Primary health care (PHC)
In recent years, the Republic of Congo, a country of over 5.5. million people in 2020 (World Bank, 2020), had made considerable progress in health. Primary health care has been a longstanding priority for the country. In 2018, former Minister of Health
and Population Jacqueline Lydia Mikolo noted during a visit from WHO Director-General Dr. Tedros, “all Congolese should have a primary health care facility within walking distance of their homes. Primary health care, along with access to medicines
and maternal-child health, are the top health priorities for Congo” (World Health Organization, 2018).
Participants in the 2021 review and joint planning workshop of 2022 priority activities between the Ministry of Health and Population, UNAIDS, UNFPA, UNICEF, World Bank and WHO in Dolisie, Republic of the Congo. ©WHO/Republic of the Congo Country Office.
Prioritizing Reproductive, Maternal, Neonatal, Child and Adolescent Health (RMNCAH) to achieve SDG3
The emergence of the COVID-19 pandemic in 2020 highlighted ongoing weaknesses and gaps within the country’s health system that contributed to poor health outcomes. A mid-term evaluation of the 2018-2022 National Health Development Plan further emphasized
the country’s challenges in achieving SDG3 targets and, particularly, a worrisome situation in reproductive, maternal, neonatal, child, and adolescent health (RMNCAH): in 2020, the maternal mortality rate was estimated at 445 deaths per 100,000
live births; the neonatal mortality rate stood at 19 deaths per 1000 live births; the infant mortality rate was 33 deaths per 1000 live births and the infant and child mortality rate 45 deaths per 1000 live births (World Bank, 2020).
As part of the implementation of the Global Action Plan for Healthy Lives and Well-being for All (SDG3 GAP) to accelerate progress toward SDG3, a situational analysis was undertaken between March and July 2021 under WHO’s leadership to propose strategies to strengthen collaboration among the multilateral organizations that are SDG3 GAP signatories and to identify priorities for the health sector. The analysis led to a consensus among SDG3 GAP signatories identifying primary health care as the priority accelerator, with a focus on RMNCAH.
An opportunity to strengthen collaboration among key partners
In April 2021, the SDG3 GAP initiative was spearheaded in the Republic of Congo by the H6 inter-agency coordination partnership, comprised of UNAIDS, UNFPA, UNICEF, UN Women, the World Bank and WHO. As part of the SDG3 GAP implementation plan, the H6 partnership was tasked to support the Government of the Republic of the Congo in its efforts to improve RMNCAH. The terms of reference of the H6 partnership were signed by the heads of country offices of the agencies and the designated focal points meet periodically to monitor implementation of the activities.
Several other key joint initiatives between signatory agencies, other partners and local key stakeholders were carried out in 2021, including the following priority activities:
- The first Technical and Financial Partners (TFP) retreat in June 2021: 20 organizations were represented at the retreat, including United Nations agencies and bilateral and multilateral partners. This event helped to strengthen synergy and coordination among health TFPs by pooling efforts to effectively support the Republic of the Congo in achieving SDG3. The participatory process led to the development of the new integrated strategy 2022-2026 for RMNCAH.
- The designation by the Ministry of Health and Population of a national GAP Focal Point (Health advisor assisted by the Director of Cooperation), which allowed for national ownership of the SDG3 GAP and the establishment of a framework for regular exchange between the TFPs and the government. The H6 group members work in close collaboration with the Ministry of Health and Population national SDG3 GAP focal point.
- The establishment of a biannual cycle of review and joint planning of priority activities, which has helped to strengthen dialogue and joint planning with regard to key Ministry of Health and Population activities.
Impact of enhanced collaboration
The enhanced collaboration between SDG3 GAP signatory agencies and the government has impacted local health systems actors at all levels, with noticeable improvements in the planning and implementation of the activities through participation in joint review and planning workshops, as well as training sessions aimed at improving the supply and quality of health care and services in general.
