The population of the Democratic Republic of Congo (DRC) is widely dispersed: more than 60% of its nearly 70 million inhabitants live in rural areas. Since 2001, the country has been recovering from a series of conflicts that occurred during the 1990s, and the country’s infrastructure remains badly damaged. Despite progress made through political and economic reforms over the past five years, many communities live hand to mouth, with little access to markets to buy or sell goods, and poor access to public services, according to the World Bank.
Gender inequality is particularly acute in the DRC, according to the United Nations Development Programme (UNDP). The UNDP’s 2011 Gender Inequality Index ranks it 142 out of 146 countries. Malaria is the chief cause of morbidity and mortality in the DRC, accounting for more than 40% of outpatient visits and for 40% of deaths among children under 5. The neonatal mortality rate has shown only moderate improvements in recent years, from 49 per 1,000 live births in 2000 to 47 per 1,000 live births in 2011. The maternal mortality ratios have shown greater improvements: falling from 930 per 100,000 live births in 1990 to 540 per 100,000 live births in 2010. The DRC has had a low tuberculosis case detection rate, low coverage of collaborative TB/HIV activities, inadequate funding for TB services (the total budget for TB in 2011 estimated at US $64 million, but only 1% was funded), and shortages of HIV kits and TB drugs.
MSH DRC’s 128 staff members (October 2012) are currently managing six different projects, and working with the Ministry of Health and its counterparts at the district, zonal, and health facility level to: build human and institutional capacity in health; manage pharmaceuticals; integrate health services delivery; and, work in priority areas of the DRC affected by conflict.
Experience in this Country
- Integrated Health Program (IHP) 2010-2015
- Tuberculosis Control Assistance Program (TB CAP) 2005–2011
- MEASURE Evaluation 2008–2017
- Strengthening Pharmaceutical Systems (SPS) Program 2007–2012
- Leadership, Management and Sustainability (LMS) Program 2005–2015
- Basic Support for Institutionalizing Child Survival (BASICS) 1999–2011
Integrated Health Program (IHP)2010-2015
The Integrated Health Program (IHP) is a 5-year project in the Democratic Republic of Congo (DRC). The project works to create better conditions for, and increase the availability and use of, high-impact services, products, and practices. The project works in four provinces with 80 target health zones. Areas of focus are: family planning; maternal, newborn, and child health; nutrition, malaria, and tuberculosis; neglected tropical disease; HIV & AIDS; and water, sanitation, and hygiene.
MSH is working with current health service providers, such as international and faith-based organizations, to unite them under a strategy to fully implement improved basic health conditions for the Congolese people.
IHP is funded by the US Agency for International Development. MSH implementing partners on IHP are the International Rescue Committee (IRC) and Overseas Strategic Consulting, Ltd. (OSC).
Tuberculosis Control Assistance Program (TB CAP)2005–2011
The Tuberculosis Control Assistance Program (TBCAP) aims to decrease morbidity and mortality by increasing case detection and treatment success of pulmonary TB patients in USAID priority countries. TBCAP is USAID’s five year centrally funded project focusing on implementing WHO’s Stop TB strategy. MSH is one of eight partners, including KNCV Tuberculosis Foundation, WHO, The International Union Against Tuberculosis, Centers for Disease Control and Prevention, Family Health International, American Thoracic Society, and the Japanese Anti-Tuberculosis Association. TBCAP recently introduced the Management and Organizational Sustainability Tool (MOST) process it has adapted to the TB context. A meeting sponsored by TBCAP for personnel from National Tuberculosis Programs in Mozambique, Namibia, Uganda, Zambia, and Pakistan gave managers hands-on experience using MOST and allowed TBCAP to validate the instrument as adapted for TB. Within TBCAP, MSH makes a unique contribution for addressing constraints such as poor management and lack of sustainable leadership, weak laboratory services and failure of drug supplies, inconsistent drug quality and inadequate drug policies, lacking information systems, weak monitoring and evaluation, and overwhelmed health systems. Through core-funded activities, MSH contributes to TBCAP by aiding in the development and implementation of the International Standards for Tuberculosis Care TB control, guidelines for TB control in prisons, and institutional capacity building. MSH also provides workshops and training for lab consultants, human resource development strengthening, and multidrug resistant tuberculosis (MDR-TB) management. MSH is making important contributions as coordinating partner for Malawi, Ghana, and Souther Sudan for expanding quality DOTS and is currently collaborating in Cambodia, Ethiopia, Indonesia, Kenya, Mexico, Nigeria, Mozambique, Namibia, Pakistan. MSH provides technical assistance in Domincan Republic and Peru.
