Medical Assistance to Self-settled Refugees (Tropical Institute Antwerp, 1998)

(introduction...)

Preface

Introduction

1. Guinea, Liberia & Sierra Leone

Three poor countries

Different histories, different economies

A patchwork of ethnic groups

The Forest Region of Guinea

The influx of refugees between 1990 and 1995

2. The health system in Guinea, 1988-96

(introduction...)

The Bamako Initiative at the health centres

Hospitals: rationalisation, cost recovery... but low utilisation

The administrative structure of the health system

Human resources in the health sector

Cost and funding of the health system

The Guinean health care system and PARLS

3. The refugee-crisis: between self-reliance and pragmatic assistance

Wave 1: rural refugees from Nimba county, January-March, 1990

(introduction...)

The Initial Assistance

More Refugees

Wave 2: urban refugees or returnees? May-June, 1990

(introduction...)

The same assistance .....

... But not for everybody

Wave 3: rural refugees from Loffa county, June-August, 1990

Wave 4: refugees from Sierra Leone, March-April, 1991

(introduction...)

More active interventions

A period of relative tranquillity: the refugees remain and PARLS is consolidated

Late arrivals: the subsequent minor waves, 1992-95

Cross-border movements in both directions

Early versus late arrivals

New agencies and changes in PARLS

Settlement patterns of refugees

The number and distribution of refugees*

'Integration' of urban refugees

Rural refugees: between 'integration' and 'segregation'

'Refugees live in camps'

4. Food aid

(introduction...)

A rational basis for deciding on food aid?

Refugee registration

Assessing the nutritional situation

(introduction...)

Monitoring of market prices

PMC monitoring

Anthropometric surveys

The limitations of anthropometric surveys

Delivering food aid

A major issue right from the start

On counting calories (1991-95)*

1996: Better supply and less fraud

Of evidence and pressure

Expert opinion versus anthropometry

Decision making in food aid

5. Control of epidemics

(introduction...)

Epidemics: bio-demographic burden & psychological impact

Control of epidemics

Epidemics and forced migration

(introduction...)

Why does forced migration result in excess mortality?

Reducing excess mortality in forced migration

Epidemics in the Forest Region

(introduction...)

Bio-demographic burden of epidemics in the Forest Region

Measuring control of epidemics

Control of cholera, measles, meningococcal meningitis & beriberi

Control measures in the forest region

Costs and effects of controlling epidemics in the Forest Region

(introduction...)

Cholera

Measles

Meningococcal meningitis

'Routine' vs. 'Intervention'

Epidemics in context

Deaths in 'natural' situation vs. 'Routine' & 'Intervention'

Cost of 'Interventions' vs. Cost of the health system

Is cost per death averted an adequate measure?

Managing epidemics: balancing response to burden and fear

6. Health services for refugees: between primary health care & emergency medical assistance

(introduction...)

Health services organisation in development & emergency*

(introduction...)

Development, disaster & emergency

Paradigms of PHC & EMA

Characteristics of PHC and EMA health services

Strategic aspects

Between development and emergency

Health services for refugees in Guinea

Management: MOH & its field partners

(introduction...)

Effective decentralisation or foreign substitution?

N'Zérékoré, Yomou & Lola

Macenta & Guéckédou

Health services supplied

(introduction...)

First line health services (FLHS)

Referral health services

Ancillary services

Resources used

(introduction...)

Human resources

Supplies

User fees vs. Free access

Total cost

Health care provided

(introduction...)

First Line Health Services

Referral services

The host population benefited from PARLS

Why health care utilisation by the refugees remained low

Was PARLS the best solution possible?

7. Towards a more balanced refugee policy

(introduction...)

From saving lives to promoting health

The bio-medical approach to refugee health

Refugees as a product of a disrupted society

The determinants of health status & coping ability

A theory of human need: health & autonomy

Becoming a refugee as a way of coping

The central role of settlement patterns

Refugee policy as a balance between self-reliance & assistance

Assistance in lieu of self-reliance

Assistance in support of self-reliance

References

Preface & introduction

Chapter 1

Chapter 2

Chapter 3

Chapter 4

Chapter 5

Chapter 6

Chapter 7

Abbreviations & Acronyms