Health Coverage Promotion in the Dr-Congo, South-Kivu

The people of the Democratic Republic of Congo (DRC) have for decades been living in a situation of chronic crisis. Thirty years of appalling mismanagement and corruption under the rule of President Mobutu had left public services in this country in disrepair, creating desperate poverty and chronic poor health. In 1996, Laurent Kabila launched a rebellion that succeeded in ousting Mobutu a year later. In August 1998, Kabila's government was attacked by a rebel movement supported by Rwanda and Uganda, thus marking the onset of the so-called 'second war'. These successive conflicts have further shredded the economic and social fabric of the country.

After the killing of Laurent Kabila in January 2001, the new regime led by his son Joseph Kabila expressed its intention to bring stability to the country. A peace agreement was signed in Lusaka, Zambia, in July 1999, but has been violated by all sides (UNOCHA, 2000). Many Congolese and foreign-armed groups are reluctant to give up control of this mineral-rich country and insecurity still reigns.

Violence, population displacement and the destruction of infrastructure and health services have devastated the health of the population of this country two-thirds the size of Western Europe. An estimated 2.7 million people have been displaced within Congo, many in insecure regions outside the reach of aid workers, while a further 331,200 have fled to DRC from neighbouring countries (UNOCHA, 2003).

There is a near-total collapse of the country's health-care system, which ranks 179 out of 191 countries surveyed by the World Health Organisation (WHO, 2000).

Decades of under-investment by the Congolese authorities have resulted in unpaid salaries, dilapidation of health centres and hospitals and poor distribution of essential medicines and supplies. Development indexes place the DRC among the world's leastdeveloped countries: the infant mortality rate is estimated at 128 per 1,000 live births (compared to seven in the US); under-five mortality rate is 207 per 1,000 live births (eight in the US); and 55 per cent of the population have no access to improved water services (UNDP, 2001).

The withdrawal of multi- and bilateral aid initiatives since 1992 has left the health system in the sole hands of NGOs, churches and private assistance. Conservative estimates show that at least 37 per cent of the population (approximately 18.5 million people) have no access to any form of formal health-care; other figures suggest this figure is as high as 75 per cent (Oxfam, 2001; WHO, 2002).

A mortality survey by the International Refugee Committee (IRC) in 2001 estimated the death toll for the 'eastern Congo' since 1998 to exceed 2.5 million (IRC, 2001). While alarming in themselves, these figures represent only a fraction of the country (North and South Kivu, Maniema, Katanga and Orientale provinces). A lack of scientific data from western and central regions equally affected by conflict should not result in a disproportionate amount of funding and assistance to eastern regions.

MSF has been providing medical assistance in the DRC since 1981 and is currently working in both government- and rebel-held territory. Activities include supervising and training health staff, vaccinations, antenatal care, epidemiological surveillance and water and sanitation improvement. Between August and October 2001, MSF conducted a survey in each of five regions to determine mortality rates, access to care, vaccination coverage and exposure to violence in five health zones in provinces not covered by the IRC survey. This survey of five regions also aimed to complement existing mortality figures from the eastern regions, and thus to create a more balanced picture of mortality and its causes in the Congo crisis. The additional aims of this project were to assist with programme planning and to inform advocacy efforts.

The collection of quality epidemiological data amid the chaos of conflict is a difficult but necessary task: such surveys are invaluable for documenting the plight of forgotten populations; they assist aid agencies in programme planning; and they provide a platform for advocacy towards the international donors for a community in desperate need of greater humanitarian assistance (Legros and Brown, 2001).

Provinces surveyed

The survey covered areas differentially affected by the war, including ceasefire zones occupied by the military (Basankusu, Kilwa), troop withdrawal zones (Lisala, Kimpangu) and non-conflict zones (Inongo). The survey areas are found in four provinces (Equateur, Katanga, Bas-Congo and Bandundu) as described below (see Figure 1).

In Equateur Province (Basankusu and Lisala) fighting has divided the province in two ?the north and east occupied by rebel forces, and the west and south controlled by the government ?causing widespread population displacement. More than 100,000 people have fled to the Central African Republic, Congo-Brazzaville and south of Basankusu (UNHCR, 2001). Health structures in 28 of Equateur's health zones have experienced systematic looting (UNOCHA, 2001a). Basankusu and Lisala, the two health zones surveyed, lie on the north-eastern rebel side. Those who stayed found themselves isolated by the closing of the Congo River because of fighting, which compounded economic collapse and limited aid to the area. Poverty is extreme and many families in Basankusu lack basic materials and farming tools.

Katanga Province (Kilwa) is also divided by the front line: the north is controlled by rebels and the south is under government control. Only 14 of the province's 40 health zones are regularly supplied with essential medicines (UNOCHA, 2001a). Intensive military activity north of Katanga has resulted in population displacements, with people seeking refuge as far away as Zambia and Tanzania. The population of the surveyed zone, Kilwa, has been afflicted by serious disease outbreaks and chronic malnutrition.

Bas Congo Province (Kimpangu) was home to a large number of refugees fleeing the conflicts of neighbouring Angola and Congo-Brazzaville. The socioeconomic infrastructure has been damaged by war, and civilians have suffered from extensive looting, destruction of health services and loss of life. In November 1999, the general reference hospital and central office of the surveyed health zone, Kimpangu, were comprehensively looted by Angolan rebel UNITA forces, with coldchain material, surgical equipment and pharmaceutical stocks taken or destroyed.

Between December 1999 and July 2000, MSF was forced to suspend activities in Kimpangu due to insecurity.

Bandundu Province (Inongo) has not been directly affected by the war, but contains over 26,000 refugees from Congo-Brazzaville (UNOCHA, 2001a) and suffers from the indirect consequences of country-wide economic crisis. Roads and bridges throughout the health zone surveyed (Inongo) have literally disappeared, making many areas practically inaccessible, as the health system continues to suffer a lack of medicines, material and money. The nearest reference hospital is 350km away in Equateur, and thus practically inaccessible. Only 17 of Bandundu's 38 health zones are regularly supplied with essential medicines.

Methods

A multi-stage sampling scheme was used to select households for survey. Provinces to be surveyed were selected based on accessibility and security. Specific health zones were then chosen on the basis of control (government or rebel), proximity to the front line and the presence or absence of humanitarian agencies. MSF is present in (or supports indirectly) three of the five zones surveyed: Basankusu, Lisala and Kilwa.

A two-stage cluster sampling was chosen, with a sample size of 30 clusters of 30 households in each zone (see below). Once specific sites were identified, health workers determined the centre of the village, hamlet or district, and chose a direction at random by spinning a pen. Households in that direction were numbered, and a number picked at random (spinning a pen on to a sheet marked with numbers 1-9) to define the household from which the survey would begin. The next household to be surveyed would be the one closest to the first, and so on. Following this methodology, a total of 4,527 households were surveyed in five zones between August and October 2001.

Calculation of sample size Sample size was calculated over an expected mortality rate of 1.5/10,000/day. The precision or confidence interval (CI) was fixed at +/- 0.44/10,000/day; so the lower limit of the CI will not include the mortality emergency threshold of 1/10,000/day (CDC, 1992). This means that for a recall period of six months it is expected that 2.7 per cent +/- 0.8 per cent of the population will have died. As is usual for a 95 per cent CI, the standard-error parameter was fixed at 1.96 (corresponding to an error risk alpha of 5 per cent). A cluster effect of between three and four was chosen, based on operational experience that in a war zone violence is not homogeneous and can be expected to vary considerably from one place to another. With those hypotheses, a sample size of between 4,731 and 6,308 people was required.

Household was defined as a group of people who sleep and eat under the same roof at least three days per week. (The notion of family is complex, implying members not necessarily living under the same roof, and including additional wives, distant cousins adopted into the family, and so on.) Data were checked as soon as supervisors returned from the field and entered their EPI Info 6.04 (CDC, Atlanta). The average number of people per household was estimated at between five and seven, corresponding to a sample size of between 676 and 1,262 households. Therefore, a two-stage cluster sampling was chosen, with a sample size of 30 clusters of 30 households (giving a total of 900 households in each zone), using WHO/EPI methodology (Henderson and Sundaresan, 1982).

A sampling frame was constructed on the basis of population lists provided by local health authorities dating from a WHO polio-vaccination campaign in July and August 2001. The clusters were selected from these lists based on probability proportionate to size to ensure that smaller clusters were not over-represented in the sample.

Twelve teams of two Congolese each were selected based on their knowledge of the region, literacy (a university degree as a minimum requirement), and ability to speak the local languages. Teams were trained on methodology and procedures over two days and then tested. Their work was systematically reviewed every evening by at least two supervisors (MSF expatriate staff or Congolese epidemiologists from the national health system), headed by a coordinator.

Data on mortality rates and health-care access were gathered retrospectively over eight months (January 2001 to time of survey), while violence and vaccination coverage were surveyed over a longer period (August 1998 to time of survey). A questionnaire comprising 22 closed or semi-open questions was used, covering four issues: mortality, access to care, vaccination coverage and violence. These questions were directed either to the whole household (mortality and violence) via the household head, or a single sick person or child randomly chosen from each household (access to health-care and vaccination) as appropriate. Cause of death for each member of the family was determined by verbal autopsy (WHO, 1999), respondents choosing from the following four options: diarrhoea, respiratory infection/pneumonia, fever/malaria and others. Respondents in Lisala were not asked questions regarding their experience of violence for reasons of security.

