Child mortality rates have dropped significantly in the world in the last ten years, but in spite of this positive development about 19 000 children still die every day, and the curve is not declining as fast in all countries. In the Democratic Republic of Congo, 170* out of 1000 children under the age of five died in 2010, a figure that ranks among the highest in the world and could be compared to Sweden where the figure was three out of 100. The country’s people have been suffering hard from rebellions, civil war and violence for a long period of time. At the same time, logistics is a huge problem in Africa's second largest country and accessibility is very difficult in some places. Politically, the health issue is not seen as a priority: only 4.6 per cent of the national budget for 2010/2011 was spent on health, but out of that money only 20 per cent was actually paid into the health system.
UNICEF’s Child Survival Programme will contribute to building up the country's health system by supporting the DR Congo's own national health policy, and the programme is implemented in collaboration with the country's health ministry. Maternal health care is also a part of the programme, since infant mortality is strongly linked to mothers' access to care during pregnancy and childbirth.
"The purpose of the UNICEF programme is to reduce mortality rate in children under the age of five, through vaccination programmes, nutrition programmes and other health care. We still have a lot of work to do, but we already see the situation improving, with child mortality rate that has actually dropped during the last decade from 213 per thousand children and year to 158," says Amadou Alassane Cisse, a medical doctor who is in charge of UNICEF’s Child Survival Programme in Eastern DRC covering 163 health zones.
Distribution of impregnated mosquito nets has contributed to the drop of child mortality, as well as vaccinations, even though the programme still doesn’t reach all children.
Malnutrition among children is a major problem in the DR Congo and nutrition, with distribution of peanut butter and milk to small children, is an important part of the health programme. The country is green and fertile but although many people actually have access to food, it’s often not well balanced or nutritious. Manioc porridge, which forms the staple diet for many, does not contain enough proteins, fats or vitamins. When children are malnourished, diarrheal diseases, respiratory diseases or epidemics-like measles and polio can pose a mortal danger. Vaccination is another part of UNICEF's programme, but it has to be carried out regularly and reach all children.
"If we miss even as little as three per cent of the children in a region when vaccinating against measles or polio, it means the population is not being protected against an epidemic, as the vaccine is never a 100 per cent protection," says Amadou Alassane Cisse and explains that one major concern for the families is being able to get to a clinic with their children.
Staff training and improved logistics
Access to clinics is one problem, but the quality of health care may also be inadequate. UNICEF is therefore investing in staff training as well as in improving the flow of logistics so that vaccines and other medicines are in place when needed, and that they are stored properly. The field activities are monitored regularly. When Amadou Alassane Cisse recently visited a village during vaccination, he and his colleagues made sure that the children who lived far from the clinic came as well, while noticing there were not enough bikes to pick them up.
"We have also prepared a list at each clinic with names of children who have been vaccinated. By doing so, we can assure they don’t only come the first time, but for the second and third vaccination as well."
Sida is the only donor providing core-funding to UNICEF's Child Survival Programme in DR Congo. In that way the money is more flexible than if being tied to a specific project, meaning it can be used for e.g. outbreaks of cholera, Ebola, measles or other crises.
"We have chosen to collaborate with UNICEF because of their long-term work with health interventions, delivering health services to the population, with the focus on mothers and children, but also working to build capacity at the country's health ministry, so that they can control and implement the health programme," says Sofia Norlin, advisor on health issues at Sida’s Conflict and Post-Conflict Department. At the same time, UNICEF is a major player acting at different levels in this huge country, where the work includes coaching health authorities on zone levels as well as health teams down on local district level.
* According to UNICEF's State of the World Children 2012 report.
About UNICEF's Child Survival Programme in DR Congo
The current cycle of UNICEF's Child Survival Programme in the Democratic Republic of Congo (DRC) started in 2008.
Sida supports the programme through 2010 to 2012 with a total of 75 000 000 SEK divided on three years. The support may possibly continue.
The goal is to reduce maternal mortality by 47 per cent and reduce the mortality rate of children under five by 41 per cent.
The programme is divided in three parts: strengthening health systems (including child health, maternal health, and combating HIV transmission mother-child), vaccination programme and nutrition programme.
The programme has many donors, where Sida is the only donor giving a non-earmarked core funding.
DRC is Africa’s second largest country (five times the size of Sweden) and children constitute 50 per cent of the population. The country is divided into 11 provinces, which in turn are divided into 515 health zones (or health districts). The Child Survival Programme is being implemented in 75 out of 515 health zones.
Dr. Amadou Alassane Cisse is responsible for the programme in the eastern part of the country (North Kivu, South Kivu, Maniema, Orientale) with more than 24 million inhabitants. 37 out of the area’s 163 health zones are included as pilot districts in the programme.
Examples of completed activities 2008-2012:
- 18,131,073 children were vaccinated against measles.
- In addition to the routine immunization of 8,487,029 children, more than 15 million received three doses of oral polio vaccine.
- Eight campaigns resulted in the deworming of 90 per cent of children aged 12 to 59 months. (In partnership with other donors.)
- Approximately 40 per cent of children were protected against malaria thanks to campaigns distributing 9,712,072 long lasting insecticide treated mosquito nets. (In partnership with other donors.)
- The number of severely undernourished children receiving community care increased from 45,652 (in 2007) to 157,000 (in 2011). (In partnership with other donors.)