WHO STUDY ON ELECTRICITY SUPPLY IN BLOOD TRANSFUSION CENTRES AND COUNTY HOSPITALS
WHO, with help of an international industrial engineer, recently conducted a study on electricity supply in national and provincial blood centres and some county hospitals during February 2003. The purpose of the study was to see how new equipment can be best installed in health institutions, taking in consideration the existing energy problems.
The study, which was in support of an ECHO funded project to strengthen blood transfusion services in the DPRK, revealed that prior to determining the type of medical equipment that should be provided to health institutions, organisations must address a number of problems. How appropriate is the equipment given the energy supply problems in the country? How do we ensure the equipment is installed and maintained correctly? How do we ensure adequate electricity for the equipment once it is installed?
The study revealed that even if the equipment was appropriate, unless it was installed correctly, it could be damaged, used improperly or simply left unused by the hospital for the want of electricity. It was also noted that problem of electricity supply did only refer to the quantity of available energy, but also its quality. Both aspects must be carefully considered in all projects that include electric powered machines, from the planning stage to the final installation of the equipment.
From the quantitative point of view, the lack of energy is the main reason for unused or under-utilised electrical medical equipment. Even though some aid organisations have been reluctant to provide generators, it has been identified that a generator is necessary in many cases to maximise the effectiveness of the equipment. When providing generators, organisations should also ensure that the right type of generator is provided.
The type of generator provided will depend on the quantity and quality of available electricity, generator fuel and the type of equipment being supported. During the study, various county hospitals in different provinces were asked to define their electricity needs. Large differences were reported in energy availability, from relatively regular supply to no electric supply at all. As a general rule, agricultural, isolated and flat regions have worse electric supply (but have access to more fuel) than industrial, mountainous and accessible regions.
The quality of the electric supply, such as unstable frequency and voltage, impose additional complications on programme staff when assessing the type of equipment that should be supplied to hospitals. In the long term, the poor quality of the electrical supply greatly reduces the life of the equipment. In the short term, it creates a high dependency on fuel if the generator is to function correctly. In the facilities that obtain sufficient electricity from the electrical grid, it is also essential to install electric devices that can enhance the voltage, such as transformers or stabilisers. These hospitals might also need a backup generator for emergency cases. It should be noted that a high power generator, with resultant high fuel needs, is not required. Large kilowatt consumers, such as autoclaves and water heaters, can be operated during the hours of regular supply.
As part of the WHO study, recommended specifications have been produced for electrical equipment based on the differing conditions of the main electrical supply.
The main conclusion of the study is that medical equipment, which is provided to DPRK, must be adapted to the existing energy situation. This may include the provision of an appropriate generator to ensure effective use of the equipment. WHO would like to cooperate with other agencies to find optimal solutions that ensure that the most basic services can be delivered in hospitals.
For further information on the study please contact: Dr.Eigil Sorensen, WHO Representative to the DPRK (Sorensen@whosea.org).
UNICEF AND PARTNERS - ENSURING THE AVAILABILITY OF VERY VITAL MEDICINES TO TREAT LIFE THREATENING CHILDHOOD ILLNESSES
So far in 2003, "very vital" medicines have been delivered to eight of the twelve provinces and cities of the DPRK. Deliveries to the remaining four provinces will be completed in March. UNICEF now supports the provision of "very vital" medicines to over 2,000 health facilities countrywide. IFRC complements UNICEF activities by distributing essential medicines to over 1,700 health facilities in accessible areas not covered by UNICEF.
With UNICEF support, the Ministry of Health's logistics system is improving, and deliveries to health facilities are now more regular and follow an annual delivery plan. Deliveries to the most distant provinces in the northeast of the country are by UNICEF's own transport. Full details of the 2003 annual delivery plan, the current health facilities coverage plan and the types of medicines provided are available from the UNICEF office.
