The largest country (by area) in Sub-Saharan Africa, the Democratic Republic of Congo is the 19th-most populous nation in the world, and the fourth-most populous in Africa. War – and its associated famine and disease – have ravaged this resource-rich nation for decades, killing more than 5 million Congolese from 1996 to 2006.
In spite of its natural riches of cobalt, gold, copper, and diamonds, factors including government instability, mismanagement, and recent violence have diminished DRC’s ability in production and exportation. Conflict has exacerbated the poverty of DRC’s population of 77.4 million, and left them without access to a quality healthcare infrastructure to manage primary health concerns, including malaria, reproductive health, clean water and HIV/AIDS.
Since 1987, PSI has continued its work without interruption in DRC, despite years of civil unrest which forced most NGOs to close. Instead, PSI expanded its range and reach with support from both large international donors and private foundations. In 1990, PSI established a network member, the Association de Santé Familiale (ASF).
PSI/ASF programs averted thousands of DALYs in 2013:
- 464,133 DALYs for condoms (445,557 for male condoms and 18,576 for female condoms)
- 174,696 DALYs for pneumonia treatment (Cotrimoxazole)
- 103,271 DALYs for family planning
- 5,304 DALYs for safe water (1,962 for PUR and 3,342 for Aquatabs)
- 2,491,744 DALYs for long-lasting insecticide-treated nets
- 415,092 DALYs for artemisinin-based combination (malaria) therapy (ACT)
Malaria is one of the largest causes of morbidity and mortality in the DRC – leading to dramatic losses of productivity and quality of life. PSI/ASF anti-malaria efforts include:
- Promoting LLINs (Long-Lasting Insecticide-Treated Nets) use via behavior change communication
- Mass distribution of LLINs
- Socially-marketed subsidized mosquito nets
- Increasing ACT (Artemisinin-based Combination Therapy) availability
- Promoting use of Rapid Diagnosis Tests and increasing their availability
Long-Lasting Insecticide-Treated Nets
In 2012, PSI/ASF won the Global Fund Round Eight Malaria Proposal as one of three prime recipients. From 2013-2014, PSI/ASF was responsible for the free distribution of 9.6 million LLINs in two provinces, Province Orientale and Kinshasa. In 2014 and continuing into 2015, PSI/ASF (thanks to additional support from the Global Fund) will distribute LLINs to three additional provinces: Bandundu, Bas-Congo and Kasai Oriental.
Artemisinin-based Combination Therapy (ACT)
Through USAID and DFID funding, PSI/ASF is now helping the DRC private sector supply quality-assured ACTs to their customers. This distribution is concurrent with the promotion and distribution of Rapid Diagnosis Tests (RDTs), in order to make sure that the treatment is appropriate.
PSI/ASF is part of ACTwatch, a five-year multi-country research project that explores ACT availability, use, cost and quality. Results of the study will help policymakers understand treatment needs.
PSI/ASF is fighting childhood mortality caused by diarrhea in the Katanga province, via integrated community case management. Through community health workers, PSI/ASF is helping communities to better treat diarrhea in children under the age of 5, by recommending a course of treatment based on Oral Rehydration Salts (ORS) and Zinc. This Lundin Foundation-funded project is also aiming to develop the capacities of private sector drug manufacturers to produce nationally quality-assured ORS and Zinc.
In addition to the Lundin Foundation project, PSI/ASF implements the USAID-funded Support for International Family Planning Organizations (SIFPO) project that also deals with diarrhea prevention and treatment in children under five by providing relevant health information to their mothers/caregivers, in addition to making available point-of-use water treatment products (P&G® water purifier sachets and Aquatabs® tablets) and diarrhea treatment kits known as Ora-Zinc®. The project’s target population lives in the following urban areas: Kinshasa, Lubumbashi, Kisangani, Kananga, Mbuji-Mayi, Bukavu, Goma, Likasi, Kolwezi, Kasumbalesa.
