iii year 4 quarterly performance report · iii year 4 quarterly performance report april 1st 2005...
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III Year 4 Quarterly Performance Report April 1st 2005 through June 30th 2005
Date: July 15th, 2005 Program Title: SANRU III (Basic Rural Health III) Award No.: 623-A-01-00-00076-00 Country: Democratic Republic of Congo (DRC) Reporting Period: April 1st 2005 through June 30th 2005 Grantee Organization: Interchurch Medical Assistance (I.M.A.) Implementing partner: Eglise du Christ au Congo (ECC) Address: P.O. Box 429 (500 Main St.- Old Main Bldg),
New Windsor MD 21776 Contact Persons: Paul Derstine, President, I.M.A. New Windsor, MD
Dr Leon Kintaudi, SANRU III Project Director Dr. William Clemmer, I.M.A. Representative in DRC
Telephone: 410-635-8720 (USA); (243) 081-813-0508 (DRC) Fax: 410-635-8726 E-mail: [email protected]
[email protected] [email protected] [email protected]
SANRU III is health zone development project managed as a partnership between Interchurch Medical Assistance (I.M.A.) and the Protestant Church of Congo (ECC). SANRU’S mandate is to strengthen the capacity of fifty-six NGO-managed health zones for priority primary health care (PHC) interventions and health zone support systems. Priority PHC interventions include a minimum package of services; reinforcement of vaccination services, provision of pharmaceuticals and supplies to hospitals and health centers, vitamin A supplementation, prevention of HIV/AIDS and STIs, family planning,
malaria diagnosis and treatment and prevention, nutrition support, management of re-emerging diseases such as tuberculosis, and elaboration and support of water, sanitation and hygiene projects. Support systems include planning and management, training and supervision; supply line and cost recovery, infrastructure rehabilitation and equipment; and information and surveillance systems. This report covers the third reporting period for year four of SANRU III (April through June 2005)
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Table of Contents
I. Year Four SANRU III Action Plan
a. Explanation of delays/changes
II. Overview of Key Activities
a. Training Accomplished
b. Supervision of Health Zones
c. Utilization of Health Services
d. Water and Sanitation Activities
III. Technical Reports and Evaluation of Key Indicators
a. Malaria (TPI and ITNs)
b. HIV/AIDS
c. Tuberculosis
d. Family Planning
e. PEV (vaccination)
f. Morbidity and Mortality Data
IV. Highlights and Notable Events from the Third Quarter
a. Gifts in Kind Shipments
b. SANRU cuts its first CD!
c. SANRU presents at the CCIH Conference
d. Pillaging of the Bolenge Hospital and Health Zone office.
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ACRONYMS AND ABBREVIATIONS AIDS/HIV Acquired Immune Deficiency Syndrome/Human Immunodeficiency Virus ARI Acute Respiratory Infection BASICS Basic Support for Institutionalizing Child Survival (US-based project) BCC Behavior Change Communications CPS Pre-School Clinics (Growth Monitoring) CPN Prenatal Clinics CYP Couple Years of Protection (family planning) DOTS Directly Observed Therapy Strategy DPT Diphtheria, Pertussis and Tetanus EHP Environmental Health Project EPI (PEV) Expanded Program for Immunizations (Programme Elargie de Vaccination) HEARTH Community-based Nutritional Rehabilitation (based on positive deviancy) HIS Health Information System HC (CS) Health Center (Centre de Santé) HGR Health Zone Reference Hospital (Hôpital Général de Référence) HZ (ZS) Health Zone (Zone de Santé) ITN or ITM Insecticide Treated Nets (or Materials) JSNV Journée sous national vaccination (sub-national/Regional vaccination day) KPC Knowledge, Practice and Coverage Surveys MCH Maternal Child Health MOH Ministry of Health OR Operations Research PEV Programme Elargie de Vaccination (EPI) PHC Primary Health Care PMA Paquet Minimum d’Activités (Priority PHC Activities) RED Reach Every District (a new program within EPI) STD/STI Sexually Transmitted Disease or Infections TA Technical Assistance TBA Traditional Birth Attendant TOT Training of Trainers UNIKIN SPH University of Kinshasa School of Public Health W/S Water and Sanitation
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I ACTION PLAN Year 4 SANRU (revised 6/1/05 activities as of June 30th 2005)
Component
Activity (2004-2005) OK DELAY NO
1st Sep-Dec
2nd Jan-Mar
3rd Apr-Jun
4th July-Sept
Finalize action plan and budget for year four X Annual board meeting at I.M.A. X Presentation (SANRU) at APHA 2004 and USAID X Submission of quarterly financial and technical reports X X X X Mid term evaluation of current year budget; earmarks and expenditures X Internal evaluation of project by project staff X X X X Annual financial audit (IMA) X External Evaluation by USAID X Technical visits and evaluation by IMA staff X X X X
Project planning
Prepare action plan and budget for year five X Design and print the SANRU annual calendar and monitoring tables X
HMIS Supply HZs (BCZS, CS, HGR) with monitoring & reporting forms, e.g., CPN, C S
X X X Procurement Establish the content and material lists for local and international procurement X
