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The Mother-Child Hospital Project in Kinshasa (Promekin) is a core component of the agreement signed at the DRC Ministry of Finance, in the presence of Joas Mbitso-Ngedza, Vice Minister of Finance, Luc Hallade, Ambassador of France, and Christian Yoka, AFD’s Director in Kinshasa.
 

 
Heart surgery in partnership with doctors from the NGO La Chaîne de l'Espoir at the Ngaliema clinic
 

Making healthcare more accessible to the poorest

The health status of the Congolese and the deterioration of the health system are major concerns for the Congolese State.

Infant and maternal mortality rates are among the highest in the world, due in part to the deterioration of healthcare services and the limited financial resources of households. Public hospitals suffer from numerous shortcomings (dilapidated state of infrastructure, lack of equipment and staff, poor quality of healthcare, deficient management, etc.).

However, there are hospitals in Kinshasa that stand out for the quality of their healthcare and their policy for affordable access. This is the case with the Monkole Hospital Center (CHM) and the Ngaliema Clinic. They are both referral hospitals under the responsibility of the Ministry of Health and are a major part of the health system. Indeed, they are providers of high-quality, specialized healthcare (heart, urological and maxillofacial defects) within the health system and act as the key training centers for medical and paramedical students.

Mothers and children a core concern

The project aims to improve the health of the population of DRC, particularly for mothers and children, by developing high-quality healthcare services in hospitals that are accessible to the poorest.

The project will specifically improve the capacities of the Ministry of Health, help develop hospital management skills, improve the healthcare services of two hospitals in Kinshasa that are recognized for their quality and will give the poorest easier access to healthcare in a situation whereby there is a lack of healthcare coverage.

 
Pediatric intensive care at the Monkole Hospital Center
 

Capacity development and partnership with hospital associations

The project will include two complementary components to support:

• capacity development for the Health Establishment Department (DES) of the Ministry of Health for its mandate to supervise the hospital system;
• the development of the Monkole Hospital Center and Ngaliema Clinic by financing the construction and upgrading works, the acquisition of equipment and capacity development activities (technical expertise, participation in workshops and training sessions, small equipment, etc.).

The project will strengthen relations between the Ministry and the two hospitals. This will allow the Ministry to capitalize on the good practices of both hospitals and to implement the hospital reform in them in an exemplary manner.

The project will also contribute to developing feedback between the two institutions.

France welcomes the Government’s commitment to implement reforms. The Promekin project comes in addition to a French Government contribution of USD1.4m for the activities of the World Health Organization (WHO) office in DRC.

France will, through this dual financing, be strengthening the partnership between our two countries, so that we can meet together the twofold challenge of reducing maternal and infant mortality and the health spending of the poorest households.

Cost and financing 

The project cost stands at €24.4m, with €8m financed by an AFD grant for component 2, which is being cofinanced with other partners (notably Spanish and Belgian cooperation), in addition to the mobilization of a loan and advances by CECFOR (Congolese Culture, Training and Development Center).

Main expected outcomes 

The project will contribute to reducing maternal and infant mortality and the health spending of the poorest households.

Moreover, the Ministry of Health will be allocating financing to an association that carries out a public service mandate (Monkole Center). This will be an innovative experience, the success of which will be an essential issue in a country where associations play a major role.

The project will also contribute to the definition of an economic model for hospitals that will guarantee the equity and quality of healthcare services.

The Regional Hospital Center (RHC) is the referral hospital in New Caledonia. This public establishment receives 25,000 patients and 46,000 emergencies every year. It has a capacity of 454 beds and 28 outpatient places spread out over 4 sites, the main one dates back to 1854. The hospital is experiencing a considerable increase in the number of hospitalizations, the occupancy rate and the number of surgical operations. Despite a general effort to upgrade the hospital over the years, all the buildings are now outdated.

One of the largest investments in New Caledonia over the next 10 years

The complete reconstruction of the RHC is scheduled on a single site in Koutio, in the suburbs of Nouméa. This project will be one of the largest investments in New Caledonia over the next decade. It will mobilize all the financial stakeholders. In addition to State support, it has been registered under the French 2012 Hospitals Plan. Médipôle will eventually group together two public facilities – the main Médipôle building, which will gather all the clinical  and medical-technical services of the RHC, and Logipôle, which will group together all the logistics required for the new hospital on one site – and a private facility, the health center for long-term care and rehabilitation.