Cooperation of the local authorities of each health zone was obtained. No material compensation was given to participants and care was taken in explaining the purpose of the survey to avoid raising expectations. Every effort was made to ensure confidentiality and to prevent any adverse effects on participants (Leaning, 2000).

Results

Mortality

Crude mortality was found to exceed the alarm threshold in Kilwa; in Basankusu it exceeded the emergency threshold (see Figure 2). The under-five mortality was more worrying, breaching alarm thresholds in Kimpangu (see Table 1). Malnutrition (24.2 per cent), diarrhoea (20.9 per cent) and suspected malaria (18.9 per cent) were reported as the leading causes of mortality in the Basankusu health zone. In Lisala, the two most common causes of death were respiratory infections (14.7 per cent) and suspected malaria (14.1 per cent). In Kimpangu, suspected malaria was the leading cause of mortality (40.3 per cent), followed by diarrhoea (11.1 per cent). In Kilwa, suspected malaria (32.7 per cent), diarrhoea (22.0 per cent) and respiratory infections (19.5 per cent) were the leading causes of death. In Inongo zone malaria (19.7 per cent) and respiratory infections (18.4 per cent) were the leading causes of death (see Figure 1).

Access to care In all health zones more than eight in 10 households had one or more member fall ill in the six months prior to the survey. People with no access to care were defined as those who did not seek a consultation when needed or obtained no or incomplete treatment following consultation. More than two-thirds of the people who fell ill in Basankusu (67.4 per cent, 59-75.9 CI) reported not seeking consultation outside the family; the figure was more than two-fifths for Lisala (41.2 per cent, 33.5-48.9 CI), Kilwa (44.3 per cent, 38.2-50.4 CI) and Inongo (42.1 per cent, 36.6-47.6 CI). In Kimpangu only 13.1 per cent (8.1-18.1 CI) reported no consultation outside the family (see Figure 2).

The most frequent prohibitive factor to complete care was the cost of consultation and medicine. In general most consultations were received at public or religious-run health centres (Table 2).

Vaccination Coverage

Polio coverage for children aged 9-59 months was surveyed in all five health zones.

Vaccination (Expanded Programme on Immunisation (EPI)) was assessed by evaluating BCG (tuberculosis) coverage (at birth) in Basankusu; while late vaccination (nine months to five years) for measles was evaluated in the four remaining health zones. Polio converage was near complete in all regions, with the percentage of those not vaccinated standing at 4.0 per cent in Basankusu (n=783, 2.1-5.8 CI); 1.2 per cent in Lisala (n=742, 0.4-2.1 CI); 0.9 per cent in Kimpangu (n=566, 0-1.9 CI); 3.4 per cent in Kilwa (n=613, 1.8-5.1 CI); and 0.7 per cent in Inongo (n=732, 0.1-1.2 CI). For other EPI vaccines, it was significantly lower. The percentage unvaccinated for TB in Basankusu was 45.3 per cent (33.2-57.5); 68.5 per cent were not vaccinated for measles in Lisala (56.1-78.8 CI), 29.5 per cent in Kimpangu (20.9-38.0 CI), 55 per cent in Kilwa (45.4-64.6 CI) and 76.8 per cent in Inongo (67.5-86.0 CI).

Limitations

In Basankusu health zone, four health areas close to the front line were inaccessible for security reasons. More than 5 per cent of the population live these areas, so results can only be extrapolated to 94.8 per cent of Basankusu's total population. In Lisala, survey coverage was limited to 97.7 per cent of the population, after a bridge was destroyed in one health area. In rural parts of Inongo a large number of empty houses were observed, possibly because the survey was carried out in the dry season when many (adult) inhabitants leave their homes for camps in the bush and forest in order to fish.

Despite the best efforts, it was impossible to hire an equal distribution of men and women for the survey teams, and in the more distant zones it was difficult to find any qualified female personnel. There was only one female team member in Basankusu, Kimpangu and Kilwa; in Lisala and Inongo, two female team members were hired. Lack of women surveyors may have influenced answers to questions about sexual violence ?a subject that remains relatively taboo in the DRC, especially when raised by men.

Depending on the region, culture and ethnic group, some communities are less inclined than others to speak to strangers about their health problems or their extreme poverty. Visibly ill people or households with obviously malnourished children stated that the family was in good health. This was particularly obvious in the Lisala and Kimpangu health zones, where consultation rates may be slightly underestimated.

Conclusions

Prior to this survey, MSF programmes had been concentrated in the national and provincial capitals. These survey findings, revealing high mortality rates in waraffected zones among a population exposed to the violence of war and with limited or no access to health-care, resulted in an increase in MSF operations in the countryside, particularly war-affected zones. The emphasis for MSF has shifted from support to health zones to direct support to the population.

An operation was established in Basankusu in March 2002 with further operations predicted in Kilwa and seven other war-affected regions (Boende, Bomongo, Bolomba, Befale, Lokutu, Djolu and Pweto) in 2003. Other potential activities include: vaccination campaigns, needs assessments among people located in other war zones, particularly Ituri and Kivu; permanent response to epidemics and natural catastrophes (30 interventions per year on average); epidemic control (such as monkey pox and cholera); surgery and mental health.

Peace remains elusive in the DRC but this should not discourage humanitarian actors and donors from augmenting their efforts in the western and central provinces where conflict is less chronic but health-care is unavailable to many. The medical and humanitarian situation remains acute across the country, particularly near the front line where mortality far exceeds alarm thresholds. Inability to pay consultation fees and purchase treatment was the rule rather than the exception in all health zones surveyed.

Generalised instability clearly has deleterious effects on rural economies, which in turn creates obstacles to providing health-care for the sick. Where exposure to violence was highest, lack of medicines was a frequently cited factor for not seeking health-care outside the family. The impact of infectious diseases, which claimed most lives, was compounded by the weakening effects of malnutrition ?itself responsible for one-quarter of deaths in Basankusu. CMRs were higher closer to the front line, and lowest in Inongo probably owing to its isolation from the violence.

Infectious disease control and treatment are a priority; in particular, given the risk of epidemics, systematic vaccination against measles should be urgently undertaken. Because of difficulty in accessing health centres, medical staff should be encouraged to go to patients and become more visible in patient health-care, for example through mobile clinics.

The curtailing of commercial traffic on the Congo River and the destruction of roads and bridges have severely damaged rural economic activities and destroyed trade networks throughout the interior. The resumption of economic life is crucially dependent upon the restoration of this infrastructure and securing safe passage against extortion.

UHC means that all individuals and communities receive the health services they need without suffering financial hardship. It includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course.

The delivery of these services require adequate and competent health and care workers with optimal skills mix at facility, outreach and community level, and who are equitably distributed, adequately supported and enjoy decent work.UHC strategies enable everyone to access the services that address the most significant causes of disease and death and ensures that the quality of those services is good enough to improve the health of the people who receive them.

Protecting people from the financial consequences of paying for health services out of their own pockets reduces the risk that people will be pushed into poverty because unexpected illness requires them to use up their life savings, sell assets, or borrow – destroying their futures and often those of their children.

Health Coverage Promotion in the Dr-Congo, South-Kivu   (HPC in the DR-Congo, South-Kivu) Solution is a palliative initiative which means and commit to broke the lake to access of all individuals and communities health services they need because of financial hardship. It  proposes the use of the improvement of the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course.

The delivery of these services in our community require adequate and competent health and care workers with optimal skills mix at facility, outreach and community level, and who are equitably distributed, adequately supported and enjoy decent work. This proposed solutions strategies intend to enable everyone to access the services that address the most significant causes of disease and death and ensures that the quality of those services is good enough to improve the health of the people who receive them.

We will work in partnership with the provincial and national Government  and urges them toward protecting people from the financial consequences of paying for health services out of their own pockets which will reduces the risk that people will be pushed into poverty because unexpected illness requires them to use up their life savings, sell assets, or borrow – destroying their futures and often those of their children.

We and our team believe to be right people to design and deliver this solution to the targeted population because as a part of civilian society, we are representative and we are living in same society and issues related to this our solution problem as stated above. For this reason, we are working with a Community engagement spirit  and cannot design and deliver a social actions, projects without working with people collaboratively through inspired action and learning to create and realize bold visions for their common future. We cannot do something without the population, so we organize inclusive community meetings, discussions and deliberation that occurs between government and citizens that allows both of us to it means that allows citizens and government to participate mutually in the formulation of policy and the provision of government services.

This strategic Community Engagement we are using necessarily means participation with a community of people, rather  than an individual citizen, and needs to incorporate the diversity and  dynamics of communities.

The process of working collaboratively with and through groups of people
affiliated by geographic proximity, help us to understand that they have made own the issue, expressed their special interest, or similar  situations and commit  to address the issues such as health care affecting the well-being of those people in our community.