Distribution of motos, vehicles, ham radios, solar equip to 56 health zones X X Request and obtain waivers from USAID for applicable material X Logistic Confirm order of all material X X Establish line of credits (depot) or kits for each health zone X X Distribution of essential medicine to SANRU depots X X Medicine Distribution of medicine kits to particular health zones X X Support biannual Vitamin A campaigns X X Training in ‘minimum paquet de nutrition’(actions essentielles en nutrition X X X Compile and distribute ‘new’ growth charts X X X X Nutrition
Provide community “relays” with nutrition counseling cards & flipcharts X X Assure the application of RED in all 56 health zones X X X X Support vaccination campaigns ( multi-antigen) in all 56 health zones X Provide community “relays” with EPI counseling cards & flipcharts X X Construct incinerators and waste disposals in 10 health zones X X Supply cold chain material to health zones (Frigos/Cold Boxes) X X
EPI
Integrated surveillance of illnesses X X X Training in malaria mgmt (PEC), social marketing (ITNs) & Mgmt of stocks (TPI) X X Monitor PEC (prise en charge) Malaria X X X X Supply of medicine and lab supplies (year four) X X Produce/distribute educational and promotional material for ITN awareness & use. X X X X Co-support the « African National Day of Malaria » X Ensure formative supervisions of the identification and treatment of malaria X X X X
Malaria
Evaluate the impact of strategic interventions to combat malaria (PEC, TPI, ITN) X X Co-support (with communities) the construction of vented latrines (VIP) X X X Co-support (with communities) repair or installation of 700 water sources. X X X Co-support (with communities) repair or installation of 25 wells, pumps, or i
X X X Ensure the completion of the two Making Cities work water projects X X Support ‘clean village projects’ in 44 villages (2/HZ) in 22 HZ PCIME-C X X X
Water and Sanitation and Hygiene
Support 20 ‘micro-projects’ in 5 villages with exceptional performance X X
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Component
Activity (2004-2005) OK DELAY NO
1st Sep-Dec
2nd Jan-Mar
3rd Apr-Jun
4th July-Sept
Train Supervisors in ‘Family Planning’ , encadreurs de relais), and ITs X X Order and Equip 22 FP HZs with material (motos, velos, kits, solar equip.) X X X X Order and Equip 22 FP health zones with contraceptives and material X X X X Repair/Construct and Equip 66 community counseling halls in 22 FP zones X X X Repair/Construct 22 Hangars in 22 FP zones X X X Design and print and distribute education material in FP X X Promote community outreach media in PF (Radio Ntemo) X X X X Hold regular evaluation workshops in FP X X X X Establish ‘tools of supervision’ in FP X Regular supervision visits and follow up sponsored activities X X X X
Family Planning
Initiate ‘Operational Research’ in FP X X X X Participate in the national review of TB X Participate in Provincial Meetings of TB Evaluation X X Sponsor and supervise anti-tuberculosis clubs X Supply the Community Relays with bicycles in designated areas X X X Organize sector reviews in TB activities X X Supervise CDTs X X X X
Tuberculosis
Ongoing collection of TB data X X X X Organize planning workshop for HIV-AIDS and PTME X Training in CDV and HIV-TB X Train BCZS personnel in IST-IO X X Train ‘relais communautaires’ in HIV-AIDS awareness and prevention X Supply health zones with test kits (Determine and UniGold) X X Supply health zones in prevention material X Organize periodic reviews in HIV/AIDS activities X X
HIV/AIDS
Supervise HIV/AIDS activities in select health zones X X X X Distribute C-IMCI promotional materials, e.g., membership cards, badges, Tshirts. X X X Supply bicycles to Institutional Relays to supervision community relays X X Distribute “Ten Commandments of Health” soccer balls X X Produce educational materials on EPI, HIV/AIDS, & and nutrition X X Train and equip C-IMCI workers in 22 HZ for HIV/AIDS work X Train and equip C-IMCI workers in 22 HZ for nutrition and IRA work X Supervise activities of Community Relays X X X X Evaluate the application of activities in hygiene et malaria in 10 HZ X Scale up PCIME Activities in 8 new zones X Monitor and document activities of the RC X X X X
C-IMCI Community-Based Integrated Management of Childhood Illnesses (PCIME in French)
Organize a national review of PCIME-C teams in HZ X Co-support 3 APOC Oncho eradication programs in BD, PO, BC provinces X X Design flipchart & treatment protocols for Oncho control and TIDC X Supply 3 projects with flipcharts (boite images) and treatment protocols X
Endemic Disease Control, e.g., Oncho Visit and follow-up of TIDC programs in 3 provinces X X Supervision Supervision of Health Zones X X X X KPC Data collection instruments and equipment have been prepared X X
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A. Explanation of delayed/incomplete activities • HIMS: Monitoring cards and charts have been printed and are being distributed to all 56 assisted
health zones
• Medicine: Shipments of Medicine Kits from IDA and Mission Pharma are scheduled to arrive in Kinshasa in July and August 2005 for distribution in 4th quarter. Delay due to time lag for drug purchase waiver. All SANRU depots have been supplied with medicine orders enabling provincial health zones to purchase essential medicine with credits supplied by project.
• PEV: Construction of incinerators in 10 health zones has been postponed until year five. SANRU was unable to find a contractor in Katanga province qualified to construct the new type of WHO incinerator. If none is found, we will build incinerators based on a local design.
