paediatric services The total cost of the project is at Beira central hospital (Sofala Province) € 591,560 for the period October

2002 - February 2006. The followingcontributed: Italian Ministry of Foreign Affairs, Hospital of Padua, Doctors with Africa Cuamm Groups and private individuals.

Training of high-level healthcare managers: The total cost of the project issupport programme for the medicine faculty of € 334,003.60 for the periodthe Catholic University of Mozambique August 2004 - August 2007.

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

Strengthening of healthcare systems in the The total cost of the project isBeira and Dondo districts € 830,807 for the period

December 2004 - November 2006.The following contributed: Italian Ministry of Foreign Affairs, Doctorswith Africa Cuamm Groups and

private individuals. Reinforcement of HIV-AIDS paediatric services Clinton Foundation in the Beira central hospital € 29,154 (100%) HIV-AIDS and malnutrition in children: an UNICEF € 37,044 (100%)integrated response in the Sofala province Nampula Province Reopening and consolidation of elementary The total cost of the project is obstetrics training centre in Alua € 472,002 for the period

September 2004 - February 2007. The following contributed: Italian Ministry of Foreign Affairs, Doctors with Africa Cuamm Groups and private individuals

General strengthening of public healthcare system Clinton Foundation in Moma district including treatment of HIV-AIDS € 19,500 (100%) Inhambane ProvinceSupport for HIV-AIDS services in Inhambane Doctors with Africa Cuamm with the province contribution of private individuals

and Doctors with Africa Cuamm Groups, € 31,485 (68%)UNICEF € 4,390 (10%)GTZ v 10,000 (22%)

Specific and vertical projectsMapping of lymphatic filariasis in the country Liverpool School of Tropical

Medicine € 25,000 (100%)

4 DETAILS OF PROJECTS

4.1 Sofala Province

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IMPROVEMENT IN LABORATORY AND PAEDIATRIC SERVICES AT CENTRAL HOS-PITAL IN BEIRA

Location Beira Central > Beneficiary population Child population of city ofBeira (500,000 people) and the Sofala province

Total budget > € 591,560 Donors > Italian Ministry of Foreign Affairs

> Doctors with Africa Cuamm, with the contribution ofprivate individuals and Groups

> Padua hospital authority Partners > Hospital managementExpatriate staff > 1 paediatrician

> 1 nurse (at the service of Padua hospital authority)Local staff > 9 nurses and 4 auxiliary workers

> 7 activistsSupport staff > 3 guardsDuration of project > 3 years, ending in February 2006

Main results achieved> Improvement in quality of healthcare provided to inpatient children through the techni-

cal support of the paediatrician, training of paramedical staff, supply of materials andstandardisation of procedures.

> Laboratory (biochemical and haematological sections) operational as a result of techni-cal support, purchase and maintenance of automated equipment, supply of reagentsand introduction of a quality control system.

> Commission set up for prevention and control of hospital infections.

TRAINING OF HIGH-LEVEL HEALTHCARE MANAGERS: SUPPORT PROGRAMMEFOR THE MEDICINE FACULTY OF THE CATHOLIC UNIVERSITY OF MOZAMBIQUE

Location > BeiraBeneficiary population > The approximately 200 students at the university and

the entire teaching staff of the faculty Total budget > € 334,003 Donors > Doctors with Africa Cuamm (with the contribution of

private individuals and Groups) Partners > Faculty of Medicine of Catholic University of BeiraExpatriate staff > 1 doctor in surgical department

> 1 doctor in infectious diseases departmentLocal staff -Support staff -Duration of project > 3 years, ending in July 2007

Main results achieved> Guaranteed coverage of theoretical and practical teaching of students in the fields of

anatomy/surgery and internal medicine/infectious diseases.> Improved access to study by providing textbooks for the Faculty’s library and 6 study

grants for students from the north of the country.

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STRENGTHENING OF HEALTHCARE SYSTEMS IN THE BEIRA AND DONDO DIS-TRICTS

Location > Beira and Dondo districts Beneficiary population > Population of Dondo district and the Beira city district Total budget > € 830,807 Donors > Italian Ministry of Foreign Affairs

> Doctors with Africa Cuamm (with the contribution ofprivate individuals and Groups)

Partners > Provincial health management> Beira district management> Dondo district management

Expatriate staff > 2 public health doctors> 1 paediatrician

Local staff > 10 nurses> 15 auxiliary workers

Support staff > 1 accountant> 1 logistician> 2 drivers> 3 guards

Duration of project > 3 years, ending in November 2006

Main results achieved> Improvement in overall management of the two districts through constant technical

support for the managements.> Higher quality and more effective services provided through training of local staff, ade-

quate equipping of health centres, structural rehabilitation and the availability of tran-sport (materials and supervision).

STRENGTHENING OF HIV-AIDS PAEDIATRIC SERVICES IN BEIRA CENTRAL HOSPITAL

Location > Central hospital in BeiraBeneficiary population > Child population of the city (total population 500,000)Total budget > € 51,666

Donors > Clinton Foundation Partners > Hospital management Expatriate staff > 1 laboratory biologist

> 1 paediatrician in partnership with UNICEF project Local staff > 3 activists

> 3 auxiliary social workers> 1 pharmacy technician> 1 day hospital nurse> 2 auxiliary workers> 1 secretary

Support staff -Duration of project > 1 year ending in May 2006

Main results achieved> Setting up of paediatric day hospital service for HIV-AIDS (250 children registered at

the end of 2005 including 120 undergoing antiretroviral treatment).> Improved diagnostics and treatment of opportunistic infections and HIV-AIDS in inpa-

tient children in the four paediatric department wards.

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

HIV-AIDS AND MALNUTRITION IN CHILDREN: AN INTEGRATED RESPONSE IN THESOFALA PROVINCE

Location > Sofala Province Beneficiary population > Child population of the province (total population

1,600,000) Total budget > € 300,833 Donors > UNICEFPartners > Provincial health managementExpatriate staff > 1 paediatrician

> 1 nutritionist nurse Local staff > 1 data entry worker for day hospitalSupport staff > 1 accountant

> 1 logistician> 1 driver

Duration of project > 17 months ending in December 2006

Main results achievedImproved healthcare for children in malnutrition ward of central hospital through trainingand increase in number of paramedical staff.Protocols introduced for early diagnosis and treatment of malnourished and/or HIV-AIDSinfected children in peripheral health centres.Connection and support network set up between paediatric department, paediatric dayhospital, peripheral health centres and communities for malnourished and/or HIV-AIDSinfected children.

4.2 Nampula Province

REOPENING AND STRENGTHENING OF ELEMENTARY OBSTETRICS TRAININGCENTRE IN ALUA

Location > Alua, Erati districtBeneficiary population > Population of Nampula province

> 60 obstetriciansTotal budget > € 472,000 Donors Italian Ministry of Foreign Affairs

> Doctors with Africa Cuamm (with the contribution ofprivate individuals and Groups)

Partners > Provincial health department Expatriate staff > 1 obstetrician

> 1 nurse Local staff - Support staff > 1 driver

> 1 surveyor/logistician> 2 guards

Duration of project > 2 years and 6 months, ending in February 2007

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Main results achieved> Training centre reopened and operational through the construction of new buildings

(kitchen/refectory, practice room/library, 5 houses for teachers), supply of books andteaching materials, technical support for management, teaching and practical trainingof students.

> Two courses organised and completed for a total of 54 qualified obstetricians.

GENERAL STRENGTHENING OF PUBLIC HEALTHCARE SYSTEM IN MOMA DIS-TRICT INCLUDING TREATMENT OF HIV-AIDS

Location > Moma, Nampula Province Beneficiary population > Inhabitants of Moma district (300,000 people) Total budget > € 452,075 Donors > Clinton Foundation Partners > Provincial Health Management

> District Health Management > Vida Positiva local NGO

Expatriate staff > 1 doctor > 1 obstetrician

Local staff > 18 nurses, obstetricians and auxiliary workers (8 inhospital + 10 in district)

> 2 social workersSupport staff > 1 logistician

> 1 driver> 1 accountant

Duration of project > 2 years, ending in October 2007

Main results achieved> project began in November 2005

4.3 Inhambane Province

SUPPORT FOR HIV-AIDS SERVICES IN INHAMBANE PROVINCE

Location > Homoine, Chicuque and Inhambane Beneficiary population > Inhabitants of the Inhambane province served by

these 3 centres (about 600,000 people). Total budget > € 150,000 Donors > Doctors with Africa Cuamm (with the contribution of

private individuals and Groups) > UNICEF > GTZ

Partners > Homoine District Health Department> Chicuque District Health Department> Inhambane District Health Department> Provincial Health Department

Expatriate staff > 1 doctorLocal staff > 10 nurses, social workers and auxiliary workersSupport staff -Duration of project > 2 years

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Main results achieved> Improved access to treatment of opportunistic infections and antiretroviral treatment in

the Homoine district. > Increased coverage of prevention of mother-to-child transmission in the area of

Homoine, Chicuque and Inhambane.

5 RESEARCH ACTIVITIES

In 2005 Doctors with Africa Cuamm in Mozambique conducted an epidemiological map-ping of lymphatic filariasis across the country. The project was carried out in cooperationwith the WHO and the Mozambican Ministry of Health. Doctors with Africa Cuamm con-tributed through ? 25,000 funding donated by the Liverpool School of Tropical Medicineand through the technical support of a public health doctor who personally led the proj-ect for 4 months (paid through a contract with the WHO of Geneva).In 2005, an attempt was made to launch an ambitious national-level survey of the equityof antiretroviral treatment programmes across the country. The project was presented tothe Ministry of Health as a combined proposal by Doctors with Africa Cuamm, ItalianCooperation and Equinet. The Ministry of Health approved the initiative and appointed itsown researcher. In July, two researchers developed the detailed protocol of the researchproject and the operational stage was scheduled to start at the end of September follow-ing approval by the national ethical committee. However, the study did not begin withinthe established timeframes as the researcher designated by the Ministry was promotedand was therefore no longer able to work on the research project (which involved at leasttwo months full-time work). As roles are currently in a state of flux, it was decided to post-pone the start of the project to the first quarter of 2006. The consequences of thisresearch project in terms of decision-making for the Ministry and partners (donors andNGOs) in the field of HIV-AIDS are potentially significant.

6 FIGURES FOR EMPLOYED STAFF

Expatriate staff:> 11 specialist doctors> 4 postgraduate doctors> 1 biologist laboratory technician> 3 nurses> 3 specialist doctors on short-term missions> 1 social science expert

Local staff:> 80 nurses, auxiliary workers and social workers engaged through the Ministry of Health> 18 accountants, logisticians, drivers

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RWANDA

Rwanda is now seeing a slow and difficult return to normality in spite of the lingeringwounds in the country’s social and political life. The policy of “iron reconciliation” prom-ised by the hard-line president Paul Kagame has not proved sufficient to achieve pacifi-cation of the country, which still today sees episodes of violence and intimidation betweenmembers of different cultural groups. Furthermore, Rwanda is located in the Great Lakesregion, an extremely volatile geopolitical area subject to continuous conflicts and clashesinvolving numerous African countries, with severe consequences for the lives of the civil-ian populations. After the 1994 genocide, new balances of power began to emerge andalthough these did not achieve any real redistribution of resources they generated furtherimbalances in terms of access. Doctors with Africa CUAMM has been operating in Rwanda since June 1994. It has con-centrated its activities in the Umutara province through actions aimed at developing thehealthcare system and in particular providing support to basic health services. Afterimplementing two projects funded by UNDP and the European Union (concluded respec-tively in 2000 and 2001), a project assigned by the Italian Ministry of Foreign Affairs (MAE)allowed the organisation to capitalise on its past experience and provide continuity to acountry programme aiming to promote and improve the state of health of the population.In June 2004, in spite of the difficulties in interacting with the local institutions, theRwandan Ministry of Health approved the request to extend the MAE assigned pro-gramme, which thus obtained an extension of 36 months to July 2007.

Population: 8,387,000

Life expectancy at birth m/f (years): 43.0/46.0

Child mortality m/f (per 1000): 213/193

Adult mortality m/f (1000): 541/455

Total per capita healthcareexpenditure (Intl $, 2002): 48

Total healthcare expenditureas % of GDP (2002): 5.3

Source: The world health report 2005

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PROJECT TO SUPPORT HEALTHCARE DEVELOPMENT IN THE UMUTARAPROVINCE

This is a project assigned by the MAE (Conv. No. 1075 of 19/11/1999) which involvesstrengthening the basic services and supporting the organisation and supervision of theservices themselves, thereby contributing to greater coverage and improved quality of theservices provided in the Umutara province. The project was extended on 06/12/04 until31.07.07. It is coordinated with the local partner and strongly sustained by the UTC. The project involves various activities ranging from healthcare building work to healtheducation campaigns. The main components of the programme are: > support for Nyagatare Nursing School> construction of two health centres> promoting public awareness and supporting the fight against HIV-AIDS.

In spite of difficulties deriving from the changes in management of local structures, theproject continued to carry out the planned activities during the first few months of 2005. However, due to administrative difficulties deriving from failure on the part of the MAE toprovide the necessary funds, the activities gradually slowed down and the project wassuspended at the beginning of July 2005, as communicated with a note on 17.05.05 (prot.no. 102/PG/2005) and on 07/12/05 (prot. no. 303/PG/2005).

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

TANZANIA

1 COUNTRY PROFILE

The country has a surface area of 945,050 sq. km including 59,050 sq. km of inland lakes.There are two wet seasons: the long wet season between March and May and the shortwet season between November and January. There are four separate topographical zonesin the country. The coastal tableland that extends from the coast to about 150 km inlandwith an average altitude of 300 m is a wet area with temperatures of between 20°C and30°C. The central Plateau has a large diurnal temperature variation and a semiarid cli-mate. The area of the large lakes (Victoria and Tanganyika) has relatively high tempera-tures and higher rainfall than the central plateau. The plateaux around Mount Kilimanjaroin the north and the mountain ranges in the south generally have a temperate climate andhigh rainfall.

1.1 Historical background

The mainland territory of the Republic (Tanganyika) and the islands of Zanzibar obtainedindependence respectively in December 1961 and December 1963. In 1964 the two areaswere unified into the United Republic of Tanzania. The President of Tanganyika, MwalimuJulius Nyerere, became the first president of the Union.

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After the Arusha declaration in 1967, Tanzania pursued a centrally-controlled socialisttype development programme. In 1986 the newly elected President Ally Mwinyi launchedthe Economic Recovery Programme with the support of the International Monetary Fund(IMF) and the World Bank. In 1989 the programme was reinforced by the Economic andSocial Action Programme. After being elected in November 1995, President Mkapapressed on with the process of privatisation and adherence to the IMF’s fiscal pro-gramme. Tanzania has continued to enjoy political stability since independence and hasacquired an important role at a sub-regional level.

1.3 Administrative divisions

In 1972 the government initiated a gradual process of decentralisation to promote popu-lar participation in decision-making processes. Mainland Tanzania has 20 regions and 114local councils (City, Municipal, Town and District). Each council is divided into 4-5 divi-sions, in turn divided into 3-4 wards. Each ward consists of about 5-7 villages. A total of10,045 villages have been counted in the country. Zanzibar has 5 regions and 10 districts. The councils are the most important administra-tive authorities and are responsible for social services. The Ministry of Health (MoH) is cur-rently attempting to strengthen the district health services.

1.4 Economy

Per capita income is estimated at around $ 270 a year. The most important sector of theeconomy is agriculture (principally coffee, cotton, tea, cashew, sisal, maize, rice, wheat, cas-sava and tobacco), which accounts for 50% of GDP and 85% of exports. For topographicaland climatic reasons, arable land area is very limited. Industry accounts for 14% of GDP andis restricted to the processing of agricultural produce and limited ranges of articles for massconsumption. The mining sector, gold in particular, has undergone considerable expansion inrecent years and has attracted foreign investment. The tertiary sector and the informal sec-tor are also important areas of employment. Tourism has seen significant growth in recentyears. GDP has risen on average by 5.3% over the last four years. Inflation has dropped from30% (1995) to less than 5%. However, the high rate of population growth means thatTanzania is unable to benefit from its good economic performance and the figures for thelevel of poverty have remained unchanged over the last decade.

1.5 Population

Tanzania has a population of 33.8 million people (1999 estimates) and an annual growth rateof 2.8%. About 75% of the population lives in rural communities. About 20% of the popula-tion is under 5 years of age and 27% between 5 and 15. About 20% consists of women ofchildbearing age (between 15 and 49). The national census was carried out in August 2002. The infant mortality and under-5 child mortality rates are respectively 99 and 152 per1,000 live births. Maternal mortality is around 529 cases per 100,000. Life expectancy is 45 years.

2. OVERVIEW OF SECTOR

2.1 Healthcare

The providers of healthcare services in Tanzania are the government and the private prof-it and non-profit sectors. The health system is organised into three levels: primary (dis-pensaries), secondary (health centres) and tertiary (hospitals). The two Ministries of Health (Tanzania and Zanzibar) and the President’s Office RegionalAdministration and Local Government (PORALG) are responsible for providing healthcare.

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The specialist Consultant hospitals and the area training centres are controlled by theMinistry of Health. The PORALG in turn is responsible for managing district and regionalservices.A dispensary generally serves about 6-10,000 users, a health centre about 50-80,000 anda district hospital 250,000. The regional hospital serves 4-8 districts and the consultanthospitals serve numerous regions.

2.2 Health conditions in the country

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

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

2.3 The healthcare development policy in Tanzania

THE NATIONAL DEVELOPMENT PLAN

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

POVERTY REDUCTION STRATEGY (HEALTHCARE COMPONENT)

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

2000 to 55% in 2003.

3. DOCTORS WITH AFRICA CUAMM IN TANZANIA

Doctors with Africa has been working in Tanzania since 1979, initially in missionary hos-pitals and since 1979 in close cooperation with the Tanzanian Ministry of Health.A total of 280 doctors and other paramedical staff have worked in Tanzania for periods noshorter than two years.The organisation is based in Dar es Salaam, where it has its offices and a house foraccommodating Doctors with Africa Cuamm staff in transit and their families.It has another office in Iringa, not far from the regional hospital.

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At Tosamaganga (Iringa region) there is a training centre that can host up to 20 people forseminars and study courses.Staff currently employed in Tanzania by Doctors with Africa Cuamm (December 2005):> 6 doctors (5 Italians, 1 Tanzanian)> 1 Italian administrator> 1 Italian nurse/ward sister

4. OVERALL STRATEGY OF DOCTORS WITH AFRICA CUAMM IN TANZANIA

TO PROMOTE HEALTH FOR EVERYONE

> Equity in health system financing: to favour the weak segments of the population, todevelop solidarity type local funding systems (Community Health Funds).

> Accessibility to services: to contribute to coverage of recurrent costs to keep chargeslow and to guarantee access to treatment for the poor, setting up of the flat ratesystem.

TO INTEGRATE HOSPITAL SERVICES WITH TERRITORIAL SERVICES

> Training staff at peripheral units (Dispensaries and Health Centres) both at a clinicallevel and with regard to public health (domiciliary care, community participation, pre-ventive medicine).

> Supervision/support of peripheral units.> Use of a referral system between hospital and peripheral units.> Use of a simple but effective monitoring and evaluation system based on the gover-

nment model.

TO INTEGRATE AND SUPPORT THE MEDIUM AND LONG-TERM GOVERNMENTHEALTHCARE PROGRAMMES

> To encourage the involvement of local and national public health authorities in the sta-ges of planning and implementation of projects.

> To be as active as possible in the Council Health Management Teams and the DistrictHealth Management Teams.

> To follow the ministerial guidelines, where present.> To avoid overlapping with the government programmes and those of private agencies

with consequent wastage of resources.

LOCAL STAFF TRAINING

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

5. PROJECTS IMPLEMENTED IN 2005

5.1 PROJECT TO “SUPPORT HEALTHCARE SERVICES IN FOUR AREAS OF TANZANIA” (KNOWN AS “FOUR AREAS” PROJECT)

The project concerns three hospitals, Mikumi, Tosamaganga and Lugarawa, and theirrespective areas of referral plus the maternity wards in the Dar es Salaam Diocese.

Staff employed > 5 Italian doctors Budget: > € 1,448,296 Donors: > Italian Ministry of Foreign Affairs – CEI –

Doctors with Africa Cuamm – Local partners Donors for complementary activities: > Doctors with Africa Cuamm Groups, private

donors, Centro pastorale per la cooperazio-ne missionaria tra le Chiese di Roma,Province of Bolzano, Trentino Alto AdigeRegion through Gruppo Medici dell’AltoAdige per il Terzo Mondo.

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Main components:1. Retraining and on-the-job training for staff.2. Adaptation of infrastructures. 3. Support for healthcare activities for pregnant women and children.4. Start-up/support of activities to control HIV infection and AIDS.5. Supply of drugs and consumable materials to keep charges low enough to assure

access to treatment for the entire population.6. Support for peripheral units for the referral areas.

In the Lugarawa hospital the new flat rate for charging was introduced just a few monthsago so it is still too early to assess its impact.However, charges for the Paediatric and Maternity wards have been kept very low for atleast two years (even prior to the project) through the direct and autonomous action ofDoctors with Africa which provided drugs and consumable materials for these two wards.At the Tosamaganga hospital a flat rate system will be adopted at the beginning of 2006.In 2005, the policy of reducing charges for patients has only concerned the Paediatric andMaternity wards. The increase in admissions to the Paediatric and Maternity wards ofthese two hospitals confirms that cost is a factor that restricts access to treatment, atleast in rural areas.

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

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

Staff employed > 1 Tanzanian doctor, 1 Tanzanian A.M.O.(Assistant Medical Officer), two secretariesand one accountant, both Tanzanian

Budget for 2005: > 47,635 USDDonors: > Global Fund. Doctors with Africa Cuamm,

together with another eleven NGOs, is a sub-recipient of AMREF, in turn the principal reci-pient of the Global Fund. Each of the elevenNGOs has to submit an action plan and bud-get to AMREF and thus the Global Fund inGeneva in agreement with the other NGOs.

Main components of project for 2005:1. Construction or refurbishment of outpatient clinics for Voluntary Counselling and

Testing (VCT sites) and for Prevention of Mother-To-Child Transmission of HIV(PMTCT).

2. Training of VCT and PMTCT Counsellors.3. Supply of consumable materials and reagents for HIV test.4. Training of Maternity staff in Post Exposure Prophylaxis (PEP).5. Community health education on PMTCT in the areas involved (Community mobiliza-

tion).

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5.3 SUPPORT FOR NATIONAL PROGRAMME TO FIGHT MALARIA AND INTEGRAT-ED APPROACH IN DODOMA AND IRINGA REGIONS

The project was funded by the Italian Ministry of Foreign Affairs. In 2005 a non-onerousextension of 9 months was requested and obtained to allow the activities to be carriedout.

Staff employed 1 Italian voluntary doctor, 1 Tanzanian doctor.Budget for 2005: € 860,000Donors: Italian Ministry of Foreign Affairs

The main components of the Project were:1. Improvement in clinical management of patients affected by malaria both in the

referral hospitals and in the peripheral centres.2. Improvement in personal protection against malaria, particularly for children and pre-

gnant women through the distribution of mosquito nets impregnated with long-lasting insecticide.

