Monday, October 11, 2004

EVERY NUMBER DENOTES A LIFE

Child mortality and morbidity poses a major threat to Somaliland as a country. Although there is no confirmed statistics to prove the statement, it is palpable for an insider who has been keeping track of the vital events in the community over a period of time. The planners, policy makers, international agencies still make use of the figures which has not been updated since long and has lost its relevance in the present context.

Everybody feels that genuine and updated records can help in better planning and monitoring but insufficient initiative from both government and non governmental agencies cripple the efforts put in for the proper programme initiation.

An inefficient management of statistics can risk missing of lives as it does to numbers for the significance of a number is not in itself but in the life that it denotes. An authentic data brings about a sense of accountability and conscientiousness in its various users. As a result of lack of proper data, earmarking of resources is difficult and that leads to exclusions. Service provision to the people is made difficult due to non demarcation of areas and the service provider being unaware of the number of people to be catered.

The major childhood killer diseases for the country are diarrhoea, respiratory infections, malaria and measles. Many regions of the country witnessed an outbreak of measles few months back which resulted in child deaths. It was quite difficult to quantify the children who were affected. Only those could be traced who came up to the health centres for availing the services. Quite a few might have gone unnoticed as they would not have been tracked due to the inefficient surveillance.

Although collection of data is a mammoth task and requires vast resources but it is essential for developing a system or base. Empowering community to record figures at the grassroots can help government and other agencies to collect and utilise the same for taking decisions for the benefit of the people.

Monday, July 19, 2004

Somaliland: Women and the informal economy


 
When the country is striving hard for international recognition, where external investment is low, high underemployment and unemployment, instable economy, there are women, who contribute most for supporting countries economy through non-formal economy.
 
The non-formal economy is the area that is not recognised, recorded, regulated and protected by the public authorities. It is under now on discussion whether the public authority should provide support and protection to the non-formal economy.
 
It is hard to realize and admit for the planner, economists and policy makers that the bulk of economy and employment are being generated in the country through informal sectors. This sector not only creates job opportunities to millions of poor and unemployed but also flourishes national economy to a greater extent.
 
Study says that in Africa itself informal economy accounted for almost 80% of non-agricultural employment, over sixty 60% of urban employment and over the 90% of new jobs over the past decade. Though there is no available statistics about informal economy in Somaliland but it is more likely same as of rest of Africa.
 
Hargeisa, the capital of Somaliland, has witnessed the rising trend of informal economy over the past few years. Businesses starting from chat (one type of leaf people chew which is mild toxic in nature) to gold are operated and managed mostly by the women. The business is so rapid and fast growing sometimes it creates illusion that the Somaliland economy is moving with this. The skills and competencies women exhibit in handling this business apart from their household chores is really surprised.  People should not be astonished if I say the women primarily control the informal economy in the Hargeisa city.
 
Why it is called informal:
 
This is not an organised sector. Economy theory does not speak much about this. Economists consider this economy does not contribute for national economy at macro level. Other reasons for considering as informal economy are based on certain criteria and assumptions like; any national law does not directly govern the sector. Government does not recognise the economy so they do not protect and safe guard the economy. As this is not recognised so it does not comes under the preview of legal framework. Many economists argue that the prime reason for non-acceptance by the government is because the economy does not directly contribute financially to the treasury of Government. Whatever the reasons there in, the truth is the sector is not properly patronised and cared.
 
The non-formal sector works under high degree of economic and social insecurity. They do not get any support in terms of formal credit linkage, skill upgradation, and business information because of its non-recognition and not organised status.  
 
How this business runs?
 
The fundamental requirements for any business to run are buyer, seller, place, materials and money. If we analyse the market ingredients of this economy in Somaliland we find that the buyers and sellers are from rural and urban local communities. They gathered mostly in the pick hour of business that is 8 am to 12 pm. The items they sell in the market are numerous starting from money exchange, vegetable vending, jewellery selling, tea vending, chat selling, traditional handicrafts business, cloth retailing to milk and meat selling. The mode of transaction is through Somali shillings (now 1 US $ is equivalent to 6500 SSh).
 
