The International Federation of Red Cross and Red Crescent Societies (IFRC) is the world's largest humanitarian organization, with 178 member National Societies, providing assistance without discrimination as to nationality, race, religious beliefs, class or political opinions to victims of natural and man made disasters.
Two main documents provide the necessary framework for the International Federation’s activities in Eastern Africa; the organization’s Strategy 2010 and the African Red Cross Red Crescent Health Initiative 2010 (ARCHI).
The Strategy 2010, outlines directions for the secretariat and National Societies to follow in order to achieve our common mission of improving the lives of vulnerable people by mobilizing the power of humanity. The core areas include promotion of humanitarian values and principles, disaster response, disaster preparedness and health and care in the community.
The overall goal of ARCHI 2010 is to make a major difference to the health of vulnerable people in Africa. It is a key public health priority for the Red Cross and Red Crescent, and focuses on:
• Addressing health problems such as high priority issues of HIV/AIDS, diarrhoea, malaria, vaccine-preventable diseases, pregnancy-related issues, accidents and injuries, acute respiratory infections, malnutrition, poverty, and substance abuse.
• Encouraging national societies to engage where they have the competitive advantage, especially through their networks of community volunteers.
• Developing active effective partnerships and linkages.
• Strengthening Red Cross Red Crescent branches and volunteer capacities
• Ensuring quality in health interventions
• Demonstrate effectiveness and impact
The International Federation supports national societies to engage in health activities that meet the following criteria:
• Large impact on morbidity/mortality by utilizing scientifically viable options as solutions for public health problems. For example the use of insecticide treated nets (ITNs) for malaria control is being applied national societies in the region of Uganda, Tanzania and Kenya. The focus is on ensuring easier access to impregnated nets for local communities through volunteer networks, local manufacture of nets - so that they are culturally appropriate - and sale on a cost-recovery basis to ensure sustainability. Emphasis is also put on reduction in all causes of mortality by mitigating disease using community based health initiatives such as Community Based First Aid (CBFA), commercial first aid and Participatory Hygiene and Sanitation Transformation (PHAST).
• Investments (both material and financial) should be reasonably low - i.e. cost benefit analysis so that there are returns from investing in health and care projects. For example, the use of village level technologies for water supply (village level operation and maintenance - VLOM) that can be operated and maintained at community level ensure that the benefits accrued from installation of fairly expensive technologies last longer. Support for activities that can raise resources locally-commercial first aid, encourage local partnerships with governments, UN agencies and other NGOs - social mobilization for routine immunization.
• Minimum training requirements - CBFA, PHAST, home based care, social mobilization for routine immunization, operation and maintenance of installed water supply systems, etc. all require minimum training for volunteers to promote better health at community level. This has two immediate advantages: results in lower investment (time, finances) which means a lower cost per beneficiary and utilizes local volunteer capacity without requiring that volunteers have highly developed technical skills to deliver services to their local communities.
• Local monitoring- development of key indicators in consultation with the beneficiaries so that both volunteers and beneficiaries are able to assess impact on a continuous basis. With the PHAST process, community members are empowered to make informed choices on new behaviour and to identify ways to ensure sustained practice through developing specific indicators. In addition, by using of ARCHI tool kits which are adapted to local environments, both volunteers and community members can also establish quick monitoring indicators.
Through co-ordination, capacity building and representation activities the International Federation supports national societies to encourage their volunteer networks to engage in the following activities:
• Advocacy - In Water and Sanitation focus is production of relevant Information, Education and Communication (IEC) materials addressing different issues such as reproductive health, female genital mutilation (FGM) or tax exemption for impregnated mosquito nets (ITNs), etc.
• Health promotion - Using PHAST and other ARCHI tool kits, volunteers are equipped with skills to promote improved or changed behaviour that causes disease.
• Initial response – Provision of early assistance to the population in communities at risk. Activities range from basic First Aid to epidemic response before referral to health facilities.
• Community action – Promote participation of community members in activities that improve their health, such as social mobilization for immunization campaigns and, renewed treatment of the already used mosquito nets.
FOOD SECURITY represents yet another area of concern for the International Federation. During a Pan African Conference in Ouagadougou, in September 2000, Red Cross and Red Crescent Societies committed themselves to addressing the two key issues that face the African continent in the next decade, namely food security and HIV/AIDS.
The Ouagadougou declaration outlines that “A person, household or community, nation or region is food secure when all members at all times have physical and economic access to buy, produce, obtain or consume sufficient, safe and nutritious food to meet their dietary needs and food preferences for a health and active life”.