3. Sponsorship of a study grant in public health management for a Tanzanian doctor.4. Improvement in epidemiological approach to malaria.5. Improvement to the Council Health Management Team in planning and implementing

initiatives to fight malaria.

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

5.4 BORN WITHOUT AIDS

Staff employed 1 Italian doctor Budget for 2005: € 200,000 Donor: Caritas Antoniana

The project, concluded on 31.12.2005, was carried out in the area of the city of Dar esSalaam, with the aim of reducing perinatal transmission of HIV infection in the populationserved by PASADA (Pastoral Activities and Services for Aids People Dar es SalaamArchdiocese), within the framework of the Tanzanian national protocol for prevention ofperinatal HIV transmission (PMTCT) through chemoprophylaxis with Nevirapina.The main components were:1. Introduction of protocols for prevention of mother-to-child transmission of HIV

(PMTCT) in the 18 maternity wards in the Diocese of Dar es Salaam.2. Training of obstetric and nursing staff in PMTCT.3. Improvement in information and data collection system in the maternity wards in the

Diocese.4. Support for diocesan HBC activities.

5.5 MAPATO PROJECT

Three-year project funded by Caritas Antoniana with a budget of € 200,000.The aim of the project was to reduce poverty through empowerment of poor or low-income women in the depressed districts of Dar es Salaam. This would be achievedthrough microcredit activities, i.e. granting loans to women to allow them to start up smallbusiness or production activities capable of generating income. The loans were grantedafter an analysis of the woman’s situations and their real need for and ability to use the

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loans. Before the loans were granted, a 4-day seminar on the basic principles of com-merce and budget management systems was held. The main components of the Project were:> Empowerment of 2,000 poor or low-income women by increasing their income through

access to credit, training and investment.> Improvement in the capacity of Caritas in Dar es Salaam to manage the project.> Strengthening of cooperation between PASADA (Pastoral Activities and Services for

Aids People Dar es Salaam Archidiocese) and Caritas of Dar es Salaam through mutualreferral of their customers.

6. ACTION ON AIDS

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

1. For the hospitals in Tosamaganga, Lugarawa and Mikumi, Doctors with Africa Cuammhad an official evaluation performed by the auditors of the National Aids ControlProgramme (NACP). Tosamaganga and Lugarawa thus gained accreditation to officially join the NACP’snational programme. Healthcare staff will receive specific free training from the NACPand the hospitals will subsequently obtain ARV drugs (again provided free throughgovernment channels) and therapy will begin. It is very important that by then the “Fourareas” project is operational to provide training to the VCT Counsellors and the HBCworkers, otherwise the therapy alone will be pointless. During the next few months, as soon as the upgrade from a Health Centre to a hospi-tal has been officially recognised, Mikumi should also be able to join the list of accre-dited health units.

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

The Global Fund Project is entirely devoted to AIDS.In the action plan submitted by Doctors with Africa Cuamm for 2006, the specific issuesaddressed are:a. Early recognition of infection and illness through VCT.b. Prevention of mother-to-child transmission (PMTCT) in the mother/child clinics and

maternity wards.c. Prevention of infection subsequent to accidental exposure to potentially infected

material in hospitals and dispensaries (PEP). d. Promoting an awareness of the problem of discrimination against HIV-positive people

or AIDS sufferers within the communities in the areas concerned.

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

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UGANDA

1 INTRODUCTION

As mentioned in the 2004 annual report, the activities of Doctors with Africa CUAMM inUganda have reached a critical watershed. The projects in progress are nearing comple-tion and there are no programmes due for imminent implementation that either may beseen as the natural continuation of those under way or are likely to become a springboardfor new areas of action. This situation stems from a number of factors, particularly the fol-lowing 3:1. Effective reliance on only one large institutional donor, Italian Cooperation, which is no

longer able to provide financial and strategic support to programmes as in the past.2. The fact that the organisation’s historic approach has been to support “healthcare

systems” (specifically those of the government and missionary groups) rather thanspecific sectors (e.g. AIDS, vulnerable groups), while the latter are at present the areasof greatest interest both for the Ugandan government and for the major donors ope-rating in Uganda (UNICEF, European Community, DANIDA).

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

Unlike other sub-Saharan African countries which are either still in a stage of emergency,generally due to conflicts or natural disasters, or in a stage of development, Uganda is ina “schizophrenic” situation in which the two aspects (emergency and development) havecoexisted chronically for more than twenty years. While part of the country is embroiledin a tragic and chronic state of conflict, recognised worldwide as one of the worst con-temporary humanitarian catastrophes (in terms of the victims of the civil war in the Acholiand Lango region), the rest of the country is undergoing gradual development and eco-nomic growth but with severely insufficient economic resources and administrativecapacities and with health and development indicators that are amongst the worst in theworld. The result of the simultaneous presence of two equally strong needs means thatthe most dramatic of the two draws almost all the attention and resources, leaving verylittle for the rest of the country. This phenomenon has become particularly evident in thelast 5 years, during which time the brutal and inhumane actions by the groups of rebelsin the Acholi region has made the refugee problem dramatic. Almost 95% of the popula-tion of 5 districts lives in refugee camps in sub-human conditions and with shocking mor-tality rates simply to escape from the attacks and violence that occur in the villages on analmost daily basis. The other factor that distinguishes Uganda is its historic fight against AIDS. Uganda waseffectively the first African country to launch and implement an extensive national policyto fight the diffusion of HIV infection and has achieved extraordinary results. In 20 years,the prevalence of the infection has fallen from values close to 27% to 6.4% (epidemiolog-ical surveillance of 2005). However, the number of people infected remains high and thesecondary social impact of the pandemic is severe (almost 2 million orphans, thousandsof deaths in productive age with severe damage to the country’s already poor economicresources). For these reasons, the strategic national healthcare programme still envisagesa major commitment in this area with substantial investments on the part of the govern-ment and the major donors. This is a second factor behind the severe polarisation of eco-nomic aid.There is also a third element of national and international economic policy that should notbe underestimating when evaluating the prospects for intervention of an NGO in Uganda

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and the possibility of gaining access to funding for its projects. Uganda was also one ofthe first countries to embrace the SWAP policy towards international donors, a policy thatwas sustained and initially appreciated by the international community as a result of strate-gies promoted by the World Bank and the International Monetary Fund. Bilateral externaldevelopment funding goes almost entirely into a single national fund which is then redis-tributed by the government to the various area of intervention according to national poli-cies and programmes. With all its limitations and potential, the system has effectively min-imised funds available to projects proposed or implemented directly by NGOs. For exam-ple, until just a few years ago the Danish cooperation agency DANIDA provided consider-able funding to projects in a variety of sectors, but in the last two years it has concentrat-ed its activities in just a few areas and almost entirely through the governmental budgetsupport policy. The SWAP policy also affected the funds of the Global Fund initiative whichwere collected directly by ministerial offices and their national programmes.

From what we have said, it is clear that the action strategies hitherto followed by Doctorswith Africa CUAMM, in spite of meeting important real needs of the population, are diffi-cult to reconcile with the strategies currently pursued by the government and the interna-tional aid agencies. The longstanding presence of Doctors with Africa CUAMM in Uganda, with its excellentquality actions and evident results, is well known and highly esteemed in the districtswhere it operates or has operated in the past but has little or no impact at a central levelwhere for several years now the decisions have been taken and the actions and partner-ships established.

As was suggested in the previous annual reports, it is necessary to rethink the model of coop-eration proposed by Doctors with Africa CUAMM to make it more suitable for the govern-ment’s top-priority healthcare policies and the sectors considered significant by donors. Thisis a difficult process that requires time and must be carried out without neglecting the inspir-ing principles of Doctors with Africa CUAMM and the real needs of people. It is probably nec-essary to review the image and positioning profile of Doctors with Africa in the context ofNGOs in Uganda, particularly at a central level in the capital, where there are a large numberof players, several of which have a high profile, good capabilities and excellent credentials,where competition is fierce and where contacts and introductions play a crucial role.Likewise in the relations between Doctors with Africa CUAMM and Italian Cooperation it isimportant to bear in mind the considerable limitations displayed by the latter in recent yearsin terms of financial capacity and operational and strategic capabilities, but without forgettingthe link that must or should exist between an Italian NGO and its national cooperation body.

To try to find a way out of this impasse, a process of renewing the strategies of Doctorswith Africa CUAMM in Uganda was initiated in 2005:> New areas of intervention were sought (e.g. participating in healthcare initiatives in the

Acholi Lango region). > Sectors more consistent with the priorities identified at a national and international level

were developed or expanded (e.g. greater involvement and visibility in the HIV AIDSprogrammes).

> New sources of funding were sought (contacts initiated or reopened with the largeinternational agencies: ECHO, EU, USAID, DANIDA, SIDA, WHO).

At the same time, efforts were made to enhance the visibility of Doctors with AfricaCUAMM at the institutional levels at which the various humanitarian agencies and NGOsmeet, while also guaranteeing greater participation at the meetings that address the coun-try’s most important healthcare issues (AIDS, disability, healthcare in the conflict areas)and initiating a process of accreditation as members of the health commissions(Development partners, HSSP committee, etc.).The results of this process will probably not be visible in the short term.

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2 COUNTRY PROFILE

The political situation in Uganda remained stable during 2005. In the Acholi region, guerrilla actions and attacks on civilians by the LRA rebels continuedthroughout 2005, albeit discontinuously during the various months of the year. This yearfor the first time vehicles of humanitarian organisations were attacked, resulting in thedeaths of both expatriate and Ugandan staff.There critical Karamoja area has also seen a deterioration in security compared to 2004with a fresh upsurge of intertribal cattle raids, bandit attacks on villages and transitingvehicles, and clashes with military and militia detachments located in the region. Therehave been numerous deaths and injuries amongst civilians. The episodes have continuedintermittently throughout the year.At the present time solutions do not appear close to being reached in either of the inter-nal conflicts, which have very different natures and dynamics.On 23 February 2006, the first multiparty presidential elections will be held, an event thatis causing some concern and uncertainty regarding the future of the country and may cre-ate problems of security and stability.The key events in the field of healthcare in 2005 were:> Presentation of the new five-year national health sector strategic plan (HSSP 2005-2010).> The national epidemiological survey for HIV-AIDS.> Completion of the first stage of administrative decentralisation with the creation of 12

new districts.> Freezing of Global Fund Initiative funds following suspected fraud and shortages of funds.> A significant reduction of much of the international aid from various European countries

due to the country’s corruption and failure to respect human rights.

The two key documents for development of healthcare policies in the country are thePoverty Eradication Action Plan 2004-2008 of the Ministry of Finance and Economy andthe Health Sector Strategic Plan 2005-2010 of the Ministry of Health.The first takes account of the UN’s MDGs and is based on 5 principles: Better economic management in order to increase growth in gross domestic product from6 to 7%.Improvement in production, competitiveness and profitability.Consolidation of internal security, conflict solving and disaster management.Good governance.Human development (where there is a health component that takes account of MDG indi-cators).The second document addresses the health component of the PEAP. Amongst otherthings, it devotes particular attention to developing the concepts of decentralisation, pub-lic-private partnership and community participation in order to provide a better responseto the specific needs of the various situations. The key tool is effective delivery of theUganda National Minimum Health Care Package (a set of standard services and treat-ments in the various areas of healthcare) to reach specific targets and obtain precise out-puts (see Boxes).At present, the sectors considered to be strategic to Uganda’s development policies andwhich impact on the activities of Doctors with Africa CUAMM are the following:> Reinforcing and accelerating the decentralisation process.> Support for the public-private partnership policy.> Introduction of effective actions to assure the greatest degree of equity, with special

attention to the most vulnerable groups (including the disabled and people displacedby the Acholi – IDP conflict).

> Fight against AIDS, TB and Malaria.> Reinforcement of action to reduce maternal mortality rate.> Increase in efficiency to offset the effects of lack of resources (including human resources).

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Box 1.1 Targets for the PEAP health related outcomes by 2009

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

Base year 2000

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

> Percentage of children <1yr receiving 3 doses of DPT/Pentavalent vaccine accor-ding to schedule by district from 87% to 93%

> Total (GoU and PNFP) per capita OPD utilization from 0.72 to 1.0> Percentage of deliveries taking place in a health facility (GoU and NGO) from 24.4%

to 50%> Proportion of approved posts (HSSP I norms) that are filled by trained health per-

sonnel from 68% to 90%> Percentage of health facilities without any stockouts of first line antimalarial drugs,

Fansidar, measles vaccine, Depo Provera, ORS and cotrimoxazole from 40% to 100%> Couple Years of Protection from 223,686 to 494,908> Reduce the Case Fatality Ratio among malaria inpatients aged less than 5 years

from 4% to 2%> Proportion of TB cases that are cured from 62% to 85%

Base year 2003/04

3 STRATEGY OF DOCTORS WITH AFRICA CUAMM

In July 2005, the first Technical Workshop for CUAMM executive was held in Kampala,during which the following strategic country guidelines were established. These were con-firmed by the board and management of Doctors with Africa during the meeting withcountry representatives held in Padua in November 2005:> Support for districts and subdistricts with limited public medicine resources, data col-

lection and actions in the strategic sectors of TB, HIV, Malaria.> Support for diocesan health structures in the context of the public-private partnership

policy.> Development and support for training activities for health staff with management capa-

cities in cooperation with the science faculty of the UMU University, Nkozi.> Development of activities and research areas in the field of public medicine, HIV, TB

and Malaria, and health administration (Health Management and Financial Health).> Development and reinforcement of actions in strategic sectors of HIV, TB and Malaria.> Consolidation and development of actions in favour of the most vulnerable groups

(disabled, epileptics, etc.).> Reinforcement and development of cooperation with other international and national

NGOs.> Identification of potential local financers (e.g. decentralised negotiation with UNICEF,

WHO, EU) to reduce the share of projects funded by Italian Cooperation to less than40%.

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4 PROJECTS IN PROGRESS

At present Doctors with Africa CUAMM operates in 6 districts located in 3 geographicalareas:> The West Nile region> The Central region> The Karamoja regionIn the Mpiji district it also cooperates with the ’Uganda Martyrs University’ of Nkozi.

4.1 Coordination of non-profit and public-private partnership health services inUganda

This three-year project funded by the Italian Ministry of Foreign Affairs (MAE) and theItalian Episcopal Conference (CEI) began in June 2002 and ended on 26 June 2005. Ittherefore completed the last six months of its activity during 2005.The project consisted of two components:1. Support for processes of reorganisation of health services in the Arua and Nebbi

Dioceses through technical assistance for the diocesan health coordination offices.2. Support for the activities of the Uganda Catholic Medical Bureau (a body responsible

for policy, coordination and representation at the Ministry of Health for all health servi-ces of the Catholic Church in Uganda) by appointing a doctor to the position ofAssistant Executive Secretary.

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

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

in building activities).

Summary of activities carried out:The various activities established by the project and initiated in previous years were com-pleted in the period January-June. The following objectives were achieved during the three years of the project:> The Ugandan doctor provided support to the executive secretary of the UCMB for acti-

vities relating to development of the national public-private partnership policy, coordina-tion between the diocesan health offices and the district health offices, and all initiativesto improve the quality of services provided by the Catholic Diocese’s health facilities.

> Technical support and coverage of the management costs of the HealthcareCoordination Offices of the Diocese of Arua and Nebbi were assured. The DiocesanCoordinators regularly attended the periodic meetings for programming and monitoringthe activities in the District Health Offices.

> The Health Councils of the two dioceses were set up with their own articles and regu-lations.

> In each diocese, a diocesan policy document was approved; and the control and poli-cy organisations, their members and their mandate were established.

> The procedure for annual presentation of an action plan, a budget of expenditure, anannual financial and activity report and balance sheet approval was regulated.

> The boards of directors were rendered operative in all hospitals and the governingbodies and their members and mandates were established. The same was done for theperipheral health units.

> Articles and regulations were established for all the structures.

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The following policies/strategies were introduced at the level of peripheral structures:• a unified employment and salary policy for all healthcare staff employed• unified financial statement procedures• unified activity report procedures• unified procedures for planning expenses and activities• unified drug procurement procedures• unified data collection procedures• census and monitoring of human resources at a national level• introduction of minimum accreditation criteria on the basis of efficiency and quality of

services• unification of services provided and their quality• unification of articles and governing bodies in peripheral units, including definition of

responsibilities and roles• representativeness of PNFP at the level of local and national authorities and institutes

(respectively, districts and subdistricts, and Ministry of Health and Education).

> A regular supply of drugs, consumable materials and basic equipment was assured toall facilities.

> 5 health centres were rehabilitated to different degrees.> 49 health operators were trained in various qualifications through the assignment of

study grants.> On-the-job training of healthcare staff was guaranteed during the three years of the

project through a calendar of seminars and theme courses.> All the units were regularly supervised every three months through an on-site training

programme. Special attention was given to correct prescription of therapies and use ofdrugs, the hospital disease control procedures (sterilisation, aseptic procedures, dispo-sal of infected materials), patient management, quality of laboratory tests, data collec-tion.

> The diocesan coordinators took part in all the peripheral unit board meetings to assu-re correct application of the employment procedures and to provide support in mana-gement of resources and finances.

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

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4.2. Support for diocesan coordination offices in Arua and Nebbi

This is a small project based on local resources with the objective of guaranteeing suffi-cient funds to allow the two diocesan health coordination offices of Arua and Nebbi tocontinue their activities of supervising, monitoring and coordinating the health units andliaising with the UCMB central offices.

Staff of Doctors with Africa CUAMM employed:> none

Summary of activities carried outFunds were guaranteed to cover the following:> The salaries of the two diocesan coordinators, a secretary and a driver.> The basic management costs of the two offices.> The expenses of the essential supervision programme. > Organisation and transport at cost price of drugs for the peripheral units and the assu-

rance of a vehicle at the Nebbi office.> The offices of Doctors with Africa CUAMM of Arua, Nebbi and the central coordination

in Kampala assured logistic support for the two diocesan coordinating offices.

4.3 Support and expansion of medical rehabilitation services in Northern Uganda

This is a three-year consortium project (AVSI, Doctors with Africa CUAMM and CCM) car-ried out by Doctors with Africa CUAMM in the Arua and Nebbi districts. The projectreceived financial contributions from the Italian Ministry of Foreign Affairs (MAE), privateindividuals and Doctors with Africa CUAMM Groups. It began in September 2003. Theproject is made up of three components:1. Development and support for orthopaedic workshops and physiotherapy departments

at the Arua and Nebbi district hospitals.2. Reactivation and expansion of the Community-Based Rehabilitation activities.3. Reactivation and support of clinics for treatment of epilepsy and provision of drugs.In 2005 it entered its second year of activity. The initiatives in progress were consolidat-ed and initial information was analysed with a view to developing a potential future proj-ect currently at the first draft stage. The project was very well received in the districts bythe political authorities, the health administration and the hospitals of the two districts.

Staff of Doctors with Africa CUAMM employed:> Stefano Vida (project leader, physiotherapist)> Patrick Pariyo (project assistant in Arua)> Francis Abdekane (project assistant in Nebbi)> Silvio Delle Vedove (physiotherapist on 3-month mission)> Dr Antonio Loro (orthopaedist, evaluation mission 20-28 February 2005)

Summary of activities carried out:> The regular convening of district coordination committees for disabilities was facilitated.> Construction and rehabilitation work on orthopaedic workshops and physiotherapy

units of the hospitals of Arua and Nebbi was completed. The structures complete withrequisite equipment were handed over to the local authorities at an opening ceremonyheld in May 2005 and attended by a delegation from the Italian Embassy in Uganda.

> The work of organising and setting up equipment in the orthopaedic workshop in Arua,which will be the regional hub for the production of prostheses, artificial limbs andorthopaedic aids, was performed under the technical expertise of physiotherapist Silviodelle Vedove on assignment from January to March 2005.

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> The first artificial limbs were produced and fitted during the second half of the year.> Dr. Loro went to the hospital in Arua on assignment from 20 to 28 February to evalua-

te the technical and logistic capabilities and the availability of instruments and equip-ment in the hospital with a view to starting up specialist orthopaedic surgery activitieswith a high level of excellence.

> 53 healthcare workers were trained in disability rehabilitation at various professionallevels.

> Data collection was completed for the study of the prevalence of the various forms ofdisability in the districts of Arua and Nebbi and the data were processed. More than10,000 people affected by disability were identified, a prevalence of about 5% of thepopulation. At the same time, the referral system for patients affected by forms ofmotor disability was consolidated at the two district hospitals’ therapy and rehabilita-tion centres.

> The orthopaedic operations performed in 2005 at the Arua hospital were facilitated,coordinated and organised.

> 20 community rehabilitation workers were trained in the use of appropriate technolo-gies and instruments for rehabilitation and support of the disabled at a village level.

> Equipment was distributed to community rehabilitation workers to help them carry outtheir work.

> Supervision was carried out regularly at health centres and at the sites where the com-munity rehabilitation workers operate and where mobile physiotherapy clinics are orga-nised.

> A peripheral centre for basic physiotherapy and rehabilitation was set up in the hospi-tals of Maracha (Arua district) and Angal (Nebbi district).

> Meetings were organised with the local authorities and radio programmes and messa-ges planned to promote an awareness of the problem of disability within the commu-nity.

> 11 clinics were opened for epileptic patients in the districts of Arua and Nebbi and sup-plied with drugs for the treatment of more than a thousand patients.

> A register was drawn up for epileptic patients and the initial data gathered on the illnessin the two districts, revealing an incidence of 0.5%.

4.4 MAE-UNICEF project: “Support to the Health Sector Strategic Plan (HSSP) of theGovernment of Uganda 2000-2005”

The project to support the UNICEF country programme has completed its second year ofactivity. It is a multibilateral project comprising 3 action components: 1. Support with state budget funding (contribution to the Poverty Alleviation Fund).2. A direct management component through the presence of an expert at the Uganda

Ministry of Health. 3. Support for UNICEF’s national programme in Uganda. This last component involves support for 8 districts with the cooperation of 3 ItalianNGOs. Doctors with Africa CUAMM operates in 4 of these districts: Arua, Nebbi, Yumbeand Moroto.The project entails direct funding for the district administrations and a technical supportrole provided by the NGO. The sectors of activity include: HIV/AIDS, TB, Malaria,Immunisation, Birth registration. The activities for each district are carried out only insome counties. The only exceptions are the vaccination campaign actions which havedistrict-wide coverage. Alongside these specific areas of activity, there is an undertakingto provide Technical Support for the district health offices, particularly in the processes ofprogramming and monitoring of healthcare information activities and systems.The planned activities are those established by the UNICEF country programme which willend in December 2006.

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Staff of Doctors with Africa CUAMM employed:> Antonio Sebben (technician) in Arua> Dr Luigi Cicciò in Arua > Innocent Komakech in Yumbe > Dr Elisabetta Fusco in Moroto> Dr Enrico Tagliaferri in Nebbi

Summary of activities carried out:> Technical support was guaranteed for the district health offices of Arua, Nebbi, Yumbe

and Moroto through participation in the planning sessions for all district healthcare acti-vities (setting out of action strategies, drafting of annual plans and budgets) and draf-ting of activity reports.