The challenges for the sector:
 
The major challenge is the nature of business itself which is highly volatile and shaky. Second challenge the sector encounter is the access to credit. People do not get formal credit through financial institutions because of the collateral issue.  Though the credit requirement differs from business to business starting from 50 US $ to 5000 US $. It was found that almost all entrepreneurs borrow money for business from the informal moneylenders mostly from relatives, businessman. Sometimes they do business on percentage share basis. They just take product from the whole sellers then sell it in the market and at the end of the day they return money to the whole seller and receive some percentage of the profit. Third challenge they face is lack of insecurity in the field of employment because of high instability and no legal bindings. Job insecurity because the sector is controlled by various invisible agents and external factor which do not guarantee professional growth and any formal contract. Labour market security is non-existence because the government policy does not protect or provide economic or social guarantee.
 
How to mainstream the informal economy:
 
In Somaliland context mainstreaming informal economy is like mainstreaming country’s economy. It is clearly evident that the Non-formal sector absorbs more people than formal sector in the country.
The greatest challenge in front of the country is access to external resource support for mega projects. So the alternative is to create environment for small enterprises both in formal and non-formal sector. This act will not only reduce unemployment but also raise per capita income of the country. This is not only Government who is responsible for everything but also it is NGOs, civil societies, academic institutions, and financial institutions who have responsibilities and duties for the people and the cause. 
 
Areas need more focus and supports:
 
Right to work as fundamental right.
Freedom of association and right to organize and bargain collectively.
Credit support through formal system to make free from debt bondage.
Protection against any kind of exploitation in business and trade.
Ensure workplace security, work decency and basic facility.
Government policy to protect the sector and economy and strengthening labour law.
Include in social security net. Like free health service, insurance etc.
NGOs can organise workers, provide basic training and education, provide financial linkages, assist in policy advocacy and law, basis health care for the workers etc.
Bankers can train them on business, extend credit facility, organise saving and credit groups and can make necessary amendments in the bank law for the credit linkage and technical support for the non-formal sector. 
  
  
  
  
  
  
  
 

Friday, July 02, 2004

Sustaining Education

Sustaining Education is Sustaining Life. While education brings changes in lives and carries prosperity to the humanity at the same time educational institutions find it challenging to sustain itself. Many educational institutions in the third world countries depend upon external donations and Government support to run the institutions. In the present fast moving and demanding world quality and excellence is the majoring rod for success. To be an effective organization it is necessary to have well defined Mission, Vision and Core Value in place and in practice. This not only allows for more experimentation, research, diversification and team work but also encourages leadership, invites strategic thinking and establishes supportive work environment and work culture. To run all these things and continue in the effort it is necessary to have technical, managerial and financial resources available within the institution for use and support.

Yesterday I had visited Amoud University in Borama. Borama is a small town of Somaliland. Borama is strategically situated bordering to Djibouti and Ethiopia.
The Amoud University is located outskirt of Borama on a valley. The scenic beauty of nature and the very location of the University not only attract students and local natives but also visitors within and outside the Somaliland. The name Amoud (literary meaning is Valley) justifies is location and presence. There are no public or private transportation facilities available for the university campus but one can avail University transportation facilities. Students and lecturers use University bus for coming to the University.

The facilities:
The University is situated over 30 to 40 acres of land. More than 25 rooms and halls available for use as class room, computer laboratory, Director’s room, staff room, library etc. The University also has an extension study centre in Baroma town. Quarters for supporting staff are also available.

The University has a generator which can supply power to all blocks of the campus, 24 hours pipe water supply and also a canteen for tea, snacks and cool drinks.

University assets:
The University has a big library with more than 83,000 reference books, magazines and reports. It has more than 50 personal computers, one printer cum photocopier and one in focus (projector). For transportation it has five 30 seated bus and a small 8 seated cab.

Teaching Staff:
There are more than 30 teaching staff, 10 supporting staff are working in the university as full timer. Most of the staff are from Hargeisa town and they stay in Baroma.

Student and courses:
At present 3 major courses are available. These are on Business administration, Education (Science stream), Medicine and Surgery. Along with these a new course is introduced for imparting training to secondary school teachers. Altogether 450 students are participating in the education in different semesters. Majority of students are from Somaliland but there are few students from neighbouring countries.

How the University has been running?

