GRHAM
Global Religious Health Assets Mapping

Putting Faith-Based  Organizations (FBOs) and their networks "on the map"

The Protestant Church of Congo - Dept. of Medical Works

ECC/DOM has played a major and largely unrecognized role in the establishment of Congo’s primary health care system and decentralized health zones of which the WHO/UNICEF report speaks. Each day ECC/DOM, through its member communities, provides direct health services to millions of Congolese. However, ECC/DOM has also played a key role is shaping the entire health delivery system of Congo. Today, ECC/DOM continues its leading role in the management of the largest health development project in Congo.

The following timeline highlights the milestones in ECC/DOM’s pioneering activities in this major health development project.

Prior to Zairian independence: The work of Protestant churches and missionaries in Congo dates back to the late 1800s with the creation of hospitals and health services. In fact, Protestant missionaries led the way in establishing the first hospitals in Congo. Eventually, in an effort to improve the coordination of services, forty protestant missionary societies from twelve different countries created the Protestant Council of the Congo in 1928. Later during the 1970s, Mobutu’s “authenticity movement” required all protestant groups to unite within one authorized national church. As a result, the Protestant Church of Zaire (Eglise du Christ du Zaïre – ECZ, but currently known as ECC – Eglise du Christ au Congo) came into existence in 1971 with around sixty member communities. At the same time, the Direction des Oeuvres Médicales (DOM) was created to coordinate the health work of the ECC members and to serve as the liaison with the Ministry of Health.

Prior to 1970: ECC manages approximately 50 hospitals and several hundred dispensaries throughout Congo. At some of these hospitals, pioneer Protestant missionaries such as Drs. Dan Fountain of Vanga and Norman Abell at Kimpese begin promoting the concepts of community-based health care in addition to hospital and dispensary-based care.

1971-1972: The medical office of ECC is officially created and opens one of the first “desirable births” offices in Kinshasa, making modern contraception available for family planning. This work expands quickly with financial assistance to ECC from U.S.-based Church World Service, Pathfinder and Johns Hopkins University.

1975: The medical offices of ECC and the Catholic Church co-sponsor a national conference in collaboration with the Ministry of Health. This conference establishes a national consensus for the concepts of “decentralized health zones” and “primary health care.”  This conference illustrates the extraordinary vision and drive of ECC/DOM, as it takes place three years before the 1978 Alma Ata conference for primary health care, in which delegations from 134 countries and 67 UN agencies agreed on the concept and importance of primary health care and the rights of people everywhere to have access to primary health care.

1976-1980: A few pilot health zones are created, including several initiated by member communities of ECC/DOM, e.g., the rural health zone of Vanga is established in 1977. In addition, the Protestant hospitals of Vanga, Wembo Nyama, Karawa, Nyankunde and Kimpese establish working models for community-based health care programs.

1980-1981: Based on repeated requests from Protestant health services for assistance, the U.S. Agency for International Development (USAID), in consultation with the ECC/DOM (director Nlaba Nsona and missionaries Florence and Ralph Galloway) designs a project to create fifty health zones around Protestant hospitals. USAID and the Ministry of Health select the ECC to manage this multi-million dollar bilateral project called the Basic Rural Health project. This is one of the first projects of this size to be managed by an umbrella organization of any Church body.

1981-1991: The Basic Rural Health Project becomes better known as SANRU (Projet Santé Rurale). ECC conscientiously decides not to limit project assistance to Protestant hospitals, but to open the project to health zones created around Catholic, governmental, and other NGO-managed hospitals. This approach quickly transforms SANRU into a national health project, and further establishes ECC/DOM as a model umbrella organization managing a national health project.

It is ECC/DOM’s management of the SANRU project that results in a bottom-up approach for the creation of Congo’s 306 health zones. While many African countries have failed in their attempts to decentralize health services, the Ministry of Health of Congo, in collaboration with ECC/DOM and the SANRU project have succeeded. The result is a highly decentralized health system that respects national policies and guidelines.

The existing network of ECC hospitals provides a good infrastructure for the management of decentralized health zones. The presence of a functional referral hospital, office space and equipment, a garage and maintenance facilities, housing and gardens, electricity and fuel, supply line for medicines, teaching facilities and schools attract and retain competent staff even in isolated rural areas. This infrastructure helps these health zones to quickly develop. It also establishes a critical mass of developing health zones and a national momentum that spreads rapidly throughout the country.

1984-1987: ECC accepts the management of an additional project  SEQ CHAPTER \h \r 1for the physical rehabilitation of 200 health centers across Congo. Working in collaboration with the  SEQ CHAPTER \h \r 1Organization for Rehabilitation by Training (an NGO of the Jewish faith) and USAID, this project demonstrates ECC’s flexibility in working with other interfaith health services.

1987-1991: ECC/DOM and USAID expand SANRU to become SANRU II and to assist the development of 100 health zones. By 1987, more than 200 decentralized health zones are functioning throughout Congo. Between 1982 and 1987 access to primary health care services in SANRU-assisted health zones increases from 10% to around 50%.

However, the worsening economic situation, the AIDS epidemic of the late 1980s, and the increasing political instability of the 1990s, rob the health system of most of the gains it has achieved. An August 1991 SANRU evaluation aptly summarizes the future of health zones in Congo:

SANRU's raison d'etre is the initiation and strengthening of the health zones' ability to render primary health care to rural populations. SANRU has been dramatically successful in initiating or extending primary health care activities . .

The concept of the health zone is a strong building block for the future development of the Zairian health system. By keeping this concept viable, SANRU can offer to a future, more development-minded GOZ a model, based on the health zone concept, on which to build a sustainable, effective, and efficient national health system.

1991-2001: The political disruptions in Congo in 1991 force USAID to close its offices and to discontinue funding for the SANRU project. However, ECC/DOM continues its leadership and assistance to health work throughout Congo through a variety of projects and funding sources. For example, ECC successfully handles the distribution of more than $4 million of essential medicines to health zones throughout Congo. This work includes providing assistance to: 

• 38 health zones in collaboration with MAP International, 1992;

• 22 health zones in collaboration with the World Council of Churches, 1993;

• Urban health zones in Kinshasa in collaboration with the World Bank, 1994;

• 46 health zones with displaced persons with the U.S. Office of Foreign Disaster Assistance 1994-95; and

• 20 health zones with Solidarise Protestante, a Belgian NGO.

1996: During the Ebola outbreak in 1996, the SANRU offices at ECC become the coordination center for all NGO and governmental agencies. This includes training and surveillance in collaboration with the Centers for Disease Control, handling radio and e-mail services and coordinating the receipt and distribution of two Department of Defense planeloads of medical materials.

2001-2006: With the return of USAID to Congo, and based on an unsolicited proposal developed by ECC/DOM in conjunction with U.S.-based Interchurch Medical Assistance, a five-year $25 million SANRU III project is funded to assist sixty health zones throughout Congo. In addition, a World Bank funded project (PMURR) also proposes to channel assistance to 18 additional health zones via ECC/DOM.

ECC/DOM’s current management of the SANRU III project is providing assistance to rebuilding and strengthening primary health care services in 56 health zones co-managed by Protestant and Catholic Faith-Based Organizations. During the past three years the SANRU project has helped health zones dramatically improve distribution of Vitamin A, usage of Insecticide Treated Nets, distribution of Ivermectin to combat Onchocerciasis, preventive treatment of malaria during pre-natal clinics, testing of blood for HIV/AIDs before transfusions, accessibility to potable water and vaccination coverage. For example, DPT3 coverage was 28% in 2001. Today with SANRU III assistance under ECC/DOM leadership DPT3 coverage is over 70%.