Events Contributing to the Decline of Events Contributing to the Decline of DR CongoDR Congo

Nationalization

Pillaging

War

Basic IndicatorsBasic Indicators Maternal mortality 1289/100,000 Maternal mortality 1289/100,000

(MICS2, 2001)(MICS2, 2001) Infant mortality 127‰ Infant mortality 127‰ (MICS2, 2001)(MICS2, 2001)

Child mortality 213 ‰ Child mortality 213 ‰ (MICS2, 2001)(MICS2, 2001)

67% of pregnant women are anemic 67% of pregnant women are anemic (PRONANUT, Mai 2005)(PRONANUT, Mai 2005)

Neonatal mortality 47 ‰Neonatal mortality 47 ‰

75% vaginal fistulas caused by 75% vaginal fistulas caused by complications of delivery complications of delivery (PNSR, (PNSR, Sept 2005)Sept 2005)

Low UtilizationLow Utilization of Services of Services (PNSR, 2004)(PNSR, 2004)

Curative Care: 30%Curative Care: 30%

Anti-natal visits: 45.3%Anti-natal visits: 45.3%

Assisted Births: 42.5%Assisted Births: 42.5%

Post partum visits: 8.8%Post partum visits: 8.8%

Family Planning coverage: 2%Family Planning coverage: 2%

The Congo Health System is based The Congo Health System is based on 515 Decentralized Health Zoneson 515 Decentralized Health Zones

Components Components of a of a

Health Zone Health Zone in DR Congoin DR Congo

A Typical Health Zone of CongoA Typical Health Zone of Congo

““Although praiseworthy, [donor resources] are Although praiseworthy, [donor resources] are inconsistent with the development of a inconsistent with the development of a sustainable health service. sustainable health service.

Too many resources are devoted to attaining Too many resources are devoted to attaining short-term goals…short-term goals…

People have very limited access to essential People have very limited access to essential quality health care and there is a shortage of quality health care and there is a shortage of medium and long-term funding”. medium and long-term funding”.

Minister of Health BongeliMinister of Health Bongeli

Goal of Project Goal of Project AXxesAXxes

To develop an effective & efficient To develop an effective & efficient health care system in DR Congo health care system in DR Congo

based on the MOH’s based on the MOH’s Health Health System Strengthening StrategySystem Strengthening Strategy

Component A: Increase access to, quality and Component A: Increase access to, quality and demand for multi-sectoral integrated PHCdemand for multi-sectoral integrated PHC

Increase access to integrated Primary Health CareIncrease access to integrated Primary Health Care Reproductive Health, STIs & Family PlanningReproductive Health, STIs & Family Planning Maternal & Newborn careMaternal & Newborn care Improve vaccination coverageImprove vaccination coverage Reduce malaria in target population Reduce malaria in target population Improve TB detection and treatmentImprove TB detection and treatment Improve Nutritional InterventionsImprove Nutritional Interventions IMCI & C-IMCIIMCI & C-IMCI HIV/Aids (Blood safety and PMTCT)HIV/Aids (Blood safety and PMTCT) Water and SanitationWater and Sanitation

Component B: Increased Capacity to the Component B: Increased Capacity to the health zone and the referral systemhealth zone and the referral system

Improve HZ Planning, Governance, Improve HZ Planning, Governance, Transparency and AccountabilityTransparency and Accountability

Develop Human Resources of HZMT, Develop Human Resources of HZMT, including training and supervisionincluding training and supervision

Drug supply managementDrug supply management Improve referral system Improve referral system Improve health information systemImprove health information system Improve community involvement & supportImprove community involvement & support Improve capacity of local NGOsImprove capacity of local NGOs

Component C: Increased capacity of national Component C: Increased capacity of national health programs and provincial/district officeshealth programs and provincial/district offices

Increase the capacity of selected national health Increase the capacity of selected national health programs: programs: 4th and 5th directions, PNLP, PEV, PNLS, 4th and 5th directions, PNLP, PEV, PNLS, PNLB, SR, PRONANUT, PNAM & PCIME PNLB, SR, PRONANUT, PNAM & PCIME

Increase the functional capacity of provincial & Increase the functional capacity of provincial & district health offices district health offices

Improve supervision of HZsImprove supervision of HZs Improve health policy implementation Improve health policy implementation

Program Manager

Regional Coordinator

& Administrator

Regional Coordinator

& Administrator

Technical Team

Field Supervisor Field Supervisor Field Supervisor Field Supervisor

3 or 4 HZs 3 or 4 HZs 3 or 4 HZs 3 or 4 HZs

Financial StaffLogistics Staff

Implementing Partner StructureImplementing Partner Structure

TA support for AXxesTA support for AXxes

JHU – M&EJHU – M&E HKI – Nutrition and micro nutrientsHKI – Nutrition and micro nutrients HEAL Africa – VF trainingHEAL Africa – VF training World Relief – Care groupsWorld Relief – Care groups MSH – Leadership, Drug management, Lab qualityMSH – Leadership, Drug management, Lab quality URC – Quality of service & improved utilizationURC – Quality of service & improved utilization ? – Neonatal health? – Neonatal health Others ?Others ?

