Project MARC

What are we doing & why

• Past, Present & Future
• Objectives & Approach
• MOU with the Vanuatu Ministry of Health
• History

MOU with the Vanuatu Ministry of Health

  
Agreed continuation period: May 1, 2004 to April 30, 2009 


 
1. GENERAL

This MEMORANDUM expresses the understandings and intentions of the Ministry of Health of Vanuatu (hereafter referred to as MOH) and The Hope Alliance (hereafter referred to as THA), concerning the responsibilities and contributions respectively of both parties in regard to Project MARC (hereafter referred to as the Program.)

This MOU is subject to the agreement between both implementing agencies as to the responsibilities and contributions as outlined herein. This MOU is accompanied by the Project MARC Operational Plan (Annex 1) outlining activities and responsibilities as mutually agreed by both implementing agencies. The Program Plan will form part of this MOU as an annex.


2. BACKGROUND

The first MOU regarding "Project MARC", a 3-yr medical assistance plan for remote Vanuatu communities -- to be selected by both parties in close consultation -- started May 1, 2001 and was signed by THA and MOH representatives in March/April 2001.

In 2001, 2002 and 2003 Project MARC volunteer teams visited all three selected target destinations, namely the Lolihor area (N Ambrym); the Aulua/Banam Bay area (E Malakula); and the Maskelyne islands (SE Malakula) throughout the June-September dry seasons. Land-based volunteer teams arrived and left on a monthly basis with the support of volunteer cruising vessels (ranging from 35 to 75 ft in length and from 8 to 70 tons in weight) which provided the primary means of transporting volunteers, patients, equipment and supplies as well as clinic building materials.

The size and scope of the assistance delivered by project MARC throughout the 2001, 2002 and 2003 seasons covered by the first MOU is as follows:

Thirty-three pallets with well over 15 tons of medical, educational and technical equipment and supplies and an estimated value of US $ 310,000 were shipped from the USA to Port Vila by container. In 2002 and 2003 an additional 4 tons of equipment and supplies, with an estimated value of US $ 15,000 were delivered by our supporting vessels "Siome" and "Ranui" from New Zealand, whereas well over 1 ton of general medical supplies and pharmaceuticals with an estimated value of US $ 25,000 was express-shipped from the USA, the UK and New Zealand by air. Finally, some 10 tons of clinic building supplies, with an estimated value of US $ 20,000 were directly purchased in Vanuatu and shipped to our target destinations by local commercial shippers, bringing the total delivered goods to 30 tons and an estimated total value of US $ 370,000.

Approximately 60 field team members provided an aggregate 60 man months of on-site medical, educational and technical assistance, supported by the crews of close to 20 cruising vessels providing an additional 55 man months of on-site service. In addition, these volunteers, as well as their supporters at home, spent an estimated 35 man months on project-related collection, packing, shipping and travelling services for a total estimated volunteer effort of 150 man months, equivalent to 24,000 service hours, worth approximately US $ 480,000, according to common accounting standards and practices for international volunteer specialist aid.

Total expenditures for food, accommodations, travel and project-related expenses over these three seasons are estimated at US $ 240,000 whereas the total donated value of vessel time (approximately 36 months on-site and underway) is in the US $ 180,000 range. Finally, direct financial assistance for ni-Vanuatu students, VHWs and local workers over these three seasons has equalled approximately US $ 20,000.

Consequently, the total estimated value of all goods and services delivered by Project MARC under the first MOU can be estimated at US $ 1,290,000 or approx. 165 million Vatu. This exceeds the predicted total project value at the start of the first MOU (US $ 945,000; see original Operational Plan) by 36.5 %.



3. OBJECTIVES

The goal of the Program (as outlined in the new Operational Plan in Annex 1) is to provide volunteer medical as well as health-related educational and technical services to Vanuatu's most remote island communities.

This is to be achieved through the following objectives:

1 - preventive medical & dental care and education;
2 - early diagnosis & screening programs;
3 - advanced training of local nurses and practitioners;
4 - emergency medical and dental care;
5 - establishment of telemedicine links; and
6 - logistic & technical support of aid posts, dispensaries and health centers.


