Working Together, Saving Lives Integrated Final Report 2010–2015 Health Project in the Democratic Republic of Congo Project Name: Integrated Health Project in the Democratic Republic of Congo Cooperative Agreement Number: AID-OAA-A-10-00054 Contact information in DRC: Avenue des Citronniers, No. 4, Commune Gombe, Kinshasa Chief of Party: Dr. Ousmane Faye, +243 0992006180 Contact information in the US: 200 Rivers Edge Drive Medford, MA 02155 Director, Country Portfolio: Kristin Cooney, Tel: +1 617-250-9168 This report is made possible by the generous funding of the United States Agency for International Development (USAID) under Cooperative Agreement AID- OAA-A-10-00054. The contents are the responsibility of the Democratic Republic of Congo-Integrated Health Project and do not necessarily reflect the views of USAID or the United States Government. Cover Photo: Warren Zelman Report Design: Erin Dowling Design Working Together, Saving Lives Final Report: The Integrated Health Project in the Democratic Republic of Congo 2010–2015 Integrated Health Project in the Democratic Republic of Congo ACKNOWLEDGMENTS To acknowledge the roles of the many people Tuberculosis Program, the National Multisectoral Program who have contributed to this project, we borrow for HIV/AIDS Prevention, the National Program for the from African wisdom: If you want to go quickly, go Fight Against HIV/AIDS, the National Program on Diarrhea alone. If you want to go far, go together. There have Prevention, the National Program on Nutrition, the been times that we have needed to move quickly, National Communication Program for Health Promotion, but it never would have been possible without the National Reproductive Health Program, National the people who supported the project to go far. Program on the Prevention of Acute Respiratory Infections, the National Program on Adolescent Health, the Technical Unit on Results-based Financing, and the National Center The Integrated Health Project in the Democratic Republic for Pharmacovigilance. We have collaborated closely of Congo (DRC-IHP) team would like to thank the Ministry with the Federation of Central Purchasing (FEDECAME) of Health of the DRC which has, at all levels, eloquently Regional Association for the Supply of Essential Medicines demonstrated, over and over, its ownership of this project, (ASRAMES) to offer high quality pharmaceutical services to from the current Minister of Health, Dr. Félix Kabange the population. DRC-IHP also worked with the Kinshasa Numbi Mukwampa, to the Secretary-General, Dr. Marcel School of Public Health on a number of activities, including Mukengeshayi, to the health authorities at provincial and hosting student interns in the project and working health zone level, including the Provincial Medical Officers, together on studies related to acceptability of rectal arte- Provincial Health Inspection, and Provincial Health Division sunate and testing of quality of care indicators for maternal management teams in Katanga, Kasaï Occidental, Kasaï and neonatal health services at the facility level, as well Oriental, and Sud Kivu. The Chief Medical Officers of the as for approval of study protocols (such as the project’s project-supported health zones and the health zone man- gender analysis). agement teams have been intimately involved in all aspects We gratefully acknowledge the support of the President’s of project implementation, and we could not have achieved Emergency Plan for AIDS Relief (PEPFAR), the United project results without their participation and insight. We Nations Population Fund (UNFPA), the United States also wish to recognize the contributions of the Minister of Agency for International Development (USAID), President’s Health and the Secretary-General at the initiation of the Malaria Initiative (PMI), the Centers for Disease Control project, Dr. Victor Makwenge Kaput and Dr. Pierre Lokadi (CDC), and the American people for funding this important Otete Opetha, respectively. project, with special recognition to the USAID/DRC DRC-IHP has enjoyed a productive collaboration with Mission for its dedication to strengthening the DRC health the various directorates and programs of the Ministry system at all levels and improving the health of the people of Health, including, but not limited to, the Directions of of DRC. We would like to thank Richard Matendo, Lina Pharmacy and Medicines, the Fight against Illness, Primary Piripiri, Izetta Simmons, Nora Madrigal, and the entire health Health Care, Studies and Planning, Health Laboratories, team—all of whom supported the project—whether Hygiene, Family Health and Specific Groups; and national reviewing a report, discussing strategy, traveling with us to programs such as the Expanded Program on Immunization, the