Profiles of Community Care Sites and provider Community Health Workers: A Case study at Gombe Matadi, Kenge and Kisantu Rural Health Zones in the Democratic Republic of Congo

Abstract

Background: In sub-Saharan Africa, the DRC is ones of countries with high infant and child mortality. To solve this problem, the Ministry of Public Health has set up a new program: IMCI-C at the level of Community Care Sites managed by non-health professionals who are provider CHWs. Since its implementation, there have not yet been many studies that concretely describe the operation of CCS. It’s why we have chosen the Realist Evaluation Approach to analyze CCS functionality in the DRC. Methods: To carry out this study which is a mixed method case study (qualitative and quantitative); we applied the fundamental principles of a realist evaluation which come down to Context – Mechanisms – Effects in the conceptual framework model that we developed with an emphasis on Mechanisms. Provider CHWs profile and CCSs functionality were defined after data collection through documentary review, CCS direct observation, in-depth interview with registered nurses and health zone team members using an interview guide with semi-structured questionnaire and a survey using a quantitative questionnaire with provider CHWs. Results: CCS functionality was measured through the standards enacted for the implantation of CCS as well as the profile of provider CHWs which manage them. At the significance level (p=0.039) has been in place for 3 years or more increases by 7 times chance that it is functional (OR = 6.7; p = 0.000), has household is located less than 5 km from the CCS increases by 4 times chance that the CCS is functional (OR = 7.04; p = 0.034), has provider CHW is regularly trained and supervised increases by 10 times chance that the CCS is functional (OR = 10.01; p = 0.031), provider CHW participation in CAC meetings (OR = 4.34; p = 0.009) and CCS Management Team leads the management of CCS increase by 4 times chance that this CCS is functional (OR = 3.6; p = 0.002). Finally, if there is an initiative for funding CCS increases by 8 times CCS functionality (OR = 8.69; p = 0.009). Conclusion: CCS are functional in the three RHZs. Their organization, establishment and operation are directly linked to the provision of services to populations living mainly in health areas with difficult access, the availability of inputs of three IMCI-C diseases management, namely uncomplicated malaria, diarrhea and pneumonia as well as building provider community health workers capacity to ensure their management. This study shows an effective contribution of provider CHWs on CCS functionality in health areas with difficult access.