• Water and Sanitation: Program of micro-credits will not be undertaken. Instead through the PCIME-Hygiene program, health zones attaining certain criteria will receive badges, flags, and other community assisted recognition.
• Tuberculosis: Bicycles for the ‘relais communautriare’ have been purchased and delivered to project headquarters. Delivery to health zones is ongoing and will be completed by 4th quarter.
• VIH-SIDA: Training of ‘relais communautaire’ for HIV prevention is an activity which will be funded by Global fund. Current funding for HIV in SANRU will focus on other priority objectives including screening of blood pool, VCT testing and PMTCT projects.
• PCIME-Nutrition: Training of ‘relais communautaire’ in nutrition and vitamin A has been postponed.
• Onchocercosis: Two of three Ivermectin Distribution projects (TIDC) have been financed and assisted in the Bandundu and Tshopo provinces. The TIDC project in Bas Congo province has been postponed pending completion of a WHO study of co-endemic Loa-Loa in this province and establishment of new guidelines. Supervision of two of these projects has been completed as of this quarter.
II Overview of Key Activities A. Training Programs
Table 1: SANRU III Training Activities (April-June 2005)
COMPONENT TYPE OF TRAINING Milieu No. Zones
No Persons
Family Planning Refresher training in family planning
Kajiji, Masa, Luozi Sona Bata, Nsona Mpangu, Kimpese
7 256
Family Planning/ PCIME
Training of health care workers in PCIME
Kajiji, Kahemba 2 105
Family Planning Insertion of IUDs Masa, Sona Bata, Nselo, Luozi,
Kinkonzi, Nsona Mpangu, Dibindi, Songa, Kabongo, Kinkondja,
13 ~250
Family Planning Training in Monitoring Masa, Sona Bata, Karwa, Loko 4 110 Total number of persons trained this quarter Approx. 721
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B. Supervision of Health Zones The project staff from Kinshasa completed 61 health zone supervision visits during this current reporting period of year four (see Table 2) a 50% increase from last quarter. The majority of supervision visits are ‘team visits’ comprising a logistical or finance person combined with a medical professional. A report is established for each visit and given to the Technical Coordinator, Dr Felix Minuku who gives feedback and recommendations to each zone in writing. Summaries of all supervision visits including successes and difficulties are compiled and printed semi-annually and are available upon request. SANRU’s objective is to visit each health zone at least twice each year. Table 2 Supervision Visits (3rd quarter year four)
Health Zones
Total Supervision Visits Apr-Jun
2005
Percentage of Zones visited this quarter
per province Per Region
Bas Congo 12 13 77% Bandundu 11 13 100% Equateur 11 13 85% Kasaï 6 4 80% Katanga 4 7 100%
Kisangani 4 4 100% East 8 7 100% Total……. 56 61 88%
1. A summary of supervision visits to each zone including problems and successes noted is compiled by the technical team on a semi-annual basis and is available upon request
Problems noted during supervision visits this quarter
Discordance between reports and findings persist in certain health zones. This has been tracked to particular health centers. Conjoint efforts by national, regional and zonal staff are underway to address these concerns.
Inadequate management of pharmaceutical stocks was highlighted in certain zones. An effort is been undertaken to assist these zones in projecting needs and monitoring current stock in order to avoid future stock outs of essential medicine.
Health zones in the Kasai and Katanga regions consistently have ‘curative care rates’ (access to health center) in the 20 percent range. SANRU is examining diverse factors such as appeal of facilities, quality of care, review of tariffs, etc.
Several health zones were out of ‘fiches de curatives’ (medical records) vital to tracking health data and usage. This is being addressed.
Weak supervision by health zone teams of health centers has been noted and is being addressed. Weak or underperforming MCZs are a commonly cited though not exclusive factor in inadequate supervision of health centers.
C. Utilization of Health Services SANRU tracks the utilization rate of key health care services in its rural health institutions: Key indicators are 1) Access to health centers; 2) Access to prenatal care and 3) Access to well child visits (where most vaccinations are given). The following graphs show access trends over four years (2001-2005). Data is obtained from monthly MOH SNIS mandated reports. The graphs analyze data for the first quarter of 2005 (January to March 2005) with 46 of 56 health (81%) zones reporting.
