World Health Organization Project Proposal Democratic Republic of Congo OVERVIEW Target country: Democratic Republic of Congo Beneficiary population: 8 million (population affected by the humanitarian crisis in North and South Kivu) Implementation period: 12 months Amount: 583,000 USD Starting date : 01/07/2005 Ending date: 30/06/2006 Applicant organization: WHO Country contact: Dr Leonard Tapsoba, WR Organisation Mondiale de la Santé, DRC Tel : + 47 241 39001 Mobile : +243 81 700 6400 GPN : 39001 Email : tapsobal@cd.afro.who.int Contact HQ: Ms Marianne Muller Tel: (+41-22) 791 1887 Mob: (+41-79) 237 3507 Fax : (+41-22) 791 3111 Email: mullerm@who.int Bank: UBS AG Case Postale 2600,1211 Genève 2 World Health Organization Genève Swift code: UBSWCHZH12A Bank account US$: No.: 240-C0169920.3 IBAN: CH31 0024 0240 C016 9920 3 Bank account Euro: No.: 240-C0169920.1 IBAN: CH85 0024 0240 C016 9920 1 STRATEGIC OBJECTIVES Objective 1. To strengthen WHO public health presence in order to provide coordinated life saving humanitarian health assistance. Objective 2. To advocate urgent humanitarian issues and good humanitarian practices through proper health information management. Objective 3. To save lives by contributing to the reduction of malaria mortality through the provision of Artemisininbased Combination Therapies (ACTs) and advocating the new malaria treatment protocols. Objective 4. To strengthen the emergency management capacity of the Ministry of Health in emergency preparedness and response at national and provincial levels.
I. INTRODUCTION AND SITUATION ANALYSIS In Democratic Republic of Congo (DRC), a peace and reconciliation process was initiated in 2002. The war, and the decades of political and economic instability preceding this, has led to elevated levels of poverty in one of the potentially richest countries in Africa. With a population of around 60 million of which 80% live on 0,3 USD/day, and with a GDP of 100 USD per capita, DRC rank among the poorest countries in the world. Living conditions vary substantially between provinces. The infant mortality rate in the Eastern provinces is twice the national average, evidencing the graveness of the humanitarian crisis in that part of the country. Also in the East, maternal mortality rates are estimated to more than 1,800 per 100,000 live births, which is far above the Sub-Saharan average. There are also great disparities in living conditions within provinces, especially between rural and urban areas. Conditions are especially severe in conflict zones or enclave areas, where difficulties in access prevents intervention by the Government and other partners. Life expectancy has plunged from 52 years in 2004 to less than 45 years in 2004. The main public health problems are malaria, TB, and diarrhoeas (cholera included). Acute respiratory infections (ARIs) and measles are other important causes to the high levels of infant morbidity and mortality. Communicable disease control remains one of the main challenges in DRC, partially due to the fact that the country is ravaged by the diseases already mentioned, but also because of the re-emergence of new pathogens such as Ebola and Marburg haemorrhagic fevers, trypanosomiasis, and plague. The ongoing conflict and the consequent crumbling of health infrastructures has severely weakened the health system that cannot meet the needs of the population. Present treatment costs are estimated between $2-4 per person (new cases). This estimate does not include new treatment protocols (e.g. ACT, ARV). Sexual and gender-based violence in conflict zones, abducted and systematically raped women, is a serious problem from a reproductive health perspective that needs to be more thoroughly documented and addressed. Malaria the reason behind 45% of the high infant mortality rates and weak coordination and management of emergency health programmes, are the dominant factors painting the picture of the alarming humanitarian situation in East DRC. For this reason, special effort is needed to initiate the new malaria treatment protocol in this region, as well as to strengthen emergency preparedness and response, in particular the coordination of emergency health interventions, to re-establish progressive and sustainable health programmes. In order to achieve this, it is necessary to: 1. Strengthening the WHO decentralized structures in East DRC The WHO coordination role in disease surveillance, early warning and outbreak response is widely recognized. There is, however, agreement on the need for consistent WHO technical coordination on broader public health issues, including environmental health, mental health, malaria, TB and HIV control, GBV, health system matters and training and education of health workers. DRC is a large country from both a geographical and demographic perspective and can therefore not be seen as one health entity. Some of the provinces are bigger than countries. For example, each of the Kivus is as big as Rwanda and Burundi together. There is no possibility of managing a major health crisis relying on centralized structures, at least in the humanitarian and transitional phases. It is therefore imperative to strengthen regional health structures. WHO is privileged (and sometimes limited) by its close relation to the Ministry of Health. In this context, WHO should strengthen its decentralized presence to provide maximal support to the provincial and zonal health structures, as this where support is crucial and badly needed. It should also be closer to regional and local actors including national and international NGOs, UN sister agencies and donors present at provincial levels. 2
