Strategy
Africa and Middle East 2013–2017
SRC International Cooperation
Swiss Red Cross
Rainmattstrasse 10 / P.O. Box
CH-3001 Bern
Phone 031 387 71 11
www.redcross.ch
Picture cover page:
Mali © IFRC, Sarah Oughton
Pictures last page:
Ghana © SRC, Hilde Eberhard
Sudan © SRK/CRS, Gabriele Hansch
Lebanon © ICRC, Marko Kokic
Eritrea © SRK/CRS
Swiss Red Cross
Strategy – Africa and Middle East 2013 – 2017
Content
Abbreviations and acronyms
2
1.
Introduction
3
2.
Framework for SRC cooperation
3
3.
Context
4
3.1
General context
4
3.2
SRC experiences and potential in Africa and the Middle East
5
4.
Strategic objectives
7
4.1
Thematic objectives
7
4.2
Geographical objectives
8
5. The guiding principles applied to the context of Africa and the
Middle East
6.
7.
8.
9
Priority lines of action
12
6.1
Disease prevention and health promotion
12
6.2
Access to health care services
12
6.3
Disaster management and disaster risk reduction
12
Risk assessment
13
7.1
Risks related to the political, social, economic and environmental context
13
7.2
Risks related to implementing partners
14
Strategic alliances and networking
14
Bibliography
16
Annexes
17
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Strategy – Africa and Middle East 2013 – 2017
Abbreviations and acronyms
BTS
Blood transfusion services
DRR
Disaster risk reduction
HDI
Human Development Index
HIV/AIDS
Human immunodeficiency virus/acquired immune deficiency syndrome
IC Department
Department for International Cooperation
ICRC
International Committee of the Red Cross
IFRC
International Federation of Red Cross and Red Crescent Societies
LRRD
Linking relief, rehabilitation and development
MDG
Millennium Development Goal
Movement
International Red Cross and Red Crescent Movement
National Society
National Red Cross or Red Crescent Society
NGO
Non-governmental organisation
SRC
Swiss Red Cross
UNDP
United Nations Development Programme
WASH
Water, sanitation and hygiene
WHO
World Health Organization
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Strategy – Africa and Middle East 2013 – 2017
1. Introduction
The Swiss Red Cross (SRC) implementation strategy for Africa and the Middle East
determines the strategic areas of intervention for the SRC Department for International
Cooperation (IC Department). It provides the framework for all IC programming in the Middle
East / North Africa, West, East and Southern Africa for the period 2013 to 2017. It reflects
the individual country strategies for 2013-2016, which were developed jointly with the
specific country delegations.
The strategy concentrates on the SRC’s two spheres of activity: disasters and health. It also
covers the IC Department’s three areas of intervention: emergency relief,
rehabilitation/reconstruction and development cooperation. Even though all three are equally
important, they may be weighted differently in each country or region. Implementation is
geared specifically to the context in Africa and the Middle East and to the needs of the
region’s population. The strategy’s overarching principles are aligned on the overall
institutional strategies of the SRC and its regional implementation strategies.
2. Framework for SRC cooperation
The SRC implementation strategy for Africa and the Middle East is based on the
Movement’s seven Fundamental Principles – humanity, impartiality, neutrality,
independence, voluntary service, unity, universality – and guided by the IFRC and SRC
policy frameworks.
In its Strategy 2020, entitled Saving Lives, Changing Minds, the IFRC renews its
commitment to humanitarian aid and calls for more action to prevent and reduce the
underlying causes of vulnerability (IFRC, 2010).
The SRC Strategy 2020 for International Cooperation sets the framework for all activities
abroad: the mission of the IC Department is to foster healthy living and improved disaster
management capacities among particularly vulnerable people and communities. The mission
encompasses the SRC’s two spheres of activity for development and poverty reduction:
disasters and health.
In both spheres, the SRC conducts emergency relief, reconstruction/rehabilitation and
development cooperation activities. By using the LRRD approach, it ensures that activities in
both spheres are tightly interlinked.
The SRC contributes to development policy discussions relating to both disasters and health
and advocates the interests of particularly vulnerable people.
SRC international cooperation activities are also guided by the Movement’s Fundamental
Principles and bound by the following overarching guiding principles:
•
focus on particularly vulnerable and deprived groups of people
•
empower communities and individuals to take self-determined action and reinforce
self-help capacity
•
promote gender equality
•
promote voluntary work
•
emphasise relevance and effectiveness
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Strategy – Africa and Middle East 2013 – 2017
•
cooperate in partnership
•
promote alliances and participate in networks
•
conflict sensitivity and do no harm
The SRC has identified the following three areas in which it monitors and continuously
improves quality:
•
relevance and impact of IC Department activities from the perspective of the
beneficiaries
•
standardised project cycle management with built-in learning loops
•
capacity building at all levels
The SRC’s preferred partners are the National Societies. In the wake of major disasters, the
SRC usually works under the coordination of the IFRC. In specific instances, it may
cooperate directly with community-based organisations and with NGOs. Programmes to
strengthen the health system usually require a contractual cooperation arrangement with the
country’s Ministry of Health.