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ACCESS TO HEALTH CENTERS
Evolution des moyennes des taux de consultation curative des zones de santé appuyées par SANRU en RDC de 2001 à 2005
60.0
50.0
40.0 Percentages
34.529.9 32.5
26.6 27.0 30.0
20.0
10.0
0.0 2001 2002 2003 2004 2005
Tx de consult curative (%) Années
Graph 1; Health Centers: The utilization rate of health centers continues to increase with 34.5% for the first quarter 2005. This is below the SANRU objective of 50%, but above the national average of 27%. The relative impoverishment of the population continues to impede access to subsidized health care services (46 of 56 health zones reporting as of 7/05) PRENATAL CARE
Evolution des moyennes des taux de CPN des zones de santé appuyées par SANRU en RDC de 2001 au 1er trimestre 2005
Graph 2; Prenatal Care: Average nationwide attendance at prenatal clinics surpasses the SANRU objective of 80%. Women attending prenatal clinics in SANRU-assisted health zones receive amenities such as free vitamins, iron and Fansidar (malaria prophylaxis) as well as access to heavily subsidize impregnated mosquito nets. (46 of 56 health zones reporting as of 3/05) (30/46or 65% reached the objective of 80%)
67.9
86.2 86.4
73.2 70.7
0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0
100.0
2001 2002 2003 2004 2005
years
Percentages
Tx de CPN (%)
SANRU Objective 50%
SANRU Objective 80%
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WELL CHILD CARE
Evolution des moyennes des taux de CPN des zones de santé appuyées par SANRU en RDC de 2001 au 1er trimestre 2005
67.9
86.2 86.4
73.2 70.7
0.010.020.030.040.050.060.070.080.090.0
100.0
2001 2002 2003 2004 2005Années
Pour
cent
ages
Tx de CPN (%)
Objective Sanru 80%
Graph 3; Well Child Visits: Attendance at well child clinics remains strong and exceeds the SANRU objective of 80% in most SANRU-assisted health zones. Well child clinics are where routine vaccination occurs and are important to SANRU objectives. (46 of 56 health zones reporting as of 6/05; 30 of 46 reached the goal of 80% 4. SUMMARY FINDINGS
Evolution des moyennes des taux de consultation curative, de CPN, d'achèvement CPN et de CPS des zones de santé appuyées par SANRU
en RDC de 2001 au 1er trimestre 2005
32.5 34.5
86.2 86.4
56.6 55.6
100.792.9
29.926.6 27.0
70.7
67.9
73.2
57.148.7
42.3
90.2
78.071.4
0.0
20.0
40.0
60.0
80.0
100.0
120.0
2001 2002 2003 2004 2005Années
Pour
cent
ages
Tx de consultcurative (%)
Tx de CPN(%)
Txd'achèvementCPN (%)Tx de CPS(%)
Graph 4; Health Service Trends: shows an upward trend in the utilization of key health services (curative, prenatal and well child) during the period 2001- 2005. (46 of 56 health zones reporting for first quarter of 2005.
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D. Water and Sanitation
The following are principal activities accomplished during this reporting period per project objective in the domain of water/sanitation and hygiene projects and their status: Objective One: Co-finance the construction of 700 clean water sources (springs) Result: As of the end of this third quarter 487 clean water sources had been financed (out of 700 projected in year four) in SANRU-assisted health zones (69% completion). The population having access to potable water though these springs is 314,813.
Objective Two: Repair and rehabilitate 25 wells and manual pumps with the initiative and involvement of local communities. Result: 25 wells and manual pumps have been installed in the Equator region. Objective Three: Construction of Ventilated Latrines (56 financed) This quarter saw the completion of the construction of 60 ventilated latrines in the Katanga Region of DRC. Water borne diseases like Cholera are prevalent in this region; the spread attributed to poor hygiene and waste control. Latrines were constructed in high risk areas
C(
Objective Three: Support and promote hygiene prprograms. Result: Over 450 flags and 740 badges were sent to hecommunities who attained certain PCIME-criteria. Inprinted and are being distributed to all 56 health zonescharged with the follow-up and monitoring of these te Study: A study of the effectiveness of the PCIME-Hywith assistance from Kinshasa’s School of Public HeaProvince health zone of Kangu. Results are pending ain the next SANRU quarterly report. Objective Four: Completion of two MCW project SANRU received funding from ‘Making Cities Workcompleted with verification scheduled in July 2005.
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ollecting potable water from a new spring (source) Kapanga Health Zone, Katanga Province May 2005)
ograms in 22 health zones with PCIME-C
alth zones and awarded to villages and addition 56,000 membership cards have been designated for community leaders (CODESA) chniques.
giene program was undertaken and completed lth. The study was performed in the Bas Congo t the time of this report and will be incorporated
s (Making City Work)
’ for two urban water projects. These have been
III TECHNICAL REPORTS
A. MalariaSANRU III promotes three principal strategies in the fight against malaria.
A. Preventative and Intermittent Treatment of Pregnant Women (TPI) B. Distribution of Impregnated Mosquito Nets to population at risk (MII) C. Appropriate management of Malaria
A summary of interventions this quarter is as follows:
Strategy I: TPI
SANRU continues to strongly support TPI programs in all its assisted health zones. Fansidar is given at scheduled times during pregnancy and is provided free of charge. Prenatal clinics are also settings where health education, insecticide treated nets and vitamins and iron are provided to pregnant women. 60% of SANRU-assisted health zones have surpassed the national target of 60% coverage rate with TPI. Strategy II: Provision of ITNs
SANRU continues to train community health leaders on the use and importance of ITNs. The limiting factor in distribution is the procurement of nets. Nearly one-sixth of the SANRU year four budget is designated for purchase of nets. Supplemental support from DIFID has allowed SANRU to nearly double the number of ITNs provided to health zones.
Despite this the average coverage per health zone is 20% compared to the national goal of 60% (pregnant women and children under 5 years of age). With increased funding, SANRU could achieve this goal.
Graph 5: 41 of 56 assisted health zones now have access to insecticide treated nets. This past Cquarter 223,955 nets were distributed compared to 87,708 for the previous quarter.
