DRC-IHPplus Quarterly/Annual Report: Year 1 (June 17, 2015 – June 30, 2016) Subagreement Number OAA-A-11-00024-01-MSH under USAID Cooperative Agreement Number AID-OAA-A-11-00024 Submitted to USAID/DRC on August 18, 2016 Revised December 20, 2016
Cover photo: Warren Zelman
Project Name: Integrated Health Project Plus (IHPplus) in the Democratic Republic of Congo, Subagreement No. OAA-A-11-00024-01-MSH, Under Cooperative Agreement Number: AID-OAA-A-11- 00024
Contact information in DRC: Avenue des Citronniers, No. 4, Commune Gombe, Kinshasa Chief of Party: Dr. Ousmane Faye, +243 0992006180
Contact information in the U.S: 200 Rivers Edge Drive Medford, MA 02155 Regional Director: Kristin Cooney, Tel: +1 617-250-9168
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TABLE OF CONTENTS
TABLE OF CONTENTS ...... 3 ACRONYMS ...... 4 PROJECT BACKGROUND ...... 6 EXECUTIVE SUMMARY ...... 9 PROJECT PERFORMANCE ...... 9 KEY ACHIEVEMENTS ...... 12 PROJECT PERFORMANCE ...... 15 Component 1: Health Services ...... 15 Intermediate Result 1 (IR1): Access to and availability of Minimum Package of Activities (MPA) and Complementary Package of Activities (CPA) services and products in target health zones increased ...... 16 Intermediate Result 2: Quality of key family health care services in target health zones increased . 36 Intermediate Result 3: Knowledge, attitudes, and practices to support health-seeking behaviors increased in target health zones ...... 84 Component 2: Health Systems Strengthening ...... 91 Intermediate Result 4: Health sector leadership and governance in target provinces improved ..... 91 PROJECT MANAGEMENT ...... 93 FAMILY PLANNING AND HIV AND AIDS STATUTORY REQUIREMENTS ...... 95 ENVIRONMENTAL MONITORING AND MITIGATION PLAN ...... 96 CHALLENGES ENCOUNTERED ...... 96 WAY FORWARD: PLANNED ACTIVITIES FOR NEXT QUARTER ...... 97 LIST OF APPENDICES ...... 101
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ACRONYMS ACT Artemisinin-based combination EPI Expanded Program on therapy Immunization AFP Acute flaccid paralysis ETL Education through listening AMTSL Active Management of Third FOSACOF Formation Sanitaire Stage Labor Complètement Fonctionnelle ANC Antenatal care (Fully Functional Service AOP Annual operational plan Delivery Point) ART Antiretroviral therapy FP Family planning ARV Antiretroviral GBV Gender-based violence BBF Brother’s Brother Foundation GRH General referral hospital BCC Behavior change HBB Helping Babies Breathe communication HIV Human Immunodeficiency Virus CBD Community-based distribution IHP Integrated Health Project or community-based distributor IMCI Integrated Management of CBO Community-based organization Childhood Illness CPLT Coordination Unit for Leprosy IPTp Intermittent preventive and TB treatment (of malaria) in i-CCM Integrated Community Case pregnancy Management IYCF Infant and young child feeding CHW Community health worker LDP Leadership Development CODESA Comité de Développement Program Sanitaire (health development LiST Lives Saved Tool committee) LLIN Long-lasting insecticide-treated CDR Centrale de Distribution net Régionale (regional distribution MDR-TB Multidrug-resistant tuberculosis center) MOH Ministry of Health CEPAC Communauté Eglises MNCH Maternal, newborn, and child Pentecôtistes en Afrique health Centrale MPA Minimum Package of Activities CPA Complementary Package of MSH Management Sciences for Activities Health CLTS Community-led total sanitation MTCT Mother to child transmission CSDT Centre de Santé de Diagnostic NGO Nongovernmental organization et Traitement ORS Oral rehydration solution CST Treatment centers OSC Overseas Strategic Consulting, CTX Cotrimoxazole Ltd. CYP Couple Years of Protection PEPFAR President’s Emergency Plan for DEP Direction Etudes et Planification AIDS Relief (Direction of Studies and PLHIV People living with HIV Planning) PMI President’s Malaria Initiative DBS Dried blood spot PMP Performance monitoring plan DPS Division Provinciale de la Santé PMTCT Prevention of mother-to-child DRC Democratic Republic of Congo transmission DTP Diphtheria, tetanus, pertussis PNAM Programme National E2A Evidence to Action d’Approvisionnement en EGM Essential generic medicines Médicaments (National Drug Supply Program)
PNDS Plan National de Développement Sanitaire (National Health Development Plan) PNLT Plan National de Lutte contre la Tuberculose (National Tuberculosis Control Program) PNLP Programme National de Lutte Contre le Paludisme (National Malaria Control Program) PNLS Programme National de Lutte contre le SIDA (National AIDS Control Program ProVIC Integrated HIV Program PRONANUT Programme National de Nutrition (National Nutrition Program) PSC Pre-school consultation RBF Results-Based Financing RDQA Routine Data Quality Assessment RDT Rapid diagnostic test SBA Skilled birth attendant SIAPS Systems for Improved Access to Pharmaceuticals and Services SP Sulfadoxine Pyrimethamine T&C Testing and counseling TB Tuberculosis UNICEF United Nations Children's Fund USAID United States Agency for International Development USG United States Government WASH Water, sanitation, and hygiene WHO World Health Organization
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PROJECT BACKGROUND This report covers the fourth quarter period (April 1-June 30, 2016) of year one of the US Agency for International Development (USAID)-funded Integrated Health Project Plus (IHPplus) in the Democratic Republic of Congo (DRC). This report also serves as the project’s year one annual report. Implemented by Management Sciences for Health (MSH) and Overseas Strategic Consulting, Ltd (OSC) under a subcontract via Pathfinder/Evidence to Action (E2A), IHPplus is a two-year “bridge” to avoid a gap in services in USAID-supported health zones upon completion of the USAID Health Office’s five-year flagship Integrated Health Project (IHP).
DRC-IHP worked closely with the Government of the DRC to strengthen the country’s health system at every level and achieve the Ministry of Health (MOH) targets of saving 437,000 lives of mothers and children over five years. Data modeling using the Lives Saved Tool (LiST) shows that DRC-IHP interventions saved the lives of more than 150,000 children over just three years. The project improved health services for more than 12 million people—17 percent of the Congolese population.
Continuing the work of DRC-IHP, IHPplus addresses “Services” and “Other Health Systems” to create better conditions for, and increase the availability and use of, high- impact health services, products, and practices in 83 health zones (the IHP 78 plus 5 additional President's Malaria Initiative [PMI]-focused zones), all within the same eight Divisions Provinciales de Santé (Provincial Health Divisions, or DPS): 1) Kasaï; 2) Kasaï Central; 3) Lomami; 4) Kasaï Oriental; 5) Sankuru; 6) Haut Lomami; 7) Lualaba; and 8) Sud Kivu (formerly the four provinces of Kasaï Occidental, Kasaï Oriental, Katanga, and Sud Kivu).
IHPplus provides varying levels of effort and support to 1,562 health facilities: 1,479 health centers and 83 general referral hospitals (GRHs) in 83 health zones. In addition to maintaining a project office in Kinshasa to facilitate communication with the DRC MOH, other host government authorities, and USAID, IHPplus has eight coordination offices that facilitate activity implementation at the field level (see box below). To ensure the continuity of reporting by coordination offices set up during IHP, IHPplus reports its achievements based on the coordination “clusters” of Bukavu, Kamina, Kolwezi, Lodja, Luiza, Mwene Ditu, Tshumbe, and Uvira.
Bukavu Representation and Coordination Office – 27 health zones Kamina Coordination Office – 9 health zones Kananga Representation and Coordination Office – 10 health zones Mwene Ditu Coordination Office – 13 health zones Lodja Coordination Office – 16 health zones
Kolwezi Coordination Office – 8 health zones Lubumbashi Representation office Mbuji Mayi Representation office Total population served: 13,882,943
The project’s vision is that: People in the 83 project health zones will continue to participate more fully in determining their health outcomes by virtue of greater access to higher quality comprehensive care Service delivery systems will be accountably and effectively managed in their interests Family-centered communication will reflect healthy behaviors that people understand and can act on in their daily lives.
The overarching objective of the project is to improve the enabling environment for, and increase the availability and use of, high-impact services, products, and practices for family planning, maternal, newborn, and child health (MNCH), nutrition, malaria, and tuberculosis (TB), Human Immunodeficiency Virus (HIV) and AIDS, and water/sanitation/hygiene (WASH) in target health zones (see Figure 1).
Figure 1: IHPplus objective and focus areas
IHPplus reinforces a people- and team-centered approach to strengthening the health system in DRC, with a focus on four intermediate results detailed in Table 1 below.
The USAID/DRC Health Office is designing a new portfolio of programs to continue the investments begun by its two flagship service delivery programs: the Integrated HIV Program (ProVIC) and IHP. These two programs ended before the new programs could be launched; therefore, to avoid major disruptions in services, among other negative possibilities, the mission continued key activities from both of these programs through the USAID/Washington-managed mechanism, E2A. E2A serves as a crucial “bridge mechanism.” The prime implementing agencies for IHP and ProVIC, MSH and PATH, respectively, are both members of the E2A consortium.
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Table 1: DRC-IHPplus Results Framework Component 1: Services Strategies by Sub-IR Intermediate Result 1: Access IR 1.1: Increased facility-based health care services/products to and availability of Provide materials and equipment Minimum Package of Provide essential medicines, commodities, and Activities (MPA) and materials Complementary Package of IR 1.2: Increased community-based health care services/ Activities (CPA) services and products products in target health Integrated Community Case Management (i-CCM) at zones increased community treatment sites Comité de Développement Sanitaire or health development committee (CODESA) - collaborative strategy at the community level IR 1.3 Effectively engaged provincial management Leadership Development Program Intermediate Result 2: Quality IR 2.1: Clinical and managerial capacity of health care of key family health care providers services (MPA/CPA) in target Training, supportive supervision health zones increased IR 2.2: Minimum quality standards Fully Functional Service Delivery Point (FOSACOF) Results-based Financing (RBF) IR 2.3: PHC referral system for prevention, care, and treatment Intermediate Result 3: IR 3.1: Health sector-community outreach linkages Knowledge, attitudes, and CODESA practices to support health- Youth outreach groups seeking behaviors increased in IR 3.2: Health advocacy/community mobilization organizations target health zones Education Through Listening CODESA IR 3.3 Behavior change campaigns Behavior change communication (BCC) messaging Mini-campaigns Champion Communities Component 2: Other Health Systems Intermediate Result 4: Health IR 4.1: Health sector policy alignment sector leadership and IR 4.2: Evidence-based strategic planning and decision-making governance in target IR 4.3: Community involvement in health policy/service provinces improved delivery
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EXECUTIVE SUMMARY PROJECT PERFORMANCE
IHPplus continues to track results for 15 groups of technical area indicators according to the project’s Performance Monitoring Plan (PMP). These areas include the following:
Family planning Gender and gender-based violence Maternal, newborn, and child health (GBV) (MNCH) Referral systems Nutrition Stock-outs of pharmaceuticals Tuberculosis (TB) Health service quality and availability HIV and AIDS Community mobilization Malaria Behavior change communication (BCC) Water and sanitation (WASH) Project Management Leadership, management, and governance (LMG)
Of the 81 IHPplus indicators, 63 were achieved at the 75% or greater level; of these, 42 achieved or exceeded their targets at the 100% level. The project is not routinely collecting data for two of the WASH outcome-level indicators and four of the new HIV indicators were not applicable this year. IHPplus is planning to conduct a study in PY2 around these two WASH indicators. IHPplus made notable improvements in increasing facility-based health care services and products in target health zones. All targeted health centers are providing the MPA, and the project exceeded the target number of GRHs providing the CPA. The health services utilization rate for each of the eight coordination zones surpassed the national average of 35% during PY1.
Working in close collaboration with IHPplus, the Systems for Improved Access to Pharmaceuticals and Services (SIAPS) program helps ensure the availability of essential generic medicines (EGM) at all IHPplus- supported sites. SIAPS continued to monitor the IHPplus PY1 order with suppliers IDA, IMRES, MEG, and ASRAMES, and to date, the regional distribution centers (CDRs) and warehouses have received 78% of the total expected delivery from these four suppliers. In addition, 88% of the first IHP PY5 order has reached the health zones, and 92% of the second IHP PY5 order has reached the health zones. For IHPplus PY1 order #2, the first shipment arrived in DRC on April 28, 2016, and amounts to 46% of the order’s total expected value. Overall, reducing stock-outs of tracer medicines remained challenging during PY1, as none of the indicators met their targets by the end of the project year. The indicator for the number of iron- folate stock-outs was the closest to meeting its target (244 compared to 200), followed by the number of ACT stock-outs (146 compared to 100). The project reported its lowest performances for the ORS and Depo-Provera stock-outs (181 compared to 100 and 243 compared to 100, respectively).
The i-CCM strategy remains effective for increasing community-based health care services. In total, 148,216 cases of malaria (61,667), pneumonia (33,302), and diarrhea (53,247) were treated at i-CCM sites by the end of the project year. IHPplus continued to treat cases of childhood pneumonia, diarrhea, and malaria in all United States Government (USG)-supported facilities. A total of 331,981 children with pneumonia were treated with antibiotics (92% of the target); 497,516 new cases of childhood diarrhea were treated with packs of combined ORS and zinc supplements (109% of the target); and 678,385 children with malaria were treated during the quarter.
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Health Development Committees (CODESAs) continue to play an important role in increasing the use of community health care services. The number of identified CODESA for this project year was 1,398, and out of these, 1,280 were reported as active. In addition, 96% of these active CODESAs have communication action plans for addressing health problems through locally-proposed solutions.
For the two WASH indicators with collected data, project performance in increasing community-based WASH services was strong. IHPplus provided access to improved drinking water supply to 228,314 of the targeted 229,950 people (99% achievement rate) and exceeded its target for the number of people with access to improved sanitation facilities (167,108 of the targeted 153,300 people, a 109% achievement rate). Strong performance was also recorded in increasing nutritional counseling services for mothers during PY1, as 110% (564,212 of 511,434) of targeted mothers received these services.
Results from the provincial teams participating in the Leadership Development Program (LDP) are promising. During PY1, the project evaluated 62 of 78 (79%) health zone management teams that started their LDPs in August 2015; 47 of the 62 teams (76%) achieved at least 80% of the targets for improving service delivery in their action plans six months after their LDP.
IHPplus continues to make great strides towards improving quality health care services. Results were particularly strong in the areas of MNCH, nutrition, HIV, and malaria. IHPplus exceeded targets for several HIV indicators, including the number and percentage of pregnant women with known status (includes women who were tested for HIV and received their results), ARV coverage for HIV+ pregnant women, and the number of individuals who received testing and counseling (T&C) services for HIV and received their test results. IHPplus’ performance was also strong in the area of improving joint HIV and TB services. The project exceeded targets for the percent of HIV-positive patients who were screened for TB in HIV care or treatment setting, as well as the proportion of registered TB cases that are HIV-positive who are on ART.
The project met or almost met targets for MNCH indicators related to pregnant women attending antenatal care (ANC) and newborns receiving newborn care, pregnant woman receiving an uterotonic immediately after birth (an essential element of active management of the third stage of labor) (99%), deliveries with a skilled birth attendant (SBA) (97%), and the number of postpartum/newborn visits within three days of birth (97%). The project almost met its PMP target for the number of newborns receiving antibiotic treatment for infection from appropriate health workers. In addition, vaccination coverage rates remain high, as five out of seven vaccines had a coverage rate of 90% or greater (DTP HepB-Hib1 and Hib3, Tetanus vaccine 2+, measles, and OPV3). These results contribute to improved child health in IHPplus-supported health zones. The project performed well in improving malaria prevention among pregnant women with intermittent preventive treatment (IPTp), with an 97% achievement rate. Regarding the delivery of malaria commodities, IHPplus’ performance was strong, as almost all results met (one indicator) or exceeded targets (three indicators) for the provision of long-lasting insecticide-treated nets (LLINs), Sulfadoxine-Pyrimethamine (SP), Artemisinin-based Combination Therapy (ACT), and rapid diagnostic tests (RDTs) at health facilities. The challenging malaria indicator this year was ACT stock-outs. Project performance for indicators related to health worker training on IPTp (intermittent preventive treatment in pregnancy), ACT, and RDT was strong, with all three indicators exceeding the PMP targets.
In family planning, the project achieved a couple-years of protection (CYP) of 430,423, compared to the target of 434,619 (99% achievement rate). IHPplus almost met its target on the number of counseling visits for family planning and reproductive health (96% achievement rate) and the number of new acceptors of modern contraceptive methods (91%). However, the project was well below its target on the number of Depo-Provera stock-outs reported this year.
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In nutrition, 564,212 mothers with children two years of age or younger received counseling, against a target of 511,434 (110% achievement). Moreover, 131% (527,593 out of 402,321 expected) of pregnant women received iron-folate supplements (against a target of 89%, which represents a 148% achievement rate). Finally, 244 facilities of the 200 expected experienced stock-outs in iron-folate, which makes it the stock-out indicator with the best achievement rate out of the four.
During PY1, performance against TB and GBV indicators was weaker. IHPplus did not reach any of the annual TB targets, and the highest performance rate reached was 72% (TB case notification rate). In the area of sexual violence, IHPplus exceeded the target number of people reached by a USG-supported intervention providing GBV services (e.g., health, legal, psycho-social counseling, shelters, hotlines, other), reaching 2,526 people compared to the targeted 2,000.
IHPplus continues to implement the Formation Sanitaire Complètement Fonctionnelle (Fully Functional Service Delivery Point, or FOSACOF) and Results-based Financing (RBF) approaches to promote the adoption of minimum quality standards at health facilities and improve the quality of care. During PY1, IHPplus evaluated 57% of the total health facilities implementing FOSACOF. Results from these evaluations indicate that most facilities (67%) meet 50-80% of the criteria, and additional support is needed to increase performance. RBF evaluations demonstrate that the RBF approach contributed to significant increases in the utilization rate of curative services and the quality of health center and GRH services.
Increasing the number of patient referrals to health facilities is an important aspect of improving the quality of health services provided to the community. During PY1, the percentage of patients referred by a community health worker (CHW) to health centers and GRHs was 4% (86% achievement rate) and 13% (76% achievement rate), respectively.
Project performance in increasing knowledge, attitudes, and practices to support health-seeking behaviors was strong: the project met or exceeded all targets for indicators in this area, including the percent of youth organizations actively completing awareness-raising activities, number of fully functional CODESAs, and the number of educational messages disseminated through mini-campaigns and mHealth technology. IHPplus currently supports 34 Champion Communities in all supported health zones.
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Figure 2: Project performance overview, PY1
HIV Malaria MNCH Family planning Community mobilization TB Nutrition Gender-based services BCC WASH L+M+G Stock-outs Availability of CPA/MPA Referral system Health services quality 0 2 4 6 8 10 12 14 16 18
Target achieved (100% or >) Almost achieved (between 75% & 99%) Target not achieved (<75%)
KEY ACHIEVEMENTS
Figure 3 on the following page presents key achievements from the year.
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Figure 3: IHPplus PY1 key achievements
Child health • 331,981 child pneumonia cases were treated with antibiotics • 497,516 child diarrhea cases were treated with ORS/ORS zinc • 678,385 child malaria cases treated with ACT
Maternal • 413,902 out of 402,322 (103%) expected pregnant women attended at least one ANC visit health • 224,619 out of 402,322 (56%) expected pregnant women attended at least four ANC visits • 350,075 out of 402,322 (87%) expected deliveries occurred with an SBA • 296 out of 302 (98%) HIV-positive pregnant women received ART
Neonatal • 337,984 out of 349,626 (97%) expected newborns received essential newborn care health • 23,857 newborns received antibiotic treatment for infection
• 351,053 children less than 12 months of age received DTP-HepB-HIB3 (101% coverage)
• 344,862 children less than 12 months of age received measles vaccine (99% coverage)
WASH • 228,314 people in target areas had first-time access to improved drinking water
supply
• 167,108 people in target areas had first-time access to improved sanitation
facilities
Family • 430,423 CYP planning • 415,540 patients accepted for the first time a modern contraceptive method
• 592,592 family planning/ reproductive health counseling visits occurred
HIV & AIDS • 45,098 individuals received testing and counseling (T&C) for HIV and received results • 4,610 HIV-positive adults and children received a minimum of one clinical HIV service • 1,240 out of 1,322 (94%) expected TB-registered patients documented HIV-positive status were on ART
TB • 4,482 out of 10,251 (45%) of all expected registered TB patients were tested for HIV • 72% TB case detection rate (8,655 new smear positive TB cases detected out of 12,069 expected) • 27 cases of MDR TB were detected
Nutrition • 527,593 out of 396,463 (133%) expected pregnant women received iron-folate tablets to prevent anemia during the last five months of pregnancy • 564,212 mothers of children 2 years of age or less received nutritional counseling
• 292,105 out of 402,322 (73%) expected pregnant women received two doses of Malaria Sulfadoxine-Pyrimethamine (SP) for IPTp • 430,718 LLINs were distributed at the first ANC visit and preschool consultation • 1,470,479 RDTs and 2,761,433 ACT treatment purchased with USG funds were distributed to health facilities DRC-IHPplus Year One Quarter Four/Annual Report: June 17, 2015 - June 30, 2016 Page 13 of 101
Key challenges and way forward:
1. Challenge: Overall, health facilities continued to report numbers of stock-outs of tracer medicines (ACT, Depo-Provera, ORS, and iron folate) that exceeded all four PMP targets during PY1. The indicator on the number of ACT stock-outs was the closest to meeting its target (146 compared to 100), followed by the number of ORS stock-outs (181 compared to 100). The project reported its lowest performances for folic acid and iron tablets and Depo-Provera stock-outs (244 compared to 200 and 243 compared to 100, respectively). Way forward: IHPplus and SIAPS will continue to address bottlenecks that contribute to high stock-out levels at the facility level. Consolidating the supply chain, streamlining procedures for ordering essential medicines, and building capacity to manage inventories and quantify essential medicine orders will help ensure adequate supplies of medicines and commodities throughout the system.
2. Challenge: None of the four TB indicators met their respective targets this year. The indicators with the lowest performance were the percent of all registered TB patients who are tested for HIV (47% achievement rate) and TB case detection rate (48% achievement rate). The low performance reported in the six out of eight coordination areas for the percentage of all registered TB patients who are tested for HIV, which do not receive PEPFAR support, primarily results from an irregular supply and repeated stock-outs of HIV tests. Regarding the TB case detection rate, only 61 of 78 health zones reported TB data during PY1Q4 due to delays in the provision of data collection and transmission tools by the Plan National de Lutte contre la Tuberculose (National TB Control Program, or PNLT). This incomplete data lowered the results of all indicators during PY1Q4, and consequently reduced IHPplus’ case detection rate for PY1. Way forward: The DPS will receive and distribute these TB data collection and transmission tools, which should positively impact the TB case detection rate performance for PY2Q1.
3. Challenge: During PY1, project performance on all three indicators related to FOSAOF evaluation was average, as two indicators (percentage of health facilities that completed an evaluation of the nine FOSACOF minimum standards, and percentage of health centers that completed an evaluation of the nine FOSACOF minimum standards) managed to almost reach their target (75% for both) and the third one (percentage of general reference hospital that completed an evaluation of the nine FOSACOF minimum standards) fell below (65%). Regarding the first indicator, IHPplus reported the lowest performance during PY1Q2 (54%), due to underperformance in Bukavu, Kolwezi and Uvira. In preparation for closeout, which was scheduled in these three coordinations ahead of the other five, the project decreased the number of supervision visits to health providers and health zone management teams, which explains the weaker performance reported during PY1Q2, and impacted the overall project’s performance for PY1. For the two other indicators, lower performance is attributed to conflicting activity calendars (since health facilities are often supported by several donors) and staff turnover. Way Forward: In PY2, IHPplus will provide technical support to the MOH to implement the new Integrated Quality Approach, which includes FOSACOF minimum standards, by conducting briefings on the new approach during regular field visits. The project will incorporate FOSACOF criteria into the RBF program as an incentive for health facilities to improve performance.
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PROJECT PERFORMANCE COMPONENT 1: HEALTH SERVICES
DRC’s health sector faces significant challenges, with a high burden of infectious disease, insecurity in many areas, and poor infrastructure. While infant mortality rates are dropping, they remain a project priority, along with the related challenges of high rates of fertility, domestic violence, malnutrition, and poor access to services. IHPplus is helping to increase low-cost, high-impact health services, and access to them, in 83 targeted health zones. Based on innovative, evidence-based strategies, our assistance to the service delivery sector focuses on the primary health care and community levels. Activities for the quarter are summarized in Table 2 below.
Table 2: PY1 health service key activities at a glance IR Strategy Key activities Targeted zones 1 Provision of • Monitored pharmaceutical management All coordination offices drugs, • Conducted health zone inventory data All coordination offices commodities, and checks products • Ordered and delivered EGM Centrale de Distribution Régionale (CDRs): CEDIMEK, CADIMEK, CADMEKO, FODESA, Communauté Eglises Pentecôtistes en Afrique Centrale (CEPAC) • Procured EGM, family planning, and PMI All coordination offices commodities Rehabilitation • Provided medical equipment to RBF health All 7 RBF health zones infrastructure centers and GRHs and equipment Reinforce • Provided EGM drugs (Ora-zinc, ACT, All supported health community care paracetamol, amoxicillin) and management zones sites/ tools to community care sites collaborative • Supervised community care sites Health zones supported approach by Mwene Ditu, Kole, and Kamina coordination offices Community-led • Renovated 222 new water sources All four health zones Total Sanitation with WASH program (CLTS)- WASH • Constructed 24,961 new latrines All four health zones with WASH program • Conducted joint supervision and monitoring All health zones LDP • Implemented LDP projects All health zones RBF • Implemented RBF All seven health zones with RBF programs 2 MNCH • Provided ANC and delivery services to All supported health pregnant women (including deliveries with zones
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skilled birth attendants, administration of uterotonic) • Provided essential newborn care Vaccination • Provided materials to support the All health zones functioning of the cold supply chain • Transported vaccines and syringes to Expanded Program on Immunization (EPI) points of service in hard-to-reach health zones Family planning • Conducted family planning counseling visits All health zones • Provided contraceptive methods to health facilities Nutrition • Implemented the infant and young child All health zones feeding program • Provided nutritional counseling to mothers Malaria • Distributed LLINs, ACTs, and RDTs to health All health zones facilities HIV and AIDS • Provided HIV T&C services Kolwezi and Kamina • Provided ARV and ART treatment coordinations • Conducted TB screening for HIV-positive patients TB • Confirmed new cases of smear-positive All health zones pulmonary TB and multidrug-resistant tuberculosis (MDR-TB) FOSACOF • Conducted evaluations of FOSACOF criteria All health zones at health facilities Referral system • Referred patients to health centers and All health zones GRHs 3 BCC • Launched mini-campaigns Seven coordination offices Community • Sent 510,168 awareness-raising text All health zones with cell Mobilization messages through FrontLine SMS network 4 Routine Data • Facilitated RDQA training Division Provinciale de Quality Santé (DPS) of Sud Kivu Assessment (RDQA)
Intermediate Result 1 (IR1): Access to and availability of Minimum Package of Activities (MPA) and Complementary Package of Activities (CPA) services and products in target health zones increased
Key IHPplus performance results, compared to targets set in the PMP, for IR1 during PY1, are summarized in Table 3 below and discussed in detail in the following section.
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Table 3: Summary of IR 1 key results for PY1Q3 IHP Plus by Sub-IR Sub-IR Key Indicators Results 1.1 Facility-based Utilization of health care services services and Availability of CPA/MPA products Availability of medicines and equipment (stock-outs) 1.2 Community- i-CCM – Pneumonia based services i-CCM—Diarrhea and products CLTS-WASH 1.3 Leadership LDP desired measureable results achieved practices
IR 1.1: Facility-based health care services and products (provincial hospitals and health zone health centers) in target health zones increased
Utilization of health care services: During PY1, the health services utilization rate for all eight coordination offices surpassed the national target of 35% (see Table 4 and Figure 4, which present the performance throughout the year and per coordination). Four offices increased or maintained their performance throughout the year: Tshumbe (from 38 to 40%), Kamina (from 47% to 51%), Mwene Ditu (from 42% to 45%), and Uvira (from 45% to 46%). Three other offices reported slightly lower performance: Luiza (from 38% to 36%), Kole (from 41% to 40%), and Bukavu (from 51% to 49%). Only Kolwezi reported a larger decrease in performance, from 65% to 59%, due to underperformance in three health zones (Mutshatsha, Kanzenze, and Bunkeya). Several factors had a negative impact on performance in these health zones: drug procurement delay, lack of availability of reporting tools in community care sites, non- implementation of flat rate pricing by several health facilities, and non-application of directives related to new curative cases definition after routine data quality audit.
Figure 4: Percentage of health service utilization rate by coordination office for PY1 70
60 PY1Q2 (%) 50
40 PY1Q3 (%)
30 PY1Q4 (%) 20 Total PY1 performance 10 (%) 0 National Target
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Table 4: Curative services utilization by coordination area during PY1 Coordination PY1Q2 PY1Q3 PY1Q4 Total PY1 National (%) (%) (%) performance (%) target (%) Bukavu 51 50 49 50 35 Kamina 47 48 51 49 35 Kole 41 43 40 41 35 Kolwezi 65 65 59 63 35 Luiza 38 36 36 37 35 Mwene Ditu 42 45 45 44 35 Tshumbe 38 39 40 39 35 Uvira 45 47 45 46 35
During the next quarter, the Kolwezi coordination will address these challenges to improve its performance by continuing to organize joint (DPS/health zone management team, or health zone management team/IHPplus) supportive supervision visits, providing community care sites with drugs and reporting tools, advocating to local health authorities (health inspector) to make sure that a flat rate is applied by all health facilities, and continuing to lead routine data quality audit missions.
Availability of Health Services - Facility-based Minimum Package of Activities/Complementary Package of Activities: Building the capacity of health centers and hospitals to offer the full spectrum of health services is a key priority for IHPplus. During PY1Q4, the project reported that 90% (70/78) of GRHs were implementing CPA, against a target of 88%, representing a 101% achievement rate (see Table 5 below).
Table 5: Number and percent of GRH implementing a CPA by coordination Coordination # of GRHs implementing CPA Total # % of GRHs Target Achievement of GRHs implementing (%) rate (%) PY1Q2 PY1Q3 PY1Q4 Total PY1 CPA result Bukavu 21 21 21 21 22 95 88 108 Kamina 6 6 6 6 9 67 88 76 Kole 7 7 7 7 8 88 88 99 Kolwezi 7 7 7 7 8 88 88 99 Luiza 9 9 9 9 9 100 88 114 Mwene Ditu 8 8 8 8 9 89 88 101 Tshumbe 8 8 8 8 8 100 88 114 Uvira 4 4 4 4 5 80 88 91 Total 70 70 70 70 78 90 88 102
During this quarter, the project also reported that 99% of the supported health centers (1,382/1,398) were offering MPA against the target of 99%, representing a 100% achievement rate (see Table 6 below). IHPplus maintained consistent performance for these two indicators during PY1. In Kamina, three health zones (Kayamba, Kitenge, and Mukanga) out of nine do not have GRHs that are implementing CPA, and patients in these localities only have access to referral health centers to seek treatment. This is due to their lack of infrastructure, equipment, and qualified staff. Some of these same challenges limit health centers in implementing MPA. Kayamba, where IHPplus introduced the RBF program, is currently building
DRC-IHPplus Year One Quarter Four/Annual Report: June 17, 2015 - June 30, 2016 Page 18 of 101 a GRH, using RBF subsidies and community support. To help strengthen performance for both indicators, IHPplus is also planning to work jointly with the DPS to identify solutions for addressing the lack of qualified personnel at GRHs and health centers.
Table 6: Number and percentage of health centers implementing MPA by coordination Coordination # of health centers implementing MPA Total # of % of health Target Achievement health centers (%) rate (%) PY1Q2 PY1Q3 PY1Q4 Total PY1 centers implementing result MPA Bukavu 399 399 399 399 399 100 99 101 Kamina 201 201 201 201 202 100 99 101 Kole 129 129 129 129 129 100 99 101 Kolwezi 105 105 105 105 106 99 99 100 Luiza 170 170 170 170 170 100 99 101 Mwene Ditu 168 168 168 168 171 98 99 99 Tshumbe 118 118 118 118 119 99 99 100 Uvira 92 92 92 92 102 90 99 91 Total 1,382 1,382 1,382 1,382 1,398 99 99 100
Availability of medicines, commodities, and equipment: SIAPS works with IHPplus to ensure the availability of quality pharmaceutical products and effective pharmaceutical services to achieve desired health outcomes. SIAPS helps ensure the availability of EGM at all IHPplus-supported sites. As part of its support for IHPplus, SIAPS implemented the following activities during PY1Q4.
Ensure the availability of medications in IHP-supported health facilities: SIAPS continued to work with IHPplus to monitor its PY1 order with suppliers IDA, IMRES, MEG, and ASRAMES, as well as the IHP PY5 emergency orders (1 and 2). SIAPS monitored both the process of obtaining all documents to facilitate the customs clearance process and the process of transporting the goods to IHPplus-supported CDRs. To date, the CDRs and warehouses have received 78% of the total expected delivery from these four suppliers and are waiting for five remaining containers (mostly from IDA). Further details are provided in Table 7.
For a more detailed breakdown by supplier and CDR, please refer to Appendices 4, 5, 6 and 7, “SIAPS Delivery Tracker for ASRAMES, IMRES, IDA and MEG for IHPplus.” Additional information on all deliveries received in the CDRs, including those not yet unpacked, is available in “MSH Cargo Tracking for IHPplus order 1” (Appendix 10).
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Table 7: Commodities expected for IHPplus PY1, order #1 (suppliers: ASRAMES, IDA, IMRES, and MEG) Province Warehouse Total order Order Order Order Order (DRC) value delivered as delivered remaining to remaining (USD) of June 2016 (%) deliver as of to deliver June 2016 (%) Sud Kivu APAMESK, $1,007,064.46 $819,969.73 81 $187,094.73 19 DCMP 8eCEPAC, and BDOM Katanga CEDIMEK $396,855.51 $264,227.72 67 $132,627.79 33 Kolwezi $212,883.47 $172,599.55 81 $40,283.92 19 Kasaï CADIMEK $368,982.50 $305,674.95 83 $63,307.56 17 Occidental Kasaï Oriental CADMEKO $545,197.11 $453,429.77 83 $91,767.34 17 FODESA $429,686.31 $324,548.81 76 $105,137.50 24 Order/Delivery Total $2,960,669.36 $2,340,450.53 79* $620,218.83 21* * Numbers may not add exactly due to rounding
To date, 87.7% of the first IHP PY5 order has reached the health zones (see Table 8 below). During this quarter, Bukavu received all deliveries expected from this order. The small amount of goods remaining represents goods that the MOH control office (at the border) has removed for analysis (quality control). For a more detailed breakdown by CDR, please refer to Appendix 9 “SIAPS Delivery Tracker for IHP PY5 Order Number 1 (TO #801), June 30 2016.”
Table 8: Commodities expected for IHP PY5, emergency order #1 (supplier IDA): Province Warehouse (DRC) Total order Order delivered Order Order Order value as of June 2016 delivered remaining to remaining (USD) (%) deliver as of to deliver June 2016 (%) Sud Kivu APAMESK, DCMP $100,118.11 $61,405.33 61 $38,712.78 39 8eCEPAC, and BDOM Katanga CEDIMEK $43,949.39 $43,928.87 100 $20.52 0 Kolwezi $37,964.25 $37,991.73 >100 $-27.48* 0 Kasaï CADIMEK $42,261.45 $42,133.18 99 $128.27 0.3 Occidental Kasaï CADMEKO $57,790.69 $57,743.13 99 $47.56 9 Oriental FODESA $40,249.48 $39,357.46 98 $892.02 2 Order/Delivery total $322,333.37 $282,559.70 88** $39,773.67 12** *The vendor delivered slightly more goods than requested **Numbers may not add exactly due to rounding
Currently, 94% of the second IHP PY5 order has reached the health zones (see Table 9 below). For a more detailed breakdown by CDR, please refer to Appendix 10, “SIAPS Delivery Tracker for IHP PY5 Order Number 2 (TO #801), June 30 2016.”
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Table 9: Commodities expected for IHP PY5, emergency order #2 (supplier IMRES): Province Warehouse Total order Order delivered Order Order Order (DRC) value as of June 2016 delivered remaining remaining (USD) (%) to deliver to deliver as of June (%) 2016 Sud Kivu APAMESK, $168,633.98 $168,640.18 100 $-6.20 0 DCMP 8eCEPAC et BDOM Katanga CEDIMEK $91,343.41 $79,043.95 87 $12,299.45 13 Kolwezi $84,316.99 $54,176.42 64 $30,140.57 35 Kasaï CADIMEK $105,396.24 $105,286.22 99 $110.02 1 Occidental Kasaï CADMEKO $119,449.07 $118,726.29 99 $722.79 1 Oriental FODESA $133,501.90 $133,479.57 100 $22.33 0 Order/Delivery total $702,641.60 $659,352.63 94* $43,288.97 6* * Numbers may not average exactly due to rounding
For IHPplus PY1 order #2, the first shipment arrived in DRC on April 28, 2016. ASRAMES stored it in its warehouses in Goma and started the distribution to the CDRs. At this time, the CDRs have received 46% of the total expected delivery (see Table 10 below). For a more detailed breakdown by CDR, please refer to Appendix 11, “MSH Cargo Tracker updated 07272016 (Order # 2 IHPplus),” and Appendix 12, “SIAPS Delivery Tracker for Mission Pharma Order for IHPplus (TO #902) June 30 2016.” By the end of September 2016, CDRs should receive all remaining deliveries for order #2.
Table 10: Commodities expected for IHPplus PY1, order #2 (from Mission Pharma) Province Warehouse Total order value Order delivered Order Order Order (DRC) (USD) as of June 2016 delivered remaining to remaining (%) deliver as of to deliver June 2016 (%) Sud Kivu APAMESK, $1,087,275.49 $565,833.07 52 $521,442.42 48 DCMP 8eCEPAC et BDOM Katanga CEDIMEK $453,502.97 $195,078.00 43 $258,424.97 57 Kolwezi $238,549.36 $105,855.01 44 $132,694.35 56 Kasaï CADIMEK $404,024.03 $172,304.08 43 $231,719.95 57 Occidental Kasaï CADMEKO $573,591.02 $290,726.23 51 $282,864.79 49 Oriental FODESA $487,647.15 $204,031.11 42 $283,616.04 58 Order/Delivery total 3,244,590.01 $ 1,533,827.50 $ 46* 1,710,762.51 $ 54* * Numbers may not average exactly due to rounding
SIAPS continued to support the distribution of the rest of the IHP PY5 emergency order drugs from the CDRs to the health zones by analyzing requisitions and the distribution plan and monitoring CDR deliveries
DRC-IHPplus Year One Quarter Four/Annual Report: June 17, 2015 - June 30, 2016 Page 21 of 101 to the health zones. To date, nearly all IHP PY5 first emergency order deliveries have reached the health zones. Distribution is ongoing, including specific commodities for malaria and family planning.
Strengthen the management of essential medicines and medical consumables: During this quarter, CDRs simultaneously received five shipments (a combination of IHP and IHPplus orders). Struggling to process this large amount of commodities, CDR staff requested SIAPS and IHPplus assistance, and the project led an eight-week supportive mission to the CDRs starting June 22, 2016. The overall goal of this mission was to provide assistance to the CDR in reconciling purchase orders with packing lists, aligning proof of delivery with bills of lading; produce an accurate and complete inventory of all the commodities received; and monitor CDR compliance with IHPplus norms and contractual terms.
To date, the joint SIAPS/IHPplus team has visited six CDRs (CAMELU, CADIMEK, CADMEKO, APAMESK, DCMP 8eCEPAC, and BDOM), and all of them now have an up-to-date stock situation report (see Annex 13 for the scope of work for the CDR monitoring mission) and have completed their proof of delivery forms. The joint supervision team also reported that the CDR staff are properly using the management tools on which they were trained and continue to work to improve storage conditions for commodities in compliance with the project’s stringent rules and regulations. During the next quarter, the joint supervision team will lead its last visit to the seventh CDR (FODESA, in Lodja) and produce its overall mission report, which will be made available at that time.
SIAPS and IHPplus, in collaboration with the Programme National d’Approvisionnement en Médicaments (National Drug Supply Program, or PNAM), conducted a pharmaceutical management training for 11 provincial and health zone management teams in Kolwezi in the Lualaba Province from January 18-21, 2016. As a follow-up action to the post-training action plan that was developed by the participants and approved by the DPS, the staff trained during PY1Q3 led a workshop from June 11-18, 2016, to reinforce the technical capacity of other DPS, CDR, and health zone management teams to manage medicines and other health commodities. A total of 70 participants (39 men and 31 women) took part in this training, which was co-facilitated by SIAPS and PNAM.
From June 25-28, 2016, SIAPS and IHPplus, jointly with PNAM, organized a second training in Bukavu. The 42 participants included 36 men and 6 women representing provincial and health zone management teams and warehouse employees from the three CDRs that are contracted with MSH in Sud Kivu. This training provided an opportunity to build the capacity of the pharmacists who were newly appointed by the MOH to the health zones to provide better support to the health facilities. At the end of the four-day session, the trained staff developed a post-training action plan, which the DPS approved, to sustain their new knowledge. For more details, please refer to Appendix 14 “Drug Management Training Report, June 2016, Bukavu.” During upcoming quarters, SIAPS and IHPplus, jointly with PNAM, are planning to facilitate the same workshop in Lomami, Sankuru, and Haut Lomami provinces.
In addition, SIAPS worked with IHPplus to improve storage conditions at its Kinshasa warehouse in accordance with recommendations from the MSH Audit Board. They renovated the warehouse by building a suspended ceiling and installed eight air conditioning units of 50,000 BTU to decrease the in-room temperature from 35 degrees Celsius to 23 degrees Celsius, which fulfills the national recommended conservation measures for medicines. Once the renovation work was completed, SIAPS and IHPplus moved the commodities previously stored in the PROCOKI warehouse to the Kinshasa warehouse, which saved the project rent and improved commodity monitoring.
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Support quarterly visits to supervise medicines management in the health zones, health facilities, and CDRs supported by IHPplus: As described above, SIAPS and IHPplus led supportive supervision missions to six CDRs during this quarter. In addition to providing assistance to the staff in reconciling orders, the joint team provided feedback on good pharmaceutical practices, including availability and use of management tools, monitoring and evaluation of storage conditions, and verification of discrepancies between reported and physical stocks.
Minimize tracer medicine stock-outs: Long-standing supply chain issues, which include insufficient quantity of pharmaceuticals ordered and delayed or extended delivery periods, continued to contribute to stock-outs of tracer medicines (Depo-Provera, folic acid, ACT, and ORS) as illustrated in Figure 5 below. During PY1, the project was unable to meet any of its target regarding stock-outs. The indicator on the number of folic acid stock-outs was the closest to meeting its target (244 compared to 200), followed by the number of ACT stock-outs (146 compared to 100). The project reported its lowest performances for ORS and Depo-Provera stock-outs (181 compared to 100 and 2s43 compared to 100, respectively).
Figure 5: Stock-outs of tracer medicines during PY1
Stock-outs of Depo-Provera Stock-outs of folic acid
300 300 243 243 250 244 244 209 250 188 200 200 167 176 150 150 100 100 50 50 0 0 PY1Q2-15 PY1Q3-16 PY1Q4-16 PY1 PY1Q2-15 PY1Q3-16 PY1Q4-16 PY1
Stock-outs of Depo-Provera Target Stock-outs of folic acid Target
Stock-outs of ORS Stock-outs of ACT
200 181 181 160 146 146 140 126 150 140 120 100 101 79 100 80
60 50 40 20 0 0 PY1Q2-15 PY1Q3-16 PY1Q4-16 PY1 PY1Q2-15 PY1Q3-16 PY1Q4-16 PY1
Stock-outs of ORS Target Stock-outs of ACT 1-5 Target
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As presented in Tables 11a and 11b below, the Kamina coordination office reported the highest number of stock-outs for the four tracer medicines during PY1. Kolwezi recorded the lowest number of stock-outs.
Table 11a: Stock-outs of tracer medicines (Depo-Provera and folic acid) by coordination office (by quarter) Depo-Provera Folic acid Coordination PY1Q2 PY1Q3 PY1Q4 PY1Q2 PY1Q3 PY1Q4 Bukavu 19 21 8 47 49 47 Kamina 62 96 89 83 30 91 Kole 11 1 5 27 7 3 Kolwezi 3 0 0 0 6 0 Luiza 26 64 26 42 0 16 Mwene Ditu 32 46 77 10 46 0 Tshumbe 28 13 4 27 13 14 Uvira 7 2 0 8 16 5 Total 188 243 209 244 167 176
Table 11b: Stock-outs of tracer medicines (ORS and ACT 1-5) by coordination office (by quarter) ORS ACT 1-5 Coordination PY1Q2 PY1Q3 PY1Q4 PY1Q2 PY1Q3 PY1Q4 Bukavu 25 36 83 7 24 20 Kamina 16 29 56 48 80 84 Kole 36 6 5 13 11 1 Kolwezi 0 0 0 0 8 2 Luiza 14 0 14 0 0 19 Mwene Ditu 5 17 0 0 0 0 Tshumbe 43 11 13 3 22 0 Uvira 1 2 10 8 1 0 Total 140 101 181 79 146 126
The greatest number of ORS stock-outs was reported in PY1Q4, with 181 compared to the target of 100, a 55% achievement rate. This represents an increase from the previous quarter (PY1Q3) of 101 health facilities reporting stock-outs. During PY1Q2, the project reported 140 stock-outs. The decline in performance is attributed to delays in the distribution of ORS from health zone central offices to health facilities. These commodities are available at the health zone central offices and CDR levels but less so in areas that are difficult to access.
During the next quarter, IHPplus will implement the following corrective measures to overcome these challenges: conduct joint (DPS/health zone management team/IHPplus) supportive supervision visits at the health facility and community care site level and train providers on clinical and community-based
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Integrated Management of Childhood Illness (IMCI) as well as triage, evaluation, and emergency treatment of pediatric diseases, procurement and monitoring of commodities, and use of management tools at the health facility and community care site levels.
In PY1Q4, 244 health facilities experienced folic-acid stock-outs against a target of 200, an achievement rate of 82%. After PY1Q2, when the highest number of stocks was reported, the project performance improved, with 167 reported in PY1Q3 and 176 in PY1Q4. During PY1Q3, the project investigated the high number of iron-folic stock-outs reported by some offices. It appeared that the continuous stock-outs within certain health zones were due to the lack of management or knowledge regarding average consumption of EGMs (in Pania, Mutombo, Minga, Lusambo, Katako-Kombe, and Tshumbe health zones); the delay in the processing of drug orders by the health centers to the health zones and the health zones to the CDR; and the delay in delivery of medicines by the CDR (in Minova, Mulungu, Kalole, Kalonge, Mwana, and Mwenga health zones). Some facilities await the monthly review meetings to request and re- stock necessary medicines (Lubudi, Bunkeya, Dilala, Kanzenze, and Lubudi health zones). During PY1Q4, the project took corrective measures to improve its performance, such as monitoring the deployment of EGM during monitoring meetings and/or during supervisory missions in the health zones, and providing support to the health zone management teams on EGM management and use during their monitoring and supervision visits to health facilities. However, some challenges remain: in Kamina, poor road conditions around Kabongo and Malemba Nkulu health areas make them hard to reach for vehicles delivering EGMs. In Kole, some health providers have not been trained on EGM monthly average consumption calculation.
During PY1, 146 health facilities experienced stock-outs of ACT for children 1-5 years of age (highest number of stock-outs being reported during PY1Q3). This represents an achievement rate of 68% against a target of 100. Most health facilities reporting ACT stock-outs were in the Kamina coordination area. Kamina’s poor performance can be explained by flooding which affected five health zones, making them inaccessible and preventing the drugs from reaching their destination by road. Since these health zones were located near the river, the project turned to an alternative supply route (river freight), which delayed the drug supply delivery. Despite the overall poor performance, IHPplus’ performance improved from PY1Q3 to PY1Q4 (a decrease from 146 health facilities experiencing stock-outs to 126).
During PY1, 243 health facilities experienced stock-outs of Depo-Provera, against a PMP target of 100, an achievement rate of 41%. The project reported the highest number of stock-outs during PY1Q3 but was able to improve its performance the next quarter by decreasing the number of stock-outs to 209. During PY1Q2, 188 health facilities had reported stock-outs in Depo-Provera.
The situation was particularly challenging in Mwene Ditu: in March, the CDRs were forced to delay restocking commodities in the health zones due to logistical difficulties and poorly-maintained roads in the health zones of Wikong and Kamiji. In Kamina, restocking through the waterway access of Malemba Nkulu was delayed, also due to accessibility problems. It is also worth noting that health zone management teams and health center providers are insufficiently motivated to rapidly distribute and restock family planning commodities when they are available in the health zone central offices. The most common explanation for this situation is that health providers do not profit from MOH commodities that are provided free to health facilities, since the health zone management teams expect a commission of 20- 30% or more of health center revenue prior to restocking their pharmaceutical supplies. As a result, these commodities often are not distributed—even those that are not classified as free.
Lesson Learned: Regular supportive supervision encourages the timely preparation and processing of medicine orders. If the delivery period in the health zones by the regional distribution centers is shortened, there will be fewer stock-outs. DRC-IHPplus Year One Quarter Four/Annual Report: June 17, 2015 - June 30, 2016 Page 25 of 101
Next Steps: IHPplus and SIAPS will continue to address bottlenecks that contribute to high stock-out levels at the facility level. Consolidating the supply chain, streamlining procedures for ordering essential medicines, and building capacity to manage inventories and quantify essential medicine orders will help ensure adequate supplies of medicines and commodities throughout the system.
IR 1.2: Community-based health care services and products in target health zones increased
Malaria, diarrhea, and pneumonia are the three main killers of children under five in DRC. For this reason, the MOH has adopted the IMCI strategy as the main approach to reduce the child mortality rate. IHPplus supports the MOH to implement this strategy at both the clinic and community levels.
Integrated Community Case Management: i-CCM is an equity-based strategy to increase access to effective case management for children suffering from malaria, pneumonia, and diarrhea, especially in hard-to-reach areas and among vulnerable populations. Through i-CCM programs, CHWs are equipped, trained, supported, and supervised to deliver life-saving treatments, including IMCI kits and pneumococcal conjugate vaccine (PCV-13), to improve outcomes for children in communities with difficult access to health facilities.
During PY1, IHPplus continued to support 777 community care sites (579 health areas and 59 health zones), representing a total population of 791,839 inhabitants (6% of the total project-supported population). In these sites, a total of 148,216 cases of malaria (61,667), pneumonia (33,302), and diarrhea (53,247) were treated by the end of the project year (see Tables 12a and 12b below). For diarrhea, performance improved in Q3, with a slight decrease in Q4. For pneumonia, the number of cases almost doubled from Q2 to Q4. This sharp increase can be attributed to the fact that there is an increased demand for services to treat children with coughs during the dry season as a result of the colder weather. Several additional factors contributed to the increase in the number of cases treated, including regular technical support provided by CHWs at health centers, trainings on IMCI, post-training monitoring and supervision, as well as the availability of medicines to treat these illnesses.
The total number of malaria cases treated decreased from Q2 to Q4. This trend was most significant in the Luiza and Kamina coordinations and was due to the increased number of RDT stock-outs at health facilities and CDRs (and thus insufficient distribution to community care sites). In addition, not all malaria cases that were treated were confirmed.
Table 12a: Pneumonia, diarrhea, and malaria cases treated through i-CCM sites during PY1 (by quarter) Diarrhea Pneumonia Malaria Coordination PY1Q2 PY1Q3 PY1Q4 PY1Q2 PY1Q3 PY1Q4 PY1Q2 PY1Q3 PY1Q4 Bukavu 3,939 1,333 1,067 778 1,049 718 2,002 1,490 2,218 Kamina 2,757 5,903 5,846 1,318 3,229 4,586 6,947 9,708 3,400 Kole 4,694 4,560 4,284 3,253 1,939 2,157 4,772 954 665 Kolwezi 481 875 352 177 257 205 1,024 1,081 1,072 Luiza 1,695 1,911 2,155 796 905 1,111 1,619 2,998 1,047 Mwene Ditu 1,357 1,934 1,886 1,519 1,929 2,161 4,266 3,316 7,332 Tshumbe 1,527 1,536 1,909 1,513 1,460 1,643 1,187 1,249 1,453
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Uvira 364 486 396 133 226 240 436 568 863 Total 16,814 18,538 17,895 9,487 10,994 12,821 22,253 21,364 18,050
Table 12b: Pneumonia, diarrhea, and malaria cases treated through i-CCM sites during PY1 (total)
Diarrhea Pneumonia Malaria
Coordination Total PY1 Bukavu 6,339 2,545 5,710 Kamina 14,506 9,133 20,055
Kole 13,538 7,349 6,391 Kolwezi 1,708 639 3,177 Luiza 5,761 2,812 5,664
Mwene Ditu 5,177 5,609 14,914 Tshumbe 4,972 4,616 3,889 Uvira 1,246 599 1,867
Total 53,247 33,302 61,667
Pneumonia: Data in Table 13 below demonstrate that during PY1, a total of 331,981 children less than five years of age presenting pneumonia symptoms were treated with antibiotics (250 mg amoxicillin tablets) by health care providers in project-supported health facilities or community care sites. Compared to the PMP target of 361,689 cases, this represents an achievement rate of 92%. Of the total cases, 10% were treated at community care sites.
Table 13: Number of cases of childhood pneumonia treated with antibiotics in USG-supported facilities and i-CCM sites Coordination PY1Q2 PY1Q3 PY1Q4 TOTAL PY1 Target Achievement Health i-CCM Total rate (%) facilities sites Bukavu 29,568 31,640 29,073 87,736 2,545 90,281 104,890 86 Kamina 18,997 22,434 20,960 53,258 9,133 62,391 57,870 108 Kole 11,693 10,210 11,281 25,835 7,349 33,184 25,318 131 Kolwezi 4,416 4,960 3,792 12,529 639 13,168 25,318 52 Luiza 8,230 11,069 11,667 28,154 2,812 30,966 39,786 78 Mwene Ditu 19,024 17,840 17,699 48,954 5,609 54,563 57,870 94 Tshumbe 7,819 7,669 7,548 18,420 4,616 23,036 25,318 91 Uvira 6,668 9,187 8,537 23,793 599 24,392 25,318 96 Total 106,415 115,009 110,557 298,679 33,302 331,981 361,689 92 *The figures in this column were rounded to the nearest whole number.
Kole and Kamina exceeded the target number of pneumonia cases treated, with achievement rates of 131% and 108%, respectively. Factors contributing to the high performance in Kole are the regular
DRC-IHPplus Year One Quarter Four/Annual Report: June 17, 2015 - June 30, 2016 Page 27 of 101 distribution of EGM and management tools (IMCI forms, partograms, etc.) to health facilities and community care sites, analysis of deliverables and data at community care sites, and post-training monitoring of CHWs conducted by DPS staff.
