Category Archives: DRC

Congo Healthcare Initiative

6 April – The British government has announced a major new programme aimed at providing essential healthcare to six million people in the Democratic Republic of Congo (DRC). The five-year, US$270.7 million project will focus on rebuilding health facilities, training health workers, and supplying drugs and equipment.


Civil war has destroyed much of the country’s health infrastructure, as well as the road networks and vital services such as electricity, meaning patients often have to travel long distances to health centres that may not be equipped to handle their complications.

IRIN has put together a list of five health issues in DRC that require urgent attention:

Maternal and Child Health
 –
DRC’s maternal mortality ratio is 670 deaths per 100,000 live births, with an estimated 19,000 maternal deaths annually. The country has a severe shortage of health workers – less than one health professional is available per 1,000 people. 

With 170 out of every 1,000 children dying before they reach the age of five and 10 percent of infants underweight, DRC has one of the worst child health indicators in the world. It is one of five countries in the world in which about half of under-five deaths occur. Some of the biggest killers of children are diarrhoea, malaria, malnutrition and pneumonia.

Sexual violence – Several studies report high levels of sexual violence perpetrated against women, children and men in DRC, both by armed groups and within the home; one study, conducted in the North and South Kivu and Ituri in 2010, found that 40 percent of women and 24 percent of men had experienced sexual violence. 

Between the stigma of rape and the dearth of decent health services in DRC, sexual violence often leaves survivors injured, infected with sexually transmitted illnesses and severely traumatized. Some of the main requirements are first aid and trauma services, counselling, diagnosis and treatment of sexually transmitted infections, HIV post-exposure prophylaxis and access to contraception.

During a recent visit to eastern DRC, UK Foreign Secretary William Hague announced $312,110 in new funding to support the NGO Physicians for Human Rights, which works at Panzi Hospital in South Kivu Province, “to help efforts to develop local and national capacity to document and collect evidence of sexual violence”.

Diarrhoeal diseases – The consumption of unsafe water is one of the main causes of the diarrhoeal diseases – such as cholera – that infect and kill children and adults in DRC. A cholera epidemic that started in June 2011 has infected tens of thousands and killed more than 200 people. In the capital, Kinshasa, which has been hit by the epidemic, less than 40 percent of people have no access to piped water. According to the UN Children’s Fund, UNICEF, 36 million people in DRC live without improved drinking water, and 50 million without improved sanitation.

Some of the measures to boost access to safe water and sanitation include hygiene awareness campaigns, rehabilitation of water supply and of sanitation facilities, disinfection of contaminated environments, chlorination of water, and distribution of soap.

Immunization – Despite the existence of an effective vaccine for measles at a cost of roughly $1 per vaccine, the disease is one of the leading killers of children in DRC. According to the Global Alliance for Vaccines, 20-30 percent of children in DRC do not have access to immunization. Some challenges to universal vaccine coverage include the poor road network, the size of the country (DRC is Africa’s second largest country), unreliable electricity for vaccines that require refrigeration, and low awareness within the population.

HIV – More than one million people in DRC are living with HIV; 350,000 of these qualify for life-prolonging antiretroviral drugs, but only 44,000 – or 15 percent – are actually on treatment. Just 9 percent of the population knows of their HIV status, largely because of low awareness, but also because of a shortage of facilities – for instance, only one laboratory in the country is equipped to carry out polymerase chain reaction tests for early infant diagnosis.

Just 5.6 percent of HIV-positive pregnant Congolese women receive ARVs to prevent transmission of HIV to their babies; according to government figures, the mother-to-child transmission rate is about 37 percent.

Humanitarian agencies have called on the government and donors to urgently boost funding for HIV prevention, treatment and care.

[Courtesy of IRIN]

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Congo: M23 Rebels puts 200,000 children at risk

 

The arrival of M23 rebels in the eastern Congolese city of Goma on 20 November, has triggered widespread concern over the humanitarian ramifications in a region already beset by armed conflict, widespread displacement and attacks on civilians.