HEALTH AND NUTRITION
Immunisations continue for children and pregnant women. In spite of the cold weather, vaccination services continued to be offered over the winter months in most parts of the country. Further upgrading of the national system for proper storage and handling of vaccines (the cold chain) is a priority for 2003. Although much of the country's cold chain equipment has been replaced over the past five years, more needs to be done to ensure that vaccines for the country's 470,000 infants and 480,000 pregnant women, each year, are potent and safe at the time of vaccination. A UNICEF technical assistant to the Ministry of Public Health arrived in country in January and is now providing both formal and on-the-job training for six months this year.
UNICEF Field visits. UNICEF staff undertake field visits to health facilities, children's institutions, primary schools, nurseries and other specific project sites in all of the 12 provinces/cities countrywide. So far in 2003, UNICEF staff have made monitoring visits to four of the 12 provinces / cities countrywide. Main findings are:
- Acute respiratory infections (pneumonia) and diarrhoea are still the most common illnesses in children.
- Moderate malnutrition is widespread, severe malnutrition is seen - these field observations are consistent with the findings of the recent nutrition assessment.
- Health clinics have very vital essential medicines for treatment of children's illnesses until April.
- Paediatric hospitals and baby homes have stock of high-energy therapeutic milk for the treatment of severe malnutrition until May.
- All institutions report fewer hours of electricity compared to this time last year.
ADRA - NEW SURGERY FOR SARIWON PAEDIATRIC HOSPITAL
ADRA DPRK has recently begun construction of a new Surgical Building for the Provincial Paediatric Hospital in Sariwon, North Hwanghae. The new surgical building will be located in the center of the hospital grounds and will be surrounded by the wards, and the dentistry. It will contain two operating rooms to cater for both internal and dirty-wound operations.
The most unique feature of the surgery will be the insulation method. Due to extremely harsh winter conditions, the operating theatres can face sub-zero temperatures making it very difficult for the surgeons to operate safely and effectively. The building will be constructed with double layer outer walls and insulated with burnt rice-shell ash. Burnt rice-shell ash is a traditional insulating material that is common to the DPRK. The process of burning or scorching the rice-shell accomplishes two goals; firstly it prevents the material from absorbing moisture, and secondly it prevents insects and animals from inhabiting it.
The FDRC is supporting this project by providing the labour for construction as well as sand, stone, and insulation material for the building. Currently the foundation is in the process of being dug. The entire project is expected to be completed by July 2003.
UNFPA - NEXT COUNTRY PROGRAMME
The UNFPA Country programme outline development mission paid a visit to DPRK during 8 - 15 February. The next country programme will be the fourth cycle of assistance for DPRK for the period of 2004-2006. The outline is based on The Common Country Assessment and Consolidated Appeal Process 2003, Mid-Term Review and Annual Review recommendations, consultations with the government, UNICEF, WHO, UNDP, WHO, OCHA, WFP and International Federation of Red Cross. This is to ensure mutual understanding and harmonization of the programme content.
Furthermore, consultation was also made with Executive Board members during the programme development process. Partners have pointed out the leading role that UNFPA could play in the Reproductive Health area.
The three main aims of the programme will be:
- Reduction of maternal mortality through provision of Reproductive Health services including maternal and newborn care, Family Planning services, and treatment of RTI/STI.
- Improved access for beneficiaries to essential Reproductive Health commodities through harmonization of donor efforts both in terms of commodity provision as well as logistics for their delivery.
- Enhanced capacity for collection and analysis of data to better monitor health delivery, including RH services.
The programme is also complementary with two of the health sector objectives of the CAP 2003, which are to:
- Strengthen the capacity of the health system to deliver essential services with an emphasis on the treatment of priority women and child illnesses.
- Strengthen the capacity of health services to provide access to improved basic and emergency obstetric care.
The programme area will be in South Hamgyong and Kangwon in the east and South Phyongan Province in the west. The Country Programme Outline 4 will be submitted to The Executive Board Session in June.