Add-in programsAdd-in programs

PMTCTPMTCT UNICEF waterUNICEF water UNICEF netsUNICEF nets GAVIGAVI Food for Peace ?Food for Peace ? Others ? Others ?

Sampling of AXxes IndicatorsSampling of AXxes IndicatorsYr1 Yr2 Yr3

Establish Reproductive & child spacing Services 60% 80% 100%

Improve DPT3 coverage from 55% 60% 70% 75%

Provide households with ITNs 20% 40% 60%

Train HC staff in TB program improvement 70% 80% 90%

Vit. A campaigns coverage 90% 90% 90%

Reinforce ORT treatment of children 40% 50% 60%

Implement IMCI in clinics and communities 50% 70% 90%

Water programs to increase household access 40% 45%

Increase women participation in CODESA to 50% 5% 20% 50%

Begin C-IMCI with trained community relays 30% 45% 60%

Train HCs to increase referral rate 60% 75% 90%

Improve drug Supply Mgmt to reduce stockouts 30% 20% 10%

Implement HC complete HIS monthly reporting 70% 80% 90%

SANRU Trends in ServicesSANRU Trends in Services

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

100%

2001 2002 2003 2004 2005 2006

Curative CareCPNAssisted brithsCPS

Family PlanningFamily Planning

0

5000

10000

15000

20000

25000

30000

35000

40000

2002 2003 2004 2005 2006

Couple Years Protection

Vaccination Vaccination CoverageCoverage

Impact of Bed Nets & IPT Impact of Bed Nets & IPT at Oicha Hospitalat Oicha Hospital

Children Under 5 & Birth OutcomesChildren Under 5 & Birth Outcomes

20032003 20042004 ChangeChange

Anemia <5sAnemia <5s 12.8%12.8% 8.6%8.6% -32.4%-32.4%

Malaria cases <5sMalaria cases <5s 51.9%51.9% 33.6%33.6% -35.2%-35.2%

Deaths <5sDeaths <5s 1.1%1.1% 0.4%0.4% -62.2%-62.2%

Low birth weightLow birth weight 22.8%22.8% 17.0%17.0% -25.4%-25.4%

Neonatal mortalityNeonatal mortality 1.7%1.7% 1.1%1.1% -22.8%-22.8%

Water, Sanitation & HygieneWater, Sanitation & Hygiene2163 Springs capped – Access increased 32% 2163 Springs capped – Access increased 32%

Waterborne disease decreased by 30%Waterborne disease decreased by 30%

0%

10%

20%

30%

40%

50%

60%

70%

2001 2002 2003 2004 2005

Access to water

Essential Medicine Distribution SystemEssential Medicine Distribution System

Regional Depot(7% markup)

Hospital Health Zone Office

Health Clinic

Patients

100%50%

80% 100%

60%60%

40%

100% 100%

100%

Community Health EndowmentsCommunity Health EndowmentsInternal Rate of Return 51%Internal Rate of Return 51%

AXxes Data FlowAXxes Data Flow

Electronic DashboardElectronic Dashboard

What has been achieved so far?What has been achieved so far? Conducted rapid assessment of health zonesConducted rapid assessment of health zones Setup district officesSetup district offices Developed technical & procedural manualsDeveloped technical & procedural manuals Signed contracts with health zonesSigned contracts with health zones Started support to HZ for supervisionStarted support to HZ for supervision Distributed locally purchased equipmentDistributed locally purchased equipment Trained ECZS in health zone managementTrained ECZS in health zone management Printed & distributed IEC, SNIS, CPS, etc materialPrinted & distributed IEC, SNIS, CPS, etc material Conducted FP training & distributed contraceptivesConducted FP training & distributed contraceptives Conducted Vit A campaignsConducted Vit A campaigns Responded to cholera outbreak in BukavuResponded to cholera outbreak in Bukavu

Challenges for AXxesChallenges for AXxes

Coordinating with Emergency Assistance Coordinating with Emergency Assistance programsprograms

New USAID priorities and indicatorsNew USAID priorities and indicators Delay in authorization and waiversDelay in authorization and waivers Need for gap funding for certain activitiesNeed for gap funding for certain activities

Bed nets & ACTsBed nets & ACTs Water and SanitationWater and Sanitation Livelihood activitiesLivelihood activities Subsidy for VFR and Cesareans Subsidy for VFR and Cesareans

New Zones New Zones for AXxesfor AXxes

57 health zones57 health zones $158,000 $158,000

assistance per assistance per health zonehealth zone

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Project AXxes

Partner Implementation MAPRevised October 2006

CRSECCWVINot Selected

LakeInland shorelines

Route Nationale asphaltéeRoute NationaleRoute secondaire en terre battueRoute locale

Chemin de fer

#Y Chef-lieu de district%[ Chef-lieu de province

#S Chef-lieu de territoi re

0 100 Ki l om et er s

Map making by AXxes IMA GIS Unit , November 2006

USAIDFROM THE AMERICAN PEOPLE

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