The Reviewed and
Revised Compendium of Christian Projects
Addressing the Diseases
of Poverty: HIV/AIDS, Malaria, and TB
SANRU III Project (Malaria
Component)
Project/ program name: SANRU III Project (Malaria Component)
Country: Democratic Republic of
Congo
Church or denomination: Interchurch Medical
Assistance, Inc. (I.M.A.) is a non-profit association of twelve Protestant
relief and development agencies that represent a constituency of churches in
America and throughout the world. The Eglise du Christ au Congo (ECC), I.M.A.'s
partner in the SANRU III project, comprises 61 Protestant church communities of
several denominations representing millions of parishioners in the Democratic
Republic of Congo.
Project summary: Malaria interventions are
featured in the 5-year SANRU III project in the Democratic Republic of Congo
(DRC) that Interchurch Medical Assistance (I.M.A.) launched in 2001 in
partnership with the Eglise du Christ au Congo (ECC), with funding from the
United States Agency for International Development (USAID). I.M.A. and ECC are
bringing assistance from several Congolese and American organizations to bear
on the health needs of DRC.
Background/ History: For almost forty years,
I.M.A. has procured and distributed medicines and medical supplies for
international health care programs that serve people in need without regard to
ethnicity, creed, color, gender, national origin, religious or political
affiliation. Other sectors of ministry include international disease control
programs and strengthening of health care systems, working in collaboration
with governmental, non-governmental and corporate partners.
The Eglise du Christ au
Congo, the SANRU III implementing partner in D.R. Congo, unites the majority of
Protestant congregations there. In its health work, it works closely with other
faith networks (Catholic, Kimbanguist) and secular organizations as well as
with government health authorities. ECC was the implementing partner in the
widely acclaimed SANRU I & II rural health projects from 1981 to 1992, with
support from USAID. After USAID withdrew support to its programs in Zaire/Congo
due to civil unrest, ECC was able to continue its exemplary work in primary
health care with assistance from several donors in the 1990's.
Improved malaria treatment
and prevention are an important issue in the Democratic Republic of Congo. The
Ministry of Health (MOH) and Centers for Disease Control (CDC) estimates that
in a total national population of 46.7 million there are each year 2.87 million
clinical cases and 200,000 deaths. Each child is believed to suffer 6 to 10
fever episodes a year mainly attributed to malaria. Other studies indicate that
these estimates are far below what is actually happening. The average incidence
is probably well over one episode of illness per year and the deaths could be
more than double what is reported.
The RBM program has
stimulated much work on malaria in DRC in recent years. Currently the national
treatment protocols are being revised and several pilot projects for
Insecticide Treated Net (ITN) distribution are taking place.
Chloroquine resistance has
risen to 38% in Kinshasa and to over 50% in the eastern part of the country. A
major change in treatment patterns is needed to address the problem. Mass
training throughout the country is required to implement these treatment
changes.
Bednet programs have been
started in Kinshasa and select sites in other parts of the country. Congo is an
ideal place to distribute insecticide treated nets because of the high
incidence of malaria and the fact that the mosquitoes there bite mostly at
night. Some of the projects are working fairly well but could be improved.
Other programs, like the distribution of nets in Kisangani after recent battles
failed miserably. More research needs to be done on how to best to expand the
bednet program. This is especially true in the rural areas.
Goals: SANRU III supports the
fundamental principles of the DRC national malaria control program in an
integrated approach to Malaria control. It provides training for health workers
at all levels to appropriately diagnose and treat malaria using the new
guidelines, promoting early identification and treatment of malaria in the home
and supporting research for environmental management of mosquitoes and malaria
cases in high-density population areas. Insecticide treated nets will be tested
in rural conditions and promoted if they are found to be effective.
Objectives:
•
Train
at least one person from every health center in SANRU supported health zones in
appropriate diagnosis, treatment and prevention for malaria.
•
Distribute
bednets in 60% of target homes in select health zones within three years.
•
Assure
that appropriate drugs for malaria are available in all SANRU supported zones
within one year
Who does the work? Key implementers of SANRU
III malaria interventions include health zone staff, community health workers,
and local churches that are playing an important role in distribution of
bednets. Partnerships are especially important in DRC, where the MOH National
Malaria Control Program and some other government institutes have the technical
knowledge. In addition, the vast majority of health services are provided by
individual private clinics, mission hospitals, NGOs, pharmacists, private drug
sellers in markets and traditional healers. Major partners with SANRU III in
this area are: the Ministry of Health, Roll Back Malaria, USAID, BASICS (a
USAID-funded Child Survival and International Health NGO), CDC, the DRC
Catholic Medical Board and Catholic Relief Services, and the University of
Kinshasa School of Public Health.
Main activities:
1.
Personnel
of health institutions of the rural health zones will be trained for malaria
diagnosis and treatment for simple and complicated cases.
2.
Information,
Education and Communication (IEC) training will be conducted at the community
level to promote appropriate home treatment, encourage environmental management
of mosquitoes and increase use of insecticide treated nets.
3.
The
project will test distribution of impregnated nets in rural areas primarily in
target populations of malnourished children and pregnant women.
Expected outcomes:
Indicators for this component
will include an increase in all of the following:
•
Percentage
of children age 0-23 months who slept under an insecticide-treated net (in
malaria risk areas) the previous night.
•
Percentage
of children with fever seen at health centers that receive an appropriate
treatment.
•
Percentage
of target households that have an impregnated net in the rural test areas.
Results: N/A
Lessons learned: The use of Insecticide
Treated Nets in rural populations with very poor transportation and
communication is problematic. Distribution of nets is probably possible because
of high perceived need, but the retreatment of the nets would probably be low.
For this reason PermaNets will be tested in this project. Even though these
nets are new and have not been extensively tested, indications are that they
will last at least twice as long as regular treated nets before needing
retreatment. These nets will first be promoted and distributed in three or four
zones. Every six months a small study will be conducted to see how effective
the nets remain at killing mosquitoes. The cost of the nets to the zone level
is $5.40 per net. They will be sold to the general population at about cost. A
system will be developed so that the target population will be able to buy the
nets at a reduced cost. One example of how this might work would be that the
consultation fee that women pay for prenatal care would be subtracted from the
cost of the net.
Funding and other resources: Support provided for this
initiative by USAID is to be approximately $1.5 million over 5 years. We are
seeking additional contributions.
Further readings or
documents:
Additional information on the SANRU program is available at
http://www.sanru.org. The ECC website is http://ecc.faithweb.com. The Roll Back Malaria web site is http://www.rbm.who.int.
Contact information:
Interchurch Medical
Assistance (I.M.A.)
P.O. Box 429
New Windsor MD 21776
Telephone: 410-635-8720
Fax: 410-635-8726
E-mail: imainfo@interchurch.org
Web site: http://www.interchurch.org/