The mission was composed of UNFPA Country Director for DPRK, Ms. Siri Tellier, based in Beijing, Dr. Katherine Ba Thike and Dr. Jayanti Tuladhar from UNFPA Country Services Support Team, Bangkok and Mr. Yu Yu, Programme Officer from UNFPA Beijing.
IFRC HEALTH CARE
Activities conducted by the IFRC health team in the period included:
- 5,824 basic drug kits, which were donated by ECHO for the 1st quarter 2003, were distributed to the health institutions responsible for Primary Health Care for inhabitants in 44 cities/counties of South Pyongan, North Pyongan, Jagang provinces and Kaesong municipality in January-February 2003. The other seven counties located in remote areas received the basic kits for the 1st quarter at the end of last year.
- 1,905 household doctor kits, which were purchased with funds from the German and Netherlands Red Cross, were distributed in January-February 2003 to household doctors in 1,759 health institutions.
- 1,515 safe delivery kits, 51 county hospital kits, 158 Ri hospital kits for institutions, and 1306 ri clinic kits, which were donated by the Canadian and Australian Red Cross, were supplied to obtain better quality of maternal care at community levels.
- Review and revision of training materials were conducted for the workshops on the topics of prevention of water-borne diseases, malaria, Acute Respiratory Infections and Tuberculosis (ARI/TB), aseptic techniques, rational drug use and safe delivery planned for 2003.
WATER AND SANITATION
Water and Sanitation -UNICEF Report Good Progress
Good progress is reported by the UNICEF-supported water and sanitation programme. The programme continues its focus on a number of selected counties for greater impact. Rehabilitation of town and rural water supplies is underway in three focus counties in Kangwon and South Hamgyong provinces. Piped water systems are being replaced; bore-wells are being drilled in institutions. Seventy-two small-scale institution based sanitation projects are nearing completion.
Activities conducted by the IFRC water and sanitation team in the period included:
- Monitoring arrival of cement for Ecosan Latrines in 4 Health Institutes and 1 village.
- Collected information on the incidence of water borne diseases from Ri clinics/hospitals in 30 villages was collected
- A watsan training workshop, which mainly focused on sanitation, was conducted in N. Pyongan Province. 40 people from 8 counties participated in the workshop.
UNICEF - CONTRIBUTIONS TO CAPACITY BUILDING
UNICEF Supports Overseas Study Visits and Technical Assistance
In January a five-member team from the Ministries of Foreign affairs, Public Health, City Management and Education, together with UNICEF senior staff, undertook a two-week study visit to Cuba to look at UNICEF-Government of Cuba cooperation and Early Childhood Development programming in particular. As a result, changes are anticipated in child care policies, emphasizing greater parental responsibility, involvement and capacity building.
A four-member team from the Ministry of City Management, together with UNICEF project staff, traveled to China and Vietnam for two weeks from February 14. In China the team spent time learning about WES item technical specifications. In Vietnam the focus was to learn about approaches to decentralized planning for improving rural water supply and community participation.
UNICEF is currently providing specific technical assistance to the Ministry of Health's national immunisation programme to upgrade the cold chain (Phase 1: January - April). Technical assistance will be provided in March to the Ministry of Public Health in Breastfeeding Management as part of the renewed effort to promote and protect breastfeeding in the DPRK.
UNICEF's approach to capacity building in the DPRK combines a number of key components:
- agreement on a well-prepared medium term action plan to build capacity rather than ad-hoc training events,
- overseas training or specially prepared study visits for key officials increasing exposure to international developments and standards,
- in-country technical assistance, and
- support for assessments/studies.
The Government-UNICEF programme plans of action for 2003 were completed in January, and signed on February 10. Copies are available upon request from UNICEF. As last year, plans are output based and developed using a logical framework approach.
On March 10, the Government and UNICEF will hold a country programme strategy meeting, to review draft plans for cooperation over the period 2004-2006. The UNICEF Regional Director for East Asia and the Pacific will attend the strategy meeting, as well as UNICEF's main partners in the DPRK.