Over financial barriers, we wish Solve can help us overcome in technical, to join a class of impressive peers that act as trusted support group offering inspiration and guidance, join a powerful network of impact minded leaders accross industries and sectors with dedicated spaces to meet year-round and during Solve,s  flagship events such as Solve at MIT, access mentorship coaching and  strategic advice from experts as well as the Solve and MIT Networks, receiving monitoring  and evaluation support to build an impact measurement practice, gain exposure in the medias  and at conferences, access relevant in-kind resources such as software licenses and legal services from Solve Members and  partner organizations.

What make our solution innovative is the Covid-19  the actual  worldwide context.  We hold for true that many countries are already making progress towards Universal Health Care, although everywhere the COVID-19 pandemic impacted the availability the ability of health systems to provide undisrupted health services. The Democratic Republic of Congo where this solution is designed and  will be cared still stagneted and does not make sustainable and positive impacts to improve this situation. This solution is a recall for commitment toward making more efforts to improve this issue in our community where people cannot access to health adequate helalth care services.We still believe that our country can still take actions to move more rapidly towards Universal Health Care despite the setbacks of the COVID-19 pandemic,  or to maintain the gains they have already made. In country where health services have traditionally been  difficult or impossibly accessible and affordable, our government is finding it increasingly difficult to respond to the ever-growing health needs of the populations and the increasing costs of health services.

Moving toward the improvement of this sector and social matter, it requires the strengthening health systems in the country. This is what our solution come with as advocacy and solution. Robust financing structures are key. When people have to pay most of the cost for health services out of their own pockets, the poor are often unable to obtain many of the services they need, and even the rich may be exposed to financial hardship in the event of severe or long-term illness.  We will urge our government  through this solution to the pooling  of funds from compulsory funding sources (such as government tax revenues) that  can spread the financial risks of illness across a population.

Improving health service coverage and health outcomes depends on the availability, accessibility, and capacity of health and care workers to deliver quality people-centred integrated care. The COVID-19 pandemic dramatically demonstrated the invaluable role of the health and care workforce and the importance of expanding investments in this area. To meet the health workforce requirements of the SDGs and UHC targets, over 18 million additional health workers are needed by 2030. Gaps in the supply of and demand for health workers are concentrated in low- and lower-middle-income countries. The growing demand for health workers is projected to add an estimated 40 million health sector jobs to the global economy by 2030. Investments are needed from both public and private sectors in health worker education, as well as in the creation and filling of funded positions in the health sector and the health economy.  The COVID-19 pandemic, which has initially affected the health workforce disproportionately, has highlighted the need to protect health and care workers, to prioritize investment in their education and employment, and to leverage partnerships to provide them with decent working conditions.

The COVID-19 pandemic showed, countries need to rapidly scale up
their investments in essential public health functions—those core public
health functions that require collective action and can only be funded
by governments or risk large market failures. These include policy making based on evidence, communication  including risk communication and community outreach to empower  individuals and families to better manage their own health, information  systems, data analysis, and surveillance,
laboratory capacity for testing; regulation for quality products and  healthy behaviours, and subsidies to public health institutes and  programmes.

To truly ensure  that all people in our community has access to sustainable health coverage, we  will be are focussed on the following specific and global goals to help poor people and marginalized communities get access to this sustainable health care service:

• Advocacy of marginalized and poor people in the national Health care agenda. Are Included in the Sustainable Development Goals: The global community has included universal health coverage within the Post-2015 Sustainable Development Goals discussion. Yet, access to health services for marginalized communities continues to be left out of the conversation. Stronger advocacy from all stakeholders needs to occur to ensure vulnerable communities are included in determining the targets of the health goal.
• Include and Fund Interventions for Vulnerable Communities in National Strategies: In 2013, one-third of 46 African National Strategic Plans for HIV did not include any proposed government intervention for MSM, going against epidemiologic evidence that shows how MSM are in need of intervention and programming on the continent. Government policies and legislation must focus on populations most in need of social services and protection and provide scientifically based interventions, fully funded, and agreed upon by the international community.
• Engage with Civil Society So All Voices Are Represented: Civil Society organizations are often the only advocates for the health and human rights needs of poor and marginalized populations. Civil Society therefore must be engaged in the planning of policies and programming within countries and at the global level. Donors and international organizations must also work to build the capacity of civil society to effectively advocate for the needs of vulnerable groups. Through such advocacy, governments can be pressured to be more engaged with civil society to ensure all voices are represented and to develop the best ways of achieving universal health coverage for all of their citizens.

Taking these approaches into account will move us considerably further in ensuring fairness and financial equity for those who need universal health coverage that will benefit both the individual, no matter who they are, and their nation.

1. Increase adult literacy rate
Our solution is aimed at progressing towards health for all. This is likely to be strongly influenced by two social factors which are not generally regarded as part of health sector education and housing. One possible indicator of the contribution of education to health is literacy rate which means the percentage of the population aged 15 and over able to read and write in any language. Our solution to collect data will be obtained during the population census, and the indicator will therefore be subject to the drawback that it can only be updated at long intervals. Our solution will target and intend to increase literacy of women rate which is particularly important for health since it is they who most often provide primary care in the home. This becomes still more important if the concept of literacy is extended to include health literacy.  We will be using an alternative indicators uses the numbers of pupils enrolled in educational institutions expressed as a percentage of the estimated population aged 5 to 19. This is initially be prepared as an aggregate indicator, refinements will be introduced later such as a distinction between primary, secondary and tertiary education. Enrolment data are subject to drawbacks, since they do not reflect the level of attendance, but they present easily available administrative statistics which can be frequently updated

2. Improve housing conditions

The most commonly available indicator of the adequacy of housing is the number of persons per room. Housing indicators should take into account  the nature of accommodation in terms of it size, it insulation against extremes of weather, the exclusion of disease carrying  insects and rodents and the availability of water and sanitary facilities.

3. Increase food availability

Our solution will work on the food availability in our community. Food and nutrition have an important influence on health status, particularly for low income groups. Similar  other indicators are  suggested for the nutritional status of the population. It would be desirable to complement these with indicators of the national food supply, in total and for different groups in the population. The per capita energy or calories availability calculated from food balance sheets which take account of local food production, imports, exports, wastage and diversion for nonhuman use is the best available indicator of total food availability but it must be interpreted with precaution since it takes no account of seasonal variations, differences between income groups, or pattern of food distributions within household.

To better change this situation, the solution has a goal as improvement of access to health care of all people and communities in the Democratic Republic of Congo, South-Kivu.

The long term outcomes that this proposed solution will be able to changes are below but not limited

-Reduced prevalence of lake of accessibility to sustainable health care services and their related consequences in our population receiving the intervention

The intermediate outcome of this solution are:

- Changes in knowledge, attitudes and skills

-Improvements in health status

The proposed solution has a  below ceilling of accountability:

-The solution aims to change individual  and community outcomes, but does not  accept responsibility for changing  levels of health problems in the wider  population (the goal), as it cannot  achieve this on its own (though it may contribute to this wider goal).

To make sure that we will be able to measure and document to  determine whether we are making  progress towards, or have achieved, each  intermediate outcome, we will proceed with periodic monitoring and evaluation to make sure that,

1. Human Resources for Health
Intermediate Outcome:
- Health care providers and managers are performing at the top of their scope.

The health workforce is central to achieving good health  outcomes. A high performing workforce is one that is  responsive to the needs and expectations of people and  is fair and efficient to achieve the best possible  outcomes given the resources available and the  circumstances.

Intermediate Outcome:
Optimized roles within health care teams.

a. At a structural level, this solution will works with health care  teams to ensure that work roles are optimized through  ensuring the right mix within the workforce with regards  to diversity and competencies.

b. Adequately trained health care providers and managers that are able to apply their training.

c. This solution will supports health systems to ensure that health  care providers and managers are adequately trained and  able to apply their training. This solution will supports health  systems to deliver training and continuing education  that promotes best practice at both a clinical and  operational level.

d. Strong supervision and mentoring structures.

The proposed solution will works within health systems to build strong supervision and mentoring structures that  support health care teams to perform at their maximum capacity, while ensuring compliance with national  standards and protocols.

e. Healthy health care providers and managers.

At an individual level, we recognizes that health  care providers and managers are impacted in similar  ways to the general population, sometimes more acutely, when communities face a high burden of  disease with insufficient access to health care  resources. This depletes health systems of critical  human resources at a time when they are needed most. In order for health systems to deliver high quality  patient-centred care, front line health care providers and  managers must be healthy and able to perform their  functions. The solution,s key intervention therefore will be to  provide discreet, specialized health care for front line  health workers

e. Positive and professional attitudes among health care  providers and managers. We also believes that the human resources within  the health system have a role in creating an  environment that is conducive to high quality,
unprejudiced health care. A key outcome for this solution  will be to ensure that health care providers and  managers demonstrate positive and professional
attitudes that encourage health-seeking behaviours  within the populations they serve.

f. Mechanisms to promote cooperation among all  stakeholders within the health system.

