Background The crisis in human resources for health is observed worldwide, particularly in sub-Saharan Africa. Many studies have demonstrated the importance of human resources for health as a major pillar for the proper functioning of the health system, especially in fragile and conflict-affected contexts such as DR Congo. However, the aspects relating to human resources profile in relation to the level of performance of the health districts in a particular context of conflicts and multiform crises have not yet been described. Objective This study aims to describe the profile of staff working in rural health districts in a context of crisis and conflicts. Methods A cross-sectional study was carried out from May 15, 2017 to May 30, 2019 on 1090 health care workers (HCW) exhaustively chosen from four health districts in Eastern Democratic Republic of Congo (Idjwi, Katana, Mulungu and Walungu). Data were collected using a survey questionnaire. The Chi2 test was used for comparison of proportions and the Kruskal–Wallis test for medians. As measures of association, we calculated the odds ratios (OR) along with their 95% confidence interval. The α-error cut-off was set at 5%. Results In all the health districts the number of medical doctors was very insufficient with an average of 0.35 medical doctors per 10,000 inhabitants. However, the number of nurses was sufficient, with an average of 3 nurses per 5000 inhabitants; the nursing / medical staff (47%) were less represented than the administrative staff (53%). The median (Min–Max) age of all HCW was 46 (20–84) years and 32% of them were female. This was the same for the registration of staff in the civil service (obtaining a registration number). The mechanism of remuneration and payment of benefits, although a national responsibility, also suffered more in unstable districts. Twenty-one percent of the HCW had a monthly income of 151USD and above in the stable district; 9.2% in the intermediate and 0.9% in the unstable districts. Ninety-six percent of HCW do not receive Government’ salary and 64% of them do not receive the Government bonus. Conclusion The context of instability compromises the performance of the health system by depriving it of competent personnel. This is the consequence of the weakening of the mechanisms for implementing the practices and policies related to its management. DR Congo authorities should develop incentive mechanisms to motivate young and trained HCW to work in unstable and intermediate health districts by improving their living and working conditions.

Background: The crisis in human resources for health is observed worldwide, particularly in sub-Saharan Africa. Objective: This study aims to describe the profile of staff working in rural health districts in a context of crisis.Methods: A cross-sectional study was carried out from May 15, 2017 to May 30, 2019 on 1090 health care workers (HCW) exhaustively chosen from four health districts in Eastern Democratic Republic of Congo (Idjwi, Katana, Mulungu and Walungu). The choice of health districts was based on the crisis context. The health districts were categorized in stable, in transition and unstable. A survey questionnaire was used to collect data. The Chi2 test was used for comparison of proportions and the Kruskal-Wallis test for medians. As measures of association, we calculated the odds ratios (OR) along with their 95% confidence interval. The materiality threshold was set at 5%.Results: The age of all HCW median (Min-Max) was 46 (20-84) years and female was 32%. 96% of HCW do not receive a state salary ; 64% do not receive government allowance for risk. In the stable district HCW were=< 34 years old [OR = 2.0 (1.5-2, 6 ); p <0.001], the matriculated HCW [OR = 2.0 (1.5-2.7); p <0.0001], those who benefited from national and / or provincial recruitment [OR = 3.9 (2.9-5.4); p <0.001], those who benefit from continuous training [OR = 2.1 (1.5-2.7); p <0.001] and those who receive the local fee -for service[OR = 5.2 (1.9-14.7); p <0.001]. In the unstable district, men [OR = 1.7 (1.1-2.5); p = 0.009], HCW =< 4 years of seniority [OR = 2.3 (1.6-3.3), p <0.001] and lower level of education [OR = 2.1 (1.5-2.9)]; p <0.001]. The percent of HCW who has monthly income >= $ 151 is 21% in the stable zone, 9.2% in the intermediate zones and 0.9% in the unstable zone.Conclusion: DR Congo authorities should develop incentive mechanisms to motivate young and trained HCW to work in unstable and intermediate health districts by improving their living and working conditions.

