Title: The SANRU Sant Rurale Program in DR Congo
1The SANRU (Santé Rurale) Program in DR Congo
Where We've Been and Where We're Going
by Leon Kintaudi and Franklin Baer
CCIH Annual Conference, May 30, 2005
2Here is Congo
3Here are the Paved Roads of Congo
4One of those paved roads
5and an unpaved road
6Congo is rich in natural resources
Coffee
Col-Tan
Natural Resources
Crude Oil
Cobalt
Cadmium
Copper
7Congo is also rich in decentralized health zones
(515 HZs)
FBOs co-developed and co-manage 1/3 of Congos
Health Zones
8A Brief History of Health System Development in
DRC
- 1875-1960 Health Infrastructure Development
- - Belgian colonial investment in urban admin.
centers
- - Missionary initiatives in rural areas
- - Post WWII investments (from copper revenues)
- - Traditional health system with 120 territory
districts
9The Hospitals of DR Congo (c. 1960)
10A Brief History of Health System Development in
DRC
- 1900-1960 Health Infrastructure Development
- 1960-1975 Pioneers in Health System
- Sims Ngwete Lejeune Luvivila Fountain
Pangu Courtejoie Ruppol Carlson
- Galloway many more
11A Brief History of Health System Development in
DRC
- 1875-1960 Health Infrastructure Development
- 1960-1975 Pioneers in Health System
- 1975 National Seminar on Community Medicine
- - Organized with Catholic and Protestant Medical
Offices
- - Established consensus and mandates for
- integrated medicine (primary health care)
- CEBEC (PHC integrated health centers)
- decentralized health zones with co-management
by FBOs
- - No funding, but this encouraged pilot HZs to
develop
12Pilot Health Zones (1975-1981)
13A Brief History of Health System Development in
DRC
- 1875-1960 Health Infrastructure Development
- 1960-1975 Pioneers in Health System
- 1975 National Seminar on Community Medicine
- 1982-1986 Five year health plan
- - Delimitation/Creation of 306 Health Zones
- - SANRU I/II and FBOs played leading roles
14Pilot Health Zones (1975-1981)
15Health Zones (1982)
16Health Zones (1984)before delimitation of Health
Zones
17Health Zones (1984)after delimitation of Health
Zones
18Health Zones (1984)after delimitation of Health
Zones
19Health Zones (1984)after delimitation of Health
Zones
20A Brief History of Health System Development in
DRC
- 1875-1960 Health Infrastructure Development
- 1960-1975 Pioneers in Health System
- 1975 National Seminar on Community Medicine
- 1982-1986 Five year health plan
- 1991-2001 The decade of HZ survival
- - Economic instability, war, projects closed
- - ECC FBOS struggle to continue support to
HZs
The health zone system is possibly the only
system in the country still recognizable even
with critically little or no support it commands
allegiance and support from health workers (WHO
2001)
21A Brief History of Health System Development in
DRC
- 1875-1960 Health Infrastructure Development
- 1960-1975 Pioneers in Health System
- 1975 National Seminar on Community Medicine
- 1982-1986 Five year health plan
- 1991-2001 The decade of HZ survival
- 2001-2005 Revitalizing HZs with Appui Global
- - ECC/IMA assists 56 HZs with USAID funding
(SANRU III)
- - CRS assists 16 HZs with USAID funding
- - PMURR 68 HZs with WB funding (19 by IMA/ECC)
- - PReSS 83 HZs proposed with WB funding
22Four Generations of NGO Development Strategies
A Final Comment
Adapted from Getting to the 21st Century, by
David Korten
23The SANRU (Santé Rurale) Program in DR Congo
Where Were Going
by Leon Kintaudi and Franklin Baer
24Protestant Church of Congo Medical Office
(ECC/DOM)
- ECC/DOM is a Christian Health Association that
include 65 member communities
- ECC/DOM member communities own 80 hospitals and
more than 600 health centers
- ECC co-manages 65 of Congos 515 HZs
25The ECC/DOM Portfolio
- Liaison with MOH for all ECC health facilities
- Co-Management of 65 Health Zones with the MOH
26ECC Co-Manages 65 Health Zones(serving a
population of 9,000,000)
27FBOs Co-Manage 1/3 of Congos HZs
28The ECC/DOM Portfolio
- Liaison with MOH for all ECC health facilities
- Co-Management of 65 Health Zones with the MOH
- Current Projects 4 major projects and numerous
subprojects ( 15,000,000/yr)
29ECC/DOM in partnership with I.M.A. is assisting
75 HZs with health systems development
- SANRU III (USAID)- PMURR (World Bank)
30Results from Oicha HZ (with EPI and ITNs fully
implemented)
31The ECC/DOM Portfolio
- Liaison with MOH for all ECC health facilities
- Co-Management of 65 Health Zones with the MOH
- Current Projects 4 major projects and numerous
subprojects ( 15,000,000/yr)
- For 2006 hoping for 5 major projects (20
M/yr)
- New directions DEVRU
- Developpment Rurale
- adding agriculture and microenterprise
- activities for synergistic development
32Keys to Health Systems Development for FBOs
CHAs
- Document and map the strengths of FBO networks
- Strengths of FBO Networks
- More public than private sector
- Generally willing to co-manage health zones
- Provide a good infrastructure for HZs (schools,
etc.)
- Are effective in community mobilization
- Have good user fee and management systems
- Have access to funding not available to the MOH
- Confidence of donors in working with FBOs
- FBOs are a permanent sustainable national
resource
33Keys to Health Systems Development for FBOs
CHAs
- Document and map the strengths of FBO networks
- Create continual dialogue/collaboration with MOH
- Promote FBOs as part of the public sector
(FBO/NGO)
- Work at all levels of the health system, esp.
national
- Create strategies for co-management of health
systems
- Establish partnerships with U.S. groups to handle
funding
34Keys to Health Systems Development for FBOs
CHAs
- Document and map the strengths of FBO networks
- Create continual dialogue/collaboration with MOH
- Promote FBOs as part of the public sector
(FBO/NGO)
- Work at all levels of the health system, esp.
national
- Create strategies for co-management of health
systems
- Establish partnerships with U.S. groups to handle
funding
- Increase your project systems management
capacity
- Be More Creative!
35Santé Pour Tous et par Tous