Work

Where does aid money come from?

2 March 2008 by Nathalie Abejero Leave a Comment

This interactive map with accompanying document shows the source of aid by country, and maps other interesting information such as corruption, natural disasters, security risk areas, etc. (If aid map is not the default, click the scroll-down map to ‘aid’.)

Aid began after WWII in the new international economic system. Supporting insufficient capital flows in developing countries became part of the Cold War politics. OECD collects data on Official Development Assistance, which does not include funds from philantrophic sources, private foundations, or NGOs.

To address poverty, in a 1970 UN resolution, industrialised nations committed 0.7% of their GNI towards international aid. Of the 22 OECD Development Assistance Committee (DAC) countries, only five regularly meet this target (Sweden, Norway, Luxembourg, the Netherlands and Denmark). On percentage of GNI, the US is one of the lowest contributors (0.18% in 2006), but in absolute amount, it is the highest contributor by almost twice the next country. That of course is now surpassed by the UK, given the devaluation of the dollar against the pound.

Foreign Aid and Development

1 March 2008 by Nathalie Abejero Leave a Comment

It’s difficult not to be cynical given the futility and waste of many aid programmes, no matter the intent of individuals. The constraints of procurements, lack of transparency and accountability, coupled with donors’ foreign policies, often lead to inefficient and ineffective efforts. All for the sake of creating viable markets out of lagging economies?

The impact of foreign aid and development has received increased visibility and debate among the mainstream media lately. There’s a downloadable podcast on NPR’s Intelligence Squared, which hosts an Oxford-style debate on many topics. Is Aid to Africa Doing More Harm Than Good?, broadcast on 12 Dec 2007, offers interesting insights from both sides of the issue.

And the following is a foreign aid blog in the New York Times, by Nicholas D Kristof. What Aid Workers Do

East-West Cultural Differences

29 February 2008 by Nathalie Abejero Leave a Comment

We recently had a team retreat where cross-cultural issues was the popular topic. Misunderstandings happen frequently due to diametrically opposed personalities, working culture, and approach to negotiations by the Khmers, Filipinos, Germans, and American.

Below are pictorials of the cultural differences between East and West, designed by Liu Young who was born in China and lived in Germany.

Blue is Western, Red is Asian

Faces: why we’re here

23 August 2007 by Nathalie Abejero Leave a Comment

Boy and grandmother, courtesy NGO GRET.

This is a family in Kampong Thom who has purchased community health insurance. They are categorised by programmers as “near poor”. Health financing efforts are aimed at those below the poverty line and also those just above it who are at risk of a financially catastrophic event. Photo courtesy NGO GRET.

Khmer kids from the boat communities just across the Tonle. Their desperately poor communities can be seen from the Royal Palace riverfront.

One of the hospitals in the capital city of Phnom Penh, where there is a Safe Motherhood Programme being implemented. Cambodia’s very high Maternal Mortality Rate (MMR) of 472/100,000 did not improve between 2000 and 2005 despite millions in aid money and technical input.

“His Excellency” Tep Lun, the Director General for Health, Cambodia, visiting a hospital.

Yii Chhi are female members of the Pagoda’s community, much like nuns in the West. Pagodas can be a place of refuge in the later years, if women have no family left or if they are escaping problems such as an abusive environment. This Yii Chha is wrapping a beetle nut in a leaf. It is chewed much like tobacco, and has a mild stimulant effect. I’ve only ever seen old rural men and women with this habit, and their teeth and mouth after many years have blackened/ rotted unattractively. Photo by H Kiss.