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SANRU’s goal in the next two quarters is to extend the provision of ITNs to all 56 health zones; focusing next on Northern Equator and the Cataract district of Bas Congo.
Training in Social Marketing: Members of the Djuma health zone office promoting nets to ‘infirmieres titulaires’ of their health centers (April 2005)
SANRU promotes the provision of ITNs (MII) to pregnant women and children under the age of five. This past quarter the following activities were undertaken to attain this objective.
Strategy III: Appropriate treatment of malaria (ACT)
SANRU III participated in a CDC study in Kimpese this quarter on the efficacy of Artemesin Combination Therapy (ACT) for the treatment of Malaria in 145 patients with routine malaria. The study revealed that the use of either molecule alone (Artemesin or Ammodiaquine) brought clinical and laboratory failure consistent with WHO alert criteria. However the combination therapy was well tolerated and showed excellent clinical and laboratory result (resolution of parasites) up to day 21 past therapy. Malaria is the leading cause of death in children in all SANRU-assisted health zones. Appropriate and efficacious treatment is paramount to curtailing malaria related mortality. SANRU will continue working with USAID and CDC to develop means to procure and implement appropriate therapy for malaria in assisted health facilities.
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B. HIV AIDS
Objective I: Maintain safety of blood donor pool by screening of donor blood. Blood transfusions are a standard treatment option for severe malaria and malnutrition in the Democratic Republic of Congo. The most common recipients are children and pregnant women; at risk for these diseases. SANRU endeavors to ensure that blood donations are free of HIV and Syphilis and provides recipient institutions with training, equipment and testing material to ensure safe transfusions. A review of stock supplies and needs per health zone for HIV testing material was completed this quarter. Feedback was given to zones with weak performance and those at risk for stock outs such as the Yakusu Health Zone where reporting mechanisms were found to be inerrant. The following cumulative data was obtained for current year programs:
Of 5657 blood transfusions in the 56 SANRU-assisted health zones during the first quarter of 2005; 5568 transfusions or 98.5% were tested for HIV. Of the 5568 units of donated blood; 218 or 4% were positive for HIV Of the 5568 units of donated blood; 19 or 0.3% were positive for Syphilis
Evolution de la sécurité transfusionnelle dans les zones de santé appuyées par sanru en RDC de 2001 au 1er trimestre 2005
69.0
98.0 98.4 96.589.5
0.0
20.0
40.0
60.0
80.0
100.0
120.0
2001 2002 2003 2004 2005
Années
Pour
cent
ages
Pourcentage dedons de sangt té
Graph 6: Evolution of HIV testing of blood transfusions in SANRU-assisted health zones. SANRU’s goal is 100% testing of transfused blood for HIV. (96.5% units tested for HIV in 2005 is an average of the mean for each province; the absolute number is 5568/5647 = 98.5%) Objective II: (PMTCT)
Prevention of HIV transmission from pregnant mother to child is another key intervention of SANRU III. SANRU is currently supporting 24 PMTCT programs in 8 SANRU-assisted health zones. An expansion from 24 to 40 sites, planned for this quarter has been delayed due to tardy funding of the UNC-Chapel Hill PMTCT project. This implementation is therefore planned for the current quarter.
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With the intention of scaling up the number of PMTCT Programs, SANRU financed the following activities this past quarter:
30 health workers were trained in PMTCT in the Equateur health zone of Karawa; The 25th site (of 40 planned) became operational this quarter; Technical assistants from UNC-Chapel Hill were involved in the supervision and follow up of existing SANRU-assisted PMTCT programs; and
Update of PMTCT data
Data from 24 PMTCT sites in SANRU-assisted health zones (update May 2005)
Zone de Santé Projet d'Appui
Beginning Date
no. sites
Formation (date)
No. Patients receiving
VCT
No Seropositif
2/3 No. Recu
NevirapineMasa SANRU/AXIOS mars 03 4 16-22/2/03 2174 57 29Kimpese SANRU/AXIOS mai 05 3 16-22/2/03 2646 63 31Luozi SANRU/AXIOS avril 05 3 16-22/2/03 1072 9 3Kuimba SANRU/AXIOS juin 05 2 16-22/2/03 1281 21 10
Tshikaji SANRU/UNC/Glazer/AXIOS Sept 05 5 Janv 04 605 15 0Karawa SANRU/UNC/Glazer/AXIOS Janv 04 1 Janv 04 2084 69 20Kangu SANRU/UNC/Glazer/AXIOS Janv 04 3 Janv 04 713 17 5Nselo SANRU/UNC/Glazer/AXIOS Janv 04 3 Janv 04 133 4 1
TOTAL 24 10708 255 99Graph 7: PMTCT progress in 24 sites (March 2003-May 2005). 10,708 women have accepted voluntary testing and of those 255 (2.3%) were seropositive. 99 of these women have subsequently delivered and received Nevirapine as of May 2005.
