The Protestant Church of Congo Medical Office (ECC/DOM) as a Faith-Based Health Network, has played a major role in the development of Congo's primary health care system and decentralized health zones. Each day ECC/DOM, through its member communities, provides direct health services to millions of Congolese. However, ECC/DOM has also played a key role is shaping the health delivery system of DR Congo. Today, ECC/DOM continues its leading role in the management of health development projects in DR Congo. The following timeline trances and highlights the milestones in ECC/DOM's pioneering activities in this major health development project.

Prior to Independence: The work of Protestant churches and missionaries in Congo dates back to the late 1800s with the creation of hospitals and health services. In fact, Protestant missionaries led the way in establishing the first hospitals in Congo. Eventually, in an effort to improve the coordination of services, forty protestant missionary societies from twelve different countries created the Protestant Council of the Congo in 1928. Later during the 1970s, Mobutu's "authenticity movement" required all protestant groups to unite within one authorized national church. As a result, the Protestant Church of Zaire (Eglise du Christ du Zaïre - ECZ, but currently known as ECC - Eglise du Christ au Congo) came into existence in 1971 with around sixty member communities. At the same time, the Direction des Oeuvres Médicales (DOM) was created to coordinate the health work of ECC members and to liaise with the Ministry of Health.

Prior to 1970: ECC manages 50 hospitals and several hundred dispensaries. At some hospitals, pioneer Protestant missionaries such as Drs. Dan Fountain of Vanga and Norman Abell at Kimpese begin promoting the concepts of community-based health care in addition to hospital and dispensary-based care.

1971-1972: The medical office of ECC is officially created and opens one of the first "desirable births" offices in Kinshasa, making modern contraception available. This work expands quickly with financial assistance to ECC from U.S.-based Church World Service, Pathfinder and Johns Hopkins University.

1975: The medical offices of ECC and the Catholic Church co-sponsor a national conference in collaboration with the Ministry of Health. This conference establishes a national consensus for the concepts of "decentralized health zones" and "primary health care." This conference illustrates the extraordinary vision and drive of ECC/DOM, as it takes place three years before the 1978 Alma Ata conference for primary health care, in which delegations from 134 countries and 67 UN agencies agreed on the concept and importance of primary health care and the rights of people everywhere to have access to primary health care.

1976-1980: A few pilot health zones are created, including several by member communities of ECC/DOM, e.g., the rural health zone of Vanga is established in 1977. In addition, church hospitals of Kimpese Karawa, Wembo Nyama and Nyankunde establish working models for community-based health care programs.

1980-1981: Based on repeated requests from Protestant health services for assistance, the U.S. Agency for International Development (USAID), in consultation with the ECC/DOM designs a project to create fifty health zones around Protestant hospitals. USAID and the Ministry of Health select the ECC to manage this multi-million dollar bilateral project called the Basic Rural Health project. This is one of the first projects of this size to be managed by an umbrella organization of any Church body.

1981-1991: The Basic Rural Health Project becomes better known as SANRU (Projet Santé Rurale). ECC conscientiously decides not to limit project assistance to Protestant hospitals, but to open the project to health zones created around Catholic, governmental, and other NGO-managed hospitals. This approach quickly transforms SANRU into a national health project, and further establishes ECC/DOM as a model umbrella organization managing a national health project. ECC/DOM's management of the SANRU project that results in a bottom-up approach for the creation of Congo's 306 health zones. While many African countries have failed in their attempts to decentralize health services, the Ministry of Health of Congo, in collaboration with ECC/DOM and the SANRU project have succeeded. The result is a highly decentralized health system that respects national policies and guidelines. The existing network of ECC hospitals provides a good infrastructure for the management of decentralized health zones. The presence of a functional referral hospital, office space and equipment, a garage and maintenance facilities, housing and gardens, electricity and fuel, supply line for medicines, teaching facilities and schools attract and retain competent staff even in isolated rural areas. This infrastructure helps these health zones to quickly develop. It also establishes a critical mass of developing health zones and a national momentum that spreads rapidly throughout the country.

