Annual Report Dokters van de Wereld (Médecins du Monde ...

Annual ReportDokters van de Wereld(Médecins du Monde Netherlands)2011Dokters van de Wereld is the Dutch branch of the international medicaldevelopment organisation Médecins du Monde. We supply medical aid tovulnerable groups everywhere in the world, even in the Netherlands, bypromoting the right to access healthcare.

Dokters van de Wereld Annual Report 2011page1. Access to Medical Care in 2011 32. Overview of the Organisation 73. Key Figures Finances 104. Budget 2012 125. Association Dokters van de Wereld 136. International Network of Médecins du Monde 147. Report of Projects Dokters van de Wereld 167a. The Netherlands – Medoc / Access to Care for undocumented migrants7b. Operation Smile - Dokters van de Wereld and network7c. Serbia - ‘Being aware’: integration of risk reduction of drug use within the healthsystem in Belgrade7d. Indonesia, Aceh - Mother and child care project8. Report of Projects Médecins du Monde France, financially supportedby Dokters van de Wereld 248a. Ivory Coast - Access to care in times of crisis8b. Colombia - Access to care for indigenous populations and Afro-Colombians8c. Indonesia West Papua – Improvement of sexual health and birth control8d. Democratic Republic of Congo - Fighting HIV / AIDS7e. Zimbabwe - The fight against HIV / AIDS and providing mother and child care inChipinge8f. Pakistan – Helping women who are victims of violence8g. Myanmar (Burma) – Better care for mother and child8h. Liberia - Improving the care for the national population8i. Horn of Africa – Kenya -Improving health care for displaced mothers and children8j. Haiti – Improving access to care2

1. Access to Medical Care 2011Access to medical care for everybody, everywhere in the world. This is what Dokters van deWereld fights for. This ambition was put under pressure in 2011, amongst others by the bill ofthe administration to criminalize illegality. Dokters van de Wereld spoke out against this bill,because the threat of criminalization for people without residence permit would make it moredifficult for them to realise their right to healthcare. We are pleased the bill has been rejected.One of the most important challenges was formed by the fact that Dokters van de Wereld didnot belong to one of the coalitions which received Dutch government support in the form of cofinancingSystem (MFS). This represented about 1 million euro less income per year forinternational projects, and has compelled us to take further measures to diversify thefundraising. Just like in 2010 we heavily invested in direct mailing and telemarketing, but alsodoor to door fundraising to acquire structural support for the organisation. We have alsoinvested in inheritances and events, especially for Operation Smile, for which more people canbe mobilised. In the coming years we will expand this and increase the visibility and thefinancial support of the organisation through this program.Growth in strength and expertise by focussing on programsTo achieve growth in strength and expertise we focussed on a range of programs under ourown implementation, in addition to raising funds for our French sister organisation. In thecoming years we will focus on obtaining the access to care for undocumented migrants in theNetherlands and the care for mothers and children living in precarious conditions in developingcountries. Additionally we will continue to expand Operation Smile project, in cooperation withDutch University Hospitals.Medoc - access to care for undocumented migrantsIn 2011 we opened a new consultation practice in Amsterdam Zuid Oost, which has begun withthe inscription of undocumented migrants in general practices in addition to the existingactivities of providing information, mediation and outreach. At national level we have more thandoubled the total number of patient consultations compared to 2010: 1367 consults in 2011 vs.643 in 2010.More positive news is that we were able to increase the number of successful mediations to84% (this was 49% in 2010). The accessibility of dental care is particularly bad in theNetherlands: dentists where responsible for 23% of the total number of denials of care.Dokters van de Wereld ran into several situations where patients where forced to pull their ownmolars.Together with other associations which denounce the issues of refugees and human rights inthe Netherlands, Dokters van de Wereld has created a network. These organisations ensurethe basic human rights of undocumented migrants in the Netherlands are guaranteed, despitethe fact they are labelled as illegal by the government.Care for mother and childThe focus of our work lies in developing and implementing sustainable mother and child careprograms such as we do in Aceh, Indonesia. We have developed training on demand, trainlocal medical staff and eventually facilitate so-called 'health committees' on community level in28 villages. The local citizens themselves contribute to the actions to prevent and resolvebottlenecks in care through these committees. Dokters van de Wereld supports them withpreventive means to be ready for the birth. Dokters van de Wereld is also actively connectingthe communities to the existing local health care services. This way we strengthen the selfrelianceof the communities in obtaining medical care.3

