The_Flemish_development_cooperation_activity_report_2008.pdf by Vlaanderen-be

ACTIVITY REPORT 2008

THE FLEMISH DEVELOPMENT COOPERATION

2 | Activiteitenverslag 2006

ACTIVITY REPORT 2008

THE FLEMISH DEVELOPMENT COOPERATION

Introduction

4 | Activity report 2008

Introduction

content

PREFACE...................................................................................................................................................6 The partner countries of the Flemish Development Cooperation.............................................................7 ACTIVITIES IN THE SOUTH....................................................................................................................8 Mozambique, the donor darling, health care , the favourite sector...........................................................9 A new sector: technical education..........................................................................................................30 South Africa, looking back and moving forward......................................................................................36 Malawi, up to speed................................................................................................................................41 Sustainable trade.....................................................................................................................................46 Humanitarian aid......................................................................................................................................50 ACTIVITIES IN THE NORTH..................................................................................................................54 Fourth pillar..............................................................................................................................................55 Sustainable consumption........................................................................................................................57 Raising awareness through the media....................................................................................................58 Development education..........................................................................................................................60 Municipal development cooperation.......................................................................................................61 Resources................................................................................................................................................62 ANNEXES...............................................................................................................................................64 South Africa.............................................................................................................................................65 Mozambique............................................................................................................................................67 Malawi.....................................................................................................................................................68 Morocco..................................................................................................................................................69 Multilateral coรถperation...........................................................................................................................70 An image of Mozambique.......................................................................................................................72

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Introduction

PREFACE

This report of the activities of the Flemish International Cooperation is the fourth in succession. It is recognisable as regards its form and style. We follow the path we took last year as regards the approach: one partner country is given our full attention. While the focus was on South Africa last year, we turn our gaze this year to Mozambique. In editorial terms, the 2008 report of activities also completely follows the line of the last report. FICA once again went to Guy Poppe to edit the report. Poppe went to Mozambique and returned with a fascinating and penetrating overview. In this report you are taken along to Tete, Moatize, and Manhangue near Inhambane and Matola near Maputo. You are given a detailed picture of six years of Flemish development cooperation in one of the poorest countries on the African continent. From the very beginning, the cooperation with Mozambique concentrated on health care and particularly on combating HIV/Aids. With an average of 16%, the level of infection in Mozambique is extremely high. A vertical approach to Aids threatened to undermine the Mozambique health system itself. For this reason, Flanders decided to strengthen the basic health care system by investing in personnel and infrastructure. For this purpose, Flanders cooperates with the Mozambique Ministry of Health (MISAU). The framework used is a SWAp (sector wide approach) in which twenty donors combine forces to develop a single coherent and integrated approach. In 2008, a second sector was chosen in which Flanders would like to invest: technical and vocational education. In the other partner countries, FICA did not waste any time either in 2008. The results clearly illustrate this. And in our own luxurious Flanders, FICA is also actively encouraging the people of the North to extend and strengthen the support for international solidarity. To conclude with the words of Guy Poppe: â€œIn 2008 FICA clearly showed that Flanders will stay on course.â€? Enjoy reading this report.

Freddy Colson Administrator-general Flemish International Cooperation Agency

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Introduction

PARTNERCOUNTRIES OF THE FLEMISH DEVELOPMENT COOPERATIONS PARTNER COUNTRIES OF THE FLEMISH DEVELOPMENT COOPERATION

T A izi

K E L A

Nyika Plateau

RUMPHI

uru uk

S. R

Y BA HA

C A B O D E L G A D O

MALAWI

A S S A

N A M P U L A

Likoma

I A W A L

Z A M B É Z I A

MOZAMBIQUE

HO T NK

TA AKO

MANICA

Lichinga

DOWA

SALIMA

LILONGWE

SOFALA

Z I M B A B W E

Lilongwe DEDZA

Lilon

Lug

MCHINJI

end

NTCHISI

ya Lake N

a gw an

CENTRAL

MALAWI

Chizumulu

KASUNGU

N I

Ruvuma

Lu we ya NK

MZIMBA

L u a n gwa

UNITED REPUBLIC OF TANZANIA

NORTHERN

Kasitu

ZAMBIA

CONGO

REPUBLIC OF

Cha

DEMOCRATIC

N. Ruku

MANGOCHI NT CH

Lake Chiuta

ir e

MOZAMBIQUE

INDIAN OCEAN Lake Amaramba

Lake Malombe

SOUTHERN Sh

Balaka

MACHINGA

BOTSWANA

INHAMBANE è

MWANZA

G A Z A

vú Re

Lake Chilwa

ZOMBA

dé Con

BLANTYRE

SOUTH AFRICA

MULANJE

MAPUTO

ZIMBABWE

Phalombe

CHIRADZULU

THYOLO

Tete

bez

re Shi

Zam

0 0

50 25

75 50

100 km 75 mi

S WA Z I L A N D

MOZ AMBIQUE

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ACTIVITIES IN THE SOUTH

Activities in the South

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MOZAMBIQUE

MOZAMBIQUE, THE DONOR DARLING HEALTH CARE, THE FAVOURITE SECTOR In 2008, additional funds were made available for the cooperation with Mozambique. It was decided to invest in technical and vocational training, so that education will become the second sector of Flemish cooperation in Mozambique from 2009. FICA continues to support the health system, amongst other things by making a direct contribution to the Mozambique budget for health care. A large share of the attention focuses on the province of Tete where various partners from Flanders have increased and expanded their joint activities in medical care together with the Mozambique authorities for some time. FICA, as FICA is known in Mozambique (the English abbreviation of Flanders International Cooperation Agency) reflects the Portuguese meaning of this name. The people of Mozambique sometimes ask “Te FICA o te ficas?” Are you going or are you staying?) FICA – or rather FICA – clearly showed in 2008 that Flanders is a stayer. TETE, IN THE HANDS OF THE DOCTORS “By the end of the programme I should actually be superfluous here.” With these words, Esther Casas (shown on the right in the photograph) confirms my remark during our walk between the various departments of the provincial hospital in Tete. The new buildings are surrounded by scaffolding and some are already being used. You do not find this very often in Africa, large hospital rooms with a great deal of air and space which are not oppressive for visitors because of the misery which exists there and because of the prevailing heat. However, this future reward, a provision of hospital care focusing on cure rather than on secretly supervising the dying – although this is still far too common in practice – also has some disadvantages during the transitional period. The whole site looks like a building site with all the

attendant consequences. You are wading through pools of mud and wonder how hygienic it is to be able to walk through the corridors of any department you like, without being stopped anywhere. The short-term concerns are being overridden for the time being by long-term aims. Nevertheless, Dr. Casas is not losing sight of the short term. She is as proud as a peacock that the issue of the waiting room has finally been resolved. Space has been created in a half-open area on the side of the main building, which looks rather like a Congolese barza. In future, patients will take a place there before they go to the reception to be referred on. This will be the end of the crowds squashed in one of the dark corridors where you start to sweat after only a few seconds. Esther is happy and relieved when she says: “It took eight months before we managed to do that,” but I can feel how she was overcome by fatigue. The time it takes to resolve such an apparently small matter such as successfully organizing a waiting line in a hospital illustrates in a nutshell what a time-consuming process development Activity report 2008 | 9

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can be. Drawing up plans and implementing them, setting up new working systems, eradicating entrenched customs or modifying them, convincing people to tackle things differently, and providing feedback for everyone at all times to find out whether you are on the right track and whether everyone is on board, often with very modest funds, is no sinecure. Marleen Temmermans’ statement of a few days ago, just before I left for Mozambique, comes back to me: “Perhaps the progress in the course of our programme has been minimal, you cannot have a clearly measurable impact in the space of a few years – this takes time. We create that time here in Flanders, and we have all sorts of excuses, for example, our state structure, when we fall behind. If we were to look at ourselves with the same standards as those we impose on our partners in the south…” In a sense, Dr. Ntak Benson, who works on training and motivating health care workers in Tete, corroborated the words of Dr. Temmerman yesterday: “If you really want to achieve your aims, you cannot stop in 2010.” In other words, Esther Casas will have to make a huge effort if she wants to make herself superfluous in the foreseeable future, but she is aware of that and her balanced appreciation of the situation makes things very clear. You cannot expect a country such as Mozambique, which was just about the poorest in the world in 1994 after a destructive civil war lasting almost two decades, to reveal itself just like that as a shining example in the South as regards the organization of health care. You cannot simply sweep this recent past with its terrible consequences under the carpet. REDE INTEGRADA This has been the keyword since the second stage of the programme for health care started in the province of Tete in 2007: Rede Integrada, literally translated as integrated network. The target is to provide a place for all the existing forms of health care in Tete, in particular those related to HIV-Aids 10 | Activity report 2008

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and the STDs, sexually transmitted diseases, in a unified structure which falls under the auspices of the DPS, the provincial health department. The key concepts of the new approach are therefore, on the one hand, the integration of the care for HIV-positive Mozambicans in the ordinary health care system. And on the other hand, there is the decentralisation so that the number of patients who go to the central hospital stops and they can go to the district hospitals more than in the past. An easier and more general supply of antiretroviral therapy (ART) should be the consequence. The programme is building on the initiatives for integration, which were taken in the first stage before 2007 – and therefore there is officially a Rede Ingrada II, but in future DPS will play a central role in the network. Specifically this means that Médecins Sans Frontières, the Institute for Tropical Medicine and the International Centre for Reproductive Health (University of Ghent) have carried out their activities in DPS since the start of the current programme almost two years ago, to carry out the new stage wanted by everyone involved in the process of integration. The provision of care for HIV-positive patients within the structure of hospitals and health centres, and no longer in separate clinics, is the message here, and the government of Mozambique also wants this. The decentralisation means that the provincial hospital where Dr. Casas gives us a tour no longer attracts all the patients, but provides room for treatment closer to home in the health centres in the districts, which become significantly more important in the new concept. She is satisfied to tell us: “We have now got to the point where we have achieved our aim to have a Mozambican doctor in all thirteen districts. Obviously the partners from Flanders are concerned about their own specific contribution. The ICRH from Ghent is concerned with the problems of STDs and AIDS, and particularly the care of mothers and babies, the prevention of

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the transmission from mother to baby. MSF is building on the decentralised services which are provided to the population, which have been set up in the health centres in the town of Tete and in a number of districts. The ITG has examined the management of the provincial hospital and has sent out employees to improve the quality of laboratory testing there. The pharmacist Jocelijn Stokx told me in confidence: “By the end of the programme, my role here should have come to an end.” The spirit of true development cooperation has also permeated here. Just as Esther Casas does not give her own consultations but supports and advises her fellow doctors and outlines policy guidelines, Jocelijn helps her Mozambican colleagues in the hospital laboratory. For some tests, the latest equipment is available, e.g., the cd4 counter, a machine which measures how many of these white blood cells a patient still has per microlitre. This determines a person’s immunity; the HIV virus targets them. The content of cd4 cells is a measure for starting ART. Using this equipment requires training and Jocelijn has invested in this. A little later I come across a young Mozambican woman who is studying to become a laboratory assistant in Beira. She is doing work experience in the laboratory – just a little longer and there will be a successor. Some of the big problems in the laboratory are the defects and maintenance, because someone has to come from the capital city Maputo for this, 1800 km to the south or two hours’ flight. It seems obvious to train someone to remedy the odd defect himself, but Jocelijn warns, “The point is, as soon as that person has mastered this skill, he will easily be tempted by the higher salaries of the private sector or an NGO, and we lose him. Other aspects of the laboratory also clearly show that Mozambique is a country in the South with all the attendant problems. Jocelijn shows me the empty spaces in the fridge where the stocks of blood are stored. Anyone with a blood group B

rh+ does not have to worry – and I immediately feel a lot more confident – but other blood groups are completely lacking. Jocelijn adds: “In those cases we have to call upon the patient’s family.” Her colleague from the ITG, Philippe Gillet, who is visiting for a few days noticed that there was no sulphuric acid available, a necessary chemical for TB testing. Philippe went to buy some in a neighbouring garage. The poor have to be inventive. THE NIGHT CLINIC With 19%, the prevalence in the town of Tete is significantly higher than average for the province where it is 13, or for the country as a whole, 16. According to Dr. Temmerman, the strategic location of Tete on the transit road from Mozambique’s neighbouring countries to the ports on the Indian Ocean is an important factor in this. Trucks from Malawi, Zambia and Zimbabwe can only cross the Zambezi River in Tete. They form jams that are miles long and are allowed to cross the only bridge in the huge area very slowly. As this bridge cannot cope with the heavy loads of the various 10 and 20-ton trucks at the same time, the bridge is crossed by one truck at a time. You can imagine the delays this causes in a country where economic activity is leaping ahead and the vast majority of goods are transported by road. The large numbers of lorries and trucks, and delays lasting hours and sometimes days for the drivers, are some of the obvious factors which encourage the flourishing prostitution and rapid spread of the Aids virus. Just crossing the bridge once is enough to realise that Marleen Temmerman is right with her analysis. Her conclusion led the ICRH to thinking about tackling the problem of Aids in a very targeted way at this local level. The idea of a Clinica da Noite, a night clinic, was born. It is only a quarter of an hour’s drive from Tete to Moatize, which is doomed to become a suburb when the economically vibrant Tete starts to exActivity report 2008 | 11

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pand. This is likely to happen in the foreseeable future. By the beginning of 2010, the railway line which transports the coal that is mined here to the port of Beira should be renovated; the World Bank is financing more than half of this.

Just past the embankments, there seem to be two barracks at the side of the road, although on closer inspection these prove to be containers. One is furnished for administrative purposes, and in the other, nursing staff carry out consultations from about 4 o’clock to 10 in the evening. Educated people work here. The nursing staff have already done a day’s work in the health centre of Moatize before they start work on their evening job in the clinica da noite. Today Jovenario is doing the honours and takes me on a tour around. A DVD player is on all the time in the waiting area between the two containers. Whether the programme is in English or Portuguese, they always have the same joint theme: Aids. For the time being, there is no material available in the local language. This spot was carefully chosen. Opposite the improvised clinic there is a large car park for truck drivers who rest there after a tiring trip before starting on the nerve-racking crossing of the Zambezi. Women from Zimbabwe have moved into the buildings behind the containers, cheap guest homes. Like so many millions of their fel12 | Activity report 2008

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low country women they have fled from the social chaos and the unliveable conditions which they inherited as a result of President Mugabe’s disastrous policies. All the women do what they can and when there is absolutely no money left, some of them work as prostitutes, though usually only occasionally. Dr. Diederike Geelhoed tells me that they are described as sex workers, but the politically correct terminology sometimes glosses over the raw reality. In addition there is a secondary boarding school very close to the night clinic and the pupils are also given sex education and answers to all their questions when they want them. The clinic has a broader reach than just the prostitutes and their clients. Five girls make an appearance. “Fourteen”, one of them answers when Dr. Geelhoed asks her how old she is. “Fifteen”, says another. A boy of sixteen who accompanies the group is looking rather sheepish. School is out and they have come to take a look. Dona Suzanna takes the girls on their own for a little to show how to use a female condom. She had already shown me before. The clinic has had these condoms in stock since December. Suzanna uses an artificial vagina and fits the condom – child’s play. “These things are really popular here,” says Diederike. She insists that the young people are not just given the message about safe sex, but also and above all, that it is much more fun to make love when you don’t have to worry. “We do not promote any particular values”, she says, “and even when a boy of thirteen comes to ask for condoms we will give him some.” Dona Suzanna is one of the peer educators, who run the night clinic together with the three nurses. They are former prostitutes or women who are still working as prostitutes and therefore know perfectly what the situation is. At the start there were twenty of them, but only twelve are still there. They can be identified by their yellow t-shirts and they scour the area to support prostitutes and their clients with advice and action, and invites them to visit the clinic. Information

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AIDS, THE NUMBER ONE FOCUS OF ATTENTION

is available there and they have a stock of condoms, there is treatment for all the sexual diseases, they can have an Aids test and go there for family planning, because as indicated above, the night clinic sees its task in very broad terms. Suzanna stands her ground, that is quite clear. But according to Geelhoed: “Sometimes we also need a few male employees, sometimes drivers are a little bit too inclined to test out the peer educators in practice.” Geelhoed would like to adopt a slightly more professional approach with a more limited group. Suzanna does not think much of this. She proudly comes up with a training schedule for all the employees. For one week, they are given additional training of an hour and a half, before starting their work at 4 o’clock so that they can do their work satisfactorily, with some understanding. If it were up to her, Geelhoed would take the whole group to Malawi for a working visit to another night clinic in Mwanza. She wonders: “How do they do things there? It would certainly be interesting to go and take a look.” There are other future plans as well, to replace the containers with a brick building, opening in the weekend, 24-hour opening, or at least opening the doors a little earlier, a request from the prostitutes, or also being available for the drivers in the morning, as they requested. The night clinic, with its decentralised approach and sharp focus, hits the target.