1984-1987: ECC accepts the management of an additional project to help rebuild 200 health centers. Working in collaboration with the Organization for Rehabilitation by Training (an NGO of the Jewish faith) and USAID, this project demonstrates how ECC can work with interfaith health services. 1987-1991: ECC/DOM and USAID expand SANRU to become SANRU II and to assist the development of 100 health zones. By 1987, more than 200 decentralized health zones are functioning in Congo, and access to primary health care services in SANRU-assisted health zones increases from 10% to around 50%. However, the worsening economic situation, the AIDS epidemic of the late 1980s, and the increasing political instability of the 1990s, rob the health system of most of the gains it has achieved. An August 1991 SANRU evaluation aptly summarizes the future of health zones in Congo: SANRU's raison d'etre is the initiation and strengthening of the health zones' ability to render primary health care to rural populations. SANRU has been dramatically successful in initiating or extending primary health care activities.

The concept of the health zone is a strong building block for the future development of the Zairian health system. By keeping this concept viable, SANRU can offer to a future, more development-minded GOZ a model, based on the health zone concept, on which to build a sustainable, effective, and efficient national health system.

1991-2001: Political disruptions in 1991 force USAID to close its offices and to discontinue the SANRU project. However, ECC/DOM continues its leadership and assistance to health work through a variety of projects and funding sources. This work includes providing assistance to:

• 38 health zones in collaboration with MAP International, 1992;
• 22 health zones in collaboration with the World Council of Churches, 1993;
• Urban health zones in Kinshasa in collaboration with the World Bank, 1994;
• 46 HZs with displaced persons with the U.S. OFDA Assistance 1994-95; and
• 20 health zones with Solidarise Protestante, a Belgian NGO.

1996: During the Ebola outbreak in 1996, the SANRU offices at ECC become the coordination center for all NGO and governmental agencies. This includes training and surveillance in collaboration with the Centers for Disease Control, handling radio and e-mail services and coordinating the receipt and distribution of two Department of Defense planeloads of medical materials.

2001-2006: ECC/DOM in collaboration with Interchurch Medical Assistance develops a SANRU III proposal to assist rebuilding of sixty FBO-comanaged health zones. The five-year project is funded by USAID for $25 Million. SANRU III dramatically improves basic health services, including distribution of Vitamin A, Insecticide Treated Nets, preventive treatment of malaria, testing of blood for HIV/AIDS, and vaccination coverage. For example, DPT3 coverage was 28% in 2001. By 2006 with SANRU III assistance under ECC/DOM leadership DPT3 coverage had increased to 75 %.

2006-present: When the SANRU III project ended in September 2006, ECC elevated SANRU from a "project" to a "program." The SANRU program currently a portfolio of projects that annually provides more than $10 Million of health development assistance. This includes:

1. Project AXxes: (Global Support to 57 Health Zones with USAID funding;
2. PMURR: Partial support to 21 Health Zones with World Bank funding;
3. Global Fund: Partial support to 25 HZs for HIV/AIDS and 16 HZs for Malaria;
4. DEVRU: (Rural Development): Priority agricultural interventions;
5. Solidarité Protestante: Assistance to 5 HZs for VIH-SIDA interventions ;
6. AMITIE: (with CRS lead): Assistance in Matadi for HIV/AIDS interventions.
7. MRP (Medical Residency Program): Family Health Internships for 30 MDs in four hospitals.

ECC and IMA World Health have now begun the legal steps to create SANRU NGO. This will, it is hoped, with support from a few key supporting partners, provide an organizational structure to sustain the work and spirit of SANRU for many years to come -- to continue "Building Health and Hope" throughout DR Congo.

In conclusion, ECC/DOM strives passionately to bring health and wholeness to impoverished and disadvantaged people throughout DR Congo. The contributions of ECC/DOM, and its member faith communities, toward alleviating human suffering in Congo in three comprehensive bullet points:

1. Provides community-based curative and preventive health to more than ten million people;
2. Co-manages with the Ministry of Health 50 of Congo's 515 decentralized health zones, and
3. Has played a key leadership role in the management of national projects, like SANRU, to develop more than 100 of Congo's decentralize health zones.