farthest health zones, or representing us in Washington. the National Malaria Control Program, the National Anti- Diana Putman, USAID Mission Director, has been a pas- iv FINAL REPORT: INTEGRATED HEALTH PROJECT IN THE DEMOCRATIC REPUBLIC OF CONGO sionate supporter of strengthening the health system and tions or projects such as SIAPS, Supply Chain Management improving the lives of the population. We would also like System (SCMS), IHP, Leadership, Management, and to recognize the contributions of previous health team Governance (LMG), TB-CARE, or Challenge TB—has leaders Connie Davis, Joshua Karnes, and Meri Sinnitt, who played a key role in the planning and implementation of provided valuable input to the project. project activities. In addition, our home office team has Our collaboration in country has extended to multilateral been an integrated part of the project every step of the organizations such as UNICEF, the Joint United Nations way, providing programmatic, technical, communications, Programme on HIV/AIDS (UNAIDS), UNFPA, the World contractual, procurement, human resources, and other Health Organization (WHO), the World Bank, the Global support. Fund to Fight AIDS, Tuberculosis and Malaria, as well We are also grateful to the many organizations that have as bilateral organizations such as the Belgian Technical participated in this project through cost share—UNICEF, Cooperation, the Canadian Cooperation, United Kingdom Project C.U.R.E. (Commission on Urgent Relief and Department for International Development (DFID), and Equipment), WHO, Latter-Day Saints (LDS) Charities, the German Corporation for International Cooperation. MAP International, Merck, Brothers’ Brother Foundation, We have enjoyed both formal and informal collabo- community health workers and other individuals, as well ration with other implementing organizations such as as project partners IRC and OSC—many of whom have IMA World Health, Communication for Change/FHI360, provided supplies and equipment essential to the imple- USAID|DELIVER/John Snow, Inc. (JSI), the Integrated mentation of primary health care activities in DRC that HIV/AIDS Project in the DRC (ProVIC)/PATH, Accès would otherwise not have been available. aux Soins de Santé (ASSP/SANRU), ICAP, Support for Finally, it has been our distinct pleasure to work with the International Family Planning Organizations/Association de people of DRC who, through many of our initiatives, have Santé Familiale/PSI, Maternal and Child Survival Program found new power and voice in working together to achieve JSI/Jhpiego, Elizabeth Glaser Pediatric AIDS Foundation, their goals—whether through participation in Champion EngenderHealth FistulaCare, Pathfinder/Evidence to Action, Communities, CODESAs, civil society organizations imple- Monitoring and Evaluation to Assess and Use Results menting gender-based violence activities and those verifying (MEASURE Evaluation), Helen Keller International, USAID results-based financing results, closed user groups spreading Applying Science to Strengthen and Improve Systems, and the word about family planning, or other initiatives. They others. have inspired us to implement DRC-IHP for the greater DRC-IHP and MSH would like to recognize the many good of the populations we serve. dedicated staff and consultants who have contributed their time and expertise to the Integrated Health Project, including our partners, Overseas Strategic Consulting (OSC) Ltd. and International Rescue Committee (IRC). Although too numerous to mention, every member of the MSH team in Kinshasa, in the provincial offices, and in the coordination offices—whether working on opera- FINAL REPORT: INTEGRATED HEALTH PROJECT IN THE DEMOCRATIC REPUBLIC OF CONGO v CONTENTS ACKNOWLEDGMENTS iv ACRONYMS xi EXECUTIVE SUMMARY 1 Project performance summary ...........................................................4 PROJECT OVERVIEW 7 Country context in 2010................................................................7 Project approach .....................................................................10 Integration . 12 Theory of change .....................................................................12 Monitoring project performance ........................................................14 Assessing Results ...........................................................................14 Using LiST to measure impact and guide implementation ...........................................14 KEY ACHIEVEMENTS 17 Intermediate Result 1: Access to and availability of MPA-plus and CPA-plus services and products in target health zones increased..................................................19 IR 1.1. Facility-based health care services and products (provincial hospitals and health zone health centers) in target