The SANRU The SANRU (Santé (Santé Rurale) Rurale)

Program in Program in DR Congo DR Congo

by Leon by Leon Kintaudi and Kintaudi and Franklin BaerFranklin Baer

CCIH Annual Conference, May 30, CCIH Annual Conference, May 30, 20052005

Where We've Been Where We've Been and and

Where We're GoingWhere We're Going

Here is Congo

Here are the Paved Roads of Congo

One of those ‘paved roads’…

and an ‘unpaved road’

CobaltCobalt

CopperCopper

CoffeeCoffee

Col-TanCol-Tan

CadmiumCadmiumCarrotsCarrots

CarrotsCarrots

CaretsCarets(of Diamonds)(of Diamonds)

CaretsCarets(of Gold)(of Gold)

Crude OilCrude Oil

Natural Natural ResourcesResources

Congo is rich in natural resources

Congo is also rich in

decentralized health zones

(515 HZs)

FBOs co-developed and co-manage 1/3 of Congo’s Health Zones

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”

The Hospitals of DR Congo (c. 1960)

A Brief History of Health System Development in DRC

1) 1900-1960: Health Infrastructure Development

2) 1960-1975: Pioneers in Health System:Sims Ngwete Lejeune Luvivila Fountain Pangu Courtejoie Ruppol Carlson

Galloway & many more

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 population100,000 population 20 Health Centers 20 Health Centers Reference HospitalReference Hospital Health Zone OfficeHealth Zone Office

Pilot Health Zones (1975-1981)

A Brief History of Health System Development in DRC

1) 1875-1960: Health Infrastructure Development2) 1960-1975: Pioneers in Health System3) 1975: National Seminar on Community Medicine4) 1982-1986: Five year health plan

- Delimitation/Creation of 306 Health Zones- SANRU I/II and FBOs played leading roles

Pilot Health Zones (1975-1981)

Health Zones (1982)

Health Zones (1984)before delimitation of Health Zones

Health Zones (1984)after delimitation of Health Zones

Health Zones (1984)after delimitation of Health Zones

Health Zones (1984)after delimitation of Health Zones

A Brief History of Health System Development in DRC

1) 1875-1960: Health Infrastructure Development2) 1960-1975: Pioneers in Health System3) 1975: National Seminar on Community Medicine4) 1982-1986: Five year health plan5) 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)

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

Four Generations of NGO Development Strategies

Adapted from “Getting to the 21Adapted from “Getting to the 21stst Century,” by David Korten Century,” by David Korten

A Final A Final CommentComment

The SANRU The SANRU (Santé (Santé Rurale) Rurale)

Program in Program in DR Congo DR Congo

by Leon by Leon Kintaudi and Kintaudi and Franklin BaerFranklin Baer

Where We‘re Where We‘re GoingGoing

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

The ECC/DOM Portfolio

• Liaison with MOH for all ECC health facilities

• Co-Management of 65 Health Zones with the MOH

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

FBOs Co-Manage 1/3 of Congo’s HZs

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)

ECC/DOM in partnership with I.M.A. is assisting 75 HZs with health systems

development

- SANRU III (USAID)- PMURR (World Bank)

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

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

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

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

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

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