Transcript Diapositive 1

Project AXxes/USAID
Project Overview March 24th, 2009
Three Components of Project AXxes for HZ Development:
A: Increase access to… integrated PHC
B: Increase capacity of Health Zones & referral system
C: Reinforce nationalprograms & provincial/district offices
Component A : Increased access to
integrated care.
1. Reinforcement of Rural HC Facilities
Photo Clemmer /Kisangani/07
1a. Rehabilitated 218 HC facilities!
Before
After
Photo: CRS/Apr 08
1b. Equipped them with:
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Solar Lights
Diagnostic Kits
Registers/Charts/
Equipment
Medicine
1c. Supplied them with:
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Pharmaceuticals
Gloves
Gauze
Waste Disposal
Syringes
Means of Transport
2. Training of personnel
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Over 23,000 trained to date
PMA, Reproductive Health,
Rational Prescription
Newborn Care. Family
Planning
• C-IMCI, etc.
• Etc.
3. Established Pharmaceutical Supply Line
• Established 5 regional project
depots
• Purchased over 5M worth of
W.H.O. essential medicine
• Implementation of drug credit
system to encourage recycling
• Training in stock
management/recycling/ordering
4. Support of clinical services
4a. Vaccination Services
▫ Re-established cold chain
▫ Supply of solar and kerosene
units
▫ Supply of vaccination related
material (i.e. syringes)
▫ Support of campaigns and
routine CPS clinics
▫ Monitoring
▫ Surveillance
Immunizations
4b. Family Planning
Services
• Established 864 sites
• Training of family
planning prestataires
• Provision of family
planning clinical kits
• Order and delivery of
products (OC, IUD, Depo,
Cycle Beads, etc)
4c. Reproductive Health Services
(safe delivery, AMSTL, and newborn resuscitation)
4.d Antenatal Services
4e. Community IMCI
• Trained staff in 929 clinics in
basic Clinical-IMCI
• Trained over 4700 relais to
date in community basedIMCI
• Establishment of up to 200
community care sites
(ongoing)
• Printing of flipcharts/ IEC
material
• Dissemination of health
messages (ten commandments
of health) to households
Key Behavior
Messages for’ Care
Seeking’ and for
‘Malaria Treatment
and Prevention’
4f. Micro-nutrient support
• Vitamin A campaign and
routine use of Vitamin A with
support from UNICEF and
HKI
• Introduction of Zinc
nationwide as Rx protocol
(USAID first to introduce in
provinces)
5.Water and Hygiene
• Constructed/Capped over 280 water
springs
• Trained water/sanitation engineers
in all supported HZs
• 212 clean village projects
• 3500 latrines fabricated (UNICEF)
before
after
6. Disease Specific Intervention
6a. Malaria
• 1. Purchase and delivery of
540,000 ITNs
• Introduction of ACTs* to all
clinics as primary treatment of
Malaria
• ITP treatment instituted in all
ANC clinics
*Imported 1,165,875 doses of ACT
6b. HIV
• Blood Safety: Introduced and
support screening for HIV,
RPR, Hepatitis B in all 57
zones.
• Establishment of 129 PMTCT
sites with 63 pilot programs in
triple therapy ARV with
support from Axios and Abbott
• Treatment of STI/co-infection
TB/ARV therapy with Global
Fund
6c. Tuberculosis
• Support of TB Detection and
Treatment Programs
• Supply of government
provided medicine to sixteen
isolated health regions
• Training, supervision,
surveillance in high risk areas
• Production of PATI-4 module
6d. GBV Related Issues
• Community wide campaigns
on prevalence and awareness
• Focused intervention to at risk
groups
• IEC awareness
• Fistula repair and prevention
Component B Increase capacity of
Health Zones & referral system
1. Reinforce and Support Formative
Supervision of all Health Centers
2. Training of ‘Equipe Cadre’
• Health zone management
(commodities and finance)
• Disease Surveillance
• Monitoring and Evaluation
• Adherence to ordinogramme
(clinical guidelines)
• Zone specific training
▫ Management
▫ PMA
▫ Surveillance
3. Surveillance and Monitor Vital
Health Statistics
• 1. Calendar and Charting
of indicators
• 2. SNIS
• 3. Dashboard (Tableau)
• 4. Monthly reporting and
verification
• 5. Support monthly
health zone reunion with
staff from all HCs
4. Transparence and Governance
• 1. CODESA health
center board
• 2. Annual HZ
meetings
• 3. Co-gestion of
health facilities
• Community
planning of
programs and
campaigns
5. Promising Partners Grants
• Support of local NGO-initiated
income generating projects to
sustain health projects
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CODESA (GBV)
AFIA (nutritional)
HALT-SIDA (BCC)
VAS (nutritional)
Livelihood agricultural project linking health center (Project) AXxes with DEVRU
Photo: Niles/Mutoto CS/2008
Component C: Reinforce national programs
& provincial/district offices
1. Supervision and functioning of
District Medical Offices
District Medical Office of Kamina
2. Policy Review and Revisions
• 1. PMTCT
• 2. SNIS
• 3. Reproductive
Health
• 4. Family Planning
• 5. Malaria treatment
• 6. Essential Drug List
• 7. Training protocols
3.