The Program aims to achieve these objectives through the implementation of Project MARC, a comprehensive professional medical assistance program involving the use of one or more mobile outpatient clinics staffed by volunteer teams and able to visit selected island communities for periods of up to 1 month.

The activities to be undertaken each year, and the respective responsibilities of each implementing agency to achieve the objectives of the Program are outlined in the Program Plan (Annex 1).


4. IMPLEMENTING AGENCIES

The implementing agencies for the Project will be The Ministry of Health of Vanuatu and The Hope Alliance, USA.


5. CONTRIBUTIONS OF MOH

The contribution of MOH will be:

· to provide advice and guidance with regard to the choice of remote communities as well as with regard to the most urgent diagnostic, curative and preventive medical needs;
· to provide access to and use of existing facilities and infrastructure to provide salaries and allowances to MOH staff involved in the Program as outlined in the Program Plan at Annex 1;
· to assist with the temporary registration of health personnel on presentation of curriculum vitae and evidence of registration in their country of origin prior to their arrival in Vanuatu (subject to criteria of Health Practitioners' Act).;
· to assist with the identification and mobilisation of ni-Vanuatu trainee nurses and nurse practitioners;
· to try and provide drugs/consumables (if and when available), as outlined in the Program Plan at Annex 1; and
· to undertake all responsibilities as mutually agreed to and outlined in the Program Plan at Annex 1.


6. CONTRIBUTIONS OF THE HOPE ALLIANCE

The contributions of THA and its associated partner organizations will be:

· to provide funds, equipment and personnel as outlined in the Program Plan at Annex 1.
· to provide support for overall co-ordination and management of Program activities to undertake all responsibilities as mutually agreed to and outlined in the Program Plan as outlined at Annex 1.
· to work together with MOH to develop a strategy for potential ongoing activities.
· to ensure curriculum vitae and evidence of registration in country of origin of project health personnel are provided to the MOH and a request for temporary registration with the Health Practitioner's Board prior to commencement of their arrival in Vanuatu.
· to ensure that health personnel can communicate in either English or French languages.
· to provide monitoring visits to the program site.
· to provide project progress and final narrative and financial reports to donors if applicable.


6. CUSTOMS

For the purpose of the Program, the MOH will facilitate the importation of all materials and equipment into Vanuatu and to the appropriate locations within Vanuatu in the following way:

· the MOH will exempt from import duties and other taxes (or will pay such duties thereon) all Program equipment and supplies.


7. ARBITRATION

Should disagreement arise on the part of either of the implementing agencies, this should be documented to the other implementing agency in writing within one month to be resolved by negotiation by both implementing agencies.


8. EVALUATION/REVIEW

An evaluation or review of the Program may be made at any time during the Program at a time arranged by and mutually convenient to both implementing agencies.
The Hope Alliance and MOH will co-operate, where necessary, to ensure that true and accurate information is available for the purposes of Program review and/or evaluation.


9. DURATION

This MEMORANDUM will take effect from the date of its signature by both implementing agencies and will be deemed to have commenced from that date. This MOU will expire 5 years from the date of its signature.


Signed for and on behalf of the Ministry of Health of Vanuatu:

(March 2004, by Miriam Abel, Director General).

Signed for and on behalf of the Hope Alliance, Park City, USA:

(March 2004, by Monty J.Eggett, President)


__________________________________________________

Annex 1:
Project MARC Operational Plan for 2004 & Beyond 
 

Definition:
Project MARC is a volunteer project for professional Medical Assistance to Remote Communities in the Vanuatu archipelago that is being carried out on behalf of The Hope Alliance and is being directed and coordinated by Dr. and Mrs. Henk and Nelleke Meuzelaar, Park City, Utah.


A - Project MARC Tasks
(as defined in consultation with MOH staff)


Task 1 - Providing Preventive Medical and Dental Care & Education

In view of the fact that Project MARC medical teams only visit each community a few weeks each year, a major focus of Project MARC will be on preventative care and public education.

Preventive care issues which will receive special attention include:

(a) immunization of children missed by earlier programs (e.g. because of lack of refrigerated vaccine storage in local clinics);

(b) pre- and post-natal care (e.g. by advanced training of ni-Vanuatu health providers and provision of modern diagnostic equipment and needed supplies;

(c) health education of school children with regard to dental care, eating habits and personal hygiene; and

(d) health education of adolescents and adults with regard to balanced nutrition, communicable diseases, substance abuse and proper use of medication.


