In 2018, UNHCR continued to ensure that urban refugees in Bukavu, Goma, Lubumbashi, Kinshasa and Gabon have access to healthcare without discrimination. The priority was placed on access to primary healthcare through public health facilities, in accordance with the Ministry of Health’s national strategy.
The arrangements for accessing medical services, including vaccinations, remained the same as in 2017. All urban refugees were provided health assistance in 2018. In support of access to primary healthcare, 765 urban refugees were enrolled in a top-up health insurance scheme in Goma; and 92 in Bukavu.
In DRC, UNHCR supported the payment of annual membership fees, whilst refugees contributed 10% of all incurred medical fees, with their insurance covering 90%. When a refugee was unable to pay their contribution, UNHCR covered the gap after case-by-case assessments by a social committee. This mechanism helped the most vulnerable persons to access services. Asylum-seekers and chronically ill people were also assessed on a case-by-case basis, and referred to public health facilities whenever possible. In Gabon, although the legal framework takes refugees under consideration, in practice refugees were asked to await until 2019 for the new programme, “FONDS 4”, to be established; in order to contribute depending on individual economic levels.
In North Kivu all 765 urban refugees were briefed on and enrolled in a top-up health insurance policy. 92 refugees were enrolled in a similar insurance scheme in Bukavu, South Kivu. In North and South Kivu, 1,697 consultations were carried out in 2018, and 106 individuals were hospitalized and supported by the insurance. 304 individuals were referred to secondary healthcare in North (255) and South Kivu (49), compared to the planned figure of 198 for 2018. At the beginning of the year 2018, 1,596 urban refugees and 221 asylum-seekers in Lubumbashi were exposed to various diseases. The absence of agreements with medical structures for refugees in rural areas (Fungurume, Mulwingishi, Kolwezi, Kasai and Dilolo) causes movement of refugees from rural areas to Lubumbashi to access health care. UNHCR through its partner ADSSE have concluded agreements with the Lisungi Mutual and the Pacific Health Center. Thus 1,851 consultations were made for the benefit of refugees.
In Gabon, 56 vulnerable POCs (22 women, 30 men, and 4 children) were referred to health partners, whilst other refugees participated in various health awareness campaigns: 55 (32 males, 23 females) for ophthalmology; 14 blood donation, testing for cancer (28 females), and testing for diabetes 13 (2H, 11F). In North and South Kivu, 88 individuals with chronic diseases benefited from assistance. In addition, UNHCR supported the fees of about 150 individuals who did not meet the insurance criteria or were not able to pay their 10% contribution. With all these mechanisms the mortality rate (1.1 deaths/1,000/month) remained within the standards (1.5 deaths/1,000/month). In South Kivu, 209 refugees seeking voluntary repatriation benefited from awareness-raising on health-related issues including personal hygiene and food safety, malaria prevention, prevention of waterborne diseases and HIV/AIDS prevention.
In addition, in August 2018 UNHCR began implementing the following Ebola prevention measures:
- Advocacy: UNHCR conducted advocacy with local health authorities to ensure that people of concern are incorporated in their preparedness plans in North Kivu and South Kivu, as well as in Ituri;
- Infection prevention and control: handwashing stations were installed, and briefings on Ebola prevention were conducted with health workers;
- Epidemiological surveys: thermometers were installed to conduct screening at the entrances of Transit Centres and Assembly Points in North Kivu; health workers were briefed on case definitions;
- Coordination: UNHCR participated in daily coordination meetings.