CCIH 29TH ANNUAL CONFERENCE

IMMUNIZATION AND THE FAITH

COMMUNITY IN DRC Dr Helene MAMBU-MA,DISU

Senior Program Officer, Sabin Vaccine Institute

Public vs. Private Sectors

Public Sector Not-for-Profit

Private Sector For-Profit

Church-Managed Health Services

?? In many countries Church-managed health services are considered private sector competitors to the MOH.

Public vs. Private Sectors

Public Sector Not-for-Profit

Private Sector For-Profit

Church-Managed Private Sector Not-for-Profit

In Congo, the MOH often delegates the management of many health zones to Church-managed health services.

Primary Health Care

Decentralized Health Zones

Collaboration with churches in providing PHC and HZ management

Projects to implement the above

Principles for Sustainable Health Systems Development in DR Congo

(established in 1975)

NATIONAL HEALTH DEVELOPMENT PLAN 1980-1984

Health zone (HZ): operational structure for planning, implementing and evaluating health activities.

National territory to be divided in HZs (306 to begin with)

Health Zone not necessarily equal to administrative Zone

HZ to be developed around existing hospitals, (many of which were faith-based) (medical officer)

HZ to be divided into health areas covered by existing health centers or to be developed (many of the existing health areas were faith-based) (qualified nurse)

Health promotion activities from the village up

Preventive activities from health center up

EXPANDED PROGRAM ON IMMUNIZATION IN DRC

1978 after smallpox eradication Fixed, outreach and mobile

strategies from existing hospitals and health centers.

Mobile strategy in the rest of the national territory

Cold chain often provided by faith-based communities.

1980, external evaluation recommended integration of immunization activities in the basic health services.

First EPI 4 year operational plan (1982 – 1986) ◦ Decentralize cold chain at provincial and sub provincial levels:

creation of EPI antennas (21 to begin now 44) ◦ Health zone: operational structure to implement immunization

program; but many existing health zones not operational enough to correctly implement EPI

First training course for health zone medical officers ◦ 15 medical officers trained (60% from church hospitals) ◦ Kangu (cath), Kimpese (prot), Kisantu (cath), Bikoro (cath), Vanga (prot),

Karawa (prot), Bwamanda (cath), Nyankunde (prot), Wembo Nyama (prot), Kaniama (state), Kasongo (state), Katana (state), Walungu (NGO), Near Goma (state), Morocco

EXPANDED PROGRAM ON IMMUNIZATION IN DRC (Continued)

Plusieurs ZS d’accès difficile

Taux de mortalité infanto juvénile: 104 pour 1 000 NV (EDS 2013) Pays décentralisé avec 11 provinces et 516 zones de santé (ZS) Interruption de la circulation du PVS depuis 3 ans

Context

Year Functional

HZ FBO/NGO

Managed HZ Nbr Nbr %

1981 8 6 75% 1982 41 32 78% 1983 64 44 69% 1984 87 61 70% 1985 112 74 66% 1987 ~220 ~130 39% 1990 179 117 65% 2000 ~100 ~60 60%

The creation of Congo’s health zones around

functional hospitals was a bottom-up process that was pioneered by FBOs.

FBO-managed Health Zones (1990) In 1990 50% of

DR Congo’s 306 health zones were managed

with FBOs/NGOs

EPI AT PROVINCIAL LEVEL COORDINATION

ANTENNA 1 ANTENNA 2 ANTENNA 3 ANTENNA 4

Zone de

santé

Zone de

santé

Zone de

santé

Zone de

santé

Zone de

santé

Zone de

santé

Zone de

santé

Zone de

santé

Zone de

santé

Zone de

santé

Zone de

santé

Zone de

santé

Zone de

santé

Zone de

santé

Zone de

santé

Zone de

santé

Buta Isiro Aru

Lokutu

Kisangani

Bunia

Butembo

Goma

Uvira Bukavu

Kindu

Kalemie

Likasi Lubumbashi

Kamina

Kolwezi

Gbadolite Gemena Bumba

Lisala

Mbandaka Boende

Inongo

Bandundu

Kenge Kikwit Kananga

Tshikapa

Luiza

Luiza Lodja

Kabinda MBJ

MueneD

Boma Mbanza Ng

Matadi

Dépôt Central

Kinshasa

Dépôt Central Dépôt Provincial avec CF

Dépôt Antenne Antennes servies par dépôt provincial

Dépôt central vers Dépôt provincial

Déplacement des Intrants par avion

Déplacement des Intrants par Véhicule

Dépôt central vers Dépôt Antenne Dépôt provincial vers les Antennes

Improving the Availability of Vaccines

FBO-managed Health Zones (2015) In 2915 40% of

DR Congo’s 516 health zones

are managed with FBOs/NGOs

Contributions of Faith-Based Communities to the improvement of immunization coverage in DRC

Provision of cold chain equipment for good quality vaccine storage

Support to community health workers for social mobilization

Provision of immunizations free of charge Social mobilization during church services

Provision of incentives to health personnel

Thank You!