> Technical support was guaranteed in management of the vaccination programme in thecommunity and collection and processing of vaccination coverage data. Constant techni-cal and logistic support was assured for the national mass vaccination campaignsagainst tetanus and measles and distribution of vitamin A amongst the child population.

> Survey support was provided for vaccination coverage conducted by the WHO and theUgandan ministry of health.

> The Technical Advisers took part regularly in supervision of the peripheral units and thesubdistrict bases.

> Actions were performed to support the VCT and PMTCT services (training of healthca-re staff and promoting an awareness within the community of the use of the services),assuring coordination with similar activities conducted by other programmes. A pro-cess of expanding these services at a district and subdistrict level was initiated.

> Training courses for birth registration (BDR) staff were organised and facilitated. Thenumber of counties involved in the programme was extended and a computerised datacollection system was introduced.

> Computerisation of the national information system (HIMS) was further developed atboth district and subdistrict levels through active participation in the staff training andsupervision of peripheral units and organisation and analysis of data.

> Control of domiciliary malaria treatment activities was guaranteed, with special atten-tion to correct distribution of drugs and drafting of the monthly reports.

> Support was provided to the Subdistricts to increase access for adolescents toReproductive Health services.

> Help was given to the district offices to develop the national CB-DOTS policy for con-trol and treatment of TB.

4.5 HIV/AIDS and TB Control in West Nile - Expansion of PMTCT services andstrengthening of DOT strategy in Arua and Yumbe Districts

The project began at the end of October 2004 and ended on 31.12.2005. Funded by theagency AIM (The AIDS/HIV Integrated Model District Programme) with USAID funds, itinvolved activities in the West Nile region in the Yumbe district and in the Marcha andKoboko health subdistricts of the Arua district. Continuation is not planned as the agencyAIM closed down its activities in Uganda at the end of 2005.It consisted of 2 components:a. Setting up 3 PMTCT centres (prevention of mother-to-child transmission of HIV) at the

Maracha and Yumbe hospitals and the Koboko Health Centre.B. Support with implementation of the DOT (Directly Observed Treatment) Strategy in TB

control in the entire Yumbe district and the Maracha and Koboko health subdistricts ofthe Arua district.

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

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

Summary of activities carried out:> In the two districts of Arua and Yumbe the activities were planned and coordinated with

the district committees for HIV-AIDS. > In the Yumbe district, the local NGOs and CBOs (Community Based Organisations)

were supported in promoting VCT awareness within the community.> In the Yumbe and Maracha hospitals and in the Koboko health centre, seminars on the

themes of PMTCT and TB were organised for healthcare staff.> Training on the themes of PMTCT and TB and on the means for assuring effective refer-

ral of patients to the diagnosis and treatment centres was provided for staff in the peri-pheral units in the Yumbe district and the Maracha and Koboko subdistricts.

> Training was organised for the TB control programme managers at a subcounty leveland for laboratory technicians in the TB diagnosis referral centres in the two Marachaand Koboko subdistricts.

> Seminars on TB-CB DOTs treatment criteria were organised for village healthcare wor-kers.

> Campaigns were organised to promote awareness of the issues of AIDS and TBamongst the population and to provide information on available services through radiomessages and informative material.

> Equipment and furnishings were provided for the laboratories and HIV-AIDS clinics atthe Maracha and Yumbe hospitals and the Koboko subdistrict health centre.

4.6 Activities of prevention and support in HIV/AIDS and TB services at Angal andMaracha hospitals in Uganda

This is a small two-year project funded with a ? 20,000 budget by Caritas Antoniana asan initiative to complement the AIM and UNICEF projects. Here too there are two compo-nents, one in the HIV/AIDS sector and one in the TB sector. For both these sectors, inagreement with the hospital managements, attention was focused on actions to foster theprovision of healthcare services at a community level in villages.

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

Summary of activities carried out:> Follow-up support for mothers included in the PMTCT programme in the Maracha and

Angal hospitals.> Organisation and strengthening of domiciliary visits to AIDS sufferers in the Maracha

subdistrict and in the Padyere county and supply of drugs for control of opportunisticdiseases.

> Support for supply and distribution of antitubercular drugs in domiciliary treatment(DOTs).

4.7 Construction of new Health Centre III at Moyo in the Arua Diocese

This is a project funded by the government of Navarra in Spain through Medicus MundiNavarra. It comprises a single structural component: construction of the new diocesanhealth centre in the city of Moyo.The project was officially concluded with the handing-over ceremony for the buildings inNovember this year. The work began in mid 2004.

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Staff of Doctors with Africa CUAMM employed:> Antonio Sebben (in service in UNICEF project)

Summary of activities carried out:> Construction of the level III health centre in Moyo was completed, including:> Outpatient clinics including laboratory, pharmacy with warehouse, medication and the-

rapy room, mother/child centre.> Inpatient and maternity ward with delivery room.> Toilets and bathrooms.> An incinerator.> Two buildings for housing staff with kitchens, toilets and bathrooms.> Complete enclosure around the complex.> Solar electrical system.> Plumbing system for collection of rainwater.

4.8 Lugazi initiative

The “Lugazi initiative” is a commitment to long-term cooperation with the Lugazi Diocesein the reorganisation and revitalisation of diocesan healthcare services (3 hospitals and 7peripheral health units). A number of different projects with various forms and sources offunding co-participate with this aim.The initiative was started up in January 2001 principally as support for the Naggalamahospital. Over time it was joined by other more structured and traditional projects (theproject funded by Fondazione Cassa di Risparmio di Padova e Rovigo began in 2002 andthe project promoted and co-funded by the Italian Ministry of Foreign Affairs (MAE) andCEI began in 2004) and saw greater involvement on the part of the health administrationsof the two districts of Mukono and Kayunga, where the Lugazi diocese is located.At the beginning of 2005, a major new partnership will begin with Mildmay Clinic, thelargest institute in Uganda for AIDS treatment and prevention, for the purpose of consol-idating the HIV AIDS clinic at the Naggalama hospital through funds from CDC of Atlanta.

In addition to MAE, CEI and Fondazione Cassa di Risparmio di Padova e Rovigo, fundingwas provided by the following:> Doctors with Africa CUAMM and private donations (for the salaries of Italian medical

staff and other items of current expenditure).> Doctors with Africa CUAMM Groups.> Private resources obtained in Uganda (Camilliani).> Tuscany region decentralised cooperation.

Staff of Doctors with Africa CUAMM employed:> Dr. Elisabetta Ruckstuhl> Dr. Monica Imi

Summary of activities carried out:> Staff housing was completed, handed over and opened in May 2005.> The HIV-AIDS clinic in the Naggalama hospital was revitalised and the community ser-

vices for sufferers were initiated.> Cooperation began with the Austrian NGO DKA for adaptation of the plumbing, electri-

cal and sewage systems at the Naggalama hospital.> The HIV-AIDS clinic at the Nyenga hospital was revitalised, antiretroviral therapy servi-

ces introduced and territorial and domiciliary care activities strengthened. Drugs wereprocured for antiretroviral therapy and for treatment of opportunistic diseases.

> Technical support was assured for the three hospitals and 7 peripheral health units of

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

> Drugs, equipment and essential consumable materials were procured for the threehospitals.

> Mobile radiological equipment was procured for the Naggalama hospital.> A € 12,000 contribution was given for the purchase of an ambulance for the

Nkokonjeru hospital.> Healthcare support was strengthened in the Buvuma Islands with the presence of a

qualified obstetrician.> Technical support was guaranteed to the district supervisors for TB and Leprosy in

Mukono and Kayunga.> An Italian doctor specialising in surgery provided voluntary service for 15 days in the

Naggalama hospital in June.

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

This is a project funded by Fondazione Cassa di Risparmio di Padova e Rovigo (totalcommitment of € 516,450,000) which involves a radical reorganisation of the Naggalamahospital and construction of new buildings. The goal is to improve accessibility, effective-ness and quality of services provided by the Naggalama hospital, particularly in the sur-gical and mother/child areas. The first stage ended in 2005 with completion of all the civilworks, which were handed over and opened at an official ceremony in May. A secondrestructure stage has already received funding and the activities began in the last quarterof 2005.

Staff of Doctors with Africa CUAMM employed:> Dr Italo Nessi (project leader provided through other Doctors with Africa CUAMM pro-

jects)> Engineer Jimmy Araba Parata (director of works)> Engineer Silver Martin Oucul (site manager)

Summary of activities carried out:> Construction of a new adult ward (male and female sections) which will hold a total of

70 beds.> Remodelling of an existing building to create two apartments for senior hospital staff.> Construction of a new block of 5 apartments for hospital staff.> Purchases have been made to supplement equipment and consumable materials for

inpatient wards.> Coordination has been assured with Austrian NGO DKA engaged to perform building

work on the hospital’s new sewage system.> Opening of new buildings and handover to diocese authorities and hospital administra-

tion.

4.10 Strengthening of health services in the Lugazi Diocese – Project for theNaggalama Hospital – Stage 2

This is the second stage of the project funded by Fondazione Cassa di Risparmio diPadova e Rovigo (funding for € 280,000). This stage likewise involves remodelling workand the construction of new buildings in the Naggalama hospital over a period of 2 yearsto complete the refurbishing work carried out during the first stage. The work comprisesremodelling of the paediatric ward, construction of covered connecting walkways

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

Staff of Doctors with Africa CUAMM employed:> Dr Italo Nessi (project leader provided through other Doctors with Africa CUAMM pro-

jects).> Engineer Silver Martin Oucul (works director).

Summary of activities carried out:> Completion of plans for civil works and submission to hospital administration for

approval.> Planning calendar of works.> Start-up of procurement of materials and organisation of site, warehouses and recruit-

ment of teams of workers.> The building work will begin in January 2006.

4.11 Strengthening of health service offerings in the Lugazi Diocese – Uganda –Improvement in quality and optimisation of costs of services

This is a three-year project (total funding € 952,425) funded by the Italian Ministry ofForeign Affairs, CEI, private donors and Doctors with Africa CUAMM Groups. It began on1 April 2004. It involves support for processes of reorganisation of health services in theLugazi Diocese through support for the diocesan healthcare coordination office. This proj-ect, like the analogous project to support the Arua and Nebbi Dioceses, is part of thenational public-private partnership healthcare policy and promotes integration of dioce-san healthcare services in district health systems.

Staff of Doctors with Africa CUAMM employed:> Dr. Italo Nessi (project leader)> Dr. Nathan Onyachi (surgeon, currently assigned to Naggalama Hospital)> Engineer Jimmy Araba Parata> Engineer Silver Martin Oucul (responsible for building activities in this project and those

funded by other projects in Lugazi Diocese as of May 2005)

Summary of activities carried out:> The project-leader doctor and the diocesan healthcare coordinator regularly took part in

all activities of programming and coordinating the healthcare activities in the Mukono andKayunga districts, particularly those concerning mother/child health, HIV/AIDS, informa-tion flow management and review of charge systems in the diocesan health units.

> Technical and material support was assured to the diocesan healthcare coordinationoffice (supply of equipment, consumable materials, transport vehicles for the supervi-sion activities).

> Support was guaranteed for the activities of coordinating the entire private non-profithealth sector.

> Technical consulting was guaranteed to the Diocesan Health Council and the DiocesanHealth Assembly.

> The Diocesan Health Plan for the new financial year and the Five-Year Diocesan HealthPlan were drawn up.

> Financial management based on cost centres was introduced in the three hospitalstogether with a manual on staff employment procedures in the peripheral units.

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> All health units were given their own articles of association, management bodies withterms of reference and mandates for individual members.

> Financial backing was guaranteed for pay rises of staff in health units as part of the har-monisation of pay policies and improvement of qualifications of operating staff.

> IT equipment (computers and printers) was provided to hospital administrations and tothe diocesan coordination office to assure full operativeness and to improve data col-lection and processing.

> Materials and equipment were purchased for the activities of on-the-job training ofhealthcare staff.

> Clinical and diagnostic equipment was purchased for the three hospitals and the sup-ply of drugs, consumable materials and essential equipment for the peripheral healthunits was guaranteed.

> Remodelling of the Nkokonjeru hospital outpatient building was completed.> 19 courses, seminars and meetings for diocesan and district healthcare staff were

organised during the year.> 18 study grants for various clinical or management/administrative training courses

were guaranteed for staff of diocesan health facilities.

4.12 Veneto region health authority project – Naggalama hospital

The arrival of an obstetric specialist marked the beginning of the cooperation projectbetween Naggalama hospital and the Este and Rovigo area health authorities (Italy).This mainly involves support for obstetric-gynaecological activities in the hospital,improvement in referral systems between the community and the hospital in the moth-er/child sector, and strengthening of the clinical and surgical areas of the hospital bysending specialist staff (with tasks that include training). The project officially began atthe end of October 2005 with the arrival of the specialist gynaecological doctor (proj-ect leader).

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

Summary of activities carried out:> The activities of reorganising the hospital’s obstetric/gynaecological department have

begun.> The first on-site training activities of staff involved in maternity treatment have begun.

4.13 Uganda Martyrs University (UMU) project: Working for a New Generation ofHealth Managers

Doctors with Africa CUAMM began cooperating with the Catholic University of Nkozi(Uganda Martyrs University) in 2000, providing technical support, teaching staff andmaterial resources for the Department of Health Sciences courses. In 2005 theDepartment was upgraded to Faculty in view of the quality of the courses offered and thevolume of the cooperation activities and research carried out. A second stage of supportfor the faculty by Doctors with Africa CUAMM is under way with a project covering a peri-od of 3 years, up until December 2006. The total funding for the new stage is ?882,280.00, of which ? 523,300.00 is provided by the Italian Episcopal Conference (CEI)and ? 358,980.00 by Doctors with Africa CUAMM. The project also received funding fromthe Cariplo Foundation through Gruppo Medici con l’Africa Como Onlus and from sever-al municipalities in the province of Vicenza through Gruppo Cuamm con Sara per l’AfricaOnlus.

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

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

chase of teaching materials).2. Scientific research and publication activities (operational research, consulting, publica-

tion of a scientific journal).

Staff of Doctors with Africa CUAMM employed:> Dr Bikaitwaha Maniple, project leader and head of faculty> Dr John Odaga, lecturer and researcher> Dr Vincent Bwete, lecturer and researcher> Dr Maurizio Murru, visiting lecturer> Dr Luigi Cicciò, visiting lecturer

Summary of activities carried out:> In January the Science department was raised to the level of faculty and Dr Maniple

was appointed dean.> The Science faculty received recognition in 2005 as the best university department for

its various activities and services.> 79 students have received diplomas and certificates in the various courses offered.

Table 1: Students completing the various courses during academic year 2004-2005Course Diplomas awarded in 20051. Certificate in Health Services Management 202. Diploma in Health Services Management 43. Diploma in Health Promotion and Education 34. Advanced Diploma in Health Services Management 215. Advanced Diploma in Health Promotion and Education 206. Master of Science in Health Services Management 11Total 79

> A new Certificate in Health Promotion and Education course has been opened.> The following numbers of students have enrolled on the various courses in the acade-

mic year 2005-2006:

Course Enrolled in 20051. Certificate in Health Promotion and Education 152. Certificate in Health Services Management 193. Diploma/Advanced Diploma in Health Services Management 154. Diploma/Advanced Diploma in Health Promotion and Education 425. Master of Science in Health Services Management 15Total 102

> The faculty has engaged a doctor from the Public Medicine School of the University ofModena to participate in the Primary Health Care, Health Policy, and Planning andManagement modules of the Public Health Masters Degree.

> Doctors with Africa CUAMM has provided study grants for the following 9 candidates

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Course Candidates sponsored in 2005

1. Diploma/Advanced Diploma in Health Services 6Management2. Diploma/Advanced Diploma in Health Promotion 1and Education3. Master of Science in Health Services Management 2Total 9

> The annual faculty conference entitled “Reducing maternal mortality in Uganda” washeld in November 2005 with the support of CUAMM.

> 14 laptop computers have been obtained for masters course students.> Textbooks have been provided free of charge to masters course students.> Expenses have been covered for field research and data collection activities for the

purposes of writing theses for the various courses.> Research studies on the organisation of human resources in hospital wards and the

attitude of healthcare workers towards the issues of HIV-AIDS have been funded.> Expenses have been covered for participation in meetings and seminars by faculty

staff.> Publication of the faculty’s journal “Health policy & development” has continued to be

published. It is now online on the website www.umu.ac.ug/hpdjournal and is affiliatedto Bioline.

> The faculty received the Makerere University’s Vice Chancellor’s Innovative AcademicExcellence Award with a cash prize of $ 8,000.

4.14 Primary Eye Care Project

The Primary Eye Care Project began in 2001 and is funded by an Italian organisation (MAC– Movimento Apostolico Ciechi) engaged in providing support to the blind. The aim of theproject is to guarantee basic eye treatment to the population in the dioceses of Arua andNebbi (West Nile region), Lugazi (central region), and Moroto and Kotido (Karamojaregion). 2005 will be the last year in the first 5-year period of cooperation between Doctorswith Africa CUAMM and MAC and a second extension of funding and activities is alreadyplanned for a further 5 years. Funding for each year is about ? 26,000 established accord-ing to the plan of activities.The project covers 7 hospitals and 36 rural dispensaries.Doctors with Africa CUAMM’s contribution to the project comprises the activity of tech-nical support, supervision and control through Doctors with Africa CUAMM’s staff work-ing in the same areas on other projects.The project has the following components:> Organisation of mobile eye clinics.> Material, financial and logistic support for eye surgery sessions.> Production and sale of glasses at subsidised prices.> Supply of ophthalmic drugs to all diocesan health units.> Prevention of neonatal ophthalmic diseases.

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

Summary of activities carried out:> Support for activities of 27 eye surgeries with more than 7,000 examinations.> Purchase and distribution of ophthalmic drugs for all 7 hospitals and 36 dispensaries

in the 5 dioceses. More than 11,000 eye infections have been treated.

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> Purchase of lenses and consumable materials for the Ediofe optical laboratory (Aruadistrict, West Nile).

> Financial backing for payment of salaries of Ediofe optical laboratory technicians.> Financial backing for payment of incentives for obstetricians involved in activities of

preventing neonatal eye infections.> Production and sale of glasses at subsidised prices (more than 700 pairs).> Financial and material support for eye surgery sessions (a total of 575 patients under-

went operations in Matany, Maracha and Arua hospitals).

4.15 Conformity Project “Support for diocesan hospital services in sectors ofmother-child health and correlated HIV/AIDS activities – Arua, Lugazi, Nebbi andMoroto Dioceses, Uganda”

This is a conformity project approved by the Italian Ministry of Foreign Affairs that allowsvolunteer doctors to be sent out from Italy with a registered contract. The project endedin November 2005 but has been extended to May 2006.The resources required for the activities come from private donors: Fondazione Cassa diRisparmio di Padova e Rovigo, Doctors with Africa CUAMM Groups and other privatecontributions.

Staff of Doctors with Africa CUAMM employed:> Dr Stefano Santini (Kampala, until February 2005)> Dr Paolo Giambelli (Kampala, from February 2005)> Dr Stefano Vicentini (Matany Hospital) > Dr Italo Nessi (Naggalama Hospital)> Dr Julian Kiwala (Nyenga Hospital) > Dr Enrico Tagliaferri (Angal and Nyapea Hospitals) > Dr Marina Anghileri (Maracha Hospital)

In addition to the above-mentioned Italian doctors, Dr Mario Marsiaj and Mrs ClaudiaMarsiaj worked in the Angal hospital without registered contracts for two periods of timeto a total of 6 months.

Summary of activities carried out:Lugazi Diocese Hospitals (Naggalama, Nkokonjeru and Nyenga)> Support was provided to hospitals for pay rises and incentives for obstetric staff. > In cooperation with the Ugandan organisation TASO, the first module of the counsel-

ling course was organised, attended by 15 staff members from the 3 hospitals.> 1 obstetrician from the Naggalama hospital was trained in communication/counselling

with paediatric patients at the Mildmay International Study Center.> The MCH services and paediatric and maternity wards received supplementary

drugs and consumable materials, particularly for prevention of opportunistic disea-ses.

> A doctor was sent to Nyenga hospital to coordinate the activities of the HIV-AIDS cli-nic, to improve data collection, the registration system and patient follow-up, and tobegin antiretroviral therapies.

> VCT and PMTCT services were further expanded in all three hospitals.> The HIV-AIDS clinic at Naggalama hospital was reorganised and support with drugs

and consumable materials was provided.> Cooperation with the community organisations for the fight against AIDS was also

strengthened.> 2 seminars for village health workers were organised to promote relations between the

hospital and the community.

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> Support for the HIV-AIDS clinic at the Nkonjeru hospital was guaranteed through thesupport of Intercare (UK).

> A project was started up at the Naggalama hospital in October with the aim of foste-ring and developing intra-hospital obstetric services and its links with the communitythrough the presence of a specialist Italian obstetrician.

Arua and Nebbi Diocese Hospitals in West Nile (Maracha, Angal and Nyapea)> Short refresher courses on the most significant mother/child and HIV/AIDS related

pathologies have been organised for nursing staff.> Drugs and other consumable materials have been purchased to supplement supplies

to MCH services and paediatric and maternity wards.> The PMTCT and VCT services have been further expanded. > HIV/AIDS clinics operate in all three hospitals. They offer services of counselling, psy-

chological support and treatment of opportunistic infections. Angal hospital also offersa service to support orphan children whose parents have died from AIDS.

> In all three hospitals a programme has been launched for domiciliary (community-based) treatment of fever and malaria within the areas they serve.

> At all three hospitals audit processes are in operation for cases of maternal mortality.> At all three hospitals staff have been trained in management of antiretroviral drugs and

in patient treatment guidelines. > At all three hospitals the first antiretroviral treatments have begun.

Moroto Diocese Hospital in Karamoja (Matany Hospital)> Refresher courses have been organised for nursing staff. The themes covered have

included the principal mother-child pathologies.> The PMTCT and VCT services are operative at the Matany hospital.> Staff have been trained in management of antiretroviral drugs and in patient treatment

guidelines.> The first patients have been admitted to the AIDS clinic for antiretroviral treatment.> Cooperation with traditional midwives has been further developed.

Summary of PMTCT activities at the 7 hospitals in the project in 2004

PMTCTMaracha Angal Nyapea Naggalama Nyenga Nkokonjeru Matany Total

Mothers receiving 891 2,182 1,067 1,644 858 1,886 1,126 9,654pre-test counsellingMothers tested for HIV 891 1,020 484 1,188 786 1,657 717 6,743Mothers found HIV+ 14 29 21 76 56 148 17 361% mothers HIV + 2 3 4 6 7 9 1 5Mothers given ARV 7 7 21 36 14 26 9 120Mothers HIV+ 12 12 5 41 17 32 9 128who deliveredBabies given ARV 11 11 0 36 14 25 18 115

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

N. paediatric admissions No. deliveriesHospital Year Year Variation Year Year Variation

03 - 04 04 - 05 % 03 - 04 04 - 05 %Angal 6,962 7,052 1.3 1,489 1,675 12.5Nyapea 3,250 3,922 20.6 860 1,101 28Maracha 3,632 4,181 15.1 732 779 6.4Naggalama 2,955 3,620 22.5 1,299 1,612 24Nyenga 2,289 3,747 63.7 402 572 42.2Nkokonjeru 1,615 1,475 -9 729 840 15.2Matany 6,939 6,672 -4 687 1,085 57.9Total 27,642 30,669 10.9 6,198 7,664 23.6

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

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

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4.16 Technical support in Nakapiripirit District

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

Staff of Doctors with Africa CUAMM employed:> Dr John Mudusu

Summary of activities carried out:> The Doctors with Africa Technical Adviser cooperated with the District Health Office in

preparing the activity and budget plan for the new financial year and helped with theOffice organisation and management processes.