Kolwezi had the lowest performance, with an achievement rate of only 52% compared to the target. The poor performance is primarily due to weak supervision, irregular distribution of medicines to health facilities and community care sites, and poor data collection and reporting. To address this challenge, a team of MOH, USAID, and project staff conducted visits to supervise CHWs, health zone management teams, CDRs and coordination staff in order to improve data collection and the availability of medicines and commodities. The supervision team recommended more frequent and better quality joint supervision visits (DPS, health zone management team, IHPplus coordination office) to continue to address this challenge in the coming year. In Luiza, with an achievement rate of 78%, the lack of systematic monitoring from head nurses of community care site activities and poor data reporting also contributed to under performance. Additional challenges during the year included incorrect and non-systematic use of IMCI management tools (chart booklets and forms) and insufficient availability of timers. IHPplus will strengthen supervision and increase the provision of the necessary tools and materials to treat childhood pneumonia in PY2.
Diarrhea: During PY1, a total of 497,516 cases of diarrhea were treated with packs of ORS and zinc supplements (see Table 14 below). IHPplus exceeded the PMP target of 456,051, representing an achievement rate of 109%. Of the total number of cases treated, 53,247 (11%) were treated at community health sites, sparing mothers from traveling long distances to reach health care services. The number of diarrhea cases treated increased each quarter (an almost 10% increase).
Table 14: Number of cases of child diarrhea treated in USG-supported programs Coordination PY1Q2 PY1Q3 PY1Q4 TOTAL PY1 Target Achievement Health i-CCM Total rate (%) facilities sites Bukavu 52,511 38,177 44,691 129,040 6,339 135,379 132,255 102 Kamina 24,711 29,132 35,841 75,178 14,506 89,684 72,968 123 Kole 18,526 19,471 20,760 45,219 13,538 58,757 31,924 184 Kolwezi 5,145 6,575 5,678 15,690 1,708 17,398 31,924 54 Luiza 11,161 17,974 17,147 40,521 5,761 46,282 50,166 92 Mwene Ditu 18,525 24,914 26,734 64,996 5,177 70,173 72,968 96 Tshumbe 10,869 11,645 14,251 31,793 4,972 36,765 31,924 115 Uvira 17,531 16,428 9,119 41,832 1,246 43,078 31,924 135 TOTAL 158,979 164,316 174,221 444,269 53,247 497,516 456,051 109 *The figures in this table were rounded to the nearest whole number.
Almost all coordinations met or exceeded their annual targets. As identified during supervision visits, the high performance in Kole, Tshumbe, Kamina, and Uvira can be attributed to the regular distribution and availability of ORS and zinc supplements and management tools, as well as active monitoring of community care sites by head nurses. The Kolwezi coordination reported the lowest performance (54%) due to data reporting challenges. Additionally, many CHWs expressed low motivation due to the lack of supervision by the health zone management team and non-engagement in health reviews.
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In PY2, IHPplus will continue to improve performance by strengthening joint supervision (DPS, health zone management team, IHPplus), improving regular distribution of ORS and zinc supplements kits at the community care site level and to CODESAs, and providing reporting tools. The project will also work to address challenges in motivating CHWs and promoting adherence to case management standards.
Malaria: In PY1, 678,385 cases of malaria were treated with ACT at health facilities (616,718 or 91%) and community care sites (61,667 or 9%). There was a slight increase in the number of treated cases in quarter three, and then a decline in Q4. The quarterly and annual results are presented below in Table 15.
Table 15: Number of children under five years old with malaria treated in USG-supported facilities in PY1Q3 IHPplus Coordination PY1Q2 PY1Q3 PY1Q4 TOTAL PY1 Health i-CCM Total facilities sites Bukavu 53,497 76,620 86,619 211,026 5,710 216,736 Kamina 45,284 49,052 24,823 99,104 20,055 119,159 Kole 15,660 10,812 11,107 31,188 6,391 37,579 Kolwezi 15,644 14,533 17,272 44,272 3,177 47,449 Luiza 26,447 26,770 13,692 61,245 5,664 66,909 Mwene Ditu 37,823 20,161 25,184 68,254 14,914 83,168 Tshumbe 14,230 11,545 16,004 37,890 3,889 41,779 Uvira 19,456 22,512 23,638 63,739 1,867 65,606 Total 228,041 232,005 218,339 616,718 61,667 678,385
The coordinations of Kole, Kolwezi, and Tshumbe reported the fewest number of children under five years old with malaria who were treated with ACT. This is primarily due to delays in ACT distribution and other commodities to these areas. IHPplus conducted supervision visits to address the challenges in Kolwezi and recommendations for strengthening the supervision of CHWs and improving the availability of RDTs and ACTs, particularly for children under one year of age at health facilities and community care sites. Additional supervision visits will be planned for Kole, Tshumbe, and Kamina.
Challenge: Maintaining availability of medicines in health facilities and management tools
Next steps: IHPplus will implement the following strategies to strengthen IMCI results in PY2: Continue the regular distribution of medicines, commodities, and management tools Monitor the status of procurement orders Promote adherence to childhood illness case management standards and practices Raise awareness among mothers of the signs indicating that children require care Conduct joint supportive supervision visits (DPS, health zone management team, IHPplus) at health facilities and community care sites Conduct trainings on c-IMCI at community care sites (promoting key practices) Implement the Emergency Triage Assessment and Treatment strategy to strengthen urgent pediatric case management practices
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CODESA (Health Development Committees): CODESA activities—such as leading awareness-raising and community mobilization activities and providing referrals to local health centers—contribute significantly to increasing the use of community health care services and products in target health zones. To facilitate these activities, IHPplus provides regular financial support to all CODESAs in its target regions through fixed subsidies, as well as managerial support to assist CODESAs in monitoring their activities and conducting monthly meetings. This support is essential to CODESA functionality in IHPplus target communities.
As a part of their duties, CODESA members dedicate a portion of their time to health activities by planning communication activities and organizing lectures on healthy behaviors and the need for communities to undertake their own development. By mobilizing populations to take part in all steps of community development the CODESA members ensure cooperation among all stakeholders. When developing integrated communications plans they consult with the head nurses of health clinics, who help prioritize issues. Through awareness-raising techniques and activities that encourage community participation, CODESA members contribute to behavior change, increase the prevention of health problems, and improve community health. IHPplus continues to provide support for all of these activities through innovative BCC methods, including Champion Communities, Education through Listening (ETL), and mHealth.
During PY1, the number of IHPplus-assisted CODESAs was 1,398, as presented in Table 16 below. Of the 1,398 project-assisted CODESAs, 1,280 are operational (92%). Compared to the annual target of 92%, this represents an achievement rate of 100%. Additional details related to CODESA activities and achievements during the quarter, challenges, and lessons learned are presented in IR 3.
Table 16: Number and percent of CODESAs that are revitalized and functional in PY1 Coordination # of PY1Q2 PY1Q3 PY1Q4 PY1 % of Target Achievement CODESAS # of active # of active # of active # of active active rate (%) identified CODESAs CODESAs CODESAs CODESAs CODESAs Bukavu 399 399 399 399 399 100 92 109 Kamina 202 190 197 190 190 94 92 102 Kole 129 129 129 129 129 100 92 109 Kolwezi 106 91 91 91 91 86 92 93 Luiza 170 147 147 147 147 86 92 93 Mwene Ditu 171 156 156 156 156 91 92 99 Tshumbe 119 74 74 86 86 72 92 78 Uvira 102 82 82 82 82 80 92 87 Total 1,398 1,268 1,295 1,280 1,280 92 92 100
Evidence-based WASH activities: During PY1, 228,314 of the targeted 229,950 people (99%) had access to an improved drinking water supply. Over the course of PY1, the number of people with first-time access to improved drinking water supply as a result of USG support in target area increased from 35,441 in PY1Q2, to 162,741 in PY1Q3, and then decreased to 30,132 in PY1Q4.
Additionally, 167,108 of the targeted 153,300 people (109%) had access to an improved sanitation facility. Over the course of PY1, the number of people with first time access to improved sanitation facilities as a result of USG support in target area increased from 29,750 in PY1Q2, to 89,149 in PY1Q3, and decreased to 48,209 in PY1Q4. Table 17 presents the number of people that obtained access to improved drinking
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Table 17: WASH indicator results per coordination for PY1 Coordination Number of First-time access to Number of First-time access to people in improved drinking water people in improved sanitation target supply as a result of USG target facilities as a result of USG areas support in target area areas support in target area (drinking # Achievement (sanitation # Achievement water) rate (%) facilities) rate (%) Luiza 71,361 76,400 107 47,596 99,413 209 Mwene Ditu 158,589 151,914 96 105,704 67,695 64 Total 229,950 228,314 99 153,300 167,108 109
The strong performance in PY1Q3 compared to PY1Q2 is due to the availability of the team of masons to complete the construction of new latrines and potable water sources following their training in PY1Q2.
Challenge: WASH specialists are extensively involved in overseeing the construction of latrines and potable water sources to prevent poor workmanship and improper use of materials. They also have a large role in managing the logistics for these activities, which limits their availability to plan and implement other WASH activities. To address this challenge, the project will look into the possibility of purchasing all materials needed to build these structures for all involved coordinations only once during the year to reduce the logistical burden.
Throughout the project year, IHPplus led monitoring visits to health zones where drinking water sources had been set up or improved by IHP between 2012 and 2015. It appeared that several of these sources were poorly maintained, which had a negative impact on the water quality and increased the chance for the population to suffer from waterborne diseases.
Next steps: IHPplus is addressing this sustainability problem by planning several activities in its PY2 workplan related to community involvement in water source maintenance, such as raising awareness in communities on their role in maintaining WASH structures, including financial contributions, maintenance, and upgrading WASH-related works projects and training WASH field-based actors (DPS teams, health zone management teams, head nurses or heads of decentralized areas [sector leads or their delegates], WASH committee members, etc.) in the areas of ownership and sustainability of WASH practices, economic impact of WASH, maintenance, monitoring epidemiologic data, and water quality control.
Population targeted for improved access to water sources and sanitation facilities: IHPplus focused on the implementation of the CLTS approach in four health zones (Ndekesha and Luambo in Luiza coordination and Kanda Kanda and Luputa in Mwene Ditu coordination), with a cumulative goal of reaching 12% of the population living in the health areas where the project is implementing WASH activities by the end of June 2016. The total population of these four health zones is estimated at 1,022,000, and annual targets for the number of people accessing improved water sources and sanitation facilities were fixed at 30% and 20%, respectively1. These targets were set taking into account the
1 Considering that WASH activities began during Q2, the annual targets were adjusted for the nine-month period: 229,950 for drinking water and 153,300 for improved sanitation facilities. DRC-IHPplus Year One Quarter Four/Annual Report: June 17, 2015 - June 30, 2016 Page 31 of 101 implementation capacities of the project partners and targeted households as well as logistical constraints related to bringing construction materials to project sites.
Improved water sources and sanitation facilities: IHPplus provided technical and financial support to the MOH and local communities to renovate water sources, which contributed to the strong performance in improving access to water sources. During PY1, 222 of the targeted 200 water sources (111%) were renovated. The number drastically increased during PY1Q3, when 147 of the targeted 114 water sources (129%) were renovated. During PY1Q4, 24 sources out of 26 (92%) were constructed or renovated.
Also in PY1, as a result of IHPplus technical support through CLTS, communities in Ndekesha, Luambo, Kanda Kanda, and Luputa health zones built 24,961 of the planned 8,018 household latrines (311%). During PY1Q2, IHPplus provided technical assistance to communities to renovate 4,254 latrines of the 2,673 targeted (159%). Performance remained high and increased in Q3 and Q4, when IHPplus renovated 12,072 latrines for Q3 and 8,635 for Q4 (which represents 452% and 323% performance rate), respectively. Table 18 below illustrates the total number of water sources and latrines renovated during PY1.
Table 18: Number of renovated water sources and latrines in PY1 Coordination Renovated water sources Renovated latrines Planned Achieved % Planned Achieved % achievement achievement Luiza 100 102 102 5,097 14,672 288 Mwene Ditu 100 120 120 2,291 10,289 352 Total 200 222 111 8,018 24,961 311
The particularly strong performance in the number of renovated latrines can be explained by the increased community awareness on the importance of using latrines and good sanitation practices such as hand washing with soap or ash. Champion Communities, CHWs, schools, and other community actors have played a large role in raising this awareness throughout the year.
In Mwene Ditu, the percent of renovated WASH structures was high whereas with the total number of people with first time access to drinking water and latrines was below the population targeted in these areas. On the other hand, IHPplus exceeded performance in Luiza in both areas. It is possible that this difference is linked to the different approach implemented by local leaders. Luiza focused on renovating structures in villages with high population concentrations, whereas the Kanda Kanda health zone in Mwene Ditu has few large villages.
Management of biomedical waste: Field visits identified a lack of attention to correctly managing biomedical waste. In many hospitals, maternity wards and health centers, waste is littered on the ground. The project is conducting a situational analysis to identify the needs in terms of equipment, capacity, and approaches needed to address this problem in communities.
Other WASH-related activities that the project led this year include the following: Provided assistance to develop a national public water strategy following the government’s enactment of the new water law on January 4, 2016. As the law describes the roles of user associations and local committees for water and sanitation, it is important to clarify their roles in
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relation to the health sector and to the heads of decentralized entities that are responsible for providing potable water. Within the context of support to the development of the new national WASH policy, IHPplus supported a WASH consortium made up of five nongovernmental organizations (NGOs) to develop a guide for WASH stakeholders involved in the implementation of the new water law. At USAID/DRC request, IHPplus’ WASH technical advisor attended the monthly meeting of the WASH inter-donor group, which discusses sector-wide issues, advocacy, and other common items. IHPplus and the USAID/Washington WASH manager visited Lualaba province from February 13-21, 2016. During this joint mission, the team visited Kanzenze and Lubudi health zones as well as Lualaba Provincial Health Division in Kolwezi to evaluate WASH achievements accomplished with the project’s continuous support. The main observations from this visit were: o Although the project recently renovated water sources in these supported health zones, they are not regularly maintained by the beneficiaries. This is probably due to the lack of an ownership strategy, clear monitoring mechanism, and a fund to cover maintenance costs through household contributions. Despite the unwritten rule that everyone should have free access to water, this maintenance fund strategy has already been implemented in Lubudi health zone where water hand pumps were installed and beneficiaries currently contribute to their maintenance by paying US$0.50 per household per month. However, this strategy still needs to be improved as this amount was randomly determined, with no reference to the actual cost of maintenance and repair. o While households seem to have adopted several good hygiene practices, there is still a gap between knowledge and action, especially regarding latrine maintenance and coverage, establishing hand washing routines with soap or ash, automatic hand washing after defecation, etc. o Sustainability of WASH installations (both water pumps and hygienic latrines) is at risk as they are often built with local construction materials, meaning they lack quality and durability. One solution could be to sub-contract these WASH activities to small local construction companies which will then be responsible for finding reliable and higher- quality procurement sources.
Challenges: Despite the strong performance during the year, several challenges remain, such as the unavailability of sustainable construction materials in targeted areas and the lack of maintenance provided to the renovated water courses and newly-built latrines by the local population, which leads to their rapid deterioration over time. The project is looking for mechanisms to provide financial incentives to WASH committees and involving local chiefs in implementing the new water law and ensuring the sustainability of their water sources and latrines.
Next steps: Continue to renovate water and latrine sources in local communities Work with WASH committees and local leaders to create community ownership to ensure the sustainability of renovated water sources and newly-built latrines Improve the engagement of local leadership and communities in the maintenance of water and sanitation sources by emphasizing the importance of monitoring the quality of the water, analyzing epidemiological data, and considering the impact of pollution
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Explore the possibility of introducing sanitation marketing2 to address the lack of adequate materials in certain health zones Finalize the situational analysis of biomedical facilities and equipment in supported health zones (strengths, weaknesses, opportunities, threats) Identify resources to strengthen biomedical facilities and equipment and the capacity of human resources to manage biomedical waste Monitor the management of biomedical waste in health centers and GRHs Adopt a multisectoral approach that addresses problems of malnutrition, limited access to financing for health care, and limited access to drinking water and proper sanitation (through revenue and non-revenue generating activities). Strengthen economic approaches for maintaining WASH structures and the motivation of teams responsible for this maintenance Improve the logistical coordination for WASH activities to decrease the time needed to procure and receive materials needed to renovate water sources and latrines
Community-based nutrition activities
Number of mothers of children two years of age or younger who have received nutritional counseling for their children: During PY1, 564,212 of the 511,434 expected mothers with children two years of age or younger received counseling (110% achievement).The number fluctuated from 182,913 in PY1Q2 to 177,885 during PY1Q3 to finally reach 203,414 during PY1Q4. More details related to this indicator are presented in IR2.1.
IR 1.3 Provincial management more effectively engaged with health zones and facilities to improve service delivery
Leadership Development Program: LDP participants work in teams, learning to lead and manage collaboratively and effectively. Teams develop a shared vision, identify long-term strategies, and commit to short-term results. They analyze what stands in the way of progress and create opportunities to practice their new skills at every step. Their superiors are fully aligned with the program and hold the teams accountable for intended results. Teams receive support from facilitators and coaches. Whether they are health officials, nurses, or volunteers, participants tend to emerge from the program with increased skills, commitment, confidence, and a sense of power. This method of leadership development goes beyond leadership theory and helps teams apply their new knowledge through practice, so they can obtain measurable results for their organizations.
To demonstrate their commitment to improving health service delivery, DPS management teams carried out monitoring and supervision visits to health zone management teams supported by IHPplus as part of their routine activities. Teams that participated in the LDP implemented leadership projects lasting between six and eight months, collaborating with other stakeholders involved in improving public health.
2 “Sanitation marketing” is an emerging field that applies social and commercial marketing approaches to scale up the supply and demand for improved sanitation.
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During PY1, 62 of the 78 teams supported by IHPplus implemented LDP projects. Table 19 presents the number and proportion of LDP teams that achieved at least 80% of their target six months after the LDP.
Table 19: Proportion of senior LDP teams that have achieved at least 80% of their desired performance during PY1
Coordination Number of Number teams Proportion (%) of Target (%) Achievement senior LDP that have senior LDP teams rate (%) teams that have achieved at least that have developed a 80% of their achieved at least leadership desired 80% of their project during performance desired PY1 performance Bukavu 17 12 71 69 102 Kamina 8 6 75 69 109 Kole 6 4 67 69 97 Kolwezi 7 6 86 69 124 Luiza 8 6 75 69 109 Mwene Ditu 9 8 89 69 129 Tshumbe 5 3 60 69 87 Uvira 3 3 100 69 145 Total 62 47 76 69 110
During PY1, 76% of LDP teams achieved at least 80% of their desired performance, which, against a PMP target of 69, represents an achievement rate of 110%. This result is explained in part by most teams’ attempts to select realistic goals. In addition, the DPS management teams have effectively monitored and supported six of the health coordination offices throughout the implementation of their projects.
Table 20 shows that the LDP teams predominantly chose projects linked to maternal and child health and TB (95 and 15, respectively, of 187 projects), and also shows the distribution of LDP projects across technical areas.
Table 20: LDP projects per technical area Focus Indicator areas # of projects # of projects Achievement Areas implemented achieving expected rate (%) results MNCH Immunization/VAT 2+ 3 1 33 Immunization/DTC-Heb-HiP- 9 6 67 Malaria/IPT3 2+ 22 20 91 Dropout rate DTC-Heb-HiP-3 5 5 100 ANC 4 18 14 78 More than 2 preschool 13 12 92 consultations
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IMCI 11 9 82 Assisted deliveries 4 3 75 More than 2 post-natal 3 2 67 consultations AMTSL* 6 5 83 ANC 1 1 0 0 Total MNCH 95 77 81 Family Availability of contraceptives 4 4 100 planning L+M+G Utilization of services 6 4 67 TB SPPT**detection 15 10 67 Nutrition Awareness sessions 11 10 91 HIV TB patients tested for HIV 1 1 100 Total 187 142 76 *Active management of third stage of labor **Sputum Positive Pulmonary Tuberculosis
Challenges: 1. While IHPplus attempted to organize LDP workshops for each health zone management team supported by the project, MOH reforms led to staff relocation and change of provincial and health zone management team dynamic and composition 2. IHPplus is ensuring that all health zone management teams using the LDP approach implement a realistic leadership project on a regular basis, as the project's past experience with the LDP has shown that teams tend to select over-ambitious objectives 3. The project needs to ensure that new provincial teams appointed by the MOH are informed about the LDP so they can efficiently engage to support their health zone management teams in improving health service delivery
Next steps: During the next quarter, IHPplus will continue to support the 78 health zone management teams through supervision visits to ensure that they regularly implement leadership projects to progressively overcome the challenges they face. IHPplus will also organize a five-day LDP workshop in Kinshasa for the seven newly-supported provincial management teams (Haut Lomami, Lualaba, Kabinda, Kasaï Oriental, Lusambo, Kasaï Central, and Sud Kivu) to enable them to support LDP teams as they improve health service delivery. The project will also brief new focal points within health zone management teams on LDP implementation and monitoring and organize refresher training for previously trained staff during supervision visits. Finally, the project will organize three-day refresher workshop on LDP for each of the seven health zone management teams that oversee the comparative health zones to those implementing the RBF approach.
Intermediate Result 2: Quality of key family health care services in target health zones increased
Increasing access to quality health services is a key objective of the IHPplus project. While the project continues to experience challenges with some indicators, particularly those related to TB, progress is being made in the areas of maternal and child health, HIV and AIDS, and referral systems and quality of care, among others. Details are presented by sector in Table 21, below.
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Table 21: Summary of Key IR 2 Results for PY1
Sub-IR Focus area Key Indicators Results 2.1 Clinical and Maternal Service delivery (ANC 1, ANC 4) Management Capacity health Service delivery (SBA) Quality of care (AMTSL) Neonatal Neonates receiving essential care health Newborns receiving antibiotics for infection Child health Vaccinations (under 12 months) Pneumonia, diarrhea, malaria treatment Family Service delivery (counseling, new planning adopters) CYP Service delivery points Nutrition Pregnant women receiving iron-folate Nutritional counseling Malaria Service delivery (IPTp) Commodities distributed Health workers trained HIV and AIDS Service delivery (testing and counseling, HIV services, ART, new enrollees) Service delivery and prevention (known status, key populations reached) Service delivery (% ART, prevention of mother-to-child transmission (PMTCT), TB screen, TB ART, lab) Tuberculosis HIV testing of TB patients New TB case detection rate MDR TB cases detected GBV GBV service delivery GBV BCC campaigns
2.2 Minimum Quality FOSACOF Health center that completed an evaluation of the nine minimum FOSACOF standards GRH that completed an evaluation of the nine minimum FOSACOF standards 2.3 Referral Systems Referrals Patients referred to health center Patients referred to GRH IR 2.1: Clinical and managerial capacity of health care providers increased
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Maternal, newborn, and child health: During PY1, IHPplus exceeded targets related to the percentage of pregnant women attending at least one and four ANC visits by skilled providers. Five indicators had achievement rates greater than 80%, and only one indicator (newborn infection case management) had an achievement rate less than 80%.
Pregnant women attending ANC visits: ANC continues to be offered to pregnant women during their pregnancies in all IHPplus-supported health facilities to improve maternal and newborn health. During PY1, 103% of projected pregnant women (413,902/402,322) attended at least one ANC visit (ANC1), and 56% of pregnant women (224,619/402,322) attended at least four ANC visits (ANC4). When compared to the annual targets, the project performed well for both indicators and exceeded the targets for ANC1 and ANC4 visits of 95% and 53%, respectively. Tables 22 and 23 summarize the number and percent of pregnant women attending ANC1 and ANC4 visits for each regional office, compared to the targets.
Table 22: Number and percent of pregnant women attending ANC1 visit by skilled providers from USG-supported health facilities in PY1 Coordination Number of pregnant women attending Number of % Target Achievement at least one ANC visit (ANC1) expected women (%) rate (%) pregnancies attending PY1Q2 PY1Q3 PY1Q4 Total (4% of pop) ANC1 Bukavu 39,169 42,495 41,396 123,060 115,212 107 95 112 Kamina 20,296 21,749 21,029 63,074 63,414 99 95 105 Kole 10,493 11,318 11,341 33,152 29,745 111 95 117 Kolwezi 10,481 102,22 9,965 30,668 27,465 112 95 118 Luiza 14,622 14,224 14,893 43,739 44,472 98 95 104 Mwene Ditu 21,092 21,274 21,514 63,880 65,703 97 95 102
Tshumbe 8,402 8,778 8,798 25,978 27,330 95 95 100
Uvira 9,542 10,456 10,353 30,351 28,980 105 95 110 Total 134,097 140,516 139,289 413,902 402,322 103 95 108
In almost all coordinations, the total number of pregnant women attending ANC1 and ANC4 visits increased from PY1Q2 to PY1Q4 (with the exception of ANC1 visits in Kolwezi). Factors contributing to this trend include: (1) the availability of LLINs, Fefol®, and SP to all health facilities, which motivates women to visit these health facilities; (2) the implementation of ANC outreach strategies in the Luiza coordination; (3) the implication of political and administrative authorities in encouraging midwifery support for pregnant women in Kole and Tshumbe; (4) the involvement of community leaders and members of Champion Communities in identifying pregnant women and encouraging them to visit health facilities; and (5) CODESAs’ involvement in conducting community awareness-raising sessions on the importance of ANC visits and seeking care early in pregnancies in the Luiza coordination.
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Table 23: Number and percent of pregnant women attending ANC4 visit by skilled providers from USG-supported health facilities in PY1 Coordination Number of pregnant women Number of % Target (%) Achievement Office attending at least four ANC visits expected women rate (%) (ANC4) pregnancies attending PY1Q2 PY1Q3 PY1Q4 Total (4% pop) ANC4 Bukavu 16,870 16,331 18,519 51,720 115,212 45 53 85 Kamina 10,022 10,658 11,034 31,714 63,414 50 53 94 Kole 7,241 7,697 8,185 23,123 29,745 78 53 147 Kolwezi 3,870 3,786 4,105 11,761 27,465 43 53 81 Luiza 10,732 10,744 11,247 32,723 44,472 74 53 139 Mwene Ditu 14,134 14,359 14,332 42,825 65,703 65 53 123 Tshumbe 5,066 5,672 5,855 16,593 27,330 61 53 115 Uvira 4,552 4,610 4,998 14,160 28,980 49 53 92 Total 72,487 73,857 78,275 224,619 402,321 56 53 105
While IHPplus exceeded its target for the percentage of pregnant women attending ANC4 visits, the number of pregnant women attending these visits remains low. Slightly more than half of the total number of pregnant women (224,619/413,903) attended ANC4 visits. Many pregnant women begin ANC visits later than advised, particularly in Kolwezi and Sud Kivu (Bukavu and Uvira coordinations), limiting the total number of visits completed prior to giving birth. To improve performance in PY2, IHPplus will continue to implement ANC outreach strategies, increase the number of household visits conducted by CHWs and Champion Communities, and provide payment for strong performance through RBF.
Deliveries by skilled birth attendant: Among the total number of deliveries in IHPplus-supported health zones, 87% (350,075/402,322) were deliveries with an SBA (see Table 24 below). Compared to the PMP target of 90%, this represents an achievement rate of 97%.
Table 24: Number and percent of deliveries with a SBA in USG-supported facilities in PY1 Coordination # of deliveries with a SBA Number of % of Target Achievement expected deliveries (%) rate (%) PY1Q2 PY1Q3 PY1Q4 Total pregnancies with a SBA (4% pop) Bukavu 31,279 30,916 33,550 95,745 115,212 83 90 92 Kamina 16,819 17,873 16,846 51,538 63,414 81 90 90 Kole 9,366 9,760 10,087 29,213 29,745 98 90 109 Kolwezi 9,706 9,660 9,131 28,497 27,465 104 90 115 Luiza 13,428 13,872 13,862 41,162 44,472 93 90 103 Mwene Ditu 19,521 19,646 19,565 58,732 65,703 89 90 99 Tshumbe 7,469 7,582 7,817 22,868 27,330 84 90 93 Uvira 6,967 7,294 8,059 22,320 28,980 77 90 86 Total 114 555 116,603 118,917 350,075 402,322 87 90 97
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Over the course of the year, the number of deliveries with an SBA increased in almost all coordinations (with the exception of Kolwezi, where there was a slight decrease). This strong performance is linked to MNCH competency-based trainings that the project conducted for health providers in seven additional health zones, the inclusion of this indicator in the RBF program, raising awareness through SMS among pregnant women on the importance of deliveries by SBAs and attending ANC visits, ETL approaches, and other BCC approaches. Additionally, post-training supervision visits in Kolwezi and Mwene Ditu assisted health providers in correctly completing the partogram to track delivery information. The incorrect use of partograms remains a challenge in all coordinations, and IHPplus will continue to provide coaching and supervision to build this capacity in PY2.
IHPplus compared the achievement rates in coordinations for attendance at ANC4 visits and the percent of deliveries by SBAs and found a strong correlation. Table 25 below presents the comparison data.
Lesson learned: There is a strong correlation between attendance at ANC4 visits and the number of deliveries by SBAs. Most coordinations with a high percentage of ANC4 visits also have a high percentage of deliveries by SBAs (with the exception of Kolwezi).
Table 25: Comparison of attendance at ANC4 visits and the percent of deliveries by SBAs Coordination Achievement rate (%) ANC4 SBA Bukavu 45 83 Kamina 50 81 Kole 78 98 Kolwezi 43 104 Luiza 74 93 Mwene Ditu 65 89 Tshumbe 61 84 Uvira 49 77
Coordinations with a high percentage of ANC4 visits (Kole, Luiza, Mwene Ditu) (more than 65% based on the total population covered) also have high SBA rates (above 85%).
Women receiving a uterotonic immediately after birth (an essential element of AMTSL): In PY1, a total of 327,239 women received an uterotonic immediately after birth (an essential element of AMTSL).3 This represents 93% of the deliveries with an SBA, falling slightly below the PMP target of 94% (an achievement rate of 99%). IHPplus’ performance steadily increased throughout the year from 104,324 women receiving a uterotonic in PY1Q2 to 113,060 women in PY1Q4 (see Table 26 below).
3 USAID reformulated this MNCH indicator since IHPplus only collects data on the number of women who received a uterotonic immediately after birth, but it does not collect data on the two other services provided as part of the AMTSL package (uterine massage and controlled cord traction).
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Table 26: Number of women receiving a uterotonic immediately after birth (an essential element of AMTSL) in USG-supported programs during PY1 Coordination Number of women receiving a # of women % of women Target Achievement uterotonic immediately after birth giving birth who (%) rate (%) PY1Q2 PY1Q3 PY1Q4 Total with a SBA received a in PY1 uterotonic Bukavu 27,620 28,003 30,502 86,125 95,745 90 94 96 Kamina 16,287 17,206 16,458 49,951 51,538 97 94 103 Kole 5,870 8,848 9,020 23,738 29,213 81 94 86 Kolwezi 8,673 8,705 8,825 26,203 28,497 92 94 98 Luiza 13,388 13,658 13,727 40,773 41,162 99 94 105 Mwene Ditu 19,411 19,425 19,437 58,273 58,732 99 94 106 Tshumbe 6,679 7,301 7,627 21,607 22,868 94 94 101 Uvira 6,396 6,709 7,464 20,569 22,320 92 94 98 Total 104,324 109,855 113,060 327,239 350,075 93 94 99
Compared to the number of actual deliveries with an SBA (350,075), the percentage of women receiving a uterotonic immediately following birth is 7% lower. This gap can be explained by the percentage of cesarean births. Oxytocin is systematically administered after the extraction of the fetus during cesarean births; however, health providers do not yet collect this data. This gap is more evident in Sud Kivu, where more than 10% of deliveries are cesarean (compared to the recommended norm of 5%) due to the increased presence of private health structures.
AMTSL is not consistently applied in all health facilities. Not all facilities have providers trained in MNCH using the new competency-based training methodology (more practical and skills-based and less theoretical), which likely contributes to the inconsistent application. IHPplus will continue to train health care providers using the new methodology in subsequent quarters, and will conduct supportive supervision visits in health zones where AMTSL application is poor to better identify the challenges.
Newborns receiving essential newborn care: During PY1, a total of 337,984 newborns received essential newborn care, representing 97% of the total newborns delivered during the year in project-supported areas (see Table 27 below). Compared to the PMP target of 89%, this represents an achievement rate of 109%. Essential newborn care services include immediate drying, aseptic umbilical cord care, skin-to-skin contact with mothers, and breastfeeding within one hour of birth. IHPplus performance improved during the year, with the number of newborns receiving essential newborn care increasing from 109,395 in PY1Q2 to 116,304 in PY1Q4 (6% increase). Data collection for this indicator remains a challenge (four data sets are required to complete the indicator), and IHPplus will continue to provide coaching to improve data quality in PY2.
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Table 27: Number and percentage of newborns receiving essential newborn care through USG- supported programs during PY1 Coordination PY1Q2 PY1Q3 PY1Q4 Total Total % of Target Achievement live newborns (%) rate (%) births who received in PY1 essential newborn care Bukavu 29,734 29,999 33,064 92,797 94,857 98 89 110 Kamina 16,295 17,485 16,620 50,400 53,604 94 89 106 Kole 8,267 8,879 9,346 26,492 28,967 91 89 103 Kolwezi 8,408 7,953 8,261 24,622 26,931 91 89 103 Luiza 13,620 13,872 13,867 41,359 40,993 101 89 113 Mwene Ditu 19,446 19,315 19,586 58,347 58,824 99 89 111 Tshumbe 7,513 7,540 7,663 22,716 23,296 98 89 110 Uvira 6,112 7,242 7,897 21,251 22,154 96 89 108 Total 109,395 112, 285 116, 304 337,984 349,626 97 89 109
High-impact interventions for newborns in project-supported areas: According to data from the LiST tools (using data from the DHS 2013), prematurity, asphyxia, and sepsis are the three main causes of newborn death in DRC. IHPplus used the LiST tool to identify high-impact interventions such as Kangaroo mother care, neonatal resuscitation, and treating neonatal sepsis with antibiotics to improve newborn health in project-supported areas.
Helping babies breathe: 193 health facilities continue to implement the Helping Babies Breathe (HBB) method as an approach for neonatal resuscitation in project-supported areas. The project trained health providers on the approach during trainings on the MNCH competency-based methodology as well as during focused trainings on the HBB approach. Of the 2,227 cases of newborns suffering from neonatal asphyxia during PY1, 88% (1,964) were resuscitated using the HBB method (see Table 28 below). The largest numbers of cases of resuscitated babies were reported in Bukavu (753), Mwene Ditu (384), Uvira (304), and Kolwezi (243).
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Table 28: Number and percent of newborns not breathing at birth who were resuscitated in USG- supported programs Coordination Number of Number of babies % of babies Office babies with resuscitated using the resuscitated using neonatal HBB method the HBB method asphyxia Bukavu 872 753 86 Kamina 86 72 84 Kole 97 92 95 Kolwezi 310 243 78 Luiza 108 96 89 Mwene Ditu 404 384 95 Tshumbe 24 20 83 Uvira 326 304 93 Total 2,227 1,964 88
Newborns receiving antibiotic treatment for infection from appropriate health workers: As illustrated in Table 29, a total of 23,857 newborns with infections were treated with antibiotics in PY1. The project fell below the annual target of 30,963, for an achievement rate of 77%. There is a large disparity among the coordinations. For example, an elevated number of newborns received antibiotic treatment for infection in Kolwezi (2,114), compared to the low number of newborns treated in Tshumbe (203). During joint supervision visits (MOH and IHPplus staff), the team noted that administering antibiotics for treating newborn infections was a systematic practice in urban, private health facilities. This contributes to the high achievement rate in Kolwezi (237%). The project will organize additional joint supervision visits with national-level staff to identify the causes for poor performance in the lower-performing coordinations.
Table 29: Number of newborns receiving antibiotic treatment for infection from appropriate health workers through USG-supported programs during PY1 Coordination PY1Q2 PY1Q3 PY1Q4 PY1 Target Achievement Total rate (%) Bukavu 2,100 1,602 2,421 6,123 8,979 68 Kamina 1,033 686 557 2,276 4,954 46 Kole 717 820 705 2,242 2,167 103 Kolwezi 1,041 1,974 2,114 5,129 2,167 237 Luiza 538 1,006 525 2,069 3,406 61 Mwene Ditu 791 1,082 975 2,848 4,954 57 Tshumbe 158 140 203 501 2,167 23 Uvira 1,013 709 947 2,669 2,167 123 Total 7,391 8,019 8,447 23,857 30,963 77 *The figures in this column were rounded to the nearest whole number.
Challenges: There is inconsistency between the number of deliveries by SBAs and other indicators related to childbirth, such as the number of women receiving AMTSL and the number of newborns receiving
DRC-IHPplus Year One Quarter Four/Annual Report: June 17, 2015 - June 30, 2016 Page 43 of 101 essential care. The norms and standards for assisted deliveries include AMTSL and essential care for newborns; therefore, the data should be close. IHPplus will conduct additional trainings (using the new MNCH competency-based training methodology) for health facilities to reinforce their knowledge and application of the skilled birth norms, and increase the number of supervision visits to health facilities to strengthen monitoring practices for deliveries.
Next steps: To continue to strengthen the capacity of health care providers in maternal and child health, the project will engage in the following steps: Strengthen community engagement in the early identification of pregnant women Increase availability of oxytocin in all health facilities Improve communication among health care providers, community leaders, and clients Increase availability of trained health care providers Distribute pediatric drugs to health facilities Improve commodity quantification and management Provide accurate and comprehensive analysis of data by health zones Conduct monitoring and supervision visits and RDQA to improve data quality (including partogram review and maternal death audit, jointly with the health zone management team4)
Expanded Program on Immunization (EPI): During PY1, the project continued to maintain overall good vaccination coverage, and the performance for five out of seven vaccine coverage rates is greater than 90% when compared to targets (see Table 30 below). Vaccines with coverage rates above 90% include tetanus vaccine 2+ (93%), DTP HepB-Hib1 (105%), DTP HepB-Hib3 (101%), measles (99%), and OPV3 (91%). Some vaccines included in the vaccination schedules did not achieve coverage of 90% or higher. For example, BCG and PCV13-3 had coverage rates of 84% and 69%, respectively, due to the low availability of these two vaccines at the national level.
Table 30: Vaccination coverage per antigen and per coordination during PY1 Coordination Tetanus BCG DTP DTP HepB- PCV13_3 OPV3 Measles (%) vaccine (%) HepB- Hib3 (%) (%) 2+ Hib1 (%) (%) (%) Bukavu 83 67 108 103 94 99 100 Kamina 107 98 107 104 33 100 103 Kole 95 88 107 103 31 92 104 Kolwezi 103 126 125 117 115 110 107 Luiza 88 84 100 98 45 92 98 Mwene Ditu 98 89 100 95 91 63 96 Tshumbe 94 74 93 89 5 82 93 Uvira 91 70 104 98 87 89 89 Total PY1 93 84 105 101 69 91 99 Target (%) 90 95 95 95 95 95 95 Achievement 103 88 111 106 73 96 104
4 While health zone management teams regularly lead maternal death audits in health facilities, they do not systematically do the same for neonatal deaths. It should be noted that the MOH is currently updating the maternal and neonatal deaths audit tool but it has not been validated yet.
DRC-IHPplus Year One Quarter Four/Annual Report: June 17, 2015 - June 30, 2016 Page 44 of 101 rate (%) PY1Q2 89 70 106 102 61 94 104 PY1Q3 91 71 102 97 70 84 94 PY1Q4 99 110 108 104 75 94 100
IHPplus exceeded the coverage rate target for four indicators, almost achieved it for two, and reported an achievement rate lower than 75% for only one (PCV13-3).
Several IHPplus initiatives contribute to the high coverage rates, including the following: Provided fuel for all refrigerators in project-supported health zones and other products to improve the functioning of the cold supply chain Transported vaccines and syringes to EPI points of service in hard-to-reach health zones (Mulungu) Conducted supportive supervision and monthly monitoring to validate data Provided leadership and management capacity building to the MOH DPS and health zone levels (the overall goal of the capacity building is to enable each provider to implement the atteindre chaque zone de santé approach, which includes annual workplanning, provision of quality immunization services, procurement and quality monitoring of immunization commodities, vaccination logistics management, surveillance of vaccine-preventable diseases, and BCC) Led community capacity building activities (organization of awareness-raising activities and trainings for volunteers and focus groups [Tshumbe], active research of vaccination drop-outs, and follow-up with communities to make sure that children are on track to receive all necessary vaccinations) Involved CODESAs in monthly meetings to analyze and monitor vaccination data, organized by health facility (Tshumbe and Mwene Ditu) Health facilities purchased vaccination indicators through the RBF program, leading to reductions in the number of drop-outs and number of non-vaccinated children and improvements in the quality of vaccination data (seven health zones)
Bukavu reported a 67% BCG coverage rate, and Uvira reported 70%, indicating that Sud Kivu province underperformed. An analysis of this situation revealed that, when the PEV ordered BCG vaccines, the 0.05 ml auto-disable syringes came from outside of the country by boat, while the vaccines arrived by air. In order to gain time, the PEV decided to send the vaccines to Sud Kivu province first, soon after they arrived, while the syringes were sent later, when they arrived in country; this explains the misalignment and delay in vaccinating people.
Kamina (Haut Lomami province) reported a 33% PCV13-3 immunization rate while Kole reported 31% coverage rate for PCV13-3. In Tshumbe (Sankuru province), a 5% coverage of PCV13-3 was reported and 45% in Luiza (Central Kasaï province). These health zones were the least adequately supplied with PCV13-3 over the last quarter by Kinshasa. The Mwene Ditu health zones reported a 63% OPV coverage rate, which implies that they were not sufficiently supplied due to the limited availability of this antigen in Kinshasa following the switch from the trivalent OPV to bivalent OPV.
Vaccination coverage for DTP-HepB-HiB3, OPV3, and PCV13-3: Figure 6 below illustrates the vaccination coverage for DTP-HepB-HiB3, OPV3, and PCV13-3 for PY1. DTP-HepB-HiB is the vaccine that is most available in health zones in all coordination areas. According to the national immunization calendar,
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Figure 6: Vaccination coverage for DTP-HepB-HiB3, OPV3 and PCV13-3 for PY1
140 120 100 DTC-Hib- 80 HepB3 60 OPV3 40 20 PCV13-3 0
The poor coverage rates for OPV3 and PCV13-3 are related to the low availability of vaccines at the central level and late deliveries of the vaccines, which results in logistical challenges in transporting and administering the vaccines in the provinces according to the schedule. However, it should be noted that the vaccination coverage for all three antigens increased (DTP-HepB-HiB3 and PCV13-3) or remained stable (OPV3) throughout the year. Tshumbe reported the lowest performance for both PCV13-3 (5%) and DTP-HepB-HiB3 (89%), while Mwene Ditu reported the lowest performance (63%) for OPV3. The low coverage rate of OPV3 was due to insufficient availability of the OPV trivalent following the switch to OPV bivalent planned for the end of April 2016. DRC, and the entire sub-region, must begin using OPV bivalent instead of OPV trivalent during vaccination campaigns during this period.
Monitoring activities for poliovirus and acute flaccid paralysis: During PY1Q2, DRC identified a vaccine- derived case of polio on January 13, 2016 (with laboratory confirmation on April 1, 2016). Following the identification, the country planned national vaccination days for children 0 to 59 months (a total of 18,266,268 children were targeted). The first national vaccination campaign took place from March 24-26, 2016, and a total of 17,058,304 children were vaccinated against polio (approximately 95% of the target population). Partners conducted independent monitoring exercises in households that verified that 5% of children were not vaccinated. Monitoring outside of the household in public places indicated that 6% of children were not vaccinated. The second vaccination campaign was organized from April 14-16, 2016, and a total of 19,111,663 children between 0 and 59 months were vaccinated against polio out of 17,970,359 expected. Partners also conducted independent monitoring exercises in households and outside of the household in public places that verified that in both cases, only 4% of children were not vaccinated (strong performance).
With regards to the monitoring of acute flaccid paralysis (AFP) cases, DRC reported 2,114 acute flaccid paralysis (AFP) cases, among which 66 were compatible cases. Ninety-three (93) AFP cases were reported from the 78 IHPplus-supported sites, and stool samples were collected for laboratory confirmation during PY1Q3. The majority of health zones that have not reported AFP cases are those with populations of less than 100,000 inhabitants (according to the norms, two to three cases of AFP are expected for every 100,000 inhabitants aged under 15). Additional efforts are needed to strengthen monitoring and community surveillance in areas where no cases are reported.
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Drop-out rate for Diphtheria, Tetanus, Pertussis-HepB-HiB3 among children less than 12 months: During PY1, 15,592 children less than 12 months did not complete the full regimen of DTP-HepB-Hib1-3 vaccination out of 366,645 who received DTP-HepB-Hib1 (4.25%), which is below the PMP target and within World Health Organization (WHO) standard (0-10%). The achievement rate for this indicator was 118%, compared to the PMP target of 5%.
Figure 7: Drop-out rate for DTP-HepB-HiB3 among children less than 12 months of age during PY1
6 5.43
5 4.25 3.68 3.69 4
3 Drop-out rate (%) 2
1
0 PY1Q2 PY1Q3 PY1Q4 PY1 average
Fight against yellow fever: IHPplus provided support to the national EPI in leading a massive vaccination campaign against yellow fever in nine health zones in central DRC (including Boma, Bungu, Kitona, Mwanda, Matadi, Nsana Pangu, Nzanza, Kimpese, and Kimpangu) in May and June 2016. This campaign was a response to a deadly yellow fever epidemic. As several communities were affected, community mobilization was strong and patients of all ages rushed to immunization sites to receive the anti-yellow fever vaccination. To manage the abnormal flow of patients, the project worked alongside immunization teams to start vaccinating patients early on and organize a schedule to avoid exhaustion and stress among the teams. In addition, the project made sure that the community was informed about this schedule and was aware that there were enough vaccines for everyone to avoid panic.
The results of the yellow fever vaccination campaign were satisfactory. For the nine health zones, the project expected 1,322,637 patients aged nine months and up, which represents around 96% of the total population (1,377,747) of these health zones. In total, 1,367,625 persons were vaccinated against yellow fever, a coverage rate of 103%. Overall, 1,439,626 doses of vaccine were received, of which 1,405,221 doses were used and 37,596 doses were lost during the immunization process (a loss rate of 3%), an acceptable rate for mass campaigns which aim for less than 5% loss.
Lessons learned: Yellow fever campaigns should be planned jointly with the EPI logistics team (EPI leadership, EPI satellite office) and logistics partners in terms of the management and assessment of daily needs for vaccination commodities and materials during mass campaigns in order to ensure all vaccines, data management tools, and other inputs are available early in the campaign (stock cards, budgeting for results tracking of vaccinations, and communications cards for storage sites located in remote areas). The major challenge remaining is insufficient availability of vaccines and other vaccination commodities at the national and provincial levels. Monitoring the daily management of immunization services remains challenging in remote and hard-to-reach health areas, particularly for vaccinated people who require
DRC-IHPplus Year One Quarter Four/Annual Report: June 17, 2015 - June 30, 2016 Page 47 of 101 timely responses if a problem occurs. Tracking of inputs by vaccination site was also a challenge as supervision teams were required to track use and daily consumption of vaccines and other immunization inputs (vaccines, cards, thinners, bins, etc.). Some vaccination sites received management tools late, and at times there is a lack of communication between planning units that communicate the results of immunizations and use of vaccines and other commodities and the provincial coordination committee. For future mass campaigns it is recommended that the health zone management and provincial support teams plan specific logistics for areas with limited access and strengthen communication to ensure that these zones or areas have live vaccines.
Next steps: To strengthen project performance, IHPplus will conduct the following activities: Support joint supervision visits to validate data through RDQA Conduct regular monitoring meetings to analyze and validate data Continue to distribute vaccines and other commodities in the provinces Continue to provide support to maintain the cold supply chain Strengthen active surveillance of diseases that can be prevented by vaccines
Family planning: Family planning activities are implemented in 1,477 health facilities. To align with the national priorities outlined in the Multisectoral Strategic Plan for Family Planning 2014-2020, which aims to increase modern contraceptive prevalence and ensure access and utilization of modern contraceptive methods by at least 2.1 million new adopters. IHPplus has expanded its family planning activities with the integration of new methods, including Sayana® Press and Implanon NxT, and has supported the utilization of other methods at the health facility and community levels. During the first year of implementing IHPplus, 445 health care providers were trained, including 136 clinical providers and 307 community- based distributors (CBDs) (229 men and 78 women). CBDs are trained to administer clinical methods, including birth control pills (both progestogen-only pills and combined pills) and Sayana® Press.
Couple Years of Protection: As shown in Table 31 below, the results obtained during PY1 (430,423 CYP) equate to a 99% achievement rate of the PMP target (434,619 CYP). A total of five coordination areas exceeded their targets, whereas three coordination areas fell short of their targets.
Table 31: CYP in USG-supported programs Coordination PY1Q2 PY1Q3 PY1Q4 Total Target Achievement PY1 Rate (%) Bukavu 35,202 31,095 28,453 94,750 126,040 75 Kamina 19,519 19,773 19,745 59,037 69,539 85 Kole 10,180 10,512 10,006 30,699 30,423 101 Kolwezi 19,189 20,283 21,765 61,237 30,423 201 Luiza 17,916 18,426 22,217 58,559 47,808 122 Mwene Ditu 25,434 24,333 28,581 78,348 69,539 113 Tshumbe 10,189 10,150 10,198 30,537 30,423 100 Uvira 5,652 5,573 6,033 17,258 30,423 57 Total 143,281 140,145 146,998 430,423 434,619 99 The following factors contributed to this strong performance: • Integrated clinical methods at the community level, including the birth control pill and Sayana® Press
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• Conducted mini-campaigns in the health zones of Ndekesha, Dibaya, Luiza, Fungurume, Kanda Kanda, and Bibanga • Ensured the availability of family planning commodities • Reinforced clinical providers’ skills • Provided post-training support and joint supervision visits
Sud Kivu’s under-performance is linked to the same situation that has decreased the number of family planning counseling visits in Bukavu and Uvira--namely, under-motivation of CHWs after the departure of other partners who paid them to be CBDs, an overall shortage of CBDs, and stock-outs of Jadelle and Implanon implants (preferred by women in Sud Kivu). On the other hand, Kamina’s under-performance is chiefly due to insufficient availability of family planning commodities at service delivery points.
Number of family planning counseling visits: As indicated in Table 32a below, nearly 600,000 family planning counseling visits took place during PY1, representing 96% of the annual PMP target. Table 32b provides the results for each quarter. More than one-fifth of counseling visits were led by CBDs. This strong performance across six coordination areas can be attributed to CBD trainings organized by both IHPplus, which trained 307 CBDs, and E2A; awareness-raising mini-campaigns organized in the health zones; and the availability of commodities. The Luiza coordination reported the highest number of counseling visits, due to the high number of CBDs in its health zones; in four health zones (Ndekesha, Dibaya, Bilomba, and Luiza), at least three CBDs per health area received family planning training. The under-performance of Bukavu and Uvira resulted from the lack of motivation of CBDs, who were receiving payment from other partners in some health zones (particularly Kalonge, Katana, Idjwi, and Kalole); and from the delayed distribution of family planning commodities to CHWs in these coordination areas.
Table 32a: Family planning counseling visits during PY1 (total) Coordination PY1 Target Achievement Clinical CBD Total rate (%) provider Bukavu 114,117 1,677 115,794 179,141 65 Kamina 79,259 23,904 103,163 98,836 104 Kole 44,277 11,682 55,959 43,241 129 Kolwezi 47,481 408 47,889 43,241 111 Luiza 48,097 40,169 88,266 67,950 130 Mwene Ditu 82,184 27,066 109,250 98,836 111 Tshumbe 34,729 11,815 46,544 43,241 108 Uvira 21,047 4,680 25,727 43,241 59 Total 471,191 121,401 592,592 617,728 96
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Table 32b: Family planning counseling visits during PY1 (by quarter) Coordination PY1Q2 PY1Q3 PY1Q4 Clinical CBD Clinical CBD Clinical CBD provider provider provider Bukavu 38,640 554 38,141 662 37,336 461 Kamina 27,691 9,630 28,330 9,763 23,238 4,511 Kole 14,188 3,848 16,554 3,662 13,535 4,172 Kolwezi 16,275 27 15,188 230 16,018 151 Luiza 17,229 15,332 14,878 11,304 15,990 13,533 Mwene Ditu 33,327 2,405 19,914 11,183 28,943 13,478 Tshumbe 10,519 4,241 15,251 3,939 8,959 3,635 Uvira 6,835 2,359 6,793 1,386 7,419 935 Total 164,704 38,396 155,049 42,129 151,438 40,876
Next steps: 1. Organize family planning trainings targeting clinical providers and CBDs in at least five health zones in the province of Sud Kivu (Katana, Nundu, Minova, and Walungu) 2. Provide trained CBDs with family planning kits 3. Ensure post-training follow-up in the health zones of Fungurume, Bibanga, and Kanda Kanda 4. Organize joint MOH-IHPplus supervision visits to ensure the quality of family planning services 5. Reinforce logistics, monitoring, and distribution of family planning commodities in the Malemba Nkulu health zone of Kamina coordination
Nutrition: Performance on the four nutrition indicators reported and analyzed in this report (number of pregnant women who received iron and folic acid supplements, number of mothers of children two years or less receiving nutritional counseling for their children, number of people trained in child health and nutrition, and number of health facilities reporting iron-folate stock-outs) is related to procurement of nutrition commodities, capacity building, monitoring, and community strengthening. During PY1 two indicators surpassed their respective targets (number of pregnant women who received iron and folic acid supplements, number of mothers of children two years or less receiving nutritional counseling for their children) and two underperformed (number of people trained in child health and nutrition and number of health facilities reporting iron-folate stock-outs). The integration of the nutrition support group approach—on infant and young child feeding (IYCF)—and culinary demonstrations contributed to the improvement of the number of mothers and children under two years receiving nutritional support.
Joint activities between USAID, the Programme National de Nutrition (National Nutrition Program, or PRONANUT), and IHPplus: Following a USAID/DRC recommendation, an IHPplus nutrition advisor participated in a multi-sectoral strategy in nutrition conference in Accra, Ghana, in January 2016. The objectives for this conference were to: • Improve understanding of USAID’s multisectoral nutrition strategy • Review recent evidence and receive technical advice to guide multi-sectoral nutrition programs • Share and learn from recent experiences of other participants in the forum • Identify gaps and reinforce promising approaches to multisectoral nutrition programs
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The USAID/Washington nutrition team, which gave a briefing on the multisectoral nutrition strategy, and the shared experiences presented by different experts, emphasized that nutrition is a cornerstone for sustainable development: approximately 20% of chronic malnutrition cases require a multisectoral nutrition response, relying on high-impact interventions during the first 1,000 days of life and among adolescent women.
USAID cited IHPplus as an example of how integrating nutrition, WASH, and other areas of health programming contributes to successful results. They noted that if the IHPplus experience was extended to other sectors, such as agriculture, or education, USAID would contribute drastically to the reduction of chronic malnutrition and therefore enhance sustainable development in DRC.
