Urbanisation and health services: developing a new model of primary health care in Goma (Democratic Republic of Congo)

ABSTRACT

In this article, we present the process leading to the pilot test of a new primary health care services model in Goma (DRC). This new model proposes the introduction of a multidisciplinary team in the urban health centres to offer comprehensive and better-quality patient care. Our contribution highlights the importance of an in-depth analysis of the urban context for the implementation of a new model of care, and the usefulness of a constructive dialogue and active participation of all relevant stakeholders. Our analysis informs launches new research perspectives on the improvement of health care services access in the urban areas.

KEYWORDS:

• Urban health
• primary health care
• action-research

Acknowledgements

Agnès Echterbille, Edgar Musubao, Mahamba Nzanzu, Katie Corker, David Chaney.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. Protracted crises are contexts in which a significant proportion of the population is acutely vulnerable to hunger, disease and disruptions to livelihoods over prolonged periods. Almost all countries with a protracted crisis have experienced violent conflict over prolonged periods of time (FAO 2010).

2. The PADISS project (2017–2021) is financed by the European Union et the Belgian cooperation, and it is coordinated by ULB-Coopération, the NGO of the Université Libre de Bruxelles. https://ulb-cooperation.org/fr/actualites/projet-dappui-au-developpement-integre-du-systeme-de-sante-du-nord-kivu-padiss-nk.

3. The first line of care is the first level of interaction between the health system and the population (Mercenier 1988). It acts as the first place where complaints, symptoms, health problems, in short, the demand for care by users, are expressed (Michel Roland 2006). It is considered as the first level of care, whose main functions summarized by Crismer et al. (2016) are: first contact with the patient, the community, the comprehensiveness and continuity of care and the coordination of care. The first line of care operates in conjunction with the second line, which performs support functions (technical, scientific, logistical) vis-à-vis the first line (ibidem). These health centres, with less than eight beds, provide a limited range of care and do not provide hospitalization for patients. However, they are allowed to keep patients under observation for a maximum of 48 hours (MSP 2006).

4. Goma and Butembo are the two main cities in the North Kivu province with a population of about one million each.

5. Therapeutic itinerary refers to the journey patients experience in the search for treatment in which individuals or social groups choose, evaluate and adhere (or not) to certain forms of assistance.

6. This authorization should be issued by the provincial health administration.

7. In DRC, primary health care facilities attended by doctors are called ‘medicalized’ (MSP 2006).

8. A focus group chaired by the head of the provincial health administration and set up in 2017 in Goma, served as a framework for collaborative analysis of the results of studies conducted in Goma and experiences developed in other countries. The main stakeholders where people from: the provincial health administration, district coordination teams of two urban health districts operating in the city of Goma, providers and organizers from the private health sector, and partners supporting the health sector in the province. A total of 5 meetings were held in 2017 and 4 meetings in 2018, complemented by a workshop extended to delegates from the central level of the Ministry of Health, providers and civil society delegates.

9. Mali was selected because it is a developing country structured in health districts as it is the case in DRC. In addition to that, an evaluation of the WHO showed that primary healthcare facilities with a doctor in Mali increased quality of care and the range of health problems addressed. See reference 2,4 and 5.

10. Comprehensive patient care ensures an accurate response to patient’s needs, by integrating not only the medical dimension, but also the mental, family and social dimensions and patient well-being over their lifetime.

Additional information

Funding

This work was supported by the European Commission [FED:/2016/382-015ULB].

Notes on contributors

Jean-Bosco Kahindo Mbeva

Jean-Bosco Kahindo Mbeva is a medical doctor with a PhD in public health sciences. He participated in the development of the Health System Strengthening Strategy and the setting up of regional supply centers of essential drugs in the DRC. Since 2017 is the coordinator of the NGO ULB-Coopération in North Kivu and responsible for the PADISS project. Dr Kahindo is also associate professor at the Official University of Ruwenzori, visiting professor at the Free University of the Great Lakes Countries and at the Catholic University of the Graben. He published more than 30 scientific articles mostly on health systems management.

Simbi Ahadi

Simbi Ahadi is a public health doctor and a graduate in humanitarian management in Geneva. After more than ten years of clinical experience, rural health district management and health emergency management, he worked as a technical adviser in support of health zones in Kinshasa. Recruited as an expert in the Directorate of Studies and Planning of the Ministry of Health in the DRC for more than ten years, he has actively contributed to the development of the DRC Health System Strengthening Strategy. He is currently project manager funded by the European Union at the Ministry of Health of the DRC.

Mara Vitale

Mara Vitale is an anthropologist. She is a PhD Candidate in EHESS (Paris) and collaborates with the NGO ULB-Coopération. His research focuses on Sufi Islam in Burkina Faso. At ULB-Coopération, where she is a member of the working group on gender mainstreaming, Mara oversees the process of knowledge capitalization and best practices within the framework of the PADISS project. She has published several papers in international journals such as Afrique Contemporaine, Cahiers d’Études Africaines, and contributed to collective books (Women Researching in Africa, Palgrave, 2018, Faith and charity: religion and humanitarian assistance in Africa, Pluto Press, 2016).

Mitangala Ndeba Prudence

Mitangala Ndeba Prudence is a medical doctor with a PhD in public health sciences, a diploma on Epidemiology and Biostatistics and a certificate on medical laboratory techniques from the Tropical Medicine Institute of Antwerp. He is also associate professor at the Official University of Ruwenzori and a visiting professor at the Regional Public School of the Catholic University of Bukavu (DRC). Since 2017 he is a technical assistant of the PADISS project for the management of the provincial hospital of North Kivu and the continued clinical training. He published many scientific articles on different topics.

Yves Coppieters

Professor Yves Coppieters is a public health doctor with a master's degree in epidemiology and a PhD in public health sciences. He is a research professor at the School of Public Health of the Université libre de Bruxelles (ULB) where he teaches epidemiology of chronic diseases, health promotion, health information systems and health service planning. He is responsible for several programs: strengthening health systems, human resources for health and health science teaching, health policies and health information system in Europe and Africa.

Daniela Chinnici

Daniela Chinnici has Desk Officer in charge of the Health Projects for the NGO ULB-Coopération, Daniela has a master on public health policies, a master on cooperation and development and a master on project management. She has more than 10 years of experience on managing public health projects in Niger, Mali, Burkina Faso, India, Brazil and DR Congo. She recently published an article on the school experience of children with diabetes as a result of a project developed while she was working for the International Diabetes Federation (2013-2017).

Hélène Lambert

Hélène Lambert holds a master's degree in anthropology of social dynamics and development from the Université Libre de Bruxelles. She currently works for ULB-Coopération in Goma as a technical assistant for the PADISS project. Her latest article entitled “Women and access to health care in Goma: representations of the population and providers (Democratic Republic of Congo) has just been accepted for publication in the French journal Santé Publique. She also presented her work on access to care for victims of sexual violence at the 1st Congress of the Mukwege International Chair in Liège University.