The final aim for treating Aids patients is to treat them with ART. As soon as the number of cd4 cells in your blood falls below 200 per microlitre, you have a right to this in any case, whether you are symptomatic or not – that does not matter. ART at an even earlier stage, from 350, is available for anyone who has clear symptoms. An examination every six months indicates what the cd4 content of your blood is. Another test after three months is possible for anyone who is close to one of the limits.

Dr. Casas describes the situation with regard to ART in Tete. A prevalence of 13% means that of the 1,800,000 inhabitants of the province, 234,000 are infected with the HIV virus. It is estimated that 15-20% of these need ART, i.e. between 35,000 and 47,000 people. In the town of Tete itself, with a prevalence of 19%, 38,000 of the 200,000 inhabitants are HIV patients. Adopting the same assumption as for the province, which is that 15-20% of those people need ART, this comes to somewhere between 5,700 and 7,600 people. This is approximately the same number as the number of people receiving ART treatment in the whole of Belgium, and that is just in the town of Tete! “Since we started with the programme, we have monitored approximately 4,000 patients who are Activity report 2008 | 13

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receiving ART in the hospital.” Esther continues her calculations: “At the moment, we are monitoring between 800 and 1,000 people.” The others have been referred to health centres in the districts as a result of the decentralisation which started two years ago. However, Esther Casas decides: “But really I don’t think that we have them all, the HIV patients who have a right to ART.” The large mobility of the urban population, the uncontrolled intake of immigrants from Zimbabwe in Tete and the Malawi population travelling to Mozambique make it impossible to draw up exact statistics. The new division of tasks between the provincial hospital and the health centres in the districts could possibly be improved further according to Casas. “We are still treating some of the patients whose condition is stable ourselves, while others who we should have kept were referred to a centre for treatment; we should work on our own criteria.” According to Casas, the process of decentralisation has certainly helped: “In the districts you’re closer to the area where the patient lives, you have a better understanding of what’s going on; we should make things as simple as possible and work out strategies in order to guarantee the best quality.” She would like to work out these quality norms together with the provincial health department and Médecins Sans Frontières. Casas continues: “Sometimes you’re forced to make do with an ad hoc solution in Tete. How to measure the quality is an essential topical matter; providing a cd4 test every six months is not enough, we should also find out how long patients are waiting for their medication and whether they trust the person treating them; in any case it was no longer possible to continue with just one referral centre for Aids.” I would like to discuss the limit of 200 cd4 cells here. The leading British medical journal The Lancet has done research into 45,000 Aids-positive patients in Europe and North America. Its con14 | Activity report 2008

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cludes that someone who is only given ART when he falls below the threshold of 350, has a 28% greater chance of getting Aids and dying prematurely than someone who is given ART when the content of cd4 blood cells is between 350 and 450. I tell Dr. Casas: “In Uganda, they’re thinking about increasing the threshold to 500.” She nods, “Yes, that is the trend.” Esther immediately points out the consequences of this measure, the higher cost price in the first place, because if you give more people ART, you need more medicine, which is not so expensive in itself, but also requires more laboratory testing, and you therefore need a whole load more people. After all, treatment costs money. Another negative aspect is that there is a risk that more people do not take up the therapy because they do not have any symptoms and they assume that they are not ill. Another thing which cuts down the cost price is the fact that you have a smaller number of heavy treatments for serious infections. They are no longer so necessary because you started the treatment at an earlier stage. These advantages and disadvantages have to be weighed up against each other. When I ask Esther at the end of our discussion whether she agrees offering HIV patients ART as soon as their number of cd4 blood cells falls below 500, she doesn’t hesitate to answer for one second. “Absolutely, yes, even here in Mozambique; if I were an HIV patient myself and was only given ART at 200, I would know that it was much too late; in Spain I would have been on therapy a long time ago.” She then adds that the medicines which are prescribed for the people of Mozambique with regard to ART are of an older generation, with more side effects such as swollen legs, etc. One of the things which is particularly necessary according to Casas, is for the people of Mozambique to have themselves tested in time. “Many of our patients reveal a cd4 content below 100 when they are tested. They come too late because they have never bothered or were

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tested once many years ago and there was no aftercare.” But she says she’s happy about the progress that has been made. As a result of the decentralisation, nurses from the hospital can be used in the health centre for consultation and Aids tests. They ask every patient about his HIV status, find out whether he has been tested, how long ago that was and whether he is prepared to have another test. “We don’t oblige just anyone, but we follow the strategy of offering absolutely everyone an Aids test.” Esther has no idea of the numbers, because the registration is below par and only partly computerised. “What interests me is not how many people have been tested, but how many we follow up.” Esther Casas touches on one point in the discussion which is of great concern to all those who are responsible for ART: the number of HIV patients who just fail to use the therapy. With an extreme example, she describes how difficult it is to estimate the situation correctly. “Four months ago a woman had been diagnosed with TB, and because the first-line medication no longer had any effect, she had been transferred to secondline treatment, much more serious and with more side effects. Last week, she didn’t come to fetch her medication because she’s much too ill and she didn’t send anyone in her place. This is a typical example of poor support. The patient is given medication but doesn’t know what it’s for and doesn’t even know that she has TB or has any idea what cd4 cells are. You have to make the sick responsible for themselves and that’s only possible if you inform them properly. We come from a culture where someone has to take pills for a fever or malaria until they’re better again. They do not even have to remember that they have even been sick. The fact that you have to take pills all your life while the doctor will never say that you are healthy again is impossible for these people to understand. You have to explain what is meant by a chronic illness.” Furthermore, the further away you live from Tete, the greater the chance that you are quite a way from a health centre and you will not be given ART or any treat-

ment. Esther explains: “Sometimes someone like this may have to walk for seven hours before he’s there, and then wait about five hours for his medication before going back home, another seven hours, so you can imagine.” She admits: “Of course, I also understand very well that the patients go to their Machamba to work in their field and do not go back to the city, they simply have to survive.”

Carla Mosse, the provincial chief medical officer, recently said in an interview that 610 HIV positive patients stopped their ART in the province last year. She explained that people moved house, talks about side effects and cultural factors and argues for a new strategy that she wants to work out together with Médecins Sans Frontières. Dr Laura Infurnari (left on the photograph) from MSF gives another explanation during the visit to the health centre 3 in Tete. Laura showed us the card index of Aids patients who come for ART every month. The cards which are still there at the end of the month belong to patients who have not turned up and have consequently not received their medication. Laura explains: “You cannot simply assume that this means they have stopped the therapy. The person may have died in the meantime or be too ill to come to the health centre to pick up his medication, or he may have left town. We don’t know, but you should not assume from the cards that are left that the patient has simply given up on the therapy.” However, the drop out rate is and certainly continues to be Activity report 2008 | 15

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a major problem, even though there are so many reasons for this that it is difficult to point to one single reason.

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In comparison with the past, it had already fallen quite a bit, because in 2004 the percentage in centre 3 was 26 and in 2002, as in 2000, it was 22. With 17%, 2001 was an exception.

DECENTRALISED CARE OF THE SICK A visit to health centre no. 3, one of the four in the town of Tete, together with Dr. Infurnari. Laura divides her time amongst all the centres so that she goes to every place at least once a week. Her working procedures are identical to those of Esther Casas in the hospital; she does not do the consultations herself but supervises and advises the nurses and the medical assistants. When a patient is referred to them, Laura always treats him together with them. The key concept is on-the-job training. Once upon a time this was very different. MSF started in Tete with a mobile Aids clinic which was separate from the still virtually non-existent Mozambique health structure. For some time, MSF, like ITG and ICRH, have integrated their operations in the joint network. We were told that what was really important was for there to be a Mozambican doctor working in every district. Like magic, Cecilia walked in (on the right in the photograph on page 15), young, small and full of life, laughing merrily. In no time at all, the Mozambican doctor was going through cases in the corridor with her Italian colleague. Today, health centre 3 is honoured with the presence of two doctors, what a luxury. But it is not all plain sailing in the centre. I should have seen the notice straightaway, when I came in: “No Aids tests today.” The material is not available, and when I ask I’m told that happens quite frequently. Normally, they do a free Aids test for every woman who comes here for the first time for a consultation, if she is pregnant or has just had a baby. But today this service is not available. This test is certainly no luxury because the prevalence of Aids in this centre over the years is alarming. In 2007 it was exactly the same as the high average for the town of Tete with 19%. 16 | Activity report 2008

There are no cold storage facilities either in the centre, which is a matter of concern for the tests for malaria, Aids, and other STD tests which require a temperature of under 30 degrees for their storage. Measuring the beads of sweat which virtually immediately start pouring down my back in some of the rooms, they certainly do not achieve that norm. In Laura’s eyes these greenhouse temperatures are also a problem for other things, not least for anyone who is waiting their turn in the poorly ventilated and poorly lit waiting room. Everyone waits there together, both the TB patients for whom centre 3 is a point of reference, as well as all the other patients. Another complaint is that a simple remedy such as magnesium hydroxide, which is used for gastric complaints and is a laxative, is not available either. I am told this is a national problem. In a poor country like Mozambique these things sometimes happen and Laura and her team have to learn to live with it. None of these things stop the director Angelo and the chief nurse Magdalena from taking me proudly on a tour from one department to another. From the pharmacy, where they provide all the medicines free of charge, apart from a few for which you have to pay 5 meticais as your personal share, about 15 euro cents, to the emergency department which is manned, or rather womaned, 24 hours a day because in Mozambique health care is increasingly run by women. In the laboratory we find five students who are training for 18 months in the Centro de Formaçao, the training centre which the ITG helps to run. This will be on my programme next. It’s is not clear where the people who are on work experience will end up when they finish their studies. The Ministry of Health decides this. One of them sheepishly grins, “Yes, it could be anywhere. Mozambique is a big country, we know

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that, but we don’t make problems about going to work in the interior.” What follows is not hilarity. In Mozambique, the communist tradition of politically correct language and action has not disappeared altogether. The five students are in neat uniforms wearing masks and gloves, in contrast with the laboratory assistant in the centre. He apologises: “We do not have that equipment here.” His successors at least know how things should be done. In another room Ana is in a good mood. She has brought some of her trainee nurses from the Centro de Formaçao where she teaches. Their specialist area is the treatment of mothers and babies. Ana gives us and her pupils such a lively explanation that almost everyone forgets that a mother-to-be is laying waiting on a stretcher behind the screen. We arrange to meet later in the training centre. THE TRAINING OF HEALTHCARE WORKERS, A THORNY QUESTION The Centro de Formaçao is part of health centre no. 2 in Tete. A few dozen metres further on, cholera patients who have been isolated are receiving treatment. This reveals how basic hygiene and sanitary provisions are by no means the rule. Last year there were more than 10,000 cases and 157 Mozambican people died of this disease. In the first weeks of 2009 another 109 people died. Tete is one of the provinces that are worst effected. At the Centro de Formaçao, Ana once again gives it her best shot. Her 30 students – and they are all young women – hang on her every word. Ana’s class is being drilled. The same answer learnt by heart is given by all the students in a staccato rhythm when she asks questions. They are here together, this group of 30, for eighteen months, and then they are ready to go to work in a health centre for mothers and babies. What are they missing? They all wear a green shirt, but they would like a white dress and white

shoes as well as … One of them plucks up courage, stands up straight and says without a blush what they would really like – some money for a party at the end of the year wouldn’t go amiss. Dr. Ntak Benson (left on the photograph on page 17) is affiliated to the DPS and is especially responsible for improving the training facilities. The personnel policy in the health sector is a cause for concern. There is one doctor for every 40,000 inhabitants and one nurse for every 4000 Mozambicans. Benson explains: “These are very poor ratios. There are simply not enough health workers.” This is partly because ART is much more accessible for many more people because of the decentralisation of health care, and there is therefore a growing need for doctors, nurses, etc., while the supply does not meet the demand for them in Mozambique. Moreover, and in saying this, Benson actually confirms what was said by Jocelijn Stokx – it’s a real job to keep them in the districts because they want to go back to the city as quickly as possible. Of course, this is not a problem which is typical Activity report 2008 | 17

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only of Mozambique – it applies in many African countries. The Institute for Tropical Medicine has taken it upon itself to draw up a programme for personnel policy in the medical sector, which FICA also supports with a special focus on Aids, and obviously on the several hundred health workers in Tete. Officially it is separate from the Rede Integrada, but essentially it is part of it, because how else could this sort of network operate effectively when there are not enough trained and motivated people? The ITG is planning to at least also make a thorough examination of decentralisation, a basic ingredient for health care, so that real synergy is achieved. For all these reasons, it sent Dr. Benson from Nigeria to Tete.

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there’s water and schools for children, so that people want to stay there.” Benson also considers non-financial incentives very important. For example, the shortage of midwives in the districts is met by giving them installation kits, finding a house for them and promising them an annual payment of € 400, with which they can buy building materials or a fridge or TV. This is known as buttering up for a good cause. In the long term, the cooperation with scientific institutes should also provide a solution. The ITG works together with a number of them, including the Eduardo Mondlane University, in which the ICRH is also a research partner. Doctors, sociologists and anthropologists are doing master’s degrees there in basic health care for two years. The first graduated in 2004. The provincial health care services can only benefit from this. THE FLANDERS RED CROSS IS ALSO ACTIVE IN TETE The Flanders Red Cross is training more than 200 volunteers, 100 in basic health care and 65 in home care for Aids and 50 in social aid, in Changara, Chifunde and Chiuta, three of the 13 districts in the province of Tete. In view of the distances in Mozambique they limited themselves to these three districts.

