PoPulationand Public HealtH etHics

practice
Identify the options available to the decision-maker, including
reasonable alternative courses of action, consideration of
implications, and potential intended and unintended outcomes
(consequences)
A reasonable course of action could have been the formalization of an agreement
between the Ingo and the government of the region for the Ingo to
intervene with its services, subject to investment being made in local capacity
building. The assistance thus could have been a collaborative venture between
the Ingo and the local government. Indeed, a collaborative agreement could
have required that local people should help and might learn from their techniques,
thus building local capacity.
Suggest a resolution or decision to the case by choosing the
supported option, and justify the decision
While each entity/stakeholder has a mandate, it is not necessary to consider
solutions with only binary options (i.e., “all” or “nothing”). Ingo mandates,
for instance, might incorporate aspects of capacity building and education
and also of influencing policy.
So, even before entering the region to help, some understanding should have
been in place to hand control back to the local authorities/community, by
then being adequately trained in the issues at hand. In this way, the government’s
role would be better defined for points of intervention to investigate,
monitor, provide health services, train people and the like.
Whether or not the Ingo receives payment for its services should not trump
the need to train local people to assume positions to carry forward the work
of the Ingo once it has left. Setting up agreements in advance to define points
for changing the level of action demanded at the time of the crisis by the
various players and/or stakeholders could help in clarifying respective roles
and responsibilities. Not only would local capacity and infrastructure remain
beyond the crisis, but a tax base could be generated from the local economy
to support community health in the region into the future.
Finally, if it were possible to determine who provided the grinding machines
and who did not enforce the illegality of their use by untrained artisanal
workers, this upstream information could be used to address what might
well be a case of criminal neglect.
PoPulation anD Public HealtH etHics
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