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TORCH PROJECT
TORCH (Tororo Community Health) PROJECT
TORCH - Introduction
The TORCH project started in November 1994 after a period of intensive
discussion at the Child Health and Development Centre (CHDC), Makerere
University, Uganda. It was decided at that time to build research training
around a long term research commitment to one district which could be
followedup for ten to fifteen years. The district chosen was Tororo
in Eastern Uganda, where both the Ugandan and Danish researchers had
long experience. The overall research strategy was to develop a thorough
knowledge of the social and medical context of a health care system
and its users at intervals. The project was conceived as a framework
of roughly defined research plans, to be refined by selected researchers;
into this framework new projects that fit with the overall idea could
also be inserted. The interaction was to remain flexible enough to be
able to respond to research needs and interests as they arose, while
having enough structure to document changes systematically.
The TORCH project encompasses both basic
and applied research, with an emphasis on involving local institutions
and health workers, and being responsible to local research needs. It
is hoped that involvement at all stages of the research, and dissemination
of results at various levels, from the Ministry of Health, down to local
councils and health units, will facilitate the use of research results.
During the first three year phase of the
project, there was close interaction with the Tororo District Health
Team and health units in the district through a series of projects.
TORCH researchers developed familiarity with the social, political and
health care complexities of the district. Tororo was going through the
difficulties of decentralisation and the government health care system
functioned poorly in several respects. The project tried to document
the problems, but also to focus on how health care providers and users
were dealing with these problems.
TORCH is a multi-disciplinary effort. So
far, it has concentrated mainly on Social Science and epidemiological
studies; bio-medical research is only now being included as the malaria
studies get underway. One of the important challenges to the project
in the second phase is to reflect upon the relation between these different
disciplinary approaches and the results they are yielding. If the various
studies are to build upon one another and contribute to an overall understanding,
continuing efforts must be made to compare and contrast methods as well
as findings.
At the close of its first three year phase,
the TORCH project was well established as a part of CHDC and training
at several levels was underway. TORCH has got working relations in (now
two) districts. Basis ethnographic research in each of the four language
groups has yielded rich material on the cultural and social contexts
in which health is produced and sickness is managed. A household survey
has documented selected social and health characteristics in five locations.
Studies of the health care system have yielded an overview of recent
history as well as specific data on quality of care.
ENRECA
The Programme for Enhancement of Research Capacity in Developing Countries,
known as ENRECA, was created by the Danish International Development
Agency (DANIDA) in 1988 and the first projects under the programme started
in 1990.
The objective of ENRECA is to build research
capacity in developing countries through provision of training, equipment,
and other physical facilities, and by facilitating the participation
of developing country researchers in global research co-operation. Support
is provided to individual co-operative research projects ("twinning
arrangements") through Danish research institutions, which collaborate
with institutions in developing countries. The projects have a duration
of 10-15 years, which makes it possible to use long-term strategies
in strengthening research capacity.
There are currently about 40 ENRECA projects
in a wide range of fields including health, agricultural, technical,
social, and natural sciences. The projects are planned jointly and the
research is carried out by both Danish and local scholars, often working
together. Support is given to researchers from developing countries
for postgraduate education at Ph.D and MSc level and to research infrastructure
such as literature, information technology, and equipment.
DISTRICTS
The research focuses on a pre-dominantly rural region in south-eastern
Uganda, inhabited by a half million people. They belong to four different
ethnic groups: Banyole, Jopadhola, Teso, and Basamia-Bagwe. Trade and
farming are the main economic activities, with increasing use of food
as a cash crop. During the last three years, poor harvests and food
shortages have been common. In terms of economy and development, the
area is in the lower middle range compared to other districts in Uganda.
The health situation is relatively poor,
though not as disastrous as in the northern part of the country. Fertility
rates are high, with women bearing 7-8 children, yielding a young population
profile and heavy use of health services by children and mothers. Malaria
is the number one cause of sickness and death, with other infectious
diseases also contributing to the high child mortality rate. The MCH
survey undertaken in the first phase of TORCH revealed that health status
and utilisation of bio-medical services was best in the town of Tororo,
and worst in the southern rural sub-county of Lumino in Busia district.
It was the original intent of the TORCH
project to follow one district over a long period of ten to fifteen
years. In 1997, a portion of Tororo District was designated as a new
district, Busia. The creation of new districts is common in East African
countries, a response to population growth and political pressures.
However, there has been little attention given to the consequences for
the health care system of such splits. We therefore proposed to follow
the new Busia District as well as Tororo District. This will allow us
to document a period of administrative confusion and creativity and
will give the possibility of making controlled comparisons in the future.
It will also permit us to continue building on the studies we have already
undertaken in the present Busia District.
Tororo District was originally chosen because
it was among the first 13 districts to be decentralised and we were
interested in following the consequences of this policy for the health
care system. The first phase revealed that the political, financial,
and administrative issues were extremely complex. A Commission of Inquiry
examined mismanagement within the District Administration and the District
Medical Officer was suspended. Mismanagement and lack of leadership
has affected the government health services. There are a number of donor
programmes and NGO's operating in the District, as well as a multitude
of private clinics, drug shops, and non-biomedical practitioners. The
complexities of this situation are challenging, but probably typical
for many parts of the country.
LINKS
- Institute of Anthropology, University of Copenhagen
www.anthro.ku.dk
The home page for the Institute of anthropology at the University of
Copenhagen. The page includes information on ongoing research, projects,
and activities at the Institute, as well as news and a few links.
- DANIDA
www.um.dk/english/udenrigspolitik/udviklingspolitik/
This site forms part of the Danish Foreign Ministry's homepage. It includes
the general guidelines for Denmark's foreign aid policy, some information
on specific countries, annual reports, and news and publications in
Danish.
- African Networks for Health Research
and Development
www.healthnet.org/afronets
AFRO-NETS is an electronic conference for organisations and individuals
working with health research and development, primarily in the Eastern
and Southern regions of Africa. The site also stores archives of materials,
as well as research proposals and results. The site is searchable.
- African Studies Association
www.sas.upenn.edu/African_Studies/Home_Page/ASA_Menu.html
The homepage for the African Studies Association includes information
on the organisation, upcoming meetings, as well as information on journals
and other publications.
- Index on Africa
www.africaindex.africainfo.no
Run by the Norwegian Council for Africa (NCA), this site contains over
2000 links to various information resources on Africa, sorted by country,
subject and news. The site is searchable.
- Healthlink
www.healthlink.org.za
Healthlink is a project of the Health Systems Trust. The site contains
medical resources of interest to people working with health in Africa,
focusing on national policy, drug use and policy, rural resources, and
the internet and health information. It also supports a server for south
African health information.
- University of Zambia Medical Library
www.zamnet.zm
The Guide to Medical Resources at the University of Zambia Medical Library
provides useful annotated links to websites, electronic journals and
directories of interest to people working with health issues in developing
countries.
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