They Just Don't Care?

We've seen and heard some bad stuff over the past few weeks, but nothing really got to me until today.

We were meeting with another NGO here who is execution partner for UNICEF, who is one of the organizations getting fortificants and therapeutic foods to moderately and severely malnourished children.

The way it is supposed to work is UNICEF brings in the food, then the government health system is supposed to distribute it to the provinces > districts > health facilities > then communities.

The way it actually works is this organization has to provide a lot of the logistical support, even though it's outside of their charter. Their other key role is regularly checking up on the health clinics to make sure people coming to work, actually helping people, etc.  There simply is no one else to provide that oversight. 

Due to the logistical challenges and lack of funding, the group is pulling out of some of the worst slums.

We asked, "What happens to the food programs?" She replied, "They will collapse. We've already started pulling out of one, and the program is collapsing."

It turns out the workers don't do their jobs because their salaries aren't "topped-up". It was a new phrase to me and means that they need to be paid extra on top of their salaries in order to actually do anything.

The government's official policy is that top-ups are not allowed, but there is one big organization here that dictates the terms of the game given the size of their checkbook, and they skirt the rule and contract directly with health workers who are technically still employed by the government. (The health workers also claim they can't do their jobs because they don't have computers or vehicles, so this NGO buys those as well. Apparently the vehicles are rarely used for official business, but lots of personal transportation needs.) This organization is also focused almost exclusively on HIV / AIDS patients, so all of their nutritional focus is on them.

So, there will be wards of moderate to severely malnourished children, but this organization that has the money and logistics doesn't treat them unless they have HIV / AIDS. So the other kids are completely dependent upon a ridiculous patchwork of other agencies that simply aren't getting enough fortified food to the facilities to feed them.

The capacity and resources are so lacking that in a lot of instances, there are moderately malnourished children who have to wait until they become severely malnourished before they qualify for a therapeutic feeding program.  Not surprisingly, it's a vicious circle where the kids often end up back in the clinic or hospital.  The other option for dealing with the malnourished children is to just send them home.

Back to the top-up conversation - the NGO was explaining how the health workers only do exactly what they're being paid to do (e.g. if they're going door to door checking that people are taking their medicines, unless they're paid an additional fee, they won't also ask them if they are feeding their children fortified food), and even then only when there is a third party checking in on them, when I asked, "So if they can't get the fortified food to the facilities and are just sending the kids home because they don't have the space or resources, what happens to them?"

She responded, "They die."

I asked, "How is that possible? How could that happen when there are clinics and health workers obviously in their community?"

Her answer, "They just don't care."