In essence this definition comprises of 3 key elements:
• Availability i.e. agricultural production in terms of sufficient quantity and quality,
• Access: the ability to purchase food through employment, gifts, donations, bartering etc.
• Utililization: e.g. preventing diarrhoea and hence loss of vital nutrients
Drawing on current Red Cross practice we have described a framework which encompasses the activities of three African National Societies that are currently in the process of building up food security programmes.
In eseence, it links availability, access and utilisation to each other, ensuring for example that irrigation corresponds to water sources and to water and sanitation.
Despite the natural tendency to view food security work of the Red Cross as food distributions and aid delivery oriented, there is an increasing experience within national societies of longer-term food security interventions. The diverse nature of programming is a positive reflection of an interest by national societies to test different intervention methods.
Africa’s Food Security reality is grim to say the least. The average food production per person on the continent continues to decline. And, although agricultural production in 20th century improved markedly throughout the world, in Africa research and production stagnated.
A series of factors are to be blamed for the present rampant food insecurity:
• Increased occurrence of drought and floods over the past two decades,
• Conflict, displacing people from agricultural production,
• Poor technology and low productivity,
• HIV/AIDS reducing the capacity of households to undertake labour intensive agricultural production,
• Government policies are not supportive of agricultural sector,
• Market systems do not function well in Africa; good harvest seasons are followed by price collapse and farmers have no incentive to increase production,
• Poor infrastructure often prevents the movement of food from surplus producing areas to deficit areas even within the same country.
The International Federation constantly advocates for the adoption and implementation - by Governments of developing countries - of appropriate policies for the agricultural sector and investment in long-term food security strategies that reduce vulnerability to recurrent disasters
East Africa - Linking food security to risk reduction activities in chronic-famine and disaster-prone areas.
There are five countries in East Africa and the Horn of Africa that have indicated an interest in getting involved in food security activities. These are Ethiopia, Eritrea, Kenya, Rwanda, and Sudan. All of them suffer from recurrent disasters that have both immediate and lasting impacts on food security, as such increasing the vulnerability of households.
Food security programming in the Eastern African region is based on the negative impact of the interaction between chronic food insecurity (related to poverty and vulnerability increased by recurrent disasters) and short term or transient food insecurity (as a result of a disaster phenomenon). Ethiopia and Kenya have planned for and developed proposals to respond to chronically food insecure areas that suffer recurrent drought.
The proposals developed by the Ethiopian Red Cross are in synergy with recent country strategies of the European Union (EU) and USAID. Both EU and USAID strategies recognise that yearly appeals for food aid, although serving the purpose of preventing loss of life, do not address underlying vulnerabilities such as asset loss that result in destitution.
In recognition of the compounding effect of disasters on chronic food insecurity, and in order to reduce the risk to disasters the EU and USAID have developed similar multiyear funding strategies for areas that are chronically food insecure.
The strategy, developed by the Ethiopian Red Cross, aims to reduce the risk of disasters while building community assets and improving their food security. The key areas addressed in the strategy are securing water sources for human and livestock consumption, mainly through spring protection and, improving traditional food and seed storage and the development of seed banks. A community-based approach will be used to implement the project, which means that communities will be involved in the planning and every step of the implementation of the programme.
The project in Kenya is an integrated food security and health programme. While using their own resources to support the programme, the Spanish Red Cross has also submitted an application for funds to the EU. The first phase of the programme is focusing on water source development that addresses both human and livestock water needs.
Each of the five countries mentioned above, have areas where chronic food insecurity is compounded by cyclical disasters such as drought. Repeated shocks on already vulnerable communities create a paradigm where relief saves lives but does not, and cannot, prevent asset loss. The final result of these repeated shocks is the loss of livelihoods and eventually destitution.
The strength of the International Federation in this respect is using the Vulnerability Capacity Assessment (VCA) as a tool that combines risk analysis, vulnerability and capacity assessment in programme design.
By incorporating food security into the analysis national societies can thereafter establish the necessary link between food security activities as disaster preparedness activities.
HIV/AIDS AND FOOD SECURITY, a deadly tandem which received much publicity in Southern Africa, pushed the International Federation to develop a long-term integrated programme to address this complex emergency situation by incorporating the current food security operation in the region with HIV/AIDS interventions.
The same situation of food insecurity as a result of HIV/AIDS is also likely to manifest in the Eastern African region where several countries are currently affected both by high prevalence of HIV/AIDS and drought.
