Experience du RDC par Dr Denis Matshifi, SANRU
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Transcript of Experience du RDC par Dr Denis Matshifi, SANRU
Africa Christian Health Associations’ Platform,
7th Biennial Conference
February 2015
Nairobi - Kenya
SANRU - Presentation
Denis Matshifi, MD, MPH
Healthcare in Conflict and Crisis Settings DRC
• SANRU= Soins de santé primaires en Milieu Rural (in short: SANTE RURAL)
• Nature: National NGO and Faith Based Organization
• Mission: Contributing in collaboration with the Government to: Initiate and Execute activities that improve
health and global wellbeing of Congolese population.
SANRU
CONTEXT
Country Size – Immense
CONTEXT (2)
Geographical Inaccessibility and Lack of communication infrastructures
1991-2001 Political crisis &
civilian war
Persisting violence and conflict from armed groups –
Eastern Congo 2001 - 2014
Multi & Bilateral
Coopérations cut off
National Health
Strategic Plan
National Health
Development Plan &
Proposed Low on UC
BACKGROUND
Political
Crisis &
Rebellion
The Congo Health System
Well designed to provide
comprehensive primary health care
through decentralized health zones
co-managed, in many cases, by
churches & NGOs.
Components of a
Health Zone in DR Congo
125,000
inhabitants/HZ 20 HC / HZ
Co-management by FBOs and NGOs
50% of Health Services provided by FBOs / NGOs
50% of Health Facilities owned by (FBOs)
50% of Health Facilities owned by Gvt and Private
HZs are MOH “owned” with FBO co-management
The DR Congo Health System
Public vs. Private Co-Management
Actions through SANRU (1)
Actions aimed to ensure:
• Access to health care
• Availability of services
• Community mobilization and involvement for ownership
• Free health care for all preventative services
Actions are based on the Minimum Package of Activities (PMA) for the HC and Complementary Package of activities of the Hospital, approved by MOH • Revitalizing Primary Health Care services
(pre-natal clinic, well child clinic, family planning, post-natal care, vaccination, etc…)
• Health education / C-IMCI • Water and Sanitation
• Training of health teams
Actions through SANRU (2)
• Training of Community structures members (Community Health Committee, Community Volunteers)
• Essential drugs supply
• Gold chain Equipment and fuel
• Health zone development
• Minor rehabilitation of facilities
• Payment of performance incentive to HZ teams and HC staff (not based on indicators but outputs)
• Support (fees) to national and provincial (intermediate) teams for formative supervision of the HZ.
Actions through SANRU (3)
Basic Indicators
Indicator PRONA
NUT
MICS
2001
DHS II
2013-
21014 Maternal mortality 1289 ‰ 846 ‰
Infant mortality 127 ‰ 58 ‰
Child mortality 213 ‰ 1O4 ‰
Anemic pregnant women
67% 38%
Neonatal mortality 47 ‰ 28 ‰
Utilization of Services
INDICATOR PNSR
2004
DHS II 2013-
2014 Curative Care 30% 34%
Antenatal visits 45.3% 88%
Assisted Births 42.5% 80%
Post-partum visits
8.8% 44%
Family Planning coverage 8% 20%
• Lack of Government leadership • Vertical funding (some donors) • Geographic targeting by donors without
harmonization with MOH and Implementing FBO or NGOs
• Compliance of free service delivery by facility personnel
• Sustainability of health zones activities after project is finished
• Staff instability (turn over for better salary) • Political instability of the Country • Knowledge and understanding of illness by the
population • Women’s conditions
Challenges & Difficulties
Large families (average 7)
Housewife and provider
Producer Financial person
Second rank citizen Male attitude
Accessibility
Condition of transportation Inadequate infrastructure
Poverty Underage mothers
Opportunities
Existence of well defined health care system
Coexistence between NGOs and Government
Existence of government policies and procedures
Global awareness
Community implication
KEYS FOR SUCCES
Working with and strengthening FBOs, NNGOs
and CBOs that have permanent contact with
communities
Aligning on and working to reinforce government
health policies
Training and reinforcing national staff specific
competencies and qualifications
Having donors’ confidence
Be Innovative and competitive