Africa Christian Health Associations’ Platform,

7th Biennial Conference

February 2015

Nairobi - Kenya

SANRU - Presentation

Denis Matshifi, MD, MPH

Healthcare in Conflict and Crisis Settings DRC

• SANRU= Soins de santé primaires en Milieu Rural (in short: SANTE RURAL)

• Nature: National NGO and Faith Based Organization

• Mission: Contributing in collaboration with the Government to: Initiate and Execute activities that improve

health and global wellbeing of Congolese population.

SANRU

CONTEXT

Country Size – Immense

CONTEXT (2)

Geographical Inaccessibility and Lack of communication infrastructures

1991-2001 Political crisis &

civilian war

Persisting violence and conflict from armed groups –

Eastern Congo 2001 - 2014

Multi & Bilateral

Coopérations cut off

National Health

Strategic Plan

National Health

Development Plan &

Proposed Low on UC

BACKGROUND

Political

Crisis &

Rebellion

The Congo Health System

Well designed to provide

comprehensive primary health care

through decentralized health zones

co-managed, in many cases, by

churches & NGOs.

Components of a

Health Zone in DR Congo

125,000

inhabitants/HZ 20 HC / HZ

Co-management by FBOs and NGOs

50% of Health Services provided by FBOs / NGOs

50% of Health Facilities owned by (FBOs)

50% of Health Facilities owned by Gvt and Private

HZs are MOH “owned” with FBO co-management

The DR Congo Health System

Public vs. Private Co-Management

Actions through SANRU (1)

Actions aimed to ensure:

• Access to health care

• Availability of services

• Community mobilization and involvement for ownership

• Free health care for all preventative services

Actions are based on the Minimum Package of Activities (PMA) for the HC and Complementary Package of activities of the Hospital, approved by MOH • Revitalizing Primary Health Care services

(pre-natal clinic, well child clinic, family planning, post-natal care, vaccination, etc…)

• Health education / C-IMCI • Water and Sanitation

• Training of health teams

Actions through SANRU (2)

• Training of Community structures members (Community Health Committee, Community Volunteers)

• Essential drugs supply

• Gold chain Equipment and fuel

• Health zone development

• Minor rehabilitation of facilities

• Payment of performance incentive to HZ teams and HC staff (not based on indicators but outputs)

• Support (fees) to national and provincial (intermediate) teams for formative supervision of the HZ.

Actions through SANRU (3)

Basic Indicators

Indicator PRONA

NUT

MICS

2001

DHS II

2013-

21014 Maternal mortality 1289 ‰ 846 ‰

Infant mortality 127 ‰ 58 ‰

Child mortality 213 ‰ 1O4 ‰

Anemic pregnant women

67% 38%

Neonatal mortality 47 ‰ 28 ‰

Utilization of Services

INDICATOR PNSR

2004

DHS II 2013-

2014 Curative Care 30% 34%

Antenatal visits 45.3% 88%

Assisted Births 42.5% 80%

Post-partum visits

8.8% 44%

Family Planning coverage 8% 20%

• Lack of Government leadership • Vertical funding (some donors) • Geographic targeting by donors without

harmonization with MOH and Implementing FBO or NGOs

• Compliance of free service delivery by facility personnel

• Sustainability of health zones activities after project is finished

• Staff instability (turn over for better salary) • Political instability of the Country • Knowledge and understanding of illness by the

population • Women’s conditions

Challenges & Difficulties

Large families (average 7)

Housewife and provider

Producer Financial person

Second rank citizen Male attitude

Accessibility

Condition of transportation Inadequate infrastructure

Poverty Underage mothers

Opportunities

Existence of well defined health care system

Coexistence between NGOs and Government

Existence of government policies and procedures

Global awareness

Community implication

KEYS FOR SUCCES

Working with and strengthening FBOs, NNGOs

and CBOs that have permanent contact with

communities

Aligning on and working to reinforce government

health policies

Training and reinforcing national staff specific

competencies and qualifications

Having donors’ confidence

Be Innovative and competitive