3. Context
3.1 General context
The continent of Africa and the Middle East region are home to nearly 1.5 billion people, half
of whom are below the age of 20. Africa alone has 54 States and, when considered together
with the Middle East, is a hugely diverse area from the geographical, climate, demographic,
economic, ethnic and cultural points of view. It goes without saying that the analysis below
does not reflect all the complexities and diversity of the context, only the main issues
relevant for the SRC strategy and its implementation.
Health indicators have improved somewhat in certain areas, e.g. fewer children are
contracting measles and malaria, the incidence of HIV infections is slowing and the number
of people south of the Sahara with access to safe drinking water has almost doubled. These
developments need to be consolidated and steps taken to ensure that vulnerable population
groups benefit from them.
Despite the progress made in certain fields, most of the countries concerned rank on the
lower end of the UNDP Human Development Index (HDI) and will not attain the Millennium
Development Goals (MDGs). Malnutrition (MDG 1), maternal and child mortality (MDGs 4
and 5), the high prevalence of infectious diseases (MDG 6) and the lack of access to safe
drinking water (MDG 7) constitute major public health issues, especially in sub-Saharan
Africa.
Malnutrition is a key issue, with 39 per cent of children suffering from stunting in subSaharan Africa (UNICEF, 2013). Global changes in the climate have led to more frequent
droughts and floods and have thereby contributed to increased food insecurity. An important
task for the SRC is to help communities foresee and prepare for disasters, thus reducing
their exposure to these risks, and to bolster their capacity to respond effectively to
emergencies. A pivotal goal is to improve overall food security.
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In the African region, 12 per cent of children die before they reach the age of 5, half of them
of diarrhoea, malaria or pneumonia (WHO, 2011). Africa has the world’s highest maternal
mortality rates. In 2008, the adjusted maternal mortality rate in Africa stood at 590 deaths
per 100,000 live births (UNICEF, 2013). Many of these deaths are caused by blood loss
during delivery and are therefore avoidable. Most low-income countries cannot ensure the
provision of sufficient quantities of safe blood for transfusion (WHO, 2012). In addition,
female genital mutilation and teenage pregnancies remain dominant problems related to
sexual and reproductive health in particular African countries.
The total number of people living with HIV is still on the rise, although the number of new
infections is falling in most African countries, with the exception of Burundi and Malawi
(WHO, 2011). This trend needs to be encouraged through systematic prevention measures
and improved access to retroviral treatment.
Access to drinking water and sanitary facilities is a vital need and basic human right that
continues to require a major effort, as it represents a big challenge in most African countries.
Only 65 per cent of people have access to improved drinking water sources, with huge
disparities between countries and between urban (85%) and rural areas (52%) (WHO,
2011).
Many African and Middle Eastern countries are currently immersed in serious political,
religious and ethnic turmoil. Civil wars have forced countless people to leave their homes in
urgent need of medical care and call for a prompt emergency response. Corruption and
nepotism are rampant. The aid agencies moving among the various groups and parties need
to demonstrate great sensitivity if they are to remain true to the principles of humanitarian aid
and avoid doing any harm.
In a growing number of African countries, natural disasters and conflicts of various kinds
occur simultaneously. In Mali, for example, an armed insurgency in the north led to an
international military intervention that coincided with a drought, compounding the suffering of
the population. It is extremely difficult for people to cope with and recover from complex and
ongoing emergencies of such proportions.
Most African countries in which the SRC works are very fragile. People lack the capacity to
respond effectively to emergencies and have little access to sufficient and adequate health
care services. Few governments can ensure full health coverage. The National Societies
could supplement government services where it not for their very limited organisational
means. The SRC’s priority is therefore to strengthen basic health services, the population’s
resilience and community capacity.
3.2 SRC experiences and potential in Africa and the Middle East
Community health care
Community health care addresses fundamental health issues in a given community and
ensures basic health care through community involvement. It entails educating people about
prevailing health problems and methods of prevention (hygiene, sanitation, maternal and
child health care) and helping communities organise themselves to employ simple measures
to prevent and control locally endemic diseases (malaria, diarrhoea, HIV/AIDS) or to improve
water and sanitation in their neighbourhood. The SRC supports National Society efforts to
recruit, train and organise community volunteers who are then entrusted with health
promotion and disease prevention tasks. One important task is to inform people about
facilities where they can get treatment and make sure they have access to them. In Togo,
Mali, Sudan and South Sudan, SRC programmes focus on this approach and have laid the
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groundwork for replication and integration with additional thematic priorities in other
countries.