Family planning services were virtually nonexistent after war destroyed the country’s healthcare infrastructure – until PSI/ASF stepped in. Now, a comprehensive range of high-quality family planning products and services are available through the Confiance network, which includes 138 clinics and 138 mobile educators throughout seven provinces.
The Confiance brand includes oral contraceptives, an IUD, an injectable contraceptive, an implant, the Standard Days Method (CycleBeads), and an emergency contraceptive. PSI/ASF creates demand for these products with mass media and interpersonal communication campaigns, which include outreach activities conducted at partner clinics, a trained network of mobile educators, and two toll-free telephone hotlines.
PSI/ASF promotes interpersonal communication (IPC) campaigns in health centers, schools and other public places. The campaigns encourage safe water use and the treatment of drinking water with products such as P&G® Purifier of Water and Aquatabs®. A sachet of P&G® Purifier of Water is used to treat 10 liters of turbid water, whereas a tablet of Aquatabs® treats 20 liters of non turbid water.
In 2013, approximately 5.3 million sachets of P&G® Purifier of Water and 4.5 million tablets of Aquatabs® were sold nationwide.
It’s estimated that about 150,000 Congolese are infected with HIV/AIDS annually. While HIV prevalence remains low for the adult population at 3.2 percent, it is much higher for certain groups such as sex workers and injectable drug users.
Since 1987, PSI and ASF have been addressing HIV/AIDS prevention. The HIV program goal is to reduce prevalence by promoting safer behaviors, distributing condoms, and providing testing services – particularly for the most at-risk populations.
PSI/ASF uses many methods to convey HIV prevention messages:
- Trained peer educators, community dramas, mobile video unit animations and mass media communication that promote personal risk assessment and self-efficacy among targeted groups
- Partnerships with other local NGOs and faith-based organizations that develop abstinence and faithfulness campaigns
- NGOs and religious leaders who are trained on dealing with stigma and clarifying misconceptions about HIV/AIDS
- Condom social marketing through PSI/ASF’s Prudence brand.
- Voluntary counseling and testing (VCT). PSI/ASF partners with providers such as the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) to provide treatment.
- U.S. Agency for International Development
- The Global Fund To Fight AIDS, Tuberculosis and Malaria
- U.S. Department of Defense
- United Kingdom Department for International Development
- Lundin Foundation
- Procter and Gamble
- Ministry of Health
- National Army (FARDC)
- National Police (PNC)
- International NGOs (EGPAF)
- Local NGOs, such as Caritas Congo, Union Congolaise des Prestataires en Planification Familiale (UCPPF), ACCO (Drivers’ association), ELCOS, TRASI, etc.
- UN agencies such as UNFPA
- Academic partners such as the Swiss Tropical and Public Health Institute (STPH), the Liverpool School of Tropical Medicine (LSTM) or the Kinshasa School of Public Health
- Towards Subsidized Malaria Rapid Diagnostic Tests. Lessons Learned from Programmes to Subsidise Artemisinin-Based Combination Therapies in the Private Sector: a Review
Private sector subsidy programmes of ACTs have been effective in increasing availability of ACTs in the private sector and driving down average prices but struggled to crowd out antimalarial monotherapies. A subsidy of rapid diagnostic tests (RDTs) in the private sector has been recommended by governments and international donors to cope with over-treatment with ACTs and to delay the emergence of resistance to artemisinin. In order to improve the cost-effectiveness of co-paid RDTs, we should build on the lessons we learned from almost 10 years of private sector subsidy programmes of ACTs in malaria-endemic countries.
- ACT Availability, Price and Market Share in Kinshasa & Katanga, DRC, 2013-2015
QA ACT availability improved in the public and private sectors of Kinshasa and Katanga between 2013-2015, however, substantial gaps in availability remain in both sectors. In addition to sub- optimal availability, QA ACT high price relative to cheaper antimalarial alternatives is likely a barrier to uptake. Distribution of QA ACT relative to SP and non-QA ACTs remains low. Ensuring that malaria is managed appropriately in DRC with quality-assured ACT requires working with the private sector to address current gaps in availability, affordability and distribution of QA ACTs.