The construction works are expected to begin by June 2012 and be completed by the end of 2015. Almost all the structural works and part of the finishing works will be conducted by local companies. The construction of the main Médipôle building (the new hospital) is expected to mobilize a total of 600 to 700 people during the main building phase.

A High Environmental Quality hospital

The hospital is certified High Environmental Quality (HQE), will have 645 beds and has been designed to provide 58,000 medical consultations a year. It will have a capacity of 40,000 hospitalizations a year and will include 8 operating rooms, an operating hall and two angiography rooms. Médipôle is currently one of the largest hospital construction projects in France.

AFD’s €40m of financing is in the form of a loan and aims to provide the RHC with part of the resources it will require to finance its share of the investment in the main Médipôle building and in the construction of the Logipôle.

French Guiana has significant needs for healthcare personnel and lacks equipment, particularly for persons with reduced mobility. This stems from the size of the Department (83,534 km², i.e. the size of Portugal), its strong demographic growth (+3.9% a year) and the lack of attractiveness of some areas in the region.

AFD is working to meet the growing needs of the region by promoting investments in the health sector that range from supporting public establishments in their investments (infrastructure and equipment) to financial support to entrepreneurs for their projects for individual services.

Guarantees from the DOM Fund (French Overseas Communities Fund) offered by AFD give entrepreneurs easier access to bank loans to finance their investments and develop their services for communities in French Guiana. Since it was set up in 1999, the French Guiana DOM Fund has supported the implementation of 610 business operations (start-ups, development and transfers) in French Guiana in all sectors.

Examples from the field

Helping a home hospitalization service company consolidate and develop its activity
French Guiana uses home hospitalization more than any other French region. AFD is contributing to financing works and equipment acquisitions that will allow this company to provide quality services and thus participate in improving healthcare coverage needs in the Department. Consult the project brief .

Supporting the transfer of a pharmacy to ensure continued service provision in remote municipalities
AFD’s support is helping the only pharmacy in the municipality of Apatou on the River Maroni to continue and develop its activity. The implementation of this project is helping to improve the social well-being of local communities and is making a positive contribution to opening up remote municipalities in French Guiana.   Consult the project brief.

Supporting the development of a transport company for persons with reduced mobility in order to meet a growing demand for services
AFD is supporting investments to acquire new vehicles made by an SME transport company for persons with reduced mobility. This project aims to allow the company to meet growing demand and to respond to the bid invitations of public authorities. It specifically helps all children go to school, whatever their disability, and reduces the isolation and day-to-day challenges of dependents. Consult the project brieft. 

Around a hundred personalities from different embassies (Japan, Luxembourg, United States, etc.), development partners (notably European Cooperation, Asian Development Bank and United Nations agencies) and ministries (Prime Minister’s Office and Ministry of Science and Technologies) attended the inauguration of the Institut Pasteur in Lao PDR by the Lao Minister of Health, in the presence of the President of the Institut Pasteur in Paris and the Director of AFD Vientiane.

Filling an existing “epidemiological gap”

The decision to create this establishment in Lao PDR came in response to the observation that an “epidemiological gap” existed when, between 2003 and 2005, there were outbreaks of SARS and avian flu and all the countries in the sub-region were mobilizing for the surveillance and control of these emerging and re-emerging diseases. At the time, this highlighted the lack of human, material and financial resources in terms of surveillance, the capacity to address current and emerging public health problems and research.

Health insurance and improving maternal and infant healthcare

The Lao Government therefore called on the Institut Pasteur in Paris and AFD’s support to finance the premises of the Institut under its project to support the Lao health sector. This project was financed by a €7 million grant to extend the national health insurance program, improve maternal and infant healthcare and support the fight against AIDS. This Institut Pasteur is part of the Institut Pasteur network in Southeast Asia (3 in Vietnam, one in Cambodia and now one in Lao PDR).
 

Promoting research and training

The two challenges now facing this institute are to promote a scientific and medical research program, along with the associated high-level training, and to generate and mobilize the financial resources required to make it sustainable. This will allow it to effectively fight against poverty and vulnerabilities and to contribute to socioeconomic development in the country.

The Ministry of Health is planning to set up a scientific hub comprising the Institut Pasteur in Lao PDR, Fondation Mérieux, the National Centre of Laboratories and Epidemiology, Wellcom Trust and the National Center of Malariology, Parasitology and Entomology. It also aims to gradually develop a research activity related to regional public health issues, develop training for students and researchers and promote local and regional partnerships.