Task 2 - Performing Early Diagnosis & Screening Programs

This is an area where our mobile clinics with their comparatively advanced diagnostic capabilities can make important contributions. However, screening programs will only be initiated with the specific encouragement and permission of MOH, the full support of local community leaders and the patient's or parent's informed consent.

Potential screening programs might focus on
(a) blindness prevention (e.g. cataract screening):
(b) vision and hearing impairment in school children;
(c) early diagnosis of tuberculosis, cancer, diabetes or STDs in adults; and
(d) early diagnosis and family treatment of scabies and lice infestations
Some medical problems detected during screening tests can be dealt with immediately by giving advice and medication, by performing minor surgery or by providing corrective devices. In all other cases contact will be made with one of Vanuatu's central clinics and a suitable course of action decided upon.


Task 3 - Training ni-Vanuatu Village Health Workers and Nurses

Project MARC medical volunteers equipped with modern diagnostic tools provide a unique resource for hands-on training of local VHWs and nurses. Besides refreshing basic diagnostic and treatment skills by working side by side with core team members and specialists, ni-Vanuatu trainees will be able to practice some specialized (e.g. dental, surgical or ob/gyn) skills while learning how and when to use of some of the newer diagnostic procedures, instruments, drugs or treatment regimes.

In return, their participation helps the team build linguistic and cultural bridges with the island communities while also providing an important reservoir of knowledge about relevant local health concerns, dietary habits and living conditions; i.e. the trainees may often become the teachers!


Task 4 - Offering Emergency Medical & Dental Care

Project MARC teams will not be frequently enough, or long enough, in a particular community to be able to take permanent responsibility for first-responder medical and dental care, particularly not in urgent situations. On the other hand, Project MARC teams may be better equipped and/or have more access to transportation and telecommunication resources than most regional health centers. Therefore, the team will need to be able to respond promptly to medical emergencies occurring within a wide radius around the target areas.

Special emergency care preparations and resources include:

(a) a sturdy and stable shoreboat with strong outboard engine, thus enabling fast transport of people and suplies between neighboring villages, bays and islands under moderate weather conditions;

(b) several emergency medical kits and radio sets, in order to support this challenging task; and

(c) a range of portable tests and test equipment for rapid urine (e.g. infections, pregnancy), blood (e.g. malaria, diabetes), skin (e.g. tuberculosis) and tissue (e.g. STD) testing.


Task 5 - Development of Telemedicine Links

Multiple national as well as international health initiatives and programs currently underway in Vanuatu should help improve rural community access to medical care over the next decade or so. However, the sheer number of remote island communities combined with the lack of economic resources make it unrealistic to expect the level of physical access to health care to approach that of the much more populous industrialized countries.

Fortunately, development of new and powerful telemedicine techniques now provides any area in the world within the reach of satellites (or other wireless voice/data communication services) with around-the-clock, near-instantaneous access to expert medical advice. The cost of commercial telemedicine services tends to be high. However, there is no reason why volunteer telemedicine networks could not be successfully established. The mobile outpatient clinic's advanced telemedicine equipment (ECG, spirometer, digital camera, satellite phone and computers) will enable us to test the viability of different concepts.


Task 6 - Logistic & Technical Support of Aid Posts, Dispensaries and Health Centers

Rural aid posts, dispensaries and health centers on Ambrym in Vanuatu may have limited access to supplies from the National Essential Drug List because of the logistic as well as economic limitations faced by MOH. Upon request by MOH, Project MARC will be able to coordinate planned visits to remote island communities with the various Central Medical Stores in order to help deliver essential supply packages to specific aid posts, dispensaries or health centers.

Besides supplying rural aid posts with basic medical tools and supplies, where needed, Project MARC intends to supply local health centers, dispensaries and clinics with MOH-approved items ranging from general medical supplies to refrigerators, sterilizers, beds, stretchers, etc.

