Democratic Republic of Congo

Democratic Republic of Congo

The FAM Project: Expanding family planning options and services in the DRC

The Democratic Republic of Congo (DRC) is a focus country of the Institute for Reproductive Health’s (IRH) Fertility Awareness-Based Methods (FAM) Project, a U.S. Agency for International Development (USAID) funded initiative. The purpose of the FAM Project is to facilitate and document the scale up of FAM services in select focus countries, and to continue supporting increased access to and use of FAM worldwide.
In 2003, the USAID Mission and the Ministry of Health’s (MOH) National Reproductive Health Program (PNSR) invited IRH to introduce the Standard Days 

Method® (SDM) in the DRC. Providers were trained and the SDM was integrated into existing clinic, community and pharmacy services in Kinshasa, Lumbumbashi and Bukavu and the rural areas of Katako Kombe. By 2007, 14 organizations had the capability to offer the SDM and this number continues to grow as IRH creates new partnerships throughout the country. By summer 2009, IRH has developed additional key partnerships with international and local NGOs and, along with a continued collaboration with the Ministry, has expanded SDM and LAM into new areas, particularly those in the conflict affected eastern provinces of the country.
IRH also continues to work towards introducing two other fertility awareness-based methods, the TwoDay Method® (TDM) and the Lactational Amenorrhea Method (LAM). The TDM was introduced though collaboration with Conduite de la Fecondite, a faith-based organization, and results of this experience will be used to potentially expand access to the TDM. A three-year, USAID funded project called AXxes integrated LAM into their reproductive health and family planning (RH/FP) services in 60 zones in eastern and southern Congo.  
 

Recent FAM Project accomplishments in DRC

A major emphasis of IRH’s work in the DRC has been to develop the capacity of local organizations to offer the SDM and significant progress has been made to engage, train, and support these organizations.  Through these local NGOs, IRH has also made strides towards a stronger focus on community-based interventions rather than focusing only on MOH facilities and the clinic-based approach.  The continued effort to maintain a supportive policy environment of the integration of SDM into family planning services also contributed to the project’s expansion and increasing use of SDM and LAM.  Due to the continued positive environment, IRH expanded its outreach to provincial MOH offices to incorporate SDM into policies, logistics and reporting systems.
The following are a few examples of IRH’s accomplishments to date:      
  • Increased geographic coverage to reach 270 out of 515 health zones (with 300 being the project end goal) located throughout the country
  • Successfully advocated with provincial MOH officials for the integration of the LAM and SDM into norms, policies, and HMIS
  • Providers in over 1800 sites, including hospitals, clinics, communities and pharmacies have been trained in the SDM
  • Organizations with trained providers include the public sector, NGOs, faith-based groups, and community development organizations
  • Two partner agencies, Population Services International (PSI) and CARE, have fully integrated SDM into all of their family planning programs in the DRC
  • The SDM has been included in the MOH’s in-service family planning training curricula and family planning training manual
  • SDM was included in the national reproductive health norms when they were finalized in 2007
  • The MOH included CycleBeads® in its five year contraceptive plan as well as on its list of essential medicines
  • SDM has expanded the method mix in DRC. In CARE-supported zones, for example, the SDM represents over 2.4% of the method mix.
The FAM Project: Expanding access to family planning in DRC
 
IRH is currently partnering with the MOH and key NGO partners to scale up SDM and LAM, as guided by the World Health Organization’s ExpandNet model developed for scaling up reproductive health innovations.   In 2009, IRH DRC staff made extension field visits to speak with provincial MOH officials as well as meet new potential partners working in USAID and non-USAID supported areas.  As a result of these focused efforts, 9 of 11 provinces integrated the SDM and LAM into their policies and HMIS.  IRH also created several new key partnerships and provided training and technical assistance to partner staff members. These efforts have resulted in the integration, expansion, and improvement of quality family planning services in areas serviced by these partners. 

 

The FAM Project addresses unmet need for family planning in DRC

Unmet need for family planning in the DRC is high and little attention has been paid to this tremendous need until recently.  For nearly 15 years, during the Mobutu dictatorship and following civil war, family planning was non-existent across the country. Family planning messages and methods have only begun to re-emerge in parts of the country recently.  Furthermore, while the western part of the country has seen some small improvements in family planning services, the continued pockets of conflict in the east leave these areas without family planning commodities or even MOH staff to provide adequate services.  IRH has made great efforts to promote SDM and LAM throughout the country, capitalizing on the methods’ easy use in hard to reach and insecure settings.   
IRH is also addressing unmet need by targeting specific communities.  In early 2009, IRH provided training and CycleBeads to a faith-based women’s organization, Maman Ansar. This resulted in increased knowledge about fertility awareness and family planning, as well as led to family planning use among this population.  IRH also began negotiations with the World Wildlife Fund (WWF) to provide SDM and LAM training and technical assistance to populations, including a significant pygmy population, living in several corridors found within Africa’s largest national park, Salanga, in Equateur province of the DRC.  Healthcare in this area is virtually non-existence and unmet need in family planning is huge.   

 

Following the research-to-practice-to-scale model in DRC

In June 2009, IRH worked with a local research organization, KARTILE, to carry out stakeholder interviews with key individuals located and working in both Kinshasa and various provinces of the DRC.  IRH also plans to carry out either household or facility level assessments to examine various aspects of knowledge and use of SDM and LAM.  The results of these studies will guide IRH as it continues its geographic expansion throughout the country.  The results will also aid IRH to re-examine training and supervision needs to ensure that good quality of care is provided as well. 
IRH is continuing its successful partnership with Conduite de la Fecondité in regards to the pilot project and research surrounding use of the TDM.  Based on the final report findings, IRH will evaluate the possibilities of scaling up the TDM along with the SDM in some areas of the DRC.  To date, however, IRH has focused most strongly on the scale up of SDM across all provinces and areas of the DRC.  Due to extremely poor existing infrastructure, IRH has focused on the national level while also recognizing the importance of outreach to the provincial partners.  One component of the scale up strategy is to improve community-based outreach and distribution.

 

Building partnerships to expand choice

IRH has engaged many partners in their work with SDM and LAM.  Since 2003, IRH has worked hand in hand with the MOH’s reproductive health department to ensure integration of the SDM and LAM into norms and policies. IRH maintains and is building upon several other partnerships with local and international NGOs to integrate LAM and SDM into their reproductive health programs throughout the country. IRH has had a particularly close relationship with PSI and CARE.  In addition to these two partnerships with international INGOs, IRH has and/or continues to partner with the local NGOs: Maman Ansar, Conduite de la Fecondite, and Action Sante Familiale (ASF), which is the IPPF affiliate in the DRC.  Over the course of 2009, IRH has reached out and created new partnerships with NGOs such as Merlin, the International Rescue Committee (IRC), Family Health International (FHI), and WWF. 

 

Contact the FAM Project in DRC 

For more information on IRH’s programs in DRC, contact IRH/DRC Country Representative, Arsene Binanga at binanga_arsene@yahoo.fr or IRH/DC Country Manager, Sarah Terlouw at st379@georgetown.edu