Profile of Health Care Workers in a Context of Instability: A Cross-sectional Study of Four Rural Health Zones in Eastern DR Congo (Lessons Learned)

Abstract

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.