HIV/AIDS
The SRC has implemented a number of HIV/AIDS projects in Africa and accumulated
considerable know-how in the field. It has introduced comprehensive HIV approaches
(service delivery model for access) in Swaziland and mainstreamed the topic into all other
programmes. The programmes comprise prevention, treatment and care, and impact
mitigation. Clinical treatment of HIV patients combined with follow-up home visits by National
Society volunteers has proven to be effective, resulting in high treatment adherence (98% in
2011) and few treatment failures. Mother-to-child transmission in National Society clinics in
Swaziland was zero in 2011. The SRC programme in Swaziland shows that cooperation
between the government and NGOs creates synergies in the fight against HIV/AIDS.
Blood transfusion services
Blood transfusion services (BTS) are part of the SRC’s core business. The SRC assists the
organisations mandated by their respective government to improve the quality of their
services. Its assistance ranges from setting up an entire national BTS (Egypt) to improving
quality management and equipping the BTS with laboratory equipment (Eritrea, Zimbabwe).
In the best-case scenario, the improvement can be shown through certification (Eritrea,
Zimbabwe).
Poverty-induced blindness
Impaired vision and blindness are serious health problems that affect families and
communities; they can be effectively addressed with modest means that have a tangible
impact on the well-being of those affected. Blind people of all ages regain their sight and
their personal autonomy thanks to cataract operations. In addition, family members
burdened with the task of looking after blind relatives are freed from their responsibilities and
children, who are usually assigned to this task, can go back to school.
The SRC has over 20 years of experience in preventing and treating poverty-induced
blindness in Ghana, Togo and Mali. In collaboration with the respective ministries of health, it
has provided infrastructure support and capacity building for health staff, thereby improving
ophthalmic services. In partnership with the National Societies, it has conducted prevention
campaigns and active patient searches, mainly among the elderly for cataract operations
and children for refractive errors. In all the regions covered, cataract surgery rates are high
and access to corrective lenses has been improved for the needy. Resistance to wearing
corrective lenses remains strong, however, especially among children, and awareness
campaigns have to be pursued.
Disaster management
The SRC has conducted many emergency response operations in various types of disasters
all over Africa. It is experienced in sharing and using most of the existing multilateral and
bilateral forms of cooperation. Within the Movement, it closely coordinates its relief
operations with the host and participating National Societies, the IFRC and the ICRC.
In order to be able to respond quickly to disasters in Africa, the SRC has started to build up
professional capacities within its own delegations and the National Societies. In addition, it
has a contingency supply of essential non-food relief items, such as family tents, family kits
(hygiene and kitchen) and shelter repair kits (tools and tarpaulins), for 5,000 people (1,000
families) at a warehouse in Accra, Ghana.
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Linking relief, rehabilitation and development (LRRD) in fragile contexts
The majority of people living in fragile and hazard-prone contexts face multiple challenges
directly affecting their health. These “protracted crises” often require an integrated approach
going beyond the traditional relief-to-development model. In such situations, the SRC
aspires to facilitate the seamless transition from relief to rehabilitation and on to
development, or vice versa. After the 2011 drought in Ethiopia, the SRC response was
initially handled by the Disaster Management unit before being passed to the desk officer for
the Horn of Africa. In Mali, the escalating armed conflict in 2012 forced the SRC to halt its
long-term programme. In its emergency response, the SRC endeavours to take the long
view and to include recovery measures as early as possible. In a “development
environment”, its aim is to better prepare people and institutions for the next disaster. Relief,
rehabilitation and development are thus linked and the cycle of intervention is complete.
Conflict sensitivity and do no harm
In order to prevent violence, the SRC applies a conflict-sensitive approach to programme
design, implementation, monitoring and evaluation; this encompasses the “do no harm”
approach and involves enhancing knowledge, gaining a sound understanding of the two-way
interaction between activities and context, and acting to minimise negative and maximise
positive impacts. Conflict-sensitive management of SRC projects applies to all contexts and
throughout all areas of SRC work and is therefore a fundamental component of SRC project
management. Capacity development and awareness raising have been incorporated into
selected programmes and are to be intensified in the future.
4. Strategic objectives
4.1 Thematic objectives
Strengthening local capacities for prevention and health promotion is a priority approach for
the SRC in Africa and the Middle East. The SRC provides support to local health services,
National Society committees and volunteer health workers, in order to improve the
population’s access to basic health care, water and sanitation. The SRC also strengthens
community structures and resources in order to prepare for and mitigate the risk of disaster.
At the same time, it works in Africa on the health system supply side, for example for the
rehabilitation of local health centres, for more efficient outreach activities or for the
institutional development of ophthalmologic services and BTS. The SRC also responds to
disasters and humanitarian crises in Africa and the Middle East.
Vulnerable groups and communities have improved access to quality health services
The SRC contributes to strengthening health systems at various levels based on needs. It
strengthens primary health care through capacity building for health staff and volunteers and
provides support to improve infrastructure in target areas.