In 2011 we visited Myanmar, with the aim to take over the project under Dutch managementstarting in 2012 for the mother and child care carried out by Médecins du Monde France.Since May 2012 this transfer became effective.Operation Smile – Design and implementation of Dutch missionsChildren with congenital or acquired physical malformations have a particularly difficult life indeveloping countries. In addition to medical problems, they also have social problems becausethey are not accepted and are excluded by the communities. For this reason Dokters van deWereld's Operation Smile conducts missions, in which children receive free reconstructivesurgery from Dutch plastic surgeons who work entire free of charge. The purpose of OperationSmile is twofold: in addition to performing reconstructive surgery, local personnel are trainedso ultimately they will be able to perform these medical interventions locally.To make the project sustainable we will create a clear link between the Dutch teams and thehospitals where we perform Operation Smile. The medical teams and the hospitals committhemselves to at least 3 years of executive support to the project, in order for a structuralknowledge transfer to take place.In 2011 Dokters van de Wereld has performed a research mission in Bangladesh together withthe Interplast Nederland foundation, which sends out teams for reconstructive operations since1990. We are looking at how to best shape the cooperation in the coming years.The first Dutch Operation Smile mission took place in Bangladesh in November 2011, where ateam of plastic surgeons of the VU University Medical Center (VUmc) and the AcademicMedical Center (AMC) operated 126 children in 2 weeks time and trained 8 doctors and 18nurses. In 2012 a follow-up mission will take place. Additionally preparations were made fortwo new missions in Sierra Leone in 2012, in cooperation with local hospitals and theUniversity Medical Center Groningen (UMCG) and the Medisch Spectrum Twente (MST).Growth by joining forces and efficiencyIn 2011 we have taken steps to strengthen our organisation with structural partnerships,calibration of our own overhead costs and innovative ways to raise funds.One of our key partners is the Nationale Postcodeloterij, from whom we again received500,000 Euros support in 2011. Each year the Nationale Postcodeloterij donates 50% of itsrevenue to charity; in total a sum of 3,5 billion Euros was donated to charity.A further extension of the cooperation was put into motion with Dutch companies. Based on aclear casus, where both Dokters van de Wereld and the company gain financial advantages,we have developed a partnership with companies that fit our social and sustainable businessmodel. In addition to the existing partnership with L'Oreal, who supports our Operation Smile,we have developed a partnership with Weleda, which will be conducted in 2012 for the benefitof our mother and child care projects.In order to obtain a reference point for the percentage of overhead costs, we had theBerenschot management consultancy company make a comparison of other, similarorganisations. This showed the total overhead costs per FTE and as percentage of therevenue was at least 15% lower than average at even larger organisations. This means wework efficiently and these costs take up a relatively limited part of our means. With a utilizationrate of 86.7% of our objectives in relation to the total spending in 2011, and cost formanagement and administration at 2.9% of our total cost, this is an additional element in whichwe positively distinguished ourselves from other organizations.Finally Dokters van de Wereld is actively developing a social enterprise in the Dutch care, incollaboration with health insurers and care institutions. The reason for this is to provide accessto quality care to citizens from different walks of life in the context of care impoverishment and4

the growing inequality of health situations. At the same time this innovation creates a structuralfinancial added value for the programs of Dokters van de Wereld.Our vision of the near futureIn a context where the development sector is under attack, and grants for national andinternational development projects continue to decline, the European crisis creates a newproblem: the deterioration of access to care, especially in southern European countries suchas Greece and Spain. The question at hand now is how the strong the European network ofDokters van de Wereld can be used to combat this. Even in the Netherlands we already feelthe access to care in under pressure both financially and as a principle of solidarity.Dokters van de Wereld wants to continue to make the difference in relation to the access tomedical care. To be able to accomplish this, we will increase our visibility as an organizationthrough the program of Operation Smile and further development of programs at national andEuropean level. We strengthen our resources by increasing sustainable cooperations withbusinesses and non-profit organizations, further development of events, increasing thenumber of donors and members. These are intense years in which we are convinced that byfocussing in programs, maintaining low costs, innovation in fundraising and new partnerships,we will achieve our goal: access to care for people the world is forgetting little by little.Remco van de PasChainman of the Board Dokters van de WereldMirjam KoppeGeneral Director Dokters van de Wereld5

Thanks!Dokters van de Wereld would like to thank everyone involved for their dedication andcontribution in 2011:Netherlands Ministry of Foreign Affairs / Matra program, Netherlands Ministry of Foreign Affairs/ MFS I, Innovation fund Health Insurers, Maria Stroot Fonds , Aids Fonds/SBL, Cordaid,Commission PIN, , Fonds NutsOhra, Skanfonds, Stichting Janivo, Stichting RCOAK, StichtingRC het Maagdenhuis, Kerk in Actie, Congregation of Judie Postel, ING employees, L’Oréal,the Nationale Postcodeloterij, the VriendenLoterij, PWC, Stichting Smile Train, interestedpeople, directors, members, volunteers, donors, trainees and employees.6

2. Overview of the OrganisationMethod of appointing directors & relevant outside activitiesThe board is appointed by the General Assembly (GA), the highest body, also supervisorybody of the association Dokters van de Wereld. The GA convenes at least once a year.Name Management function Outside activitiesRemco van der Pas Chairman (as per22/02/2011)Tropical doctorMelissa DiazSecretaryDoctor, SOA/HIV combating Std AidsNetherlandsJoost van DuinTreasurer (as per22/02/2011)Financial Interim ManagerBernard Juan General Board Member EntrepreneurFrancoise SivignonGeneral Board Member(Chairman up to22/02/2011)Harm Peters General Board Member DoctorCasper van RijnTreasurer (up to22/02/2011)Radiologist, Mission responsible BurmaMdM FranceBankerTREAsA Technical Referent/External Advisor (TREA) is connected to each project of Dokters van deWereld. This person works on a voluntary basis and is closely involved in monitoring andsupervising the project. In 2011 TREAs have visited their project multiple times and providedadvice. The TREAs are: Petra Wisse for our project in Indonesia, Harm Peters for the Serbiaproject, Gerd Beckers and Tessa Versteegde for the national project for undocumentedmigrants (Medoc). For the Operation Smile project the TREA position remained vacant.Board of AdviceThe Advisory Council of Dokters van de Wereld was founded in 2007. The Advisory Councilserves as a sounding board, opening to networks, booster of new ideas and projects and as acritical listener to the plans of Dokters van de Wereld. The Advisory Council convenes twice ayear.The members of the Advisory Council 2011 are:Mr. Emeritus Prof. J. Pronk (Chairman)Mr. Prof. Dr. I.N. WolffersMr. Prof. Dr. H.S.A. HeymansMrs. Prof Dr. C.M.A.M. van der Horst7