The Eboteli project, initiated in 2021 and led by the government, UNFPA and Royal Philips (a health technology company) is a maternal health initiative aiming to halve maternal and newborn mortality rates within the next five years (United Nations Population Fund (UNFPA), 2021). Through the project, UNFPA has been working in close collaboration with WHO and the Ministry of Health and Population, leading to synergies in efforts and resources. These joint efforts have translated into real-world improvements, with the impact being felt at the provider and patient levels. The availability of health care workers, and the safe care of pregnant women in hospital facilities had always been a challenge. The COVID-19 pandemic exacerbated the situation with the risk of infection endangering both health care workers and patients. An early example was reported at Dolisie General Hospital, in the eastern part of the country, where the pandemic had impacted the hospital’s workforce and the quality of care provided to pregnant women, requiring prompt action from SDG3 GAP partners (World Health Organisation, 2021).
WHO’s leadership and the joint efforts of the SDG3 GAP signatory agencies and other partners enabled the challenges that came with the risk of COVID-19 infection and the management of pregnant women during a pandemic to be swiftly managed. WHO supplied the hospital with key supplies and equipment, including protective equipment, and trained staff in infection prevention and control standards. Dr. Bernard N'Dala, head of the hospital’s gynecology and obstetrics department, noted that “the delivery room for women suspected of being infected with COVID-19 and the equipment used to manage deliveries have been improved by the layout of the premises.” Dr Maurice Mpompolo, Director General of Dolisie General Hospital, noted that “these new provisions have made it possible to limit the risk of infections between patients and staff and to reassure women before their delivery. The number of staff infections has dropped from 16 infections in March 2020 to 0 infections as of November 2021 and maternity ward consultations have increased by 2%.”
At a national level, UNICEF has also been leading on key RMNCAH activities. The agency, in collaboration with WHO and UNFPA, focuses on a wide range of RMNCAH targets, including the prevention of mother to child transmission of HIV (PMTCT), and access to water, sanitation, and hygiene (WASH) to prevent life-threatening illnesses. UNICEF continues to support the government in scaling up PMTCT services through capacity building activities and by implementing point-of-care testing services. To date, a total of 163 health care workers, including 96 midwives, have been trained in antenatal care and delegation of tasks in PMTCT services. This led to more than 31,000 live births being supported in key health districts, as well as a 139% increase of the number of pregnant women tested for HIV from 10,491 in 2020 to 25,129 in 2021, and an increase in early HIV diagnoses of infants born to HIV-positive from 7% in 2020 to 10.3% in 2021.
In addition, under the UN Development Assistance Framework and in collaboration the government, UNICEF has supported the supply of 21 water systems in key regions of the country, which provides safe drinking water to an estimated 13,354 people, including over 7,000 women. UNICEF and other partners are also supporting the roll-out of community health initiatives to help expand access to key RMNCAH services in hard-to-reach areas. In the span of five months, this approach – carried out in two peri-urban health districts of Pointe Noire currently without health facilities – has made it possible to ensure the management of 8551 cases of malaria, acute respiratory infections, and acute diarrhea (notably, 1141 cases of malaria, 1923 cases of cough/cold and 5487 cases of diarrhea).
Moving forward
The SDG3 GAP team, in collaboration with other agencies and local partners, aims to continue improving RMNCAH indicators in the country, including improving care and service delivery in more hospitals and health facilities, and providing access to other key RMNCAH services across the country.
In 2022, H6 and partners will support the development of the SDG3 GAP joint action plan to continue coordinating reproductive, maternal, neonatal, child, and adolescent health interventions in RoC. This action plan will inter alia focus on resource mobilization and on strengthening the implementation and monitoring of joint projects with the aim of better documenting good practices and progress.
What is the SDG3 GAP?
The Global Action Plan for Healthy Lives and Wellbeing for All (SDG3 GAP) is a set of commitments by 13 agencies that play significant roles in health, development and humanitarian responses to help countries accelerate progress on the health-related SDG targets. The added value of the SDG3 GAP lies in strengthening collaboration across the agencies to take joint action and provide more coordinated support aligned to country owned and led national plans and strategies. A “recovery strategy” (Oct 2021) serves as a strategic update on the SDG3 GAP in the context of achieving an equitable and resilient recovery from the COVID-19 pandemic to the health-related SDG targets.
The purpose of GAP case studies is to monitor SDG3 GAP implementation at country level.
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