The University has a management committee to look after over all work. Director of the University manages day to day functions of the University. To run the University an amount of 200,000 US dollars required each year. Though the actual requirement is more but University manages within this by reducing activities and payments. Nearly forty to fifty percent of total revenue comes from Students fees and rest of amount comes from donation from International Organizations, donor agencies, local community in Somaliland and Somali Diaspora and from government grant.
The library books and vehicles are donated by agencies and individual donors from Diaspora. Generator and some computers are received from the President of Djibouti as donation, Computers for students and staff are from International Cooperation for Development (ICD). ICD (CIIR) also provides Development Workers to the University under skill sharing programme. Development workers supported University for management of library and Information Technology program.
The major expenses for the university are under the head salary to the staff, teaching materials and student’s examination expenses, running cost for Generator, Water, Vehicle, maintenance and day to day management.

The Challenge:

The Challenge before the University is how to be self-sufficient in terms of financial, technical and managerial.

I request your suggestions and opinions. Suggest how the University can run with limited external funding or no external support.

I am putting my suggestions here:

Corpus Fund: Generating fund by collecting from agencies, Government, individuals and from different sources in the form of donations or revenue. Continue collections and deposit in the bank as a fixed deposit. After 10 to 15 years the interest of the bank deposit can be used as a part of sustenance.

Research, Training and consultancy Programme: As the University has infrastructure (Rooms, Library, Bus, generator, Computer, projector) and person power for general and technical support (teaching and supporting staff) in place so the university can take up small training programmes with the help of teaching staff for Local NGOs, INGOs, Government, business people and other groups. Using their present area of expertise of the university like economics, science, health, medical, computer etc, training programmes like Micro – credit, self help group, small business / entrepreneurship, laboratory technician training, community health training, data entry operator, basic English, training for health staff, general management, human resource management etc can be organised. University can take up research and consultancy projects of Government, UN, INGOs and others to generate revenue.

Field Extension Programme: Under field extension programme University can take up development projects with the support of UN, International Donors, Government and NGOs. Separate development wing can be functional with the guidance of some teaching staff. Student’s knowledge, skill and time can be use for this. Or field work could be a part of teaching and every student should take field work as a compulsory subject.

Facility renting: University can rent its existing facility like rooms, computer, library etc for different training programmes, conference, workshop, seminar etc to outsiders.

Opening study centres: University can open study centres for International Education Institutions in the university campus.

Certificate Courses: 3 months or 6 months Certificate course on Rural Development, Business Management, Health Management, IT management, Data entry operator, etc can be introduced. Government, private and Non Government Agencies can be contacted for providing job placement of these students.

To start all these University needs to do two major things. One is equipping its staff through training, orientation or exposure to take up above tasks. Second is establishing contact with any agency or agencies to avail support to start the activities at the beginning stage.

What is your suggestions?


Tuesday, June 29, 2004

Cost – Sharing in Primary Health Care

In the year 1987, the World Bank recommended that that the principle of cost recovery be incorporated into an agenda for financing publicly provided health services in developing countries. (World Bank, Findings, Africa Region)
Subject provoked many people across the globe to debate and react over it. Controversy and debate over cost-recovery system not only limited to the subject itself but also pointed so many issues relating to that. Issues like will poor able to pay? What about Government’s commitment towards peoples’ health? What about peoples’ right to equitable health? And the debate was not confined to a group, country or region; it challenged the very intension and commitment of United Nations commitment for Health for All. And now the Millennium Development Goals (MDGs).

Cost- recovery in most of the poor countries in Africa, Latin America and Asia is the bi-product of Structural Adjustment Policy or Health Sector Reform initiatives, and also a compulsion in the part of the poor National Government to adopt this because of its poor economic condition that denies free health care to its people.

What ever the reason behind the present cost-recovery system (cost sharing) there in but the ultimate truth is it does not benefit any one, neither the country nor its people. Most of the people in the third world countries are already far from the access to health service due to so many factors and the present cost-recovery system develops more gap between the people (poor) and health care. If we analyse the cost benefit or profit and loss of present cost-recovery system we will find there is little benefit or profit but more loss and burden. The poor people in the cost-recovery system are either forced to take loan from relatives or money lenders by mortgaging household assets to avail the health service or just remain in ill health and disease. Both the activities create economic burden to the family and the country. If people lost household assets or remain diseased that further breaks the chain and system of capital formation and productivity and put people vicious circle of poverty and disease. To get recover from the vicious circle of ill health and poverty both Government and People will have to spend more resources in terms of money, material, manpower and time than actually they contributed for the health services in the cost sharing.

