1. Project AXxes/USAID Project Overview March 24 th, 2009

2. Three Components of Project AXxes for HZ Development: A: Increase access to… integrated PHC B: Increase capacity of Health Zones & referral system C: Reinforce national programs & provincial/district offices

3. Component A : Increased access to integrated care.

4. 1. Reinforcement of Rural HC Facilities Photo Clemmer /Kisangani/07

5. 1a. Rehabilitated 218 HC facilities! BeforeAfter Photo: CRS/Apr 08

6. 1b. Equipped them with: Solar Lights Diagnostic Kits Registers/Charts/ Equipment Medicine

7. 1c. Supplied them with: Pharmaceuticals Gloves Gauze Waste Disposal Syringes Means of Transport

8. 2. Training of personnel Over 23,000 trained to date PMA, Reproductive Health, Rational Prescription Newborn Care. Family Planning C-IMCI, etc. Etc.

9. 3. Established Pharmaceutical Supply Line Established 5 regional project depots Purchased over 5M worth of W.H.O. essential medicine Implementation of drug credit system to encourage recycling Training in stock management/recycling/ordering

10. 4. Support of clinical services

11. 4a. Vaccination Services ▫Re-established cold chain ▫Supply of solar and kerosene units ▫Supply of vaccination related material (i.e. syringes) ▫Support of campaigns and routine CPS clinics ▫Monitoring ▫Surveillance

12. Immunizations

13. 4b. Family Planning Services Established 864 sites Training of family planning prestataires Provision of family planning clinical kits Order and delivery of products (OC, IUD, Depo, Cycle Beads, etc)

14. 4c. Reproductive Health Services (safe delivery, AMSTL, and newborn resuscitation)

15. 4.d Antenatal Services

16. 4e. Community IMCI Trained staff in 929 clinics in basic Clinical-IMCI Trained over 4700 relais to date in community based- IMCI Establishment of up to 200 community care sites (ongoing) Printing of flipcharts/ IEC material Dissemination of health messages (ten commandments of health) to households

17. Key Behavior Messages for’ Care Seeking’ and for ‘Malaria Treatment and Prevention’

18. 4f. Micro-nutrient support Vitamin A campaign and routine use of Vitamin A with support from UNICEF and HKI Introduction of Zinc nationwide as Rx protocol (USAID first to introduce in provinces)

19. 5.Water and Hygiene Constructed/Capped over 280 water springs Trained water/sanitation engineers in all supported HZs 212 clean village projects 3500 latrines fabricated (UNICEF) before after

20. 6. Disease Specific Intervention

21. 6a. Malaria 1. Purchase and delivery of 540,000 ITNs Introduction of ACTs* to all clinics as primary treatment of Malaria ITP treatment instituted in all ANC clinics *Imported 1,165,875 doses of ACT

22. 6b. HIV Blood Safety: Introduced and support screening for HIV, RPR, Hepatitis B in all 57 zones. Establishment of 129 PMTCT sites with 63 pilot programs in triple therapy ARV with support from Axios and Abbott Treatment of STI/co-infection TB/ARV therapy with Global Fund

23. 6c. Tuberculosis Support of TB Detection and Treatment Programs Supply of government provided medicine to sixteen isolated health regions Training, supervision, surveillance in high risk areas Production of PATI-4 module

24. 6d. GBV Related Issues Community wide campaigns on prevalence and awareness Focused intervention to at risk groups IEC awareness Fistula repair and prevention

25. Component B Increase capacity of Health Zones & referral system

26. 1. Reinforce and Support Formative Supervision of all Health Centers

27. 2. Training of ‘Equipe Cadre’ Health zone management (commodities and finance) Disease Surveillance Monitoring and Evaluation Adherence to ordinogramme (clinical guidelines) Zone specific training ▫Management ▫PMA ▫Surveillance