From February 13-26, 2016, USAID and IHPplus representatives conducted a joint mission in the Kanzenze and Lubudi health zones located in the Kolwezi DPS in the Lualaba province. The goal of this mission was to assess project progress in nutrition and WASH interventions. Findings related to nutrition include the following: • Improvements in IYCF occurred as a result of financial and technical support of IHP in all health zones visited • Monitoring of nutrition activities in the Kanzenze health zone is not done at all levels (DPS, health zone central office, and health centers) • In the Lubudi health zone, the health zone management team oversees and assists health providers and community volunteers in promoting IYCF; as a result, functional IYCF support groups and cases of successful breastfeeding were observed
IHPplus, UNICEF, and the Interchurch Medical Assistance (IMA) World Health jointly funded and provided technical support to the Kinshasa workshop on Strengthening of the PRONANUT Nutrition Information System in the DRC in December 2015. This workshop included 40 participants from the PRONANUT central and provincial nutrition coordination offices (including Nord Kivu, Sud Kivu, Kwilu, Haut Katanga, Kasaï Oriental, Kasaï Central, Kongo Central, Equateur, and Maniema), national statistics institutions, and nutrition partners (UNICEF, World Food Program, Food and Agriculture Organization, WHO, IHP, IMA, Hellen Keller International, Cooperazione Internazionale, Adventist Development and Relief Agency, Caritas, Save the Children, etc.). Participants reviewed the information system of three major nutrition pillars (Système de Surveillance Nutritionnelle, Sécurité Alimentaire et Alerte Précoce [SNSAP], nutrition surveys and routine nutrition data) and analyzed weaknesses such as poor data management (collection and analysis of data, decision-making to address the worst-performing indicators, and data archiving). Data quality remains a challenge at both the health center and national levels, from the central health zone offices and the provinces. Workshop participants identified practical solutions for each pillar: Pillar 1: Nutrition monitoring system, food security, and early warning program [Supplemental Nutrition Assistance Program]; Pillar 2: Nutrition surveys; and Pillar 3: Data generated by routine response activities (preventive and curative). The outcome of the workshop included an action plan with assigned responsibilities and deadlines.
In June 2016, the PRONANUT central office, represented by its deputy director, participated in the IHPplus PY2 workplanning workshop.
Proportion of pregnant women who received iron-folate tablets to prevent anemia during the last five months of pregnancy: During PY1, 527,593 pregnant women, or 131% of the expected pregnancies, received iron-folate supplements (see Table 33 below). Compared to the target of 89%, this represents an achievement rate of 148%.
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Table 33: Number and percent of pregnant women who received iron-folate to prevent anemia during PY1 Coordination # pregnant women receiving iron-folate Number of % pregnant Target Achievement expected women (%) rate (%) PY1Q2 PY1Q3 PY1Q4 Total PY1 pregnancies receiving (4% pop) iron-folate Bukavu 43,414 47,478 64,574 155,466 115,212 135 89 152 Kamina 19,193 25,043 25,910 70,146 63,414 111 89 124 Kole 14,191 15,503 11,045 40,739 29,745 137 89 154 Kolwezi 16,742 13,947 15,348 46,037 27,465 168 89 188 Luiza 15,004 21,617 18,166 54,787 44,472 123 89 138 Mwene Ditu 37,198 34,421 31,755 103,374 65,703 157 89 177
Tshumbe 10,296 11,090 12,603 33,989 27,330 124 89 140 Uvira 6,000 7,702 9,353 23,055 28,980 80 89 89 Total 162,038 176,801 188,754 527,593 402,321 131* 89 148 *Numbers may not add exactly due to rounding
As shown in Table 33, project performance increased throughout the project year (from 162,038 in PY1Q2 to 188,754 in PY1Q4). All coordinations but Uvira (80 compared to 90) surpassed their quarterly objectives. These results exceed the expected targets because, on one hand, in partnership with the CDRs, IHPplus provided an ongoing supply of EGMs –including iron-folate–based on the needs of the zones. On the other hand, through prenatal consultations, pregnant women coming from surrounding areas, outside the funded health zones, also received supplements through Bukavu.
Lesson learned: Iron-folate availability appears to positively influence the use of ANC services across health zones.5
Next steps: During PY2, the project will increase the indicator annual target, continue to supply health zones with iron and folic acid on a quarterly basis, support health zone management teams to better manage these commodities at health facilities, and encourage the teams to put in place a distribution plan and assume responsibility for transport costs to health facilities.
Number of mothers of children two years of age or younger who have received nutritional counseling for their children: During PY1, 564,212 of a target of 511,434 expected mothers with children two years of age or younger received counseling (110%). Overall, IHPplus performance improved over the year. During PY1Q2, the project reported 182,913 mothers who received counseling, a number that decreased to 177,885 during PY1Q3. However, the project was able to apply corrective measures in time to reverse the downward trend and reported 203,414 mothers during the last quarter (see Table 34 below).
5 When health facilities experience iron-folate stock-outs, ANC visits tend to decrease as pregnant woman seem encouraged to attend ANC visits when they know they will receive iron-folate supplementation. However, the project is challenged to prove this theory as no data is collected related to the number of women who say they attend ANC visits to receive iron-folate supplementation.
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Table 34: Number of mothers of children two years of age or younger who have received nutritional counseling for their children during PY1 Coordination PY1Q2 PY1Q3 PY1Q4 Total PY1 Target Achievement (%) rate (%) Bukavu 61,085 53,798 65,951 180,834 148,316 122 Kamina 21,234 20,379 19,764 61,377 81,829 75 Kole 9,538 9,945 12,178 31,661 35,800 88 Kolwezi 13,082 15,900 16,942 45,924 35,800 128 Luiza 16,885 15,917 21,006 53,808 56,258 96 Mwene Ditu 35,731 36,449 37,227 109,407 81,829 134 Tshumbe 7,862 7,540 8,508 23,910 35,800 67 Uvira 17,496 17,957 21,838 57,291 35,800 160 Total 182,913 177,885 203,414 564,212 511,434 110
Uvira (160%), Mwene Ditu (134%), Kolwezi (128%), and Bukavu (122%) reported the highest performance during PY1. Three other coordinations almost achieved their respective target: Luiza (96%), Kole (88%), and Kamina (75%). Tshumbe underperformed, with 67% achievement rate.
IHPplus exceeded its PMP targets through continuous support to IYCF promotional activities at the health facility and community level, such as the following: Trained health providers and community volunteers in the Mpokolo and Dibindi health zones on IYCF promotion Trained health providers in the Kanzenze and Mutshatsha health zones to provide specific guidance regarding child feeding during pre-school consultation (PSC) sessions (according to anthropometric parameters of height and weight for age) Provided written feedback after IYCF health zone support group data was analyzed (many health providers have improved their performance after receiving IHPplus coordination staff feedback, such as Uvira, Ruzizi, and Lemera health zones, which all received written feedback during PY1Q3 and saw their performance drastically improve for the indicator related to the number of mothers of children two years of age or younger during who have received nutritional counseling during PY1Q4, from 17,957 to 22,004) Conducted joint IHPplus/MOH supervision missions to reinvigorate IYCF support groups in some health zones such as Uvira, Ruzizi, Lemera (Uvira Coordination); Lodja, Vangakete, Kole Ototo, Bena Dibele, Lomela, Omendjadi (Kole Coordination); and Tshumbe, Wembonyama, Djalo, Katako- Kombe, Lusambo. and Dikungu (Tshumbe Coordination) Integrated community weighing into the new PSC protocol in the Luiza health zones, during which health workers advise mothers on feeding their children according to anthropometric parameters (height, weight) Supported home visits led by CHWs to advise households on breastfeeding and nutritional best practices for children
During PY1Q2, IHPplus staff and PRONANUT provincial office teams conducted joint missions in February 2016 to follow up on IYCF integration through the IYCF support groups and at the health facilities in the following health zones: Ndekesha and Kalomba (Luiza); and Ruzizi, Nunu Uvira, and Lemera (Uvira).
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During the missions, supervisors observed that some health zone management teams provided poor feedback and guidance to health care providers. CHWs continue to conduct home visits to provide household counseling on breastfeeding and on food fortification for children. IYCF support groups are still operational; and the topics linked to good nutrition practices are presented by the providers during the nutrition and health training sessions of the PSC, ANC, etc. IHPplus worked with stakeholders to develop immediate action and recovery plans for any weaknesses noted in each facility. IHPplus expanded the integration of IYCF in March 2016 by funding a health care provider and CHW training in IYCF in all of the health zones of Mpokolo and Dibindi, facilitated by PRONANUT experts from Kasaï Oriental province.
IYCF support groups and active CODESAs both contribute to the strengthening of information and the adoption of good practices regarding infant nutrition. The continuation of IYCF activities in the health areas requires the guidance of the health zone management team, as well as the need for activities on areas of interest such as food security.
Next steps: In order to maintain project performance, IHPplus will implement the following actions during the next quarter: Provide financial support for IYCF integration training in the Bilomba, Luambo, Dekese, and Yangala health zones (Luiza coordination) Extend IYCF promotional activities through training health providers and community volunteers in Songa, Kayamba, Kinkondja, and Malemba Nkulu health zones (Kamina coordination) Conduct joint missions to revitalize IYCF support groups in collaboration with PRONANUT Provide advice cards to build awareness of IYCF support groups (Kolwezi coordination) Provide supportive supervision with health facility staff during PSC sessions and invite health zone management teams to conduct joint monitoring of IHP activities and support groups for all health zones (particularly Tshudi and Lomela [Kole coordination]) Conduct quarterly monitoring of community nutrition activities with PRONANUT in the lowest- performing health zones (Kalole, Kitutu, Mwenga, and Shabunda), equip health facilities with IYCF reporting and advocacy tools, and support training for CHWs and health providers on IYCF in Nyangezi and Walungu health zones (Bukavu and Uvira coordinations)
Number of people trained in child health and nutrition through USG-support: During PY1, IHPplus trained 131 people on health and nutrition in Mwene Ditu and Kolwezi health zones, which represents a 12% achievement rate compared to the PMP target of 1,111. This underperformance can be explained by the fact that the project began reporting on this indicator only during PY1Q3 and in one coordination. The PMP target is pending USAID approval.
During PY1Q3, only Mwene Ditu provided financial and technical support to train 74 health staff in child health and nutrition from Mpokolo and Dibindi health zones. In each health zone, 37 people were trained: two members of the health zone management team, 10 nurses from the health centers, and 25 CHWs. Other coordination areas were unable to conduct any training during PY1Q3, due to conflicting activity calendars between those supported by IHPplus and those supported by other partners.
During PY1Q4, 57 health workers were trained on health and nutrition in Kolwezi. The project led two types of training: Five-day training to strengthen health workers (one nurse per health area) and health zone management team members’ skills to deliver revitalized PSC in Kanzenze and Mutshatsha health zones. This training was facilitated by PRONANUT staff in Lualaba province with technical support
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from PRONANUT leadership and the IHPplus technical nutrition advisor. In total, 40 people were trained (34 men and 6 women). Three-day briefings for managers in the Lualaba DPS on nutrition interventions including : management of Integrated Management of Acute Malnutrition, IYCF promotion, revitalized PSC, community-based nutrition, Supplemental Nutrition Assistance Program guidelines for IYCF support groups, Children’s Health Days, and post-training monitoring and supervision of nutrition activities. Seventeen people (16 men and 1 woman) were briefed.
Lessons learned: Providing briefings to DPS officials on nutrition interventions helped increase their monitoring of these activities during their supervision visits and led to an increase in the number of mothers who received guidance on feeding their child during PSC.
Next steps: Each coordination office will determine its quarterly target for this indicator. In addition, the project will implement, with the provincial PRONANUT teams, the action plan drafted during PY1Q4, which indicates planned nutrition and health trainings for the coming project year.
Malaria
Prevention: During PY1, a total of 292,105 pregnant women, or 73% of expected pregnancies, received two doses of IPTp (see Table 35a). Compared to the target of 75%, this represents an achievement rate of 97%. As shown in Table 35b, the number of pregnant women receiving two doses of IPTp steadily increased during the year: PY1Q2 (90,865), PY1Q3 (99,565), and PY1Q4 (101,675). Project performance increased 6 percentage points from the beginning of the year, from 70% in PY1Q2 to 76% in PY1Q4.
Four of the eight coordination offices achieved or exceeded their targets of 75. Kamina and Bukavu fell slightly below their targets, with 73% and 70%, respectively. The lowest-performing coordination areas were Kolwezi (65%) and Uvira (52%). The four coordination areas underperformed largely because pregnant woman begin attending ANC visits (where they receive their IPTp) late in their pregnancies.
Table 35a: Number and percentage of pregnant women who received at least two doses of SP during ANC visits during PY1 (total) Coordination Number of pregnant Total number of Percentage of Target (%) Achievement women who expected pregnant women rate (%) received at least pregnancies in who received at two doses of SP USG-assisted least two doses of during ANC visits health facilities SP (%) PY1 Bukavu 79,770 114,093 70 75 93 Kamina 45,713 62,799 73 75 97 Kole 22,751 29,457 77 75 103 Kolwezi 17,571 27,198 65 75 87 Luiza 38,273 44,040 87 75 116 Mwene Ditu 52,628 65,065 81 75 108 Tshumbe 20,464 27,065 76 75 101 Uvira 14,935 28,699 52 75 69 Total 292,105 398,416 73 75 97
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Table 35b: Number and percentage of pregnant women who received at least two doses of SP during ANC visits during PY1 (by quarter) Coordination Number of pregnant women Total number of expected Percentage of pregnant who received at least two pregnancies in USG-assisted women who received at doses of SP during ANC visits health facilities least two doses of SP (%) PY1Q2 PY1Q3 PY1Q4 PY1Q2 PY1Q3 PY1Q4 PY1Q2 PY1Q3 PY1Q4 Bukavu 22,552 27,880 29,338 37,285 38,404 38,404 60 73 76 Kamina 14,960 14,289 16,464 20,523 21,138 21,138 73 68 78 Kole 8,406 7008 7,337 9,627 9,915 9,915 87 71 74 Kolwezi 5,632 6,011 5,928 8,888 9,155 9,155 63 66 65 Luiza 12,004 13,890 12,379 14,392 14,824 14,824 83 94 84 Mwene Ditu 17,185 18,271 17,172 21,263 21,901 21,901 81 83 78
Tshumbe 6,373 7,100 6,991 8,845 9,110 9,110 72 78 77 Uvira 3,753 5,116 6,066 9,379 9,660 9,660 40 53 63 Total 90,865 99,565 101,675 130,202 134,107 134,107 70 74 76
IHPplus, in collaboration with SIAPS and CDRs, distributed 3,461,000 SP tablets to health facilities on a regular basis (618,000 tablets in PY1Q2, 1,887,000 tablets in PY1Q3, and 956,000 during PY1Q4), which contributed to this strong performance. Compared to the PMP target of 1,800,000, this represents an achievement rate of 192%. At the end of PY1Q4, all CDRs had 3,639,000 SP tablets (13-month supply). While the coordination areas of Bukavu and Uvira did not achieve the target of 75%, their performance improved significantly over the year, from 60% to 76% and 40% to 52%, respectively. In addition to the regular distribution of SP tablets, community interventions such as awareness-raising initiatives conducted by Champion Communities and CHWs, household visits, and mini-campaigns encouraging pregnant women to visit health centers as soon as they missed a menstrual period contributed to these results.
In the next quarter, IHPplus will strengthen its focus in Kolwezi, where performance remained low throughout the year (varying between 63% and 66%). The project is also planning to develop plans to improve performance with awareness-raising activities in health zones with particularly low performance such as Bunkeya (26%) and Manika (39%).
Number of LLINs purchased with USG funds that were distributed: As illustrated in Table 36a, below, a total of 430,718 LLINs were distributed in PY1 during ANC and PSC visits. The project exceeded the target of 341,250 LLINs, for an achievement rate of 126%. Table 36b summarizes the number of LLINs distributed during each quarter.
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Table 36a: Number of LLINs purchased with USG funds that were distributed during PY1 Coordination Total PY1 Target (%) Achievement rate (%)
Bukavu 133,483 98,961 135 Kamina 23,302 54,600 43 Kole 13,409 23,889 56 Kolwezi 46,960 23,889 197 Luiza 25,433 37,533 68 Mwene Ditu 114,884 54,600 210 Tshumbe 27,410 23,889 115 Uvira 45,837 23,889 192 Total 430,718 341,250 126
Table 36b: Number of LLINs purchased with USG funds that were distributed during PY1 (per quarter) Coordination PY1Q2 PY1Q3 PY1Q4 ANC PSC TOTAL ANC PSC TOTAL ANC PSC TOTAL Bukavu 16,624 7,709 24,333 38,150 6,350 54,500 38,255 16,395 54,650 Kamina 9,913 5,889 15,802 - - - 5,250 2,250 7,500 Kole 2,609 1,750 4,359 - - - 6,335 2,715 9,050 Kolwezi 5,154 4,106 9,260 26,390 11,310 37,700 - - - Luiza 7,369 4,564 11,933 2,030 870 2,900 7,420 3,180 10,600 Mwene Ditu 11,180 6,472 17,652 9,940 4,260 14,200 58,122 24,910 83,032
Tshumbe 3,654 3,156 6,810 - - - 14,420 6,180 20,600 Uvira 4,283 3,104 7,387 22,015 9,435 31,450 4,846 2,154 7,000 Total 60,786 36,750 97,536 98,525 42,225 140,750 134,648 57,784 192,432
Project performance increased each quarter, from 97,536 in PY1Q2 to 192,432 in PY1Q4. This represents an increase from 86% of the quarterly target of 113,750 LLINs to 169%. The strongest performing coordination areas were Uvira, Bukavu, Tshumbe, Mwene Ditu, and Kolwezi. Additional efforts are needed to increase the availability of LLINs in health facilities in the coordination areas of Luiza, Kole, and Kamina. As explained for the previous malaria indicator, the three coordination areas underperformed largely because pregnant women start ANC visits (where they receive their LLIN) late in their pregnancies.
In addition to continuing to transport LLINs from CDRs to health facilities, IHPplus will regularly monitor the management of malaria commodities with health zone and DPS staff to strengthen performance in low-performing coordination areas. The project will also improve monitoring of LLIN distribution from health zone central offices to health facilities, which is currently the weakest link in the supply chain. During supervision visits, the supervision team will verify distribution plans and delivery orders.
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The percentage of pregnant women receiving LLINs during ANC visits has increased significantly during PY1. Compared to IHP PY5, when 46% of pregnant women received an LLIN during the first ANC visit, 70% of pregnant women (293,959/413,902) received an LLIN during the first ANC visit. To achieve this result, during joint supervision visits, IHPplus and the MOH promoted the strategy of providing LLINs to pregnant women during other ANC visits if there were stock-outs during the time of their first ANC visit.
Correctly managing malaria cases in health facilities through training and distribution of medicine and commodities (ACTs, RDTs, and supervision): During PY1, IHPplus distributed 2,761,433 ACT treatments: 2,699,974 in health facilities and 61,659 through community care sites (see Table 37a below). Compared to the target of 2,400,000, the achievement rate is 115%. As illustrated in Table 37b, over the course of the year, distribution of ACT treatments increased to health facilities, from 440,850 in PY1Q2 to 1,096,349 in PY1Q4. Distribution to community care sites remained relatively the same: 22,045 in PY1Q2, 21,364 in PY1Q3, and 18,050 in PY1Q4.
Health zones in the coordination offices of Kolwezi (233%), Uvira (210%), Bukavu (131%), and Tshumbe (125%) had the strongest performance. The lowest performance was recorded in Kamina (56%), where the highest number of health facilities reported stock-outs of ACT treatments. IHPplus will strengthen efforts in this coordination area to improve performance in the coming quarters.
Table 37a: Number of ACT treatments purchased with USG funds that were distributed during PY1 (total) Coordination PY1 Total PY1 Target (%) Achievement rate (%) Health Community facilities Bukavu 905,824 5,710 911,534 696,000 131 Kamina 196,573 20,055 216,628 384,000 56 Kole 142,421 6,185 148,606 168,000 88 Kolwezi 388,633 3,177 391,810 168,000 233 Luiza 185,352 5,664 191,016 264,000 72 Mwene Ditu 324,115 14,914 339,029 384,000 88
Tshumbe 205,917 3,889 209,806 168,000 125 Uvira 351,139 1,865 353,004 168,000 210 Total 2,699,974 61,459 2,761,433 2,400,000 115
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Table 37b: Number of ACT treatments purchased with USG funds that were distributed during PY1 (by quarter) Coordination PY1Q2 PY1Q3 PY1Q4 Health Community Health Community Health Community facilities facilities facilities Bukavu 134,257 2,002 278,585 1,490 492,982 2,218 Kamina 79,481 6,947 71,067 9,708 46,025 3,400 Kole 24,102 4,566 68,771 954 49,548 665 Kolwezi 42,657 1,024 310,048 1,081 35,928 1,072 Luiza 37,957 1,619 72,452 2,998 74,943 1,047 Mwene Ditu 42,838 4,266 143,059 3,316 138,218 7,332
Tshumbe 42,748 1,187 72,301 1,249 90,868 1,453 Uvira 36,810 434 146,492 568 167,837 863 Total 440,850 22,045 1,162,775 21,364 1,096,349 18,050
Since PY1Q3, IHPplus adopted several strategies to improve the availability of malaria commodities at health facilities on a regular basis, including providing a six-month supply instead of three months and conducting joint missions to monitor malaria commodity management. During these monitoring missions, the supervision team verified the commodity distribution plan at health zone central offices. In a total of 766 community care sites, IHPplus provides a complete package of care to fight the three most common childhood illnesses (pneumonia, diarrhea, and malaria). During PY1, the project distributed 61,459 ACT treatments for children ages 2-11 months and 1-5 years through these sites. As a result, more than 60,000 children less than five years of age received the necessary care for malaria early, at the community level.
To treat severe cases of malaria, IHPplus distributed 96,484 vials of quinine and 139,229 artesunate suppositories to health facilities at the referral network level. The project also distributed 6,329 artesunate suppositories (50 mg) and 983 suppositories (200 mg) to community care sites and health centers for severe malaria case management at the community level.
Challenge: The Bukavu and Uvira coordinations have a surplus of artesunate injectable at the CDR level (440,087 artesunate injectables, or approximately a 60-month supply). Most health zones in Bukavu and Uvira use quinine injectable to treat severe cases of malaria, as only six of the 27 health zones have been trained on the use of the artesunate injectable for treating severe cases of malaria. Use of artesunate injectables in these areas remains low, and the commodities are at risk for expiration.
Next steps: IHPplus, in collaboration with the Sud Kivu DPS, will expedite training for health providers on the use of the artesunate injectables in GRHs and CSRs in the remaining 21 health zones with the goal of completing trainings in all remaining health zones by the end of September 2016. In PY2Q1, IHPplus will revitalize 10 community care sites in the Kalenda health zone and establish 40 new sites in the project’s new health zones: Miabi (7), Kabinda (21), and Kansasa (12), which should contribute to solving the ACT overstock problem reported in Bukavu and Uvira.
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IHPplus has observed a gradual improvement in the number of RDTs distributed to health structures over the course of PY1 (see Table 38 below). In total, the project distributed 1,470,479 RDTs to health structures, which represents an achievement rate of 78% when compared to the target of 1,875,000: 366,533 in PY1Q2 (58% achievement rate), 526,200 in PY1Q3 (92% achievement rate), and 577,746 in PY1Q4 (93% achievement rate). The low results in PY1Q2, as well as poor performance in Mwene Ditu (38%) and Kole (51%), contributed to the overall underperformance for the year.
Table 38: Number of USG-funded malaria RDTs that were distributed during PY1 Coordination Number of RDT purchased with USG funds that were distributed Achievement PY1Q2 PY1Q3 PY1Q4 Total PY1 Target rate (%) Bukavu 96,381 170,370 203,761 470,512 543,750 87 Kamina 90,896 116,436 125,693 333,025 300,000 111 Kole 25,441 23,940 17,484 66,865 131,250 51 Kolwezi 23,388 34,594 47,629 105,611 131,250 80 Luiza 29,689 52,666 41,826 124,181 206,250 60 Mwene Ditu 19,137 48,346 46,343 113,826 300,000 38 Tshumbe 31,189 22,987 38,106 92,282 131,250 70 Uvira 50,412 56,861 56,904 164,177 131,250 125 Total 366,533 526,200 577,746 1,470,479 1,875,000 78
There is a shortage of RDTs in the country, which are managed by USAID|DELIVER. As of the end of June 2016, CDRs have no remaining stock of RDTs. Health zones are using their current stock of RDTs; however, some have already reported stock-outs. USAID|DELIVER informed IHPplus that additional RDTs would be available again in the country in August 2016.
To improve performance throughout the year, IHPplus and the MOH conducted “open door days” and provided free health care services to patients presenting a fever or who had a fever within the past 48 hours. This strategy helped increase the curative services utilization rate and use of commodities with close expiration dates. A report demonstrating how IHPplus used 30,000 RDTs with short expiration dates from May-April 2016 in the Kamiji, Mpokolo, and Bibanga health zones is included as Appendix 15.
Lesson learned: “Open door days” is an effective strategy for increasing the curative health services utilization rate and avoiding loss of stock due to expiration.
Next steps: To continue to improve malaria case management in the coming year, IHPplus will use the “open door day” strategy in other coordination areas to increase the use of RDTs and other commodities with close expiration dates at health facilities.
To better anticipate stock-outs in health zones, IHPplus redistributed commodities from the Kamina warehouse to CAMELU and Kolwezi; however, the quantities received were not sufficient and covered needs for only one month. IHPplus also requested commodities from the Global Fund’s SANRU project, which is in the same situation and experiencing stock-outs.
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Strengthening the capacity of health providers in malaria case management: In PY1, IHPplus trained a total of 1,231 health providers (1,000 men, 231 women) on treating and managing malaria cases through ACT, IPTp, and RDTs (697 in PY1Q2, 115 in PY1Q3, and 419 in PY1Q4). While the number of staff trained in ACT, IPTp, and RDTs are reported in distinct indicators, the project trained health providers simultaneously in the utilization of all three treatments during PY1, which explains why the results reported for PY1 are identical for the three indicators. Compared to the PMP target number of health workers trained in IPTp (860), this represents an achievement rate of 143%. The project also exceeded the target number of health workers trained in ACT and RDTs (1,000), for an achievement rate of 123%. IHPplus also conducted post-training monitoring visits to reinforce the application of skills and competencies learned.
Other activities related to malaria led by the project team during PY1: The implementation phase of the feasibility study on the use of rectal artesunate in community care sites took place from May 2015 to March 2016. It should be noted that it was extended by two additional months (from the original timeline) to allow the sample population to reach its estimated size. During PY1Q3, the implementation phase of the feasibility study was completed, with follow-up visits scheduled in seven health zones. During PY1Q4, IHPplus conducted monitoring visits in each health zone targeted for the feasibility study, visiting at least 60% of participating community care sites.
Following the conference in Nairobi, Kenya, on IMCI scale-up, IHPplus supported national c-IMCI coordination efforts to implement key recommendations from the conference. The project conducted a two-day workshop to develop the terms of reference and budget for the c-IMCI strategic plan.
Finally, IHPplus, in collaboration with the National Malaria Control Program and SIAPS, redistributed ACT treatments for all ages with short expiration dates that were purchased by the Global Fund’s SANRU project to IHPplus-supported health zones in Mwene Ditu and Luiza. The project is applying the principle of interchangeability to minimize risks of commodity stock-outs.
Next steps: In the context of the rectal artesunate feasibility study, IHPplus will conduct the training for supervisors in July 2016, and field visits will begin in mid-August. The project will also provide technical and financial support to draft the c-IMCI strategic plan according to the established timeline.
HIV and AIDS: In PY1, IHPplus supported the MOH to fight HIV and AIDS at 73 HIV health sites – 45 in Kolwezi (Lualaba province) and 28 in Kamina (Haut Lomami province). IHPplus provides a complete package of HIV services to reduce the HIV and AIDS burden, including HIV testing and counseling, PMTCT, HIV care and support, ART, HIV and TB co-infection, integration of family planning and HIV services, and strengthening the interaction and linkages between health facilities, the community, and laboratory services, training for health providers and psychosocial assistants, and conducting evaluations and quality audits of HIV testing laboratories, among others.
Percentage of PEPFAR-supported sites achieving 90% ARV or ART coverage for HIV+ pregnant women: In PY1, 97% of PEPFAR-funded HIV sites achieved at least 90% ARV or ART coverage for HIV+ pregnant women. Compared to the PMP target of 76%, this represents an achievement rate of 104%. Table 39 below summarizes the number of sites achieving 90% coverage compared to the total number of sites with HIV-positive pregnant women. All of the sites in Kamina had 100% coverage throughout the year. In Kolwezi, project performance improved from 88% in Q2 to 100% in Q4. This strong performance is linked to the presence of personnel at HIV sites that are trained in administering Option B+ as well as the availability of ARVs.
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Table 39: Number of sites achieving 90% coverage compared to the total number of sites with HIV- positive pregnant women Coordination PY1Q2 PY1Q3 PY1Q4 PY1 # of sites # of sites # of sites # of sites # of sites # of sites with HIV+ achieving with HIV+ achieving with HIV+ achieving pregnant 90% ARV pregnant 90% ARV pregnant 90% ARV women coverage women coverage women coverage Kamina 2 2 8 8 5 5 Kolwezi 17 15 32 31 24 24 Total 19 17 40 39 29 29 37/40 (93%)* *The numerator represents the total number of sites achieving 90% coverage in PY1 (not cumulative). The denominator represents the number of HIV-positive women during ANC visits or delivery ward during PY1 (not cumulative).
Number and percentage of pregnant women with known status (includes women who were tested for HIV and received their results): A total of 22,727 women out of the 24,195 women (94%) tested for HIV were aware of their HIV status after HIV counseling and testing and received their results during ANC visits and in the labor and delivery ward. Compared to the PMP target of 85%, this represents an achievement rate of 111%. Table 40 below illustrates the improved performance from Q2 to Q4.
Table 40: Number and percentage of pregnant women with known status (includes women who were tested for HIV and received their results) Coordination PY1Q2 PY1Q3 PY1Q4 PY1 # of # of # of # of # of # of pregnant pregnant pregnant pregnant pregnant pregnant women women women women women women attending with attending with attending with ANC visits known HIV ANC visits known HIV ANC visits known HIV status status status Kamina 3,589 3,052 3,700 3,409 3,400 3,087 Kolwezi 4,766 4,566 4,358 4,281 4,386 4,332 Total 8,355 7,618 8,058 7,690 7,786 7,419 Total percent 91% 95% 95% 94% (7,618/8,355) (7,690/8,058) (7,419/7,786) (22,727/24,199)
During Q4, Kamina reported that 91% of pregnant women (3,087/3,400) know their status after HIV counseling and testing. The performance in Kolwezi was higher, with 99% of pregnant women (4,332/4,386) knowing their HIV status. Of the 22,727 pregnant women with a known status, 311 tested positive for HIV. This represents an overall seropositivity rate in the 73 project-supported sites of 1.36% (311/22,727) in PY1—0.24% (23/9,548) in Kamina and 2.18% (288/13,179) in Kolwezi. Table 41 below shows the trends in seropositivity rates during PY1.
Table 41: Seropositivity rates during PY1 in Kamina and Kolwezi Coordination PY1Q2 PY1Q3 PY1Q4 PY1 Seropositivity Seropositivity rate Seropositivity rate Overall rate Seropositivity rate Kamina 0.03% (1/3,052) 0.35% (12/3,409) 0.32% (10/3,087) 0.24% (23/9,543)
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Kolwezi 2.12% (97/4,566) 2.26% (97/4,281) 2.16% (94/4,332) 2.18 % (288/13,179)
The seropositivity rate among pregnant women remained stable throughout the year in Kolwezi/Lualaba; however, it increased significantly from Q2 to Q3 in Kamina. This increase is largely due to the coaching provided to health providers during joint supervision visits (MOH and IHPplus staff) at the end of IHP.
IHPplus continues to make great progress towards reaching the WHO’s 90-90-90 objective of achieving 90% of all people living with HIV with a known status by 2020. In addition, 90% of all people with a diagnosed HIV infection must receive sustained antiretroviral therapy, and 90% of all people receiving antiretroviral therapy must have viral suppression by 2020. Key factors contributing to these results include quality HIV counseling provided by health providers, strengthening the testing circuit, and the availability of HIV testing commodities.
Percentage of HIV-positive pregnant women who received ARVs to reduce risk for mother-to-child- transmission (MTCT) during pregnancy and delivery: During PY1, 95% of pregnant women (297/311) received ARVs to reduce the risk of MTCT (100% in Kamina and 95% in Kolwezi) during pregnancy, labor, or through breastfeeding. The project exceeded the PMP target of 85% with an achievement rate of 115%. Table 42 below summarizes the results for each quarter in Kamina and Kolwezi.
Kamina reported 100% of HIV+ pregnant women receiving ARVs to reduce MTCT each quarter. In Kolwezi, performance improved from 97% in Q2 to 100% in Q4, with a slight decrease in the middle of the year to 89% (86/97). This strong performance is linked to the availability of ARVs and the implementation of Option B+ by well trained and supervised health providers.
Table 42: Number and percent of HIV-positive pregnant women who received ARVs to reduce risk for MTCT during pregnancy and delivery Coordination PY1Q2 PY1Q3 PY1Q4 PY1 # of HIV+ # of HIV+ # of HIV+ # of HIV+ # of HIV+ # of HIV+ pregnant pregnant pregnant pregnant pregnant pregnant women women who women women who women women who received ARVs received ARVs received ARVs Kamina 1 1 12 12 10 10 23/23 (100%) Kolwezi 97 94 97 86 94 94 274/288 (95%) Total 98 95 109 98 104 104 297/311 (95%)
Number of key populations reached with individual and/or small group level HIV preventive interventions that are based on evidence and/or meet the minimum standards required: The project reached a total of 214 female sex workers--either individually or in small groups--through HIV prevention interventions based on evidence and/or minimum required standards (110 in Q2, 85 in Q3, and 19 in Q4). All sex workers were reached in Kamina due to the involvement of CHWs in raising awareness of HIV in this key population group and the support provided by IHPplus in improving HIV testing and HIV health services for this targeted population. The Linkages project (led by FHI360) is providing this technical support in the health zones of Fungurume, Lualaba, Manika, and Dilala.
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Number of individuals who received testing and counseling (T&C) services for HIV and received their test results: In total, 45,098 individuals received HIV T&C services and received their test results (14,421 in Q2; 15,280 in Q3; and 15,397 in Q4). The project exceeded the PMP target of 37,500, for an achievement rate of 120%. In Kolwezi, 25,909 individuals received T&C services for HIV and received their test result, compared to 19,189 in Kamina. The results, disaggregated by sex, age, and HIV status, are presented in Table 43.
Table 43: Number of individuals who received T&C services for HIV and received their test results, disaggregated by sex, age, and HIV status during PY1 Coordination Sex Age HIV status Women Men Under 15 15 years+ HIV- HIV-negative years positive Kamina 14,920 4,269 457 18,732 167 (1%) 19,022 (99%) Kolwezi 20,525 5,384 891 25,018 1,986 (8%) 23,923 (92%) Total 35,445 (79%) 9,653 (21%) 1,348 (3%) 43,750 (97%) 2,153 (5%) 42,945 (95%)
The percent of HIV-positive individuals was much higher in Kolwezi than Kamina, 8% compared to 1%, respectively. IHPplus will strengthen initiatives to fight HIV in the Lualaba province in Kolwezi, accordingly, including launching the RBF program at HIV care sites in five health zones to improve HIV indicators. This focus is in line with PEPFAR’s strategy of targeting support in the “right place.”
The service delivery points for T&C services varied. The number of tested clients from the various service delivery points is presented in Table 44 below.
Table 44: Number clients receiving T&C services at service delivery points in Kamina and Kolwezi in PY1 Service Kamina Kolwezi Total delivery point ANC visits and 9,548 13,179 22,727 (50%)* maternity and delivery wards TB 1,040 979 2,019 (5%) consultations Sexually 1,780 1,887 3,667 (8%) transmitted infection consultations Out-patient 3,087 6,184 9,271 (21%) consultations In-patient 435 1,226 1,661 (4%) consultations Voluntary 2,029 2,454 4,483 (10%) testing Other 1,270 0 1,270 (3%) Total 19,189 25,909 45,098 *All percentages in this table are calculated based on the total number of individuals tested (45,098)
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The strong performance during the year is primarily due to the availability of HIV tests and the implementation of the provider-initiated testing and counseling (PICT) strategy by trained health providers, as well as the joint supervision by MOH and IHPplus staff. These successes were achieved within the challenging context of the mining boom in Kolwezi, which often increases the health vulnerabilities of the population frequenting mining sites. There is often increased promiscuity among those working at mining sites for extended periods of time, a behavior that is known to increase the risk of STD transmission (including HIV and AIDS).
Number of HIV-positive adults and children who received at least one of the following during the reporting period: clinical assessment (WHO staging) or CD4 count or viral load: During PY1, 4,610 people living with HIV (PLHIV) received at least one clinical assessment (WHO staging), CD4 count, or viral load of the infection’s progress (4,411 in Kolwezi and 199 in Kamina). The project exceeded the PMP target of 3,600, for an achievement rate of 127%. This performance is mainly due to the availability of PIMA equipment and CD4 tests provided by the project.
Health facilities were unable to identify patients’ viral load in Kolwezi as the necessary equipment for this test is not available. This test is currently only available to PLHIV in Lubumbashi and Kinshasa, where the analysis can be performed within six hours following the sampling time. PEPFAR, in agreement with the PNLS, recently agreed to make tests available at the Lualaba DPS to identify patients’ viral load locally.
Number of HIV-positive adults and children receiving a minimum of one clinical service: During PY1, a total of 4,610 HIV-positive adults and children received at least one clinical service at the HIV sites (199 in Kamina, 4,411 in Kolwezi). Compared to the PMP target of 3,600, this represents an achievement rate of 127%. The availability of cotrimoxazole (CTX) and other HIV commodities provided to health facilities by partners such as IHPplus, the Global Fund, and mining companies working in the Kolwezi health zones contributed to this strong performance.
TB/HIV: Percent of HIV-positive patients who were screened for TB in HIV care or treatment setting: During PY1, 1,968 of the targeted 2,264 (87%) HIV-positive patients were screened for tuberculosis in an HIV care or treatment setting. Project performance improved from 57% to 87% during the year. Compared to the PMP target of 70%, this represents an achievement rate of 124%. To improve performance for this indicator, IHPplus conducted a training on HIV and TB co-infection for health providers at all HIV sites and conducted supervision visits to monitor results related to this indicator during the previous quarter. IHPplus continued to make available the TB screening tool. Table 45 below outlines the number and percent of HIV-positive patients who were screened for TB during the year.
Table 45: Number and percent of HIV-positive patients who were screened for TB during PY1 Coordination PY1Q2 PY1Q3 PY1Q4 PY1 # of # of HIV+ # of # of HIV+ # of # of HIV+ # of # of HIV+ HIV+ patients HIV+ patients HIV+ patients HIV+ patients patients screened patients screened patients screened patients screened for TB for TB for TB for TB Kamina 114 114 162 162 199 199 199 199 Kolwezi 610 301 3,338 516 2,065 1,769 2,065 1,769 Total 724 415 3,500 678 2,264 1,968 2,264 1,968 57% 19% 87% 87%
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Number of adults and children receiving ART (current): During PY1, a total of 3,534 HIV-positive adults and children received ART (196 in Kamina, and 3,338 in Kolwezi). Compared to the PMP target of 2,900, this represents an achievement rate of 122%. Strong performance in this area is attributed to the availability of ART treatment commodities in all health facilities, the implementation of Option B+ at all the PMTCT sites since the last quarter of IHP, and the technical support provided to health care providers by the health zone management teams and IHPplus staff.
The major challenge related to this indicator is the loss of PLHIV on ART in HIV care sits surrounding mining sites, as patients come and go according to when mines open and close. IHPplus also trained psychosocial assistants and mentor mothers to reduce the loss of PLHIV, which reached almost 10% per month in some sites (for example, the GRH in Manika health zone).
Number of HIV-infected adults and children newly enrolled in clinical care during the reporting period and received at least one of the following at enrollment: clinical assessment (WHO staging), or CD4 count, or viral load: In PY1, a total of 1,882 HIV-positive individuals that are newly enrolled in clinical care received at least one clinical assessment (WHO staging), CD4 count, or viral load (152 in Kamina and 1,730 in Kolwezi). Compared to the PMP target of 1,245, the project reported an achievement rate of 151%. Strong performance is linked to the mining boom of Lualaba and the availability of PIMA equipment at the two IHPplus-supported coordination areas.
Proportion of registered TB cases that are HIV-positive who are on ART: During PY1, 1,240 out of the anticipated target of 1,322 (94%) TB patients registered who are also HIV-positive were placed on ART. Kamina reported a 100% achievement (14/14), while Kolwezi reported a 99% achievement (1,226/1,308). This represents an achievement rate of 104% against the PMP target of 90%. The demand generated from the mining boom in Lualaba and the availability of HIV testing contributed to the high performance in both coordination areas.
Percentage of laboratories and Point of Care (POC) testing sites performing HIV diagnostic testing that participate and successfully pass an analyte-specific proficiency testing (PT) program: A total of 55 of an expected 45 laboratories successfully completed the first step of the PT program (122%). Compared to the PMP target of 100%, this represents an achievement rate of 122%. In addition, all sites and POC laboratories ensure HIV testing. Laboratory quality control for the PEPFAR-supported HIV care sites is conducted biannually in partnership with the Lubumbashi provincial PNLS laboratory.
Number of PEPFAR-supported testing facilities (laboratories) that are recognized by national, regional, or international standards for accreditation or have achieved a minimal acceptable level towards attainment of such accreditation: Following an evaluation carried out by teams from both the PNLS national office and Lubumbashi provincial office, the Gecamines Hospital (Hôpital Général du Personnel de Kolwezi) in Dilala health zone, and Mwangeji GRH in Manika health zone, have the potential to receive accreditation (exceeding the PMP target of one). Based on the results of the PNLS evaluation, Mwangeji GRH still needs to make improvements at the infrastructure, human resources, and organizational levels to receive full accreditation.
Family planning and HIV integration: Number of HIV service delivery points supported by PEPFAR that are directly providing integrated voluntary family planning services: With IHPplus support, 73 functional PMTCT sites systematically integrated family planning and safe motherhood services. The project performance for this indicator is higher than the PMP target of 72, which represents an achievement rate of 101%. The project also ensured family planning commodities were available at all sites. Health
DRC-IHPplus Year One Quarter Four/Annual Report: June 17, 2015 - June 30, 2016 Page 66 of 101 providers were trained in long-term family planning methods, followed by post-training supervision by health zone management teams. Awareness-raising campaigns, including SMS messaging, were launched to inform the public about the availability of integrated HIV and family planning services at these sites.
Number of infants born to HIV-positive women who were started on CTX prophylaxis within two months of birth at USG-supported sites within the reporting period: During PY1, a total of 239 HIV- exposed children (all in Kolwezi) received CTX prophylaxis to reduce the risk of HIV transmission. Compared to the target of 270, the project reported an 89% achievement rate. Despite the project’s efforts to make CTX available in sites supported through PEPFAR and Global Fund funding, the number of infants reported decreased from 96 to 75 between PY1Q3 and PY1Q4.
Number of infants who had a virologic HIV test within 12 months of birth during the reporting period: During PY1, 129 HIV-exposed children (all in Kolwezi) were tested for HIV before their first birthday. Compared to the PMP target of 96, the project attained a 134% achievement rate. This performance was made possible due to ongoing efforts to ensure the availability of dried blood spot (DBS) tests in PEPFAR- supported health facilities. Despite the fact that the project exceeded performance in this area, availability of this testing is not sufficient to meet the needs. Early infant diagnosis can only be done at the PNLS laboratories (the provincial-level lab in Lubumbashi or the national level in Kinshasa). As a consequence, the supported facilities receive analysis results with extensive delays or not at all. To overcome this challenge, the project is currently working with the management teams of the PNLS laboratories to define an effective circuit to transport DBS samples from project-supported sites to the laboratories and to get the results back to sites in a timely manner.
Number of infants HIV-exposed infants with a documented outcome by 18 months of age disaggregated by outcome type: The project was not able to collect data for this indicator during PY1Q2 and PY1Q3 because of the lack of activity from the psychosocial assistants working in supported sites. The PNLS postponed the training planned to build the capacity of the psychosocial assistants to produce and collect data for this indicator for PY1Q3 to PY1Q4. Therefore, by the end of PY1, the project was able to report that only five HIV-exposed children were able to get a documented outcome by 18 months of age, which represents a 6% achievement rate against the PMP target of 84.
Number of adults and children newly enrolled on ART: During PY1, 1,312 new PLHIV (98 in Kamina and 1,214 in Kolwezi) were placed on ARV treatment. The project exceeded the target of 1,074, reporting a 122% achievement rate. Overall, the project improved its performance after each quarter, reporting 318 new PLHIV placed on ARV treatment during PY1Q2, 475 during PY1Q3, and 519 during PY1Q4. Several factors had a positive impact on project performance: high availability of ART in supported health facilities, introduction of Option B+ in all PMTCT care sites during the last quarter of IHP, and continuous support of health facility staff by the project team. This strong performance was also due to the mining boom in Lualaba, which increased the demand for this service.
Number of adults and pediatric ART patients with a viral load result documented in the patient medical record within the past 12 months: In the geographical context of IHPplus, this indicator is not applicable. The only laboratories equipped to perform this testing are the PNLS labs. Since the viral load protocol requires that samples not be transported for more than six hours, the project is unable to report data for this indicator due to the absence of nearby laboratory equipped to determine the viral load of HIV-positive patients receiving treatment in Lualaba province care sites.
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Number of viral load tests from adult and pediatric ART patients conducted in the past 12 months with a viral load inferior to 1000 copies/ml: In the geographical context of IHPplus, this indicator is not applicable, for the same reason as stated for the indicator above.
Number of adults and children who are still alive and treatment at 12 months after initiating ART: This indicator can be reported only on a yearly basis; this report presents only three quarters of data. Therefore, the project was unable to report data for this first year of the project.
Number of HIV-infected adults and children receiving care and support services outside of the health facility: The PNLS postponed the training that the project had planned this quarter to build the capacity of the psychosocial assistants to collect data for the indicator until the end of PY1Q4, so data for this indicator should be available for collection during PY2.
Aggregated outcome of TB treatment among registered new and relapsed TB cases that are HIV-positive in the treatment cohort: During PY1, 77 TB/HIV-positive co-infected patients in Kolwezi completed their TB treatment. Of these, 40 were declared cured from TB, 24 needed to start their TB treatment over again since they had relapsed, and nine had passed away. Compared to the target of 144, the project’s achievement rate is 53%.
Tuberculosis: IHPplus’ support to the PNLT aims to strengthen prevention of TB, HIV/TB co-infection, and MDR-TB, and improve the quality of these services in 78 health zones supported by the project. With 61 of 78 health zones reporting for this quarter, a total of 10,251 new cases of TB were detected during PY1.
Notification rate for new cases of smear-positive pulmonary TB in USAID-supported health zones: As seen in Table 46a below, a total of 8,655 new cases of bacteriologically-confirmed pulmonary TB were reported during PY1 for a notification rate of 108 cases for every 100,000 inhabitants (108/100,000). These results represent an achievement rate of 72% (108/150) of the PMP target of 150 cases for every 100,000 inhabitants. They show an increase from IHP’s PY5 notification rate of 96 cases for every 100,000 inhabitants. Table 46b presents the number of new cases detected and notification rates for each quarter per coordination area.
Table 46a: New TB cases notification rates during PY1 (total) Coordination Population PY1 covered MTB+ Rate Target Achievement detected (per 100,000 (per 100,000 (%) inhabitants) inhabitants) Kolwezi 747,819 995 177 150 118 Kamina 1,737,612 2339 179 150 120 Kole 848,285 841 132 150 88 Tshumbe 749,578 537 96 150 64 Bukavu 3,040,236 966 42 150 28 Uvira 671,237 399 79 150 53 Mwene Ditu 1,800,258 1,652 122 150 82 Luiza 1,133,569 926 109 150 73 TOTAL 10,728,594 8,655 108 150 72
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Table 46b: New TB cases notification rates during PY1 (by quarter) Coordination Population PY1Q2 PY1Q3 PY1Q4 covered MTB+ Rate (per MTB+ Rate (per MTB+ Rate (per detected 100,000 detected 100,000 detected 100,000 inhabitants) inhabitants) inhabitants) Kolwezi 747,819 315 168 339 181 341 182 Kamina 1,737,612 668 154 745 171 926 213 Kole 848,285 302 142 278 131 261 123 Tshumbe 749,578 152 81 183 98 202 108 Bukavu 3,040,236 414 54 253 33 299 39 Uvira 671,237 84 50 158 94 157 94 Mwene Ditu 1,800,258 518 115 614 136 520 116 Luiza 1,133,569 336 119 321 113 269 95 TOTAL 10,728,594 2,789 104 2,891 108 2,975 111
This improved performance is largely the result of supportive supervision visits from IHPplus staff and the Coordinations provinciales lèpre et tuberculose (Provincial Coordination Unit for Leprosy and TB, or CPLT) to all coordination areas, which built the capacity of health care providers, and of active TB screening activities in the coordination areas of Kole and Tshumbe. Performance could have been even stronger if all IHPplus-supported health zones had provided complete data. During PY1Q4, only 61 of 78 health zones reported TB data (15 of 27 health zones in the coordination area of Sud Kivu, 4 of 8 health zones in the coordination area of Kolwezi, and 7 of 8 health zones in the coordination area of Tshumbe). Incomplete data lowered the results of all indicators during PY1Q4, and consequently reduced IHPplus’ case notification rate for PY1. It is important to note that the PNLT’s delays in providing data collection and transmission tools to 23 IHPplus-supported DPSs where CPLTs are located contributed in large part to the low level of data completeness during PY1Q4. The PNLT was late in distributing these tools because of a lengthy process in selecting a vendor and printing the documents (from January to June 2016).
At the end of PY1, the coordination areas of Kamina and Kolwezi reported above-target notification rates, with 179 (Kamina) and 177 (Kolwezi) cases confirmed for every 100,000 inhabitants. This represents an achievement rate of 120% (132/150) in Kamina and 118% (122/150) in Kolwezi against the PMP target. The coordination areas of Kole, Mwene Ditu, Luiza, and Tshumbe achieved close to the target with case notification rates of 132/100,000 (Kole), 122/I00,000 (Mwene Ditu), 108/100,000 (Luiza), and 96/100,000 (Tshumbe). Tshumbe’s case notification rate increased during the past two quarters (98/100,000 in PY1Q3 and 108/100,000 in PY1Q4) compared to a rate of 76 cases per 100,000 inhabitants during PY5 of IHP. Tshumbe’s performance is remarkable considering that, for the past 10 years, Tshumbe has never reported a notification rate above 85 cases for every 100,000 inhabitants. This improvement is primarily the result of door-to-door mini-campaigns to promote TB testing organized in three health areas (Tshumbe 1, Tshumbe 2, and Kalema) known to have low notification rates.
On the other hand, Bukavu reported a notification rate of only 42 cases for every 100,000 inhabitants during PY1Q4. This under-performance was largely due to incomplete data, as only 10 of 22 health zones in Bukavu reported TB data for PY1Q4.
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IHPplus faces four main challenges to maintaining the upward trend in the TB case notification rate: Incomplete data for TB activities Low exposure of the population to key messages related to the fight against TB (low community involvement) Insufficient number of supervision visits from CPLT provincial coordination teams to health zones and Centres de Santé de Diagnostic et Traitement (CSDTs) Stock-outs of TB laboratory supplies due to difficulty accessing certain health zones in the coordination areas of Bukavu, Kamina, Tshumbe, and Kole.
Percentage of registered TB patients tested for HIV in USAID-supported health zones: As indicated in Table 47a below, only 45% of the 10,013 TB cases reported during the first year of IHPplus received HIV testing (4,482/10,013). Of the 4,482 TB cases who received HIV testing, a total of 397 patients (9%) tested positive for HIV. Although IHPplus reported a low overall percentage of TB cases tested for HIV, the project’s performance on this indicator improved significantly during PY1, with 22% of cases tested in PY1Q2, 55% in PY1Q3, and 53% in PY1Q4 (see Table 47b). This progressive increase is largely attributable to PEPFAR-funded HIV tests and ARVs provided to the coordination area of Kolwezi. During PY1Q4, with 53% of registered TB patients tested for HIV (2,151 of 4,089), almost half of TB patients in 61 of 78 health zones did not receive HIV testing. This percentage equates to an achievement rate of 56% (53/80) against the targeted 80% testing rate.
Table 47a: Number and percentage of TB patients tested for HIV during PY1 (total) Coordination PY1 # of Counseled Tested % TB patients Target Achievement registered & Tested HIV+ tested for (%) rate (%) TB patients HIV Kolwezi 1,369 1,283 227 94 80 117 Kamina 2,694 1,410 61 52 80 65 Kole 1,119 455 24 41 80 51 Tshumbe 596 166 5 28 80 35 Bukavu 1,183 379 25 32 80 40 Uvira 594 104 4 18 80 22 Mwene Ditu 1,429 426 44 30 80 37 Luiza 1,029 259 7 25 80 31 Total 10,013 4,482 397 45 80 56
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Table 47b: Number and percentage of TB patients tested for HIV during PY1 (by quarter)
Coordination PY1Q2 PY1Q3 PY1Q4
HIV
# of registered # patients TB Counseled& Tested tested # HIV+ patients TB % for HIVtested of registered # patients TB Counseled& Tested HIV+ Tested patients TB % for tested of registered # patients TB Counseled& Tested HIV+ Tested patients TB % for HIVtested Kolwezi 315 426 6 135 577 513 147 89 477 344 74 72 Kamina 668 184 36 28 901 531 12 59 1,125 695 13 62 Kole 302 - - - 437 226 23 52 380 229 1 60 Tshumbe 152 - - - 213 80 1 38 231 86 4 37 Bukavu 414 - - - 404 137 11 34 365 242 14 66 Uvira 84 - - - 225 50 0 22 285 54 4 19 Mwene Ditu 518 - - - - 86 - - 911 340 44 37 Luiza 336 - - - 378 98 7 26 315 161 - 51 Total 2,789 610 42 22 3,135 1,721 201 55 4,089 2,151 154 53
The percentage of TB patients tested for HIV during PY1 varied dramatically among the coordination areas supported by IHPplus. For example, the coordination area of Kolwezi, which receives PEPFAR-funded HIV tests and other HIV commodities, reported a 94% testing rate (1,283/1,369). This result largely exceeded the PMP target of 80%. Among the 1,283 TB patients tested for HIV in Kolwezi, a total of 227 patients (18%) tested positive for HIV. This elevated rate of positive results (compared to 13% estimated by the PNLS) reflects the prevalence of mining activities in this province, since miners are part of the population at high risk of contracting HIV. Outside of support from PEPFAR, the high percentage of TB patients receiving HIV testing in Kolwezi results from capacity building training for providers in case management of HIV/TB coinfection, which took place during a supportive supervision visit jointly organized with the CPLT during PY1Q3. It also results from the integration of coinfection activities in the Centres de Santé de Traitement de la TB (TB treatment centers, or CST) and of voluntary HIV counseling and testing sites (VCT). The coordination of Kamina, which also received PEPFAR support through the end of 2015, reported that 52% of registered TB patients were tested for HIV during PY1 (1,410/2,694). The low performance reported in the six other coordination areas, which do not receive PEPFAR support, primarily results from an irregular supply and repeated stock-outs of HIV tests.
Number of MDR-TB cases detected: A total of 27 cases of MDR-TB cases were detected during PY1, for an achievement rate of 60% compared to the PMP target of 45 cases for the three quarters (see Table 48a). T coordination areas of Bukavu, Kole, and Kolwezi reported the highest number of MDR cases at seven, seven, and six cases, respectively. Table 48b presents the number of MDR-TB cases detected during each quarter. Ten cases were detected in PY1Q2, with a decrease to seven cases in PY1Q4.
