PRIMARY HEALTH CARE IN THE CONTEXT OF RIVER BASIN DEVELOPMENT-AMIBARA IRRIGATION PROJECT AREA, AWASH RIVER BASIN, ETHIOPIA: AN EXPLORATORY STUDY

Abstract

River basin development projects are of major importance for economic and social development. Today, nobody would question the immense benefits for mankind that have accrued from the construction of dams, the improvement of water, the creation or extension of irrigation systems, and the drainage of swamps and marshes. Such projects, however, involve a disruption of the living condition of the indigenous populations and is followed by a large migration of permanent and seasonal labour force, thus forcibly changing and upsetting the environment. It also modifies the social structure of the participating population. All these factors lead to increased disease prevalence in the development area, possibly to such an extent as to hinder the development itself and seriously decrease its economic return, if no preventive and curative health measures are enforced. However, there is a common problem encountered in the implementation of such health measured in river basin development projects, primarily because of the number of agencies and organizations involved. There is a need to bring all supporting services in a combined operation and with joint participation and funding to incorporate the necessary community health protection. Now, that primary health care has been recognized and accepted internationally as an approach to the solution of health problems through a multidisciplinary and multisectional collaboration and with an active participation of the communities; there is a greater urgency for overcoming the problem. This study which is primarily an exploratory descriptive study in nature was undertaken in the Amibara Irrigation Project area of the Awash River Basin in Ethiopia. The purpose of the study was to investigate the existing health care delivery system in the area, to identify the constraints and possibly to suggest solutions within the concept of primary health care approach. Therefore, the organization and administration of health services in the area has been examined with a focus on six health care establishments functioning under three different agencies which include the Ministry of State Farms Development, the Ministry of Health and the Relief and Rehabilitation Commission. The findings indicate that the coverage of the eight essential elements of primary health care in the activities of the health establishments were fragmented and inadequate and do not seem to be planned in view of the health problem and needs of the area - problem of poor sanitation and water supply, malnutrition, malaria and other infectious disposes. All health units provided curative patient care, individual counselling, delivery care for expectant mother and also involved in the control of schistosomiasis which was instituted by the inter-institutional committee as a pilot project. A very limited services in KCH and family planning, water supply and sanitation, control of endemic disease like malaria and health education were provided. Important programmes like promotion of food supply find nutrition and immunization have not been covered. The major constitution in the delivery of an effective health care was found to be the lack of proper planning, priority setting, inadequacies in logistic, support, community involvement, inter and intra-organisational collaboration which indicate the inadequacy of the institutional and managerial arrangement. Thus indicating the need for re-organisation and re-orientation of the health services along the line of the primary health care approach. Two main suggestions emerge from this study. To strengthen the Nelka Werer Health Centre of the Ministry of Health in terms of trained man-power and budgetary provision in order to enable it coordinate all health services in the area; and also establish a health unit at the farm Enterprise level of the State Farm Ministry for bettor planning, coordinating and evaluating of the activities within its own health establishments and also to enhance the coordination with that of the Ministry of Health. This could be a short term objective and; To establish an adhoc health service for the Awash River basin with branches in the upper, middle (including the study area) and the lower parts for an effective management. This could be considered as a long range objective that may need a policy decision. With this as a basis, an effective and sound primary health care programme can be planned a planned an implemented. Of course the role functions, work and development action to be pursued in health by or through and in conjunction with the Ministry of health need to be clarified so that this health work is properly coordinated with the national health development programme as part of the overall socio-economic development.