For us mechanisms to promote cooperation  among all stakeholders within the health system are  critical to enabling health care providers and managers
to perform at the top of their scope. Cooperation  mechanisms include health worker advisory groups,  technical working groups, donor coordination groups,
private sector, professional associations, communities,  and client/consumer groups. This solution will support these  cooperation processes as part of its efforts to achieve improved human resources for health.

2. Health Care Delivery
2.1. Health care delivery is optimized through integrated  screening, diagnosis and treatment of patients.

Patients are at the core of a health system and how we  take care of them is an important component of our  work. Health systems are only as effective as the
services they provide. We will works within health  systems to ensure that the delivery of care is optimized  through effective and integrated screening, diagnosis  and treatment. Direct engagement with patients is  an important part of how we operate. While we  support the Ministry of Health to improve health care  delivery, we also, as a team and as individuals, deliver  health care to patients. This is a critical part of our work that gives us agency, credibility and first-hand  experience of the systems we are influencing

2.2. Organized community engagement.
We recognizes that quality health care begins with  organized patient and community engagement and  believes in the importance of including communities  as active participants in decision-making in the health  system. Community engagement is an important  strategy to ensure that health services are organized  around needs and priorities of target populations,
including marginalized and underserved populations.
We will supports stakeholders within the health system to increase their knowledge and understanding of  community engagement, and to enhance their skills, practice and implementation of these processes.

2.3. Positive patient-provider interaction.
Positive patient-provider interaction is another key component of successful health care delivery. For us this positive interaction is based on  cultural competence and patient-centeredness that  results in improved clinical outcomes and patient  satisfaction rates. It improves the quality of the
patient-provider relationship and decreases the use of  diagnostic testing, prescriptions, hospitalizations, and  referrals.

2.4. Comprehensive and integrated package of clinical and  public health interventions.
For health systems to deliver on their mandate, they  must have the capacity to provide a comprehensive and  integrated package of clinical and public health
interventions that respond to the complete scope of  health challenges faced by the populations they serve. This is about improving how we take care of people.
We works within the health system to improve the  delivery quality of these interventions. We will places  particular emphasis on the service delivery areas where  it can achieve the greatest impact: the provision of  integrated clinical services, effective clinical monitoring  and laboratory services, well-functioning referral  systems and retention strategies, and adequate supplies,  materials and infrastructure. For us, emphasis will  be placed on ensuring that heath care services are  effectively integrated along the entire cascade of care
(within and across service areas and organizations).

2.5. Comprehensive standards of care protocols and  guidelines.
Underpinning all effective health care delivery is a  comprehensive standard of care protocols and  guidelines that determine access and define quality of
care, including safety, effectiveness, integration,  continuity, and people-centeredness. We believes  it has a role to play in accompanying health systems to  develop and disseminate these standards, norms and  guidelines as part of its broad goal of strengthening  health systems.

2.6. Strong Health Information Systems.
Reliable and relevant evidence generated from  dependable information systems underpins the  effectiveness of health care delivery. Functioning health
systems require good information on the  effectiveness of clinical interventions and on the  performance of the health system itself. Our solution’s contribution to generating health data and information  and to building reliable information systems will focus  primarily on access to care, on the quality of the services
provided, and on effective clinical diagnostics and  interventions. We will use health data to support  health systems to develop a culture of continuous
improvement and evaluation. We also believe it has a specific contribution to make  to support policymakers and planners to prepare for  future challenges such as epidemiological shifts  (changing disease profile of an aging population),  changes in the environment (extreme weather events or  disasters linked to climate change), as well as managing  current, high-burden health issues in both the general  and at-risk/marginalized populations.

3. Equitable & Evidence-based Health Policy

3.1. Organized community engagement.
We recognizes that quality health care begins with  organized patient and community engagement and  believes in the importance of including communities  as active participants in decision-making in the health  system. Community engagement is an important  strategy to ensure that health services are organized  around needs and priorities of target populations,
including marginalized and underserved populations.
Our solution will supports stakeholders within the health system  to increase their knowledge and understanding of  community engagement, and to enhance their skills,  practice and implementation of these processes.

3.2. Positive patient-provider interaction.
Positive patient-provider interaction is another key  component of successful health care delivery. For us this positive interaction is based on  cultural competence and patient-centeredness that  results in improved clinical outcomes and patient  satisfaction rates. It improves the quality of the  patient-provider relationship and decreases the use of  diagnostic testing, prescriptions, hospitalizations, and  referrals.

3.3.Comprehensive and integrated package of clinical and  public health interventions.
For health systems to deliver on their mandate, they  must have the capacity to provide a comprehensive and  integrated package of clinical and public health
interventions that respond to the complete scope of  health challenges faced by the populations they serve.
This is about improving how we take care of people.  We will work within the health system to improve the  delivery quality of these interventions. We place  particular emphasis on the service delivery areas where  it can achieve the greatest impact: the provision of  integrated clinical services, effective clinical monitoring  and laboratory services, well-functioning referral  systems and retention strategies, and adequate supplies,  materials and infrastructure. For Our emphasis will  be placed on ensuring that heath care services are
effectively integrated along the entire cascade of care  (within and across service areas and organizations)

3.4. Comprehensive standards of care protocols and  guidelines.
Underpinning all effective health care delivery is a  comprehensive standard of care protocols and  guidelines that determine access and define quality of
care, including safety, effectiveness, integration,  continuity, and people centeredness. We believes  it has a role to play in accompanying health systems to  develop and disseminate these standards, norms and
guidelines as part of its broad goal of strengthening  health systems.
3.5. Strong Health Information Systems.
Reliable and relevant evidence generated from  dependable information systems underpins the  effectiveness of health care delivery. Functioning health
systems require good information on the  effectiveness of clinical interventions and on the  performance of the health system itself. Our contribution will be to generating health data and information  and to building reliable information systems will focus  primarily on access to care, on the quality of the services
provided, and on effective clinical diagnostics and  interventions. We will use health data to support  health systems to develop a culture of continuous
improvement and evaluation.

3.5. Intermediate Outcome:
Health policies are equitable, evidence-based,
resourced and implemented.
Within the leadership and good governance framework  of health systems, we define its role with a specific  focus on evidence-based and equitable health policy.  Our interventions in this part of the health system will focusing on ensuring that evidence-based and  equitable health policies are resourced and
operationalized.We will influence national health  policies, strategy and plans to ensure that they establish  a clear direction for the health sector and express in
particular the value-driven high level policy goal of  health equity. One way in which we will do this is  through participation in technical working groups and
convening national and international communities of  practice composed of policymakers, researchers and  practitioners.

What our success will look like?
Our team will establish its own set of indicators to  measure organizational progress towards each of the  long-term, intermediate and immediate outcomes
identified in our theory of change detailed above. We will conduct  an annual review process to establish these targets and  measure progress against them. Our ability to reach  these targets and to measure progress will be key to
determining our success.
In addition to our own targets, we will also measure our  success by our ability to work in partnership with others  to make a measurable contribution by 2030 to  Sustainable Development Goal three in communities  facing a high burden of disease and unequal access to  health care services.

We will bring interventions toward achieving these above indicators, these are:

-Community awareness campaign
̵ Anti-depressant medication

The assumptions of the solution are

Political will to support the program  exist
̵ Funders continue to fund  and support the solution
̵ Task-sharing is politically and  culturally acceptable

With 2021 well behind us, COVID-19’s presence still continues to linger
around the world. Of all the industries that have been forever changed  by the impacts of the global pandemic, healthcare arguably has changed  the most. With significant advances in technology and methods necessary  to support the high demand of access to healthcare and growing  digitization of protected health information, the healthcare industry  has evolved in novel ways to continue to deliver the same exceptional  quality of service.

As we press on into the future, it’s critical to remain mindful of the  trends driving healthcare technology in 2022. Although legacy software  and infrastructure is critical to the success of modern hospitals and  care centers, it’s important that we consider how those systems can  integrate with newer technologies or how they may eventually be replaced with more reliable systems. The focus should be on improving  performance, productivity, efficiency, and security without sacrificing  reliability or accessibility. The use of technology by our solution will have a positive impact for the change we want to bring in our community.

We will use  Artificial Intelligence (AI) in healthcare

AI has been and continue to be helpful in analyzing crowd temperature data even during this hard time of Covid-19. This makes thermal screening a much more viable option for identifying potentially symptomatic individuals. Advances in AI-powered facial recognition have also made it viable toward identifying individuals even if they  are wearing a face mask. It can also detect if the user is wearing a  mask in the areas where it’s mandatory.

AI in diagnosis and drug development

Artificial intelligence has plenty of applications outside of treating and responding to the pandemic. AI is incredibly helpful for improving efficiency with information processing and decision making. In the healthcare industry, machine learning is extremely helpful for the development of new pharmaceuticals and the efficiency of diagnosis processes.

For those being treated for the effects of COVID-19, AI is helping  analyze CT scans to detect pneumonia. Microsoft developed  Project InnerEye, a radiotherapy AI tool. This dramatically speeds up the process of 3D contouring of the patient, bringing time to completion down to minutes instead of hours. The project is open source on GitHub. Project Hanover is another Microsoft AI system meant to catalog biomedical research papers from PubMed. This helps reduce time for cancer diagnosis and assists with deciding on which drugs should be used for each patient.

