UNDP plays its part / by Timothy Rothermel

UNDP plays its part by Timothy Rothermel uring the spring of 1971, over six million people from East Pakistan, now Bangladesh, fled civil war and sought refuge in neighbouring India. An outbreak of cholera in the monsoon months of June and July attacked refugees already devitalised by exhaustion, malnutrition and exposure. Logistical difficulties and a lack of trained personnel made treatment of the sick with intravenous fluids virtu- ally impossible. The death toll grew heavy in overcrowded camps where three out of every ten people afflicted with cholera and cholera-like diseases were dying. In the library-room of the Johns Hopkins Centre for Medical Research and Training in Calcutta, a team of relief workers set-up a make-shift assembly line, measuring portions of glucose and salt into polythene bags, inserting simple instructions, and seal- ing the bags with a hot iron. A round- the-clock convoy trucked the packets some 50 miles to an emergency treatment centre at Bongaon, near the India-Bangladesh border, where more than 350,000 refugees were encamped. Over a two-month period, more than 3,700 people stricken with chol- era were treated with an oral solution prepared from the packaged powder and fresh drinking water. Administra- tion of the "oral glucose-electrolyte" solution brought dramatic results: only 135 deaths occurred-a case fatality rate of just 3.6 per cent. Cholera- related deaths had been cut nearly four-fold below the norm. The experimental treatment which saved the lives of Bangladesh refugees was the direct product of many years of intensive research work carried out by such institutes as the Cholera Re- search Laboratory in Dhaka-a long- time pioneer in testing and develop- WoRLD HEALTH , April 1986 ment of cholera treatments . Soon after the successful field trials in the refugee camps, the now famous "Dhaka cock- tail" was being tested by CRL scien- tists on a larger scale in several Bang- ladesh villages afflicted with severe dysentery. After a two-year study, researchers reported that diarrhoea- related deaths had been reduced more than four-fold in communities which used oral rehydration salts (ORS) pac- kets prepared by local UNICEF officers. UNDP has helped millions of people, mostly in the rural Third World, to gain access to safe drinking water. Photo WHO/Zafar Development and popularisation of cost-effective therapies like ORS are more often the results of long-term, cost-intensive, basic research, broad- scale organization and concerted social marketing. Diarrhoeal diseases treatment and prevention have proved no exception. Complementing the activities of other UN bodies, the UN Development Programme (UNDP) has focused atten- tion and resources on furthering the basic research essential to effective treatment of diarrhoeal diseases, and ensuring that the latest research findings are promptly disseminated through a global network of concern- ed institutions. UNDP's direct involve- ment began in 1978 when US $5 million of Interregional Programme resources were committed to a global Diarrhoeal Diseases Control programme in collaboration with WHO, UNICEF, the World Bank and other donors. Total UNDP commitments now exceed $9 million. Important catalyst Some $1.5 million of that initial UNDP grant have gone to support the groundbreaking work of the Cholera Research Laboratory, now known as the International Centre for Diar- rhoea! Disease Research. The Centre is an important catalyst in promoting ORT practices, synthesising research findings, disseminating health-care in- formation, and training health-care workers for the entire world. The UNDP and UNDP-associated funds are also assisting in boosting produc- tion of pre-packaged ORS formulas both in developed and developing countries, most recently in Somalia and Mozambique. About 270 million ORS packets were produced worldwide in 1985, 135 million of them in more than 40 Asian, African and Latin American countries. The UNDP, the World Bank, and other UN bodies have stepped up their support for the water and sanitation sector since the launch of the Interna- tional Drinking Water Supply and Sanitation Decade (mwssD) in 1980. An estimated 345 million people- mostly in poor rural regions of the developing world- gained access to safe drinking water during the first three years of the UN "Water De- 27 Biogas plant in an Indian village. UNDP and other agencies are helping developing coun- tries to benefit from new waste disposal facilities. Photo W HO/C. Stauffer cade." In addition, about 140 million people in developing countries bene- fited from new waste disposal facilities . But while progress during the Decade has been impressive, some 1,200 million people in developing countries remain without access to safe water, and some 1,900 million without adequate sanitation. Hardship in Africa Fifteen years ago world concern focused on addressing the deprivation and human suffering in the emerging nation of Bangladesh. Out of such desperate conditions came not only the promise of ORT but also the realis- ation that the fight against diarrhoea! diseases was really just one part of a 28 larger battle to overcome chronic pov- erty and malnutrition. The economic hardship and despair ravaging the Af- rican continent today is again remind- ing the international community that comprehensive relief and develop- ment aid responses are essential. It was malnutrition which took the lives of nearly five million African children during 1984; malaria, chol- era, sleeping sickness, yellow fever or other endemic diseases were simply additional scourges. Inadequate food, contaminated drinking water, over- crowded dwellings, poor sanitation and poor maternal education underlay the vast majority of serious illnesses. The African crisis is clearly systemic and corresponding responses must be holistic. UNDP is responding to Africa's ur- gent needs at two levels. At the pro- gramme and project level, the tradi- tional emphasis on integrated ap- proaches with a strong rural bias has been redoubled. In the health sector, the preference is for integrated rural health care over metropolitan medi- cal and training facilities-and a bal- ance is sought between prevention, control and treatment of disease. Dur- ing the first five years of the IDWSSD, UNDP and its associated funds have invested some $85 million in African projects featuring low-cost sanitation methods, rural handpumps and inte- grated resource recovery. UNDP is responding at the policy level by offering support in some 18 African countries for major aid review meetings with their principal external partners in a process of "round table" consultations. These are now based on thorough sector analyses and provide a coordinated means by which govern- ments can evaluate the substantive implications of the development strategies they wish to pursue, review them with their major aid partners and jointly forge programmes of sustained development cooperation. Through this more comprehensive approach to development planning, UNDP is con- tributing to build durable bridges to assist Africa's recovery and alleviate poverty in the long term. • W oRLD HEALTH, April 1986