Background: The crisis in human resources for health is observed worldwide, particularly in sub-Saharan Africa. Objective: This study aims to describe the profile of staff working in rural health districts in a context of crisis. Methods: A cross-sectional study was carried out from May 15, 2017 to May 30, 2019 on 1090 health care workers (HCW) exhaustively chosen from four health districts in Eastern Democratic Republic of Congo (Idjwi, Katana, Mulungu and Walungu). The choice of health districts was based on the crisis context. The health districts were categorized in stable, in transition and unstable. A survey questionnaire was used to collect data. The Chi2 test was used for comparison of proportions and the Kruskal-Wallis test for medians. As measures of association, we calculated the odds ratios (OR) along with their 95% confidence interval. The materiality threshold was set at 5%.Results: In terms of standards, in all the health districts the number of doctors was very insufficient with an average of 0.35 doctors per 10,000 inhabitants, however, the number of nurses is sufficient, there is an average of 3 nurses per 5000 inhabitants, the nursing / medical staff (47%) were less represented than the administrative staff (53%). The age of all HCW median (Min-Max) was 46 (20-84) years and female was 32%. 96% of HCW did not receive a state salary; 64% did not receive government allowance for risk. In the stable district HCW were=< 34 years old [OR = 2.0 (1.5-2, 6); p <0.001], the matriculated HCW [OR = 2.0 (1.5-2.7); p <0.0001], those who benefited from national and / or provincial recruitment [OR = 3.9 (2.9-5.4); p <0.001], those who benefited from continuous training [OR = 2.1 (1.5-2.7); p <0.001] and those who receive the local fee -for service [OR = 5.2 (1.9-14.7); p <0.001]. In the unstable district, men [OR = 1.7 (1.1-2.5); p = 0.009], HCW =< 4 years of seniority [OR = 2.3 (1.6-3.3), p <0.001] and lower level of education [OR = 2.1 (1.5-2.9)]; p <0.001]. The percent of HCW who has monthly income >= $ 151 is 21% in the stable zone, 9.2% in the intermediate zones and 0.9% in the unstable zone. Conclusion: The context of instability compromises the performance of the health system by depriving it of competent personnel, so the management of health care workers require some adaptations.DR Congo authorities should develop incentive mechanisms to motivate young and trained HCW to work in unstable and intermediate health districts by improving their living and working conditions.

Background: The concept of biopsychosocial care is one of the approaches recommended in the health system by the WHO. Although efforts are being made on the provider side to implement it, community involvement is needed to enable its integration into the health sector. For this to happen, the community must first have an understanding of the approach, as a stakeholder and direct beneficiary. The objective of this study is to understand the community's views on the concept of integrated health care according to the biopsychosocial approach (BPS) at the Health Center of a Health District. Methods: We conducted a qualitative study based on individual semi-directive interviews with members of the Health Development Committees of six Health Areas belonging to four Health Districts as well as with some patients met in health facilities. A total of 15 interviews were conducted. The adapted NoMAD tool, derived from the Theory of the Normalization Process of Complex Interventions, allowed us to collect data from November 2017 to February 2018, and then from November 2018 to February 2019. After data extraction and synthesis, we conducted a thematic analysis using the NoMAD tool to build a thematic framework. Results: Initially, community perceptions were diverse in relation to the BPS approach of integrated care in the Health Centre; but later, the concept became clearer with the implementation of the approach, even for the providers with the change in their way of working (interprofessional collaboration, sharing of responsibilities...). Certain practices were encouraged to help the approach, notably the development of financial autonomy and mutual support. According to the community, the BPS model has further strengthened the performance of health workers and should be expanded and sustained. Stakeholders throughout the country were called upon to support the BPS concept in its implementation. Conclusions: The results of our study should encourage the involvement of community participation in any process of integrating the biopsychosocial model of person-centred health care, even at higher levels of care. However, the barriers and enablers to the BPS mechanism identified in our study should be taken into consideration.