DirectionThe General Director is responsible for the implementation of the strategy, as reflected in theannual plan and long-term plan. The financial framework is determined by the budget asproposed by the Treasurer and approved by the General Assembly. The General Director isalso chairman of the management team. This team consists of representatives from thedepartments Projects, Communication & Fundraising and Finance and HR. The GeneralDirector represents Dokters van de Wereld in external meetings. The General Director alsomaintains contacts with delegations of the international MDM network. Since 1 January 2009Miriam Koppe is General Director of Dokters van de Wereld.To determine the wages, we use a salary scale in line with similar organizations. In 2011,research by Berenschot indicated the salary levels of Dokters van de Wereld were 5% belowthe average salary level is similar NGOs. An annual (standard) increase in salary is onlypossible after good performance. Additionally an inflation adjustment can be applied. Thegrading of the Director is based on experience, education and age. She is evaluated by theBoard once a year. The annual salary of the General Director is€ 67,132.80 gross for a full-time employment of 40 hours per week.EmployeesIn 2011 the number of FTE in the office increased from 8.4 to 8.9 and from 3.3 to 3.9 FTE onprojects. The following organisation chart is applicable from January 1, 2011:GeneralAssemblyBoardDirector1 fteHead ofFinance & HRHead ofComms &FundraisingProgramManagerProgramManager0.8 fte0.8 fte(Int’l)(National)HRCoordinator0.6 fteOffice Manager0.8 fteBookkeeper0.4 fteCoordinatorPrivateFundrasing0.7 fteCommunications Officer0.6 fteGeneralCoordinatorAceh1 fteProject‘OperationSmile’Servia Project(partner VEZA)TREA (2x)Coord inst &eventfundraising0.8 fteCoordinatorMedoc Project0.75 fteTREA (2x’VolunteerOfficemanagementCoordinatorMigrants0.6 fteProjectemployeeMedoc0.85 fteMedocvolunteers45 pr year8

VolunteersDokters van de Wereld and volunteers are inextricably linked. The volunteers are vital forcesfor the operations of Dokters van de Wereld and we gladly offer them the opportunity todevelop themselves. This applies to office work and to the national and international projects.Dokters van de Wereld believes it is important to keep both the salaried staff and thevolunteers involved with all departments and activities of the organization.In 2011 18 volunteers where working at the office, in the following areas: Communication andPrivate Fund Raising, ISO, HR and Legal Support. The Dutch Medoc project for migrantsenjoyed the intensive involvement of 45 (para) medical volunteers.In 2011, 10 medical and para medical professionals where send out to various projects. Thesevolunteers where active in Burma, Liberia, Indonesia, Colombia, Ethiopia, Serbia, Pakistanand Bangladesh. 8 volunteers were involved with the Operation Smile project.9

3. Key Figures FinancesDevelopments in RevenueThe total revenue available for the goals decreased from € 2.8 million in 2010 to € 1.9 millionin the year 2011. In the budget, the total revenue available for the goal was budgeted at € 2.0million. The decrease in revenue is mainly due to the expiration of the grant from the cofinancingsystem (MFS I) of the Netherlands Ministry of Foreign Affairs.Developments in ExpendituresThe expenditures for the goal are broken down in education and awareness, preparation andcoordination from the Netherlands for domestic and foreign projects, structural aid andemergency relief. In total € 1.7 million Euros were send towards these goals. Our expendituretowards the goal compared to the total expenditures (€ 1.96 million) was 86.7%.Key figures 2007 - 2011DescriptionStandard 2011 2010 2009 2008 20071. % spend on goal n.a. 86.7% 90.1% 91.9% 90.7% 91.3%2. % own fundraising 25% 24.1% 20.7% 18.8% 16.5% 19.8%3. % management andadministration max 4% 2.9% 2.1% 1.9% 1.3% 0.6%Education and AwarenessIn 2011 a total of € 421,000 was spend on education and awareness. This money was spenton the design and implementation of the education and awareness policy in the form of,among others events, campaigns and public education.Preparation and coordination from the Netherlands for domestic and foreign projectsThe cost for domestic and foreign projects amounted to € 103,000 in 2011 for preparation andcoordination from the Netherlands.Structural AidThe expenses for structural aid in 2001 amounted to € 1.13 million and consisted of€ 301,000 for assistance/grants provided to projects directed by Médecins du Monde,€ 489,000 for projects directed by Dokters van de Wereld and € 340,000 cover otherimplementation costs. The assistance / grants to projects under the direction of Médecins duMonde France include where spent on projects in the Democratic Republic of Congo,Zimbabwe, Ivory Coast, Pakistan, Colombia and Burma.10

Emergency ReliefExpenses for emergency aid totalling € 46,000 and € 45,000 for assistance / grants providedto projects directed by Médecins du Monde and € 1,000 covers other implementation costs.The assistance / grants provided to projects directed by Médecins du Monde France havebeen spent on emergency relief missions in the Horn of Africa and Haiti.Implementation costs own organisationCompared to the year 2010 the costs for management and administration have almostremained unchanged at € 56,000 (€ 55,000 in 2010). The budget for 2011 was set to € 55,000in total. The organization strives to achieve a maximum of 4% of the total spending onmanagement and administration. For 2011 the expenses amounted to 2.9% of our totalspending.Developments in EquityBalance of income and expensesBy the end of 2010 our equity showed a positive balance. At that time appropriated reserveswere created to enable research of new projects, investments in fundraising and increasingour brand awareness in 2011. In 2011 the total expenditures where € 77,000 higher than thetotal income. The reserves where addressed to cover this planned shortage.ReservesIn 2011 our reserves decreased from € 401,000 to € 324,000. The continuity reserve remainsstable at € 214,000 at the end of 2011. The Board seeks a reserve level equivalent toapproximately three months of operating costs, in addition to the contribution of Médecins duMonde to guarantee continuity.11

