|Along the continuum of care, RMNCAH+N interventions are delivered at following levels in North and South Kivu:|
• Promotion of essential preventive practices related to hygiene, appropriate child feeding, malaria prevention, as well as some component of IMCI occur at community level;
• Antenatal consultations, normal deliveries, postnatal care, vaccination and IMCI are provided at the health center level;
• Family planning, treatment of sexually transmitted infections (STIs), and HIV testing are provided at hospital level. Family planning is also offered at health centers and health posts. However, it was reported that “reproductive health is forgotten in post-crisis or emergency situations. Partners may bring nutrition and protection but forget that reproductive health is really an essential component both in normal times, and even more in conflict or post conflict situations” (Provincial MoH). Attempts are made by provincial authorities to ensure that the Minimum Initial Service Package (MISP) is included in all emergency programs;
• Comprehensive care for sexual assault survivors is usually provided at the hospital level, although post-exposure prophylaxis (PEP) kits are available also in many health centers. The multi-sectoral support package includes medical and psychosocial treatment, legal support and socio-economic reintegration;
• Nutrition programs for the treatment of severe acute malnutrition are few and supplementary programs addressing moderate acute malnutrition almost inexistent (to be noted is that prevalence of wasting is usually below emergency level). “UNICEF is practically the only [actor] who provides therapeutic products and Plumpy’Nut to malnourished children in this country” (UN) and is confronted with important supply challenges;
• Programs focusing specifically on adolescents are still very new and seldom implemented. Service providers recognize that “we are as well adolescents in the implementation of these services […] but we notice that there is interest among adolescents who come as soon as we start providing this service” (Health Zone Chief Medical Officer). Adolescents are usually treated together with the rest of the patients. The few health centers that have specific interventions for adolescents focusing on reproductive health and sexually transmitted infections are supported by external technical partners (e.g. NGOs with a specific mandate for this group); and
• Given the community-based approach streamlined by the MoH, all health facilities organize and work through community-based actors (see Table 4).