2. To advocate urgent humanitarian issues and good humanitarian practices through proper health information management WHO has an extensive network of staff in DRC. This network is basically dealing with Poliomyelitis control and eradication. It has 12 sub offices spread over the country, including in the conflict affected region. However, the information coming from this network should be processed, analysed and disseminated to partners to provide the base for coordination, planning, decision making and advocacy. Health issues like malaria mortality among IDPs, GBV and environmental issues can only be successfully advocated if the information coming from WHO network, from partner NGOs and from BC-ZS is properly collected, verified, analysed and disseminated. 3. Support the initiation of the new malaria treatment protocol in North and South Kivu provinces Increasing resistance of the malaria parasite (P.Falciparum) towards sulfadoxine+ pyrimethamine (SP), the previous first-line drug (since 2001) is a growing problem. The resistance rate varies considerably in the country from 20-60%. This development justified the urgent discussion to review national treatment strategies, which took place in March 2005. Partners are now looking into the logistic and financial consequences if health zones are switching to ACTs. Some NGOs already changed the first-line treatment to Artemisinin based Combination Therapy (ACT). Both the availability of the drug and the enforcement of its use are the tow key issues to reduce malaria mortality among vulnerable population. Malaria represents 45% of cause behind the high infant mortality rates. 4. Support the Ministry of Health in the coordination and management of emergency health programmes Due to the lack of coordination and the absence of the controlling and directing functions of the Ministry of Health and its regional and local structures, the standards of assistance is not well known and variable between areas and present NGOs. The MoH administrative structures, despite suffering from an absolute shortage of funds, never ceased to exist during the war. Also the health administration in the Eastern provinces, although being cut off from the central administration, remained functioning but at a reduced level. 3
II PROGRAMME OBJECTIVES Overall objective To contribute to the reduction of ongoing suffering and immediate avoidable mortality related to the humanitarian crisis in the North and South Kivu provinces in Eastern DRC. Specific objectives & activities Objective 1. To strengthen WHO public health presence in order to provide coordinated humanitarian health assistance. Activities 1.1 Recruitment of two emergency health coordinators to be posted in Goma (North Kivu) and Bukavu (South Kivu) for an initial time-period of 6 months; 1.2 Provision of technical assistance to the provincial health administrations through health assessments, coordination of emergency response and guidance of technical public health matters, in particular on malaria; Objective 2. To advocate urgent humanitarian issues and good humanitarian practices through proper health information management. Activities 2.1 Recruitment of information officer to be posted at the WHO country office for a time-period of 6 months. 2.2 Gather, analyse, produce and disseminate information material on the health aspects of the humanitarian crisis in DRC, with a special focus on the Eastern part of the country. Objective 3. To save lives by contributing to the reduction of malaria mortality through the provision of Artemisinin-based Combination Therapies (ACTs). Activities 3.1 Procurement and distribution of ACTs to health centres and provincial hospitals; 3.2 Training of health professionals at zonal level in new malaria treatment guidelines 3.3 Increase awareness among health actors working in the area of malaria treatment and prevention on the new malaria protocol. Objective 4. To strengthen the emergency management capacity of the Ministry of Health in emergency planning preparedness and response at national and provincial levels. Activities 4.1 Support the Ministry of Health in the elaboration of a national contingence plan for major health risks, including malaria. 4.2 Assist the provincial administrations in North and South Kivu in the elaboration of provincial contingence plans for major health risks, including malaria. 4
III BUDGET Objectives Activities Costs (USD) 1. To strengthen WHO public health presence in order to provide coordinated humanitarian health assistance. 1.1 Recruitment of two emergency health coordinators to be posted in Goma (North Kivu) and Bukavu (South Kivu) for an initial time-period of 6 months. 130,000 1.2. Provision of technical assistance to the provincial health administrations through health assessments, coordination of emergency response and guidance of technical public health matters, in particular on malaria. 38,000 2. To advocate urgent humanitarian issues and good humanitarian practices through proper health information management. 2.1 Recruitment of humanitarian advocacy information officer to be posted at the WHO country office for a time-period of 6 months. 2.2 Gather, analyse, produce and disseminate information material on the health aspects of the humanitarian crisis in DRC, with a special focus on the Eastern part of the country. 168,000 a 60,000 20,000 80,000 3. To save lives by contributing to the reduction of malaria mortality through the provision of Artemisinin-based Combination Therapies (ACTs). 3.1 Procurement and distribution of ACTs to health centres and provincial hospitals; 3.2 Training of health professionals at zonal level in new malaria treatment guidelines 200,000 12,000 3.3 Increase awareness among health actors working in the area of malaria treatment and prevention on the new malaria protocol. Included in 1.2 and 3 212,000 b 5
