Against Great Odds, Deep Impact in Congo

KINSHASA, Democratic Republic of Congo (DRC), August 1, 2005 — In a health organization that puts measurable health impact above all else, the Association de Santé Familiale (ASF), PSI's affiliate here, has achieved a special status: In 2004, ASF registered a five-fold increase in health impact over 2003, the largest percentage increase of any PSI program in the world.

And it was accomplished in the most challenging of environments. The DRC, a country the size of western Europe devoid of a working road system, is wracked by instability and considered the world's largest humanitarian crisis, according to the United Nations.

ASF, the only NGO active in all 11 provinces, delivered 1.3 million "person years of protection (PYPs)" in 2004 — more than five times its 2003 total. It also directly prevented an estimated 21,000 HIV infections in 2004.

The PYP is an indicator developed by PSI that combines several indices of protection into one aggregate unit estimating the annual protection PSI provides through the sale of its products and services as well as some types of behavior change unrelated to product/services. PSI is one of the few nonprofit organizations that counts its health impact similar to the way that a for-profit company tracks its profits.

The DRC was PSI's first program in Africa, started in 1987 and operated without interruption despite years of civil unrest that forced many other NGOs to close their doors. The main donor during all those years has been the U.S. Agency for International Development.

With USAID funding, PSI promoted the "ABC approach" to AIDS prevention in Zaire, as it was known then, in 1988, even before the expression was coined. Research showed that the program was successful in increasing abstinence, mutual fidelity and consistent and correct condom use.

How did it achieve such results in such a challenging environment? There were many factors, of course, including new developments in 2004: ASF added four products to its health arsenal, signed agreements with the chauffeur association, police and army and implemented training for religious leaders.

The four products launched by ASF in 2004 included: Mama Serena insecticide treated nets (ITNs), Delivrans clean delivery kits; Confiance cycle beads; and Prudence Femme female condoms. Serena ITN, launched in 2003, expanded to Kinshasa where it is being sold on a cost recovery basis, along with Delivrans.

Much of the health impact came from ITN sales which increased by 2,000% over 2003 and resulted in 8.7 million cases of malaria averted. ASF's ITN program is funded by the British Department for International Development (DFID). This phenomenal growth was possible despite unrest in eastern DRC throughout the year, which caused thousands of ITNs to be rerouted from Goma, DRC to Kigali, Rwanda for safekeeping during the summer of 2004. During the same period ASF's expatriate in Goma was evacuated to Rwanda and a program vehicle stolen.

ASF signed national protocols with the Association of Congolese Chauffeurs (ACCO) — of which nearly all truckers and taxi drivers are members — the Congolese National Police and the Armed Forces to establish partnerships for the prevention of HIV/AIDS among members. These partnerships expand ASF's access to high-risk groups at a low cost. The ACCO's 2005 membership cards carry the message "Roulez Protégez — La nation a besoin de vous!" ("Drive protected — the nation needs you!") reinforcing earlier condom use messages.

ASF has also received funding from USAID for a five-year family planning project in eight of the eleven provinces. The program has already made progress through its training of 112 religious leaders from 23 churches on the role that modern contraception can play in the church.

In 2004, a PSI training seminar facilitated religious leaders from 10 French-speaking countries in West and Central Africa to mobilize their congregations against AIDS. The seminar trained church leaders to develop policies and programs regarding prevention, care, support and stigma reduction for people living with HIV/AIDS.

Additionally in 2004, ASF reached more than 350,000 people in target groups with interpersonal communications in the areas of malaria, family planning and HIV/AIDS, and reached 5.8 million people with its Trusted Partner campaign which aired over three months on TV and radio in Lingala, Swahili and French.

The Trusted Partner campaign is a regional behavior change communication initiative implemented through PSI's AIDSMark project. The research-based campaign seeks to personalize and increase risk perception, communicating that trust in one's partner does not protect against sexually-transmitted infections and HIV/AIDS or make the behavior any less risky.

— Katharine McHugh, PSI/Democratic Republic of Congo

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ASF, PSI's affiliate in the DRC, signed a national protocol with the Association of Congolese Chauffeurs and its membership cards will carry the message “Drive protected —The nation needs you!”