Four cases of MDR-TB were reported for PY1Q4, which represents under-performance compared to PY1Q3, when six cases were detected. This under-performance is explained by the low number of sputum tests from suspected MDR-TB patients transported from CSTs/CSDTs to GeneXpert sites in coordination areas with a high rate of TB (Kamina and Kolwezi). Only three coordination areas (Bukavu, Kole, and Tshumbe) were able to ensure the transportation of sputum tests from certain health zones to the GeneXpert laboratory.
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To meet the challenge of transporting sputum samples from suspected MDR-TB cases to GeneXpert sites, it is important for each IHPplus coordination office to increase its collaboration with the CPLT and strive to involve CBOs in raising awareness of TB patients and finding ways to transport the sputum samples to MDR-resistant TB testing sites.
Table 48a: Number of MDR-TB cases detected during PY1 (total) Coordination Population PY1 (annual) covered MTB+ Target Achievement detected rate (%) Kolwezi 747,819 6 3 200 Kamina 1,737,612 0 6 0 Kole 848,285 7 3 233 Tshumbe 749,578 2 3 67 Bukavu 3,040,236 7 12 58 Uvira 67,1237 1 3 33 Mwene Ditu 1,800,258 4 9 44 Luiza 1,133,569 0 6 0 Total 10,728,594 27 45 60
Table 48b: Number of MDR-TB cases detected during PY1 (by quarter) Coordination Population PY1Q2 PY1Q3 PY1Q4 covered MTB+ Target MTB+ Target MTB+ Target detected detected detected Kolwezi 747,819 0 1 4 1 2 1 Kamina 1,737,612 0 2 0 2 0 2 Kole 848,285 7 1 0 1 0 1 Tshumbe 749,578 2 1 0 1 0 1 Bukavu 3,040,236 0 4 6 4 1 4 Uvira 67,1237 1 1 0 1 0 1 Mwene Ditu 1,800,258 0 3 0 3 4 3 Luiza 1,133,569 0 2 0 2 0 2 Total 10,728,594 10 15 10 15 7 15
To further improve the quality of services for TB case management, MDR-TB, and HIV/TB coinfection, as well as the completeness and availability of reporting data, IHPplus will use the following strategies in all supported health zones during the coming year: Conduct joint supportive supervision visits with the PNLT and the PNLS with the goal of building the capacity of service providers to incorporate the new directives for basic TB care outlined in the Integrated Anti-Tuberculosis Program (Programme Antituberculeux Intégré, or PATI V) Provide training in PATI V for health care providers in Kamina, and in managing HIV/TB coinfection for health care providers in eight health zones in Kole Provide post-training follow-up for providers trained in managing coinfection in Kolwezi and Tshumbe
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Further involve CBOs by organizing door-to-door mini-campaigns to raise awareness and promote TB testing for suspected cases of TB and for people exposed to index cases of TB in health zones with low detection rates, as well as involving them in transporting sputum tests from suspected MDR-TB patients to GeneXpert sites Finance the transportation of anti-TB medicines and the provision of data collection and transmission tools to health zones
Sexual and gender-based violence: During PY1, the total number of people reached by a USG-supported intervention providing GBV health services reached 2,526. Compared to the PMP target of 2,000, this represents an achievement rate of 126% (see Table 49a).
The Sud Kivu province reported the highest number of people reporting sexual violence, with 2,086 cases reported in Bukavu and 321 in Uvira. The high number of cases is linked to the resurgence of armed conflict in this region, particularly in the health zones of Kaniola and Minova. Additional contributing factors include the presence of the Panzi referral hospital in the region, which provides holistic care for victims of sexual violence, and the awareness-raising campaign that the Panzi Foundation conducted in surrounding health zones (Ibanda and Kalonge, among others) that promoted increased reporting of sexual violence among victims.
As seen in Table 49b, among the 2,526 survivors of sexual violence, 1,344 (53%) sought care at a facility within 72 hours, and 1,098 (43%) between 72 and 120 hours. The number of cases reported doubled from Q2 to Q4, largely due to the awareness-raising campaign conducted in Kalonge as well as increased instability in the region. The large majority of victims reporting sexual violence were women (92%), with a ratio of only one man reporting sexual violence for every 13 women.
The project also supported the health zones by making post-exposure prophylaxis kits more available to complement the contributions of other partners.
Table 49a: Number of people reached by GBV services funded by the USG, disaggregated by sex and period of arrival at a health facility Coordination Number of people reporting sexual violence in USG-supported health clinic PY1Q2 PY1Q3 PY1Q4 Total PY1
# Female # Male Total # patients patients Of patients Bukavu 439 655 992 1,916 170 2,086 Kamina 5 3 7 11 4 15 Kole 26 11 12 40 9 49 Kolwezi 0 0 0 0 0 0 Luiza 0 0 0 0 0 0 Mwene Ditu 0 0 25 25 0 25 Tshumbe 0 15 15 28 2 30 Uvira 114 91 116 314 7 321 Total 584 775 1,167 2,334 192 2,526
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Table 49b: Number of people reached by GBV services funded by the USG, disaggregated by sex and period of arrival at a health facility (detailed) Coordination Number of Number of people Number of Number of people people reporting reporting sexual people reporting reporting sexual sexual violence violence in USG- sexual violence violence in USG- in USG- supported clinic in USG- supported clinic given supported clinic between 72 and supported clinic emergency within 72 hours 120 hours given ARVs contraceptive Bukavu 965 1,121 783 635 Kamina 12 3 3 3 Kole 42 7 7 6 Kolwezi 0 0 1 0 Luiza 0 0 0 0 Mwene Ditu 20 5 10 8 Tshumbe 23 7 12 7 Uvira 282 39 282 314 Total 1,344 1,182 1,098 973
Fistula: IHPplus supports Kaziba GRH in providing fistula repairs (vesico-vaginal and recto-vaginal) as well as uterine and rectal prolapse repair to women living in the Bukavu coordination area. During PY1, among the 180 female patients who were treated at the hospital after consulting about urinary incontinence, 72% (129) were diagnosed with urogenital fistula and 7% (14) for recto-vaginal fistulas, 19% (35) for incontinence, and 1% (two) for both recto- and urogenital fistula. Overall, Kaziba GRH repaired 89% (161) of these 180 cases in a routine procedure, and patients were released from the hospital with their fistula repair site fully closed and dry. Among the 180 fistula patients on whom the Kaziba staff operated, the primary causes were obstructed labor (46%) and home births (34%). The 20 failed operations were relapses from previous fistulas.
Table 50: Fistula repair at Kaziba GRH during PY1 PY1Q2 PY1Q3 PY1Q4 Total PY1 Number of operations 60 60 60 180 Causes Home birth 23 20 19 62 Obstructed labor 25 27 31 83 Other 12 13 10 35 Type of Urogenital fistula 42 42 45 129 operation Recto-vaginal fistula 6 4 4 14 Recto and urogenital fistula 0 1 1 2 Other (prolapsus, 13 12 10 35 incontinence, etc.) Operation Successful 54 53 54 161 outcome Failed 6 7 6 19 Death 0 0 0 0
Next steps: Conduct supportive supervision visits on partogram usage in Kaziba health zone to help service providers quickly decide whether to refer women with obstructed labor to the GRH
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Organize awareness-raising activities in the health zone and surrounding areas to encourage women to attend the fourth ANC visit and give birth at the hospital rather than at home.
IR 2.2: Minimum quality standards for health facilities (general referral hospitals and health zone health centers) and services developed and adopted
FOSACOF approach: During PY1, IHP and IHPplus trained 611 teams (from the DPS and health zone coordination offices), 1,474 health service providers FOSACOF CRITERIA at health facilities, and 3,685 community leaders to implement the FOSACOF 1. Infrastructure 2. Equipment approach. Overall, 737 health centers and 38 GRHs are using FOSACOF 3. Essential medicines and across the 78 health zones supported by IHPplus. supplies 4. Personnel An average of 419 of the total 737 health facilities (or 57%) completed an 5. In-service training 6. Community approach evaluation of the nine FOSACOF criteria (see box at right). This result falls 7. Community support below the PMP target of 76% and represents an achievement rate of 75%. 8. Clinical quality The project performance increased during each quarter from 54% in PY1Q2 9. Management to 59% in PY1Q4.
Of the 419 health facilities (health centers and GRHs), 118 were evaluated as part of the RBF program during quarterly verification exercises. Table 51 below presents the average number of health facilities that led a FOSACOF evaluation during PY1.
Table 51: Percentage of health facilities that completed an evaluation of the nine FOSACOF minimum standards during PY1
PY1Q2 PY1Q3 PY1Q4 Average
PY1 (%)
Coordination Health Health that facilities an completed evaluation Health with facilities FOSACOF implemented % Health that facilities an completed evaluation with HF FOSACOF implemented % Health that facilities an completed evaluation Health with facilities FOSACOF implemented % Bukavu 21 159 13 78 159 49 94 159 59 40 Kamina 44 77 57 35 77 45 23 77 30 44 Kole 45 49 92 49 49 100 27 49 55 82 Kolwezi 15 79 19 62 79 78 32 79 41 46 Luiza 78 93 84 46 93 49 83 93 89 74 Mwene 86 97 89 55 97 57 86 97 89 78 Ditu Tshumbe 68 93 73 58 93 62 41 93 44 60 Uvira 21 52 40 19 52 37 34 52 65 47 Total 378 699 54 402 699 58 420 699 60 57
IHPplus reported the lowest performance on this indicator during PY1Q2 (54%), due to underperformance in Bukavu, Kolwezi, and Uvira. In preparation for closeout, which was scheduled in these three coordinations ahead of the five other ones, the project decreased the number of supervision visits to health providers and health zone management teams, which explains the weaker performance reported during PY1Q2. Overall, the three coordinations that reported on average the highest percentage of health
DRC-IHPplus Year One Quarter Four/Annual Report: June 17, 2015 - June 30, 2016 Page 75 of 101 facilities that completed a FOSACOF evaluation were Kole (82%), Luiza (74%) and Mwene Ditu (78%). The coordination that reported on average the lowest result was Bukavu (40%).
Table 52 below presents the results of the FOSACOF evaluations of health facilities during the year, and based on the results of the FOSACOF evaluation, most of health facilities are in Class B and A.
Table 52: Results of FOSACOF evaluation of health facilities during PY1 Evaluation results Evaluation results Evaluation results during
during PY1Q2 during PY1Q3 PY1Q4
(0<25%)
Coordination Coordination implementing HF of # were that FOSACOF evaluated implementing HF of # were that FOSACOF evaluated implementing HF of # were that FOSACOF evaluated
Class C 25< 50%) 25< C Class
Class D Class 50%) (25< C Class B (50<80%) Class 80%) (≥ A Class (0 D <25%) Class B (50<80%) Class 80%) (≥ A Class (0 D <25%) Class 50%) (25< C Class B (50<80%) Class 80%) (≥ A Class Bukavu 21 1 10 9 1 78 0 0 66 12 94 12 17 65 0 Kamina 44 0 10 33 1 35 0 12 20 3 23 4 3 13 3 Kole 45 0 10 35 0 49 0 10 39 0 27 2 7 8 10 Kolwezi 15 0 0 10 5 62 4 10 46 2 32 4 4 23 1 Luiza 78 0 12 63 3 46 0 3 36 7 83 0 20 61 5 Mwene 86 0 9 53 24 55 0 7 45 3 86 0 20 61 5 Ditu
Tshumbe 68 0 20 43 5 58 0 0 48 10 41 3 7 21 10 Uvira 21 0 5 15 1 19 0 0 15 4 34 2 7 21 4 Total 378 1 76 261 40 402 4 42 315 41 420 27 71 279 43 Ratio 54% 1% 20% 69% 11% 58% 1% 10% 78% 10% 60% 6% 17% 66% 10%
By the end of PY1Q4, the three coordinations that reported by far the higher number of health facilities that were classified in B and A category were Bukavu (65), Luiza (77) and Mwene Ditu (66). Overall, across all coordinations, 67% met 50-80% of the criteria, 10% met 80% or greater of the criteria, 17% achieved 25-50% of the criteria, and 6% met only 0-25% of the criteria.
Table 53 presents the average number of GRHs that completed a FOSACOF evaluation during PY1.
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Table 53: Number of GRHs that led a FOSACOF evaluation throughout PY1
PY1Q2 PY1Q3 PY1Q4 Average
PY1 (%)
% % %
Coordination GRH that GRHthat an completed evaluation GRHwith FOSACOF implemented GRHthat an completed evaluation GRHwith FOSACOF implemented GRHthat an completed evaluation GRHwith FOSACOF implemented Bukavu 5 10 50 8 10 80 6 10 60 63 Kamina 1 3 33 1 3 33 2 3 67 44 Kole 1 4 25 3 4 75 3 4 75 58 Kolwezi 1 3 33 3 3 100 3 3 100 78 Luiza 1 5 20 4 5 80 5 5 100 67 Mwene Ditu 3 5 60 3 5 60 3 5 60 60 Tshumbe 4 5 80 2 5 40 4 5 80 67 Uvira 1 3 33 3 3 100 2 3 67 67 Total 17 38 45 27 38 71 28 38 74 63
By the end of PY1, the three coordinations that reported on average the highest percentage of GRH that completed a FOSACOF evaluation is Tshumbe(67%), Uvira (67%) and Luiza (67%). The coordination that reported on average the lowest result was Kamina (44%).
Table 54 below presents the results from the evaluations of GRHs by coordination area. An average of 19 of the 38 GRHs (68%) completed an evaluation. This lower performance can be explained by conflicting activity calendars and staff turnover. The result falls slightly below the target of 76% of GRHs, representing an achievement rate of 93%. However, the result is an increase from the 17 GRHs that were evaluated during PY1Q2. Seven of these evaluations were conducted during the quarterly RBF data verification exercises. Of the 27 GRHs evaluated, 78% met 50-80% of the FOSACOF criteria, 19% met 80% or more of the criteria, 4% met 25-50% of the criteria, and no GRHs met less than 25% of the criteria.
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Table 54: Results of FOSACOF evaluation of GRHs during PY1 Evaluation Results during Evaluation Results Evaluation Results during
PY1Q2 during PY1Q3 PY1Q4
50%)
Coordination Coordination implementing GRH of # were that FOSACOF evaluated implementing GRH of # were that FOSACOF evaluated implementing GRH of # were that FOSACOF evaluated
Class D (0 D <25%) Class 50%) 25< C Class B (50<80%) Class 80%) (≥ A Class (0 D <25%) Class 50%) 25< C Class B (50<80%) Class 80%) (≥ A Class (0 D <25%) Class 25< C Class B (50<80%) Class 80%) (≥ A Class Bukavu 5 0 4 1 0 13 0 0 13 0 6 0 0 4 2 Kamina 1 0 0 1 0 1 0 0 0 1 2 0 0 1 1 Kole 1 0 0 0 1 1 0 0 1 0 3 0 0 2 1 Kolwezi 1 0 0 0 1 3 0 1 1 1 3 0 0 2 1 Luiza 1 0 0 0 1 1 0 0 1 0 5 0 2 1 2 Mwene 3 0 0 2 1 3 0 0 1 2 3 0 1 1 1 Ditu Tshumbe 4 0 1 2 1 1 0 0 1 0 4 0 2 1 1 Uvira 1 0 0 1 0 4 0 0 3 1 2 0 0 1 1 Total 17 0 5 7 5 27 0 1 21 5 28 0 5 13 10 Ratio 45% 0% 29% 41% 29% 71% 0% 4% 78% 19% 74% 0% 18% 46% 36%
The FOSACOF approach offers an opportunity to promote hygienic practices in the supported health zones, through joint supervision visits by MOH and IHPplus staff to health centers and GRHs. If routine supervision visits do not allow for systematic collection of hospital hygiene information, the information can be collected during FOSACOF evaluations. Table 55 below presents a sample of hygiene data reporting from monitoring visits conducted by IHPplus and MOH staff in hospitals and health centers during FOSACOF evaluations at the 432 health facilities.
Table 55: Percentage of health facilities with hygiene equipment Equipment Incinerator Garbage Placenta Sharps Latrines with Latrines with monitored for pit pit disposal hand hand infection containers washing washing prevention stations for stations for practices patients staff Total facilities 432 432 432 432 432 432 visited during PY1 Facilities with 248 372 372 401 428 430 hygiene equipment % of facilities with 57% 86% 86% 93% 99% 100% hygiene equipment Facilities whose 240 365 362 390 391 420 staff use hygiene equipment correctly
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% of facilities 97% 98% 97% 97% 91% 98% whose staff use hygiene equipment correctly
Table 55 shows that the majority of health facilities have sufficient equipment for infection prevention and that personnel in health facilities correctly use hygiene equipment. A high percentage of health facilities have placenta pits and garbage pits and containers for disposing sharp items (86%, 86% and 93%, respectively), and a large number of staff at the facilities know how to use them correctly (98%, 97% and 97%, respectively). Incinerators were the least prevalent, with only 57% of facilities reporting having this equipment. Most facilities face difficulties paying for this equipment, and additional support is needed to fill this gap. On average, 96% of facility staff use all hygiene equipment correctly. Sud Kivu—particularly the coordination areas of Bukavu and Uvira—is the province with the best-equipped health facilities.
Challenges: Improving the availability and use of hospital hygiene equipment in health facilities Continuing to supply health facilities with necessary hygiene equipment to prevent infection that they themselves cannot procure Ensuring that health zone management teams continue to conduct quarterly evaluations in at least 80% of health facilities, develop quarterly improvement plans, and implement recovery plans Ensuring that health zone management teams and trained service providers organize evaluation meetings and share successes
Lessons learned: 1. The FOSACOF strategy provides an opportunity to promote hygiene practices within the supported health zones 2. The application of the FOSACOF strategy to evaluate the quality of services and care offered by the service delivery point has improved (across almost all service delivery points visited) a. The service delivery point inventory system b. Environmental management through appropriate waste disposal c. The service delivery point archiving system
Next steps: In the next quarter, IHPplus will continue to strengthen support to the coordination areas of Kole, Kolwezi, Tshumbe, and Kamina during routine supervision visits, provide basic equipment in health facilities in the health zones supported by the eight coordination offices (Bukavu, Kamina, Kole, Luiza, Mwene Ditu, Tshumbe, and Uvira), and provide technical support to health zones to mobilize local resources for renovations of health structures that improve hygiene hardware and practices (Kole, Luiza, Tshumbe, Bukavu, and Uvira).
Results-based Financing: RBF provides incentives to health service providers to improve performance. Under RBF, facilities receive payments based on achievement of agreed-upon targets, rather than for inputs or processes as in traditional financing. The project implemented the following RBF activities, with full ownership by the MOH: Supported preparations to integrate RBF at 38 IHPplus-supported HIV sites in Lualaba Province. These preparations took place during two workshops organized by the MOH’s RBF Technical Unit, which also received support from the Division des Stratégies des Soins de Santé Primaire of the 5è Direction (5th Directorate’s Division of Primary Health Care Strategies) and the PNLS. Organized technical verification of annual data in the seven RBF health zones
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Organized the counter-verification of verified annual data in seven health zones by 14 CBOs Monitored data entry in the portal to ensure the payment of performance-based bonuses to the health zones Organized routine supervision visits to monitor RBF program progress throughout 7 RBF health zones (118 health centers, 7 GRHs, 7 health zone central offices, and 14 community organizations) as a joint team of IHPplus/ MOH RBF unit/Provincial Health Division staff
During PY1, as indicated in Table 56 below, the quality score of health center services, according to the FOSACOF evaluation criteria, decreased from 73% in Q2 to 68% in Q3 before increasing to 73% again in Q4. The FOSACOF quality score for the GRHs decreased slightly from 89% to 87%. The utilization of curative services decreased slightly from 43% to 42%.
Table 56: Progress of RBF results over IHPplus three quarters of implementation* PY1Q2 PY1Q3 PY1Q4
Utilization rate of 43 46 42 curative services (%) FOSACOF health center 73 68 73 global score (%) FOSACOF GRH global 89 83 87 score (%) *Numbers may not add up exactly due to rounding
Figure 8: Results of RBF over 27 months of implementation in GRHs and health centers 100
90 89 87 85 83 80 81 78 75 73 73 70 73 71 70 68 60 62 Utilisation rate of curative 57 54 55 services (%) 50 50 50 46 FOSACOF health facility score 39 43 42 40 37 39 43 44 (%) 33 32 31 30 31 30 FOSACOF GRH scores (%)
20 21
10
0
The drop in the utilization rate of curative services was mainly due to the unavailability of health care providers at health facilities in the coordination areas of Kolwezi and Kamina. These providers took part in many training activities that led to long absences from their health facilities.
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It may not be possible to greatly increase the quality of services in future quarters, because most of the remaining areas needing improvement require interventions outside the scope of the project (such as repairs, equipment, and staff training). But even if not, the utilization of curative treatments may still continue to increase and surpass the 2011-2015 Plan National de Développement Sanitaire (National Health Development Plan, or PNDS) target during the next reporting period.
Although the utilization rate of curative services fell during the last quarter for the reasons outlined above, RBF has contributed to a significant increase in the utilization rate of curative services and in the quality of services provided by health centers and GRHs.
Lessons learned: During PY1, IHPplus observed that the RBF strategy accomplished the following: 1. Contributed to rapidly attaining the objectives of the PNDS, particularly Target 7 (maternal and child health) and Target 6 (access to quality health services) 2. Improved the quality of services, enabling health facilities which scored as low functioning before RBF to attain the status of moderately functional health facilities (for health centers) and completely functional training (for GRHs) 3. Developed the management skills of health providers, leading to improvements in health facility management 4. Improved the quality of health information by reducing discrepancies between reported data and verified data 5. Strengthened community participation in primary health care 6. Encouraged a patient-centered vision of care delivery that emphasized improving overall patient satisfaction and being more attentive to their perception of the services received 7. Contributed to reducing inequalities based on gender at the community level 8. Contributed to motivation, accountability, and stability of health personnel in the health zones 9. Enhanced project ownership at all levels of the health pyramid, from the community level to the central level 10. Presented local, national, and international opportunities to share successful practices and experiences in the DRC 11. Provided success stories and best practices that can be used to strengthen the DRC health system through extending RBF to other health zones and to all levels of health pyramid 12. Strengthened USAID leadership in the field of RBF and innovations in health financing in DRC
In the spirit of cooperation and efficient resource management, depending on the level of intervention needed, supervisory and supportive visits from the MOH are organized jointly with IHPplus monitoring trips. These visits have helped to strengthen the management capacity of RBF providers, particularly providers who had not received formal training in RBF. They have also allowed IHPplus to observe significant positive changes in provider behavior and many local innovations and successful experiences in the health zones and health areas, which were shared with other provinces during the annual review of RBF in Kinshasa. In particular, improvements were seen in employee satisfaction, respect for working hours and the workday, quality of care, cleanliness, availability of personnel, affordability of drugs, and community participation.
Challenges Despite good progress and many success stories, RBF still faces the following challenges: Meeting the aspirations of the MOH to extend RBF to other health zones and to the intermediate and central levels
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Increasing the amount of performance-based payments to health centers to be more competitive with other RBF projects Ensuring fairness by accounting for socioeconomic differences, geographical accessibility, and the presence of physicians in referral health centers when providing health facilities performance-based payments Involving Champion Communities in performing counter-verification of RBF data Reducing the frequency of late payments, despite challenging conditions in which banks are scarce and not functioning optimally at all times Retaining trained and competent staff in a context where the lucrative private sector in health zones not implementing RBF offer very high salaries compared to RBF payments Ensuring a continuous supply of quality drugs to RBF facilities Ensuring that progress indicators integrated in PY2 are properly monitored, since they did not undergo a baseline assessment Monitoring the HIV and CPR indicators, which are not integrated throughout the program.
IR 2.3: Referral system for primary health care prevention, care, and treatment between community and health facilities (district and provincial levels) institutionalized
During PY1, 4% of patients were referred to GRHs after being seen by a CHW or health care provider, against a PMP target of 5%, which represents a 76% achievement rate (as shown in Table 57 below). Overall, the project maintained its performance throughout the year, with a number of patients referred to GRHs that remained relatively constant from PY1Q2 to PY1Q4 (varying between 58,834 and 59,746) and a referral rate that remained at 4% over the three quarters.
Table 57: Number and percentage of patients referred to GRHs Coordination # of patients (adults and children) referred Total number % Target Achievement to GRHs by a CHW or health care provider of patients patients (%) rate (%) seen by a referred PY1Q2 PY1Q3 PY1Q4 Total CHW or to GRH PY1 health care provider Bukavu 20,360 17,297 16,307 53,964 1,412,047 4 5 80 Kamina 3,441 3,601 3,288 10,330 809,547 1 5 20 Kole 7,663 8,195 8,622 24,480 263,097 9 5 180 Kolwezi 1,972 2,149 1,717 5,838 400,326 1 5 20 Luiza 2,378 2,713 2,694 7,785 418,398 2 5 40 Mwene Ditu 11,858 13,200 12,411 37,469 606,137 6 5 120 Tshumbe 6,574 7,216 7,747 21,537 422,216 5 5 100 Uvira 4,712 5,375 6,048 16,135 322,277 5 5 100 Total 58,958 59,746 58,834 177,538 4,654,045 4 5 76
Four coordination areas (Tshumbe, Mwene Ditu, Kole, and Uvira) met or exceeded the PMP target; four out of the eight (Bukavu, Luiza, Kolwezi, and Kamina) reported a rate below the project average. The GRHs in Kamina and Luiza are located in remote areas, which explains the lower performance. However, as 80% of Kolwezi coordination territory is urban, the underperformance is due to the non-respect of the referral system and health pyramid by the practitioners working in the coordination area.
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Next Steps: During the next quarter, the project will lead the following corrective actions: Ensure procurement of EGM for GRHs Work with health zone management teams during supervision visits to health centers and GRHs to provide guidance to head nurses, CHWs, and nurses working in community care sites on the use of flow charts and meeting planning and coordination Brief head nurses working in health centers on how to properly use the coaching checklist with CHWs who work in community care sites
During PY1, CHWs referred 13% of patients to health centers. Compared to the PMP target of 15%, the project reached an 86% achievement rate this quarter (see Table 58 below). The project drastically improved its performance during the last quarter, when the number of patients referred to health centers increased from 5,144 in PY1Q2 to 10,102 in PY1Q4, and the referral rate improved from 12% in PY1Q2 to 21% in PY1Q4.
Table 58: Number and percentage of patients referred to health centers Coordination # of patients (adults and children) Total number of % Target Achievement referred to health centers by a patients seen patients (%) rate (%) CHW by a CHW or referred PY1Q2 PY1Q3 PY1Q4 Total health care to health PY1 provider centers
Bukavu 1,026 412 3,808 5,246 6,990 75 15 500 Kamina 954 1,552 1,556 4,062 21,195 19 15 127 Kole 621 1,159 865 2,645 36,849 7 15 47 Kolwezi 201 315 181 697 14,439 5 15 33 Luiza 770 599 1,432 2,801 14,217 20 15 133 Mwene Ditu 255 594 583 1,432 44,588 3 15 20 Tshumbe 1,177 1,021 1,427 3,625 19,779 18 15 120 Uvira 140 182 250 572 2,818 20 15 133 Total 5,144 5,834 10,102 21,080 160,875 13 15 86
While five coordination areas (Bukavu with 500%, Kamina with 127%, Luiza with 133%, Tshumbe with 120%, and Uvira with 133%) all exceeded by far their PMP target, three others (Mwene Ditu with 3%, Kolwezi with 5%, and Kole with 7%) brought down the project’s overall performance for this indicator. The coordination areas that reported higher performance were able to do so because of supervision visits focused on the referral system provided by the health zone management teams to health providers, community care sites, CHWs, and CODESAs. Health providers--such as head nurses--also led supervision visits to community care sites, CHWs, and CODESAs to reinforce their capacity in referring patients to health centers. As a result of this close follow-up, both health providers and CHWs were able to put into practice the feedback and teaching they received. In addition, the project ensured procurement of referral tools and forms for health centers and community care sites. The four underperforming coordination offices suffered from a low level of community involvement (CHWs were already busy and involved with the organization and implementation of mass campaigns such as immunization, vitamin distribution, etc.) and the lack of health zone management team supervision visits to health centers.
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Next Steps: To improve underperformance in the next quarter, the project plans to implement strategies that were successful in the five other coordination areas: Expand the i-CCM approach by implementing more community care sites in Mwene Ditu and Luiza (proven to be successful in Bukavu, Tshumbe, Uvira, and Kole) Ensure regular drug procurement to health centers, including community care sites Increase the number of supportive supervision visits by health providers such as head nurses to community care sites, CHWs, and CODESAs Increase procurement of referral tools and forms for health facilities, community care sites, and CODESAs
Intermediate Result 3: Knowledge, attitudes, and practices to support health-seeking behaviors increased in target health zones
Community participation is one of nine principles of primary health care included in the PNDS. IHPplus uses approaches such as Champion Communities, ETL, and mHealth to encourage exchange of health knowledge, change attitudes harmful to health, and help communities support healthy behaviors and use of health care services. Through these approaches, IHPplus helps maximize health sector–community outreach linkages, foster health advocacy and community mobilization, and facilitate BCC (see Table 59).
Table 59: Summary of IR 3 key results for PY1 by Sub-IR Sub-IR Key Indicators Results 3.1 Health sector-community Youth and vulnerable group NGO participation outreach linkages Active Champion Communities 3.2 Health advocacy and Rehabilitated CODESAs community mobilization 3.3 BCC Functional CODESAs with communication action plans mHealth text messaging
IR 3.1: Evidence-based health sector-community outreach linkages—especially for women, youth, and vulnerable populations—established
Youth Associations: Youth associations continue to play a vital role in the promotion of healthy practices and behaviors. Of the 221 youth organizations identified by IHPplus, 180 are actively participating in awareness-raising activities (see Table 60 below) during PY1. The project reported increasing performance from PY1Q2 to PY1Q4 (from 143 to 180). The project exceeded the PMP target of 146, for an achievement rate of 123%.
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Table 60: Number of youth organization completing youth awareness-raising activities Coordination Number of Number of Number of Number of Total number youth youth youth youth of youth CBOs/NGOs CBOs/NGOs CBOs/NGOs CBOs/NGOs CBOs/NGOs participating in participating in participating in participating in awareness- awareness- awareness- awareness- raising activities raising raising raising during PY1Q2 activities activities activities during PY1Q3 during PY1Q4 during PY1 Bukavu 28 10 10 10 10 Kamina 13 4 5 13 13 Kole 35 35 35 35 35 Kolwezi 12 10 10 10 10 Luiza 18 15 15 15 15 Mwene Ditu 58 54 58 58 58 Tshumbe 19 2 2 11 11 Uvira 38 13 13 28 28 Total 221 143 148 180 180
To ensure the sustainability of positive behavior changes within the community, IHPplus encourages youth to be involved in decision-making on program activities. For this to be possible, it is important that youth are well informed, have access to health services, maintain relationships with organizations working on youth issues, and remain involved in decision-making and activity management.
IHPplus provided assistance to a number of youth organizations whose primary goals are to promote sexual and reproductive education and health, as well as encourage youth to take an active role in community development. During PY1Q4, youth organizations with IHPplus assistance accomplished the following: Dilala health zone (Kolwezi coordination area): Forty youth from the Maria Polis parish participated in an education session on sexual violence and sexually transmitted diseases (STDs). After the lecture, youth reached an additional 132 youth and adolescents working in mines to raise awareness on these health issues. Additionally, youth distributed 1,400 condoms, referred 43 suspected cases of STDs to a clinic, and reported five cases of suspected sexual violence to local authorities. Dibaya health zone (Luiza coordination area): Three youth associations supported by teachers organized six sessions for 1,900 adolescents in their final year of school on the negative effects of alcoholism, smoking tobacco, and early marriage. Lodja and Tshumbe coordinations: Seventeen youth associations raised awareness among 530 people on the prevention of HIV and TB. They distributed 50 spittoons and accompanied a number of suspected TB cases to a clinic. Also, 300 condoms were provided to youth association members that volunteered for the awareness-raising activity. Kalomba health zone: Two youth associations created a fish and rabbit farm. They currently have 67 rabbits and the fish farm covers two acres. Kamina coordination: The youth of the Batwa Bemba NGO organized two meetings at a market to discuss early marriage and HIV and AIDS. A total of 174 youth attended these awareness-raising sessions. Katana health zone (Bukavu coordination area):
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o The Remopak NGO provided 150 youth (85 girls and 65 boys) in the health areas of Nuru, Kabushwa, Kabamaba, and Mugeri, with information on early marriage, unplanned pregnancies, and the proper use of male condoms. o The youth of Remopak NGO participated in the production of six broadcasts on HIV for Radio Maendeleo in Bukavu, and 13 published reports on the same topic.
Challenges: Lack of funding to implement similar sessions and lectures in the other health areas
Lessons Learned: Promoting peer education allows for the dissemination of information where funds are limited. Youth organizations are an effective means by which to overcome social customs that have a negative impact on community health, as a result of the educational activities they organize on a regular basis in schools and churches. Involving community leaders in CBO youth awareness-raising activities fosters an atmosphere of trust between youth and adults.
Next Steps: Assist youth organizations in integrating their activities in NGO Champion Community workplanning, and gain access to funding.
IR 3.2 Health advocacy and community mobilization organizations strengthened
As noted, 1,280 IHPplus-supported communities have CODESAs that are actively involved in managing priority health activities. IHPplus assists them in developing and implementing self-designed solutions to community health problems they have identified. Locally proposed solutions to health problems are codified into action plans, and IHPplus assists the CODESAs in tracking the development, implementation, and results of these plans. Examples include partnering with local opinion leaders such as pastors to announce health messages in churches, group discussions on health topics, and public announcements of WASH, MNCH, and family planning messages with megaphones in village centers. Of the 1,280 CODESAs that are actively involved in managing priority health activities, 1,225 (96%) have a communication action plan, exceeding the target of 1,200 (an achievement rate of 102%) (see Table 61).
Table 61: Number of CODESAs with communication action plans during PY1 Coordination PY1 Number of PY1 Number of revitalized and CODESAs functional CODESAs with a revitalized and communication action plan functional Bukavu 399 380 Kamina 190 190 Kole 129 129 Kolwezi 91 89 Luiza 147 142 Mwene Ditu 156 149 Tshumbe 86 74 Uvira 82 72 Total 1,280 1,225
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During the year, the project integrated CODESAs in the BCC activities of health campaigns (vitamin A supplementation, polio, and measles vaccination) throughout the health zones. CODESAs were involved in pre-briefing meetings and helped mobilize communities via churches, schools, and households. CODESAs performed counts of households and children younger than five years old, and assisted in overcoming misconceptions and discrediting rumors about vaccinations and their rumored side effects.
For the diarrhea outbreak (April and May 2016) in Uvira health zone, the CODESAs raised community awareness on handwashing, bathing, food preparation, sanitary latrines, sewage, and potable/non-potable water during informational sessions in churches (67) and household visits (1,346). Educational pamphlets were printed (160 copies) and distributed at churches, schools, and marketplaces.
CODESAs achieved the following development activities in PY1Q4: In Bukavu, the Ciburi health area (Mwana health zone) CODESA completed the construction of a health center in Lwarhamba and housing for medical staff in Kashadu. In Kamina, the Nkole health area (Malemba health zone) CODESA mobilized the community to complete the construction of a health center. The community, under the CODESA’s instruction, transported construction materials.
Challenges: Difficulties with record-keeping/archiving documents for a number of CODESAs due to their lack of offices or infrastructure Loss of CHWs due to lack of motivation and incentives Difficulties with CHW capacity building, monitoring, and supervision due to their large numbers, and lack of logistical and financial means to cover these activities Lack of coordination among CODESAs and other community-level organizations, such as religious organizations, teachers, local government leaders, CBOs, and community leaders Limited CODESA activities in areas with security-related population displacements (Mulungu, Shabunda, Kalole, Bunyanki, Kalonge, Lemera, and Haut Plateau)
Lessons Learned: Monitoring and supervising CODESAs during work planning reinforces leadership structures and helps clearly define objectives and activities
Next Steps: Organize monitoring and supervisory missions to reinforce CODESA activities and operations in conjunction with the Programme National de Communication et de la Promotion de la Santé and DPS representatives To motivate CODESA members, IHPplus will continue to finance CODESA meetings and facilitate collaboration with organizations operating in target health areas, with an emphasis on organizations with the financial means to back CODESA projects and provide incentives.
IR 3.3: Behavior change campaigns involving opinion leaders and cultural influences (people and technologies) launched
Behavior Change Communication
Champion Communities: IHPplus currently supports 34 Champion Communities in the eight coordination areas, of which 32 are active. Compared the PMP target of 34, the project reached a 94% achievement rate. Neighboring communities, desiring to improve their own health standards, have adopted the
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Champion Community method on their own. During PY1Q4 and throughout the past year, as the Champion Communities have become NGOs, they have broadened their activities to include surrounding areas. In addition to developing their own health priorities, a number of Champion Communities have helped neighboring health areas create autonomous Champion Communities through knowledge sharing. In the past year, 10 autonomous Champion Communities were created, three of which were created during PY1Q4: Kamina: The Champion Communities of Kabongo and Malemba have each assisted in the implementation of an autonomous Champion Community in their respective health zones. Luiza: All six project-implemented NGO Champion Communities have assisted in the establishment of neighboring autonomous Champion Communities. These Champion Communities plan to cover all of the health zones in which they operate.
Table 62 summarizes the number of active Champion Communities in PY1, as well as the number of autonomous Champion Communities by coordination office.
Table 62: Champion Community creation as of the end of PY1 Coordination Number of active Number of active Number of non- Number of Place or health Champion Champion active Champion autonomous zone benefiting Communities Communities Communities Champion from the implemented by implemented by implemented by Communities autonomous IHPplus IHPplus with IHPplus Champion workplans Communities Bukavu 4 4 1 0 N/A Kamina 3 3 N/A 0 N/A Kole/Lodja 3 3 N/A 2 Lodja Kolwezi 4 4 1 0 N/A Luiza 6 6 N/A 6 Bilomba, Luiza, and Dibaya Mwene Ditu 4 4 N/A 0 N/A Tshumbe 3 3 N/A 1 Tshumbe Uvira 5 5 N/A 1 Ruzizi Total 32 32 2 10 N/A
During PY1Q4, the project continued to provide technical support for developing and implementing workplan activities to all 34 operational Champion Communities throughout the quarter. Furthermore, the project assisted the 30 NGO Champion Communities define their objectives and development plans to facilitate their pursuit of grants and subsidies. The four remaining Champion Communities (Mwene Ditu) are in the process of receiving Ministry of Justice recognition as NGOs.
The NGO Champion Communities completed the following activities: The Rhusimane NGO Champion Community in Mwana received funding from Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) for the construction of a youth center. By mobilizing the Luchiga health area’s population, and collecting donations and materials, the Rhusimane Champion Community built infrastructure that provides the community and health center with potable water. The Tuwe Mfano NGO Champion Community in Katana opened the Kabushwa modern health center for treatment of patients this quarter. The land on which the health center was built was
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financed by the community as well as funds obtained through the Champion Community’s advocacy efforts. Five members of the Tuwe Mfano and Kenguka Champion Communities in Katana participated in a household study in the Katana health zone for a baseline study for the implementation of USAID’s Ushindi project, led by IMA. In Kolwezi, the Ushindi Champion Community and the Bon Pasteur NGOs partnered to provide awareness-raising, tutoring, and counseling services to 145 children aged 6 to 14, including orphans and former child miners. Additionally, the NGOs enrolled 69 children in apprenticeship programs in baking, hair cutting, welding, and cobbler work.
Challenges: Some NGO Champion Communities have difficulties writing development proposals.
Lessons Learned: The receipt of grants/funds for NGO Champion Community projects reinforces the notion of communities having the capacity to manage their own development and increases the “esprit de corps” and pride in their work.
Next Steps: Provide technical support to NGO Champion Communities in writing and implementing workplans.
Champion Men Initiative: The Champion Men initiative continues to be implemented to change men’s perceptions on the roles of women in their families and communities. The initiative strives to create an equitable balance between men and women in family decision-making, especially as related to children’s education, health care, and finances.
In Katana, 32 women credited the initiative with increasing the recognition they receive from their husbands, which has improved their own self-esteem. The initiative fostered discussions on family planning between women and their husbands. Three years ago, one member of the Kenguka Champion Community NGO removed his daughters from school, believing girls of their age should not attend to school. This year, after joining the Champion Men initiative, he re-enrolled his daughters in school.
In Lodja, 14 women reported increased household dialogue because of the Champion Men initiative. The Lodja Champion Men are currently being monitored and evaluated for positive behavior changes. They are encouraged to assist each other and are provided with additional information and guidance as necessary.
Challenges: Some men are resistant to the initiative, believing that women are inferior due to social and religious customs.
Lessons Learned: The introduction of the Champion Men initiative in Katana positively changed the behaviors of men towards women. The initiative has made husbands more aware of their household’s wellbeing and has increased dialogue with children. Men who participated in the initiative are becoming models for their community. Positive statements made by the wives of Champion Men have motivated women to encourage their husbands to join the initiative.
Next Steps: Monitor and evaluate the Champion Men initiative
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Establish the initiative in neighboring villages and health areas Perform a study on BCC indicators in health areas prior to the implementation of the Champion Men initiative mHealth: The mHealth campaigns are effectively disseminating health-related information via SMS messages to targeted persons, their households, and surrounding communities. During PY1, the project sent 510,168 SMSs (see Table 63 below), exceeding the target of 360,000 messages (an achievement rate of 142%). The project performance varied between the quarters (191,066 during PY1Q2, 147,607 during PY1Q3 and 171,495 during PY1Q4) but always remained above the PMP quarterly target of 120,000.
Table 63: Number of SMS messages sent by coordination and by quarter during PY1 Number of SMS messages sent by coordination PY1Q2 PY1Q3 PY1Q4 PY1 Bukavu 16,507 11,368 28,332 56,207 Kamina 16,370 14,201 14,438 45,009 Kole/Lodja 22,661 22,661 21,369 66,691 Kolwezi 15,019 3,040 13,480 31,539 Luiza 70,600 59,400 36,700 166,700 Mwene Ditu 16,008 4,140 16,008 36,156 Tshumbe 17,150 19,840 21,843 58,833 Uvira 16,751 12,957 19,325 49,033 Total 191,066 147,607 171,495 510,168
Table 64: Number of SMS messages sent by health topic and coordination during PY1 Health topic Bukavu Kamina Kole Kolwezi Luiza Mwene Tshumbe Uvira Total Ditu Malaria 14,635 5,432 5,733 - - 5,603 6,215 6,409 44,027 Family 2,999 - 4,861 6,280 5,200 3,202 4,280 - 26,822 planning WASH 4,896 - - - - 2,401 - - 7,297 MNCH - 6,203 3,178 4,300 25,700 - 4166 - 43,547 TB 2,510 - - - - 1,602 - - 4,112 Exclusive 3,292 - - - 5,800 - - - 9,092 breastfeeding Vaccination - - 7,597 2,000 - - 7,182 9,507 26,286 Diarrhea/ - - - - - 3,200 - 3,409 6,609 Cholera HIV and AIDS - 2,803 - 900 - - - - 3,703 TOTAL 28,332 14,438 21,369 13,480 36,700 16,008 21,843 19,325 171,495
These SMSs contribute greatly to community discussion on malaria, ANC, family planning, vaccinations, TB, and diarrhea. Through SMSs, 2,456 women received information on the importance of ANC, vaccinations, and mosquito net use in the coordination areas of Luiza (Bilomba, Dibaya, and Ndekesha), Kamina (Malemba and Kabongo), Bukavu (Katana), and Uvira (Uvira). Women consistently cited SMS as their source of information during 39 community debates and exchanges held by the Champion Communities. They expressed their desire to receive more SMSs on a regular basis.
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In the health zones of Dibaya, Kole, Lodja, Luiza, and Dilala, 130 teachers have set up inter-school question and answer games. Students answer questions on TB, diarrhea, vaccination, HIV, malaria, and hand washing information shared in the SMSs. The students are encouraged to share the information with their parents, friends, and acquaintances, as well as to create community discourse.
Challenges: Lack of FrontLine software fluency and SMS plan use by some health zone central office personnel Weak to non-existent cell phone coverage in some health zones
Lessons Learned: Well-targeted, regular, and repeated SMSs increase the likelihood of positive behavior changes. This has been especially evident with women in Kole, 32 of whom attended all necessary ANC visits and gave birth in clinics after having received regular SMSs on MNCH.
Next Steps: Assist health zone central offices to access Airtel or Vodacom SMS plans to reduce the costs of the SMS campaigns and increase coverage area Encourage SMS knowledge-sharing during non-health related community meetings Study impact of SMSs by performing evaluations at the health centers
COMPONENT 2: HEALTH SYSTEMS STRENGTHENING
Table 65: Summary of key IR 4 results for PY1Q3 Sub-IR Key Indicators Results 4.1 Provincial Health zones with annual operational plans (AOPs) health sector based on national policy policies aligned Health zone management teams with appropriate with national policy management system tools
Intermediate Result 4: Health sector leadership and governance in target provinces improved
IR 4.1: Provincial and national level health sector policies aligned
Annual Operational Plans: The number and percentage of AOP drafts developed and validated during PY1 reached, respectively, 61 and 78% by the end of PY1Q4 (see Table 66). This is a great improvement compared to PY1Q2 and PY1Q3, when the number and percentage of AOP drafts developed and validated during the quarter remained the same (27 and 35%, respectively). During PY1Q2, there was a misunderstanding between the MOH Direction of Studies and Planning (DEP) and the DPS about the activities to prioritize. While the DEP was focused on designing the new PNDS, the DPS had received instructions to start with their local health development plans. The new PNDS was almost completed as of the end of March 2016. However, insufficient financial support further delays the DPS work to finalize their local health development plans and AOPs. While health zones were able to get their AOPs consolidated at the DPS level, they were still waiting on their boards to validate them by the end of PY1Q3. The various boards of health zones met in May 2016. IHPplus provided subsidies through its grants program to health zones to organize these meetings to increase the number of validated AOPs during PY1Q4. Only DPS teams from Lualaba and Haut Lomami provinces have not yet organized their board
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Table 66: Number and percentage of AOP drafts developed and validated by province and field offices Province Coordination Health zones Health zones with Percentage (%) AOP validated during PY1 Kasaï Occidental Luiza 9 9 100 Kasaï Oriental and Mwene Ditu 9 9 100 Lomami Sankuru Kole 8 8 100 Tshumbe 8 8 100 Haut Lomami Kamina 9 0 0 Lualaba Kolwezi 8 0 0 Sud Kivu Bukavu 22 22 100 Uvira 5 5 100 Total 78 61 78
IR 4.2: Evidence-based tools for strategic planning and management decision-making adopted
IHPplus continued to provide technical and financial support to the MOH to strengthen monitoring and evaluation systems and the national health information system. During PY1, a total of 49 people (DPS and project coordination staff) were trained on RDQA.
During PY1Q2, a total of 37 people (15 from Lualaba DPS and 22 from Kasaï Central DPS) were trained. Attendees for the Lualaba training included two managers from the health provincial inspection of Haut Katanga and eight managers from the new Lualaba DPS. IHPplus encouraged the DPS to include female employees in the training; however, no women attended. During the Kasaï Central training, the attendees included two managers from the health provincial inspection, eight managers from the Kasaï Central DPS, and six independent/external participants, including two women. During PY1Q3, IHPplus trained 12 staff from the DPS in Sud Kivu and 10 project staff in performing RDQA.
IHPplus and DPS staff conducted RDQAs in six health zones (Kaziba, Miti Murhesa, Ruzizi, Kaniola, Mwana, and Mwenga). The DPS used information collected during these exercises to assess the quality of data during the annual provincial review and determine corrective actions to improve data quality. Involving the DPS in using the RDQA tool proved successful and enabled staff to identify additional challenges related to data collection, completing tools, and data analysis. During PY1Q4, the project led one RDQA mission in Mwene Ditu. To improve MNCH data tracking, the project also distributed data collection tools to every health zone supported by IHPplus.
DPS and IHPplus staff used project data and results to make decisions on planned activities for PY2 during the annual workplanning workshop, held June 6-10, 2016. Each coordination office included several M&E activities in its respective workplan, with a focus on building project and MOH staff capacities in RDQA. Once the workshop ended, the project M&E team organized a seminar to draft overall recommendations to share with the rest of the staff for overcoming routine data quality challenges at the health facility level.
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Finally, the M&E team also provided additional support to the HV technical advisors on the selection of indicators related to RBF integration in the health zones overseen by the Lualaba DPS.
Another initiative undertaken by the project during PY1 to improve data reporting was the implementation of the DHIS2 web portal for data management. In collaboration with the project IT Manager, IHPplus’ DHIS2 consultant developed training materials to be used by the project to train all technical and M&E staff working in every coordination office. To date, all project staff have been trained on DHIS2 and have started using it. The functionality of DHIS2 depends on the availability of data in health facilities. The project is in the process of uploading data from health facilities on DHIS2, which will enable the project to report PY2Q1 data using DHIS2.
Several obstacles remain to improving data quality, including insecurity and instability in certain health zones (such as Mulungu and Kalole, for example). IHPplus will continue to conduct trainings on RDQA with new DPS staff in Kasaï and will monitor the use of the RDQA tool in all trained DPS and coordination areas supported by the project.
IR 4.3: Community involvement in health policy and service delivery institutionalized
During PY1, 1,280 CODESAs were reported as active. In addition, 96% of these active CODESAs have communication action plans for addressing health problems through locally-proposed solutions. Through awareness-raising techniques and activities that encourage community participation, CODESA members contributed to behavior change by increasing community prevention actions and utilizing health services, in order to improve community health. The CODESAs were also able to mobilize the community to complete renovations of health facilities in Bukavu and Kamina.
The project engaged 180 youth organizations to continue to play a vital role in the promotion of healthy practices and behaviors with IHPplus assistance. Their accomplishments include but are not limited to reaching an additional 132 youth and adolescents working in mines in Kolwezi through education session on sexual violence and sexually transmitted infections (STIs), distributing 1,400 condoms, referring 43 suspected cases of STIs to a clinic, and reporting five cases of suspected sexual violence to local authorities. In Dibaya health zone, three youth associations supported by teachers organized six sessions for 1,900 adolescents in their final year of school on the negative effects of alcoholism, smoking tobacco, and early marriage. In Tshumbe, 17 youth associations raised awareness among 530 people on the prevention of HIV and TB, distributed 50 spittoons, and accompanied a number of suspected TB cases to a clinic. The project provided 300 condoms to youth association members that volunteered for awareness- raising activities. In Kalomba health zone, two youth associations created a fish and rabbit farm. They currently have 67 rabbits and the fish farm covers two acres.
PROJECT MANAGEMENT Success stories: The project produced nine success stories to contribute towards the annual target of 24 stories. They are found in the last section of the report. The topics covered were MNCH (2), RBF (2), BCC (2), access to care (1), family planning (1), and TB (1). During the next quarter, the project will develop more success stories on the LDP, malaria, i-CCM, FOSACOF, nutrition, and GBV to ensure fair representation of each health topic across the project.
Cost share: Brother's Brother Foundation (BBF) is a non-profit international humanitarian relief organization that equips the world’s most resource-limited medical facilities with donated medical supplies and equipment. MSH started working with BBF under IHP and continues this collaboration under
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IHPplus. BBF recently donated 53 hospital beds as well as one bulk roll of vinyl material to cover mattresses to the project. These items arrived in country on November 2, 2015, and were distributed to GRHs located in health zones prioritized by the MOH for support. The estimated value of this cost share is $23,860 (fair market value of all donated goods) and was booked in May 2016.
IHPplus also worked during the quarter to pursue two additional cost-share opportunities with Project CURE and Vitamin Angels. Project CURE (a US-based gift-in-kind donation agency) shipped eight 40-foot containers of medical supplies for IHP, and additional donations are planned under IHPplus. To determine the type and quantity of medical supplies needed, a volunteer for Project CURE conducted a need assessment in eight hospitals located in Sud Kivu from March 13 to 19 and submitted a report (including packing list requests) on April 22, 2016. IHPplus is working on reviewing the needs assessment report and drafting a scope of work (including number of containers, allocation, and sequencing strategy) to be shared with Project CURE during next quarter. The second cost-share opportunity is with Vitamin Angels, a California-based nonprofit helping to alleviate global micronutrient deficiency among at-risk populations— specifically pregnant women, new mothers, and children under five—and help them gain access to lifesaving vitamins and minerals. IHPplus is exploring a partnership with Vitamin Angels to secure donations for the project’s ongoing vitamin A supplementation program. IHPplus submitted the needs assessment for this commodity on July 12 to the DRC program adviser for Vitamin Angels and is waiting to hear back from him on their decision regarding the quantities to be donated.
Status of pharmaceutical procurement order #1: The first IHPplus order was placed with IDA, ASRAMES, IMRES, and MEG in August 2015, for pickup in December 2015. A total of 23 shipments has been managed by global shipping and logistics experts and distributed in the country by Groupe Transport Multimodal (GTM). The pharmaceutical shipments are well under way: 22 shipments have arrived at their final destination. At the time this report was written, the last shipment was on its way to its final destination.
Status of pharmaceutical procurement order #2: The second order of pharmaceuticals was placed with MissionPharma in December 2015. All shipments from countries of origin to Goma will be managed by MissionPharma’s freight forwarder and will be stored and distributed in the country by ASRAMES. ASRAMES has fully delivered three shipments. The fourth and fifth shipments are in their way to their final destination. For the remaining shipments, one is waiting on a note verbale, two are pending import authorization from the MOH, and one is scheduled to arrive in Goma in mid-August (arrival not confirmed before report was completed).
Warehousing: During IHP PY5Q2, as a result of using the expiration-warning system that SIAPS set up within MSH’s warehouse monitoring system, IHP identified 19,244,157 condoms that were at risk of expiring. The total estimated value of this supply was $769,766. USAID was officially alerted and called an urgent meeting to develop a plan to redeploy the supply. Following this meeting, it was agreed that MSH would redistribute 69% (13,183,000) of these condoms to partner CDRs. By the end of IHPplus PY1Q3, 71% of the total stock had been distributed (13,665,006 out of 19,244,157) which was a combined effort of all USAID partners. Unfortunately, the 5,579,151 condoms left (valued at $223,166) expired in April 2016. During PY1Q2, SIAPS also alerted USAID of a stock of 173,571 oral contraceptives (Microgynon) valued at $46,864 at risk of expiring in the Kinshasa warehouse. Regrettably, it was too late to develop a redeployment plan, as the contraceptives expired in April 2016. The process to destroy both expired stocks is ongoing as SIAPS already sent USAID official correspondence informing them of the situation, followed by a request to the MOH Inspection Department to proceed with the destruction. As of today, the team is waiting to hear back from the MOH and the stock destruction is planned for mid-August 2016.
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SIAPS worked jointly with IHPplus to improve storage conditions in the Kinshasa warehouse in accordance with MSH Audit Board recommendations. To do so, they renovated the warehouse by building a suspended ceiling and installed eight air conditioning units of 50,000 BTU to decrease the in-room temperature from 35 degrees Celsius to 23 degrees Celsius, which fulfills the national recommended drug conservation measures. Once the renovation work was completed, SIAPS and IHPplus moved the commodities previously stored in the PROCOKI warehouse to the Kinshasa warehouse, which saved the project rent and improved the monitoring of commodities.
FAMILY PLANNING AND HIV AND AIDS STATUTORY REQUIREMENTS During Year 1, IHPplus staff, service providers at health facilities, and community health workers at care sites provided family planning and HIV and AIDS services while ensuring that USAID’s regulations concerning family planning and HIV and AIDS were followed.