- Le Magazine « 100% Jeune », Source D’Information éDucative Pour Les Jeunes en âGe De ProcréEr en RéPublique DéMocratique Du Congo (Rdc)
As presented in the Strategic Plan (2011-2015) of the National Program for Adolescent Health (NASP), young people aged 10 to 24 number more than 20 million people in the DRC. This layer of the population, particularly girls, faces problems related to sexual and reproductive health.
- Ligne Verte: Outil D’Informations Sur La Planification Familiale en Republique Democratique Du Congo
The DRC is a country of vast extent (2,345,410 square km) whose population (70 million) is distributed over a range of streams, forest vegetation, and poorly developed roads, making access difficult in certain geographic areas. The majority of this population (70%) lives in rural areas characterized by enormous health needs, limited access to correct information about FP, and the persistence of socio-cultural barriers.
- Market Trends for Malaria Blood Testing in Sub-Saharan Africa, 2009-2014
In 2012, the World Health Organization (WHO) launched the Test, Treat, Track initiative recommending confirmatory testing prior to antimalarial treatment. National malaria control programs (NMCP) across subSaharan Africa (SSA) subsequently aligned national guidelines with this recommendation. Strategies to scale up testing using malaria rapid diagnostic tests (mRDT) were introduced by NMCPs. We examine malaria testing availability, price and market share using national market survey data collected by the ACTwatch project.
- SP Availability and (Mis)Use in Sub-Saharan Africa: Antimalarial Market Data From 8 Countries
As evidence of reduced chloroquine efficacy against plasmodium falciparum mounted in the 1990’s, sulfadoxine-pyrimethamine (SP) became first-line malaria treatment in many endemic countries in sub-Saharan Africa (SSA). Between 2002-2005, countries in SSA adopted artemesinin combination therapies (ACT) as first-line treatment. SP is still recommended by the WHO and used across SSA for intermittent preventive treatment of malaria during pregnancy (IPTp). We examine availability and distribution of SP using national antimalarial market survey trend data collected by the ACTwatch project.
- Transforming the Private Sector Market for Quality Malaria Case Management in Kinshasa, Democratic Republic of Congo
The Democratic Republic of Congo’s (DRC) malaria treatment guidelines state that all suspected cases should be confirmed by diagnostic testing prior to treatment. Positive cases of simple malaria should be treated with artesunate+amodiaquine (ASAQ) or artemether+lumefantrine (AL), ideally with a WHO pre-qualified product.
- Enabling the Healthy Spacing and Limiting of Pregnancies: Programmatic Approaches to Expand Postpartum IUD Access
Under the Support for International Family Planning Organizations (SIFPO) project funded by USAID, PSI published a technical brief on 'Enabling the Healthy Spacing and Limiting of Pregnancies: Programmatic Approaches to Expand Postpartum IUD Access'. The brief introduces the need for expanded postpartum family planning options, reviews the advantages and disadvantages of the PPIUD, describes the components of successful initiatives to add PPIUD to the range of options for postpartum women, and illustrates three different models for PPIUD service delivery through case studies from the Democratic Republic of the Congo, Guinea, Zambia and Pakistan.
- Understanding Private Sector Antimalarial Distribution Chains: A Cross-Sectional Mixed Methods Study in Six Malaria-Endemic Countries
This article presents evidence on the composition, characteristics and operation of private for-profit distribution chains in six malaria-endemic countries (Benin, Cambodia, Democratic Republic of Congo, Nigeria, Uganda and Zambia).
- Planes, Barges, Canoes and Bicycles: The Challenge of Distributing 9.5 Million Life-Saving Mosquito Nets in Post-Conflict Democratic Republic of Congo
This brief outlines PSI/ASF's challenge: distribute nearly 9.5 million long-lasting insecticide treated mosquito nets (LLINs) in three provinces in the Democratic Republic of Congo: Bas Congo, Kasai Occidental and Kasai Oriental.