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Enhancing Health Care in DR Congo through Project AXxes

The project aims to strengthen the health system in DR Congo by improving access to quality integrated primary health care, reproductive health services, and maternal and newborn care. It also focuses on enhancing vaccination coverage, reducing malaria, and addressing nutritional interventions.

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Enhancing Health Care in DR Congo through Project AXxes

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  1. Events Contributing to the Decline of DR Congo Nationalization Pillaging War

  2. Basic Indicators • Maternal mortality 1289/100,000 (MICS2, 2001) • Infant mortality 127‰ (MICS2, 2001) • Child mortality 213 ‰ (MICS2, 2001) • 67% of pregnant women are anemic (PRONANUT, Mai 2005) • Neonatal mortality 47 ‰ • 75% vaginal fistulas caused by complications of delivery (PNSR, Sept 2005)

  3. Low Utilization of Services (PNSR, 2004) • Curative Care: 30% • Anti-natal visits: 45.3% • Assisted Births: 42.5% • Post partum visits: 8.8% • Family Planning coverage: 2%

  4. The Congo Health System is based on 515 Decentralized Health Zones

  5. Components of a Health Zone in DR Congo

  6. A Typical Health Zone of Congo

  7. “Although praiseworthy, [donor resources] are inconsistent with the development of a sustainable health service. Too many resources are devoted to attaining short-term goals… People have very limited access to essential quality health care and there is a shortage of medium and long-term funding”. Minister of Health Bongeli

  8. Goal of Project AXxes To develop an effective & efficient health care system in DR Congo based on the MOH’s Health System Strengthening Strategy

  9. Component A: Increase access to, quality and demand for multi-sectoral integrated PHC • Increase access to integrated Primary Health Care • Reproductive Health, STIs & Family Planning • Maternal & Newborn care • Improve vaccination coverage • Reduce malaria in target population • Improve TB detection and treatment • Improve Nutritional Interventions • IMCI & C-IMCI • HIV/Aids (Blood safety and PMTCT) • Water and Sanitation

  10. Component B: Increased Capacity to the health zone and the referral system • Improve HZ Planning, Governance, Transparency and Accountability • Develop Human Resources of HZMT, including training and supervision • Drug supply management • Improve referral system • Improve health information system • Improve community involvement & support • Improve capacity of local NGOs

  11. Component C: Increased capacity of national health programs and provincial/district offices • Increase the capacity of selected national health programs: 4th and 5th directions, PNLP, PEV, PNLS, PNLB, SR, PRONANUT, PNAM & PCIME • Increase the functional capacity of provincial & district health offices • Improve supervision of HZs • Improve health policy implementation

  12. Implementing Partner Structure

  13. TA support for AXxes • JHU – M&E • HKI – Nutrition and micro nutrients • HEAL Africa – VF training • World Relief – Care groups • MSH – Leadership, Drug management, Lab quality • URC – Quality of service & improved utilization • ? – Neonatal health • Others ?

  14. Add-in programs • PMTCT • UNICEF water • UNICEF nets • GAVI • Food for Peace ? • Others ?

  15. Sampling of AXxes Indicators

  16. SANRU Trends in Services

  17. Family Planning

  18. Vaccination Coverage

  19. Impact of Bed Nets & IPT at Oicha Hospital

  20. Water, Sanitation & Hygiene2163 Springs capped – Access increased 32% Waterborne disease decreased by 30%

  21. Essential Medicine Distribution System 100% 40% 100% 100% 100% 60% 60%

  22. Community Health EndowmentsInternal Rate of Return 51%

  23. AXxes Data Flow

  24. Electronic Dashboard

  25. What has been achieved so far? • Conducted rapid assessment of health zones • Setup district offices • Developed technical & procedural manuals • Signed contracts with health zones • Started support to HZ for supervision • Distributed locally purchased equipment • Trained ECZS in health zone management • Printed & distributed IEC, SNIS, CPS, etc material • Conducted FP training & distributed contraceptives • Conducted Vit A campaigns • Responded to cholera outbreak in Bukavu

  26. Challenges for AXxes • Coordinating with Emergency Assistance programs • New USAID priorities and indicators • Delay in authorization and waivers • Need for gap funding for certain activities • Bed nets & ACTs • Water and Sanitation • Livelihood activities • Subsidy for VFR and Cesareans

  27. New Zones for AXxes • 57 health zones • $158,000 assistance per health zone

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