"A very important moment in the history of Franco-Lao medical cooperation”

For the former Ambassador of France, Mr. Sénémaud, “This inauguration is a very important moment in the history of Franco-Lao medical cooperation, which has developed considerably in recent years thanks to the operations of a number of public and private stakeholders (...) Agence Française de Développement,  the French Ministry of Foreign Affairs, which is financing an ambitious support program for higher education, as well as the Mérieux and Pierre Fabre Foundations, the Rhône-Alpes Region, the ESTHER Public Interest Group and several NGOs, such as Médecins du Monde, which are doing outstanding work here. We have thus built a cooperation hub around the University of Health Sciences. The Institut Pasteur is its latest component.”

€4.7m of financing secured:

AFD: (construction): €1.6m
Institut Pasteur in Paris (mainly salaries for IP Paris consultants):  €1.1m
French Ministry of Health (microbiology equipment):  €0.3m
Luxembourg (unearmarked use): €1.0m
Private foundations (Nam Theun 2 Health Program): €0.5m
Asian Development Bank (equipment): €0.2m

A cette occasion, nous vous invitons à échanger sur différents thèmes :

• Santé et coopération décentralisée
• Collectivités locales, acteurs privés, ONG : quelles convergences pour un accès universel à
• la santé ?
• Les OMD au service du renforcement des systèmes de santé
• La santé dans la continuité de l’action humanitaire
• Quels financements pour la santé dans les pays du Sud ?

Vous pouvez vous inscrire pour participer à cet événement en cliquant ici.

Dans le cadre de cette initiative, et afin de répondre au besoin des collectivités françaises de mieux se situer dans ce domaine central de la coopération décentralisée, ACTED et CUF co-présenteront les résultats de l’étude menée depuis fin 2010 « Coopération décentralisée et Santé ».

Le premier Baromètre Pansons le Monde sera publié. Ce document de plaidoyer est destiné à mettre en valeur les initiatives et les prises de position des participants sur les enjeux liés à l’accès à la santé.

La plateforme « Pansons le Monde »

En 2010, l’ONG ACTED a lancé l’initiative de la plateforme Pansons le Monde qui vise à fédérer les acteurs qui s’engagent en faveur de l’accès de tous aux soins et à des médicaments de qualité : collectivités locales, professionnels de la santé, structures associatives! Elle vise à proposer des solutions innovantes et à promouvoir des projets et des convergences pour assurer l’accès des populations les plus fragiles à des soins de qualité, en rassemblant les acteurs issus des secteurs public, associatif et privé, spécialisés ou généralistes.`

Les Journées de la coopération décentralisée

Cités Unies France a lancé les Journées de la coopération décentralisée en décembre 2006. Ces Journées, à vocation transversale, offrent aux collectivités une occasion de s’informer sur une thématique d’actualité grâce à une expertise de haut niveau. Cette première JCD de 2012 aura pour thématique la Santé.

In Chad, AFD is helping displaced populations return home via a programme to support stabilization in the east of the country.
The program aims to give communities access to basic services such as drinking water in their home villages, or in areas they voluntarily return to, similar to those they had access to on the sites for displaced persons supported by humanitarian action. It also comprises a component for economic recovery.

Read the interview with Jeanne Milleliri, project manager for Chad and Thierry Liscia, in charge of psychosocial treatment at the “Crisis Prevention and Post-Conflict” unit".

A psychosocial support program for the project’s health component

For the first time, AFD has included a psychosocial support program for these so-called “returned” persons in the third project component devoted to health, notably via the construction or refurbishment of five health centers.

Communities who no longer communicate with each other

Five months of activities have already achieved positive results: well-being of persons taken care of by self-help groups, complementarity of psychosocial activities with the primary healthcare component, participation of women in community management…
These psychosocial activities have also brought together communities who had not communicated with each other for a long time. Yet this juxtaposition of communities is one of the major problems that hamper the development of Chad.

This post-traumatic psychosocial support program is new for Agence française de développement. Why such an initiative?
AFD works in several conflict- and crisis-affected countries: Haiti, Palestinian Territories, Afghanistan, several African countries… In these contexts, it seemed obvious to us that the impact these tragedies have on economic, social and human development needed special attention at the community grassroots level. So, the work we are doing in several villages in the region of Goz Beida in Chad is indeed a first for AFD.