AI in Mental Health

Artificial intelligence innovations don’t just apply to physical health. MIT and Harvard University researchers have utilized machine learning to track trends and mental health in correlation to the COVID-19 pandemic. By using an AI model, they were able to analyze thousands of online Reddit messages to find that topics of suicidality and loneliness had nearly doubled over a period of time. This has the potential to transform our understanding of the mental health of larger populations.

The Key to AI in Healthcare:

The most important element that powers artificial intelligence’s success
in healthcare is data. More specifically, training data. Software  powered by machine learning will never outperform the quality of its  training data set. The higher the quality and breadth of the data we give to the model, the better it will perform. It’s essential that our  AI team will be composed of experienced software developers and data scientists that can work together to produce the best results.

Telemedecine and the evolution of remote care

Telehealth has come along way since the beginning of the pendemic in 2020. In 2022, care providers regularly have video conference meetings with patients over the Internet to discuss concerns and give advice. The infrastructure to support this has vastly improved.

Cloud Hosting and Data Storage

Storing data in most cloud storage services is relatively secure, but not necessarily compliant with government regulations on protected health information. HIPPA  compliant  cloud hosting solutions are critical for maintaining functionality and efficiency for any healthcare operation needing electronic health records (EVR).

However, teleconferencing and data hosting aren’t the only features that may be useful for your organization. Other features like security, location services, appointment management, secure messaging, healthcare provider reviews, visit history, and wearable integration are all potentially useful features.

Some applications may need to store fitness data from consumer devices such as Google Fit and Apple HealthKit. Being able to maintain these integrations in a secure and efficient manner can benefit the patient and caregiver greatly.

Extended reality in Healthcare settings

Extended reality, a blanket term including augmented reality, virtual  reality, and mixed reality, has a great deal of potential in the  healthcare industry. From assisting surgery to aiding telehealth  applications, AR and VR technologies can improve the healthcare industry substantially.

Augmented Reality in Healthcare

Augmented reality and mixed reality are useful in a variety of healthcare settings. One of the most popular and useful forms of this technology is the use of mixed reality headsets like Microsoft Hololens 2 by  surgeons. The headset can provide heads up information to the surgeon while allowing them to use both of their hands during the procedure.

Not only can these surgeries be enriched by this heads up information, but it can be a collaborative and remote effort and assist in training purposes. The head-mounted camera view of the headset can enable other doctors to observe the surgery and offer advice. The ‘holographic’ nature of the device can be used to enrich training as well. Similar applications are possible with on the rise AR headsets. More specialized software solutions will also be necessary to expand its use to different types of surgeries into the future.

AR isn’t just restricted to headsets and operating rooms. The technology can also be used to help nurses  find veins to draw blood from.

 Augmented reality development relies heavily upon artificial intelligence and specialized sensors to function. Whether you’re developing for mobile devices or other kinds of hardware, appropriate data and software expertise will be required. AR developpers focus heavily upon leveraging AI with the software frameworks of target hardware to make these products successful.

IoT and Wearables in Healthcare

With wearables and IoT technologies  becoming more popular, their potential in the healthcare industry has  grown significantly. For applications in telemedicine and telehealth  technologies many have come to call this trend in micro processing the  Internet of Medical Things.

Organ Care Technology and Bioprinting

With the world’s transplantation market size predicted to reach $26.5 billion by 2028, organ transplants are certainly an important part of the healthcare industry. According to Matthew J Everly, about 2,000 heart transplants take place in the United States every year. However, it’s estimated that over 50,000 people need a heart transplant.

Bioprinting creating New Organs

In addition to keeping organs alive outside of the body, other options should also be explored. Although it may sound like science fiction, 3D printed organs are a very real, although developing, technology that has already made its way into clinical testing. Ears, corneas, bones, and skin are all organs in clinical testing for 3D bioprinting.

The process is not too different from traditional 3D printing. First a digital model of the tissue must be created. Careful attention needs to be paid to the resolution and matrix structure, as the materials used in the printing process are quite literally living cells called bioink. They then need to test the organ’s functionality with stimulation.

One of the ways that rejection of an organ can be prevented is by using the cells of the patient requiring transplantation. These cells can be grown in a culture and then cultivated into the bioink necessary for printing.

Technology and humans hand-in-hand for a better healthcare.We honestly believe that this is the only way forward. Technology can only aid and improve our lives if we stand on its shoulder and if we are always (at least) two steps ahead of it. But if we adhere to this rule, the cooperation between people and technology could result in amazing achievements.
In medicine and healthcare, digital technology could help transform unsustainable healthcare systems into sustainable ones, equalize the relationship between medical professionals and patients, provide cheaper, faster and more effective solutions for diseases – technologies could win the battle for us against cancer, AIDS or Ebola – and could simply lead to healthier individuals living in healthier communities.
But as the saying goes, one has to be a master of his own house, so it is worth starting “the future” with the betterment of our own health through digital technologies, as well as changing our own attitude towards the concept of health as such and towards medicine and healthcare.
And what does it all look like in practice? To serve as an introduction, this article will explore 10 ways in which medical technology is reshaping healthcare.

1.Artificial intelligence

We believe that artificial intelligence has the potential to redesign healthcare completely. AI algorithms are able to mine medical records, design treatment plans or create drugs way faster than any current actor on the healthcare palette including any medical professional.

2. Virtual Reality is changing the lives of patients and physicians alike

VR is being used to train future surgeons and for actual surgeons to
practice operations. Such software programmes are developed and provided
by companies like Osso VR and ImmersiveTouch and are in active use with promising results. A recent Harvard Business Review study
showed that VR-trained surgeons had a 230% boost in their overall  performance compared to their traditionally-trained counterparts. The  former were also faster and more accurate in performing surgical
procedures.

The technology is also benefiting patients and has been proven to be
effective in pain management. Women are being equipped with VR headsets
to visualize soothing landscapes so as to help them get through labour pain. Patients suffering from gastrointestinal, cardiac, neurological and post-surgical pain have shown a decline in their pain levels when using VR to distract them from painful stimuli. A 2019 pilot study even showed that patients undergoing surgery lessened their pain and anxiety and improved their overall hospital experience.

3. Augmented reality

Augmented reality differs from VR in two respects: users do not lose touch with reality and it puts information into eyesight as fast as possible. These distinctive features enable AR to become a driving force in the future of medicine; both on the healthcare providers’ and the receivers’ side.

In case of medical professionals, it might help medical students prepare better for real-life operations, as well as enables surgeons to enhance their capabilities. This is already the case at Case Western Reserve University where students are using the Microsoft HoloLens to study anatomy via the HoloAnatomy app. Using this method, medical students have access to detailed and accurate, albeit virtual, depictions of the human anatomy to study the subject without the need of real bodies

4. Healthcare trackers, wearables and sensors
As the future of medicine and healthcare is closely connected to the empowerment of patients as well as individuals taking care of their own health through technologies, I cannot leave out health trackers, wearables and sensors from my selection. They are great devices to get to know more about ourselves and retake control over our own lives.

5. Medical tricorder

When it comes to gadgets and instant solutions, there is the great dream of every healthcare professional: to have one almighty and omnipotent device, with which you can diagnose and analyze every disease. It even materialized – although only on screen – as the medical tricorder in Star Trek. When Dr McCoy grabbed his tricorder and scanned a patient, the portable, hand–held device immediately listed vital signs, other parameters, and a diagnosis. It was the Swiss Army knife for physicians.

6. Genome sequencing

The whole Human Genome Project cost approximately $2.7 billion for the US government, which is an insanely huge amount of money. Especially if you consider that in January, 2017, DNA sequencing giant Illumina unveiled a new machine that the company says is “expected one day” to order up your whole genome for less than $100. Last year, the company’s CEO reiterated that Illumina is still working towards that benchmark. This would mean that you might have a cheaper genetic test than a general blood test (for which prices vary between approximately $10-150). Mind-blowing!

Such a test has so much potential! You can get to know valuable information about your drug sensitivity, multifactorial or monogenic medical conditions and even your family history. Moreover, there are already various fields leveraging the advantages of genome sequencing, such as nutrigenomics, the cross-field of nutrition, dietetics and genomics. Some companies such as the California-based start-up, Habit, are offering personalized diets based on genetic codes.

7. Revolutionizing drug development

Currently, the process of developing new drugs is too long and too expensive. However, there are ways to improve drug development with methods ranging from artificial intelligence to in silico trials. Such new technologies and approaches already are and will be dominating the pharmaceutical landscape in the years to come.

8. Nanotechnology

We are living at the dawn of the nanomedicine age. I believe that nanoparticles and nanodevices will soon operate as precise drug delivery systems, cancer treatment tools or tiny surgeons.

9. Robotics

One of the most exciting and fastest growing fields of healthcare is robotics; developments range from robot companions through surgical robots until pharmabotics, disinfectant robots or exoskeletons.

10. 3D-printing

3D-printing can bring wonders in all aspects of healthcare. We can now print biotissues, artificial limbs, pills, blood vessels and the list goes on and will likely keep on doing so.

