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Partnering and Health Development Partnering and Health Development Partnering and Health Development Partnering and Health Development The Kathmandu Connection by Melville Kerr UNIVERSITY OF CALGARY PRESS AND INTERNATIONAL DEVELOPMENT RESEARCH CENTRE © 1996 Melville G. Kerr. Ail rights reserved. University of Calgary Press International Development Research Centre 2500 University Drive N.W. 250 Albert Street, P.0. Box 8500 Calgary, Alberta, Canada T2N 1N4 Ottawa, Ontario, Canada KI G 3H9 Canadian Cataloguing in Publication Data Kerr, Melville G., 1929- Partnering and health development Includes index. ISBN 1-895176-73-5 University of Calgary Press ISBN 0-88936-819-8 International Development Research Centre l. Public health - International cooperation. 2. Medical sciences - Research - International cooperation. 3. International cooperation. 4. Tribhuvan University. Institute of Medicine. 5. Davao Medical School Foundation. Institute of Primary Health Care. 6. University of Calgary. Division of International Development. I. Title. RA441.K47 1996 362.1 C96-910473-l TheAlberta Foundation for the Arts COMMT1TED TO .1THE DEVEWPMENT OF CULTURE AND THE ARTS Financial support provided in part by the Alberta Foundation for the Arts. Ail rights reserved. No part of this work covered by the copyrights hereon may be reproduced or used in any form or by any means - graphie, electronic or mechanical - without the prior permission of the publisher. Any request for photocopying, recording, taping or reproducing in information storage and retrieval systems of any part of this book shall be directed in writing to the Canadian Reprography Collective, 379 Adelaide Street West, Suite Ml, Toronto, Ontario M5V 1$5. Printed and bound in Canada. @ This book is printed on acid-free paper. Contents Acknowledgements ................................................................ vi List of Abbreviations ............................................................. viii List of Photographs ................................................................. ix List of Maps ............................................................................. ix Preface ..................................................................................... xi 1. A Tale of Three Cities 1. Tribhuvan University, Nepal .................................................... 3 2. The Kathmandu Connection ................................................. 19 3. The Costs and Benefits of the Kathmandu Connection ...... 59 4. Davao Medical School Foundation, Mindanao .................... 75 5. The Davao Connection ........................................................ 105 6. The Division of International Development, The University of Calgary .................................................... 125 II. The Ideas of Developing and Partnering 7. The ldea of Developing ....................................................... 147 8. The ldea of Partnering ......................................................... 167 III. The Practice of Health Development and Institutional Partnering 9. The Practice of Health Development .................................. 187 1O. Universities as lnstitutional Partners .................................. 207 11. Official Development Assistance and lnstitutional Partnering ................................................. 225 Postscript ............................................................................... 235 Index ...................................................................................... 241 vi PARTNERING AND HEALTH DEVELOPMENT Acknowledgements I am deeply indebted to the many friends who played important roles in the events on which this narrative is based. I cannot forget those who have shared their knowledge and experience with me. Innumerable Nepalese friends created the favourable environrnent in which institutional partnering could flourish. Many are named in the following pages. Bhisma Prasai has been my friend and colleague throughout those years and he has scrutinized my account of the Kathmandu connection. Hemang Dixit is the acknowledged historian of the health sector in Nepal and I have relied heavily on his extensive knowledge. Dibya Shree Malla is a fellow obstetrician and her unfailing friendship and encouragement were invaluable. Filipino friends played a sirnilar role in fostering the Davao connec­ tion. Dra Trinidad De La Paz was a constant inspiration until her un­ tirnely death in 1990. Sony Chin, adrninistrator of the Institute for Prirnary Health Care, master rrtinded the Davao Health Development Programme and was an inexhaustible source of experience in cornrnunity develop­ ment. I have fond memories of Mindy antopina and the young staff of the Institute of Prirnary Health Care in Davao. I recall the warrnth of their friendship and