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Assessment of the private health sector in the Republic of Congo
This country assessment is part of a set of studies planned in order to provide a better understanding of how to improve the business environment in which the private sector operates in Congo and other African countries. The assessment was conducted in order to establish a baseline of information, to help with political decision-making and provide market information. The private health sector assessment in the Republic of Congo provides a diagnosis of the nature and the effectiveness of the interface between the public and private sectors, establishes a dialogue on policy with stakeholders, and makes recommendations for reform that would bolster public and private involvement. The methodology is based on a supply and demand approach to identify market, policy and institutional barriers, and options for reducing these barriers by changing policies and initiatives. The information pertaining to demand reveals how users perceive private providers and their potential. The information pertaining to supply gives a better understanding of the role that private providers play and the challenges they encounter. The institutional information shows how Congo's institutions have facilitated or hampered the private participation. The study methodology includes the following aspects: (i) presentation of the general context of the private health sector in Congo, (ii) multidimensional analysis of demand, (iii) multidimensional analysis of supply, and (iv) analysis of institutional context. Options for action presented in this report include (i) policy and governance initiatives, (ii) regulatory initiatives, (iii) incentive initiatives, and (iv) concrete measures for public-private partnerships (PPP) in the health sector-- Source other than Library of Congress.
Book
Assessment of the private health sector in the republic of congo
The private health sector was officially recognized in the Republic of Congo over 20 years ago June 6, 1988, establishing the conditions for the independent practice of medicine and the medical-related and pharmaceutical professions. The Congolese government recently expressed its commitment to working with the private health sector in order to strengthen the health system, improve the health of the population and preserve the basic human right to a healthy life through the National Health Care Policy, which it adopted in 2003, the 2007-2011 National Health Development Plan and the 2010 Health Care Services Development Program. Throughout these various documents there is an acknowledgement that the lack of coordination with the private health sector is a weakness of the health system. Nevertheless, the scarcity of information about the private sector in policy and planning documents suggests that the government's engagement with the private health sector is limited. There is no official government policy on the private health sector, or strategies or working plans to encourage cooperation between the public and private sectors. The objective of this assessment was to better determine the role, position, and importance of the private sector within the health system, in order to identify the limitations to its development as well as ways it can be integrated into the efforts to meet the objectives of the Plan national de developpement sanitaire (PNDS) [National Health Development Plan]. The World Bank Group contracted with the Results for Development Institute (R4D, United States) and Health Research for Action (HERA, Belgium) as well as with a team of local consultants, to conduct a 'study of the private health sector in the Republic of Congo.' This study was conducted in close collaboration with the Ministry of Health and Population (MSP), which arranged and oversaw a steering committee consisting of actors from the public and private sectors to facilitate and guide the study. The goal of the study and the workshops was a concrete plan of action for the health sector that could be used by the Congolese government, the private sector in the Republic of Congo, and international development partners. Certain aspects of the action plan should be included in the work programs of the Programme de developpement des services de sante (PDSS) [Health System Development Project] for the years 2011-2013.