There should be some improvement by the end of 2010. Benson is thinking of several measures, such as higher salaries and a better working environment, conditions which are linked to the work as such. But he is also thinking of other matters. He explains: “The government should work on the development of the districts and make sure

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The hundred volunteers who focus on basic care visit homes to explain about basic hygiene, e.g., washing hands etc., the purification of drinking water and the installation of latrines and sanitary provisions. The repair of wells in the villages is also one of their tasks. They have more general sessions in public places such as markets or first aid centres, where they talk about diseases such as malaria and TB. The people who are involved in home care follow up a number of Aids patients in consultation with the health care centres of the district. An agreement with the Ministry of Public Health determines how many home visits the Red Cross

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volunteers should make every week, and the exact nature of their task. They monitor whether the patient is taking his medication and when he has to go back to the hospital for a check-up. The social workers zoom in on orphans and vulnerable children, try to ensure they go to school and distribute school materials. If the home situation leaves something to be desired, they call on the assistance of the Ministry for the Woman and Social Action. Some volunteers have been trained to act and organize shows on issues such as Aids, malaria or TB. They do this at least once a week. Linda Bleuckx, who is responsible for the Southern Africa region, explains: “In these villages it’s the event of the week, I’ve experienced this many times and the show attracts many people. Usually the plays are overacted, but there’s lots of laughter, it’s fun and the message of the volunteers, usually young people from the community who speak the local language, may be something like: use a mosquito net against malaria, preferably soaked in something that kills mosquitoes.” This sort of network of volunteers is the strength of every Red Cross association all over the world, particularly in Mozambique where the structure of health care is weak and there are not enough women, while there is also a great need for additional training. The volunteers of Cruz Vermelha, the Mozambique Red Cross, can be found all over the country in the most isolated villages, an enormous advantage. The work in the first aid centres in communities which are a long way from any health centre, is very important. These are simple buildings, built together with the local population who make the bricks and bring the water. They can go there for simple matters. The Red Cross volunteers have been trained to recognise the symptoms of malaria and give pills for this, combat diarrhea, dress wounds and identify all sorts of complaints, and refer the patient on to a health centre. They are not nurses and therefore do not give vaccina-

tions, but a mobile brigade with nurses does go to the centres to give inoculations against measles and other children’s diseases. Linda Bleuckx considers that these first aid posts are important information centres. The fact that you can find volunteers from the Red Cross all over Mozambique also has a side effect. The government likes to call upon this network in the case of disasters. The National Institute for Combating Disasters is usually established in the district capital and because of the poor roads is not able to provide assistance in isolated areas. By using the Red Cross volunteers who are active in places where there is no other health care infrastructure in the case of flooding or a cyclone, the national disaster plan can be carried out anywhere. This cooperation which takes place to everyone’s satisfaction is institutionalised to some extent because even the National Institute gives financial support to the Mozambique Red Cross. In exchange for this, Cruz Vermelha engages in mobilisation and prevention. At the start of the rainy season, the volunteers go out to the villages to advise the population living near to a river to move to higher areas. When a real disaster occurs such as the Favio cyclone in 2007 or the severe flooding in 2008, employees from the Red Cross are used in enormous numbers during the largescale operations following these events. They help to evacuate the victims and provide first aid. According to Linda Bleuckx: “The disadvantage of this is that long-term projects such as those which we have in Tete, as well as the everyday activities of the volunteers, come under pressure and are kept on hold for a while.” Every setback requires an intervention and that is another of the essential characteristics of every Red Cross association. When Favio was raging across Mozambique, one month before the training centre was to be finished, it caused serious damage to the building in Vilanculos, for which Flanders had provided financial support a few Activity report 2008 | 19

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years before. FICA provided extra funds for this from the budget for emergency assistance. The centre in Vilanculos has been completed since that time but is not yet operational. In 2008 Flanders did not contribute directly at the time of the flooding, but money from Music for Life was sent to Mozambique. This is logical because in September 2007, “water” was the topic for the Studio Brussels campaign. As part of the collected funds came from the Flemish Community, you could say that Flanders provided indirect aid. It is a coincidence that in recent years Mozambique has been affected by the seven plagues of Egypt. There seems to be no end to it. The United Nations has warned that because of the extreme drought, 350,000 people need food aid. Since October 2008, there has only been half the usual rainfall in large parts of the country. As a result of the poor harvest, there are acute food problems in seven of the eleven provinces. What else has Mozambique had to cope with? They are not all natural disasters. In March 2007 there were almost 100 fatalities when an ammunition depot exploded in Maputo. There is cholera in the country again – in Tete we saw a camp – and in the spring of 2008, about 30-35,000 Mozambicans crossed the border back into the country after the riots against immigrants in South Africa. And who was there to help them? Once again it was the Red Cross volunteers, armed with blankets and soup, ready to look for the traumatised refugees and their families and to provide psychological and social assistance. All this took up a great deal of the energy of Cruz Vermelha. However the positive side of all this should not be forgotten. The disaster plan is effective. While Mozambique was caught hopping in 2000 in the flooding resulting from heavy rainfall and a cyclone, and an estimated seven to eight hundred people died, the number of victims in 2007 was limited to a few dozen. The country is now prepared and the people are better informed. The 20 | Activity report 2008

government has insisted that they must not settle so close to a river, even if the land is more fertile there and they have been living there for generations and their ancestors are buried there. Reception centres have been built higher up which enable the people to continue working in their fields down below without necessarily having to spend all their time there. Assistance has now also been provided for the construction of a house, and this involves thousands of houses. The activities of the Red Cross and Rede Integrada come together at one point. In Tete, Cruz Vermelha has concluded an agreement with Médecins Sans Frontières about making volunteers available. The two organizations are working there in more or less the same districts. If there is an outbreak of cholera, MSF can in future use volunteers from the Red Cross in the treatment

centre. Cooperation is also possible for following up HIV patients. While MSF is concerned with the medical aspects in health centres, the Red Cross volunteers are responsible for the social supervision of those patients. When MSF and the Red Cross

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visit one of these centres together, they find that it is actually the sick themselves who are followed up by the volunteers in their community, who register with MSF. Katrien Ringelé, who represents the Flanders Red Cross in Mozambique, has explained: “We would like to coordinate this. I am not saying that the cooperation is perfect, but at least the two partners are now better informed about each other’s programmes and can coordinate them better, which should ultimately benefit the patients.” The funding of FICA for the Red Cross programme in Tete comes to an end by the end of 2009, which means that it is gradually time to draw up the balance. According to Katrien: “It’s not easy, because we have at most a general picture of the community we are working with in Tete and cannot measure the impact our programme has on the level of the knowledge of individuals.” Lynda Bleuckx sees some possibilities: “Have any latrines been built? Have the volunteers found that the people are actually using them when they make door-to-door visits? Have the water pumps been repaired? Is there less malaria in children over five years old? A period of five years is a good length of time to look for an answer to these questions. After all, this involves a change of attitude, and changing habits does not happen just like that.” Once again this is an implicit argument for long-term programmes – not for the first time. A NEW HEALTH CENTRE IN INHAMBANE It’s an hour’s drive from the airport of Inhambane to Mahangue in the predominantly rural part of that province. A brand new health centre opened there in November 2008. It’s exactly 470 km from Maputo, slightly too far to drive back and forth by car, which is why we travel by plane. It is easy to underestimate the impact of the distances in Mozambique, time and time again. We would like to see this new centre, because for FICA the ex-

pansion of the health network in these areas is a top priority. There are three nurses who work here permanently. Açucena, who is responsible for mother and baby care, including inoculations, gives us the tour. One of her colleagues is in reception for the patients. She decides on the simplest medical treatment herself and refers others on to Açucena or to the third nurse in the centre, whose main task is prevention. In principle all the basic medication is available here although it sometimes stays in the provincial hospital in Inhambane for rather a long time. This should not be the case, but efficient supplies continue to be an enormous challenge in Mozambique. Dr. Mercia comes flying in. She comes to provide support for the team from time to time. She divides her time over the nine health centres in the district of Morrumbene. This is quite a challenging task for her, but in practice we can see with our own eyes that there is now a Mozambican doctor based in every district. Açucena and her two colleagues do their work in airy, neatly separated rooms. I can easily think of dispensaries in Burundi and Congo where the working conditions are a lot worse. This is quite a relief! The maternity department is housed in a separate building. There is a bed for giving birth in one room, and there are three beds in a second room where the young mothers spend the Activity report 2008 | 21

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first 24 hours after giving birth. Açucena assures me that most women come to the centre to have their baby, but a woman who comes for a consultation for the first time today appears to have had the baby she is breastfeeding now, at home a month ago. Not all the women follow the same line. Apart from the postnatal advice, there are about 150 patients who go to Mahangue every day. A quick calculation reveals that this comes to 50 patients per nurse, so there is quite a heavy workload. The patients who are waiting sit outside on a bench under the corrugated iron roof, which covers a generous area and protects the women from the first drops of rain of the day. They are all women. Dr. Mercia tells me, “No men come here”, with a slight grin. Healthcare in Mozambique also appears to be a matter for women on the demand side. With regard to the infrastructure and electricity supply, there is still certainly quite a bit of work to do, but other aspects surprise me in a positive sense. In the first place, there is a large water tank on the edge of the site, where a solar panel runs the pump, an ingenious system. In the second place, I am struck by the melons which are grown around and between the buildings. The patients are given fresh fruit free of charge. On the way back to the airport I see a sign on the side of the road. The sign says, “Water for sale.” The explanation for this follows when the airplane from Johannesburg lands. It is Friday afternoon and scores of white South Africans have travelled to Inhambane. The arrivals hall is filling up and their things for the barbeque are in the hand luggage. This area is famous for its beautiful beaches, but I realise that this will have to wait for another time. One hour’s drive from here and women are happy that they have been able to receive decent health care for a few months. Just wait until there is electricity in Mahangue!

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The centre in Mahangue is not the only thing which was funded by FICA. In the province of Inhambane a health centre has also opened in Nhapandine. The new operating theatre in the hospital of Manjacaze, in the province of Gaza has been completed and gone into use. Construction can start on the rural hospital in Fingoé in the province of Tete. The Cybersonic company has been given the contract, as we read in the newspaper in the airplane. This is a Mozambican business, as required by law, although it uses Chinese capital. The same company, Cybersonic, has also managed to get the contract for a new children’s department, planned in the central hospital of the port of Beira. The bank guarantee has been provided and now it is a matter of waiting for the starting signal for a period of construction which will take between fifteen and eighteen months. Healthcare is the main focus of attention of Flemish development cooperation in Mozambique.

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BUDGET SUPPORT FOR HEALTHCARE Marleen Temmerman had told me just before I left: “Mozambique is a donor baby.” Esther Bouma calls the country a “donor darling.” It comes down to the same thing: there are many donors active in this country – the UN and other multinational institutions, all the large bilateral actors, quite a lot of NGOs. FICA is only a modest player and there is quite a lot of money flowing into the country, often as direct contributions to the government budget, rather than all sorts of individual programmes and projects. This means there is a need for coordination and Bouma is responsible for this. She has her office in the obviously expanding embassy of the Netherlands, her own country, but she works for DFID, the British department for international cooperation. DFID is taking over the management of a group of 25-30 partners one of these days. But not everyone is joining in. For example, China is staying out of it. The contact with the Ministry of Public Heath takes place at three levels: twice a year with the minister himself, once in order to look back at what has been achieved and at the expenditure, and a second time to look forward to the plans and the available budget. Every month a small delegation of the partner group sits round the table with the management of the ministry, and in addition about ten working groups have been set up. These discuss how the budget was used, what was not achieved and why, and provide technical support for the donors with regard to financial management, personnel policy, infrastructural works, etc. Bouma prepares for these meetings with the donors every month, so that she can make arrangements with the Mozambicans on the basis of a uniform and thoroughly discussed point of view. This means that everyone is moving in the same direction. The spirit of the Paris Declaration, which argues for better donor coordination, is clearly present in Maputo. The Mozambicans benefit from this procedure, as they could oth-

erwise be faced with everyone who provides money, large and small, turning up all over the place. Bouma concludes this part of her story: “Mozambique is one of the big examples and yet still more coordination is needed, also at the level of technical assistance and infrastructural works; I know of a case where two health centres were constructed in the same village, although there was not a single one in the rest of the district, simply because the two donors had started talking to different people in the ministry.”

There has to be something set against more coordination amongst the donors. Mozambique drew up its social and economic plan for the next few years in close cooperation with them. According to Bouma: “In comparison with other countries, this is striking and the Minister of Public Health is open to the input of its partners.” The result is a sector-wide approach for healthcare, commonly known as SWAp, a mechanism for the ministry to support the cooperation with the partners. In practice, the SWAp imposes a code of conduct on the Mozambique government and the donors. Activity report 2008 | 23

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Mozambique undertakes to draw up transparent budgets and annual plans which reveal all the funding to work with contracts, combat corruption and improve its capacity to take over the health system itself. For the donors, the rules are: predictable payments, follow the planning schedule and use the bookkeeping system used by the Mozambique government.

Budgetary support is the result of all these agreements. Flanders has joined this most far- reaching form of donor coordination and harmonization. Since 2006, FICA has given €2 million every year to Prosaude, the common fund for the health sector. Until recently there were three funds in Mozambique for healthcare, one umbrella fund, a provincial fund and a third fund for the purchase of medicines. These three were combined in Prosaude II. As a result of this streamlining, it is now possible to draw up a single comprehensive budget for healthcare, in which it is no longer clear who is funding what or whether the money comes from 24 | Activity report 2008

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the own funds or from donors. In practice, this ideal has not yet been achieved. Some UN agencies do allow the anticipated sum to be allocated to the budget, but keep control themselves. Other partners opt for a targeted transfer for a certain programme rather than general budgetary support, and some NGOs work outside the plan. According to Bouma: “Altogether there has been a great deal of progress. For example, the government knows that the purchase of mosquito nets is assured, even if it does not pay for them itself.” Mozambique funds 40% its health budget with its own funds, 60% comes from donors, a large part via NGOs. Bouma explains: “They spend $200 million in the sector, without the involvement of the ministry.” Therefore there is still a long way to go, but a few steps forward have already been taken. The donors respond to these developments. Aware that predictable promises are absolutely vital, they do not immediately impose sanctions when the annual evaluation of the performance that has been achieved reveals a poor result. In other words, Mozambique receives credit, in a literal and metaphorical sense. The evaluation in the context of the Performance Assessment Framework continues to be the basis for the progress of the cooperation, but if it is estimated that the past year has not been satisfactory, this does not have any consequences for the promises for this year. At the earliest, it could have an effect on the commitments for the next year. Furthermore, the donors must give an idea about what they are committing themselves to in the next three years. 33 indicators have been agreed, with which Mozambique’s partners can assess the performances. There are very concrete objectives, for example, how many people have access to ART. The ministry routinely collects the data itself every year but is not very good at this, as Bouma admits, and there are no random tests. Together they analyse the data and try to find out why some targets have not been achieved: were the

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aims too high or was there not enough money on the table? Some donors make a choice from this list of indicators and use two or three of them to draw up a balance. According to Bouma: “For example, the European Union commits itself to a certain sum and will then add another sum if Mozambique performs well for the two specific criteria on which the EU focuses.” The ultimate touchstone for all this is of course whether the average Mozambican is offered better healthcare. Is his life expectancy, which is under 40, increasing with leaps and bounds, and is infant mortality decreasing drastically? Bouma warns: “This does not happen from one day to the next, it is a very long process and it is difficult to see any improvement in the space of one year; for example, the fall in life expectancy is entirely related to Aids and the access to healthcare services continues to be a problem as long as people have to walk for miles in certain areas.” Esther Bouma concludes: “The greatest problem is the shortage of personnel in the health

sector. There is a lack of staff in every field. Mozambique is a huge country with a widespread population, most of the inhabitants live in the north, but the personnel mainly go to work in the south. If you look at the evolution since 1994, you will find some improvements, but Mozambique does not have the money to increase the number of healthcare workers to the norm used by the World Health Organisation.” As regards the number of healthcare workers, there is a real crisis in Mozambique. The figures are amongst the worst in the world. The shortage of healthcare personnel is the greatest obstacle to achieving the millennium goals in 2015. The World Heath Report of 2006 states that a minimum of 2.3 healthcare workers per thousand inhabitants are needed for this. With 1.26 doctors, nurses and midwives, only just over half, Mozambique is a long way from this norm. For this reason, the country has drawn up a plan covering the period from 2008 to 2015. Problems such as the lack of training, low salaries, poor

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motivation, the brain drain into the private sector, limited management capacity and personnel shortages must be solved in the course of these seven years. The table below gives a prognosis of the expected growth of healthcare personnel. The success of the plan depends on the extent to which the Mozambique government mobilises additional financial and technical support. On 12 December 2008, the Flemish Government decided to release â‚Ź1 million for training. Some of Mozambiqueâ€™s international partners argued for increased funding on the home front, but only very few were successful in their lobbying. Is the worldwide crisis also having an effect on development cooperation? AN EXAMINATION OF HEALTHCARE The health of the Mozambican population has improved, but there are still large differences between the provinces. Drawing up the balance of the social and economic plan and the health sector in 2007 shows that 79% of the budget for public health was carried out that year, an increase of 4% compared to 2006. Although the network of basic health services has been extended, access to it and its use and quality have deteriorated. This is due to the shortage of healthcare personnel.

