Geneva, Palais des Nations - May 3-6, 2000
CITIES OF THE SOUTH:
SUSTAINABLE FOR WHOM?
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ESF/N-AERUS International Workshop Geneva, Palais des Nations - May 3-6, 2000
CITIES OF THE SOUTH:
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G Felber, N. Othingué, N. Yemadji, K. Wyss
Swiss Tropical Institute, Basel - Centre de Support en Santé Internationale, N'Djaména - Department of Geography, University N'Djaména
In the South, urban environmental and social management is often based on top-down approaches which use technologies and strategies not corresponding to the demands of the inhabitants and to their social, economic and ecological realities. This paper discusses how a community-based, participatory approach can be favourable for malaria control and more specifically for the dissemination of insecticide treated bednets. At the example of N'Djaména, capital of Chad, the text investigates the potential of this approach for mobilising and strengthening sustainable activities and capacity-building at community level.
In 1994 the Swiss Tropical Institute initiated a project in N'Djaména, for better management of the urban environment, funded by the Swiss National Science Foundation, the Swiss Agency for Development and Cooperation and TDR of the World Health Organization. In close collaboration with various partners (Enda Graf, University of Avignon, municipality, associations) research and implementation activities look at the management of the social and environmental situation in urban low-income zones by the inhabitants of the area. This with the aim of promoting existing community initiatives. Such initiatives are seen as very relevant in situations where basic social services are inadequate or insufficient.
From 1997 onwards and in the context of WHO's recent initiative "Roll back on malaria" , one of the components of the project became the introduction and promotion of the use of insecticide-treated bednets (ITN) for malaria control. This, as it was recognised that there is a great need to carry out research on the most efficient means to implement and sustain the use of such nets in urban settings where malaria is endemic (Lengeler et al., 1996). ITN's have been shown to reduce considerably malaria transmission. Several studies in Burkina Faso and other African countries revealed that a reduction of infant mortality up to one third is possible trough correct use of ITN's..
The objectives of net related activities were: (1) To introduce, promote and maintain the use of ITN's by using a participatory approach, (2) to create and sustain commercial centres of sale and of impregnation, (3) to identify the advantages and disadvantages of using the "Research Action Capacity building" approach, (4) to empower grass-root initiatives and to strengthen their knowledge, their capacities of organisation and communication.
A Research - Action -Capacity building (RAC) (French: "Recherche Action Formation") approach such as outlined by Enda Graf (Ndiaye, 1999) was selected as conceptual framework for the promotion of insecticide treated nets. In contrast to a top-down approach, the RAC approach includes the concerned people directly in the planning, execution and the ongoing evaluation as well as in the redefinition of the activities. The RAC approach values the human as important resource and skills of the local people (Figure 1).
Figure 1: The Research-Action-Capacity-building process
South-South and North-South research partnership and collaboration at various levels was considered as crucial in order to increase and strengthen relations and exchanges of expertise in the field of urban environmental management. The development and sharing of ideas, concepts and activities between local people (associations), institutional and professional actors (municipalities, NGOs) as well as with institutions from the South (Enda Graf, CREPA, EIER) and the North (Swiss Tropical Institute, University of Avignon), was a crucial part of the project (Yémadji et al, 1999). In N'Djaména, the carriers of the project were three neighbourhood associations active in the health and environment management. They have created by local people as a sort of self-help group in order to improve living conditions due to the absence of basic public services such as water supply, waste management or health services.
At the beginning of activities, an assessment of the situation together with the associations was done. A "professional" and popular researcher evaluated mosquito and net related problems in their immediate environment. This inquiry showed that malaria is perceived as an important health problem highlighted by the fact that people contributed substantial resources to treatment and prevention (Nadjitolnan, 1998).
There were different stages and problems to overcome in the process of the establishment of the treatment and commercialisation centres. First, the associations worked out a proposal, which included details on procedures selected, prices of services, indemnities for workers, localisation the commercialisation centre, organisation of sale promotion, administration of the centres, the replacement of the stock etc. For this, the group had to put together their knowledge and experiences. Together with the facilitators of the STI, many reunions were hold for discussing and decision taking.
Some of the main problems, which led the groups to rethink their procedure, were the accessibility to cheap ITNs affordable for the local population. There is no industrial or local production of ITNs in Chad. So the groups tried different channels for the net supply, first in Cameroon and later in Thailand. The extremely high prices due to importation taxes led to the fact that nets had to be priced high and were thus only affordable to best off people.
