Democratic Republic of Congo: Kokolopori

Bonobo Health Clinic, Kokolopori

(project established: 2007)

Our support of the Bonobo Health Clinic ensured a number of successes during 2010-11. Despite limited funding, restricted local resources and capacity, severe geographical barriers and a challenging logistical context, the clinic continues to function and ameliorate the poor health conditions of residents throughout the Kokolopori community.  Between July 2010 and July 2011, our assistance amounted to $35,833.

Project Background

The Bonobo Health Clinic operates in Kokolopori, in the Democratic Republic of Congo (DRC), which is situated deep in the heart of the Congo Basin rainforest. We have supported the clinic since July 2007.

The focus of Phase One of the project (2007-2009) was: the prevention of malaria, particularly in mothers and children, through distribution of insecticide treated nets, with some education and malaria treatment; support of health and sanitation education; and the provision of nurses’ salaries, along with basic pharmaceuticals and medical supplies.

The main objectives of Phase Two of the project (2010-2012) are to improve: the capacity of clinic; community awareness of disease and prevention through public health education; the capacity of Vie Sauvage to manage the project; and improved resource allocation and collaborative partnerships.

What’s been happening in 2010-11?

Over the past year, the project has drawn media attention and has more clearly defined what can and can’t be done with existing resources and capacity. It has also been extremely challenging with the needs, ideas and agendas of the project’s partners requiring regular discussion and negotiation.

Key points of interest include:

• In July/August 2010, a monitoring and evaluation trip was conducted by (French speaking) public health professional, Veronique de Clerck, whose report provided very useful information to help improve the project.
• A highlight of the year was the trip to Kokolopori made by the Australian Broadcasting Corporation’s current affairs program Foreign Correspondent at the same time as Veronique’s visit.  Although the predominant focus of the final show was the Bonobo ape, some footage of the clinic, community and interviews with Veronique was shown.  The media exposure generated substantial additional support for the project.
• The clinic user fee debate (user fees versus free service) has been a continuing issue for over a year. After research on ‘best practice’, much debate among key stakeholders (including input from the local community), and visits to Kokolopori by Veronique and Ingrid Schulze, indigo foundation slightly altered our ‘free service’ position.  The amended Commitment Agreement now states that free service must be provided to women over 15 years old, all ante and post natal care, children under 5 years of age and men deemed over 60.  The community has agreed those outside these parameters can pay equivalent of 30 cents for consultations, laboratory work and treatments, an amount deemed accessible for that group of users.
• Kelsey OYong, a post-graduate student in the United States, conducted a desk review of Community-Based Finance Schemes in rural areas of Africa.  This was to assess the viability of such a scheme being implemented and managed in Kokolopori to help meet the resource needs of the health program. The results of Kelsey’s study will be published in the next newsletter. Many thanks to Kelsey for conducting this research!
• In June, one of our US-based project partners, the Kokolopori-Falls Church Sister City Partnership (KFCSCP) was dissolved by its director, Ingrid Schulze.  Ingrid’s decision stems from a mix of personal, local and professional reasons which do not have anything to do with indigo foundation, Vie Sauvage or the clinic.  The dissolution of KFCSCP will mean that fewer resources are going to the project. This will have a significant impact on the clinic since the salaries of the doctor and a senior nurse, besides medicines, equipment and some infrastructure, were being provided by KFCSCP. The Bonobo Conservation Initiative, the fourth organisation in the partnership is committed to raising funds to fill the gap.
• A warm welcome is extended to Jessica Glover who has just come on board to assist in the writing aspects of the project, e.g. newsletter articles, website updates, etc. Jessica is a student at the University of Wollongong, doing an International Development and Journalism major and we hope this experience will be an enjoyable and rewarding one!

How are we going with our objectives?

It is all very well to be busy with project-related activities but, ‘at the end of the day’ it’s about what is happening in Kokolopori. Below is how the project is faring with its 2010-2012 objectives.

Improve the capacity of the Bonobo Health Clinic

(i.e. well-equipped, properly staffed and functioning in a professional manner).

• Two other health outposts opened in response to community pressure were found to be unsustainable as they diffused expertise and resources, caused stock ruptures, decreased quality of health care, and staff salaries were stretched too thin. An amendment to the Commitment Agreement (Jan 2011) stated that our support would only go to the established Bonobo Health Clinic.  Subsequently the two health outposts have been closed and the resources, staff and supplies have again been centralised to help maintain a consistent healthcare presence in Kokolopori.
• Staff motivation has improved significantly since salaries were increased. This is also tied to an improved medicine stock management system (which Veronique recommended), and the adapted ‘user fee’ policy (wherein the clinic is generating at least some income to help offset the periodic deficit in clinic supplies).
• We have encouraged Vie Sauvage and the clinic to shift from its original aim of becoming a hospital clinic to a Centre de Sante (basic clinic). This is in keeping with the Ministry of Health’s guidelines for health care facilities serving a population of under 10,000, along with project’s limited resources and management capacity.  An inventory has just been conducted at the clinic to see what already exists and what needs to improve to get the clinic to the standard of a government-recognized Centre de Sante.

Improve community awareness and preventative measures generated through consistent public health education on malaria, tropical diseases, sanitation and hygiene, reproductive health and nutrition.

Malaria has decreased by 24 per cent as result of the insecticide treated nets distribution and the curative strategy supported by us. We achieved a better result in the malaria field and sexually transmitted diseases, but have registered an increase in cases of filariose/onchocercose disease, acute respiratory infections and diarrhea.

Strengthen the capacity of Vie Sauvage to successfully manage the health program.  After supporting the clinic (by funding staff salaries, medicines and transportation – a huge expense in this isolated region), there is little money left to help strengthen the capacity of Vie Sauvage. We provide funds for internet communication, some trips to Kokolopori to deliver salaries and medicines but the consistent and professional management of the project requires more resources than what Vie Sauvage has.

Optimise resources, commitment and momentum for the health program through collaborative partnerships among key stakeholders, including the streamlining of communications and reporting.  As with any health program, it is an ongoing challenge to optimise resources and their allocation, especially in DRC. However communication among the partnership, when parties are accessible, is good and reporting has improved over the past year.

Summary

In May 2011 we conducted a critical review of this project. We found:

“Notwithstanding the challenges of the project, what the project and our involvement in it has achieved, is noteworthy. Projects in Africa are very difficult and the weaknesses of the Congo project are typical of low resource, remote African settings.”

Recommendations included:

1. increase our commitment to assist the Clinic to become a government recognised Centre de Sante; and
2. strengthen community health education to ensure Kokolopori residents have access to greater primary health care knowledge.

Next year promises to be as full as this one – we are looking forward to it!

Project Manager	Leanne Black (nee Hankey)
Project Assistant	Jessica Glover
Technical Advisor	Veronique de Clerk
Management Committee Representative	Philip Strickland
Contact for more information	info@indigofoundation.org