DKT- Hållbar kapacitetsuppbyggnad av SRHR i nordöstra Kongo

The year 2023, was the last year of implementation for DKT. The Embassy has however decided to continue supporting DKT for an additional 2 years through an agreement amendment. This decision is based on the positive results coming out of DKTs business model which is evolving to become a sustainable model for employment and for SRHR services. The project has trained more than 110 Bees in North and South Kivu (majority being in North Kivu), who together bridge the gap between healthcare facilities and communities, offering essential SRHR information, support, and services. DKT has an ambition to cover all health areas in the two provinces, rather than covering all health zones, this will allow them to get closer to the populations they wish to target. In Bukavu the Bees cover 24 out of the 38 health areas, but DKT is present in all the three health zones in Bukavu, the goal for the coming years will be to cover all the 38 health areas. On a national level DKT covers 55% of all health areas in the country. - mitigate financial barriers to contraception use by providing affordable solutions/products - address social barriers to break misconceptions and myths around contraception All of the above has been visible during field trips to the eastern part of the country as well as the yearly increase in CYPs. In 2023 DKT generated 76.244 CYPs of which the Bees accounted for 10.6% of this, the rest was generated from pharmacies and clinics. In the three years of implementation, DKT has generated 594,887 CYPs, which over exceeded their target of 500.000. Data shows that contraception prevalence is higher in Health Zones where DKT is present than in Health Zones were DKT is not present. Based on the successes from the project, DKT has expanded the Bees model to other provinces. A positive outcome that demonstrates the appreciation of the model was that the Bees have decided to advance the model by forming small cooperatives, ranging from 5 to 8 Bees, where they organise themselves to purchase products from DKT in order to sell them within their communities, and benefit from bonuses provided by DKT. This will as a result generate more CYPs on initiatives driven by the Bees themselves. This is a clear example that the sustainability model is working. DKT plans to support the formation of these cooperatives in the next phase that the Embassy will support. Following the domestication of the Maputo Protocol, DKT began working on abortion access. The Embassy urged collaboration with Ipas to support this area of work. Together the two organisations succeeded in lobbying for abortion products be included on the list of essential medicines that can be imported to the country. DKT became the first importer of misoprostol/mifepristone. During a field visit to DKT in Bukavu, it was noticed that there were different brands selling misoprostol/mifepristone following the approval. This demonstrated the role that DKT plays as an enabler in market development, which can also regulate pricing on SRH products, thus making products more affordable. Towards the end of 2023, DKT has been assessing in more depth some of the lessons learned from previous years. For example, 30% of Bees were let go during 2022 due to misunderstanding on their renumeration, this left many Bees stressed and worried as they did not understand why these Bees had been dismissed. DKT learned that more clarity and stringent measures were needed for the bonus system to work. In 2023 DKT was ready to communicate and address this issue with the other Bees who had not been let go. DKT has also learned that they can expand demand creation through communicating more in local languages, something that is in the pipeline for the next phase. In the next phase DKT also needs to improve their supply manufacturing, to avoid stock outs. It is worth noting that DKT moved their provincial office (for the East DRC) to Bunia. The decision was taken after they partnered with Aviation Sans Frontier for delivery of their commodities, and Aviation Sans Frontier has their office in Bunia which made DKTs work easier to be in the same location Moving into a new support, DKT plans to continue working with the same number of Bees and maintain the level of knowledge among the Bees while exploring how to support the organisations/cooperatives they have created. The Bees have requested that DKT support the associations they have created, e.g., through fund management or financial trainings. This could allow them to become more independent and access more financing to expand their supplies. The escalated conflict in the East is however a major concern as this will impact DKT (and the Bees) operations, where there is a risk that family planning prevalence might go down. This is included as a risk factor.

This contribution from Sweden will improve access to family planning services and modern contraceptives methods that build on a sustainable model of social marketing (to increase demand and uptake) in North and South Kivu provinces and the surrounding areas. DKT will strengthen the province's distribution system to ensure a permanent presence of contraceptive and Post Abortion Care as well as Medical Abortion products. Through the program, community-based providers will be trained and empowered to work within their communities to educate women and men on Sexual and Reproductive Health and Rights (SRHR). Health care providers will also be trained to serve survivors of gender-based violence (GBV) and address taboos around sexuality, and family/community influences on family size.  The goal is to strengthen national ownership and the long-term sustainability of reproductive health care, including abortion and GBV care in the DRC.