Budgeting For Our Projects

My predecessor has flown home. I have my computer and keys to the office and safe. I guess it is time to get working as that is what I have come here for. Essentially my job is to manage the finance teams in the field, ensuring that they have enough cash to do what they need to do and that for every rupee spent there is reasonable justification and a correct accounting record. My days are punctuated with cheque signing and authorising payments and a large part of my work is relationship management down at the local bank. Nothing new there then. Except that things do not quite work in the same way here in Pakistan as in Europe. It is quite a wonder to work mostly in cash. I have to deal with large physical transfers of money that literally burst out of my backpack there are so many bundles and wads.

In order to draw up the budget, it is crucial that I understand the project and our operations. We have eight different cost centres that fund several activites:

MSF France returned to Pakistan after a previous evacuation to act following the earthquake in 2008. Since then we currently have a project in the Masehra district, where we are treating patients for Cutaneous Leshmaniasis, a skin infection transmitted by sandflies. Due to increasing security risks, we have evacuated all expatriates from the town and are running this project by remote control from a large city several hours away called Abbottabad.

We have another activity in the North Western Frontier Province (NWFP). Here we are running a cholera treatment centre and have a presence in the in patient department and emergency room of a local hospital. We are very successful in this region as people are are travelling for miles passing public hospitals just to attend our basic clinics for accurate diagnosis and referral.

Coordinated from Peshawar we are running basic health units and mobile clinics to allow free access to health care to those in need, in addition to revamping operating theatres in local hospitals. Non-food item distribution is another activity that we are fond of, providing blankets, temporary housing and soaps to fleeing refugees. The area was home to many internally displaced persons (IDP) who fled the recent military operation in Swat Valley and previously we were running some IDP camps in the region. These camps closed for two reasons, firstly the army wanted to assist in their management whereas we do not condone any military or political associations, nor do we accept arms in our places of work, and secondly because most IDPs preferred to stay in local homes. The Pakistani culture of privacy for their women is such that life living in camps all in the same tent is not easily accepted, thus they choose to find shelter with other families in a house. This can mean many families under one roof, with hygiene conditions that encourage the spreading of disease.

We also have further activity in the Kurram Agency, in the Federally Administered Tribal Areas (FATA) bordering Afghanistan. Again managed by remote control, we have activities in a region that is plagued by sectarian Shiite-Sunni conflict. The road into FATA is too dangerous to cross with a high risk of kidnapping, even for locals, as the area is under Taliban control. Our medical activities support local hospitals, and are run out of two towns, one Shiite and one Sunni.

Our latest project is just in its birth stages. The focus of military attention has shifted from Swat to Warziristan where we expect bloody violence and consequently a new movement of refugees. We had originally intended to take over a disused hospital in the city of Dera Ismail Khan and had obtained permission from the local authorities to do so. During a meeting to finalise this permission, the District Police Officer received a phonecall and then informed us that we had 30 minutes to evacuate the region with a police escort. We are now in the process of setting up a trauma centre and operating theatre from a Punjabi town bordering the Dera Ismail Khan district. We will operate from there and will rely on ambulance shuttles to access the area bringing patients for treatment.

This makes for a lot rupees needed, and a lot of rupees spent. I plan to visit those fields that are accessible to meet the team and enhance my comprehension of the technical operations, as I don't have any medical background whatsoever. During my first week I was responsible for drawing up the budget. This is a task that should normally take about three weeks for one cost centre. In Pakistan we were responsible for producing budgets for eight cost centres in just one week. We worked fifteen hour days for ten days solid. However, this was a great way to understand exactly what we are doing and what it is costing. Not working for profit is very different to working for the private sector. I am used to deciding what can be spent based on an arbitrary budget allowance. Here we are deciding what to do then estimating how much it will cost and thus we have our budget. Completely the other way around but not altogether foolish.

Our cholera treatment centre and staff