EDUCATION - UNICEF PROVIDES BASIC STUDENT MATERIALS FOR 1,500 SCHOOLS
Distribution of basic school materials - including pencils, rulers, erasers - and textbooks using 2002 contributions is now being completed in advance of the new school year, which begins on 1 April.
The project provides support to over 1,500 primary schools- mainly primary schools in the northeast of the country. For the first time since 1988, all 14,500 kindergartens countrywide have recently received reprinted textbooks through the project.
AGRICULTURE - TRIANGLE G.H. SUPPORT TO ENVIRONMENTAL PROTECTION
In March 2003, Triangle GH will start a forestry and environmental protection project in South & North Pyongan and South & North Hwangae Provinces. This one-year project, funded by the Swedish International Development Cooperation Agency (SIDA) is an integrated project for tree nurseries rehabilitation and environmental protection that will concern 5 tree nurseries at the county level. Attention will be focused on both the nurseries and the transplanting areas in order to improve erosion control and production of fuel wood and fodder. Staff training and capacity building will be strongly developed with the organisation of a study tour in China and local workshops for the Heads of the targeted tree nurseries.
FOOD AID - WORLD FOOD PROGRAMME
Due to the shortfall in donations, in February WFP was not able to provide food aid for up to 2.9 million vulnerable people, including children in nurseries and kindergartens, primary school children, pregnant/nursing women, elderly people, and caregivers in child institutions. Cereal distributions to children in nurseries, kindergartens and pregnant and nursing women, which were suspended in some regions late last year, will resume only after the middle of March until the arrival of the 46,000 mt (ECHO contribution) shipment.
With the arrival of the ECHO contribution, food distribution needs for all beneficiary categories - pregnant and nursing women, children in orphanages, nurseries, kindergartens and primary schools, the elderly and caregivers at children's institutions - will be met through April.
However, if no new contributions are received by then, distributions will again need to be cut from May onwards. Food-for-work project food allocations for the spring season have been curtailed to about 70% of that planned as resources dwindle.
In February, cash contributions were received from the governments of Australia (USD 1.76 million) and Norway (USD 900,000). Both will be used for the purchase of wheat.
However the outlook for the second half of the year remains grim. WFP's emergency programme remains heavily under-funded for all commodities in the latter half of the year. It is imperative that additional donor contributions, including cereals, pulses, Corn Soya Milk, oil and sugar, are confirmed as soon as possible to cover the third and fourth quarters.
To avoid worsening the widespread hunger and malnutrition in the country, donor contributions for about 77,000 mt of food are urgently required to cover the operation for the first half of 2003. In addition to 60,000 mt of cereals, requirements also include powdered milk (2,200 mt), CSM (8,000 mt), sugar (600 mt), pulses (6,000 mt), and oil (800 mt).
Nutrition Survey Report released
According to the Nutrition Survey results announced on February 20, 2003, malnutrition among children in the DPRK has been reduced significantly over the past four years. The field portion of the survey was carried out in October 2002 after the DPRK government agreed to a follow-up survey, with the participation of UNICEF and WFP, to that conducted in 1998. WFP staffed the majority of the survey teams with its international and national Emergency Officers.
The survey covered children under seven years of age and their mothers, from 6,000 randomly selected households in 10 of the country's 12 provinces and municipalities. The youngest child from each household was weighed and measured, and the mother's nutritional condition was assessed. In addition, questions were asked about factors that could influence nutrition, such as food availability, child feeding and care, and health status.
Although the new assessment is not strictly comparable with the 1998 survey, clear positive trends are discernible:
- The proportion of children underweight (weight-forage) has fallen from 61 percent in 1998 to 21 percent in 2002.
- Wasting, or acute malnutrition (weight-for-height), has fallen from 16 percent to 9 percent.
- Stunting, or chronic malnutrition (height-for-age), has dropped from 62 percent to 42 percent.
