Conflict and Humanitarian Crisis
In September 2016, the Kamuina Nsapu militia swept through the DRC’s Kasai region where Sophie lives—and where an estimated 67% of ASSP’s target population is located—creating a security and humanitarian crisis. Many health centers in the region were forced to close, and at the height of the violence, up to 3.3 million people were thought to be displaced—more than a third of the total population served by ASSP.
Many of the project’s maternal and child health interventions were health facility-based. Among its other goals, ASSP aimed to increase the number of women who attended antenatal care visits, who received family planning counseling and antimalarial bed nets and who delivered their babies with the help of a trained birthing attendant. Visits to ASSP-supported health facilities typically cost patients 50 cents to $1—a small but important fee that helped to finance health facility operations. But with families fleeing their homes and livelihoods, patients could no longer afford the fees, and some health facilities were unable to pay their staff or keep their doors open.
Strengthening Health Systems During a Crisis
Leveraging lessons learned from years of strengthening health systems in fragile settings, IMA World Health secured funding from the Office of U.S. Foreign Disaster Assistance in 2017 to help ASSP provide free health care in the conflict zone. Instead of using temporary tents and foreign health workers to weather the crisis, ASSP invested in local health workers and reopened existing health facilities. The community response to these free services was robust, and many of ASSP’s indicators rebounded. By the project’s end in April 2019, several maternal and child health indicators—such as fistula repair—met or exceeded targets. Select examples include the following:
- Number and percentage of births attended at a health facility by skilled health personnel: 1,848,043 (101% of target)
- Number and percentage of 1-yr-old children vaccinated against measles: 1,742,466 (100% of target)
- Number and percentage of pregnant women provided with two doses of intermittent presumptive treatment (IPTp) for malaria: 1,603,010 (101% of target)
- Number of children and pregnant women reached with nutritional interventions (e.g. five home visits for children and three doses of iron and folate for pregnant women): 1,433,891 (103% of target)
- Number and percentage of pregnant women and children under one year provided with a long-lasting insecticide-treated bed nets (LLINs): 971,407 (101% of target)
- Number of new acceptors of modern methods of family planning: 1,680,128 (101% of target)
As for Sophie, she is grateful for the care she received at her local health center. “I don’t have anything to give ASSP. I can only pray that God will reward them a hundred times over, and that he grants them a long life on this Earth,” she told IMA staff. Though the indicators show the immense success of the ASSP project, it is hard to measure the true impact of having one’s health and dignity restored.
*Last name withheld