Though our approach, we envision a diverse workforce in which every Department employee understands their individual and  collective responsibility to actively promote equity and inclusion. Our values: We value all forms of diversity, including, but not limited to age, race, gender, ethnicity, religion, sexual  orientation, gender identity, gender expression, socio-economic status, ability, and veteran status.
We recognize that social determinants play a driving role in the overall health and well being of South-Kivu communities.
We acknowledge that segregation and poverty are public health issues.
We value the voices of South-Kivu people affected by our policies and programs.
We strive to address challenges through collaboration and data-driven solutions.
We lead with empathy and respect.
We appreciate that the work of diversity, equity, and inclusion is ongoing and commit to continued  learning and development in this work.

Our approach has a below goals :

(1) Increase workforce diversity to better reflect the communities we serve.
(2) Cultivate a work environment that demonstrates respect and empathy for all employees and clients and leverages the strengths of their diversity.
(3) Develop an inclusive infrastructure to advance data-driven health equity programs across all Department services.
(4) Provide outstanding public service that is informed by, and responsive to, the needs of the communities we serve.

Goal 1: A Diverse Workforce
Objective 1A: Implement best practices for hiring a diverse workforce.
• Publicly share baseline metrics for workforce diversity that clearly state the race, ethnicity,  gender, and age of employees across the Department.
• Add questions about applicant demographics to all online applications.
• Develop a hiring guide for managers outlining best practices for diversity in hiring that  covers the continuum of employment practices, from the creation of a job description and  establishing a hiring committee, through the interview and offer process.
• Increase training for staff to promote best practices for hiring a diverse workforce, including  education about Equal Employment Opportunity (EEO) and implicit bias in hiring.
• Promote opportunities for employees to participate in hiring committees as leadership and  professional development opportunities.

• Establish a process for tracking additional information not currently captured in workforce data, including disability and LGBTQ+ status.
• Implement applicant flow analysis to evaluate efficacy of DEI recruitment efforts and demographics of applicants at various stages of the search.

Objective 1B: Promote diversity through proactive talent recruitment and pipeline development.
 
• Develop external messaging for hiring at the Department that emphasizes the goal of creating a diverse workforce that is representative of the communities served.
• Add questions about where an applicant learned of a position to all applications.
• Design hiring manager reports to assess outreach and hiring process and recommend qualified candidates to alternative open positions.
• Utilize the Workforce team Committee to support staff attending hiring events, and regularly  connect with community-based organizations and professional organizations to promote Department searches and increase the diversity of applicant pools.
• Promote shared applicant practices to find placement for talent throughout the Department.
• Develop relationships with relevant professional organizations, schools, and training programs to maintain active lists of potential sources of outreach for recruitment.
• Provide training for supervisors on how to utilize personnel management systems to monitor  career paths for their employees and develop professional development plans.
• Promote policies and practices to ensure pipeline development for health professions.
• Create Office-specific plans for the increased use of paid internships to attract diverse talent and  improve the internship experience.

Goal 2: Inclusive Work Environment

Objective 2A: Publicly promote team efforts as a core aspect of health and human services work.

 Strategies:
• Develop our web-page with a dashboard of our key measures and a clear statement about solution  at the Department.
• Regularly update the web-page with news of note and include links to the web page in team  Departmental communications.
• Work with our team Office Directors and Superintendents to promote this our plan for Office and hospital staff, connecting goals to their core operations.
• Partner with external organizations to provide webinar opportunities for multidisciplinary learning and participate in external panels to promote our work at the team Department when appropriate.
• Design public-facing dashboards to provide transparent performance metrics measuring the success of our team efforts throughout the Department.

Objective 2B: Require all our team Department staff to demonstrate understanding of our plan and racial equity as a core component of professional and leadership development.

Strategies:
• Develop our team training plan for each Office and State hospital that indicates learning opportunities for staff to develop cultural competencies and advance their understanding of barriers and strategies to achieving equity.
• Require CORE or an equivalent training for all new employees as part of new employee orientation and onboarding.
• Build upon CORE to offer additional training opportunities related to our team , including training  specifically focused on gender, ethnic, tribal, racial equity.
• Design and implement required team training as part of the Managing in province Government training.

• Review all job descriptions to ensure requirements outline expectations that candidates  communicate effectively across difference, consider equity throughout their work, and seek development opportunities to improve our team skills.
• Include review of the team skill development during performance evaluations for current staff.

Objective 2C: Cultivate a work culture that is flexible, collaborative, and inclusive so all employees feel safe and are encouraged to contribute their diverse perspectives.

 Strategies:
• Continuously reinforce working norms and recognize exceptional performance.
• Support employee participation in the Workforce team Committee by ensuring that opportunities to participate are shared broadly, and supervisors are encouraged to make it possible for interested employees to participate in committees.
• Update the Department calendar to recognize population-focused celebrations and major  religious observances.
• Pilot employee resource groups for the purpose of mentoring, recruitment, and developing programs to support employees and promote population-based health initiatives and programs.
• Evaluate physical spaces for inclusivity (i.e., gender-neutral bathrooms and areas for nursing, prayer, and medication management)

• Improve transparency and access to Equal Employment Opportunities (EEO) and civil rights processes.
• Evaluate and enhance opportunities for professional development related to EEO and civil rights issues.
• Improve training for supervisors on best practices for supporting employees engaged in these processes.
• Improve transparency of process and support for employees to safely report concerns about workplace culture, including the behavior of a supervisor.
• Initiate a dialogue with labor unions to explore the alignment of our strategies with union objectives and incorporate status updates at regularly scheduled meetings with labor management.


Goal 3: Inclusive Infrastructure

Objective 3A: Develop infrastructure dedicated to health equity.

 Strategies:
• Hire additional staff dedicated to health equity.
• Regularly convene a Health Equity Leadership team with representatives from all Department Offices with direct responsibility for our team initiatives.
• Ensure broad community participation in population health studies and needs assessments.
• Utilize stakeholder input and statewide data on population health to establish clear goals for health equity initiatives.

• Enhance training opportunities for staff related to social determinants of health and the Provincial Culturally and Linguistically Appropriate Services in Health and Healthcare Standards.
• Expand partnerships with faith-based organizations and community-based organizations that are led and operated by the communities they serve.

Objective 3B: Utilize data-driven approach to assess health disparities and inequities throughout Departmental programs and policies.

Strategies:
• Collect demographic data across all team Departmental programs and service contracts in a manner that allows for comparative analysis across programs, while simultaneously allowing for disaggregation of demographic data and assuring compliance with various Provincial and National Government Health requirements.
• Develop subcategories for further disaggregation of data and clear methods of reporting that avoids double counting individuals and align with the Federal Office of Management and Budget  categories.
• Utilize focus groups to ensure categories are appropriate and likely to elicit high-quality data.
• Provide regular training for Department staff and providers on how to collect and report demographic data.
• Pilot the use of an equity analysis tool to analyze programs and policy development.
• Analyze pilot results and adapt for widespread use across the Department.

Objectives 3C: Increase Supplier Diversity
Strategies:
• Review contract riders to strengthen inclusive language, non-discrimination guidance, and expectations around culturally and linguistically appropriate service delivery.
• Promote transparency of the State bidding process to ensure a broader range of businesses and non-profits are aware of procurement opportunities in a timely manner.
• Provide our team training to staff involved in procurement processes.
• Conduct training on how to do an equity review of competitive bidding processes, proposals, and contracts and make training available to all staff participating in contracting processes.
• Develop a supplier diversity program for the Department that encourages the use of minority-owned, women-owned, veteran-owned, LGBTQ+-owned, and historically underutilized business, and Small Business Administration-defined small businesses as vendors and direct service providers.
• Support the growth of diverse providers and vendors through increased technical assistance.
• Incentivize mentorship for new providers and peer-to-peer support for established providers.
• Require all providers and applicants for funding to speak to their ability to promote diversity, equity, and inclusion in their workforce and service delivery.
• Develop an equity review tool to be utilized in DHHS contract processes and provide training for staff engaged in that review process.

Goal 4: Equitable public service

Objective 4A: Ensure meaningful stakeholder engagement throughout the work of the Department.

Strategies:
• Work with the Permanent Commission on the Status of Racial, Indigenous, and Maine Tribal Populations to develop a regular method of communication about the structure and direction of health equity work at the Department.
• Establish a health equity advisory council for the Department that includes providers, clients,  and community advocates representing a broad range of diverse populations.
• Develop a community-based approach whereby advisory council members are actively involved in the facilitation and development of meeting agendas and are compensated for their time.
• Ensure transparency through development of public-facing equity dashboards.
• Work with the advisory committee to develop ongoing stakeholder engagement methods that seek to include community partners at the earliest stages of project development, and continuously engage thereafter.
• Develop succession plans for advisory committee membership.