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Nevertheless, there was an increase in trained healthcare personnel in 2007, although there are still gaps. It seems to be problematical to keep doctors, nurses and midwives working in less privileged areas. The goals were achieved for three of the five most important indicators of the Performance Assessment Framework in 2007. Just before this report went to press, the data were published for the evaluation of 2008, with amended and supplemented results. This shows that in that year only one of the five goals was achieved. The European Commission published a list of seven indicators, showing that in 2008 Mozambique achieved at most two of the goals that had been set. The evaluation of 2008 also shows that healthcare has a good score in Mozambique as regards tracing malaria and eradicating leprosy. The number of children born in hospitals and dispensaries has also increased. This is also the case for the number of women who use family planning and the number of HIV-positive pregnant women taking ART, so that the risk of transferring the HIV virus to their child is reduced. But there is still a lot of work to be done. The Mozambique healthcare

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has poor results as regards the lack of personnel and the unsatisfactory storage of medicines. The number of mothers who die in childbirth in hospitals has increased. In general, Mozambique achieved the aim for 18 of the 33 agreed indicators, i.e., slightly more than half. If you look at how many indicators achieved 80% of the target, this percentage increases to two thirds. The international partners which support healthcare in Mozambique have concerns about several weak points. For example, they would like to do something about the delays in recruiting new healthcare personnel. They would like to see the process of decentralisation taking place in more stages and with better preparation, so that the treatment with ART is not jeopardised. At the end of September 2007, 418,265 cases of sexually transmitted diseases had been counted, compared with 403,007 in 2006, an increase of almost 4%. The figures were highest in the provinces of ZambĂŠzia and Nampula, with respectively 17.2% and 14.5%. This is an alarming situation. Even though it is possible that the higher percentages are the result of better diagnoses, they indicate that more attention is needed for prevention in these two provinces. The number of HIV-positive cases increased from 30,332 in 2006 to 69,003 at the end of the third quarter of 2007, more than double. It is possible

that the new approach and better treatment possibilities attracted more users to the health centres and influenced the figures in this way. By the end of November 2008, 124,191 patients were being treated with ART. In the Rede Integrada in the province of Tete, 4,687 were receiving this treatment by the end of 2008. In the country as a whole, 16% of the population is infected with the HIV virus. In the centre, this is 18% and in the north 9%, and in those parts of the country you could say that the Aids situation has stabilised. The south has been particularly hard hit and the situation has deteriorated there. The prevalence is 21%. The figures reveal that the problem of Aids is a source of great concern in Mozambique. The Minister of Public Health, Dr. Ivo Garrido, recently conducted a survey. He sees the reasons for the expansion of the scourge of Aids as being the proximity of South Africa â€“ where the percentages certainly are very high â€“ and above all, the habit of the people of Mozambique to have several sexual partners at the same time, and having sexual relations with them without using a condom. The message is that people will have to change their behaviour if Mozambique is to gain control of the Aids epidemic. Other explanatory factors for the high figures are the large mobility of the population, the weak position of women who do not make any demands, and economic inequality, so that some women are tempted to gain an income as sex workers. Sexual violence, the consumption of alcohol and drugs, the stigma related to Aids, and the lack of communication about sexuality are also mentioned by the minister. He has asked the donors to work on those elements in their approach to the Aids question. As regards the gender aspects, FICA is very active. It has supported a UNAIDS project for several years to combat the growing feminisation of the Aids epidemic. 56% of the patients are women. This trend for the epidemic to affect women most returns every year. This reveals the Activity report 2008 | 27

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great need for a programme which is sensitive to this. In the course of 2009 this should result in a national action plan. The balance of what FICA does in Mozambique with regard to Aids is certainly significant. When she goes through the list of preventive actions suggested by Minister Gariddo, the FICA representative in Maputo, Katarina Planckaert (shown in the centre of the photograph) insists that: “The Flemish development cooperation is on the right track.” Many of these priorities are reflected in the range of tasks adopted in the Rede Integrada by Médecins Sans Frontières, the International Centre for Reproductive Health, and the Institute for Tropical Medicine: taking Aids tests, making condoms available, giving high risk groups special treatment (the night clinic!), detecting STDs, devoting special attention to the mother and baby 28 | Activity report 2008

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relationship, improving the access to medical treatment and organizing the storage of blood. Thus in recent years Flanders and Mozambique have formed a relationship. This is reflected in the new Memorandum of Understanding which applies for an indeterminate period. It was signed in Brussels on 2 April 2009 during the visit of the Mozambique Vice-Minister for Foreign Affairs and Development Cooperation, Henrique Banze. The first framework agreement, which dated from 2004, had expired at the beginning of 2009.

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A NEW SECTOR: TECHNICAL EDUCATION The site is still empty and the first excavations will be carried out shortly. Workplaces for future teachers of electronics and mechanics will be built here. The area looks good. Father JosĂŠ Angel Rajoy proudly gives us a tour of the buildings of the Don Bosco institute with its spacious classrooms, airy administration and management offices, computer room, cafeteria and kitchen, where the students develop an inner strength and those below them, who are following a tourism and catering course, are learning to do this. We are near Matola, a suburb of Maputo, which I remember because of the fatal raid carried out there by the South African army at the beginning

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of 1981, at the time that the military top brass of the ANC had their headquarters here. There is a commemoration every 30th of January, but for the rest of the 364 days of the year, Matola looks like the industrial settlement which has developed in this district more than a quarter of a century later, now that apartheid has been relegated to the history books for good. The aluminium factory is established in the free port of Matola Mazal, from which exports to Antwerp have reached such a high tonnage that Belgium is now the first country to which aluminium is exported. Therefore a place like Matola is extremely suitable for building an institute like Don Bosco, which specialises in technical and vocational education.

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Like everywhere else in the world, the Salesians have thrown themselves at the niche of vocational and industrial courses. In the context of the planned educational reforms, the Mozambique government is keen to make use of their services. The Salesians train the teachers; the Ministry of Education pays the lecturers their salaries. In addition to hotel and tourism studies, the future teachers can go to Don Bosco for training in administration or management, and from the autumn of 2009, also for electronics and mechanics. After three years they have a bachelor’s degree in education. Education in Mozambique is forging ahead. The government is taking fifteen years to improve the technical and vocational education. The educational target is to provide professionals who can be used in the labour market immediately – industry is complaining about this –or are able to start their own business, even if this is in the informal sector. In 2006, the preparations for the testing stage started in a limited number of institutes, about ten. This takes place under the name PIREP, which stands for projecto integrado da reforma da educaçao profissional, an integrated project for the reform of vocational education. Two of the ten institutes have actually started using the test. PIREP runs until 2011. FICA would like to make a contribution to this project which is mainly funded by the World Bank and the Netherlands. It opted for teacher training. This was because of the conclusion that there are gaps in PIREP in this respect, because there was not enough thought at the start of the trial period about where the teaching colleges are going. There are quite a few things wrong. The sector is underfunded and there is a lack of quality. The need for new manuals, teaching aids and appropriate equipment is enormous. The teaching personnel is rather old and demotivated, partly because of low salaries. This results in a high turnover. Career guidance is also a difficult point and the infrastructure is in dire need of renovation.

Spain invested in the capital which is needed to get the Don Bosco complex off the ground. What is missing is the workshops where the future electricians and mechanics can practice. Up to now they have had to learn the skills in the vocational school of the Salesian school in Matola, not a very efficient way of moving about. For this reason, FICA has committed itself to building two workshops in the open space next to the school buildings. Once these have been built, Father José Angel will provide the rest: “Soldering irons, jigaws, screwdrivers, from the simplest tools to computer-aided maintenance systems for buses will be available.” The future teachers can rest assured that the workplaces will be completed with everything they need. FICA is focusing on the construction of these workshops. In December 2008, the Salesians were promised € 1.8 million. In the spring of 2009, they took the first steps when the plans were submitted and the contract was awarded. If everything goes to plan, there will be two brand new workshops for future teachers on the empty site of the Don Bosco institute in Matola by the end of 2010. In addition, the Minster of Development Cooperation allocated €150,000 for FUNDEC for education. This government fund, part of PIREP, is aimed at providing small-scale courses in rural areas in the context of combating poverty. There is a shortage of trained workers in Tete and Manica, and FICA wants to spend money on a maximum of eight projects, particularly in those provinces, although not exclusively there.

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Mozambique in 1982, 1994 and 2009, three different countries A traveller walking round the town of Tete in 2009, remembering a previous visit 27 years before, cannot imagine what has happened. In the Zambeze hotel where a room has been reserved for him, he was warned, it’s the best they have, but still… and don’t count on the internet. He can’t believe what he sees. Downstairs there is a new reception and on the top storey a breakfast buffet, and with a bit of luck, a view of the bridge over the river. The South Africans, traditionally dressed in shorts, who are staying in the hotel – their accents suggest that some of them are Afrikaners – have reserved the best spots. In his large room with a corner seat and silent air conditioning, a fridge, television and DVD player, the astonished traveller discovers the cherry on the cake: a wireless (if insecure) internet connection, which has the advantage that your laptop gives you access to the sites you want immediately without any obligations. What’s going on? The warning on a sign on the street has shown me: a new hotel is being built. I can see the skeleton standing at the top of the hill and the unrestricted view over the river is bound to be fantastic. Hotel Zambeze has learnt its lesson and is taking preventive measures. Anyone who is danger of losing a monopoly must arm himself against the competition. As a result I unexpectedly find myself in a luxury situation which is certainly not shared by all foreign members of development cooperation, let alone the people of Mozambique. The stories about the daily struggle for running water which I have heard show me that I have really landed on my feet in Tete, with the best that is there. In front of the hotel there is a fleet of taxis who interpret competition as a form of armed conflict. There is plenty of choice and the one we have chosen for our first drive could have earned a good wage today, if he had given his mobile telephone number correctly on his improvised visiting card. Around the corner, on the way to the office of the provincial healthcare department, my attention is drawn by an attractive place to eat and drink. They are serving a lunch buffet on their terrace, in the afternoon. Mealie (maize), manioc and other vegetables, meat and fish – you can make your own meal from the range on offer. You pay per weight, at least if the scales are working, because the restaurant is still suffering from teething problems. Until recently this was a meeting place, and they have clearly gone for an upgrade. Behind the scenes I can hear the Brazilian accent of the new owner. During the drive from the airport to the hotel, I had noticed the brand new complex of Riversdale, the Australian mining company which has come to mine the Mozambique coal mines. Some way further on, on the way to Moatize, the piles of coal are glinting in the sunshine like slag heaps in the Borinage. The mining of black gold is more or less above ground here, a very profitable business. Australians, Brazilians, South Africans. I am surprised by the attraction of Tete. In my memory it was still the sleepy little town where nothing worked, literally nothing. I remember only too well how it was impossible to find any food or any transport, not even to the airport, which wasn’t too bad really, all things considered, because there was no airplane anyway. The drive from Tete to the Cahora Bassa Dam, the energy supplier for South Africa, which was in dire need of electricity, was carried out under military control. In April 1982, the towns had been more or less surrounded by the rebels of Renamo, which impeded supplies to such an extent that there was hardly any food for sale. I had already found this in Beira and certainly in Maputo, where you couldn’t even find a piece of bread in the Loja Franca, the dollar shop. I remember a glass of tea absolutely full of sugar on an empty terrace as the height of culinary luxury. 32 | Activity report 2008

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Nothing of this remains in Tete in 2009. The economic boom from which Mozambique has been benefiting for some years, which first became apparent in the south of the country, is gradually moving across the central, rather isolated province of Tete. It looks like a quiet provincial town, but things are starting to move. Tete will have to learn to take advantage of advantages such as the restaurants on the banks of the Zambezi, where the lowing of hippopotamuses is louder than the clinking glasses of South African Chardonnay. But 1982 has definitely been consigned to oblivion. Twelve years later in 1994 I found a completely different situation when I visited Mozambique for the second time. The country had been shot to pieces after a disastrous war which had lasted seventeen years. It was a country where production in the fields had come to a stop, and stone buildings, which had housed the dispensaries and churches, schools or mission houses, had been destroyed. It was a country without roads, where you could wreck your car without any problems; the train carriages were rusting on the tracks where they had been left after an attack had blocked the way. It was a completely impoverished country, possibly the poorest in the world. Going to Mozambique has the advantage that you end up in a completely different country every time. Maputo, which was a dead town in 1982, and completely destroyed in 1994, is brimming with activity in 2009. Traffic, shops, bars, restaurants, hotels – I can no longer find my way. To my surprise, I am staying in the same street as I was fifteen years ago. But it is unrecognisable. There are people in the streets late at night and anyone who has been in the unsafe, deadly downtown areas in South Africa can only feel relieved. Is this misleading? It’s certainty a pleasant experience, but it’s actually also very deceptive. Mozambique continues to be one of the poorest countries – the statistics do not lie. The recent UN report on human development places it in 172nd place in a world order which includes 177 countries. However, there has been progress in the last twenty-five years in a number of different fields. The Gross National Product went from $476 per inhabitant in 1980 to 337 in 1985 and 416 in 1995 – the war certainly had an effect throughout that period! – to $739 in 2006, an increase of 55% in a period of ten years, an average of 5% per year. Of course it was starting from nothing, which makes it a lot easier to rage through the economic landscape like a tiger, and the worldwide economic crisis certainly also has an influence in this country, that is something you should never forget. What about the growing gap between the rich and poor? Is Mozambique going the way of the neighbouring country and the beacon of South Africa, where the poor distribution of prosperity is gradually becoming legendary. Or are the former communists of the governing Frelimo party, which is still in control in the multiparty system which was introduced since 1994, succeeding in moderating the negative effect of globalisation? There are other positive evolutions. The level of literacy has increased from 27.1 to 43.8%, and the level of education from 31.8 to 54.8%. This is a good sign for anyone who believes in the transfer of knowledge as a lever for development in the long term, but is low enough to justifiably make education a priority in the cooperation. However, the figures on life expectancy show that there is still a great deal of work to be done. In 1980, a Mozambican could still count on reaching the age of 42.8 years when he was born, but in 2006, the message was that he will die during the course of 2048, after 42 years and slightly more than 4 months. The spectre of Aids is everywhere.

