The health of people of the poorest population groups in Africa, Asia and South America was the focus of the work of DAHW German Leprosy and Tuberculosis Relief Association in 2009. Indispensable requirements for the successful treatment of the infectious diseases of leprosy, tuberculosis, Buruli ulcer and other forgotten diseases are early and correct diagnosis, quality inspected drugs and their correct intake. The training and further qualification of medical personnel are of special importance.
The aim of all assistance is to support patients in successfully completing their long treatment, which is often accompanied by strong side effects, and to re-integrate them successfully into their community. DAHW perceives itself as liaison between the governmental health services or non-governmental stakeholders and the individual patient.
The donors' great trust in our work is duty and obligation to us.
Programmes and projects
In 2009 DAHW contributed to 287 (2008: 285) projects in 32 (2008: 33) countries. Among these were 118 projects in Africa, 113 in Asia and 39 in South America (see also p. 16 f). In addition, 11 cross-country research projects were cofinanced by DAHW as well as international training programmes for the further qualification of local staff.
Approximately half of DAHW’s funds have been used to support parochial and non-governmental initiatives, training centres and patients’ associations. The remaining 50 percent have been used to support national programmes in the fight against leprosy, tuberculosis and Buruli ulcer. Most of the financial funds went to Africa, a trend which will be reinforced in 2010.
A growing problem in fighting leprosy and tuberculosis has for many years been the lack of research about open questions in the understanding of both diseases and about new medicines for treating these.
Consolidation
In order to consolidate the budget all departments have scrutinised their budgets for savings potential. The biggest savings were related to the budget for medico-social work. DAHW developed criteria in consultation with its country offices and the people in charge locally. These criteria were the economic situation of the country, the quality of the project and of the partners, the cost-effective use of DAHW’s funds for the diagnosis and treatment of new cases of leprosy and TB, the consequences of retiring or reducing the support of DAHW as well as the connections to a donor group in Germany. Taking these factors into consideration, it was decided to stop DAHW support to Argentina, Ecuador, Kenya, Syria, China and Cambodia. We did not come to this decision easily; however, we saw to it that leprosy control work especially would be continued by governmental services or other non-governmental organisations. At the end of the year the country office in Thailand was closed down as had been planned for some years already, because the number of new cases of leprosy has reduced drastically and the remaining tasks can be fulfilled by the governmental health services.
For cost reasons there are no longer country offices in Khartoum and Islamabad. In Pakistan Dr. Christine Schmotzer (ALP) has taken over coordination of the north of the country and Dr. Ruth Pfau (MALC) that of the south. Northern Sudan has been served from Uganda since 2010.
Quality assurance
In order to further improve project work, DAHW workers have developed principles for the control of infections in tuberculosis and for the treatment of reactions in leprosy. The latter were even included in the WHO guidelines as these principles are valid worldwide.
The appointment of the medical advisor of DAHW in Uganda, Dr. Joseph Kawuma, as Head of the “Technical Advisory Group” of the World Health Organisation (WHO) is evidence for the high esteem in which DAHW’s competence is held. Dr. Christine Schmotzer, the medical director of our project partner Aid to Leprosy Patients (ALP) in Pakistan, also was appointed to this advisory body. In the “Technical Advisory Group” independent experts from various countries cooperate.
Quality only can be attained and improved if an organisation is learning from its own experiences and results as well as from those of others. Over the past year a working group of the medico-social projects department has developed a framework for quality assurance based on a model of the European Foundation for Quality Management (EFQM). To put it simply, the framework deals with preconditions that have to be considered if certain aims have to be achieved or described. These aim for better approaches to health services or a higher quality of medical services. The decisive criteria are the cost-consciousness, the quality of the service and the project partner and the participation of all stakeholders.
Within the scope of this activity, the professional exchange between our partner countries was strengthened. For example, the social worker from Tanzania has given his judgement and recommendations about the CBR work of Nigeria and his colleague from Ethiopia has given valuable advice for the strategic development of the social programme in Sierra Leone.
