Project AXxes/USAIDProject Overview March 24th, 2009

Three Components of Project AXxes for HZ Development:A: Increase access to… integrated PHCB: Increase capacity of Health Zones & referral system C: Reinforce national programs & 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:• Solar Lights• Diagnostic Kits• Registers/Charts/• Equipment• Medicine

1c. Supplied them with:• Pharmaceuticals• Gloves• Gauze• Waste Disposal• Syringes• Means of Transport

2. Training of personnel• 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)

YEAR 1 YEAR 2

Q1Q2Q3Q4Q5Q6Q7Q8

0K

5K

10K

15K

Sum of ACP

10,000 10,000

Couple Year Protection evolution up to present

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 based-IMCI

• 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

▫ 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

Q2Q3Q4Q5Q6Q7Q8

20%

25%

30%

35%

Use of ServiceS

35%

Rate of Use of Health trend YEAR 1 YEAR 2

Q2Q3Q4Q5Q6Q7Q8

0K

200K

400K

600K

Use of services

637,536 637,536

Use of Health services' trend

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• 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. Povertyas 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

N° DESCRIPTION 

Suppliers MODEDestination1 Frigo Sibir Kinshasa WEM Sea freight2 Tables Opération & Lampes scyalitiques 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

10 Medecines for Dépôt BUKAVU(+/- 35% of order amount) Bukavu IDA Sea freight

11 Nets (30000 pour ECC) Kinshasa VESTEGAARD Sea freight

12 Nets (120000 pr Bukavu) Bukavu VESTEGAARD Sea freight

13 Nets (30000 L'shi ) Lubumbashi VESTEGAARD Sea freight

14 Solar Refrigerator Kinshasa SUNDANZER Sea freight15 GIK3: baptists commodities KINSHASA IMA Sea freight

16 GIK4:labo kits,microscopes,furnitures; computers;Tasok… KINSHASA IMA Sea freight17 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

20 Nets(to BUKAVU for CRS & WVI) BUKAVU VESTEGAARD Sea freight

21 Nets(to Lubumbashi for WVI & ECC Ktga) LUBUMBASHI VESTEGAARD Sea freight

22 GIK5: divers IMA/PCUSA/TASOK… KINSHASA IMA Sea freight

23 Autoclave/Sterilizer ASCO KINSHASA ASCO Sea freight24 Tables examination,obstetrical KINSHASA ASCO sea freight25 Freezers(72) KINSHASA Electrolux Sea freight26 SP/Oxytocine/Vitamine A/New born Kit… KINSHASA IDA Airfreight

27 Medicines Y2(po 40063&po40137) IDA Bukavu 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 freight30 GIK 6 KINSHASA IMA  

31 Cycles beads KINSHASA Cycles technologies Sea freight32 Seringues AB KINSHASA BD Sea freight33 Simulators/New born KINSHASA IMA  

34 Medicines Y2/MP LUBUMBASHI Mission Pharma Sea freight35 Medicines Y2/MP KINSHASA Mission Pharma Sea freight36 Medicines Y2/MP BUKAVU Mission Pharma Sea freight37 Medecines Y2/MP(narcotics) KINSHASA Mission Pharma Airfreight38 CPD-a-bag for blood taking KINSHASA IDA Sea freight39 Nets year 3/Bukavu,62500pcs BUKAVU VESTEGAARD Sea freight

40 Nets year 3/Lubumbashi,60000pcs LUBUMBASHI VESTEGAARD Sea freight41 Nets year 3/Kinshasa, 30000pcs KINSHASA VESTEGAARD Sea freight

42 Cycles beads Year 3 KINSHASA Cycles technologies Sea freight43 Nets year3/Bukavu,27500pcs BUKAVU VESTEGAARD sea freight44 GIK 7:solar system/batteries, vehicle… KINSHASA IMA sea freight

45 Medicines Year 3/IDA Lubumbashi LUBUMBASHI IDA sea freight

46 Medicines Year 3/IDA, Cotri pmtct, blood giving set Kinshasa KINSHASA IDA sea freight

47 Medicines Year 3/IDA, Bukavu BUKAVU IDA  48 Gauze/Glove/Fistula kit KINSHASA IDA sea freight

49 Medicines/cotri pmtct LUBUMBASHI IDA seafreight50 Medicines/cotri pmtct KINSHASA IDA seafreight51 medicines ACTs/IDA Year 3 KINSHASA IDA seafreight

Container Manifest (container #71 is at Matadi!)

Import Route of International Shipping Containers Project AXxes (2007-2009)

Port of Matadi (44)

Tanzania(16)

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)