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report

Rats save lives There are rats which go for the scent in a minefield in order to trace the mines so that the people removing them can start doing their work, admittedly still manually, but with a much lower risk to life and limb. This was something that was shown in February 2009 on TV Een, in a programme called Flanders Holiday Country. The images were of Chokwe, in the Inhambane province, but FICA also funded this sort of operation in Gaza.

Apopo is the name of the mine clearance project. This initiative of Belgian and Tanzanian researchers has developed an internationally recognised method for removing anti-personnel mines. They use giant hamster rats and give them odour samples of explosives. Then the creatures really start to search for mines. For 20 minutes they examine a piece of land and detect the mines. This would easily take a person two days to do. Obviously this is a very special approach, but the most striking aspect is that more than fifteen years after the end of the civil war there are still large areas which are unsafe because of the presence of mines in the ground. In the run-up to the first democratic elections in the country in 1994, I was given a map by the UN when I travelled into the interior of Mozambique, clearly indicating which roads they had dealt with and were therefore safe to drive on. But their message was to take great care because only the road itself had been cleared of mines, not the verges, so that even if you just wanted to take a peeâ€Ś I understood, it was a question of going behind the car in the middle of the road. The mines in Inhambane and Gaza were laid by the rebels during the war which had raged in Mozambique from the mid-1970s up to 1992. In these two provinces the minefields followed the route of the railway from Zimbabwe to the coast, so that transport by train was impossible in practice, one of the many ways in which the rebels undermined Mozambique economically. Mozambique is one of the first countries to draw up an internationally recognised humanitarian minesweeping programme. Limited military minesweeping is restricted to safeguarding corridors, but in the humanitarian version, not a single mine is left in the territory. This concept is a precondition for the success of development activities. Therefore it is only logical that in choosing Mozambique as a priority partner, FICA gives full support to the Apopo project.

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The figures are appalling. At the end of 2008, there were still 10,657 km2 to be cleared. In that year a great deal of work had been carried out on clearing 155 minefields, together amounting to 1.5 km2, i.e., 386 areas to go! The efforts planned for 2009 are significantly more ambitious. The National minesweeping institute hopes to tackle about half of the remaining minefields, together almost 4 km2, slightly less than 40% of the remaining area. It is expected that in 2009 another 200 people will step on a mine in Mozambique. For this year Mozambique needs almost $9 million (approximately €7 million) in order to carry out this task successfully. One third of this comes from its own funds, the rest from donors. In June 2008 Flanders approved a new portion of €400,000 to continue minesweeping in Gaza, the lion’s share of which was paid for that year. Six of areas earmarked for this year by the National Minesweeping Institute are situated in Gaza and the Flemish rats can start work there. Ceramic poppies are on sale to help to fund the operation of Apopo. The artist Anita Huybens wrote: “For me every poppy is a symbol of an amputation and a protest against the disfigurement caused by anti-personnel mines” Nearly everyone in Flanders knows that poppies are a symbol of peace. In Flanders fields the poppies blow. The people of Flanders and Mozambique come together in times of peace knowing the atrocities which can be caused by cruel warfare.

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LOOKING BACK AND MOVING FORWARD The train which FICA put on the tracks in recent years thunders on in South Africa. There are four large programmes in the three provinces, Limpopo, KwaZulu-Natal and the Free State, each with funding for five years. €7.5 million has been allocated to every province. In Limpopo, the initiatives in commercial agriculture (agro-business) and rural tourism (agro-tourism) progressed to a satisfactory level in 2008. The two programmes in Free State, one for support for small and medium-sized enterprises and another which focuses on young people and preventing Aids, were established with the proviso that a new approach is adopted in which the Provincial Parliament also has a say. FICA has allocated €3,750,000 for each of these two programmes. In KwaZulu-Natal, where the emphasis is on food security, there has been an acceleration in the programme. In order to diminish the increasing scarcity of food, the province has funded large-scale investments, a unit for food security was established in the Agriculture Department, and the cooperation with councils has been intensified. It was also the year to start looking back. In fact, in 2009, Flanders and South Africa have been engaged in cooperation together for fifteen years. In response to this, the journalist Annemie Struyf and the photographer Lieve Blancquaert produced a book on the preceding years “Iemand. Gepakt door Zuid Afrika” (Someone. Touched by South Africa) at the end of 2008. It was published by Lannoo and has been available in bookshops since the beginning of March 2009. Blancquaert and Struyf travelled through the three provinces where FICA is active and made a series of portraits. They were looking for simple things, which may be selfevident for some, but are unachievable for others: a house, a bed, water, food, health, and respect.

36 | Activity report 2008

All the things which make someone instead of no one. In South Africa there are also a number of older projects which date from the early period. They relate to HIV/Aids, nursery education, sustain-

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able management of nature, domestic violence and housing. AGRICULTURE AND TOURISM GO HAND IN HAND IN LIMPOPO The aim of the provincial government in Limpopo is to take farmers out of survival farming and give them a place in the commercial circuit. This is done by preparing them for market-oriented activities by means of training and re-dividing the land. For this purpose, two agricultural colleges were converted into training centres, one in the south and one in the north of the province. In recent years there have been an additional 40,000 new landowners in Limpopo. It is mainly the women who work on the land; 85% of the farmers are female.

These new female farmers can add to their knowledge with courses at Tompi Seleka College on the Arabie dam on the Olifant river and Madzivhandela. There they learn how to run their business and commercialise their harvest. Extension workers support them to do this successfully and are welcome at the two colleges. The ultimate aim is to ensure that many of the families in Limpopo achieve a higher standard of life. Two of the former homelands are integrated in the province, Lebowa and Venda, one of the poorest parts of South Africa. FICA supports the work of Tompi Seleka and Madzivhandela. In 2008 they organized 42 courses there on a diverse range of subjects, such as the operation and maintenance of agricultural machinery, bookkeeping and processing products. More than 2,500 new farmers followed courses there.

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Ex-Change, the platform for sending out experts, with which FICA concluded an agreement (see the chapter on “Sustainable Enterprise”), carried out an audit at the two institutes and gave advice on their management and the programme for the farmers receiving training.

students and older pupils. It is aimed at giving them an idea of how their parents and ancestors lived in rural South Africa, what they ate, how they survived in dire circumstances and what the environment was like then, close to nature and wild animals.

A second part of the FICA operation in Limpopo is the support for the tourist project in Hamakuya. This was also a choice of the provincial government. The camp is idyllically located on the edge of the Kruger Park, surrounded by baobabs, in a relatively isolated area not very far from the border with Zimbabwe, and has a view over the river. Baboons and antelopes, crocodiles, and from time to time a giraffe that has got lost, live together in this earthly paradise.

The young people can also book a stay in a Venda community. This means that they stay in a traditional environment for one or more days. In February 2009, there was a report in the programme on TV, Flanders Holiday Land, showing how young South Africans find out that they have to sleep on the floor, wash themselves in a zinc tub and are given the same food to eat every day. At the end of her stay, one of the eight pupils said: “Don’t go shopping in a mall when you go to South Africa, go to one of these places because then you will find out how people live here.”

With the encouragement of scientists from the Witwatersrand University in Johannesburg, a formula for sustainable tourism was put into practice in Hamakuya. The project focuses on

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The provincial government is trying to link the promotion of agro-industry to its efforts with re-

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gard to educational tourism. It is drawing up a tourist route and linking up the agricultural businesses to hotels and guest houses which provide bed & breakfast. The fruit and vegetables grown by the new farmers in their fields are sold to the tourist sector and this is what also happens in Hamakuya. In this way the two aspects come together. The tradesmen who learned their trade while the camp was being built also continue their business. They make tables, chairs and garden furniture and build modern toilets. The women sew clothes, both the traditional clothes and modern versions. At the moment, Hamakuya is breaking even and the local communities to which the camp is linked have an income, which they did not have in the past. The representative of FICA in Pretoria, Christel Op de Beeck explains: “This relatively small project provides work for 30 people, i.e., 30 families now have a better life. The impact may be small but it makes a world of difference. Tourism is the second industry in the province of Limpopo, and Hamakuya serves as a blueprint for what the Department of Agriculture and the Department of Tourism can achieve together.” For Limpopo the model that was tested in Hamakuya is a starting point for other initiatives. Two years after the start, the two parts of the FICA programme in Limpopo, commercial agriculture and sustainable tourism, are ready for an evaluation. It wants to learn lessons from this for the next three years of the project. ENTERPRISE AND AIDS IN FREE STATE In Free State the provincial government has opted to work on two topics together with FICA. There are incentives for SMEs allocated by SEDA, the Small Enterprises Development Agency, supported by the South African government. FICA cooperates with SEDA and concentrates on practical training, which ranges from providing

teaching materials to bookkeeping courses and the use of micro credits, with supervision afterwards. Nowadays SEDA also focuses on some new aspects, such as the coordination of the training, a mentorship focus on employees and aftercare on the work floor. The second programme is related to combating HIV/Aids. In South Africa Aids is the number one cause of death. According to the latest UNAIDS figures, 4.6 million adults in South Africa are carriers of the HIV virus, viz. 18.1% of the population. The epidemic is stabilising according to the report, but at an unacceptably high level. Free State is one of the most affected provinces. Combating Aids is concentrated in Xhariep, a poor district in the south, where the unemployment figures are very high. FICA supports the Youth Community Welfare Programme there, which aims to give young people a stronger starting position by helping them to find work. FOOD SECURITY IS A BROAD CONCEPT IN KWAZULUNATAL The programme in KwaZulu-Natal is called Empowerment for Food Security. It started on 1 April 2006. This food security programme not only concerns the cultivation, but also the processing of products, and is concerned with the state of health of the people, as well as dealing with the social and cultural aspects of food. Empowerment for Food Security attracts particular attention from the provincial government. In addition to the sum of €7.5 million which FICA has reserved for the programme for a period of five years, it has allocated €3,350,000 itself. The most important partner in KwaZulu-Natal is the Department of Agriculture and the Environment, but FICA also cooperates with other departments and town councils. Empowerment for Food Security covers eight of the 51 municipalities in KwaZulu-Natal, spread over four districts. In those communities it is the local committees which formulate the proposActivity report 2008 | 39

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als for concrete projects to improve food security. In 2008 more than 80 of these were carried out. They range from planting vegetable gardens which are managed jointly by a few families, to rearing chickens and the construction of hospital and school gardens. Others are concerned with water, fencing, the distribution of seed and the training of local authorities with a view to sustainable investments in agriculture. 25 provincial agricultural consultants followed training on food security, and more than a thousand schoolchildren were informed about the importance of a healthy diet. For example, in some centres they organize training for grandmothers on market days or when they are paid their pensions or child allowance.

Africa are given funds by the government to give the pupils a meal. In this way more than seven million children have their only meal of the day at school. Usually the school buys one-sided and nutritionally limited foods for preparing these meals such as mealie (maize) supplemented with preserved fish. With the development of school gardens, Empowerment for Food Security is trying to improve the quality of the food and introduce more variety. To do this it is investing in water supplies, fencing and preparing the ground for suitable crops. The project on the social economy focuses on these school gardens. It is creating jobs: 60 people are starting work in the 30 test schools. They have to increase the production in the gardens and diversify in order to prepare good quality meals in the school kitchens. Their training and salaries are paid from the budget which the government makes available for the food for the pupils. In the long term, a school can sell any extra produce from its garden to crèches or hospitals, so that the employment has a sustainable character. €250,000 from Flanders is activating €3 million in this way from KwaZulu-Natal, and in addition, the food security programme is providing “the Department of Provincial and Local Government” with a practical model of what we call the social economy. Ex-Change has also played a part in KwaZuluNatal. It advised the Department of Agriculture and the Environment on its policy with regard to personnel, finance and planning. This department provides services for more than 10 million citizens in the province, focusing on land reform, animal husbandry, fishing, the management of flora and fauna, disease control, waste management and environmental planning and education.

In cooperation with the Flemish Department for Work and Social Economy, FICA set up a project in KwaZulu-Natal in 2008 to promote the social economy. How does this work? Schools in South 40 | Activity report 2008

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MALAWI

UP TO SPEED 2008 was a crucial year for the cooperation between Malawi and Flanders. The first results of the joint programme with the FAO, the Food and Agriculture Organisation of the UN, become visible. The final preparations to get the cooperation with Malawi up and running, were undertaken as well. On 7 November the Flemish Government ratified the country strategy paper of June. This builds on the Memorandum of Understanding, the agreement with which Flanders and Malawi initially officialised their partnership at the end of November 2006. The strategy memorandum indicates how this cooperation will take place. Flanders will make €5 million available for five years to combat poverty and promote sustainable development. The joint plan focusing on training agricultural extension officers was drawn up in October 2008. The budget of €4.5 million were allocated and the programme was discussed with the Malawi partners. Everything was ready to start in April 2009, and this objective was achieved. Agreements have also been concluded for a smaller programme concentrating on irrigation, for which €300,000 was made available. In February, on the 12th, the FICA office was officially opened in Lilongwe, but Katrien de Pauw, who represents FICA in Malawi, had already been working there since September 2008. A few months later the FICA office was reinforced by another employee, Nathan Khuthe (see photograph). The fact that there is now someone permanently on site has certainly benefited the expansion of the programme. The local representative contributes to one of the aims of the Paris Declaration: better coordination between the donors is now significantly easier to achieve in practice. FICA participates in the monthly discussions without any difficulty.