Monitoring of impact
In cooperation with 14 German non-governmental organisations and their partners in the South DAHW is participating in the initiative NGO-IDEAs where tools for the participatory monitoring of impact are developed. The aim of the initiative is to enable disadvantaged groups of the population and self-help groups to monitor and judge projects in the fields of education, health, savings and credit, disability and inclusion as well as human rights.
Annual proceeds
With donations, fines, heritages and legacies amounting to 11.8 million Euros DAHW ended the year 2009 with a slightly smaller income (-4,65%) than in 2008. However, the number of donation receipts increased by four percent compared to 2008: meaning that although we received more individual donations, they amounted to a bit less in their total sum.
In total the number of active donors has increased slightly. The targeted fundraising activities led to this increase. Looking back over the last five years we have had to note a decrease in legacies.
The public relations and fundraising activities for the 80th birthday of Dr. Ruth Pfau were especially successful: over decades the medical doctor has built up a nationwide net for the control of leprosy and TB in Pakistan. This special birthday prompted many people to donate again or to donate more.
During the last ten years the income from direct fundraising activities, from disbursements of trusts to DAHW, from support from other relief agencies and from federal countries trusts as well as from fines and inheritances has decreased. Therefore in 2009 DAHW has, for the second year running, increased its budget for public relations material. Simultaneously means were re-allocated: instead of using them for the standard PR work (posters) they were used for activities to find new donors.
The donations of other non-governmental associations like the Aussätzigenhilfswerk Österreich remained steady due to well-established communication links with these donors. The rather strong reduction in the field of fines’ receipts during the past years could be stopped. Added to the income are grants of the Federal Ministry for Economic Cooperation and Development (Bundes-ministerium für wirtschaftliche Zusammenarbeit – (BMZ), the Credit Bank for Reconstruction (Kreditanstalt für Wiederaufbau –KfW) and the European Union as well as direct grants from partner organisations, altogether amounting to 920,000 Euros. Accordingly the total of donations and grants amounts to 12.7 million Euros.
Seen as a whole, in 2009 it was almost possible to balance the budget through higher income and making additional savings.
Voluntary work
Voluntary workers were a strong pillar of DAHW in 2009, too. They provided information about the situation of people suffering from leprosy or tuberculosis to action groups, parishes, groups of Kolping and of the Catholic Womens’ Association (Katho-lische Frauengemeinschaft – kfd), municipalities, communes or even to individuals. They also showed the problems caused by these diseases and gave information about the success of treatment for the health and the re-integration of people into society.
“The outcasts – yesterday and today” is the title of a play which was developed by a group of young people from Aurich/Ostfriesland. The play was performed ten times in several places over the past year. More than 3,000 people have seen this play about leprosy in the middle ages and HIV/AIDS today, amongst others at the German Protestant Convention (Evangelischer Kirchentag) in Bremen and in the theatre for young people ATZE in Berlin.
Many activities took place especially on World Leprosy Day, on World Tuberculosis Day and during the Easter and Christmas Season. More than 1,600 volunteers participated in 80 bazaars and received around 25,000 visitors. Sales of waffles and roasted apples, of Christmas trees or of filled dumplings, charity concerts, sales of candles or flowers, stands at festivals of parishes or at communal festivities or at parish fairs, flea markets, bicycle trips (“Pedals”), sponsored walks, collections at special masses for leprosy and other collections: Volunteers drew attention to the situation of leprosy and tuberculosis patients passionately and full of ideas and they donated the income from their work to DAHW.
Dr. Ruth Pfau and Hannelore Vieth reported about their work in Pakistan and Brazil respectively during their lecture tours. Dr. Tobias Vogt from Ärzte für die Dritte Welt presented the TB treatment at an Indian hospital, which is supported by DAHW.
In Würzburg a memorial march and a Pontifical Mass were held on the occasion of the canonisation of the patron of leprosy patients, Father Damian, through Pope Benedikt XVI. in October 2009.