HIV/AIDS is triggering national emergencies and most heads of state in the region have declared the pandemic a national disaster. The combined effect of the food crisis, poverty, vulnerability and HIV/AIDS in Africa is horrifying and no one can accurately predict what the future holds. Households, communities and governments are all struggling and unable to cope.
To mitigate the combined effect of the epidemic, 14 national societies in the Eastern African region with the support of the Nairobi Regional Delegation developed a comprehensive strategic plan for five years. The element of access to health care, water and sanitation, care for People Living With HIV and AIDS (PLWHA) and advocacy against stigma and discrimination are integrated into the five-year strategic plan.
The main challenge facing the Red Cross Red Crescent remains the implementation of these strategic plans by national societies, as their capacity and relative lack of experience in managing HIV and AIDS programmes.
The integration of HIV/AIDS into other programmes also include the element of food security via the disaster preparedness and response activities. Notably, the national societies of Burundi, Tanzania, Uganda and Somalia, have created political and population movement working groups. These have been instrumental in developing HIV/AIDS interventions in complex emergency operations for internally displaced people (IDP) and refugees.
Role of Red Cross/Red Crescent in dealing with HIV/AIDS and food security
The International Federation and its national societies are particularly concerned about the worsening situation in the region and the challenge it represents for the National Societies of Africa. The key issue is: what role should and can the Red Cross and Red Crescent play?
The Federation is in a strong position to develop an appropriate response in Africa.
Much of the food security management capacity should be maintained within those national societies that have established it, and developed in those that feel it is a priority for them. The same capacity should be maintained at regional level. Staff should cooperate on the integration of programmes with elements of food security and home based care, including access to basic prevention and care of common diseases, TB and malaria, work with orphans and vulnerable children and other community activities. National societies programme coordinators, where they exist, will play a key role in this integration.
The expansion of the HIV/AIDS programme over the next five years presents a key opportunity to use it as the platform for a scaled up and integrated community-based programme. A model for such a community care package shows how the Red Cross Red Crescent can address root causes, by working with others to address overall community challenges, ensure basic preparedness and put a safety net in place for the most vulnerable.
The overall concept is to pool our own and our partners’ resources to help the community help itself. When that is not possible, the pooled interventions should provide services aimed at reducing vulnerability and reaching self-help levels as soon as possible.
The programmes should also be seen as a platform for national societies’ advocacy on HIV/AIDS, food security and poverty issues. To reinforce this aspect, national societies themselves should lead the review of how food security, poverty and the HIV/AIDS programmes interact and what are the consequences for programming.
A more integrated programme approach should produce both cost effectiveness and better results. National societies leadership work with effective country-based International Federation support, is critical. But the International Federation and its national societies alone cannot accomplish everything: a serious commitment must be made to partnerships at all levels.
HIV/AIDS and food security – A holistic approach needed
A major obstacle to progress has been, and still is, the current vertical programme approach to many of the problems. In this approach, acute and chronic food security programmes are addressed separately from HIV/AIDS, water and sanitation and other health initiatives.
A holistic approach is needed, to monitor, analyse and address problems and trends. A consortium of partners with special interests and capacity should be set up, to address the current pressing problems and to meet the need for a medium-term and long-term vision, focused on a return to normality, with a substantially lessened vulnerability to disease and disasters.
The increased engagement of bilateral actors working within an agreed framework to deliver an agreed model represents an opportunity for the region. Trilateral agreements will be critical, and a phased approach essential. Securing multi-year commitments to support the adaptation and integration process should be a priority.
The challenges are substantial. National societies and the International Federation will need strong partners especially in those areas where others have stronger expertise. Human resource implications at all levels is another challenge when scaling up and integrating programmes. There is an obvious risk of overloading volunteers and staff and of exposing them to disease in their working environment. This needs special attention.
Some key points on food security and HIV/AIDS:
• An increased dependency ratio is likely with higher numbers of sick adults to children and elderly in households,
• The lives of people living with HIV/AIDS could be prolonged by appropriate nutrient intake,
• Care required for the individual affected by HIV/AIDS should including food aid,
• A long-term food security strategy is required in order for other household members to reduce the risk of destitution.
HIV/AIDS – Stigma and discrimination
HIV/AIDS is triggering national emergencies and most heads of state in the east Africa region have declared the pandemic a national disaster. The East Africa Regional Health Task Force has been set up and aims to bring together representatives from sub regions to address priority issues, including HIV, and to share information. The task force will coordinate the development of HIV prevention and care guidelines and policies.