28. 3. Surveillance and Monitor Vital Health Statistics 1. Calendar and Charting of indicators 2. SNIS 3. Dashboard (Tableau) 4. Monthly reporting and verification 5. Support monthly health zone reunion with staff from all HCs

29. 4. Transparence and Governance 1. CODESA health center board 2. Annual HZ meetings 3. Co-gestion of health facilities Community planning of programs and campaigns

30. 5. Promising Partners Grants Support of local NGO-initiated income generating projects to sustain health projects ▫CODESA (GBV) ▫AFIA (nutritional) ▫HALT-SIDA (BCC) ▫VAS (nutritional)

31. Livelihood agricultural project linking health center (Project) AXxes with DEVRU Photo: Niles/Mutoto CS/2008

32. Component C: Reinforce national programs & provincial/district offices

33. 1. Supervision and functioning of District Medical Offices

34. District Medical Office of Kamina

35. 2. Policy Review and Revisions 1. PMTCT 2. SNIS 3. Reproductive Health 4. Family Planning 5. Malaria treatment 6. Essential Drug List 7. Training protocols

36. 3. Annual Reviews, Strategy Planning, Conferences and Work Plans (PNLP, PNLS, PNSR)

37. 4. Data Storage and Management at Level of Ministry of Health

38. IV SHORTFALLS

39. Need to promote care-seeking behavior

40. Breaking the 35% barrier

41. Dr Lauren Blum (Care Seeking Behavior Study)

42. Decrease distance and barriers to care

43. Establishment of 200 Community Care Sites for Clinical-IMCI

44. Sustainability of what was built

45. Understand Partnership 1. Primes 2. Incentives 3. Performance Contracts 4. Integrity 5. Unmet expectations 6. “you didn’t give us..  oil for the oil change  dispenser bags for prescription meds  Sand for the concrete

46. V Challenges

47. 1. Poverty as an impediment to access to care Photo: Lodja.June 2008/Mulongo

48. 2. Infrastructure (or lack of) as an impediment of access for project personnel Photo: ECC/AXxes 2008