IMPROVING CATTLE FARMING THROUGH BETTER KNOWLEDGE The government is aware that there is a huge lack of agricultural extension officers. These are the veterinary officers and other specialists who support farmers to increase their knowledge. There is a large shortage in number and there is an urgent need to update their expertise. The government only employs seven veterinarians, who all obtained their degree abroad. In the 1980s there were more than 3,000 of these extension workers, but since that time their number has fallen to less than half. This means that every person providing information has to train and raise the awareness of about 1,300 farmers. One for every 750 would be the ideal ratio. Furthermore, most of these people were trained more than ten years ago and have barely had any refresher courses since then. Consequently the effect of their work in agriculture is much less than you would expect. This is very noticeable in cattle farming. 85% of cattle farmers do not carry out any commercial activities. For many of them, cows are there to be slaughtered when there is not enough food left to eat. The government wants more cattle farmers to produce for the market and to see a higher productivity in the sector, in order to increase the

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incomes of farming families increase. For this reason, the training of extension officers for the cattle vets has been identified as one of the priorities. Flanders supports the approach of the Malawi government and has adopted a two-track policy in this respect. FICA is focusing its efforts on three agricultural colleges which will train the extension workersand is funding in-service courses for those who have already been working for many years. The three colleges are the Mikolongwe Veterinary College, the Natural Resources College and the Bunda College of Agriculture. All three are part of the University of Malawi. Bunda, which gives a degree to its students after four years, received a subsidy from Flanders in 2007 to examine the issue of extension services. The findings helped to draw up the programme that is being set up now. Bunda would like to work, above all, on the efficient use of resources, capital and land, and in this way, find solutions which are closely related to the needs of the farmers. The Natural Resources College extension officers after a course of two years. It was only in 2005, after closing down for many years, that this course started again. The first students graduated in 2008. However, the NRC does not have enough an good material in the laboratory, so it is hardly possible to carry out experiments. In some fields there are no specialist lecturers. In 2007, FICA supported NRC to renovate the laboratory. The college is hoping to bring its farm up to standard, so that the quality of the courses provided improves. Mikolongwe Vetinary College trains assistants for cattle vets, but stopped doing so for a long time. The college only started again in 2006. It is run by the Department of Animal Health and Livestock and closely cooperates with the NRC for the practical lessons, because it has the animals and facilities which the NRC does not have. Mikolongwe specialises in artificial insemination and provides in-service training for farmers and 42 | Activity report 2008

NGOs in this. Artificial insemination should help to drive up the milk yield, because the current supply cannot keep up with the demand for milk. The only installation for liquid nitrogen in Malawi is situated in Mikolongwe. This is necessary to store the bullâ€™s sperm, but is by no means enough to provide the whole country. That is why it is necessary to build a second factory so that sperm can be provided to the north and centre of Malawi. The services of Mikolongwe to cattle farmers should be improved in any case. FICA calls upon an NGO with experience in the field and two departments, the Department of Animal Welfare and the Department of Agricultural Extension Services, to provide in-service training for extension officers who have been working with farmers for years. The latter is responsible for the coordination of the programme. The employees can follow a course in Bunda. The NGO, Small Scale Livestock Promotion Programme, concentrates on cattle farming and milk production. It instructs extension workers about the way in which projects can be taken to local farmers, as it has a great deal of experience of this. Its personnel can also go to Bunda for additional courses. SSLPP is also continuing the work which FICA started in recent years in Kasungu and Mzimba. In order to avoid a fragmented approach, it was again decided to opt for these two districts.

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The programme which started in April 2009 to provide more and better training for the people providing information on cattle farming will run for four years. The funding for this programme, which is €4,491,939, is divided as follows.

Bunda College of Agriculture

1.359.143 €

Natural Resources College

695.700 €

Mikolongwe Veterinary College/ Department of Animal Health and Livestock

989.200 €

Department of Agricultural Extension Services

752.990 €

SSLPP

694.906 €

EFFORTS FOR FOOD SECURITY FICA is financing the FAO programme in the districts of Kasungu and Mzimba, focusing on the precarious food situation of small farmers. Too much dependence on maize there resulted in a one-sided diet, and in the case of a poor harvest, in direct malnutrition. The number one objective of the Malawi government is to ensure better and higher food production. It would also like to make agriculture a much more commercial matter than is the case at the moment and so that producers are no longer just farming to survive. Small-scale farming now provides 80% of the food. There is every reason to turn food security into a priority. Since the turn of the century, Malawi has experienced two periods of serious drought. In 2002 this resulted in the greatest starvation for fifty years and three years later another five million Malawians, 40% of the population, were dependent on food aid, two million more than in 2002. Many families ate only once a day, or not at all.

In the following years the harvest of maize, the most important crop, was high because of the government fertilizer subsidy for and improved seeds. Extra money is also allocated to poor farmers and vulnerable groups such as widowers HIV infected persons. Malawi succeeded in providing its own food needs and was even able to export, amongst other things, to the neighbouring country of Zimbabwe, which was affected by an unparalled crisis. In November 2008, President Bingu wa Mutharika received the Agricola Award from the FAO, a prestigious agricultural prize, for the revolution which he brought about in Malawi, from being a food aid recipient to an exporter of cereals in a very short space of time. However, appearances can be deceptive and the balance is fragile. Several causes could lead to big disappointments each year, such as poor rainfall and cattle diseases. The high mortality rate among the population can cause severe setbacks as well, given the fact that 8 out of 10 Malawians are active in agriculture. Malawi comes in 164th place out of 177 on the UN list of human development. Life expectancy is slightly over 40. Half of the children aged four or younger are stunting, meaning that they have low height for their age and which is caused by long term insufficient nutrient intake. More than 55% of the population survives on less than $1 per day. For all these reasons, the government is making every effort in achieving the Millennium Development goal to halve poverty by 2015. For this purpose, it has published a policy document, the Malawi Development and Growth Strategy, which gives priority to five focus areas. Sustainable economic growth is one of these. In this context, agriculture and food security are given top priority. For this reason, FICA decided to support the approach of the FAO ever the start of the cooperation with Malawi; 80% of the budget which is allocated to food security is spent in the field. The involvement of small farmers and groups of Activity report 2008 | 43

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MALAWI

working on the development of this Agricultural Development Programme. It is comparable to the SWAp (sector-wide approach) for healthcare in Mozambique. IRRIGATION

farmers has a central place. During the last sowing seasons, they started to use fallow ground in Kasungu and Mzimba by fertilising it and by using better seed. The farmers are now growing food on many more fields than in the past. Micro projects are supported, such as the cultivation of mushrooms and the use of foot pumps for small-scale irrigation, with a view to increasing and diversifying production. On farmer field days, the villagers demonstrate what they have achieved to their neighbours. FICA funds this, and in coordination with the Government of Malawi, the FAO has appointed a programme manager, a coordinator for every district and an irrigation specialist. At the request of the Malawi government, Flanders is also funding a policy advisor for three years. Approximately 15% of the budget which is allocated to food security goes to this form of policy support. The expert has been working since June 2008 and reports directly to the president. Her task is to underline the importance of diet and incorporate this in the whole policy, particularly of the Department of Agriculture, but also of other departments. A few months after her appointment she succeeded in giving the aspect of food a more explicit place in the policy plan for culture than was originally the case. All the interested parties and the donors have been 44 | Activity report 2008

Irrigation is a specific part of the strategy with regard to agriculture and food security. Malawi would like revitalize old and undervalued irrigation schemes. FICA is supporting this project and is tackling three areas in Nkhotakota, together covering 55 hectares. By means of irrigation, farmers can cultivate crops all year round and are no longer dependent on the rain. Furthermore, they can then also grow cash crops and vegetables in addition to the traditional maize. All these elements have a positive influence on food security, as the worst famine occurs exactly during the periods between the two harvests. FICA sees Nkhotakota as a test. During these activities it is a matter of measuring the effects on the environment and on the families before more support is provided in the next stage. Funds have been provided to examine and analyse the environmental effects. Another aspect which is given special attention in Nkhotakota is that farmers run the project themselves, manage the water and draw up the accounts. They are given training to do this. Money is also provided for this institutional aspect. In short, at the end of the test stage, more should have been achieved than only the construction of pumps and the installation of a system of pipelines. The trial project which takes up the thread of the irrigation in Nkhotakota will end at the end of 2009. The budget is divided as follows.

Irrigation infrastructure

110.000 â‚Ź

Institutional development of farm- 153.000 â‚Ź ers and communities

Activities in the South

MALAWI

Environmental impact report

17.000 €

Management, administration, 20.000 € monitoring and evaluation

the Catholic University of Leuven promotes initiatives in forestry such as the planting of fruit trees, combating erosion and fixing nitrogen to make the soil more fertile. AIDS

SUPPLY OF DRINKING WATER In Malawi there is a lack of good drinking water. On average, only half of the population of Malawi has access to this with the use of a water pump or another system. The aim is to increase this to 80% and to ensure that all schools and health centres are guaranteed drinkable water. At the end of 2008, FICA contributed €632,000 to the UNICEFWASH programme which stands for Water, Sanitary and Hygiene Education.

From the start of the cooperation in 2006, the Flemish Government has worked on Aids in Malawi. In October of that year it was agreed that Flanders would contribute € 3 million to UNAIDS for the period up to 2010. 2 million was made available immediately, half of which was aimed at drawing up a national plan for Malawi which should eliminate the vulnerable role of women and young girls. In fact, it is aimed at coming up with a strategy which will reconcile Aids prevention with traditional customs which are diametrically opposed to this, such as the tradition on a widow moving in with the brother of her deceased husband. The second million was allocated to prevention and the rights of the child in the region, particularly in the countries which are part of the regional Southern African Development Community, the SADC. At the end of 2008, Flanders made the remaining sum of €1 million available for the period 20082010. Once again these means were allocated to be used in Southern Africa via SADC, for women and girls, young people, children and vulnerable target groups in emergency situations. The actions which UNAIDS supports with this and in which countries depends on the needs. With the publication of this report, three instalments of €250,000 were carried out with regard to the sums for 2006, and half of the million for 2008 was transferred to the UNAIDS account.

FORESTRY FICA allocated a subsidy of €181.064 to the Catholic University of Leuven. Together with the ICRAF, the acronym for the World Agroforestry Centre,

According to the last report of UNAIDS, 780,000 people in Malawi are infected with the HIV virus, 11.9% of the adult population. In 2001, the prevalence was 13.3%. The report notes that the Aids epidemic has stabilised in Malawi and that there are indications of positive changes in behaviour. Activity report 2008 | 45

Activities in the South

SUSTAINABLE TRADE

SUSTAINABLE TRADE EX-CHANGE

chapter on South Africa, Ex-Change has examined projects which were supported by FICA in Limpopo and KwaZulu-Natal. MICRO CREDITS

In 2008 Ex-Change carried out 140 interventions in developing countries in Africa, Latin America and Asia. Ex-Change is a platform for sending out business leaders and other experts. At the request of companies in the South the association sends them on a voluntary and temporary basis for tasks which are particularly aimed at identifying problems and trying to resolve them in what we describe as smaller and medium-sized enterprises. FICA agreed with Ex-Change that 30% of its missions will take place in the three partner countries. It has been fairly successful is keeping to this agreement. 46 missions, one third of the total number were carried out in South Africa, Malawi or Mozambique, respectively representing 25, 14 and 7 of the tasks. In South Africa Ex-Change is active in Free State, amongst other places, where it cooperates with the Small Enterprise Development Agency, which works on the same lines as FICA. This means that Ex-Change has been able to work together with partners of FICA. In the province of Limpopo it worked on the production capacity of a tea plantation which was taken over from a private company by the department of agriculture. As indicated in the 46 | Activity report 2008

In 2008, the Guarantee Fund for Micro Funding approved three applications to provide guarantees, two of which were for Incofin and one for Alterfin. These two Flemish development funds received recognition, which means that they can submit proposals to FICA. Their aim is to support micro funding institutes in the South, with the risk management of their transactions. Alterfin and Incofin provide these micro funding institutes with capital to loan to small entrepreneurs. They cannot borrow this money at normal rates to an adequate degree in their own country. Incofin received a guarantee for a loan to Marang Financial Services. This micro funding institute is active in five provinces in South Africa, including KwaZulu-Natal and Limpopo, two of the three on which FICA focuses. Marang Financial Services mainly concentrates on women in rural areas. The second and most recent dossier which was approved by Incofin is the guarantee for the micro funding institute ACME in Haiti. Haiti is one of the poorest countries in the world. ACME particularly

Activities in the South

SUSTAINABLE TRADE

works with SMEs in the informal sector and with vulnerable groups, such as people infected with HIV Aids. Alterfin also received a guarantee for the Moroccan Micro funding institute, INMAA.

coordinators started work in each of the three countries after being trained in Flanders. Secondly, the help desk would like to support matchmaking, i.e., by channelling the demand of the three countries for sales outlets for their products and services, and by finding suitable partners in Flanders or Europe.

GONORTH The improvement of the export possibilities, the knowledge of supply and demand, the communication, the exchange of technical business matters and other experience, the creation of higher added value, own production possibilities and working with target group analyses are still in the pipeline for a later stage. There is also a plan for conferences in Flanders and the three target countries.

UNIZO International established the Import Flanders help desk with the name “GoNorth”. The Flemish Government would like to help companies from the partner countries, Malawi, Mozambique and South Africa, to gain access to the Flemish and European market. The help desk particularly devotes attention to local SMEs, because they are responsible for providing stable employment and sustainable welfare. A subsidy of €300,000 was allocated in 2008, as it was in the starting year 2007. In this way, GoNorth continued on the path it had taken. In the first place, it would like to establish a network of contacts in the three countries, where entrepreneurs can go with their questions about legislation on trade, etc. A team of specialists is trained to supervise companies with regard to exports for Europe and preparations for this, for each country and in South Africa for each province. GoNorth provided the expertise for this. Unizo appointed a Flemish coordinator and local

Networking, training, transfer of experience and know-how, contacts between African and Flemish entrepreneurs, encouraging businesses with regard to this concept and publicising their activities is what GoNorth is all about. For this purpose it uses its website www.helpdeskgonorth.eu and regularly organizes events, contact days and meetings on doing business. SOCIALLY RESPONSIBLE ENTERPRISE In 2008, FICA funded the International Consortium for Sustainable Enterprise (Cido). Cido aims to establish a Flemish knowledge centre and network on international enterprise that is relevant for development, without losing sight of the ethical, sustainable and intercultural aspects of the matter, but with the emphasis on the first two aspects. There is special attention for the cooperation between the public and the private sector and initiatives in which several interested organizations are involved. Partners in Cido include Kauri, the knowledge centre and network for sustainable, honest and transparent business practices, of which FICA is a member, Voka Chamber of Commerce in HalleVilvoorde, the Centre for Global Governance Activity report 2008 | 47

Activities in the South

SUSTAINABLE TRADE

Studies at the Catholic University of Leuven, the European Centre for Development Policy Management in Maastricht and CIMIC, the Centre for Intercultural Management and International Communication in Mechelen. The focus of the consortium is to place the know-how with regard to intercultural management which affiliated associations have in house, on the agenda of the companies. How do you prepare for new activities in South Africa or India? What attitude do you take to the presence of foreign managers? These are questions which increasingly present themselves in companies as a result of globalisation, and to which the exact answer is not always available in house. Cido would like to provide these answers. How does the consortium tackle this? In the first place by making an inventory of the sustainable business initiatives in Flanders. Examples of this are Max Havelaar for coffee, the Clean Clothes Campaign and the Kimberley process in the diamond sector. Cido would also like to make tailor-made information available for companies on digital cards. 27 of these have been prepared on a wide range of issues. They range from the millennium goals, the directives of the OECD, initiatives in enterprise on sustainable trade and development cooperation, intercultural management, micro funding, human rights, Fairtrade Labelling Organisations International, the umbrella organization of national organizations and producer networks, the World Fair Trade Organization which groups producers, traders, networks and labels for fairtrade from 70 countries. Cido constantly updates both the cards and the inventory. At the end of the line it should be possible to consult them on wikipedia. The preparations for this have been made. Finally, Cido would like to organize information sessions and network activities, and bring experts together for meetings on particular themes, as happened in Mechelen in October 2008 on intercultural management. 48 | Activity report 2008

The International Consortium for Sustainable Enterprise used the subsidy from FICA for the startup stage. FICA funded â‚Ź78,650 of the â‚Ź113,100 cost price. It is now up to the organizers to continue the work in working groups in order to introduce their ideas in the business world. ITC: SUPPLY CHAIN AND LOGISTICS DEVELOPMENT PROGRAMME FICA supports the Supply Chain and Logistics Development Programme, which aims to strength-

en the supply chain and logistics services in eight countries of the Southern African Development Community (SADC). By providing easier access to the world market for small agricultural businesses in this way, the programme aims to combat poverty and stimulate trade. The first three countries where this is being introduced are Malawi, Mozambique and South Africa. Specific measures taking into account the policy priorities and the needs of the countries are introduced for all three.

