PIN health team stepped up close collaboration with health authorities, says head of programmes in DR Congo

What are the main problems the Congolese people face every day in Kitutu?

Congolese people face a variety of problems in a remote place like Kitutu. Their biggest problem is that their government neglects basic services, so roads are in terrible condition, which means that the peoples’ small businesses and livelihoods simply can’t get off the ground. Such neglect also means that less than 50% of teachers receive salaries and health personnel in state-run health centres are not paid at all. Less than half the children are even sent to school because in the current situation there is such little benefit to schooling – and the quality is so poor that high school graduates don’t have functional French to help them obtain formal-sector jobs or go on to further studies. Very few jobs are available so people remain in the informal sector or live by subsistence farming. Poverty and ignorance are vicious cycles, so while people in Kitutu are trying to do everything they can to feed their families and get ahead, they are hampered by living in a dysfunctional state.

What is the biggest challenge in providing healthcare in DRC?

The biggest challenge in healthcare is getting the government to take up its share of responsibility. NGOs and other international partners abound who are heavily involved in the health sector, but government tends to abdicate on financing healthcare so international bodies often over-compensate by providing very needed, but full-scale assistance which fuels government dependency. Healthcare quality remains problematic, fluctuating in improvement and deterioration, depending on outside funding. Let us say you are a resident of Kitutu health zone. You fall sick, you go to a state-run health clinic all of which are supported by People in Need; the diagnosis has a 60% of being accurate, another real improvement over the past; but medications have only a 50% chance of answering fully and rationally to your needs because despite much training and even more supervision and mentoring, clinic personnel are aiming at their profits and so they try to keep up with the private clinics which over-prescribe medication. You will pay a fee which is high for you, but reasonable, given the real costs of healthcare. You will have free medications because these are donated by PIN. Health workers, unlike teachers, have become unmotivated and corrupted by an unhealthy system.

How did you try to improve the situation?

PIN DRC has worked hard to combat these problems in healthcare. First of all, it is crucial to hire national staff who are self-motivated problem-solvers, not just doing their work as a routine, and the DRC mission has through trial and error succeeded in this. Secondly, PIN believes that ex-patriates must be on the ground, spending as much time in the villages as possible, year after year, experiencing first hand the successes and failures of the project strategies in order to better adapt them.  The health team stepped up close collaboration with local and provincial health authorities, and PIN managers courageously advocated with success for the replacement of the incompetent, corrupt health zone director. Increasingly, strict protocols holding health personnel responsible for their work have been implemented. The zone’s new Medical Director is a competent, highly-cooperative person, so the will is there. But the battle for improved and sustainable healthcare is very hard to win. The Medical Director is rarely present in the health zone to enforce sanctions because state and NGO affairs incessantly require his participation in the provincial capital. Health personnel are very resistant to submit to financial penalties, and the clock is ticking toward the inevitable pull-out date when the zone must try to stand on its feet without PIN’s support.

And what about education? On what activities you focused in this sector?

In my opinion, supporting education in Kitutu is more effective than supporting health because the detrimental side of the two-edged sword of assistance - meeting needs but creating dependency - has not kicked in yet in the education sector...  However, they often lack motivation and competency because of lack of pay and support. PIN has carried out some basic education support in Kitutu for 42 primary schools – training teachers (most of whom had not received training literally in decades), providing much-needed teachers’materials and books for pupils, building two primary schools and assisting over 15 communities to reconstruct their own schools. While sustainability is always an issue because receiving gifts is not as useful as achieving success through one’s own effort, when people are really in need, a balance of making donation but requiring community contribution is a pragmatic stategy. This is why PIN built two schools in Kitutu, funded generously by the Spanish taxpayers; but even more so, PIN staff were extremely gratified to see Kitutu residents contribute time and even their hard-earned money to build many simple but durable schools for themselves. The parents and community members dig up sand and rocks themselves for the foundations, and dig huge pits in the clay soil to mould bricks and burn them so as to mount the walls of their schools. PIN steps in to crown their efforts with a roof.

There is also a big problem with sexual violence against women in DRC. How did you help abused women?

The problem with sexual violence in DRC is caused by the confluence of several factors. Firstly, armed conflict, which uses rape as a weapon to control and punish a population, drastically elevated the occurrence of rape in the DRC. Most of these conflicts have subsided now, but two factors have combined to keep rape at a high rate a) the low status of women which means their rights are rarely defended, and b) the modern politico-economic set-up in which the fabric of traditional society has unravelled, wiping out the taboos on anti-social behaviour which previously protected the dignity of clan or family, hence protecting against rape. Now, even in Kitutu, modern society means that individual wealth rather than family standing gives status – so boys quit school to mine for gold,  education is much less respected than possession of a nice new motorbike or a wife bought with a high bride price. Central to this picure is the fact that rape comes easy because everyone can be bought off – particularly the girls’ parents and customary leaders, and the authorities if they even get involved. In 2010, when armed groups were still operating on the fringes of Kitutu, women and girls were subject to rape in the fields where they farmed or along remote road. PIN has assisted rape survivors by supporting the local health clinics to provide free medical care, including free drugs both to treat infections and injuries, and to prevent disease and pregnancy. We have also supported local NGOs which provide counseling for the women, and also family mediation if and when husbands reject their wives out of the stigma of rape. (If the rape occurs during an incident in which the whole village suffered and several rapes occurred, there is less individual shame and less rejection, but if an individual case occurs, there is a real problem of stigmatization.

Did you also focus on post and pre-natal activities? What were the biggest problems in these activities?