> Technical support was provided to all Health Centres in preparing annual action plans.> Consolidation of activity of the District Health Assembly, which draws together the

various public and private partners and the international NGOs engaged in the heal-thcare sector in the Nakapiripirit District.

> The Doctors with Africa Technical Adviser assisted the District Health Office in imple-menting its activities and in seeking new forms of collaboration and financing withvarious cooperation agencies (UPHOLD, HSPS, CHDC, UNICEF, AMREF).

> The study document on the potential new healthcare strategies for the specific contextof Karamoja was officially presented with a view to defining concrete action policies.

> Support was given to the district for organisation and implementation of the vaccina-tion campaigns, the national programme for the fight against TB and the developmentof HIV-AIDS services.

5 NATIONAL COORDINATION - KAMPALA

The National Coordination in Kampala serves to represent Doctors with Africa CUAMM in allthe institutional offices in Uganda, towards the international and national cooperation anddevelopment agencies and towards other Italian and foreign NGOs operating in the country. It plays a role of liaising and coordinating between the various projects, promoting activitiesand developing new initiatives, projects and partnerships and seeking funds and resourcesfor implementing the various initiatives. It also has important administrative and managementfunctions for the projects under way, for human and instrumental resources and for the logis-tic structures present in the various areas of the country. In 2005 the Guest House buildingunderwent radical refurbishing as well as operations of routine and reactive maintenance.Other work was carried out in order to transfer the offices from the old location to the two-floor building behind the headquarters of Doctors with Africa CUAMM. A process of upgrad-ing the communication systems was initiated. These operations were necessary to adequate-ly accommodate the increase in staff in the projects sector and the administration andaccounting sector. Maintenance and restoration work on the former office building is plannedin 2006 to transform it into accommodation for the country representative TA.The coordination in Kampala acquired two new figures in 2005 to strengthen cooperationand to design projects and to revitalise the network of contacts and relationships with theUgandan institutions, other international agencies and NGOs.

Staff of Doctors with Africa CUAMM employed:> Dr Paolo Giambelli (Country Representative) > Dr Peter Lochoro (TA for Country Representative)> Simona Schiava (Project Assistant)> Tito Dal Lago (Administrator/logistician)> Nicoletta Cavaliere (Assistant accountant)

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Summary of activities carried out:Representation activities and External partnerships> Relations with various partners, cooperation and development agencies and local and

international NGOs have been looked after and maintained. The following are the mostrepresentative: Italian Embassy, Nunziatura Apostolica, UTL (Local Technical Unit) ofItalian Cooperation, Ugandan Ministry of Health, Uganda Catholic Medical Bureau,European Union, ECHO, DANIDA, SIDA, Japanese Embassy, Irish Embassy, USAID,WHO, OCHA, UNDP, UN Human Rights Commissions, International Red Cross, MSF,MMN, AVSI, COOPI, CESVI, ISP, SVI, District Authorities, Dioceses, Uganda MartyrsUniversity.

> Meetings called by the following were regularly attended:• ECHO• EU• OCHA• Development Partners• UCMB• UTL• WHO

> The country representative regularly took part in the meetings of the following: • Uganda Stop TB Partnership of which Doctors with Africa CUAMM is a member.• The Uganda Aids Commission.• The Joint Review Mission of Development Partners.

Logistic/administrative activities> Accounting of all projects was assured on a quarterly basis. The funds were used proper-

ly without residual shares. Irregularities and delays in provision of funding were experien-ced throughout the year, and this had consequences for the overall management ofaccounting and for the coverage of management costs of the planned activities.

> Logistic and administrative support was assured to all Doctors with Africa CUAMMprojects in progress, to the district offices where Doctors with Africa operates, to thenational TB programme, to the diocesan hospitals that are partners of Doctors withAfrica CUAMM, and to missionary institutes.

> Logistic and accommodation support was provided to voluntary staff and to the mis-sions sent by the Padua health authority to evaluate cooperation projects with theNsambia-Kampala hospital.

> The employment manual and regulations for local staff was reviewed, the job descrip-tions written for each position and the responsibilities of all figures regulated.

> The records of expatriate and local staff of Doctors with Africa CUAMM were reorganised.

Accommodation activities (Guest House)> The Doctors with Africa CUAMM Guest House accommodated 316 guests in 2005 with

a total of 1,235 days’ accommodation.> The staff shifts were reorganised and rationalised.

Project supervision activity> Regular supervision visits to all projects were assured. In particular, regular supervi-

sions of the Naggalama hospital works sites were carried out.

Planning activities> The following projects were drafted and presented:> The project for post exposure prevention (PEP) of AIDS in a hospital environment in the

Nsambia and Nebbi hospitals was drafted and submitted to the Veneto region’s decen-tralised cooperation agency as a consortium with the hospital of Padua.

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> Completion and review of the project promoted for the West Nile diocese currently atthe preliminary stage.

> Completion and review of the project for the UMU University in Nkozi currently at thepreliminary stage.

> Drafting of the project proposed to the EU in a consortium with AISPO and UMU forPEP in all health facilities of 4 West Nile districts: not approved.

> Drafting of project proposed to ECHO for support to health facilities in the Oyam coun-ty, Apac district: reviewed in accordance with EU funding policy.

> Drafting of project to propose to Japanese embassy to support orthopaedic workshopat the Arua regional hospital.

> Review and redrafting of project promoted to support the Moroto and Kotido diocesesfor submission to Italian Cooperation.

> Participation in completion of drafting of the project proposed to the decentralised coo-peration agency of the province of Trento for support to the Moroto diocese.

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

Training and research activities> A research study was initiated on the impact of AIDS mother-child contagion preven-

tion services in cooperation with AVSI for submission to the AIDS 2006 world congressto be held in Canada.

> Feasibility study and initial data collection for the study of operational research on TBwith just two expectorate samples in cooperation with WHO.

> In July 2005 the first Technical Workshop was organised for Doctors with AfricaCUAMM staff with management functions operating in Uganda.

> The periods of participation of the JPOs in Doctors with Africa CUAMM projects in theWest Nile region and in the Matany hospital were organised, as was participation of theJPOs in health management course modules held at the UMU university in Nkozi.

HUMAN RESOURCES SECTOR

GENERAL FRAMEWORK

Working Personnel

Recruiting and Selection

Training and Preparation

Monitoring and Evaluation

Documentation Center

ASSOCIATIVE LIFE

Student college

Information Meetings

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GENERAL FRAMEWORK

Working in Africa is today a difficult and complex challenge, requiring answers as muchdifficult and complex, in terms of general strategies, analysis, research, knowledge of thereality and of the problems, organizations, motivations and passion.This implies that Doctors with Africa Cuamm counts mainly on human capital, the mostimportant investment the organization can make. The future of Doctors with AfricaCuamm is intimately linked to this kind of investment that, as we know, gives fruit in longor medium term.In the 2000 Political Document we state: “In health care, the development of profession-al expertise and managerial skills is one of the necessary ways to strengthen systems andturn them towards sustainability. The best result cooperation can achieve is when it’s notnecessary anymore. This result will be possible if cooperation is considered mainly as animprovement of local resources, particularly human resources.This is a difficult, as well as fascinating and stimulating task.

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

1. WORKING PERSONNEL

In Pic. 1 we can observe the number and the status of the individuals working in our proj-ects during 2005. The total number has further grown as regards to the previous years.Together with health care positions, administrative and logistic roles are becoming moreimportant.

Pic. 1

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

Fig. 2

Pic. 3 emphasizes that the countries with the biggest number of workers at the firstexperience are Angola and Mozambique: this is due both to some JPO – Junior ProjectOfficer (Mozambique) and the type of on-going projects (Angola); Uganda instead is thecountry with the greatest number of African professionals. The africanization processhas started and is gradually bearing fruit. It has contributed to make our work increas-ingly appreciated by our local counterpart; it has facilitated the fruitful exchange ofexperience and skills among our local and expatriated personnel and the organism itselfhas been enriched.

Pic. 3

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In Pic. 4 we can observe how the majority of our workers is made up of expatriate per-sonnel with prior experience on the field (redeployed); the personnel at first experiencealso include specialising doctors (5 in 2005) who have not been involved in projects,rather have supported senior doctors, as doctors in training. The number of African professionals in our projects has maintained steady.

Pic. 4

2 RECRUITING AND SELECTION

Together with our ordinary recruiting methods, we have tried to undertake, with greaterdetermination and method, the path of active recruiting of strongly needed professionalspecializations. New channels have been activated, through which to make ourOrganisation better known, as well our proposal of training and our commitment forAfrica: among others, deserve mentioning the contacts with some Medical Associations,the Federazione Nazionale Ordine dei Medici (FNOMCEO), Postgraduate Schools ofMedicine, Health, and Hospital Centers, Associations and Societies of Doctors and sci-entific journals usually addressed to experts who are the most sought for the on-goingprojects.A process of focused recruiting has been started, by publishing vacancies on the Italianportals dedicated to the development cooperation and forwarding the vacancies to theAssociations of Doctors identified on the basis of the professional profiles required (e.g.Italian Society of Paediatrics).The web-site of the Organisation, renewed and re-launched in 2005, has become themain point of contact for those approaching Doctors with Africa Cuamm: beyond theoverview of the inspiring principles, the working modalities, the on-going projects, it hasproved a useful tool to provide basic indications for those willing to leave for the projects;it also functions as filter, as it highlight the professional profiles required for the projects.Furthermore, on the web-site a form is available for those who are interested, to be filledin in order to receive the useful information on the recruitment procedure. During the current year 534 individuals interested in our work have contacted us, 134 sentthe personal form and – after a first screening of the candidates based on the informationgleaned from the form – 92 people have been invited for an orientation interview in orderto start the training process.

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

Pic. 5

With regard to selection, an internal process has been initiated to improve the selectioncriteria and expand the selection tools in order to achieve an overall evaluation of theapplicants that emphasizes each individual’s skills and expertise to best identify andselect the most qualified people for each project.The desired output is a more accurate and comprehensive selection process that exam-ines all the different qualities necessary to carry out a professional activity in Africa.In addition to the usual learning evaluation tools and the personal monitoring of candidatesduring the Basic Course, this year a psychological questionnaire was introduced, which isadministered at the end of the basic course, under the supervision of a psychologist, it ispresented to those who are interested and discussed individually during the final interview.Moreover, the evaluation group, composed of educators, recently returned volunteers andpsychologists, continues to concentrate on the identification of new evaluation tools and tothe formulation of the course final evaluation (see section on the Basic Course).In the case of experienced candidates coming from other organizations, we try to imple-ment an accurate selection process, organizing several meetings and interviews in orderto facilitate a reciprocal understanding between the individual and Doctors with AfricaCuamm as deeply as possible. Required references, of good quality and judiciously, arevery important and seriously examined.

3 TRAINING AND PREPARATION

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

Twenty-seven health operators (chosen after the Introductory Week) participated to theBasic Course 2004/05 (ended in May 2004).Among these, five left as specialized physicians, five as a specializing physician accept-ed in the Junior Project Officer project and one physiotherapist. Twenty-five people participated in the 2005/2006 Basic Course: 19 physicians, 5 nurses,1 physiotherapist. (Pic. 6)

Pic. 6

This year, besides maintaining our commitment to the several Postgraduate Courses inwhich we are involved and that are useful for “positioning” and qualifying the image ofDoctors with Africa Cuamm, we have undertaken an important initiative regarding thetraining of trained candidates departing for a period of service, which led to the prepara-tion of a CD “Guide for departing for a period of service and rules of behaviour’, includ-ing information on the destination countries and useful details for the departure.We have had 33 departures and 33 re-entries (Pic. 7), which have ensured a continuouspresence in the field.

Pic. 7

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The specific training offered by Doctors with Africa Cuamm (Basic Course, PostgraduateCourse in health services management, Master in health services management in Nkozi)surely improves the candidate’s theoretical preparation and is important in developing anunderstanding of the Doctors with Africa Cuamm intervention philosophy. However, it does-n’t completely satisfy the required professional standards, especially in the managementfield, both for clinical and public health. There are several workers who possess the require-ment of strong training in the field of health management, and the number is still growing.As many projects in progress require more detailed and targeted expertise, a large per-centage of our personnel is composed of “re-entries”, operators with working experienceacquired in poor countries.Out of 33 recent departures, 16 have been individuals beginning their first experience (ofwhom 5 are JPO - specializing doctors) and 17 were personnel with prior experience. Thedistribution among the different roles is shown in the chart below. (Pic. 8)

Pic.8

Pic.9

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This is the reason for the intensification of efforts and activities directed towards “young”doctors through the Junior Project Officer (JPO) project.This project aims to offer first experience operators, under the guidance of a “senior”expatriated doctor, a theoretical and practical preparation as adequate as possible inorder to satisfy required professional standards. Such “field training”, economically sup-ported by a scholarship that the specializing student maintains, could allow, at a latertime, a successful placement of the same doctor within the Health Cooperation Project. During the year five specializing doctors, engaged in hospitals or in Public Health projects inMozambique and Uganda, have departed. These experiences – still on-going – involve theUniversity of Modena – Reggio Emilia and the University of Torino for the Specialization inPublic Health, the University of Florence for the Specialization in Gynaecology andObstetrics, and the University of Padua for the Specialization in Internal Medicine. In October 2005, a doctor student in Public Health of the University of Padua returned,after eleven months of theoretical – practical training in Beira district (Mozambique) in aproject for the strengthening of the District Health System under the supervision of a proj-ect leader.During the year, we maintained contacts with several Italian Universities and ad hoc promo-tional material have been prepared and distributed in the Universities of Bologna, Florence,Milano Bicocca, Modena, Siena and Turin, where the year before we organized meetings toinform them of the initiative of the Graduate School Directors and its specialists.The initiative of Junior Professional Officer has also been promoted through the portalsdedicated to the specialists and has been presented to the Italian specialists in Pediatricsin the frame of the Italian Symposium of ONSP (Osservatorio Nazionale SpecializzandiPediatria), held in Sciacca (Agrigento) from 27 to 29 May 2005. The training value of theinitiative has been also recognized with the publishing of the training proposal in n. 3/2005of the ONSP Bulletin. Moreover, in the second half of the year, the basis for the collaboration of the PediatricClinic and the School of Specialisation in Pediatrics of the University of Padova, aimed atoffering some specialist the opportunity of a period of theoretical – practical training inAfrica to some specialists. Agreeing on the need for a tailored training for those who arewilling to participate to the initiative, we have decided to organize a training course to pro-vide some tools to understand the context where the specialists may be sent to, as wellas some basic elements for the treatment of the main pediatric pathologies of the devel-oping countries (see later on).

3.1 Training Courses detailed presentation

Pic. 10

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TRAINING “BASIC COURSE” FOR HEALTH OPERATORS IN DEVELOPING COUNTRIES

In 2005 the training course has been carried out, following an active methodology andconstituted of four weeks modules and a conclusive seminar. Apart from the issues relat-ed to the health cooperation programmes, specific topics related to anthropology, ethicsetc have been included. The course has dealt issues mainly on public health, the organisation and the manage-ment of health services, both at the local level and at the hospital level.The course has training purposes as well as aims related to recruitment and knowledgeof the candidates: the first step in the recruitment is represented by the interview (and bythe psychological test), which is preceding the step from the introductory week, broaderand more general, to the following weeks, more specific, while the second important stepin the recruitment is the exam at the end of the course, together with the second psycho-logical test and the final interview.

> Weeks modules:

Course 2004/2005:17-21 January 2005 second week of the Basic Course 27 participants07-11 March 2005 third week of Course 27 participants 13-14 May 2005 Conclusive Seminar 27 participants

Course 2005-2006:12-16 September 2005 Introductory week 35 participants15-19 November 2005 First week of Basic Course 25 participants

Thirty-one trainers of Doctors with Africa Cuamm have been involved in activities of theCourse in 2005. A month before the lectures, some preliminary information material issent to the participants for each week course in order to allow a thorough reading, whilethe remaining material is distributed during the courses or sent afterwards.Upon completion of the course, all material is filed in a cd, which is provided to the train-ers and to the Country representatives.

> Evaluation

In itinere evaluation sessions have been introduced this year: a written exam is envisagedeach week with multiple choice questions that relate to the topics dealt in the previousweek. Moreover, a written exam has been prepared, at the end of the course, with open ques-tions aimed at evaluating the knowledge as well as the skills to organise the knowledgeto solve a problematic situation.Beyond the evaluation and recruitment ordinary tools, this year a second psychologicaltest has been introduced, which highlights relevant personal characteristics (communica-tion skills, flexibility, leading skills etc): the test is filled in by participants at the end of thecourse, evaluated by a psychologist and discussed individually during the final interview.

> Language skill test

In replacement of the test, a certificate attesting the knowledge of English or Portugueseis now requested to the candidates.

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3.2 Week modules – course Doctors with Africa Cuamm

COURSE TIMETABLE: 9 AM – 1 PM, 2 PM – 6 PM17-21 January 2005 7-11 March 2005 12-16 September 2005 14-19 November 2005second week Third week Introductory Week First weekCourse 2004-2005 Course 2004-2005 2005-2006 Course 2005-2006“Planning at “General principles of “Development and “Health systems in district level” health management” Povery” Africa: definition and Carlo Resti Alessandra Gatta Massimo La Raja historical notes”

Roberto Gnesotto Alessandra Gatta Adriano CattaneoMara Mabilia

“Planning an “The Hospital” “State of health “Origin, evolution and Intervention” Gavino Maciocco in the world” transformation of health Cinzia Montagna Rita Polo Roberto Turra systems”Valerio Mecenero Marina Spaccini Gavino Maciocco“ Planning activities “Integration hospital / “Globalisation, market “Primary Health Care. at local level” territory: the and health policies” Conceptual basis”Alessandro Bavcar management of the Giorgio Pellis Carlo Frizzi

delivery room” Adriano Cattaneo Marco PratesiPatrizia Morganti

project implementation” “Integration hospital / Massimo La Raja territory: primary

surgery”Giorgio Pellis

“Economic evaluations “Integration hospital / “The concept of health “Primary Health Care. for planning” territory: Intra and in a comparative view” Organisation models. Roberto Gnesotto extra hospital IMCI” Mara Mabilia Health and child health”

Marina Spaccini Annamaria Dal Lago Patrizia MorgantiMajor Public Health Fanelli CarmeloProblems: malaria “Immunization”Giampietro Pellizer “Working group, Luca Scali

team work”Luigi Ranzato

“HIV and AIDS: impact “Supervision” “The proposal of “Health Information on health, society Marco Pratesi Doctors with Africa system”and economy” Cuamm” Luca Scali

Marzia Franzetti “The territory: drugs Luigi MazzucatoVinicio Manfrin and pharmacies” Dante Carraro “Psychological Mara Mabilia Adriano Cattaneo Valerio Mecenero opportunities and risks

Anna Talami in the work of health personnel”Luigi Ranzato

3.3 Conclusive seminar

BASIC COURSE DOCTORS WITH AFRICA CUAMM 13-14 MAY 2005

Thursday 13/05 “Sustainability of international cooperation interventions”Bianca Nucci Carlo Frizzi

Friday 14/05 “Learning from past experiences”Luigi RanzatoMaria Teresa Fenoglio

3.4 Other training initiatives

In 2005, Doctors with Africa Cuamm has collaborated with various Universities in order torealize Postgraduate Courses aimed at the promotion of Health and International cooper-ation in the Health field:

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> “Postgraduate Course in Tropical Medicine and International Health”, activated bythe Clinic of Infectious and Tropical Diseases at the University of Brescia in collabora-tion with Doctors with Africa Cuamm, the Tropical Diseases Centre of the NegrarHospital, the Burlo Garofolo Institute of Trieste, and the Doctors Without Borders, com-pleted its seventh iteration in 2005.The Course – addressed to health personnel interested in committing to cooperationactivities – is recognized as Basic-Course for the International Health Master in theTropEdEurope circuit, subscribed to by all the main European Schools of InternationalMedicine.The lessons took place at the Clinic of Infectious and Tropical Diseases at theUniversity of Brescia from February 7 to May 13 2005, with the participation of 30 can-didates. Twelve Doctors with Africa Cuamm trainers were involved.

> “Postgraduate Course in Anaesthesia in Developing Countries”, activated by theDepartment of Pharmacology and Anaesthesiology of the University of Padova in col-laboration with Doctors with Africa and the Bethania Hospital, has finished its ninth ite-ration in 2005 and took place from April 4 to April 8 2005, with the participation of 5students and 4 Doctors with Africa Cuamm trainers.

> “Postgraduate course on Human Development and Management of HealthServices in Countries with Limited Resources”: the Course is organised by Doctorswith Africa Cuamm in partnership with the Department of International Studies of theUniversity of Padova. It reached the fourth edition in 2005 and it took place fromJanuary 10th to October 8th 2005, for a total of 160 hours.

> As in the previous edition, the course was constituted of four weeks, in order to favourthe participation of foreign lecturers and ensure the didactical continuity to the partici-pants. The thematic modules have been:• Module 1 - human development and health in Africa (10-15 January 2005)• Module 2 – Elements of health policy, planning and management (4-9 April 2005)• Module 3 – Health Economics and financing in the health services (20-25 June 2005)• Module 4 – The major public health challenges in Africa (3-8 October 2005)The course was intended for health professionals and other professionals approachingto international health cooperation, as well as updating for those who have already par-ticipated to health cooperation projects, with particular focus on experienced Doctorswith Africa Cuamm staff.Twenty-three people participated to the 2005 edition and a fourth of the participantswas of experienced Doctors with Africa Cuamm staff, who has taken the opportunityto refresh also with the view of the new departure in the future; moreover, the numberof professional health and non health staff who have participated to the course evenwithout having previously contacted the Organisation has increased. The overall pictu-re of the participants (fig. 11) seems to evidence the effectiveness of the communica-tion and promotion strategies started, including the preparation of ad hoc material andpublication of advertisements in sectoral portals and press and specifically addressedto universities, ASLs and hospitals, Italian NGOs working in the health domain.

> The 2005 Course, as the two previous editions, has been accredited within theContinuing Medical education programme following the accreditation procedures ofthe Veneto Region.

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Pic. 11

Among the twenty-four trainers who have contributed to the course in 2005, there hasbeen four lecturers of the Faculty of Health Sciences of Uganda Martyrs University, aUNICEF officer coming from New York, two FAO officers, a consultant of the Ministryof Health of Uganda, two consultants who mainly work in Mozambique, an NGO staffworking in North Uganda and South Sudan; of the thirteen professionals working inItaly, six are university lecturers and six are Doctors with Africa Cuamm’ trainersAccording to the aims stated, the 2005 course has confirmed the links with theUniversity of Padova, it has allowed to strengthen the collaboration with the Universityof Bologna and the Course on Development Cooperation, the University of Pavia andthe International Master in Cooperation and Development, the Inter-departmentalCentre for Human Rights of the University of Padova, the Faculty of Health Sciences ofUganda Martyrs University and AVSI.

