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Right to health

Brazil - the CREN (Nourishment Recovery and Education Center) experience

The 2020 Global Food Outlook of the International Policy Research Institute issued in August 2001, states that in 2020 famine will strike one billion and three hundred millions people, and that one child out of four, in the age range between zero and six, will be undernourished.
From the social point of view, undernourishment is not only a question of famine and children, but it implies consequences on the health, learning capacity and development of the person lasting all his/her lifetime.
The most dramatic situations continue to be those of the sub-Saharan region of Africa and Asia, where 40% of children is undernourished. However, in Brazil undernourishment remains as one of the side effects of poverty, both in the marginal urban areas and in rural regions. In the "favelas" or slums of the big Brazilian cities, 40% of children is undernourished, mainly as a consequence of energetic and protein failures.
In face of such scenario, the consciousness remains that famine is not an abstract question that may be solved only with structural interventions on the economy of the country, but is a matter concerning people that can be faced starting from people themselves. The Cren (Undernourishment recovery and educational Center) experience originates from this consciousness. It was established in Sao Paolo, Brazil in 1993 from sharing with the families of the favelas the need of care and support for undernourished children.
At that time it was immediately clear that undernourishment is not merely due to low income, but to a series of difficult circumstances (unemployment, division of the family, violence, etc.) reflecting on a poor education for the care of the person and particularly of the child.
Cren, in partnership with the Federal University of Sao Paulo - Escola Paolista de Medicina - Salus, an NGO involved in health programs, and AVSI, started an activity aimed not only at caring undernourishment, but also at education and prevention in order to avoid hospitalization and to bring help directly in the community, taking into the Cren only the most serious cases.
During 2000, Cren made over 1300 home calls and successfully cared some 2000 cases of light or medium undernourishment.,
Evidently, to face child undernourishment it is not sufficient to distribute food supplements or meal substitutes. Such an approach of mere assistance may give results immediately, but does not influence the concepts of children care and family education. When the emergency intervention is over, the situation starts to worsen again.
Food education and education to the care of the child and person invest the whole person. The mother is made responsible, educated to use food to care her family, to recover an adequate diet close to the traditions of her community.
The task of parents is enhanced to give soundness to the family and to the adult person.
Today, the activities carried out by CREN are :
· outpatient's department (evaluation of the nourishment level and identification of a suitable diet)
· day hospital for undernourished children (evaluation of the nourishment level, treatment diet, child stimulation)
· care of families (social activity to reduce distress situations, psychological treatment, food education, test labs, education on health and sanitation issues, sensitization of parents)
· activities favoring prevention and awareness in the community (sensitization meetings on health and sanitation issues, measurement of the level of nourishment in the community, food education).

In addition, CREN has activated a process of dissemination of its method, setting up a master in nourishment and pediatrics. In collaboration with the Federal University of Sao Paolo, it has started training courses for the staff of educational centers, involving popularization and preventive actions within the communities.
In collaboration with the Banco Nacional de Desenvolvimento Economico e Social (BNDES), the Cren is also developing handbooks for the medical staff and nurses, educators, the public institutions charged with the care and growth of the child, as well as a special web site on the issue of undernourishment.

Nigeria - St. Kizito Clinic

Nigeria, the giant of Africa with a population of over 120 million, oil producer, presents a precarious health situation that has been deteriorating in recent years, instability of health services, due to strikes of operators who do not get their salaries, unavailability of vaccines and AIDS spreading without any control.
AVSI has been active in Nigeria, in the suburbs of Lagos (10 millions inhabitants), since 1998 with a social, health and educational project. The primary care center of Llasan, a suburb of Lagos, offers its services to some 200 patients a day, with particular attention to pregnant women and children aged under 5, representing a vulnerable part of the population.

Specifically AVSI established a nourishment center to assure food support to children and families, taking care of some 100 children. Purpose of the center is to educate mothers and to provide health and food support to mothers and children, with food prepared and distributed at the center and food to be taken home. In recent years the center started taking care of some HIV infected children by vertical transmission. A home treatment relation has been started with them, extended to the mothers who are also HIV infected. The problems linked to family are very complex : unemployment and no income, repeated diseases that prevent to carry out even the small trade activities for daily survival. The center has become a point of reference also for grown up children, from 3 to 10, with afternoon recreational activities to foster health recovery also through play and friendship.

