PSI

The third largest country (by area) in 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 in recent years, killing more than 5 million Congolese from 1996 to 2006.1

In spite its natural riches of cobalt, copper and diamonds, government instability, mismanagement and recent violent history have diminished DRC’s ability in production and exportation. Conflict has exacerbated DRC’s population of 70.9 million living n poverty 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 continued its work without interruption in DRC, despite years of civil unrest that 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 local affiliate, l’ Association de Sante Familiale (ASF) – the only NGO with activities in 10 out of DRC’s 11 provinces.

1. 1. “The Deadliest War In The World,” Time, May 2006.

Health Areas

Child Survival, Diarrheal Disease, HIV, Malaria, Reproductive Health

Health Impact

PSI/ASF programs averted thousands of Disability-Adjusted Life Years (DALYs) in 2010.1

• 181,535 DALYs for condoms (179,920 for male condoms and 1,614 for female condoms).
• 1,149 DALYs for clean delivery kits (CDK).
• 31,463 DALYs for family planning (FP).
• 2,936 DALYs for safe water (486 for PUR and 2,450 for Aquatabs).
• 437,547 DALYs for long-lasting insecticide-treated nets (LLINs).
• 15,106 DALYs for artemisinin-based combination (malaria) therapy (ACT).

1. 1.“The Deadliest War In The World,” Time, May 2006.
2. 2.The DALY (Disability-Adjusted Life Year) is a widely-used, credible metric that was first developed by the World Bank and is now routinely relied upon in the public health community.

1. 1. The DALY (Disability-Adjusted Life Year) is a widely-used, credible metric that was first developed by the World Bank and is now routinely relied upon in the public health community.

Health Interventions

• Oral Contraception
• Intrauterine Device (IUD)
• Injectable Contraception
• Clean Delivery Kits
• PUR
• HIV Counseling and Testing
• Female Condom
• Male Condom
• Contraceptive Implants
• Standard Days Method & Cyclebeads
• Long Lasting Insecticide-Treated Nets

Improving Health in DRC

Malaria

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/DRC anti-malaria efforts include:

• Promoting LLINs use
• Increasing ACT availability
• Expanding malaria prevention programs for children

Long-Lasting Insecticide-Treated Nets (LLINs)

In 2008, PSI/DRC distributed approximately 3.74 million LLINs in eight provinces via:

• Mass campaigns
• Routine public sector distribution, targeting children under 5 and pregnant women
• Subsidized social marketing

PSI/DRC also won the Global Fund Round 8 malaria proposal as one of three prime recipients. PSI/DRC is responsible for the free distribution of 9.4 million LLINs to three provinces in 2010/2011 (Kasaï Occidental, Kasaï Oriental, and Bas Congo).

Artemisinin-based Combination Therapy (ACT)

In 2007, PSI/DRC launched SérénaDose, a pre-packaged malaria therapy, for children under 5. The therapy is socially marketed in nine urban centers and available through NGO partners, which increases access to high-quality, effective treatment.

PSI/DRC is also part of ACTwatch, a 5-year multi-country research project that explores ACT availability, use, cost and quality. Results of the study will help policymakers understand treatment needs.

Childhood Illnesses

In 2009, PSI/DRC launched a multi-country pilot project with the WHO/TDR to evaluate home-based management of malaria, pneumonia and diarrhea – the leading causes of death among children under 5. Community health volunteers distributed ACTs, ORS + zinc, and cotrimoxazole in 10 health zones in the Sub-Ubangi district of the Equateur province. Project outcomes will help determine best practices for future campaigns. In 2011, PSI/DRC plans to launch diarrheal treatment kits (DTKs) through a USAID funded project in DRC.

Reproductive Health

Family planning services were virtually nonexistent after war destroyed the country’s healthcare infrastructure – until PSI/DRC stepped in. Now, a comprehensive range of high-quality family planning products and services are available through the Confiance network, which includes 78 clinics, 277 pharmacies and 91 mobile educators throughout eight provinces.

The Confiance brand includes two types of oral contraceptives, an IUD, an injectable, an implant and the Standard Days Method with CycleBeads. PSI/DRC creates demand for these products with mass media and interpersonal communication campaigns which include open houses conducted at partner clinics, a trained network of mobile educators and two toll-free telephone hotlines.

In 2004, PSI/ASF added a clean delivery kit (CDK) to its products. Délivrans is distributed to health centers, pharmacies and midwives. More than 151,167 kits have been sold, creating enough income to self-sustain the product.

Safe Water/Child Survival

PSI/ASF promotes interpersonal communication (IPC) campaigns in health centers, schools and other public places. The campaigns encourage safe water use and hygienic behaviors such as washing hands. Millions of Congolese see and hear PSI/ASF’s mass media campaigns – in both French and local languages – on TV, radio, billboards and community theater.

Since October 2006, about 10.6 million sachets of PUR have been distributed nationwide. An additional product, Aquatabs, was launched in May 2009, and more than 1 million liters of water were treated by year’s end.

HIV

It’s estimated that about 150,000 Congolese are infected with HIV/AIDS annually.1 While HIV prevalence remains low for the general population at 1.3%, it’s much higher for certain groups. For example, infection rates among sex workers in Kinshasa ranged from 27% to 38% between 1985 and 1997.2
Since 1987, PSI and ASF have addressed HIV/AIDS prevention by promoting the ABCs – Abstinence, Being faithful and Condoms. The HIV program goal is to reduce prevalence by promoting safer behaviors, distributing condoms and testing services – particularly for at-risk groups.

ASF/PSI 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. In 1987 PSI/ASF launched the Prudence male condom brand. In 2005, a survey helped reposition the brand and change its packaging to improve perception among its target groups. The revitalized brand now includes a female condom.
• Voluntary counseling and testing (VCT). PSI/ASF partners with providers such as Family Health International (FHI) and AMO Congo to increase demand for VCT and mobile services

1. 1. Source: WHO, Epidemiological Fact Sheet on HIV and AIDS: DRC, 2008. PNLS Annual Report, 2006
2. 2. Source: USAID, Health Profile: DRC, November 2004

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