|Water Sanitation Case Studies and Analyses (Peace Corps)|
|Republic of Sierra Leone|
|History of Peace Corps water/sanitation activities|
In the early 1970s, Togo's health infrastructure was well established but lacked trained manpower and funds. Peace Corps/Togo's health programming aimed at meeting these manpower needs with skill-trained Volunteers.
Peace Corps/Togo's five-year plan in health for that period called for provision of personnel for the Health Education Department; the renovation and equipping of 50 dispensaries, including the provision of clean water supplies and elementary sanitary facilities; and arresting communicable and infectious diseases through surveys and vaccination programs, particularly for tuberculosis, whooping cough, measles, yellow fever, and onchocerciasis. (CMP FY1970-73.)
Health Education Project (1969-78)
Collaborating Agencies: Peace Corps, Ministry of Health WHO
From 1969 to 1976, Peace Corps' Health Education Project fielded 80 trained Volunteers as Health Educators working for both the Health and Education Ministries. These Volunteers promoted preventive measures as a complement to the curative medicine already practiced in Togolese hospitals and dispensaries, by introducing health education into the schools and dispensaries. They worked with schoolteachers, nurses, midwives, sanitation agents, and social workers in giving lessons and by practical application of the lessons in construction of latrines, wells, and cisterns. (CMP FY1977, p. 12. )
Major accomplishments of this project were the production of health education texts and numerous visual aids, some of which were incorporated into the official national schools curriculum and widely disseminated (School Hygiene Manual/Manuel d'Hygiene Scolaire, a teacher's resource book, two teacher manuals on sanitary education for grades 3-4 and 56, Fiches d'Education Sanitaire, and Health Advice for the African Family, Conseils de Sante a la Famille Africaine). Conseils de Sante is used in village clinics for giving basic family health lessons to women who have come in to give birth or for pre- or postnatal checkups. (It is widely distributed in Francophone Africa through ICE and has been translated and adapted for Anglophone Africa as well. )
In 1973-74, four Volunteers conducted a survey of those afflicted with onchocerciasis for the Department of Endemic Diseases. The Volunteers traveled throughout Togo taking skin snips for analysis to determine disease prevalence and geographical distribution. As a direct result of this year-long Peace Corps project, Togo participated actively in a massive West African "river blindness" campaign sponsored by the World Health Organization. (CMP FY1977, p. 2.)
Despite these accomplishments, only six of 18 trainees remained in the project in 1975. The Volunteers felt the major goals and objectives of the project had been achieved even before they began service, that Togolese personnel then in service were competent to teach health education, and that a Volunteer presence was no longer needed. The remaining six Volunteers spent their second year introducing a Peace Corps-developed sex-education manual in certain pilot primary schools and conducting sex-education workshops for school teachers. These materials were adopted by the school system on an experimental basis. Although the GOT solidly supported the promotion of sex education, public disapproval brought these efforts to a halt. No trainees were requested for 1976. (CMP FY1977, p. 13.)
Staffing problems also contributed to the decline of the Health Education Project. One reason for the Project's relative success between 1969 and 1973 was the presence of an APCD/Health who was a respected professional person with excellent relations with the Ministries of Education and Health. When she left in 1973, PC/W, in an economy move, abolished the position and gave those responsibities to the Peace Corps Medical Officer (PCMO). The Health Education Project was a low fourth in the PCMO's order of priorities, following: (1 ) medical care of Volunteers and staff; (2) medical care of Embassy personnel and their families; and, (3) the onchocerciasis project, which he directed.
Nonetheless, the PCMO and a PCVL (a Ph.D. candidate in Public Health) managed the program well. However, when both left Togo in 1974, a PCV without experience or professional credentials took over the leadership role in health education. From that point, relations with the Ministry of Health declined, and programming diminished. Volunteer attrition rates increased as of 1974, and by 1976 this project was ranked eighth of ten by PC/T. (Morris, 1983.)