Finally, upon request by local, regional or national caregivers Project MARC technical volunteers are ready to help repair and improve solar power systems, clinic water supplies, tele-radios, antennas, ceiling lights or window screens.


B - Proposed New Operational Model


1 - Objective and Rationale

As a result of the the marked progress achieved in each of our three current target regions, viz. Lolihor (N Ambrym), Aulua/Banam Bay (E Malakula) and the Maskelynes (SE Malekula), we no longer see the need for infrastructure rebuilding by large teams over longer periods of time. Instead, we propose to deploy smaller, highly mobile teams that can assist with a wide range of possible problems, whether of an acute transient, or of a more chronic structural nature.
Moreover, our experience with these areas, first evaluated by our exploratory teams in July and August 2000 and subsequently visited in each of the following years under the terms of our 3-year MOU, has taught us that the nature of our involvement in each island location tends to change from year to year as the needs and resources in each region develop along various paths. This prompts us to propose a new three-phased operational model with a high degree of built-in flexibility and adaptability, as outlined in section B (Operational Model).
Since local socio- and politico-economic conditions, as well as other factors outside of our control, e.g. unseasonal weather or logistic mishaps, can significantly accelerate or hamper our progress, the time required to complete each phase is expected to vary between 1 and 2 seasons. In order to properly accommodate and buffer such variations, we estimate the length of the required MOU extension at 5 years, viz. from May 1, 2004 thru April 30, 2009.


2 - Operational Model

Phase I concentrates on exploration and evaluation of potential new target areas to be carried out in direct collaboration between both MOU partners. Phase II centers around the rapid "Jumpstart" of basic primary care in selected areas and Phase III involves special programs designed to address the specific medical needs of a given community or region.

(Phase I - Exploration and Evaluation)
A typical phase I scenario starts when the Hope Alliance receives a request from MoH to explore and evaluate a new outer island target area for potential assistance by Project MARC. Typically, this would be a hard-to-reach area where the primary health care infrastructure has collapsed and where Project MARC's proven capabilities and resources (i.e. specially equipped, mobile field teams, VHW training expertise and vessel transportation plus telecommunication equipment) can offer immediate assistance.
Provided the request is received well before the start of the dry season, Project MARC coordinators will try to assemble a special volunteer team to visit the new target area in August or September for up to 3 weeks. The team will evaluate the "how" and "why" of the infrastructure degradation, the quality as well as quantity of the remaining resources and the most pressing medical problems or needs.
Preferably, the Project MARC team will be able to host a designated MoH advisor, familiar with the area and its problems. While at their target location, the medical members of the exploration and evaluation team are likely to be fully occupied with urgent primary medical care, thus leaving the other members to complete a comprehensive survey. The questionaire needed for the survey should be developed in collaboration with MoH. Upon return to Port Vila or Luganville, the team and its MoH advisor can then present their written findings to designated MoH as well as Project MARC representatives, together with a preliminary plan for phase II operations in subsequent years, if deemed feasible and desirable.
Besides the needs of the prospective target area, various critical secondary issues will need to be considered. These include such factors as the accessibility of the area by sailing vessels (with or without the construction of specialized moorings), the presence of suitable candidate VHW trainees, social and political stability levels and the ability and/or commitment of the communities involved, to support and maintain the local health facility. If MoH and Project MARC representatives agree that Phase I findings warrant primary care jumpstart activities the project can be approved to move into Phase II.

(Phase II - Jumpstarting Primary Care)
The rationale of the Phase II "Jumpstart" approach is that in all rural areas our teams were thus far able to restore acceptable levels of basic primary care within a matter of weeks, including hands-on training of local VHWs. However, the abovementioned uncontrollable factors (e.g. inability of the community to support) often keep VHWs and aidposts from staying fully functional after our departure. Thus, the proposed new approach offers a nearly seamless transition between initial operation by VHW trainees (under our supervision) and final operation by the newly trained VHWs alone. In case local conditions still lead to the collapse of an aidpost after our departure a second Jumpstart attempt may be needed during the following season.
The envisaged Jumpstart phase involves 4 weeks of intensive, hands-on local VHW training and patient treatment by a quartermaker team equipped with a small, transportable medical clinic. Fully installed, this 2-story, 4x4 m self-contained field clinic features built-in patient examination and treatment, as well as team accommodation modules. The modular nature of this type of field clinic facilitates rapid installation in nearly all rural environments.
Although the novelty of this concept creates an inherent risk of technical setbacks, the design of the mobile clinics is based on years of experience with various types of boat-, tent-, nakamal- or bungalow-type field clinics in rural Vanuatu. Moreover, under the proposed time schedule a fully functional mobile field clinic package need not be available until the start of the first Phase II activities in 2005 or 2006, thus providing ample time for assembly and testing at our US facilities.
The ambitious end objective of Phase II is to leave a fully operational aidpost or dispensary behind, including one or more hands-on trained and Project MARC certified VHWs as well as a full complement of approved aidpost medications and supplies. The sturdy outer framework can be readily turned into a permanent village aidpost or even a basic dispensary.

