Additional reportage, also see earlier interviews by Francis
DRC: malaria equals “over seven Airbus A320 crashes a year"
By Francis Mbala
With massive financial support from the Global Fund, malaria fighting remains an
impenetrable world in the DRC. Appointments don’t materialise, requests for info
are met with polite intransigence. Then there is intimidation, and then a week in
jail and a loss of my mobile and recordings, all because I dared to try to
penetrate this mysterious fortress. Though the institutions involved –ASBL,
SANRU, Unicef, the Ministry of Public Health, the National Malaria Control
Programme, hospitals and health centres are all officially open to public
information requests, a report that was estimated to take two weeks ended up
taking two months. And still I had to glean most of the relevant information
undercover. In this country, even ordinary facts are kept behind closed doors.
It was a crazy endeavour, trying to understand the chain that is absorbing the
donated millions of financial and material support. And even when that chain
itself became a bit clearer, a second high mountain had to be overcome: actually
meeting the relevant officials and managers in the institutions involved. For two
whole weeks, every time I fix an appointment, the person involved does not pitch
up. In other cases there is telephonical avoidance.
The SANRU (Primary Health Care in Rural areas) NGO is the main recipient of the
implementation of the malaria project with funds from the Global Fund. The
organization is a cornerstone in the system because its executives work
alongside the NMCP, (the national program for the fight against malaria), which
is in turn the technical body of the Ministry of Public Health.
The SANRU parking is full of sleek black cars. Inside, the offices are polished and
airconditioned. In contrast to many other institutions n the DRC, every single
desk here has his own computer. The environment smells of luxury.
The lady receptionist gently makes me aware that all officials are away this week
for a training workshop. I ask for phone numbers but she refuses. As I leave,
however, I see a phone number on a sheet plastered on the wall: it says it is of
the SANRU Executive Director. As it is now 4 PM and close to closure of office
hours, I wait until the next morning before I phone it. But the (male) director is
not the one who picks up the phone. A lady’s voice answers; she then refers me
to the SANRU chief communications officer and spokesperson.
The spokesperson, credit where it’s due, answers within an hour and invites me
to her high-class office. But I don’t sit down there for long: she then tells me to
see a SANRU doctor in charge of the malaria project, with the latter telling me to
come back tomorrow, since “we are busy with meetings in connection with the
new funding just received from the Global Fund for projects between 2015 and
2017.”

 I keep coming back to SANRU every day for a long period afterwards, but the
meetings never end. Then, one day, I finally do get to see the project officer in
charge of the malaria project. I see Dr Mongala for a good fifteen minutes,
during which she tells me that the money received from the GF is ‘minimal’ and
‘not enough to support all the health facilities’ in the project. She finishes by
saying that people should just sleep under mosquito nets to prevent malaria.
I want to ask how come an amount of over US$ 138 million (US$ 138 million six
hundred and eleven thousand to be precise; question: must SANRU’s office and
staff be paid out of this budget, or have overheads been excluded?) is so
‘minimal,’ bearing in mind that the project only supports 219 health zones, less
than half of the 518 such zones in the DRC. Divided over 219 zones and 30
months, that is still US $ 252 000 per year; 21 000 per area per month, or US $
700 per area per day.
Doctor Francis Xavier Mwema, the division chief on malaria cases in the NMCP is
away on a trip. "I'll be back in a week," he confirms the phone. He is the only
person who wants to talk to a journalist about his work. One week later, indeed,
Dr Mwema enthusiastically welcomes me into his office. He rattles off statistics
that, though known to me, still make me shiver. “Last year, malaria deaths alone
counted for 36 % of all causes of death. 80% of these deaths are of pregnant
women and children under 5. In 2014, 25,502 people died of this disease in our
country." He opens his briefcase and pulls out a calculator to illustrate this some
more: "take the example of an Airbus crash with 300 passengers on board. The
world's media will make special editions and programmes about thatin their
programs. But let 25,502 divided by 12 months the result it gives is that we
suffer the losses of seven Airbus crashes every month. But the Congolese
government allocates only 5.6% of its GDP to this sector.”
Does he raise this with the government?
In the DRC many health zones do not even have proper facilities. Everything is in
tatters. The health zone centre in Ngaliema in Kinshasa, where the chief
physician receives me, is a small block (?) of about 3 x 5m. A small stock of
intrants (medicines?) lies on the floor. The chief physician is very large, about
1m80 and 90 kg. Sitting with him in the cubicle, tight like in a tin, he says "all is
well in our health area. Except we sometimes run out of stock, but that is all.” He
jokes about his imposing bulk "I weigh so heavy, if someone dares to divert what
we give him, I can sit on him and it will hurt” - without laughing or smiling.
The evening of that day I return to the same area to see the supervisor
pharmacist who is in charge of distribution to the clinics in the area (how many
are there? The pharmacist says there are no public facilities here at all?). What
he says contradicts the words of the chief physician. "Beneficiary structures are
not reporting their uses. They do not have much else outside of antimalarials,
mosquito nets and the training the managers receive now and then. Even we
don’t get much,” says the pharmacist. In this area there is no hospital or state
health center, all facilities are private. Thus, patients do not receive drugs free of
charge as expected.

