1In eastern DRC, UNICEF and partners have piloted a roving health mechanism to respond to the urgent health needs of displaced people and host populations.

mobile clinics: health care on the move

multi-sectoral emergency response mechanism, the Rapid Response to Movements of Population (RRMP) programme, which is co-managed by UNICEF and OCHA.

Design: how it works

To develop and implement an emergency health intervention, UNICEF partnered with MERLIN, an international NGO with extensive experience delivering emergency health interventions in the region.

The project is designed according to the following structure, which is shared across the larger RRMP programme:

1. Fully operational assessment teams are prepared and ready to be deployed in response to crises related to population movements.

2. Funds are already available and stocks are prepositioned to enable a quick response.

3. Fully operational medical response teams are ready to bedeployedwheremajorneedsareidentified.

4. Independent dedicated monitoring teams are available for on-going and post intervention monitoring.

Inconflictsituations,healthinfrastructureisoftendestroyed,andlargeinfluxesofpeopleoverwhelmhealthstructuresinhost communities. Seeing that in very remote areas there was no support available to help cope with the increased demand, UNICEF and its partners developed a mobile methodology that would meet the health needs of populations when and where they were needed. In a country where people often have to

walk for hours or days to receive health care, the mobile clinics target the most common causes of morbidity (malaria, diarrhoea, acute respiratory infections, and

seasonalflu),bring-ing life-saving care to where it is needed most. The mobile clinics are a part of UNICEFs larger

unite for children

2 The pilot project consisted of both direct service provision through the operation of mobile clinics, and institutional support to health facilities. Mobile clinics operated in intervention sites at least two days a week (rotating between multiple sites) for a period of three months. The clinics were fully staffed by medical teams who provided freetreatmenttobeneficiariespresentingwithmalaria,diarrhoea,respiratoryinfectionsorseasonalflu.Allseriouscases requiring in-patient care were referred to pre-identifiedreferralhealthcentres,aswerepregnantwomenin need of obstetric care. The referrals were conducted using a voucher system to ensure free access to care for the patient referred, and were carefully monitored by RRMP Health quality teams.

Deliver: What has been achievedInspiteofthedifficultiesandchallenges,bothconceptualand operational, inherent in an ambitious pilot project such as RRMP-Health, the project has seen successes acknowledged by the humanitarian community throughout North Kivu. Over the pilot phase the project has reached nearly all set objectives and targets, both quantitative (52 evaluations completed, 41,000beneficiariesreached),andqualitative(anaverageof27patient consultations per provider per day, 84% of patient exit surveys report satisfaction with services offered and quality of care, 90% of patients treated as per national protocols). Mobile clinics were deployed in Goma, Nzulu, Bunyatenge, Luofu, and Kanunu.

Mobile clinic staff do an inventory check before opening the clinic to the community. Before leaving an area, the mobile clinics will donate essential medicines to local health facilities to ensure a continuity of treatment.

Discover: What is working

Fillingacriticalgap:RRMP is the largest humanitarian multi-sectorial response mechanism in the DRC. For years, the programme has delivered emergency assistance in the areas of water, sanitation

UNICEF/DRC/Ridsdel

3to a range of different contexts and accessibility challenges: they can be deployed out of cars, planes or boats. This adaptability makes them a highly appropriate mechanism to respond to the short-term health needs of populations on the move.

Rapid,flexibleresponse: Like the other components of the RRMP programme in eastern DRC, the mobile clinics are a pre-positioned mechanism. The partnership, staff and suppliesarethereforenotboundtoaspecificpopulationorgeographicarea.Thisflexibilityallowsthemobileclinicsto be rapidly deployed to an area in response to a sudden

4-month old Liliane and her mother wait while a nurse fills out their prescription. They are both being treated for respiratory infections by the mobile clinic that brings emergency health services to their doorstep in their remote village of Muhanga, North Kivu. Lilianes family has recently returned there after having been displaced by violent conflict.

and hygiene, education and the provision of essential household items. Yet population displacement carries with it a high risk of morbidity that can only be managed through medical care. Among forcibly displaced populations in developingcountries,thetopfivekillersofchildrenundertheageoffiveare:malaria,diarrhoea,respiratorytractinfections, measles, and malnutrition: all preventable, treatable illnesses. With an increasing need for emergency healthresponseandfewrapidandflexibleemergencyhealth programmes in the DRC, the RRMP mobile clinics contributetofillingacriticalgapinlinewiththemostessential humanitarian imperative of saving lives.

Responsivenessandadaptability: Mobile clinics can be rapidly deployed and bring with them everything they need: medical supplies, simple diagnostic equipment, andqualifiedhealthprofessionals. The mobile clinics can easily be adapted

UNICEF/DRC/Ridsdel

4crisis, meeting needs within the shortest possible delay.

Supporttoexistinghealthcapacity: Short-term, emergency medical care is not a substitute for long-term service provision, but it can be a complement. When deployed to a particular area, the mobile clinics establish working relationships with health centre personnel and asses the needs of the local health posts. Based on their assessment, the health posts can be eligible for a small grant for infrastructure rehabilitation and restocking vital drugs. The mobile health personnel also provide refresher training and capacity building on how to deal with health issues that particularly affect displaced populations,

for example acute malnutrition.