Activities in the South

SUSTAINABLE TRADE

The International Trade Centre drew up the programme. This took place in the context of the international trade policy Aid for Trade, and the EU approach to substantially increase the support for trade. ITC is a cooperative ventures of UNCTAD and the World Trade Organisation (WTO), which focuses on developing industry. By creating a better framework for small and micro companies, ITC concentrates on finding regional and international sales outlets for their fresh fruit and vegetables. The biggest problem in all this is actually the international sales norms. Even if favourable trade agreements are concluded, e.g., with the EU, this is not to the advantage of the poor communities in the SADC. For them it is impossible to comply with all the product and market conditions. SUSTAINABLE TRADE: 4C The first project with coffee farmers in the province of Santander in Colombia provided a testcase for a code of conduct with economic, social and environmental norms for the production and trade of coffee. This proved to be so successful that a second project was started. The code is known as 4C, the Common Code for the Coffee Community. FICA, a co-founder of the association which established 4C and the Federaciรณn Nacional de Cafeteros de Colombia, one of the largest federations of coffee farmers in the world, have chosen the province of Antiochia this time. This project was successfully concluded in November 2008.

project has had a big impact in the field in Antiochia where coffee is grown. The whole economy has been boosted, the environment and biodiversity have benefited and the farmers have learned how to manage their businesses better. In 2008 a third project was started with 4C. For this project ISEAL, International Social and Environmental Accreditation and Labelling Alliance, developed a benchmarking procedure for 4C. ISEAL has the leading labels for fair and ethical trade as members. With this assessment procedure, ISEAL hopes to draw up a set of norms in order to determine how 4C complements other, more specialised codes. This gives coffee farmers worldwide an opportunity to gain access to more demanding sustainability labels better and faster. For this third project, Rainforest Alliance drew up the norms. In this way, the businesses can market as 4C coffee all their coffee which they cannot sell under that label, even if it has been accredited. In 2009, FICA will continue to expand the concept. 4C is gradually finding its way into other regions, also in poorer areas. For example, there are exploratory discussions taking place to introduce 4C in Malawi.

The aim was to get the coffee farmers who are engaged in obtaining the certification of a label such as Fairtrade, Rainforest Alliance or Utz Certified to join the 4C system. They are all trained to start using the process of certification and 4C verification. With the introduction of sustainable production methods, the three hundred families involved have improved the quality of their coffee and their competitive capacity. This means that their standard of life has improved and they have a greater chance of certification with a label. The Activity report 2008 | 49

Activities in the South

HUMANITARIAN AID

HUMANITARIAN AID In 2008, FICA provided €2,009,000 of emergency aid, 8% more than the previous year. With this budget, six organizations were subsidised, together for 13 projects. As in 2007, the lion’s share of the humanitarian aid, 80%, went to Africa. On average, €154,538 was spent per project, an increase of more than 15% compared with 2007 when the average was €133,000. In Mozambique, one of the three partner countries, FICA assisted with various emergencies, in some cases indirectly. For example, in 2008 it again subsidised the Apopo mine clearance project. This was also the case in previous years, but the action of Studio Brussels, Music for Life which focused on the issue of anti-personnel mines, certainly contributed to mine clearance becoming eligible for further support from the budget for emergency aid as a matter of course. Apopo is the largest item on the budget and a fifth of the emergency aid goes to that project. More information on the mine clearance project can be found in the chapter on Mozambique. The next action of Music for Life in the following year, 2007, which focused on the issue of drinking water, led to tangible results in Mozambique. In order to help the victims of the flooding, Red Cross Flanders was allocated a subsidy with which it funded the distribution of jerry cans and water purification bags. In other countries in Southern Africa which had been hit by flooding, the Red Cross also used this budget to set up an identical emergency action. A significant sum of humanitarian aid went to Congo. A quarter of the emergency aid served to help the population suffering in conflict areas. Some of these subsidies were channelled there via the Flanders Red Cross. In Kivu in the east, this provided aid for victims of sexual violence, as well as psycho-social and economic violence. 50 | Activity report 2008

A process of awareness raising for the local authorities and the communities where the victims belong are also part of their approach. In Goma, in South Kivu, two projects were subsidised relating to the fighting which broke out in that city in the autumn of 2008, both based on the concern to guarantee food security for the population. UNICEF Belgium distributes food packages, including high-energy biscuits. It also works there in health centres. Caritas International distributes seeds and agricultural equipment in order to encourage people in the region to take on the responsibility for producing food themselves. When Madagascar was hit by two successive cyclones, Ivan and Fame, UNICEF organized an intervention there. It started with the purification of wells, the distribution of water filters, and the distribution of medicines for diseases related to the use of impure water. After Indlala in 2007, for which Madagascar had also received emergency aid, more cyclones undermined the development. In Kenya, the UN High Commissioner for Refugees provided relief when riots broke out after the elections and the inhabitants of the slums around the capital of Nairobi were driven out of their homes. The UNHCR provided them with housing kits and they were temporarily accommodated in secure camps. Ethiopia has been confronted with three successive failed harvests. The farmers were not able to plough and plant in time, first as a result of flooding, and then because of a lack of rain. The poor food situation resulting from this led to serious malnutrition and an increase in infant mortality. In that country, Caritas is focusing on young children and pregnant and breastfeeding mothers.

Activities in the South

HUMANITARIAN AID

There are several reasons for the food shortages in Zimbabwe: the political crisis, changing weather conditions and the Aids epidemic, which is removing the most able bodied people from farmingâ€Ś In response to this, Flanders Red Cross has taken on the distribution of maize flour, oil, beans and corn soy blend, an enriched mixture of wheat and maize. Outside Africa, emergency aid was also sent to South East Asia. In Bangladesh, world solidarity focused on the irrigation of agricultural land and the diversification of cultivation. In fact, some of the population was threatened by starvation after the cyclone Sidr raged over the country at the end of 2007. In order to meet the needs of these victims a subsidy had also been provided in 2007. Cyclones are a constantly recurring destructive phenomenon.

had been destroyed to repair their houses so that they could move back in before the winter. Because of the fighting in South Ossetia, which was trying to break away in the summer of 2008, many people had been drive out of their homes.

Itâ€™s the same in Myanmar. A great deal of attention was focused there on the damage caused in 2008 by another cyclone, Nargis. Unicef created child-friendly zones there, where it looked after and protected children left on their own with no one looking after them. It identified and registered them, and tried to reunite them with their families. There was also an urgent need for medical care. The University of Antwerp set up the project Help Myanmar there. Finally, emergency aid was also given to Georgia. The UNHCR helped people whose homes Activity report 2008 | 51

Activities in the South

HUMANITARIAN AID

Organization

Country

Project

Amount

APOPO

Mozambique

Mozambique Mine gramme 2008

Pro-

€ 400,000

Red Cross – Flanders International

Southern Africa

Emergency aid for the victims of the floods in Southern Africa

€ 150,000

Red Cross – Flanders International

Democratic Republic of Protection for the victims of sexual Congo violence

€ 300,000

Unicef Belgium

Democratic Republic of Support for the health and food secCongo tor for the victims of the humanitarian crisis in East Congo

Action

€ 100,000

Caritas International

Democratic Republic of Stimulating self-sufficiency for disCongo placed families in North Kivu

€ 100,000

Caritas International

Ethiopia

Food programme for children, pregnant and breastfeeding women

€ 150,000

Red Cross – Flanders International

Zimbabwe

Food insecurity in Zimbabwe

€ 108,955

Unicef Belgium

Madagascar

Support for the health sector for the victims of the Ivan and Fame cyclones

€ 150,000

UNHCR

Kenya

Emergency aid for the refugees in Kenya

€ 150,000

Unicef Belgium

Myanmar

Direct protection of children affected by the cyclone Nargis

€ 100,045

University of Antwerp

Myanmar

Medical emergency team led by Dr. Beaufourt

€ 50,000

World Solidarity

Bangladesh

Emergency aid for the victims of the Sidr cyclone

€ 150,000

UNHCR

Georgia

Emergency aid for people who lost their homes

€ 100,000

52 | Activity report 2008

Activities in the South

HUMANITARIAN AID

The money is usually spent on emergency aid via Flemish organizations with experience in the field. The cooperation with UN organizations such as Unicef and the UNHCR also uses a significant portion of the budget, viz. 30%.

Activity report 2008 | 53

Activities in the North

ACTIVITIES IN THE NORTH

54 | Activity report 2008

Activities in the North

FOURTH PILLAR

FOURTH PILLAR De website www.4depijler.be is the new meeting point for anybody in Flanders involved in undertaking development cooperation initiatives, apart from the government, international organisations and NGOs, which are acknowledged as being the first, second and third pillars respectively of the development effort in Flanders. The fourth pillar is the collective term for the partnerships concluded with countries of the southern hemisphere by youth associations, companies, institutions, trade unions, health funds and friendship groups. They often undertake these initiatives in addition to their own tasks but they do indeed take this step.

Bringing together all these initiatives, the www.4depijler.be website operates as a gateway. The site provides an opportunity for all kinds of organisations to encounter and learn from each other. Information-gathering, swapping ideas, sharing knowledge, asking questions and providing tips, placing a wanted add â€“ the list goes on and on. Within a short period of time over 150 organisations have registered with the site, unveiling themselves to a large public. From a Risting Star, a non-profit-making body from Emblem, providing educational and medical services in Gambia, to ZuidDag, a project established in Brussels, seeking to raise awareness among the business community and schools about the North-South issue.

Activity report 2008 | 55

Activities in the North

FOURTH PILLAR

A new network is being developed here, now involving between 25,000 and 60,000 committed volunteers. Together they raise between â‚Ź47 and 68 million every year. Activities in the North The idea dates back to a conference FICA staged in May 2007 to consider the theme of the 4th pillar, on the basis of exploratory research the Higher Institute for Labour Studies (HIVA) undertook in 2006. The site came on-line on October 2008, one and half years after the meeting. The Flemish Minister-President, Kris Peeters, officially inaugurated the site on 2 December by saying: â€œOur aspirations and expectations are extremely high, not only for Flanders but also for the momentum of the development cooperation process, building upon the solid international policy Flanders has been conducting since1993â€?. www.4depijler.be first of all offers material support to all who are actively involved in the NorthSouth issue. They are offered tailor-made training in cooperation with 11.11.11, a coalition of the North-South movement, which, together with FICA, seeks to make the project a source of support for the 4th pillar. Professionalisation is the operative word. Financial support is deliberately eschewed owing to the concern that the government is anxious to avoid imposing any obligations on the 4th pillar. The website is the first step towards what is set to develop into a fully-fledged helpdesk. Anyone is entitled to send questions to the support centre supervisors, who will immediately set about catering for the request for information. A newsletter is published every month to keep everyone up-to-date with developments. The support centre also organises opportunities to meet for initiators and those who are the inspiration behind all these initiatives, while promoting a dialogue and cooperation with municipalities, provinces and NGOs. Lastly, the support centre 56 | Activity report 2008

is keen to prepare for social and political developments on the development cooperation front, and more particularly in the case of the 4th pillar. HIVA proceeded in the autumn of 2008 to initiate a second research programme focused on the 4th pillar. The idea was not only to delve more deeply into the findings of the previous research work but also to plug the existing knowledge gaps. FICA aspires to find answers to questions such as how extensive the 4th pillar is and who is involved, what sectors are the staff and volunteers focusing on and how many of them are there, what type of projects they are conducting, how cooperation with the South is facilitated and where do they secure their financial resources? HIVA is trying to discover whether it can establish a typology for 4th pillar initiatives and what opportunities and requirements are available to them in terms of support and professionalisation. The study findings will be published in the spring of 2009

Activities in the North

SUSTAINABLE CONSUMPTION

SUSTAINABLE CONSUMPTION FAIR TRADE WEEK In what is gradually becoming a tradition, Flemish civil servants are offered a fair trade restaurant meal once a year. The date in 2008 was 9 October and on that day FICA provided a variety of fair trade products for information stands in all the premises belonging to the Authorities of Flanders. The information stands in premises located in Brussels were manned by FICA employees, who were more than willing to offer explanations to anyone making inquiries about the items on offer. The civil servants were regaled with ample quantities of the well-known fair trade chocolate, tea and coffee, while the FICA also introduced them to fair and sustainably produced stockings, bed linen and cleaning and personal care products, such as Q-tips, bath foam and soap.

Flemish civil servants set a good example, because their consumption of beverages is a reflection of the fair trade ethos. In 2008 the catering service poured no less than 37 tonnes of coffee, 21,000 one litre bottles of fruit juice, 19,000 twenty cl bottles and 4,000 bottles of red and white wine. All products obtained from the fair trade market.

SUSTAINABLE PURCHASING The Authorities of Flandersâ€™ buying policy pays special heed to ensuring sustainability, regarding it as a development instrument thanks to the way it guarantees a better standard of living for producers in the southern hemisphere.

Trade market in Ghent FICA joined forces with the city of Ghentâ€™s NorthSouth cooperation service, on 5 and 6 December 2008, to organise an alternative Christmas market. Distributors of fair and ethical products and 4th pillar organisations were provided with an opportunity on Sint- Baafs square in the centre of Ghent to show their wares to the general public. Activity report 2008 | 57

Activities in the North

SUSTAINABLE CONSUMPTION

RAISING THE AWARENESS THROUGH THE MEDIA THE FLEMISH NORTH-SOUTH PRESS AWARD “The paint on the wall is flaking off and the stench of rubber is suffocating but nobody is wearing a mask here. The 300 employees work seven days a week from 7.30 am to 11.30 am and 12.30 pm to 5.30 pm. They eat in the company canteen and sleep in the company dormitory. They earn Euro 150 a month. A somewhat older woman uses ink to print the shoe size on a wooden pallet. In an adjoining room girls on stools inspect the outer soles with their hands. Back down below a machine is pressing rubber. Once again no gloves or masks are in sight. In the room on the other side, a man is cutting rubber soles out with a blank. The gym shoes are stretched on iron blanks on a metre-long belt and glued by hand. Right at the end, they still have to go in to two large 120 °C steam machines for three-quarters of an hour. Once the rubber has dried it is sent to the first floor where rows of hands pack them into small white boxes. The same gym shoes used to roll off another belt for many years. A few thousand kilometres further West, in 58 | Activity report 2008

Pakistan. The Pakistani shoe last travelled along to the Chinese plant. Monique Smit, the Dutch buying & development manager for Rucanor: “Pakistan was too expensive. This is the first year we have worked with Haifa. We have one contract for each order.” Mellina Zevenhuizen, Rucanor’s marketing manager, adds. “At one stage the Pakistani plant thought we were not buying enough shoes. That was not right at all because we definitely purchased huge quantities. Then you simply take a look at which plant gets closest to the quality required.” An extract from “De omzwervingen van een turnpantoffel van 3,99 €”, (The adventures of a €3.99 gym shoe) for which Nico Schoofs won the North-South press award in 2008: a cheque for €5,000. Part of the series “De globalisering in uw winkelkar” (Globalisation in your shopping trolley) the article appeared on 31 May 2008 in Vacature. This is the fourth North-South press award in a row. This time around 12 journalists entered the competition, some with more than one contribution. Schoofs followed Han

Activities in the North

SUSTAINABLE CONSUMPTION

Zinzen, David van Reybrouck and Anne de Graaf in the list of honour. Schoofs’ article followed the journey made by a Dutch gym shoe (Rucanor brand). His story begins at the manufacturer’s end, in Wenzhou, in south-east China, where a workforce of 300 people turns out 350,000 pairs of shoes a year. Schoofs stayed two days in the city of a 1,000 shoe manufacturers. He travelled with the gym shoes along the Suez canal, to Rotterdam port and as far as the final destination in Belgium, in the Colruyt stores, which were selling gym shoes at €3.99 a pair. Nico Schoofs’ report paints a clear picture to provide a multi-perspective understanding of globalisation. The three other articles in the series followed the adventures of a refrigerator, a pair of contact lens and a digipas from the manufacturer to the buying public. The Ine Roox jury awarded an honourable mention to De Standaard’s foreign correspondent for her series, “De schande van Oost-Congo” (The disgrace of East Congo), which the newspaper published from 25 to 29 February 2008. Roox’s reports describe the sexual violence again women during the armed conflict that has raged in the eastern part of Congo for many years now. The jury also paid tribute to “De helaasheid van corrupt Congo” (The alasness of corrupt Congo) by Filip Michiels, which also appeared in Vacature. As a result of this mention and the decision to choose the series “De globalisering in uw winkelkar” to be the winner, the jury was also keen to turn the spotlight on Vacature itself. The publication featured no less than six of the 15 articles submitted for the press award. Vacature regularly publishes human interest stories that have a close bearing on the lives of readers, and economic feature articles to do with the North-South relationship. The publication shows that when well presented the North-South story does strike a chord. It brings the issue out of its isolation. Congratulations to Vacature, because globalisation is a phenomenon of the contemporary world, so says the jury in its report.

