• Central Level:
  • The Ministry of Health, the General Secretariat (secretariat general), 12 Divisions (known as “directions”), and 52 national programs , of which the National Program of Reproductive Health (PNSR) is one. PNSR was established to play a leadership role in coordinating family planning (and safe motherhood) services throughout the country.
• Intermediate Level:
  • Provincial health inspection (inspection provincial de la santé), health zones (districts sanitaires)
• Operational level:
  • Zones de santé (515 in total, of which 35 are in Kinshasa), with a reference hospital (hôpital général de référence) and health centers that deliver integrated health services to the population of the health zone.

PRIVATE, NON-PROFIT SECTOR, INCLUDING NGOs

This sector is no longer limited to the churches, although FBOs remain the major and often most stable player in the social sector. Numerous secular organizations, both local and international, have joined the FBOs. In the health sector, several PVOs (private voluntary organizations) provide family planning services in the DRC (see “FP organizations”). FP services are provided through one of the following mechanisms: (1) clinic-based integrated services; (2) social marketing; (3) community outreach; (4) provision by a stand-alone clinic.

1. Clinic-Based Integrated Health Services
This delivery model entails the delivery of FP services through existing facilities in the health zones as an integral part of the MPA. However, chronic shortages of financial, material and human resources make it difficult for a large proportion of health centers and health posts to offer all, or even most, of the services included in the MPA. Hence, the actual delivery of family planning services, including availability of contraceptives, varies greatly. In spite of this constraint, many donors in DRC work through this model. Examples include the following:

• CIDA: will soon start a new program in 7 health zones in Kinshasa
• DfID: is increasing the number of zones from 20 to over 30 that will deliver FP as part of an integrated health services
• UNFPA: supports integrated health in 20 health zones of 4 provinces
• USAID: provides technical support and commodities to health zones through its partner agencies, including:
  • World Bank, which has financed the delivery of integrated health services in 80 zones, including FP, but is currently awaiting the lifting of a temporary blockage of funds invested in the DRC

2. Social Marketing
This delivery model is relatively underdeveloped in the DRC, in contrast to many developing countries with highly visible marketing campaigns for condoms and other socially-marketed products. Only two organizations have social marketing programs in the DRC, namely: PSI and DKT-RD Congo. PSI’s social marketing program has consisted primarily of ensuring a steady supply of products to health centers and pharmacies through its Confiance and Advancing Social Marketing for Health in the Democratic Republic of Congo projects. PSI, which has operated continuously in the DRC since 2003, uses point of sales advertising with a limited amount of mass media marketing. DKT-RD Congo began its activities in DRC in July 2010. It promotes DKT-RD Congo branded condoms (OK Condoms), oral contraceptive pills, and IUD. It will begin selling all products under its own brand in 2012 via its social marketing program. At present, DKT-RD Congo is operating in Kinshasa, Bas Congo, Katanga, and Bandundu through its sales people at private sector outlets, including wholesalers, pharmacies, clinics, and non-traditional outlets. Training of clinic based providers and pharmacists and community mobilizers is also being conducted. DKT will be expanding to other provinces in 2013 and will be adding additional family planning products to its portfolio.

3. Community-Based Distribution or Outreach
Community-based distributors (CBD) do not have formal clinical training, but undergo short-term training provided by that programs that enables them to deliver basic care for specific conditions included in the MPA. As such, FP is one of 10-12 areas that may fall within their job description. Typically, CBDs offer a limited range of methods, often just pills, condoms, CycleBeads®, and (only rarely) injectable. This model of service delivery, relatively uncommon in the DRC, is usually set up by PVOs. ABEF, the IPPF member association in DRC, is one of the organizations that rely on this mechanism of delivery. It reports having 155 CBD workers in Kinshasa alone. A second example is the IRH, which assisted the Muslim organization – Maman Ansar – to establish a CBD program in Kinshasa in 2011, with an estimated 66 volunteers participating in the program (including 14 Imams, 40 CBDs, and 12 clinical providers). The WWF offers services in Salonga National Park using a network of CBD workers.

4. Stand-Alone Clinic
Described as “vertical programs,” stand-alone clinics provide family planning as their sole or primary service. In some cases, these facilities provide other reproductive health services (such as pap smears or HIV testing) but not the MPA. FP stand-alone clinics are rare in DRC. The capital city of Kinshasa has only three outlets that use this approach, namely the Kintambo PNSR center, named Libota Lilamu and two clinics operated by ABEF (although these two clinics provide other maternal and child health services). This type of service delivery focused largely on family planning is the rare exception to the general rule of integration of FP into a broader range of services.