(Phase III - Specific Needs Assistance)
Recent "specific needs assistance" experiments in our current target areas have demonstrated the effectiveness of the proposed Phase III concept. Over the past three seasons, our teams have carried out special programs for eye screening and for dental care in all 3 target areas. Rapid diagnosis and treatment programs for malaria and skin parasite infestations were initiated and women's health problems were addressed in SE Malakula. As documented in our annual progress reports, all special programs are closely coordinated with local nurses and VHWs in order to provide advanced hands-on training opportunities for local health workers.
Rather than to wait several years until new target areas become eligible for Phase III support, we propose to keep providing specific support to our existing target communities for the next 1 or 2 years. In particular, the malaria fighting, skin parasite reduction, hygiene education and women's health improvement needs of our SE Malakula communities -- clearly some of the economically weakest in all of Vanuatu -- require continued assistance. Finally, the Health Center in Nopul (N Ambrym) is in urgent need of our special technical support in order to help repair and improve the water supply system as well as the defunct solar power, light and telecommunication systems.


C - Sponsorship and Budget Estimates

1 - Sponsorship Arrangements

Project MARC is sponsored by The Hope Alliance with the support of a broad range of donors interested in underwriting the objectives of Project MARC. The list of institutional and private sponsors and supporters in the acknowledgement section of our 2003 Operational Report illustrates the breadth and scope of our potential sponsors for 2004 and beyond.

The Hope Alliance is a nonsectarian, charitable corporation focusing on medical, educational and economical development support to remote, economically disadvantaged communities around the globe. The Hope Alliance website at www.hopealliance.com contains information about successfully completed as well as currently active projects including Project MARC. The Hope Alliance warehouse in Salt Lake City remains the anticipated source of most of the medical supplies and instruments to be provided by Project MARC over the 2004 season and beyond.

2 - Budget Estimate

In view of the highly inexact nature of our basic budget assumptions and estimates as well as the unpredictable scope of the anticipated phase1 activities (to be undertaken upon specific request by MOH) under the new operational model, no speculative budget estimates are being offered here. Instead, the economic values of donated equipment, supplies, and volunteer labor, as well as of volunteer travel, food, accommodation and operating costs in 2004 and beyond are assumed to remain comparable to those of the past 3 years, possibly showing continued modest growth.


D - Program Vision & Pledge


1 - Program Vision

The fundamental vision of Project MARC is to use appropriate technology which is locally sustainable and economically viable. The envisaged phase 1 exploration and evaluation activities may be made economically viable through collaboration with volunteer teams and/or noncommercial vessels already active in the Vanuatu archipelago or neighboring S. Pacific regions. Examples are Youth Challenge International (YCI) and SV "Alvei". The key mobile clinic concept of the envisaged Phase II Jumpstart operations allows for increased direct participation by Project MARC supporters within the USA while offering improved hands-on training capabilities to ni-Vanuatu health workers, leaving a locally sustainable aidpost facility behind and minimizing disruptive social impact upon rural host communities.


2 - Pledge

All Hope Alliance volunteer teams are deeply aware of the fact that the remote island communities of Vanuatu also harbor its most precious and vulnerable cultural and ecological heritage. Therefore, we pledge to seek guidance and approval from Vanuatu's representative as well as traditional authorities and to be highly mindful of local laws and customs during all stages of the proposed Project MARC activities.