Three Community Health Centres 

Three community health centers currently operating: Lemba Imbu, Nkandu III (Inkisi) and Kingantoko. In 2011, the Susila Dharma (SD) Network started the building of a model Community Health Centre or CSCOM, co-managed by the community and local health services of the Democratic Republic of Congo (DRC).
Community health centres or CSCOMS  
The National Health Development Plan of the DRC aims at ensuring to its population quality and affordable healthcare and at a reasonable distance of their homes. To that effect, the country was divided into 556 Health Zones each of them equipped with a Referent Hospital providing surgery and specialised consultations, and a Central Health Zone Board with a Chief Medical Officerand agents includinga Community Organiser; each Health Zone is subdivided in several Health Areas equipped with a Community Health Centre or CSCOM that is delivering primary healthcare within the following framework: 
  • Delivering quality and affordable healthcare.
  • Very rigorous management: financial balance reached after 1 year at most.
  • Community highly involved in management and exterior actions (Health Committee or COSA, and Management Committee or COGES).Integrated into the National Health System: 
  • Provides primary healthcare and follow-up: delivers a Minimum Activities Package such as defined by government, followed by a Complementary Services Package when authorities give their Approval.Care and consultations are provided by nurses using questionnaires and diagrams supplied by health authorities. All cases out of their scope of practice are forwarded to the Health Zone Referent Hospital. A Health Zone medical officer performs a few visits at the CSCOM.
  • Serves from 4,000 persons in rural zones, to 10-15,000 persons in urban zones, within a radius of around 5 km.
  • Delivers health actions in the local community: vaccinations campaigns, education to health and nutrition campaigns, with volunteer community relays.
  • Monitoring by health zone that covers part of the salaries and medical supplies and permanent training of staff.
  • Respect of the DRC national health standards. 
  • Payment not for each act but for each treatment and including medicines (amount defined by the COSA and around $1 to 1.5).
  • Cooperation with a complementary Health Mutual Association that will make it possible at a later stage to financially support the cost of its members' care.
Working with the community  
Working with the community is essential, because its involvement in the management of the Centre demands its awareness-raising and the training of its representatives to the management of a CSCOM, and also training the volunteer community relays who perform the actions in the community. 

Negotiating with the Health Zone allows the integration of the CSCOM into the national health organisation and may lead to supporting part of the costs of salaries and medical supplies.  
partneR
Buchan Family Foundation - SDIA - SD Canada - SDFE - SD RDC
LOCATION
DR of Congo  
YEAR
2012 - 
The Health Centre of Kingantoko  
Within this framework, the SD Network with SDIA supported SD RDC, together with a Canadian foundation, for creating a network of CSCOMs in the DRC. 

It should be noted that a CSCOM costs around $250,000, including a stock of medicaments and supplies and the salaries of the staff, this amount allowing 6 months of operation. Electrical supply is done by photovoltaic panels and a generator; the centre is linked to the national electrical grid when available, but it is not always reliable. For energy saving and operating cost reduction,low-consumption refrigerator and bulbs are used; average power requirement is around 1.5kW, except when some apparatus such as a sterilizing unit are in use.


Now, 3 CSCOMs are already operating in the DRC: Lemba Imbu, Nkandu III (Inkisi) and Kingantoko; they are well integrated into the national health system and soon reached financial balance. 

A great progress achieved for the maternity-ward at Lemba Imbu  
We have now reached a consolidation stage: lessons learned from theproceeding of the construction works and difficulties met, evaluation of existing centres, finalising procedures and manuals, starting networking for CSCOMs, improving the training of local teams to building site management and monitoring, standardising designs of buildings and supply-purchasing. 
 
Setting up around ten CSCOM is considered for the next 3 years.