4. Budget 2012Vereniging Dokters van de Wereld Jaarrekening 2011Begroting 2012 in EURO´sBegroot 2012 Werkelijk 2011 Begroot 2011FondsenwervingBaten uit eigen fondsenwerving 936.208 655.277 674.011Baten uit acties derden 1.192.709 760.683 945.866Subsidies overheden en anderen 0 322.293 309.411Médecins du Monde 100.000 150.000 150.000Overige baten 2.100 1.300 1.200______ ______ ______Totaal beschikbaar voor doelstelling 2.231.017 1.889.553 2.080.488BestedingenVoorlichting/bewustmaking 525.901 421.736 324.111Voorbereiding en coördinatie 102.505 103.395 186.255Structurele hulp 1.304.771 1.132.925 1.440.930Noodhulp 0 45.986 0______ ______ ______1.933.177 1.704.042 1.951.296Kosten eigen fondsenwerving 171.767 157.946 185.876Werving baten (acties derden, subsidies) 47.538 47.951 83.815______ ______ ______219.305 205.897 269.691Beheer en administratie 53.460 56.330 46.564______ ______ ______Totale bestedingen 2.205.943 1.966.268 2.267.551Overschot /tekort 25.074 -76.715 -187.063Toevoegingen / onttrekkingen aan decontinuïteits reserve 0 0 0bestemmingsreserve 25.074 -76.715 -187.06312

5. Association Dokters van de WereldAssociation Dokters van de WereldDokters van de Wereld is an international medical development organisation. Our goal is:Supplying medical aid to vulnerable groups everywhere in the world, including theNetherlands, in order to improve the access and the right to health care and to testify in goodconscience about the violation of human rights, as well as educating the public.Vulnerable groupsWe do not make any distinction as to religion, race or political affiliation. Dokters van deWereld focuses on victims of armed conflicts and natural disasters, refugees, minorities, streetchildren, AIDS patients and drugs addicts.Worldwide and in the NetherlandsDokters van de Wereld is not only active in the medical assistance worldwide, we are alsoactive in health care in Europe and in the Netherlands.Right to access health careOur work consists of offering medical assistance in long term projects and emergency aidprojects.TestimoniesBy publicing testimonies Dokters van de Wereld fights injustice like violations of human rightsand injustice in access to health care.EducationDokters van de Wereld informs society about the actual activities in the projects. Ourknowledge of medical aid is used to stimulate the conscience in society and to increase thesupport of the right to access health care.ImpartialityWe only supply aid in case of emergencies. We supply aid to everybody without making anydistinction on religion, ethnical origin, gender, nationality, or political affiliation.IndependenceWe do not promote national or international agenda’s. We do not take position for or againstthe parties in a conflict. We refrain ourselves from financing originating military organisations.Because Dokters van de Wereld is supported by many private donors, we also offer help inareas which are not on the political agenda, but which do need aid urgently.Emergency aidWe work on medical aid in crisis situations, as well as providing materials and medicine,building drinking water and sanitary installations.13

6. International network of Médecins du MondeDokters van de Wereld and Médecins du Monde international networkDokters van de Wereld is the Dutch brand of the international network of Médecins du Monde.The network consists of 14 international delegations with their own (inter-) national projects,which work closely together. Médecins du Monde France supports Dokters van de Wereld bothfinancially and with the implementation of projects. Conversely, the same: Dokters van deWereld finances projects implemented by Médecins du Monde France. All projects ofMédecins du Monde France supported by Dokters van de Wereld in 2011 have beenmentioned in the annual account. Additionally doctors and other professionals are recruited inthe Netherlands and send out to foreign projects which are implemented by Médecins duMonde France. The annual account 2011 of Médecins du Monde France and the annualreport, with an approved account auditor's reports provided by SCP GVA from Paris, can bedownloaded via the website www.medecinsdumonde.org.International ProjectsAll projects of the international network of Médecins du Monde aim to realise access to carefor vulnerable populations. These people have often been excluded because of economic,social, legal, religious or ethnical reasons.In 2011 all organisations of the international network of Médecins du Monde combined haveimplemented 151 international projects in 64 countries:- in Africa: 68 projects in 24 countries (45%);- in South America: 37 projects in 14 countries (24%);- in Asia: 22 projects in 13 countries (15%);- in North Africa and the Middle East: 17 projects in 8 countries (11%);- in Europe: 7 projects in 5 countries (5%).Médecins du Monde Greece has to deal with a large economic crisis in Greece. Doctors andother volunteers are currently working under difficult circumstances. The requests for help fornational projects are growing by the day. More and more people need medical help. EvenMédecins du Monde Portugal and Spain see a direct impact of the economic crisis in theirnational projects.Delegations of Médecins du Monde have supplied care to vulnerable people on the borderbetween Libya and Tunisia during the revolution. All our teams in Haiti have battled the choleraepidemic and helped the Ministry of Health to take over the medical care.National projects, relief in a country with a delegation of Médecins du MondeIn 2011 the international network of Médecins du Monde had 190 national projects in 13countries to help people who did not have access to health care. Testimonies have beenrecorded and advocacy activities have been held on a regular basis with the health careauthorities and politicians. This in order to improve the access to health care for vulnerablegroups and to guarantee other fundamental rights.The international network of Médecins du Monde has worked on a specific EuropeanAdvocacy project in 2011, the report on access to health care for undocumented migrants inEurope.Human ResourcesNone of these projects could have been realized without qualified personnel, local andinternational. On a daily basis 7700 people worked on projects of the international network ofMédecins du Monde.14

BudgetThe international network of Médecins du Monde had a budget of 113 million Euros in 2011.15

