Democratic Republic of the Congo. July 2005 OVERVIEW

Transcription

1 World Health Organization Project Proposal WHO s Role to Save Lives and Improve Public Health in the DRC Democratic Republic of the Congo OVERVIEW Target country: Democratic Republic of the Congo Beneficiary population: 28 million people of the Democratic Republic of the Congo Implementation period: 12 months Amount: 1,691,866 USD Starting date : 01/07/2005 Ending date: 30/06/2006 Applicant organization: WHO Country contact: Dr Leonard Tapsoba, WR Organisation Mondiale de la Santé, DRC Tel : Mobile : Fax : GPN tapsobal@cd.afro.who.int omskin@cd.afro.who.int Contact HQ: Ms Marianne Muller Donor Relations Unit Health Action in Crises Tel: Fax : mullerm@who.int Bank: UBS AG Case Postale 2600,1211 Genève 2 World Health Organization Genève Swift code: UBSWCHZH12A Bank account US$: Swift Code UBSW CH 12A US dollar account number CO Bank account Euro: No.: 240-C IBAN: CH C STRATEGIC OBJECTIVE To save lives and reduce suffering in the Democratic Republic of the Congo during the crisis and the transition.

2 I. PROBLEM STATEMENT Bad and Deteriorating Health Status Indicators Humanitarian needs are likely to continue to exist while the capacity of agencies to deliver humanitarian services is often not adequate to meet al the needs, mostly due to the size and inaccessibility of many parts of the country, aggravated by continuing insecurity and instability in the east of the country. The situation is fragile, resembling a stalemate of neither peace nor war Since the fighting re-erupted during summer 2004, areas have again become inaccessible for humanitarian agencies and more people have become displaced. Mortality rates found in mostly eastern DRC continue to be above emergency thresholds. Childhood mortality is at least double the normal rate, indicating that the severity of the crisis is still in emergency conditions. Most of these excess deaths are attributable to malaria and other common diseases, less than 2% of deaths in 2002 were found to be directly associated with violence. Maternal mortality rates in the east of the country are estimated at around 2,000 per 100,000 live births (compared to a sub-saharan average of 950). Most important outbreaks are cholera, measles, but include pertussis and re-emerging pathogens such as Marburg, Ebola, trypanosomiasis and plague. The EPI programme has low coverage, with for example only 40% of children vaccinated against measles. Gender-based violence has after recent surge in violence increased in conflict areas, whereby women are abducted, systematically raped and enslaved, although mostly undocumented, these horrible acts remains a major threat to women's health. Many of the health problems described above are due to structural vulnerability factors such as extreme poverty, unemployment, displacement, political instability, lack of security, reduced access to potable water, food insecurity and weak health services. Weak Health Care Delivery System Conflict and the collapsed infrastructure have resulted in a severely weakened health system with insufficient capacity to meet the needs of the population. During the war, health structures suffered from looting, lack of material and drainage of human resources. Health services, if not run by a church-based organization, became the responsibility of the community. Except for investments paid for by donors, services were financed by out-of-pocket user fees. Humanitarian agencies have been supporting local Primary Health Care services where and when the humanitarian space allowed. The strategy chosen was to subsidize the provision of care mainly through the delivery of essential drugs and sometimes through financial incentives and to regulate prices in order to make health care more accessible to users. WHO s Role to Save Lives and Improve Public Health in the DRC 2

