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Review process
This following review was undertaken on 15-16 February
2004 by an external team (external to the Villingili Island community) consisting
of participants from the Ministries of Health (Mr Ahmed Waheed, Asst.
Under-secretary, MOH, Maldives), Atolls Administration (Mr Mohamed Sameeu,
Director, Ministry of Atolls Administration, Maldives), Urban Development (……..), and the World
Health Organization (Dr Jorge Luna, WHO Representative to Maldives, and Dr
Abdul Sattar Yoosuf, Director/SDE, WHO/SEARO, New Delhi).
The objective of
the review was to identify the relevance and adequacy of programmed
input, the performance in the
achievement of the set objectives, the managerial issues faced in
implementation, learn lessons for the future, and facilitate the island
community set new targets for the next phase of the program.
The review approach
was through a series of actions that included focused discussion with main
community groups (community leaders, women, adolescents, fishermen, business
community, and teachers), by direct observation of action undertaken, and
interaction with the Villingili Healthy Island Coordinating Committee. All this was corroborated in the review
team’s interaction with the main groups in the community through individual
meetings that focused discussions on the concerns in the plan of action and
the outputs it had planned one and a half years ago. Much of the planned
actions in each of the areas were achieved to a significant degree. At the
end of the community group discussion, they were encouraged to give a final
score on a scale of one to ten on how well they perceived the outputs had
satisfied them as a community. The scores ranged from 6 to 10. Most achieved
a score of 7 or more. This indicated a sense of great satisfaction by the
community on the achievements.
Discussion of findings
 The
three defining elements of a healthy settings program are the written plan of
action, the managerial set up for implementation, and the opportunities
presented in the operational mechanism for community participation. These
form the basis of whether the program conforms to a healthy-city-type of
process or one that merely follows a project-type of community development
approach. Other program related aspects that this review also looked at are
community participation/ownership, program management process, resource
mobilization, political ownership/commitment, central level support, and the
promise of program sustainability.
Program
implementation process
The program implementation was carried out very
systematically through forming several community volunteer teams that dealt
with the main issues enunciated in the first workshop – each relating to the
area of concern. Each group prepared elaborate schedule of home visits to
sensitize the community on the various issues. They prepared pamphlets that
elaborated on the issue at hand and made these available to the households.
Community action was generated through this orientation/motivation process.
Actions for addressing the issues and achieving the
various outputs were thought through by the teams assigned for each issue
area. The team leader played a significant part to provide the leadership to
this thinking process and for coordinating the approaches used for getting
the work done. For example the team on water availability worked through the
existing water tanks procurement program open to the Southern Atolls by the
Ministry of Atolls administration. Encouraging the households to invest in
this was the task carried out by the team and facilitating the procurement
process along the program procedures. The team on sanitation encouraged the
community business leaders to take the challenge of laying out a sewer and
then entertaining others to join in the lateral connections. The health group
made effort at households to see that mothers were made aware of the need to
have regular antenatal visits and saw to it that these mothers did attend.
The Healthy Atoll coordinator Mr Mohamed Naseer, functioning from the Atoll
Office in Villiingili provided the overall oversight to program
implementation.
Program performance
– achievement of objectives
This has largely been achieved (see matrix). Issues
endogenous to the community have been discussed and decided in the community.
Where to locate the solid waste dumps; how to advocate for and approach the
issue of solid waste management; the encouragement to grow more fruits and
vegetables, all have been attempted through approaches conceived by the
community. The details on the status of achievement on any given issue area
may be read from the matrix included in this report. The matrix also notes
some of the constraints that appeared exogenous to the community and the
possible targets that may be set for the next phase.
Relevance and
adequacy
 What
is observed here is community perceived operational relevance in its essence.
The selection of such main core issues (as mosquito and fly nuisance, shortage
of storage capacity for drinking water, solid waste disposal, etc) are not
typically what a technically prepared health plan of action would include.
But this is just what a healthy setting tries to promote – the communities’
perception and thus a greater ownership through addressing their perceived
health concerns, not that of a technical community. This way, the solutions
proposed are also typically relevant, and attempts to implement these are
also conceived within the community capacity available. The lesson we learnt
has been that there is a lot the community can do themselves if approached in
this way and that communities may derive encouragement and motivation from
the small successes they score for building a more secure and sustainable community
management system for the future. As noted from the discussion with the
community groups, there appeared to be no internal constraints that were
noteworthy from their point of view
External
(exogenous) constraints: Implementation difficulties faced by the
community are noted in situations where the community could not decide on
legal or technical grounds. Where in the lagoon to locate the fish waste
storage container (for want of technical environmental considerations) or how
to address the mosquito problem rising from the unmanageable mangrove areas
(the technical aspects of biodiversity and environmental concerns) and the
recycling/reusing of waste-water being wasted into the sea from the sewer
outfalls, or how to eliminate the tree disease (technical, agricultural,
environmental/engineering concerns) are such constraining decision
situations. These require the support
(technical, legal) from the centre, such as for the Ministries of Health,
Environment, Planning, Agriculture, etc.