Fighting around the city led to the cancellation of a humanitarian assessment mission in North Kivu  Province – of which Goma is the capital – scheduled for 19 November.

Rebel spokesman Vianney Kazarama broadcast a message to the city telling residents to carry on with their normal activities, saying M23 was there for their security. He provided his own phone number and that of two intelligence officers for citizens to call if they had any concerns.

Kazarama also called on government soldiers and police to assemble at a stadium on 21 November for an identification process.

Goma resident Jean Baptiste Musabyimana told IRIN that M23 appeared to be in control of Goma. “We can see the M23 patrolling the main road that runs through our neighbourhood,” he said.

Another resident, Florentin Baruti, told IRIN that in Bwirere District, where fighting took place on 20 November,  most people were still indoors but that some young men were in the streets to see what was happening.

“It’s a relief that the fighting ended quite quickly,” said Baruti, “but we’re worried about the possibility of a counter-attack by the FARDC [government forces].”

One of the main concerns of humanitarian agencies in the region relates to the 60,000 residents of the Kanyarucinya camp for internally displaced persons (IDPs) to the north of Goma shortly before M23 reached the outskirts of the town. The camp is one of five dotted around Goma, which have a combined population of around 95,000.

“One problem is that many displaced families were split up on Monday [19 November] as they tried to get away from the fighting,” said Tarik Riebl, Oxfam’s coordinator in Goma. “When we talk to people they say they don’t know where some of their family members are.”

He added: “For the moment food is one of the main needs, and another is non-food items, such as water containers and other household items, and shelter. There needs to be a distribution of these items.”

Displaced children at risk

The Internal Displacement Monitoring Centre (IDMC) and the Norwegian Refugee Council (NRC) warned that displaced children now “face an increased risk of rape, abuse and recruitment.”

“What we are seeing now is that fighting between the rebel group and the army is displacing the displaced again, stretching the coping abilities of an already exhausted community,” Sebastian Albuja, the head of IDMC’s Africa department, said in a statement.

“Internally displaced children and specifically boys in North Kivu are at particular risk of being recruited by a variety of armed groups,” said Olivia Kalis, policy and advocacy adviseor for the NRC country office.

“IDPs are locking up or hiding their children, fearing attack and forced recruitment with girls and boys taken by armed actors,” she said.

Another NGO, World Vision, expressed similar concerns, putting the number of at-risk children in Goma alone at 200,000.

“Spontaneous camps for displaced families have been forming around Goma as communities flee to safety. Through its partners, World Vision is receiving reports that in the confusion, children are getting separated from parents – and the implications of this are devastating,” the agency said.

“We know from the recent practices of the groups involved in this latest fighting that unaccompanied children in this part of DRC are in immediate and real danger of forcible recruitment into armed groups,” said World Vision’s Dominic Keyzer, from the Rwandan border town of Gisenye.

Keyzer added that the violence had impeded humanitarian response and that World Vision has had to suspend some life-saving programmes in eastern DRC.

Widening insecurity

The International Crisis Group (ICG) said the government’s “capitulation to the M23 could send shockwaves throughout the Kivus and relaunch open warfare between the DRC and Rwanda” – which has been accused of backing the rebel movement, a charge it denies.

The ICG also warned that the fall of Goma might lead to the settling of scores “or even targeted extrajudicial executions against authorities and civil society activists who have taken a stance against the M23 since the beginning of the crisis”.

The neighbouring province of South Kivu “is also affected by the deteriorating security situation which threatens thousands of civilians and has led to the suspension or reduction of humanitarian activities in the area”, according to the UN Office for the Coordination of Humanitarian Affairs (OCHA).

“South Kivu has been severely affected by repeated clashes between various armed groups and between armed groups and the Congolese army since mid-October. Several villages have been attacked over the last few weeks, triggering the flight of more than 30,000 people, while more than 300 houses have been destroyed or burned in these attacks. The current violence, primarily in the Kalehe and Shabunda territories, has reportedly killed more than 160 people in the past 10 days and led to serious human rights violations. Inter-communal tensions have compounded the situation,” OCHA said.