The prize award jury comprises the president Flip Voets, the secretary general and ombudsman of the Council of Journalists, Lodewijk Berlage, emeritus professor, Corine van Kelecom, communication coordinator for 11.11.11, Jan Ouvry, foreign coordinator for the VRT (Flemish Radio and Television ) news, and Alma de Walsche, journalist with MO* (a Flemish monthly magazine on globalisation). INTER PRESS SERVICE (IPS) SAFE FOR YEARS FICA joined forces in 2008, with 11.11.11, to help provide the news agency IPS-Vlaanderen a guarantee about its long-term finance. The executive agreement with FICA covers the period until 2012. IPS is in receipt of a €120,000 in the form of a financial grant for the operation of its news service. Another € 30,000 grant is earmarked for the website, www.mo.be, that IPS together with MO* launched in 2007. IPS-Vlaanderen is part of Inter Press Service, an international press agency boasting 350 correspondents in over 150 countries. Against this background, the editorial team in Brussels prepares articles ready for publication in the press and on websites, while also writing its own reports. The emphasis is on reporting from Africa, Asia and Latin America. IPS pays particular attention to themes such development, globalisation, migration, environment and minorities. 2008 was a successful year for IPS. The agency had a record number of its articles published in the mass media, so that they reached out to nearly1.6 million Flemish newspaper readers. Websites, featuring news originating with IPS, attract over 170,000 visitors a day. The quality and variety of reports has also increased. IPS reported news from 144 countries in 2008. It is most notably the reporting about Africa that has made a huge leap forward. Cooperation with InfoSud, its French-language counterpart, and Wereldmediahuis, which is published by MO*, has had a successful outcome. All articles IPS-Vlaanderen supplied in 2008 are available at www.ipsnews.be. Activity report 2008 | 59

Activities in the North

DEVELOPMENT EDUCATION

DEVELOPMENT EDUCATION FICA attaches great importance to development education, thereby lending support to projects every year, which are actively promoted. The activities are geared to citizens, not only young people, teachers and volunteers but also ordinary people, keen on making a contribution to international solidarity. FICA announced its approval for four projects in 2008. Kidscam Natuurpunt Educatie Wereldwerkplaats Zuiddag Kidscam from Mechelen is turning its attention to artistic education. The aim is to have children from all corners of the globe make 12 short cartoon films about fair trade. And these are available in an instructive DVD book. Kidscam takes care of the form, while joining forces with Maya Honing for the content. Kidscam has partners in Burkina Faso, Brazil, Canada (Quebec), Mexico and Taiwan. Their target group is primary school children aged 7-14, plus their teachers, parents and the public at large. Natuurpunt Educatie from Turnhout produced a DVD called The world has its say. As a reflection of a journey across several continents, this relates the story of sustainable development. Natuurpunt Educatie works together with 11.11.11 and Oxfam shops. The target group comprises volunteers from these organisations along with ordinary people, professionals from the socialcultural sector, the education system and youth groups. The aim of the Wereldwerkplaats project from Leuven, Examples from the South, is two-fold. The idea is to offer pre-school and primary school teachers training materials and development ed-

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ucation-related 4th pillar initiatives, via an inventory, for example. Zuiddag is conducting a project called Work once a day for the South. As part of this initiative, young people go out to work and give up a dayâ€™s pay for the South, after peers from the South paid them a visit beforehand. In 2007 they Fair trade around the world DVD The world has its say Examples from the South Work one day for the South opted for the theme Stop violence again women. ZuidDagâ€™s partners are Kleur Bekennen and the Hoger Instituut voor Vertalers en Tolken (Higher Institute for Translators and Interpreters).

Activities in the North

MUNICIPAL DEVELOPMENT COOPERATION

MUNICIPAL DEVELOPMENT COOPERATION In recent years various municipalities have concluded development cooperation agreements with the Authorities of Flanders. By late 2008, 37 of them had signed such pacts. Introduced in the year 2005, the municipal development cooperation Decree encourages municipalities to create their own North-South policies. Financial grants are awarded to municipalities developing a strategic three-year plan under this heading. This is the form the cooperation takes. For the 2009-2011 period FICA had received 23 application packages by late September 2008. Eighteen of them refer to an extension of the first agreement, which expired in 2008. Leuven Universityâ€™s Higher Institute for Labour Studies (HIVA) was commissioned by FICA in 2008 to make a review of the agreements for the 2005-2007 period. â‚Ź 2,451,000 by way of financial grants is earmarked in the 2009 budget for municipal education cooperation, over 8% more than in 2008.

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Activities in the North

RESOURCES

RESOURCES The development cooperation budget in 2008 was in excess of €28 million, over 60% more (or nearly 11 million) than in 2006, FICA’ first operating year.

butions to these agencies are mainly allocated to the three partner countries or Southern Africa in general, in particular with the member countries of the SADC.

Hence there is a definite upward trend in the development cooperation budget since FICA was created. The sharpest rise was in 2008, with a rate of growth of over six million.

Against the background of the need to attain the Millennium Development Goals 4 and 5 (reduce child mortality and improve maternal health) a new programme on pre- and post-natal care has been launched with the WHO. On behalf of the Employment and Social Economy Department, FICA has also been lending support to the ILO’s Decent Work Programme. These operations are consistent with the geographical focus of the Flemish development cooperation approach, involving a key theme with specific relevance for Flanders, gender, in the context of labour relations and women entrepreneurs.

The higher budgetary leeway is chiefly earmarked for boosting cooperation with countries in the southern hemisphere. The budget for projects in the South has risen in both absolute and percentage terms ever since FICA was launched, in 2006. This applies to a) resources for governmentto-government cooperation and cooperation with international agencies, and b) to emergency aid. €18,948,000 and 2,009,000 respectively was made available for these two items to make a total of €20,957,000, or nearly 74% of the FICA budget – up 8.7 million on 2006. There was also an absolute increase of 4.2 million over 2007, up by nearly 25%. In the final analysis FICA in fact spent €22,617,000 on projects in the South in 2008, 8% more than budgeted for. Over 30% of the operating appropriations, nearly €6million, was invested in Mozambique, primarily for health care and HIV/AIDS projects. Nearly 25% of the appropriations, or €4.5 million, was earmarked for Malawi and South Africa, focused chiefly on agricultural with a view to improving food security. Apart from bilateral cooperation FICA also works with specialist UN agencies, such as the International Labour Organisation (ILO), the World Health Organisation (WHO) and the Joint UN Programme on HIV/AIDS (UNAIDS). The contri62 | Activity report 2008

FICA’ level of activities in the North was also up on 2006 in absolute but not percentage terms. €5,021,000 was made available for enforcing the policy on awareness-raising, municipal agreements and initiatives for extending support, such as fair trade, school links and exchanges of knowledge. The resources are deployed for existing initiatives, such as Ex-Change, new awarenessraising projects, such as Kidscam, Natuurpunt Educatie, Wereldwerkplaats and Zuiddag, and financial grants to municipal authorities.

Activities in the North

RESOURCES

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BIJLAGEN

ANNEXES

Introduction

ANNEXES

SOUTH AFRICA Project Title Empowerment for food security 2005-2009 Agribusiness Development Academy Programme 20052009 Job creation/Small-medium and micro enterprises in the Free State 2005-2009 The Youth and Community Wellness Programme in Xhariep in de Free State. Strengthen Voluntary Confidential Counselling and Testing in the Free State Province The Voluntary Counselling and Testing Project in the Limpopo Province Home and community based care in Limpopo A Domestic Violence and Rape Victim Empowerment programme targeted at Children and Women in the Free State Province Children at risk: breaking the cycle of violence in Free State.

The Manyeleti Youth Academy Project Youth Development Centre Project” Implementation of a housing component within a municipal structure and provide housing consumer education at municipalities/part II

Partner Department of Agriculture and Environmental Affairs, KwaZulu Natal Department of Agriculture; Limpopo

Sector Agriculture – food security Agriculture – farm management

Department of the Premier; Free State

SME sector – Employment/ business centres Department of the Premier, HIV/AIDS – Youth Free State welfare Department of Health, Free HIV/AIDS – prevenState tion

Flemish budget 7.500.000,00 €

7.500.000,00 €

3,750,000 €

609,985.00 €

Department of Health and Welfare of Limpopo

HIV/AIDS – prevention

837,115.39 €

Limpopo Department of Health and Welfare Department of Public Safety, Security and Liaison, Free State”.

HIV/AIDS – home care Domestic violence against women and children

835,041.06 €

Department of Social Development Free State

Young people as secondary victims of domestic violence or their transition to become perpetrators. Juvenile delinquency

826,383.00 €

Juvenile delinquency

601,102.00 €

Housing

590,179.00 €

Department of Safety, Security Limpopo Department of Public Safety, Security and Liaison; Free State Department of Housing of KwaZulu Natal

491,399.53 €

680,825.00 €

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Introduction

ANNEXES

Groutville Community Care Homes Project in KwaZulu Natal. SOHCO: Delivery of Social Housing Units of Low Income Earners in the E’Thekwini Metropolitan Council Local Governance Unit/ Part II

Training and support of the after care centres for adults with a mental retardation in the Northern Province of South Africa

Department of Housing KwaZulu Natal,

Housing – HIV/AIDS orphans

The New Housing Company

Housing - Social housing

Department of Local Government and Housing Free State Department of Welfare Limpopo + Fenix Unite vzw

Local authority management

MOZAMBIQUE Project Title Integrated network to fight HIV/AIDS in Tete en Moatize

Building a new ward in the central hospital of Beira Building of health infrastructure in Inhambane and Gaza provinces Strategy to address the increasing feminization of the HIV epidemic in Mozambique Support for PROSAUDE (joint fund for the health sector) Human Resources for Health

Basic health care and capacity building in Tete province Expansion of basic health care services in Maravia district (Tete province)

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Partner

Disabled sector

Sector

297,188.00 €

487,400 €

341,400.00 €

779,590 € + 371,840 €

Ministry of Health (MISAU), Provincial Health Services of Tete, Doctors Without Borders, Institute for Tropical Medicine, Ghent University (International Centre for Reproductive Health) Ministry of Health (MISAU)

Health care

Flemish budget 9,117,788 €

Health care

1,043,082 €

Ministry of Health (MISAU)

Health care

560,000 €

UNAIDS

Health care

815,000 €

Ministry of Health (MISAU)

Health care

3,000,000 €

Ministry of Health (MISAU), Institute for Tropical Medicine Red Cross Flanders and Red Cross Mozambique Ministry of Health (MISAU)

Health care

1,063,600 €

Health care

740,086 €

Health care

3,404,898 €

Introduction

ANNEXES

Repair of damage to Vilanculo Skills Training Centre Sociedade Salesiana Mocambique Pirep Executive Secretariat

International Labour Organisation

MALAWI Project Title UNAIDS

FAO: Contribution to an improved food security and food situation Support to agricultural extension training and services Support to agricultural extension training and services Support to agricultural extension training and services Support to agricultural extension training and services Support to agricultural extension training and services Rehabilitation and management of irrigation schemes in the presidential greenbelt initiative Developing an up-scaling platform for diversifying the food security of farm households

Social Infrastructure Fundaçao para o Desenvolvimento da Comunidade (FDC) Education Construcao das oficinas de Mecanica e Electricidade do isdb Pirep Executive Support to Fundec Secretariat (Fundo De Desenvolvimento De Competencias) 161 Social infrastructure Decent work country programme support project - improving social dialogue in Mozambique

Partner Capacity building to fight the vulnerability of women and girls regarding this disease FAO of the UN

Small Scale Livestock Promotion Programme Bunda College of Agriculture Natural Resources College Department Of Animal Health And Livestock Development Department Of Agricultural Extension Services Ministry Of Agriculture And Food Security

Catholic University of Leuven

Sector HIV-AIDS

Agriculture and food security Agriculture and stock farming Agriculture and stock farming Agriculture and stock farming Agriculture and stock farming Agriculture and stock farming Agriculture and stock farming

Agriculture and food security

219,471 €

1,851,194 €

150,000.00

778,394.10

Flemish budget 2,000,000 €

4,100,000 €

694,906 € 1,359,143 € 695,700 € 989,200 €

752,990 € 300,000 €

181.064 €

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Introduction

ANNEXES

SUPPORT FOR THE PROGRAMMES OF INTERNATIONAL AGENCIES Response To High Food Prices United Nations World Emergency food aid Food Programme Who Initiative for Healthy Preg- World Health Organisation Fertility nancy: introducing the WHO Antenatal Care Model in Southern Africa Unaids Health Contribution to combating HIV/AIDS in SADC countries: women, young people and children Sustainable Trade The ITC Supply chain and logis- International Trade Centre tics development programme for Africaâ€™s SADC Region

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1,000,000.00 1,000,000.00

1.000.000,00

Introduction

ANNEXES

Activity report 2008 | 69

Introduction

AN IMAGE OF MOZAMBIQUE

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Introduction

Activity report 2008 | 71

Introduction

ABOUT THIS PUBLICATION Published by: Freddy Colson, FICA, Boudewijnlaan 30, 1000 Brussels Coordination: Gitti Van den Borre, FICA Editorial process: Guy Poppe, journalist Layout: General Government Policy Services, Communication department, Ingrid Van Rintel Photographs: Guy Poppe and FICA Cover photo: women waiting in Inhambane health centre, Mozambique. Printing: Agentschap Facilitair Management, digital printing Deposit number: D/2009/3241/174

FOR FURTHER DETAILS Visit our website: www.fica.be E-mail: ontwikkelingssamenwerking@vlaanderen.be

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