Objective III (leveraged support) 1. Global Fund Awards: SANRU has been awarded a grant from Global Fund to augment HIV prevention activities in 17 of its assisted health zones. The annual renewable grant includes 1.4 million dollars per year for HIV prevention and testing in SANRU-assisted health zones. In addition, Global Fund has invited SANRU to apply for a supplemental grant of 1.3 million dollars plus per year to supply ARTs in 8 of these health zones. Project Design: SANRU has been involved at the national level of Global Fund planning and design. SANRU was at the table in planning of the 2nd round of Global fund activities and participation in planning for the 5th round of Global Fund (HIV-AIDS). 2. Pfizer Pharmaceuticals: SANRU received an evaluation team in May 2005 comprising representatives of Pfizer Pharmaceutical. Pfizer awarded IMA/ECC a $100,000 grant last year for the care of those living with HIV. Subsequent to this visit, Pfizer has invited IMA/ECC to apply for a phase II grant 3. Johnson & Johnson Pharmaceuticals: Johnson & Johnson has provided funding and pharmaceutical products (Tibozole) for the treatment of opportunistic fungal infections in HIV positive patients in 6 hospitals in the DRC though IMA/ECC.
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C. Tuberculosis
SANRU works in collaboration with the Ministry of Health to enhance both the detection and cure rate of Tuberculosis in SANRU-assisted health zones. Activities undertaken this quarter include:
Analysis of TB detection and cure statistics in all assisted health zones with concentration on those health zones with a weak performance.
Supervision of Tuberculosis Activities in key health zones.
Participation in the elaboration of TB and HIV interventions in the 5th round of funding from Global Fund.
Review of key data
SANRU supports 160 CDT centers (diagnostic and treatment centers) which registered 1115 cases of pulmonary TBC this period (rate of detection of 63% with 85% of facilities reporting).
Of 1195 patients who presented for treatment during the same period last year; 987 completed a successful therapy (rate of cure 83%)
While most SANRU-assisted health zones had favorable rates of detection and cure; a few isolated zones (like Bibanga) had cure rates under 60%. These zones have been highlighted for an on site supervision (SANRU and MOH) for determination of obstacles and difficulties.
Graph 8 compares of TB cure rates for first quarter of 2004 and 2005.
69%
83%
TRIM 1 2004 TRIM 1 2005
EVOLUTION DU TAUX DE GUERISON ENTRE LE 1ER TRIMESTRE 2004 ET LE 1ER TRIMESTRE 2005 DANS LES ZS SANRU
Graph 8: Comparison of TB cure rates in SANRU-assisted testing and treatment centers in assisted health zones (first quarter 2004 versus first quarter 2005)
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D. Family Planning With assistance from USAID (Population Funding) and Advance Africa in project years 3 and 4, SANRU has helped re-establish family planning services in 22 key health zones. These zones have had little or no family planning services for over ten years. The results continue to trend upwards reflecting a high demand for family planning services. 1. Indicators (New Acceptors and CYP) New Acceptors: The number of new acceptors continues to increase (from 9.3% to 13.6% in the past 12 months). Monitoring is done on an annual basis and previous clients are counted as ‘new acceptors’ for the current year.
CYP: The completion of training modules in IUD insertion and voluntary sterilization (primarily post partum) has caused a significant increase in CYP in many assisted health zones. The graph below shows the CYP quarter by quarter with figures contributed by the phase I zones (original 12) in blue and the newer 10 zones (phase II) in pink.
Graph 9 : Evolution of percentages of new acceptors over the past five quarters in SANRU-assisted HZs
Graph 10 : Evolution of CPY in SANRU-assisted family planning zones over a one year period; phase I (12) versus phase II (10) zones broken out.
2. 3. 4.
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5. Training
Over 300 persons were trained in family planning activities this quarter (including PCIME-family planning). The interest and demand of family planning services after a ten year period of no services has necessitated broad scale training and awareness programs.
Supervisions
Supervision of family planning activities is essential; given the recent introduction of this service after an absence of nearly a decade. SANRU tracks percentage of use per province as well as trends from quarter to quarter. As one can see from the graph below; there is a sharp fall off of family planning new clients in this first quarter of 2005 in the Equator Region; despite this being one of the strongest areas in Phase I. The SANRU family planning team will be going to the Karawa area in mid-July to further evaluate this lapse of services and assist in re-vitalizing services in family planning.
Graph 11: Percent of new acceptors province by province over the past 5 quarters. (note fall-off in Northern Equator (EQ-N) area)
4. Family Planning Counseling Halls SANRU is funding the building or family planning counseling halls as an annex to current health centers in all 22 health zones. Counseling Halls (see picture below) are where women can gather to receive information on family planning and where village wide presentations of awareness can be made. These have been incorporated into the regular services of community health centers. The structures are built with material provided by the project and labor in part by the local community
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Family planning counseling hall in the Bas Congo health zone of Masa (Kiloso Health Ctr)
SANRU Family Planning team at work in Kinshasa (left to right: Madame Jackie MAFUTA, Dr Marie Claude MBUYI Madame Yvette MULONGO, Dr Chantal.
