ICRC Special Fund for the Disabled (SFD), Annual Report 2001
The ICRC Special Fund for the Disabled (SFD) was set up by the International Committee of the Red Cross in 1983 in response to Resolution XXVII of the 24th International Conference of the Red Cross and Red Crescent.
B. Activities by regional centre
1 - Ethiopia
2 - Viet Nam
3 - Nicaragua
C. Activities in Geneva
The ICRC Special Fund for the Disabled (SFD) was set up by the International Committee of the Red Cross in 1983 in response to Resolution XXVII of the 24th International Conference of the Red Cross and Red Crescent. Its objectives are to:
ensure the continuity of ICRC projects for the war-disabled in countries where the ICRC’s mandate has ceased to apply;
assist the disabled in low-income countries by placing at their disposal the limb-fitting techniques which have been developed for war-disabled persons.
In June 2000, the ICRC Assembly declared itself in favour of converting the SFD into a foundation under Swiss law and of opening up its Board to non-ICRC members.
On 12 January 2001, the SFD was legally constituted and entered in the Geneva Trade Register as a new non-profit-making foundation governed by articles 80 et seq. of the Swiss Civil Code.
The Statutes of the new foundation provide for a board comprising a maximum of 15 members including six ICRC representatives. In October 2001 the SFD Board accepted the application of Mr Sven Mollekleiv to sit on the Board as a representative o f the Norwegian Red Cross, thus making him the first non-ICRC member of the Board. (See list of Board members attached.)
In 2001 the SFD assisted 48 prosthetic-orthotic centres in 25 countries through its three regional centres in Addis Ababa, Managua and Ho Chi Minh City. The assistance, which was organized by SFD expatriates, consisted mainly of orthopaedic components and other equipment, technical advice, further-training modules and, in some countries, administrative support.
Thanks to this assistance, the following number of prostheses were manufactured:
- centres supported from Addis Ababa:
- Vietnamese centres:
- centres supported in and from Managua :
N.B.: the above list does not include orthoses (supports for paralysed persons), which are manufactured without direct help from the SFD.
B. ACTIVITIES BY REGIONAL CENTRE
1 - ETHIOPIA
The ICRC unit currently in charge of physical rehabilitation centres for the w ar-disabled began work in Ethiopia in 1979. Cooperation with the Prosthetic-Orthotic Centre (POC) in Addis Ababa, which is run by the Ministry of Labour and Social Affairs, also dates back to this time.
Given the growing number of activities managed by the SFD, in 1995 it was decided to set up a training centre within the POC's premises. Expatriate and Ethiopian
prosthetists based at the centre carry out yearly technical inspections of former ICRC centres and other prosthetic-orthotic centres in Africa, the Middle East and India.
In 2001 seven month-long courses were arranged for 31 prosthetists from 14 countries: Algeria, Belgium, Canada, Ethiopia, France, Kenya, Morocco, Norway, Sri Lanka, Sweden, Switzerland, Tanzania, Togo and Zimbabwe. The participants included prosthetists from SFD-supported centres and expatriate prosthetists sent to Addis Ababa for training before their first assignment to an ICRC centre.
The courses focused on the practical aspects of the ICRC prosthesis-manufacturing technique based on the use of thermoformable plastics and polypropylene components. Trainees also had an opportunity to review the basic principles of prosthetics and orthotics under the supervision of SFD instructors.
Two Ethiopian students selected in agreement with the University of Addis Ababa began a three-year training programme at the Tanzania Training Centre for Orthopaedic Technology. This school, which was set up in the 1980s with support from the " German Society for Technical Cooperation " (GTZ), is run by the Ministry of Health. Some students received grants through the " United States Agency for International Development's Patrick J. Leahy War Victims Fund " (USAID - P.J.L.W.V.F).
(c) Technical inspections and assistance
In 2001 equipment was provided for 34 centres in 18 countries. Seventeen of these centres in eight countries (Cameroon, Chad, Djibouti, Kenya, Mali, Mauritania, Somaliland and Zambia) were visited and received technical advice by Addis Ababa based SFD prosthetists.
In addition to providing further training, the purpose of such visits was to check the condition of the equipment and to determine what supplies were needed in terms of tools, raw materials and orthopaedic components used to manufacture prostheses such as artificial feet and knees and other fittings. (See attached list of assisted projects.)
( d) Output
According to the figures supplied by 20 prosthetic-orthotic workshops receiving support from the SFD, the output for 2001 was as follows:
prostheses (including 3,079 made of polypropylene) for persons missing lower limbs.
orthoses or support devices for persons with paralysed limbs.
(e) Partnership relations and cooperation agreement with the POC
Each year the SFD redefines its working arrangements with the POC by means of a cooperation agreement.
In accordance with the agreement renewed in November 2001, the two parties will continue working together to assist former ICRC projects and other projects in developing countries by upgrading the skills of the prosthetists involved and ensuring that the disabled can acquire orthopaedic appliances of a quality that represents good value for money.
