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

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

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.

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 ?

• 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

Health Care Waste Management !

CONSTRAINTS /CHALLENGES

InsecurityLogistics, location only accessible by flights (expensive and unreliable)Transport in the area – motorbikesRainy SeasonFrench speaking international personnelMobile population – IDP’s returned home sooner than expected

MSF Lulingu Intervention5 expats and 30 national staffBudget 500,000 for 6 mths Actual Cost 370,841 Euros as shorterComprehensive package of care, PHC and SHC referral including ATFP and SGBVFixing of cold chain management in certain clinics and creation of HCWM in othersActual Duration – 4 and a half months

July 09 August 09 September 09

Resident IDP Resident IDP Resident IDP

<5 >=5 <5 >=5 <5 >=5 <5 >=5 <5 >=5 <5 >=5

Total Consultation

694

1380

394 8621138

2356

5881590

1133

2499

4741279

Diarrhoea287

164 150 91 371 245 190 123 312 240 91 131

RTI159

256 95 170 333 335 127 214 313 304 82 146

Conf. Malaria

43 52 25 30 72 159 42 75 75 125 24 77

Fever of un-known origin

76 114 43 47 31 109 29 66 72 173 34 114

STI 0 95 0 64 0 144 0 79 0 157 0 72

OPD

July 09 August 09September

09Resident

IDPResident

IDPResident

IDP

ANC 1st visit 80 41 67 30 61 23

ANC follow-up visit

118 41 116 35 80 16

Total deliveries

30 20 51 26 49 17

Direct obstetric maternal deaths

0 0 0 0 0 0

Uncomplicated vaginal deliveries

28 19 48 26 45 16

% uncomplicated vag. Deliveries

93.3 %

95.0 %

94.1 %

100 %

91.8 %

94.1 %

Instrumental vaginal deliveries

2 1 0 0 0 0

% instrumental vag. Deliveries

6.7 %

5.0 %

0.0 %

0.0 %

0.0 %

0.0 %

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

FAMILY PLANNING

Resident IDP Total

New Users 212 67 279

Follow up 110 --- 110

Total 322 67 389

MSF Studies on Free Health Care

Access to Health and Violence in Congo, DRC in 2001Access to Health Care in Burundi, 2004Access to Health care, Mortality and Violence in DRC March – May 2005User fees in the Eastern DRC July – August 2005Accéc aux Soins dans l’unité communale de Santé de Petite Riviére Verretes La Chappelle, Haiti, Sept 2005Access to health care in post-war Sierra Leone, January 2006Evaluation de l’acces financier aux soins pour les populations de la province de Karuzi, DRC June 2006Uitilisation des services du CHR par la population de 2003-2006 Cote d’Ivoire June 2007

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

16

4M

Results= 26325

<5 = 6,412

12M8MResults=33,325

<5 = 8235

Results= 36,934

<5 = 10,416

Free access

CHW New HC

40% -9%

Shabunda 2006

13%

Total

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

CONCLUSIONS

MSF believes in free health care in the contexts in which we workAlthough Lulingu intervention had some unexpected elements (lessons learned) we would do the same againMSF strives to provide quality monitored and supervised health care for the most vulnerable patients