This trip had four major goals:
- attend the partners/stakeholders’ meeting to review the country’s Master Plan for control and elimination of neglected tropical diseases,
- pay a courtesy visit to the newly appointed coordinator for the CDTI Lubutu project,
- arrange meetings and interviews with several village chiefs in support of our adopt-a-village program, and
- pursue and hopefully complete the long and frustrating process for complying with additional government registration requirements for humanitarian organizations.
On January 20, 2013 or two days before the partners’ meeting, I had the pleasure of hosting in our office in Kinshasa two USAID/Envision representatives in town for the meeting to a little taste of Congolese cuisine and hospitality. We spent 2-3 hours after dinner discussing a variety of issues for a possibility of future collaboration.
The meeting to review the national Master Plan for control and elimination of neglected tropical diseases (NTDs) in the Democratic Republic of Congo (DRC) was organized by the Ministry of Health and held from 22-23 January 2013 at the Grand Hotel in Kinshasa, with about 70 guests in attendance. Prominent among the participants were the Ministry of Health’s cabinet members, representatives from WHO, USAID, DFID and NGDO. The primary objective for the meeting was to present the draft of the Master Plan for 2012-2016, including the road map milestones and the related budget to stakeholders and international partners for their review and discussion, and to mobilize the required technical, material and financial resources to cover the costs. The framework for the DRC national plan was based on the one recommended to other African countries by the management of WHO African region.
Three brief presentations were made to mark the official opening of the conference, one by the representative of the Health Minister, Dr. Felix Kabange Numbi, the second by the National Director of Disease Control, and the third by the WHO representative in DRC. The strong will and commitment by the government to endorse the London Declaration in working toward the elimination of NTDs in DRC by 2025 was confirmed by the Ministry of Health’s announcement of the government’s pledge of 1 million dollars to support the initial field activities during the first year.
The expected outcomes of this meeting forum would be the approval of the Master Plan including the budget, and the partners’ commitment to contribute the necessary technical, material and financial resources to get the job done.
Current situation in the fight of NTDs in DRC
Currently, the program to control NTDs through mass drug distribution is placed under the National Program for Disease Control. It is comprised of three major vertical programs, 1) National Program for Onchocerciasis Control, National Program for Lymphatic Filariasis Control, and 3) National Program for Schistosomiasis and Helminthes Control. At this point, only the onchocerciasis control program has been active for over a decade. The other two programs are still at the mapping stage. It was quite obvious to all that this approach is not in line with the current broader vision of well coordinated and integrated interventions. All participants expressed their hope to see an integrated approach be implemented in DRC.
The DRC Master Plan
The mass drug distribution programs of the Master Plan include onchocerciasis, lymphatic filariasis, schistosomiasis, soil-transmitted helminthes and trachoma. The treatment and morbidity control programs include African trypanosomiasis, leprosy, dracunculiasis (Guinea worm) and Buruli ulcer. The mapping of onchocerciasis is nearly completed with the exception of conflict and post-conflict regions. The integrated mapping of the other NTDs is urgently needed and is either in progress for a few areas or planned to start in the near future for others. Specific objectives are to distribute ivermectin alone or ivermectin plus albendazole to at least 84% of the population in all endemic health zones for onchocerciasis and lymphatic filariasis, respectively. Also planned is the distribution of albendazole and praziquantel to at least 80% of at risk populations in all health zones prevalent for helminthes and schistosomiasis, respectively. The endemicity of trachoma will be determined in all regions that are close to neighboring countries known to be endemic for trachoma, and appropriate control measures will be implemented. Proper management of 100% detected cases of leprosy, African trypanosomiasis, Buruli ulcer and Guinea worm will be carried out.
The budget for this phase of the Master Plan was estimated at $140 million, including the cost of the medications or $78 million excluding the cost of the drugs.
Partners’ response to the Master Plan
After extensive discussions of the various aspects of the plan, it was the view of virtually all the partners that additional details on the road map, milestones and the budget were needed before they could articulate their positions on the pledges. A recommendation was made for the requested details to be included and the revised plan to be sent to all stakeholders.
Field trip to Lubutu
This trip had a dual goals, a visit with Dr. Louis Kitete, the newly appointed coordinator of the project, and meetings of selected chiefs in the region for the expansion of UFAR’s adopt-a-village program. I travelled from Kinshasa to Kisangani and back on one of several daily UN/MONUSCO scheduled flights provided free to humanitarian organizations formally registered with them. Since the CDTI Lubutu project does not currently have a vehicle, arrangements were made to use a rental car during the duration of my visit, January 30 – February 4, 2013. Before leaving Kisangani, I made a courtesy visit to the WHO office and meet key staff members. I also had the opportunity to see the broken down vehicle belonging to the Lubutu project that had been poorly handled by the previous project coordinator who has since left. The vehicle apparently with a broken engine and only 28,000 mileage has been there since 2009.
We travelled from Kisangani to Lubutu by car, a distance of 245 km on a fairly good road in 4 hours. As required by protocol, I was immediately introduced to local government authorities upon arriving in Lubutu. Then, I met and discussed things with our project staff, and met several of our local collaborators. I found out that two of the international organizations I met in Lubutu during my 2010 visit, namely Doctors without Borders and MERLIN had just left the area due to termination of their contracts.
I very was pleased with the overall progress achieved to date by Dr. Louis Kitete and his staff, without a vehicle and with only two old and extensively used motorcycles. Their 2012 Mectizan distribution activities had just recently been completed and they were in process of collecting the registers for data analysis. Random spot checking of several registers confirmed proper handling of the registers. The actual results in terms of coverage data for 2012 will not be available until around mid-March. The critical need of a reliable vehicle before the 2013 Mectizan distribution campaign starts has been brought to the attention of WHO/APOC management which is primarily in charge of providing such means of transportation to each project.
Through strong support of the local administrative authorities which even provided us with an escort for two days, we were able to meet, interview and take photos of 14 village chiefs. They were willing and very happy to have their villages adopted by individuals or organizations in the US interested. This is a program intended to ensure the durability of the long range community-based and community-directed efforts to control and eliminate onchocerciasis and other NTDs.
New government registration requirements
Believing that the last phase in registering UFAR for compliance with new government regulations, the phase that involves presenting the final documents to the City Hall in Kinshasa to be notarized, would be better handled by a lawyer, I was pleased to get one who was referred to me and who was willing to assist. As it turned out, even lawyers have difficulties working in DRC. It took him well over a week and still the job did not get done before my departure. He mentioned the unreliability of the Notary Public in charge as the primary reason. I plan to handle it myself next time. So the saga and setbacks continue.