the inspiration of their dedication to the wellbeing of their cornrnunities. I can never forget the generous hospitality of villagers of Mindanao who welcomed my wife and myself into their cornrnunities. Colleagues in the Faculty of Medicine and the Division of Interna­ tional Development of The University of Calgary have been a consistent source of encouragement. Many are identified in the following pages. However, Danielle Sikander, who administered the Nepal Project vol­ untarily through its early years, deserves special recognition. Without her unflagging energy and interpersonal skills our work would have been stunted in its formative years. After the Division of International Development was forrned in 1986 I becarne heavily dependent on Gloria Eslinger as Adrninistrator of the Division. I was also fortunate to be able to rely on the secretarial skills of Anke Berner, Nidia Mackintosh and Olga Ramirez. Acknow/edgements vii Although 1 accept full responsibility for the judgements and opin­ ions expressed in the following chapters, many friends have contrib­ uted significantly to their preparation. Those Canadian project managers who were responsible for the work that 1 describe have read sections of the text and corrected my errors and omissions. Bhisma Prasai, Dibya Shree Malla, Pramod Shresthra, Jojo Deles and Reggie de la Paz lngente scrutinized and amended appropriate sections. Consequently, although this is a persona! interpretation of events, my account has been signifi­ cantly influenced by the ad vice of colleagues. Canadian friends David McGinnis, Bob Lee and John Evans, together with Scottish friends Philip Myerscough and Henry Walton have read the entire manuscript. Roger Maltby helped greatly to improve the prose style of the text. The final text owes a great deal to their criticism and advice. However, by far my greatest debt is due to my wife, Nan. She has accompanied me shoulder to shoulder on every step of my journey from its beginnings in 1976 through toits completion in 1992. She shared many sleepless nights and every moment of joy and despair but never lost her ability to support and encourage. She was directly responsible for the establishment of Calgary House in Kathmandu in 1981. Her capacity for caring went a long way towards transforming formal institutional relationships into a circle of friendship. This volume is a small tribute to her selfless companionship over many years. 1 thank the Division of International Development (DIO), International Centre, The University of Calgary, and The University of Calgary's Pub­ lication Subvention Fund for providing financial assistance for the pub­ lication of this book. 1 also thank the co-publisher, International Development Research Centre (IDRC) for their assistance with this project. viii P ARTNERING AND ffEALTH DEVELOPMENT List of Abbreviations AIHD Asean lnstitute for Health Development CAP Canada Asia Partnership CFHA Community Funding and Health Association CHILD Community Health Through Integrated Livelihood Development CIDA Canadian International Development Agency DA Diploma in Anesthesiology DGO Diploma in Gynecology and Obstetrics DIO Division of International Development DMSF Davao Medical School Foundation DPF Development of People Foundation HOP Health Development Programme IDRC International Development and Research Centre IOE lnstitute of Engineering IOM lnstitute of Medicine IPHC lnstitute of Primary Health Care MBBS Bachelor of Medicine, Bachelor of Surgery MNLF Muslim National Liberation Front MOH Ministry of Health NPA New People's Army ODA Official Development Assistance OIC Organization of the lslamic Conference PR Participatory Research QLC Quality of Life Circle SDF Social Development Fund SEAMEO South East Asian Ministers of Education Organization SHIELD Sustained Health Improvement through Integrated Livelihood Development TROPMED Centre for Tropical Medicine UNICEF United Nations International Children's Emergency Fund WHO World Health Organization Photographs and Maps ix List of Photographs 1. Dr. Mo in Shah ................................................................................... 20 2. Dr. Bhisma Prasai ............................................................................. 21 3. Dr. D. N. Regmi ................................................................................ 21 4. Dr. Hemang Dixit ............................................................................. 22 5. Tribhuvan University Teaching Hospital, Kathmandu .............. 23 6. Birendranagar street scene .............................................................. 35 7. Surkhet valley ................................................................................... 36 8. Mehlkuna health post .....................................................................
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