454 of 516 health zones
The iCCM package includes treatment of acute respiratory infections, diarrhoeal disease, malaria, family planning and nutrition.
In DRC, CHWs are referred to as “community relais”. There are two types of community relais: “Site Relais” and “Promotional Relais”.
All training materials are available in accordance to national policies of case management of diarrhea, malaria, malnutrition and ARI. There are 9,385 trained relay to animate all volunteers, community care sites. The Government does not pay the community relais. Some of the relais receive financial incentives to pay for transport to file the report or withdraw the drugs to the care sites. Others have bikes, stick-on distinctive (T-shirts, caps,) signs. Each supporting partner finds ways to motivate the relais in the health zones receiving support.
The training of the relais is supported mainly by implementing partners. There is no clear policy on the motivation or incentives for the relais. However, there has been more support and advocacy around including the community relais pay in the state budget.
The presence of the support partners are a source of opportunity to address the challenges faced within the Congolese context.
The IMCI Working Group serves as a coordination body for iCCM and includes counterparts from the Ministry as well as implementing partners.
The integration of a framework from civil society, APA, and OAC has been the main challenge surrounding coordination.
In order to address some of the challenges around coordination, there is opportunity for partners to support the meetings to push the agenda forward.
Funding of activities is supported mainly by the partners. The Government gives wages to public servants of the State (doctors and nurses) but the site relais are not paid by the State.
Low motivation of relais, medication and supply material as well as all support to activities for the functioning of care sites tend to stop at the departure of partner or at the end of projects.
The DRC National Health Development Plan (PNDS 2016-2020) provides iCCM activities. The country is also engaged in GFF with an investment case, involving currently 14 provinces of the 26 total. There is also opportunity for the financing of iCCM with the presence of technical support and financial partners for iCCM sites.
The drugs and resources are purchased at the provincial level warehouse and are used at the care site level. This is consistent with government policies as well as the supply circuit.
The needs in terms of medication and resources to support and implement iCCM activities has not yet been determined.
Development of IMCI strategic plan including development of scaling of iCCM plan and activities of iCCM.
Currently, the standards and tools for the supervision of the relais are determined and many relays are supervised.
Many relais are supervised, however due to the lack of material and financial resources there an irregularity in supervision as a result.
Presence and the support from partners could help ensure that supervision is regular and integrated.
There are readily available communications tools at care sites and the relais communicates with the community.
The lack of planning surrounding social mobilization causes challenges.
There is opportunity to address the challenges in social mobilization through the community involvement and development of scale-up plan for iCCM.
Some iCCM indicators are integrated in the SNIS and the DHIS2 on the functionality of the sites (number of functional sites, sites that reported) and on the management of cases (total of the new, old cases, total referrals, cases of fever received, RDT tests conducted, cases of fever treated according to national policy, cases of diarrhea, diarrhea treated according to national policy, cases of pneumonia, pneumonia treated according to national policy, malnutrition with MUAC in the red band, danger signs and cases for referral).
Completeness of DHIS2 is still very weak and does not allow to have data in a timely manner.
Implementing partners and further developing the iCCM website to highlight activities carried out at country level would be beneficial to addressing M&E issues.
1. MCHIP. Review of Integrated Community Case Management Materials: Ten African Countries. Washington, DC: 2013.
2. MCHIP. Integrated Community Case Management of Childhood Illness: Documentation of Best Practices and Bottlenecks to Program Implementation in the Democratic Republic of the Congo: Summary Report. Washington, DC: 2012.