In Gemena, the capital of Sud Ubangi Province in northern Democratic Republic of Congo, World Vision has implemented the local advocacy approach called “Citizen Voice and Action” (CVA).
The objective of this activity is to access to and the quality of healthcare services for mothers and their children. This is being achieved by training community facilitators to monitor and evaluate the services provided and report shortfalls to the appropriate authorities to ensure they are addressed.
To do this, Mr. Gloire Muteule,the Advocacy Manager at the National Office trained 25 facilitators, including four women, on the operating standards of health structures, as described by the Ministry of Public Health.
By knowing these standards, facilitators were then able to monitor 11 health posts of Gemena which serve between 11,173 and 25,541 residents each. Identifying the population served by the health centers reveled the need for more health centers, as the standards specify that each health center should only be tasked with meeting the needs of between 5,000 and 10,000 people.
The results of this evaluation allowed health care providers and community members to identify gaps in the delivery of care and to develop plans to address these gaps by meeting with leaders including the Provincial Minister of Health, Doudou Lezose.
Mr. Lezose expressed his satisfaction with the implementation of this approach at the local level, which will allow the decision-maker to cross-check the data received in the report and the results of community satisfaction with the care they receive.
"This work could extend beyond city of Gemena to the other health zones of Sud Ubangi province,” said Mr Lezose. “I would like to use the Citizen Voice and Action approach to advocacy to improve the delivery of health and various basic social services,” he added.
These action plans helped influence community members, caregivers and decision makers (Member of the provincial government) to improve the quality of care made objectively.
Gaps in the health system identified during field visits
It should be noted that during the implementation of advocacy activities, deficits were raised, which need to be overcome. Those deficits include:
• In the field of human resources: the insufficient number of qualified personnel (midwives and laboratory assistants);
• In terms of equipment and materials; the majority of health centers did not have delivery beds, baby scales and other necessary healthcare materials;
• Regarding compliance with the service schedule; providers did not respect the hours of service;
• In the area of management; there is a lack of collaboration between the multi-purpose team of health centers and that of the Health Committee (CODESA)
These deficits negatively impacted the services provided by the Health Center and did not allow community community members, especially mothers and children under five, the necessary access quality health care.
Major changes in the health system in Gemena
The action plans that were produced led to considerable changes in the four health centres of Gemena which having begun implementing their action plans:
1. At the GemenaIII Health Center:
• Attendance increased from 387 to 888 patients three months after the launch of the CVA approach:
• Community members reiterated their confidence and the Health Committee became active again
• Toilets were built,
• A solar kit for Health center light and a tank for water conservation at the maternity level were purchased from the health center’s own funds;
2. The Provincial Minister of health donated land to the City Health Center, which was renting a space, and GAVI (The Vaccine alliance) agreed to build a health centre that aligns with health standards, including the construction of a latrine block, incineration, placenta hole, water storage devise and access to clean water.
3. At the Salongoii health center: Financial resources were committed in to hire a laboratory technician. Additionally, training was provided in nursing ethics and the labor a delivery bed was improved.
4. At the Bokonzo/Gemenaii health center: Again, this health center, which was renting, was given a parcel of land to build a permanent facility. Today, the community is working together to build a proper structure to house the services.
"Three months after this assessment, we have seen a big change in our health center,” says Methe Kpawe, 45, community member and mother of 10 children. “Now, we have a birthing bed, a light source, devices for water conservation and sanitary facilities. Also, medicines are now available. We owe these achievements to the advocacy team formed by World Vision using the Citizen Voice and Action approach. Thanks to the work that has been done, a great change has happened for the benefit of our community,” she adds.
The CVA approach implementation to the Ledia program has greatly influenced the improvement of the quality of care in health centers, prompting decision-makers and governments to find lasting solutions for the health of mothers and children.
The collaboration between the CVA facilitators and the technical and financial partners (PDSS) made it possible to assess the level of compliance with subsidized flat rate pricing supported by the government.
Today, Health Centers have an increased attendance in terms of patients who go there for treatment or consultation (as is the case at Gemena III Health center).
Challenges and recommendations
It should be noted that the majority of health centers still remain tenants, that is to say, they have no plots of their own and often operate out of substandard buildings. Added to this problem is the lack of medicines and basic care materials. Many of these health centers, for example, do not even have delivery beds, as are stipulated by the standards.
The government and its partners should support these centers by providing appropriate delivery beds and other health care materials, including the provision of medicines to improve access to quality health care for mothers and children.