 The next day I head to another health zone: Bandalungwa. Here, a nice
receptionist introduces me to a young nurse, a girl of about 20 years. Here, I
make myself pass for a charge of another health center looking for some
technical and material support. The young girl is very nice and we establish a
friendly relationship. I visit her the next day and the next, and then I put the
question to her: do they get salaries or are they just using the SANRU material to
live? The young nurse falls into the trap. "The SANRU people do not give us
anything except drugs. There is no money (for us) while they benefit from large
funding from the Global Fund and others to enrich themselves. They treat us as
their subordinates without pay. Hence we just sell their drugs to patients and
pharmacists.”
In all the health zones of Kinshasa I visited (HOW many?) there is not one where
the principle of free service to patients with support of the Global Fund is
implemented.
The result of this is that many patients self-medicate, often using fake drugs,
which significantly increases the number of deaths. Specialists and other
researchers interviewed during my investigation say that, outside the appalling
figures that are listed in hospitals, many deaths also occur in the home.
In order to improve the situation, clearly, the Ministry of Health should get its
structures in order. But, say those in the know, the Ministry is characterized by a
fatal laxity. “The inappropriate behaviour of drug diversion must be stopped,”
says one malaria project official. But how, if the programme, or the department,
don’t even pay the nurses?
I understand that Global Fund audits, whenever they take place, focus on the top
levels and that the grassroots levels, where swindlers reign, are simply never
seen.
Effectively fighting malaria in the DRC will require that civil society demands
more commitment of the various role players, more investment of material,
financial and human resources, and simply more action on the side of the
political and administrative authorities in the fight.
ENVIRONMENT
Among the major contributing factors of malaria in DRC there are also the bad
state of the environment .The ANP (National Sanitation Programme) has no
adequate means to deal with the lack of sanitation in the city. With a very high
population density, Kinshasa produces 25000 tons of waste per day.
ROADS –see interview with bednet distributor
CUK story, also see http://www.zammagazine.com/chronicle/chronicle-15/256-amalaria-arrest
I also went to see the University Clinics in Kinshasa, which are among the bestknown health facilities in the DRC, to see malaria patients and meet with

 officials. The goal was to compare how malaria cases are dealt with in places
that are not supported by the Global Fund.
After a few rounds of rooms, I find myself in a common room facing the waiting
care patients. I cannot resist taking out my cell phone to take a picture. But one
of the patients cries out and the chief of staff, who happens to be in the area,
calls security. I introduce myself as a journalist but he dismisses all my
explanations with a wave of the hand. I am subsequently apprehended like a
common criminal and pejorative qualifications rain down on me. I am thrown into
a police cell where I spend three days. My phone, full of photos and interviews, is
still confiscated by the police up to today.
Notes Evelyn
In this article from 2006, an NMCP officer, Angbalu, http://www.irinnews.org/indepth/57926/10/drc-despite-efforts-malaria-still-the-leading-killer says that at
least US $300,000 to $500,000 was needed yearly for each of the country's 515
health zones in order to obtain a comprehensive result in the fight against
malaria. Standing at US$ 252 000 for each of the 219 health zones, we should
surely be getting there?
http://www.kebaafrica.org/malaria-prevention-2/ Ghana: 171/1000