Assessing Access and Healthcare Quality of Maternal and Child Health Services in Facilities of Kasai Province in the Democratic Republic of the Congo (DRC)

Abstract

Background: The Democratic Republic of the Congo (DRC) is classified among the 5 countries with the highest global maternal mortality ratio (MMR) and highest under-five mortality rate (U5MR) in the world. Kasai is one of 14 provinces of the DRC, which have a high U5MR and MMR. Despite this overriding concern, almost no studies have been conducted to assess maternal et child situation in this province. The aim of this study was to assess access, availability, and quality of maternal and child health services in Kasai Province in the DRC. Methods: A cross-sectional survey of 49 Health Facilities (HFs) integrating quantitative and qualitative data collection was conducted in 18 Health Zones in Kasai Province in the DRC. Documentary review, interviews and direct observation of HFs were performed to collect data. Pearson’s chi-squared test was performed to establish the relation between variables.Results: Nearly 54 % of visited HFs population had a geographical access to maternal and child health services and the majority of medical acts were unaffordable. Basic and comprehensive emergency obstetric care (EmOC) were offered respectively by only 11.8% and 7.6% of HF and none provided high quality basic or comprehensive EmOC. This low availability and quality of EmOC are due to the insufficiency of necessary inputs and personal for maternal and child health services in the majority of HFs. Conclusion: The situation of maternal and child health services is very precarious in Kasai Province. The improvement of EmOC coverage will require rehabilitation of infrastructure, dotation of equipment, regular supply of medicines and strengthening of human resource capacity.

Facilitators and barriers to supply-side maternal, newborn, and child health service availability in DRC: a systematic review and narrative synthesis

“…ASSESSMENT OF STUDY QUALITY Of the 26 studies, none were assessed as "weak," 13 as "moderate" 15,23,[30][31][32][33][34][35][36][37][38][39][40] and 13 as "strong". 36,[41][42][43][44][45][46][47][48][49][50][51][52] STUDY LOCATION All documents included the DRC. Six had a multi-country scope.…”

“…Eighteen studies identified supplies, equipment, and/or infrastructure at health facilities as critical factors affecting MNCH service availability. 15,23,30,31,33,34,[37][38][39][41][42][43][44][45][47][48][49][50] The availability of vaccines, medicines, and supplies was hindered by low supply, poor management, procurement from various sources, weak transportation systems, delivery delays and logistical challenges, weak cold chain systems, lack of access to stable electricity or equipment, low staff capacity, and poor distribution resulting in overstocking at the center and stockouts elsewhere. [43][44][45]48,49 Con-flict exacerbated issues given looting, damages, additional procurement and delivery delays, and frequent stockouts.…”

“…49 Approximately 80% of facilities surveyed in Kasai Province had insufficient infrastructure, limiting the availability of emergency obstetric services. 41 In a study of Kwango and Kwilu provinces, drinking water was available in only 25% of all facilities, while electricity was available in 49.2% of labor rooms and 67.6% of delivery rooms. 33 Gaps in electricity availability and equipment servicing were persistent barriers to the use of equipment such as antenatal ultrasound machines 31 and Haematocric centrifuges 43 for testing and diagnosis.…”

“…33 HUMAN RESOURCES FOR HEALTH Twenty articles discussed HRH in relation to MNCH services, with emphasis on HRH availability, capacity, compensation, turnover, motivation, and training. 23,30,31,33,34,36,[38][39][40][41][42][43][44][45][46][47]49,50,53,54 The DRC's MNCH needs outweighed the capacity of trained health workers. 41,42,46,53 There was only one midwife per 20,000 people.…”

“…23,30,31,33,34,36,[38][39][40][41][42][43][44][45][46][47]49,50,53,54 The DRC's MNCH needs outweighed the capacity of trained health workers. 41,42,46,53 There was only one midwife per 20,000 people. 53 Shortages and poor HRH distribution hindered access to services, especially in rural and conflict settings.…”