Great Lakes Region - Dem Rep of Congo


DRC: Health and Humaitarian Action
July 2000 – June 2001

Source: World Health Organization

Life Expectancy in DRC is only 45 years. Infant mortality rates have risen from 1984 and 1995 to 128 and 207 respectively; the maternal mortality rate is among the highest in the world, at 1,800 per 100,000 live births (Source: Polio Campaign 2000 DRC - WHO Office Kinshasa)

1. Appealing Agency: World Health Organisation, 20 Avenue Appia, CH-12 Geneva - Switzerland

2. Project Title: Health and Humanitarian Action for the Year 2000-2001

3. Country: Democratic Republic of Congo

4. Beneficiary Population: Population of 11 Provinces of DRC

5. Total Project Cost: 3,655,000 USD

6. Specific Products: 6.1. epidemiological surveillance strengthened

6.2. specific epidemics appropriately managed

6.3. prevention and control of HIV/AIDS in complex emergencies developed and tested

7. Project duration: July 2000 – June 2001

8. Contribution sought from:

6. Grant Payment Details

Swift code UBSW CH GG 12 A
US dollar account no. CO-169-920.3
U B S - SA
Agence de l'OMS
1211 Genève 27

 7. Contact desks in WHO/EHA Geneva

Pier Paolo Balladelli, MD
dir.telephone: (+41-22) 791 3748 fax: 791 4844
mob.telephone: (+41-79) 3782024
balladellip@who.ch
Yonas Tegegn, MD
dir.telephone: (+41-22) 791 2722 fax: 791 4844
mob.telephone: (+41-79) 2189804
tegegny@who.ch

SITUATION ANALYSIS

 1. General Context

To help implement Lusaka Ceasefire Agreement, the Security Council extended the United Nations Organization Mission in the Democratic Republic of the Congo (MONUC) to 31 August 2000, adopting Resolution 1291 and authorized displacement of 5,537 troops to the country. General situation in the country is very unstable: refugees from the Democratic Republic of Congo continue to cross into neighbouring Republic of Congo (ROC).

 In the first two months of the year, a 15 percent increase was reported in the number of IDPs and Congolese refugees in third countries as compared to December 1999. This represents almost 260,000 persons. By mid February 2000, internal movements of the civilian population were affecting all 11 provinces and the capital of DRC. The internal displacement was on the rise due to renewed fighting in Equateur and Kasai provinces; and sustained high-level of inter-ethnic tensions in Ituri district of Orientale (OCHA, March 2000).

The local coping mechanism and traditional social safety nets have been frayed to the point of rupture. The existence of 1.2 million displaced within the DRC and across its frontiers represents the most visible facet of the humanitarian drama in DRC.

The recent clashes between Ugandan and Rwandan troops in Kisangani have led to 75 percent destruction of that town and breakdown of hospital, vaccination, water and sanitation system with approximately 1000 deaths, about 2000 injured and 85,000 IDPs.

Health is seen more and more as a strategic asset to increase access to war zones.

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2. Health Sector and Humanitarian Action

Since 1994, DRC has experienced various epidemics such as cholera, dysentery, meningitis, measles, poliomyelitis, plague, viral haemorrhagic fever and monkey pox. In 1999, an outbreak of Marburg haemorrhagic fever was detected and contained in Orientale Province (Durba/Watsa). On 13 March 2000, WHO received notification of possible Marburg haemorragic fever in 8 persons from Durba, Province Orientale of DRC, 3 of which have been confirmed positive. For the second time in this decade the DRC experienced an outbreak of the dangerous haemmorhagic fever epidemic. In 1998 and 1999, outbreaks of cholera, meningitis, polio and dysentery have been prevalent in provinces such as Katanga, Oriental, North and South Kivu, Western Kasai and Eastern Kasai, Bandundu and Bas-Congo. More than 20.000 new cases of HIV infection are being identified each year and estimates suggest that this figure is on the conservative side. A lack of HIV screening possibilities was observed during the rapid assessment conducted in Kinshasa and Bas-Congo by UN Agencies in August 1998. In a situation of crisis like the one experienced in DRC it becomes extremely important to be able to detect communicable diseases and outbreaks at an early stage so as to control and limit spreading of fatal illnesses.

In fact, as a consequence of the war, Infant and Maternal Mortality rates related to communicable diseases have greatly increased during the last two years. Charts 1 and 2 stress this trend by comparing the 1998 rate officially reported with the one reported by WHO in the formulation of the United Nations Interagency Consolidated Appeal 2000.

Comparing with 1998, a sharp increase in epidemic diseases, such as cholera, measles, polio, meningitis, is reported in all provinces of the DRC, reflecting poor access to potable water and limited access to primary health services (Charts 3 and 4).

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In addition to the already insufficient health infrastructure, many health institutions, including those rehabilitated by relief agencies in 1997/98, were looted or severely damaged in Province Orientale, North and South Kivu, Maniema, Katanga and Equateur.

Many achievements have been reached by WHO, UNICEF and other organizations in the health sector. We can mention, among others output, the nation-wide polio vaccination campaign that was conducted in three phases in August, September and October 1999. Ten million children in DRC had not yet been immunised against polio. The UN Secretary General had called for days of tranquillity to enable this campaign to take place.