3 II. PROJECT JUSTIFICATION 1. There is a lack of coordination in the management of support to these health zones. Some of them have many donors and others have none. The criteria to support these health zones are not clear. 2. Because of the lack of coordination and the absence of control and direction from MSP in regional and zonal (ZS) structures, the standards of assistance are not known and therefore vary from zone to zone according to supporting NGO. The MoH administration, despite suffering from a near absolute shortage of funds and, in the case of the East, from being cut off from the central administration, never ceased to exist during the war, although functioning at a reduced level. 3. WHO coordination role in managing surveillance (including AFP surveillance) for early warning and disease outbreak is widely recognized. However, there is a consensus on the need for a consistent WHO technical coordination in wider public healthy issues including environmental health, mental health, malaria, TB and HIV control, Gender-Based Violence, health system issues and training and education of health workers. 4. DRC, with its large population and even larger size, should not be seen as a single health entity. Some of the health zones are bigger than countries; for instance, each of the Kivus is as big as Rwanda and Burundi together. Without strengthening the regional health governance structure, there is no possibility of managing the country major health crisis relying on centralized structures, at least in the humanitarian and transitional phases. 5. WHO is privileged (and sometimes limited) by its close relation to MOH/MSP. In this context, WHO should be decentralized to provide maximal support to the Provincial and ZS structures where support is acutely needed. It should also be near the regional and local actors including national and international NGOs, sister agencies and donors who are also acting at provincial levels. III. WHO IN DRC WHO has an extensive network of around 200 staff in DRC and has expanded its human resources capacity in the country through recruitment of national and international staff. This network works from 11 Provincial sub-offices and around 40 district offices. Its well-established network in the country provides not only for the eradication of polio but also for integrated disease surveillance and is also addressing emergencies in all regions. Training on various emergency issues has been conducted for all MEP and their MOH counterparts network on March 2005 in Kinshasa. In the inter-agency context, WHO is coordinating the health sector. The essential coordination structure is the Health Coordination Group which operates under the overall coordination of OCHA. A Communicable Disease Profile for DRC has been finalized with input from all agencies. WHO has Representative Offices in all nine neighbouring countries. The main responsibilities of WHO offices are health coordination, assessment, technical assistance, surveillance and tackling health priorities. WHO developmental programmers are funded for two years from Regular budget resources for each biennium. In addition to Kinshasa, Geneva and New York, there is a coordination structure for WHO in Brazzaville. Apart from supporting programme management, this Regional Office (AFRO) is responsible for the coordination of the work between DRC and its neighbours. WHO HQ enters into this coordination picture whenever issues are exceeding the AFRO geographical caption and extends to other areas such as monitoring the outbreak of poliomyelitis in Sudan and its impact on the NIDs in the northern provinces of DRC. WHO s Role to Save Lives and Improve Public Health in the DRC 3

4 In the framework of regional coordination, and because of the absence of donor, NGOs and regional UN structure in Brazzaville, WHO has created a post of HAC Focal Point in Nairobi where all structures dealing with the Great Lakes are located. The Focal Point for the Great Lakes Region is also the support and surge reserve of the country office in DRC. The WHO Regular Budget for the biennium for DRC is USD 3,450,000, out of which around 1.5 million are earmarked to sustain WHO office in the country. The balance (around 2 million/biennium) is spread over 13 programmes extending from disease surveillance to control of communicable diseases, women s health, mental health, essential drugs, etc. The implementation of these projects is on-going. This RB is supported by around 13 million for the biennium from extra budgetary funds earmarked for special programmes like polio eradication (around 9 million) and combating HIV/AIDS and TB (around one million each). All other programmes are severely under-funded. In addition, WHO received limited support from Finland for addressing Gender-Based Violence (GBV), from OCHA to tackle the outbreak of typhoid in Kinshasa and from ECHO to strengthen coordination and support health transition to development. All these projects are ongoing. IV. COORDINATION ISSUES a) Re-establishing (or reforming) the MSP at central level, currently under way with the reform of governmental structure and civil service. However the reform at provincial levels should complement it. This is especially applicable in the eastern region where the re/unification has just started. Meanwhile, coordination, particularly with NGOs, will be needed at provincial level. b) Coordinating assessments of damaged health services and to link these assessments with a clear response to avoid waste of time and resources. c) Coordinating the delivery of essential health packages in priority areas. d) Responding to disease outbreaks such as the ongoing cholera, typhoid and plague outbreaks. e) Bringing technical guidance and coherence in cross cutting issues like human resources, Sexual and Gender-Based Violence, HIV, environmental health and quality control of essential drugs brought in by various actors. f) Using health as an issue to promote dialogue and reconciliation and the functioning of civil society, within a wider peace-building context. V. COORDINATION TOOLS 1) Discussion, meetings and video or teleconferencing; 2) Dissemination of guidelines protocols and assessment reports; 3) Exchange of information through agencies and UN-wide electronic media (Web sites and s); 4) Emergency library kits (140 guidelines and books on health in emergencies). WHO s Role to Save Lives and Improve Public Health in the DRC 4