In the first months after setting up the centres, some dozens of ITNs and insecticide treatments were sold. However, quickly it became obvious that inhabitants didn't know the newly introduced technology. Subsequently information campaigns - such as radio broadcasting - were organised witch could increase selling and treating rates.
Nevertheless, over the time it became clear that the centres have hard times to be economically sustainable. Incomes of the centres were low and no indemnities could be paid to the workers. So, the number of active group members started to decrease with the result that fewer women were working at the level of the centres and monthly indemnities could now be paid to them. This revealed a more general problem of voluntary associations where it can not be expected that people with very low incomes are able to invest a lot of time for voluntary activities. In consequence, participating people have strong personal financial interests around the centres. But incomes of an association were not enough to remunerate every member.
Skills for organisational and administrative matters imperative for an adequate functioning of a commercialisation centre were another problem. Most of the associations had difficulties to share tasks in between members, to carry out campaigns or to administrate the money collected. By accompanying the associations most of these issues could be improved, for example by training on book keeping or opening accounts banking the collected money.
Over the time it appeared that it might be difficult to sustain the centres run by the associations. Nevertheless, the RAC approach revealed the associations' potential in identifying and promotion solutions for the promotion of nets and their treatment with insecticide. Furthermore, skills and capacities for communication and negotiation of popular actors with institutional actors could be strengthened. Thus the RAC revealed clearly to have a potential for (1) the empowerment of participants including grass-root initiatives for the management of the urban environment, (2) the collaboration through participation, (3) acquisition and exchange of knowledge, and change / development at the micro- and meso-level.
The Research - Action - Capacity building approach revealed that the promotion of insecticide treated nets in urban contexts underlies a triple logic: a technical, an economic and a social.
On the technical level, an innovation could successfully be introduced and adopted by the local actors organised within associations. Mutual research activities between members of the associations and the facilitators have shown the demand of the inhabitants for impregnated nets. After training on the technical issues of impregnation the associations were able to provide services of adequate quality.
On the economic level, the sustainability of selling and impregnation centres revealed to be very fragile. This mainly due to high prices of nets and impregnation services making them not all affordable for the majority of the urban population. This is moreover true as economic conditions of the population in N'Djaména are very hard. So, efforts have to be done in finding solutions for cheaper or subsidised ITNs. One aim on the institutional level could be the exemption of nets from importation taxes.
On the social level, the members of the associations have gained knowledge in commercial thinking and management of micro-enterprises. These skills can be very useful for further activities of the associations in the field of urban environmental and social management, but also for personal activities. Since the beginning, the RAC frame valued not only visible "success stories", for example in the case of the promotion of ITNs a high the number of sold unites and services, but more importantly skills and capacities of popular actors for communication and negotiation. Thus, activities initiated, could in an important way strengthen the organisational skills of the associations, their negotiation practices with institutional actors (NGOs, municipality, donors), new manners of reflection, knowledge in handling techniques and technologies. The project showed also how collaboration, partnership and communication between popular and institutional actors govern sustainable management of the urban environment. Key events in the process of action research are the regular meetings and workshops at local, regional and international level with all partners and actors involved (inhabitants, researchers, municipal planners and administrators, donors). They provide an efficient platform for exchange, discussions and readjustments of the activities, findings and consequences.
More importantly, they create an interface for donors and organisations that can assist the solutions and initiatives of urban inhabitants.
Lengeler C., Lines J.D., Cattani J. et al. (1996). Promoting operational research on insecticide-treated netting: a joint TDR/IDRC initiative and call for research proposals. Tropical Medicine and International Health 1(2): 273-276
Nadjitolnan O.(1998). L'utilisation des moustiquaires imprégnées d'insecticide dans la lutte contre les nuisances dues aux piqûres de moustiques : le cas de deux quartiers périphériques, Chagoua et Milézi, N'Djaména, Tchad. Mémoire de maîtrise de géographie, Université d'Avignon et des Pays du Vaucluse/France et l'Université de N'Djaména/Tchad
N'Diaye M (1999). Recherche populaire. In: Environnement urbain - recherche et action dans les pays en développement (Eds: Bolay JC, Odermatt P, Perdrazzini Y, Tanner M). Birkhäuser, Basel: 23-28
N-AERUS: Network-Association of European Researchers on Urbanisation in the South
http://www.naerus.net