Congo primary health care

Final PES covers the period 6/82-8/85 and is based on document review and site visits. Establishment of a health information system (HIS) to monitor and evaluate project variables and their effect on health status has been a tedious process. The system, which collects data at the village, dispensary, and hospital levels, is only just completed and, as a result, data on project impacts are scant. The project has established 34 village health committees with functioning political councils. Only about a third of these are active, however, level of activity being correlated with good leadership and isolation from fixed health facilities. Fifty village health workers (VHW"s) have been trained. VHW"s provide both curative and preventive services (including sanitation, immunization, and growth monitoring). Fees are charged (and willingly paid by villagers) for both treatment and medicines. Plans are underway for training VHW"s to provide oral rehydration therapy, malaria chemoprophylaxis, and drugs to treat intestinal parasites. Effective supervision by dispensary nurses has been a clear determinant of VHW success. However, the project"s lack of authority over the nurses (who are selected by the Ministry of Health) has, along with transportation problems, sometimes limited its effectiveness. The expanded program of immunization, including a cold chain, a warehouse, and vaccination schedule, has been implemented very successfully, with all targets met; particularly notable was a 1984 measles vaccination campaign. The maternal child health center was finally opened in 4/85, following long construction delays; the center provides basic health care, nutrition education, and growth monitoring services. A pharmaceutical warehouse, from which VHW kits are resupplied, was established in 6/84. The project teaches that PHC systems require (1) a simply designed HIS which covers both health impacts and service delivery, (2) host government support, and, for maximum impact, (3) integration with other community development activities (especially nutrition). Also, realistic targets should be identified and developed by individuals familiar with PHC systems and care should be taken that a fee-based PHC system not fall prey to overemphasis of curative services.