Cofinancing
The high professional esteem in which it is held, especially in the fields of leprosy, tuberculosis, Buruli ulcer and the rehabilitation of people in their familiar environment (community based rehabilitation – CBR), made DAHW an in-demand partner for cofinancing. In the past year 47 projects in total were supported by grants from institutions and partners: among others two were supported by the Federal Ministry for Economic Cooperation and Development (Bundesministerium für wirtschaftliche Zusammenarbeit – BMZ), 13 were cofunded by other leprosy associations (ILEP), two by the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), two by TBCAP (Nigeria, Ethiopia) and one project by Family Health International. The volume of the funds which were granted to DAHW and directly to its country offices amounted to 1.9 million Euros in total. One third of these funds comes from other leprosy relief associations that are members of ILEP; in return, DAHW supported other ILEP projects to a sum of 328,860 Euros.
Networks
DAHW is a member of the Association of German Development NGOs (Verband Entwicklungspolitik deutscher Nichtregierungsorganisationen – VENRO) and is cooperating in five working groups (disability and development, education, health, cofinancing and impact monitoring). In addition, it is a member of the International Federation of Anti-Leprosy Associations (ILEP) and of the Stop-TB-Partnership of WHO. In Germany, DAHW cooperates with Action against AIDS Germany and United for Africa.
Development of staffing
On 31 Dezember 2009 DAHW had 51 employees in the central office at Würzburg and in the office at Muenster: 30 persons worked full-time and 20 part-time. One employee was on parental leave. All but four employment contracts are open-ended. In addition there are two apprentices: a merchant for office communication and a media designer. One member of the civilian service is working in Würzburg and Münster, each. In 2009 six of our colleagues were in the active phase of partial retirement, four in the passive phase.
At the end of 2009 in total eight experts from Germany had been working in a leading position at DAHW country offices of Brazil (2), Nigeria, Senegal, Southern Sudan, Tanzania, Togo and Uganda. The offices in Ethiopia, Brazil, Colombia, India and Sierra Leone are managed by local experts.
Ombudsman
The honorary board has created the position of an ombudsman in its body and has appointed Jochen Schroeren.
Chances and Risks
DAHW is financing its work mainly from donations. It is getting more and more important to find new donors since, last but not least, loyal and long standing donors have to reduce or finish their support for reasons of health and connected financial burdens. We especially need permanent donors to enable us to plan long-term.
It is not yet possible to forecast the effects of the financial and economic crisis on the readiness to donate. However, a reduction of income from interest and the effects of price increases have already been felt by local partners.
In cooperation with our Swiss partner organisation FAIRMED, we have started a pilot fundraising project in India.
Outlook
In 2010 we are planning to organise a workshop on the future mandate of DAHW with our employees from home and abroad, as well as with volunteers. In cooperation with the country offices the medico-social projects department will develop new guidelines for contemporary and task-oriented project work in the fields of leprosy, TB, neglected diseases and CBR.
Verifiable cost-efficiency and impact measuring are gaining importance because the evolution of tuberculosis and leprosy is rather different across the world – leprosy figures are not increasing, cases of TB, MDR-TB and TB/HIV are increasing.
DAHW must strengthen its profile as a competent and reliable medico-social relief association.
Operational points of main efforts in 2010
- Leprosy: to extend surveys of contacts in order to find patients as early as possible
- TB: to avoid interruption or break-off in therapy, to extend possibilities for the treatment of MDR-TB
- Buruli ulcer: to participate in the development of a vaccine
- To strengthen research activities
- CBR: to support the change from SER to CBR
Whether DAHW will remain an “important” and influential relief association in the fight against leprosy and tuberculosis and its effects will largely depend on DAHW’s ability to inspire and motivate more people to its aims.
Burkard Kömm,
Chief Executive Officer
Dr. Adolf Diefenhardt,
Deputy Chief Executive Officer