What aspects do you work on as a first priority?
The traumatic impact of extremely violent conflicts leads some people to develop depression-type anxiety or mood disorders. They no longer believe in the future, they withdraw in on themselves and therefore cut themselves off from society. Some become addicted to psychoactive substances. We therefore support initiatives that will aim to rebuild links between people and to provide “social support” to people who need it.   

Do these post-traumatic disorders affect the whole population?
Thankfully no. It is generally estimated that 60% of people pull through by drawing on their own resources and thanks to support from their loved ones or from the community; 10% will develop serious disorders which are psychiatric cases. Finally, 30% of people become fragile, vulnerable, and can eventually develop the types of disorder mentioned before if they are left without any attention. It is consequently clear that a large part of the population is potentially concerned by the appearance of these disorders and may in this case need support. It is therefore this segment of the population that we wish to support through certain AFD projects.

What activities are implemented in the field?
Generally speaking, individual support, discussion groups, self-help groups… The discussion groups have a very strong liberating effect. Talking relieves the burden of the secret and by sharing these painful experiences people can free themselves from shame, particularly women rape victims.
Another example is a tontine system, like the one set up in Chad. It makes it possible to buy textbooks for children whose parents can no longer cope with living in their environment and, beyond this, to include these people in a traditional solidarity system and therefore keep them in touch with the community.
In the specific case of the Chad project, COOPI, the Italian NGO which is implementing phase 2 of this project, has begun to create specific places for this psychosocial support work:  a place for group work and a box for individual support.
Then in each village, the NGO has appointed and trained two community mobilizers, a man and a woman, and has set up solidarity self-help groups made up of ten women. These groups have the role of identifying problems in the community and the people who have psychosocial disorders.
In order to help firmly establish the self-help group in the village, when it was set up a declaration was signed by both the village chief and the president of the health committee.

At mid-term, what are the initial results?
In view of the short period of time that has elapsed since this program was set up, they are broadly positive and have been achieved in several areas:

- first, the well-being of people receiving care.

The direct beneficiaries receiving individual care from the NGO’s psychologist or from the activities of self-help groups speak about how their well-being has improved. In addition to being in better health, they can find a job and can once again support their families.

- the complementarity between psychosocial activities and primary healthcare

The introduction of the psychosocial program has helped to gain a better understanding of what was going on in both the community and in the health centers. Testimonies gathered during the psychosocial training have, for example, made it possible to realize how impossible it is for a woman to express these effects when she goes to health centers, because her husband generally speaks for her. The medical staff in the health centers realized that listening to a person could guide their action better and consequently asked to be trained in patient reception and in how to better integrate patient psychology.

- the participation of women

During COOPI’s first visits to the villages, men had not invited women to take part in the discussions. This is no longer the case today.
The testimonies gathered from both men and women have highlighted the fact that there are fewer domestic disputes and that women have more voice in decisions concerning the community.

- the mutual interaction between individual beneficiaries and the community
The focus is people-to-people relations, i.e. on ways in which the community can take into account people who are in difficulty or ill. So, while psychosocial activities generally aim to give people who have suffered from a trauma the means to reintegrate the community, in this case it is also a question of taking direct action on the diseases that can affect a community by seeking to promote the idea of “living together”. For example, the community is involved in topics such as coexistence between ethnic groups, accepting “mad people” in the community and destigmatization, the attention that should be paid to one’s child, domestic violence, or again the isolation of people in need. It therefore goes further than mental diseases alone…

What are the future prospects of this initiative?
For this project in Chad, some challenges still need to be met for this first psychosocial component in an AFD project, notably:

- the complexity related to the size of the areas covered.

There are about a hundred villages covered by the health centers and over forty nomad camps.

- and the sustainability of community mobilizers.

The fact that they are volunteers means there is a twofold risk that (i) these support leaders will lose their motivation as they will no longer benefit from the recognition of the NGO’s psychologist, and (ii) they may not be legitimized by the community. One solution could be to organize a triangular relationship between the hospital, health centers and community mobilizers, with a regular supervision of the centers by the hospital and of the mobilizers by the centers.

Beyond this, we must continue to convince of the need to integrate this dimension into the relevant projects. However, thanks to support from a number of colleagues who back this initiative, other psychosocial components are coming into being for projects related to AFD’s different activities, from health to urban redevelopment, including education or microfinance.