There are more than 1.6 million IDPs in the two Kivu provinces.

Courtesy IRIN News

DRC: Mother-to-Child HIV transmission – “Catastrophe”

 

KINSHASA, 24 April 2012 (PlusNews) – Poorly integrated maternal health services, a lack of human resources and a serious shortage of money for treatment mean the Democratic Republic of Congo (DRC) is unlikely to meet the global plan of eliminating mother-to-child transmission by 2015.

“It is a catastrophe. An HIV test during antenatal visits is not automatic – the information may be given but the tests may not be available, or the treatment may not be available,” said Thérèse Kabale Omari, the director for Kinshasa Province of Femme Plus, an organization that works with women living with HIV in seven provinces of the DRC.

Only one laboratory in the country is equipped to carry out polymerase chain reaction tests for early infant diagnosis. “When an HIV-positive mother has a baby in [the southern province of] Kasai-Occidental, the centre must send the sample to Kinshasa, the capital of DRC. Getting results back can take weeks, and these women often don’t live near the health centre,” Omari said.

According to 2011 government statistics, just 5.6 percent of HIV-positive pregnant Congolese women receive ARVs to prevent transmission of HIV to their babies, but the official estimate puts the mother-to-child transmission rate at 36.8 percent.

A nationwide shortage of life-prolonging antiretroviral (ARV) drugs after the closure of some HIV projects and reduced funding for others means Omari is often forced to negotiate with doctors for HIV-positive women to be accepted in local treatment programmes. “I have to plead with them to prioritize pregnant women when someone dies or drops out off treatment,” she said.

“If you help someone to find out their HIV status, then you should have a way to treat them if they test HIV-positive, but today we can’t give women that assurance,” Omari noted. Dr John Ditekemena, country director of the Elizabeth Glaser Paediatric AIDS Foundation (EGPAF), says while the DRC has strong policies and strategies for fighting HIV, and for the prevention of mother-to-child transmission (PMTCT), a severe lack of resources means they cannot be fully implemented.

“A main problem is coverage – many pregnant women who are tested will not return to the same facility for delivery. The DRC is a huge country with very limited resources – human resources, logistics, problems with the supply chain coordination – and the disastrous situation of the health infrastructure mean we won’t be able to reach the goal of eliminating mother-to-child transmission by 2015,” he said.

Femme Plus’s Omari noted that ‘free’ treatment was rarely completely free. “For example, the HIV test may be free, but you have to pay for the patient card, for the syringe they use if you need some treatment, for transport – the costs add up and few women can afford them,” she said.

Mariam, in her 20s, was diagnosed with HIV while she was pregnant a year ago, but has not started on ARVs because she cannot afford the US$15 it costs to get a CD4 test, which measures immune strength. She has since had her baby but the child has not been tested for HIV.

Mariam’s husband travelled to the southeastern city of Lubumbashi shortly before she was diagnosed and has not returned. She suspects he has left her and their children for good. To make ends meet, she sells plastic bags of drinking water on the streets of Kinshasa, the capital, but the money she makes is barely enough to feed her family, let alone pay for health care.

“I have not been tested and I think I am getting sick because I have noticed an itchy rash all over my arms recently,” she told IRIN/PlusNews. “I have two other children who are healthy but the baby gets sick often – I am worried.”

EGPAF and its partners, under a project known as Projet Intégré de VIH/SIDA au Congo – Integrated HIV/AIDS Project (ProVIC) – supported by the US President’s Emergency Plan for AIDS Relief (PEPFAR), are assisting 24 maternal health facilities in five provinces of the DRC. Separately but also funded by PEPFAR, EGPAF is supporting 53 sites in Kinshasa and 17 in Lubumbashi as part of the “Malamu” project – meaning ‘good’ in the local Lingala language – to accelerate the pace of PMTCT in the DRC.