5. Trends in the acceptance/use of family planning services
Graph 12: SANRU-assisted family planning zones have seen a continual rise in the number of new acceptant per year
Evolution de la moyenne des proportions de nouvelles acceptantes des 12 premières HZ pilotes naissances désirables appuyées par SANRU III (2002-2005)
16.0
14.0 Pourcentages 13.6
12.0 11.610.410.0 9.9
8.58.0
6.0
4.74.0
2.0
0.0ProportionProportionProportionProportionProportionProportion
acceptantesacceptantesacceptantesacceptantesacceptantesacceptantes2005 (1e T)2004 (4eT)2004 (3e T)2004 (2e T)2004 (1e T)2003
AnnéesMoyenne
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E. Vaccinations 1. A summary of key activities accomplished this quarter
Participated at ongoing Provincial reviews of PEV activities (South Kivu)
Intensive supervision (national and provincial) of health zones with inferior vaccination data (this quarter Equator, North and South Kivu, and Province Orientale
Supplied vaccination tracking and promotion data to health zones (boite images, cartes conseils, fiches CPS and formularies)
Provided logistical and technical material to health zones (bicycles, refrigerators, cold boxes, and motorcycles
Organized microplanifacation of annual vaccination drives (DTC, Measles,etc) concurrent with microplanification for Vitamin A
Assisted zone specific monitoring sessions in all 56 health zones.
2. Analysis of vaccination data SANRU tracks key vaccination data on a national, provincial and health zone level. An analysis of province by province helps reveal low coverage areas such as Equateur (EQ) and Oriental Province (POR). Provincial wide variation is usually linked to supply chain problems (PEV antennes), incorrect base line population information, and weaknesses in logistics and supervision. Such trends helps SANRU focus on geographic areas that are in need of intense supervision and reinforced assistance.
. Graph 13: Comparison of key vaccinations (DTP, Measles and DTP drop out) by province for first quarter 2005.
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3. Vaccination Rates for first quarter 2005
The first quarter is traditionally the weakest in terms of vaccination data for reasons of planning, mobilization and trends of visits to health centers. DTP is a key vaccine and indicates attendance at well child visits. A comparison of DTP3 vaccinations given in the first quarter 2004 and first quarter 2005, show a slow but steady increase nationally in health zones assisted by SANRU.
a. DTP vaccination in the first quarter of 2005 by province
Moyennes des couvertures en DTC3 des zones de santé appuyées par SANRU par coordination par rapport à la moyenne nationale souhaitée. RDC.
1er trimestre 2005
83.3
60.5
70.3
104.6
61.4
77.4
0.0
20.0
40.0
60.0
80.0
100.0
120.0
Bandundu Bas Congo Equateur Est Kasaï Katanga Kisangani
Coordinations
Pour
cent
ages
CV DTC3 (%)
Graph 15: Shows the average vaccination rates of DTP3 province by province (46 of 56 health zones reporting) (30/46 reached the objective of 70% coverage)
Graph 14 DTP vaccination in SANRU-assisted zones (first quarter 2004 versus first quarter 2005)
SANRU Objective 70%
National Average 47%
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b. Measles vaccination rates in SANRU-assisted health zones (first quarter 2005) province by province
Moyenne de couverture en VAR des zones de santé appuyées par SANRU par coordination par rapport à la moyenne nationale souhaitée en en RDC.
1er trimestre 2005
63.1
79.0
99.5
55.548.3
82.0
0.0
20.0
40.0
60.0
80.0
100.0
120.0
Bandundu Bas Congo Equateur Est Kasaï Katanga KisanganiCoordinations
Pour
cent
ages
CV VAR(%)
Objectifnational
Objectif usaid 70%
Objectif national 50%Moyenne nationale 50%
Graph 16. Measles vaccination rates with the average in each province surpassing the national average of 50% (46 of 56 health zones reporting) 24/46 reached the objective of 70% coverage).
c. POLIO vaccination trends (provincial) for 1st quarter 2005
Moyennes des couverture en VPO3 des zones de santé appuyées par SANRU par coordination par rapport à la moyenne nationale souhaitée. RDC.
1er trimestre 2005
78.9
100.0
75.9
60.062.767.2
0.0
20.0
40.0
60.0
80.0
100.0
120.0
Bandundu Bas Congo Equateur Est KasaïKatanga
KisanganiCoordinations
Pour
cent
ages
CV VPO3 (%)
SANRU Objective 80%
Moyenne nationale
Graph 17: Vaccination rates for Polio (OPV3) in SANRU-assisted health zones (Jan-Sept 2004). Three of six provinces have rates that approach or exceed the SANRU Objective of 80% (46 of 56 health zones reporting) (23/46 reached the objective of 80% coverage)
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4. Summary and Trends of Major Vaccines
Evolution des moyennes des couvertures vaccinales des zones de santé appuyées par SANRU en RDC de 2001 au 1er trimestre 2005
80.0
73.0 72.068.072.069.6
55.9
48.5
62.0 64.0
81.083.3
54.9
67.872.6
58.2
52.8
73.074.0
64.1
55.450.660.0
60.4
44.0
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
2001 2002 2003 2004 2005Années
Pour
cent
ages
CV BCG(%)
CVVPO3(%)CVDTC3(%)CV VAR(%)
CVVAT2+(%)
Graph 18: Evolution of key vaccination rates from 2001 to 2004 shows a continual rise in key indicators over the course of the past three years (46 of 56 health zones reporting)
Vaccination data is tracked nationally. Only seven Health Zones had DTC coverage less than 50% (fewer than last quarter). Intensive supervision and monitoring is being undertaken in these zones to improve vaccination coverage.