Thus a timely support system (a practical referral system
for problem solving) may need to be well established for optimizing this
operational harmony between the centre and the program site at the island
level. The healthy settings coordination committee at the centre (composed of
MoH, MoAA, Environment, etc) may be a good mediator to flag such issues as
and when they occur and sequester timely support from their technical/legal
sources). Some salient managerial and technical issues faced by the community
in this regard are noted in the matrix.
The healthy island
work-plan: this was well prepared. In simple and uncluttered language so
that the community was able to know what exactly had to be done to achieve
the planned objective/targets. These were tangible, practical and well
indicative of what the completed work should be. The specific outputs planned
for the first year are noted in one column of the matrix provided in this
report.
The managerial
process: The main gamut of responsibility in this Villingili island case
was taken by the island administration and the operational teams that were
formed. The leaders in these were those that took part in the planning
workshop a year ago (in October 2002) and thus had an in-depth understanding
of the work that was being undertaken – ie from issue they identified and
strategies they conceived. The Atoll office assumed a facilitative role but
provided a good degree of independence to the island community for carrying
out the implementation.
Community
participation/ownership: The community leadership provided the way for
others to be involved in the teams and visit households on various task
forces. There were funds generated from the community and the community
assumed responsibility of managing the tasks such as the laying of the sewer
pipes, and managing it, advising and encouraging throwing of garbage and fish
wastes in a sequestered way, agreeing to and helping with the household
ventilation design improvement. Many provided support to get such work done.
The performance of these appears not to have been done through any
administrative instruction (as is usually the case in the island
administrative process in Maldives),
but through the community awareness of the need for these to be health
promoting, or at least through the awareness that life may be better livable
with such action. It appears that much of the action executed were through
some discussion among community leaders. Thus, we may surmise that the
process of public participation and decision making regarding project activities
has been quite effective and there has been a sense of ownership of program
action.
Political
ownership: This has been very much so from the beginning. The WHO
advocacy has been endorsed by the government of Maldives
and they had adopted the healthy settings policy as one of the means for
promoting the southern Atolls Development program. The decision to locate
this initial effort in Villingili island in Gaaf Alif Atoll was a conscious
decision by the Ministry of Atolls administration, given that this atoll has
been reasonably isolated from the mainstream of development work in Maldives.
This program has been endorsed by the Ministry of Health and Ministry of
Atoll administration (as the primary focal points) and the Gaaf Alif Atoll
office hosted the planning workshop in 2002. The then assistant atoll chief
was the main program coordinator assigned for the program.
Support from the
centre for the national initiative: There is political support as in the
above statement. There appears to be good facilitation by these two
ministries. The undersecretary of Mo AA took part in the fist workshop and in
this review process too and encouraged the community to lead on and provided
the go-ahead to expanding the initiative to three more islands also under the
lead coordination of the same Healthy Atoll Coordinator Mr Mohamed Naseer.
There is thus recognition of the potential of this process as a productive
mover of local community. Generally, the Healthy Atoll program enjoys good
support from the Ministry of Health too in that the National Healthy Atolls
program coordinator Mr Ahmed Waheed is from the MOH. Also the Minister of Health, upon being
appraised of the success of this first phase in Gaaf Alif Atoll desired that this
process be emulated for Male island and the next neighboring island
of Villingili in Male atoll also.
This is a good political achievement for the program.
Potential for
sustainability: Very high – given the present involvement by the
community both in the financing and delivery of actions. The enthusiasm may
have to be maintained though through central level recognition of the
community effort and congruent support in facilitating those aspects of
development that the community cannot support by themselves. Regular and
systematic technical backstopping, through making this process an integral
part of the Atoll Ministry’s atoll development process, facilitating
administrative procedures, and giving timely clearances for requests etc.
will sustain the enthusiasm.
Resource
mobilization: This has been a great strength of the program. Several
thousands of rupees have been collected for implementing several of the
activities. Notable have been the financial contributions to laying sewer
pipes and making the fish waste container (koshi). Also the purchase of the
HDP water tanks through the revolving fund of the Ministry of Atolls
Administration -- are financial commitments the community has made towards
improving their health and wellbeing. These small successes may now be noted
for making the case for mobilizing some external resources too in the future
(both from the government and from external donors). The past Maldivian
culture of the community’s collective-pooling of resources for local
development effort has proven to be still intact.
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