1. Family planning: The project supplied two new methods of contraception, Sayana® Press and Implanon NxT, in addition to the previously-available selection of contraceptive products (CycleBeads, male condoms, female condoms, Depo-Provera, ParaGard copper intrauterine devices, standard Implanon, Microlut, and Microgynon) to service delivery points, which ensured that clients could make an educated selection from a range of methods after attending family planning counseling sessions. Sixty-eight IHPplus technical staff members and 10 partners from the MOH completed the online course on USG family planning regulations. A USAID/Washington team trained six IHPplus staff members on USAID’s family planning policies and supply chain requirements. Five hundred Tiahrt posters were distributed to health facilities. Family planning statutory requirements were systematically integrated into the supervision framework. IHPplus supported training and refresher sessions on family planning for 139 service providers and 306 CHWs, incorporating presentations on the USG family planning regulations.
2. HIV and AIDS: In the coordination areas of Kolwezi and Kamina, where IHPplus implements the HIV service package, all staff and providers involved in HIV care previously received HIV and AIDS training. All HIV care sites continued to provide HIV pretest and post-test counseling. They also provided counseling to people living with HIV and AIDS prior to initiating ART. Condoms distributed at IHPplus HIV care sites were accompanied by accurate and specific medical information, including public health benefits of condom usage and failure rate. Providers at IHPplus-supported HIV and AIDS care sites continued to observe and enforce infection-control regulations by taking universal personal precautions (washing hands and wearing masks and gloves) administrative precautions (properly ventilating workplaces, spacing out medical visits for TB patients and people living with HIV/AIDS), and environmental precautions (properly managing biomedical waste, specifically by sorting waste and using incinerators).
Next steps: Request additional Tiahrt posters from USAID to replace old, unreadable, and damaged posters at health facilities
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Continue to monitor adherence to the USG family planning and HIV and AIDS regulations during supervision visits Facilitate IHPplus technical staff from the Kolwezi and Kamina coordination offices who are involved in implementing the HIV package of services to take the online course on HIV and AIDS Legal and Policy Requirements
ENVIRONMENTAL MONITORING AND MITIGATION PLAN
The MOH and IHPplus conducted field visits to 439 health facilities. An assessment of the proper disposal of biohazard wastes and appropriate individual hygiene practices was included in the field visit assessment. Field visits identified a lack of attention to correctly managing biomedical waste in some sites. In many hospitals, maternity wards and health centers, waste is littered on the ground. The project is conducting a situational analysis to identify the needs in terms of equipment, capacity, and approaches needed to address this problem in communities.
On average, 96% of facility staff use all hygiene equipment correctly. A high percentage of health facilities have placenta pits and garbage pits and containers for disposing sharp items (86%, 86%, and 93%, respectively) and a large number of staff at the facilities know how to use them correctly (98%, 97%, and 97%, respectively). Incinerators were less present, with availability in only 57% of facilities visited.
IHPplus continued supporting the health zone management teams in implementing the following actions: Through Champion Communities and CODESAs, support health facility to mobilize local resources to increase hygiene hardware availability and improve recommended hygiene practices. During the health zone management team monthly supervision visits, continue to evaluate health facilities and sensitize head nurses on the importance of compliance with recommended biohazard waste management and individual and facility hygiene practices during the monthly monitoring meetings and field visits.
During PY1, communities in Ndekesha, Luambo, Kanda Kanda, and Luputa health zones built 24,961 household latrines. As a result of IHPplus technical support through CLTS, 167,108 people had first time access to an improved sanitation facility. The project provided access to improved drinking water supply to 228,314 people, by renovating 222 water sources. The project conducted training for WASH committees to empower them in managing water sources and promoting hygiene and sanitation practices.
CHALLENGES ENCOUNTERED The main challenges that the project experienced during PY1 included the following:
Supply Chain Management System: Overall, health facilities continued to report a number of stock-outs of tracer medicines (ACT, Depo-Provera, ORS, and iron folate) that exceeded the project’s PMP target (all four of them) during PY1. The indicator on the number of ACT stock-outs was the closest to meeting its target (146 compared to 100), followed by the number of ORS stock-outs (181 compared to 100). The project reported its lowest performance for the iron folate and Depo-Provera stock-outs (244 compared to 200 and 243 compared to 100, respectively).
IHPplus and SIAPS will continue to address bottlenecks that contribute to high stock-out levels at the facility level when concerned products are available in the health zones and the CDRs. In addition to continuing the supervision visits and training of DPS and health zone management teams on pharmaceutical supply chain management, IHPplus and SIAPS will amend the EGM management
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Data Quality: Ensuring the quality of data remains a challenge. During the year IHPplus provided technical and financial support to provincial health division management teams to conduct RDQA post-training visits. In order to reinforce health zone and DPS accountability in ensuring data quality, IHPplus plans to include RDQAs reports as deliverables from the subgrants the project provides to them.
Security: During the year, armed groups continued to be active in Sud Kivu. IHPplus continues to work closely with the health zones and health authorities in the affected health zones to make sure that basic support is provided for health facilities, including timely delivery of essential medicines, commodities to maintain the cold chain for vaccines, as well as the grants to health zone management teams and DPS.
To address this challenge, the MSH security officer assessed properties of MSH-managed projects in Kinshasa and Bukavu, including office, residences, activity venues, and warehouses. He helped with further improving the organization’s security system. IHPplus receives almost daily updates on insecurity related events from International NGO Safety Organization (INSO) DRC, particularly in Nord and Sud Kivu, as well as specific safety recommendations for our staff and properties.
WAY FORWARD: PLANNED ACTIVITIES FOR NEXT QUARTER Key activities planned for quarter one of PY2 include the following6:
IR1 Access to care Provide basic equipment in health facilities in the health zones supported by the eight coordination offices (Bukavu, Kamina, Kole, Luiza, Mwene Ditu, Tshumbe, and Uvira) Provide essential medicines and other specific commodities for family planning, HIV, TB, and malaria in health facilities supported by the coordination offices (Bukavu, Kamina, Kole, Kolwezi, Luiza, Mwene Ditu, Tshumbe, and Uvira) and establish an efficient management system for medicines and commodities Renovate health structures (Kole, Luiza, Tshumbe, Bukavu, and Uvira)
Community-based health care services and products Continue to provide technical assistance to CODESAs to be actively involved in management of priority health services by orienting CODESA members on priorities and approaches in the various health domains (Kamina, Luiza) Strengthen i-CCM of childhood illness through training and regular monitoring (Kole, Mwene Ditu, Tshumbe, Luiza, and Kolwezi) and the provision of materials (Kole, Tshumbe, Kolwezi, and Uvira) Scale up and strengthen WASH activities with a focus on promoting greater ownership and sustainability through training (Kamina, Luiza, Mwene Ditu, Tshumbe, Bukavu, and Kolwezi), providing water quality control kits (Kamina, Luiza, Mwene Ditu, Tshumbe, Bukavu, Kolwezi, and Uvira), promoting the new water law, and building/renovating water and hygiene sources
6 Pending USAID approval of the final PY2 workplan
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Strengthen and mobilize IYCF support groups in supported health zones through trainings and monitoring (Bukavu, Kamina, Kole, Kolwezi, Luiza, Mwene Ditu, Tshumbe, and Uvira) Strengthen community involvement in reducing the prevalence of TB in health areas by establishing Club des Amis Damien, local TB support groups, in health zones (Kamina, Kole, Luiza, Mwene Ditu, and Tshumbe)
LDP Strengthen the capacity of LDP teams to implement the approach and promote increased engagement and monitoring from stakeholders by conducting refresher briefings on the LDP approach (Kole, Luiza, Tshumbe, Bukavu, Uvira, and Kolwezi), holding senior alignment meetings (Luiza, Mwene Ditu), and working with LDP teams to monitor address challenges in implementing their LDP projects (Bukavu, Kamina, Kole, Kolwezi, Luiza, Mwene Ditu, Tshumbe, and Uvira) Strengthen health management systems in health zones through supportive supervision (Bukavu, Kamina, Kole, Kolwezi, Luiza, Mwene Ditu, Tshumbe, and Uvira)
IR2 MNCH Conduct briefings on MOH norms and directives for MNCH in project-supported health zones to improve the quality of preventive and curative services (Bukavu, Kamina, Kole, Kolwezi, Luiza, Mwene Ditu, Tshumbe, and Uvira) Train health care providers on the MNCH competency-based approach (Kamina, Kole, Luiza, Tshumbe, Bukavu, Kolwezi, and Uvira) Strengthen the management of newborn care through the implementation of the Kangaroo mother care (Kole, Luiza, and Tshumbe), HBB (Luiza), and Emergency Triage Assessment and Treatment approaches (Kole, Mwene Ditu, Tshumbe, and Bukavu), and trainings on neonatal resuscitation and sepsis Train health care providers in family planning (including new themes such as long-term family planning methods, utilization of the new Sayana® Press injectable, and postpartum contraception) using the competency-based methodology (Kamina, Kole, Luiza, Mwene Ditu, Tshumbe, Bukavu, Kolwezi, and Uvira) Train CHWs and CBDs in strengthening family planning at the community level and provide community-based distribution kits (Kamina, Kole, Luiza, Mwene Ditu, Tshumbe, Bukavu, Kolwezi, and Uvira) Conduct monitoring and supervision visits of MNCH and family planning activities (Bukavu, Kamina, Kole, Kolwezi, Luiza, Mwene Ditu, Tshumbe, and Uvira)
EPI Strengthen routine immunizations in project-supported health zones by assisting the EPI to monitor the implementation of the atteindre of each health zone approach and vaccination activities in areas with low immunization coverage (Kamina, Kole, Mwene Ditu, Tshumbe, Kolwezi, and Uvira), and conduct briefings for health zone management teams, health center teams, and CHWs in health zones with a risk of polio and vaccine- preventable diseases on community-based surveillance (Luiza) In collaboration with UNICEF, WHO, and other partners, organize independent monitoring missions during global immunization days in health zones with elevated risk for the circulating vaccine-derived polioviruses (Bukavu, Kamina, Kole, Kolwezi, Luiza, Mwene Ditu, Tshumbe, and Uvira)
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Provide solar refrigerators, fuel, and other spare parts to support the functioning and maintenance of the cold supply chain system in all health zones
Malaria Support health care providers to correctly diagnose and treat cases of malaria in the health facilities/communities care sites through training, refresher training, supportive supervision, and strengthening data collection (Bukavu, Kamina, Kole, Kolwezi, Luiza, Mwene Ditu, Tshumbe, and Uvira) Revitalize and participate in PNLP malaria task force meetings (national and provincial levels) (Bukavu, Kamina, Kole, Kolwezi, Luiza, Mwene Ditu, Tshumbe, and Uvira) Conduct field visits to collect data for the final evaluation (phase III) of the feasibility study on the use of rectal artesunate in community care sites and disseminate findings to stakeholders (Bukavu, Kamina, Kole, Kolwezi, Luiza, Mwene Ditu, Tshumbe, and Uvira)
Tuberculosis Strengthen the fight against TB, TB and HIV co-infection, and MDR-TB through supportive supervision of health providers, provision of reliable transportation of TB samples, and joint follow-up visits to supported health zones, participation in TP epidemiological reviews (Kamina, Luiza, Kole, and Tshumbe), organization of active TB screening (Kole, Tshumbe), and participation in an evaluation on the Directly Observed Treatment Strategy (Kole, Tshumbe, and Bukavu) Conduct a study on TB prevalence among health staff working at the CSTs and CSDTs located in IHPplus-supported health zones to prevent and decrease transmission in health care settings (Bukavu, Kamina, Kole, Kolwezi, Luiza, Mwene Ditu, Tshumbe, and Uvira) Conduct a situational analysis on infection prevention and control in health facilities treating a high number of PLHIV and/or MDR-TB patients and located in IHPplus- supported health facilities (Bukavu, Kamina, Kole, Kolwezi, Luiza, Mwene Ditu, Tshumbe, and Uvira)
GBV Improve clinical care to victims of sexual violence through trainings and briefings on GBV (Kamina, Kolwezi), distribution of educational materials and management tools, provision of Post-Exposure Prophylaxis (Bukavu, Uvira), mini-campaigns on GBV and women’s' rights (Mwene Ditu, Bukavu), and monitoring and supervision of GBV activities, particularly in areas with low performance
HIV Provide HIV sites with the necessary materials and commodities to deliver quality HIV services and strengthen the capacity of health care workers to provide quality HIV services through training, supervision, and the implementation of social assistance clubs (Kolwezi)
FOSACOF/Integrated Quality Approach Provide technical assistance to the MOH to implement the new Integrated Quality Approach and the clinical and therapeutic guide to improve the quality of health services through training and monitoring Strengthen the capacity of MOH staff to implement and monitor the FOSACOF approach in health facilities to improve the quality of services by conducting FOSACOF evaluations, monitoring the implementation of FOSACOF improvement plans, and conducting briefings
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for new focal points on the FOSACOF approach, as well as facilitating refresher sessions for staff already trained
RBF Implement the RBF program and scale-up the approach to 38 new HIV sites (Kamina) Monitor, observe, and evaluate the RBF program through monthly updates of the database, organization of joint visits for follow-up and supervision with the DPS teams and the health zone management teams, verifying RBF data, and reviewing RBF tools (Kamina, Kole, Luiza, Tshumbe, and Uvira)
Referral system Provide technical and financial support to health zones to reinforce the network of two- way referrals between community and health facilities (referral and counter-referral) through trainings, supervision, Fixed Amount Awards (FAA), and RBF, among others (Bukavu, Kamina, Kole, Kolwezi, Luiza, Mwene Ditu, Tshumbe, and Uvira)
IR3 Champion communities Strengthen Champion Communities by conducting trainings on project management (Kamina, Kole, and Tshumbe) and monitoring visits, and supporting Champion Communities to obtain NGO status (Mwene Ditu, Kolwezi) Provide technical support and FAAs to Champion Communities, RBF local NGOs, and CODESA to strengthen and document participation of women and youth in health-related activities in their communities Implement the Champion Men initiative through trainings, briefings and focus group discussions to share learnings and best practices (Kamina, Kole, Luiza, Mwene Ditu, Tshumbe, and Bukavu) Create and mobilize youth groups to improve sexual and reproductive health of adolescents and young persons (Kamina, Kole, Luiza, Mwene Ditu, Tshumbe, and Bukavu)
CODESA Improve the presence and operations of CODESAs through the finalization and implementation of their communication action plans Organize monitoring visits with staff from the health district office, the health zone management team, and IHPplus to revitalize CODESAs Supply CODESAs with office supplies and BCC tools Conduct mini-campaigns on themes related to family planning, malaria, GBV, TB, and WASH, among others
mHealth Conduct phone-based information campaigns and finance the quarterly dissemination of awareness-raising SMSs on priority intervention areas in communities within IHPplus- supported health zones
BCC Conduct awareness-raising activities in celebration of global and national health days
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Print and distribute to health zones BCC materials and training related documents (Tuendeni-Kumpala communication strategy, ETL, Champion Communities, etc.)
IR4 Alignment of national and provincial health sector policies Support the implementation of health policies at the district and provincial levels by providing assistance to health zones and DPS to develop and validate 2017 AOPs and conducting supervision and monitoring visits Provide technical and financial support to the various coordination organizations at the provincial level, including advisory boards, task forces, interagency coordination units, and other working groups
Adoption of evidence-based tools for strategic planning and management decision-making Provide financial support through FAAs to improve the functionality of the MOH at the provincial and health zone levels Provide fuel and kerosene in the EPI centers and health zones in accordance with the terms of the grants
Community Involvement Work with civil society organizations to strengthen their participation, representation, and accountability in provincial policy and planning processes (provincial steering committee, advisory boards, task forces, interagency coordination units) Work with civil society groups to reinforce their voices, their engagement, and their responsibility in the planning process and provincial health politics (e.g., revitalize health management committees)
LIST OF APPENDICES Appendix 1: DRC-IHPplus Performance Monitoring Plan, PY1 Appendix 2: DRC-IHPplus International Travel (STTA Plan) Appendix 3: DRC-IHPplus Organizational Chart Appendix 4: SIAPS Delivery Tracker for MEG for IHPplus (TO #901), as of June 30 2016 Appendix 5: SIAPS Delivery Tracker for ASRAMES for IHP plus (TO #901), as of June 30 2016 Appendix 6: SIAPS Delivery Tracker for IMRES for IHP plus (TO #901), as of June 30 2016 Appendix 7: SIAPS Delivery Tracker for IDA for IHPplus (TO #901), as of June 30 2016 Appendix 8: MSH Cargo Tracking updated 30062016 (Order # 1 IHPplus) Appendix 9: SIAPS Delivery Tracker for IHP PY5 Order Number 1 (TO #801), June 30 2016 Appendix 10: SIAPS Delivery Tracker for IHP PY5 Order number 2 (TO #801-1), June 30, 2016 Appendix 11: MSH Cargo Tracker updated 07272016 (Order # 2 IHPplus) Appendix 12: SIAPS Delivery Tracker for Mission Pharma Order for IHPplus (TO #902) June 30 2016 Appendix 13: SOW for CDR monitoring mission, June 16 2016 Appendix 14: Drug Management Training Report, June 2016, Bukavu Appendix 15: Report on the Open Door Days for Malaria Testing and Treatment in the health zones of Mpokolo, Kamiji, and Bibanga Appendix 16: Audit report of the management of essential generic medicines in three health zones (Kitenge, Songa, Kabongo) Appendix 17: Report of the mission to follow-up on the recommendations from the analysis of contraceptive data in the health areas of Walungu and Bagira in Sud Kivu
*Appendices 4, 5, 6, 7, 8, 9, 10, 11, and 12 are attached separately as Excel files.
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A clinic of our own: A health-facility team and CODESA make their dream a reality
For more than a decade, Kanda Kanda health center paid modest rent for a Management skills and private building. Then the landlord doubled the rent—twice—until it reached results-based financing help about $450 a year—a lot in rural Democratic Republic of Congo (DRC). an enterprising health-center Around the same time, the USAID-funded Integrated Health Project Plus team bid the landlord good- (IHPplus) enrolled the Kanda Kanda health team in the Leadership bye--and attract more Development Program (LDP). For their real-life project, the Kanda Kanda patients team decided to construct a new building from the ground up, in coordination with the local health committee, or CODESA.
Kanda Kanda lies in the Luiza health zone, where IHPplus and its predecessor, IHP, had been implementing a results-based-financing (RBF) approach since 2013. Under RBF, health facilities and providers earn a bonus for reaching agreed-on targets. The Kanda Kanda health center was achieving its targeted results and receiving about US $900 each quarter, of which 10 percent was allocated for investments. Photo: MSH Photo: Under construction: The Leadership Development Program team teamed up with the CODESA to The center purchased sheet metal—10 sheets each quarter—from its construct a purpose-built health facility. investment funds, and the CODESA started to manufacture bricks. It took two years to construct a new home for the clinic of Kanda Kanda, designed “I am thrilled that our project, for the needs of patients and staff. once a dream, is now a reality. “I am thrilled that our project, once a dream, is now a reality,” said CODESA The funds we would have president Philippe Malala. “Our neighbors in Kanda Kanda seem delighted to spent on rent will now go to the have their own health center in our own building, where our families can finishing touches on our receive high quality care, in a lovely setting. The funds we would have spent building. And the number of on rent will now go to finishing touches on our building.” people coming for curative services rose from about 1000 “We’ve also noticed that the number of people coming for curative services to 1200 in just three has increased. From October to December 2015, 1,000 people sought months….” treatment; from January to March 2016, that number increased to 1,200. More women are coming here to deliver than came to the old center—from -- Philippe Malala 114 between October and December 2015 to 124 between January and President, local March 2016.” CODESA health Speaking for both the CODESA and the health team, he added, “We would committee like to warmly thank our partner IHPplus for introducing innovative approaches like the LDP and RBF, which enabled us to achieve our objective.” Implemented by Management Sciences for Health and Overseas Strategic Consulting, Ltd (OSC) in 83 health zones under a subcontract via Pathfinder/Evidence to Action (E2A), IHPplus is considered a two-year “bridge,” to avoid a gap in services in USAID-supported health zones upon completion of the five-year flagship IHP. Beating two major diseases thanks to upgraded, free health services: “I once again believe in my future and that of my children”
A surprise for one man: Armel Kashobwe*, a 47-year-old metal worker in the copper capital of Lualaba Province, became sick in 2015 and found it difficult to work. He treatment is better in the bought various medications but only grew weaker and more impoverished. village—IHPplus is there. After his wife left him, he took their six children and retreated to his A father of six who expects village, Kalwa, to “wait for death in the company of my forefathers.” to leave his children orphans Then Kashobwe’s luck turned. Kalwa lies in Bunkeya, one of 83 health receives free, high-quality zones supported by the USAID-funded Integrated Health Project (IHPplus). care for both HIV and TB— Health providers there had been trained in managing HIV and TB, and and returns to his job in the related skills such as psychosocial support for patients. city. “I examined Armel and did a rapid (GeneXpert) diagnosis for TB as well an HIV test,” says Pierre Kibuye, nurse at the Kalwa health center. As Kibuye had guessed, “He was co-infected. We decided to put him immediately on both antiretroviral and TB treatment.” Kashobwe then worried how he would pay for medication. “But the nurse told me the medicine is free, thanks to IHPplus. I really had a sigh of relief, since I was depleted.” It is May 2016, four months later, and Kashobwe is no longer waiting to die. He is back at work and smiling as he watches his children. Photo: Management Sciences for Health for Sciences Management Photo: A nurse measures an HIV-positive patient’s CD4 “I really hadn’t expected to find good treatment in the village—but was count to monitor the health of his immune pleasantly surprised to see all that they did for me,” says Kashobwe. “I am system. and will always be grateful to the nurse and the IHPplus project.” “I was worried they’d ask a lot Over 3,200 PLHIV are on ARV treatment in IHPplus project areas in Lualaba for the medications, like they Province. Of these patients, nearly 460 are, like Armel, co-infected with did in the city. But the nurse HIV and TB and being treated free for both, thanks to IHPplus support. told me the medicine is free, thanks to IHPplus. I really had Implemented by Management Sciences for Health and Overseas Strategic a sigh of relief, since I was Consulting, Ltd (OSC) in 83 health zones under a subcontract via depleted.” Pathfinder/Evidence to Action (E2A), IHPplus is considered a two-year “bridge,” to avoid a gap in services in USAID-supported health zones upon completion of the five-year flagship IHP. -- Armel Kashobwe*, co- infected HIV/TB patient, now treated and back at work * (a pseudonym for privacy)
Community-based organizations check on the performance of health facilities, and also lend a hand, thanks to results-based financing
As part of a results-based Results-based financing (RBF) can improve health outcomes by paying financing program, health facilities a bonus if they achieve agreed-on goals. But incentives can community-based also create a temptation to inflate results. To confirm the accuracy of results data, the USAID-funded Integrated Health Project Plus (IHPplus) in organizations (CBOs) are the Democratic Republic of Congo (DRC) competitively recruits paid to verify health-facility community-based organizations (CBOs) to independently verify results on performance. behalf of the Ministry of Health.
Sometimes these CBOs go “Our role is…to confirm if lives are really being saved, and if there’s real above and beyond…. customer satisfaction,” says Faustin Edingo, President of Udilo, a CBO in Lomela health zone. “During our verification, we noted that two health centers—Alanga and Onyangondo—were decrepit: there was no pavement, the walls weren’t plastered, and there was no hand-washing station,” said Edingo. “So our organization agreed to contribute whatever we could toward improving the centers and saving lives. We managed to rehabilitate the two centers: we plastered walls and paved walkways (this took 10 sacks of cement). We painted, contributing 48 liters of paint and 128 liters of lime. We donated essential furnishings, such as four benches and two faucets
Photo: Management Sciences for Health for Sciences Management Photo: for handwashing. We also provided two large trash cans. And ten pieces of sheet metal for latrines.” A rehabilitated health center in Lomela. “All this cost US $1,300. But we’ve already seen an improvement in the utilization rate of these centers by community members,” said Edingo. “We are pleased with Udilo’s support,” said supervising nurse André Djamba. “They came not only to inspect us, but also supported “Day after day, the training renovations and helped to raise the utilization rate.” from IHPplus helps us develop In July 2015, the Alanga health center received just over 50 percent of our skills in management of expected patients (256 of an expected 502). In June 2016, the rate had both financial and human risen to 62 percent (322 compared to an expected 518 visits). The resources, and gives us Onyangondo health center’s utilization rate was also 51 percent in July opportunities to make sure the skills stay in the community.” 2015, and 61 in June 2016. “Day after day, the training from IHPplus helps us develop our skills in -- Faustin Edingo, management of both financial and human resources, and gives us President of Udilo, a opportunities to make sure the skills stay in the community,” said Edingo. community-based Implemented by Management Sciences for Health and Overseas Strategic organization Consulting, Ltd (OSC) in 83 health zones under a subcontract via Pathfinder/Evidence to Action (E2A), IHPplus is considered a two-year “bridge,” to avoid a gap in services in USAID-supported health zones upon completion of the five-year flagship IHP. “I didn’t even know how I got to the hospital”: Saved from eclampsia by skilled medical attention
One night in February, a heavily pregnant 17-year-old was rushed to the Training enables health emergency room of the Dipeta General Referral Hospital in Fungurume providers to treat a common health zone--unconscious and convulsing. cause of maternal mortality in the DRC—saving lives and The medical team sprang into action: They quickly diagnosed the young families woman with eclampsia, began treatment with the recommended magnesium sulfate medication, and performed a successful Cesarean section. Two days later, Assy Ntshila awoke from her coma to find a newborn boy in her arms. “You can’t imagine the joy I felt,” she says. “I didn’t even know how I got to the hospital. It’s a miracle…. I want to thank the whole team of Dipeta for saving both my baby and myself. I am truly delighted and grateful.”
Thanks to the highly skilled Dipeta team and the availability of the right medications, both mother and baby left the hospital well. Such might not have been the case a few years ago, or in many other hospitals in the Democratic Republic of Congo (DRC), where maternal and neonatal mortality are both high. But in early 2015, the USAID-funded Integrated Health Project (IHP) trained 24 health providers in maternal and newborn health in Fungurume health zone. The intensive training emphasized Photo: Management Sciences for Health practical skills and focused on eclampsia, a common cause of maternal Assy Atshila with her newborn at the Dipeta General Referral Hospital death in DRC. Since June 2015, the Integrated Health Project Plus (IHPplus) has continued the work of IHP.
“The assistance of IHPplus is Since then, of 19 patients with eclampsia received at the Dipeta Referral substantial and has helped us Hospital between February 2015 and May 2016, 18 survived. In contrast, to significantly reduce between 2013 and 2014, of 13 eclampsia cases, 6 patients died. maternal and infant mortality.” “Today we are very confident in treating eclampsia,” said Dr. Auguy Okese, -- Dr. Auguy Okese, Director of Medicine at the Dipeta Referral Hospital. “We get good results with that and the Misgav Ladach cesareans (an updated, less invasive Director of Medicine at method of cesarean surgery). We even gather magnesium sulfate from the Dipeta General other facilities that are not using it. The assistance of IHPplus is substantial, Referral Hospital and has helped us to significantly reduce maternal and infant mortality.”
Implemented by Management Sciences for Health and Overseas Strategic Consulting, Ltd (OSC) in 83 health zones under a subcontract via Pathfinder/Evidence to Action (E2A), IHPplus is considered a two-year “bridge,” to avoid a gap in services in USAID-supported health zones upon completion of the five-year flagship IHP. For tuberculosis patients in rural DRC, fighting stigma is half the battle; a community-based organization seeks patients out so they can be treated
A mother of eight left her “I had gone to the house of the shaman because I thought I was cursed . I had stayed more than a year and thought I would die there,” family and was preparing to remembers Julienne Musenge, a 56-year-old mother of eight. “Then die--until approached by a in September 2015, Madame Biguette came and took my spit to be partner of IHPplus to get tested. I discovered I was suffering from TB--not sorcery!” tested and treated for TB. Musenge’s case is all too common in rural Democratic Republic of Congo (DRC), where stigma against illness is strong and more trust is put in sorcery and traditional healers than in health clinics. Many people die of untreated TB.
Fortunately, Musenge’s story has a happy ending: “I followed the treatment for only six months and feel healthy. I risked death because of ignorance—but now I am healed,” says Musenge.
The Malemba health zone where Musenge lives is a project area of the USAID-funded Integrated Health Project Plus (IHPplus). Madame Photo: Management Sciences for Health for Sciences Management Photo: Biguette (left) made sure that Musenge (right) got Biguette, who convinced Musenge to be tested, leads a community- tested and treated for TB. based organization contracted by IHPplus to help with verifying health data as well as intensifying the fight against TB in communities.
“I discovered I was suffering With capacity-building assistance from IHPplus, her organization has from TB—not sorcery!” coordinated with zonal health officials, enlisted the support of local leaders, and held public awareness and testing campaigns, referring --Julienne Musenge, those diagnosed to treatment centers. This uptick in activity led to the former TB patient detection and treatment of nearly 200 TB cases between April and June 2016, compared to 117 the previous quarter.
Household by household, partner organizations of IHPplus are educating and treating TB patients—reducing the number of contagious cases in the community, and increasing trust of modern health services.
Implemented by Management Sciences for Health and Overseas Strategic Consulting, Ltd (OSC) in 83 health zones under a subcontract via Pathfinder/Evidence to Action (E2A), IHPplus is considered a two- year “bridge,” to avoid a gap in services in USAID-supported health zones upon completion of the five-year flagship IHP.
From shunning to solidarity: Helping young mothers in Dibaya
In the Tshimayi health area of the Dibaya health zone, girls and young A Champion Community women are shunned by their communities for unplanned pregnancies out offers education through of wedlock. They often have no means by which to raise their children and listening sessions and no health education to guide them. Some are even homeless. income-generating activities The Tuibake Champion Community received official nongovernmental to help young mothers organization (NGO) status in July 2015. A Champion Community is achieve independence. comprised of local leaders and other residents with a passion for community health and development who work with local health officials and facilities to conduct grassroots health education and organizing. The Tuibake Champion Community decided to assist Tshimayi health area’s young mothers, planning a series of 12 meetings with 30 young moms to discuss sexual and reproductive health, and infant and child nutrition. In addition, they sent the young women SMS texts on family planning, such as: “Leaving time between births increases a family’s wealth and strength. Birth control can be found at the health center.” Of the 30 women, 18 started using modern contraception of some type, including female condoms, injections (DMPA), or implants (Implanon). Photo: Overseas Strategic Consulting, Ltd. Consulting, Strategic Overseas Photo: Tshimayi’s young mothers meet regularly to learn more about health and child rearing. The Champion Community also held 100 education through listening (ETL) sessions that included information on how the women can organize as a support group. And they helped the new moms start income-generating “We were abandoned, alone, activities. but thanks to the Tuibake With the Champion Community’s assistance, the young mothers have Champion Community, we acquired a communal field for breeding rabbits and another for growing organized a support group. vegetables for home use. Ten of the women have attended apprenticeship They have provided us with the programs: five became bakers and five became tailors. knowledge to take care of our The USAID-funded Integrated Health Project helped organize 34 Champion sexual and reproductive health Communities in 27 health zones throughout four provinces; they continue as well as the motivation to under IHPplus. succeed.” Implemented by Management Sciences for Health and Overseas Strategic --Nicole Mbombo and Annie Consulting, Ltd (OSC) in 83 health zones under a subcontract via Mputu, unwed mothers Pathfinder/Evidence to Action (E2A), IHPplus is considered a two-year benefitting from an IHPplus “bridge,” to avoid a gap in services in USAID-supported health zones upon completion of the five-year flagship IHP. “Champion Community”
Making health education accessible and fun: Health SMS texts and quiz games become popular in the DRC
In the Democratic Republic of Congo (DRC), health literacy is generally low, IHPplus extends its reach and people tend not to know what health services may be available to with SMS text messages on them. To provide health education, the USAID-funded Integrated Health health. Facilitators helped Project Plus (IHPplus) sends health-related SMS messages to mobile users teachers take that info and to share with their communities. Teachers in Kole and Luiza health zones develop a quiz game for recently created a question & answer (Q&A) quiz game based on the SMS students. Now students are information. Now the students are educating their peers and parents. teaching peers and others at In April 2016, behavior change communication (BCC) specialists organized public forums. three workshops for 130 teachers from the Dibaya, Kole, Lodja, and Luiza health zones. Workshop participants developed a quiz game based on the SMS health messages, focusing on sanitation, hygiene, sexually transmit- ted diseases, sexual and gender based violence, pregnancy, and alcohol and drug use. Back at school, the teachers used the game more than 200 times in May and June, involving nearly 1,500 students. Afterward, students held 211 public health education sessions, and teach- ers have held 69 follow-up sessions with their students. The Q&A games held in the Dibaya, Kole, Lodja, and Luiza health zones Photo: Overseas Strategic Consulting, Ltd. Consulting, Strategic Overseas Photo: Students in Lodja play a quiz game that teaches demonstrate the potential that teachers have not only to educate their them important health information. students, but also to mobilize them. Engaging the students in a fun and competitive manner makes them more eager to participate in public dis- cussions with the greater community. And integrating school staff into pro- ject activities creates opportunities for using school structures to better “The discussions have helped understand and meet the health needs of youth. identify girls who are at a greater risk of abuse.” In addition to the number of forums held by students, anecdotal evidence -- Béatrice Ngalula, suggests some immediate health benefits. For instance, one student said, “What I’ve learned has helped me convince a friend to stop smoking and teacher get himself tested for HIV. I am grateful to IHPplus and our teachers for this initiative.” Implemented by Management Sciences for Health and Overseas Strategic Consulting, Ltd (OSC) in 83 health zones under a subcontract via Pathfind- er/Evidence to Action (E2A), IHPplus is considered a two-year “bridge,” to avoid a gap in services in USAID-supported health zones upon completion of the five-year flagship IHP. Simple techniques make (radio) waves in the DRC: a grateful mother broadcasts the message to others
Fallone Ntumba, a radio journalist in the Democratic Republic of Congo Fallone Ntumba’s daughter (DRC), was only 24 weeks pregnant when she was admitted to the Dipeta weighed only three pounds General Referral Hospital with a prematurely ruptured membrane. at birth. But a prescription of skin-to-skin contact with her After three weeks in the hospital, Fallone gave birth to a daughter. Baby mother helped baby Gracia Gracia weighed only three pounds, and Dipeta Hospital’s incubator had not worked in three years. Like many hospitals in the DRC, they lacked the thrive. resources to replace or repair it when a part malfunctioned.
“When the head nurse told me the news, I was ready to give up hope,” Fallone recalled. “The nearest hospital with an incubator was over sixty miles away and cost fifty dollars per week – out of my family’s reach.” Fortunately, the USAID-funded Integrated Health Project (IHP) had supported Dipeta Hospital in the Fungurume health zone since 2011. IHP trained the hospital staff on managing pregnancy, labor, and newborn complications--including a technique called Kangaroo Mother Care (KMC). KMC uses skin-to-skin contact between mother and baby to help premature babies gain weight. Between October 2015 and May 2016, Photo: Management Sciences for Health for Sciences Management Photo: sixteen low-birthweight babies born at Dipeta Hospital survived with the Fallone and her daughter Gracia (right) with help of KMC. Thérèse, head nurse at Dipeta Hospital. When the maternity team taught Fallone about KMC, she was skeptical at first--but the results spoke for themselves. By the time Gracia was one month old, she weighed four-and-a-half pounds and could be released “As an educated woman living from the hospital. At home, Fallone and her husband took turns practicing in the 21st century, I never KMC with Gracia. After another month, she weighed eight pounds. expected that a simple method “My husband and I were both amazed at Gracia’s progress. As an educated like Kangaroo Mother Care st could save my daughter’s life.” woman living in the 21 century, I never expected that a simple method -- Fallone Ntumba, radio like KMC could save my daughter’s life,” Fallone reflected. “I’ve decided to start including messages about these low-cost methods that save lives in journalist my broadcasts on Radio Mukaba, to educate mothers and other members of my community,” she continued.
Implemented by Management Sciences for Health and Overseas Strategic Consulting, Ltd (OSC) in 83 health zones under a subcontract via Pathfinder/Evidence to Action (E2A), IHPplus is considered a two-year “bridge,” to avoid a gap in services in USAID-supported health zones upon completion of the five-year flagship IHP.
Theory and practice: a family planning “mini-campaign” inspires almost 1,000 couples to try modern contraception
In the Democratic Republic of Congo (DRC), closely spaced and numerous Health workers trained in births contribute to the high mortality rates among mothers and babies. Yet few couples use modern contraception. Recently, the DRC government family planning hit the made family planning a priority, with a goal of making services available to streets to offer family- 2.1 more million women by 2020 and increasing the contraceptive planning counseling and prevalence rate from 8 to 19 percent. services in an underserved area of DRC The USAID-funded Integrated Health Project Plus (IHPplus) is supporting the Ministry of Health (MOH) to add new contraceptive methods to the mix offered, and make them available through local community health workers (CHWs). New methods include the Sayana® Press and Implanon NxT—long-term implants that can be administered by a CHW.
In June 2016, the MOH provincial office organized a 12-day training with IHPplus support in Lomami, a health zone where reported contraceptive use lagged below 4 percent. Participants included 50 community health workers and 17 providers from health facilities. After a nine-day workshop, the next three days were devoted to real-life practice in a mini-campaign
Management Sciences for Health Sciencesfor Management in the areas of Kanda Kanda and Mutebwe.
hoto: P The results? Nearly four times the typical number of new adopters for a Anna Mujinga, her husband, and youngest child with the doctor who implanted her Implanon three-month period. Of approximately 1,150 people reached (1,024 NXT – a new, long-acting contraceptive. women and 122 men), 951--or 83 percent--became new acceptors of modern family planning. (The previous quarter, 337 people had become new adopters in the same areas.) Offered a wide choice of methods, the “We chose to use [long-acting new adopters collectively signed up for 617 couple years of protection. contraceptive implant] Two kinds of oral contraceptive pills were the most widely selected; after Implanon so I can recover my that, the long-term implants Implanon and Sayana® Press. Male and health. And with our limited female condoms came at the bottom of the list, after cycle beads. means, it will help us better raise and educate the children Anna Mujinga, a 38-year-old farmer with 11 children, attended with her we already have.” husband. “My health doesn’t permit me to have more children,” she said. “We chose to use Implanon so I can recover my health. And with our -- Anna Mujinga, a 38-year-old limited means, it will help us better raise and educate the children we farmer with 11 children, already have.” during the family planning mini-campaign Implemented by Management Sciences for Health and Overseas Strategic Consulting, Ltd (OSC) in 83 health zones under a subcontract via Pathfinder/Evidence to Action (E2A), IHPplus is considered a two-year “bridge,” to avoid a gap in services in USAID-supported health zones upon completion of the five-year flagship IHP.
Achievements Means of Verification Baseline for IHPplus (Oct‐ PY1Q1 ( Jul‐ Indicator Definition PY1Q2 (Oct‐ PY1Q3 (Jan‐ PY1Q4 (Apr‐ Achievement Target Y1 for Data Party 2014 – Jun‐ Sep 2015) % Achievement Frequency Dec 2015) Mar 2016) Jun 2016) Y1 IHPplus Source Responsible 2015) Startup
USAID/DRC/IHPplus Objective: Increase use of high‐impact health services, products, and practices for FP, MNCH, nutrition, malaria, NTDs, TB, HIV and AIDS, and WASH in target health zones
1 FP: Couple years of protection (CYP) in USG‐ The estimated protection provided by family 426,098 n/a 143,282 140,143 146,999 430,423 434,619 HMIS Monthly M&E Specialist supported programs planning (FP) services during a one‐year period, based upon the volume of all contraceptives provided to clients at health facilities and community level in the IHPplus target areas during that period 99 1.1 FP: Couple years of protection (CYP) after The estimated protection provided by family 169,760 n/a 67,344 68,163 77,747 213,253 173,155 HMIS Monthly M&E Specialist exclusion of LAM and self‐observation methods planning (FP) services during a one‐year period, (NFP) for FP in USG‐supported programs based upon the volume of all contraceptives provided to clients (exclusion of LAM and self‐ observation methods [NFP]) in the IHPplus target areas during that period 123 2 FP: Number of new acceptors for any modern Number of new FP acceptors of a modern method 447,812 n/a 149,472 133,788 132,280 415,540 456,768 HMIS Monthly M&E Specialist contraceptive method in USG‐supported family will be calculated based upon records from USG‐ planning (FP) service delivery points supported FP clinics in the IHPplus target areas
91 3 FP: Number of counseling visits for FP/RH as Number of FP/RH counseling visits at USG‐ 605,616 n/a 203,100 197,178 192,314 592,592 617,728 HMIS Monthly M&E Specialist result of USG support supported service delivery points 96 4 FP: Number of USG‐supported delivery points Number of USG‐supported service delivery points 2,162 n/a 2,131 2,097 2,152 2,152 2,205 HMIS Quarterly M&E Specialist providing family planning (FP) counseling or (excluding door‐to‐door CBD) providing FP services counseling or services, disaggregated by type of service 98 Disaggregated by type of service delivery: (a) Health facility based 1,527 n/a 1,447 1,477 1,477 1,477 1,557
(b) Community‐level based 635 n/a 684 620 675 1,979 648
5 FP: Number of USG‐assisted health facilities Maximum number of USG‐supported health 146 n/a 188 243 209 243 100 HMIS Monthly M&E Specialist experiencing stock‐outs of Depo‐Provera during facilities experiencing stock‐outs of Depo‐Provera the quarter during the quarter 41 6 MNCH: Percent of pregnant women attending at Numerator: # of pregnant women attending at 408,357 n/a 134,097 140,516 139,289 413,902 382,209 HMIS Monthly M&E Specialist least one antenatal care (ANC) visit with a skilled least one antenatal care (ANC) visit with a skilled provider from USG‐supported health facilities provider from USG‐supported health facilities Denominator: # of expected pregnancies in USG‐ 386,812 n/a 134,107 134,107 134,108 402,322 402,322 supported health facilities (4% of total population) Numerator/ Denominator (in percentage) 106% n/a 100% 105% 104% 1 95% 108 7 MNCH: Percent of pregnant women attending at Numerator: # of pregnant women attending at 204,787 n/a 72,487 73,857 78,275 224,619 213,231 HMIS Monthly M&E Specialist least four antenatal care (ANC) visits with a skilled least four antenatal care (ANC) visits with a skilled provider from USG‐supported health facilities provider from USG‐supported health facilities
Denominator: # of expected pregnancies in USG‐ 386,812 n/a 134,107 134,107 134,108 402,322 402,322 assisted health facilities (4% of total population)
Numerator/Denominator (in percentage) 53% n/a 54% 55% 58% 1 53% 105 8 MNCH: Percent of deliveries with a skilled birth Numerator: # of deliveries with a skilled birth 352,626 n/a 114,555 116,603 118,917 350,075 362,091 HMIS Monthly M&E Specialist attendant (SBA) in USG‐supported facilities attendant (SBA) in USG‐supported facilities Denominator: # of expected deliveries in USG‐ 386,812 n/a 134,107 134,107 134,108 402,322 402,322 supported health facilities (4% Tot Pop) Numerator/ Denominator (in percentage) 91% n/a 85% 87% 89% 1 90% 97 9 MNCH: Number of women giving birth who Number of women giving birth who received a 331,511 n/a 104,324 109,855 113,060 327,239 340,365 HMIS Monthly M&E Specialist received uterotonic in the third stage of labor (OR uterotonic in the third stage of labor (OR immediately after birth) through USG‐supported immediately after birth) supplied by a USG‐assisted programs program or with assistance of a health worker trained by a USG‐assisted program. Uterotonic could include oxytocin or misoprostol. Uterotonics represent one element of active management of third stage of labor (AMTSL).
Denominator: # of deliveries with a skilled birth 352,626 n/a 114,555 116,603 118,917 350,075 350,075 attendant (SBA) in USG‐supported facilities
Numerator/Denominator (in percentage) 94% n/a 91% 94% 95% 1 94% 99 10 MNCH: Number of postpartum/newborn visits Number of postpartum/newborn visits within 3 339,446 n/a 110,728 112,096 114,575 337,399 346,236 HMIS Monthly M&E Specialist within 3 days of birth in USG‐supported programs days of birth (Includes all skilled attendant deliveries plus facility or outreach postpartum/ newborn visits for mothers/newborns who did not have SBA delivery) (4% Tot Pop)
97 11 MNCH: Percent of newborns receiving essential Numerator: Number of newborn infants who 339,780 n/a 109,395 112,285 116,304 337,984 358,068 HMIS Monthly M&E Specialist newborn care through USG‐supported programs received essential newborn care from trained facility, outreach or community health workers through USG‐supported programs/IHPplus target areas
Denominator: # of newborns delivered in the 386,812 n/a 114,684 116,370 118,572 349,626 IHPplus target areas (4% of total population)
Numerator/ Denominator (in percentage) 88% n/a 95% 96% 98% 1 89% 109 12 MNCH: Number of newborns receiving antibiotic Number of newborn infants identified as having 30,357 n/a 7,391 8,019 8,447 23,857 30,963 HMIS Monthly M&E Specialist treatment for infection from appropriate health possible infection who received antibiotic workers through USG‐supported programs treatment from appropriately trained facility, outreach or community health workers through USG‐supported programs/IHPplus target areas (4% of Total Population *6% Infection rate‐MICS 2010)
77 13 MNCH: Number of child pneumonia cases treated Number of children under five years old with 354,596 n/a 106,415 115,009 110,557 331,981 361,689 HMIS Monthly M&E Specialist with antibiotics by trained facility or community pneumonia treated with antibiotics by trained health workers in USG‐supported programs facility or community health workers in USG‐ supported programs/IHPplus target areas (20% Tot Pop*6% infection rate‐MICS 2010) 92 14 MNCH: Number of cases of child diarrhea treated Number of children under five years old with 447,108 n/a 158,979 164,316 174,221 497,516 456,051 HMIS Monthly M&E Specialist in USG‐supported programs diarrhea treated with Oral Rehydration Therapy (ORT) or ORT plus zinc supplements in USG‐support programs/IHPplus target areas (20% Tot Pop*18% infection rate‐MICS 2010) 109 15 MNCH: Percent of children less than 12 months of Numerator: Number of children less than 12 346,925 n/a 115,858 113,113 122,082 351,053 330,237 HMIS Monthly M&E Specialist age who received DPT‐HepB‐Hib3 from USG‐ months who received three doses of DPT, Hepatitis supported programs B, and Haemophilus Influenza (DPT‐HepB‐Hib1‐3) vaccine from USG‐supported programs/IHPplus target areas
Denominator: # of children less than 12 months of 337,493 n/a 113,601 117,009 117,009 347,618 347,618 age in the IHPplus target areas (3.49% of Total Population ref EPI) Numerator/ Denominator (in percentage) 103% n/a 102% 97% 104% 1 95% 106 16 MNCH: Drop‐out rate in DPT‐HepB‐Hib3 among Numerator: Number of children less than 12 19,045 n/a 4,429 6,489 4,674 15,592 16,188 HMIS Monthly M&E Specialist children less than 12 months of age months who did not complete the full regimen of DPT‐HepB‐Hib1‐3 vaccination
Denominator: All children less than 12 months who 365,970 n/a 120,287 119,602 126,756 366,645 366,645 received DPT‐HepB‐Hib1 Numerator/ Denominator (in percentage) 5% n/a 3.68% 5.43% 3.69% 0 5.00% 118 17 MNCH: Percent of children less than 12 months of Numerator: Number of children less than 12 334,963 n/a 117,914 110,062 116,886 344,862 330,237 HMIS Monthly M&E Specialist age who received measles vaccine from USG‐ months of age who received measles vaccine from supported programs USG‐supported programs/IHPplus target areas
Denominator: # of children less than 12 months of 337,493 n/a 113,601 117,009 117,009 347,618 347,618 age in the IHPplus target areas (3.49% of Total Population ref EPI)
Numerator/ Denominator (in percentage) 99% n/a 104% 94% 100% 99% 95% 104 18 MNCH: Maximum Number of USG‐assisted health Number of USG‐assisted health facilities 80 n/a 140 101 181 181 100 HMIS Monthly M&E Specialist facilities experiencing stock‐outs of ORS during experiencing stock‐outs of ORS the quarter 55 19 NUTRITION: Proportion of pregnant women who Numerator: Number of pregnant women who have 424,488 n/a 162,038 176,801 188,754 527,593 356,817 HMIS Monthly M&E Specialist received iron‐folate to prevent anemia received iron‐folate tablets to prevent anemia during the last five months of pregnancy
Denominator: # of expected pregnancies in USG‐ 386,812 n/a 134,107 134,107 134,107 402,321 402,321 assisted health facilities (4% Tot Pop)
Numerator/ Denominator (in percentage) 110% n/a 121% 132% 141% 1 89% 148 20 NUTRITION: Number of mothers of children 2 Number of mothers of children 2 years of age or 487,081 n/a 182,913 177,885 203,414 564,212 511,434 HMIS Monthly M&E Specialist years of age or less who have received nutritional less who have received nutritional education within counseling for their children group support (8% of Total Population X 15% Malnutrition Prevalence Rate) 110 21 NUTRITION: Number of people trained in child This indicator measures the number of people ND n/a 0 74 57 131 1,111 HMIS Monthly M&E Specialist health and nutrition through USG‐supported trained in child health and nutrition through USG‐ programs supported programs 12 22 NUTRITION: Number of USG‐supported health Maximum Number of USG‐supported health 304 n/a 244 167 176 244 200 HMIS Monthly M&E Specialist facilities experiencing stock‐outs of iron‐folate facilities that experienced stock‐outs of iron‐folate tablets during the quarter 82 23 TB: Case notification rate in new sputum smear Numerator: Number of new sputum smear positive 9,692 n/a 2,789 2,891 2,975 8,655 12,873 Health Quarterly M&E Specialist positive pulmonary TB cases per 100,000 pulmonary TB cases reported in the past year (150 facility population in USG‐supported areas cases for 100,000 people) records
Denominator: Total population in the specified 9,670,297 n/a 10,728,594 10,728,594 10,728,594 10,728,594 10,728,594 geographical area Numerator/ Denominator (per 100,000 population) 100 n/a 104 108 111 108 150 72 24 TB: Percent of all registered TB patients who are Numerator: Number of registered TB patients who 2,756 n/a 610 1,721 2,151 4,482 4,482 Health Quarterly M&E Specialist tested for HIV through USG‐ supported programs are tested for HIV facility records Denominator: Number of registered TB patients in 3,779 n/a 2,789 3,135 4,089 10,013 10,013 TB screening and treatment health facilities offering HIV testing Numerator/ Denominator (in percentage) 73% n/a 22% 55% 53% 0 80%
56 25 TB: Case detection rate Numerator: Number of new smear positive TB 9,680 n/a 2,789 2,891 2,975 8,655 9,873 Health Quarterly M&E Specialist cases detected facility Denominator: Estimated number of TB cases 14,505 n/a 4,023 4,023 4,023 12,069 14,796 expected
Numerator/ Denominator (in percentage) 67% n/a 69 72 74 72 150 48 26 TB: Number of multi‐drug resistant (MDR) TB Number of TB cases with multi‐drug resistance 113 n/a 10 10 7 27 45 Health Quarterly M&E Specialist cases detected registered in USG‐supported facilities 60 facility 27 HIV: Percentage of PEPFAR‐supported sites Numerator: Number of PEPFAR‐supported sites 51 n/a 17 39 29 85 34 Health Quarterly HIV Technical achieving 90% ARV or ART coverage for HIV+ achieving 90% ARV or ART coverage for HIV+ facility Advisors + pregnant women pregnant women records M&E Specialist
Denominator : Total number of PEPFAR supported 69 n/a 19 40 29 88 45 sites providing PMTCT services (HTC and ARV or ART services) Numerator/ Denominator (in percentage) 74% n/a 89% 98% 100% 1 76%
104 28 HIV: Number and percentage of pregnant women Numerator : Number of pregnant women with 10,278 n/a 7,618 7,690 7,419 22,727 22,727 Health Monthly HIV Technical with known status (includes women who were known HIV status (includes women who were facility Advisors + tested for HIV and received their results) (DSD) tested for HIV and received their results) records M&E Specialist
Denominator: Number of new ANC and L&D clients 13,587 n/a 8,355 8,054 7,786 24,195 24,195
Numerator/ Denominator (in percentage) 76% n/a 91% 95% 95% 1 85% 111 29 HIV: Percentage of HIV‐positive pregnant women Numerator: Number of HIV‐positive pregnant 232 n/a 95 113 105 313 313 Health Monthly HIV Technical who received antiretrovirals to reduce risk for women who received antiretrovirals to reduce risk facility Advisors + mother‐to‐child‐transmission (MTCT) during of mother‐to‐child‐transmission (MTCT) during records M&E Specialist pregnancy and delivery (DSD) pregnancy and delivery
Denominator: Number of HIV‐ positive pregnant 270 n/a 98 121 105 311 324 omen identified in the reporting period (incl ding Numerator/ Denominator (in percentage) 86% n/a 97% 93% 100% 1 85% 118 30 HIV: Number of individuals who received Testing Number of individuals who received T&C services 21,357 n/a 14,421 15,280 15,397 45,098 37,500 Health Monthly HIV Technical and Counseling (T&C) services for HIV and for HIV and received their test results during the facility Advisors + received their test results (DSD) reporting period records M&E Specialist 120 31 HIV: Number of HIV‐positive adults and children Number of HIV positive adults and children 1,088 n/a 4,525 4,573 4,610 13,708 10,800 Health Monthly HIV Technical who received at least one of the following during (aggregated by age/sex : female, male , <15 and facility Advisors + the reporting period: clinical assessment (WHO <15) who received at least one of the following in records M&E Specialist staging) OR CD4 count OR viral load ( DSD) the reporting period: clinical assessment (WHO staging) OR CD4 count OR viral load (DSD) 127 32 HIV: Number of HIV‐positive adult and children Number of HIV‐positive adults and children 3,502 n/a 4,525 4,573 4,610 13,708 10,800 Health Monthly HIV Technical who received at least one of the following during –aggregated by age/sex , female, male , <15 and > facility Advisors + the reporting period; clinical assessment (WHO 15) in the reporting period receiving a minimum of records M&E Specialist staging) or CD4 count or viral load one clinical service (DSD)
127 33 TB/HIV: Percent of HIV‐positive patients who Numerator : Number of HIV‐positive patients who 584 n/a 415 678 1968 1,968 3,600 Health Monthly HIV Technical were screened for TB in HIV care or treatment were screened for TB in HIV care or treatment facility Advisors + setting setting records M&E Specialist Denominator: Number of patient HIV‐positive 1157 n/a 724 3500 2264 2,264 2,264
Numerator/ Denominator (in percentage) 50% n/a 57% 19% 87% 1 70% 124 34 HIV: Number of HIV‐infected adults and children Number of HIV infected adults and children 2,850 n/a 3,374 3,490 3,400 3,534 2,900 Health Monthly HIV technical receiving antiretroviral therapy during the receiving antiretroviral therapy during the reporting facility Advisors + reporting period (current) DSD period (current ) DSD records M&E Specialist 122 35 HIV: Number of HIV‐infected adults and children Number of HIV‐infected adults and children newly 350 n/a 653 609 620 1,882 1,245 Health Monthly HIV technical newly enrolled in clinical care during the enrolled in clinical care (aggregated by age/sex , facility Advisors + reporting period and received at least one of the female, male , <15 and >15) during the reporting records M&E Specialist following at enrollment: clinical assessment period and received at least one of the following at (WHO staging) OR CD4 count OR viral load enrollment: clinical assessment (WHO staging) OR CD4 count OR viral load 151 36 HIV/TB: Proportion of registered TB cases who Numerator : The number of registered TB cases 180 n/a 521 280 439 1,240 567 Health Monthly HIV Technical are HIV‐positive who are on ART with documented HIV‐positive status who start or facility Advisors + continue ART during the reporting period records M&E Specialist
Denominator : The number of registered TB cases 190 n/a 528 285 509 1,322 630 with documented HIV‐positive status during the reporting period
Numerator/ Denominator (in percentage) 95% n/a 99% 98% 86% 1 90% 104 37 HIV: Percentage of laboratories and POC testing Number of PEPFAR‐supported laboratories and 20 n/a 18 47 55 55 55 Health Monthly HIV Technical sites that perform HIV diagnostic testing that testing sites that participate and perform analyte‐ facility Advisors + participate and successfully pass in an analyte‐ specific testing on HIV serologic/diagnostic testing , records M&E Specialist specific proficiency testing (PT) program CD4, EID and TB diagnostic
Denominator : Total number of laboratories and 68 n/a 20 45 45 45 45 testing sites
Numerator/ Denominator (in percentage) 24% n/a 90% 104% 122% 1 100% 122 38 Family Planning and HIV Integration: Number of Number of supported HIV service delivery points 68 n/a 72 72 73 73 72 supported HIV service delivery points that directly that directly provide integrated voluntary family provide integrated voluntary family planning planning service service 101 39 PMTCT_CTX Number of infants born to HIV‐ Cotrimoxazole prophylaxis is a simple and cost‐ n/a n/a 68 96 75 239 270 positive women who were started on CTX effective intervention to prevent Pneumocystis prophylaxis within two months of birth at USG pneumonia (PCP) among HIV‐exposed and ‐infected supported sites within the reporting period infants. PCP is the leading cause of serious respiratory disease among young HIV‐infected infants in resource‐limited countries and often occurs before HIV infection can be diagnosed.The indicator is the sum of infants having received CTX within 2 months of birth during the reporting period at PEPFAR‐supported facilities. 89 40 PMTCT_EID Number of infants who had a This indicator measures the extent to which infants n/a n/a 82 26 21 129 96 virologic HIV test within 12 months of birth during born to HIV‐positive women receive virologic the reporting period testing to determine their HIV status within the first 12 months of life. 134 41 PMTCT_FO Number of infants HIV exposed In settings where national guidelines support n/a n/a 005 584 infants with a documented outcome by 18 breastfeeding of HIV‐exposed infants, antibody months of age disaggregated by outcome type testing of all HIV‐exposed children at 18 months of age and/or 6 weeks after cessation of breastfeeding is recommended to determine final HIV status (‘final outcome’/FO) of HIV‐exposed children. In settings where national guidelines recommend HIV‐antibody testing at 18 months of life, this indicator measures progress toward ensuring that all infants born to HIV‐positive women have an outcome documented. 6 42 Tx_NEW Number of adults and children newly The indicator measures the ongoing scale‐up and n/a n/a 318 475 519 1,312 1,074 enrolled on ART uptake of ART programs. The numerator can be generated by counting the number of adults and children who are newly enrolled in ART in the reporting period, in accordance with the nationally approved treatment protocol (or WHO/UNAIDS standards). 122 43 Tx_VIRAL Number of adults and pediatric ART This indicator monitors the proportion of n/a n/a n/a n/a 978 n/a 2,934 patients with a viral load result documented in adult and pediatric patients on ART who have the patient medical record within the past 12 received a viral load test within the recommended months testing interval (i.e., 12 months). n/a 44 Tx_UNDETECT Number of viral load tests from ART is viewed by the scientific community and n/a n/a n/a n/a 787 n/a 2,361 adult and pediatric ART patients conducted in the PEPFAR not only as essential for decreasing past 12 months with a viral load inferior to 1000 morbidity and mortality, but also as a highly copies/ml. effective approach to prevent HIV transmission. This indicator monitors the proportion of viral load tests from adult and pediatric ART patients with an undetectable results (<1,000 copies/ml), allowing ART programs to evaluate to what degree they are improving the clinical outcomes of patients in care.