The SRC supports secondary- and/or third-level care in the areas of eye care and BTS. It
works to anchor national BTS in sound quality management with a view to ensuring sufficient
supplies of safe blood, thereby helping to lower maternal mortality rates and prevent HIV
infections by contaminated blood products. It also conducts programmes to prevent and treat
poverty-induced blindness.
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The health behaviour of target groups is improved and healthy living is promoted
The SRC enables the local population to improve health through health education and selfhelp activities. It strengthens the capacities of partner National Societies and community
health worker schemes for community mobilisation, health promotion, first aid and home
care. Properly trained, equipped and supervised community health workers and volunteers
can bridge the gap between community needs and the formal health system.
To address the challenges of communicable and water-borne diseases, the SRC promotes
prevention and appropriate treatment in target populations and improves water and
sanitation infrastructure.
Whenever possible, the SRC helps community-based organisations engage in policy
dialogue with the health authorities at regional and national level.
The target population is able to react to emergencies and to reduce disaster risks
The SRC supports efforts to improve people’s resilience to conflicts and natural disasters.
For that purpose, it will improve the disaster preparedness and disaster risk management
capacities of National Societies as national disaster coordination bodies in the countries in
which it works. It will also promote community-based DRR. The SRC emphasises the
mobilisation of volunteers for activities like vulnerability assessment, awareness raising,
organising and supporting communities at risk and or providing first aid.
4.2 Geographical objectives
The SRC Strategy 2020 for International Cooperation sets out the following geographical
objective: the SRC moderately reinforces the overall programme with a special focus on
Africa. The SRC programme in Africa currently includes development programmes in 11
countries: four in East Africa, three in West Africa, two or three in Southern Africa and two in
the Middle East / North Africa (see map, Annex 1). All projects in countries in which the SRC
operates are regularly reviewed for relevance and comparative added value, and in order to
inform decisions on whether they should be continued or phased out. Expansion into
additional countries in Africa or the Middle East may be considered in order to reinforce the
programme. In countries outside its strategic geographical areas, the SRC engages in
disaster relief operations according to needs and its own capacities.
Middle East/North Africa – Expansion
The SRC has been active in Egypt for over ten years and assisted the government in
building up a national BTS. This project will be finalised by 2015. Prompted by the “Arab
Spring”, the SRC supports activities to build capacity in DRR and disaster management in
Egypt. It has also started a BTS project in the Palestinian refugee camps in Lebanon, the
aim being to improve the health system by supporting access to safe blood. In response to
the Syrian crisis, the SRC has started emergency programmes for refugees in Jordan,
providing support in particular for cash distributions to refugees and host families. The
overall aim is to step up activities in the Middle East/North Africa, using the LRRD approach
and emphasising DRR components. A potential future development programme may cover
blood transfusion services in Lebanon.
West Africa – Consolidation and replication of good practices
Projects in West Africa (Ghana, Togo and Mali) currently focus on eye care (prevention and
treatment of visual impairment) and on primary health care in rural areas. The SRC
conceives and carries out the projects in triangular cooperation with the national health
ministry and the National Society. It will be exiting operationally from some regions in Ghana
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Strategy – Africa and Middle East 2013 – 2017
and Togo and expanding its activities to others where the good practices gained will be put
to use. It will also incorporate DRR activities.
In Mali, the SRC was forced to close down its programme in the Timbuktu area in 2012
owing to the deteriorating political situation and the heightened security risk. It is currently
preparing rehabilitation and recovery programmes to be implemented once the security
situation allows people to return, and is striving to reactivate its well-established eye-care
programme in the Timbuktu area.
East Africa – Consolidation and expansion
East Africa is a conflict-prone region that is home to several unstable States and millions of
internally displaced people. Food insecurity in the Horn of Africa, the result of natural
disasters, the post-conflict situation in Sudan and South Sudan and, to some extent, lack of
governance, requires a long-term SRC commitment to mitigate human suffering.
In Eritrea, the SRC’s long-term support for the National Blood Transfusion Service will come
to an end after 15 years with the successful implementation of a quality management
system. In Ethiopia, the programme launched in 2012 focuses on WASH and disaster
preparedness/prevention; it is to be developed into a more integrated approach with the
addition of basic health care (community-based health and first aid), DRR and volunteer
management support. In Sudan, the primary health care and WASH programme will be
consolidated and expanded to include DRR and conflict-sensitive project management
aspects. In South Sudan, the current health/WASH programme has been expanded into
neighbouring regions and is to be consolidated. The focus will be on health system
strengthening, supporting the health authorities from community level to county and state
level in two South Sudanese states. To mitigate suffering, nutrition, DRR and community
resilience measures will be added to the programmes.
Southern Africa – Consolidation and extension
Many countries in Southern Africa suffer from low development, high poverty rates, high
under-5 and maternal mortality rates and multiple health problems. The prevalence of
HIV/AIDS is one of the highest in the world. The HIV epidemic affects health, the economy
and social structures.