“The idea is to have a network of sites where women can receive the full package of PMTCT services, which will help improve coverage,” said Ditekemena, adding that the project was working to build up other areas of PMTCT such as male involvement and counselling on infant feeding.

“If you invite 100 women to the antenatal clinic with their husbands, only 10 or 12 will show up – we are extending the hours of service to allow men to come in after work or at the weekend,” he added. “Mother and infant follow-up is difficult if she is not counselled properly, especially if she does not have a support system around her – spouse, family, community.”

The ProVIC project aims to see 50,000 pregnant women tested for HIV and get their results in 2012, while the Malamu project aims to test 30,000 women.

“Slowly, step by step, we can increase coverage and improve the quality of care,” said EGPAF’s Ditekemena. “Perhaps by 2019 we will have eliminated mother-to-child HIV transmission in the DRC.”

[Courtesy of IRIN News]

DRC: HIV/Aids Funding Crisis

The lives of thousands of HIV-positive people in the Democratic Republic of Congo (DRC) are at risk as the country faces declining donor funding and a severe shortage of HIV treatment, according to Médecins Sans Frontières (MSF).

MSF recently launched a year-long advocacy campaign to raise awareness of the DRC’s HIV crisis.

“The problem is quite old in the DRC; the country has always been minimized by donors who have not seen it as a priority, mainly because HIV prevalence is relatively low at between 3 and 4 percent,” Thierry Dethier, advocacy manager for MSF Belgium in the DRC, told IRIN/PlusNews. “But look at the indicators: more than one million people are living with HIV, 350,000 of whom qualify for ARVs [antiretrovirals] but only 44,000 – or 15 percent – are on ARVs.” 

Dethier said the main reason for the ARV crisis was the end of six years of World Bank funding in 2011. International health financing mechanism UNITAID, which provides funding for paediatric and second-line ARVs, is also ending its funding to the DRC in December 2012; the cancellation of Round 11 funding by the Global Fund to fight AIDS, Tuberculosis and Malaria is only likely to worsen the situation.

Seventy-five percent of HIV funding in the DRC is from the Global Fund, 25 percent is from UNITAID through the Clinton Health Access Initiative – which provides funding for paediatric ARVs and second-line ARVS – and from the US President’s Emergency Plan for AIDS Relief (PEPFAR), which funds prevention of mother-to-child HIV transmission.

“The country is currently using funds from round seven and eight of the Global Fund; these funds are due to be consolidated but have also been cut – round seven by 30 percent… round eight may also be cut,” Dethier said. “We expect that the consolidated funds will last through 2014, after which there is no funding for DRC.”

The DRC did not qualify for funding under the Global Fund’s ninth and 10th round.

According to the director of an NGO in the capital, Kinshasa, who preferred anonymity, funding problems mean many of his patients’ lives are at risk.

“In Kinshasa alone we have shut two out of the three health centres we used to run, a situation which leaves us [caring] for only 1,800 out of 3,000 people living with HIV,” he told IRIN/PlusNews. “Today we are running the one remaining health centre for HIV-positive people by charging each of them US$5 per month.

“When the funding was available patients could come for checking whenever they were feeling unwell… we do give them treatment but today we receive them once a month unless their health condition has deteriorated,” he added. “We are now appealing to the government to intervene in filling the gap that Global Fund is leaving in funding interventions for people living with HIV.”

Dethier noted that there were also problems with HIV testing. “Since there is no treatment people feel it’s pointless to test,” he said. “As many as 15,000 people have tested HIV-positive and qualify for treatment but are not receiving it,” he said.

The Global Fund says it is reviewing a request for continued funding, and no life-saving programmes will be cut as a result of funding shortages.

“In terms of future additional funding, Round 11 was cancelled and replaced by a transitional funding mechanism that will allow countries to apply for funding for essential services for continuation of prevention, treatment and/or care services currently financed by the Global Fund,” said Marcela Rojo, Global Fund spokeswoman. “Countries that face significant programme disruption between January 1 2012 and March 31 2014 may apply for up to two years of funding.