Replenishment of stocks of protection materials against haemorrhagic fevers and meningitis was done by WHO. Epidemiological surveillance and epidemics control was resumed in 8 out of 11 provinces of the DRC – (WHO through UNDP funding). Since 1997, WHO has supported the Ministry of Health in building an early warning system through the establishment of seven epidemiological surveillance sub-offices (Bukavu, Goma, Kikwit, Mbandaka, Lubumbashi, Kananga, and Kisangani) headed by a National Public Health Officer/Epidemiologist. Offices remained operational before, during and after the crisis, providing technical support to the provincial health authorities, NGOs and UN Agencies. Health and nutritional centres were furnished with essential medicines (UNICEF).

As per the health sector in its totality, the operational actions for the year 2000-2001 in DRC include:

 

OPERATIONAL PLAN FOR HEALTH
AND HUMANITARIAN ACTION

Goal: To reduce morbidity and mortality due to communicable diseases

Development Objective: Assure quality of response to epidemics.

Product 1 Existing health information systems, including the epidemiological surveillance, strengthened (setting of a capillar surveillance system capable to monitor health and nutritional status of the population) and information concerning the health emergencies and best practices provided

Product 2 Management of specific epidemics during their occurrence improved

Product 3 Prevention and control measures for HIV/AIDS in complex emergency designed, implemented and their impact evaluated (case study).

Target Population: Population of all 11 provinces of the DRC with a particular emphasis on IDPs, Refugees and war affected communities

Implementing Partners: WHO, Ministry of Health and NGOs

Resume

Considering the weakness of the existing health information system and the priority need for timely and relevant health information in the complex crisis of DRC, WHO intends to improve the network of existing sub-offices and to expand it with three new sub-offices in provinces where the surveillance system is not yet present. The National Laboratory (INRB/Kinshasa) and the AMIKIVU Laboratory (Goma) will be provided with logistical support (laboratory reagents, vaccines). Capacity building on early detection of epidemic diseases of health staff in complex emergencies represents an urgent need. Training of health staff will be developed along with early detection and investigation of outbreaks. Information and coordination of drug supplies and donations will be considered as well to better fulfill the drug needs for priority diseases. A guidelines for drug donation specific for DRC needs to be developed.

A second product of this proposal, which is very much related to the first one, is the increased capacity of the local health services to prevent (vaccine) and cure (drugs and other supplies) the confirmed epidemic cases when outbreaks of cholera and meningitis occur. An early treatment of the patients would have a tremendous impact both on avoiding unnecessary deaths and decreasing the number of new cases.

The third product is concerns the quick development and implementation of tools and strategies to control the spread of HIV/AIDS in complex emergencies. In this specific case, WHO will provide a package of control activities for HIV/AIDS in complex emergencies in partnership with the relevant national and international actors as well as programme implementation with operational research to monitor and test the process and its impact.

For both products 2 and 3, supply systems that are appropriate to the context of DRC shall be established in order to ensure equity in the access to the medicines by the population. Expert working groups will also be established to develop therapeutic guidelines to ensure rational drug use. Workshops and seminars will also be held to promote their use.

 Activities and Budget:

USD

Product 1: HEALTH INFORMATION SYSTEM AND EPIDEMIOLOGICAL SURVEILLANCE

1,390,000

1.1. Contracting of 1 epidemiologist – internationally recruited, of 2 UNV staff and 6 local support staff

330,000

1.2. Capacity building for local staff – 11 national workshops for management of epidemics

80,000

1.3. Setting up a capillary surveillance system to monitor health and nutritional status, focusing on IDPs and refugees: opening of three new sub-offices in eastern Kasai, Kinshasa and Bas-Congo (surveillance antennas) and completion of the eight current sub-offices in the other provinces: one vehicle, coordination costs, combustible, hardware and software, communication equipment, furniture and operational costs.

580,000

1.4. Laboratory equipment, including kits for water testing

200,000

1.5. Dissemination of health data: one international workshop and a bi-monthly health emergency bulletin.

200,000

Product 2: MANAGEMENT OF SPECIFIC EPIDEMICS

1,120,000

2.1. Purchasing of cholera kits

500,000

2.2. Anti-meningitis vaccine

200,000

2.3. Antibiotics for meningococcal meningitis

20,000

2.4. International and local transport and handling costs

400,000

Product 3: HIV/AIDS CONTROL IN COMPLEX EMERGENCIES

1,065,000

Mobilization costs for networking with partners and preparing and distributing guidelines

140,000

Increase awareness of special vulnerable groups (women and children in displaced camps and refugees, humanitarian workers, soldiers and injured people) through promotion, education and social activities

160,000

Counseling activities, support to laboratory for early detection and distribution of condoms

200,000

Capacity building or health staff through 8 workshops

55,000

Emergency kits of anti retroviral drugs and safe blood for medical protection of humanitarian workers

120,000

Safe transfusion: HIV free blood supply and test kit for safe- blood programmes

140,000

Hardware Equipment, software, furniture, rent, combustible, etc.

250,000

GRAND TOTAL

3,575,000

(*) PSC and management of public health cost are already included.


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