Democratic Republic of Congo

Background

Years of civil war and unrest have exacerbated extreme poverty in Democratic Republic of the Congo (DRC) and the poor health status of the population. Maternal and child mortality rates continue to trump those of other countries, and the DRC has one of the lowest contraceptive prevalence rates and highest total fertility rates in the world. Gender-based violence is widespread. The country’s geography presents a formidable challenge to the delivery of health services; the DRC is an expansive country with roads in poor condition and an extremely difficult terrain to navigate.

E2A is working in three provinces—Lualaba, Kasai Central, and Lomami—to establish an effective network of community-based distributors who provide family planning and maternal and child health (MCH) services in conjunction with existing health facilities. The health of populations living in these three areas is especially poor, and health indicators fall below national averages.

Across all activities in DRC, E2A looks for ways to catalyze new and existing partnerships and to integrate activities into existing efforts. E2A focuses on building the capacity of local actors to lead and manage the activities, which have been designed as scalable solutions which can be adopted by a wide range of stakeholders.

Community-Based Family Planning Program

Despite the many obstacles that exist to the equitable delivery of quality health services, DRC’s current health system serves as a sufficient foundation for strengthening the delivering of community-based services, and the government has made several national commitments to improving family planning and MCH services. E2A is working closely with the DRC government to leverage existing health plans and structures to efficiently and effectively improve and expand community-based services in 15 health zones of the three intervention provinces. E2A is also collaborating with other USAID-funded projects that are focusing on family planning and maternal and child health in the country—in particular the Integrated Health Project, referred to in DRC as PROSANI.

With the support of USAID Democratic Republic of Congo, E2A aims to raise awareness about family planning in the three provinces, generating demand for quality services, while simultaneously ensuring the delivery of high-quality family planning and MCH services at the community level.

Quality community-based family planning and MCH services

Community-based distributors are at the heart of E2A’s work in DRC. By training 408 health volunteers to be community-based distributors of family planning services and linking them with health posts and health centers for training, supervision, and support, E2A is strengthening the capacity and breadth of the community-based health workforce. At the same time, E2A is working with provincial and national health offices to adapt existing supervision tools for use with community-based distributors, and to create tailored training programs for use at the community level.Community-based distributors are trained to provide an integrated package of family planning services and MCH services. The integrated package of services includes:

• Quality community-based family planning services that contain a broad mix of short-acting contraceptives (which are complemented by the provision of injectables and implants by clinical nurses at health posts, health facilities, and at bimonthly outreach events in communities)
• Information about and provision of oral rehydration salt and zinc for prevention of and management of diarrhea
• Information about water purification and the provision of water purifiers

Strong health systems

Effective community-based services depend on the right systems being place. This component therefore focuses on building the capacity of health zones and provinces in several areas of health planning and implementation, including commodities, training, supervision, and health management information and referral systems. The program relies on facility-based providers to provide clinical family planning methods, and to support and supervise community-based distributors on all elements of the integrated services package, while strengthening linkages between community health workers, health posts, and health facilities.

Increasing awareness and demand

E2A is building the capacity of health managers, community- and facility-based providers, and other influential community members to conduct one-on-one counseling, group sensitization activities, and mass media efforts to encourage the use of modern family planning methods, oral rehydration salt, and water purification tablets. Couples counseling and the engagement of men are emphasized in all project activities. E2A is working closely with PROSANI and other partners to use local radio programs to promote the benefits of family planning and healthy timing and spacing of pregnancies, and to address myths and misconceptions related to modern methods.

Gender equality and male involvement

Gender norms in the DRC impede the use of family planning services, and gender-based violence is pervasive. E2A ensures all staff and stakeholders involved in project activities are well aware of how gender impacts the acceptance and use of family planning, as well as national laws and human rights principles related to gender. As a step towards gender equality in the delivery of health services, the program works to recruit equal numbers of male and female community-based distributors, and encourage the election of women to local health development committees called CODESAs.

Other gender-focused program activities include engaging religious leaders and church programs to reach men and sensitize them to the benefits of family planning and the positive role women play in decision making about their own health as well as that of their families; working with community leaders to conduct sensitization programs related to male involvement; using positive deviants as community champions; organizing women’s health days during which a variety of services, information, or products are made available; and targeting young males for sensitization at community sports events, schools, and churches.