> “Training Course in health assistance in complex emergency”: the idea of the cour-se came from the presence, among the trainers in the Postgraduate course on HumanDevelopment and Management of Health Services in Countries with Limited Resourcesin 2004, of a consultant who collaborates with the WHO Health Action in CrisesDepartment.The commitment in countries that are now facing emergency situations and the inte-rest to get into more details in said topics, which are dramatically present, led theOrganisation to decide to organise an intensive course aimed at suggesting an overallview on the current conflicts, their consequences on the health of the population, theresponses of the health systems, and the re-organisation and restoration process of thehealth system after the prolonged conflict.The course, mainly addressed to the experienced Medici con l’Africa Cuamm staff andalso promoted outside the Organisation, has taken place from 11th to 16th April andregistered the participation of 30 health professionals, 24 of whom with previous expe-riences in health international cooperation projects or in emergency projects; theCuamm experienced staff represented half of the participants (fig.12).All the four trainers engaged in the course have a consolidated experience in complex emer-gency contexts, who work for Non Governmental Organisations or as WHO consultants.

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

Pic. 12

Apart from the above mentioned training courses and postgraduate courses, someoptional courses have been organised for the students of Faculty of Medicine:

> Optional Course for Students of the Faculty of Medicine of the University of Padova“Health and Healthiness”: the Course, organised by Doctors with Africa Cuamm in col-laboration with the Faculty of Medicine of the University of Padova, has been held from7th to 11th November 2005 with the participation of five Doctors with Africa Cuamm’ strainers, among whom Doctors with Africa Country Representative in Mozambique. Thecourse has envisaged the assignment of university credits to the students of the fifth yearof the course in Medicine. The participants were 120 for each session.

> Optional Course for Students of the Faculty of Medicine of the University ofTrieste “The great epidemics of the new millennium”: the Course has been organi-sed by Doctors with Africa Cuamm in collaboration with the association Doctors withAfrica – Blood Bank of Trieste and the Desk of Microbiology of the Faculty of Medicineof Trieste, under the sponsorship of SISM. Sessions were held on 18, 20, 25 and 27January 2005, with the participation of 50 students and a trainer of Doctors with AfricaCuamm. The course has envisaged the assignment of university credits to the studentsfrom the third to the fifth year of the course in Medicine.

3.5 Education Meetings for the managerial staff

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

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

Coordinator of the Faculty of Medicine of Beira (Mozambique), who presented the realityof the Faculty of Medicine of Beira, the distinctive features of its courses and the of thelearning method applied in the Faculty (Problem Based Learning), which has also testedby the participants with a simulation.The training proposal took origin from the need to create a group of trainers available toteach – according to the specialisation needed – in the various modules of the course ofthe Faculty of Medicine in Beira or to support the development of the Faculty curriculawith their skills. The achievement of the objective has been evidenced by the departureof two experts who participated to the meeting and carried out training activities at theUniversity of Beira in autumn 2005.

Meeting for TrainersThe various initiatives involved not just trainers, who have collaborated with care and ded-ication to the activities proposed by Doctors with Africa Cuamm, but also “occasional”trainers who we would like to involve more actively and in a more coordinated and har-monious way.In 2005 a meeting with the trainers engaged in the various training courses organised byDoctors with Africa Cuamm has been organised: a presentation of the training activitieshas been done, an update on the on-going projects, with the relating human resourcesinvolved and an overview of the Basic Course.

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

Pic. 13

4 MONITORING AND EVALUATION

Monitoring and evaluation are crucial activities in the management of human resources.Through these processes, we receive indispensable inputs that serve to confirm orimprove all the processes regarding working personnel: training, selection, preparationand in loco support. We have started to work on this aspect but we need to improve interms of composition and method.

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MONITORINGThe elements considered in monitoring are: “job description”, language, interpersonalrelationships with locals and expatriates, relations with the Cuamm, logistic and contrac-tual problems, personal motivations and difficulties, and suggestions for improvement.

ToolsAt Single Operator levelBiannual report by the operator.Interview with the operator in Padova coinciding with vacations or in loco during visits.Any other kind of informal or friendly communication (letters, etc.)

At the Organization levelIn loco visit by Doctors with Africa Cuamm/Padova, at least once a year.Update (see biannual/annual report) by the Project-leader or Country Representative.

FINAL ASSESSMENTThe elements considered in the assessment are: professional adequacy, language skill,relational aptitude with locals and expatriates, sense of belonging to the Cuamm organi-zation, and future prospects.

ToolsFor each Operator a Final Assessment is drawn up; a report is written by Doctors withAfrica Cuamm/Padova, one by the Operator and another one by the Project-leader orCountry Representative.

5 DOCUMENTATION CENTER

Objectives- To be up to date in the International news in the Tropical Medicine field (to spread seri-ous and specialized culture).- To improve the professional qualification of candidates at their departure, of workingdoctors, and of partners (Training and Updating Courses).-To encourage contacts and exchange of research at the International level in the healthcooperation field with Developing Countries (enhancement of acquired, and under wayexperience).

The Documentation Center offers a series of cultural and scientific publications, as broadand up-to-date as possible, on the issues regarding Developing Countries andInternational cooperation. It includes over 3,000 books and scientific journals, periodicalsand various publications, often not available in other libraries or bookstores in Italy.Part of the Center is a General Medicine library with more than 3,800 books, annuallyupdated, and representing an important support for the medical professionals.

5.1 Carried out activities

International and Tropical Medicine Collaboration Prof. Giovanni Baruffa (Pelotas/Rio Grande do Sul, Brasile); from 28 March to 18 June2005.

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

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Documentation Center AccessThe consultation of available material is possible in agreement with the Training Official.Along with books and journals, slide sets from TALC, assembled in 15 areas are also avail-able:Public Health, Ginaecology and Obstetrics, Infectious Diseases, Stomatology,Endocrinology, Ematology and Immunology, Radiology, Diagnostic Tecnichs, Feeding,Pediatrics, Opthalmology, General Surgery, Rehabilitation and Orthopedics, Anaesthesia,Microbiology and Parasitology.

VideotapesVideotapes are available for public information events and awareness campaigns. Theyare divided by subject: Health, Doctors with Africa Cuamm Programs, Training, andVarious subjects.

Libraries Updating for coordination groups in Africa> For the coordination offices in Africa and for the personnel, distribution of the Cd of the

training course on organisation, management and health services in Africa” > For the coordination office in Uganda: 4 books (Tb and HiV, Tropical Medicine, Medical

Laboratory 1/2)

Subscriptions for coordination groupsTropical Doctor (see Table 2)

2005 Subscriptions for Nkozi Martyrs University“International Journal of Health Planning and Management”

Subscriptions for Doctors with Africa Cuamm libraryNew subscriptions for the year 2005 have been eight. Concerning other journals anexchange with our journal “Salute e Sviluppo” has been achieved.

Table 1JOURNALS OF TROPICAL HEALTH CENTER 2005

AIM Reports MozambiqueAppropriate technologyBulletin WHOContact (CMC Churches)Health Policy and PlanningJournal of Tropical PediatricsTropical DoctorWeekly Epidemiological Record

Table 2SUBSCRIPTION FOR HOSPITALS AND AFRICAN HEADQUARTERS: 2005

Tropical Doctors forCuamm DAR ES SALAAM (TANZANIA)Cuamm MAPUTO (MOZAMBICO)Cuamm KAMPALA (UGANDA)Cuamm ADDIS ABABA (ETIOPIA)Cuamm LUANDA (ANGOLA)

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ASSOCIATION LIFE

1 STUDENTS COLLEGE

1.1 AimsDoctors with Africa Cuamm was born as boarding school for the training of the studentsof the Faculty of Medicine, oriented to rendering their voluntary services in the develop-ing countries and engaged in sensitisation activities in Italy.According to art. 2 of the code, “Cuamm proposes the aim to contribute, in the spirit ofGospel and as not-for-profit , to the redemption and growth of each person, mainly themost in need and the suffering, to the independent and autonomous development of thepopulations of the third countries, to the assertion of values of international solidarity, ofjustice and peace”To share these aims, an accurate professional training within a serious and regular train-ing path is required.

1.2 Activities

The students hosted by the College in 2005: 50Indian religious people, students of the Faculty of Medicine, hosted in institutes in Padovathanks to Doctors with Africa Cuamm: 4Students graduated in 2005: 4The training path of the college is articulated in three domains:> Spirituality> Culture> Sensitisation and solidarity

1.3 Spirituality

> A day of spirituality in Advent: 19th November> End of week in Lent: 30th April> Weekly Eucharist

1.4 Culture

For the internal students, various sessions are proposed for their knowledge:a. participation to the Optional Course “Health and Healthiness in Africa”. Topics dealt:

> Health and health services in Africa (dr. Roberto Gnesotto);> Health and the territory: public health interventions (dr. Claudio Beltramello);> Primary Surgery: referring surgical cases (dr. Rita Polo);> Child health: hospital and primary health care services (dr. Marzia Franzetti);> Mother health care (dr. Patrizia Morganti)

b. participation to Saturday Cuammc. meetings with expert Doctors with Africa Cuamm staff

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1.5 Sensitisation and solidarity

The college is integral part of the NGO Doctors with Africa Cuamm and is requested tocontribute, according to its capacities and possibilities, to the health development proj-ects that are on-going in Africa. It is a concrete activity that is rendered explicit through:a. sensitisation activities and fundraising in the parishes or associations where they come

from;b. sensitisation activities and fundraising designed and managed in the College, mainly

addressed to the university and the town of Padova.Among them, deserve mentioning:> collaboration with radio programmes of the Radio of the Diocese> cineforum, discussions after films, in collaboration with the Diocese Centre for Social

Communication; > a music party for the university students> update of Doctors with Africa Cuamm web-site (www.doctorswithafrica.org) ;> active participation during “Saturday Cuamm”> support various activities of Doctors with Africa Cuamm in the area, including the pre-

paration of small works.

2. INFORMATION SESSIONS

These meetings take place, every two months, on Saturday morning, at the Doctros withAfrica Cuamm headquarter. They intend to present and discuss issues concerningInternational health, cooperation, and development.It is an initiative of awareness, information, and discussion addressed to health operatorsmainly, but also to a broader audience.The invitation reaches in particular the Padova area and it is sent to those “in contact”with the organization (around 600 addresses).

COMMUNICATION AND INFORMATION SECTOR

COMMUCATION AND INFORMATION

Sensitisation campaigns and Public Relations

The year’s products

The year’s principal events

Publications

Sensitisation material

Educating for developement

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COMUNICATION AND INFORMATION

Overall, in addition to its traditional activities, the year has seen a series of specificactions carried out by the Communications sector, concentrated in three main areas:

> Co-ordinated Identity RestylingThe restyling of the organisation’s co-ordinated identity has led to a decisive improvementin image and reputation. This has involved a careful and profound rethinking of all the var-ious instruments of communication in Italy and Africa, intended to promote a better-defined and more incisive perception of Doctors with Africa Cuamm and clearly distin-guish it from other and larger organisations in the same field.

> Communication PlanOur aim has been to improve our performance in proposal, debate and information onthemes concerning Healthcare Co-operation. As a consequence, we have carried out amethodical and integrated media campaign (in the press, TV, radio, at local and nationallevels), to publicise Doctors with Africa Cuamm’s aims and activities via the creation of aspecific sensitisation campaign on the theme of “with Africa”.

> Integrated Communication StrategyWe have pursued the objective of rationalising in a unified and coherent manner the con-tent, form and means of communication, through the creation of an Image Manual. Our integrated communication strategy has been applied on two different levels:integration and homogeneity of all Doctors with Africa Cuamm’s communication instru-ments and actions;integration and homogeneity of the instruments produced by Doctors with Africa Cuammgroups or by single areas.

1 SENSITISATION CAMPAIGNS AND PUBLIC RELATIONS

1.1 The “With Africa” Campaign

2005’s most significant project has been the launch of the “with Africa” campaign.Presented to the public on the 18th of November in the Sala del Carroccio in the seat ofRome’s municipal government, its aim is to promote public sensitisation of the conceptof the African people’s right to health. The predominant message is the theme of sharing.Doctors with Africa Cuamm’s bond with the African continent is made up of over fiftyyears’ field work inspired by that one key word: “with”. Doctors with Africa (and not “forAfrica”) is an expression of the choice of sharing with others, signifying profound partici-pation, exchange, joint effort, working and suffering together with African mothers andchildren, with people infected by Aids, tuberculosis and malaria, with all those in need ofmedical treatment.In order to give voice to the real Africa, whose daily struggle is shared by Doctors withAfrica, the “with Africa” campaign is the first communications project by a non-govern-ment organisation to make use of internationally recognised and successful Africanartists: in the press campaign and in radio and TV commercials it is Africa and the Africanswho speak about themselves, their potentials and their needs. Thus art becomes a potentuniversal instrument for the transmission of a message of social responsibility….“because we have to affirm in a radical but not merely provocative way that we are nei-ther Westerners nor Africans, but simply human beings”, as the artist Pacale MarthineTayou underlined at the presentation, “and as such, at home and citizens everywhere”.

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> The “with Africa” press campaign develops the theme of the encounter with othernessand of mutual sharing, involving for the first time some of the best-known contempo-rary African artists whose work speaks of their continent: Myriam Mihindou, PascaleMarthine Tayou, and Outtara Watts.

> The subject of the TV commercial is “Hands”: it focuses on the unbandaging of anAfrican man’s hands, metaphor for healing but also for the release of Africa’s expressi-ve potential. The commercial is by the African director Mohammed Soudani, with musicby Lokua Kanza, collaborator of Peter Gabriel.

> In the radio commercial, the speaker evokes the idea that encounter and sharing withotherness is an occasion for enrichment and growth. The soundtrack is by the Africanmusician Lokua Kanza.

Press advertising and TV and radio commercials have begun appearing at national andlocal levels, thanks mainly to the unpaid collaboration of broadcasters and publishers.The campaign has specifically involved the main national weekly magazines, magazinesupplements published with the major national daily newspapers, some national radiostations and many local TV stations. In 2006 this process will be extended to the princi-pal national TV networks.

1.2 Other activities

In parallel to the “with Africa” Campaign, we have pursued our other activities connectedwith press-releases, press dossiers and documental archives in connection with theyear’s most important events (see calendar of the year’s principal events). Also importanthas been the organising of appearances and interviews on radio and TV. External com-munication activities have particularly concerned Study Days, local exhibitions, the daysdedicated worldwide to specific diseases, and making known the organisation’s positionon various topical subjects.

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2 THE YEAR’S PRODUCTS PUBLICATIONS DESCRIPTIONHealth and Developement > Issue n° 2. 2004

> Issue n° 3. 2004> Issue n° 1. 2005> Health and Development 2004

Cuamm Solidarity > Two issues in 2004 and five issues in 2005, one every two months

The Four Winds Two issues, one in June one in December

SENSITISATION DESCRIPTIONMATERIALSProject brochures for > Ethiopia Orthopedic Brochuresensitisation > Advanced Training courses Brochure

> Vocational Training Poster> Post-cards and posters

Promotional Accessories > Institutional Brochurein Africa and Italy > Personalised Diaries

> Visiting Cards> Press Kits> Personalised Pencils (reprint)> Pens> Personalised T-shirts for adults and children> Cloth bags> Choker Key-rings> Badges> Stickers> Africa Kit (backpack, belt-bag, T-shirt, doctor’s coat, cap,

sleeveless jacket)> Sensitisation Campaigns Campaign Cards and >Envelopes> Pre-printed Post Office payment forms> Press Advertising

Sympathiser Fidelity > Headed writing paper and envelopes for Thank You lettersMaterials > 2005 Special Aids Appeal

> Christmas Cards 2004

MATERIALS FOR EVENTS DESCRIPTIONOpen Day, Study Days, > 2 PVC banners, color-printed on both sides, 100x200cmsCuamm Saturday > 10 PVC banners, colour-printed on one side, 78x150 cmsNotebooks > 2 Forex panels with coloured vinyl adhesive stickers

240x200 cms> 1 Giant Poster 200x300 cms> Leaflets for Study Days 2004-2005 (1,500)> Invitation Postcards for Study Days 2004-2005 (2,500)> Leaflets for Open Day (1,500) Invitation Postcards for

Open Days (2,500)> Study Day Records

Material for Doctors with > 1 PVC banner, presenting Countries and Cuamm Africa Cuamm Party, > Projects 10m x 3 m18/06/2005 > 1 PVC banner 2m x 3m

> Cuamm Party Postcards (3,000 copies)> 50 copies DVD “Roads”> 2 hand-painted panels

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Civitas 6-7-8 /05/2005 > 1 PVC banner, one side color-printed, 400x250 cmsTerrafutura (Futureland) > 1 PVC banner, one side color-printed, 400x250 cms8-9-10/04/2005Caorle Exhibition > 50 posters 33x47 cms16/7 - 01/8 > 250 single-leaf invitations 16.5x10.5 cmsEducating > 3,000 metal-bound “A day with Mazengo” dossiers, for Developement > 15x20 cms, closed format

> 400 copies of slides “A day with Mazengo”Perugia-Assisi March > 1 PVC banner 250x100 cms11/09/2005Mozambique Donors > 250 folded invitations 10.5x22 cmsConference 19/09/2005“with Africa” Campaign > 1,500 folded invitations 21x10.5 cms18/11/2005 > 200 folded invitations (in English) 21x10.5 cms

2.1 Website and Digital Newsletter

Doctors with Africa Cuamm’s new website (www.mediciconlafrica.org) has been onlinesince April 2005. The result of a complete renewal in graphic design, programming andcontent, this operation has created an instrument for presenting the organisation and itsactivities aimed at projecting the image of Doctors with Africa through Internet. Anextremely simple graphic layout helps navigators quickly find the different sections andeasily search for the information that interests them. The site is further enriched by numer-ous service instruments, including the possibility of consulting the complete onlinearchive of Health and Development from 1999, as well as the latest issues of CuammSolidarity and Quattroventi (Four Winds).In parallel to the website, the digital newsletter “Voices from Africa” was inaugurated inOctober, and is a new communication instrument which broadens the organisation’sinformative panorama. News and information, first-hand accounts, stories from Doctorswith Africa Cuamm’s various projects and a selection of upcoming events, all helping thereader, wherever they may be, to be “with Africa”. Conceived as a more agile way of cir-culating information thanks to its electronic flexibility, the newsletter is structured in fourmain sections. Under “Focus” come the month’s most important news items, while “FromAfrica” carries first-hand accounts from volunteers in service, and “Appointments” listsimportant upcoming events. The section “Let’s make a network” (“Facciamo rete”)deserves a special mention. It is dedicated to initiatives and discussions on the theme of“being with Africa” in Italy. It lists activities organised all over the country and carriesaccounts of experiences from our partners, especially the Doctors with Africa CuammGroups, who are active at a local level in promoting being with Africa in Italy.

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3 THE YEAR’S PRINCIPAL EVENTS

EVENT DESCRIPTION Saturday > “Aids: an uphill road. Comparing experiences”22.01.2005 > “Health objectives for the millennium. Commitments or 12.03.2005 wishes?”07.05.2005 > “Margins at the centre. Forgotten illnesses in Angola and 22.10.2005 Mozambique”.

> “A question of coherence: educating for development, the other side of co-operation.”

Terrafutura > Promotional Stand and sale of material, run with help from (Futureland) Florence volunteers from Tuscany.8-10 April 2005Italy Africa > Promotional Stand and sale of material, run with help from Rome volunteers from Rome. Good attendance and excellent 21-28 May 2005 visibility.Civitas, Padua Present in Civitas with a Promotional Stand6-8 May 2005Cuamm Party > Large-scale get-together of all the Doctors with Africa 18 June 2005 Cuamm who in the fifty five years of the organisation’s

history have served in Africa. “with Africa” Campaign > Communication campaign (press campaign, radio and TV 18 November 2005 commercials) on the theme of Sharing, basic element of

Doctors with Africa Cuamm’s identity.Invisibile Africa > Good attendance, important opportunity for sensitisation on Exhibition the problems of co-operation and Doctors with Africa Caorle (Venice) Cuamm’s projects.16 July - 01 August 2005

3.1 Participation in events in Italy

> TERRA FUTURA (Future World) FLORENCE8-10 April 2005 – promotional stand run with help by volunteers from Tuscany

International Exhibition and Conference on viable sustainability practices under way in var-ious fields: everyday life, social relations, the economic system, government practice…“Terra Futura” (Future World), held in Florence, at the Fortezza da Basso, from the 8th

to the 10th of April 2005, was an excellent opportunity for the presentation and promo-tion of all those initiatives that have been taken to try out and utilise in the fields of gov-ernment, social relations and organisations, consumer behaviour, production, finance andsustainable commerce. Organised around five main themes: habitation, production, culti-vation, action, government. Doctors with Africa Cuamm was present at Terra Futuro with a promotional stand in the“Action” section.

> ITALY AFRICA – ROME21-28 May 2005 – Promotional Stand run with help from local volunteers

The 28th of May was our NGO’s second showing at the Italy – Africa event. This year weagain felt the need to participate in this event as a way of drawing sufficient attention tothe injustices, the wars and the new kinds of slavery that still crush hundreds of millionsof people, to reinforce the commitment to justice and to stress that our own futuredepends on the future of Africa.

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> CIVITAS 2005

Doctors with Africa Cuamm took part again in this year’s Civitas event, with a promotion-al stand that kept our volunteers busy over the non-profit fair’s three days. The high atten-dance at Civitas makes it an important opportunity for increasing Doctors with AfricaCuamm’s visibility. Above all it offers a chance to reach a young public, and to someextent the schools.

> STUDY DAYS AND CUAMM SATURDAY EVENTS

During the first part of 2005 we were still using material planned at the beginning of the2004-2005 “Cuamm Saturdays”. As we began on our new programme, new materialswere established, and this was a useful contribution to what is an important sensitisa-tion initiative greeted with growing interest and attention by school-age children anduniversity students. In line with last year’s approach, we continued to explore themesnot exclusively dealing with health, a method that offers interesting angles of reflectionand at the same time broadens appeal.

4 PUBLICATIONS

Once again, Doctors with Africa Cuamm’s publications offer their annual contribution tothe panorama of Italian publishing with various intentions: to promote discussion of ideas,to compare different approaches, to provide information on new international policies, toprovoke thought and dialogue and to evaluate the many kinds of possible means andways of co-operation and sensitisation. They also aim to transmit first-hand accounts, tobear witness, to stimulate the growth of a co-operation culture through the example ofpeople’s real experiences in the field. In particular they promote in-depth study of sub-jects connected to the idea of “health and development”, perspectives on internationalco-operation and volunteer contributions, and crucial issues in the health field and differ-ent approaches to the organisation of health services.

