ICRC Special Fund for the Disabled (SFD), Annual Report 2001

 

     

 A. INTRODUCTION  

    

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:	3,755 prostheses
- Vietnamese centres:	2,404 prostheses
- centres supported in and from Managua :	498 prostheses
Total	6,657 prostheses

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  

 (a) Overview  

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.

 (b) Training  

    

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:

3,755	prostheses (including 3,079 made of polypropylene) for persons missing lower limbs.
5,321	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  

    

 (a) Overview  

    

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.

 (c) Statistics  

    

All categories (including destitute patients)    1988-2001			Destitute patients only (paid for by the SFD) 1992-2001
Period	New patients	Prostheses manufactured	Period	New patients	Prostheses manufactured
1988-1995	11,046	12,633	1992-1995	5,562	5,676
1996-2000	5,626	9,947	1996-2000	4,119	4,843
2001	866	2404		590	1228
(1988-2001	17,538	24,984		10,271	11,747)

    

 
   

 3 – NICARAGUA  

 (a) Overview  

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).

 (c) Statistics  

    

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).

Period	New patients for prostheses	Prostheses manufactured	New patients for orthoses	Orthoses manufactured
ICRC - 1984 -1993	1,709	2,901	4,677	8,032
SFD - 1994 - 2000	644	2,224	4,697	12,691
Année 2001	119	498	672	1,026
Total	2,472	5,623	10,046	21,749

 (d) Staff  

    

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.

 
 
 
 

 Annexe 1  

 
 

No.	Countries	No.	Projects
	From Ethiopia
1	Cameroon	1	Yaounde
2	Chad	2	N'Djamena / Kabalaye
		3	Moundou
3	Djibouti	4	Djibouti
4	Ethiopia	5	Addis Ababa / P.O.C.
5	India	6	Vellore
6	Kenya	7	Nairobi / Kangemi
		8	Nairobi / Kenyatta National Hospital
		9	Nairobi / Kenyatta Medical Training College
		10	Nairobi / Kikuyu Rehabilitation Centre
		11	Lokichokio
7	Lebanon	12	Sidon
		13	Beit Chebab
		14	Tripoli
8	Mali	15	Bamako
		16	Kayes
		17	Sikasso
		18	Ségou
		19	Mopti
		20	Tombouctou
		21	Gao
9	Malawi	22	Blantyre
10	Morocco	23	Oujda
11	Mauritania	24	Nouakchott
12	Nigeria	25	Enugu
		26	Uturu
13	Somaliland	27	Hargeisa
14	Syria	28	Damascus / Palestinian Red Crescent
15	Tanzania	29	Moshi
16	Yemen	30	Sanaa
17	Zambia	31	Lusaka
		32	Ndola
18	Zimbabwe	33	Harare
		34	Bulawayo
	From Nicaragua
19	Nicaragua	35	Managua / CENAPRORTO
		36	Léon
		37	Trinidad
20	El Salvador	38	San Salvador / Don Bosco University
21	Colombia	39	Bogota / CIREC
22	Ecuador	40	Quito
23	Guatemala	41	Guatemala City
24	Honduras	42	Tegucigalpa
	From Vietnam
25	Vietnam	43	Ho Chi Minh City
		44	Can Tho
		45	Qui Nhon
		46	Danang
		47	Vinh
		48	Than Hoa

    

 
 
 

 Annexe 2  

 
 

    

• 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