7. Report of projects of Dokters van de Wereld7a. The Netherlands – Medoc / Access to Care for undocumentedmigrantsDokters van de Wereld has been working since 2005 to improve the access to the Dutchhealth care for migrants without valid residence papers. Because of the absence of theirresidence status they are not allowed to take out health insurance. However, they are legallyentitled to all medically necessary care. Barriers such as lack of information about rights andfinancial resources or fear of being arrested, impede good access.Activities 2011: Informing groups of migrants via the website, folders in their own language, local radio,self-help organisations and migrant churches Informing undocumented migrants about their rights and care options during individualconsulting hours, at 3 locations (Amsterdam Centrum and Zuidoost, The Hague) andvia the telephone helpline Offering blood pressure measurements, blood tests and self-care resources to closethe gap to regular care Active inscription of undocumented migrants at GP practices Registration of access problems and mediation with health care professionals andfacilities Advocacy with (local) government and health professional organizations, amongstothers through a national NGO platformResults 2011: Consultancy and mediations: A total of 1,367 client consultancies have been given (714in consultancy hours, 653 via telephone). 146 access problems where reported ofrefused or delayed care. Of these 84% was solved with mediation of Dokters van deWereld Pilot offering consulting hours Amsterdam Zuidoost was started 78 patients where inscribed in a GM practice, some after intensive mediation Workgroups investigated the themes of Cardiovascular risks, Mental Health andHealthy pregnancy & sexual health examination, by offering different test services,which can be implemented in 2012 Advocacy: In collaboration with the Breed Medisch Overleg (BMO) (Broad MedicalConsultation) the closed expert meeting 'Effects of exclusion of the Public Health,casus undocumented' was organized, in which professional organizations and otherprofessionals vowed to actively help find solutions We participated in the International Observatory of the international network of Doktersvan de Wereld, with questions about the health and access to care of 103 patients.These will be used (anonymously) for the joint European lobby.16

Numbers 2011:Target audience:Personnel:Financing:migrants with access problems to care1 project coordinator, 2 coordinators migrant care, 45 volunteers with amedical or social background, 2 medical experts for technical supportCommission PIN, Skanfonds, Fonds NutsOhra, Stichting Janivo,Stichting O.K. het Maagdenhuis, Stichting RCOAK, Cordaid, Kerk inActie, Congregation of Judie Postel, Dokters van de WereldExpenditure: € 150,275Prospects 2012The offer from Amsterdam Zuidoost is evaluated and where possible implemented in 2 otherconsultancy hour locations. By using a group of regular consultation volunteers, intakesconsultations, mediation and GP referrals are handled efficiently. An information pack iscreated about Heart and Vascular diseases and actively offered for group informationsessions. The increased reach of migrants through consultation hours and outreach will becontinued.17

7b. Operation Smile - Dokters van de Wereld and networkSince 1989, delegations of Dokters van de Wereld of Japan, France, Germany, Great-Britainand the Netherlands organise ‘Operation Smile’ in Asia and Africa. These are short-termmissions where children and young adults with cleft lip (harelip) or burn contractures, receivefree reconstructive surgery. These conditions result in physical and social problems, but manypeople in developing countries cannot afford specialized care. Besides conducting operations,strengthening the capacities of local medical personnel is an important objective.In 2011 Dokters van de Wereld has made grade strides. An independent mission wasconducted in Bangladesh, with medical staff of the Academic Medical Center (AMC) and VUMedical Center (VUmc). A special experience in which we were able to treat 126 children andyoung adults. Following contacts in the Netherlands with the Lion Heart Foundation, we alsostarted with the preparation for missions in Sierra Leone. In cooperation with local partnersand a local Dutch tropical doctor, we examined five hospitals, two of which are selected for themissions in 2012.Activities 2011: Establishing partnerships with Dutch hospitals to jointly carry out missions indeveloping countries Entering into partnership with Interplast Holland to support (sharing expertise,resources and materials) Implementation of two preparatory missions to Sierra Leone and Bangladesh to selectappropriate hospitals and partners Implementation of Operation Smile mission in Bangladesh with a Dutch medical teamof AMC and VUmc Development of standard tools to ensure the uniformity, quality and safety of themissionsResults 2011: Sending out a Dutch medical team; 3 plastic surgeons, 2 anaesthesiologists and 2surgical assistants / nurses Offering reconstructive surgery to 126 children and young adults 26 local medical personnel trained through on the job training Alliance started with physicians of 4 Dutch hospitals: AMC, VUmc, University MedicalCenter Groningen (UMCG) and Medisch Spectrum Twente (MST) Alliance with Interplast Holland started: to support the mission in Bangladesh a teammember joined the mission to select hospitals and Interplast Holland has made surgicaland anaesthesia equipment available In total, 807 patients were operated in 2011, and Dokters van de Wereld Nederlandaccepted 126 patients.18

Number 2011:Target audience:children and you adults with met cleft lip or burn contracturesPersonnel: 7 medical volunteers send out to Bangladesh, 2 field volunteers to prepare themission in Sierra Leone and Bangladesh and 2 volunteers for the office to supportthe missionFinancing:L’Oreal and Dokters van de WereldExpenditure: Total expenditure MdM network: €450,759; DvdW expenditure: €33,610DvdW contribution to MdM network: €53,000Prospects 2012:Next year we will have 4 missions to Bangladesh and Sierra Leone, in collaboration with theaforementioned Dutch hospitals and local hospitals. In support of potential new missionspossibilities for cooperation are examined with medical teams from other Dutch hospitals andInterplast Holland.19

7c. Serbia - ‘Being aware’: integration of risk reduction of druguse within the health system in BelgradeSince 2009 Dokters van de Wereld collaborates with the local organization VEZA to improvecare for drug addicts in Belgrade and provide information on drug use among high-risk groups.The majority of the 10,000 drug addicts live on the street. As a result they run extra risk ofinfections and are also exposed to discrimination, exploitation and violence. The VEZA team iscommitted to reach this group through low-threshold activities such as a drop-in center andfield activities (outreach). Access to health care and other services is limited because the lackof proper documents and insurance but also because of stigmatisation and negative treatment.We improve laws and regulations (lobby) and increase awareness about the issue (antistigma).In 2011, the last project year, Dokters van de Wereld worked with the Dutchorganizations Mainline and Correlation Netwerk to strengthen Veza and partners. Thus theyare able to pursue assistance independently and continue to set up and implement trainingprograms for medical personnel.Activities 2011: Providing accessible medical, legal and social assistance to drug addicts in Belgradewith a shelter and field activities Organization of information activities at festivals and clubs to reach young people andinform them about drugs and prevention Organization of round table discussions at national and international levels withrelevant partners, government and policy makers to improve laws and regulations toguarantee of care for drug addicts The strengthening VEZA team members so they can train health care personnel ofprimary and secondary clinics in BelgradeResults 2011: 2,300 beneficiaries took part and traded in their needles in exchange programs 262 social work consultations and 320 medical consultations were given by the team inthe shelter 169 medical professionals attended the training (doctors, nurses) 1 national round table session was organised 1 international round table session was organised with participating countries:Romania, Bosnia, Herzegovina, Slovenia Photo exhibition and publication on 3 years of fieldwork at the conclusion of theprogramNumbers 2011:Target audience:Personnel:Drug addicts in Belgrade, GPs, emergency room physicians, specialistsin hospitals, policymakersVEZA team (17 employees), 7 trainers on assignment (Mainline andCorrelation Network)20

