UN mission highlights massive public concerns

The key message of a joint WHO and UNICEF health mission to the DRC in late July was that health care must be redirected from the current “facility-based curative care” to “a public health approach focused on the main killer conditions” in order to address unacceptable mortality and ill health. The mission found that up to 70 percent of the Congolese population was now excluded from basic health services, while all forms of preventive public health activities were “severely curtailed” - not least because health workers salaries were usually linked to curative care, according to a WHO report. This observation led to the mission’s second key recommendation: that health workers’ salaries must be separated from payment by patients and “linked to performance of a package [of services] which directly targets the main killers, both in the household centre and at household level.” The nine-person mission also called for “a massive effort” on HIV/AIDS and malnutrition, which, they said, provided “an increasingly frightening underlay” to the general public situation. It also called for a better coordinated and standardised approach to the surveillance and treament of malaria, particularly in the east of the country, where it the magnitude of the problem was described as “nearly overwhelming.” Public health authorities have estimated, based on information from five regional sites, that there were in the region of 173,000 new HIV cases each year, and almost 1.3 million adults and children living with HIV, the WHO reported. The five sentinel sites - in Kinshasa, Karawa (Equateur Province), Mikalay (Kasai Occidentale), Kibondo (Orientale) and Sendwe (Katanga) - were currently producing limited data on the HIV/AIDS pandemic in the DRC but an in-depth, countrywide investigation of the situation was long overdue, it said. Meanwhile, multiple troop movements and population displacements to and from neighbouring countries with high HIV prevalence rates (including Rwanda, Uganda and Zambia) have left the DRC well set for “an explosion of HIV/AIDS”, according to WHO focal point Dr Tshioko Kweteminga. “I can hardly think of a better vector than tens of thousands of young men with hard currency roaming around the country,” the agency cited another observer as saying. [For more details, see separate IRIN story of 15 August headlined “DRC: Conditions ripe for HIV/AIDS explosion”; for WHO mission report, go to: http://www.who.int/eha/disasters]