The recent study conducted by Somali Red Crescent Society in two health centres in Somaliland where cost sharing (cost recovery) system has been initiated gives very grim picture of the initiatives.

The target set by the ministry of health for the project period that is 30 months as the community contribution in terms of user fee was 26 % of the total project cost for both of the health centres. Government contribution 5 % and rest the donor contribution. At the end of the evaluation it was estimated that local Government had contributed 2 % in one health centre and 3 % in another. Community contributed 1.5 % in one health centre and 3.5% in another centre.

The findings are revenue generated for the purpose was very small and negative impact of user fee scheme on attendance. User had resulted in reduced utilization of services and some people cannot afford the fee. Poor people are excluded from the services and many did not come for the service and some could not finish the complete treatment because they could not pay for the whole course of treatment. Study says that in Adadley health centre 1 in every 4 household had to borrow to pay the fee. Even in during drought period many patients were not exempted because health centre did not know their economic conditions.

Though the government policy says about exemption of user fee for poor, destitute, chronic patients, medical emergencies, mentally handicap without having family support, women in child bearing age, preventive services for under five children, immunization service but in reality lack of data to identify exempted persons and guidelines on user fees exclude people to get benefit of the government policy.

Here with I conclude that the paying capacity of the people, Government’s exemption or waiving policy & guideline and its enforcement, quality care and service, provision of low cost drugs, improve accessibility, etc are the key to the success of cost-sharing system.

The debate continues………………….




Monday, June 28, 2004

Struggle for Co-Existence

“The Appropriate code of conduct for a Globalised world should be the five principles of Peaceful Co-Existence and not the over-lordship of one super power or group of nations” said former Indian President K.R.Narayanan addressing a two-day international seminar on Five Principles of Peaceful Co-Existence in Beijing on 15th June 2004.
Today is the 50th anniversary of the five principles (pancha sheela) agreement initiated by India, China and Myanmar in 29 June, 1954. The five principles are on mutual respect to each other’s territorial integrity and sovereignty; mutual non-aggression; mutual non-interference of each other’s internal affairs; equality and mutual benefit and peaceful co-Existence. Even after 50 years Five Principles remains extremely relevant and valid framework for peace and sovereignty in the world. The five principles has relevance to the changing world of today and tomorrow where every one struggle for Co-Existence.

The Five Principles:

The word “Pancha sheela” denoted “Five Taboos” in the ancient Buddhist scriptures governing the personal behaviour of Indian (later Chinese and other foreign) monks. This was taken from the holy book by the first Prime Minister of independent India Pundit Jawaharlal Nehru to be applicable for international behaviour and order. It is also stated that Jawaharlal Nehru was borrowed the idea from Gandhian Philosophy of Satyagraha – the non-violence to use for peaceful coexistence with the neighbouring countries. Nehru was convinced that five principles would bring changes in the international relation and would help in bridging gap between United States and former Soviet Union.
Peaceful Co-Existence have become the basic norms in developing and maintaining state to state relations transcending regional social, cultural and economic barriers. The five principles of peaceful coexistence are diametrically opposed to power politics which have been in dominance in the international relations over the last few centuries.

Relevance in present world context

Five principles has undoubted relevance in the present world order to bring mutual understanding and cooperation among the nations. The major primary beneficiaries of the principle agreement have been India and China. India and China resolved their long standing border issue through this agreement. The present world where border issue has been the cause of conflict for many African and Asian countries like India, Pakistan, Somalia, Somaliland, Israel and Palestine, Indonesia and Timor etc . The five principles will help in building an environment for mutual trust, security and reconciling border issues.