Financing:MATRA - Netherlands Ministry of Foreign AffairsExpenditure: € 215,50721

7d. Indonesia, Aceh - Mother and child care projectSave pregnancies everybody's business!Since 2007, Dokters van de Wereld in collaboration with the Indonesian government work toprovide care for pregnant women and newborns in Aceh. A project was started late 2011 for amother and child care project in the Permata subdistrict. The Bener Meriah district is a remotearea in the highlands of central Aceh. The people of Aceh, Gayo, belong to one of the most'forgotten' groups in Indonesia. The mother and child mortality is unnecessarily high. There is ashortage of properly trained personnel, lack of materials and a dysfunctional reference system.The distances to the nearest hospitals are large and because of poverty villagers often cannotpay for transport costs. In cooperation with village leaders and public health, Dokters van deWereld works to improve participation and care for women before, during and after birth.Activities 2011: Recruitment of project team and training in participatory methods for both thepopulation and health care personnel involved in the rollout of the program All midwives and medical staff in the subdistrict are trained on the theme of safepregnancies and births for which tailor-made training are being developed Establishing village health committees and the implementation of the birthpreparedness system according to the National Strategy of the Ministry of Health iskey. This system ensures that women visit a qualified midwife during the pregnancywhich includes a first visit within the first trimester Encouraging women to take care of blood donors and having the village create asavings scheme and provide transportation to the hospital. The community themselvescomes up with ideas, so the improvements in society are embedded Intensify sustainable partnerships and exchange meetings to improve referralsbetween villages and health facilitiesResults 2011: The project team has been recruited and trained in participatory methods Together with the Ministry of Health, district health authorities and health staff as wellas village leaders, an action plan was made in 28 villages to create a health committeeto implement a birth readiness system The implementation was started in four villages with information briefings. Furthermore,preparations were made with the development of training for medical personnel andmembers of village committeesNumbers 2011:Target audience:Personnel:Financing:Pregnant women and newborns, midwives, health workers in the clinic,village volunteers, district health care service1 international and 8 national employeesInnovation funds from Health Insurers, Maria Stroot Fonds, Dokters vande WereldExpenditure: € 53,93922

Prospects 2012In 2012, a series of courses are planned for 70 midwives, doctors and nurses in Bener Meriahas well as a control system designed to improve the quality of midwifery care. In 28 villages inPermata health committees are formed and trained to implement the birth readiness system.This reduces the risk of complications during pregnancy and childbirth.23

8. Report of projects Médecins du Monde France, financiallysuported by Dokters van de Wereld8a. Ivory Coast - Access to care in times of crisisThe presidential elections in November 2010 created a chaotic situation in the Ivory Coast.Two candidates, Alassane Ouatarra and Laurent Gbagbo where both declared the winner.This led to conflict and crisis, with devastating consequences for the economy and socialservices (health services) in the capital Abidjan. Dokters van de Wereld offered support andaccess to care in this situation.Activities 2012: Assessing the needs in collaboration with local authorities For several months, the support of 21 health centers and 5 mother and child careclinics in the most vulnerable districts of Abidjan Restoring the centers themselves, offering consultations and medicines, support ofmedical staff Assistance for victims of sexual and physical violence, people with mental problems,people infected with HIV and tuberculosisResults 2011:113.007 have been for a consultationNumbers 2011:Target audience:Personnel:Financing:Vulnerable population from disadvantaged neighbourhoods in Abidjannational 14 persons, international 5 personsDokters van de Wereld, MdM, Echo, Chaine du BonheurExpenditure: Total expenditure MdM € 759,549; contribution DvdW € 23,000Prospects 2012After the crisis ended in Abidjan the work of Dokters van de Wereld focussed on improvingmedical care to people in rural areas, the population here has minimal access to healthcare.24

8b. Colombia - Access to care for indigenous populations and Afro-ColombiansStarting 2003 Dokters van de Wereld supports the indigenous population and Afro-Colombianswho are deprived of medical care (due to the armed conflict) in the Atrato region. The goal ofthe project is to improve access to care and to advocate equal treatment within the nationalhealth care system. Dokters van de Wereld provides assistance to the population which isaffected by internal conflicts, illegally, fights over coca plantations and armed forces and hasbecome extremely vulnerable.Activities 2011: Treatment for malnutrition and care for pregnant women and children under 5 years Medical consultations for people in remote areas and conflict zones Establishing and strengthening of village health committees and conducting awarenesscampaigns on health. Dokters van de Wereld operates in such a way that its activitiesin this region can be transferred to local medical teamsResults 2011: 12 mobile clinics 10 information briefings on health and prevention in 6 villagesNumbers 2011:Target audience:Personnel:Financing:indigenous populations, Afro-Colombiansnational 8 persons, international 4 personsDokters van de Wereld, MdM, AECIDExpenditure: Total expenditure MdM € 230,801; contribution DvdW € 29,000Prospect 2012Dokters van de Wereld has concluded her work in the region of l'Atrato in June 2011. Atravelling photo exhibition provides a permanent agenda of the lack of accessible health carefor these vulnerable and isolated populations.25