The main problem is to be accepted as persons. In this sense the staff of the St. Kizito Clinic, through the unity they live at work, create the conditions to welcome people - and particularly those infected by AIDS - who often experience margination .

Uganda - Aids

Recent reports have indicated that the main diseases that cause and perpetuate poverty, especially harming children and women, can be successfully controlled.

Countries like Senegal and Uganda indicate that it is possible to reduce HIV infection rates and there are ways to effectively mitigate the effects of the pandemia.
The declines are increasingly attributed to changes in sexual behaviour, particularly a delay in sexual debut among the youth and a decrease in number of sexual partners among sexually active adults.
What led to this decisive behaviour change in Uganda? The Uganda Government did not fear frankness and openness! AIDS goes beyond the mere health of people. Therefore a multisectoral, democratic participatory strategy has been adopted since mid 80s!
While control measures were centered in the health sector, full-fledged control programmes were established in all key sectors: communication, education, community services, defence and economic planning. The AIDS Commission has guided the fight providing a real conducive and free environment. An emphasis on health education, counselling and change of sexual behaviour guided a national mobilisation against the disease, having realised that HIV infection is mostly dependant on voluntary behaviour unlike most other transmittible diseases.
In fact some evidence suggests that in addition to the prevention and care interventions commonly supported by national AIDS control programs throughout the continent, there existed in Uganda positive elements of social cohesion. It is suggested that these elements served as catalysts to convert AIDS knowledge and information to personal modification of sexual lifestyles. It is fundamental to maintain the extensive AIDS-prevention strategies and educational programme, which have proved in Senegal and Uganda to be effective and respectful of the cultural context of the targeted population.
Moreover is necessary that the cost of drugs and other preventive measures does not exclude the majority of affected people, who live in sub-Saharan Africa.

Since mid 1980s AVSI is involved in the fight against AIDS in the context of the National Programmes of the Government of Uganda, in partnership with the AIDS National Commission.

The main areas of operations in the Health Sector, in collaboration with Ministry of Health, focus on strengthening Health Service Delivery Systems in the districts of Kitgum, Pader and Gulu (Northern Region), Hoima (Western Region) and Kampala City (Central Region).
With the help of various donors, AVSI supports the Ministry of Health in one district hospital, in one regional hospital and in three PNFP hospitals.

In the same districts AVSI works in partnership with local NGOs and CBOs , such as Meeting Point, Kyamusa Obwongo and Companionship of Works Association, in providing integrated home care services to PLWHAs and their families.

The strategies are

Prevention of new infections, above all teaching young people how to avoid it in a human and responsible way and by implementing MTCT prevention in Antenatal Clinics;
Care and treatment of those already infected;
Protection of those, whom HIV/AIDS has left most vulnerable, starting with children it has orphaned.

Prevention is the mainstay of our response, investing in education most of the available resources. Through a nation-wide Distant Support for Orphaned Children Programme more than 3,000 children are in schools. Teachers are trained in identification and dealing with vulnerable persons in the context of a Psychosocial Support Programme in Kitgum District. The empowerment of women, through the support of women groups and adult literacy projects, contributes to the reduction of vulnerability and poverty in the slums of Kampala and in rural remote areas in Northern Uganda.

In Uganda it is estimated that every year about 40,000 HIV infected children are born . Mother to Child (HIV) Transmission (MTCT) Prevention interventions need to be implemented, being also a powerful entry point to other mother and child health services provision, including immunisation, Integrated Management of the Childhood Illnesses (IMCI), Prevention and Care of Disabilities and Psychosocial Support.

Both prevention and treatment cannot simply be made up of techniques, tools or availability of funds; rather they should always rely on the human factor and be situated within a vision of the human person as a whole.

Programmes cannot be limited to child care and protection. The well being of children depends upon those around them: their parents, families, communities, teachers, religious and political leaders. So while remaining focused on the child, our work aims to strengthen the entire community.
This is of fundamental importance in Africa, where emergencies are chronic and complex. Therefore, an emergency should never be allowed to deflect the humanitarian organisations, donors and NGOs from addressing the larger issues of development and sustainability. Long term development must be the goal, but an emergency situation can be the trigger for that development. Local populations should be always seen not as mere beneficiaries, but as responsible partners.