State of Israel Israel-Ghana Partnership for Development MASHAV Israel s Agency for International Development Cooperation
At the Millennium Summit in September 2000 world leaders adopted the UN Millennium Declaration, committing their nations to a new global partnership to reduce extreme poverty. This Summit laid the foundation for the formulation of what would become the Millennium Development Goals (MDGs). The MDGs are the most broadly supported, comprehensive and specific development goals the world has ever agreed upon. The UN Millennium Declaration and the MDGs are an important point of reference for MASHAV Israel s Agency for International Development Cooperation. Foreword MASHAV is dedicated to providing developing countries with the best of Israel s experience in development and planning. As a country that moved from an underdeveloped state in the 1950s, to just recently becoming a new member of the OECD, we feel that we can share with others our firsthand experience in development. We are proud to be one of the oldest international development agencies in the world. Founded in 1957, MASHAV is responsible for the design, coordination and implementation of the State of Israel s development cooperation programs. Since its inception, over 270,000 professionals from around the world have participated in MASHAV s professional programs. MASHAV s activities focus primarily on areas in which Israel has a comparative advantage including agriculture and rural development; water resources management; micro-enterprise development; community development; medicine and public health; empowerment of women and education. At the same time MASHAV operates according to the needs and demands of the partner countries, rather than programs initiated by Israel that might not be relevant and effective elsewhere. Although a modest player in the international assistance arena, MASHAV provides fast, flexible, hands-on, pragmatic, original and practical solutions to development challenges, thus becoming a significant contributor to sustainable development. Israel and Ghana maintain bilateral relations including trilateral agreements signed with partner countries in the areas of health and medicine, education and agriculture. Cooperation between the two countries will be enhanced following the official opening of the new Israeli Embassy in Accra, in September 2011. This paper gives an overview of some of MASHAV s development cooperation, human resources development and capacity building activities in Ghana, towards the 2015 target date for reaching the Millennium Development Goals, in the fields of: Reducing Neonatal & Maternal Mortality, Water & Sanitation, Early Childhood Education, and Agricultural Cooperation focusing on the citrus value chain.
Reducing Neonatal and Maternal Mortality in Kumasi n early 2006 the Millennium Cities Initiative (MCI), launched Kumasi as a Millennium City. Since then MCI is conducting research aimed at identifying the services, resources and infrastructure needed for the people of Kumasi to attain the Millennium Development Goals (MDGs). Within this framework, a successful partnership was forged between MCI-MASHAV and the Kumasi Metropolitan Authorities. Kumasi, Ghana s second largest city is the capital and cultural center of the Ashanti Region. Located in the south-central part of the country, with a population of approximately 1.5 million people, Kumasi boasts a high number of public and private health facilities and many people from nearby villages and towns travel to the city to receive medical care. The Beginning of the Project In December 2006 MASHAV dispatched a medical team consisting of two Israeli physicians to Kumasi on a fact-finding mission to help design a program in the field of healthcare together with the MCI Project Manager in Ghana. Their findings were the following: The city of Kumasi has 1.5 million inhabitants, and serves most of northern Ghana, which has a population of approximately eight million people. Under the auspices of the government of Ghana, significant progress in the field of health care has been made in recent years with the introduction of free ante-natal care, delivery services, and well-baby clinics. Malaria, tuberculosis and HIV-AIDS are amongst the most pressing problems. The municipal hospitals in Kumasi are lacking specialists and tools for diagnosis and treatment refer many patients with medical problems beyond their expertise and capabilities to the Komfo Anokye Teaching Hospital (KATH). In addition many patients bypass the municipal hospitals and come 3 Capacity Building in Ghana
directly to KATH. All this causes severe overcrowding which makes effective treatment in KATH extremely difficult. The only neonatal facility in Kumasi is the Neonatal Intensive Care Unit (NICU) at KATH which had occupancy of over 200% and an unacceptable mortality due to overcrowding and cross infections. Many high risk and sick babies shared the same incubator and the staff though committed and knowledgeable is overwhelmed by the great number of sick babies. The situation of newborn care in Kumasi is extremely difficult and it is clear why the city s metropolitan health administration has given the upgrading of newborn services a very high priority. Objective: To Reduce Neonatal and Maternal Mortality in Kumasi Each year an estimate 28,000 babies are born in Kumasi. Of these, over 4,000 are low birth-weight, high-risk, or sick and in need of special care. Following the professional needs assessment, and Ghana s Ministry of Health and Health Services own protocols and priorities, it was clear that there was an urgent need to establish additional neonatal special-care units in Kumasi. The Kumasi metro health directorate made a strategic decision to establish level II nurseries with Kangaroo Mother Care in all its 5 Submetro hospitals. This plan would reduce the number of sick newborns in the NICU of KATH by 50% and provide the conditions necessary for becoming a regional level III referral center. Following this plan, MASHAV committed itself to establish the first two Mother and Baby Units (MBUs) for low birth weight, high risk and moderately sick neonates and their mothers at Suntreso and Kumasi South hospitals. For this purpose MASHAV partnered with the professional teams of the Department of Neonatology at Soroka University Medical Center and cooperated with the American Global Alliance NGO. Neonatal Care Levels L E V E L Provides basic care for healthy newborns. L E V E L Provides special care for low birth weight, high risk and moderately sick newborns. At this level care can be successfuly provided with limited resources by a well trained nursing staff with active participation of the mothers and some medical supervision. L E V E L The Neonatal intensivecare unit (NICU), cares for very sick newborns and needs specialized medical and nursing staff and costly equipment.
