Supporting Local Health Care in a Chronic Crisis Management and Financing Approaches in the Eastern Democratic Republic of the Congo (2006) / Chapter Skim
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2 The Organizations
2 The Organizations
Pages 13-35
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From page 13... ...
, ASRAMES began drug distribution in support of the Congolese population of North Kivu in 1995. Currently, all organizations provide medications as well as other forms of support to the local health institutions (see Table 2-1)
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IRC Activities The IRC strove to strengthen the functioning of the health centers and simultaneously improve access to care. In 2001-2002, its ultimate sector objective was to reduce mortality for the population served by 32 percent by September 30, 2004, in a manner that strengthens local capacity to sustain these results.
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Because the Katana bureau was never fully part of the national health system, this organization had been integrated into the local zone bureau, playing a leading
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As a humanitarian organization committed to primary health care and funded by OFDA, the IRC mainly supports health centers and reference health centers (i.e., those to which more serious cases are referred)
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Organizational Setup A memorandum of understanding between the IRC and the zone bureau sets out the basic forms of cooperation between them and the health facilities. In order to ensure a high level of contact regarding IRC activities in health facilities, the IRC employs one health supervisor3 per four health centers.
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. Access to the Punia health zone was irregular due to fighting between TABLE 2-3 Merlin Health Zone Summary, 2002 Total Health Facilities Reference Health Estimated Health Health Zone Populationa Hospital Center Center Total Kindu 180,000 1 1 21 23 Kalima 170,000 1 2 23 26 Puniab 100,000 1 1 21 24 Lodja North 200,000 1c n/a 32 n/a Lodja South 150,000 c n/a 35 n/a TOTAL 800,000 4 n/a 132 n/a aPopulation figures are estimates based on the 1984 population census.
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As a consequence of the insecurity and the long distances involved, Health Facilities Supported Reference Health Health Hospital Center Center Total 1 1 19 21 1 2 21 24 1 1 13 15 1c n/a 17 n/a c n/a 15 n/a 4 n/a 85 n/a bIn September 2002, Merlin expanded its activities in Punia to 14 health areas and also began to support the local hospital. cNorth Lodja and South Lodja share one hospital.
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Merlin Activities The overall goal of Merlin in the DRC is to reduce mortality and morbidity rates in its health zones. The Merlin activities in these zones are · To distribute free essential drugs and renewable medical supplies, so the local population can obtain these at an affordable price and on a regular basis.
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5In summer 2002, Merlin could reach only 20 health centers in Kalima and 18 in Kindu. In Punia, 22 health centers should serve the local health needs; however, only 12 of these health facilities were accessible due to the insecurity.
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In practice, the community fund was labor intensive for Merlin staff, warinduced hyperinflation caused financial risks, and health committee representatives of different health centers could not agree on the allocation of the money. Third, the memorandum authors doubted whether the 25 percent of cost-sharing revenues for the zone bureau was either fair or efficient.
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3. To lower the health zone bureau's part of cost-sharing revenues from the health facilities from 25 percent to 10 percent.
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The Bukavu TABLE 2-4 Malteser Health Zone Summary, 2002 Total Health Facilities Reference Health Estimated Health Health Zone Population Hospital Center Center Total Walungu 504,000 1 0 38 39 Nyangezi 142,000 1 0 17 18 TOTAL 646,000 2 0 55 57 aThe actual number accessed depends on the security situation.
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Malteser focused on support of the health centers. The cooperation between Malteser and Louvain Développement was quite positive; Health Facilities Supported Reference Health Health Hospital Center Center Total 1 0 25a 26 1 0 17 18 2 0 42 44
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The zone bureau and Malteser operated under a memorandum of understanding, and Malteser health supervisors generally visited the field together with zone bureau officials. The health supervisors also provided on-the-job training to the health staff.
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Several health zones, including Pinga, Mweso, Birambizo, Manguredjipa, Rwanguba, Walikale, and Masisi, have been hard, and sometimes dangerous, to access. By the end of 2000, ASRAMES could reach only 249 health facilities.
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ASRAMES Activities Since ASRAMES is responsible for an entire province, it cooperates with many international organizations, either with specific functional tasks or in health zones: · UNICEF for the protection of mother and child (immunization program)
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· Projet de Développement de la Santé Rurale, a program for institu tional support and drugs supply in five health zones (Goma, Rwanguba, Katwa, Oicha, and Musienene)
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. In addition to its regular supply and other activities in its health zones, ASRAMES also delivered drugs to many international organizations active in the eastern DRC.
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Organizational Setup ASRAMES works with its own health supervisors, who are generally recruited when they already have several years of experience in supervising health care at NGOs and the zone bureau. When they go into the field, they always go together with the zone bureau supervisors for the specific health center.
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Its health supervisors visit "their" health facilities at least once a week. And at least once a month, IRC supervisors visit their health centers together with the zone bureau supervisors, while Malteser operates with only two supervisors for each health
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If the cost recovery approach would be instituted further and if there would be funding for improving the functioning of the zone bureau, then ASRAMES would be able to transform itself to a real procurement and distribution agency. The provincial health inspec tion would then take over the supervisory tasks, training, health information analysis/management, transport of drugs, support to the health facilities and itself, as well as specific studies, such as socioeconomic surveys.
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They also moved into more developmentoriented activities. Their main strategies are · Geographic expansion, as Merlin did with its operations in Lodja North and South and ASRAMES with reaching more health facilities in North Kivu.
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Although they cooperate with other organizations in UN and NGO coordination meetings, they often prefer to work alone -- or at least without interference of other organizations -- in their health zones. Merlin does this explicitly.
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