PHOTO: A DRC hospital, located in the Kenya neighborhood of the town of Lubumbashi, displays a banner announcing health services available through a collaboration among FHI, the Emergency Plan and the Global Fund. (FHI/DRC)

OCTOBER 2006 � Working together, we can have the greatest impact.

FHI, the U.S. President's Emergency Plan for AIDS Relief and the United Nations Development Program Global Fund (UNDP-GF) have learned this lesson well in the Democratic Republic of Congo (DRC).

Since May 2006, the three have been working together to provide comprehensive HIV/AIDS prevention, care and treatment services at three DRC government hospitals, located in Bukavu, Matadi and Lubumbashi.

Their collaboration is notable not only because it is efficient � patients can be tested for HIV and immediately referred for treatment at the same hospital if they test positive � but also because it is building the capacity of local NGOs and government health structures that implement the program.

The Emergency Plan supports counseling and testing (CT), including comprehensive city-level referrals. The UNDP-GF funds prevention of mother-to-child transmission (PMTCT) and care and treatment � including ARV therapy. All services are provided at a single site, and referrals made within a single structure.

According to Mayala Mabasi, FHI country director in DRC, to date 323 people have begun antiretroviral therapy (ARV) at the hospital sites and some 12,000 have been counseled and tested. Although the PMTCT numbers are not quite as high, they are expected to rise as the hospitals become better known in their respective communities.

Serving the Community, Building Local Capacity

Two Local NGOs, Foundation Femme Plus and AmoCongo, are working with FHI to implement CT programs and refer eligible HIV-positive clients for ARV therapy and other treatment. Interacting with FHI is helping them build organizational capacity and strengthen their management systems.

Ellen Lynch, HIV/FP Officer for USAID DRC and Protection Team Leader, says this type of arrangement is a cornerstone of the Emergency Plan. "We want to partner with host nations to build local, in-country systems that are sustainable for the long term," she says.

It is also advantageous that, at these three sites, the Emergency Plan and Global Fund share implementing partners. This means referral networks and systems are more easily established and monitored.

"We can be more confident that those who enter the system through the Emergency Plan are appropriately referred to treatment and care and support programs," Lynch says.

Reaching a Target Group

Another important benefit of this collaboration is that it enables FHI and the Emergency Plan to connect tuberculosis (TB) patients with CT. They are a target group for CT because those who also have HIV are more likely to manifest the active transmissible form of TB, accelerating the spread of the disease. In turn, TB is more likely to accelerate the progress of a patient's HIV infection.

Most TB patients in DRC are treated at government hospitals where the UNDP-GF had already established ties. By partnering with them, FHI and the Emergency Plan were able to gain access to TB patients receiving treatment at government hospitals and offer them CT.

"Research indicates that, when asked, a majority of people say that they would like to know their status," Lynch says. "Counseling and testing is an entry point to care and treatment, and is also a crucial opportunity for prevention education�for those who are infected and their partners, and also for those who are not infected. Yet counseling and testing remains stigmatized and utilized by far too few people in nations hard-hit by HIV/AIDS. In this program, the Emergency Plan offers the entry point, counseling and testing, and the Global Fund offers the assistance that leads to treatment and completes the package of services."

Moving Forward

Besides these three sites, FHI is implementing other HIV/AIDS prevention and treatment activities at 22 sites throughout eight provinces in DRC: Twelve are supported by the Emergency Plan, and ten by UNDP-GF. Many follow DRC Ministry of Health recommendations that sites have integrated activities.

DRC Minister of Health Emile Bongeli and USAID Mission Director Bob Hellyer took part in site launch activities. They have encouraged all partners to efficiently use limited resources and enthusiastically support partners' efforts.

According to Alain Akpadji, HIV/AIDS chief of project,
UNDP�Global Fund, one of the greatest challenges lies in the fact that, while the need in DRC is great, national capacity is still weak. The government often has trouble guaranteeing a livable wage for hospital staff. Those treating TB patients in hospitals taking part in this project are now compensated better because of UNDP-GF's commitment, but this is not a long-term solution.

 "We have to identify how this kind of partnership can be developed so it can provide even greater coverage," Akpadji says. "We hope to expand the program to many other sites and continue to build local capacity, at both the national and provincial levels. For now, we are glad that the partnership is working on so many levels: between financial institutions, technical institutions, government and civil society."