Supporttohostcommunities:In keeping with the broader RRMP framework, the mobile clinics provide assistance not only to displaced people but also to host families and communities. While host populations are often

excluded from humanitarian assistance, from a health perspective, treating them is a critical factor in preventing the spread of epidemic illnesses.

Transparencyandcommunication:Unlike regular health services, RRMP mobile clinics provide short-term, free assistance. To ensure that there is no confusion between emergency and long-term service provision, mobile clinics set up in a separate geographical space. The mobile health team works with local leaders to ensure that essential programme information is made public, such as who is eligible for the programme (IDPs, returnees, and vulnerable individuals in host communities) and why,

Daima, 31, gives feedback to a quality control officer after bringing her 2-year old daughter, Aimerance, to a mobile clinic in the remote village of Muhanga. Aimerance was treated for malaria and for an acute respiratory infection.

UNICEF/DRC/Ridsdel

5Peak moment

In the remote village of Muhanga, two-year old Aimerance (pictured below) has her arm circumference measured to check for signs of malnutrition. Aimerance is one of hundreds of children who are receiving free health care through a weekly visit by a mobile clinic. Aimerances mother, 31-year old Daima Kyakimwa, has recently returned to her home village after having been displacedbyconflict.Returningonfoottoherformerhome,sheandherfamilywereexhausted,andhadnomoneyformedicineor food.

Daima says that she is extremely grateful for the mobile clinic, which is providing free emergency health care for hers and oth-ersfamilies.WhenIfirstarrivedback,mynewborndaughterwasweakandsick,andIdidnthaveenoughbreastmilktofeedher, recalls Daima. When the mobile clinic doctors examined the infant, they immediately recognised the danger signs of acute malnutrition. Merlin transported the two-month old to a district health centre, six hours drive along an insecure and, in places, nearly impassable muddy road. It would have taken Daima two days to walk there, and even if she could have left her other seven children behind, she didnt have any money to pay for treatment. Thanks to UNICEF and Merlin, the baby was treated for acute malnutrition, and was returned to her mother in good health. It was one of the happiest days of my life, says Daima.

UNICEF/DRC/Ridsdel

6and how long the intervention will last. The teams also broadcast programme information and key health messages via community radio.

Synergieswithnationalhealthobjectives:Theflexibilityofthemobile clinics allows UNICEF and its partners to respond to broader health priorities when an emergency arises. Recently in the remote area of Punia, Maniema province (in the west of North Kivu) an area completely inaccessible by road the mobile clinics used motorbikes to deliver measles vaccinations to nearly 44,000 children.

Deliveringhealthservicesinremoteareas:Eastern DRC has some of the worlds most inaccessible territory. RRMP has a history of meeting the needs of displaced or returning populations no matter where they are, delivering goods and services to them by plane, car, boat, motorcycle, bicycle, and even on foot. The mobile clinics are an extension of this commitment, delivering urgently needed health care to people in some of the most inaccessible areas of the country.

UNICEF/DRC/Ridsdel

7The clinics can also double as an ambulance service, referring patients to specialised care, for example women in need of an emergency caesarean operation.

Dream: vision for the future

The pilot of the emergency mobile clinics as a rapid response mechanism has been convincing. UNICEF and OCHA are now seeking to bring the RRMP health component to scale in North Kivu, and investigate partnerships to expand coverage to other provinces in eastern DRC. With support from donors also interested in expanding on this model to other provinces, UNICEF hopes to start up an RRMP Health partnership in South Kivu before the end of the year.

In2013-2014,morethan187,000peoplewillbenefitfromhealth care provided by RRMP Health. RRMP Health will also expand the range of illnesses treated to offer its patients the full PMA (Minimum Activity Package), and two additional teams will be added for implementation of the pilot activities, nutrition, vaccination and care activities.

Building on the experiences of the past year, the RRMP Health partners will be improving the overall reach of the projectandaimtoincreaseitsflexibilityandreactivitytotheidentifiedneedsofpopulations.Inthisrespect,overthenextyear, UNICEF and its partners will 1) amplify the projects capacities of evaluation and response 2) develop new strategies of intervention and exit, and 3) emphasise the continual improvement and quality control of all activities.

UNICEF also envisions that in the future, emergency health

Watch a video of the first mobile clinic:

https://www.youtube.com/watch?v=CuhR_kZL4fQ

programming, especially for returnee populations, will have stronger linkages to long-term health initiatives and local health authorities in order to ensure that people have continued access to basic, life-saving services.

Partners:

Partnerships are crucial for UNICEFs work. UNICEF thanks its partners for the successful collaboration.

RRMP Partners: Co-coordinated by UNICEF and OCHA and implemented by Solidarites International, NRC, AVSI, IRC, Save the Children and Merlin. Donors: Pooled Fund, ECHO, UKaid, OFDA, SIDA, CERF, Japan, Swiss Government, CIDA, UNICEF National Committees.