Transcript Slide 1

Events Contributing to the Decline of
DR Congo
Nationalization
Pillaging
War
Basic Indicators
 Maternal mortality 1289/100,000
(MICS2, 2001)
 Infant mortality 127‰ (MICS2, 2001)
 Child mortality 213 ‰ (MICS2, 2001)
 67% of pregnant women are anemic
(PRONANUT, Mai 2005)
 Neonatal mortality 47 ‰
 75% vaginal fistulas caused by
complications of delivery (PNSR,
Sept 2005)
Low Utilization
of Services
(PNSR, 2004)
- Curative Care: 30%
- Anti-natal visits: 45.3%
- Assisted Births: 42.5%
- Post partum visits: 8.8%
- Family Planning coverage: 2%
The Congo Health System is based
on 515 Decentralized Health Zones
Components
of a
Health Zone
in DR Congo
A Typical Health Zone of Congo
“Although praiseworthy, [donor resources] are
inconsistent with the development of a
sustainable health service.
Too many resources are devoted to attaining
short-term goals…
People have very limited access to essential
quality health care and there is a shortage of
medium and long-term funding”.
Minister of Health Bongeli
Goal of Project
AXxes
To develop an effective & efficient
health care system in DR Congo
based on the MOH’s Health
System Strengthening Strategy
Component A: Increase access to, quality and
demand for multi-sectoral integrated PHC
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Increase access to integrated Primary Health Care
Reproductive Health, STIs & Family Planning
Maternal & Newborn care
Improve vaccination coverage
Reduce malaria in target population
Improve TB detection and treatment
Improve Nutritional Interventions
IMCI & C-IMCI
HIV/Aids (Blood safety and PMTCT)
Water and Sanitation
Component B: Increased Capacity to the
health zone and the referral system
 Improve
HZ Planning, Governance,
Transparency and Accountability
 Develop Human Resources of HZMT,
including training and supervision
 Drug supply management
 Improve referral system
 Improve health information system
 Improve community involvement & support
 Improve capacity of local NGOs
Component C: Increased capacity of national
health programs and provincial/district offices
 Increase
the capacity of selected national health
programs: 4th and 5th directions, PNLP, PEV, PNLS,
PNLB, SR, PRONANUT, PNAM & PCIME
 Increase
the functional capacity of provincial &
district health offices
 Improve supervision of HZs
 Improve health policy implementation
Implementing Partner Structure
Program Manager
Technical Team
Regional
Coordinator
& Administrator
Financial Staff
Logistics Staff
Regional
Coordinator
& Administrator
Field Supervisor
Field Supervisor
Field Supervisor
Field Supervisor
3 or 4 HZs
3 or 4 HZs
3 or 4 HZs
3 or 4 HZs
TA support for AXxes
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JHU – M&E
HKI – Nutrition and micro nutrients
HEAL Africa – VF training
World Relief – Care groups
MSH – Leadership, Drug management, Lab quality
URC – Quality of service & improved utilization
? – Neonatal health
Others ?
Add-in programs
 PMTCT
 UNICEF
water
 UNICEF nets
 GAVI
 Food for Peace ?
 Others ?
Sampling of AXxes Indicators
Establish Reproductive & child spacing Services
Improve DPT3 coverage from 55%
Provide households with ITNs
Train HC staff in TB program improvement
Vit. A campaigns coverage
Reinforce ORT treatment of children
Implement IMCI in clinics and communities
Water programs to increase household access
Increase women participation in CODESA to 50%
Begin C-IMCI with trained community relays
Train HCs to increase referral rate
Improve drug Supply Mgmt to reduce stockouts
Implement HC complete HIS monthly reporting
Yr1
Yr2
Yr3
60%
60%
20%
70%
90%
40%
50%
80%
70%
40%
80%
90%
50%
70%
40%
20%
45%
75%
20%
80%
100%
75%
60%
90%
90%
60%
90%
45%
50%
60%
90%
10%
90%
5%
30%
60%
30%
70%
SANRU Trends in Services
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Curative Care
CPN
Assisted briths
CPS
2001
2002
2003
2004
2005
2006
Family Planning
40000
35000
30000
25000
20000
15000
10000
5000
0
2002
2003
2004
2005
Couple Years Protection
2006
Vaccination
Coverage
Impact of Bed Nets & IPT
at Oicha Hospital
Children Under 5 & Birth Outcomes
2003
2004
Change
Anemia <5s
12.8%
8.6%
-32.4%
Malaria cases <5s
51.9%
33.6%
-35.2%
Deaths <5s
1.1%
0.4%
-62.2%
Low birth weight
22.8%
17.0%
-25.4%
Neonatal mortality
1.7%
1.1%
-22.8%
Water, Sanitation & Hygiene
2163 Springs capped – Access increased 32%
Waterborne disease decreased by 30%
70%
60%
50%
40%
30%
20%
10%
0%
2001
2002
2003
Access to water
2004
2005
Essential Medicine Distribution System
Regional Depot
(7% markup)
100%
80%
40%
Hospital
Health Zone Office
50%
100%
100%
100%
Health Clinic
100%
60%
Patients
60%
Community Health Endowments
Internal Rate of Return 51%
AXxes Data Flow
Electronic Dashboard
What has been achieved so far?
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Conducted rapid assessment of health zones
Setup district offices
Developed technical & procedural manuals
Signed contracts with health zones
Started support to HZ for supervision
Distributed locally purchased equipment
Trained ECZS in health zone management
Printed & distributed IEC, SNIS, CPS, etc material
Conducted FP training & distributed contraceptives
Conducted Vit A campaigns
Responded to cholera outbreak in Bukavu
Challenges for AXxes
 Coordinating with
Emergency Assistance
programs
 New USAID priorities and indicators
 Delay in authorization and waivers
 Need for gap funding for certain activities
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Bed nets & ACTs
Water and Sanitation
Livelihood activities
Subsidy for VFR and Cesareans
New Zones
for AXxes
Project AXxes
USAID
F R O M T H E A M ER IC A N P E O P L E
Lubutu
Partner Implementation MAP
S
#
Lubutu
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Revised October 2006
S Punia
#
Kasai-Oc
Punia
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S
#
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#
Y
S
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Luputa
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Kansimba
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Kabon go
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Map makin g by A Xxes IMA GIS U nit , Nove mber 2006
100 Kilometers