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F. Maternal-Infant Mortality Rates SANRU III strives to document the incidence of maternal and neonatal death rates based on data from deliveries performed in maternities, hospitals and health centers, but not including home-based deliveries. The following graphs show data trends from 56 health zones over a 3-4 year period.
Graph 19: Reveals a slow but progressive decline in maternal and infant mortality concurrent with an increase in assisted births during the five year period 2001-2005.
Birth Weight and neonatal mortality compared to assisted births
Graph 20: shows a slow but continued downward trend in both the neonatal and maternal mortality rates in 56 health zones over a 4 year period. (numbers per thousand live births) (46 of 56 health zones reporting for 2005)
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IV. Highlights and Notable Events from the Second Quarter 1. Gifts in Kind Shipments Interchurch Medical Assistance has a long history, since 1960, of providing pharmaceutical and medical equipment to its twelve member agencies for their work in developing countries. One highlight of IMA’s involvement in the SANRU project has been the acquisition of donated U.S. pharmaceuticals and hospital equipment for SANRU-assisted health zones. The following table summarizes these donations for the past four years in terms of value and quantity obtained from U.S. pharmaceutical companies and hospitals.
Summary of Gifts-In-Kind Contributions Containers sent from IMA to Kinshasa: 12 containers Air drop shipments from IMA to Kinshasa 6 air-shipments Value of donated pharmaceuticals and equipment:
11.1 million U.S.D.* * does not include value of Mectizan
Clockwise from left top:
1) Warehouse at Brethren Service Center preparing pallets for shipment to DRC 3) Donated pharmaceuticals from Johnson & Johnson destined to DRC (IMA) 3) IMA pharmacist Don Padgett next to donated pharmaceutical products (IMA) 4) Volunteers preparing blankets and linens for DRC maternities
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2. SANRU cuts its first CD! As part of HIV Prevention and the Promotion of Family Planning Services, SANRU engaged the services of local musicians to compose and record music related to these activities. These songs and messages are now being been broadcast by a local radio station which reaches over a dozen health zones twice weekly. The songs are followed by messages concerning health promotion and the avoidance of risky and promiscuous behavior. These broadcasts have been very well received by the population and SANRU has received positive feedback from all sectors of society. The messages are recorded in four languages -- Lingala, Swahili, Tshiluba and Kikongo. An example of one lyric (translated in French) is as follows:
Chers parents, ce n'est plus une maladie honteuse,
parlons-en en famille et et faisons attention.
Cette maladie ne respecte personne, ni enfant, ni jeune,
ne tient compte d'aucune race, elle décime des populations entières.
Suivons les conseils de SANRU III à savoir:
*ne jamais transfuser du sang non testé
*n'utiliser que des seringues à usage unique et acheté en pharmacie
*manier avec attention les objets tranchants
* let surtout ayons un comportement sexuel responsable
Dear parents this is not an illness to hide ;
talk about in your family and be attentive
This sickness respects on one; children, young people
nor take note of any race…it decimates all
Follow the counsel of SANRU III
*don’t ever accept untested blood
*only use single use syringes bought in a pharmacy
*be careful with sharp objects
*and above all follow safe and responsible sexual habits.
Dissemination of radio messages with popular lyrics is one of the ways that SANRU is promoting primary health care services and creating an awareness of the dangers of endemic diseases such as HIV-AIDS.
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Reference Hospital of Bolenge before pillaging
3. SANRU presents at the CCIH Conference Dr. Leon recently shared lesson learned from SANRU and ECC at the CCIH conference (Christian Connections for International Health) in Germantown, MD (not far from I.M.A. HQ). Dr. Kintaudi’s presentation, made together with IMA/ECC senior advisor Dr. Franklin Baer, was entitled, “The SANRU Program in DR Congo: Where we've been and where we're going.” They presented the history of health zone development and the role that Faith-Based Organizations (FBOs) played in that process. Dr. Kintaudi also suggested ways that Faith-Based Organizations could promote health systems development.
The CCIH conference was attended by more 100 participants from a dozen countries, including Christian Health Associations from Kenya, Malawi, Nigeria and India. Dr. Kintaudi also attended the “Global Health Hot Topics and Technical Issues” sponsored by USAID, along with Drs. Albert Kalonji, Daniel Aukerman, and Franklin Baer. Dr. Kintaudi was also a commencement speaker for the 2005 La Verne University graduation ceremony (his alma mater), where he also received an honorary doctorate degree.
4. Pillaging of the Bolenge Hospital and Health Zone office
Armed soldiers near Mbandaka went on a pillaging streak on July 3-4th reportedly after the death of one of their comrades. The week was when elections had been previously scheduled and a time of nationwide threats of civil disorder. The soldiers responsible for the pillaging were reportedly from the previous rebel groups who were in the process of being integrated into the national army. Among the institutions that were pillaged was the Disciples hospital of Bolenge, 15km outside of Mbandaka. The amount of loss reported by Bolenge was extensive: all supplies, beds, equipment, doors, windows, medicines, laboratory, surgical, and cold chain supplies with losses exceed $80,000. The health zone office was also pillaged and sustained losses estimated at $15-$20,000. IMA/ECC has sent a team to the hospital (which is currently closed) to evaluate the losses and examine various plans of reopening.
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