49. Road Transport in DR Congo

50. Photo: National Highway #1 BDD/Mar 07/Clemmer

51. Photo: Equateur Province.Mar 08/ Mulongo

52. 3. Delivery of Project Commodities

53. N°DESCRIPTION SuppliersMODE Destination 1Frigo SibirKinshasaWEMSea freight 2Tables Opération & Lampes scyalitiquesKinshasaWEMSea freight 3Cars(10 + 01)KinshasaWEMSea freight 4GIK 1:Ordinateurs, solar batteriesKinshasaIMASea freight 5GIK 2:Solar systemsKinshasaIMASea freight 6Table gyneco,Vaccine carriere(Unicef)KinshasaUNICEFSea freight 7Table examen(Unicef)KinshasaUNICEFSea freight 8Mini Kits/Gloves/Chirurgical setsKinshasaIDASea freight 9Medecines for dépôts (+/-50% of order amount )Knga,Klzi,Kma&KowziKinshasaIDASea freight 10Medecines for Dépôt BUKAVU(+/- 35% of order amount)BukavuIDASea freight 11Nets (30000 pour ECC)KinshasaVESTEGAARDSea freight 12Nets (120000 pr Bukavu)BukavuVESTEGAARDSea freight 13Nets (30000 L'shi )LubumbashiVESTEGAARDSea freight 14Solar RefrigeratorKinshasaSUNDANZERSea freight 15GIK3: baptists commoditiesKINSHASAIMASea freight 16GIK4:labo kits,microscopes,furnitures; computers;Tasok…KINSHASAIMASea freight 17Medecines for BUKAVU(Year1 part2)BUKAVUIDASea freight 18Medecines to Kinshasa for ECC&WVI Ktga(Year1 part2)KINSHASAIDASea freight 19Nets(to Kinshasa for ECC Kasai & Ktga)KINSHASAVESTEGAARDSea freight 20Nets(to BUKAVU for CRS & WVI)BUKAVUVESTEGAARDSea freight 21Nets(to Lubumbashi for WVI & ECC Ktga)LUBUMBASHIVESTEGAARDSea freight 22GIK5: divers IMA/PCUSA/TASOK…KINSHASAIMASea freight 23Autoclave/Sterilizer ASCOKINSHASAASCOSea freight 24Tables examination,obstetricalKINSHASAASCOsea freight 25Freezers(72)KINSHASAElectroluxSea freight 26SP/Oxytocine/Vitamine A/New born Kit…KINSHASAIDAAirfreight 27Medicines Y2(po 40063&po40137) IDA BukavuBUKAVUIDASea freight/road 28Medicines Y2(and Y1P2) IDA KinshasaKINSHASAIDASea freight 29Medecines Y2(cpd,gloves,medecines,,,0 40068;40073;40134/133;40139/168)KINSHASAIDASea freight 30GIK 6KINSHASAIMA 31Cycles beadsKINSHASACycles technologiesSea freight 32Seringues ABKINSHASABDSea freight 33Simulators/New bornKINSHASAIMA 34Medicines Y2/MPLUBUMBASHIMission PharmaSea freight 35Medicines Y2/MPKINSHASAMission PharmaSea freight 36Medicines Y2/MPBUKAVUMission PharmaSea freight 37Medecines Y2/MP(narcotics)KINSHASAMission PharmaAirfreight 38CPD-a-bag for blood takingKINSHASAIDASea freight 39Nets year 3/Bukavu,62500pcsBUKAVUVESTEGAARDSea freight 40Nets year 3/Lubumbashi,60000pcsLUBUMBASHIVESTEGAARDSea freight 41Nets year 3/Kinshasa, 30000pcsKINSHASAVESTEGAARDSea freight 42Cycles beads Year 3KINSHASACycles technologiesSea freight 43Nets year3/Bukavu,27500pcsBUKAVUVESTEGAARDsea freight 44GIK 7:solar system/batteries, vehicle…KINSHASAIMAsea freight 45Medicines Year 3/IDA LubumbashiLUBUMBASHIIDAsea freight 46Medicines Year 3/IDA, Cotri pmtct, blood giving set KinshasaKINSHASAIDAsea freight 47Medicines Year 3/IDA, BukavuBUKAVUIDA 48Gauze/Glove/Fistula kitKINSHASAIDAsea freight 49Medicines/cotri pmtctLUBUMBASHIIDAseafreight 50Medicines/cotri pmtctKINSHASAIDAseafreight 51medicines ACTs/IDA Year 3KINSHASAIDAseafreight Container Manifest (container #71 is at Matadi!)

54. Import Route of International Shipping Containers Project AXxes (2007-2009) Port of Matadi (44) Tanzania (16) Zambia (11)

55. 4. Limited means of commercial transport to health zones (safe) once it gets into DRC Photo Goma Apr 08/cnn.com

56. Dr Ebonabo/AXxes/Malemba-Nkulu 07

57. Photo: Route de Matadi Apr.08/Clemmer

58. Carlson/Karawa Health Zone/Mar 09

60. 5. Weak Government Support to Health Zones Photo: General Hospital, South Kivu 2004/Clemmer

61. 8. Underestimating the size (and weight) of the challenge Photo Clemmer/Kinshasa/2006

62. 7. Retention of trained personnel Photo: ITM Sona Bata. 2004/Clemmer

63. 8. Chronic Insecurity Photo Mission Hospital Occupied by armed elements:. South Kivu. Apr 02/Cemmer

64. Continued conflict in the Kivus Photos: CNN.Com /DRC/2005.

66. 9. Resurging Epidemics Photo: Ebola.Outbreak.Ground Zero. Mweka.Oct 07/Clemmer

67. Photo/Clemmer/Bulape/08

68. 10. Global Economy and Outlook ?

69. Mission Aviation Fellowship (USA)

70. USAID Assessment of SANRU III (2004)