The Buchan Family Foundation commits to establish, implement, and totally fund two Community Health Centers in the province of Lower Congo. The first will be the Nkandu Health Center, located in Inkisi, which will serve a population area of 34,300 people where the average family income is $30 per month. The second center is the Kingantoko Health Center, which will be located in Massa, near Kasangulu. This facility will serve a population area of 5,000 who live on an average income of less than one dollar per person per day.
The Buchan Family Foundation will work with its partner, the Susila Dharma International Association (SDIA) and its local chapter, SD DRC, to develop and implement a model of community co?managed, not?for?profit health centers that are accountable to the populations they serve. Each center will have a locally administered Health Mutual Association which is specifically designed to help ordinary Congolese families serviced by the Community Health Center save for and benefit from a basic package of quality health services that they have participated in defining. The Buchan Family Foundation calls this model the Community Health Center (referred to in the French language as a CSCOM). It is important to note that this model is in line with both the recommendations of the Bamako Initiative and the DRC's own national health planning objectives.
The strategy is based upon the creation of a sustainable and scalable Network of Community Health Centers
(CSCOMs) in which each center is economically affordable and accountable to the local population while being well-managed and providing quality care. The Buchan Family Foundation will ensure that each center runs in line with good governance practices (established through By?Laws, management, and on?the?job?training of the healthcare team) and sound medical protocols (established by Medecins D'Afrique and supervised by local health officials and the Susila Dharma DRC medical team).
The Buchan Family was involved in the Ndjili Kilambu Healthcare Center pilot serving a population of 19,000. This build identified a number of significant lessons to be learned. In moving forward the Buchan Family Foundation will seek to understand if the Operations Manual created from these key learning's will enable other Foundations and NGOs to establish and implement sustainable Community Health Centers.
Step 1 of the action plan is to establish contact with local health authorities and create the Community Health Committee. This is a platform for community dialogue on health problems and priorities. The timeline for this step is up to 4 months.
Step 2 is to establish by-laws, carry out training and gain community acceptance of them. The timeline for this step is up to 4 months and will occur concurrently with Step One. The By-Laws are predetermined by the Operations Manual. They must be agreed to by the Board of Directors of the Community Health Center. If there is no community commitment, the building of the Community Health Center will not occur.
Step 3 is the construction of the Community Health Center. This will be based upon architectural drawings which have already been drawn up and which meet the government's specifications and requirements.
Step 4 is the implementation and promotion of the Health Mutual. The Health Mutual is owned by its members, and determines a specific package of coverage based on the services required by the community and the means of families to make monthly deposits. Health mutual members and their families can then access services based on savings, rather than on a fee-for-service basis, and local employers are encouraged to contribute.
Nkandu (Inkisi) Health Center was launched in April 2012 for occupancy in October 2012. Its Health Mutual Association memorandum of understanding will be established by the end of October 2012. Kingantoko Health Center (near Kasangulu) was launched in May 2012 for occupancy in December 2012. The Health Mutual Association is projected to be completed by January 7, 2013. Monitoring and supervision will be conducted on a monthly basis thereafter and training will be conducted every three months thereafter.
The relatively high costs, inaccessibility and poor quality of health services throughout the DRC has led to high rates of morbidity and mortality. The child mortality rate is estimated at 170/1000 live births (WHO, 2010). The malnutrition rate, including stunted growth, is estimated at 45% for children less than 5 years of age, and acute malnutrition is 14% (WHO, 2007). Around 4% of the population is HIV/AIDS positive (WHO, 2008), and the health coverage rate is very low. Food insecurity touches 47% of families, improved drinking water supply is available to 25% and only 40% have access to hygienic latrines (WHO, 2010). It is estimated that 70% of the population have little or no access to health care. According to the World Health Organization, in 2010 there were only 2.2 doctors and 9 trained nurses/midwives per 10,000 population.
The Buchan Family Foundation has a goal to provide seed capital which enables the development and implementation of a model of community co-managed, not-for-profit health centers that are accountable to the populations they serve and which are self-sustaining. Ultimately, the model must be scalable to allow for the creation of a Network of Community Health Centers.
The following key health delivery problems are to be addressed by the Community Health Center Model:
-High cost of health care
-Poor quality of care
-Lack of input from the local health authorities
-Lack of accountability to the community
-Need to engage communities in sanitation and preventive health programs
-Need to create financial sustainability