FOREIGN CORRESPONDENT
8 June 2001, Manieka Health Zone, Katanga Province, Democratic Republic of Congo

It takes more than bricks and mortar to improve public health and bring back patient confidence in a country where state health services have been starved for 25 years.

Kisanfu health centre has seen the number of patients using it over the past year quadruple, from 15 visits a month to over 60. It's not an outbreak of disease, nor a take-over by an international organization with free drugs and expat doctors, but the slow home-grown resurrection of a facility which until recently had very little to offer its community.

Kisanfu is part of a just-completed US$3 million project funded by the United Nations Development Fund and implemented by WHO which not only rehabilitated health facilities in six health zones in the west of the Democratic Republic of Congo over the past year, but targeted the ability to provide, sustain and pay for these services.

A big part of the programme has involved renovating and re-equipping parts of district hospitals, such as the operating theatre, maternity ward and pharmacy in nearby Manieka District Hospital, supplying significant amounts of essential drugs to the health zones to trigger cost recovery supply, and reinforcing health zone management to allow it to start functioning again.

In Kisanfu, it's not the lick of paint, the cheerful hand-painted health promotion posters, or the epidemiological graphs on the wall indicating new training knowledge that has made the difference. It's medicines and beans.

Like other health centres in the zone, Kisanfu has benefited from the injection of essential drugs which have allowed it to get back into the cycle of selling at cost recovery prices and restocking. When drugs are available, people come to the centre. They're also more willing to pay the small consultation fee that tops up the centre's workers' poor salaries, which in turn makes them more motivated in essential tasks such as vaccination and disease surveillance.

But if the patients don't have money to pay, the whole system collapses again. Which is where the beans come in.

With a $1500 grant from the project, the health committee brought three 60kg sacks of haricot beans and fertiliser and with volunteer labour cultivated a two hectare plot. Last month they harvested 24 sacks of beans. Three sacks were paid to the harvest team, and three more will go to replant the community land. The remainder has been divided between local small farmers in the area who have been advised to eat some of the high protein produce, and plant the rest for income and seed return next year, and the health committee who will use the money to try and ensure an adequate supply of drugs and materials in the centre, subsidise patients who can't pay the small fees and, they hope, eventually renovate the maternity 'ward' - currently just bare room at the back of building shared with the remaining sacks of haricots.

"The aim of the project is to improve the health of the people and their ability to pay for health treatment," says Alexi Ilungaconde, the health centre's nurse.

Currently the health committee, formed during training with WHO, reckons 50% of their 3,600- strong community can't pay a consultation or a prescription fee. It hopes the income from the beans will both increase the ability of individual families to pay and act as a sort of health insurance fund for the community.

"What we want to see is the impact of the new source of income on the use of this health centre and on the public health of this community." says Dr Jean de Dieu Illunga, head medical officer for Manieka health zone. "If it works, we want to spread the idea to other health centres by giving them seed beans from our harvest to start their own."

Getting to this stage has been a lot of work, according to Professor Ngo Bebe, WHO's national adviser on health services management, and co-ordinator of the UNDP/WHO project throughout DRC, and not just the back-breaking kind in the field.

'We've done a lot of training. We've trained health zone officials in managing health systems, doctors, nurses and laboratory technicians in epidemic surveillance and investigation, community leaders and local organisations in forming health committees, and in small project management so that they feel they can make projects like the haricot beans work for them. We've also done a lot of work with the populations themselves to sensitise them to why they should use the health centres. It's too early to know whether projects like the haricot beans are having an effect on people's actual health, but the dramatic increase in use of the centres is encouraging."

Even without the war, says Prof Ngo Bebe, DRC's state health centres were in crisis. "Everyone basically forgot about them because they didn't have any supplies. Now the early figures show people have more confidence in their health facilities. We'll have to wait and see whether they can make the income generation work to support their service and it can actually improve families' standard of living and their health."

For further information please contact:

WHO Kinshasa: Prof. Ngo Bebe, health services management cooordinator, ph: 00 243 88 444 08, ngobebed@jobantech.cd

WHO Lumbumbashi: Dr Kambale Magazani, chef d'atenna, kambalemagazani@hotmail.com