“This means that no recipient will be forced to suspend any essential services as a consequence of the round 11 cancellation,” she added.

According to Rojo, with Phase 2 funding, the country aims to scale up treatment to 67,000 people by end-2014.

MSF’s Dethier noted that other donors would have to step up their funding.

“With funding from the Global Fund, only 15 percent of people have access to ARVs, so we need others to contribute and we need the existing partners – UNITAID and PEPFAR – to honour their commitments to the people they are already supporting and to expand their programmes,” he said. “The government aims to have 160,000 people on ARVs by 2014, which means putting roughly 3,500 people on ARVs per month – with money, this can be done.”
[Courtesy IRIN]

Cholera, Measles Kill Hundreds:DRC

Outbreaks of measles and cholera in parts of the Democratic Republic of Congo have killed hundreds of people, with thousands more infected, says an official of the UN World Health Organization (WHO).
“Since September 2010, 115,484 measles cases and 1,145 related deaths have been reported in South Kivu, Katanga, Maniema, Kasaï Occidental, Equateur, Bas Congo and Kasaï Oriental provinces,” Tarik Jasarevic, a WHO media and advocacy officer, told IRIN.

According to Jasarevic, a lack of government funding halted follow-up mass immunization activities in the regions, leading to the measles outbreak.

Close to six million children were vaccinated in the most affected areas in April and May, but the epidemic spread to other provinces not covered in the immunization campaign.

Mass immunization campaigns are planned. At least 915,000 children in nine provinces are targeted for vaccination in the first two campaigns scheduled for July.

WHO and the UN Children’s Fund (UNICEF) are seeking an additional US$9 million to carry out these two campaigns in September and the first semester of 2012.

Measles is a highly contagious viral disease, preventable by immunization. It can cause complications such as blindness, encephalitis (inflammation of the brain), severe diarrhoea, ear infections and pneumonia.

Cholera 

Some 1,449 cholera cases and 74 deaths have also been recorded since March in Kisangani, Orientale, with the outbreak spreading along the Congo River to Bandundu and Equateur provinces and to Kinshasa, the capital, Jasarevic said. As of 8 July, 3,245 cholera cases had been reported with 192 deaths.

The International Federation of the Red Cross (IFRC) is supporting the DRC Red Cross in hygiene promotion activities in the affected provinces, according to a 13 July report by the UN Office for the Coordination of Humanitarian Affairs (OCHA).

The health ministry and partners are also setting up water chlorination points and providing free cholera treatment to contain the outbreak, said Jasarevic.

Cholera is an acute intestinal infection caused by the consumption of food or water contaminated with the bacterium Vibrio cholerae. Associated diarrhoea and vomiting can lead to severe dehydration and death without prompt treatment.

The DRC is also grappling with new cases of the wild polio virus, with a total of 62 cases recorded by 7 July, according to Victor Makwenge Kaput, the Minister of Public Health.

[Courtesy of IRIN]

Congo: Measles Epidemic

29 March 2011 (IRIN) – A cholera outbreak in Katanga Province is likely to exacerbate the measles epidemic that for the past six months has been sweeping through the Democratic Republic of Congo (DRC). Aid workers warn it is now likely to get out of control and spread from five provinces to the rest of the country.

“Children who contract cholera and haven’t received any inoculations against measles will be more vulnerable to the disease. We need to act quickly to control the epidemic,” Ayigan Koffi, health coordinator of the World Health Organization (WHO) in the DRC, told IRIN.

“We are working on ways to increase and better coordinate the response. If nothing is done, the epidemic is likely to spread further,” Koffi told IRIN.

Measles is a highly contagious infection of the respiratory system that is only preventable by vaccination and can be fatal in children if not treated. According to Médecins Sans Frontières (MSF) data, measles can kill between one and 15 percent of un-vaccinated children who contract the disease and up to 25 percent of malnourished or vulnerable groups with limited access to healthcare.

WHO says the total number of cases since the beginning of the year has reached 6,524 cases, with 33 deaths.

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