1. Churches and Health Care in DR Congo by Leon Kintaudi ECC-DOM Medical Director

2. 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

3. ECC-DOM and IMA World Health

4. ECC-DOM Protestant Church of Congo Medical Office 61 member communities 80 hospitals 600+ health centers 70 co-managed health zones (see map)

5. – Adventist Development Relief Agency– Lutheran World Relief – American Baptist Church USA– Mennonite Central Committee – Christian Church (Disciples of Christ– Presbyterian Church (USA) – Church of the Brethren General Board– United Church of Christ – Church World Service & Witness– Episcopal Relief and Development – United Methodist Church, Global Min. – Vellore Christian Med College IMAWH is a member association of twelve U.S. church relief and development agencies:

6. 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.

7. Operational Strengths Collaboration with MOH Procurement Project management Networking Financial management ECC-DOM and IMA World Health

8. A Brief History of Health Zones in the DR Congo

9. 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.

10. Health Zone Administrative Structure Central office : Health Zone Management Committee Health Center Management Committee Hospital Management Committee Health Post Health Center Referral H.Center Referral Hospital Supervision Hospital Director ReferralReferral Referral

11. Components of a Health Zone in DR Congo - 125,000 people - 20 Health Centers - 1 Ref. hospital

12. A Typical Health Zone

13. 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

14. 1975 National Workshop Adopted concepts of decentralized Health Zones and primary health care. Adopted concepts of decentralized Health Zones and primary health care. Agreed on a principle of co-management by Government and church hospitals. Agreed on a principle of co-management by Government and church hospitals.

15. Pilot Health Zones (1981)

16. Health Zones (1982)

17. 1984 – before HZ delimitation 75% of the first 85 health zones were developed around church hospitals

18. 1984 – after HZ delimitation 75% of the first 85 health zones were developed around church hospitals

19. The Role of Faith-Based Health Services in DR Congo

20. The Roles of FBOs in Health Care 1)Pioneering of community health services 2)Provision of PHC services at community level 3)Provision of Referral Services (hospitals) 4)Co-Management of Health Zones (~180) 5)Management of Regional Services (depots) 6)Management of National Projects (SANRU)

21.  ~50% of health services provided by FBOs / NGOs  ~50% of health facilities are owned by FBOs  HZs are MOH “owned” with FBO co-management Co-management by FBOs & NGOs Public vs. Private Co-Management

22. 35% of the current 515 health zones are co-managed by FBOs

23. 1981-86 SANRU I 50 HZs 1981-86 SANRU I 50 HZs 1986-91 SANRU II 100 HZs 1986-91 SANRU II 100 HZs 1991-00 ECC/DOM12-36 HZs 1991-00 ECC/DOM12-36 HZs 2000-06 SANRU III & PMURR 75 HZs 2000-06 SANRU III & PMURR 75 HZs 2006+ AXxes, PMURR, Global Fund128 HZs 2006+ AXxes, PMURR, Global Fund128 HZs SANRU Rural Health HZ Development Assistance

24. AXxesPMURRAbbottSP+GFMRPDEVRU Health Development in 128 of DRC’s 515 health zones

25. SANRU the project has evolved into SANRU the Program ECC-DOM’s partnership with IMA World Health manages $10 million of assistance to health zones each year

26. ECC / IMAWH SANRU Program Objectives  Integrated Primary Health Care especially for Mothers and Children especially for Mothers and Children  Health Systems Strengthening of decentralized health zones, of decentralized health zones, especially those co-managed by FBOs especially those co-managed by FBOs (including community & congregation (including community & congregation

27. Actions through SANRU Strengthening Integrated PHC Strengthening Integrated PHC (pre-natal clinic, well child clinic, family planning, post-natal care, vaccination, etc) (pre-natal clinic, well child clinic, family planning, post-natal care, vaccination, etc) Health education / C-IMCI Health education / C-IMCI Water and Sanitation Water and Sanitation Malaria prevention & treatment Malaria prevention & treatment Training health teams Training health teams Essential drugs supply Essential drugs supply Health zone development Health zone development

28. Vaccinations

29. Curative care

30. Prenatal care

31. Well Child Care

32. Preventive care

33. Blood Safety

34. Essential Drug Supply

35. Water and Sanitation

36. Training Health Teams

37. SANRU Trends in Services

38. Family Planning

39. Vaccination Coverage

40. Malaria: Fever during last 14 days among households with and without ITNs n=514

41. Water, Sanitation & Hygiene 2163 Springs capped – Access increased 32% Waterborne disease decreased by 30%

42. Challenges and Future Perspectives

43. 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

44. Large families (average 7)

45. Housewife and provider

46. Producer

47. Financial Person

48. Second Rank Citizen

49. Male attitude

50. 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.

51. Santé Pour Tous et Par Tous