The Democratic Republic of Congo (DRC) is the 17th most populous country in the world, and the fourth most populous in Africa. War, famine and disease have ravaged this resource-rich nation for decades, killing more than five million Congolese between 1996 and 2006.
Despite possessing abundant natural riches such as cobalt, gold, copper, coltan and diamonds, factors including government instability, mismanagement, and recent violence have diminished the DRC’s production and export potential. Conflict has exacerbated the poverty within the DRC and left them without access to quality healthcare infrastructure to manage primary health concerns, including malaria, reproductive health, clean water, and HIV/AIDS.
Since 1987, PSI has worked without interruption in the DRC during years of civil unrest that forced most NGOs to close. Instead, PSI expanded its reach with support from both large international donors and private foundations. In 1990, PSI established its Congolese network member, the Association de Santé Familiale (ASF).
PSI/ASF estimates that in 2015, its products and services helped avert 6,159,146 DALYs, including, by health area:
- 5,857,683 Malaria DALYs
- 53,843 HIV DALYs
- 225,341 FP DALYs
- 21,012 MNCH DALYs
- 1,267 WASH DALYs
PSI/ASF’s family planning programs also provided 468,823 couple-years of protection.
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’s anti-malaria efforts include:
- Promoting long-lasting insecticide-treated nets (LLINs) use via behavior change communication.
- Mass, routine and continuous distribution of LLINs.
- Increasing availability and use of intermittent preventive treatment in pregnancy (IPTp).
- Increasing availability and use of ACT (Artemisinin-based combination therapy).
- Promoting use of rapid diagnosis tests (RDTs) and increasing their availability.
Long-Lasting Insecticide-Treated Nets
From 2012 to 2016, thanks to the financial support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, and additional support from the UK Department for International Development (DfID), PSI/ASF was responsible for the free distribution of about 50 million long-lasting insecticide-treated nets (LLINs) to the Congolese population in 24 out of the 26 provinces of DRC. Impressively, over 24 million of these LLINs were distributed in just one year, 2016.
Since 2014, PSI/ASF has distributed over 1.8 million LLINs to pregnant women and children under five at health facilities. This initiative has been funded by DfID and the U.S. Agency for International Development’s (USAID)/President’s Malaria Initiative (PMI). In June 2015, PSI/ASF began piloting the continuous distribution of LLINs in schools and communities in 12 health zones located in Kasaï Central Province. More than 252,000 LLINs were distributed in schools as of December 2016.
Intermittent Preventive Treatment in pregnancy (IPTp)
Between 2014 and 2016, PSI/ASF distributed over 1.9 million free doses of sulfadoxine-pyrimethamine to pregnant women as intermittent preventive treatment of malaria in pregnancy. USAID’s funds made it possible in 68 health zones within nine provinces.
Artemisinin-based Combination Therapy (ACT) and Rapid Diagnostic Test (RDT)
Through USAID, the Global Fund and DfID funding, PSI/ASF is now helping both the DRC public and private sectors to supply quality-assured ACTs to their customers. This distribution is concurrent with the promotion and distribution of malaria RDTs. PSI/ASF has been supporting the public sector for some time now, with over 9.2 million ACTs and 4 million RDTs distributed to health zones over the last three years. Its support to the private sector started in 2016 with 350,700 RDTs distributed to private clinics in Kinshasa and about 472,000 doses of ACTs sold through local importers.
Since 2009, PSI/ASF has been part of ACTwatch, a multi-country research project that investigates ACT availability, use, cost and quality. Results of the study help policymakers understand treatment needs. The most recent outlet surveys were conducted in 2013 and 2015. Interestingly, the 2015 survey integrated family planning. More information on ACTwatch and research findings is available on the project website: www.actwatch.info.
Since 2014, PSI/ASF has been fighting childhood mortality caused by diarrhea in the former Katanga Province via integrated community case management, under a project funded by Lundin Foundation. Through community health workers, PSI/ASF helped communities to better treat diarrhea in children under the age of five, by recommending a course of treatment based on oral rehydration salts (ORS) and zinc. During the life of the project, about 77,500 kits of ORS-Zinc (known as Ora-Zinc®) were distributed. Moreover, thanks to water purifiers distributed under this project, about 128 million liters of water were treated. This project was also aiming to develop the capacities of private sector drug manufacturers in providing quality-assured ORS and zinc locally.
In addition, PSI/ASF implements the USAID-funded Support for International Family Planning Organizations (SIFPO) 2 project. This also deals with diarrhea prevention and treatment in children under five by providing relevant health information to their mothers and caregivers. It makes Ora-Zinc® available, as well as point-of-use water treatment products (P&G® Purifier of Water sachets and Aquatabs® tablets). The project’s target population lives in the urban areas of Kinshasa, Lubumbashi, Kisangani, Kananga, Mbuji-Mayi, Bukavu, Goma, Likasi, Kolwezi and Kasumbalesa.