Annual Reviews, Strategy Planning,
Conferences and Work Plans (PNLP, PNLS, PNSR)
4. Data Storage and Management at
Level of Ministry of Health
IV SHORTFALLS
Need to promote care-seeking behavior
Breaking the 35% barrier
Dr Lauren Blum (Care Seeking
Behavior Study)
Decrease distance and barriers to care
Establishment of 200 Community Care Sites
for Clinical-IMCI
Sustainability of what was built
Understand Partnership
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1. Primes
2. Incentives
3. Performance Contracts
4. Integrity
5. Unmet expectations
6. “you didn’t give us..
 oil for the oil change
 dispenser bags for
prescription meds
 Sand for the concrete
V Challenges
1. Poverty
as an
impediment
to access to
care
Photo: Lodja.June 2008/Mulongo
2. Infrastructure (or lack of) as an
impediment of access for project
personnel
Photo: ECC/AXxes 2008
Road Transport in DR Congo
Photo: National Highway #1 BDD/Mar 07/Clemmer
Photo: Equateur Province.Mar 08/ Mulongo
3. Delivery of Project Commodities
Container Manifest
N°
Destination
Suppliers
MODE
1 Frigo Sibir
Kinshasa
WEM
Sea freight
2 Tables Opération & Lampes scyalitiques
DESCRIPTION
Kinshasa
WEM
Sea freight
3 Cars(10 + 01)
Kinshasa
WEM
Sea freight
4 GIK 1:Ordinateurs, solar batteries
Kinshasa
IMA
Sea freight
5 GIK 2:Solar systems
Kinshasa
IMA
Sea freight
6 Table gyneco,Vaccine carriere(Unicef)
Kinshasa
UNICEF
Sea freight
7 Table examen(Unicef)
Kinshasa
UNICEF
Sea freight
8 Mini Kits/Gloves/Chirurgical sets
Kinshasa
IDA
Sea freight
9 Medecines for dépôts (+/-50% of order amount )Knga,Klzi,Kma&Kowzi
Kinshasa
IDA
Sea freight
Bukavu
IDA
Sea freight
Kinshasa
VESTEGAARD
Sea freight
Bukavu
VESTEGAARD
Sea freight
Lubumbashi
VESTEGAARD
Sea freight
10 Medecines for Dépôt BUKAVU(+/- 35% of order amount)
11 Nets (30000 pour ECC)
12 Nets (120000 pr Bukavu)
13 Nets (30000 L'shi )
14 Solar Refrigerator
Kinshasa
SUNDANZER
Sea freight
15 GIK3: baptists commodities
KINSHASA
IMA
Sea freight
16 GIK4:labo kits,microscopes,furnitures; computers;Tasok…
KINSHASA
IMA
Sea freight
17 Medecines for BUKAVU(Year1 part2)
BUKAVU
IDA
Sea freight
18 Medecines to Kinshasa for ECC&WVI Ktga(Year1 part2)
KINSHASA
IDA
Sea freight
19 Nets(to Kinshasa for ECC Kasai & Ktga)
KINSHASA
VESTEGAARD
Sea freight
BUKAVU
VESTEGAARD
Sea freight
LUBUMBASHI
VESTEGAARD
Sea freight
20 Nets(to BUKAVU for CRS & WVI)
21 Nets(to Lubumbashi for WVI & ECC Ktga)
22 GIK5: divers IMA/PCUSA/TASOK…
KINSHASA
IMA
Sea freight
23 Autoclave/Sterilizer ASCO
KINSHASA
ASCO
Sea freight
24 Tables examination,obstetrical
KINSHASA
ASCO
sea freight
25 Freezers(72)