8c. Indonesia West Papua – Improvement of sexual health and birthcontrolThe highlands of West Papua are one of the most isolated areas of the world, where thepopulation only has a very minimal access to health care. In these regions, the AIDS rate is2.4%, the highest level of the country. In this context, Dokters van de Wereld launched aprogram aimed at sexual health care and birth control, with a diagnosis and treatment ofpeople with HIV / AIDS.Activities 2011: Strengthen the cooperation with local partners: the district health office, the studentassociations and the Primari association. Development of educational materials and organize briefings on sexual health and birthcontrol in collaboration with partners Creation of two screening centers and training of medical staff and health educatorsResults 2011: Trained 111 health educators in the field of sexual health and birth control 4,000 participants to information briefingsNumbers 2011:Target audience:Personnel:Financing:local population and health educatorsnational 17 persons, international 2 personsCordaid, Dokters van de Wereld, MdMExpenditure: Total expenditure MdM € 199,504; contribution DvdW € 82,500Prospect 2012The completion of the project of Dokters van de Wereld is planned for May 2012, when thelocal organisations take over the educational work. In April 2012 a joint meeting is held toformulate the best practices and lessons learned over the entire project.26

8d. Democratic Republic of Congo - Fighting HIV / AIDSDespite the return of peace in most parts of the country, the year 2011 was marked byelectoral unrest and the country slid to the lowest echelons on the global ranking ofhumanitarian development. Dokters van de Wereld supports both the health authorities andsocial organizations in providing care to the most vulnerable groups. This includes the fightagainst major epidemics and violence against women. The program, started in 2003, is aimedat the prevention and control of sexually transmitted diseases and reducing HIV / AIDScontaminations.Activities 2011: Collaboration with health organizations at local and national level for the projects inGoma and Karisimbi In order to reduce sexually transmitted diseases, there are services such as: free andanonymous assistance in health care centers, integrated approach in the HIV / AIDStreatment centers and two centers designed to prevent mother to child infection Educational programs where created together with 12 local organizationsResults 2011: 5.756 patients followed, of which 1,496 with anti-viral treatment 3,395 new screenings performed (HIV prevalence 13%)Numbers 2011:Target audience:Personnel:Financing:local population and health educatorsnational 26 persons, international 3 personsMFS - Netherlands Ministry of Foreign Affairs, MdM, WFP, UNDPExpenditure: Total expenditure MdM € 492,351; contribution DvdW (MFS) € 24,850Prospect 2012The fight against HIV / AIDS and the long experience that Dokters van de Wereld has isshared with local organizations and health authorities. Dokters van de Wereld suppliestechnical and financial support in DRC. This is a challenge at a time when budgets for HIVAIDS are under pressure and less money is available.27

8e. Zimbabwe - The fight against HIV / AIDS and providing motherand child care in ChipingeThe health structure in Zimbabwe remains extremely precarious. High mortality rates and anacute shortage of nursing staff. This is contrasted by an increasing percentage of HIV infectedpeople. The Chipinge area in particular is a poor and isolated area in the Manicaland province.Previously a cholera epidemic ravaged the region. Dokters van de Wereld is the only medicalaid organization which is active here.Activities 2011: Preventing mother to child transfer (HIV / AIDS), particularly for pregnant women andchildren in the 3 hospitals and 48 clinics in the district At community level Dokters van de Wereld works for young people, orphans andchildren with HIV / AIDS to: Reduce stigma, increase HIV testing and improving the treatments in the differentcommunities, through home visits and constructing gardens for growing crops forpeople with HIV / AIDS and raise awareness of young people about HIV Care of orphans and vulnerable children by the 'grands-mères du coeur' - thegrandmothers with a heart.Results 2011: 375 health workers trained 6,949 pregnant women tested for HIV; 122 children being treated with anti-retro viralmedication; treated 725 cases of choleraNumbers 2011:Target audience:Personnel:Financing:mothers and children, health workersnational 31 persons, international 4 personsMFS - Ministry of Foreign Affairs, MdM, EuropeAid, Echo, UN-ERF,regional counsel Ile-de-FranceExpenditure: Total expenditure MdM € 992,893; contribution DvdW (MFS) € 24,850Prospects 2012:Dokters van de Wereld will continue along the same lines as in 2011 in order to transfer theactivities to local organisations where possible with the aim to stop the project in June 2012.28

8f. Pakistan – Helping women who are victims of violenceIn Pakistan, women are frequently victims of violence and therefore very vulnerable. In 2009,8,548 women where officially registered as victims of violence. 1988 women died as a result ofhonour killings. These numbers reflect the reality. Vulnerable women are stigmatized or notrecognized.The Dar ul-Amans (DUAs) or houses of peace are supported by the Department of SocialAffairs in the province of Punjab, and are the only bodies that stand up for vulnerable women.They offer protection, medicine, legal and psychosocial support.Activities 2011: The activities (medical / legal and psychological assistance) of Dokters van de Wereldare running in line with the transfer planning of the Department of Social Affairs.Dokters van de Wereld wants to improve the skills of employees in the 34 DUAs. Inconjunction with the Department of Social Affairs they are working on management,monitoring, job descriptions and action plans In addition Dokters van de Wereld is a member of Mumkin, a local NGO platform thatdefends the rights of women in Punjab. Mumkin improves the coordination of legalissues and is working on a bill regarding domestic violenceResults 2011: In 2011 10,682 women and 2,805 children found temporary shelter in one of the 34DUAs in PunjabNumbers 2011:Target audience:Personnel:Financing:women and their children who are victims of (domestic) violencenational 41 persons, international 3 personsDokters van de Wereld, EuropeAid, Foundation PPR, embassy ofNorway and DenmarkExpenditure: Total expenditure MdM € 601,881; contribution DvdW € 18,000Prospects 2012:Dokters van de Wereld will gradually withdraw from the project. Looking ahead to 2013, a startwill be made to gradually transfer the supervision of the DUAs to the Department of SocialAffairs. The support of capacity in the project continues as planned until the end of the project.In addition Dokters van de Wereld will remain active as Mumkin member.29