In order to achieve these goals, the POC undertook to:
let the required buildings to the SFD;
make available to the SFD two Ethiopian prosthetic-orthotic technicians who will work as assistant instructors and carry out regular technical follow-up missions;
take part in selecting Ethiopian candidates to be trained in Tanzania;
provide accommodation for patients fitted by students within the framework of the SFD training.
The SFD, for its part, undertook to:
cover the cost of maintaining the buildings it uses and pay the salaries of Ethiopian SFD staff members;
cover the cost of training foreign students and of accommodating patients who make themselves available for these students;
share with the POC the technical improvements made within the framework of training activities;
pay the living expenses of Ethiopian trainees in Tanzania (USAID defrays their tuition fees);
purchase from the POC the orthopaedic devices not imported by the SFD.
( f) Support for ICRC programmes
The SFD coordinator also managed ICRC projects in Mekele, Harar, Dessie and at the POC for people disabled in the recent conflict between Ethiopia and Eritrea. At the end of the year, however, it was decided to run SFD and ICRC projects separately since it would be easier to manage them this way.
2 – VIET NAM
This programme was set up to serve the large number of war amputees in Viet Nam (currently estimated at around 60,000). It covers two periods:
1988-1995: this period was financed out of the ICRC’s operational budget;
1996- 2001: this period was financed by the SFD in accordance with the agreements signed with the Ministry of Labour, Invalids and Social Affairs (MOLISA).
During the first period the aims were to:
supply amputees in the southern provinces with prostheses;
set up a unit for manufacturing prosthesis components at the physical rehabilitation centre in Ho Chi Minh City.
During the second period the aims were to:
give “destitute” amputees (i.e. those not in receipt of State support) access to physical rehabilitation by assuming the cost of manufacturing their prostheses;Around 30,000 destitute amputees live in the southern provinces, 12,000 of whom are within the catchment area of the rehabilitation centre in Ho Chi Minh City; the remaining 18,000 receive treatment from the other centres in Can Tho, Quy Nhon and Da Nang.
introduce the ICRC prosthesis-manufacturing technique based on the use of polypropylene to other MOLISA centres in Da Nang, Can Tho, Quy Nhon, Vinh and Thanh Hoa;
improve the quality of the prostheses and components manufactured at the centre in Ho Chi Minh City;
enable prosthetists from the six MOLISA centres to receive further training in the basic principles and subject areas (anatomy, biomechanics and alignment) of prosthetics and orthotics. In addit ion, the SFD bore the costs of a three-year training programme for two students from Ho Chi Minh City at the MOLISA school in Hanoi (VIETCOT), which is supported by the GTZ.
(b) Activities in 2001
A quota system was set up giving priority to women and children.
Work continued on introducing the polypropylene technique to the five centres referred to above. The Da Nang and Can Tho centres have now acquired a considerable degree of autonomy in this area.
A pilot project involving the Vietnamese Red Cross and the Da Nang prosthetic-orthotic centre was launched in August, the aim being to register destitute amputees in the six provinces served by the centre and to ensure their transport there. In the last five months of 2001, the Da Nang centre manufactured 337 prostheses and registered 327 destitute amputees.
The Da Nang Red Cross has 1,000 young volunteers available to ensure that these patients receive good aftercare.
The SFD head of programme limited the number of prostheses produced at the centre to 60 per month, placing the emphasis on quality rather than on quantity. The cost
of the prostheses, which are reimbursed by the SFD, averages out to US$ 60 per patient, including ancillary services, transport and accommodation.
In addition to the two students from Ho Chi M inh City, a student from the Kon Tum prosthetic-orthotic centre also began a course of training at the MOLISA school in Hanoi with a grant from the SFD. The Kon Tum centre, which is supported by the Swiss NGO " Nouvelle Planète " , manufactures orthopaedic appliances for disabled members of the ethnic minorities who live in the central highlands.
Two expatriates worked for the SFD programme in Viet Nam in 2001.
(b) Support for ICRC programmes
The head of the Viet Nam programme did two missions to Myanmar and North Korea, spending around two weeks in each country.
All categories (including destitute patients)
Destitute patients only (paid for by the SFD) 1992-2001
3 – NICARAGUA
In 1984, in conjunction with the Ministry of Health, the ICRC set up a physical rehabilitation centre in Managua for the many peop le who lost limbs in the civil war. At the same time it launched a training programme.
In 1988, after a three-year course of training, 12 Nicaraguan students passed the final examinations, which were held under the supervision of two representatives from the " International Society for Prosthetics and Orthotics " (ISPO).
In 1993 the Ministry of Health took over the centre, known as the " Centro Nacional de Producciòn de Ayudas Tecnicas y Elementos Ortoprotésicos " (CENAPRORTO).
From 1984 to 1993, CENAPRORTO manufactured 2,901 prostheses for 1,709 amputees.
Since the ICRC's withdrawal, the SFD has been carrying out yearly technical inspections.
