CORE Group Global Health Practitioner Conference Fall 2017

1. Positioning iCCM
to the
National Priorities
THE EXAMPLE OF THE DRC
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Serge Raharison, September 2017
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2. Under-Five Mortality Rate (per 1,000 live births)
NeonatalMortalityRate(per1,000livebirths)
Fig. Non-newborn vs. Under-five deaths in top 12 high mortality
countries, 2015
Context
• Pop. 85,026,000 [2015]
• Extreme challenges in
accessibility to health
care
DATA FROM:
http://www.childmortality.org/files_v20/download/IGME%20report%202015%20child%20mortality%20final.pdf
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3. iCCM in the Health System
Healthsystem
MOH Central
Province
Health Zone
Norms and regulations
 University and Research Hospitals
26 Decentralized Ministries
 Provincial Hospitals
516 Health Zones ~ 100,000 – 150,000 hab
 General Referral Hospitals
8,504 ‘Aires de Santé’ ~ 5,000 – 10,000 hab
 Health Centers
 iCCM sites
13 Technical Directorates
+ 52 National Programs
55 urban
461 rural
8,266 functional
11 new
since 2015
393 functional
6,968 existing
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4. Evolution of iCCM in the DRC
Dec 2005 Sept 2010 Early 2014 Dec 2015 Sept 2016 July 2017
iCCM sites 12 1,117 1,197 5,451 5,551 6,968
Pop covered 10,869 1,962,379 -- 7,727,556 -- 10,179,461
Implementing HZs 1 94 119 326 327 402
Eligible HZs -- -- -- 461* 461* 461*
Existing HZs 515 515 515 516 516 516
*The MOH determined that 55 urban HZs should be covered exclusively by health facilities
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5. Current coverage and implementing partners
Situation as of July 2017
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6. A National Health Plan as a Framework for Planning
PNDS
2016-2020
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7. A National Health Plan as a Framework for Planning
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8. A Child Health Plan to Guide iCCM
1. Skills of providers
“IMCI” Strategic Plan [2017-2021]
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9. 2. Family and community practices
8,000 additional iCCM sites
to cover 70% of the
country’s need
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10. 3. Health system
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11. 4. Coordination
vs. PNDS total 5y budget of ~US$ 6,607,493,422

12. Where Things Happen : OPERATIONAL PLANS
Health Zones [and Provinces]
Strategy and activity Indicators Timeline and target Cost Funding Sources
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13. Tracking progress through routine data
• Sample iCCM-related data captured
on DHIS2
How many promotional relais are there?
How many iCCM sites are functional?
What services are they providing?
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14. Tracking progress through routine data
• Sample DHIS2 report: Cases seen by CHWs in first semester of 2017
Period [# sites reported]
Diarrhea Pneumonia Fever
# cases seen
# treated
according to
protocol
# cases seen
# treated
according to
protocol
# cases seen
# treated
according to
protocol
Jan 2017 [5,826] 24,734 22,284 17,791 15,649 115,329 89,967
Feb 2017 [5,827] 24,112 23,005 18,547 16,555 108,949 82,614
Mar 2017 [5,941] 25,481 22,408 19,562 17,259 112,084 82,676
Apr 2017 [6,067] 25,186 22,239 17,317 14,514 116,862 89,814
May 2017 [6,189] 27,407 23,877 18,148 16,075 122,952 93,559
Jun 2017 [5,963] 27,456 25,122 18,726 17,050 119,577 89,092
TOTAL 154,376 138,935 110,091 97,102 695,753 527,722
– Completeness for Jan-March 2017 is 86.3% for basic service
[as of Sunday Sept 17, 2017]
– 21/26 provinces [i.e. 80.7%] have at least 80% completeness
– The last province (Tshuapa) has 50.5% completeness 14
Average Jun 2017 [per site] 4.60 -- 3.14 -- 20.05 --

15. This used to
be the system
Kenge, Bandundu,October 2010
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16. Future of iCCM in the DRC
1. The DRC has no other option but to continue iCCM in the next 5 years, and
undoubtedly beyond.
2. The DRC understands that planning, implementing and monitoring iCCM
program should be done in an integrated and coordinated manner, and has
developed the strategy to do so.
3. However, political instability, complexity of government’s structure, geographical
barriers and poor infrastructure make it extremely challenging.
4. The DRC has a decentralized system but the HZs and the provinces have often
very limited resources and human capacity [particularly the new ones]
5. DHIS offers a powerful platform to collect, analyze and use data for program
monitoring and management. It still is facing major challenges.
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17. For more information, please visit
www.mcsprogram.org
This presentation was made possible by the generous support of the American people through the United States Agency for
International Development (USAID), under the terms of the Cooperative Agreement AID-OAA-A-14-00028.The contents are the
responsibility of the authors and do not necessarily reflect the views of USAID or the United States Government.
Merci
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