Factores Competitivos de las MIPYMES del Sector de Artesanías

In order to arrive at tangible contributions to health care management on district and communal level, there are a number of feasible options which can be applied consecutively. They can be executed without ample resources as they are borne in the existing social and cultural structures and can be built upon existing infrastructure and the plural medical system.

1) There is the possibility to revive community-based institutions which improve the prerequisites for sustainable health conditions on local level. They entail the revitalisation of community health committees, community health workers, and the structural co-operation with traditional practitioners in the range in which they are available (cf. Ambaretnani 2012, Chirangi 2013). It could perform as an alternate health manpower resources pool, provided there is willingness on district level to co- operate. The mobile outreach routine of the early days of Primary Health Care could be reinstalled to perform as a liaison and training facility, complementary to its original function as monitoring and control of MCH activities.

2) There is a request for an enhanced curriculum (see 8.3.3) to train staff in applying indigenous knowledge in their daily activities. Integration of social sciences in public health management curricula will improve the communications on community level, instigate a change in attitude and better reflection on the motives of the local population. It will enable health staff at different levels to identify with the health utilisation behaviour of their target group, and improve both preventive and curative services. The relationship between the two proves to be dependent on the perception of quality and accessibility of service. It could lead to a structural co-operation with TM practitioners, resulting in mutual respect, exchange of knowledge, and a reduction of health hazards.

3) There is underestimated potential in the revitalisation of the Community Health Fund (CHF), by considering alternative ways of organising it. Integration with existing indigenous institutions on

160

communal level, i.e. farmers’ co-operatives, religious affiliations, or voluntary associations involved in any other economic activity related to reciprocal credit, are eligible ways to consolidate a health insurance. Additionally, there could be proper re-evaluation as to which type of service should be covered, with consensus of all party’s involved, and with long term commitment to build confidence. Finally, there are a large number of alternatives with regard to the payment of fees which have not been explored yet. The spreading in instalments, cost sharing, collective saving schemes, rechannelling through local associations, or digitalising via mobile communications, could all prevent potential patients from avoiding consultation because of the financial impact.

4) There is a desire to start a digitalised health information system between the referral stations in terms of exchanging and analysing morbidity rates, drug supplies, health hazard early warning, monitoring and control, by applying technology which is already available, but has until now not been operationalised. There is commitment at A-level to establish such form of communications, and they could be established at a fraction of the cost of traditional logistics and physical movement. The hardware and software is available, internet providers are available, electricity is available, and the knowledge is available.

5) There is an option to enhance the impact of health education campaigns by extending the sourcing in primary and secondary education, while increasing the frequency of role plays to appeal to the tradition of oral transmission in the transfer of indigenous knowledge. Additionally, because of the changing modalities of communications with mobile telecom, it is imperative to investigate the use of existing networks to introduce health hazard messaging on mobile devices. The next generation in particular will prove susceptible to these channels and they could create a platform for proliferation, possibly through eligible social media.

6) There is the possibility a to re-animate the research into the applications of indigenous traditional medicine. A number of traditional practitioners indicated they would be eager to have their material examined. They propose that the scientific analysis of the components would have a twofold effect. First of all, it would take away the stigma of not having any recorded qualifications, secondly it would enable them to further develop their medicine in terms of conservation or reproduction and receive recognition. The main objective, in their words, is to finally receive feedback on the offer which they have consistently made. It is simultaneously a solid basis for future co-operation, and the intended integration between medical systems. It should receive the deserved attention, more so because the same practitioners foresee a lack of interest by the younger generation to engage in the laborious task of collecting and preparing the needed species. They fear that the knowledge will not be maintained or transferred, while they simultaneously experience a diminished availability of some species, endangering their preservation (Chapter VI).

161 Notes chapter VIII

35. Mobile outreach clinics were a core activity of PHC in covering large rural areas with limited infrastructure. The activities combined ante-natal monitoring, detecting sources of communicable diseases, individual general counselling, dispensing elementary drugs and birth registration, making it a versatile exercise, but it involved a multidisciplinary crew and transportation on a regular basis. It requires extra input but may prove a feasible alternative to extending facility based preventive services in the short term (cf. Azevedo 2017b).

36. Various utilisation studies (cf. Marsland 2007; Jangu 2010; Towns 2014; Stanifer 2015;) have shown that the interpretation of recurring symptoms, on account of chronic diseases, or the display of convulsions with young children as a result of malaria related fever, may lead to a delayed or insufficient treatment, which may prove risk full. In the co-operation with TM professionals these delicate differences must remain on the agenda.

37. Prevention of Mother to Child Transmission (PMTCT) aims at making women aware of the impact of an HIV-infection in case of pregnancy, both as a health information campaign as well as leading them to subsequent participation in testing and counselling (cf. WHO 2015)

38. The dispensary at Natta is equipped with desktop computers in a separate room with elementary software and capable of processing and analysing health statistics. Yet the recording and reporting was done with pen and paper and kept on carbon copies. If there would be an internet connection the digitalised data could be sent to the Public Health Department in Mugumu directly and answered with relevant advice or directives via E-mail instantaneously.

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