n/a 45 Tx_RET Number of adults and children who are This indicator measures the proportion of n/a n/a n/a n/a 863 n/a 2,589 still alive and treatment at 12 months after individuals who have retained on antiretroviral initiating ART therapy (ART). Death and loss to follow‐up are the two highest causes of patient attrition from ART, especially in the first few months after initiating on ART. High retention is one important measure of program success, specifically in reducing morbidity and mortality, and is a proxy for overall n/a quality of the ART program 46 CARE_COM Number of HIV infected adults and The purpose of this indicator is to determine how n/a n/a n/a n/a 78 n/a 234 children receiving care and support services many PLHIV receive care and support services outside of the health facility outside of the health facilities where they are registered for HIV care and treatment. Data collected through this indicator will inform PEPFAR country programs about the scale‐up and coverage of community care services. n/a 47 TB/HIV_ TB outcome Aggregated outcome of TB This indicator measures the aggregated outcome of n/a n/a 0 47 30 77 144 treatment among registered new and relapsed TB TB treatment among registered new and relapsed cases who are HIV‐positive in the treatment TB cases who are HIV‐positive in the treatment cohort cohort. 53 IR 1 :Access to and availability of Minimum Package of Activities (MPA)‐plus and Complementary Package of Activities (CPA)‐plus services and products in target health zones increased
IR 1.1: Facility‐based health care services and products (provincial hospitals and district health centers) in target health zones increased
48 ***L+M+G: % of general reference hospitals Numerator: # of GRHs implementing CPA 69 n/a 70 70 70 70 69 Health Annually M&E Specialist (GRHs) implementing complementary package of facility activities (CPA) Denominator: Total # of GRHs 78 n/a 78 78 78 78 78 Numerator/ Denominator (in percentage) 88% n/a 90% 90% 90% 1 88% 101 49 ***L+M+G: % of health centers implementing Numerator: # of health centers implementing MPA 1,382 n/a 1,382 1,382 1,382 1,382 1,382 Health Monthly M&E Specialist MPA facility records Denominator: Total # of health centers 1,398 n/a 1,398 1,398 1,398 1,398 1,398 Numerator/ Denominator (in percentage) 99% n/a 99% 99% 99% 1 99% 100 50 MALARIA: Percent of pregnant women who Numerator: Number of pregnant women who 255,509 n/a 90,865 99,565 101,675 292,105 301,742 received at least two doses of SP for Intermittent received at least two doses of SP for IPT during ANC Preventive Treatment (IPT) during ANC visits visits/ Denominator: Total number of pregnant women 386,812 n/a 134,107 134,107 134,108 402,322 402,322 attending ANC visits in the reporting period (12 months) Numerator/ Denominator (in percentage) 66% n/a 68% 74% 76% 1 75% 97 51 MALARIA: Number of USG‐supported service Number of USG‐assisted service delivery points 80 n/a 79 146 126 146 100 Health Annually M&E delivery points experiencing stock‐outs of ACT for (SDPs) experiencing stock‐outs of ACT for 1 – 5 facility Specialist, 1‐5 year olds years at any time during the defined reporting records HMIS Officers period 68 52MALARIA: Number of LLINs purchased with USG Number of LLINs purchased with USG funds that 117,606 n/a 97,536 140,750 192,432 430,718 341,250 funds that were distributed were distributed 126 52.1 (a) through campaigns 0 n/a 000 0 0
52.2 (b) through health facilities 117,606 n/a 97,536 140,750 192,432 430,718 280,000 Health Annually M&E facility Specialist, 52.3 (c) through the private/commercial sector 0 n/a 000 0 0
52.4 (d) through other distribution channels 0 n/a 000 0 0 52.5 ( e ) through voucher schemes 0 n/a 000 0 0 53 MALARIA: Number of health workers trained in Number of health workers (doctor, nurse, nurse’s 0 n/a 697 115 419 1,231 860 Health Annually M&E IPTp with USG funds disaggregated by gender assistant, clinical officer) trained in IPTp with USG facility Specialist, (male/female) funds records HMIS Officers 143 Male 0 n/a 579 95 326 1,000 559 Female 0 n/a 118 20 93 231 301 54 MALARIA: Number of SP tablets purchased with Number of SP tablets purchased with USG funds 890,976 n/a 618,000 1,887,000 956,000 3,461,000 1,800,000 Health Annually M&E USG funds that were distributed to health that were distributed to health facilities (hospitals, facility Specialist, facilities health centers, health posts/stations, clinics) records HMIS 192 55 MALARIA: Number of health workers trained in Number of health workers (doctor, nurse, nurse’s 0 n/a 697 115 419 1,231 1,000 Health Annually M&E case management with ACTs with USG funds assistant, clinical officer or community/village facility Specialist, (Disaggregated in 2 sub‐categories: health facility health worker) trained in case management with records HMIS Officers workers, community level workers) artemisinin‐based combination therapy (ACTs) with USG funds 123 (a) Number of health facility workers trained Male 0 n/a 579 95 326 1,000 559 Female 0 n/a 118 20 93 231 301 (b) Number of community‐level workers trained Male 0 n/a 000 090 Female 0 n/a 000 050 56 MALARIA: Number of ACT treatments purchased Number of ACT treatments purchased with USG n/a 462,895 1,184,139 1,114,399 2,761,433 2,400,000 Health Annually M&E with USG funds that were distributed funds that were distributed facility Specialist, records HMIS Officers 115 56.1 Disaggregated in 3 sub‐categories: (a) to health facilities n/a 440,850 1,162,775 1,096,349 2,699,974 2,352,000 Health Annually M&E facility Specialist, 56.2 (b) to community health workers (HBMF, CCM) n/a 22,045 21,364 18,050 61,459 48,000 Annually
56.3 (c) to the private/commercial sector 0 n/a 000 0 0 Annually
57 MALARIA: Number of health workers trained in Number of health workers trained in malaria n/a 697 115 419 1,231 1000 Health Annually M&E malaria laboratory diagnostics (RDTs or laboratory diagnostics (RDTs or microscopy) with facility Specialist, microscopy) with USG funds, disaggregated in 3 USG funds records HMIS Officers sub‐categories: 123 (a) Number of health facility workers trained Male n/a 579 95 326 1,000 559 Female n/a 118 20 93 231 301 (b) Number of community‐level workers trained Male n/a 000 090 Female n/a 000 050 (c) Number of laboratory workers trained Male n/a 000 0 0 Female n/a 000 0 0 58 MALARIA: Number of RDTs purchased with USG Number of RDTs purchased with USG funds that n/a 366,533 526,200 577,746 1,470,479 1,875,000 Health Annually M&E funds that were distributed to health facilities were distributed to health facilities facility Specialist, 78 records HMIS Officers IR 1.2: Community‐based health care services and products in target health zones increased 59 ***L+M+G: % of communities with CODESAs Numerator: # of communities with CODESAs with 1,282 n/a 1,268 1,295 1,280 1,280 1,280 IHPplus Monthly M&E Specialist actively involved in management of priority active involvement in management of priority Reports health services health services for their communities
Denominator: Total # of communities in IHP target 1,398 n/a 1,398 1,398 1,398 1,398 1,398 area Numerator/Denominator (in percentage) 92% n/a 91% 93% 92% 1 92% 100 60 WASH: Number of people gaining access to an Number of people gaining access to an improved 35,441 n/a 35,441 162,741 30,132 228,314 229,950 IHPplus Quarterly M&E Specialist improved drinking water source as a result of USG drinking water source (Improved drinking water Reports support technologies are those more likely to provide safe drinking water) 99 61 WASH: Percent of the population using an Numerator: Number of people using an improved n/a n/a TBD TBD TBD TBD TBD Survey Annual M&E Specialist improved drinking water source as a result of USG drinking water source support Denominator: Total population targeted for the n/a n/a 330,537 330,537 330,538 330,538 991,612 given period Numerator/ Denominator (in percentage) n/a n/a TBD TBD TBD TBD TBD n/a 62 WASH: Number of people gaining access to an Number of people gaining access to an improved 21,318 n/a 29,750 89,149 48,209 167,108 153,300 IHPplus Quarterly M&E Specialist improved sanitation facility as a result of USG sanitation facility (Improved sanitation facilities Reports support include those more likely to ensure privacy and hygienic use, e.g., connection to a public sewer, connection to a septic system, pour‐flush latrine, simple pit latrine, and ventilated improved pit (VIP) latrine)
109 63 WASH: Percent of the population using an Numerator: Number of people using an improved n/a n/a TBD TBD TBD TBD TBD Survey Annual M&E Specialist improved sanitation facility as a result of USG sanitation facility support Denominator: Total population targeted for the n/a n/a 330,537 330,537 330,538 330,538 991,612 given period Numerator/ Denominator (in percentage) n/a n/a TBD TBD TBD TBD TBD n/a IR 1.3: Engagement of provincial management with health zones and facilities to improve service delivery increased
64 ***L+M+G: % of senior LDP teams that have Numerator: # of senior LDP teams that have 46 n/a 52 47 43 47 54 IHPplus Semi‐ LDP achieved at least 80% of their desired achieved at least 80% of their desired performance Reports annually Coordinator performance according to indicators in their according to indicators in their action plans within action plans within six months of completing the six months of completing the LDP LDP Denominator: Number of health zones with 78 n/a 62 59 66 62 78 leadership that has undergone LDP training 59% n/a 84% 80% 65% 1 69% Numerator/ Denominator (in percentage) 110 IR 2: Quality of key family health care services in target health zones increased (Component 1)
IR 2.1: Clinical and management capacity of health care providers increased
65 ***L+M+G: Percent of health zones (HZs) with Numerator: # HZ with validated actions plans 53 n/a 61 61 61 61 78 IHPplus Annually M&E Specialist validated action plans Reports 78 Denominator: Total # HZs in IHP target area 78 n/a 78 78 78 78 78
Numerator/ Denominator (in percentage) 68% n/a 78% 78% 78% 1 100%
65.1 ***L+M+G: Percent of health centers with 1,058 n/a 1,169 1236 1,310 1,238 1,118 IHPplus Semi‐ M&E Specialist accurate and up‐to‐date inventory records Numerator: Number of health centers with up‐to‐ Reports annually date and accurate record of inventory of essential drugs and supplies (“accurate” means that the records correctly reflect the inventory of essential drugs and supplies that are currently in stock)
Denominator: Total number of health centers in 1,398 n/a 1,398 1,398 1,398 1,398 1,398 IHPplus areas Numerator/ Denominator (in percentage) 76% n/a 84% 88% 94% 1 80% 111 65.2 ***L+M+G: Percent of hospitals with accurate Numerator: Number of hospitals with up‐to‐date 64 n/a 61 76 74 71 70 Health Semi‐ M&E Specialist and up‐to‐date inventory records and accurate record of inventory of essential drugs facility annually and supplies (Accurate means that the records records correctly reflect the inventory of essential drugs and supplies that are currently in‐stock)
Denominator: Total number of hospitals in IHPplus 78 n/a 78 78 78 78 78 areas Numerator/ Denominator (in percentage) 82% n/a 78% 97% 95% 1 90% 101 66 GENDER: Number of people reached by a USG‐ Number of people reached by a USG‐supported 1,937 n/a 584 775 1,167 2,526 2,000 Health Quarterly Gender supported intervention providing GBV services intervention providing GBV health services facility Technical (e.g., health, legal, psycho‐social counseling, records Advisor shelters, hotlines, other) 126 67 GENDER: # of BCC campaigns launched delivering # of BCC campaigns developed and launched with 5 n/a 001 116 IHPplus Quarterly Gender key health messages targeting women and girls as key prevention priority messages for FP, nutrition, reports Technical primary audience malaria, and WASH within the IHPplus target areas Advisor 6 IR 2.2: Minimum quality standards for health facilities (provincial hospitals and district health centers) and services developed and adopted
68 *L+M+G: % of health facilities that completed an Numerator: # of health centers and GRH meeting n/a n/a 395 429 432 419 560 IHPplus Semi‐ M&E Specialist evaluation of the nine FOSACOF minimum that completed an evaluation of the nine FOSACOF records annually standards minimum standards
Denominator: Total # of health facilities n/a n/a 737 737 737 737 737 implementing the FOSACOF approach
Numerator/ Denominator (in percentage) n/a n/a 54% 58% 59% 1 76% 75 68.1 *L+M+G: % of health centers meeting that Numerator: # of health centers that completed an 332 n/a 378 402 420 400 531 completed an evaluation of the nine FOSACOF evaluation of the nine FOSACOF minimum minimum standards standards Denominator: Total # of health centers 312 n/a 699 699 699 699 699 implementing the FOSACOF approach
Numerator/ Denominator (in percentage) 106 n/a 54% 58% 60% 1 76% 75 68.2 *L+M+G: % of general reference hospitals that Numerator: # of GRH that completed an evaluation 37 n/a 17 27 12 19 29 completed an evaluation of the nine FOSACOF of the nine FOSACOF minimum standards minimum standards Denominator: Total # of GRH integrating the 455 n/a 38 38 38 38 38 FOSACOF approach Numerator/ Denominator (in percentage) 8 n/a 45% 71% 32% 0 76% 65 IR 2.3: Referral system for primary health care prevention, care and treatment between community structures and health facilities (district and provincial levels) institutionalized
69 % of patients referred to HCs, disaggregated by Numerator: # of patients (adults and children) 17,204 n/a 5,144 5,834 10,102 21,080 17,400 Health Quarterly HMIS Officer gender, and age groups (< 5 years; 5‐14 years; >15 referred to health centers by a CHW facility years) records Denominator: Total # of patients seen by a CHW 111,776 n/a 42,580 72,514 47,453 162,547 115,998
Numerator/ Denominator (in percentage) 15% n/a 12% 8% 21% 0 15% 86 70 % of patients referred to GRHs, disaggregated by Numerator: # of patients (adults and children) 174,245 n/a 58,958 59,746 58,834 177,538 60,000 Health Quarterly HMIS Officer gender, and age groups (< 5 years; 5‐14 years; >15 referred to GRHs by a CHW or health care provider facility years) records Denominator: Total number of patients seen by a 4,474,662 n/a 1,469,267 1,744,704 1,440,074 4,654,045 1,200,000 CHW or health care provider Numerator/ Denominator (in percentage) 4% n/a 4% 3% 4% 0 5% 76 IR 3: Knowledge, attitudes, and practices to support health‐seeking behaviors in target health zones increased (Component 1)
IR 3.1: Evidence‐based health sector‐community outreach linkages –especially for women, youth and vulnerable populations– established
71 ***L+M+G: % of NGOs representing women, Numerator: # of NGOs representing women, youth, 146 n/a 332 332 332 332 155 IHPplus Quarterly BCC Technical youth and vulnerable groups participating in and vulnerable groups attending NGO coordination Reports Advisor coordination meetings meetings 214 Denominator: # of NGOs representing women, 212 n/a 455 455 455 455 212 youth and vulnerable groups registered in DRC
Numerator/ Denominator (in percentage) 69% n/a 73% 73% 73% 1 73%
72 ***L+M+G: # Champion Communities achieving # Champion Communities achieving the 34 n/a 32 32 32 32 32 IHPplus Quarterly BCC Technical the deliverables set in their signed fixed amount deliverables set in their signed fixed amount Reports Advisor awards (FAAs) awards (FAAs) 94 73 ***L+M+G: # youth organizations participating in # youth organizations conducting member 146 n/a 143 148 180 180 146 IHPplus Quarterly BCC Technical youth education outreach strategy outreach and health education as part of IHPplus Reports Advisor youth health education strategy 123 IR 3.3: Behavior change campaigns involving opinion leaders and cultural influences (people and technologies) launched
74 BCC: # of CODESAs supported by IHP and which # of CODESAs supported by IHPplus within the IHP 1,192 n/a 1,211 1,221 1,225 1,225 1,200 IHPplus Quarterly BCC Technical have a “Communications action plan” target area and which have a “Communications Reports Advisor action plan” developed 102 75 BCC: # of educational SMS messages during BCC Key messages targeted to select groups (mothers, 500,000 n/a 191,066 147,607 171,495 510,168 360,000 IHPplus Quarterly BCC Technical campaigns or mini campaigns on malaria, caretakers, partners, etc.) sent via SMS in FP, Reports Advisor nutrition and/or family planning nutrition, malaria, WASH, etc., within the IHPplus target areas (annual targets will be based on pilot studies in PY2 as included in the workplan)
142 IR 4: Health sector leadership and governance in target provinces improved (Component 2)
IR 4.1: Provincial health sector policies and national level policies aligned
76 ***L+M+G: % of health zones with an annual Numerator: # of health zones with an annual 78 n/a 61 61 61 61 78 IHP Annually M&E Specialist operational plan based on National Development operational plan based on National Development Reports Plan ("PNDS") Plan ("PNDS") Denominator: Total # of health zones 78 n/a 78 78 78 78 78 Numerator/ Denominator (in percentage) 100% n/a 78% 78% 78% 1 100% 78 77 ***L+M+G: % of health zone management teams Numerator: # of health zone management teams 43 n/a 61 61 60 60 55 IHPplus Annually M&E Specialist with a performance management system that with a performance management system that Reports includes essential components includes any of the three essential components: 1) up‐to‐date job descriptions and organigrams, 2) work plans (including supervision plan and guide), and 3) performance review reports
Denominator: Total # of health zones 78 n/a 78 78 78 78 78 Numerator/ Denominator (in percentage) 62% n/a 78% 78% 77% 1 71% 109 Project Management 78 PM: Number of success stories developed Number of success stories developed disaggregated 23 n/a 989 2624 IHPplus Quarterly M&E Specialist by technical components and sub‐components Reports where applicable (HIV and AIDS, TB, Malaria, NTD, MNCH, FP/RH, Nutrition, WASH, GBV, Gender, HSS, BCC, Commodity security, Coordination, M&E, etc.)
108 IHPplus International Travel and STTA Plan June 2015 - June 2016
TECHNICAL AREA SUGGESTED PERSON INDICATIVE SCOPE OF WORK Origin/destination Length of trips Airport Notes (optional: add any memory Airfare Per Diem (at rate Transfer Misc aids or details to ID or explain ORG Travel dates to days of $406/day) ($75/trip) Visa ($15/day) STATUS trip in any way) STTA/PROJECT MANAGEMENT AND MONITORING
Quarter 1 June-September 2015*
Provide technical and management support PM Program Management Dan Nelson MSH July 20-August 22, 2015 and visit project sites as acting DCOP until Boston/Kinshasa 32 2,500.00 12,992.00 75.00 600.00 Completed. the permanent candidate is in place
Provide IHP and its partners with short- August 30-September 8, term technical assistance in monitoring the RBF Results-Based Financing Alfred Antoine Uzabakiliho MSH Boston/Kinshasa 9 2,500.00 3,654.00 75.00 250.00 - Completed. 2015 function of the DRC Results-based Financing (RBF) web portal
41 5,000 16,646 150 850 -
Quarter 2 October-December 2015
Provide technical and management support PM Program Management Kristin Cooney MSH October 1-15, 2015 Boston/Kinshasa 15 2,500.00 6,090.00 75.00 250.00 - Completed. and visit project sites Quarter 3 January-March 2016
RBF Results-Based Financing Jean Kagubare MSH February 24-March 6, 2016 Provide technical support for RBF activities Boston/Kinshasa 12 2,500.00 4,872.00 75.00 250.00 - Completed.
Perform needs assessment to determine Project MNCH MNCH Stephanie York March 13-19, 2016 cost share donation of medical supplies and Boston/Kinshasa 7 2,500.00 2,842.00 75.00 250.00 - Completed. C.U.R.E. equipment
Provide technical and management support PM Program Management Kristin Cooney MSH March 19-April 1, 2016 Boston/Kinshasa 12 2,500.00 4,872.00 75.00 250.00 Completed. and visit project sites
31 7,500 50,750 451 2,000 -
Quarter 4 April-June 2016
Provide technical and management support PM Program Management Jeanne Hamon MSH May 7-June 18, 2016 to finalize the PY1Q3 report and support Boston/Kinshasa 43 1,820.00 17,255.00 75.00 250.00 Completed. the PY2 workplanning process
Provide security management assistance Operations Operations John McKenney MSH May 18-26, 2016 Boston/Kinshasa 9 2,500.00 3,654.00 75.00 250.00 Completed. and training or refresher training to staff
43 1,820 17,255 75 250 - Total 130 16,820 90,741 751 3,350 -
Appendix 2: IHPplus International Travel and STTA Plan June 2015 to June 2016
Origin/destination Length of trips
Notes # TECHNICAL AREA SUGGESTED PERSON ORG Travel dates INDICATIVE SCOPE OF WORK (optional: add any to days Airport memory aids or details Airfare Per Diem (at rate Transfer Misc to ID or explain trip in of $.../day) ($100/trip) Visa ($15/day) STATUS any way) INTERNATIONAL TRAVEL OF LOCAL STAFF AND PARTNERS Quarter 1 June-September 2015*
Quarter 2 October-December 2015
Attend the Accelerating Children's PM HIV/AIDS Dorah Kashosi MSH Nov 15-20, 2015 HIV/AIDS Treatment (ACT) Initiative Kinshasa/Lusaka 6 2,000.00 1,710.00 60.00 400.00 - Completed. workshop in Zambia from Nov 16-19, 2015
Present a poster on the FOSACOF approach at the 8th Annual Conference on the PM Health Delmond Kyanza MSH December 11-18, 2015 Kinshasa/Washington, D.C. 7 2,500 2,842 75 250 0 Completed. Science of Dissemination and Implementation 13 4,500 4,552 135 650 - Quarter 3 January-March 2016 Attend the West Africa Multi-Sectoral Nutrition Global Learning and Evidence PM Nutrition Matthieu Koy MSH January 18-22, 2016 Kinshasa/Accra 5 1,500 1,655 75 400 0 Completed . Exchange (MSN-GLEE) workshop in Accra, Ghana, from January 19-21, 2016 Attend the iCCM/Rectal Artesunate PM Malaria Jean-Fidele Ilunga MOH February 14-20, 2016 Kinshasa/Nairobi 7 2,500 2,520 75 250 Completed. workshop in Nairobi from Feb 14-20
Use or disclosure of data contained on this sheet is subject to the restrictions on the title page of this proposal. Notes TECHNICAL AREA SUGGESTED PERSON INDICATIVE SCOPE OF WORK Origin/destination Length of trips Airport (optional: add any memory Airfare Per Diem (at rate Transfer Misc aids or details to ID or explain ORG Travel dates to days of $406/day) ($75/trip) Visa ($15/day) STATUS trip in any way) Attend the iCCM/Rectal Artesunate PM Malaria Jeanine Musau MSH February 14-20, 2016 Kinshasa/Nairobi 7 2,500 2,520 75 250 Completed. workshop in Nairobi from Feb 14-20 19 6,500 6,695 225 900 -
Use or disclosure of data contained on this sheet is subject to the restrictions on the title page of this proposal. Katanga Provincial Rep FOS Sud Kivu Project Director & FOS Kamina Matthieu Koy Ousmane Faye Doudou Tubaya FOS KASAI-Oriental Faustin Bushabu FOS KASAI- FOS Kolwezi & Prog Occidental Kamina Raphael Tshinzela Country Rep Assistant (Based in Kinshasa) Philippe Tshiteta TBD Augustin Mwala
M&E Senior M&E Advisor Communication Manager Sam Manager COMU DIRECTOR RMNCAH Deputy Project Moussa Traore Mbuyamba Landry Malaba Rood Merveille Director Director/ Narcisse Hortense HMIS/Web M&E Advisor COMU Embeke Angoran-Benie Alidor See Page 2 Specialist Derek Kahongo Kuamba
MNH Technical Heath Syst TA WASH Technical Malaria Technical Fin &Cap Building BCC Technical Advisor Advisor SIAPS Advisor Advisor Director/ OSC DEO Mirindi TBD Jeremie Fikiri Jeanine Musau Augustin Mwala Jean Baptiste Mputu
GENDER Technical TB Technical RBF Technical Specialiste Log Advisor Advisor Advisor CH/ IMCI STA Serge Nyembwe TBD Modeste Kesereka Wivine Mbwebwe Didace Demba
Associe HIV Technical Capacity Building Tech/Produits de Advisor Technical Advisor EPI/PEV Technical Sante Dorah Kashosi Freddy Tshamala Advisor Christian Kisimba Joseph Kongolo
Technical NUTRITION Associate Appendix 3 - DRC-IHPplus Organizational Technical Advisor Jean Claude Katanga Matthieu Koy Chart as of June 30, 2016 Kinshasa Office (HQ – page 2)
Director of Operations Finance & Administrative TBD Specialist (Key) Desire Zongo Senior Executive Assistant Evelyne Mayolo
Senior Operations Manager Finance Manager Justin Mukoka Contracts Manager HR Country Manager IT Manager Joel Amisi Mugeni Marius Mie Toko Hypolite Ndjibu Patrick Maheshe
Administrative Senior Accountant Administrative Procurement Associate IT Specialist Coordinator Cecile Kambeya Coordinator Viviane Bonga TBD Nathalie Mansubi Astrid Dinganga Administrative Accountant I (3) Administrative Administrative IT Coordinator Coordinator Jean Reddy Anke Coordinator Assistant/Data Analyst William Mawikila Patricia Kakassi Lucette Mwanza Diogene Nshue Marcel Kazadi Flory Dikala
Administrative Accounting Assistant HR Assistant Assistant TBD TBD Esthel Likaka
Receptionist Archiviste Doc. Laetitia Kikongi Patrick Ntabudi
Financial Analyst Transport & Logistics Celestin Mbuyi Coordinator Junior Kiama Accountant I Log Assistant Jolie Kaja Daniel Ali Drivers IHP (2) Francois Makinu Jean Kongolo Financial Analyst Moise Kapend Drivers SIAPS (2) Guy Tshisuaka Joseph Ipoma Accountant I Daniel Ngongo Délice Katshiki
IHPplus Field Office: Kananga, Kasaï Central
Senior Technical Advisor/Field Office Supervisor Raphael Tshinzela (based in Kinshasa) Senior Tech. Advisor/ Provincial Rep TBD
Tech. Advisor/ IH Field Director (acting) Matthieu Lutondo
Technical Advisor Accountant Operations Grant Technical Technical Coordinator BCC Expert (3) M&E Specialist Pierre Coordinator Officer Anny Kaja Associate/WASH (2) William Mpata Anicet Eddy Kipoke Bob Kitu Kadiebue TBD Pius Kinumbe Joseph Ekandji Balandeke Patrice Wembolenga
Senior Technical Logistics Coordinator(4) Assistant/Driver Jeannot Kayembe, Daniel Mpumbu Jean Felix Mubayi Francois Tukumbane Severin Bushiri
Driver s (3) Joseph Kongolo Nkongolo Benjamin
IHPplus Field Office: Lodja, Sankuru
Senior Tech. Advisor/FOS Matthieu KOY (based in Kinshasa)
Senior Technical Advisor/Provincial Representative TBD
Senior Technical Advisor/ IH Field Director Freddy Mbuse
Technical Operations M&E Accounting Grant Specialist Advisor Coordinator Freddy Mbuse Coordinator BCC Specialist Coordinator Kabuyaya Barthelemy OSC (2) Patrick Luyeye Lusuna Any Lushimba TBD Andre Francois Tshibangu Augustin Mudibantu Senior Technical Driver (2) Coordinator (6) Leon Ankese Charlotte Awondjo Denis Ikopo Richard Lokosu Alphonse Kenemo Daniel Omambo Albert Omokamba Daniel Shongo Evariste Kalonji Richard Batulenga
IHPplus Field Office: Mwene-Ditu, Lomami
Senior Tech. Advisor/Field Office Supervisor Matthieu Koy (based in Kinshasa) Senior Technical Advisor/Provincial Representative TBD
Senior Technical Advisor/ IH Field Director Emmanuel Mulunda
Financial Analyst Technical Specialist Technical M&E Grant Coordinator Bernardin Ngwamashi BCC Specialist J. Michel Mutombo Associate/WASH Specialist TBD Tony Ngandu Merveille Kombo Jean Claude Jean Pierre
Lubamba Bianga
Operations Coordinator Alphonse Tshibangu Senior Technical Coordinator (2) Gaston Muvudi Severin Bushiri
Driver (2) Balthazar Tshibanda Benoit Mutuapi IHPplus Field Satellite Office: Mbuji-Mayi, Kasai-Oriental
Senior Technical Advisor/ Field Office Supervisor Matthieu Koy (based in Kinshasa)
Senior Technical Advisor/ Provincial Representative Adamo Fumie (based in Mbuji-Mayi)
Senior Technical Technical Coordinator Associate/WASH Driver/Log Assistant Fellly Otshudi Deca Banza Olivier Yakabue
IHPplus Field Satellite Office: Lubumbashi, Katanga
Senior Technical Advisor/ Haut Katanga Provincial Representative Doudou Tubaya (based in Lubumbashi)
Operation Accounting Associate Coordinator Etienne Ndiwulu Jeanne Mutombo é
Administrative Assistante TBD
Driver Patrick Nkolomonyi IHPplus Field Office: Kamina, Haut Lomami
Field Office Supervisor/Kamina Provincial Representative Doudou Tubaya (Based in Lubumbashi)
Senior Technical Advisor/ IH Field Director Jean Jacques Mpiana
Technical Operations BCC Specialist Accountant Grant Advisor (2) M&E Specialist Coordinator Gustave Alexis Ndumbi Thierry Munongo Coordinator Amide Ngongo Blaise Mana Mana Numbi Freddy Bayakwa TBD
Senior Technical Driver (2) Coordinator (1) Jacques Kasongo Paul Olongo Emmanuel Mukadi Jean Paul Kasongo
IHPplus Field Office: Kolwezi, Lualaba
Senior Technical Advisor/Field Office Augustin Mwala (Based in Kinshasa)
IHP Coordinator Thierry Salamu
Operations Grant Accountant Technical Specialist HIV Technical Eric Lukwete Coordinator Coordinator Christian M&E Officer BCC Specialist--OSC Mpembele Advisor Adolphe Lubila Arlette Lybia Bodel Ali TBD Emmanuel Delphin Kabakila
Mulowayi Willy Nfumi Drivers (2) Health Zone Supervisors (2) 1. Valentin Kapondo Kapini 2. Manasse Mazau 1. Crispin Mboyi Health Zone 2. Charles Mbuyu Supervisors (1) Gaetan Ngoyi IHPplus Field Office: Bukavu, Sud Kivu
Field Office Supervisor Matthieu Koy
(based in Kinshasa) Sud Kivu Provincial Representative Janvier Barhobagayana
IHP Coordinator/TA Janvier Barhobagayana
Technical Specialist (2) Operations Accountant Security Officer M&E Officer Coordinator Grants Coordinator Rose Bokashanga Joseph Mselu Franck Mukosa Sauli Lubanda Fidele Vincent Witumbula Dieudonne Zirirane
Accountant BCC Specialist—OSC Drivers (4) Assistant II HZ Supervisors (4) 1. Gaston Musulu. Beevans Mpoy 1. Zacharie Mudosa 2. Dodo Ilolwa Mulenda 2. Theodore Kabuta Kabua 1. Parfaitine 3. Evariste Kabala Chirhalwirwa 4. Yves Chishugi 2. Yissa Zagabe 3. Dieudonné Cigajra 4. Iyungamo Isa 5. Luc Mweze
Appendix 13 : MISSION D’ACCOMPAGNEMENT DES 8 CDRs/DEPOTS PARTENAIRES DE MSH DANS LE SUIVI DES COMMANDES IHP ET IHPplus
Juin et Juillet 2016
I. Contexte
Management Sciences for Health (MSH), en partenariat avec Overseas Strategic Consulting, Ltd. (OSC) et Evidence to Action (E2A) mettent en œuvre le Projet de Santé Intégré plus en République Démocratique du Congo, un projet pont d’un an soutenu par l’USAID. Ce projet a pour but d’améliorer l'environnement propice pour, et accroître la disponibilité et l'utilisation de services, produits et pratiques à fort impact pour la planification familiale (PF); la santé maternelle, néonatale et infantile (SMNI), la nutrition, le paludisme et la tuberculose (TB) ; les maladies tropicales négligées (MTN), le VIH, et l'eau / assainissement et l'hygiène (WASH) , l’approvisionnement en médicaments dans toutes les Zones de santés appuyées par le projet susmentionné dans les provinces du Sud-Kivu, le Haut Lomami, Lualaba, Kasaï Central, Kasaï, Kasaï Oriental, Lomami et Sankuru.
Dans le cadre de l’appui aux approvisionnements en médicaments essentiels, PROSANI et PROSANIplus viennent en appui au Ministère de la Santé Publique en RDC conformément à la politique pharmaceutique nationale (PPN) dont l’objectif consiste à assurer l’approvisionnement régulier et l’usage rationnel des médicaments essentiels de bonne qualité et à un coût accessible à la majorité de la population.
Les projets susmentionnés ont ainsi signé des contrats avec les CDRs : BDOM BUKAVU, APAMESK BUKAVU, 8ème CEPAC BUKAVU, CAMELU au KATANGA, CADMEKO à MBUJI MAYI, FODESA à Lodja, CADIMEK à KANANGA dans le but de répondre aux normes qui exigent entre autre que la gestion des médicaments soit confiée aux dépôts ou CDRs agréés par l’Etat Congolais. Dans les régions où la difficulté de contracter se fait sentir, les projets susmentionnés ont pris en location un dépôt pouvant permettre d’assurer une bonne gestion des médicaments destinés aux structures sanitaires. C’est le cas de la province de Haut-Lomami.
Dans le cadre de cette collaboration avec les CDR, certaines difficultés ont été exprimées ces dernières, notamment en rapport avec la documentation qui accompagne les livraisons des médicaments. Vu l’importance des flux de livraisons actuellement en cours et la difficulté à distinguer les différentes commandes par les CDR, il s’avère nécessaire d’assurer un suivi rapproché en vue d’aider ces partenaires à réconcilier tous les écarts entre les différentes livraisons, les TO et les documents commerciaux.
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II. Objectifs
L’objectif de cette mission est de s’assurer de la bonne gestion des médicaments PROSANI, PROSANIplus, PMI, PEPFAR, PF, etc, du suivi des clauses contractuelles avec les CDRs concernées, de la réconciliation de différentes commandes des médicaments à compter de la commande de la quatrième année PROSANI jusqu’à la deuxième commande PROSANIplus.
III. Objectifs spécifiques/tâches
1. -Rafraichir les CDRs sur les procédures minimales de gestion des médicaments ; 2. -Orienter/Rappeler les CDRs sur l’article F.4.b. ou E.4.b. Partager sur les points ci- dessous en rapport avec les éléments attendus pour soumission d’une facture :
Chaque facture comportera les indications suivantes :
Facture de gestion des médicaments : a) Nom et adresse (insérer également le numéro de téléphone et adresse e-mail) de la Partie contractante ; b) Date et numéro de la facture ; c) Nom et adresse officiels de la Partie contractante à qui le paiement doit être adressé (détails du numéro de compte pour paiement ; d) Numéro du Contrat (par exemple 2015-109) et Numéro de l’Ordre d’exécution (par exemple TO 901 / IDA: TO #IDDE005 (Ref# CD208-1HP150717) conformément au calendrier des paiements figurant dans la Section E.3.b. e) Tous les soubassements permettant de vérifier la conformité de la facture de gestion : Facture de demande de paiement, PV de réception signé entre toutes les parties ; factures fournisseurs permettant de vérifier la conformité du prix appliqué, packing list, documents du transporteur ayant livré les médicaments au niveau de la CDRs, LTA,…
Facture de gestion de distribution des médicaments : a. Nom et adresse (insérer également le numéro de téléphone et adresse e-mail) de la Partie contractante ; b. Date et numéro de la facture ; c. Nom et adresse officiels de la Partie contractante à qui le paiement doit être adressé (détails du numéro de compte pour paiement ; d. Numéro du Contrat (par exemple 2015-109) conformément au calendrier des paiements figurant dans la Section E.3.b. e. La documentation des coûts directs encourus pour la distribution (comme convenu à l’avance par MSH et le contractant. Entre autre : plan de distribution signé par toutes les parties, facture du transporteur, Bon de livraison aux structures bénéficiaires,… ;
3. Orienter les CDRs sur le tableau ci-dessous au sujet des différentes commandes des médicaments MSH pour un bon suivi ainsi que le rapportage ;
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N° # TO (task Order) fait par # TO (task Order) fait par Commentaire MSH-Kinshasa et adressé MSH-Siège (USA) et aux CDRs en contrat avec adressé au fournisseur, MSH (en RDC) voir facture fournisseur 1 TO 701 TO #IDDE003 Il s'agit de la commande de la 4ème Année PROSANI avec comme fournisseur IDA.
Ces deux numéros de TO (TO 701 et TO #IDDE003) correspondent à une même commande, mais adressés de manière distinct aux CDRs DRC ainsi qu'au fournisseur auprès duquel les médicaments ont été achetés au niveau de MSH siège (USA). 2 TO 801 SQ142798 Il s'agit de la 1ère commande d’Urgence PROSANI (5èmeannée) avec comme fournisseur IDA.
Nous vous transmettons les autres détails dès que disponible.
Ces deux numéros de TO (TO 801 et TO SQ142798) correspondent à une même commande, mais adressés de manière distinct aux CDRs DRC ainsi qu'au fournisseur auprès duquel les médicaments ont été achetés au niveau de MSH siège (USA). 3 801-1 #IMDE001 - CD083- Il s'agit de la 2ème commande d’Urgence 1HP151015 PROSANI (5èmeannée) avec comme fournisseur IMRES.
Ces deux numéros de TO (TO 801-1 et TO # CD083-1HP151015) correspondent à une même commande, mais adressés de manière distinct aux CDRs DRC ainsi qu'au fournisseur auprès duquel les médicaments ont été achetés au niveau de MSH siège (USA).
Page 3 of 6
4 901 ,-IDA: TO Il s'agit de la 1ère commande PROSANIplus avec comme fournisseur IDA, MEG et #IDDE005 (Ref# CD208- IMRES. 1HP150717) Ces numéros de TO (TO 901 ainsi que les ,-MEG: TO numéros des TO,
#MEDE004, (Ref# CD208- -IDA: TO #IDDE005 (Ref# CD208- 1HP150717) 1HP150717)
,-IMRES: TO ,-MEG: TO #MEDE004, (Ref# CD208- 1HP150717) #IMDE001, (Ref# CD208- 1HP150717) ,-IMRES: TO #IMDE001, (Ref# CD208- 1HP150717))
correspondent à une même commande, mais adressés de manière distinct aux CDRs DRC ainsi qu'aux fournisseurs auprès desquels les médicaments ont été achetés au niveau de MSH siège (USA). 5 901-1 Ref# CD208-1HP150717 Il s’agit de la quantité complémentaire des médicaments en rapport avec la 1ère commande de PROSANIplus avec comme fournisseur Asrames.
Ces deux numéros de TO (TO 901-1 et TO dont la référence est Ref# CD208- 1HP150717) correspondent à une même commande, mais adressés de manière distinct aux CDRs DRC ainsi qu'au fournisseur auprès duquel les médicaments ont été achetés au niveau de MSH siège (USA). 6 902 Task Order #MPDE001/ Il s'agit de la deuxième Commande de ref # CD208-1HP151130 PROSANIplus avec comme Mission Pharma.
Ces deux numéros (TO 902 et TO #MPDE001/réf # CD208-1HP151130) correspondent à une même commande, mais adressés de manière distinct aux CDRs DRC ainsi qu'au fournisseur auprès duquel les médicaments ont été achetés au niveau de MSH siège (USA).
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4. Partager avec les CDRs toutes les factures fournisseurs concernées par ces différentes livraisons de manière spécifique à chaque commande ; 5. Faire état des factures déjà envoyée à l’Unité Contract, payées et en cours de paiement et faire correspondre les numéros des TO concernés pour besoin de réconciliation ; 6. Rappeler les CDRs de transmettre les demandes de paiements à MSH en faisant ressortir sur la facture de demande de paiement, le numéro du task Order communiqué au niveau de MSH DRC et celui adressé au fournisseur pour l’achat de ces médicaments (faire correspondre les deux numéros de TO étant donné qu’il s’agissant d’une même commande pour un bon suivi) ; 7. Vérifier les preuves de réception dans les CDR des produits expédiés à partir du dépôt MSH basé à Kinshasa ; 8. Vérifier la conformité de l’entrepôt aux bonnes pratiques des stockage et de distribution des médicaments ; 9. Actualiser les états de stocks des CDR ; 10. Echanger avec la DPS sur son implication dans les différents processus de quantification des besoins, d’élaborations des plans de distribution des médicaments aux zones de santé suivant le les différents réquisitions obtenues à cet effet et le suivi de la gestion de ces médicaments au niveau des structures bénéficiaires.
IV. Méthodologie de travail
¾ Réunion avec l’équipe du bureau de coordination concerné pour le « kick off meeting » ; ¾ Réunion avec l’équipe des différentes CDRs concernées pour le « kick off meeting » ; ¾ Réconciliation de différentes commandes des médicaments susmentionnés ; ¾ Visite des entrepôts concernés ; ¾ Echange avec les DPS concernées ; ¾ Visite de quelques zones de santé (selon la disponibilité) dans le cadre de suivi de la réception des médicaments.
V. Equipe/missionnaire
1 Staff technique SIAPS pour aider à la distinction des différentes commandes, l’élaboration des états de stocks et la vérification des bonnes pratiques ; 1 staff de la logistique pour fournir tous les documents commerciaux manquants ; 1 staff de l’unité contrat pour tous les aspects contractuels avec les CDR.
VI. Outils de travail à rendre disponible pour la mission x Modem ; x Appareil photo ; x Laptop ;
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x Différents documents nécessaires pouvant intervenir dans le cadre de cette activité. A titre illustratif les factures fournisseur, les différentes commandes des médicaments concernés ; x Téléphone et crédit pour la communication,…;
VII. Période et durée de la mission
La première étape de la mission débute le mardi 21 juin et se clôture le mercredi 06 juillet 2016. Elle sera focalisée sur les CDR CAMELU, CADIMEK et CADMEKO. La deuxième phase portera sur Lodja, Kamina et Sud Kivu. La période sera précisée.
VIII. Résultat attendu
La réconciliation de toutes les commandes et les états de stocks sont réalisés.
Fait à Kinshasa, le 16 juin 2016
Nathalie MANSUBIE Jérémie FIKIRI Administrative Coordinator Conseiller technique
Page 6 of 6
Appendix 14
République Démocratique du Congo MINISTERE DE LA SANTE PUBLIQUE SECRETARIAT GENERAL
Programme National D’Approvisionnent En Médicaments Essentiels P.N.A.M.
RAPPORT DE MISSION D’APPUI A LA DPS DU SUD-KIVU SUR LA FORMATION DES CADRES PROVINCIAUX EN GESTION DES MEDICAMENTS ET AUTRES INTRANTS DE SANTE
Bukavu, du 25 au 28 Juin 2016
Avec l’appui de :
Présenté par : - Ph. NGOMA BAZIKANGE Fidele, Directeur Adjoint du PNAM - Ph. TUNGUNGA MASCOTY Etienne, Responsable des estimations des Besoins Pays au PNAM
Juin 2016
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Ce rapport n’aurait pas été possible sans le soutien de l’USAID à travers les projets SIAPS et PROSANIplus mis en œuvre par MSH. Ces deux projets contribuent au renforcement des capacités de la RDC dans la gestion efficace des médicaments et autres produits de santé. Ils contribuent également à la promotion de l’accès de ces médicaments et de leur usage approprié.
Citation recommandée
Ce rapport peut être reproduit pourvu que PNAM y soit mentionné. Veuillez utiliser la citation suivante : NGOMA BAZIKANGE Fidele, Directeur Adjoint et TUNGUNGA MASCOTY Etienne, Responsable des estimations des besoins Pays, au PNAM/RDC: Mission de formation des cadres des Zones de Santé sur la gestion des médicaments et autres intrants de santé à Bukavu dans la province du Sud-Kivu, du 25 au 28 Juin 2016.
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REMERCIEMENTS
Nous tenons à remercier la haute hiérarchie du Ministère de la santé publique pour nous avoir mandatés dans la réalisation de cette mission de formation sur la gestion des médicaments en appui à la DPS du SUD-KIVU.
Nos remerciements s’adressent également aux partenaires du ministère de la Santé, en l’occurrence l’USAID pour son appui technique et financier à travers les projets SIAPS et PROSANIplus mis en œuvre par MSH.
Nous avons apprécié à sa juste valeur la collaboration avec l’équipe de la DPS, la coordination provinciale de MSH (SIAPS et PROSANIplus) et les équipes cadres des ZS concernées au cours de cette mission.
Qu’ils soient tous remerciés.
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I. CONTEXTE ET JUSTIFICATION
Dans le cadre des activités visant les missions d’appui du PNAM aux DPS en rapport avec la gestion des médicaments, il a été constaté que les FoSa avaient une faible maîtrise des données de consommation, plusieurs ruptures et / ou Sur Stock des médicaments, nombreuses pertes des médicaments liées à des raisons diverses, une faible capacité technique des prestataires doublée par la perdition des personnels formés, d’une part.
D’autre part, une multiplicité et mauvaise tenue des outils de gestion dans les structures entrainant ainsi une grande difficulté dans la collecte et l’analyse des données appuyée par le non-respect du circuit officiel de transmission des rapports de gestion.
Bref, trois grands problèmes majeurs en rapport avec la gestion des MEG se posent dont :
- Mauvaises estimations des besoins ; - Mauvaise tenue des outils - Manque ou mauvais rapportage des données logistiques Ce constat de non performance a été aussi épinglé par MSH/SIAPS qui approvisionne vingt sept zones de santé du SUD-KIVU en médicaments essentiels et autres intrants de santé dans le cadre de la mise en œuvre du projet PROSANIPlus .Mais cette formation n’a concerné que 19 Zones de sante, etant donne que les 8 autres avaient déjà été capacitee par d’autres partenaires dont la GIZ,SANRU et l’IPS/DPS à travers la Banque Mondiale
Voilà pourquoi, le PNAM a effectué une mission d’appui à la DPS du SUD-KIVU sur la formation des prestataires avec le financement d’USAID/MSH/PROSANIPlus au cours de la période allant du 24juin au 02 juillet 2016.
II. INFORMATIONS GENERALES
THEME Formation des cadres provinciaux de la DPS du Sud-Kivu en gestion des médicaments et autres intrants de santé LIEU Salle des Conférence de CAP Bukavu dans la Province du Sud-Kivu DATE Du 25 au 28 Juin 2016 DUREE 4 jours STRUCTURES ¾ IBANDA,,KADUTU,BUNYAKIRI,KALONGE,KATANA,MITIMURHESA, CONCERNEES IDJI,WALUNGU,MUBUMBANO,MWENGA,KAMITUGA,KITUTU, KALOLE,NUNDU,UVIRA,RUZIZI,HAUTSͲPLATEAUX,LEMERA ,MULUNGU, DCMP 8e CEPAC, APAMESK, BDOM ET DPS.
PARTICIPANTS Catégories Nombre Provenance (Structures) (Homme=H, (Liste de présence en annexe) Femme=F) Pharmaciens H : 19 F : 06 Médecins H :00 F : 00 Administrateurs H : 12 Gestionnaires F : 00 Assistants en H : 00 - Pharmacie F : 00 Infirmiers H :01
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F : 00 Autres (Préposés) H : 04 F : 00 Total H : 36 soit 86 % F : 06 soit 14% Taux de Participation 93 % Soit 42/45 Participants prévus. TYPE DE SESSION Session continue FACILITATEURS N° NOM QUALIFICATION INSTITUTION / FONCTION STRUCTURE 1 NGOMA Pharmacien, MPH PNAM Directeur Adjoint BAZIKANGE Fidele 2 TUNGUNGA Pharmacien PNAM Responsable des MASCOTY estimations des besoins Etienne Pays en MEG AUTORITES Pépin NAMUGOBE SHAMAVU, RENCONTREES Chef de Division Provinciale de la Santé du Sud-Kivu
III. INFORMATIONS PEDAGOGIQUES
OBJECTIFGENERAL Contribuer à l’amélioration de l’état de santé de population.
OBJECTIFSSPECIFIQUES Les participants sont capables de : 1. Maitriser les généralités sur la gestion des MEG ; 2. Sélectionner correctement les MEG ; 3. Acquérir correctement les MEG 4. Distribuer correctement les MEG ; 5. Utiliser correctement les MEG 6. Rapporter les données logistiques des MEG
RESULTATS 45 cadres provinciaux de la DPS sont formés dans la gestion des OBTENUS médicaments et autres intrants de santé METHODOLOGIE L’approche active a été privilégiée avec des techniques d’apprentissage UTILISEE telles : 1) Brainstorming ; 2) Exposés d’orientation ; 3) Lecture individuelle ; 4) Exercices illustratifs ; 5) Travaux des groupes ; 6) Discussion en plénière. RESSOURCES ¾ Guide du formateur en gestion des médicaments DOCUMENTAIRES ¾ Fiches techniques de gestion des médicaments au niveau de l’HGR et du CS ¾ Outils de gestion des médicaments au niveau de l’HGR et du CS ¾ Liste Nationale des Médicaments Essentiels de la RDC ¾ Echantillon d’outils de gestion tenus par les formations sanitaires
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IV. SYNTHESE DU DEROULEMENT DE LA MISSION
Pour atteindre les objectifs assignés à notre mission, nous avons réalisé les activités ci- dessous : ¾ Participer aux réunions pédagogiques et préparatoires ; ¾ Rencontrer les autorités politico-administratives de la Province ; ¾ Faciliter la session de formation; ¾ Assister les participants dans les travaux des groupes.
Après notre arrivée à Bukavu le vendredi 24 juin 2016, nous avons tenu une réunion préparatoire au bureau de la DPS. Cette dernière a porté sur : l’ajustement de l’agenda de la formation, la mise au point des aspects technique et matériel de la formation, la répartition des tâches ainsi que la sélection des exposés et activités à réaliser au cours de ladite formation. Durant les 4 jours, la formation a été tablée sur les informations clés ci-après : Au premier jour, après les différents mots de circonstance prononcés respectivement par le Directeur Adjoint du PNAM Représentant du niveau national , le Représentant provincial de MSH/SIAPS et le chef de division de la santé du Sud-Kivu en guise de la cérémonie d’ouverture, la lecture des Termes de référence de l’atelier et la présentation des participants ainsi qu’ un pré-test des connaissances des participants, s’en sont suivis. Sur les 34 participants qui ont pris part à ce pré test, seuls 16 participants ont obtenu une note supérieure à la moyenne, soit 47 % de réussite seulement. Néanmoins, ce résultat s’est sensiblement amélioré à la fin de la formation (Voir tableau à la page 10).
