Medical Assistance to Self‐settled Refugees: Guinea 1990‐1996

Abstract

* Carrying capacity is defined here as the population that can sustain themselves on the agricultural resources of the area. 19-21 country. There were no telephone services, nor was television reaching the area. The only possible connection between N'Zérékoré and the capital Conakry was by road, a trip which, under favourable climatic conditions, took 18 hours. There were many wooden bridges and a ferry on the main axis between Macenta and N'Zérékoré. Many villages could not be reached by car, and during the rainy season, mud or broken bridges often limited access even further. Even the main roads could be impracticable for several days, except for 4-wheel drive vehicles. On the other hand, N'Zérékoré was only at some 300 km tarmac road from Monrovia. Before the war broke out in Liberia in 1990, this road was in excellent condition. A trip between N'Zérékoré and Monrovia took only 5 hours. Supplies thus reached the Forest Region more easily through Liberia than from Conakry. Economically, the Forest Region of Guinea was more integrated with Liberia, and partly Côte d'Ivoire, than with the rest of Guinea. From the mid-1980s onwards foreign donors started investing in the Forest Region. In the Diecké area, host to large numbers of refugees since January 1990, the Société guinéenne de Palmiers et Hévéa improved the exploitation of the agricultural resources. The valley swamps were used for rice cultivation, and the use of water control measures improved considerably their yield. In the flood plains, palmtree and rubber plantations were created, employing many workers. These interventions attracted migrants to Diecké and created a monetarised economy in the project area. In Guéckédou, host to the largest concentration of refugees from 1991 onwards, the Projet Agricole de Guéckédou also introduced swamp farming. It is in this poorly developed region-even by Guinean standards-that some 500,000 refugees from Liberia and Sierra Leone would arrive between 1990 and 1995. * The only official private health facilities in Guinea were two mine hospitals, one mission hospital, a few mission dispensaries, and some rare private practises in the capital, Conakry. The informal private sector, however, was well developed.

A comparison of the programme coverage of two therapeutic feeding interventions implemented in neighbouring districts of Malawi

“…Historically, evaluation of selective feeding programmes has focused on cure and mortality rates 28 , and the coverage of therapeutic programmes has either gone unmeasured 2 or, on the few occasions where it has been assessed, has been extremely low 5 . Figure 6 demonstrates the importance of coverage as an indicator of impact.…”

“…On average, treatment takes 27 days to recovery in well-run TFCs 2 and longer in others 3 . These high opportunity costs limit programme coverage rates and therefore limit the population-level impact of centre-based programmes 4 , 5 . Since the 1970s, these problems have prompted many to try, with varying success, to move the locus of treatment away from hospitals towards the community, either into simpler nutrition rehabilitation centres, existing primary health care clinics or into the homes of those affected 6 – 8 .…”

Community Management of Acute Malnutrition in the Developing World

“…The overall coverage was predominantly above 70% [39,55] a figure that is higher than in centre-based programs, where coverage is often less than 10% [56,57]. …”

Historicising Humanitarian Action

“…Mickaël: Indeed, we are currently engaging on how to finance a health programme (in this case a hepatitis C elimination programme) in lower income countries that do not receive international donors support. We may be revisiting old ground, though, like in Guinéa at the end of the 1990s when we implemented long-debated costsrecovery projects (Van Damme, 1998). So I do not know if this is a new cycle in humanitarianism, but the fundamental point of your question Bertrand is to determine for MSF: to what extent we want to engage routinely in such space, should health financing be part of our project objectives?…”