A key reason for the spread of HIV/AIDS is the stigma attached to it. Individuals who have it, may not know or do not want to admit or talk about it, governments refuse to acknowledge its existence, cultural barriers and beliefs have made the topic taboo, and people living with AIDS are actively discriminated against.
The stigma of HIV/AIDS is seen as one of the most critical issues inhibiting changes in perception, attitudes and behaviour. The Red Cross Red Crescent Movement has an obligation to act, to speak out, to lobby for policy changes and to fight stigma and discrimination in all its forms at international, national and community levels.
National Societies from hard hit countries have scaled up their response and are implementing large-scale programmes that include interventions to fight stigma and discrimination, to prevent the disease from spreading further and to provide people infected and affected by HIV and AIDS with appropriate care, support and treatment, ensuring that responsibilities of the National Society, governments and other partners are well defined.
The International Federation is committed to provide education that will prevent the further spread of the pandemic in the Africa and to promote, advocate for and defend the dignity and respect for all those affected by HIV and AIDS. The International Federation works with a range of partners, including governments, networks and associations of People Living with HIV and AIDS, to help create conditions of safety for persons affected by discrimination or violence including a comprehensive workplace programme for all staff and volunteers.
ACCESS TO WATER
The International Federation’s concern about access to water is such, that a continental approach is needed to try to secure this universal human right for the people of Africa. A major development in many countries, especially in Africa, is the dramatic shift in the responsibilities of government rural water agencies in the last decade from service provider to regulator and facilitator. This shift has meant that rural and suburban communities are increasingly responsible for ensuring and improving their access to safe and affordable water supplies and adequate sanitation. To help in this effort, communities need to build up their volunteer networks and develop partnerships with other organizations to make sure that there is no gap in service delivery.
The International Federation strives to enable communities to improve access to a safe and affordable water supply and sanitation by building volunteer and knowledge capacities. This goal is an essential component of the International Federation’s Strategy 2010, specifically for health and care in the community.
The African Red Cross Red Crescent Health Initiative 2000 – 2010, referred to in the beginning of this document, focuses on supporting community based health care with an aim to make a major difference in the health of vulnerable people in Africa.
How African people can have universal access to water?
Governments need to develop and implement policies that clearly define issues of:
• Ownership – who owns water and how is it managed both at macro (national/municipalities and local councils) and micro levels (village level/grass roots).
• Control- government plays a co-coordinating role with clear structures on who controls the water resources at different levels. Stakeholder analysis focusing on government, private sector, civil society and local communities and their roles and responsibilities within the policy. The policy should recognize the role of gender (men and women in different socio-economic groups).
• Financing – fostering partnerships between different stakeholders. Private sector could for example be involved in research, financing of water supply programmes/projects, provide implements and after sale service to communities by locating themselves in areas where local communities can easily reach them. Multi-national/bi-lateral donors should support sustainable projects (impact on communities, replicability and utilization of appropriate technologies). Government’s role should be to provide transparent and accountable systems where other actors are comfortable to be involved. Banking institutions should diversify their lending policies to support water supply development.
• Conservation/management of ecosystem /protection of watersheds. Issues of pollution control (encompassing sanitation issues), afforestation, water harvesting technologies and water re-use. Strengthening legislation that is currently very weak resulting in pollution of water bodies and destruction of water catchment’s areas that are central to water availability. In arid and semi-arid areas there are no policies that address the promotion of water harvesting technologies. Water re-use should be promoted especially in urban/industrial areas.
• Water resource development and management- Promotion of appropriate technologies and establishment and institutionalizing management structures especially at community level to harness available water resources. Software issues (institutional development at community level, safe water handling, operation and maintenance) of the installed systems should be linked to rehabilitation/ construction of water supply systems.
Water for economic service
How can Africa develop and manage water resource in its development process?
Development of macro-water projects
In the industrialization process, many industries consume water as the basic raw material and within the reproduction process of other products. These industries for example could develop or contribute to the development of water resources. This means that in addition to being a basic human right, water is an economic good and should be treated as such.
Review of international treaties
Legislation allowing or disallowing water resource development for water resources that are shared by different countries e.g. the River Nile should be reviewed on a constant basis to ensure that it is still relevant.
Better management of water resources
With better-managed water resources, generation costs of hydroelectric power will be significantly reduced hence lowering the production costs of goods and services. Water losses during distribution should be reduced through better management, which will reduce the costs met by beneficiaries for water.
Provision of safe water
Consumption of safe water results in improved health, which results in reduced health care costs and economic gains resulting from loss of person hours due to disease.