Baptist community in northern Congo (CBCN) Health project

Background:
Bas Uele is a region in the Oriental province in the northern part of the Democratic Republic of Congo. The population of the region is approximately 731.000, and the density of the population is less then 10 per square kilometre. Most of the area is covered by rainforest. People live from farming, fishing and hunting. In spite of some diamond and gold mining, this area is considered the poorest part of DR Congo.
CBCN runs twelve health centres and one hospital in Bas Uele, and NORAD has supported this work for many years. The period of the present health project is from 2006 till 2010, and a half time evaluation was planned for 2008.

Purpose/objective:
To evaluate the project according to plans and goals and to propose changes for the last two and a half years of the project period if necessary.

Methodology:
Background documents were read and five health structures were chosen for a visit, based on geographical accessibility, the time available and variations in size and quality level. The following were done during the visits:
Checking the statistical figures, dialogues with the personnel in the different centre,
dialogues with the members of health committees (CoSa) and the Community
contacts, observations of the patients, meetings with the chief consultants in health districts, dialogues with the local coordinating committee and the project coordinator from BUN.

Key findings:
Bas-Uélé is an area often neglected by the Congolese authorities and the NGOs intervening in the region are few. On this background the medical services offered by the CBCN institutions are very important for the public health.
The project undoubtedly improves the medical situation in the Bas-Uélé area and especially for its target groups (mothers and children).
Nevertheless, the standard of care given by the centres in the project is very variable and there is need for improvement concerning medical competence, equipment and management.
It is also necessary to improve the function of the coordinating committee

Recommendations:
The coordinating committee of the project seems to be a weak point. To improve the situation we propose:
All the members of the committee must have a written "job description" and the qualifications (or profile) to be named supervisors must de defined.
Supervision of the centres must be regular and systematic, if possible each three months (by one of the qualified members of coordinating committee). Standard reports should be worked out after each visit so that all-important information arrives at coordinating office for the "monitoring" of the project.
The Coordinating committee must organize regular meetings and working sessions to discuss and dissolve problems related to the project and to take part in the meetings with other partners.
Our proposals may ask for a reinforcement of competence in the coordinating committee and also a more effective use of the existing personnel.
It should be made sure that in all the centres, the person in charge of management and storage of drugs understands how to manage the medical products (secure storage with protection from sun, heath and humidity, monitoring the stock etc...).
It should be made sure that the persons in charge in each centre understand how to fill in the statistics correctly and what the statistics give as useful information to evaluate the activity in each institution.
To make sure that there is a good cooperation between a health centre and its population concerned, it is of great importance that the COSAs are active and that they actually represent the people
If possible, malaria diagnosis should be confirmed by blood smears.
The health centres should be supplied with vaccination cards and standard health charts used for pre-natal consultations
We also propose to re-view the criteria to fulfil in order to get a free mosquito net
There are national protocols for handling of different common infectious diseases, and it is important that the CBCN nurses know them and follow them. (For example for malaria, respiratory infections, sexually transmitted infections and gastroenteritis.)
The activities on prevention of STD/AIDS are weak, sporadic and must improve much to make it possible to reach the objectives of the project.
It will be necessary to define a common strategy, a well defined program which specifies which topics should be covered and which are the target groups (for example schools, the parishes, youth clubs, tradesmen, mines...) Three nurses are trained for this work and their competence should be used efficiently and regularly. In addition the follow-up and more recycling of health personnel on the topics are desirable.
In addition, it is necessary on the one hand, to multiply the volunteer community health agents/contacts ("relais communautaires") and on the other hand, to ensure their education (for example in the form of seminars).

Even if it will be necessary to improve certain sides of the project , there is no doubt that it plays an important role in offering this population its basic right to medical care and health
If external finances is brought to an end after 2010, the health centres will not survive - especially not in the poorest regions of the Bas Uele.
We propose therefore that the NORAD/UBN continue to finance this project also after 2010 given that the CBCN respect the intentions of the project and show ability and will to resolve the problems recovered during this evaluation.
The size and the duration of this financing must be studied further, but the CBCN should take a larger responsibility for financing the project after 2010

Comments from the organisation, if any:
In February 2009 the recommendations were taken into consideration, and new plans and working documents were worked out according to the suggestions.