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3	Events Contributing to the Decline of DR Congo
4	Basic Indicators Maternal mortality 1289/100,000 (MICS2, 2001) Infant mortality 127‰ (MICS2, 2001) Child mortality 213 ‰ (MICS2, 2001) 67% of pregnant women are anemic (PRONANUT, Mai 2005) Neonatal mortality 47 ‰ 75% vaginal fistulas caused by complications of delivery (PNSR, Sept 2005)
5	Low Utilization of Services (PNSR, 2004) Curative Care: 30% Anti-natal visits: 45.3% Assisted Births: 42.5% Post partum visits: 8.8% Family Planning coverage: 2%
6	The Congo Health System is based on 515 Decentralized Health Zones
7	Components of a Health Zone in DR Congo
8	A Typical Health Zone of Congo
9	"“Although praiseworthy" “Although praiseworthy, [donor resources] are inconsistent with the development of a sustainable health service. Too many resources are devoted to attaining short-term goals… People have very limited access to essential quality health care and there is a shortage of medium and long-term funding”. Minister of Health Bongeli
10	Goal of Project AXxes To develop an effective & efficient health care system in DR Congo based on the MOH’s Health System Strengthening Strategy
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12	Component A: Increase access to, quality and demand for multi-sectoral integrated PHC Increase access to integrated Primary Health Care Reproductive Health, STIs & Family Planning Maternal & Newborn care Improve vaccination coverage Reduce malaria in target population Improve TB detection and treatment Improve Nutritional Interventions IMCI & C-IMCI HIV/Aids (Blood safety and PMTCT) Water and Sanitation
13	Component B: Increased Capacity to the health zone and the referral system Improve HZ Planning, Governance, Transparency and Accountability Develop Human Resources of HZMT, including training and supervision Drug supply management Improve referral system Improve health information system Improve community involvement & support Improve capacity of local NGOs
14	Component C: Increased capacity of national health programs and provincial/district offices Increase the capacity of selected national health programs: 4th and 5th directions, PNLP, PEV, PNLS, PNLB, SR, PRONANUT, PNAM & PCIME Increase the functional capacity of provincial & district health offices Improve supervision of HZs Improve health policy implementation
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17	TA support for AXxes JHU – M&E HKI – Nutrition and micro nutrients HEAL Africa – VF training World Relief – Care groups MSH – Leadership, Drug management, Lab quality URC – Quality of service & improved utilization ? – Neonatal health Others ?
18	Add-in programs PMTCT UNICEF water UNICEF nets GAVI Food for Peace ? Others ?
19	Sampling of AXxes Indicators
20	SANRU Trends in Services
21	Family Planning
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23	Impact of Bed Nets & IPT at Oicha Hospital
24	Water, Sanitation & Hygiene 2163 Springs capped – Access increased 32% Waterborne disease decreased by 30%
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26	Essential Medicine Distribution System
27	Community Health Endowments Internal Rate of Return 51%
28	AXxes Data Flow
29	Electronic Dashboard
30	What has been achieved so far? Conducted rapid assessment of health zones Setup district offices Developed technical & procedural manuals Signed contracts with health zones Started support to HZ for supervision Distributed locally purchased equipment Trained ECZS in health zone management Printed & distributed IEC, SNIS, CPS, etc material Conducted FP training & distributed contraceptives Conducted Vit A campaigns Responded to cholera outbreak in Bukavu
31	Challenges for AXxes Coordinating with Emergency Assistance programs New USAID priorities and indicators Delay in authorization and waivers Need for gap funding for certain activities Bed nets & ACTs Water and Sanitation Livelihood activities Subsidy for VFR and Cesareans
32	New Zones for AXxes 57 health zones $158,000 assistance per health zone