But all our effort would not be enough to get these results if we did not have the necessary funds. That’s why, in acknowledgement of the need to meet our stakeholders’ requests, we have explored how we develop, stabilise and diversify our income.
STAYING SUSTAINABLE WHEN THINGS GET HARDER
“2019 was a crucial year in Sudan. The protests that began at the end of 2018 went on through the following spring, eventually bringing down the regime that had ruled the country for 30 years. The installation of a new government began a transition period of further deep tension, political uncertainty and economic instability that will last a long time. People’s hopes for peace and wellbeing soon hit a wall of ever-rising prices and worsening living conditions.
Local medical authorities have always been key partners in the success of EMERGENCY’s projects in the country. In 2019, government funding covered 30% of our running costs, while our agreements with them meant we could train local people and let our staff and patients travel as part of the Regional Programme.
The change of government forced us to replace most of the interlocutors we had been using until then, and with whom we had formed working relationships in our more than 15 years of working in Sudan. At the same time, rapid inflation brought salaries crashing down for the over 600 Sudanese employees working on our projects, driving a lot of them to emigrate to other countries, mostly Saudi Arabia, in search of better economic conditions which might let them support their families. Our international staff also found themselves in entirely new surroundings. A country whose cities had been easy to get around turned into one of limited movement and harsh safety measures.
Many times our work was made more complicated and we had to face constant changes and challenges. We strove hard to get support and funding from local ministries once again, and to review our Sudanese workers’ salaries and slow the turnover of our staff.
In spite of everything, our hospitals have always stayed open, thanks in no small part to the help of our many Sudanese workers, who showed their trust in and respect for EMERGENCY’s humanitarian work by choosing to stay with us. Once again, we believe that the Salam Centre for Cardiac Surgery in Khartoum and the Paediatric Centres in Mayo and Port Sudan have acted as a symbol of hope, showing how free, high-quality treatment is possible and sustainable in Africa, in countries like Sudan, which has been hit by a deep financial and political crisis and is socioeconomically fragile.”
Roberto Crestan, Area manager for EMERGENCY’s Centres of Medical Excellence
ECONOMIC AND SOCIAL SUSTAINABILITY
EMERGENCY’s humanitarian activities around the world are always carried out in collaboration with local authorities. It is a distinctive characteristic of the organisation’s intervention methods, whose goal is not to replace national health services – where they are present and functioning – but to integrate with them. The ultimate objective of our work is always for local governments to take responsibility, as well as the integration of our various activities into the economic and social fabric of the countries where we operate.
Upon the launch of a new project, EMERGENCY and the relevant national authorities – usually the ministry of health – sign a memorandum of understanding, an official document defining the organisation’s mandate in the country, roles and mutual responsibilities, and terms of collaboration between the two parties. Furthermore, we sign specific memoranda with relevant ministries or directly with local schools of specialisation (where present) to formally recognise the training courses that EMERGENCY provides for its medical and nursing staff. Other dialogues and agreements take place with different representatives of civil society, for example with community elders in Afghanistan, the popular committees in Sudan or, in cases of collaboration, local organisations.
EMERGENCY commits in everything it does to respect the regulations and legislation of the countries it works in, paying particular attention to codes and regulations on work, taxes and imports, where they exist. From the earliest stages we involve local authorities in defining our projects and training local staff, so that we can share goals and responsibilities.
Where possible, this assumption of responsibility by governments should also translate into them funding our hospitals, to make it easier both to run them and eventually to hand them over to the authorities.
On this front in 2019, Sierra Leone’s Ministry of Health formed, at EMERGENCY’s suggestion, a working group to improve how surgical emergencies were handled in the country’s capital, at Connaught Hospital – the country’s main state referral centre for adults – and EMERGENCY’s Surgical Centre. With the coordination of the Ministry of Health, and after performing an analysis of EMERGENCY’s work that considers how local health services have improved and how the number of patients injured in traffic accidents has gone up, we aim to formulate a working system for patients and a suitable division of work between the two hospitals that makes the most of the two facilities’ features. The aim is to integrate EMERGENCY’s hospital as far as possible within the local health system.
AFGHANISTAN – ANABAH
EMERGENCY’s Maternity Centre, opened in the Panjshir Valley in 2003 beside our existing Surgical Centre, is still the only free, specialist facility in the area today offering gynaecology, obstetrics and neonatal care, as well as family planning and contraception services. The hospital is also a training centre for Afghan staff, recognised as such by the Ministry of Health and the Ministry of Education. More than 100 Afghan women work there every day alongside international staff, and get theoretical and practical training. In its report ‘A quiet revolution. The EMERGENCY Maternity Centre in Anabah and women’s empowerment’, EMERGENCY tells of its more than 15 years working at the hospital, analysing its effects on the health and social standing of the women who come there, as both patients and staff. The great acceptance that EMERGENCY enjoys among the local people has not just made our work sustainable, but helped improve the standing of female medical workers in the region. These women are no longer tolerated exceptions to the rule that women must stay at home. They have become points of reference in their communities. At the hospital, women can act out the social roles of mothers and medical workers, with assertiveness and independence. Imitating this model of access to health, training and work could be the basis for a virtuous circle in other parts of Afghanistan and indeed other countries.
ITALY – CASTEL VOLTURNO
Ever since it opened in 2015, our clinic in Castel Volturno (near Caserta) has been part of a network with other facilities in the region. Thanks to charities constantly raising awareness of the needs of foreigners living in the area, the local health authority in Caserta decided to improve health services for holders of temporary residence permits. It doubled opening hours at its existing basic medicine clinic and set up a new one in Mondragone. In 2019, our team trained the staff at both clinics. The regional health system taking in everyone who needs it is a big step when it comes to making the right to treatment a reality. It is also another great example of everyday collaboration between charities and local authorities. For that reason – and to avoid doubling up services that are already available in the area – EMERGENCY’s clinic in Castel Volturno will be turned into a socio-medical information point in 2020.
In all its projects, EMERGENCY ensures high standards in its medical treatment and constantly strives to improve the services it provides. Along with medical aid and its own staff’s safety, proper and sustainable running of facilities is essential to a hospital’s efficiency.
Though most of us may not see it, disposing of hospital refuse (syringes, gauzes, catheters and so on) and waste water is just one example of the essential elements of a well-functioning hospital. Everywhere it works, EMERGENCY disposes of refuse and waste water carefully, even though rubbish disposal services cycles and proper treatment are by no means guaranteed in many of these locations. At our hospitals in Kabul and Anabah, Afghanistan, we have bolstered our waste management system by training our staff to separate it by type, so that the two centres can now handle large volumes of solid rubbish. Two incinerators with a postcombustion chamber for totally oxidising effluent gases complete the process for medical and other hospital waste, turning it into stable ash. Given the advantages this offers the system will be replicated at our Lashkar-Gah hospital too, where upgrades to the facility and improvements to its services mean we can now purify waste water from the laundry room using carbons in a vat to pick out chlorine, surfactants and micropollutants.