Churches and Health Care in DR Congo

by Leon Kintaudiby Leon KintaudiECC-DOM Medical DirectorECC-DOM Medical Director

Presentation Outline

• ECC-DOM and IMA World Health• A Brief History of Health Zones• The Role of Faith-Based Health Services• Challenges and Future Perspectives

ECC-DOM and IMA World Health

ECC-DOMProtestant Church of Congo Medical Office

• 61 member communities• 80 hospitals• 600+ health centers• 70 co-managed health zones

(see map)

– – Adventist Development Relief AgencyAdventist Development Relief Agency –– Lutheran World Relief Lutheran World Relief

– – American Baptist Church USAAmerican Baptist Church USA – Mennonite Central Committee – Mennonite Central Committee

– – Christian Church  (Disciples of ChristChristian Church  (Disciples of Christ – Presbyterian Church (USA) – Presbyterian Church (USA)

– – Church of the Brethren General BoardChurch of the Brethren General Board – United Church of Christ– United Church of Christ

– – Church World Service & WitnessChurch World Service & Witness – Episcopal Relief and Development– Episcopal Relief and Development

– – United Methodist Church, Global Min. United Methodist Church, Global Min. – Vellore Christian Med College– Vellore Christian Med College

IMAWH is a member association of twelve U.S. church relief and development agencies:

The IMA World Health Mission The IMA World Health Mission

To provide essential products and services for emergency, health and development programs

of interest to member agencies which serve people in need without regard to ethnicity,

creed, color, gender, national origin or religious or political affiliation.

Operational Strengths Collaboration with MOH

Procurement

Project management

Networking

Financial management

ECC-DOM and IMA World Health

A Brief History of Health Zones in the DR Congo

The Congo Health System…

is well designed to provide comprehensive primary health

care through decentralized health zones co-managed, in many cases,

by churches & NGOs.

Health Zone Administrative Structure

Central office :Central office :

Health Zone Health Zone Management Management CommitteeCommittee

Health Center Health Center Management CommitteeManagement Committee

Hospital Management Hospital Management CommitteeCommittee

Health Health PostPost

Health Health CenterCenter

Referral Referral H.CenterH.Center

Referral Referral HospitalHospital

SupervisionSupervision Hospital Hospital DirectorDirector

ReferralReferral

ReferralReferral

ReferralReferral

Components of a Health Zone in DR Congo

- 125,000 people- 20 Health Centers- 1 Ref. hospital

A Typical Health Zone

The Purpose of Health Zones is to provide Primary Health Care

Curative Care… treating the fever

Preventive Care… sleeping under a bednet

Promotional Care… draining swampy areas

The challenge is to maintain a balance of resources

1975 National Workshop

Adopted concepts of decentralized Adopted concepts of decentralized Health Zones and primary health care.Health Zones and primary health care.

Agreed on a principle of co-Agreed on a principle of co-management by Government and church management by Government and church hospitals.hospitals.

Pilot Health Zones (1981)

Health Zones (1982)

1984 – before HZ delimitation75% of 75% of the first the first 85 health 85 health

zones zones were were

developed developed around around church church

hospitalshospitals

1984 – after HZ delimitation75% of 75% of the first the first 85 health 85 health

zones zones were were

developed developed around around church church

hospitalshospitals

The Role of Faith-Based Health Services

in DR Congo

The Roles of FBOs in Health Care

1) Pioneering of community health services2) Provision of PHC services at community level3) Provision of Referral Services (hospitals)4) Co-Management of Health Zones (~180)5) Management of Regional Services (depots)6) Management of National Projects (SANRU)

~50% of health services provided by FBOs / NGOs~50% of health services provided by FBOs / NGOs

~50% of health facilities are owned by FBOs~50% of health facilities are owned by FBOs

HZs are MOH “owned” with FBO co-managementHZs are MOH “owned” with FBO co-management