Pre- and post-natal activities include the problem of early ‘marriage‘ when girls have complications during pregnancy because of their young age (more than half of the female population gives birth in their teens). On the whole however, Kitutuans celebrate birth-giving, so almost 100% of pregnant girls and women do come to pre-natal clinics for health checks and counseling. Post-natal health care is adhered to for newborns, but sharply drops off for young children. These are the dangerous years, when small children are subject to malnutrition in some instances, but mainly water-borne and respiratory diseases, malaria etc. Too often parents take their children for treatment when the problem has already become serious, and money is not available to transport them to a referral hospital. PIN expends much energy trying to tackle these problems, both by regular training, supervision and evaluation of health personnel on the quality of pre- and post-natal care they deliver, and also by working with community health volunteers whose job it is to raise awareness in their immediate neighbourhoods on a variety of key health issues.

Have you seen any progress in healthcare and education during your stay in DRC? In what way?

I have certainly seen progress because efforts have been enormous. On the other hand, progress has been small, because that is the nature of aid – it is an assistance that comes from the outside, and can not easily effect the real roots of causes. And as mentioned, the real problem in DRC is government reliance on aid and neglect of responsibility. PIN assisted half of the 84 primary schools in Kitutu. There are at least books and teaching-aid materials available now; at least some aspects of trainings have improved their quality of teaching. Certainly, a great contribution was made when communities reconstructed their schools. This was a good basic contribution to education. But better methods always need to be tried to make a training have a more lasting effect, or motivate a community to maintain their school, or a director to exact discipline or student-centered teaching from his staff.

What were the biggest problems?

The biggest problem in making a difference in the lives of Kitutuans and others in DRC is for donors and NGOs to avoid what I call ‘long-term harm‘. You can think you are helping people, and indeed you are providing them assistance in the current moment, but if what you are doing is making them feel they can sit back and pray for donations all their lives, or look to you for help rather than be active in their own communities or pressure their own authorities and politicians for less corrupt, decent governance, then you have fallen into the trap of doing long-term harm. This is what PIN tries to avoid although it is very challenging.

Can you mention some concrete stories of people you helped?

Having said that, there is a real people-to-people exchange when you work on the ground, and you must implement a programme that expects the community to give as much as it gets; the joy and enthusiasm of school directors who literally made the bricks that built their schools, a school girl who is clearly enjoying the chance to become active and speak out in her community against problems like rape, and teachers who are genuinely thrilled to have received some guidance and intellectual stimulation from training on class management techniques. The director of Kabilongo school was frustrated because PIN would not contribute more than a modest sum for the carpenters charges to make the roof of the school they had built themselves – in the end the carpenter came down a lot in his price because he knew it was a community effort, so the modest sum was enough. The head nurse of Tukenga Health Centre was angry and humiliated when I told him plainly that his health centre was performing poorly in a variety of areas, even though he knew better, and that if performance didn’t improve the following month, we had no choice but to respect the protocol and withhold their monthly ‘bonuses‘, i.e. salaries. Instead of smiling, thanking me and insisting he would improve but never doing it, like so many of his colleagues do, he felt offended, thought seriously about the potential financial loss, and took action. His centre has become one the of best-performing centres in Kitutu.

Was you work dangerous? Have you personally ever been attacked?

NGOs operate taking minimal calculated risks and adequate precaution. PIN DRC does a good job keeping up good security measures that ensure that we are not in danger. And if an alert comes up that due to an incident, travel should be avoided in a certain vicinity for a day or two,  we wait. Almost without exception, I felt perfectly safe during my two years in Congo.

What do you personally consider as your biggest success in DRC?

On reflection, what I feel was my biggest success was the excellent performance of my staff, who I feel very proud of. I am very strict as a manager, I give a lot praise when it is due, and also blame when it is due. I myself need to be held to a high standard or I will slack off, and I’ve seen great improvement when I held my staff to high standards – either that or they would be let go. Congolese people are extremely polite people, and my staff forgave me when I was less than polite. We put in a huge effort together, and they are still putting in a huge effort without me, and I’m cheering them on on the sidelines.

Is there anything you would have done in a different way?

I would try to have more courage to correct my failings as a professional. Otherwise, for me being on an NGO mission pays off expotentially the longer you stay – in the first year you are learning how things work and implementing what you’ve been given to the best of your ability. By the second year you can look very critically to see what needs to be changed and improved, and you have the courage due to experience and seniority to push for these changes. So I regret that I wasn’t able to speed up that process for making maximum impact.

What about the future? Do you want to visit DRC sometime in the future or work in the country?

I plan to take up a full-time teaching position in the English Department at a university in Bukavu next year. I was teaching there on the weekends and I see their needs are enormous – the literature section of their library hardly contains a single book published after the 1970s. The ability of students to do any research is almost nil. I’m really happy I can contribute directly, by being a local teacher. I can see myself living in Congo for perhaps some years, and remaining in Africa, but frankly, when I look at the intelligent young people I know in Congo, I feel very sad that they don’t have a chance at a real future because their government has no intention of breaking out of dependency.

PIN in DRC

People in Need established its permanent mission in the Democratic Rebublic of Congo in January 2009 thanks to the financial support of the Czech Republic. With projects focused on improving access to safe drinking water, better-quality healthcare and education and support for victims of sexual violence, PIN operates in the province of South Kivu in the east of the country. Mortality rates in the eastern DRC continue to be above emergency thresholds; in the last years, millions of people have died in excess of the normal baseline mortality rates for sub-Saharan countries. People in Need focuses on reconstructing healthcare facilities, providing basic equipment including medication, raising awareness about the most pressing healthcare issues and training local medical personnel.

ECHO Humanitarian Aid

The Humanitarian Aid Department of the European Commission funds relief operations for victims of natural disasters and conflicts outside the European Union. Aid is channelled impartially, straight to victims, regardless of their race, ethnic group, religion, gender, age, nationality or political affiliation.