4. To strengthen the emergency management capacity of the Ministry of Health in emergency planning preparedness and response at national and provincial levels. 4.1 Support the Ministry of Health in the elaboration of a national contingence plan for major health risks, including malaria. 4.2 Assist the provincial administrations in North and South Kivu in the elaboration of provincial contingence plans for major health risks, including malaria. 10,000 30,000 40,000 5. Management, reporting and project support costs Project management and reporting 50,000 Project support costs 33,000 Total 583,000 Note: (a) Assuming that the focal points will use already existing resources. (b) Other programmes provide bed-nets. 6
UNCERF Log frame Objectives Measurable indicators Means of verification General objective To contribute to the reduction of ongoing suffering and immediate avoidable mortality related to the humanitarian crisis in the North and South Kivu provinces in Eastern DRC. Reduction of malaria mortality rates among vulnerable groups Specific objectives Objective 1. To strengthen WHO public health presence in order to provide coordinated humanitarian health assistance. Objective 2. To advocate urgent humanitarian issues and good humanitarian practices through proper health information management. Objective 3. To save lives by contributing to the reduction of malaria mortality through the provision of Artemisininbased Combination Therapies (ACTs). 1.WHO effective presence in North and South Kivu provinces 2.Health information on the humanitarian crisis available 3. Reduction of malaria mortality rates among vulnerable groups Assessment reports Reports from health stakeholders Information material Statistic data from health centres and hospitals Objective 4. To strengthen the emergency management capacity of the Ministry of Health in emergency planning preparedness and response at national and provincial levels. 4. Contingency plans and guidelines for the management of health in emergencies Contingency plans and guidelines Important assumptions A stable military and political situation Effective cooperation with the Ministry of Health WHO role accepted among health stakeholders Other partners are playing a complementary role
Expected Results: Expected results objective 1. 1.1 WHO presence in the field strengthened with two (2) public health experts 1.2 Technical assistance to provincial authorities provided 1.3 Coordination strategies and mechanisms to address the deteriorating health situation put in place. Expected results objective 2. 2.1 Information management, coordination and distribution on the health aspects of the humanitarian crisis in Eastern DRC strengthened. Expected results objective 3. 3.1 Distribution of ACTs to health centres and hospitals in North and South Kivu. 3.2 Health professionals trained on the new malaria protocol. 3.3 Awareness raising campaign on the new malaria protocol conducted. Expected results objective 4 4.1 Contingency plans for major health risks at national level, in particular malaria, produced. 4.2 Contingency plans for major health risks at provincial level, in particular malaria, produced. 1.1 Two qualified public health experts recruited. 1.2 Number of technical meetings and workshops with provincial health authorities. 1.3 Number of coordination meetings with health stakeholders, number of health stakeholders present, number of health stakeholder using information provided by the WHO in implementing emeregncy health action. 2.1 Information officer recruited, number of newsletters produced, number of health partners receiving and using WHO information. 3.1 Number of health centres and hospitals provided with ACTs, and with good case management. 3.2 Number of workshops, number of health professionals trained. 3.3 Number of health actors using the new malaria protocol 4.1 Number of workshops, profile of participants, contingency plan available 4.2 Number of workshops, profile of participants, contingency plan available Contracts Workshop and meeting reports Calendar for coordination meetings Contract Newsletters Webpage Reports from health partners Procurement and distribution documents Statistical data from health units Training reports NGO reports Workshop and meeting reports Reports from health partners Qualified candidates available Geographical access Qualified candidate available Close collaboration with health partners Close collaboration with health partners Functioning hospitals and health centres Close collaboration with the Ministry of Health
Activities: Objective 1 1.1 Recruitment of two emergency health coordinators to be posted in Goma (North Kivu) and Bukavu (South Kivu) for an initial time-period of 6 months; 1.2 Provision of technical assistance to the provincial health administrations through health assessments, coordination of emergency response and guidance of technical public health matters, in particular on malaria; Objective 2 2.1 Recruitment of information officer to be posted at the WHO country office for a time-period of 6 months. 2.2 Gather, analyse, produce and disseminate information material on the health aspects of the humanitarian crisis in DRC, with a special focus on the Eastern part of the country. Objective 3 3.1 Procurement and distribution of ACTs to health centres and provincial hospitals; 3.2 Training of health professionals at zonal level in new malaria treatment guidelines 3.3 Increase awareness among health actors working in the area of malaria treatment and prevention on the new malaria protocol Objective 4 4.1 Support the Ministry of Health in the elaboration of a national contingence plan for major health risks.. 4.2 Assist the provincial administrations in North and South Kivu in the elaboration of provincial contingence plans for major health risks. Inputs: See attached budget Technical and financial report Financial resources secured