8g. Myanmar (Burma) – Better care for mother and childSince 2009, Dokters van de Wereld operates in the Delta region of Myanmar, one of thepoorest regions of the country. First with an emergency program to provide immediate medicalattention after the cyclone Nargis. Later a mother and child care project was started in Pyaponto structurally improve healthcare. In this district, the maternal mortality is very high. Manywomen do not come to clinic, or arrive too late because of the great distances and lack ofmoney. They also have very limited access to birth control programs. There are not enoughadequately trained local midwives and health workers.Activities: Visiting remote villages with a team of field staff consisting of midwives, nurses andcommunity mobilisers, mainly by boat Formation of village health committees in 137 villages, and training local healthworkers, who help to organise that information briefings Establish funds for care for the most remote villages Strengthening the health system at local and national levels in collaboration with theMinistry of Health, NGOs and the United NationsResults 2011: Every month, over 100 villages are visited by the mobile medical team In 25 villages a fund is established in order to pay for transport and hospital treatments 110 local health workers and 47 midwives trained, 126 patients treated thanks to villagefundsTarget audience:Personnel:Financing:mothers and children under 5 years, health workersnational 37 persons, international 3 personsDokters van de Wereld, MdM, EuropeAid, UNFPA, JIMNCHExpenditures: Total expenditure MdM € 325,999; contribution DvdW € 13,000Prospect 2012By May 1, 2012, the activities will be taken over by the Dutch branch of Doctors of the World.We will continue the chosen path to expand the care for mothers and young children andstrengthen the village health committees.30

8h. Liberia - Improving the care for the national populationAlthough maternal mortality figures remain alarming (990 mothers die in 100,000 births), thehealth system in Liberia has developed positively. The country has received internationalsupport, a good omen for the further development of the country. In this context, Dokters vande Wereld continues its activities in the Bong district with a focus on training and skills transfer.Activities 2011: Dokters van de Wereld supports, together with partners, 16 health facilities, includingCB Dunbar hospital in the capital of the district Gbarnga. Support for generalconsultations, maternal and child care, as well as mental health care and basic healthcare Additionally health activities where developed in the surrounding villages Since March 2011, CB Dunbar Hospital (55 beds) is the reference hospital of thedistrict for gynaecological and neonatal emergencies. Dokters van de Wereld supportsthis in the areas of logistics and staff Dokters van de Wereld also works to enhance capacity of management staff of thehealth district, which is responsible for coordinating and monitoring the activities Continue training of medical staffResults 2011: 1022 children born in the CB Dunbar hospital, 356 caesareans 93,758 medical consultationsNumbers 2011:Target audience:Personnel:Financing:119,642 direct and 330,000 indirect53 national and 9 internationalEcho, EuropeAid, AFD, McCall MacBain Foundation, Dokters van deWereldExpenditure: Total expenditure MdM € 2,070,162; contribution DvdW € 16,000Prospects 2012:Starting 2012 Dokters van de Wereld begins with the reduction of involvement in the wholehealth structure and strengthening the capacities of management staff of the health district. Bythe end of 2013, Dokters van de Wereld will transfer its activities to the health district31

8i. Horn of Africa – KenyaImproving health care for displaced mothers and childrenIn 2011, the worst drought in sixty years was measured in the Horn of Africa. This droughtcaused a severe food crisis. In northern Kenya, on the border with Somalia and Ethiopia in thedistrict Dadaab displaced persons are given shelter in refugee camps. Displaced persons arevery vulnerable. They have been on the run for a long time, looking for food and a safe placeto stay. Dokters van de Wereld, with more than 20 years presence in the region has launcheda program to provide the basic needs of these vulnerable displaced persons.Activities 2011: In cooperation with the NGO WAHA, Dokters van de Wereld is working in a hospital inDadaab. The displaced persons from the refugee camps can be treated here. Dokters van de Wereld provides equipment and medicines to the hospital. AdditionallyDokters van de Wereld organises medical staff sessions and creates educationalprograms. The support for 9 health units in the region is stopped for safety reasons.Results 2011: 7,049 consultations where held, and 68 deliveries and 35 caesarean have taken place The rehabilitation of the hospital with 60 beds Supplying 10 ambulances for the communityNumbers 2011:Target audience:Personnel:Financing:Expenditure:7,152 direct and 68,000 indirect4 internationalMaria Stroot Fonds, Stern Stunden, Foundation ROI BaudouinTotal expenditure MdM € 349,322; contribution DvdW/Maria StrootFonds € 15,000Prospects 2012:Dokters van de Wereld continues to work on the rehabilitation of the hospital until June 2012.The NGO WAHA will subsequently take over the activities of our program in the next 2 years.32

8j. Haiti – Improving access to careAs a result of the earthquake in January 2010, Dokters van de Wereld, has set up 10temporary clinics to improve access to care for the vulnerable population. Rebuilding after theearthquake is steadily progressing and resources of local authorities are limited. Dokters vande Wereld will remain active in this 'post emergency' period with the authorities so ourtemporary medical clinics can be transferred into public health centers step by step.Activities 2011: 6 temporary clinics of Dokters van de Wereld have been integrated into 2 Haitianhealth centers. The clinics offer free access to care (reproductive health care and basic health care).The psychosocial assistance (discussion groups / individual and psychologicalconsultation) are fully at everybody's disposal. Additional research is taking place to beable to give optimal help to the victims of sexual violence.Results 2011: 81,057 free consults performedNumbers 2011:Target audience: local populationPersonnel: national 108 persons, international 5 personsFinancing:Dokters van de Wereld, Echo, UNICEFExpenditure: Total expenditure MdM € 2,493,034; contribution DvdW € 30,000Prospect 2012Dokters van de Wereld is gradually handing over the temporary clinics to the Haitian healthauthorities. The transfer is facilitated in cooperation with the Ministry of Health Care.33