Ituri and Haut Uélé / Democratic Republic of Congo
Building up a functional health system
Despite its wealth of natural resources including minerals, diamonds, gold, and tropical forests, the DR Congo is one of the poorest countries in the world: more than 75% of its population lives in poverty. The country has been constantly hampered by decades of bad governance, wars and armed clashes that killed thousands and left millions displaced. The so-called ”brain drain” of trained professionals, who move to foreign countries in search for better jobs, is also very common in DR Congo. Most of the country’s infrastructure, which mainly consists of remains of colonial times, has collapsed.
The Congolese are still struggling with the war’s aftermath – in some pockets, armed conflicts are still looming. This fragile state is reflected in poor to non-existent public social services, particularly when it comes to health care. Public health care services are organized as profit centres. The health care facilities work on an autonomous level and ask for payment for the services offered.
Developing a functional health system
Since 2006, Malteser International has been participating in the Ministry of Health’s health care system development programmes in the DR Congo, which are financed by the European Union. Within these programmes, Malteser International started in summer 2011 another 3-year project in the Oriental Province's Aru health district, situated in the northeast of the country near the Ugandan border. Altogether, 13 health zones with about 125 basic health care centres, regional referral hospitals and a regional pharmaceutical warehouse are included in the project.
The main goal is to enhance the functionality of the health system in order to improve the health status of the population through high-quality health care. This includes:
- Health centres offering quality primary health care services in adequate premises
- A regular supply of subsidised drugs
- Referral hospitals providing quality secondary health care
- Effective monitoring and evaluation by local health authorities
Knowing that the intervention area is almost twice the size of Belgium, has 1.7 million inhabitants, and has hardly any road network and infrastructure, meeting these objectives is a challenging task.
A regional pharmaceutical warehouse with two outlet points distributes drugs and medical supplies to all health care structures included in the programme, with a yearly volume of about one million Euros. Since 2006, this regional warehouse is an independent charity named Caamenihu, a joint venture between the local churches, Malteser International, the health districts and civil society, originally evolving from the former pharmacy of Malteser International and the diocese of Mahagi. Furthermore, the pharmaceutical warehouse ensures continuous supply for all emergency projects Malteser International is running in the region.
Malteser International is organising training programmes for health personnel – nurses, auxiliary nurses, midwives – on all health service levels in order to increase the treatment quality. Due to the introduction of a quality-based management and regular trainings in previous programmes, the quality of diagnostic and prescription has already increased.
In this programme, a special focus is laid on the referral hospitals. Malteser International developed planning tools which allow the referral hospitals to carry out self-evaluations in order to detect weaknesses and shortcomings in management, service delivery and service quality. Together, we work on appropriate measures to improve the shortcomings.
- Improvement of the permanent availability of drugs and medical supplies in public health facilities
- Improvement of service offers and service quality in selected referral hospitals in the health district
- Improvement of quality-based management and monitoring and evaluation of local health authorities
- Increasing the population’s involvement in the development and management of their health facilities
- Distribution of subsidised medicines, medical supplies and laboratory equipment through a regional pharmaceutical warehouse to public health facilities, with the participation of the local health authorities
- Qualified training and supervision of health staff on all levels of the health care system
- Introduction of planning tools for, and training in, self-evaluation for referral hospitals in order to achieve better hospital management and service delivery
- Support of referral hospitals with adequate funds for self-evaluation
- Rehabilitation, reconstruction, and building of selected health care facilities and provision with equipment
- Strengthening the monitoring and evaluation capacities of local health authorities and facilitating their work through performance-based contracts
- Introduction of a community-based health insurance in a pilot health zone of the district
|Financing:||Malteser International, EuropeAid / CoFED|
|Partner:||public health care facilities (primary health care centres, referral hospitals), local and national health authorities, population|