5 VI. INDICATORS Health coordination meetings will be regularly held in five sub-offices and in Kinshasa; WHO and MOH guidelines will be available to all actors through WHO network of suboffices in the country; Reference scientific material will be available in mini-libraries in three provinces, some key districts (HZ) and in Kinshasa; Regular health situation reports covering all accessible provinces of DRC especially affected population are dispatched from the field to the WHO Representative office in Kinshasa, WHO Regional Office for Africa (AFRO) and WHO Headquarters, and then made public on the Internet; Potential health threats/outbreaks are identified in a timely manner and addressed through efforts of all humanitarian actors. VII. ACTIVITIES a) Recruitment of four international Public Health Coordinators to be fielded in Bunia, Bukavu, Goma, Kindu and Kissingani (Kinshasa is covered by ECHO funding); b) Induction briefing and training on key coordination issues; c) Provision of coordination equipments (PC, IT tools and Emergency Library Kits); d) Provision of additional logistics (moss compliant motorbikes and vehicles); e) Technical support and material from AFRO and Headquarters. WHO s Role to Save Lives and Improve Public Health in the DRC 5

6 VIII. LOGICAL FRAMEWORK Intervention Logic Objectively Verifiable Indicators Sources of Verification Risks and Assumptions Overall Objectives To save lives and reduce avoidable morbidity through coordinated public health interventions More targeted and cost effective actions through better information management and strengthened disease surveillance Morbidity and mortality figures shred with actors Health system information available Project reports (interim and final) Commitment of all stake holders (MOH, Donors and NGOs) Logistics currently in place continue to be provided by agencies UNHCR, WFP and MUNOC planes. Continuation of commercial flights No dramatic worsening/resurrection of the conflict Specific Project Purpose Decentralized public health sub offices in five locations in four provinces and in Kinshasa Supporting existing surveillance and health information system in order to track patterns of and respond to lifethreatening diseases among those at risk Identification and enabling the filling of critical gaps in the public health sector (e.g. response to disease outbreaks, environmental health, malaria, nutrition, chronic disease management, mental health and GBV) Offices in place b y June 2005 Guidelines, standards and protocols agreed upon by all actors Disease surveillance information analyzed Health assessment undertaken to identify gaps Inception and Progress reports Health situation reports MOH, NGOs and donor reports Assessment reports See above

7 Outcome : Health needs are identified, monitored and coordinated 1.1 Health sector represented in all relevant humanitarian coordination forae in four affected provinces and in Kinshasa. 1.2 Monitoring systems in place, including health activities (MIS), disease and nutrition surveillance ; 1.3 Capacities to conduct rapid health assessments in place Number of health coordination meetings Evidence of follow-up on joint decisions Number of reporting sites and estimated coverage Number of assessment teams Number of assessments undertaken Morbidity and mortality by all communicable diseases Minutes circulated Reports MIS Reports from NA Monthly provincial health reports Humanitarian coordination platforms established by the UN throughout the country remain in place Security and general conditions of access do not deteriorate dramatically Activities Deploy adequate staff in the field Procure and distribution of health library kits Monitor situation of communicable diseases Provide and distribute Guidelines, protocols and policy documents Number of staff deployed in the field Number of EHL kits delivered IT equipment purchased and distributed Training courses and induction briefing conducted Staff contracts Minutes of IA meetings Reports on reception of Emergency health libraries see above Logistic facilities provided donors and UN remain available

