"Health & Medical News"

One of the Millennium Villages is just down the road from Mbarara.  I have known this, kind of, since my first visit to western Uganda in 2005.  But this past Sunday several of us, led by a friend working for the UN in Mbarara, drove the hour or so up a tortured dirt road into the highlands of Isingiro district where residents with assistance from various local and regional governments and international funding, are working to improve their way of life. 

The drive through hilly farm country was striking - deep green banana farms planted to the base of lighter green grass hills; wattle and cement homesteads dotting the red dirt roadside.  Near the Millennium Villages pilot, the road rose quickly, I had to shift into low gear and creep up to the ridge road that took us to Ruhiima.  The air was cool along the ridge road and the views of distant gray storm clouds, green valley farms, and everywhere cultivated land was impressive.  Small farms of banana, cabbage, potatoes, beans, and other produce were planted on the hillsides.  Homes were often located on hilltops, requiring someone to do a lot of climbing when fetching water.  Well kept, graded dirt roads connected villages and farms. 

We visited a tree nursery, an improved water spring, a recently constructed health clinic, a telecommunications center, and a renovated primary school.  The core ‘village’, referred to as MV1 by the UN staff, has about 5000 residents and a prospective cohort of 300 volunteer households enrolled in rather intense observation. The intervention area surrounding MV1 is called, well, MV2 with roughly 45,000 residents and subject to less frequent research efforts. 

We were clearly on the visiting dignitaries loop but it was great to finally see the place.  I was struck by what I heard about the community involvement in each of the projects - the Millennium Village felt like the Peace Corps on a serious funding kick.  The requirement for some level of community contribution, the community members’ planning meetings, and the focus on incremental but important improvements to the agricultural economy were familiar in tenor (though far larger in scale and scope) to what Peace Corps volunteers have attempted with neighbors and friends in many places (check out the PC Partnerships grant program).  There have been multi-year integrated rural projects coordinated by Peace Corps volunteers in the past with mixed results.

The project is premised on making large-scale changes in social behavior.  The primary school, for instance, has a new feeding program.  In the first year, the MVP procures beans and rice with an agreement from parents and perhaps other residents (in our quick visit it wasn’t clear who was involved) that in each succeeding year, local farmers will contribute increasing percentages of food until they shoulder the full responsibility by the end of the program’s fifth year.  The assumption that the local residents would take on greater involvement over time was built into every improvement we visited. This can be a weak assumption largely conditional on a culture of effective leadership.

From where I stood in the village, the development efforts looked like what we would expect from any good government investing in the common weal.  [Also brought to mind this JAMA article (”Informing Resource-Poor Populations…“) on the health effects of simply educating villagers about existing government programs.]  The inevitable question followed - how long will it all continue after external funding ended?  The answer passed by then in the form of a flatbed truck heavily loaded with green bananas.  There is a good deal of local commercial agriculture.  “Matooke” banana are cultivated everywhere and sold to middle-men who truck the green fruit to urban centers (Kampala for the most part) in drier eastern Uganda where less bountiful rains inhibit matooke production. You can see where a broad-spectrum but geographically focused investment in the inputs of development has the potential to strengthen long-term economic links like the matooke trade and dairy production far beyond the borders of the Millennium Village.

There were a couple of other threads that came to mind during the visit. 

1. Vertical versus horizontal programs.  For a great discussion on this in the context of global health, see the CGD blog (”Should All Vertical Programs Just Lie Down?“). Standing at the improved water source with locals proudly telling us the water was now clean while children harvested huge cabbages on the drainage slopes downstream, it was clear what it means to have functional water systems, a school with a teacher and involved parents, and a newly hired doctor at a renovated health clinic all at once.
 
2. Policy makers have been drawn to ‘clusters-as-catalysts’ in other settings including ‘village-based’ counterinsurgency strategies.  Bad metaphor for the MV effort… but does this cluster strategy work in security or development?

Popularity: unranked [?]