It takes a community: extending health coverage in hard-to-reach areas of the Democratic Republic of the Congo
The Democratic Republic of the Congo (DRC), with Nigeria, bears 40% of the global malaria burden. This preventable and curable illness, along with pneumonia and diarrhoea, can be deadly for children under 5 if treatment is not available
In DRC's remote Tanganyika Province, WHO's Rapid Access Expansion Programme is helping the Ministry of Public Health to train and support community health workers to diagnose and treat these diseases and decrease preventable child deaths.
Going to a health centre often means travelling over poor roads and long distances
In the Democratic Republic of the Congo’s (DRC) Tanganyika Province, going to a health centre often means travelling over poor roads and long distances, carrying a sick child and supplies. WHO’s Rapid Access Expansion Programme (RAcE), generously funded by Global Affairs Canada, brings diagnosis and treatment for the 3 deadliest childhood diseases – malaria, pneumonia and diarrhoea – into remote communities. In the DRC, these diseases, which can kill children under 5 if untreated, account for 42% of deaths in this age group.
With adequate training, members of the community can provide life-saving services to children
RAcE supports the DRC Ministry of Health to train members of the community known as relais communautaires to provide life-saving services to children. Using specially-designed forms and simple tools, the relais diagnose children in their communities. As part of programme innovation, the forms recently were redesigned as pictorial tools to accommodate low literacy levels and to streamline the diagnostic and reporting work.
Rapid diagnostic tests help determine whether a child with fever has malaria
Barwani Mombo, a relais communautaire, uses a rapid diagnostic test to determine whether a young girl who has come to his hut with fever has malaria. If the test is positive, he will administer the first dose of artemisinin-based combination therapy (ACT) tablets and will advise the girl’s mother about timing for additional doses, as well as on the correct use of a long-lasting insecticidal mosquito net.
Providing life-saving services to local children and newcomers alike
Mombo's work recently increased. Kalunga Village has welcomed almost 3900 additional people who have been internally displaced due to conflict in a northern district of DRC. These additional people, of whom approximately 20% are children under 5, have settled in straw huts on a nearby hillside. The village health committee has let the newcomers know about the life-saving services he provides for local children.
Trained community members are trusted and respected by the rest of the community
Jean Claude Muganga, a relais communautaire in Kingombe, is a school teacher. He was one of the first people selected to undergo RAcE training. He is trusted and respected by the community, and the under-5 children he saves one day will be his students. Occasionally, since he is in the middle of the village during the day, community members will interrupt class to ask that he provide diagnosis and treatment services urgently. The children enjoy watching him work.
Martha Kiabu Kazembe is realizing a dream and providing a critical service to the community
Martha Kiabu Kazembe, the relais communautaire, of Bwana Kutcha, uses a timer and a set of coloured beads to count the breaths of a 6-month-old boy whose mother is concerned about his rapid breathing. If Martha arrives at a green bead (red for children over 12 months of age) within a minute, she will diagnose pneumonia and administer amoxicillin, an antibiotic. Martha, who was married at the age of 17, dreamed of being a doctor. This is her way of realizing her dream and of providing a critical service to her community.
Malnutrition can make a child more vulnerable to repeated illness
Part of diagnosing a sick child involves taking a health history and performing basic checks for contributing causes of illness. Pascaline Tonga, a relais communautaire in Kalenga, uses a special tape to examine an 18-month-old girl for signs of malnutrition. The red colour signals severe malnutrition, which makes the toddler more vulnerable to repeated illness.
The distribution of bicycles has helped training members of the community cover the long distances
Every month, the relais communautaires report on their number of cases and treatments and also re-stock their supplies of medicines, rapid diagnostic tests and latex gloves. RAcE has provided bicycles to help the relais reach the health centres where the pharmacists ensure consistent supplies of quality medicines. Even with a bicycle, the distances and road conditions are challenging, especially since the volunteer relais communautaires also work in the fields or as school teachers to help their families.
Shabani Yuma provides supervision and mentoring to ensure that selected members of the community continue delivering quality services
Supervision and mentoring are important to ensure that the relais communautaires continue to deliver quality services and have the opportunity to confirm what they learned during their 6-day induction training. The Tanganyika Provincial Ministry of Health RAcE focal point, supported by an International Rescue Committee project support counterpart, visits each relais communautaire regularly. The supervisory nurses, like Shabani Yuma (pictured) of the Bwana Kutcha health centre, also provide refresher training.
The presence of trusted resource persons in the community has increased care-seeking behaviour in remote areas
Traditionally, people in Tanganyika Province either bring their sick children to traditional healers or visit informal pharmacies instead of traveling the long and sometimes dangerous routes to health centres. The treatments range from non-helpful to life-threatening. The presence of RAcE-trained relais communautaires, and the provision of free, high quality medicines have increased care-seeking within the province’s remote communities. The pharmacists at the Kalemie General Referral Hospital keep detailed records to track, forecast and ensure continuous supply of the needed commodities.
Integrated community case management can be a sustainable way to build health systems
RAcE is designed to support ministries of health to develop the knowledge and resources to continue integrated community case management as a sustainable way to build their health systems. Virginie Nkulu Niemba (pictured, third from left), the Minister of Gender, Family and Child Social Services, and Humanitarian Action in Tanganyika Province, notes how her communities have welcomed the life-saving programme and the importance of sustainability. Of her RAcE team, she says “We must take ownership of this programme because it involves human lives.”