The HIV/AIDS programme in Swaziland, which is conducted in collaboration with the
National Society, is to come to an end in 2014. In order to strengthen sustainability, new
partners will be sought for impact mitigation activities.
The SRC plans to expand the number of countries in which it works in Southern Africa by
two or three in the next five years, starting with Malawi and Lesotho. Community-based
health care, access to quality health services, and blood safety are health topics currently
being considered for the Southern African region.
5. The guiding principles applied to the context of Africa and the
Middle East
The SRC implementation strategy for Africa and the Middle East draws on the guiding
principles set out in the SRC Strategy 2020 for International Cooperation. In Africa and the
Middle East, implementation features the specific aspects below.
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Strategy – Africa and Middle East 2013 – 2017
Focus on marginalised and most vulnerable people
Social disparities arising from the region’s colonial past and cultural norms are very marked
in Africa and the Middle East. They deprive many of education, jobs and promotion, thus
preventing them from breaking out of the cycle of poverty.
Women, young people and children are particularly vulnerable and therefore at the heart of
the SRC’s health interventions. The vulnerable groups vary from region to region, depending
on the context, e.g. burden of disease and natural or manmade disasters. In East and West
Africa and in the Middle East, the SRC puts the emphasis on vulnerable populations in
emergencies caused by natural disasters (hunger/food security) or conflicts/war; it gives care
and support to internally displaced people and returnees/refugees. In Southern Africa, the
SRC concentrates on people infected and affected by HIV, on orphans and vulnerable
children and on pregnant teenagers.
Empowering people
The SRC’s community-oriented approaches are based on the participation and engagement
of the community itself, the aim being to make each community aware of its own capacities
to influence lives and the environment. The beneficiaries become active agents; they learn to
have a say and that they are entitled to claim fundamental human rights such as the right to
have access to health services and to clean drinking water. Their decision-making power is
activated and leads to ownership, self-determination and ultimately to empowerment.
Promoting gender equality
Gender equality is a building block for development and poverty reduction. In Africa and the
Middle East, women have less access to income, health and protection. They suffer from
culturally rooted customs and gender-based violence. Through its programmes, the SRC
sensitises its partner organisations to gender aspects and promotes change in healththreatening customs by partnering with local stakeholders. The programmes are regularly
and critically screened for how they address the socio-cultural position of women within their
societies. In the coming years, special attention will be paid to reproductive and sexual
health, as it affects girls and women’s health in many countries in Africa and the Middle East.
In HIV prevention programmes, the specific target group is men, who are not easily reached
by general prevention programmes.
Promotion of volunteering
The Movement is predicated on the idea of voluntary service. Every National Society’s
strength is its capacity to recruit, train and guide volunteers from the beneficiary
communities. Good practices are to be strengthened and further developed. One example is
the “mother clubs” in West Africa: mothers of all ages organise in the villages as Red Cross
volunteers in clubs and promote family health in their communities. Another example is the
teachers who are trained to detect vision impairment in students. In fragile or post-conflict
contexts, access to volunteer training can be a first step to adult learning (South Sudan).
One of the biggest challenges in volunteer management, besides recruiting capable
volunteers, is keeping them. Volunteer training offers opportunities for beneficiaries but it
also qualifies them for the job market. The result is a high turnover, which must be taken into
account when planning. The fact of not paying volunteers in a context of extreme poverty
poses a critical challenge. The SRC follows the IFRC’s policy of offering no salary to
volunteers but only reimbursement of direct expenses and payment of allowances.
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Strategy – Africa and Middle East 2013 – 2017
Emphasise relevance and effectiveness
Besides being guided by the international policy frameworks mentioned in section 1, SRC
programmes in Africa and the Middle East are designed in such a way as to contribute to
relevant local, national and global development goals and policies, particularly in the areas
of health and disaster management. Programmes and projects are based on a thorough
assessment of the local disease burden, the health needs of the beneficiaries and the
capacities of local health systems. SRC projects are based on an understanding of the local
pattern of mortality, morbidity, vulnerabilities and risk factors and on the available evidence
of the effectiveness and impact of the activities chosen. They are reviewed and evaluated at
key points in the implementing cycle, in particular in terms of effectiveness, relevance and
impact. Wherever possible, the SRC lobbies to have innovative and successful approaches
adopted as national policy.
Working in partnership
The principles for working in partnership are outlined in detail in the 2010 concept paper,
Partnership in International Cooperation. The SRC chooses its partners and works with them
with a view to achieving the greatest possible efficiency and effectiveness in implementation
and to ensuring that its emergency relief, rehabilitation/reconstruction and development
cooperation programmes have a sustainable impact, focusing all the while on the population.
SRC programmes in Africa and the Middle East work with the Movement’s components. The
SRC endeavours to set down its engagement with its partners in tripartite agreements.