HEALTH AND DEVELOPEMENT

This magazine began 16 years ago as a means of internal communication within the asso-ciation and of providing news on its projects. It assumed its definitive title as “Health andDevelopment” in 1999, and is published every four months in editions of 90-100 pages,with a print-run of 4,000.Up to the first issue of 2001 the graphic design and internal structure introduced in 1999remained constant. Each issue has eight sections:

1. In this issue: a single page listing the contents.2. Dialogue: a series of brief editorials from various writers, offering points of reflection

and discussion.3. Health Politics: the transformations underway and the most important issues and

debates.4. Health Co-operation: institutional and NGO policies and strategies.5. Afrinews: subdivided into three sections: Agenda (significant upcoming events), Focus

(in-depth discussion of one issue), and “History” (aspects of Africa’s past).6. Observatory: information from international sources.7. Health Numbers: data and statistics of special interest.8. Review: books, articles, conferences and events.

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Today the magazine is increasingly in demand by research bodies, operators in the samefield, and students preparing theses. A substantial restyling was introduced from the secondissue of 2001, reflecting the desire to reach a wider public with an issue dedicated entirely toAids. In subsequent issues, while returning to its usual structure it maintained the radicallynew graphic design and format, which consolidated itself over the course of the year 2002.The first issue of 2003 saw the beginning of a new feature within the Health Co-operationsection where, under the title Focus/Nation, each issue devotes itself to one of the coun-tries where Doctors with Africa Cuamm operates, offering detailed information and analy-sis on budgetary data, the hospital situation, the project context, along with critical reflec-tion:

Issue CopiesN° 2.2004 3,900N° 3.2004 3,800N° 1.2005 3,800N° in English 1,000Totale 12,500

CUAMM SOLIDARITY

This news-sheet originally came into being as a supplement to Health and Development,with the idea of communicating the same subjects in simplified terms so as to reach awider, more heterogeneous and non-specialised public. In 2001 it underwent a restylingin order to improve its achievement of these goals and doubled its number of pages soas to be able to treat issues in a more articulate way.By 2003 its structure had become well established: the first two pages focussing on onetopical subject, the two central pages devoted to current initiatives in Africa (statistics,needs, experiences and testimonies), and the last two dealing with events in Italy anddescriptions of members’ experiences in the field.Cuamm Solidarity is an increasingly important and well-received organ of communicationwithin the organisation and between its supporters, with a print-run of over 43,000 copies,mostly sent by postal subscription. A few thousand copies are distributed in variousItalian sensitisation events where the issue’s main subject is related to the theme promot-ed in the event.2005 saw the publishing of two issues relating to 2004 and 5 issues relating to 2005:

Issue Main Subject CopiesN°5/04 Patience in sowing seeds/Vocational training in Africa 45,0006/05 Training, hospitals and territory/All the dimensions of caring 42,0001/05 Infinite Pain/Another disaster in Angola 45,0002/05 With Africa at heart/Exchanges of gifts and of life 43,0003/05 Doctors with Africa Cuamm/2005’s Projects 45,6004/05 An appeal from a poor country/Committment in Dubbo, Ethiopia. 43,0005/05 Cradle of Hope/The Africa of dignity and courage 43,250

FOUR WINDS

This is the traditional channel of communication within the association, renewed in manyaspects in 2000. It too was restyled in 2001, and the graphic design of its articles and imagesenlivened. Published twice yearly in June and December, it carries updated news on the lifeof the Doctors with Africa Cuamm, using letters and personal reflections of the volunteer per-sonnel, registering departures and returns, births and marriages, dates and events.

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Issue CopiesDecember 2004 1,100June 2005 1,200Total 2,300

RECORD OF STUDY DAYS

A comprehensive record of all the contributions to the Study Days at Padua head officein 2004/2005 was published in one volume, of which 1,000 copies were printed.

5 SENSITISATION MATERIAL

The year by year updating of our instruments of communication and information is intend-ed to make Cuamm better known and to promote sensitivity and attention to Africa’s prob-lems. In 2005 various brochures, posters, leaflets, and PVC panels were used to promotemeetings. Already existing materials were also distributed and in some cases reprinted:

BROCHURES ON SPECIFIC INFORMATION CAMPAIGNS

Subject CopiesEthiopia Orthopedic Brochure 1,500Aids Brochure 44,000Angola Brochure 800,000Total 845,500

To reach and mobilise new supporters, we carried out a major subscription-letter postalcampaign, concentrated on the same themes. During the year over 800,000 fund-raisingletters were sent out, each with a presentational brochure. This operation required a reor-ganisation of our contacts database and the subsequent sending out of thank you letters,all of which weighed heavily on the Communications Sector’s budget. 15,000 thank youletters and envelopes were printed and posted.

PROMOTIONAL ACCESSORIES

As part of our communications campaign in Africa and Italy we made the following:

Kinds of material CopiesInstitutional Brochures 20,00Personalised Diaries 170Visiting Cards 2,900Press Kits 500Personalised Pencils (reprint) 1,000Pens 1,500Personalised T-shirts for adults and children 1,000Cloth bags 2,000Choker key-rings 1,000Badges 500Stickers 5,000Christmas Cards 800Africa Kit (Rucksack, belt-bag, T-shirt, 200doctor’s coat, cap, sleeveless jacket)Photoresists for visiting card reprints 400

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6 EDUCATION FOR DEVELOPEMENT

Some of the encounters organised in schools

Date School Subject19/11/2004 State Secondary School, Vigodarzere (Pd) Mazengo

First Year Students26/11 State Secondary School, Vigodarzere (Pd) Mazengo



First Year Students7/1/2005 State Secondary School, Vigodarzere (Pd) Mazengo








First Year Students10/1/2005 State Secondary School, Vigodarzere (Pd) Mazengo

Second Year Students17/1 State Secondary School, Vigodarzere (Pd) Mazengo











Second Year Students

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9/5 State Secondary School, Vigodarzere (Pd) MazengoSecond Year Students



4/12/2004 State Secondary School, Camposampiero (Pd) MazengoSecond Year Students

11/12 State Secondary School, Camposampiero (Pd) MazengoSecond Year Students


22/1/2005 State Secondary School, Camposampiero (Pd) MazengoSecond Year Students












10/10/2005 State Secondary School, Vigodarzere (Pd) MazengoThird Year Students









GROUPS SECTOR

THE GROUPS

Partner groups of doctors with Africa Cuamm

Friends of doctors with Africa Cuamm groups

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THE GROUPS

As defined in the Doctors with Africa Cuamm internal regulations, “the Groups are legal-ly constituted autonomous associations which within specific regions promote Cuamm’sideals and support its initiatives. An Association becomes a Cuamm Group when, satis-fying the essential requisites as specified in a relevant document, and undertaking to fol-low the guidelines set out in the appropriate protocol agreement and to participate in theco-ordinating organism as defined in the following article, they have been officially recog-nised as suitable by the Board of Directors. An Association ceases to be a Cuamm Groupif it fails to engage in activities directly connected with Cuamm, or if it has been declaredunsuitable by the Board of Directors.” (Article 8 of the Regulations)The Groups are recognised as being among the legitimate participants in the organisation(Article 4 of the Regulations) and actively contribute to carrying out its activities, both inAfrica and Italy. The Groups’ main activities are:> offering support to Doctors with Africa Cuamm’s health co-operation projects in Africa;> promoting public sensitisation and educating for development in Italy.

Offering support to projects in Africa consists principally in recruiting human resources,fund-raising, planning relevant local co-operation projects and mobilising other donors.Activities related to educating for development consist in information campaigns and sen-sitisation, involvement with the world of education (e.g. in schools), the organisation oflocal events, solidarity operations (e.g. involving immigrants), and are aimed at revivinginterest and hope in Africa’s future among institutions and public opinion, on the onehand, and also at promoting values concerning solidarity and co-operation between peo-ples.

At present the Groups are organised in three categories:> Doctors with Africa Cuamm Groups, recognised by the Board of Directors (9 Groups)> Partner Groups of Doctors with Africa Cuamm, close to the organisation but not yet

recognised by the Board of Directors (4 Groups)> Friends of Doctors with Africa Cuamm Groups, associations with a wider range of objec-

tives and activities who regularly support some of the organisation’s projects (10 Groups)

In May 2005, in order to promote and co-ordinate the activities of the various Groups ina more efficient and structured way, a Group Sector was set up at Doctors with AfricaCuamm’s head office. At present staffed and run by one person, this sector co-ordinatedthe organising of a workshop on the 29th of July 2005, open to all the Groups and dedi-cated to presenting and discussing proposals regarding the activity and organisation ofthis new Sector and its relations with the Groups. These proposals were further discussedwith single Groups during a series of visits made by the Sector’s director to the followingGroups: Medici con l’Africa Modena and Reggio Emilia (Modena, 4th October 2005),Medici con l’Africa Como Onlus (Como, 18th November 2005), Associazione CuammLecco (Lecco, 21st November 2005), Santarcangelo Città del Mondo (Santarcangelo-Rimini, 22nd November 2005), Medici dell’Alto Adige per il Terzo Mondo Onlus (Bolzano,3rd December 2005), Africa Chiama Associazione Amici dei Medici con l’Africa(Conegliano, 16th December 2005), and Jenga-Insieme Cuamm Medici con l’Africa Siena(Siena, 17th December 2005). The proposals will also be discussed by the Group Co-ordi-nation Committee, whose job is to co-ordinate the activities of the various Groups andconnect them with those of the head office, to promote the creation of new Groups, andto discuss and prepare proposals and opinions to be submitted to the Board of Directorsand/or the Executive Director (Article 9 of the Regulations).

Here are a series of detailed accounts of activities carried out by single Groups during2005…

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1. DOCTORS WITH AFRICA CUAMM GROUPS

CUAMM MEDICI CON L’AFRICA - TRENTINO

Address: Via Valsugana, 51 - 38100 Trentino Tel. 0461 2397976 - cell. 340 7231600Fax 0461 983929E-mail [email protected] Adriano Bertoldi

N° members 50

Activities in support of Doctors with Africa Cuamm’s healthcare co-operation proj-ects in Africa

Countries supported:Angola - Ethiopia

Projects supported: > Support for the Canova Vocational Training Centre for nursing personnel in the provin-

ce of Uige, Angola.> Healthcare and peacekeeping in the province of Cunene, Angola.

Initiatives carried out:In 2005 the Group promoted the following projects, financed respectively by Trentino AltoAdige Region and by the Province of Trento, in support of Doctors with Africa Cuammprojects in Angola:

> Support for Permanent Vocational Training Centre for nursing personnel in the provin-ce of Uige.

> Modernisation of medical facilities in the Chiulo Hospital

In support of Doctors with Africa Cuamm projects in Ethiopia, the Group has also submittedthe following projects for funding by the Provincial and Regional local governments in 2005:

> Structural renovations to the Health Centre in Wolisso, submitted to the Trentino AltoAdige Region for financing.

> Institution of a Department of Public Health in the hospital in Dubbo, submitted to theProvince of Trento for financing.

During 2005 the Gruppo Cuamm Medici con l’Africa - Trentino also took part in the“Mozambique Consortium”, within the framework of the decentralized joint co-operationproject between the Province of Trento and the Province of Caia in Mozambique, collab-orating on a health care project which includes Aids prevention, the renovation of variousHealth Centres, and the “ante natal clinic”. The President of the Consortium is a doctorwho works with Doctors with Africa Cuamm.

In the context of supporting the recruitment of medical personnel for African projects, inJune a new volunteer of Doctors with Africa Cuamm, Dr. Mario Battocletti from Trentino,departed for Ethiopia with his family. Various solidarity initiatives and fund-raising eventswere organised in connection with this event, as briefly listed here:

> May: an evening presenting Doctors with Africa Cuamm and the Battocletti family in theMezzolombardo Theatre.

> The Mezzolombardo Missionary Group committed itself to support the Dubbo hospitalwhere Dr. Battocletti works. From the 8th to the 10th December it organised a smallMissionary Market.

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> On the 23rd December the little Oratory theatre and the Hosanna Choral group ofMezzolombardo presented the recital “The Legend of the Fourth King”. Doctors withAfrica Cuamm promotional materials (T-shirts, bags, etc) were distributed in the foyer,and the box-office takings were donated to the Association.

> In November there was a fund-raising concert featuring three local musical groups. Abrief film of Dr. Battocletti’s work was shown and the box-office takings were donatedto Doctors with Africa Cuamm.

> Towards the end of December 700 calendars were printed, using photos taken inEthiopia by Dr. Battocletti’s wife Miriam, to be distributed to various supporters andbenefactors.

Local sensitisation activities and educating for development.

> 2 March – Primary School, Canale di Pergine (Tn), educational and sensitisationencounter with the catechesis group preparing for their Confirmation. Representativesof Doctors with Africa Cuamm were Carmelo Fanelli and Laura Maldini. 18 children and3 catechists attended.

> 19 March – Oratory, Levico Terme (Tn), sensitisation encounter with 5 Primary scho-ol catechism groups, with catechists and parents, followed by frugal supper of boiledrice. Representatives of Doctors with Africa Cuamm were Carmelo Fanelli and LauraMaldini. Between adults and children, about 70 people attended.

> 30 March – Nursery School, Pian dei Pradi (Tn), preparatory evening with parents ofchildren attending the nursery school, in view of an encounter to take place with theirchildren during school hours. Representatives of Doctors with Africa Cuamm wereCarmelo Fanelli, Laura Maldini and Roberto Cappelletti. About 40 adults participated.

> 25 May – Nursery School, Centa San Nicolò (Tn). During school hours CarmeloFanelli introduced Africa to the children using a slide show and games made by Africanchildren.

> 9 June – Public Encounter in the Auditorium, Vigolo Vattaro. Representatives ofDoctors with Africa Cuamm were Carmelo Fanelli and Laura Maldini. About 25 peopleattended.

> 24 October – Primary School, Vattaro (Tn). During school hours Carmelo Fanelli intro-duced Africa to the children using a slide show and games made by African children.About 20 children took part.

> 15 November – Primary School, Levico Terme (Tn). During school hours CarmeloFanelli introduced Africa to the children using a slide show and games made by Africanchildren. About 70 children took part.

> 20 November – Multifunctional Hall, Mattarello (Tn). Solidarity Concert “Children forthe Children”, organised by the Torrefranca Chorus in collaboration with the MarzariBakery. Performances by the Torrefranca Mini-chorus from Mattarello and the “Vogliamcantare” chorus from Trento. At the end of the concert Carmelo Fanelli gave a brief talkwith slideshow on Doctors with Africa Cuamm’s mission. About 200 people attended.

> 26 and 27 November – Multifunctional Hall, Romagnano (Tn). Solidarity Bazaar infavour of Doctors with Africa Cuamm, organised by the “Le Gnampe” Group fromTrento. Various hand-made items were on sale (plates, vases, ornaments, clothes etc.decorated with decoupage). Over the two days Doctors with Africa Cuamm’s activitieswere illustrated with poster displays and other information. On the afternoon of the 27th

of November Carmelo Fanelli gave a slideshow talk on the subject of Doctors withAfrica Cuamm.

> 30 November – Nursery School, Calceranica (Tn). During school hours CarmeloFanelli introduced Africa to the children using a slide show and games made by Africanchildren. About 35 people took part.

> 6 December – Primary School, Canale-Pergine Valsugana (Tn). During afternoon

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school hours Carmelo Fanelli introduced Africa to the children using a slide show andgames made by African children. About 100 people took part.

> 8 December – Presentation of a project by the Vattaro Primary School’s Fifth Class,“From Brother to Brother”. The children and their teachers performed a play, attendedby the mayors of Vattaro and Bosentino (Tn). Part of the items in the Christmas Bazaarorganised by the children were sold in aid of Doctors with Africa Cuamm. The repre-sentative of Doctors with Africa Cuamm was Carmelo Fanelli.

> 13 December – Public Encounter in the Primary School of Canale-PergineValsugana (Tn). Representatives of Doctors with Africa Cuamm were Carmelo Fanelliand Laura Maldini. About 15 people took part.

> 15 December – Nursery school, Matterello (Tn). During school hours Carmelo Fanelliintroduced Africa to the children using a slide show and games made by African chil-dren. About 120 people took part.

> 17 December – Susà-Pergine (Trento), at the Artigianelli Theatre, children from the CanalePrimary school, together with the parish choirs of Canale, Santa Caterina and San Vito,organised a fund-raising Christmas Concert. Representatives of Doctors with AfricaCuamm were Carmelo Fanelli and Laura Maldini. About 350 people attended.

> 20 December – Primary School, Levico Terme (Tn). Christmas Bazaar in aid ofDoctors with Africa Cuamm. The representative of Doctors with Africa Cuamm,Carmelo Fanelli.

> 23 December – Vigolo Vattaro (TN). Volunteers from Vigolo Vattaro’s S.A.T. group orga-nised a Banquet to publicise Doctors with Africa Cuamm, the price of the meal beingdecided by each guest, and the proceeds going to Doctors with Africa Cuamm.

ASSOCIAZIONE CUAMM LECCO

Address: Viale Turati 22 - 23900 LeccoTel. 0341 602961 - cell. 328 6163941Fax 0341 350330E-mail [email protected] Giovanni Molinari

N° members 80


Countries supported: Ethiopia - Mozambique

Projects supported:Reinforcement of the district healthcare system in the Beira Corridor (Sofala Province, Mozambique)Wolisso Hospital and Nursing School (Oromia Region,South West Showa, Ethiopia)

Initiatives carried out:The Group carried out various fund-raising activities over the year 2005, receiving somedonations on a regular basis from various members and sympathisers, and other dona-tions on an occasional basis from participants in various events. It also presented a micro-project in support of the Beira Project, participating in the com-petition organised by the Lecco Committee for Peace and Co-operation between peoples(financed by the Province of Lecco). Subject: public health (no prize won)

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During the year two members, the orthopaedic doctors Marco Incerti and RiccardoBonfanti, continued their collaboration with the activities of the Orthocuamm group, par-ticularly in aid of the Wolisso hospital in Ethiopia.


One Ordinary and one Extraordinary Association Assemblies were organised, open alsoto the public:

> in mid-May an Ordinary Assembly featured the first-hand testimony of Doctors withAfrica Cuamm volunteer Dr. Cristina Pizzi, in service in Beira-Dondo, Mozambique(about 40 participants);

> at the end of the year an Extraordinary Assembly heard Dr. Cristina Pizzi speak of theend of her service in Mozambique and her upcoming service in Ethiopia, as well as ex-volunteer Dr. Marina Anghileri. Presentation of Doctors with Africa Cuamm’s new cul-tural project “with Africa” (about 40 participants).

The Group ran a Stand promoting the Association in these local events:> “Manifesta 2005”, a Province of Lecco’s voluntary workers’ Happening held in Osnago

from the 20th to the 22nd of May;> “Festa Missionaria”, a parish initiative in Monte Marenzo from the 1st to the 5th of

June.

The Group was also present at various occasions promoting the culture of solidarityorganised by local committees or groups. Our councillor Dr. Riccardo Bonfanti continuedto participate in the meetings of the Lecco Committee for Peace and Co-operationbetween Peoples.

From 20th November 2004 to 8th of January 2005 two Group members, Annapia and PaoloMoioli, visited Dr. Cristina Pizzi in Beira. Their experience and testimony was presented toa reunion of the Association’s Board of Directors.

Other initiatives of the Association:> Council Meetings, attended also by some members or sympathizers (about 15 people),

held on average once a month; in the November Meeting the Group met Serena Foresi,the new director of the Doctors with Africa Cuamm Groups Sector.

> The president of the Association attended the 29th of July workshop, in the Paduahead office, for the presentation to the Groups of Doctors with Africa Cuamm’s newcultural project and a discussion of the various Groups’ role in it.

> Some members participated in the activities for Active Members at the Doctors withAfrica Cuamm head office.

AFRICA CHIAMA - ASSOCIAZIONE AMICI DEI MEDICI CON L’AFRICA

Address: Via Cavour, 23 - 31015 Conegliano (Treviso)Tel. 0438 450452 – cell. 340 6408309Fax 0438 411164e-mail [email protected] Rinaldo Bonadio

N° of members 98

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Country supported: Angola

Projects supported:Tuberculosis control in the provinces of Luanda and Uige.Mother-and-child assistance in Damba and Maquela.Providing Secondary Maternal and Child Care to displaced people in Uige Province (Uige,Songo and Negage Municipalities)

Initiatives carried out:The Group-promoted decentralized co-operation project “HARAMBEE” continued tosupport the Tuberculosis Cure Project. This three year project concludes in December2006 and is based on the Province of Treviso’s collaboration with the three ASL healthservice departments in its territory, each of which are overseen by their respectiveMayors’ Conference, covering a total of 95 Municipalities. The project provides for anannual contribution of .19 ? for every citizen resident in the territories covered by theULSS districts 7, 8 and 9. It is also supported by the Diocese and the Parishes of VittorioVeneto for the initiative entitled “The Day of Rice”, as well as by other Associations oper-ating in the social sector (the Fishing Sport Association “I Gabbiani” of San Fior, theMareno Amateur Football Association, the Campologo Amateur Football Association, theCollabrigo Sports Group, the Santa Lucia di Piave Amateur Football Association).

In support of the Songo hospital, the Water Supply project for the town and hospitalof Songo, devised and run by the Group, arranged towards the end of the year for theacquisition in Italy, the transport, and the installing of a motor-pump and its relative watersupply pipelines serving the hospital. The installation work was carried out by three tech-nician volunteers from the Group, during a 15 day trip to Angola. Also involved in the proj-ect were: the Mato Grosso Group from Chiarano, the Vittorio Veneto USMI, theMunicipality of Conegliano, the Province of Treviso, the Veneto Region, the writers ArturoBuzzat and Rita Musumeci, the Orafo Vicentino, the Orsago Banca della Marca, theConegliano Corocastel, the “Tre Milioni” theatre company, the San Salvatore Choir, andnumerous private citizens.

As its contribution to the mother-and-child care project in Damba and Maquela, the Grouphas contributed to the conversion and renovation of the Damba school, very close tothe hospital. The G. Marconi and the Saint Francis Primary schools in Conegliano andthe Sansovino Higher Institute for Surveyors and Accountants in Oderzo were bothinvolved, on a fund-raising and sensitisation basis. Other schools have shown interestand will become involved in the near future.


Various encounters have been organised with Primary and Secondary schools, and twoprojects carried out:> “Thirst for Justice” on the theme of water as a fundamental human right, with special

attention paid to the aspect of “water and health”. The encounters took place at theMarconi Primary school and the Saint Francis Primary school in Conegliano, on the12th, 14th and 29th of April and the 6th and 11th of May, 2005.

> “Africa goes to school”, a project stressing the link between education and health, onthe 7th and 14th December 2005. This opened the possibility of involving the schools insupport of the conversion and renovation of the school in Damba, and a Christmas

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Bazaar was organised on the 22nd and 23rd of December, with a display of Africangames, instruments and objects. Further school encounters will take place in Spring2006.

Two further encounters on the theme of voluntary work and the Doctors with AfricaCuamm’s aims and activities took place in High Schools, on the 10th of June in theCollegio Immacolata High School in Conegliano, and on the 7th of November in theSansovino Higher Institute for Surveyors and Accountants in Oderzo. The secondencounter concluded with a collection in aid of the Damba school.

The Group took part in the course entitled “Workshop, School, Volunteer work”, organ-ised by the Province of Treviso.

On the 5th of March it participated in the Conference on volunteer work organised by the“Scuola delle Opere” in the ex-convent of Saint Francis, during which a film on the proj-ect for curing tuberculosis in Angola, “TB Angola”, was projected.