The assessment also provided the first objective analysis of differing vulnerability across the country. Stunting among children in Nampo City was 25 percent, for example, compared to 48 percent in South Hamgyong Province. The wasting rate in Pyongyang, the capital, was just under 4 percent, against 12 percent in South Hamgyong. The survey found similar patterns in food availability and the incidence of childhood diarrhoea. A further important finding was that about one-third of mothers are malnourished and anaemic.
Though child malnutrition has fallen considerably, the UN agencies believe there is still cause for great concern and that gains could be lost if international support for humanitarian assistance to the country continues to decrease. According to World Health Organization criteria, the underweight rates are still "high", and the stunting rates are "very high." Moreover, the recent slump in external donations for food, medical and other assistance could compromise the gains.
A joint UNICEF/WFP presentation of the results of the Nutrition Survey was made to the resident humanitarian community and WFP staff after the release of the report.
WFP Conducts Nutrition Workshop
Two nutrition workshops were conducted in Pyongyang by staff from the WFP Regional Bureau in Bangkok, Ms. Judit Katona-Apte and Ms. Anette Haller, during the month. WFP international and national staff attended the workshops.
Daily food rations provided by the government through Public Distribution Centers (PDCs) in February remained at 300 grams/person/day, similar to that in the last quarter of 2002. Distributions at this level are expected through March.
WFP - Monitoring and Access
All WFP sub-offices were operational in February, as the Hyesan office in Ryanggang province re-opened for regular monitoring activities. Though Food For Work activity was less in February compared to one year earlier, monitoring visits have increased by about 15%. Further, Emergency Officers have increasingly been able to observe food distributions in PDCs.
Monthly Monitoring Visits
Access as at end February 2003
Of the remaining 17 incomplete long-term projects from the autumn 2002 season, 6 FFW projects were monitored during February. Due to resource constraints, only 24,000 mt of food has been allocated for the 2003 spring season, about 70 percent of the planned tonnage.
East coast provinces were allocated 18,000 mt and west coast provinces 6,000 mt. In total 91 FFW project proposals were received from the government by the end of February.
Two FFW workshops were conducted from February 4 to 12 for provincial and local authorities in Kangwon, Ryanggang and North and South Hamgyong provinces. The FFW Unit introduced the prospect of implementing new types of FFW projects: water sanitation, urban activities, community/household food security, and food-for-training. The findings of these workshops are also being used to review the project types proposed for implementation in the coming spring season.
Mr. Rezaul Karim, FFW technical consultant from WFP Bangladesh, is in-country from February 22 to March 8, to assist the FFW unit in developing operational guidelines and revising work norms.
During his review of WFP-assisted FFW activities in the DPRK and field visits, work-norms were highlighted and the feasibility of various new activities assessed. Initial discussions with FDRC on work norms for different project types were also initiated.
A meeting was held with Mr. Ralph van Gelder of UNOPS on IFAD's Upland Food Security Project (UFSP) in Ryanggang and North Hwanghae provinces to discuss WFP's participation through the FFW programme. Preliminary food requirements for assisting tree-planting projects in UFSP areas would be about 1,200 mt for 2003.
Local Food Production
The total output for February was 1,328 mt, with an increase of operational factories from five at the beginning of the month to fifteen during the last week of February as factories began to receive wheat and DSM (powdered milk). The latter was reallocated from the CSM/CMB (corn soya milk/ cereal milk blend) factories after recipes were (temporarily) changed to exclude DSM. Those factories will now produce CSB (corn soya blend) and CB (cereal blend). From the beginning of March, all 18 factories are expected to be operational.
ADRA Switzerland's contribution of 27 mt of skimmed milk powder to WFP's RMB (rice milk blend) production was received in the month.
Caritas Hong Kong is looking at possibilities to provide 100 mt of DSM and 600 mt of sugar for WFP's LFP facilities. 100 mt of canned meat for pregnant and nursing women and children in orphanages in the north east of the country may also be included.
The Caritas donation of 2,200 mt of rice arrived at Hungnam port in February, for distribution to kindergarten children in the east coast provinces. The ration, 300 grams/day/child will last for about 38 days.