Promote alliances and participate in networks
The SRC forms strategic alliances whenever feasible in order to bundle resources for
increased efficiency at local, regional and national level. In Africa and the Middle East, the
SRC fosters exchanges between its delegations within the region and sub-regions.
At country level, the SRC networks with government authorities and other organisations
through existing platforms for humanitarian and development players on public health,
ophthalmology, WASH, disaster management and DRR, takes advantage of synergies and
participates actively in the development of standards.
The SRC also seeks to exchange views and coordinate with other Swiss organisations and
the coordination offices of the Swiss Agency for Development Cooperation at national and
regional level.
Nationally and internationally, the SRC operates as part of the Movement, which comprises
the National Societies (host and participating), the IFRC and the ICRC.
Conflict sensitivity and do no harm
In order to guarantee a long-term positive impact and strengthen community capacities to
address crises and avert conflict, the SRC promotes conflict-sensitive approaches in all its
development activities in Africa and the Middle East. It endeavours to improve living
conditions and people’s resilience by involving the communities and taking care to avoid
asymmetries that can cause communal tension and strife. Root causes and group dynamics
that could trigger violence are considered in the planning process. This is particularly
important when intervening in diverse and multi-ethnic societies, and explains why the SRC
plans systematically to provide capacity development for its staff and for the staff of partner
organisations.
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6. Priority lines of action
6.1 Disease prevention and health promotion
In the countries in which it works, the SRC uses a community-based approach to encourage
people to take the initiative and improve their living conditions and prevent disease. The
SRC works through trained volunteers. It encourages people to organise into village health
committees and to improve their health literacy, thereby empowering them to act on their
health needs. Particular emphasis is placed on mothers and children.
The SRC provides care for orphans and vulnerable children and for people living with HIV, in
particular training youth peer educators about HIV/ AIDS, sexual and reproductive health
and hygiene. To improve the nutritional status of people in need, it establishes back-yard
and community gardens and provides direct nutritional support in emergency situations and
to people living with HIV and to needy children.
The SRC promotes hygiene (WASH) and provides instruction in how to prevent mosquitoand water-borne diseases (e.g. malaria, diarrhoea, cholera). It improves access to safe
drinking water and sanitation by constructing or rehabilitating boreholes and wells. It ensures
technical maintenance and empowers beneficiaries to administer their facilities themselves.
Preventing and treating vision impairment and blindness requires active community
outreach. National Society volunteers and facility staff do outreach work in schools and
villages in order to overcome fear, superstition and fatalism regarding blindness and to help
affected people obtain access to health facilities where they can get treatment.
6.2 Access to health care services
In order to secure basic, good quality health care services, the SRC supports primary health
care with well-organised basic facilities. Sustainability is ensured by partnering with national
health providers. The SRC trains professionals, administrative staff and volunteers in all of
the countries in which it works in Africa and the Middle East.
The SRC strengthens National Society capacity to provide HIV and tuberculosis treatment in
clinics. It provides the National Societies with guidance on how to develop a steady flow of
funds for their health services.
The SRC conducts eye care programmes with the aim of preventing and treating povertyinduced blindness and vision impairment. As part of these programmes, it sets up and
equips primary health facilities, fosters the training of ophthalmic nurses and provides
support to referral clinics where cataracts are operated.
The SRC trains BTS professionals in quality management in order to ensure a sufficient
supply of safe blood for the population.
6.3 Disaster management and disaster risk reduction
In the immediate response to disasters, the SRC – in coordination with its Movement
partners – provides relief assistance. As soon as the situation allows, it engages in capacity
building in order to enhance the National Society’s preparedness for future disasters. In
order to enable communities to better prepare for and cope with disasters and conflicts, it will
seek to integrate DRR into five of its development country programmes in Africa and the
Middle East by 2017. This will entail tasks such as training partner organisations and
communities to assess vulnerabilities and capacities, to draw up contingency plans and to
take measures against impending dangers. The SRC will establish new or strengthen
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existing emergency committees by working with its National Society partners and
government institutions.
7. Risk assessment
7.1 Risks related to the political, social, economic and environmental context
The Sahel region has historically been affected by conflicts between pastoralists and farmers
over resources and between Christians and Muslims. Today it is increasingly troubled by
drug and weapon trafficking and by population movements caused by poverty and violence.
Other conflicts result to increasing movements of Arab jihadists from North and West Africa
towards the Arabian Peninsula. The Arab Spring, a series of protests and revolutions in the
Arab world, is a source of hope for social change but also raises fears of further
destabilisation. In Mali, for example, Tuareg mercenaries returning from the conflict in Libya
allied with the jihadist movement and started a civil war. The Syrian conflict has had a
tremendous impact on people there and in its neighbouring countries, including Lebanon,
and it is feared that it will further inflame the long-standing conflict between Israel and
Palestine. In Egypt, after widespread protests the military overthrew an elected government,
exacerbating the situation as of mid-2013. All these conflicts, with their complicated lines of
interest or solidarity, have the potential to further intensify, and there is not telling what the
consequences may be.