The Kangaroo Mother Care The introduction of Kangaroo Mother Care (KMC) in developing countries has revolutionized the treatment of low birth weight babies by replacing the use of expensive incubators. Very small babies are carried 24/7 in direct skin to skin contact between the mothers breasts and are fed expressed breast milk through N/G tube by their mothers. By providing a theroneutral environment, nutrition and protection from cross infections KMC has significantly reduced mortality of low birth weigh infants in the developing world. Professional Program Over the years, Soroka s Department of Neonatology of the Faculty of Health Sciences at Ben Gurion University has developed an outstanding training program for doctors and nurses caring for high risk and sick newborns in rural hospitals of the developing world. The training is based on a clinical low-cost, low-tech approach which also includes Kangaroo Mother Care. So far, two Mother and Baby Kangaroo Mother Care Units with all the necessary medical equipment for the care of high risk and moderately sick newborns and their mothers, have been established by MASHAV in Kumasi based on this approach. One unit in Kumasi South Hospital (in 2008) and a other in Suntreso Hospital (in 2009). As part of the project, MASHAV also provided several on site training courses for the staff of the new MBUs by a team of
doctors and nurses from the department of neonatology of Soroka. Within this framework, MASHAV has also funded a three month training program in the department of neonatology at Soroka for two pediatricians and two senior nurses from Kumasi. The graduates are now prominent experts and teachers in newborn care in Kumasi and have trained hundreds of nurses all over Ghana. One of them Mrs. Regina Obeng has received the Neonatal Excellence Nursing Award at the international conference of nursing 2010. Training of physicians in Komfo Anokye Teaching Hospital (KATH): MASHAV and its professional partners have trained KATH physicians in several courses targeted at strengthening their capacity to provide efficient up to date care in the fields of trauma and medical emergencies, prevention of cross infections and support for persons infected with HIV/AIDS. 6 Capacity Building in Ghana
Water and Sanitation Within the framework of the project, there was an urgent need to upgrade the water quality, ensure regular water supply, and expand Komfo Anokye Teaching Hospital (KATH) access to healthy sources of water. To tackle this challenge, MASHAV sent an Israeli expert from Mekorot Israel s National Water Company, who in cooperation with Ghana s Water Authority implemented and monitored the project, including the upgrading of two existing wells and drilling two additional ones (65 meters deep) in a watercourse near the hospital. Water pumps were installed and the wells were connected to the hospital s water system. Results and Outcome The MCI Project Manager for Ghana is in charge of monitoring the project, including its effect on the NICU at KATH. After less than six months operation, the two new MBUs had managed to decongest the NICU by more than 30 percent, a highly successful result even before a good track record assures mothers that they can make these lower-level facilities their first stop, as a safe place to deliver their babies. In addition to the successful effect on the NICU of KATH, and following the current results, the entire Ashanti region, whose numbers are driven by those in Kumasi, is expected to report a significant reduction in maternal mortality.
