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Events Contributing to the Decline of DR Congo

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

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Events Contributing to the Decline of DR Congo

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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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