In East Africa, persistent unrest and conflict are undermining and handicapping the fragile or
failed States in the region (Sudan, South Sudan, Kenya and Somalia). The conflict between
Eritrea and Ethiopia is not resolved.
In general, the struggle over resources (oil, water, access to the sea) constitutes a high risk
for African countries, which may be influenced by the external interests of industrialised or
emerging nations. Political power games are reflected in proxy wars that are destabilising
north, west, east and central Africa.
Compared to these conflict-affected regions, the Southern African countries seem relatively
stable. The risk here lies in the HIV pandemic compounded by the growing prevalence of
multidrug-resistant TB.
As a result of climate change, severe drought and extreme rainfall and floods are becoming
increasingly common in all regions of Africa. There are recurrent widespread droughts in the
Sahel, where water resources continue to shrink. Equitable access to drinking water is
compromised, primarily in resource-poor settings, leading to political tension between
States.
In view of the complex and brittle situation prevailing in many of the continent’s countries, it
is important to apply conflict-sensitive project management in order to prevent additional
negative consequences and to react appropriately to challenges. Country strategies must be
reviewed in shorter time spans and adapted accordingly.
Africa has also known positive developments. Economic growth rose from an average 2.5
per cent in the decade to 1998 to 5 per cent in the decade to 2008. Structurally, however,
many African economies depend on agriculture and raw material exports, and there is a
huge need for diversification. The figures on inequality show that the situation has improved
somewhat in several countries, but the gap between rich and poor is widening in many
others. In 2009, growth stumbled: the global economic and financial crisis reduced exports of
13
Swiss Red Cross
Strategy – Africa and Middle East 2013 – 2017
goods and services from Africa and slowed net inflows of remittances and private capital
(Aryeetey et al., 2012)
7.2 Risks related to implementing partners
The SRC’s implementing partners – governments and National Societies – pose further
risks. Health systems in particular are affected in all African countries by loss of qualified
personnel. The global dimension of this phenomenon undermines many promising mitigation
initiatives. By working at the most appropriate and most directly effective levels, SRC
programmes help maintain basic service provision.
Some of the region’s National Societies are not completely independent of government
structures. This may enhance the chances for successful collaboration with the respective
government, but it can also hamstring innovation.
Many of the region’s National Societies are paralysed by outdated organisational and service
concepts. Hierarchical decision-making hampers bottom-up participatory approaches and
some of the SRC’s partner National Societies remain stuck in the concept of a charity
receiving funds from the government or donors. SRC programmes aim to promote the
change in mind-set and legal/organisational frameworks needed for innovation and
sustainability.
In order to enhance programme sustainability and impact, SRC programmes in Africa and
the Middle East strengthen government and National Society partners, at times in
cooperation with the IFRC, in all areas of operational and institutional management.
Ultimately, though, successful programme implementation hinges on the partners and their
performance, and not on the SRC alone.
8. Strategic alliances and networking
In all its programmes in Africa and the Middle East, the SRC seeks to work closely with other
organisations active in the field and to exchange its experience with them. Networking is
crucial, as there are many different organisations with a wide array of competences working
on similar topics or in the same geographical area. The SRC stands to learn a great deal,
and fruitful alliances may emerge for common goals and shared interests.
For the SRC, important networks are:
•
The Movement. In all countries where the SRC operates it collaborates with the
National Society and seeks to join forces with other partner National Societies active
in the country. The Movement offers helpful platforms and forums on specific topics
such as HIV/AIDS, mother, newborn and child health, water and sanitation, DRR and
disaster prevention and preparedness.
•
VISION 2020, the global initiative for the elimination of avoidable blindness run by
WHO and the International Agency for the Prevention of Blindness (IAPB). It has an
international membership of NGOs, professional associations, eye care institutions
and corporations.
•
The national and international organisations engaged in blood transfusion, such as
Transfusion SRC Switzerland, Swisstransfusion, WHO and the International Society
of Blood Transfusion.
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Swiss Red Cross
Strategy – Africa and Middle East 2013 – 2017
•
Swiss platforms engaged in specific themes like HIV/AIDS or coordinating
internationally active aid agencies in the realm of health (Medicus Mundi).
•
Organisations active in WASH programmes, such as the Swiss Water Consortium
and the Swiss Water Partnership.
15
Swiss Red Cross
Strategy – Africa and Middle East 2013 – 2017
Bibliography
Aryeetey et al. (2012). The Oxford Companion to the Economics of Africa, Oxford University
Press.
IFRC (2010). Strategy 2020: Saving lives, changing minds, Geneva.
IFRC (2012). World Disaster Report. Forced Migration and Displacement. Available at:
www.ifrcmedia.org/assets.
SRC (2010). Concept Paper: Partnership in International Cooperation, Bern.