The Maternal and Child Survival Program (MCSP) is a USAID-funded project implemented by a consortium of NGOs. Within this framework, PSI/ASF has started to offer a complete package of health care services to children under age five. This includes the management of malaria, pneumonia, diarrhea and malnutrition cases in 24 health zones located in Tshopo and Bas-Uele provinces.
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 franchise, which includes 110 clinics and 55 community-based educators throughout seven provinces. PSI/ASF is also in charge of delivering family planning services in the 24 health zones of Tshopo and Bas-Uele as part of the MCSP project.
The Confiance brand includes oral contraceptives, an intrauterine device (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 community-based educators, and two toll-free telephone hotlines.
PSI/ASF promotes interpersonal communication 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 2016, approximately 980,000 sachets of P&G® Purifier of Water and 14 million tablets of Aquatabs® were sold nationwide.
It’s estimated that about 34,000 Congolese are infected with HIV/AIDS annually. While HIV prevalence remains low for the general population at 1.1%, it is much higher for certain groups, such as sex workers and men who have sex with men.
Since 1987, PSI and ASF have been addressing HIV/AIDS prevention. The HIV program goal is to reduce prevalence by promoting responsible 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 and free distribution of generic condoms.
- Voluntary counseling and testing (VCT).
Since 2014, PSI/ASF has been working on the U.S. Department of Defense-funded project Elikya FARDC, which promotes responsible behaviors for Congolese military personnel and their dependents. Under this project’s umbrella, PSI/ASF is also partnered with the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) to provide treatment to adults and children as well as care and support activities.
- U.S. Agency for International Development (USAID)
- The Global Fund to Fight AIDS, Tuberculosis and Malaria
- U.S. Department of Defense
- UK Department for International Development (DfID)
- Lundin Foundation
- Procter and Gamble
- United Nations Population Fund (UNFPA)
- Ministry of Foreign Affairs of the Netherlands
- Bill & Melinda Gates Foundation
- Ministry of Health
- National Army (FARDC)
- National Police (PNC)
- International NGOs such as EGPAF, Greenmash, CORDAID, UMCOR, HPP, IRH, JSI
- 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
- DRC FPwatch 2015 Outlet Survey Research Brief
This brief highlights important findings from the FPwatch 2015 DRC outlet survey.
- DRC FPwatch 2015 Overview: Kinshasa and Katanga
In Kinshasha and Katanga, DRC, FPwatch provides estimates for key family planning market indicators using cross-sectional outlet surveys representative at the provincial level.
- DRC FPwatch 2015 Reference Document: Kinshasa & Katanga
This report contains the comprehensive findings from the 2015 FPwatch outlet survey conducted in the provinces of Kinshasa and Katanga DRC.
- DRC FPwatch 2015 Outlet Survey Presentation
This presentation summarizes findings from the FPwatch 2015 Outlet Survey conducted in DR Congo provinces of Kinshasa and Katanga.
- DRC FPwatch 2015 Outlet Survey Dissemination Report
A total of 170 partners from the private, public and not-for-profit sectors participated in the FPwatch dissemination events in Kinshasa and Katanga. This document summarizes the key activities and outcomes of the five events.
- Reproductive Health Supplies Coalition: Parallel Session Presentation
On October 13, FPwatch findings from DRC and Nigeria were presented at the Reproductive Health Supplies Coalition (RHSC) Annual Meeting in Seattle.
- FPwatch Supplement: Misoprostol
This document gives an overview of misoprostol tablet availability, price, and volume across FPwatch study countries.
- FPwatch Supplement: Pregnancy Test Kits
This document gives an overview of pregnancy test kit availability, price, and volume in Nigeria, Democratic Republic of Congo, and Ethiopia.
- FPwatch Final Results and Key Themes Presentation
These slides summarize key themes from the FPwatch 2015-2016 outlet surveys conducted in Ethiopia, Nigeria, DRC, India, and Myanmar.
- Do anti‑malarials in Africa meet quality standards? The market penetration of non quality‑assured artemisinin combination therapy in eight African countries
This paper uses national and sub-national medicine outlet surveys conducted in eight study countries (Benin, Kinshasa and Kantanga [Democratic Republic of the Congo, DRC], Kenya, Madagascar, Nigeria, Tanzania, Uganda and Zambia) between 2009 and 2015 to describe the non-QAACT market and to document trends in availability and distribution of non-QAACT in the public and private sector.