Equality and mutual benefit was one of the basic principles of Pancha Sheela. Under the agreement both country had decided to open trade centres in different places of the countries with mutual understanding and respect to trade and traders. In the present world system where countries are struggling for trade and commerce and there is a huge gap between International and multi national companies and local producers could learn lessons from the agreement. The agreement says “the Trade Agencies of both parties shall be accorded the same status and same treatment”. The article of the agreement says,
“Inhabitants of the border districts of the two countries, who cross borders to carry on petty trade or to visit friends and relatives, may proceed to the border districts of the other party as they have customarily done heretofore and need not be restricted to the passes and route specified in Article IV above and shall not be required to hold passports, visas or permits”. This article will not only encourages inter – country or inter-region trade and relation but also at the present context enlightens International Trade Organizations like WTO to think over this.
“Pilgrims of both countries need not carry documents of certification but shall register at the border check post of the other party and receive a permit for pilgrimage”. This article profoundly establishes relationship between the people of both countries and spreads cultural and religious harmony among the nations.
Mutual respect to each other’s territorial integrity and sovereignty as one of the principles demonstrates respect to the country and its sovereignty. In the present world context it would help to build peace and would remove conflict between the countries.

Challenges before Co-Existence
Co-existence means learning to live together. Co-existence is accepting diversity and implying positive and truthful relationship among the humanity. Co-existence should not be seen within a limited framework of inter-state relation but should be perceived as intra-state, intra-community, intra-religion paradigm. The present world is separated in races, groups, clans, rich and poor, north and south. The great challenge is to build confidence among people and countries. Provide scope and opportunity to understand each other and to build up relationship and trust. Co-existence between people, races, religious groups, clans, tribes within a broad spectrum of distinctiveness will be the real test for all of us in the coming years. Human dignity and freedom of independence will be the measuring rod for the civilization.
Our Commitment:
The commitment for institutionalizing co-existence should be the agenda for all. It should start with the people, community, and civil society as a social movement not as a political agenda. Education is the basic foundation for the coexistence. Stronger education system with a responsive civil society and effective governance together can bring changes in the present world order.

Wednesday, June 23, 2004

Diagnosing the health of Medicines

Medicines that are dispensed at the health facilities by both Government and private hands in Somaliland do need to check its health, suggested one of my Telesom friends. You must be wondering about two factors one is Telesom friend and Health of medicine. Isn’t that? In Hargeisa town one private telecommunication company named Telesom provides unlimited talk time on the telephone over a fixed charge of amount per month. So most of the people like us take this advantage and chat for a long hour on any topic. This facility also helps to make friendship with people both known and unknown and I call them Telesom friend.
I light heartedly replied to my telesom friend, all over world only few drug companies are in collapsing stage or already collapsed but majority of them are always with high fever if you see the stock exchange bar you can know. Most of the drug companies’ health is good. My friend annoyed with my reply and said we should not joke for everything. This is very serious concern for all of us. I kept quite. The phone line then got disconnected when I tried to reconnect but there was no signal available.

The Situation

In the country the provision of drugs is left to the hands private suppliers. Except UN agencies, who procure drugs for their programme from their own secure sources, all most all agencies including Government buys from local open market through an open tender. I do not have statistics to comply what percent of people gets UN supplied drug but I roughly estimate more than 90% people buy from outside.

The prevailing situation in this country is no one obtains free medicines except some vaccines and few other medicines in Government Health Centre. Everybody has to pay for medicines. Paying for medicines is not always easy for people mostly poor. Many poor say, sometimes paying for drugs is more painful that disease itself.

Drug choice by people and also service providers in both rural and urban areas is mainly rest on two things one is drug name and another is drug manufacture country name. the general perception among people and health professionals about drug is, supplies come from India, China, Pakistan (Asian country) are relatively less qualitative than supplies from European nations. Reasons may be some drugs really are effective or may be it is only perception or propaganda. What ever reason may be there in, the real pain in neck is most of drugs suppliers do not keep drug efficacy report or laboratory test report of all drugs with them and many buyers not only individual but also institutions do not ask for it.
It is not that drugs available in the market do not have proper documentation but it is simple error in part of people not seeking for it.

The cost of drugs

There is no single rate for any drug all over world. But for the people of Somaliland the drug price is exceptionally high and many times not affordable. It is obvious because all drugs are imported and there are lot of taxes and duties are levied on the drugs. By calculating everything and including profit margin definitely drugs will be expensive.

