Based in the Netherlands, HealthNet International (HNI) operates in 12 countries affected by war. It works with the local population to rebuild health structures and encourages increased local action and responsibility. Director Willem van de Put spoke to Lauren Pollock about the organisation’s goal to break the cycle of conflict, poverty, and ill health. AN: What is the mission of HealthNet International?WV: The mission of HealthNet is to support people in building their own health structures in stable circumstances. We used to call that post-conflict, but there are more countries that have chronic crises now. Our largest operations are in Afghanistan and, furthermore, we have some 14 other countries where we work. The big ones, next to Afghanistan and Pakistan, are Cambodia, Sudan, Rwanda, and the Balkans.AN: How does HNI help people to take care of their own health? WV: We provide assistance in setting up health systems. In most cases, these are general health systems, and sometimes when there are specific demands we focus on one specific area. For disease control, we have malaria programmes. We also have mental health programmes. The type of programme depends on the need and the local capacity to build these services. We want to use the existing capacity that we find somewhere and build upon that. It is important to use the resilience of people who are living in the conflict areas. AN: What programmes do you have in Afghanistan?WV: All over the country, we have a malaria control programme. In the eastern zone, we have a general health project. That includes everything from very primary level care to the university hospital in Jalalabad. We have offices in four places in Afghanistan – Mazar-i-Sharif, Kabul, Jalalabad, and Kandahar. AN: What projects do you have in other countries? WV: In Bosnia, we do mental health projects. We do the same in Kosovo In both countries, we are trying to make mental health a regular aspect of health care. We work in both countries within the health system to try to help the health staff become more receptive to mental health problems. In Cambodia, we do poverty reduction by setting up health services in very poor districts. The paradox is that we have people pay for the health services. The result of this is that the local health staff receive a salary that for the first time in their lives, that they can actually live on. Therefore, they give more reliable health services and the population is about 50 percent better off. They pay 50 percent less for health care than they did before the system was installed, which makes a difference of about $40 a year per family. In those very poor areas, that is an immense difference. We’re very happy that this system has worked. In Sudan, we provide co-ordination and support to some 30 NGOs who all have river blindness in their portfolio of activity. In Rwanda, we are trying to increase the health staff and we are setting up a whole new system of training for nurses.river blindness in their portfolio of activity. In Rwanda, we are trying to increase the health staff and we are setting up a whole new system of training for nurses.AN: What challenges do you face at HNI?WV: The challenges that we face are that it is difficult to find the right counterpart to work with in a given country. Usually there is no government. There are no local agencies available because the countries have just come out of war. Very often, there is still an enormous amount of fear about what it means to get organised. What we often do is to promote the construction of a civil society. We hope to bring people to the point that they actually start organising themselves. As soon as they do that, we are very happy to hand over whatever we’ve done and leave. The whole idea is to restore people’s dignity in a sense. The challenge that we face all the time is to make sure that, in our co-operation with the local people, we provide a sense of security for them that allows them to set up their own agencies and begin to claim their own rights. AN: What are your long-term goals for the organisation? WV: Disease control, health finance, and in mental health, we want to set new standards of work. We try to be innovative. We work together with different schools of public health all over the world and we try to find new ways of working in an area that has not been covered for many years. There’s a gap between relief and development, the grey zone where things happen after humanitarian input but before regular development begins again. That is where we work. That field of work is slowly beginning to become labelled as a kind of recovery. The long-term goal of our agency is to show what can be done in those circumstances. I think those circumstances are becoming ever more relevant because so many countries in Africa do not prove to be in a continuum from relief to development. They are rather in a cycle of conflict, increased poverty, and more conflict. These kinds of chronic crises are not really the field of work for emergency organisations. At the same time, they are not the field of work for regular development organisations either, so everybody asks what you should do then. We’re trying to develop that part.regular development organisations either, so everybody asks what you should do then. We’re trying to develop that part.AN: What are your upcoming projects? WV: We are starting in Indonesia soon to work on the problem with internally displaced people. We’re also starting in Congo and we are trying to get started in Serbia. In Congo, we will work in the centre of the country very close to where the front was. There we are hoping to assist the health authorities to rebuild their health structures and that way bring at least some minimal stability back to the region after many years of warfare. Based on our experience in Bosnia over the last seven years and our experience in Kosovo over the last two years, we’re trying to close the triangle by setting up services in Serbia and linking them with the projects we have in Romania. In the Balkans, it’s pretty much the same. What needs to be done is a whole new system of health care that has very little to begin with. The war in the Balkans over the last 10 years has hurt the health care system. There we are looking at mental health as an integrated aspect of health care, but we are also looking at things such as home care for the elderly. That is what we are experimenting with in Romania, and it’s similar things that we would like to get started with in Serbia, but that country is the least clear. Congo and Indonesia are certain, and the others are under negotiation. at things such as home care for the elderly. That is what we are experimenting with in Romania, and it’s similar things that we would like to get started with in Serbia, but that country is the least clear. Congo and Indonesia are certain, and the others are under negotiation. AN: How did you personally become interested in working in this field?WV: I worked in the emergency field and then for a couple years setting up mental health services in transcultural psychiatry. Then I got in touch with the people who had originally started HealthNet back in 1992. In 1998, I joined HealthNet as the director. HealthNet brings together the different parts of the work I was doing before. We are actually trying to build that bridge between emergency relief and more structured development. Wherever I’ve been, I’ve seen a population in distress but with an amazing amount of resilience. The humanitarian organisations that come in hardly ever take advantage of that though. An emergency organisation, by definition, is not built to take the time to work with local capacity. You’ve got to come in and do what you have to do. I respect this very much and you need emergency agencies but, in these countries of chronic crisis, that simply doesn’t apply. Looking for new answers to those chronic crises is the thing that appeals most to me. At the same time, the more regular development agencies do not find what they need to work in those areas of chronic crisis because there are no local structures to be their counterparts that they can have planning sessions with. They simply doesn’t exist because people are still too upset by what has been going on and too frightened by political pressure to build their own organisation. It’s exactly being in the middle of those two things that I find very interesting because I believe it appeals to an enormous amount of people.e same time, the more regular development agencies do not find what they need to work in those areas of chronic crisis because there are no local structures to be their counterparts that they can have planning sessions with. They simply doesn’t exist because people are still too upset by what has been going on and too frightened by political pressure to build their own organisation. It’s exactly being in the middle of those two things that I find very interesting because I believe it appeals to an enormous amount of people.
