Institutional strengthening for evidence-based health policies in the DR Congo (RIPSEC): Impact

Issue

In the DRC, the need to strengthen the health system for a more equitable charge of the health of the population in a perspective of universal health coverage proves to be relevant. Develop a culture that promotes decision-making based on scientific evidence, essential to improve the overall performance of the health system from this perspective

Description of the Problem

The RIPSEC program aims to (i) develop the capacity to manage health knowledge in the DRC through the creation of a Health Knowledge Center in the DRC, (CCSC- Asbl); to strengthen the scientific capacity of the Public Health Schools and the National Institute of Biomedical Research in health systems research and education and to strengthen the training capacity of the Public Health Schools by Development of Learning and Research Health Districts (LRHD). We assess the level of achievement of the results of this program.

Results

The majority of objectives have been reached.The CCSC-Asbl, created is an autonomous institution with legal personality. It produces scientific evidence and support for decision-making. The Ministry of Health has been strengthened and diversified. Institutional capacities and visibility have been strengthened through continuing education and the publication of scientific articles. But, no doctorals theses has been completed yet. Establishment of a consultation framework for health science training institutes: online training, short-term joint training on health system research. The third component concerns the development of LHRD; Transformation processes in the district went through a strengthening of the capacity of the district health teams and via a process of action-research.

Lessons

The RIPSEC program is increasingly becoming part of the Congolese health system as a strong partner.

Key messages

This experience can be used elsewhere in different contexts This program could be continued to perpetuate these fragile achievements. It corresponds to the felt needs and the priority of the health education system in the DRC or elsewhere.

Developing local knowledge centre for health policy

With the support of the European Union, the Health Knowledge Centre in DR Congo was initiated. The Centre is a small independent organisation, that has strategic liaisons with three Schools of Public Health in DR Congo and with the National Biomedical Laboratory. The Centre produces policy advice, often based on knowledge generated in the universities.

Through its direct relationship with the Ministry of Health it is able to develop new policy directions in the health sector, e.g. through analysing and advising on healthcare financing.

The Centre produces policy briefs, organises round tables, and has a website to inform stakeholders on policies in health.

Most important lesson learned: an organisation that mediates between universities on the one hand and policy makers on the other hand is able to formulate evidence-based policies.

Development of Learning and Research Health Districts (LRHD) in the DR Congo: results

Issue

There is great need in DRCongo for adequate training sites where national public health managers and workers can discover what is means to manage complex district healthcare delivery systems in a perspective of PHC and UHC. The development of such LRHD is coherent with the national policy in DRC advocating for demonstration districts.

Description of the Problem

The RIPSEC has launched three sites called LRHD, two of which are rural and one urban. A specialist in the organization and management of health services, from each of the three schools of public health, supervised the development and monitoring of those LRHDs. The Provincial Supervisor was also involved. Three approaches to solving priority problems have been defined: strengthening leadership at the HD level; transform health services into a learning and research framework. We analyze the transformation process obtained in these HD.

Results

Transformation processes in the district went through a strengthening of the capacity of the district health teams and via a process of action-research. The results of those LRHD after 4 years were mixed: the leadership of the management teams has improved. A reflexive attitude developed which contributes to more appropriate decision-making,monitoring and evaluation.At least one hospital service and 2 health centers have been transformed according to specific problems,improving the interaction between health structures, in order to quality of care has improved, the results of action research have made it possible to resolve local health problems. RIPSEC support to Provincial Supervisor to develop their working tools to better address their functions and responsibilities. However, the documentation of these changes induced by RIPSEC was not yet systematized. No residential internship could be carried out due to operational constraints.

Lessons

Mentoring, through its intellectual inputs, has contributed to a dynamic of change in the HD.

Key messages

The basis of the strategy is the improvement of the leadership of the HD management team,reinforced by mentoring and systematic documentation of complex decisions. This program could be continued to perpetuate these fragile achievements. This experience can be used elsewhere in different contexts. But,the residential internship requires other resources.

Evaluation of the performance of the partograph in the Kisanga health zone in Lubumbashi

Introduction

The partograph allows adequate fetal-maternal care during childbirth and the immediate postpartum in a maternity hospital. The objective of this study was to determine the proportion of the correct use of the partograph in maternity hospitals in the Kisanga Health Zone in Lubumbashi.

Materials and Methods

It was a cross-sectional study on the holding of the partograph, carried out in the Kisanga health zone in Lubumbashi during the month of November 2018. In total 794 partograms completed during the study period by providers in 89 maternity wards were analyzed. Two indicators have been known for the proper use of the partograph (for the decision price) and compliance with the benchmark. An element was considered correctly applied if its compliance rate was greater than 75%. The data were analyzed using SPSS 20

Results

Of 794 partograms collected, 63.6% were official (MSP or WHO) and 36.4% of wealth. In 32.6% of maternities, filling the partograph was easy. In total, 10.1% of maternities made the decision based on the line of attention of the partograph and 17.2% based on the line of action. The overall compliance rate for filling the partograph was 43.4% [41.1-45.6]; it was 50.0% [47.8-52.5] for maternal parameters, 54% [52.8-56.0] for fetal-adnexal parameters and 48.2% [47.4- 49.0] postpartum. The decision-making was 18.4% [18.2-18.5] and the filling time 33.3% [29.3-37.3]. It was found that 85.1% of partograms were completed during labor and 3.0% postpartum. The first point was correctly placed on the alert line in 19.6%

Conclusions

Partograph coverage, correct use and compliance rate are low in the Kisanga health zone. It turns out to be imperative to reinforce the correct use of the partograph and to rethink, if possible, a more simplified model with very sensitive items.

Key messages

This study has just helped to identify the parts of the partograms which are among the least filled and therefore the least understood by health care providers in health facilities. It has the merit of putting the thorny question of simplifying partograms back on the table for discussion in order to facilitate optimal use.