Scaling Up Scaling Down: Overcoming Malnutrition in Developing Countries by Thomas J. Marchione

Author:Thomas J. Marchione [Marchione, Thomas J.]
Language: eng
Format: epub
Tags: Social Science, Anthropology, General, Technology & Engineering, Agriculture
ISBN: 9789057005473
Google: 8yRQgSpSlyIC
Goodreads: 2980980
Publisher: Routledge
Published: 1999-01-15T13:39:40+00:00

PROJECT BACKGROUND

Togo is a small country in Western Africa bordered on the west by Ghana, on the north by Burkina Faso, on the east by Benin, and on the south by the Atlantic Ocean. Its total population is estimated at 3.5 million. For three decades, the country has made significant progress in improving the health status of its population. The under-five mortality fell from 264 to 135 between 1960 and 1993 and infant mortality from 154 to 84 (UNICEF 1995a). However, despite these improvements, when the PHCP started in 1989, the general social and economic environment was weak and unstable, partially due to the democratization process the country was going through. Other health status indicators were also low. Some 20% of new-borns were underweight, 22% of children between six and 11 had a goiter and the maternal mortality rate was high: more than 640 per 100,000 live births (WHO–UNICEF 1996).

The Central Region town of Sokode, where the project is based, is situated on the main north-south road that runs through the country linking it to Burkina Faso, Mali and Niger to the north and to the capital city of Lome some 350 kilometers to the south. Estimated at 350,000 people, the region’s population lives primarily from agriculture and small trade. A very limited proportion of the people are involved in public administration and other non-farm employment. The region has no manufacturing industry. In 1990, the average net income of a farmer was estimated at CFA 5,000/month (US $1 = CFA 250) (PHCP 1991). The Central Region was considered as a transition region between the relatively wealthy south of the country, where the capital and the port are located, and the poor arid north region.

The region is divided into three health districts. Every district is headed by a district medical officer associated with a referral hospital. There is also a regional hospital with specialists in Sokode. Some 55 health centers/dispensaries (HC) are spread throughout the region, which represents a ratio of one health unit per 6,000 inhabitants. The government’s contribution to the functioning of health services is important. In addition to paying the staff’s salaries, it provides each health center with an annual budget of CFA 700,000 for the purchase of drugs.

However, when the project started, health centers experienced frequent drug shortages. Togopharma, the para-governmental organization which imported and distributed drugs to health units, mainly supplied brand name products. With their annual budgets, health centers could not afford to buy drugs and supplies which would enable them to cover the needs of the population for a whole year. Since the use of drugs was not well rationalized, a six-month supply barely lasted a couple of months. After that period, patients who consulted the health units were given prescriptions to buy drugs either from depots or private pharmacies. Also, as the system was centralized, funds generated at health centers were used by the health staff without any system of accountability to the community and the health authorities.

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