|C.I.S.F.A.M.: Consolidated Information System for Famine Management in Africa - Phase One Report (Centre for Research on the Epidemiology of Disasters - World Health Organisation, 1987, 33 p.)|
|CHAPTER 1: Famine, Health and Relief: Issues and Observations|
Famines and acute food shortages are usually caused by a combination of natural disasters such as droughts, floods, cyclones; socio-economic problems such as income inequities, unemployment, migration, marketing constraints; and man-made crises such as wars, civil strife or fires. It is not enough only to recognise the existance of the food scarcity situations but is more important to prevent the situation or, in case of occurrence to minimise the costs of relief activities, and develop community resistance.
Africas economic and social conditions began to deteriorate in the 1970s and continue to do so. Gross domestic product grew at an average of 3.6 percent a year between 1970 and 1980, but has fallen every year since then. With the population rising at over 3 percent a year, income per capita has declined since 1980, and food imports have increased. The effects of drought have understandably claimed international attention and immediate priority has been given to saving human lives through emergency relief operations. The effects of the drought are, however, only the most extreme and distressing aspects of the more pervasive developmental crises in Africa. Pressing as these current problems are, it is important to emphasize that emergency relief as applied provide traditionally short term solutions.
Prolonged food and water shortages, inadequate shelter, contaminated water sources, deteriorating sanitary conditions and breakdown in already inadequate access to basic health services had initiated an explosion in communicable and parasitic diseases to which these weakened communities are susceptible. Dramatic increases in the incidence of malaria, respiratory infections, trachoma, meningitis has been reported in Niger within the last three years. Increasing infant mortality rates in the famine struck countries exceeding 250 in some provinces of Mozambique and 225 per 1000 in some regions of Mali, testify to the synergism between malnutrition and disease. In most of these countries, infant mortality rates that had been showing some signs of decline have made a volte face and have, in certain cases surpassed levels of the past 15 years. (The Human Face of Famine; UNICEF, 1986).
Over the recent years however, India, Bangladesh and a few African countries have demonstrated that with careful planning and management, very poor developing countries can block the chain of events that leads from crop failure to widespread death (J. Mellor and S. Gavian Science, vol. 235,1987, pp 540-545).
National and international policy set the stage for all famines. Poor policies, both in assistance and in public sector along with armed conflicts heighten a nations vulnerability to famine. If proper policies are in place, natural disasters should not evolve into famine.
In Africa, international relief assistance played a major role in response to the 1984 famine. Despite the urgency of the situation, the lesson to be learnt is clearly that of providing relief in ways that could strengthen continuing development activities. Frequently however, emergency mandates of international and multi-lateral bodies lack the flexibility required to integrate relief with development. These restricted mandates preclude integrated planning for relief and development, making it impossible for public sector relief units to plan jointly with development units. Unfortunately, famine relief policies, define a limited period as emergency and thereby encourage thoughtless spending, inappropriate and ineffective action. Emergency funds for famine often can not be used to strengthen primary structures to prevent and mitigate future crises. As a result, the international community repeatedly pays for curative response of limited effect, as illustrated by the two massive Sahelian famines within the span of just one decade.
The health sector in acute food crisis, is necessarily pulled into centre stage due to death, disease and acute malnutrition that accompanies famine. Despite the fundamentally socio-economic nature of famines, the potential for the health infrastructure especially within a primary health care context to play a major role in famine management and prevention is significant.
The inadequacies in current emergency and relief policies, both amongst the donors as well as the executing bodies, are perhaps best illustrated by the proliferation of early warning systems in various famine struck countries. Systems financed at great cost, manned by qualified expatriates and requiring stable and functioning logistical and administrative structures have been installed in many countries under the wave of donor empathy with the media coverage of the appalling African famine. As is frequently the case in disaster programmes elsewhere, these efforts are beginning to suffer the effects of lack of interest from both host governments and donor agencies, whose priorities have changed with the easing of the crisis. (International Disaster Institute Seminar, Draft Report, January 1987).
This example only serves to illustrate that disaster or relief programmes in the Third World can only succeed and be maintained on an on-going basis, if it can be approached like any other social or human welfare programme and be completely integrated within the appropriate plan at different administrative levels.
Recently a great deal of effort, good-will and resources have been generated to combat this disaster. Nevertheless, there remains considerable room for improvement in the efficiency and effectiveness of the employment of available resources. Famine is clearly a multisectoral problem that requires long-term solutions. The complexity of the problem explains to a certain extent, the relatively disappointing outcome of action so far taken in Africa.
The principle hurdles to effective interventions were, frequently, inappropriate action, delayed action, insufficient local information, logistical back ups and duplication of efforts. Fortunately, most of these can generally be avoided by timely information and planning, especially if long-term goals are to be achieved via such programmes. Although a great deal of information exists scattered in different organizations. Ignorance of their existance as well as their lack of standardization have resulted in a gross underuse of existing sources.