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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. 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

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  1. MSF OCA Intervention in Lulingu,Shabunda District,South Kivu Province,DRC Clermont Ferrand December 2009

  2. 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

  3. 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.

  4. 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 ?

  5. Decision taken to start a 6 month intervention in Lulingu & Katshungu for IDPs and host population pre-discussed with all actors including CRS and AAP

  6. Health Care Waste Management !

  7. CONSTRAINTS /CHALLENGES 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

  8. MSF Lulingu Intervention • 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

  9. OPD

  10. Reproductive health • (Covering Antenatal care, Obstetrics and Gynaecology Ward, Postnatal care and Family planning)

  11. FAMILY PLANNING

  12. MSF Studies on Free Health Care • 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

  13. 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

  14. Free access 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%

  15. Lessons Learned • 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

  16. CONCLUSIONS 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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