1. The SANRU (Santé Rurale) Program in DR Congo by Leon Kintaudi and Franklin Baer CCIH Annual Conference, May 30, 2005 Where We've Been and Where We're Going

2. Here is Congo

3. Here are the Paved Roads of Congo

4. One of those ‘paved roads’…

5. and an ‘unpaved road’

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

7. Congo is also rich in decentralized health zones (515 HZs) FBOs co-developed and co-manage 1/3 of Congo’s Health Zones

8. A Brief History of Health System Development in DRC 1)1875-1960: Health Infrastructure Development - Belgian colonial investment in “urban” admin. centers - Missionary initiatives in rural areas - Post WWII investments (from copper revenues) - Traditional health system with 120 territory “districts”

9. The Hospitals of DR Congo (c. 1960)

10. A Brief History of Health System Development in DRC 1)1900-1960: Health Infrastructure Development 2)1960-1975: Pioneers in Health System: SimsNgwete Lejeune LuvivilaFountain Pangu Courtejoie RuppolCarlson Galloway& many more

11. A Brief History of Health System Development in DRC 1)1875-1960: Health Infrastructure Development 2)1960-1975: Pioneers in Health System 3)1975: National Seminar on Community Medicine - Organized with Catholic and Protestant Medical Offices - Established consensus and mandates for: ~ integrated medicine (primary health care) ~ CEBEC (PHC integrated health centers) ~ decentralized health zones with co-management by FBOs - No funding, but this encouraged pilot HZs to develop  100,000 population  20 Health Centers  Reference Hospital  Health Zone Office

12. Pilot Health Zones (1975-1981)

13. A Brief History of Health System Development in DRC 1)1875-1960: Health Infrastructure Development 2)1960-1975: Pioneers in Health System 3)1975: National Seminar on Community Medicine 4)1982-1986: Five year health plan - Delimitation/Creation of 306 Health Zones - SANRU I/II and FBOs played leading roles

14. Pilot Health Zones (1975-1981)

15. Health Zones (1982)

16. Health Zones (1984) before delimitation of Health Zones

17. Health Zones (1984) after delimitation of Health Zones

20. A Brief History of Health System Development in DRC 1)1875-1960: Health Infrastructure Development 2)1960-1975: Pioneers in Health System 3)1975: National Seminar on Community Medicine 4)1982-1986: Five year health plan 5)1991-2001: The decade of HZ survival - Economic instability, war, projects closed - ECC & FBOS struggle to continue support to HZs The health zone system is possibly the only system in the country still recognizable… even with critically little or no support it commands allegiance and support from health workers (WHO 2001)

21. A Brief History of Health System Development in DRC 1)1875-1960: Health Infrastructure Development 2)1960-1975: Pioneers in Health System 3)1975: National Seminar on Community Medicine 4)1982-1986: Five year health plan 5)1991-2001: The decade of HZ survival 6)2001-2005: Revitalizing HZs with Appui Global - ECC/IMA assists 56 HZs with USAID funding (SANRU III) - CRS assists 16 HZs with USAID funding - PMURR: 68 HZs with WB funding (19 by IMA/ECC) - PReSS: 83 HZs proposed with WB funding

22. Four Generations of NGO Development Strategies Adapted from “Getting to the 21 st Century,” by David Korten A Final Comment

23. The SANRU (Santé Rurale) Program in DR Congo by Leon Kintaudi and Franklin Baer Where We‘re Going

24. Protestant Church of Congo Medical Office (ECC/DOM) ECC/DOM is a Christian Health Association that include 65 member communities ECC/DOM member communities own 80 hospitals and more than 600 health centers ECC co-manages 65 of Congo’s 515 HZs

25. The ECC/DOM Portfolio Liaison with MOH for all ECC health facilities Co-Management of 65 Health Zones with the MOH

26. ECC Co-Manages 65 Health Zones (serving a population of 9,000,000)

27. FBOs Co-Manage 1/3 of Congo’s HZs

28. The ECC/DOM Portfolio Liaison with MOH for all ECC health facilities Co-Management of 65 Health Zones with the MOH Current Projects– 4 major projects and numerous subprojects ($ 15,000,000/yr)

29. ECC/DOM in partnership with I.M.A. is assisting 75 HZs with health systems development - SANRU III (USAID) - PMURR (World Bank)

30. Results from Oicha HZ (with EPI and ITNs fully implemented)

31. The ECC/DOM Portfolio Liaison with MOH for all ECC health facilities Co-Management of 65 Health Zones with the MOH Current Projects– 4 major projects and numerous subprojects ($ 15,000,000/yr) For 2006 – hoping for 5 major projects ($20 M/yr) New directions: DEVRU – –Developpment Rurale –adding agriculture and microenterprise activities for synergistic development

32. Keys to Health Systems Development for FBOs & CHAs 1)Document and map the strengths of FBO networks Strengths of FBO Networks More public than private sector Generally willing to co-manage health zones Provide a good infrastructure for HZs (schools, etc.) Are effective in community mobilization Have good user fee and management systems Have access to funding not available to the MOH Confidence of donors in working with FBOs FBOs are a permanent &sustainable national resource

33. 1)Document and map the strengths of FBO networks 2)Create continual dialogue/collaboration with MOH 3)Promote FBOs as part of the public sector (FBO/NGO) 4)Work at all levels of the health system, esp. national 5)Create strategies for co-management of health systems 6)Establish partnerships with U.S. groups to handle funding Keys to Health Systems Development for FBOs & CHAs

34. 1)Document and map the strengths of FBO networks 2)Create continual dialogue/collaboration with MOH 3)Promote FBOs as part of the public sector (FBO/NGO) 4)Work at all levels of the health system, esp. national 5)Create strategies for co-management of health systems 6)Establish partnerships with U.S. groups to handle funding 7)Increase your project & systems management capacity 8)Be More Creative! Keys to Health Systems Development for FBOs & CHAs

35. Santé Pour Tous et par Tous