These Yii Chhi don’t live in the pagoda, and instead traveled there on the 8th days of the Buddhist calendar to make their offerings. After about an hour of prayer and light activity in the pagoda’s Sala Chan (smaller wooden structure on the compound for eating and community activities) they lay down and take a rest. Photo by H Kiss.

just the basic human rights, please

22 August 2007 by Nathalie Abejero Leave a Comment

It seems common sense, but it takes a policy document to implement this mindset. Imagine not knowing your basic human rights. In the health sector the patient-provider relationship inequality foments a host of problems in this area. Because patients are dependent on the provider they don’t question the diagnosis and decisions, or expect (much less demand) safe, quality care. Given their status, providers feel their judgment ought not be questioned. The cycle perpetuates unethical behaviour and promotes dangerous practices in medicine.

Cambodia is just now introducing, in two provinces in the country, the concept that people are entitled to a set of fundamental human rights when seeking health care.

Right to equality
Right to information and health education
Right to health care
Right to privacy
Right to confidentiality
Right to choice and informed consent
Right to express opinion and to participation

Generating demand is one of the approaches to improving proper, safe, quality health services. Developed countries took centuries to develop the level of competence and standards of quality in health care that they are now at. In Cambodia and other poor countries development goals aim at fast-tracking that pace.

A series of workshops were held in the communities within the catchment area of our project intervention health facilities, to disseminate information about Clients’ Rights. Invited are the community leaders such as Commune Council members, Village Chiefs, Womens’ Association representatives, etc. Participants register to receive their per diems, or travel allowance, to attend the workshop.

Low-tech presentation to the community at the meeting hall of a Pagoda in Chakreyting Village. At this site we did not have electricity to conduct the presentation by projector.

At the workshop in another Pagoda in Troey Koh Village, Kampot Province, a facilitator conducts a group pre-test. The pre-test was designed as a questionnaire, but even though all participants are literate, the concept of questionnaires pose difficulty if they have never seen one. So the facilitator obtained answers by show of hands. Ideally, after the day-long workshop a post-test is also conducted to see if participant knowledge increased as a result of the presentations and discussions.
Photos courtesy H Kiss

Aid frustrations: A Doctor’s View Into Humanitarian Aid

21 July 2007 by Nathalie Abejero 2 Comments

Guest Poster: J Chan. She captures quite nicely the frustrations of development work:

I’m back in Mozambique again, now in the 2nd largest city in the country- Beira. It’s nice to be back in Mozambique and the 30hr plane rides are getting more monotonous. I hope to spend a little bit more time checking out the towns along the way while I’m working.

I’m here for the 2nd phase of another project. We were able to get the lay of the land of the flood situation back in May and now we are back to perform a more rigorous assessment of the water and sanitation activities in the resettlement camps (like refugee camps in some ways) by the Zambezi River. We will try to link this information with the risk for cholera outbreaks to help the project guide their future programming in the region.

Consulting for a large international NGO such xxx has been rewarding this year, but also a bit frustrating because it has provided the window to much of the disorganization in the humanitarian world. The interplay between government interests, NGOs strapped by funders as well as their own disorganization and at times lack of skills, create a challenging atmosphere for providing services to communities such as those affected by the floods in Mozambique. Services are being provided to some degree, but not often in a timely manner and often without the greatest leadership.

This work is so different from working in the ER in Boston, where flow, efficiency, and quick, accurate decision-making are the keys to making a shift work well. Accountability is also another element of providing medical care in the ED (as with most of medicine in the US), but now being an attending physician I feel that and see that in a whole new light.

In this post emergency phase in Mozambique I wonder who is responsible and even accountable for the fact that many people still are living without homes, little sustainable water and from what we know so far still living in high risk areas of poor sanitation. Is it the NGOs who are in the field, some of whom lack leadership to make decisions and provide water sources, or is it the local government who lack human capacity and support that they themselves don’t provide services either… But in the end the communities who live by the Zambezi river are returning to their lives with or without the help of govt and aid workers–as they do this every few years when the Zambezi rivers flood…. It the resilience of these communities and the savvy coping mechanisms they create to withstand these multiple shocks that are most powerful in my mind..

Its a great balance to have both types of work (ER and Humanitarian work) fill my days, and I can’t complain at all for these opportunities.