In 1999, after an external audit revealed management difficulties, the SFD decided, in agreement with the Ministry of Health, to renew its involvement with CENAPRORTO in order to carry out an administrative and technical reorganization of the centre according to a division of labour set out in a cooperation agreement signed in February 2000.
In 2000 this agreement made it possible to:
standardize and reorganize administrative tasks, in particular by computerizing the accounts and patient records;
reduce the number of employees (from 41 to 31) and appoint a new director;
renovate the premises;
improve the output of the workshops and especially the manufacture of prostheses by setting up a quality-control system and using ICRC components to guarantee the best value for money;
upgrade employee skills by organizing further-training modules.
(b) Activities in 2001
In July the Ministry of Health and the SFD agreed to the principle of setting up a local foundation as a means of ensuring the future of the project.
Through its various branches, the Nicaraguan Red Cross was asked to set up a network to identify amputees and register them in Managua.
The SFD gave grants to two students so as to allow them to take a three-year professional training course at Don Bosco University in San Salvador, which receives technical support from the GTZ. The two students have successfully completed the first year of their course.
Cooperation with other centres in Nicaragua and in neighbouring countries:
The SFD supplied orthopaedic components for the NGO " Walking Unidos " in Leon and for the prosthetic-orthotic centre in La Trinidad, run by the Ministry of Health and supported by " Handicap International " .
Four prosthetists from Guatemala, El Salvador and Honduras took a one-week course in the polypropylene technique at CENAPRORTO.
CENAPRORTO arranged for three prosthetists to take part in an internet training course given by the " Centre for International Rehabilitation " in Chicago.
Material assistance was provided in Colombia, Ecuador, El Salvador and Guatemala.
A student from the foundation for " Reconstructive Surgery " in Bogota (an SFD partner) completed a three-year training programme (ISPO Category II) in prosthetics and orthotics paid for by the SFD.
A cost-accounting analysis showed that the reorganization had led to a 20-60% cut in the cost of prostheses. For example:
Below-knee prosthesis: Sfr. 434 (2001 prices), Sfr. 593 (1998 prices).
Arm prosthesis: Sfr. 641 (2001 prices), Sfr. 1,870 (1998 prices).
Following this second year of renewed SFD involvement, CENAPRORTO registered 119 new amputees and manufactured 498 prostheses (including replacements ). It also registered 672 new paralysed persons and manufactured 1,026 orthoses (including replacements).
New patients for prostheses
New patients for orthoses
ICRC - 1984 -1993
SFD - 1994 - 2000
The following people worked at CENAPRORTO in 2001:
two expatriate prosthetists, including one Argentinian consultant (for six months);
one management consultant who visited the centre for one week on four occasions to advise on the administrative reorganization and work on the plan to set up a local foundation.
C. ACTIVITIES IN GENEVA
The SFD Bureau regularly monitors activities in the field and takes operational decisions based on proposals submitted by the director. The latter i s in permanent contact with SFD managers in the field and with the SFD's local partners. He harmonizes SFD activities with ICRC physical rehabilitation projects, drafts instructions and documents for the meetings of the Bureau and the Board and manages expatriate staff together with the ICRC Human Resources Division.
In 2001 the SFD Board held two meetings.
On 31 January:
the Board discussed issues relating to SFD funding, in particular the contribution from the Norwegian Red Cross and government;
Dr Jacqueline Avril, a Board member, reported on her trip to Nicaragua, where she had talked over the plan to set up a local foundation to ensure that CENAPRORTO could eventually become autonomous;
the Board agreed to hire a part-time secretary/assistant, who took up her duties in May.
On 29 October:
the Board approved the 2002 budgets;
it also approved a new project to help the NGO Bangladesh Rural Advancement Committee set up a prosthetic-orthotic workshop with funding from the " Pro Victimis Foundation " in Geneva;
Mr Sven Mollekleiv was coopted onto the Board as a representative of the Norwegian Red Cross;
Mr Jean de Courten introduced Mr Andreas Lendorff, a new Board member appointed by the ICRC Assembly. Mr Lendorff was also appointed a member of the Bureau, where he will deal with fundraising matters.
The SFD Director travelled to Nicaragua, Viet Nam and Ethiopia. He also visited the headquarters of the Norwegian Red Cross with the SFD President to discuss funding and other issues.
N'Djamena / Kabalaye
Addis Ababa / P.O.C.
Nairobi / Kangemi
Nairobi / Kenyatta National Hospital
Nairobi / Kenyatta Medical Training College
Nairobi / Kikuyu Rehabilitation Centre
Damascus / Palestinian Red Crescent
Managua / CENAPRORTO
San Salvador / Don Bosco University
Bogota / CIREC
Ho Chi Minh City
Jean de Courten, SFD President and member of the ICRC
Françoise Krill, Deputy director of ICRC Operations
Sven Mollekleiv, Representative of the Norwegian Red Cross
Yves Etienne, Head of Assistance division
Andreas Lendorff, Consultant
Christian Saugy, Representative of the ICRC Finances and Administration division
Theo Verhoeff, Head of the ICRC Physical Rehabilitation Unit