UNICEF
(2013).
Customized
statistical
tables,
available
http://www.unicef.org/statistics/index_24183.html (last accessed on 29 May 2013).
WHO (2011). Atlas of Health Statistics of the African Region 2011.
WHO (2012). Blood safety and availability, Fact sheet No. 279, June 2012.
16
at:
Swiss Red Cross
Strategy – Africa and Middle East 2013 – 2017
Annexes
1. Map of Africa and the Middle East
2. Policy framework for SRC international cooperation
3. Key thematic issues and partner organisations by country
4. Comparative health and vulnerability indicators
17
Swiss Red Cross
Strategy – Africa and Middle East 2013 – 2017
Annex 1: Africa and the Middle East
18
Swiss Red Cross
Strategy – Africa and Middle East 2013 – 2017
Annex 2: Policy framework for SRC international cooperation
19
Swiss Red Cross
Strategy – Africa and Middle East 2013 – 2017
Annex 3: Key thematic issues and partner organisations by country
Country
Key thematic issues
Partner organisations
Ghana
Eye care, basic health care, DRR
Ghana Red Cross Society, Ministry
of Health
Togo
Basic health care, eye care, WASH, DRR
Togolese Red Cross, Ministry of
Health
Mali
Relief, recovery, basic health care, eye care,
treatment of malnutrition, WASH
Mali Red Cross, Ministry of Health
Egypt
Restructuring of the BTS
Ministry of Health
Disaster prevention/ preparedness
Egyptian Red Crescent Society
BTS improved provision and quality
management in hospitals of the Palestine
Red Crescent Lebanon branch
Palestine Red Crescent Society –
Lebanon
Support for BTS throughout Lebanon
Lebanese Red Cross
Eritrea
Support to quality management systems of
the NBTS
Ministry of Health
Ethiopia
Food security and drinking water availability,
disaster prevention/preparedness, basic
health care, WASH
Ethiopian Red Cross Society,
Ministry of Water and Agriculture,
Ministry of Health
Sudan
Strengthening of the national health care
system, active community participation
(civilian
population),
WASH,
disaster
prevention/preparedness
Sudanese Red Crescent, Ministry of
Health, Ministry of Water
South Sudan
Strengthening of the national health care
system, active community participation,
WASH, nutrition, DRR
National Society, Ministry of Health,
Ministry of Water
Lesotho
Community-based health care, access to
quality health services
Lesotho Red Cross Society, Ministry
of Health
Malawi
Community-based health care, access to
quality health services, blood safety
Malawi Red Cross Society, Ministry
of Health
Lebanon
20
Swiss Red Cross
Strategy – Africa and Middle East 2013 – 2017
Egypt
Eritrea
Ethiopia
Ghana
Lebanon
Lesotho
Malawi
Mali
South
Sudan
Sudan
Togo
Switzerland
Annex 4: Comparative health and vulnerability indicators
8
82.3
5.6
87
25.5
4.3
2.2
15.9
16
9.4
33.5
6
Gross national
income
per
capita
(PPP
international
2
$)
50,900
6,160
580
1,110
1,820
14,000
2’070
340
1,050
1,050
1,030
Population
living on less
than 2 USD /
2
day (%)
0
2
--
39
29
--
43
74
55
20
39
Life
expectancy at
1
birth (years)
80/85
70/74
59/63
57/60
63/65
70/75
48/47
53/53
50/52
50/53
58/62
60/65
4
21
68
7
78
9
86
83
176
--
--
110
HIV
prevalence %
2
(15-49 years)
0.4
0.1
0.6
1.4
1.5
0.1
23.3
10.0
1.1
--
--
3.4
Total
expenditure on
health (% of
3
GDP)
10.9
4.9
2.6
4.7
4.8
6.3
12.8
8.4
6.3
8.4
8.4
8
HDI
4
2011
0.913
0.662
0.351
0.396
0.558
0.745
0.461
0.418
0.344
0.2
2
2.8
2.4
2.4
1.6
3
3
3.2
2.8
2.4
2.8
29.6
34.4
--
30
39.4
--
63.2
39
40.1
--
--
--
Total
population
1
(millions)
Under 5
mortality (per
1,000 live
2
births)
value
Population
annual growth
rate (%) 20101
2030
Gini Index
5
0.414
0.459
1
Datenreport Stiftung Weltbevölkerung:
http://www.weltbevoelkerung.de/oberes-menue/publikationendownloads/zu-unseren-themen/datenreport.html?gclid=CK6r6dnaj7QCFYlb3god-UwAFA.
2
UNICEF: http://www.unicef.org/statistics/index_step1.php .
3
WHO: http://www.who.int/countries/en/.
4
UNDP: http://hdrstats.undp.org/en/indicators/default.html.
5
CIA, World Factbook: https://www.cia.gov/library/publications/the-world-factbook/fields/2172.html.
21