Introducing Change in Early Childhood Education in Kumasi n May 2003, the Ministry of Education and Sport in Ghana came out with an Education Strategy Plan (ESP) for 2003-2015. The ESP serves as the framework by which Ghana will meet its commitments to achieve the Millennium Development Goals (MDG) in Education. Before 2003, preschool education for children aged 4-6 years was not part of the formal system in Ghana. It was included eventually as a result of the recommendations made by the President s Committee on Review of Education Reforms (October 2002), where the importance and the far-reaching effects of early childhood development were clearly outlined. Following the Millennium Cities Initiative (MCI), launching of Kumasi as a Millennium City, a successful partnership was forged between MCI and Early Childhood Education specialists from the Golda Meir Mount Carmel International Training Center (MCTC), one of MASHAV s core professional training institutes. They cooperated to develop a system of early childhood education with the goal of implementing it in all public schools in Kumasi and its surroundings. O The Aims of the Program The program was based on the following three aspects: 1. Empowerment of the teachers to believe that ECD is the basis of further education and that their role is vital in this process. Their main role as kindergarten teachers is to mediate between the child and the world around him. 2. Creating a rich and stimulating indoor and outdoor learning environment in the kindergarten bringing the outside world into the kindergarten for the child to experience. 3. Build a flexible curriculum and daily schedule based on the children s world and providing opportunities for developing creativity and thinking skills in the child. 8 Capacity Building in Ghana
The Beginning of the Project The project began in 2008 by visiting and observing the kindergartens in Kumasi and mapping out the situation. The findings showed small, dark classrooms with up to 100 children crowded around tables, sitting on chairs of different heights. The children all faced the teacher, who stood in front of them, holding a long cane and pointing it at English letters on the blackboard. The children were expected to repeat, again and again, what the teacher said in English, since that was the language of instruction. There were no books in the classroom suitable to their culture, and stories were never read to them. The teachers, who had been trained as primary school teachers, were using the same methodology that they had learned at school, and were now emulating in the kindergarten. bjective To introduce a new concept of Early Childhood Development Objective: To introduce a new concept of Early Childhood Development Following a meeting with the Metro Director of Education in Kumasi and the MCI Project Manager in Ghana, it was decided that the first step of the program would be to bring the Metro Director and her staff of four early childhood development coordinators to Israel to see and learn a different way of organizing ECD. A two year program was planned by the Metro Director, her team and the MCTC staff for a core group of teachers who would become teacher trainers in the future. The Director and her staff decided upon their return from Israel, that they would choose five schools, with their 25 kindergarten teachers to be the pilot group. A first Israeli team went to Kumasi to train these 25 kindergarten teachers. 9 Capacity Building in Ghana
Professional Program The first realization was that children learn through play and experience. The main emphasis was on building a new learning environment following the belief that a change of the environment will help to change the approach to the new ideas. The new environment included activity corners for socio-dramatic play, a book corner, a corner for creative activities, blocks and table games, at different levels and which could be used in different teaching situations. This was done by actually building a kindergarten environment in the classroom. In order to turn theory into reality, the teachers had to experience playing by themselves in the different corners. This experience was very important to them and they were very happy and enthusiastic throughout. In n addition to this, the number of children in the class had to be reduced. The teachers identified the need to write books, using their own folk tales and cultural heritage and learned how to read them to the young children. When the teachers agreed to change the arrangement of the rooms they enthusiastically collected toys and other materials for the children to play with.
The professional program included the dispatch of Israeli expert teams to Kumasi to train the group of kindergarten teachers for at least two weeks every few months. In between, the ECD coordinators took it upon themselves to support the kindergarten teachers in their efforts to implement what they had learned. Each training session was based on the previous knowledge learned and implemented in the kindergartens, and following the teachers requests about any problems they were having in implementing what they had learned. The basic philosophy was that children learn through play and experience, therefore all the trainings were experiential, providing many opportunities for the teachers to play. In all aspects of the workshop, theory was drawn from the active involvement of the teachers. This training model observes needs in the field, prioritizing the culture and traditions, and emphasizing the need to examine the underlying why and how questions of implementing the existing Ghanaian ECD curriculum. Results and Outcome The Ghanaian professional team, the Metro Director and her staff are partners every step of the way. They share in the planning, supervision, implementation and evaluation of this unique program. In the time since the program started, great changes are to be seen in the kindergartens. The number of children has been reduced, and there is more space in the classroom, the arrangement is more flexible, the learning environment has changed to include relevant talking walls, display of the children s work and activity centers. Reading books has become part of the daily schedule, and at least twice a week the room is arranged for free play. The kindergarten reflects the integrative program of all the domains, allowing the children to learn through active participation, playing in small groups, learning to return toys and materials to their place. The role of the teacher has changed from being a disciplinarian to being less authoritative, and more at the children s level. Teachers work with the children in small groups, ask questions and listen to their answers rather than expecting them to learn 11 Capacity Building in Ghana
only through repetition. They have also discovered that they can make table games such as lotto and route games at different levels, and have learned the joy of constructing jigsaw puzzles from old calendar pictures. The role of the classroom attendant has also changed from being a cleaning woman to being a partner in running the daily program. It was decided to ask Kumasi s St. Louis Teacher Training College s ECD lecturers to act as supervisors and support the teachers. They participated in three of the Kumasi workshops, together with the kindergarten teachers. At a later stage, ten teacher trainers, including the Principal and Deputy Principal of the St. Louis Teacher Training College, came to Israel for a specially designed workshop, where they were exposed to different ECD frameworks. The third step was a one-week workshop in the College for all the ECD lecturers as well as for 75 ECD students who had completed their formal studies and were going to practice teaching in the kindergartens. The project has been expanded to include five more schools in the Kumasi area, with 25 kindergarten teachers in all, each of whom has been adopted by one of the more experienced teachers in the pilot project. Fifty kindergarten teachers in Kumasi are in the process of change.