The MEASURE Evaluation project, which began in 1998, is USAID’s flagship Monitoring and Evaluation project and was established based on the premise that generating demand for and improving the use of data in policy formulation, program planning, monitoring and evaluation improves health systems which in turn affects health outcomes. The project is now in Phase III and is led by the University of North Carolina. In addition to MSH, the partners include Futures Group, JSI, Macro International , and Tulane University. MSH provides capacity building in the area of organization and leadership development to enhance sustainability using MSH’s virtual and other tools and also offers direct support to country M&E teams.
Strengthening Pharmaceutical Systems (SPS) Program2007–2012
Strengthening Pharmaceutical Systems is a follow-on to the Rational Pharmaceutical Management (RPM) Plus Program. MSH is pleased to announce that the US Agency for International Development has awarded us the Strengthening Pharmaceutical Systems (SPS) Leader with Associates Cooperative Agreement. SPS will focus on four key results:
- Improve governance in the pharmaceutical sector
- Strengthen pharmaceutical management systems to support public health services
- Contain the emergence and spread of antimicrobial resistance
- Expand access to and improved use of essential medicines
- BroadReach Healthcare
- Ecumenical Pharmaceutical Network
- The Lewin Group
- LMI Government Consulting
- University of Washington Department of Global Health
- WHO Collaborating Center in Pharmaceutical Policy: Harvard University/Boston University
- African Medical and Research Foundation
- American Society of Health-System Pharmacists
- Euro Health Group
- Infectious Disease Institute at Makerere University
- Joint Commission International
- London School of Hygiene and Tropical Medicine
Since 2004, USAID has supported MSH's Rational Pharmaceutical Management Plus (RPM Plus) and its follow-on, the Strengthening Pharmaceutical Systems (SPS) program, to support the National Malaria Control Program (NMCP) and to strengthen the Democratic Republic of Congo (DRC) general pharmaceutical supply system through capacity building of Ministy of Health counterparts.
SPS works closely with the DRC national drug regulatory authority, the national essential medicines program, as well as various national vertical programs such as the national HIV/AIDS program, the national TB program, the national malaria control program, the national reproductive health program and others.
Leadership, Management and Sustainability (LMS) Program2005–2015
The Leadership, Management and Sustainability (LMS) Program develops managers and leaders who achieve results in the areas of reproductive health, HIV & AIDS, infectious disease, and maternal and child health. LMS works with health organizations in the public and private sectors to create sustainable programs and systems through improved leadership and management. By strengthening management systems and increasing system-wide leadership, LMS improves the performance of health care organizations at all levels, develops human resources, and builds the capacity to anticipate and respond effectively to changing external environments.
LMS has been working to increase the quantity and quality of health services offered to about three million people in the Kasai Oriental and Kasai Occidental provinces in the Democratic Republic of Congo, to increase the demand and service utilization in these areas, and to strengthen the local capacity of the Ministry of Health and NGO partners in management and delivery of health services.
Basic Support for Institutionalizing Child Survival (BASICS)1999–2011
As a technical assistance partner for newborn and child health to the USAID Bureau for Global Health, the Basic Support for Institutionalizing Child Survival (BASICS) Project develops and implements strategies to reduce preventable infant and childhood deaths in the developing world. MSH works as a partner in BASICS, which began its third phase in October 2004. Under this indefinite quantity contract (IQC), BASICS assists USAID/Washington Bureaus, USAID field missions, host-country governments, donor agencies, NGOs, PVOs, research institutions, and the private sector to scale up and increase the use of newborn and child health and nutrition interventions by families, communities, and health systems. Since 1993, BASICS has worked to achieve substantial improvements in coverage and to expand effective newborn and child health interventions. BASICS focus areas include newborn health, essential nutrition actions like vitamin A supplementation, immunization, integrated management of childhood illness, treatment of diarrhea and pneumonia, and malaria control. In addition to strengthening the delivery of basic newborn and child health services, BASICS has expanded its technical scope to include pediatric HIV & AIDS, birth spacing, and child survival and nutrition in complex humanitarian crises. BASICS areas of expertise include assistance to countries on comprehensive strategies or selected interventions for newborn and child health, building partnerships, delivery of quality newborn and child health services, community-based treatment and private sector approaches to expand access to services, and capacity building and training.
BASICS' priorities in the Democratic Republic of Congo included scaling up a community-based framework for treating and referring cases of pneumonia, diarrhea, and malaria, and referring cases of malnutrition. Emphasis was also placed on revitalizing diarrhea disease case management in the country by improving health workers' ability to manage diarrhea and reinforce communication for improved home care