Essential drugs

Putting a lot of medicines both essential and non-essential on sale would definitely raise the overall price of the product. Because investment cost, any loss or damage, expire etc will add to it. But important thing about essential drug is there is no list of essential drug to follow by the Government and Private practitioners. Many drugs available in the health institutions and shops are not necessary at all and drugs prescribed by the doctor and pharmacists do not always follow essential drug category. Self medication and taking drugs from drug retail store is a practice and rampant in both the urban and rural area. This is may be because there is lack of doctors to appoint for each area, lack of access to doctor or hospital and may be people’s ignorance about the subject.

What we can do now?

In my understanding we should focus on four or five major areas,

First is develop essential drug list, supply only essential drugs to health centres and train health service providers on use of essential drugs and motivate doctors to prescribe essential drugs. Enforce the follow up system.

Secondly, Develop pharmaceutical formulary of drugs according to the requirement of the country. Categories them as drugs indispensable for general use, drugs reserved for specialists use and high risk drugs to be used only under strict protocols.
List of drugs only can be sold by doctor’s prescription.

Thirdly, Government can buy essential and other live saving drugs from world market in bulk. Government can take loan from any individual or aid agency or company and sell the drugs to Government institutions and private parties. Or Any aid agency can buy the bulk amount of drugs from international market by making international tender and sell to government and private and run the operation through a revolving fund managed by Government or NGOs.

Fourthly, Encourage individuals to set up drug manufacturing unit or any Multi National pharmaceutical companies to come and set up units in the country.

Fifthly, Government to ensure drugs coming to the country has proper documented and certified by the international or recognised lab.

After all it is our responsibility as Government, drug supplier, consumer, doctor, retail shop owner, health professional, administrator, planner and development organization to protect million lives of the country through an effective and quality service. It is our self conscience, professional ethics and morality that helps a country to move forward and shine.

Tuesday, June 22, 2004

Water harvests Water

Last week I was in Dar E Salaam District head quarter. Dar E Salaam is one of the districts of Somaliland. It is nearly 13 kilometres from Hargeisa, the Capital of Somaliland. I visited the health centre of Dar E Salaam with one of my colleague. We had meeting with the Traditional Birth Attendants, Community Health Committee members and Health staff of the Health Centre. My friends in the health centre suggested us to visit nearby farms. I was little surprised after hearing the word farm. With my all eagerness, I asked what they mean by farm. They said it’s a farm, Mango Farm. Out of my curiosity I decided to see the farm. I could not believe my eyes when I saw a green belt of trees and plenty of mango, Guava and lemon spreading all over under the trees.

Dar E Salaam has been a favourite place for most of the farmers inside and outside of the area. It is all because of available water in all the seasons. Farmers are successfully use ground water by water lift points and irrigate trees through pipe water irrigation system. Most of the trees in the farm are matured and some are even more than 20 years old. Each matured mango tree bears on an average 200 to 300 Kilograms of mango in a good harvesting season. An orchard of 25 to 30 trees is more than sufficient for a family to sustain livelihood.

But all areas of Somaliland are not fortunate enough as Dar E Salaam. Where farmers get enough water for the trees and animals. The question comes to my mind; can it be possible to have water for the agriculture and pastoral activities? Different study and development projects claim that small scale water harvesting structure can have increasing water security in the area. Water harvesting structures like sub-surface dams will be most effective in the areas. And also small scale water conservation methods like construction of check dams and contour and gully points will help to check rain water run off and restore water for pastoral use. It will also help in recharging the ground water. Though rain water harvesting structure and system is under developed and in very infant stage in the country. Very few demonstrated and effective model are available.

The general livelihoods of the people are mainly based on agro-pastoralism activities in the area. Development of livestock and agriculture is the main challenge before the people and Government. Sustaining and strengthening pastoral activities through proper management of natural resources is the concern for all. Large scale dry season migration has posed very negative impact for the both human and cattle population. In order to minimise large scale dry season migrations and to sustain agro-pastoral activities it is necessary to harvest and sustain water for consumption of human and cattle. Construction of more water bodies in the basins to harvest rain water could be one of the activities towards the same. With this increasing reservoir capacity would also help in drought mitigation and would reduce large scale migration. Community owned small watershed would definitely make differences in the sustaining livelihoods. Development agencies can work with the pastoral community on watershed management and natural resource management. Nature has not given us plenty but what ever is there if managed with sense and wisdom could bring changes in the life of people. It is sure that we could experience more like Dar E Salaam in near future.