Trilateral Agricultural Cooperation Israel-Ghana-Germany hana s Shared Growth And Development Agenda (GSGDA), 2010-2013 underlines that Agriculture will remain decisive for economic growth and development, job creation and the reduction of poverty. Given its central role in generating income and providing subsistence for majority of the people of Ghana as well as its potential to lead the transformation of the economy, agriculture is expected to drive the new development agenda. The main focus of agricultural development policy, over the medium-term, will be to accelerate the modernisation of agriculture and ensure its linkage with industry through the application of science, technology and innovation. The Ministry of Agriculture of Ghana (MAoFA), the Ministry of Foreign Affairs of the State of Israel through MASHAV, and the Federal Ministry of Economic Cooperation and Development of Germany (BMZ) established a trilateral cooperation seeking to strengthen and enforce the framework and activities of the market oriented agricultural program (MOAP) of Ghana, focusing at the beginning on the citrus value chain. The project focuses on technology development and transfer of know how intended to support applied research activities especially in citrus as well as strengthening the research/extension/farmer s linkage. It also includes capacity building programs for researchers, the extension service, and establishment of Public Private Partnerships (PPP). The gender issue is a factor for consideration in the program. The Beginning of the Project A first fact-finding Israeli-German delegation met in Ghana with the local authorities in August 2010. As a result, MASHAV sent a few months later a team comprised of a professional citriculture and marketing experts from the Ministry of Agriculture and Rural Development, Extension Service. 13 Capacity Building in Ghana
The aim was to meet with and advise local citrus growers, research workers and trainers in the field of citriculture and marketing and to recommend improved growing practices that would lead to better fruit yields and higher profits for the farmers. bjective Improving yields productivity to increase income generation Objective The experts team outlined the growing practices and other operations that are recommended to implement in the orchards and ways to apply them, in order to increase the citrus yields. Post-harvest recommendations were presented and ways of implementation for improving the marketing of citrus fruit in a more productive manner, thus increasing the amount of profits made by the orchard growers and the farmers. It was envisaged that implementation of these recommendations would lead to the further development of the sector, making it more productive, efficient and adapted to market conditions, in order to facilitate an intensive and efficient citrus production at local conditions. Additional activities are in planning and will continue the implementation of the program.
Future Cooperation Future activities are being planned for all three projects and their implementation in the near future: Reducing Neonatal & Maternal Mortality The planning for future activities includes expanding the project to include aspects of Public Health to achieve a holistic approach of Mother and Child Care, from birth to school age to improve maternal and child health services in the city. The model includes implementation of the Israeli Mother and Child Health Clinics A Drop of Milk. The model has proven it success in diminishing infant mortality, maternal morbidity and mortality by increasing access to ante-natal and post-partum care in a selected area; providing immunization coverage; and as an effective tool for health education for mothers. To consolidate this plan a young and energetic physician sponsored by MASHAV and selected by Metro Health Authorities in Kumasi is coming to Israel to study for his M.A. degree at the International School of Public Health in Jerusalem starting November 2011. This physician will also receive training in newborn care in Soroka and upon his return will take charge of maternal and child public health services and all Mother and Baby Units in the city. Further on, to ensure a professional and stable operational framework, MASHAV and MCI, in cooperation with Kumasi s health authorities, designed a specialized training course for medical assistances in the field of neonatology. The course will take place in Kumasi, and will be organized by the local authorities and monitored by experts from MASHAV and the Soroka Hospital. Early Childhood Education MCI has recently declared Accra as its newest Millennium City. Future planning includes replicating in Accra the MASHAV-MCI s ECD program as being presently implemented in Kumasi; with the ultimate goal of expanding the model to the whole country following a national education strategy. Agricultural Cooperation Future planned activities include the establishment of improved citrus nurseries, and joint research conducted by Ghanaian and Israeli researchers in the areas of, among others, introducing new irrigation methods to improve the size of the harvest, and examination of new varieties grafted on to suitable rootstocks.
MASHAV Israel s Agency for International Development Cooperation http://mashav.mfa.gov.il mashav@haigud.org.il Tel. 972-2-5303220 Fax. 972-2-5303727 Embassy of Israel ACCRA, GHANA info@accra.mfa.gov.il Production: Haigud Society for Transfer of Technology Graphic design: Yuval Tal ltd.