KINSHASA
Electrolux
Sea freight
26 SP/Oxytocine/Vitamine A/New born Kit…
KINSHASA
IDA
BUKAVU
IDA
Sea freight/road
28 Medicines Y2(and Y1P2) IDA Kinshasa
KINSHASA
IDA
Sea freight
29 Medecines Y2(cpd,gloves,medecines,,,0 40068;40073;40134/133;40139/168)
KINSHASA
IDA
Sea freight
30 GIK 6
KINSHASA
IMA
31 Cycles beads
KINSHASA
Cycles technologies
Sea freight
32 Seringues AB
KINSHASA
BD
Sea freight
33 Simulators/New born
KINSHASA
IMA
34 Medicines Y2/MP
LUBUMBASHI
Mission Pharma
Sea freight
35 Medicines Y2/MP
KINSHASA
27 Medicines Y2(po 40063&po40137) IDA Bukavu
Airfreight
Mission Pharma
Sea freight
BUKAVU
Mission Pharma
Sea freight
37 Medecines Y2/MP(narcotics)
KINSHASA
Mission Pharma
Airfreight
38 CPD-a-bag for blood taking
KINSHASA
IDA
Sea freight
BUKAVU
VESTEGAARD
Sea freight
LUBUMBASHI
VESTEGAARD
Sea freight
41 Nets year 3/Kinshasa, 30000pcs
KINSHASA
VESTEGAARD
Sea freight
42 Cycles beads Year 3
KINSHASA
Cycles technologies
Sea freight
36 Medicines Y2/MP
39 Nets year 3/Bukavu,62500pcs
40 Nets year 3/Lubumbashi,60000pcs
43 Nets year3/Bukavu,27500pcs
BUKAVU
VESTEGAARD
sea freight
KINSHASA
IMA
sea freight
LUBUMBASHI
IDA
sea freight
KINSHASA
IDA
sea freight
BUKAVU
IDA
KINSHASA
IDA
44 GIK 7:solar system/batteries, vehicle…
45 Medicines Year 3/IDA Lubumbashi
46 Medicines Year 3/IDA, Cotri pmtct, blood giving set Kinshasa
47 Medicines Year 3/IDA, Bukavu
48 Gauze/Glove/Fistula kit
49 Medicines/cotri pmtct
50 Medicines/cotri pmtct
51 medicines ACTs/IDA Year 3
LUBUMBASHI
KINSHASA
IDA
KINSHASA
sea freight
seafreight
IDA
seafreight
IDA
seafreight
(container #71 is at Matadi!)
Port of Matadi (44)
Tanzania
(16)
Import Route of International
Shipping Containers Project AXxes
(2007-2009)
Zambia
(11)
4. Limited
means of
commercial
transport to
health zones
(safe) once it
gets into DRC
Photo Goma Apr 08/cnn.com
Dr Ebonabo/AXxes/Malemba-Nkulu 07
Photo: Route de Matadi Apr.08/Clemmer
Carlson/Karawa Health Zone/Mar 09
Carlson/Karawa Health Zone/Mar 09
5. Weak Government Support to Health
Zones
Photo: General Hospital, South Kivu 2004/Clemmer
8. Underestimating the size (and weight)
of the challenge
Photo Clemmer/Kinshasa/2006
7. Retention of trained personnel
Photo: ITM Sona Bata. 2004/Clemmer
8. Chronic Insecurity
Photo Mission Hospital Occupied by armed elements:. South Kivu. Apr 02/Cemmer
Continued conflict
in the Kivus
Photos: CNN.Com /DRC/2005.
9. Resurging Epidemics
Photo: Ebola.Outbreak.Ground Zero. Mweka.Oct 07/Clemmer
Photo/Clemmer/Bulape/08
10. Global Economy and Outlook
?
Mission Aviation Fellowship (USA)
USAID Assessment
of SANRU III (2004)