1. Health Care and DOC/UCC in DR Congo

2. 12% of children die before the age of one year. 10-20% of children are malnourished Did you know that in DR Congo…

3. Did you know that 400,000 Congolese depend on DOC/UCC for basic health care?

4. Congo is Big!

5. Here are the Paved Roads of Congo

6. One of those ‘paved roads’…

7. and an ‘unpaved road’

8. Cobalt Copper Coffee Col-Tan Cadmium CarrotsCarrots Carets (of Diamonds) Carets (of Gold) Crude Oil Natural Resources Congo is rich in natural resources

9. The Congo Health System is based on Decentralized Health Zones Congo is also rich in health zones

10. Health Zone Development (1975- 1984)

11. SANRU I (1981-86) 50 Health Zones SANRU I (1981-86) 50 Health Zones SANRU II (1986-91) 100 Health Zones SANRU II (1986-91) 100 Health Zones SANRU: Santé Rurale (1981-1991) USAID – MOH - ECC

12. 1991-2001

13. A 2001 WHO/UNICEF report “The health zone system... is possibly the only system in the country still recognizable as a nation-wide quasi-state structure “The health zone system... is possibly the only system in the country still recognizable as a nation-wide quasi-state structure... and even with critically little or no support, it commands allegiance and support from health workers.”... and even with critically little or no support, it commands allegiance and support from health workers.”

14. SANRU I (1981-86) 50 Health Zones SANRU I (1981-86) 50 Health Zones SANRU II (1986-91) 100 Health Zones SANRU II (1986-91) 100 Health Zones SANRU III (2001-2006) 60 Health Zones SANRU III (2001-2006) 60 Health Zones (from Emergency to Development Assistance) 1991 2001 SANRU Project USAID – MOH - ECC

15. SANRU & PMURR 75 Health Zones

16. 1)Decentralized Health Zones 2)Integrated & Comprehensive PHC 3)Co-management by FBOs and NGOs 4)Policies & projects to implement the above The DR Congo Health System is firmly based on...

17. 1)Decentralized Health Zones 2)Integrated & Comprehensive PHC 3)Co-management by FBOs and NGOs 4)Policies & projects to implement the above The DR Congo Health System

18. 1)Decentralized Health Zones  100-200,000 population / HZ  20 Health Centers / HZ)  Ref. Hosp. & HZ Office  1982 MOH vision of 300 HZs  Platform for Middle-Out Development  Donors & projects coordinated by HZ The DR Congo Health System

19. A Typical Health Zone of Congo Ref. Hospital, BCZS & Health Centers

20. 1)Decentralized Health Zones 2)Integrated & Comprehensive PHC 3)Co-management by FBOs and NGOs 4)Policies & projects to implement the above The DR Congo Health System

21. 2) Integrated & Comprehensive PHC  Balances Curative, Preventive & Promotive Care  Supports priority health care interventions The DR Congo Health System

22. 1) Exclusive Breastfeeding 2) Vaccinate completely 3) Vitamin A twice a year 4) Sleeping under bednets (ITN) 5) Prompt treatment for fevers 6) Oral Rehydration Therapy for diarrhea 7) Washing hands regularly 8) Prenatal preventive treatment of malaria 9) Child Spacing 10) Abstinence and loyalty to avoid AIDS Ten Commandments of Health

23. The Ten Commandments of Health

24. 1)Decentralized Health Zones 2)Integrated & Comprehensive PHC 3)Co-management by FBOs and NGOs 4)Policies & projects to implement the above The DR Congo Health System

25. 3) Co-management by FBOs and NGOs  50% of Health Services provided by FBOs / NGOs  50% of Health Facilities owned by FBOs  HZs are governmental with FBO co-management The DR Congo Health System Public vs. Private Co-Management

26. FBO/NGO Co-Management (1991)

27. 1)Decentralized Health Zones 2)Integrated & Comprehensive PHC 3)Co-management by FBOs and NGOs 4)Policies & projects to implement the above The DR Congo Health System

28. 4) Policies & projects to implement the above  From 1981-1991, ECC managed the SANRU I/II projects to develop 100 of Congo’s 306 HZs.  Today, I.M.A. and ECC are helping to rebuild and sustain 75 of Congo’s 515 health zones.  Tomorrow, I.M.A & ECC would like to assist more health zones in collaboration with DCC/UCC The DR Congo Health System

29. The DOC/UCC Medical Work is concentrated around six hospitals in S. Equateur

30. In 2001 with SANRU III, Bolenge (near Mbandaka) became the first DOC co-managed health zone 2001

31. The 2004 re-delimitation of health zones has created five new DOC co-managed health zones. 2004

32. The Six DOC Co-managed Health Zones serve a population of 400,000 Congolese Health Zone Estimated Population Bolenge56,000 Mondombe90,000 Monieka50,000 Wema78,000 Lotumbe76,000 Ntondo53,000 403,000

33. A new World Bank- funded project (PReSS) will target health zones in S. Equateur, including all the DOC-UCC co-managed HZs. I.M.A.-ECC hope to manage some of that assistance in districts #2 and #7.

34. Areas proposed for I.M.A./ECC expansion with World Bank PReSS Funding

35. Three Questions 1) How to reinforce DOC/UCC co- management of health zones? 2) How to best inform and mobilize partners in N. America (and elsewhere)? 3) How to best coordinate DOC/UCC assistance with I.M.A., ECC, and SANRU?

36. Santé Pour Tous et par Tous