8 IX. BUDGET Title Planned RB + OS (USD) Due Date Expense Type By Whom Decentralized Public Health Presence 1,691,866 WHO public health presence decentralized 1,205,000 TYP focal point in Goma established 51,000 Recruitment of EHA TYP PH Coordinator DONORS Recruitment of two national support staff 24,000 Apr-05 LCS RO/WR Recruitment of one national drivers 12,000 Apr-05 RO/WR Purchase of two moss compliant cars Jan-04 RO/WR Two computers (one desk top and one labtop) 10,000 RO/WR Office rental, furniture and running costs Guest house rental and running costs (only running costs since the rental is ensured) 5,000 Apr-05 RO/WR WHO presence in Ituri (Bunia) established 377,000 Recruitment of EHA PH Coordinator 140,000 Jun-05 RO/WR Recruitment of three national support 36,000 Apr-05 LCS RO/WR Recruitment of one national drivers 12,000 Apr-05 RO/WR Purchase of two moss compliant cars 80,000 Jul-05 RO/WR One ICT kit 80,000 S&E Office rental, furniture and running costs (present office outside security coverage) 12,000 May-05 RO/WR Guest house rental and running costs 12,000 Apr-05 LCS RO/WR Local travel (to Goma by commercial flights available 4 times /week) 5,000 Apr-05 LCS RO/WR WHO presence in Kissingani established 260,000 Recruitment of EHA PH Coordinator 140,000 Jun-05 RO/WR Recruitment of three national support 36,000 Apr-05 LCS RO/WR Recruitment of two national drivers Jan-04 RO/WR Purchase of two moss compliant cars (4 vehicles are available. One need repair) Moss compliance of some cars needed. Two motorbikes to be purchased 30,000 Jul-05 RO/WR Two ICT kits (telecommunication present but needs some upgrading 20,000 Apr-05 S&E RO/WR Office rental, furniture and running costs (present office not responding to security requirements) 12,000 May-05 RO/WR Guest house rental and running costs.(hotel available and recommended by FSO) 12,000 Apr-05 LCS RO/WR WHO s Role to Save Lives and Improve Public Health in the DRC 8

9 Title Planned RB + OS (USD) Due Date Expense Type By Whom Flight to Goma and Bonia by commercial flights 10,000 LCS RO/WR WHO presence in Kindo established 325,000 Recruitment of EHA PH Coordinator 140,000 Jun-05 RO/WR Recruitment of two national support 24,000 Apr-05 LCS RO/WR Recruitment of two national drivers 24,000 Apr-05 RO/WR Purchase of one moss compliant cars 40,000 Jul-05 LTS RO/WR One ICT kits 80,000 Apr-05 STC RO/WR Office rental, furniture and running costs Jan-04 LTS RO/WR Guest house rental and running costs 12,000 Apr-05 LCS RO/WR Internal flights 5,000 May-05 LTS RO/WR WHO presence in Bukavu established 192,000 Recruitment of EHA PH Coordinator 140,000 Jun-05 RO/WR Recruitment of one national administrator 12,000 Apr-05 4 RO/WR Recruitment of two national drivers (5 available) Jan-04 RO/WR Purchase of one moss compliant cars 40,000 Jul-05 STC RO/WR Two computers Laptop and desktop May-05 S&E RO/WR Office rental, furniture and running costs Jan-04 RO/WR Guest house rental and running costs Jan-04 4 RO/WR Transport costs EHA management in Kinshasa strengthened 246,000 Upgrading management capacity of EHA/Kinshasa 196,000 Purchase of one vehicle 40,000 Recruitment of national support staff 36,000 RO/WR Local coordination costs 10,000 RO/WR Transport costs(flights to provinces ) 10,000 Apr-05 LTS RO/WR Recruitment of information/communication offices 100,000 May-05 STC Technical assistance for areas of public health gaps 50,000 Project Management, Monitoring and Reporting 145,100 Subtotal 1,596,100 PSC at 6% Total 95,766 1,691,866 WHO s Role to Save Lives and Improve Public Health in the DRC 9