On the 17th of September, the “Conegliano for Water” event took place, organised byAfrica Calls, with the patronage of the Veneto Region, the Province of Treviso and theMunicipality of Conegliano. During the event there was the presentation of a book on thetheme of African immigration “In viaggio dall’altopiano” (“The journey from the plateau”)(from Eritrea to Lampedusa) and a concert of traditional songs of Italian immigrants sungby the Corocastel Città di Conegliano choir.

“Queen of Africa and of the whole world” was an event dedicated to the lay mission-ary work of the Doctors with Africa Cuamm, held in the Follina Abbey from the 8th ofOctober to the 4th of November. On the 23th of October, World Missionary day, the SanSalvatore Choir gave a concert. A film made by the Group was shown, entitled“Motivations for a choice: Africa seen through the eyes of someone who has known it justa little, but loved it a lot”. The initiative received appreciative coverage both in the localpress and on the Regional television news, and was sponsored by the Banca Prealpi, theArtisans’ Association and various local businesses.

Between the 30th of October and the 6th of November the Group collaborated in the “WNairobi W” initiative, with school guided visits of the photographic exhibition and a con-ference on the 4th of November with the title “The right to health: from words to deeds”,in co-operation with the Zikomo Association and the G.Marconi Classical High school.

On the 17th of November 2005 the Group took part in the cycle of conferences entitled“Black Africa, cradle of humanity” organised by the Conegliano Municipality, the Forumon Immigration north of the Piave, and the social co-operative “A Home for Man” fromMontebelluna, together with the Community of Sant’Egidio, on the theme “The otherAfrica of civil action and unofficial networks: the role of the Church and the NGO’s.”

CUAMM MEDICI CON L’AFRICA – GRUPPO DEL PIEMONTE

Address: V. Morazzone 11 – 10132 TurinTel. 011 8192193 – 339 5627232fax 011 8192193E-mail [email protected] Marco Pratesi

N° members 47 (concentrated in the Biella and Pinerolo districts and in and around Turin)

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Country supported: Ethiopia

Projects supported:Support for the Dubbo Hospital (SNNP Region, Wolaita)Support for Mekele Physical Rehabilitation Centre (Tigray Region, Mekele)Wolisso Hospital and Nursing School (Oromia Region, South West Showa)

Initiatives carried out:Agreements were made with two parishes in the Biella area providing for them to raisefunds during the year, and this resulted in a major financial contribution to our chosenaid projects. We also continued our “target mailing” activity; this was run by three cou-ples among our members who carried out not only the traditional Christmas donationcampaign but also two other campaigns aimed at private sector businesses in thePinerolo and Biella areas.

The Group participated directly in Doctors with Africa Cuamm’s healthcare co-operationprojectsin Africa. Some Orthopaedist members and a Turin colleague of theirs took part in theOrtho-Ethiopia project and undertook brief missions to Ethiopia within the ambit of theWolisso and Makallé projects. A student from Turin specialising in Hygiene served in Beira(Mozambique) for 6 months, as part of the Junior Project Officer programme. A Groupmember participated in the first week of the basic course in Padua run for those wishingto serve in administrative roles in an African project. Our Association’s President is amember of the Doctors with Africa Cuamm’smain Board of Directors, representing all the Groups, and attended 7 board meetings inPadua.

Some Group members have taken part in various Doctors with Africa Cuamm assembliesin Padua, in the encounter with the African country representatives, in the “Trainers’ Pool”reunions, and in the Group Co-ordination meetings.

We were represented by a member as part of the Doctors with Africa Cuamm delegationon the Perugia-Assisi Peace March (11.09.05)

Thanks to donations received, the Group was able to acquire and send various items ofmedical equipment to Africa:> 1 electro-coagulator (from the Biella hospital), 300 transfusion bags (through the Ivrea

hospital), and 100 phials of hysterosalpingography contrast dye (through the Pinerolohospital) for the Dubbo hospital;

> various surgical and orthopaedic instruments (from the hospitals of Biella, Pinerolo andChivasso), destined for the Wolisso hospital and the Makallè Rehabilitation Centre;

> sanitary equipment (beds, gynaecological equipment etc.) received from the Biellahospital, to be checked and sent to projects in need of them;

> a request for the acquisition of 3 oxygen concentrators and an obstetric cupping-glasswas submitted to the Biverbanca Foundation. These will be sent to the hospitals inDubbo and Wolisso.


During the year the Group participated in numerous meetings on the theme of volunteerwork promoted by the Province of Biella (Round Table for Peace) and by the Municipalitiesof Pinerolo and Rivoli, as well as other meetings on the subject of Immigration.

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In 2005 the Gruppo Piemonte was officially admitted to the Province of Biella’s Registerof Voluntary Workers and was accredited by provincial Voluntary Work Service Centres (2in Turin and 1 in Biella), being able therefore to take advantage of their facilities (loan ofvehicles, vocational courses, printing resources etc.).

We also contacted the Piedmont NGO Consortium, with a view to becoming members,and the Onlus of the San Luigi Hospital in Orbassano, with a view to obtaining support forDoctors with Africa Cuamm projects.

One of our members is on the management committee of the Piedmont HPH HospitalNetwork, at present involved in improving medical care for immigrants.

As a Group we have organised a number of conferences (8 in the province of Torino:Torre Pellice, Pinerolo, Rivoli, Turin; 5 in the province of Biella: Biella, Cossato), and set upstands within various relevant public events (7 in the province of Torino and 9 in theprovince of Biella: Pinerolo, Rivoli, Cossato, Biella, Cumiana, Abano Terme). These initia-tives were also intended to raise funds for projects in Africa. A special mention for theoccasion on June the 2nd, in the context of the “Ciclolonga Cumiana-Erlagen” (orCumiana-Erlagen Bicycle Outing), a collective bicycle ride to celebrate friendshipbetween peoples, promoted by the Francesco Camuso Bicycle-lovers group of Cumianato commemorate the 1944 civilian massacre in Cumiana. A number of our members tookpart in the ceremonies at the start of the ride, out of solidarity with the principles under-lying an event which the Group had collaborated in organising. In Salussola the 22 cyclistsfrom Cumiana later met up with a large delegation from the Biella area (co-ordinated bythe ApertaMente Association and the Cuamm Medici con l’Africi – Gruppo del Piemonte)that wished to demonstrate friendship and moral support and which included the munic-ipal and provincial councillor Luca Sciaretta and the councillor in charge of PeaceInitiatives Davide Bazzini. In Piazza Duomo to greet the group’s arrival was Alberto Zola,Biella’s Councillor in charge of Peace Initiatives, and another group of sympathisers.

2005 marked the first time that the Group went “on the air”: in June on Radio BecwithEvangelica, broadcast in the Pinerolo area, to talk about the Association and advertise forthe recruitment of volunteer workers for the National Volunteer Service, and on the 21st

of July on the Biella local radio, talking on the Association and imminent events in thearea. We were also mentioned in various articles in the Biella press related to initiativeswe had organised or taken part in (e.g. the summer work project), and in the Pinerolopress in relation to social service volunteer recruitment.

The traditional biennial event entitled EquaMente was held from the 30th of September tothe 9th of October in Ochieppo Inferiore (Biella), and the Group participated with a Doctorswith Africa Cuamm photographic exhibition entitled “it’sAfrica”, as well as its usual Stand.

The Group carried out a number of Educating for Development schools initiatives. A totalof 7 classes from 4 Primary schools from Luserna San Giovanni and Cossato wereinvolved in a cycle of conferences run by Group members and integrated with projectsorganised by their respective teachers. A similar approach was taken with a High schoolclass from Cossato. Informational and illustrational stands on Doctors with AfricaCuamm’s activities were on display for a week in two High schools in Pinerolo.

The Group has also carried out numerous activities connected with vocational training.Several members have taught in vocational training courses, usually 1 or 2 intensive days,such as the Social Medicine course within the courses for Cultural Mediators in Pinerolo,“Primary Health Care” in the Paediatric department, the Doctors with Africa Cuamm basiccourse, in the Hygiene faculty in Turin, on “Buildings for Health care” in the Architectural fac-ulty in Turin, “Continuous Training” in the Doctors with Africa Cuamm basic course, and“Travel precautions” with the Sportika theatre group from Pinerolo. One member organiseda training course in inter-cultural relations and ethno-psychiatry for health workers in thePinerolo national health service ASL. Other members participated in training courses run byvarious organisations (Fund Raising Course/Solidarity Idea/Turin and CSV/Biella, Course on

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administrative requirements to be observed by Voluntary work associations/VSSP/Turin,Course on CSV planning/Biella, Communications Course/CSV/Biella, Course on managingparticipants in the National Voluntary Service/Municipality of Turin and Solidarity Idea/Turin,Doctors with Africa Cuamm Course on humanitary emergencies/Padua, inter-cultural andethno-psychiatric course/ASL 10/Pinerolo, Course on the inter-cultural approach to medicalassistance/Piedmont HPH Hospital network/Turin).

Two further “Committed Tourist” journeys were organised during 2005, to visit Doctorswith Africa Cuamm projects in Ethiopia, at Wolisso (in October) and Dubbo (in November).These journeys were first publicised, especially in medical circles, then became the objectof numerous interviews with people interested, to verify their expectations and attitudes,and culminated in an encounter “for preparation and re-orientation” with the “tourists”before their departure. Unfortunately, one of the travellers had to interrupt her journey inRome, due to a sudden death in the family, while the journey to Dubbo had to be indefi-nitely suspended due to the political violence in Ethiopia.

The Group has involved itself in a number of activities in support of immigrants. It wasa participant in the ”Round table on Immigration” set up by the municipality of Pinerolo,and brought pressure to bear on the Regional Health Department and the relativeRegional Taskforce to improve healthcare services for illegal immigrants. It organisedcourses on the subject for health workers in Pinerolo’s ASL and took part in the trainingof local Cultural Mediators. It participated in the Piedmont HPH Hospitals network, one ofwhose main short-term objects is the improvement of health services for immigrants, andpromoted, organised and conducted, together with the local ASL services, two encoun-ters with the area’s Chinese community.

From the 24th to the 29th of July, in the context of “Operation Restitution” based in theParish of Hope in Cossato, the Group’s local section promoted and organised a summercamp for the 18-22 age-group. Every day, participants alternated reflection and discus-sion sessions, manual work, and evening encounters with representatives from tradeunions and local associations and co-operatives. Over the week, many of the talks weredevoted to the theme of work today, particularly in relation to the non-profit sector.

Two volunteer workers from the National Volunteer Service entered service in Pineroloin October, in premises lent by the “Solidarity Idea” CSV. On average they are committedto 25 hours work per 5-day week, and so we have counted on them to increase ourGroup’s activities. The project they are due to carry out includes sensitisation activities,but they have been active too in connection with the reception and integration of immi-grants in the Pinerolo area. They also took part in the Doctors with Africa Cuamm meet-ing with African National Representatives in Padua. Among their other activities in 2005was the preparation of a project plan for a series of events under the title “The otherAfricas”, submitted to the Fondazione Cassa di Risparmio di Torino. If financing isapproved, in April 2006 the “it’sAfrica” photographic exhibition will come to Pinerolo, anda series of cultural events will take place in Pinerolo and the surrounding valleys (multicul-tural workshops in dance, music, cooking and other manual activities, as well as perform-ances and conferences), all of which will make the Association better known throughoutthe area. The planning phase of this project, at the end of 2005, involved a series ofreunions and agreements with other organisations and associations (Not just a foreigner,Dreams of Having More, the Fair Trade shop, cultural workers and councillors, social serv-ices personnel, the public works department, the society of authors, etc.), all of which willprovide precious contacts for the future.

The Group held its two regular annual assemblies as planned, both of them opportunities forreflection, discussion and decision on our activities. The first was in Torre Pellice, the 19th ofFebruary, and the second in Cossato, on the 23rd of October. On the 21st of January in Turinwe organised a meeting dedicated to health workers in general, and on the prospects for col-laboration that Doctors with Africa Cuamm and its Gruppo Piemonte can offer them.

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Various equipment has been acquired to facilitate the Group’s activities. The Banca diBiella e Vercelli donated a portable PC with printer, scanner and digital camera for theBiella section of the Group, the Turin “Solidarity Idea” Service Centre for voluntary worklent a PC and printer to the Pinerolo section, and the Biella Service Centre for voluntarywork paid for various carpentry tools for use in the Cossato summer camp.

One activity which some of the Group’s members have carried out for a number of years,although substantially independent from other initiatives, has been a Solidarity ShoppingGroup, based in Turin, which has about 30 members, most of whom are not members ofour association. At present this activity is going through a critical period due to the fatiguefelt by those who have been its driving force, and their sense of lack of support from othermembers. In addition, there has been a reduction of reflection and discussion on theissues that underlie the creation of such a group, with the result that its activities nowconsist merely of group acquisition of biological and fair trade products. Ameeting/assembly to decide on the destiny of the initiative is envisaged for the beginningof 2006.

CUAMM CON SARA PER L’AFRICA

Address: Via Rossini n. 13, 36061 Bassano del Grappa (VI)Tel. 0424 567961 – 333 9066322E-mail [email protected] Carlo Girardi

N° members 85


Country supported: Uganda

Projects supported:Nkozi – Uganda Martyrs University

Initiatives carried out: The Group’s principal activity, in aid of the University of Nkozi’s Department of MedicalSciences, has been fund-raising to support its academic activities (see below). Thanks tothe contributions of many donors, in 2005 the University was able to reclassify itsDepartment as a fully-fledged Faculty of Medical Sciences. Financial assistance for thisproject was further boosted by the involvement of a number of Municipalities andAssociations in the Province of Vicenza, among them the Municipality of Rosà and the“Solidarity Market” Association of Bassano del Grappa.


In chronological order, these are the activities we have carried out during the year:> 03 February – In Memory of Marisa Ferrari, a year after her tragic death in Angola on

the 1st of February 2004, don Dante Carraro, vice-director of Doctors with AfricaCuamm, celebrated a memorial Mass at 7pm in Marisa’s birthplace Valstagna, in thepresence of her family and members of the Gruppo Cuamm con Sara per l’Africa.

> February – Meeting in the Art Institute in Nove, to promote sensitisation of NGO acti-

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vities in the Third World and particularly in Africa. Main speaker was a doctor fromDoctors with Africa Cuamm, Dr. Andrea Quarello.

> February – Round Table in the J. Da Ponte Scientific High school in Bassano delGrappa. The participants were representatives of Doctors without Frontiers, the BancaEtica, Doctors with Africa Cuamm, and local voluntary workers, and the High school’sfifth year classes attended. It was an interesting encounter that revealed little-knownrealities, problems and aspects of solidarity which certainly provoked reflection amongthose present and helped them better understand the situation in underdevelopedcountries. The representative of Doctors with Africa Cuamm was Dr. AlessandroMecenero.

> 26 February – Solidarity with Africa Evening, held in the “P.G.FRASSATI” Oratory inthe Santa Croce Parish and organised in order to create an opportunity for encounterbetween the members of the association, its sympathisers and all those sensitive toworld poverty. It was also an occasion for explaining the Associazione Cuamm conSara per l’Africa’s motives, activities and initiatives, as well as those of Doctors withAfrica Cuamm. 150 people were present.

> 03 April – In collaboration with the “Alpini” organisations from the Bassano area, andparticularly from Casoni, as well as the Municipality of Mussolente, the parish ofCasoni, and the Pro-Loco association, we organised a Celebration Day for ProfessorGiovanni Baruffa’s 50 years with Doctors with Africa Cuamm. At 10.30am Mass wascelebrated by Mons. Luigi Mazzuccato, director of Doctors with Africa Cuamm, follo-wed by a ceremony in the church square where a plaque was presented to Prof. Baruffain recognition of his commitment towards the poor of Africa and Brazil. Throughout themorning the Association displayed material promoting the activities of Doctors withAfrica Cuamm, and those of the Association. About 200/250 people attended.

> 04 April – Encounter with Prof. Giovanni Baruffa in Casoni di Mussolente. TheProfessor gave a talk, and the Association displayed Doctors with Africa Cuamm pro-motional material on its projects and current activities. 90 to 100 people attended.

> 16 April – Encounter with the pupils of Cartigliano Seconday school on the subjectof Sub-Sahara Africa, and particularly on the situation of children and their mothers.The encounters were animated by Dr. Chiara Bertoncello and her husband Dr. Luca DeMattia, and by Orianna Ferracin, a nurse with a long experience of Africa, all three beingDoctors with Africa Cuamm volunteers and connoisseurs of Africa. Participants: thefirst and second year classes, in separate encounters.

> 20 May - Meeting in Breganze organised by the mons. Camillo Faresin Foundation,entitled “A smile for the Mato Grosso: paths, experiences, projects”, in collabora-tion with Doctors with Africa Cuamm, the Alpini association, the Pro-Loco and with thepatronage of the municipality of Breganze. Speakers were Don Dante Carraro (vice-director of Doctors with Africa Cuamm), Prof. Giovanni Baruffa (friend and collaboratorof mons. Camillo Faresin, bishop of Guiratinga in Mato Grosso, Brazil), Dr. Paolo Curry(chief doctor in the Santa Maria Bertilla Hospital founded by mons. Faresin inGuiratinga), and mons. Giacomo Prandina (parish priest of Breganze and member ofthe Foundation’s directors’ board.) Material was displayed promoting the initiatives ofDoctors with Africa Cuamm, to whom the evening’s offerings were donated. 200 to 250people attended.

> 27 May – Encounter at the ITC Einaudi in Bassano del Grappa with four second yearclasses on the subject of public health issues in African developing nations. Dr. AndreaQuarello, doctor from Doctors with Africa Cuamm was present.

> 29 May – Participation in the Associations’ Day organised by Macondo, in theChristian Brothers’ school in Romano d’Ezzelino. The Group was present with a stand(display of material on Doctors with Africa Cuamm and its projects, and sale of tickets,T-shirts and books). Objective: sensitisation on Doctors with Africa Cuamm, theAssociazione Cuamm con Sara per l’Africa and the Nkozi project which the Group iscommitted to supporting.

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> 12 June – Maestro Emanuele Bellò’s traditional Young Artists Concert was held in theChurch in Solagna. During the concert the parish priest of Solagna, don Francesco,requested a testimony on Sara and her love for Africa, and this was delivered by thepresident of the Association. 100/150 people attended.

> 24 July – Initiative with other voluntary work groups on the occasion of the Celebrationof Saint Anne of Rosà. Stand with display of promotional material on Doctors withAfrica Cuamm, the Associazione Cuamm con Sara per l’Africa and the Nkozi project.

> 15 August - Doctors with Africa Cuamm Day, organised with the parish of Enego,thanks to the affectionate helpfulness of the parish priest, don Ruggero Ferrazzi.Testimonies were read during the Masses, during some of which mons. LuigiMazzuccato, director of Doctors with Africa Cuamm, was present. Association standwith promotional material, distribution of Doctors with Africa Cuamm material to thecongregations and gathering of donations in aid of the Nkozi project in Uganda.

> 28 October – Encounter meeting in the Chiesetta del Angelo in Bassano delGrappa, chaired by Dr. Massimo La Raja, doctor belonging to Doctors with AfricaCuamm and specialist in Haematology at the Trieste Hospital; theme “A fair share forall….health inequalities in the world”. 50/60 people attended.

> 15 November – Gospel Concert in the parish church in Solagna, performed by theBassano Blue Spiritual Band, consisting of 45 male and female singers, two soloists anda 12-man orchestra conducted by maestro Diego Brunelli. Sara Lessio was rememberedby the parish priest, don Francesco, and by Dr. Maurizio Ferracin who served with Doctorswith Africa Cuamm in Uganda for over six years and who described to the public the roleand the presence of Doctors with Africa Cuamm on the African continent. The church wascompletely full, with standing room only. The proceeds from the collection were donatedto Doctors with Africa Cuamm for the project in support of the Nkozi University in Uganda.

> 4 December – Day in Piazza Libertà in Bassano del Grappa with the voluntaryAssociations united under the co-ordination of “Under the skies of the world”.

JENGA-INSIEME ONLUS - CUAMM MEDICI CON L’AFRICA SIENA

Address: Via Lombardia 15, 53100 SienaTel. 0577 349004 - 335 5411618E-mail [email protected] Paolo Rossi

N° members 100


Country supported: Kenya

Projects supported:Programme of Community Developement for Disabled People in Nyahururu, Kenya

Initiatives carried out:The Group is very directly involved in the realisation of the Nyahururu project, given thattwo of its members, Dr. Barbara Tomasini and Dr. Stefano Zani, are also the co-ordinatorsof the project. Both of them undertook a monitoring and evaluation mission to Kenya inJune-July 2005, also with a view to the project’s continuation. Support for this project hasbeen concentrated on the search for funds, often in collaboration with other entities.

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The Group’s activities in support of projects in Africa have also concerned the training andrecruitment of healthcare personnel. Collaboration has continued with the Siena Hospitaland the Faculty of Medicine, who have recognised Doctors with Africa Cuamm’s trainingcourse for doctors in the training curriculum of the Specialisation Schools (see below).


In the course of 2005 the Group has participated in the Tuscany Regional Government’sMeetings of the Africa Round Table, in the context of the Region’s decentralized co-operation activities. Other encounters were held in Siena, on the Decentralized Co-oper-ation with the Province of Siena.

On the 20th April 2005 it ran a Training Encounter at the Saint Catherine’s Training Highschool, with displays of photographs and promotional material on the Kenya project.

In June the Group had a display stand in the Spring Festival in Pergine di Montalto(Arezzo), which for the last two years has treated the Association as a fixed and privilegedguest.

From the 6th to 8th of October the Group took part in the “Africa on the March” event,organised by the Municipality of Siena in collaboration with the Tuscany RegionalGovernment, presenting a stand with photographic and promotional material, and deliv-ering a talk in the Sala delle Lupe in the Siena town hall on the activities of the GruppoJenga-Insieme Onlus - Cuamm Medici con l’Africa Siena.

On the 28th of November the Group ran a Training Day in Health Co-operation forDevelopment, entitled “International co-operation in support of humanitarian and health-care development in countries with limited resources”, in collaboration with the SienaUniversity Hospital, as part of a project recognised by the Tuscany Regional Government.This consists of 4 days of training in international health co-operation, and follows theinstitution of a Committee on International Health Co-operation within the University hos-pital, on which some of our group members serve, as they also do on the TechnicalScientific Committee. The Group was in charge of organising the day and inviting thetraining teachers, and also presented its promotional stand on Doctors with AfricaCuamm and produced presentation material including a CD-Rom with photos and music.

On the 4th of December the Group took part in the San Mamiliano in Valli ParishSolidarity Fair, displaying photos and promotional material and taking donations.

On the 10th of December we were invited by the Siena Galileo Galilei Scientific Highschool to an educational encounter on healthcare co-operation themes in Africa.

On the 17th of December Irene Stracciati’s Stranensemble Association (a dance ensemblemade up of the able and the disabled) offered a Dance Theatre Performance wherethere was also the presentation of Doctors with Africa Cuamm promotional material, theproduction of a “A Mosaic of Love” CD-Rom with photos and music, as well as fund-rais-ing activity.

