by Virginia Thomas
A clinic started by Lemba Imbu School near Kinshasa, DR Congo.
While the battle rages in the US about how to provide health coverage for all in the richest country in the world, the issue seems even more pressing for the poorest. The Democratic Republic of Congo’s (DRC) health indicators are among the worst in the world and reflect the hardships resulting from many years of civil war, continuing conflict in some regions, high levels of government corruption and the deterioration of health services throughout the country. Malaria, tuberculosis and HIV/AIDS take a high toll on both human and economic resources. One out of six children dies before their fifth birthday and chronic malnutrition affects both educational performance and individual productivity. The synergistic effects of malnutrition and disease are currently shape the lives of most young children in the DRC.
The Right to Healthcare: Are we going backwards?
The lack of government capacity for and commitment to healthcare for all means that DRC’s health situation is worse today than it was in the 1990s. From 1990 to 2004 infant mortality went from 96 to 129 cases per 1000 live births, while the TB prevalence rate went from 226 to 551 per 100,000. Maternal mortality was measured at 870 per 100,000 live births in 1990, but went up to 990 per 100,000 by the year 2000. These rates are among the highest in the world and reflect the failure of the government and the international community to bring improvements in healthcare at the grassroots level. It appears that, if communities do not become involved in managing their own healthcare, no one will.
Cost is a major factor
The cost of healthcare is a major barrier to access for ordinary people. Health facilities operating with little or no financial support from the government survive by charging user fees to cover the full cost of treatment. The cost of transport, construction materials and refrigeration of medicines, among other things, render health costs greater in rural areas, so user fees are also higher. This means that the rural poor tend to forgo medical care altogether. In a country where the World Bank estimates the average Congolese lives on $0.20 per day, the price charged by most health providers is too high, and the poorest are the most vulnerable.
Community-based healthcare solutions
Samuel Chapleau visited the Kimpemba Medical School that provides training for nurses, D.R. Congo.
In Susila Dharma DRC there are seven health centres privately run by members that could be turned into Community Health Centres. On October 24, 2009, SDIA team member Samuel Chapleau invited Susila Dharma project leaders in the DRC to meet with Dr. Theophile Bansimba of Médecins D’Afrique (African Doctors) to explore how community health mutual societies and community health management committees, when implemented together, can reduce costs and improve the quality of healthcare and disease prevention in both the rural and urban areas.
‘When community health management committees are twinned with a system of mutual health insurance, the result is cost-effective, quality care,’ says Arnaud Delune, an SDIA Board member who recently met with Dr. Banzouzi of Médecins d’Afrique in Europe. In these arrangements, families contribute small amounts on a regular basis, calculated according to their income. The poorest pay less, the richer more. These contributions entitle families to consultations, care and medicines at reduced prices or free of charge. In addition, school-aged children receive quarterly check-ups with a full medical team (doctor, nurse, psychologist, nutritionist, etc.). Serious cases are referred to a hospital with which the Community Health Centre has signed a cooperation agreement. The partnering of the community health committee with mutual health insurance permits the Community Health Centre to become financially self-sufficient and sustainable within one year.
Lemba Imbu Infirmary on the outskirts of Kinshasa is the first Susila Dharma clinic to agree to work in partnership with Médecins d’Afrique and to ensure community responsibility for the provision of its own healthcare services. SDIA is encouraging other clinics to follow Lemba Imbu’s example. According to Dr. Banzouzi of Médecins D’Afrique in Europe ‘Community Health Centres are the missing element and the platform that is needed to deliver all sorts of healthcare and services to poor communities in Africa.’ For its part, SDIA, in partnership with Médecins D’Afrique, will be working to assist Susila Dharma health projects to create Community Health Centres responsible for the identification of and outreach to the poorest households, and for finding creative and sustainable ways to ensure that even the poorest will be able to access services.
Virginia Thomas
Virginia is a Socio-Economist, Evaluator and Consultant specialising in organisational development, human rights, gender and governance. Virginia works as a researcher with various UN agencies and has been the Executive Director of SDIA since 2007. Virginia lives in Montréal, Canada.