DR Congo

Use of facility assessment data to improve reproductive health service delivery in the Democratic Republic of the Congo

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Abstract

Background

Prolonged exposure to war has severely impacted the provision of health services in the Democratic Republic of the Congo (DRC). Health infrastructure has been destroyed, health workers have fled and government support to health care services has been made difficult by ongoing conflict. Poor RH indicators illustrate the effect that the prolonged crisis in DRC has had on the on the reproductive health (RH) of Congolese women. In 2007, with support from the RAISE Initiative, the International Rescue Committee (IRC) and CARE conducted baseline assessments of public hospitals to evaluate their capacities to meet the RH needs of the local populations and to determine availability, utilization and quality of RH services including emergency obstetric care (EmOC) and family planning (FP).

Methods

Data were collected from facility assessments at nine general referral hospitals in five provinces in the DRC during March, April and November 2007. Interviews, observation and clinical record review were used to assess the general infrastructure, EmOC and FP services provided, and the infection prevention environment in each of the facilities.

Results

None of the nine hospitals met the criteria for classification as an EmOC facility (either basic or comprehensive). Most facilities lacked any FP services. Shortage of trained staff, essential supplies and medicines and poor infection prevention practices were consistently documented. All facilities had poor systems for routine monitoring of RH services, especially with regard to EmOC.

Conclusions

Women's lives can be saved and their well-being improved with functioning RH services. As the DRC stabilizes, IRC and CARE in partnership with the local Ministry of Health and other service provision partners are improving RH services by: 1) providing necessary equipment and renovations to health facilities; 2) improving supply management systems; 3) providing comprehensive competency-based training for health providers in RH and infection prevention; 4) improving referral systems to the hospitals; 5) advocating for changes in national RH policies and protocols; and 6) providing technical assistance for monitoring and evaluation of key RH indicators. Together, these initiatives will improve the quality and accessibility of RH services in the DRC - services which are urgently needed and to which Congolese women are entitled by international human rights law.

Background

Reproductive Health among Conflict-Affected Populations

Complex humanitarian emergencies caused by armed conflict are characterized by social disruption, population displacement and collapse of public health infrastructure [1]. Humanitarian assistance for refugees and internally displaced persons (IDPs) requires specific attention to ensure that the reproductive health (RH) rights of the population are recognized. Women living in conflict and post-conflict settings are faced with many RH concerns including high risk of death or disability due to pregnancy-related causes, lack of information about and access to family planning (FP), complications following unsafe abortion, gender-based violence and sexually transmitted infections (STIs) including HIV [2]. Women and men affected by armed conflict have the right to RH-related information and access to safe, effective, affordable and acceptable FP methods as well as appropriate and effective health care services that will enable women to experience safe pregnancies and childbirth [3].