IRC has operated a multi-sector program in the South Kivu District of the Democratic Republic of Congo (DR Congo) since November 1996. Initially, the program focuses on meeting the urgent public health needs of Rwandan refugees and the local war-impacted community. Today, the program concentrates on the rehabilitation of primary health care services in the region, targeting the local community and internally displaced persons who have escaped fighting in other regions of DR Congo. The overall goal of the program is to reduce morbidity and mortality in the region through the re-establishment of basic primary health care services.
Mortality Survey in DRC
One of the major challenges in addressing the widespread health needs in DR Congo to date has been the lack of adequate data concerning the health status of the local population. Poor security and difficult logistics in eastern DR Congo have made it extremely difficult to obtain access to many communities during the current war. But an extensive study conducted by the IRC from April to May 2000 demonstrated that there had been an estimated 1.7 million excess deaths in the region over the previous 18 months. Only 11 percent of these deaths were attributed to violent trauma, with the remainder being due to largely preventable diseases such as malaria, pneumonia, diarrhea, and malnutrition. The results of this survey have led IRC to re-evaluate our health program in the region. While the overall goal of the program will remain the same, the size and scope of our services will continue to expand to meet the huge needs in the region.
Main Program Activities
To date, IRC’s health program has supported primary care clinics in Katana and Kabare health zones within South Kivu District. Lessons learned from these programs will be used in the development of other program sites and services, such as Kisangani. The main activities of the program have included:
- Provision of drugs and equipment
- Training of local health workers
- Development of a basic health information system
- Integration of reproductive health services.
Immunization Program
Importantly, IRC has also contributed to the expansion of the expanded program of immunization (EPI) program in Katana and Kabare. In early 1999, a mortality survey conducted by IRC demonstrated that a widespread measles epidemic had killed approximately 1,400 children in Katana. IRC collaborated with local health officials and UNICEF on two highly successful vaccination campaigns that resulted in vaccination levels of greater than 90% in both health zones. These campaigns helped to lay the foundations for subsequent improvement and expansion in the regional EPI programs.
Reproductive Health
The integration of comprehensive reproductive health services into primary health care services is an important and exciting initiative. Currently, safe motherhood, family planning, and STD/HIV prevention and treatment are promoted by IRC in clinics in Katana and Kabare. A sexual and gender based violence prevention program is also planned.
Sustainability and Capacity Building
Together with local health authorities, IRC is working to promote the sustainability and financial viability of the health system in Katana. Under current government policy, health services in eastern DR Congo are auto-financed, with clients paying for drugs and clinical services. But South Kivu is an impoverished region and many people simply cannot afford to pay for their health care. IRC has therefore worked with local health committees to identify persons and families within each community that are unable to pay for their health care, based on mutually agreed upon criteria. At the end of each month, IRC reimburses local clinics for drugs and services provided to these individuals and families. Those who can afford their own health care continue to pay for these services.
New Program in Kisangani
Based on the results of the recent mortality survey, IRC opened another site for its health program in the town of Kisangani, Orientale District, during July 2000. This represented the first time that IRC’s newly established Emergency Response Team had been deployed. The initial task of the IRC team was to collaborate with Medecins Sans Frontieres in the control of an on-going cholera epidemic in the surrounding area. Since then, IRC has supported local clinics with drugs, equipment, training, and laboratory support.