Co-management by FBOs & NGOs

Public vs. PrivatePublic vs. Private Co-ManagementCo-Management

35% of the current 515 health zones are co-managed by FBOs

• 1981-86 1981-86 SANRU I SANRU I 50 HZs50 HZs

• 1986-91 1986-91 SANRU II SANRU II 100 HZs100 HZs

• 1991-00 1991-00 ECC/DOMECC/DOM 12-36 HZs12-36 HZs

• 2000-062000-06 SANRU III & PMURR SANRU III & PMURR 75 HZs75 HZs

• 2006+ 2006+ AXxes, PMURR, Global FundAXxes, PMURR, Global Fund 128 HZs128 HZs

SANRU Rural HealthHZ Development Assistance

AXxesAXxes

PMURRPMURR

AbbottAbbott

SP+SP+

GFGF

MRPMRP

DEVRUDEVRU

Health Development in 128 of DRC’s 515 health zones

SANRU the project has evolved into SANRU the Program

ECC-DOM’s partnership with ECC-DOM’s partnership with IMA World Health manages $10 million IMA World Health manages $10 million

of assistance to health zones each yearof assistance to health zones each year

ECC / IMAWH ECC / IMAWH SANRU Program ObjectivesSANRU Program Objectives

Integrated Primary Health CareIntegrated Primary Health Care especially for Mothers and Childrenespecially for Mothers and Children

Health Systems Strengthening Health Systems Strengthening of decentralized health zones, of decentralized health zones, especially those co-managed by FBOsespecially those co-managed by FBOs (including community & congregation(including community & congregation

Actions through SANRUActions through SANRU

• Strengthening Integrated PHC Strengthening Integrated PHC (pre-natal clinic, well child clinic, family (pre-natal clinic, well child clinic, family

planning, post-natal care, vaccination, etc)planning, post-natal care, vaccination, etc)• Health education / C-IMCIHealth education / C-IMCI• Water and SanitationWater and Sanitation• Malaria prevention & treatmentMalaria prevention & treatment• Training health teamsTraining health teams• Essential drugs supplyEssential drugs supply• Health zone developmentHealth zone development

VaccinationsVaccinations

Curative careCurative care

Prenatal carePrenatal care

Well Child CareWell Child Care

Preventive carePreventive care

Blood SafetyBlood Safety

Essential Drug SupplyEssential Drug Supply

Water and SanitationWater and Sanitation

Training Health TeamsTraining Health Teams

SANRU Trends in Services

0%10%20%30%40%50%60%70%80%90%

100%

2001 2002 2003 2004 2005 2006

Curative CareCPNAssisted brithsCPS

Family Planning

0

5000

10000

15000

20000

25000

30000

35000

40000

2002 2003 2004 2005 2006

Couple Years Protection

Vaccination Vaccination CoverageCoverage

Malaria: Fever during last 14 days among households with and without ITNs

54%

22%

35%

22%

44%

14%0%

10%

20%

30%

40%

50%

60%

Pregnant Women Children 0-11months

Children 12-59months

Without Bed Nets With Bed Nets n=514 n=514

Water, Sanitation & Hygiene2163 Springs capped – Access increased 32%

Waterborne disease decreased by 30%

0%

10%

20%

30%

40%

50%

60%

70%

2002 2003 2004 2005

Access to water

Challenges and Future Perspectives

Challenges• Sustainability of HZs after projects end.

• Stability of the country

• Control of endemic diseases like Malaria, ARI, HIV/AIDS, Tuberculosis and Malnutrition

• Knowledge and understanding of illness by the population

Large families (average 7)

Housewife and provider

Producer

Financial Person

Second Rank Citizen

Male attitude

FUTURE PERSPECTIVES• Continue present activities in health zones• Continue collaboration with the MOH• Improve training (ST & LT) for health personnel• Improve income activities for HZs & population• Emphasize Maternal, Child & new born care• Identify funding for newly formed HZs and health

zones without development partners.

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