En ce premier jour de la formation, les attentes des participants ont été également listées. En résumé, tous les participants ont émis le souhait de bénéficier d’une formation axée essentiellement sur les difficultés qu’ils rencontrent régulièrement au cours de leur prestation et sur des exercices pratiques en rapport avec le calcul des différents indicateurs ou données logistiques ciblés. A cet effet, l’agenda de la formation proprement-dite a porté sur les matières dont la synthèse est reprise dans le tableau ci-dessous : Plages Points à retenir Les généralités Dans cette plage les points ci-dessous ont été développés : sur la gestion des - Les définitions des concepts clés dont : le médicament, médicaments ME vitaux, médicaments essentiels, médicaments génériques, les spécialités pharmaceutiques, médicaments altérés, médicaments falsifiés, médicaments corrompus ; médicaments périmés, consommables médicaux et petits matériels ; Notons que pour chaque définition, un exemple concret a été donné En rapport avec chaque type des médicaments cités. - Le cadre légal des approvisionnements des ME en RDC en décrivant entre autre le circuit national d’approvisionnement des MEG; - Le cycle logistique de la gestion des ME (La gestion des médicaments passe par un cycle comportant quatre étapes principales dont : la sélection, l’acquisition, la distribution et l’utilisation). Avant de clore cette plage, le facilitateur a développé aussi les « 6 BONS » qui régissent la chaîne logistique des médicaments à savoir : bons produits, en bonne quantité, dans les bonnes conditions, au bon endroit, au bon
RapportdeformationdesprestatairesdelaDPSduSudKivuenGestiondesMédicaments,Juin2016 Page6of32 Appendix 14
moment, et au bon coût. Sélection des S’agissant de la « sélection des médicaments », la question fondamentale est Médicaments de savoir Quels médicaments à acquérir dans une structure sanitaire ? En effet, cette activité a été résumée en deux taches que doivent exécuter les prestataires à savoir : (i) Choisir les médicaments et (ii) Dresser la liste des médicaments choisis Les facilitateurs ont mis un accent sur les documents appropriés pour la sélection des médicaments ainsi que leur importance. Il s’agit notamment de la LNME, les ordinogrammes et les DST. Acquisition des Au cours de cette plage, le facilitateur s’est appesanti sur les différents types Médicaments d’acquisition des médicaments notamment l’allocation et la commande ou la réquisition. Pour cette activité, 4 taches ont été développées dont (i) Quantifier les besoins (ii) Passer la commande (iii) Réceptionner les médicaments (iv) Assurer la qualité des médicaments. A cet effet, une lumière a été apportée sur le mode de calcul de la CMM, du Stock Disponible et Utilisable, du MAD, du Stock Maximum, du Stock Minimum, de la quantité à commander, de la quantité en risque de péremption ainsi que pour l’ajustement des données à tous les niveaux de la chaîne.
A fin de lier la théorie à la pratique, le facilitateur a procédé à la résolution d’une série d’exercices illustratifs. Ensuite les participants ont été répartis en 4 groupes et 8 Exercices pratiques leur+ ont été donnés pour les travaux en groupes dont les résultats ont été par la suite présentés en plénière sous la modération du facilitateur.
Retenons par ailleurs qu’un accent particulier a été mis sur les normes Max/Min mises en place en RDC pour chaque niveau de la chaîne d’approvisionnement.
Ensuite, les notions sur les bonnes pratiques de réception et l’assurance qualité ont été développées. En résumé : Le prestataire posera les actes ci-après lors de la réception des médicaments : ¾ Réceptionner les documents qui accompagnent la livraison ; ¾ Dénombrer les colis ; ¾ Vérifier la conformité de la livraison vis-à-vis de la commande (Vérifier s'il n'y a pas de discordance entre le bordereau de livraison délivré par la CDR/fournisseur agréé et les quantités, formes et dosage du Bon de Commande) ; ¾ Vérifier la qualité physique et les dates de péremption, les numéros des lots etc. des produits livrés ; ¾ Dresser un PV de réception ; ¾ Signer le Bordereau de livraison et en conserver un exemplaire dans les archives au dépôt.
S’agissant de l’Assurance qualité, le facilitateur a rappelé les facteurs à considérer pour assurer la qualité des médicaments. Ces facteurs se résument dans la théorie de 5M dont :
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M : Matières M : Milieu M : Matériel M : Méthodes M : Main d’œuvre Le contenu et le rôle de chaque M dans l’assurance qualité des médicaments ont été clairement expliqués. Distribution des Dans ce chapitre, le facilitateur est revenu essentiellement sur le stockage et Médicaments la tenue des outils de gestion, avant de procéder aux exercices pratiques y relatifs.
En résumé, les normes à observer en matière de Stockage ont été rappelées. Ces normes portent sur le classement, le rangement, le local et le matériel. S’agissant du classement, deux modes ont été expliqués dont : l’ordre alphabétique et l’ordre thérapeutique. En ce qui concerne le local, les conditions d’un local approprié ont été passées en revue dont : la construction en matériaux durable, l’aération suffisante, bon environnement extérieur, sécurité suffisante. Quant au matériel : les étagères en bois plaqué ou en métal de préférence etc.
Ensuite, quelques concepts clés relatifs aux médicaments ont été définis et expliqués aux participants en vue de faciliter la compréhension des prochaines étapes. Il s’agit notamment des concepts suivants : le Médicament, Médicament altéré, Médicament falsifié (contrefait), Médicament corrompu, Médicament périmé, Médicament essentiel, FIFO, FEFO.
Enfin, les outils de gestion ont été présentés, décrits et leur tenue a été clairement expliquée, soutenue par des exercices de démonstration. A cet effet, un modèle de chaque outil a été décrit, expliqué et rempli. Les outils concernés étaient : ¾ La fiche de stock ¾ Le bon de commande/Réquisition ¾ Fiche d’inventaire ¾ RUMER ¾ Fiche de température et d’humidité ¾ Fiche Hors usage ¾ Canevas de rapport d’inventaire
Utilisation Dans ce chapitre, trois points ont été développés à savoir : rationnelle des ¾ La prescription des médicaments ; Médicaments ¾ La Dispensation ou délivrance des médicaments ; ¾ Le Suivi de l’utilisation des médicaments par rapport aux effets indésirables.
Par rapport à la Dispensation, les tâches à exécuter sont : 9 Reconditionner les comprimés dans les emballages en plastique propres, secs et bien fermés, sans mélanger plusieurs produits ; 9 Eviter de reconditionner dans les papiers coton sales et adsorbants ou dans des récipients sans fermeture ;
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9 Marquer la date limite d’utilisation des produits en ajoutant 30 jours à partir de la date de reconditionnement ; 9 Expliquer aux malades : les posologies, quand et combien de fois par jour et pendant combien de temps ; 9 Avertir aux malades la survenue des effets indésirables éventuels
En ce qui concerne le suivi de l’utilisation des Médicaments, le facilitateur a démontré aux participants comment procéder au suivi de la consommation des Médicaments en exhortant au malade de faire un feedback à la structure en cas d’effets indésirables autres que ceux prévenus par le prestataire de la Pharmacie. Gestion de A ce propos, les points essentiels du Système d’Information en Gestion l’information Logistique (SIGL) notamment son rôle, but, les données logistiques logistique essentielles, les informations logistiques/indicateurs, les supports, les acteurs (SIGL) et leurs rôles ont été développés.
Notons par ailleurs que les informations logistiques à rapporter ont été énumérées et calculées avec exercices illustratifs pratiques. Ces informations sont : la CMM, le MAD, le SDU, le Taux de Perte et le capital Médicaments.
V. EVALUATION DES CONNAISSANCES DES PARTICIPANTS Au début comme à la fin de la formation, les participants ont été soumis à des tests dont les résultats se présentent comme suit : PRETEST POSTTEST GAIN CODE % % % @ 50 66,67 17 A 29 66,67 38 ADK 54 62,50 8 AK 21 ͲͲ21 ALPHA+ 33 58,33 25 AS 42 45,83 4 AS 41,67 42 ASB2 54 66,67 13 BD 33 58,33 25 BJ 42 58,33 17 BK 50 ͲͲ50 BKN 50 66,67 17 BL 50 83,33 33 BN 54,17 54 BS 54 79,17 25 CHRM 63 66,67 4 CPB 58 70,83 13 DMA 46 75,00 29 DPZK 42 62,50 21 JB 29 54,17 25 JMK 50 66,67 17 JNOT 54 66,67 13 KAKA 25 95,83 71 KEM12 67 91,67 25 KLL 33 37,50 4 KZ 29 38,33 9,3
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LJOH 29 58,33 29 MMA 58 58,33 0 MMM 46 Ͳ Ͳ O5O30 66,67 67 PATRIARCHE 42 70,83 29 PC 54 70,83 17 PK 54,17 54 PZ 70,83 71 SMM 50 45,83 Ͳ4 VIDE 66,67 67 VIDE 79,17 79 VM 25 50,00 25 XXL 58 58,33 0 XXY 29 54,17 25 Z 46 54,17 8 Commentaires : 41 ¾ Avant la formation, sur les 34 participants qui ont pris part au pré-test, seuls 16 ont obtenu une note supérieure à la moyenne, soit 47 % de réussite seulement. ¾ Après la formation, sur les 38 participants ayant participé au post test, 34 ont obtenu une note supérieure à la moyenne, soit 90 % de réussite. Ce qui fait une amélioration de 43 %. ¾ Toutefois, bien qu'en dessous de la moyenne, la majorité des participants restant ont tout- de-même amélioré leurs notes après la formation. Il s’agit par exemple des participants VM et XXL. ¾ Dans l’ensemble, 100 % des côtes du pré-test ont été améliorés au post-test, ce qui nous rassure que cette formation a été d’une très grande utilité pour cette cible. Par ailleurs, nous pouvons observer des cas de distinction ci-après : ¾ La cote de l’apprenant KAKA est passée de 25 % au pré-test à 95 % au post-test ; ¾ La cote de l’apprenant BL est passée de 50 % au pré-test à 83 % au post-test ; ¾ L’apprenant KEM12 qui au pré-test a obtenu la côte élevée de 67% est passée à 91 %.
D’autres détails peuvent être observés dans le graphique ci-dessous :
Graphique 1 : Résultats Moyens du test d’évaluation des participants
RésultatsMoyensdutestd’évaluationdesparticipants(en%) 100 95 90 90 63 80 70 53 60 43 43 PRETEST(%) 50 47 40 38 POSTTEST(%) 30 GAIN(%) 17 20 32 21 10 10 0 Côtelaplus Côtelamoins Tauxderéussite Tauxd'échec élevée élevée
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Commentaires : ¾ La côte la plus élevée est passée de 63 % à 95 % avec un gain de 32 % ¾ La côte la moins élevée est passée de 21 à 38 % avec un gain de 17 % ¾ Le taux de réussite a augmenté de 47 % à 90 % avec un gain évalué à 43 % ¾ Le taux d’échec a été sensiblement réduit de 53 % à 10 % soit un taux de réduction de 43%
VI. EVALUATIONS JOURNALIERES DES ASPECTS TECHINIQUES ET LOGISTIQUES DE LA FORMATION
Chaque jour avant la clôture de la journée, les participants procédaient à l’évaluation partielle de la formation pour permettre aux facilitateurs et organisateurs d’améliorer leurs prestations et de s’assurer que la formation se déroule comme prévu. Les détails de cette évaluation peuvent être trouvés dans les graphiques ci- dessous.
Graphique N°2: Résultats d’évaluations journalières Resultatsd'evaluationjournalièreen% 100 90 80 70 60 Jour1 50 Jour2 40 30 Jour3 20 10 Jour4 0 Moyenne
Graphique N°3 : Résultat Moyen d’évaluations journalières
Graphiquedesresultatsmoyensd'évaluationsjournalieres
100 86 76 75 90 71 74 77 63 80 70 60 50 40 30 20 10 CoteMoyenne 0
RapportdeformationdesprestatairesdelaDPSduSudKivuenGestiondesMédicaments,Juin2016 Page11of32 Appendix 14
Dans l’ensemble cette formation a été évaluée à 83 % de réussite en se basant sur les critères ou éléments d’évaluation ci-dessus notamment la qualité de la facilitation, la participation, le repas, le temps, la logistique et le logement des participants.
Comme nous montre ce graphique, la facilitation et la participation des apprenants sont les éléments qui ont obtenu un meilleur score moyen évalué respectivement à 86 et 76 %.
VII. CONCLUSION
En se basant sur les résultats d’évaluation générale, nous affirmons que cette formation a apporté un bagage consistant de connaissances additionnelles à tous les participants. Ce fut un succès et pour les facilitateurs ainsi que pour les participants En terme de connaissances additionnelles, le gain de cette formation est estimée à 43 % au regard du nombre d’échecs au test de début et de la fin de la formation.
Nous espérons que dans un futur proche, les pratiques de gestion des médicaments dans les formations sanitaires de la DPS du Sud-Kivu connaitront une amélioration considérable.
RapportdeformationdesprestatairesdelaDPSduSudKivuenGestiondesMédicaments,Juin2016 Page12of32 Appendix 14 ANNEXES
RapportdeformationdesprestatairesdelaDPSduSudKivuenGestiondesMédicaments,Juin2016 Page13of32 Appendix 14
ANNEXE 1 : PLAN D’ACTION POST FORMATION/DPS SUD-KIVU
Activités Echéance Résultat Livrables Responsable DPS, avec appui Mettre en place le groupe Provincial du GPM installée dans la DPS du SUD- Rapport d'installation Juillet 2016 PROSANIPlus, SIAPS et Médicament (GPM) KIVU d'ici fin Juillet 2016 de la GPM PNAM Former les prestataires d’au moins 90% Octobre Les prestataires d’au moins 90% des Rapport de formation ECZS, DPS avec appui des FOSA en GEMED. 2016 FOSA sont formés en fin septembre 2016 et tous les annexes. du PNAM Distribuer les outils de gestion dans les Octobre 90% des FOSA appuyées par USAID PV de réception des DPS, USAID et autres formations sanitaires 2016 disposent des outils de gestion PNAM outils Partenaires Mettre en place les comités de Octobre D'ici octobre 2016, les CQ sont installés Rapport d'installation quantification dans les ZS de la DPS DPS, ECZs 2016 dans les ZS de la DPS Sud-Kivu des CQ SUD-KIVU La liste des médicaments traceurs de la Liste des Elaborer la liste des médicaments Octobre ZS est disponible au plus tard en Octobre médicaments ECZS, Pharmacien traceurs dans les ZS 2016 2016 traceurs Quantifier les besoins provinciaux en Les besoins de la DPS sont estimés sur DPS, ECZS avec l'appui Décembre Rapport de Médicaments en se basant sur les base des données de consommation d'ici du PNAM, 2016 quantification données de consommation décembre 2016 PROSANIPplus et SIAPS ECZS, sous la Tenir un Atelier d'analyse et de Décembre coordination de la DPS, validation des données issues du Atelier tenu d'ici décembre 2016 Rapport de l'atelier 2016 PROSANIplus, SIAPS et terrain et actualiser les CMM des Fosa PNAM Organiser des Supervisions conjointes décembre Toutes les ZS formées sont supervisées DPS avec l’appui de Rapports supervision DPS-SIAPS, PROSANIPlus, PNAM 2016 en décembre 2016 PROSANIplus et SIAPS
Fait à Bukavu, le 28 Juin 2016 NGOMABAZIKANGEFidele EtienneMASCOTY PépinNAMUGOBESHAMAVU PNAM/RDC PNAM/RDC ChefdeDivisionProvincialedela Santé
RapportdeformationdesprestatairesdelaDPSduSudKivuenGestiondesMédicaments,Juin2016 Page14of32 Appendix 14
ANNEXE2:TERMESDEREFERENCEDELAFORMATION
République Démocratique du Congo MINISTERE DE LA SANTE PUBLIQUE
SECRETARIAT GENERAL A LA SANTE
Programme National d’Approvisionnement en Médicaments essentiels, PNAM Kinshasa
TERMES DE REFERENCE DE LA MISSION D’APPUI A LA DPS DU SUD-KIVU SUR LA FORMATION DES CADRES PROVINCIAUX EN GESTION DES MEDICAMENTS ET AUTRES PRODDUITS DE SANNTEDANS D LLES ZS CIBLEEES
Avec l’appui de :
Juin 2016
RapportdeformationdesprestatairesdelaDPSduSudKivuenGestiondesMédicaments,Juin2016 Page15of32 Appendix 14
I. Contexteetjustification Danslecadredesactivitésvisantlesmissionsd’appuiduPNAMauxDPSenrapportaveclagestion des médicaments, il a été constaté que les FoSa avaient une faible maîtrise des données de consommation, plusieurs ruptures et / ou Sur Stock des médicaments, nombreuses pertes des médicamentsliéesàdesraisonsdiverses,unefaiblecapacitétechniquedesprestatairesdoubléepar laperditiondespersonnelsformés,d’unepart.
D’autrepart,unemultiplicitéetmauvaisetenuedesoutilsdegestiondanslesstructuresentrainant ainsiunegrandedifficultédanslacollecteetl’analysedesdonnéesappuyéeparlenonͲrespectdu circuitofficieldetransmissiondesrapportsdegestion.
Bref,troisgrandsproblèmesmajeursenrapportaveclagestiondesMEGseposentdont:
- Mauvaisesestimationsdesbesoins; - Mauvaisetenuedesoutils - Manqueoumauvaisrapportagedesdonnéeslogistiques CeconstatdenonperformanceaétéaussiépingléparMSH/SIAPSquiapprovisionnedixͲneufzones desantéduSUDͲKIVUenmédicamentsessentielsetautresintrantsdesantédanslecadredelamise enœuvreduprojetProsaniplus.
Voilàpourquoi,lePNAMsepropose,d’effectuerunemissiond’appuiàlaDPSduSUDͲKIVUsurla formationdesprestatairesaveclefinancementd’USAID/MSH/SIPASaucoursdelapériodeallantdu 22au30Juin2016.
II. Objectifgénéral Contribueràl’améliorationdel’étatdesantédepopulation.
III. Objectifsspécifiques
1. MaitriserlesgénéralitéssurlagestiondesMEG; 2. SélectionnercorrectementlesME; 3. AcquérircorrectementlesME 4. DistribuercorrectementlesME; 5. UtilisercorrectementlesME 6. RapporterlesdonnéeslogistiquesdesME
IV. Résultatsattendus
Ͳ LesgénéralitéssurlagestiondesMEG,sontmaitrisées Ͳ LesMEsontcorrectementsélectionnés; Ͳ LesMEsontcorrectementacquis; Ͳ LesMEsontcorrectementdistribués; Ͳ LesMEsontcorrectementUtilisés; Ͳ Lesdonnéeslogistiques,sontrapportées.
V. Méthodologie
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Laméthodologieseraparticipativeetdevras’appuyersurlestechniquesciͲaprès:
x Exposésthématiques x Travauxengroupes x Restitutiondestravauxdegroupeenplénière x Synthèsedesfacilitateurs x Evaluationjournalièredesparticipants x Réunionpédagogiquedesfacilitateurs
VI. Profildesparticipants
Les pharmaciens et un autre personnel chargé des questions liées à la gestion des MEG au niveau de la zone de santé, quatre cadres de la Division Provincial de la Santé ainsi que les représentantsdesdifférentsdépôts(APAMESK,CEPAKETBDOM)soituntotalde45personnes.
VII. Outilspédagogiques. - FichestechniquesMEG; - Guidestechniquedesformations - LNME,version2014 - DST - Autres
VIII. Matérielsdidactiques: - CarnetsA4 - Fardeàrabat - Bics - Ramespapiers - Vidéoprojecteur - Ordinateur - Flipchart - Marqueurpermanent(noir,rouge,bleu)
IX. Facilitateurs: Cetteformationseraessentiellementaniméepardeuxfacilitateursduniveaunational(PNAM)
X. DEROULEMENTDELAFORMATION Laformationdureraquatrejoursetserarésidentiellepourlesparticipantsprovenantdel’extérieur deBUKAVU.Lesfacilitateursdevrontarrivertroisjoursavantlesparticipants(22juin2016)pourla planificationdesactivitésyrelatives(réunionspédagogiquesetc.).
XI. Budget:
AchargedeMSH/SIAPSFaitàKinshasa,le
PourleDirecteurenMission Ph.NGOMABAZIKANGEFidele,MPH DirecteurAdjoint
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ANNEXE3:AGENDADELAFORMATION
HEURES JOUR1 JOUR2 JOUR3 JOUR4 8h30à Présentationdescivilitésdes OùensommesͲnous ? OùensommesͲnous? OùensommesͲnous ? 10h30 facilitateursauxautorités Lectureetadoptiondu Lectureetadoptiondu LectureetadoptiondurapportJ3 sanitaires rapportJ1 rapportJ2 (exercices):plénière Arrivéedesparticipants Activité2Acquérirles Activité3Distribuerles Activité5Gérerl’Information: Cérémonied’Ouverture médicaments: médicaments: Ͳ Tâche1:collecteretcompiler Présentationdes Ͳ Tâche1:quantifier Ͳ Tâche1:enregistrer lesdonnéessurlagestiondes participants lesbesoins lesmédicaments médicaments LecturedesTDR Ͳ Tâche2:passerla Ͳ Tâche2:stockerles Ͳ Tâche2:analyserlesdonnées CollectedesAttentesdes commande médicaments Travauxdesgroupes participants Ͳ Tâche3: Ͳ Plénière PRETEST réceptionnerles Travauxdes médicaments Travauxdesgroupes Ͳ (exercices) 10h30à 11h00 11h00à Activité2Acquérirles Posttest 12h00 Généralitéssurlagestion médicaments:Suite Activité3Distribuerles Evaluationdesattentesdes desME(Cyclelogistique) Exercicesengroupes médicaments: participants Ͳ Tâche3:livrerles Synthèsedelaformation médicaments(jeude rôle) Ͳ Tâche4:tenirla
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fichedeStock (exercice) Ͳ Tâche5:tenirles inventaires 12h00à ExposésurleCircuitdu 14h00 SNAME Activité2Acquérirles médicaments:Plénière Activité3Distribuerles médicaments:Travauxdes groupes(exercices) Plénière Activité3Distribuerles Ͳ ) médicaments:Travauxdes groupes(exercices) Plénièreetplénière 14h00à 15h00 15h00à Activité1sélection: 16h30 Ͳ Tâche1:Choisirles Activité2Acquérirles Activité4Utiliserles médicaments médicaments:Pleniere médicaments: Travauxdesgroupes Tâche1:délivrerles (exercices) médicaments Plénière Travauxdesgroupes
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(exercices) Plénière 16h30à Evaluationetclôturedela Evaluationetclôturedela Evaluationetclôturedela 17h00 journée journée journée
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ANNEXE4:PREETPOSTTEST A.NONCORRIGE I.Cocherla(les)bonne(s)réponse(s): 1. Les conditions suivantes sont susceptibles de modifier la qualité des Médicaments et autresintrants, à l’exceptionde: a) Lachaleur b) Lapoussière c) Lalumière d) L’aération e) L’humidité f) Lesrayonssolaires 2.Pourunebonneréceptiond’unecommande,lestâchesciͲdessoussontrecommandéesàl’exceptionde: a) Vérifierl’emballage b) EtablirunPVderéception c) Vérifierl’étiquetage d) Travaillerenéquipe e) Vérifierlesquantitésreçues f) Ignorerlen°lotetdatesdepéremption 3.Undesélémentssuivantsn’estpasunoutildegestiondesmédicaments,ils’agitde: a) Fichedestock b) Fichedeprélèvementdelat° c) Bondecommande d) PVderéception e) Bondecaisse f) Bondelivraison 4.Le(s)bon(s)moment(s)pourpasserunecommandeest(sont): a) LorsqueleMD/ITestabsent b) Lorsqu’onatteintlestockmaximal c) Lorsqu’onestenrupturedestock d) Lorsqu’onatteintlestockd’alerte e) Lorsquelesproduitssontpérimés f) Lorsqu’onatteintlestockminimum 5.PoursélectionnerlesproduitsàutiliserdansvotreFosa,vousvousservezde: a) LalistenationaledesME b) Lalistemodèledel’OMS c) LesdirectivesStandardsdetraitement/ordinogrammes d) Votrepropreliste e) Aucunebonneréponse 6. Les assertions suivantes ne respectent pas les bonnes pratiques d’entreposage des médicaments, à l’exceptionde: a) Lesproduitssontclassésausol,lescartonsparterre b) Lesproduitsthermolabilessontdanslesarmoires c) Lesétagères/armoiressontclasséescontrelesmurs d) Lesstupéfiants/psychotropessontsurlesétagères e) Aucunebonneréponse II.Cocher(a)sic’estVRAI,(b)sic’estFAUX: 1.Unproduitquiaunedatedepéremptionprochesortlepremiermêmesisadated’acquisitionenstockest récente.a.b. 2.Pendantl’inventairedestock,ilfautarrêtertouslesmouvementsdustock,saufs’ils’agitd’unecommande d’urgenceàréceptionner.a.b. 3.Avecunoutilinformatique/Logicieldegestiondestock,laprésenced’unefichedestockendurestinutile a.b. 4.Quesignifie: a. FEFO:
RapportdeformationdesprestatairesdelaDPSduSudKivuenGestiondesMédicaments,Juin2016 Page21of32 Appendix 14
b. FIFO: c. DCI: d. MEG: e. StockMaximum: f. StockMinimum: g. SIGL: III.Cocherlabonneréponse Ledocumentdetransactionquiaccompagnelesmédicamentslorsdelaréceptiondansvotrestructureest: a) Lebondelivraison/Facture b) LePVderéception c) Lafichedestock d) Leregistred’entrée IV.Cocherla(les)bonne(s)réponse(s):LesdonnéesciͲaprèssontdesdonnéesessentielles: h. Quantitéreçue i. Quantitécommandée j. Quantitéconsommée k. Stockdisponibleetutilisable l. Quantitéperdue m. Nombredejoursderupturedesstocks n. Recettes V.Cocherla(les)bonne(s)réponse(s):lesinformationsciͲaprèssontessentielles: o. ConsommationMensuelleMoyenne p. MoisdeStockDisponible q. StockMaximum r. StockMinimum s. Stockd’Alerte B.CORRIGE I.Cocherla(les)bonne(s)réponse(s): 1. Les conditions suivantes sont susceptibles de modifier la qualité des Médicaments et autresintrants, à l’exceptionde: g) Lachaleur h) Lapoussière i) Lalumière j) L’aération k) L’humidité l) Lesrayonssolaires 2.Pourunebonneréceptiond’unecommande,lestâchesciͲdessoussontrecommandéesàl’exceptionde: g) Vérifierl’emballage h) EtablirunPVderéception i) Vérifierl’étiquetage j) Travaillerenéquipe k) Vérifierlesquantitésreçues l) Ignorerlen°lotetdatesdepéremption 3.Undesélémentssuivantsn’estpasunoutildegestiondesmédicaments,ils’agitde: g) Fichedestock h) Fichedeprélèvementdelat° i) Bondecommande j) PVderéception k) Bondecaisse l) Bondelivraison 4.Le(s)bon(s)moment(s)pourpasserunecommandeest(sont): g) LorsqueleMD/ITestabsent h) Lorsqu’onatteintlestockmaximal i) Lorsqu’onestenrupturedestock j) Lorsquelesproduitssontpérimés
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k) Lorsqu’onatteintlestockminimum 5.PoursélectionnerlesproduitsàutiliserdansvotreFosa,vousvousservezde: f) LalistenationaledesME g) Lalistemodèledel’OMS h) LesdirectivesStandardsdetraitement/ordinogrammes i) Votrepropreliste j) Aucunebonneréponse 6. Les assertions suivantes ne respectent pas les bonnes pratiques d’entreposage des médicaments, à l’exceptionde: f) Lesproduitssontclassésausol,lescartonsparterre g) Lesproduitsthermolabilessontdanslesarmoires h) Lesétagères/armoiressontclasséescontrelesmurs i) Lesstupéfiants/psychotropessontsurlesétagères j) Aucunebonneréponse II.Cocher(a)sic’estVRAI,(b)sic’estFAUX: 1.Unproduitquiaunedatedepéremptionprochesortlepremiermêmesisadated’acquisitionenstockest récente.a.b. 2.Pendantl’inventairedestock,ilfautarrêtertouslesmouvementsdustock,saufs’ils’agitd’unecommande d’urgenceàréceptionner.a.b. 3.Avecunoutilinformatique/Logicieldegestiondestock,laprésenced’unefichedestockendurestinutile a.b. 4.Quesignifie: t. FEFO:FirstExpiredFirstOut u. FIFO:FirstInFirstOut v. DCI:DenominationCommuneInternationale w. MEG:MedicamentsEssentielsGénériques x. StockMaximum:Stockexpriméennombredesmoisànepasdépasseràchaqueniveau y. StockMinimum:Stockexpriméennombredesmoisquidéclencheunenouvelle commande. z. SIGL:Systèmed’InformationenGestionLogistique V. Cocherlabonneréponse Ledocumentdetransactionquiaccompagnelesmédicamentslorsdelaréceptiondansvotrestructureest: e) Lebondelivraison/Facture f) LePVderéception g) Lafichedestock h) Leregistred’entrée IV.Cocherla(les)bonne(s)réponse(s):LesdonnéesciͲaprèssontdesdonnéesessentielles: aa. Quantitéreçue bb. Quantitécommandée cc. Quantitéconsommée dd. Stockdisponibleetutilisable ee. Quantitéperdue ff. Nombredejoursderupturedesstocks gg. Recettes V.Cocherla(les)bonne(s)réponse(s):lesinformationsciͲaprèssontessentielles: hh. ConsommationMensuelleMoyenne ii. MoisdeStockDisponible jj. StockMaximum kk. StockMinimum ll. Stockd’Alerte
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ANNEXE5:FICHED’EVALUATIONJOURNALIERE Echelled’appréciation N° Elémentsd’évaluation 1 3 4 5 1 Facilitation 2 Participationdesapprenants 3 Qualitédurepas 4 Respectdutiming 5 Logistique 6 Logement Commentaires:…………………………………………………………………… …………………………………………………………………………………….. ……………………………………………………………………………………..
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ANNEXE6:EXERCICESILLUSTRATIFS 1. Après8moisdegestiondesMEauseinduCS…,lerapportdeconsommationdeQuinine comprimés250mg,seprésentedelamanièreciͲdessous: N° Période Consommation Observation (Pièce) 1 Janvier 884 ? 2 Février 410 ? 3 Mars 760 ? 4 Avril 425 ? 5 Mai 717 ? 6 Juin 764 ? 7 Juillet 856 ? 8 Aout 743 ? CMM ? ? QuelestlestockdisponibleetleMSDsachantqu’aprèsinventaireledépôtetl’officineduCS disposentd’unstockphysiquede2242Comprimésdont58,87,43sontrespectivement altérés,corrompus,cassés? 2. Après6moisdegestiondesMEauseindel’HGR…,lerapportdeconsommationdelaquinine 250mgcomprimésseprésentedelamanièreciͲdessous: N° Période Consommation Observation 1 Janvier 184 ? 2 Février 210 ? 3 Mars 160 ? 4 Avril 150 ? 5 Mai 161 ? 6 Juin 152 ? CMM ? ? ¾ QuelestlestockdisponibleetleMSDsachantqu’aprèsinventaireledépôtetl’officinedel’HGR disposentd’unstockphysiquede872Comprimésdont24,35sontrespectivementaltérés, cassés? ¾ QuelleanalysepouvezͲvousfaireparrapportàcettesituationetquelledécisionenvisageriezͲ vous? 3. Endatedu28décembre2014,aprèsinventairedesMEdanslazonedesantéde…….constituée de5structuresdeprisedontleBCZSet4entitésdepriseenchargede…,lesdonnées statistiquesenrapportavecl’utilisationouladistributiondeArtesunate1ginjectable,se présententdeamanièresuivante: N° Entité Stock CMM(Vial) MSD(Mois) Observation Disponible(Vial) ouAnalyse 1 BCZS 4400 1400(Distrib) ? ? 2 HGR 800 300 ? ? 3 CS1 200 110 ? ? 4 CS2 250 170 ? ? 5 CS3 230 250 ? ? ZONEDESANTE ? ? ? ? SD,CMM,MSD(ZS) ? ? ? ?
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Ajustés ¾ QuelleanalysepouvezͲvousfaireparrapportàcettesituation? ¾ QuellesdécisionsenvisageriezͲvous? 4. Endatedu30Mars2014,aprèsinventairedesMEdanslazonedesantéde…….constituéede 10structuressanitairesdontleBCZSet9entitésdepriseenchargede…,lesdonnées statistiquesenrapportavecl’utilisationouladistributiondeASAQdontlavaliditéesde6 moiscàdEXP:10/14),seprésententdeamanièresuivante: N° Entité Stock CMM(Cure) MSD Observation Disponible(Cure) (Mois) ouAnalyse 1 BCZS 4736 478(Distribut) ? ? 2 HGR 1567 273 ? ? 3 CS1 372 152 ? ? 4 CS2 225 154 ? ? 5 CS3 343 170 ? ? 6 CS4 189 115 ? ? 7 CS5 232 134 ? ? 8 CS6 248 110 ? ? ZONEDESANTE ? ? ? ? SD,CMM,MSD ? ? ? ? (ZS)Ajustés ¾ QuelleanalysepouvezͲvousfaireparrapportàcettesituationet ¾ QuelledécisionenvisageriezͲvous? A. ExercicesdesGroupes 5. Après8moisdegestiondesMEauseinduCS…,lerapportdeconsommationdeTDR,se présentedelamanièreciͲdessous: N° Période Consommation(Pièce) Observation 1 Janvier 1884 ? 2 Février 1.410 ? 3 Mars 1.760 ? 4 Avril 935 ? 5 Mai 1.771 ? 6 Juin 1.772 ? 7 Juillet 3856 ? 8 Aout 1643 ? CMM ? ? ¾ QuelestlestockdisponibleetleMSDsachantqu’aprèsinventaireledépôtetl’officineduCS disposentd’unstockphysiquede6422Comprimésdont85,133,sontrespectivement altéréscorrompus,cassés? 6. Après6moisdegestiondesMEauseindel’HGR…,lerapportdeconsommationdelaquinine 250mgcomprimés,seprésentedelamanièreciͲdessous: N° Période Consommation Observation 1 Janvier 1184 ? 2 Février 1210 ? 3 Mars 1060 ? 4 Avril 1250 ? 5 Mai 1361 ?
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6 Juin 1252 ? CMM ? ? ¾ QuelestlestockdisponibleetleMSDsachantqu’aprèsinventaireledépôtetl’officinede l’HGRdisposentd’unstockphysiquede4872Comprimésdont324,35,43,sont respectivementaltéréscorrompus,cassés? ¾ QuelleanalysepouvezͲvousfaireparrapportàcettesituationetquelle décisionenvisageriezͲvous? 7. Endatedu28décembre2014,aprèsinventairedesMEdanslazonedesantéde…….constituée de5structuresdeprisedontleBCZSet4entitésdepriseenchargede…,lesdonnées statistiquesenrapportavecl’utilisationouladistributiondeArtesunate1ginjectable,se présententdeamanièresuivante: N° Entité Stock CMM(Vial) MSD(Mois) Observation Disponible(Vial) ouAnalyse 1 BCZS 2400 700(Distrib) ? ? 2 HGR 600 300 ? ? 3 CS1 100 120 ? ? 4 CS2 150 130 ? ? 5 CS3 130 200 ? ? ZONEDESANTE ? ? ? ? SD,CMM,MSD(ZS) ? ? ? ? Ajustés ¾ QuelleanalysepouvezͲvousfaireparrapportàcettesituatione ¾ QuelledécisionenvisageriezͲvous? 8. Endatedu30Mars2014,aprèsinventairedesMEdanslazonedesantéde…….constituéede 10structuresdeprisedontleBCZSet9entitésdepriseenchargede…,lesdonnéesstatistiques enrapportavecl’utilisationouladistributiondeALdontlavaliditéesde4moiscàdEXP: 08/14),seprésententdeamanièresuivante: N° Entité StockDisponible(Cure) CMM(Cure) MSD Observation (Mois) ouAnalyse 1 BCZS 6473 678(Distribut) ? ? 2 HGR 2256 473 ? ? 3 CS1 472 232 ? ? 4 CS2 325 254 ? ? 5 CS3 543 270 ? ? 6 CS4 289 145 ? ? 7 CS5 432 234 ? ? 8 CS6 348 210 ? ? ZONEDE ? ? ? ? SANTE SD,CMM, ? ? ? ? MSD(ZS) Ajustés ¾ QuelleanalysepouvezͲvousfaireparrapportàcettesituationet ¾ QuellesdécisionsenvisageriezͲvous?
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ANNEXE7:EXERCICESILLUSTRATIFSCORRIGES Question1:Après8moisdegestiondesMEauseinduCS…,lerapportdeconsommationde Quininecomprimés250mg,seprésentedelamanièreciͲdessous: QuelestlestockdisponibleetleMSDsachantqu’aprèsinventaireledépôtetl’officineduCS disposentd’unstockphysiquede2242Comprimésdont58,87,43sontrespectivement altéréscorrompus,cassés? Réponse1 N° Période Consommation Observation (cé) 1 Janvier 884 Typique 2 Février 710 Typique 3 Mars 760 Typique 4 Avril 425 Atypique 5 Mai 717 Typique 6 Juin 764 Typique 7 Juillet 856 Typique 8 Aout 1743 Atypique CMM(Cés) 781,8 Ͳ SD(Mois) 2054 Ͳ MSD(Mois) 2,62 Surstock Décisionsàenvisagernotamment: Ͳ Surseoirlalivraisonencasderéquisition Ͳ Descentesurterrainpours’enquérirdelasituationréelle Question2:Après6moisdegestiondesMEauseindel’HGR…,lerapportdeconsommationdela quinine250mgcomprimés,seprésentedelamanièreciͲdessous: ¾ QuelestlestockdisponibleetleMSDsachantqu’aprèsinventaireledépôtetl’officinede l’HGRdisposentd’unstockphysiquede872Comprimésdont24,35sontrespectivement altérés,cassés? ¾ QuelleanalysepouvezͲvousfaireparrapportàcettesituationetquelle décisionenvisageriezͲvous? Réponse2: N° Période Consommation Observation 1 Janvier 184 Typique 2 Février 168 Typique 3 Mars 160 Typique 4 Avril 150 Typique 5 Mai 161 Typique 6 Juin 152 Typique CMM(Cés) 169,5 Ͳ SD(Mois) 813 Ͳ MSD(Mois) 5 Surstock Décisionsàenvisagernotamment:
RapportdeformationdesprestatairesdelaDPSduSudKivuenGestiondesMédicaments,Juin2016 Page28of32 Appendix 14
Ͳ Surseoirlalivraisonencasderéquisition Ͳ Descentesurterrainpours’enquérirdelasituationréelle Question3:Endatedu28décembre2014,aprèsinventairedesMEdanslazonedesantéde……. constituéede5structuressanitairesdontleBCZSet4entitésdepriseenchargede…,lesdonnées statistiquesenrapportavecl’utilisationouladistributiondeArtesunate1ginjectable,se présententdeamanièresuivante: ¾ QuelleanalysepouvezͲvousfaireparrapportàcettesituatione ¾ QuellesdécisionsenvisageriezͲvous Réponses: N° Entité Stock CMM(Vial) MSD(Mois) Observation Disponible(Vial) ouAnalyse 1 BCZS 4400 1400(Distrib) 3,14 SousStock 2 HGR 800 300 2,66 SousStock 3 CS1 200 110 1,81 Sousstock 4 CS2 250 170 1,47 SousStock 5 CS3 230 250 0,92 SousStock ZONEDESANTE 5880 830 7 SurStock Décisionsàenvisagernotamment: Ͳ PasserlacommandepourleBCZS Ͳ RéapprovisionnerlesstructuresdePEC Ͳ Descendresurterrainenvuedes’enquérirdelasituationréelle Question4:Endatedu30Mars2014,aprèsinventairedesMEdanslazonedesantéde……. constituéede10structuressanitairesdontleBCZSet9entitésdepriseenchargede…,lesdonnées statistiquesenrapportavecl’utilisationouladistributiondeASAQdontlavaliditéesde6mois càdEXP:10/14),seprésententdeamanièresuivante: ¾ QuelleanalysepouvezͲvousfaireparrapportàcettesituationet ¾ QuellesdécisionenvisageriezͲvous? N° Entité Stock CMM(Cure) MSD(Mois) Observation Disponible(Cure) 1 BCZS 4736 478 9,9 SurstocketRisquede (Distribut) péremptionde3,9mois 2 HGR 1567 273 5,73 Surstock 3 CS1 372 152 2,44 Surstock 4 CS2 225 154 1,46 Sousstock 5 CS3 343 170 2 Equilibre 6 CS4 189 115 1,64 Sousstock 7 CS5 232 134 1,73 Sousstock 8 CS6 248 110 2,25 Surstock ZONEDE 7912 1108 7,14 Surstock SANTE SD, 9890 1421 6,95 Surstock CMM,MSD (ZS)Ajustés Décisionsàenvisagernotamment: Ͳ DistribuerlestockexcédentaireduBCZSauxstructuresensousstock Ͳ PasserlacommandepourleBCZSpourlesstructuresensousstock
RapportdeformationdesprestatairesdelaDPSduSudKivuenGestiondesMédicaments,Juin2016 Page29of32 Appendix 14
Ͳ RéapprovisionnerlesstructuresdePEClesstructuresensousstock Ͳ Descendresurterrainenvuedes’enquérirdelasituationréelle B. EXERCICESGROUPESCORRIGES Question1:Après8moisdegestiondesMEauseinduCS…,lerapportdeconsommationdeTDR, seprésentedelamanièreciͲdessous: ¾ QuelestlestockdisponibleetleMSDsachantqu’aprèsinventaireledépôtetl’officineduCS disposentd’unstockphysiquede6422Comprimésdont85,133,sontrespectivement altérés,cassés? Réponses1: N° Période Consommation(Pièce) Observation 1 Janvier 1884 Typique 2 Février 1410 Typique 3 Mars 1760 Typique 4 Avril 935 Atypique 5 Mai 1771 Typique 6 Juin 1772 Typique 7 Juillet 3856 Atypique 8 Aout 1643 Typique CMM(Pièce) 1710 Ͳ SD(Mois) 6204 Ͳ MSD(Mois) 3,62 Surstock Décisionsàenvisagernotamment: Ͳ Surseoirlalivraisonencasderéquisition Ͳ Descentesurterrainpours’enquérirdelasituationréelle Ͳ Sidatedepéremptiontrèsproche,envisageruneréalloction Question2:Après6moisdegestiondesMEauseindel’HGR…,lerapportdeconsommationdela quinine250mgcomprimés,seprésentedelamanièreciͲdessous: ¾ QuelestlestockdisponibleetleMSDsachantqu’aprèsinventaireledépôtetl’officinede l’HGRdisposentd’unstockphysiquede4872Comprimésdont324,35,43,sont respectivementaltéréscorrompus,cassés? ¾ QuelleanalysepouvezͲvousfaireparrapportàcettesituationetquelles décisionenvisageriezͲvous? Réponses2: N° Période Consommation ObservationouAnalyse 1 Janvier 1184 Typique 2 Février 1210 Typique 3 Mars 1060 Typique 4 Avril 1250 Typique 5 Mai 1361 Typique 6 Juin 1252 Typique CMM(Cés) 1220 Ͳ SD(Mois) 4470 Ͳ MSD(Mois) 3,66 Surstock Décisionsànvisagernotamment: Ͳ Surseoirlalivraisonencasderéquisition
RapportdeformationdesprestatairesdelaDPSduSudKivuenGestiondesMédicaments,Juin2016 Page30of32 Appendix 14
Ͳ Descentesurterrainpours’enquérirdelasituationréelle Ͳ Sidatedepéremptiontrèsproche,envisageruneréallocation Question3:Endatedu28décembre2014,aprèsinventairedesMEdanslazonedesantéde……. constituéede5structuresdeprisedontleBCZSet4entitésdepriseenchargede…,lesdonnées statistiquesenrapportavecl’utilisationouladistributiondeArtesunate1ginjectable,se présententdeamanièresuivante: ¾ QuelleanalysepouvezͲvousfaireparrapportàcettesituatione ¾ QuellesdécisionsenvisageriezͲvous? Réponses3: N° Entité StockDispo(Vial) CMM(Vial) MSD(Mois) Observation/Analyse 1 BCZS 2400 700(Distrib) 3,42 Sousstock 2 HGR 600 300 2 SousStock 3 CS1 100 120 0,83 Sousstock 4 CS2 150 130 1,15 Sousstock 5 CS3 130 200 0,65 SousStock ZONEDESANTE 3380 750 4,5 Sousstock SD,CMM,MSD 3380 750 4,5 idem (ZS)Ajustés Décisionsànvisagernotamment: Ͳ PasserlacommandepourleBCZS Ͳ RéapprovisionnerlesstructuresdePEC Ͳ Descendresurterrainenvuedes’enquérirdelasituationréelle Question4:Endatedu30Mars2014,aprèsinventairedesMEdanslazonedesantéde……. constituéede10structuresdeprisedontleBCZSet9entitésdepriseenchargede…,lesdonnées statistiquesenrapportavecl’utilisationouladistributiondeALdontlavaliditéesde4moiscàd EXP:08/14),seprésententdeamanièresuivante: ¾ QuelleanalysepouvezͲvousfaireparrapportàcettesituationet ¾ QuelledécisionenvisageriezͲvous? Réponses4 N° Entité Stock CMM(Cure) MSD ObservationouAnalyse Disponible(Cure) (Mois) 1 BCZS 6473 678(Distribut) 9,54 Surstockavecrisquede péremptionde5,54mois 2 HGR 2256 473 4,77 Surstock 3 CS1 472 232 2,03 Equilibre 4 CS2 325 254 1,28 Sousstock 5 CS3 543 270 2,01 Equilibre 6 CS4 289 145 1,99 Equilibre 7 CS5 432 234 1,85 Sousstock 8 CS6 348 210 1,66 Sousstock ZONEDESANTE 11138 1818 6,13 Equilibre SD,CMM,MSD 13923 2331 6 Equilibre (ZS)Ajustés Décisionsàenvisagernotamment: Ͳ DistribuerlestockexcédentaireduBCZSauxstructuresensousstock Ͳ PasserlacommandepourleBCZSpourlesstructuresensousstock Ͳ RéapprovisionnerlesstructuresdePEClesstructuresensousstock
RapportdeformationdesprestatairesdelaDPSduSudKivuenGestiondesMédicaments,Juin2016 Page31of32 Appendix 14
Ͳ Descendresurterrainenvuedes’enquérirdelasituationréelle Ͳ Redéploiementdesstocksenrisquedepéremption ANNEXE8:LISTEDEPRÉSENCE N° NOM&POSTͲNOM FONCTION SEXE NUMTEL 1 FloribertLUTWAMUZIRE PhcienBCZ M 829111852 2 FraterneMALYRA AGBCZ M 824962805 3 BenjaminKITULANOBISIMWA PhcienBCZ M 817885547 4 BAHINDULWANGOLO AGBCZ M 810924513 5 MITIMAMWANDAZA PhcienBCZ M 852331788 6 SergeBAGUHE PhcienHGR M 854795605 7 StephanBUGAMBA PhcienBCZ M 818787442 8 JohnMUGARUKAKASALI PhcienHGRPANZI M 997119353 9 JeannotMBEKUMISENGA PhcienBCZ M 813999779 10 ZABIBUGetrude PhcienHGR F 998824133 11 DidierRIZIKIPONDO PhcienBCZ M 978269714 12 MUTEWASANDA AGBCZ M 991084819 13 KingKYAKWIMAWAMULAKILWA PhcienBCZ M 970297004 14 KennedyWATUTAKWAMULOBA AGBCZ M 998787724 15 BATACHOKAKAPULI PhcienBCZ M 997754546 16 IbrahimRWIHANIRAMBO AGBCZ M 970249582 17 NathanKASANGANDJO PhcienBCZ M 997798037 18 BABAIMANI AGBCZ M 994260235 19 MolièreSHAURIMOKE PhcienBCZ M 971124525 20 DésiréBAGAZAMUSAGBA AGBCZ M 816264613 21 MOKEIKUKU PREPOSEEAUBCZ M 973446288 22 DhamasKALAKALANDUME AGBCZ M 993190108 23 MARHEGANEMUGISHO PhcienBCZ M 853508858 24 ClaudePARAGUKABABONE PhcienHGR/CIRIRI M 853645955 25 AlineKAZINGUVUKAHINDO PhcienneBCZ F 974966545 26 JonathanTSHONGOWAINDA IS M 997704619 27 CecileBUSIMESHEMAHAMBA PhcienneHGR F 991409678 28 KAZIRINDUNGUKA PREPOSEEAUBCZ M 892474710 29 ABEDISEMUTAKI PhcienBCZ M 810478760 30 JulesBAHATIBAGANDA AGBCZ M 813755919 31 LisetteMAMIMAMI PhcienneBCZ F 990541567 32 PièrreKALUMUNAKARUME AGBCZ M 994609629 33 AKONKWAMUNGUDouce PhcienneBCZ F 898730576 34 NTAITUNDAMURHEBWA AGBCZ M 992054191 35 VianneyMWATI AGBCZ M 998858266 36 JanvierKULIMUSHI Inspecteur M 995745995 37 ClementineKAHAMBIRANYOTA Analyste/BureauAPPROV/AͲT F 994343380 38 EmmanuelKANYONYO AnalysteAssistant,BͲAT M 998820472 39 PatrickNGABOCHIZA Inspecteur M 994259952 40 PatientMWAMBALIBAKENGA GestionnaireAssistant M 992582280 41 MoiseMUKENGEMUGARUKA ResponsabledépôtCEPAC M 999553342 42 JuniorAkiliMali PhcienBDOM M 997089626
RapportdeformationdesprestatairesdelaDPSduSudKivuenGestiondesMédicaments,Juin2016 Page32of32 Appendix 15
RAPPORT DES JOURNEE PORTE OUVERTE SUR LE
DEPISTAGE ACTIF ET TRAITEMENT DU PALUDISME SIMPLE DANS LES ZONES DE SANTE DE MPOKOLO, KAMIJI ET
BIBANGA
Journee porte ouverte du paludisme ,ZS de kamiji
AVRIL & MAI 2016 1 Appendix 15
LISTE DES ABBREVIATIONS
ACT Artemisin combined Therapy (Combinaisons thérapeutiques à base d’artémisinine) CDR Centrale de Distribution Régionale des Médicaments CPN Consultations prénatales CS Centre de Santé DPS Division Provinciale de la Santé ECZS Equipe Cadre de la Zone de Santé FM Fonds Mondial de lutte contre le VIH/SIDA, le Paludisme et la Tuberculose HGR Hôpital Général de Référence M&E Monitoring and Evaluation MILD Moustiquaire Imprégnée d’Insecticides à Longue Durée d’action MSH Management Sciences for Health ONG Organisation Non Gouvernementale OSC Overseas Strategic Consulting PEC Prise en charge President’s Malaria Initiative (Initiative du président Américain pour la lutte contre PMI le paludisme) PNLP Programme National de Lutte contre le Paludisme PROSANIplus Projet de Santé Intégré (Integrated Health Project) PV Procès Verbal RDC République Démocratique du Congo SP Sulfadoxyne Pyrimethamine TDR Test de Diagnostic Rapide (du Paludisme) TPI Traitement Préventif Intermittent USAID United Stated Agency for International Development ZS Zone de santé
2 Appendix 15
I. CONTEXTE ET JUSTIFICATION
Le paludisme reste un problème majeur de santé publique en RDC. Il reste en tête des causes de consultation, d’hospitalisation et de décès dans les formations sanitaires à travers le pays. Dans l’analyse situationnelle contenue dans le PNDS 2011-2015, le paludisme est responsable, avec les infections respiratoires aigües, la diarrhée et les affections néonatales, de 77% des décès chez les enfants de moins de 5 ans en RDC. Cependant, des progrès remarquables entre 2010 et 2014 ont été enregistrés en rapport avec la réduction de la morbidité palustre (10%) et la mortalité infantile a baissé de 37% passant de 92‰ en 2010 à 58‰ en 2014 dont 33% liés à la prévention du paludisme. Ces progrès sont réalisés grâce à l’implémentation des stratégies telles que la distribution de la MILD en routine aux femmes enceintes et aux enfants de moins d’une année ; à la prise en charge des cas de paludisme simple précocement avec les TDR pour le diagnostic biologique et les ACT pour le traitement. La RDC grâce à l’appui financier et technique de ses partenaires qui subventionne l’approvisionnement des commodités anti paludique arrive à couvrir les besoins dans les 515 ZS. L’Initiative du Président Américain pour la lutte contre le Paludisme (PMI) est un des partenaires clé de la RDC depuis 2010. Il apporte à travers le projet IHPplus un appui technique et financier pour l’implémentation des interventions de prévention (MILD et TPI), prise en charge des cas (TDR et ACT), renforcement des capacités des prestataires de soins et communication pour le changement social et de comportement (CCSC) dans la communauté dans 83 Zones de sante. Apres une mission de supervision conjointe avec la DPS du Kasaï au mois de mars 2016 dans la ZS de kamiji, il a été constaté une quantité importante de TDR proche de péremption (25 mai 2016) au niveau du BCZS de kamiji. L’action prise a été d’estimer les besoins de consommation pour les fosa de la ZS et de redéployer le surplus afin d’éviter la perte par péremption. 1675 TDR ont été redéployé dans les fosa de la ZS de kandakanda qui étaient en rupture de stock. Cet exercice a été faite dans le reste des ZS de la coordination de Mweneditu, c’est ainsi que des mini-campagnes « journées portes ouvertes paludisme » ont été lancées dans les ZS de Mpokolo, Kandakanda et Kamiji où on a constaté un surstock de TDR a risque de péremption dans certaines formations sanitaires.
II. OBJECTIFS
2.1. OBJECTIF GENERAL L'objectif principal des mini-campagnes « journées portes ouvertes paludisme » a été d’éviter la perte par péremption des TDR utilisés comme moyen de confirmation biologique des cas de paludisme simple.
3 Appendix 15
2.2. OBJECTIFS SPECIFIQUES Les objectifs spécifiques de cette activité sont :
1. Dépister activement avec les TDR tous les cas de paludisme simple dans la communauté ou les écoles primaires 2. Traiter correctement avec les ACT tous les cas de paludisme simple confirmés
III. METHODOLOGIE
SITES ET PERIODE
La coordination de Mwene ditu compte 9 ZS dont 6 sont appuyées par PMI dans le volet paludisme et les 3 autres ZS par le FM (Dibindi, Kandakanda et Mwene ditu). De ces 6 ZS, des mini campagnes ont été menées dans 3 ZS à savoir les ZS de Kamiji, Mpokolo et Bibanga. Toutes les mini campagnes se sont déroulées entre avril et mai 2016.
x ZS de Mpokolo : 4 sur 15 AS ont menées l’activité x ZS de Bibanga : 15 sur 17 AS ont menées l’activité x ZS de Kamiji 4 sur 17 AS ont menées l’activité à savoir et 36 écoles primaires pour les classes de 1ere année dans toutes les AS.
STRATEGIES
Dans la communauté x chaque AS concernée par la mini campagne a organisé des séances de sensibilisation dans les églises par les leaders religieux et des visites a domiciles par les relais communautaires. x Plaidoyer auprès des autorités politico-administrative et religieuse locale pour la sensibilisation de la communauté x Briefing des acteurs de terrain qui vont réaliser l’activité (ECZ, infirmiers titulaires, infirmiers de postes de santé, relais communautaires de site de soins communautaires et autres)
Dans les écoles x Plaidoyer auprès des autorités scolaires pour avoir accès dans les écoles primaires, le sous proved EPS/INC a mis à la disposition du Bureau central de la Zone de Sante la liste des écoles primaires (au total 36) avec leurs effectifs x Briefing des acteurs de terrain qui vont réaliser l’activité (ECZ, infirmiers titulaires, infirmiers de postes, relais communautaires de site de soins communautaires et autres)
MESSAGES
x Dans la communauté : « Se rendre immédiatement au centre de santé, poste de santé ou site de soins communautaire le plus proche le plus proche, si fièvre ou antécédents de fièvre dans les 48 heures ayant précédé la diffusion de ce message où vous serez prise en charge gratuitement pour le paludisme ».
4 Appendix 15
x Dans les écoles : « tout enfant de l’école primaire présentant de la fièvre ou déclarant avoir fait de la fièvre dans les 48 heures précédant l’activité »
DEROULEMENT DE L’ACTIVITE
x Sensibilisation : des séances de sensibilisation et de plaidoyer ont été organisées dans les AS concernées par l’activité. Dans le message, le relais communautaire ou leader religieux en plus du message, annoncent les jours et les sites retenus pour le déroulement de l’activité. x Briefing des acteurs de terrain (infirmiers titulaire ou auxiliaire, infirmiers de poste de santé, relais des sites de soins communautaires) par l ECZS qui coordonne l’activité sur l’organisation de l’activité et le circuit de rapportage des données.