Objective 4B: Improve Language Access

Strategies:
• Improve information available to staff outlining language access services, including location, language capacity, as well as various language access services for each provider.
• Include fluency or proficiency in a second language as a job requirement for some frontline staff in offices where populations with limited English proficiency (LEP) are prevalent.
• Develop protocols to screen for an individual’s needs related to language access services.
• Work with State-run hospitals to improve access to interpreters and translation services for patients.
• Ensure translation services, closed captions, and sign language interpreters for public appearances, such as press conferences.
• Improve training for language access to include more information about South-Kivu’s population, and a focus on the national  standards.
• Evaluate current online and written materials and prioritize translation for each Office within the Department and designate a staff member in each office to regularly review public materials for language access.
• Conduct language analysis to better understand language prevalence across the Province of South-Kivu.
• Evaluate current online and written materials and prioritize translation for each Office within the Department and designate a staff member in each office to regularly review public materials for language access.
• Increase the number of local language access providers able to provide written translation.
• Support user testing for new translations to ensure accuracy for South-Kivu populations.
• Improve interpreter access for telephonic services.
• Improve use of accessibility tools including captions and alternative text for videos and social media to more effectively reach populations with LEP, visual disabilities, and those who are deaf and hard of hearing.

We know that the value in health care is the measured improvement in a person’s health outcomes for the cost of achieving that improvement. While some descriptions conflate value-based health care and cost reduction,
quality improvement, or patient satisfaction, those efforts—while
important—are not the same as value, which focuses primarily on
improving patient health outcomes. We aim to bring together an interdisciplinary team of caregivers to design and deliver comprehensive solutions to address those needs. The team will measures the health outcomes and costs of its care for each patient and uses that information to drive ongoing improvements.
Care provided in this way  will aligns delivery with how patients experience
their health and reconnects clinicians to their purpose as healers. It will
also asks physicians to think differently about their role within the
larger care team and about the services that team provides. Through our work we will also suggest medical schools to incorporate education on the principles
and implementation of value-based health care throughout the undergraduate medical curriculum to prepare their graduates to lead the transformation to value-based health care as they enter the physician workforce.

We will measure value in health care by the measured improvement in a patient’s health outcomes for the cost of achieving that improvement.
The goal of value-based care transformation is to enable the health
care system to create more value for patients. Because value is created
only when a person’s health outcomes improve, descriptions of
value-based health care that focus on cost reduction are incomplete.
Our work plan to make accessible the health care to everyone in our community by improving services. Of course we will advocate for reducing the health care costs to give the chance to patients to benefit from these last. We know that reducing costs is important but not sufficient: If the real goal of value-based health care were cost reduction, pain killers and compassion would be sufficient.

Our work plan aim to improve value matters

Improving a patient’s health outcomes relative to the cost of care is our aspiration that will be embraced by stakeholders across the health care system, including patients, providers, health plans, employers, and government organizations.

By focusing on the outcomes that matter most to patients, value aligns
care with how patients experience their health. In this context, health
outcomes can be described in terms of capability, comfort, and calm.
Capability is the ability of patients to do the things that define them as individuals and enable them to be themselves. It is often
tracked with functional measures. Comfort is relief from physical and emotional suffering. In addition to reducing pain, improving patients’ comfort requires addressing the distress and anxiety that frequently accompany or exacerbate illness. Calm is the ability to live normally while getting care. It encompasses freedom from the chaos that patients often experience in the health care delivery  system, and it is especially important for people with chronic and
long-term conditions. Care that improves outcomes in all 3 of these  dimensions creates a better experience for patients. Moreover, capability, comfort, and calm describe outcomes that result from the efficacy and empathy of health care, rather than its hospitality.

Our value-based health care will connects clinicians to their purpose as healers, supports their professionalism, and will be a powerful mechanism to counter clinician burnout.  Instead, value-based health care’s focus on better health outcomes aligns clinicians with their patients. That alignment is the essence of empathy. Measured health outcomes demonstrate clinicians’ ability to achieve results with patients and families and drive improvement in the results that matter most to both patients and clinicians. This intrinsic motivation is often missing in the health care system, where clinicians are directed to spend countless hours on tasks that do not impact their patients’ health.

Our work focus on better outcomes that will also reduce spending and decrease the need for ongoing care. By improving patients’ health outcomes, our value-based health care will reduces the compounding complexity and disease progression that drive the need for more care.

Our work will use below framework to implementing our value-based health care

Improving value in health care is not an unreachable utopian ideal for our team and that why our work is most important for our people and community.
Around the globe, health care delivery organizations—in varied payment
settings, with an array of regulatory structures and many different care
traditions—have demonstrated dramatically better health outcomes for
patients, usually at lower overall costs. That is what we want to bring as contribution in our community.

The  transformation to what we are working will starts when our team will identifies and understands a segment of patients whose health and related circumstances create a consistent set of needs. A dedicated, co-located,
multidisciplinary team of caregivers designs and delivers a  comprehensive solution to those needs. Our  integrated team will measures  meaningful health outcomes of its care for each patient and the costs of its services and then learns from that information to drive ongoing improvements in care and efficiency. Finally, as health outcomes improve, evidence of better care creates opportunities for the team to serve more patients through expanded partnerships.

1. Understand shared health needs of patients

Throughout the economy, service providers organize their offerings around a defined set of customers whose needs are similar.

Think, for example, of transportation providers. Transportation is an incredibly broad economic sector.
Services range from jets that deliver tons of time-sensitive cargo to
drones that deliver individual bags of blood, and from buses to rented
electric scooters. In each case, the transportation company matches its
services to the needs of its customer segment.

Health care is the outlier. In the health care system, most services are organized around the service providers. Endocrinologists practice in groups with other endocrinologists, as do cardiologists, ophthalmologists, and podiatrists. A patient with diabetes, who likely needs the coordinated—or, even better, integrated—services of these various clinicians, has to be the organizer. Health care’s general failure to structure around patient needs accounts for its inconvenience and lack of integrated services. Failing to structure for what is common and routine also increases the burden on caregivers, who too often must improvise to solve routine problems. This structural mismatch is a root cause of why health care is so expensive and does not deliver better results for patients.

To be effective and efficient,  our health care solution should be organized around segments of patients with a shared set of health needs, such as “people with knee pain” or “elderly people with multiple chronic conditions.” Organizing care in this way allows clinical teams to anticipate consistent patient needs and provide frequently needed services efficiently, doing common things well. The efficiency afforded by structuring care around patient segments frees clinicians from scrambling to coordinate services that are needed routinely. The added bandwidth allows them to personalize services for individual patients who may have somewhat different needs.

2. Design a comprehensive solution to improve health outcomes

Starting by identifying the common needs of a patient segment enables teams to design and deliver care that provides a comprehensive solution for patients or families. When the goal of care shifts from treating to solving patients’ needs, care teams can both address the clinical needs of patients and begin to address the nonclinical needs that, when left unmet, undermine patients’ health. For example, a clinic for patients with migraine headaches might provide not only drug therapy but also psychological counseling, physical therapy, and relaxation training. Similarly, a clinic for patients with cancer might include transportation assistance as a service for those who have difficulty getting to their regular chemotherapy appointments. Broadening and integrating the services provided to patients achieves better outcomes by identifying and addressing gaps or obstacles that undermine patients’ health results.

3. Integrate learning teams

Implementing multifaceted solutions requires a dedicated team drawn from an array of disciplines, many of which are not typically viewed as medical. An effective team integrates services, reducing or even eliminating the need for coordinators. Team members are often co-located, enabling frequent informal communication that supplements the formal channels of communication to ensure effective and efficient care. What is critical is thinking together to improve and personalize care and learning together so health outcomes improve with experience. The team structure can also expand across locations, extending state-of-the-art knowledge to remote clinicians and enabling world-class care to be delivered locally rather than requiring patients to travel.

4. Measure health outcomes and costs

It is a truism of business that management requires measurement. Recognizing that the essential purpose of health care is improving the health of patients, it is axiomatic that health care teams must measure the health results as well as the costs of delivering care for each patient. Leaders cannot align health care organizations with their purpose without measurement of health outcomes. In addition, the current dearth of accurate health outcomes and cost data impedes innovation.

Measurement of results will allows our  team to know we are succeeding. Measuring health outcomes  will also provide us the data needed to improve care and efficiency. Although caregivers are burdened with reporting reams of information, they rarely consistently track the health outcomes that matter most to patients and thus to themselves as clinicians. Cost and health outcomes data will also enable condition-based bundled payment models, empowering teams of caregivers to reclaim professional autonomy and practice clinical judgment.

Of course measuring health outcomes is not as complex as it is often perceived to be. Routine clinical practice does not dictate, nor can it support, the voluminous health outcome measure sets used in clinical research. Instead, we will work with clinicians who need to focus on measuring the outcomes that define health for their patients.

In addition to health outcomes, our team in collaboration with our partners including clinicians will measure the costs of our services for every patient.

5. Expand partnerships

Organizing around patients with shared needs and demonstrating better value in care create opportunities to expand partnerships and improve health outcomes for more people. For example, with evidence of care that has fewer complications and allows employees to return to work more quickly, employers are increasingly willing to contract directly with providers and even to pay more per episode of care than they had previously, because faster and fuller recovery reduces other employer costs such as those associated with absenteeism. Working in partnerships with and among clinical organizations and our team will also expand as teams gain expertise and the ability to work across more stages of the care cycle or more locations. Integrated teams may work with partners for an array of reasons, such as using new technology to share information with patients, supporting rural clinicians as they provide patients with care close to home, or offering services to support lifestyle changes in a community. These are natural partnerships because the shared goals of creating high value and achieving better health outcomes for patients align the interests of patients, family members, employers, health plans, and clinicians, as well as medical technology suppliers whose services may facilitate these relationships.

