1. The SANRU Program of ECC & IMA World Health

2. SANRU is currently assisting 115 health zones in DRC with support from various agencies and partners.

3. Origins of the SANRU Program were the well known USAID funded SANRU Projects SANRU I 1980-86 50 health zones 10 Million SANRU II 1986-1991 100 health zones 40 Million SANRU III 2000-2006 56 health zones 28 Million

4. SANRU III Project was built on partnerships with U.S. faith-based partners (Catholic and Protestant) during a time of conflict and division in the DRC SANRU III Assistance to 56 HZs (2000- 2006) 5 year 28 Million USD 56 Health Zones

5. In 2006 following the release of the ‘Fragile States Policy’ Project AXxes replaced the SANRU III project 5 year 28 Million USD 56 Health Zones 3 year 42 Million USD 57 Health zones

6. 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

7. AXxes Progress for Key Indicators Indicators Year 2 Target Year 2 Achieved % Rate of use of health services 2,550,1442,235,492 88% Couple years of protection (CYP) 40,00048,461 121% Births attended by skilled personnel 174,868204,216 117% Antenatal care (ANC) visits 233,156273,826 117% VAT2 (or 5 doses VAT) 186,524203,219 87% Children with measles vaccination 228,856216,673 95% DPT3 Coverage 228,856241,671 106% Pregnant women received IPT 186,524149,554 80% TB Detection Rate 8,74411,099 127% Child with ARI/pneumonia treated correctly 291,448283,046 97% Children with diarrhea treated correctly 291,448147,187 51%

8. Family Planning

9. Reproductive Health & Newborn

10. Immunizations

11. Malaria & TB

12. Challenges for Project AXxes and the SANRU Program

13. 1. Poverty and (in)access to care Photo: Lodja.June 2008/Mulongo

14. 2. Infrastructure (or lack of) Photo: ECC/AXxes 2008

15. Photo: Equateur Province.Mar 08/ Mulongo

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

17. 3. Decreasing means of commercial transport Photo Goma Apr 08/cnn.com

18. 4. Constraints of importing goods Photo: Route de Matadi Apr.08/Clemmer

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

20. Photo: Yakusu Health Zone. February 2002/ Clemmer

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

22. 7. Uncoordinated donor coordination Photo: Moanza Health Zone: Apr 06/Clemmer

23. 8. Resurging Epidemics Photo: Ebola.Outbreak.Ground Zero. Mweka.Oct 07/Clemmer

24. 9. Retention of trained personnel Photo: ITM Sona Bata. 2004/Clemmer

25. Vision for Future Health Zone Development

26. Trends Observed 1)Geographic shift of USAID assistance (from 8 provinces to 4 with focus on south + eastern DRC) 2)Decrease in support to co-managed HZ partnerships (33% in AXxes vs. 70% for SANRU II) 3)Decreased leveraging with US-based partners historically linked to some health zones. 4)Possible fragmentation of Appui Global with vertical projects and multiple funding streams.

27. Suggested Strategies

28. 1) Continue Appui Global to 57 AXxes-assisted Health Zones

29. 2) Re-establish assistance to 30 former SANRU III HZs currently without a development partner

30. 3) Expand to 20 (or more) additional HZs with US-based partners to leverage and coordinate additional aid. 4) Support Geographic Equity in Appui Global & Integrated Projects