IV. RESULTATS
Au total 11 892 cas orientes ont pu être testes avec les TDR et 7856 cas avaient un TDR positif soit un taux de positivité de 66 %. Tous les cas avec TDR positif ont bénéficiés d’un traitement avec les ACT selon leur tranche d’âge respectif. Les résultats sont repartis de la manière suivante :
ZS de Mpokolo
Aire de Sante Cas reçus TDR réalisés TDR positifs Cas traites aux ACT
Cas < 5 ans Cas >5 ans
ANUARITE 198 198 29 57 86
CIBOMBO 732 732 166 487 653
DISANKA 776 776 172 79 251
KAMISANGI 292 292 91 176 267
TOTAL 1998 1998 458 799 1257
ZS de BIBANGA
Aire de Sante Cas reçus TDR réalisés TDR positifs Cas traites aux ACT
Cas < 5 ans Cas >5 ans
5 Appendix 15
BIBANGA 102 102 55 33 88
60 60 18 35 53 BUFUA 106 106 41 38 79 CIBILA 81 81 25 23 48 CIKUYI 236 236 30 86 116 CILUILA 23 23 5 18 23 KABALA I 141 141 67 42 109 KABALA II 73 73 45 17 62 KALUNDA 601 601 238 153 391 KAPONJI 750 750 480 150 630 KATANDA I 224 224 112 70 182 KATANDA II 311 311 197 36 233 KATSHIAMPANGA 750 750 119 493 612 LUKANGU 175 175 57 46 103 MANJA 416 416 124 84 208 MOLOLA 4049 4049 1613 1324 2937 TOTAL
ZS de KAMIJI
Sites Cas reçus TDR réalisés TDR positifs Cas traites aux ACT
Cas < 5 ans Cas >5 ans
ECOLES 4395 4395 1339 1510 2849 PRIMAIRES
COMMUNAUTE /4 1470 1470 773 0 773 AS
TOTAL 5845 5845 2112 1510 3662
6 Appendix 15
V. CONCLUSION ET LESSONS APPRISES
L’organisation des mini campagnes de dépistage actif du paludisme a permis de sauver 7 856 vies, d’accroitre l’utilisation des services curatifs et d’éviter la perte par péremption de 11 892 TDR. Comme leçons apprises :
La réussite de l’activité dépend de l’Implication des autorités scolaires, administratives, coutumière et des chefs de ménages, des infirmiers et relais communautaires sous la coordination de l ECZS La gratuité des soins améliore l’accessibilité de la population aux soins de qualité Tous les cas dépistés ont été traites précocement selon le protocole national L’organisation de ces mini campagnes ne nécessite pas beaucoup de moyens financiers.
7 Appendix 16: Audit report of the management of essential generic medicines in three health zones (Kitenge, Songa, Kabongo)
PROVINCE DU HAUT LOMAMI MINISTERE DE LA SANTE PUBLIQUE
Division Provinciale de la Santé COORDINATION IHPplus KAMINA
RAPPORT DE MISSION SUR L’AUDIT DE LA GESTION DES
MEGS DANS TROIS ZONES DE SANTE DONT KITENGE,
SONGA ET KABONGO
OCTOBRE 2016 Appendix 16: Audit report of the management of essential generic medicines in three health zones (Kitenge, Songa, Kabongo)
CONTEXTE ET JUSTIFICATION
Le Projet de Santé Intégré Plus en sigle PROSANIplus est un projet tampon financé par l’USAID pour une durée de deux ans et mis en œuvre par un consortium (MSH, E2A, OSC). Il consolide les acquis de PROSANI qui a terminé ses activités techniques en septembre 2015 après 5 ans de fonctionnement. PROSANIplus continue l’appui à la réalisation des activités des Soins de Santé Primaires dans 83 Zones de Santé (78 avec l’appui global et 5 avec l’appui PMI) réparties dans 8 provinces de la RDC, à savoir le Sud Kivu, Haut-Lomami, Lomami, Lualaba, Kasai, Kasai Central, Kasai Oriental et Sankuru. PROSANIplus et SIAPS figurent parmi les projets far de la Stratégie de Coopération pour le Développement du Pays (CDCS en sigle) de l’USAID.
Le Projet a pour objectif d’assurer le renforcement des capacités en leadership et gouvernance des cadres du ministère de la santé et de la communauté afin d’améliorer l’accès, la disponibilité et la qualité des services dans les 83 zones de santé ciblées, dans le cadre de l’appui à la mise en œuvre du Plan National de Développement Sanitaire (PNDS) du Ministère de la Santé Publique. Les principaux domaines d’interventions du projet sont la planification familiale et la santé de la reproduction, la santé maternelle, néonatale et infantile, la nutrition, la lutte contre le paludisme, la tuberculose et le VIH/SIDA ainsi que l’eau, l’hygiène et l’assainissement.
Le système de gestion des médicaments développé ou mis en place par le projet de Santé Intégré plus ainsi que le projet SIAPS est basé sur la politique pharmaceutique nationale dont l’objectif consiste à « assurer l’approvisionnement régulier, l’usage rationnel des médicaments essentiels de bonne qualité à un coût accessible à la majorité de la population ainsi que la disponibilité des services pharmaceutiques de qualité».
Ainsi les Procédures Opérationnelles Standards du Ministère de la Santé Publique (fiches techniques de gestion des médicaments) développés et mises en œuvre par le Programme National d’Approvisionnement en Médicaments, avec l’appui financier et technique de l’USAID avec le projet SIAPS sont reconnues comme outils de base de gestion pharmaceutique dans le cadre de Prosani plus et doivent être utilisés à tous les niveaux du système.
La gestion pharmaceutique est une charnière névralgique dans la réussite et la pérennisation d’un projet des soins de santé primaires ; qu’il s’agisse d’activités préventives ou curatives La gestion de stock peut être considérée comme une discipline de gestion dont l’enjeu principal consiste à disposer de ressources suffisantes, tout en cherchant à les contrôler pour des questions de performance opérationnelle. Il est toujours regrettable de constater la présence de médicaments en attente ou entreposée au bureau central alors qu’ils sont en rupture au niveau des formations sanitaires tel que Appendix 16: Audit report of the management of essential generic medicines in three health zones (Kitenge, Songa, Kabongo)
révélée par la dernière mission de suivi d’approvisionnement menée par le projet SIAPS de MSH dans les zones de santé de Songa, Kabongo, Kitenge et Kayamba. Une bonne gestion de stocks permet d’assurer une bonne dynamique dans la chaîne d’approvisionnement. Malheureusement, les outils de gestions qui auraient dû permettre de prendre des décisions n’existent pas ou plutôt s’ils existent, ils ne sont pas à jour et pire encore il n’y a pas un agent commis à ce poste pour gérer les médicaments. Par conséquent, il n’y a pas un répondant et les procédures standards de gestion sont bafouées. Le recouvrement des fonds issus de médicaments est entaché de beaucoup d’irrégularité.
OBJECTIF GENERAL
Contribuer à l’amélioration de la qualité des soins et des services par le renforcement du système de santé dans les 9 zones de santé ciblées dans la division provinciale du Haut - Lomami.
OBJECTIFS SPECIFIQUES
1. Evaluer la fonctionnalité de la chaine d’approvisionnement au niveau périphérique ; 2. Vérifier la traçabilité du recouvrement des coûts sur les médicaments à tous les niveaux (formation sanitaire, bureau central et division provinciale).
DEROULEMENT DE LA MISSION
• AVANT LA MISSION PROPREMENT DITE
Les deux parties prenantes (partenaire d’appui technique et financier ainsi que le ministère) ont mis sur pied un guide ou check list qui a permis de récolter les informations. Nous avons retenu 4 thématiques pour cet audit dont: 1) Evaluation de la réalisation des recommandations formulées lors de la mission antérieure dans ces 3 ZS précitées; 2) Suivi de la chaîne d'approvisionnement en médicaments de la province jusqu'au dernier consommateur/ le Malade; 3) Suivi des fonds réserve médicaments sur base des données disponibles en province jusqu'au CS; 4) Suivi du respect des principes de base de gestion pharmaceutique dans les structures à visiter.
Appendix 16: Audit report of the management of essential generic medicines in three health zones (Kitenge, Songa, Kabongo)
• MISSION PROPREMENT DITE
SITUATION ACTUELLE
Faible proportion de recouvrement de 30% sur le coût des médicaments.
DEFI
Comment allons- nous pérenniser la disponibilité de MEGS dans les formations sanitaires à l’aide du recyclage des MEGS à partir des comptes malgré le contexte de faible recouvrement de 30% ?
OBSTACLES
- Faible capacité managériale de répondre au changement. Nous n’avons pas besoin de déclaration de bonne intention de changer mais nous voulons voir ce changement dans l’amélioration du recouvrement. Cela implique de persuader les bénéficiaires sur le bénéfice de cet exercice.
- Inexistence et /ou mauvaise tenue des outils de gestion Pour une bonne traçabilité des informations de gestion des médicaments : il faut avoir les outils ci-dessous : Bordereau de livraison, Procès- verbal de réception, Bon de commande, fiche de stock, RUMER ainsi que leurs archives; Pour une bonne traçabilité des informations de gestion financière, il faut avoir le outil ci-dessous : bon d’entrée, livre de caisse, ordre de payement, bon de sortie et quittancier, RUMER, ainsi que leurs archives.
- Détournement C’est-à-dire affectation de l’argent issu de la vente de MEG à d’autres fins en dehors de l’achat de médicaments. Exemples : emprunt, assistance sociale, préfinancement des activités de la zone de santé, achat de carburant pour la supervision en cas d’approvisionnement tardif, achat des futs vide, amputation des subventions à la source pour payer les 30% ;
- Vol C’est à dire toute somme d’argent dépensée ou non dont la destination est inconnue
Appendix 16: Audit report of the management of essential generic medicines in three health zones (Kitenge, Songa, Kabongo)
- Manque de répondant pour la gestion des médicaments Il n’y a pas un agent commis pour l’activité de gestion ou plutôt il existe, il ne connait pas ce qu’il doit faire. Il y a également un manque de leadership dans les animateurs de l’ECZ voire même des conflits soit il n’a pas encore bénéficié d’une formation, soit il n’est pas qualifié.
- Mauvaise qualité de supervision Une supervision réalisée sans analyse des données et sans canevas n’a pas un impact sur les performances de prestataire quand bien même il y aurait les termes de référence. Cela prouve à suffisance que la plupart de supervisions ne sont pas préparées.
- Déficit de communication Les infirmiers séquestrent l’information et il y a ignorance du montant des subventions octroyées mensuellement par IHPplus ainsi que les rubriques y afférents pour les subventions parmi les membres de l’équipe du centre de santé et /ou de quelques membres du CODESA.
Appendix 16: Audit report of the management of essential generic medicines in three health zones (Kitenge, Songa, Kabongo)
ILLUSTRATIONS DES QUELQUES PARTICULARITES
EXEMPLES DES PROBLEMES PARTICULIERS DE LA ZONE DE SANTE DE KABONGO
• GESTION DES MEGS
BL du mois d’octobre 2015 :
1. BL n’existe pas ; 2. PV de réception n’existe pas le jour de la mission d’audit pendant que le PV était disponible lors du dernier passage de l’équipe de supervision (2 semaines après); 3. Fiches de stock intégrant une partie des MEGS ; 4. Pertes énumérées de certains produits pharmaceutiques tels que 400 Baxter de sérum glucosés 5%,1120 flacons d’amoxicilline sirop, 40000 comprimés de Hyoscine butylbromide 10mg,, 8000 comprimés de salbutamol sulphate 4mg et 3000pièces de l’eau distillée ; 5. Mauvais archivage des outils de gestion pharmaceutique et financière.
BL du mois d’Août 2016
1. BL existe ; 2. PV de réception n’existe pas ; 3. Plan de distribution ne reprend pas tous les items pendant que la distribution est déjà effective ; 4. Fiches de stock non à jour ; 5. Pertes de 690 Baxter (après exploitation de trente-deux bordereaux, on n’a pu retrouver que douze baster seulement) ; 6. Ecarts énormes constatés entre PV de réception et BL à Kabongo à retrouver selon le tableau ci-dessous à titre indicatif :
Appendix 16: Audit report of the management of essential generic medicines in three health zones (Kitenge, Songa, Kabongo)
Description item Qté PV Qté BL Qté inventoriée Ecart Date Num. de lot réception physiquement d’expiration BCZ (exercice) 1 Acide ascorbique cs Bte 0 10 10 -10 070614 06/2017 1000cs 2 Cimétidine cs Bte 0 10 7 -10 4MJ122 09/2017 1000cs 3 Cloxacilline cs 1000cs 0 10 9 -10 14184011 10/2016 4 Ciprofloxacine cs 500mg 200 500 300 -200 100cs 5 Ciprofloxacine inf. 60 9000 3660 -5340 C443860 11/17 Baxter 6 Ora-Zinc Kit 120 4000 1560 -2440 7 Seringue 5ml 100pces 0 20 20 -20 8 Catheter G18 Bte 0 8 8 -8 50pces 9 Sachet d’emballage 0 10 3 -10 500pces 10 Sparadrap 5x5 RL 40 200 156 -160 A20131220 12/2016 11 Benzoate de benzyl FL 0 60 15 -60 12 Benzanthine 60 500 350 -440 624141041 10/2017 benzylpenicilline fl inj.
• GESTION DES FINANCES 1. Disparition du livre de caisse de 2012 2. Prix exorbitant de produit sac à sang et dextrose 3. Tableau de suivi des fonds de la ZS en dollars
DEFICIT ENTRE MONTANT MONTANT SOLDE DES MONTANT PERCU MONTANT RECONNU VERSE AVEC ATTENDU PAR BCZS AVEC VERSE PAR VERSE DES PREUVE DE ET LES PREUVE A L’APPUI ET LES CS ET BCZ PAR LA PAYEMENT VERSES MONTANT MONTANT ATTENDU 30% HGR AU BCZ DPS DANS VERS LA DPS REEL DES REELLEMENT VERSE DES AFFICHE AU LE COMPTE PAR LE FOSA DANS LE COMPTE No STRUCTURES APPROVISIONNEMENTS (1) BCZ (2) DE LA ZS (3) BCZ/HGR (4) (5)=(1) –(2) (6) = (2) – (4) 1 CS ZS KABONGO 50070,3 12973,3 ND 7751,7 37097,1 5221,6 2 HGR KABONGO 16849,6 1100 ND 1100 15749,6 0,0 3 TOTAL CS+ HGR 66919,9 14073,3 6831,0 8851,7 52846,6 5221,6 4 CS KINA ND ND ND ND ND ND
Appendix 16: Audit report of the management of essential generic medicines in three health zones (Kitenge, Songa, Kabongo)
PROBLEMES PARTICULIERS DE LA ZONE DE SANTE DE SONGA
• GESTION DES MEGS 1. Séquestration des produits par le préposé de la pharmacie, NUMBI Kahemba, empêchant ainsi les prestataires de prendre en charge correctement les problèmes de santé de la population de Mai 2014 à Mars 2015 qui correspond à la durée de l’absence du MCZS de Songa ; 2. Utilisation d’une multiplicité des outils qui ne sont pas normés au niveau de l’HGR Songa ; 3. Les Fosa ne reçoivent pas de BL lors d’un approvisionnement à partir du bureau central ; 4. Discrimination négative : ce sont surtout ceux qui ne versent pas l’agent qui reçoivent des grands lots des médicaments ; 5. Mauvais archivage des outils de gestion pharmaceutique et financière. • GESTION DES FINANCES 1. C’est la dernière zone de santé avec une très faible proportion des versements au niveau de la banque et/ou à la DPS; 2. Aucune preuve de versement de l’HGR depuis le début du projet jusqu’à ce jour ; 3. Disparition du livre de caisse de 2013-2014 ; 4. Détachement d’un bon d’entrée d’une valeur de 299$ 5. Discordance entre le montant perçu dans le registre de perception et le passage de l’écriture dans le livre de caisse ; 6. Dépenses non éligibles effectuées avec l’argent des médicaments : assistance sociale, emprunt et préfinancement des activités de la zone de santé ; 7. Lors de la réhabilitation du MCZS, le constat fait après l’état de lieux fait état d’une perte des médicaments d’une valeur de… 3600$.. 8. Conflit entre MCZS et AG. 9. Tableau de suivi des fonds de la ZS en dollars
SOLDE MONTANT MONTANT MONTANT DES DEFICIT ENTRE VERSE PAR RECONNU VERSE AVEC ATTENDU MONTANT PERCU LES CS ET VERSE DES PREUVE DE ET LES PAR BCZS AVEC HGR AU BCZ PAR LA PAYEMENT VERSES PREUVE A L’APPUI BCZ DPS DANS VERS LA REEL DES ET MONTANT MONTANT ATTENDU 30% AFFICHE LE COMPTE DPS PAR LE FOSA REELLEMENT VERSE DES APPROVISIONNEMENTS AU BCZ DE LA ZS BCZ/HGR (5)= (1) – DANS LE COMPTE No STRUCTURES (1) (2) (3) (4) (2) (6)= (2) – (4) 1 CS ZS SONGA 29715,45 7560,26 ND 2733,3 22155,19 4826,96 2 HGR SONGA 7852,66 0 ND 0 7852,66 0 3 TOTAL CS+ HGR 37568,11 7560,26 1112 3148,1 30007,85 4412,16 4 CS LUKANVWE 372,7 249,2 277,8 123,5 -28,6 Appendix 16: Audit report of the management of essential generic medicines in three health zones (Kitenge, Songa, Kabongo)
PROBLEMES PARTICULIERS DE LA ZONE DE SANTE DE KITENGE
• GESTION DES MEGS 1. X Livraison du mois de 16 septembre 2016 non intégrée sur la fiche de stock ; 2. Les écarts de médicaments complétés après les grandes livraisons ne figurent pas sur les fiches de stock ; 3. Faible taux d’exécution des recommandations de supervisions antérieures de la gestion des MEG ; 4. Mauvais archivage des outils de gestion pharmaceutique et financière.
• GESTION DES FINANCES 1. Amputation des subventions à la source pour couvrir les frais de recouvrement de 30% sur le cout des médicaments au détriment des activités pour lesquelles les subventions ont été allouées dans le contrat; 2. Aucune traçabilité des subventions ni des amputations dans le livre de caisse 3. Les IT ne disposent pas les preuves de payement de leur 30% au BCZ ; 4. Non maitrise de la clé de répartition de subventions et des rubriques y afférente ; 5. Trop perçu de remonté de 30% dans 5 fosa par rapport à la ligne de crédit obtenue au BCZ 6. Tableau de suivi des fonds de la ZS en dollars
DEFICIT ENTRE MONTANT MONTANT MONTANT MONTANT PERCU VERSE PAR RECONNU VERSE AVEC SOLDE DES PAR BCZS AVEC LES CS ET VERSE DES PREUVE DE ATTENDU PREUVE A L’APPUI HGR AU BCZ PAR LA PAYEMENT ET LES ET MONTANT BCZ DPS DANS VERS LA VERSES REELLEMENT MONTANT ATTENDU 30% AFFICHE LE COMPTE DPS PAR LE REEL DES VERSE DANS LE DES APPROVISIONNEMENTS AU BCZ DE LA ZS BCZ/HGR FOSA (5)= COMPTE (6)= (2) – No STRUCTURES (1) (2) (3) (4) (1) – (2) (4) 1 CS ZS KITENGE 39027,7 17900,5 ND 9579 21127,2 8321,5 2 HGR KITENGE 13933,2 2883,7 ND 2883,7 11049,5 0 3 TOTAL CS+ HGR 52961 20784,2 9579 12462,7 32176,8 8321,5 4 CS KITENGE ND ND ND ND #VALUE! #VALUE!
Appendix 16: Audit report of the management of essential generic medicines in three health zones (Kitenge, Songa, Kabongo)
ACTIONS PRIORITAIRES ou PLAN DE REDRESSEMENT
PROBLEMES CAUSES ACTIVITES RESPONSABLE ECHEANCE
Faible capacité Manque de - Elaborer un projet De Oct- Déc. 2016 managériale de leadership du MCZ de leadership de la ECZS répondre au à songa ZS changement.
Insuffisance de - Intensifier les DPS, IHPplus Chaque trimestre suivi du niveau visites de suivi dans intermédiaire les ZS
Faible taux de - Elaborer un plan de MCZS Apres chaque réalisation des suivi des supervision recommandations recommandations antérieures de toutes les supervisions
Faible traçabilité des Inexistence des - Rendre disponible DPS, ECZS 1 mois données de gestion outils de gestion les différents outils de gestion normés énumérés pour la gestion des MEG et des finances Outils de gestion - remplir ECZS A chaque mal rempli et non correctement les mouvement à jour outils de gestion MEG et finance pour améliorer la traçabilité ;
Manque de - Associer le IHPplu/SIAPS A chaque réception / numéros de lot, Pharmacien validation des numéro du inspecteur commandes des ZS bordereau de provincial dans livraison et la certaines activités valeur de la du dépôt des MEGS livraison sur (réception, analyse certains des commandes, bordereaux - Absence de suivi - Compléter un IHPplus/SIAPS Fin Octobre de relevé de thermo hygromètre température et à Songa pour le l’humidité dans les dépôt central ainsi lieux qu’au dépôt de d’entreposage Kitenge pour le Appendix 16: Audit report of the management of essential generic medicines in three health zones (Kitenge, Songa, Kabongo)
remplacement de celui qui a été endommagé par les rongeurs. - Faible remontée Emprunt non - Déterminer le délai ECZS, DPS Immédiatement des fonds de 30% remboursé et le mode de sur le cout des remboursement MEGs pour chaque personnel ayant emprunté
Assistance sociale - Initier une note DPS 1 semaine par les fonds circulaire générés par les interdisant MEG l’utilisation des Préfinancement fonds MEG pour des activités d’autres fins outre que l’achat MEG
Non maitrise des - Elaborer un fichier DPS, IHPplus 1 mois lignes de crédit par structure MEG par les Aires reprenant les lignes de sante de crédit
- Actualiser le ECZS, DPS 1 mois versement et l’épargne par structure Amputation des Activités en - Initier une lettre DPS 1 semaine subventions à la souffrance au interdisant source mettant en niveau des fosas, l’amputation des péril la faible engouement fonds à la source et conformité du des IT au encourageant le contrat remboursement versement des fonds réserve obligatoire par les MEG, FOSA (IT, MCZS, AG, détournement MDH, Préposé) Ecart entre les Déficit non justifié, - Ouvrir une action DPS 1 semaine versements des disciplinaire structures et les Séquestration des - Afficher les IT, ECZS Immédiatement montants versés à informations en informations en la DPS rapport avec les rapport avec la subventions gestion de subventions dans Appendix 16: Audit report of the management of essential generic medicines in three health zones (Kitenge, Songa, Kabongo)
toutes les fosa Le comité de - Créer et ECZS, DPS 1 mois quantification non redynamiser le fonctionnel dans comité de les FOSA quantification des MEG
Détournement des - Ouvrir une action DPS 1 semaine fonds disciplinaire Relations - Vulgariser le job DPS 1 semaine conflictuelles description de entre le MCZS et chaque Agent (AG, l’AGZS MCZS) ; - - Vulgariser les DPS, IHPplus 2 semaines procédures d’utilisation des documents financiers suivants ordre de payement, bon d’entrée, livre de caisse, bon de sortie, quittancier et/ou reçu et rapport financier
Les rapports - Rendre obligatoire DPS 1 semaine financiers non le dépôt du rapport élaborés dans les financier (MEG, Zones de sante subventions) ECZS Chaque mois comme livrables à déposer à la DPS pour améliorer la gestion axée sur les résultats Non maitrise de la - Traquer DPS Chaque mois situation détaillée l’information du compte de actualisée à partir chaque formation de chaque zone de à la DPS santé IHPplus Chaque mois - Requérir le visa de la DPS avant l’octroi du code par le bureau de coordination Faible Inexistence d’un - Rétablir la préposée ECZS, DPS 1 semaine performance agent commis à la à la pharmacie du Appendix 16: Audit report of the management of essential generic medicines in three health zones (Kitenge, Songa, Kabongo)
d’agents commis à gestion des MEGS BCZS Kabongo dans la gestion des ses fonctions MEGS - Rendre disponible les outils nécessaires pour la gestion MEG Préposé à la - Visiter DPS, IHPplus Trimestriellement pharmacie non régulièrement les formé en gestion zones de santé de ECZS Mensuellement de médicaments l’axe Kabongo avec un accent particulier à Songa en vue d’améliorer ses performances Manque de suivi - Recalculer les IHPplus/ A chaque livraison de ligne de crédit valeurs des BL en y SIAPS, DPS soustrayant les valeurs des intrants PMI, PEPFAR, PF et SECUTRANS et communiquer la situation a tous les propriétaires des comptes de médicaments que sont les Fosa .
Insuffisance et Rapport non Tenir régulièrement la ECZS Chaque mois faible qualité de analysé réunion du comité de supervisions quantification en vue réalisée par les d’analyser les données ECZs de gestion MEGS
Manque d’un Préparer une ECZS mensuellement canevas de supervision à travers les supervision éléments suivants : Termes de référence, calendrier de supervision, canevas de supervision, retro information ou rapport de supervision Appendix 16: Audit report of the management of essential generic medicines in three health zones (Kitenge, Songa, Kabongo)
Déficit de Les organes de Redynamiser les DPS, ECZS, 1 mois communication particom ne sont organes de particom IHPplus pas impliqués dans (COGE, CODI, CODESA) la gestion des ZS
Inadéquation Soustraction Proposer les mesures DPS 1 semaine entre les frauduleuse des correctrices (Actions médicaments MEG à Kabongo disciplinaires) livres et ceux enregistrés dans discordances entre - Convoyer les IHPplus /SIAPS Chaque livraion les outils les bordereaux de approvisionnement livraison et les PV s pour minimiser de réception les;
Mauvais - Absence de -Rendre disponible des ECZS 2 semaines archivage des traçabilité classeurs et outils de gestion d’information perforateurs afin de pharmaceutique de gestion classer tous les outils et financière antérieure ; selon le type et en - Dispersion des ordre chronologique; outils disponibles et leur mauvaise conservation
Appendix 16: Audit report of the management of essential generic medicines in three health zones (Kitenge, Songa, Kabongo)
• APRES LA MISSION Les parties prenantes se sont réunies une fois de plus pour élaborer le rapport synthèse de la mission et faire la restitution de la mission.
DIFFICULTES RENCONTREES
La DPS n’a pas pu mettre à notre disposition la situation à ce jour du compte de chaque zone de au niveau de la banque pour comparer avec celle que nous avons trouvée sur terrain voire même la situation détaillée de chaque formation sanitaire dans l’enveloppe de la zone de santé. D’où la nécessité de partager à chaque versement de la zone de santé la liste de formation avec la part de chaque fosa.
La mission a démarré avec deux jours de retard selon le calendrier en attendant la formalisation des procédures du projet.
PROCHAINES ETAPES
1. Etendre cette mission d’audit aux autres zones de santé restantes en vue de recadrer la gestion à partir de l’état des lieux ; 2. Evaluer périodiquement la mise en œuvre de ces actions prioritaires
Explication des outils au CS kitenge Audit au BCZS KITENGE Appendix 16: Audit report of the management of essential generic medicines in three health zones (Kitenge, Songa, Kabongo)
Photo famille avec l’equipe du CS
Verification des donnees dans le RUMER
Appendix 16: Audit report of the management of essential generic medicines in three health zones (Kitenge, Songa, Kabongo)
ANNEXES : CONDENSE EN RAPPORT AVEC LES DEUX AUTRES OBJECTIFS SPECIFIQUES DE LA MISSION EN DEHORS DE L’AUDIT SUR LA GESTION DES MEDICAMENTS
Objectifs spécifiques
- Renforcer les capacités managériales du bureau de coordination en vue d’améliorer ses performances en général et la communication avec la DPS en particulier - Organiser l’orientation des nouveaux staffs au sein de la coordination IHPplus Kamina ;
Résultats obtenus
Communication avec la DPS
• COMITE PROVINCIAL DE PILOTAGE Il ressort de la réunion du Comité National de Pilotage qu’une recommandation particulière a été formulée à la DPS du Haut-Lomami pour que soit organisé le Comité Provincial de Pilotage afin que la province puisse endosser la responsabilité en validant le Plan de Développement Provincial de Santé, les Plan d’Action Opérationnel ainsi que le rapport de la revue annuelle qui sont considérés comme des drafts .Cette réunion sera présidée par le Gouverneur de la province qui invitera tous les délégués .Celle-ci devra être précédée par une réunion de cinq groupes de travail afin d’apprêter les présentations concernant :les MEGS et intrants spécifiques, la gouvernance, l’encadrement et accompagnement de la zone de santé, le traitement de l’information et la surveillance épidémiologique et enfin l’inspection. La réunion se tiendra au cours d’une journée et le budget est de 15000 dollars car il y a aussi des délégués qui viendront de l’intérieur .La mobilisation des ressources font état de promesses ci- dessous : OMS 4000$, GAVI RSS 4000$ et IHPplus 2000$. La date probable est le 26/10/2016.
• CONSEIL D’ADMINISTRATION La présidence des conseils d’administration par le chef de division est un critère de cotation annuelle de chef de division. En 2015, le projet avait rendu disponible les fonds pour la tenue de conseil d’administration mais il n’y a que trois zones de santé qui en avaient tenu ; Nous attendons les livrables de ces zones de santé pour amorcer les formalités administratives pour appuyer la tenue des CA pour 2016. Les autres zones de santé avaient déjà reçu des fonds depuis l’année passée qui peuvent servir pour cette fin.
• LIVRABLES Depuis un temps les gens sont versées dans la routine au point que les ECZS déposent des faux rapports qui n’ont pas de sous bassement et/ou des copies de classement à la base voire même que ces activités n’ont pas eu lieu et/ou ils jouent à faire des copier et coller en changeant juste les dates ou des titres en vue de bénéficier des subventions. Cela relève d’une violation flagrante du contrat. De ce qui précède, hormis la contre-vérification qui peut se faire pendant les descentes sur terrain, nous avons sollicité et obtenu du Chef de division l’organisation d’une réunion pour valider le draft de l’outil d’analyse initié par les techniciens du bureau de Appendix 16: Audit report of the management of essential generic medicines in three health zones (Kitenge, Songa, Kabongo)
coordination Il a promis de détacher une équipe composée de 5 Encadreurs Provinciaux Polyvalents, le chargé de suivi et évaluation, le chef de bureau de l’information sanitaire et le Bureau d’appui technique pour produire une version finale qui est opposable à tous. Il reste à fixer la date pour cette séance de travail.
• CARBURANT Un lot de 10800 litres de gasoil a été déposé par nos services à la DPS qui a fait le PV de réception. Mais après analyse, nous avons réalisé qu’il s’agit d’une dotation de deux trimestres pour la division et les deux antennes répartis respectivement 2400 litres pour la DPS et 4200 pour chaque antenne. Nous avons suggéré au Médecin Chef de Division d’inviter les MCA à venir récupérer leur quota et de déposer à nos bureaux les PV de reception avec les quantités précises pour chaque institution et cela pour couvrir deux trimestres.
• PLAN DE SUIVI DES RECOMMANDATIONS DE LA MISSION D’AUDIT Nous avons communiqué au Médecin Chef de Division que nous allons soumettre un plan de suivi des actions prioritaires du rapport d’audit qui sera évalué périodiquement en vue d’inverser la tendance. Il a souligné que cet outil permettra de faire une auto évaluation .Et que il fera un débriefing au Ministre de la santé aussitôt qu’il sera de retour verbalement voire même par écrit.
Capacités managériales du bureau
Nous avons abordé quelques points sur la fonctionnalité du bureau de coordination selon l’esprit de la réunion des FOS en vue de baliser le chemin selon les critères .Ceci a fait l’objet d’une communication du FOS au cours de la réunion hebdomadaire de Mardi 11/10/2016.
Orientation des nouveaux staffs
Ce dernier objectif spécifique n’a pu être atteint faute de temps et pourrait être réalisé prochainement
Appendix 16: Audit report of the management of essential generic medicines in three health zones (Kitenge, Songa, Kabongo)
Liste des Auditeurs
POSTNOM N° NOMS S PRENOMS SEXE PROVENANCE FONCTION TELEPHONE E-mail
TUBAYA BULELE Doudou M IHPplus Lshi FOS/Kamina 970007768 [email protected] 1
MPIANA Jean Jacques M IHPplus Kamina IHFD Kamina 970160482 [email protected] 2 KASONGO NTAMBUE Jean Paul M IHPplus Kamina STC 970001686 [email protected] 3 MARHEGEKO BAHIZIRE Adolphe M SIAPS/MSH Kamina PR/TA SIAPS 972616960 [email protected] 4 MSH
LUAMBWA MWANZA Leon M IHPplus Kamina TA 970002073 [email protected] 5
6 NGOYI KABUE Freddy M DPS HL PIP 815757526 [email protected]
MAKONGA NDALAMBA Alain M DPS HL CB Inspection et 810369874 [email protected] 7 controle
KYUNGU KIMBA Toto M DPS HL CB Hygiène 815101170 [email protected] 8 Liste des personnes contactées
LISTE DE PRESENCE DES PARTICIPANTS SEX N° NOMS POSTNOMS PRENOMS E PROVENANCE FONCTION TELEPHONE E-Mail BANZE Berck M Kitenge MCZS 814046022 [email protected]
1 om NGOYI Jonh M Kitenge ISSP 815354342 2 LULA MUHINGWE Pierre M HGR Kitenge Prepose a la 813864786 3 Phcie MUAMBAYI MALOBA Jean Paul M HGR Kitenge DDN 822586083 4 NGOYI WA ILUNGA Jean Paul M HGR Kitenge AG 818042473 5 LUSANGA ILUNGA Denis M CS KINTENGE IT 8183821440 6 MAPINGA MWABA Garrard M CS KINTENGE ITA 825967688 7 MITONGA MBAYO Carine Rose F CS KINTENGE ACC 819473641 8 NKUMBA ILUNGA Arthur M BCZS KABONGO MCZS 814754471 nkumbaarthur@yah
9 oo.fr 10 MALALE Agnes M BCZS KABONGO Prep a Phcie 81947611 KATONGOLA KAYEMBE Joseph M HGR KABONGO MDH 815700312 11 KALAMBO NGOY Benoit M HGR KABONGO DN 819419378 12 13 KISHIKO KISHIKO M HGR KABONGO Prep a Phcie 814316995 KAPEMBA WA MWANZA Sabin M HGR KABONGO AG HGR 812711303 14 KABILA WA SENGA Patient M ZS SONGA AGZS 811828697 15 KASONGO NGOLOSON Jean M ZS SONGA MCZS 814061697 jeanrobert2002@ya
16 Robert hoo.fr NDAY MONGA YULU M CS LUKANVUE ITA 820757638 17 18 MWANYA MAKOBO Dominique M CS LUKANVUE ITA 815608510 Fait à Kamina, le 12/10/2016
Le rapporteur de l’Equipe
REPUBLIQUE DEMOCRATIQUE DU CONGO MINISTERE DE LA SANTE PUBLIQUE PROVINCE DU SUD KIVU
DIVISION PROVINCIALE DE LA SANTE B.P. 1899 BUKAVU
RAPPORT DE LA MISSION DE SUIVI DES RECOMMANDATIONS DE L’ANALYSE DES DONNEES DES CONTRACEPTIFS DES ZONES DE SANTE DE WALUNGU ET BAGIRA APPUYEES PAR PROSANIplus AU SUD KIVU
Ce rapport contient toutes les étapes de la mission qui s’est déroulée du 02 au 12 août 2016
Equipe:
Emmanuel KANYONYO MURHULA, Analyste Assistant/B.AT/DPS ;
Emmanuel BAHIZI MURHIMANYA, Superviseur Provincial/PNSR ;
Isa IYUNGAMO SAMAMBA, STC/IHPplus/Bukavu ;
Parfaitine CHIRHALWIRWA NAWEZA, STC/IHPplus/Bukavu ;
Cyrille MASSAMBA MATUMONA, STA RMNCH/SIAPS/Kinshasa
Août 2016 Page 1 of 13 Appendix 17
TABLE DES MATIÈRES
TABLE DES MATIÈRES ...... 2 LISTE DES ABREVIATIONS ...... 3 I. INTRODUCTION ...... 5 II. OBJECTIFS DE LA MISSION ...... 5 II. 1. Objectif général ...... 5 II. 2. Objectifs spécifiques ...... 5 III. ACTIVITÉS, PRINCIPALES TROUVAILLES ET RÉALISATIONS ...... 5 III. 1. Jour 1, mardi 2 août 2016 ...... 5 III. 2. Jour 2, mercredi 3 août 2016...... 5 III. 3. Jour 3, jeudi 4 août 2016 ...... 6 III. 4. Jour 4, vendredi 5 et jour 5, samedi 6 août 2016 : visite de la ZS de Walungu ...... 6 III. 5. Jours 6 et 7, lundi 8 et mardi 9 août 2016 : visite de la ZS de Bagira ...... 6 III. 6. Jour 8, mercredi 10 août 2016 : visite du Dépôt pharmaceutique ...... 7 APAMESK ...... 7 III. 7. Jour 9, jeudi 11 août 2016 : Visite à CORDAID ...... 7 III. 8. Points forts dans la ZS de Walungu ...... 7 III. 9. Points à améliorer dans la ZS de Walungu ...... 7 III. 10. Points forts dans la ZS de Bagira ...... 7 III. 11. Points à améliorer dans la ZS de Bagira ...... 8 III. 12. Points forts au Dépôt Pharmaceutique APAMESK ...... 8 III. 13. Points à améliorer au Dépôt Pharmaceutique APAMESK ...... 8 III. 14. Actions correctives ...... 9 IV. ÉTAPES PROCHAINES ...... 9 V. ANNEXE: PERSONNES RENCONTRÉES ...... 12
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LISTE DES ABREVIATIONS
APAMESK : Association Provinciale pour l’Approvisionnement en Médicaments Essentiels au Sud Kivu
ASF : Association de Santé Familiale
B. AT : Bureau Appui technique
BCZS : Bureau Central de la Zone de Santé
BDOM : Bureau Diocésain des Œuvres Médicales
CORDAID : The Catholic Organisation for Relief and Development Aid
CS : Centre de Santé
CTMP : Comité Technique Multisectoriel Permanent
DISMED : Distribution des Médicaments
DIU : Dispositif Intra Utérin
DPS : Division Provinciale de la Santé
ECZS : Equipa Cadre de la Zone de Santé
FOSA : Formation Sanitaire
HGR : Hôpital Général de Référence
IHPplus : Integreted Health Project plus
IT : Infirmier Titulaire
ITA : Infirmier Titulaire Adjoint
MCZ : Médecin Chef de Zone
MEG : Médicament Essentiel Générique
MSH : Management Sciences for Health
PEC : Prise En Charge
PF : Planification Familiale
PNSR : Programme National de Santé de la Reproduction
PROSANIplus: Projet de Santé Intégré plus
PSI : Population Services International
RMNCH : Reproductive Maternal Newborn Child Health
RSPA : Rapport de Suivi de la Planification des Approvisionnements
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RUMER : Registre d’Utilisation des Médicaments et Recettes
SIAPS : Systems for Improved Access to Pharmaceuticals and Services
SNIS : Système National de l’Information Sanitaire
SR : Santé de Reproduction
STA : Senior Technical Advisor
STC : Senior Technical Coordinator
UNFPA : United Nations Population Fund
USAID : United States Agency for International Development
ZS : Zone de Santé
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I. INTRODUCTION La planification familiale est un des domaines clés de Systems for Improved Access to Pharmaceuticals and Services (SIAPS) dont le but est de sensibiliser, au plus haut niveau, sur l’importance de la gestion pharmaceutique des contraceptifs et leurs approvisionnements.
Chaque trimestre, SIAPS réalise le suivi des approvisionnements des contraceptifs des Zones de Santé (ZS) appuyées par le Projet de Santé Intégré plus (PROSANIplus), afin de relever les problèmes de la chaîne d’approvisionnement et d’y apporter les solutions.
Etant sur terrain, dans la province du Sud Kivu pour l’évaluation ex ante de l’utilisation de la chlorhexidine digluconate 7,1% dans les soins ombilicaux, couplée à l’accompagnement de prestataires, Le STA RMNCH de SIAPS en a profité pour faire aussi le monitorage des stocks de contraceptifs dans les ZS et aires de santé appuyées par PROSANIplus tel que recommandé dans le rapport d’analyse des données des contraceptifs des ZS appuyées du mois de mai 2016.
II. OBJECTIFS DE LA MISSION
II. 1. Objectif général Contribuer à l’amélioration de la disponibilité des commodités de planification familiale dans les provinces appuyées par l’USAID au travers de ses projets PROSANIplus et SIAPS.
II. 2. Objectifs spécifiques - confronter les données des contraceptifs rapportées au 2ème trimestre calendaire à la réalité, - monitorer le stock de contraceptifs dans les ZS et aires de santé, - sensibiliser les décideurs au niveau provincial et les partenaires qui approvisionnent les ZS couvertes par PROSANIplus sur le Rapport de Suivi de la Planification des Approvisionnements (RSPA).
III. ACTIVITÉS, PRINCIPALES TROUVAILLES ET RÉALISATIONS
III. 1. Jour 1, mardi 2 août 2016 Séance de travail de l’Equipe SIAPS au bureau de Coordination PROSANIplus Bukavu afin d’harmoniser le calendrier d’activités Présentation de l’objet de la mission au PNSR et au Bureau Appui Technique, discussion sur les activités du CTMP, la gestion des données des contraceptifs à la Division Provinciale de la Santé (DPS) Sud Kivu et le RSPA.
III. 2. Jour 2, mercredi 3 août 2016 Préparation logistique au bureau de Coordination PROSANIplus Bukavu Séance de travail avec le Superviseur/PNSR et l’Analyste Assistant/ B. AT à la DPS Sud Kivu. Deux points étaient retenus, à savoir : lecture des termes de référence et discussion sur les aspects logistiques.
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III. 3. Jour 3, jeudi 4 août 2016 Séance de travail avec deux STC de PROSANIplus chargés de commodités PF au Bureau de Coordination PROSANIplus Bukavu sur :
la collecte, transmission des données des commodités SR et période d’envoi de rapport ; les outils de collecte et mode de collecte des données SR ; le canevas de rapport à transmettre au niveau central ; le programme de travail : l’équipe MSH était composée de STA RMNCH/SIAPS et STC PF/PROSANIplus de l’axe Uvira pour la visite de la ZS de Walungu. Quant à la ZS de Bagira, l’équipe était composée de RMNCH/SIAPS et STC PF/PROSANIplus de l’axe Centre.
III. 4. Jour 4, vendredi 5 et jour 5, samedi 6 août 2016 : visite de la ZS de Walungu Au Bureau Central de la Zone de Santé (BCZS) ; après que les missionnaires aient présenté l’objet de la mission à l’Equipe Cadre de Zone de Santé (ECZS) ; le Médecin Chef de Zone (MCZ), à son tour, avait présenté la carte postale de sa ZS en se focalisant sur :
- l’approvisionnement en commodités SR, - la gestion des données des contraceptifs, - les difficultés rencontrées dans la gestion des médicaments en général et en commodités SR en particulier.
A la pharmacie Zonale, à l’Hôpital Général de référence (HGR) et aux deux Centres de Santé (CS) ciblés, l’équipe des missionnaires a mesuré les paramètres de fiabilité des données des contraceptifs ainsi que la disponibilité des contraceptifs. En plus, le stock théorique des contraceptifs était confronté au stock physique.
La fiabilité des données des contraceptifs des services de planification familiale concernait la concordance des données entre le niveau de dispensation des contraceptifs et ce de centralisation des données dans le rapport SNIS. Celle des données des contraceptifs des pharmacies concernait la concordance des données du stock initial plus les entrées durant le deuxième trimestre calendaire 2016 et les données des sorties de la même période plus le stock final sur les fiches de stock.
La disponibilité des contraceptifs avait été mesurée par leurs présences en stock le jour de la visite.
III. 5. Jours 6 et 7, lundi 8 et mardi 9 août 2016 : visite de la ZS de Bagira L’équipe des missionnaires a procédé de la même façon qu’à la ZS de Walungu. Il s’est entretenu avec les membres de l’ECZS afin d’évaluer la gestion des données des contraceptifs dans la ZS. Ensuite, les paramètres de fiabilité des données et la disponibilité des contraceptifs ont été mesurés.
Le Dépôt Pharmaceutique BDOM avait été visité le 9 août 2016. La cessation des livraisons des contraceptifs remontait au mois de mars 2016. La disponibilité des contraceptifs était nulle le jour de la visite.
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III. 6. Jour 8, mercredi 10 août 2016 : visite du Dépôt pharmaceutique APAMESK A APAMESK ; après entretien avec le Directeur et la gestionnaire des stocks, l’équipe des missionnaire a procédé à la vérification de la liste des contraceptifs du secteur public, des bons de livraison des contraceptifs ; de l’outil de distribution mensuelle des commodités PF (DISMED). Enfin, la fiabilité des données et la disponibilité des contraceptifs avaient été mesurées.
III. 7. Jour 9, jeudi 11 août 2016 : Visite à CORDAID L’équipe composé de STA RMNCH et le représentant SIAPS à Bukavu avait tenu une séance de sensibilisation ; de la présidence de CTMP Bukavu, assuré par CORDAID ; sur le RSPA.
III. 8. Points forts dans la ZS de Walungu
. Le SNIS est fonctionnel . La disponibilité de contraceptifs était de 100% à la pharmacie Zonale . Existence des fiches de stock pour toutes les commodités PF à la pharmacie Zonale . La fiabilité des données des contraceptifs à l’HGR était bonne . Service PF était intégré au CS KAZIMU . Appui de I+ solution dans l’organisation de la chaîne d’approvisionnement des médicaments
III. 9. Points à améliorer dans la ZS de Walungu
. La dysharmonie parmi les acteurs provinciaux, partenaires et la ZS . L’approvisionnement en contraceptifs des principaux partenaires (PROSANIplus, UNFPA et CORDAID) sans appui à la chaîne d’approvisionnement . Le système d’allocation des contraceptifs était d’application . La tenue de la revue SNIS entre le 10ème et 13ème jour du mois . Absence de registre PF révisé à l’HGR . Présence des infirmiers formés en insertion de DIU et Jadelle dans 12,5% des FOSA . Aucun prestataire n’était formé en insertion d’implanon NXT . Sensibilisation faible en PF dans la ZS . Discordance entre le nombre de nouvelles acceptantes et les quantités de Depo provera et implants dispensées . Rupture de stock de 30 jours des pilules . Les cartons des médicaments étaient entassés les uns sur les autres à la pharmacie Zonale . Le non-respect du circuit de distribution des commodités PF à l’HGR . Le rapport des données des contraceptifs était non fiable au CS KAZIMU . La gestion des commodités PF était incorrecte au CS KAZIMU
III. 10. Points forts dans la ZS de Bagira
. Le SNIS était fonctionnel . La cohérence entre les données du registre et les données rapportées dans le rapport SNIS de l’HGR, des CS NYAMUHINGA et LUMU
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. Le service PF était intégré aux CS NYAMUHINGA et LUMU . La disponibilité de contraceptifs était de 80% au niveau du service PF de l’HGR
III. 11. Points à améliorer dans la ZS de Bagira . L’ECZS était composé des cadres nouveaux . La gestion des données des contraceptifs approvisionnés simultanément par ASF/PSI et PROSANIplus dans les mêmes FOSA était incorrecte . Les commodités PF livrées en urgence au mois de juin n’étaient ni enregistrées ni vues le jour de la visite . Rupture de stock de Microlut et d’Implanon NXT à la pharmacie Zonale . Rupture de stock de Depo provera, Microlut et DIU datant de janvier 2016 était enregistrée à la pharmacie de l’HGR . Les commodités livrées sans fiche de stock représentaient 50% à l’HGR
. Les outils de gestion de stock des contraceptifs à l’HGR étaient non appropriés . les contraceptifs au CS NYAMUHINGA étaient en sur stock . les commodités approvisionnées par ASF/PSI étaient livrés directement au service PF de l’HGR et au CS NYAMUHINGA . Réduction du nombre d’infirmiers de la ZS formés en PF suite au mouvement du personnel . la Distribution à Base Communautaire était non fonctionnelle . Aucun membre du personnel n’était formé en PF au CS LUMU . Les contraceptifs en rupture de stock au CS LUMU représentaient 60%
III. 12. Points forts au Dépôt Pharmaceutique APAMESK . la fiabilité des données des contraceptifs était bonne . la disponibilité des contraceptifs était à 100% . le rapport de distribution des contraceptifs était à jour
III. 13. Points à améliorer au Dépôt Pharmaceutique APAMESK . La liste des contraceptifs dans l’outil de distribution mensuelle des commodités PF (MSH DISMED PF) était non actualisée . le remplissage des entrées des contraceptifs aux mois de mai et juin 2016 dans MSH DISMED était incorrect . Le Jadelle et l’Implanon NXT étaient classés et enregistrés indistinctement . Les contraceptifs étaient enregistrés sous les rubriques B. consommables médicaux et C. réactifs de laboratoire des bons de livraison
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III. 14. Actions correctives DPS et partenaires Sensibilisation des décideurs au niveau provincial et le Président de CTMP sur le RSPA Dépôt APAMESK Insertion de la rubrique des commodités SR sur le bon de livraison Classement distinct de jadelle et d’implanon NXT Radiation de Lofeminal et Ovrette de la liste des contraceptifs Désignation des contraceptifs par les noms de marque pour la gestion correcte de la demande ZS Sensibilisation des MCZ et autres membres de l’ECZS sur le respect du délai d’envoi du rapport mensuel des contraceptifs/MEG Pharmacies Zonales Orientation des gestionnaires de stock sur le remplissage correct et complet de fiche de stock et calcul des indicateurs clés HGR, CS Briefing des IT, ITA, sur le remplissage correct du rapport SNIS, registre PF, RUMER ; le circuit d’approvisionnement et le système de gestion des contraceptifs
IV. ÉTAPES PROCHAINES
Activité Responsable Délai Tenir la réunion de DPS, CORDAID et MSH Avant le 31 octobre 2016 redynamisation du CTMP Sud Kivu Bukavu Tenir la réunion d’analyse, PNSR et MSH Sud Kivu Avant le 15ème jour du dernier d’adoption et de partage des mois du trimestre calendaire données trimestrielles des contraceptifs de la DPS du Sud Kivu Actualiser le canevas du STA SIAPS, STC IHP+ et Avant le 31octobre 2016 rapport mensuel de gestion Représentant SIAPS Sud des MEG et commodités PF Kivu Doter les FOSA en outils de Coordination PROSANIplus Sans délai gestion PF révisés Sud Kivu Ramener la date butoir Service Contrat MSH Avant le 31 octobre 2016 d’envoi de rapports de gestion des contraceptifs/médicaments au
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10ème jour de chaque mois Harmoniser la gestion des Health Commodities A la réunion prochaine des données des contraceptifs Logistics Specialist, Supply partenaires PF de l’USAID approvisionnés Chain Management/USAID simultanément par ASF/PSI et PROSANIplus dans le secteur public de la ZS de Bagira Rendre disponible les Coordination PROSANIplus Sans délai posters/ Affiches avec Logo Sud Kivu PROSANIplus dans les FOSA Accompagner la DPS et STA RMNCH SIAPS Novembre 2016 MSH Sud Kivu dans le Briefing des prestataires sur la gestion de stock des contraceptifs Accompagner l’ECZS de DPS Sud Kivu A planifier Bagira en management des soins de santé primaires Faire le suivi de contraceptifs DPS et MSH Sud Kivu Sans délai en sur stock dans les ZS de Walungu et Bagira Identifier l’infirmier ECZS Sans délai superviseur point focal PF Accompagner la DPS et MSH Sud Kivu Sans délai pharmacienne de la ZS Walungu et la préposée à la pharmacie zonale de Bagira dans la gestion de stockage des médicaments Analyser et valider les ECZS Avant le 10ème jour du mois données mensuelles des contraceptifs/MEG avant leur transmission à la hiérarchie Transmettre à la DPS et à Directeur d’APAMESK et Chaque 10ème jour du mois PROSANIplus le rapport MCZ des ZS appuyées par mensuel de gestion des PROSANIplus contraceptifs/MEG ainsi que les données SNIS Veuillez au respect du circuit MCZ de Walungu et Bagira Sans délai d’approvisionnement des médicaments Veuillez au respect du circuit PNSR Sud Kivu et MCZ de A chaque Livraison des de distribution des la ZS de Bagira contraceptifs approvisionnés commodités PF du secteur par ASF/PSI marketing social Briefer les IT sur le PF ECZS avec appui de la DPS A planifier et MSH
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Briefer les IT sur la tenue ECZS avec appui de la DPS A planifier correcte des outils de gestion et MSH des contraceptifs Faire le suivi de gestion des ECZS Une fois le trimestre contraceptifs dans les structures Informer les FOSA de la ECZS A chaque livraison provenance des contraceptifs
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V. ANNEXE: PERSONNES RENCONTRÉES
Noms Titre Organisation
Dr Janvier BARHOBAGAYANA Technical Advisor/ IH Field MSH/Sud Kivu Director
Ph César KASONGO Technical Advisor/Provincial MSH/ Sud Kivu Representative SIAPS
Franck MUKOSA Chargé de Sécurité MSH/ Sud Kivu
Dr Socrate CUMA BYAMUNGU Assistant Technique Point focal MSP/PNSR Sud Kivu SGBV et SQI
Dr ZOZO MUSAFIRI Chef de Bureau Appui MSP/DPS Sud Kivu Technique
Dr Ghislain KASONGO M. Médecin Chef de Zone MSP/ZS de Walungu
Ph Lisette MAMINAMI Pharmacien MSP/ZS de Walungu
Jean Fabien KAGABO KAFAYO Infirmier Superviseur ZS de Walungu
Pierrot CISHESA ZIHALIRWA Directeur de Nursing HGR de Walungu
Pascasie CISHUGI Responsable de la Maternité et HGR de Walungu MUNYERENKANA Point focal PF
Alphonse MUHANGAZA Infirmier Titulaire Adjoint CS KAZIMU/ Walungu ZIHALIRWA
ZIRHEBANA MUKOMA Infirmière Accoucheuse CSR BIDEKA/ Walungu CIBALONZA
Dr Yolande SHOMBO Médecin Chef de Zone MSP/ZS de Bagira
Floribert BONANZIMA CIZA Infirmier Superviseur PEV & MSP/ZS de Bagira PALUDISME
Innocent BATUMILLE Nutritionniste MSP/ZS de Bagira
BISIMWA NTAKOBANDIRA Préposée de la Pharmacie a.i ZS de Bagira
John BAHATI Administrateur Gestionnaire HGR de Bagira
ETUMBA CIBABWA HGRde Bagira
Sébastien MUNGANGA BUJINGO Infirmier Titulaire CS NYAMUHINGA/ Bagira
Nestor KISHERU MONGANE CS NYAMUHINGA/ Bagira
Sylvain CERUBALA CISHULI Infirmier Titulaire CS Diocésain LUMU / Bagira
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Ph Emmanuel BASHAGALUKE Pharmacien Dépôt BDOM
Ph Desmond KASHOSI Directeur Dépôt APAMESK
Chanceline BAHATI MALERANO Gestionnaire des stocks Dépôt APAMESK
Dr Michel YALAZA Country Representative I+ solutions/RDC
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