Services we are providing.

Our solution will  advocate and provide below but not limited services according to the context and need of our population.

Doctor care

We will work hardly  and push doctors visit a patients at home in regular term to diagnose and treat the illness(es). Through this service the doctors may also periodically review the home health care needs.

Nursing care

The most common form of home health care is some type of nursing care depending on the person's  and our community needs . In consultation with the doctor, a registered nurse will set up a plan of care.  Nursing care may service we want to see be provided in our community  include wound dressing, ostomy care, intravenous therapy, administering medication, monitoring the general health of the patient, pain control, and other health support.

Physical, occupational and/or speech therapy

Some patients in our community are in need of  help relearning how to perform daily duties or improve their speech after an illness or injury.  This service is important in a sens that it will help  physical therapist s to put together a plan of care to help  patients regain or strengthen use of muscles and joints. An occupational therapist will help patients with physical, developmental, social, or emotional disabilities relearn how to perform such daily functions as eating, bathing, dressing, and more. A speech therapist will help a patient with impaired speech regain the ability to communicate clearly.

Medical social services

Medical social workers are needed in most remoted areas of the province of South-Kivu. Our solution aim to increase the number of these workers who will  provide various services to the patient, including counseling and locating community resources to help the patient in his or her recovery. Some social workers are also the patient's case manager if the patient's medical condition is very complex and requires coordination of many services.

Care from home health aides

We aim to increase Home health aides in our community who will help the patient with his or her basic personal needs such as getting out of bed, walking, bathing, and dressing. These aides must have received or will receive specialized training to assist with more specialized care under the supervision of a nurse.

Homemaker or basic assistance care

While a patient is being medically cared for in the home, a homemaker or person who helps with chores or tasks can maintain the household with meal preparation, laundry, grocery shopping, and other housekeeping items.

Companionship

In our community there are an important number of patients who are home alone and who require a companion to provide comfort and supervision.  So our solution aim to develop companions skills and workers. Some  of these companions will also perform household duties.

Volunteer care

The need of volunteers is great in our community. Raising volunteers from our community is helpful as they will provide basic comfort to the patient through companionship, helping with personal care, providing transportation, emotional support, and/or helping with paperwork.

Nutritional support

Our community need dietitians to come to a patient's home to provide dietary assessments and guidance to support the treatment plan.

Pharmaceutical services

We wish accessibility of medicine and medical equipment to be delivered at home. If the patient needs it, training can be provided on how to take medicines or use of the equipment, including intravenous therapy.

Transportation

There are  a lake of companies that provide transportation to patients who require transportation to and from a medical facility for treatment or physical exams. Though offering this service we want to improve this situation by augmenting the availability of these companies in our community

Home-delivered meals

Often called Meals-on-Wheels, many communities offer this service to patients at home who are unable to cook for themselves but this does not exist in our community. Depending on the person's needs, hot meals can be delivered several times a week. This is an innovative service we want to provide to these patients.

Our proposed solution is an innovative work that has specifics and global goals  to achieve the intended outcomes and improve the accessibility of health care for all in the South-Kivu which is impossible without funding that will help us fulfill our activities and covering related expenses. As financially we are not able to fund this work, we have to work in partnership with people of good will and faith, national and international organizations, networks, and our  government to collect donations, grants, selling products or services,raising investment capital or a combination of all to be strictly oriented for the enabling us to become operational and well-manage our funds through regular financial evaluation and controls to make sure the funds are spend for covering specific expenses of the proposed work. We will need our teem to be trained about financial management and accountability of funds.

Looking at the perspective of donors and non-profit organizations sustainability of a project simply implies the continuation of  our project
activities and sustenance of project outcomes after the initial/primary
grant expires. We know that most donors are concerned about sustainability aspect of a project and often fund projects which have a well defined
sustainability plan in place. It is a challenge for NGOs to ensure a steady flow of funds for executing their projects and programs.
Integrating sustainability principles in our ongoing projects can is an effective way to ensure long term impact.

For us remain financially sustainable means continuing to perform and deliver project benefits to the primary target group which is all people without exclusion and community  after the potential funding from  donors terminates. Through this sustainability we aim to maintain and continue our efforts after the funding is over.

We understand that that sustainability requires long term planning to facilitate diverse donor engagement and for improving our team capacity of the target population. Sustainability planning is an important step for our team as it prepares us to deliver positive outcome in the absence of primary funding.

Through our  Financial sustainability plan, we aim to ensuring a steady flow of funds and generating revenue for maintaining and continuing the our team work.

Our Institutional ustainability/organizational plan aim to ensuring proper working of our organization  that were developed as part of the proposed project.

Our Programmatic Sustainability plan aim to continue our organization projects and programme in the absence of donor support.

Before start writing our sustainability plan, we discussed with our
project team about the various processes and mechanisms that can be
utilized for ensuring sustainability. Along with discussions with your
colleagues and have consider the following:

Long term vision 

Our team vision for a period of five years is to see everyone heave access to quality  sustainable health care services and live in a community of well-being where everyone can fulfill his best potential. To achieve this vision we have explain in previous pages how and what we will be doing to achieve this goal with the use of collected data and facts, the process,resources required to ensure success.

• Integrate sustainability in all our projects: It was important for us to integrate sustainability aspects in our project right from the beginning. This will help us to develop partnerships and relations with relevant stakeholders at an early stage of project development. This will also ensure that once the primary funding terminates we will have a strong support to continue our project.
• Communication and Outreach: We will develop a strong communication strategy so that our project results will be shared with a large audience.  We will make sure our project is well documented results that will help us in getting support from a range of stakeholders and donors. We agree that a well thought communication strategy can avoid last minute rush of donor search.
• Involve key stakeholders: For us another major step to ensure sustainability is the involvement and participation of key stakeholders in program development. As part of the project activities we will initiate multi-stakeholder dialogue workshops to involve relevant people in our project.
• Diversify funding sources: The most important aspect of sustainability  to which we plan is to diversify our donor base and to develop long term partnerships with donors to support us in our endeavor. We plan to  do not just look at the traditional donor agencies but explore new opportunities as well.
• Create inventory of resources:  We plan to create an inventory of all physical resources that our team will keep after a project ends. Some devices and equipments purchased during a project that will be used. Training modules, camera, recorder, furniture for a school etc. will be used even after the grant expires.
• Use our donor database: We will  enlist a few donors from our donor database who are likely to fund our project.  We will keep in touch with such agencies so that they are aware about our project.

How will we ensure our financial sustainability

We plan through this work to understand our potential donors and their priorities areas. Some of our opted options that we can be used are:

Sale of product: Some of the products that our team or organization produces will  be sold in the market. This may not be a huge amount but will help us to continue our efforts.

• Diversifying donors:  we will look at various options through which we  can get dome funding, this includes from corporate houses, local institutions, individuals etc.

• Service Fee: Once the funding comes to an end  we plan to start charging a nominal fees from the target beneficiaries for the maintenance and functioning of our project.

• Membership fees: We may charge annual fee from all our members, this may be a small amount but can help us in continuing some of the project activities.

• Online Fundraising:  we will use online fundraising that will help us reach a wide audience and individuals who  will like our project  and that can fund us.

• In Kind donations: We will do not just look at financial support from agencies as in-kind support can also help us in sustaining some of our project activities.
  

 The ways to achieve our Institutional and Organizational Sustainability?

• Explore new opportunities: we will Keep a flexible approach while looking for new opportunities we may have to modify our priorities to adopt to changes.
• Develop new partnerships: To develop a sustainable organization we will develop new partnerships. These partnerships will make us stable and will also help us in taking our mission ahead.
• Boost existing relations: Along with investing time and energy on developing new partnerships it is equally important  for us  to manage existing relations with our potential  donors, stakeholders and beneficiaries in a proper way.
• Communication and Outreach:  We will have a strong communication strategy that will help us in showcasing our project results to a large audience. We will have a monthly communication plan that will be used for updating our webpage, social media profile, sending donor mails etc.
• Volunteer engagement: one of the strategies that our team will  use to sustain our  project is through engaging volunteers for performing some activities. As volunteers do not take any salary we can use this human resource to continue our mission without spending money.

How to ensure Programmatic sustainability?

• Community involvement: involving our community is the key to have long term impacts from our project.  We will make sure that our project involves the community at various stages, this will give them ownership of the project and there are high chances that they may continue with some project aspects even after the project duration. As the entire process will be participatory the skills and knowledge gained by the present group of people, will be transferable and also replicable.
• Institutionalize local groups: Local groups play a very important role in maintaining our program objectives. We will strengthen local institutions and involve them in planning and implementation phase of our project.
• Community advocacy:  We will sensitizing the community about the benefits of our  particular project and then initiating a policy advocacy that will  also ensure sustainability in the long run.
• Involving local government and departments: Involvement of local agencies and government will ensure improved access to the government initiatives in this direction. As these agencies are permanent, they will help in sustaining our project activities beyond the project duration.