On the 19th and 20th of December we displayed posters and photos in the Santa MartaNursery School in Siena and organised a collection of pens, pencils and notebooks forthe “Christmas Together with Africa” initiative.

On the 22nd of December the Group took part in the inauguration of a new mini-bus withthe “Playing at clouds” group in Siena. We displayed Doctors with Africa Cuamm pro-motional material and collected donations.

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NOI CON L’AFRICA - ZIMELLA

Address: Via Molini 32, 37040 VeronaTel. 0429 82495E-mail [email protected] Antonio Loro

N° members 4


Country supported: Ethiopia – Tanzania

Projects supported:Wolisso Hospital and Nursing School (Oromia Region, South West Showa, Ethiopia)Prosthesic-Orthesic Centre in Adis Abeba, EthiopiaOrthopaedic Laboratory, Dodoma Regional Hospital, Tanzania

Initiatives carried out:In 2005 the Group continued its financial support for the clinical activities of the San Lucacatholic hospital in Wolisso and its Orthopaedic and Traumatology services. In particularwe continued to sustain the Orthopaedic project, through Italian specialists who periodi-cally visit the hospital on a purely voluntary basis. To this end we constituted a group ofDoctors with Africa Cuamm othropaedic specialists, under the name Ortho-Cuamm, inwhich some of our members take part. Some members also participated in a 15-dayworking mission to the Wolisso hospital. The Group was active in supporting the Doctorswith Africa Cuamm’s 2005 fund-raising campaign in aid of disabled children in Ethiopia.

The Group was also active in economically supporting the physically disabled patientswho frequent the Dodoma Regional Hospital’s Orthopaedic Laboratory in Tanzania, theFaraja House for Homeless Children in Iringa, Tanzania, and the construction of low-costhousing for the Dodoma Disabled group, Tanzania.

During the year we worked in close collaboration with the Fair Trade network and with theVoluntary Work Associations operating in the southern part of the Verona region. In thiscontext the Associations’ Joint Council granted us a financial contribution collectedamong the area’s voluntary workers, and the Municipality of Zimella gave a specific granttowards our Group’s activities.


Over the year our members were active in informing and sensitising on the healthcareproblems (and other problems) afflicting countries in sub-Saharan Africa. Our sensitisa-tion activities were directed especially towards schools, parishes around Zimella, andyouth, always taking advantage of opportunities for contact with other organisations inthe area. This involved the organisation of numerous sensitisation encounters in localschools, encounters with groups of children and adolescents in the parishes of AltavillaVicentina and San Bonifacio, and participation in local sporting events and courses inthe Trentino Third Age University.

On the 2nd and 3rd of December the Group took part in the “Doing is Living” exhibitionorganised by Verona’s ULSS 20, setting up and running a stand with information on

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Doctors with Africa Cuamm’s activities for the disabled. Many other associations andsocial or medical entities involved in work with the disabled took part in the exhibition.

The Group has also collaborated with Doctors with Africa Cuamm teaching activities(Basic Course, Course in Tropical Medicine and International Health) and provided twoDoctors with Africa Cuamm contributions during the European Society of Osteo-articula-tory Infections Congress in Ljubljana, Slovenia, last May. We have organised various fund-raising birthday parties and an encounter on physical disabilities in Lonigo, Vicenza, takenpart in church services in local parishes, sold Fair Trading products after Mass in someparish churches and on other occasions, and organised an evening on the disabled inAfrica in Saletto, Padua.

SANTARCANGELO CITTÀ DEL MONDO

Address: Via Emilia 384, 47821 S. Giustina di Rimini Tel. 0541 680016 – 335 8436758E-mail [email protected] Patrizia Bettini

N° members 15


Country supported: Ethiopia

Project supported:Aid project for the Dubbo hospital

Initiatives carried out:The Group is closely connected to the project for healthcare co-operation with the Dubbohospital, especially since our founding member works as a voluntary doctor in that hos-pital. Our activities in support of the 2005 project have specifically involved sending andrepairing medical equipment for the hospital and collecting and sending financial aid.


Apart from fund-raising activities, no sensitisation or educating for development activi-ties took place in 2005.

On the occasion of one of our medical volunteer in Dubbo’s periodic returns, we heldour annual assembly, with an account of the situation in Ethiopia.

Our members are committed to promoting the Dubbo project as much as possible dur-ing their professional and business activities.

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MEDICI CON L’AFRICA MODENA – REGGIO EMILIA

Address: Via U. Tirelli 211, 4100 ModenaTel 0522 692202 – 333 4060790E-mail [email protected] Ruggero Urselli

N° members 22


Country supported: Tanzania

Project supported:Aid for health services in four areas of Tanzania

Initiatives carried out:The Group’s financial support for the project in Tanzania has been channelled towards:> lowering the cost of medicines for the Maternal and Paediatric departments in the

Lugarawa hospital;> paying the salary of one Public Health Nurse, in support of the Public Health activities

of the Lugarawa hospital;> providing an aqueduct for Lugarawa (project for financing by the Province of Modena,

presented 22/4/2004);> financing the cost of a course in tropical medicine at the Swiss Tropical Institute atten-

ded by Dr. Giuseppe Iozzelli, doctor with Doctors with Africa Cuamm serving at theLugarawa hospital;

> making a special donation to Doctors with Africa Cuamm for the Marburg emergencyin Uige, Angola.

Fund-raising activities:> Charity Dinner, Saturday 11th of June in Cognento di Modena> Flower selling, Guastalla (Reggio Emilia), 8 May> Submission of a project and funding request to the Provincial Government of

Modena, entitled “Completion of laboratory and provision of outpatient facilities,particularly for HIV/AIDS patients, at the Lugarawa hospital, Tanzania.” Submitted9th November.

> Written request presented to the management office of the Modena General Hospitalon the 13th September, requesting eligibility for financing under the so-called LunchVoucher Initiative. Details of project to be submitted in February 2006 in order to applyto be in line for benefits from the initiative programmed for November-December 2006.If received, the grant would go to covering the recurrent costs of chemical reagents forthe Lugarawa hospital laboratory.

> CONAD Initiative, 14 November-31 December, “Help us support the Lugarawa hospi-tal in Tanzania”. Presentational Press Conference Friday 11 November in the ModenaConad premises.

> Charity Dinner in Guastalla (Reggio Emilia), 23 October> Dinner in Carpi, Friday 25 november> Subscription in memory of Cristiano Venturelli, with fund-raising in aid of the Nutrition

Unit in the Lugarawa hospital, involving about 20 paediatricians, colleagues and friendsof the deceased doctor.

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These initiatives have involved almost all of the 22 members of our association. The Dinnerswere attended by roughly 200 people, had groups of Boy Scouts serving at the tables, andcooks provided by the voluntary cooks organisation from Limidi di Soliera (Modena).


> Report delivered by Dr. A. Foracchia in the “My future as a doctor” Conference, orga-nised by Professor Masellis, director of the Obstetric and Gynaecological departmentin the Carpi hospital, at the Auditorium G.Fini in Modena. Title of the report: “Being aninternational co-operation doctor”. Audience: students and post-graduate students inMedicine and Surgery.

> 23 January, Dr. A. Foracchia participated in the Reggio Emilia Voluntary Work Forum> Adhesion to the Provice of Modena Co-ordination Body for Associations involved

in International Co-operation. Group member Dr. Zaynal Kahfian appointed delega-te/contact person for relations with Medici con l’Africa Modena - Reggio Emila andrelative co-ordination.

> Adhesion to the “Flying in Carpi” initiative, aimed at sensitisation among Secondaryschool and High school pupils on the subject of voluntary work. Dr. Ruggero Urselligave two talks in two different schools on the subject of international voluntary work.

> Organisation of two “Committed Tourist” journeys to Tanzania. The first, from 27/8 to11/9, comprising 8 people including two Group members, Gino Camellini, paediatricianfrom Guastalla and councillor, and Cleo Castagnoli Claudina, the other travellers beingfriends, nurses or colleagues and children. The second trip began on the 18/10 and forfive travellers lasted until the 2/11, while two others stayed on until the 8/11. Amongthe party were two doctors (Dr. Emanuela Carossini, gynaecologist and Group member,and Dr. Gamberini, a non-member family doctor), plus one nurse (Annamaria Cavallaro,Group member), and friends. Also in the party were the Carpi Municipal Councillorresponsible for social services, together with a colleague.

The Group is frequently in direct contact with the Faculty of Medicine and Surgery, withits students and with the director of the Specialisation School in Hygiene and PreventiveMedicine. Some of the post-graduate students from this department are participants inthe Doctors with Africa Cuamm Junior Project Officer programme.

2. PARTNER GROUPS OF DOCTORS WITH AFRICA CUAMM

CUAMM MEDICI CON L’AFRICA MOLFETTA

Address: Via Cavallotti 26, 70056 Molfetta Tel 080 3971376 – 338 2312998E-mail [email protected] Giovanni Balacco

N° collaborators and sympathisers 16


Country supported: Angola

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Project supported:Tuberculosis control in the Provinces of Luanda and Uige, AngolaProviding secondary Maternal and Child Care to displaced people in Uige Province (Uige,Songo e Negage Municipalities - Angola)

Initiatives carried out:The Molfetta Group is a very small-scale affair which with perseverance has done its bestto support Doctors with Africa Cuamm projects, especially in Angola, partly due to thepresence there of two doctors from Molfetta. Little by little and with discretion, more byword of mouth than through public events, the Group has spread the word about Doctorswith Africa Cuamm. Interest and support have grown, to the extent that in the case ofmany of the encounters and events in which the Group has taken part during 2005 it hasbeen the host organisations that have chosen and invited Doctors with Africa Cuamm asfunding beneficiary or partner in dialogue or discussion.

Among the initiatives carried out we would mention:> Special operation of gathering and sending hygienic and sanitary material for the

Marburg emergency in Angola. In collaboration with the Apulia Regional Governmentand the Civil Defense.

> Financial support for projects raised through systematic donations (monthly contribu-tions) and occasional donations (funerals, graduations, birthdays and holidays areoften moments when people renounce certain habitual expenditures and donate theequivalent sum to Doctors with Africa Cuamm projects.


In the course of 2005 the Group organised and promoted a number of school encoun-ters (Primary, Secondary and High schools) and encounters with parochial or diocesangroups, and also took part in various charity events and occasions. For example, thecharity basketball match between the local team at the top of the C1 league and a near-by team from the B1 leaugue, played on the 20th December in Molfetta and organised bythe local team together with the ”don Cosmo Azzolini” Primary school, which has beensupporting Doctors with Africa Cuamm projects for the last three years. This initiative was conceived, carried out and organised with minimal involvement on theGroup’s part; the children had their own ideas and made posters, drew Angolan flags, andput together displays using “institutional” materials effectively and imaginatively. Themothers, instead of giving Christmas presents to the teachers donated the equivalentsum to Doctors with Africa Cuamm. In December the Group also participated in thediocesan youth party, with music and moments of reflection. The entrance contributionswere donated to Doctors with Africa Cuamm. At all such encounters the Group regularlydistributes Doctors with Africa Cuamm promotional material and gadgets.

GRUPPO DI APPOGGIO TOSAMAGANGA HOSPITAL

Address: Via Timavo 9, 33077 SacileTel 360 275617E-mail [email protected] Nicola La Porta



152

Project supported:Aid for healthcare services in four areas of Tanzania

Initiatives carried out:Our main activity in support of the project has been private fund-raising in aid of theadministration of the Tosamaganga Hospital in Tanzania, and specifically for the two mostimportant budgetary items: the paying of salaries and the buying of medicines. This inorder to allow the administration to then charge lower and more accessable patient fees,especially for children and pregnant women.


Visits to the project sites in Tanzania have inspired the desire to promote future “commit-ted tourist” journeys within the ambit of the Doctors with Africa Cuamm’s WelcomeProject.

MEDICI CON L’AFRICA COMO ONLUS

Address: Via Dante Alighieri 127, 22100 ComoTel 3031 3371052 – 339 3348051E-mail [email protected] Giovanni Foglia Manzillo

N° members 35

Country supported: Uganda

Projects supported:Broadening of healthcare services in the Diocese of Lugazi, UgandaQualitative improvement and optimisation in cost of services.

Initiatives carried out: The Group has been active in fund-raising, both from institutions (in part through grantapplications) and from from private citizens, businesses, associations and parishes, in aidof the Uganda project. The funds raised have been channelled to the project partlythrough the Doctors with Africa Cuamm head office and partly directly to Kampala inUganda. In the course of the year some Group members visited the project site inUganda.


The Group has carried out information campaigns and educating for development onhealth issues in southern hemisphere countries in numerous high schools in the Provinceof Como (course of 2-3 encounters of 2 hours each). These activities are part of the 2005-06 school year.

We also participated in the “Right to health” course within the ambit of the School ofHuman Rights organised by the Como Co-ordination for Peace, of which our Group is part.This course is aimed mainly at pupils in their final years in High schools in the Province ofComo and takes places outside school hours. It also includes evening classes for youngpeople already employed. These activities are part of the 2005-06 school year.

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The 2005 edition of the annual “The faces of Africa” event was held; a cycle of confer-ences open to the public, with African speakers, on problems inherent in the world ofAfrica (the 2005 edition treated the topic of multi-ethnic Africa). The event took place inOctober, in collaboration with the Como Diocesan Missionary Centre and the GuanellianoMissionary Centre.

Invited by parish groups, missionary groups and sporting associations, we also participat-ed in various encounters and conferences on the subject of health problems on theAfrican continent.

The Group collaborates with the Como province Caritas on healthcare assistance forimmigrants.

GRUPPO LUGARAWA

Address: Via Breda 2, 35010 S. Giorgio delle Pertiche Tel 049 5742356E-mail [email protected] Giancarlo Ometto



Project supported:Aid for healthcare services in four areas of Tanzania

Initiatives carried out:The Group has supported the Lugarawa hospital, sending funds for the hospital’s activi-ties and for the Lugarawa district. The main source of funding has been through meetingswith parish missionary groups and in the parish churches.

Local sensitisation activities and educating for development.The Group is strongly committed to Doctors with Africa Cuamm’s educating for devel-opment activities, mainly through Group members’ participation in sensitisation and edu-cational events in Primary and Secondary schools. Members of the Group have taken partin various educational and promotional initiatives in the area, sharing their testimony asvolunteer doctors serving with Doctors with Africa Cuamm.

3. FRIENDS OF DOCTORS WITH AFRICA CUAMM GROUPS

The Groups and Associations who come into this category are:Voluntary Work Association Doctors with Africa – Trieste Blood Bank:has raised funds to support Doctors with Africa Cuamm’s activities in the Uige Hospital inAngola. Committe for children in Angola, Work group from Reggio Emilia’s 3rd district:> the solidarity campaign “Ten euros and….you save a life”, launched in 2003 to raise

funds for Doctors with Africa Cuamm’s project for the control and cure of Tuberculosis

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in Angola, has recently come to an end, with great success. The donations have beenused to buy medicines and equipment and have made it possible to reach over 6,000children. The campaign was carried out with the active participation of Reggio Emilia’s4th and 5th districts, numerous families, students, parishes, social centres and privatebusinesses.

> Association Friends of children infected by Hiv/Aids Onlus (Leghorn): has raisedfunds in aid of projects in Tanzania for the prevention and cure of HIV/AIDS, especiallyin children and mothers.

> Association “Let’s save our brothers from poverty and leprosy” – Onlus(Bergamo): has raised funds in aid of the Doctors with Africa Cuamm’s project for phy-sical rehabilitation in West Nile, Uganda.

> Support group for the Matany Hospital – Onlus (Milan): has collaborated in financialsupport for the Doctors with Africa Cuamm project in the Matany Hospital, Uganda.Donations have gone in particular to covering the cost of the Doctors with AfricaCuamm volunteer doctor in the hospital.

> Association Toyai Onlus (Broni, PV): has supported the Doctors with Africa Cuammproject for the Matany Hospital in Uganda.

> Solidarity Market (Bassano del Grappa): has raised funds for the Doctors with AfricaCuamm project in support of the Nkozi University in Uganda, together with the “Gruppo Cuamm con Sara per l’Africa-Onlus”.

> Association Alto Adige Doctors for the Third World (Bolzano): has presented twoprojects for funding to the Trentino Alto Adige Regional Government and the Provinceof Trento, in aid of the activities of Doctors with Africa Cuamm in Tanzania related toAIDS prevention and mother-and-child care. Both projects were approved.

> Association “Friends of Angal”: has continued its support for the hospital in Angal,Uganda, by sending funds, medical equipment and medical personnel missions. It isalso active locally in sensitisation, promotion and fund-raising for the hospital.

> Asiago Missionary Group: has promoted fund-raising initiatives in favour of Doctorswith Africa Cuamm projects in Angola.

OTHER ACTIVITIES

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OTHER ACTIVITIES AND INITIATIVES

ASSEMBLY OF ACTIVE MEMBERS

These were held on the following dates: 15.01.2005, 23.04.2005, 17.09.2005 and12.11.2005.

Assembly of 15.01.2005On the agenda:> Report on the work carried out by the assembly’s Committe> Report on the work carried out by the Board of Directors> Report on the work carried out by the committee for Group co-ordination > Examination and approval of requests for admission by new active members > Role of active members in the life of the association > Approval of the new subscription fee > Report on Cuamm’s activities in various countries> Update on the financial situation

Participants: 37.

Assembly of 23.04.2005On the agenda:> Presentation, discussion and comparison on Cuamm’s “Planning Guidelines”> Approval of new requests for active membership of Doctors with Africa Cuamm > Approval of the financial statements> Various

Participants: 62.

Assembly of 17.09.2005On the agenda:> Approval of the minutes of the previous assembly> Constitution of theme study groups> Audit-report on the Marburg epidemy in Angola> Report on the financial situation > Communication Plan> President’s message

Participants: 42.

Assembly of 12.11.2005On the agenda:> Approval of the minutes of the previous assembly> Ratification of new active membership requests> Reports by Country Representatives> Discussions after each Country Represenatative’s report> Any other business

Participants: 43.

BOARD OF DIRECTORS

Met on the following dates: 07/01, 24/01, 23/04, 20/06, 26/09, 14/11, 21/12.

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BOARD OF AUDITORS

Met on the following dates: 02/03, 01/06, 30/08, 24/11.

COUNTRY REPRESENTATIVES MEETING

Held on the 07-14/11.

VIGIL OF THE SENDING

On 14/10/04 the Bishop of Padua presided over the Vigil of the Sending (Veglia dell’Invio)in the Cathedral, during which crucifixes were presented to a number of Cuamm volun-teers who were either departing, in service, or returned from Africa.

PARTICIPATION IN FOCSIV ASSEMBLIES, BOARD OF GOVERNORS MEETINGSAND ENCOUNTERS

> 19/02: Focsiv Board Meeting (Dr. Giancarlo Ometto)> 09-10/04: Ordinary and Extraordinary Focsiv Assemblies (Dr. Giancarlo Ometto)> 18/06: Focsiv Board Meeting (Dr. Giancarlo Ometto)> 24/09: Focsiv General Assembly (Dr. Giancarlo Ometto)> 03-04/12: Focsiv Ordinary Assembly (Dr. Giancarlo Ometto)

OTHER ENCOUNTERS AND PARTICIPATIONS

> 25/02: don Dante Carraro participates in the General Assembly of Medicus MundiInternational, in Brussels, Belgium.

> 11/03: Andrea Borgato participates in the Ordinary Assembly of Italian NGOs in Rome.> 16/06: Dr. Anna Talami participates in the Seminary Day on Educating for development

organised by the Association of Italian ONGs, in Rome.> 22-23/06: Dr. Marzia Franzetti and Dr. Mara Mabilia partecipate in the AIDS Forum

organised by the Aids Observatory, in Montecatini Terme..> 16/09: Dr. Giorgio Pellis participates in the General Assembly of Medicus Mundi

International, in Rome.> 02/12: dr. Giorgio Pellis participates in the Executive Board of Medicus Mundi

International, in Brussels, Belgium.

BRIEF TECHNICAL MISSIONS

> 28/01-07/02: Tanzania (Dr. Giampietro Pellizzer).> 04/02-04/03: Ethiopia, Wolisso (Dr. Silvio Pasquato and Dr.Silvia Pini).> 18/02-25/02: Tanzania (Dr. Paolo Lanzoni).> 09/03-19/03: Ethiopia, Wolisso (Dr. Maurizio Piazza).> 03/04-23/04: Ethiopia, Wolisso (Dr. Nicola Vinassa).> 07/04-23/05: Tanzania (Dr. Alessio Panza).> 08/07-24/07: Ethiopia, Wolisso (Dr. Antonio Loro and Dr. Annamaria Dal Lago).> 24/07-21/08: Ethiopia, Wolisso (Dr. Giorgio Pellis and Dr. Marina Spaccini).> 28/07-13/08: Ethiopia, Wolisso (Dr. Renato Spadoni).> 27/08-12/09: Mozambique, Beira (Dr. Alessandro Mecenero).> 10/09-26/09: Mozambique, Beira (Dr. Giorgio Dalle Molle).> 18/09-06/10: Ethiopia, Wolisso (Dr. Danilo Mellano).> 19/09-19/10: Ethiopia, Dubbo (Dr. Rossella Peruzzi).> 24/09-09/10: Angola (Francesco Beldì, Italo Bernardi and Giuseppe Marcon).

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> 28/10-25/11: Ethiopia, Wolisso (Dr. Giovanni Cescato).> 02/11-19/12: Ethiopia, Wolisso (Dr. Claudio Pierandrei).> 13/11-27/11: Ethiopia, Mekele (Dr. Silvio Pasquato).> 04/12-21/12: Ethiopia, Wolisso (Dr. Giuliano Novaretti and Dr. Renato Sattin).> 30/12-20/01: Ethiopia, Wolisso (Dr. Luigi Conforti).

INSTITUTIONAL MISSIONS

> 14/01-22/01: Ethiopia (don Luigi Mazzucato and Dr. Antonio Loro).> 18/01-01/02: Mozambique (don Dante Carraro, Dr. Egidio Bosisio and Dr. Alessandra

Gatta).> 28/01-05/02: Angola (don Luigi Mazzucato and Dr. Rinaldo Bonadio).> 27/04-04/05: Angola (don Dante Carraro and il Dr. Giovanni Putoto).> 13/05-21/05: Uganda (don Luigi Mazzucato, Dr. Gianpaolo Braga and Dr. Roberto

Saro).> 11/07-20/07: Tanzania (don Dante Carraro, Dr. Valerio Mecenero and Cristina Biason).> 05/08-17/08: Ethiopia (Dr. Ilaria Bianchi and Dr. Maurizio Murru).> 28/11-10/12: South Sudan (don Dante Carraro, Dr. Massimo La Raja, Dr. Monica Favot,

and Antonio Sebben)> 05/12-14/12: Tanzania ( Andrea Borgato and Dr. Azzurra Rosa)

BENEVOLENCE WORK

CUAMM ‘s life and activities depend fundamentally on voluntary work.It would be impossible to formulate an exact valutation of the contributions offered interms of human resources and material. We may mention some quantifiable elements:

> Brief Missions: 422 days.> Unpaid work by teachers on training courses: approximately 600 hours.> Participation in training teacher encounters: 450 hours

Documents

Annual Report 2005 english