A total of 6,091 mt of food arrived in February (excluding FALU):
- 2,886 mt of pulses (USA) arrived on the MV Hua Sha at Nampo port.
- 2,000 mt of wheat (Luxembourg) arrived at Sinuiju by rail from Dalian, China.
- 151 mt of sugar (Australia) arrived at Sinuiju by rail from Dalian, China.
WFP WELCOMES NEW AID FOR NORTH KOREA BUT WARNS OF CONTINUING SHORTAGES
(Press release 4 March 2003)
PYONGYANG - The World Food Programme today welcomed recent pledges of assistance for its 2003 emergency operation in the Democratic People's Republic of Korea, but urged donors to help plug a continuing shortfall in resources that has left millions of the most vulnerable without vital rations.
"The commitments to date are very important, because they will ensure that many of the children, women and elderly people currently deprived of outside support are fed again", said Rick Corsino, WFP Country Director for the DPRK. "It is also crucial that more contributors come forward quickly, because there is nothing in the pipeline beyond June."
On 25 February, US Secretary of State Colin Powell announced an initial US contribution for 2003 of 40,000 tonnes of commodities, and said a further 60,000 tonnes would be made available if improvements in WFP's ability to access the needy and monitor distributions are allowed. A contribution of 46,000 tonnes of wheat purchased with funds provided by the European Commission's Humanitarian Aid Office is due to begin arriving in the DPRK next week. The targeted beneficiaries are children in nurseries, kindergartens and primary schools, and pregnant and nursing women.
WFP, by far the largest aid agency in the DPRK, hoped to mobilise 512,000 tonnes of food for 6.4 million people during 2003, but deliveries have fallen well short of needs. Additional pledges of more than 325,000 tonnes are required for the remainder of the year. A sharp slide in donations, which began last year, left the UN agency unable to feed 2.9 million of its 4.2 million "core" beneficiaries by end-February, up from 2.2 million in January. "There's no such thing as retroactive feeding", Corsino noted.
WFP primarily targets urban residents who cannot easily obtain food outside the government-run Public Distribution System, which serves some 70 per cent of the 23 million population. This year, the PDS expects to provide an average of no more than 270 grams of food per person per day - less than half a survival ration.
"This is clearly not enough for the average human being", Corsino said. "The situation has been made worse as the cut-off in WFP aid has occurred during the country's harsh winter months when caloric needs increase."
Aid arrivals over the coming weeks will allow a temporary resumption of some distributions, and a re-opening of a number of WFP-supported food factories shut down for lack of donor-supplied ingredients. The recent pledges underscore the distinction donors make between humanitarian imperatives and political considerations, Corsino said, but added that contributors have a right to know their food is reaching the vulnerable.
"While our operating conditions have improved over the years, they are still more restrictive than in other recipient countries. Above all, we are not allowed to carry out truly random spot checks at distribution sites. We raise these issues with the DPRK authorities at every opportunity, and will continue to do so. "
The results of a major survey conducted in October by the DPRK government, UNICEF and WFP, released last month, showed a considerable improvement in child malnutrition rates since the last such assessment in 1998. The proportion of underweight children under seven years fell to 21 per cent, from 61 per cent; wasting, or acute malnutrition, fell to 9 per cent, from 16 per cent; and stunting, or chronic malnutrition, fell to 42 per cent, from 62 per cent.
Food aid targeted to young children and child-bearing women clearly has been critical in achieving these important gains. "It would be a tragedy if they were to be reversed. We sincerely hope donors can keep the pipeline flowing, so that WFP can fully implement its operation for the remainder of the year", Corsino said.
(WFP Press Release - Pyongyang 4 March 2003)
The OCHA Office in DPRK produces this Bulletin on the basis of information supplied by contributing organizations and public sources
Sweden is funding the OCHA Office in 2003
- UN Office for the Coordination of Humanitarian Affairs
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