Community involvement in health has long been a hallmark of Democratic Republic of Congo (DRC) health policy. Since the 1980s, the DRC has promoted Primary Health Care based on Community Participation as the guiding strategy for national health policy. The policy recognizes the importance of the involvement of the local community and its ownership of health initiatives. It concentrates most health activities at the village level, assuming that a sensitized community will help improve individual health knowledge and positive behaviors.
However, despite efforts to improve primary health care (PHC) during the past 25 years, community participation and governance with respect to the health sector remains weak in the DRC, as reflected in the low uptake of particular services and a lack of close collaboration between communities and health facilities.
Analyses identify a number of obstacles that impede community engagement. The challenges relate primarily to community organization and management, rather than willingness. In general, communities lack capacity in planning, implementing, monitoring and evaluating health interventions. While there are reserves of goodwill and volunteers, especially in areas of previous donor investment, communities need assistance in developing and managing realistic, effective community-led structures for PHC improvement that accommodate the volunteer nature of these efforts.
Since the 1980s, the DRC has adopted the strategy of Primary Health Care (PHC) based on Community Participation as its national policy of health. This policy recognizes the need to ensure the sustainability of PHC by the involvement of the local community and its ownership of initiatives. It concentrates most of the activities at the local level (village) instead of having them depend on external initiatives. It combines the people concerned in promoting their own health.
The Village Santé approach has improved coverage of key health interventions through self-driven community-led work. Supporting ASSP Outcome 6: Increased Leadership and Governance, Village Santé improves community ownership and governance for health outcomes in the near-term and improves health service delivery indicators on leading primary health care issues in the medium- and long-term.
The Village Santé approach has contributed to achieving the following key objectives under ASSP for improving primary health care:
- Improved distribution and use of long-lasting insecticide-treated nets for malaria protection
- Increased uptake of vaccination among children for leading causes of morbidity and mortality
- Improved uptake of modern methods of family planning
- Increased numbers of children and mothers accessing nutrition interventions
- Improved access to safe drinking water and sanitation
- Increased community financial and in-kind support to bolster health centers
- One-year-old children vaccinated against the measles, raising the project’s cumulative achievements to more than 300,000 vaccinated. ASSP achieved a measles vaccination population coverage rate of 94%, exceeding the initial program target of 90%.
- Safe Delivery: More than 1,198, 166 women had delivered with skilled birth attendants due to the project’s activities during the project
- ASSP continues to achieve success in helping pregnant women access IPT, 81% of pregnant women taking two or more doses of IPT through project-supported health facilities surpassing the target of 80%, preventing thousands of malaria cases.
- ASSP also provided more than 1,829,673 LLINs to pregnant women and children under one through routine and mass distribution.
- New Acceptors of Modern Family Planning: In Year 5, there were 87,411 new acceptors of modern methods of family planning. ASSP achieved 98% of its Year 5 target as a result of improved availability of contraceptives and the scale up of services e offered at project health facilities.
- Child Nutrition: ASSP reached 897,842 children and pregnant women with nutritional interventions
- To date these volunteers have screened 1,759,095 children for malnutrition and referred 196,874 for further evaluation by a health provider
- RECOs (community volunteers) conducted at least 5 home visits to more than 191,513 malnourished children