Msf oca intervention in lulingu shabunda district south kivu province drc
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MSF OCA Intervention in Lulingu, Shabunda District, South Kivu Province, DRC. Clermont Ferrand December 2009. HISTORY. MSF left Shabunda in December 2007 following 10 years of supporting the HGR and 7 health centres. CRS took over the HC’s and CORDAID took over support to the HGR

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Msf oca intervention in lulingu shabunda district south kivu province drc

MSF OCA Intervention in Lulingu,Shabunda District,South Kivu Province,DRC

Clermont Ferrand December 2009


History
HISTORY

  • MSF left Shabunda in December 2007 following 10 years of supporting the HGR and 7 health centres. CRS took over the HC’s and CORDAID took over support to the HGR

  • May/June 2009 in Shabunda province, govt. troops (FARDC) begin chasing FDLR & there are reports of 35,000 IDPs on the run in Shabunda & Lulingu (Kimia II)

  • Following a request from the MCZ - MSF team in Bukavu conducted an explo in Shabunda & Lulingu in June 2009


Explo findings
Explo Findings

  • June 2009, MSF Explo team visited Shabunda & Lulingu towns and villages and health centres in the neighbourhood

  • Appeared to be large scale displacement, approx 35,000 Shabunda was deemed not to be the right location and needs were still being met

  • Free care for indigents hardly existed, the added burden of the IDP population could not be met.


Explo findings continued
Explo Findings continued

  • Drug ruptures in many AAP supported health centres

  • Absence of MD’s because of lack of drugs and medical materials

  • In Katshungu hospital, needles were being “cooked” to re-use for patients

  • Non functioning cold chains due to lack of fuel

  • Problems with monitoring identified: E.g. in 1 HC, no drugs were found for STI tx yet cases were registered as treated ?



Health care waste management
Health Care Waste Management ! Katshungu for IDPs and host population pre-discussed with all actors including CRS and AAP


Constraints challenges
CONSTRAINTS /CHALLENGES Katshungu for IDPs and host population pre-discussed with all actors including CRS and AAP

Insecurity

Logistics, location only accessible by flights (expensive and unreliable)

Transport in the area – motorbikes

Rainy Season

French speaking international personnel

Mobile population – IDP’s returned home sooner than expected


Msf lulingu intervention
MSF Lulingu Intervention Katshungu for IDPs and host population pre-discussed with all actors including CRS and AAP

  • 5 expats and 30 national staff

  • Budget 500,000 for 6 mths Actual Cost 370,841 Euros as shorter

  • Comprehensive package of care, PHC and SHC referral including ATFP and SGBV

  • Fixing of cold chain management in certain clinics and creation of HCWM in others

  • Actual Duration – 4 and a half months


OPD Katshungu for IDPs and host population pre-discussed with all actors including CRS and AAP


  • Reproductive health Katshungu for IDPs and host population pre-discussed with all actors including CRS and AAP

  • (Covering Antenatal care, Obstetrics and Gynaecology Ward, Postnatal care and Family planning)


FAMILY PLANNING Katshungu for IDPs and host population pre-discussed with all actors including CRS and AAP


Msf studies on free health care
MSF Studies on Free Health Care Katshungu for IDPs and host population pre-discussed with all actors including CRS and AAP

  • Access to Health and Violence in Congo, DRC in 2001

  • Access to Health Care in Burundi, 2004

  • Access to Health care, Mortality and Violence in DRC March – May 2005

  • User fees in the Eastern DRC July – August 2005

  • Accéc aux Soins dans l’unité communale de Santé de Petite Riviére Verretes La Chappelle, Haiti, Sept 2005

  • Access to health care in post-war Sierra Leone, January 2006

  • Evaluation de l’acces financier aux soins pour les populations de la province de Karuzi, DRC June 2006

  • Uitilisation des services du CHR par la population de 2003-2006 Cote d’Ivoire June 2007


  • MSF has been working in DRC Kivus since 1991 responding to effects of conflict on the population

  • Until 2005, MSF charged a “prix forfait” of 20 francs congolais in Shabunda and other projects at request of MoH

  • From 2006, prix forfait was phased out by MSF

  • Total number of consultations increased with removal of prix forfait consistently in all our projects

  • Experience of CHWs showed that cost was a barrier for some ill patients requiring referral


Free access effects of conflict on the population

New HC

CHW

12M

4M

8M

Results=33,325

<5 = 8235

Results= 36,934

<5 = 10,416

Results= 26325

<5 = 6,412

40%

-9%

Total

Shabunda 2006

13%


Lessons Learned effects of conflict on the population

  • Time Lapse between explo and intervention was too long, 5 weeks due to difficulty in finding French speaking international staff available & flight constraints

  • Overestimation of needs and patient numbers

  • Anticipated numbers of SGBV not found

  • Different displacement characteristics to MSF North Kivu experience - IDP’s returned home sooner than anticipated


Conclusions
CONCLUSIONS effects of conflict on the population

MSF believes in free health care in the contexts in which we work

Although Lulingu intervention had some unexpected elements (lessons learned) we would do the same again

MSF strives to provide quality monitored and supervised health care for the most vulnerable patients


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