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Democratic Republic of Congo Final Country Report

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Democratic Republic of Congo Final Country Report USAID ASSIST Project Democratic Republic of Congo Final Country Report Cooperative Agreement Number: AID-OAA-A-12-00101 Performance Period: October 1, 2013 – September 30, 2016 DECEMBER 2016 This final country report was prepared by University Research Co., LLC for review by the United States Agency for International Development (USAID). The USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project is made possible by the generous support of the American people through USAID. USAID ASSIST Project Applying Science to Strengthen and Improve Systems Democratic Republic of Congo Final Report Cooperative Agreement Number AID-OAA-A-12-00101 Performance Period: October 1, 2013 - December 31, 2016 DECEMBER 2016 DISCLAIMER This country report was authored by University Research Co., LLC (URC). The views expressed do not necessarily reflect the views of the United States Agency for International Development or the United States Government. Acknowledgements This final report was prepared by University Research Co., LLC (URC) for review by the United States Agency for International Development (USAID) under the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, which is funded by the American people through USAID’s Bureau for Global Health, Office of Health Systems. The following URC staff provided improvement technical assistance in Democratic Republic of Congo: Dr. Teddy Manday, Cecile Edambolo, Elie Twite from the Kinshasa Office; Aime Eyane and Cyprien Tendo, from the Haut Katanga office, and Fidele Kanyanga and Julien Saleh from the Lualaba office.URC regional staff based in Niger provided technical support for ASSIST activities in the Democratic Republic of Congo: Maina Boucar, Zakari Saley, and Sabou Djibrina. Support for the preparation of this final report was also provided by Mayssa el Khazen and Silvia Holschneider of URC. The USAID ASSIST Project is managed by URC under the terms of Cooperative Agreement Number AID-OAA-A-12-00101. URC's global partners for USAID ASSIST include: EnCompass LLC; FHI 360; Harvard T.H. Chan School of Public Health; HEALTHQUAL International; Initiatives Inc.; Institute for Healthcare Improvement; Johns Hopkins Center for Communication Programs; and WI-HER, LLC. For more information on the work of the USAID ASSIST Project, please visit www.usaidassist.org or write [email protected]. Recommended citation USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project. 2016. Democratic Republic of Congo Final Report. Published by the USAID ASSIST Project. Bethesda, MD: University Research Co., LLC (URC). Table of Contents List of Tables and Figures .......................................................................................................................... i Abbreviations ............................................................................................................................................. ii 1 INTRODUCTION ....................................................................................................................................... 1 2 PROGRAM OVERVIEW ............................................................................................................................ 1 3 KEY ACTIVITIES, ACCOMPLISHMENTS, AND RESULTS .................................................................... 2 Activity 1. Quality improvement technical assistance for integrating NACS into HIV care and treatment services .............................................................................................................................................. 2 Background ............................................................................................................................................................ 2 Key Accomplishments and Results ......................................................................................................................... 2 Activity 2. Improve HIV care and treatment for people living with HIV (PLHIV) ........................................ 6 Background ............................................................................................................................................................ 6 Key Accomplishments and Results ......................................................................................................................... 7 Activity 3. Build capacities at all levels in QI and related health system strengthening .......................... 15 Background .......................................................................................................................................................... 15 Key Accomplishments and results ........................................................................................................................ 15 IMPROVEMENT IN KEY INDICATORS .......................................................................................................... 16 4 SUSTAINABILITY AND INSTITUTIONALIZATION ............................................................................... 17 5 KNOWLEDGE MANAGEMENT PRODUCTS AND ACTIVITIES ........................................................... 17 6 GENDER INTEGRATION ........................................................................................................................ 18 List of Tables and Figures Table 1:Changes implemented at NACS target sites (July-Sept 2014) ........................................................ 3 Figure 1: Percentage of PLHIV assessed correctly according to standards (anthropometric, clinical, and food security) at 4 sites in Lubumbashi (Jan 2014-Sept 2014) ..................................................................... 4 Figure 2: Percent of PLHIV who received a nutritional assessment according to norms, 9 NACS sites, Kinshasa Province (Jan – Sept 2015) ........................................................................................................... 6 Figure 3: Quality gaps among the HIV continuum of care, 39 sites, Kinshasa, Katanga and Orientale provinces (sample: 1,048 patient files) (July-Aug 2015) ............................................................................... 8 Figure 4: Percentage of items filled in files of patients coming for ART follow-up, 39 sites, Kinshasa, Katanga and Orientale provinces (sample: 1,048 files) (July – Aug 2015) ................................................... 8 Figure 5: Percentage of PLHIV retained on ART, Lualaba, by Health Zone, 10 sites (Aug 2015 - Sept 2016) ........................................................................................................................................................... 11 Figure 6: Percentage of PLHIV retained on ART by sex, Lualaba, 10 sites (Aug 2015 - Oct 2016) .......... 12 Figure 7: Percentage of PLHIV retained on ART by sex in Lualaba provincial referral hospital (HPK) (Aug 2015 - Oct 2016) ......................................................................................................................................... 13 Figures 8: Evolution of the retention gap in ART clients, 10 sites, Lualaba Province, Aug 2015 – Oct 2016 .................................................................................................................................................................... 14 USAID ASSIST Democratic Republic of Congo Country Report FY16 i Abbreviations ART Antiretroviral therapy ARV Antiretroviral ASSIST USAID Applying Science to Strengthen and Improve Systems Project DRC Democratic Republic of the Congo FANTA Food and Nutrition Technical Assistance Project FY Fiscal year HIV Human immunodeficiency virus IP Implementing partner KM Knowledge management LIFT Livelihoods and Food Security Technical Assistance Project MNCH Maternal, newborn, and child health MOH Ministry of Health MSH Management Sciences for Health NACS Nutrition assessment, counselling, and support PEPFAR U.S. President’s Emergency Plan for AIDS Relief PLHIV Persons living with HIV PMTCT Prevention of mother-to-child transmission of HIV PNLS National AIDS Control Program PNMLS National Multisector AIDS Control Program PROSANI Projet des Soins Intégrés (Integrated Health Program) ProVIC Integrated HIV/AIDS Project Q Quarter QI Quality improvement QIT Quality improvement team TA Technical assistance URC University Research Co., LLC USAID United States Agency for International Development ii USAID ASSIST Democratic Republic of Congo Final Report 1 Introduction The USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, managed by University Research Co., LLC (URC), provided technical assistance to the Ministry of Health (MOH) in the Democratic Republic of Congo (DRC) from October 2013 to December 2016 to improve nutrition services for HIV clients and improve HIV care and treatment services for persons living with HIV (PLHIV). In fiscal year (FY) 2014, the USAID ASSIST Project worked collaboratively with FHI 360’s Food and Nutrition Technical Assistance Project (FANTA) and Livelihoods and Food Security Technical Assistance project (LIFT) to improve nutrition services for HIV clients through the integration of nutritional assessment, counselling, and support (NACS) into HIV care and treatment. Together they prepared and delivered trainings, developed tools, and monitored the integration of the NACS approach at 16 targeted health facilities in the DRC. ASSIST jointly with these partners also supported the MOH in the DRC to improve quality of nutrition services for HIV clients through
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