eBook
Assessment of the Private Health Sector in the Republic of Congo
This country assessment is part of a set of studies planned in order to provide a better understanding of how to improve the business environment in which the private sector operates in Congo and other African countries. The assessment was conducted in order to establish a baseline of information, to help with political decision-making and provide market information. The private health sector assessment in the Republic of Congo provides a diagnosis of the nature and the effectiveness of the interface between the public and private sectors, establishes a dialogue on policy with stakeholders, an
Publication
Reasons for consultations and afflicted body systems in rural areas of The Republic of the Congo: A cross-sectional study
In the Republic of the Congo, rural areas are characterized by vulnerable populations and endemic infectious diseases, while health facilities have limited technical capabilities. Our objective was to study the distribution of reasons for consultation and afflicted body systems in rural health facilities. We conducted a cross-sectional study in Bouenza, Lékoumou, and Sangha departments. Individuals attending General Medicine outpatient services of selected health facilities were included in the study between September 2020 and January 2021. Reasons for consultation and afflicted body systems were standardized using the second edition of the International Classification of Primary Care (ICPC-2). The overall results were subsequently stratified by department, sex, and age. Most participants were females (53.2%) and the most attended health facilities for consultation were health care centers (55.9%). The most common reason for consultation was fever (25.7%), followed by headache (8.9%), with the most common combination of reasons for consultation being ‘fever-cough-nasal congestion’ (4.5%). In Bouenza specifically, asthenia (3.0%) and headache (11.6%) were the most common reasons for consultation, whereas skin rash (4.6%) and foot injuries (2.0%) were the most frequent in Lekoumou and cough (8.1%) and chills (6.6%) the most frequent reasons for consultation in Sangha. Although neglected tropical diseases (NTDs) are considered to be common diseases in rural areas of the Republic of the Congo, reasons for consultation related to NTDs were uncommon in this study. According to the ICPC-2 classification, “fever or chills” (taken as non-specific manifestations, thus separate from body systems) and the digestive system were the most afflicted body systems, as observed in 29.7% and 21.2% of cases, respectively. The main reason for consultation was fever, and “fever or chills” was found to be the most frequent afflicted body system, followed by the digestive system. Further studies are required to complete the history of diseases, the medical diagnoses, and collect information during rainy seasons due to the seasonal nature of several diseases.
Journal Article
Incidence of catastrophic expenditures linked to obstetric and neonatal care at 92 facilities in Lubumbashi, Democratic Republic of the Congo, 2015
Background
In the Democratic Republic of the Congo (DRC), more than 93% of users must pay out of pocket for care. Despite the risk of catastrophic expenditures (CE), 94% of births in Lubumbashi are attended by skilled personnel. We aimed to identify risk factors for CE associated with obstetric and neonatal care in this setting, to document coping mechanisms employed by households to pay the price of care, and to identify consequences of CE on households.
Methods
We used mixed methods and conducted both a cross-sectional study and a phenomenological study of women who delivered at 92 health care facilities in all 11 health zones of Lubumbashi. In April and May 2015 we followed 1,627 women and collected data on their health care and household expenses to determine whether they experienced CE, defined as payments that reached or exceeded 40% of a household’s capacity to pay. Two months after discharge, we conducted semi-structured interviews with 58 women at their homes to assess the consequences of CE.
Results
In all, 261 of 1,627 (16.0%) women experienced CE. Whether a woman or her infant experienced complications was an important contributor to her risk of CE; poverty, younger age, being unmarried, and delivering in a parastatal facility or with more highly trained personnel also increased risk. Among a subset of women with CE interviewed 2 months after discharge, those who were in debt or who had lost their trading income or goods were unable to pay their rent, their children’s school fees, or were obliged to reduce food consumption in the household; some had become victims of mistreatment such as verbal abuse, disputes with in-laws, denial of paternity, abandonment by partners, financial deprivation, even divorce.
Conclusions
We found a higher proportion of CE than previously reported in the DRC or in other urban settings in Africa. We suggest that the government and funders in DRC support initiatives to put in place mutual-aid health risk pools and health insurance and introduce and institutionalize free maternal and infant care. We further suggest that the government ensure decent and regular payment of providers and improve the financing and functioning of health care facilities to improve the quality of care and alleviate the burden on users.
Journal Article
Incidence of loiasis clinical manifestations in a rural area of the Republic of Congo: Results from a longitudinal prospective study (the MorLo project)
Loiasis is endemic in Central Africa. Despite evidence of clinical complications and increased mortality, it remains excluded from the list of neglected tropical diseases. The main manifestations are Calabar swellings (CS), Eyeworm (EW) and non-specific general symptoms such arthralgia and pruritus. We calculated incidence rates for clinical manifestations of loiasis from a 13-month study on clinical manifestations in 991 individuals living in Loa loa-endemic areas in the Republic of Congo.
From September 2022 to September 2023, community health workers collected weekly symptoms from cohort participants. Detailed data on symptom duration, intensity, associated pruritus, and impact on sleep were recorded. Laboratory procedures included thick blood smear for L. loa microfilaremia measurement, creatininemia measurement and eosinophilia counts. We used multiple failure analysis and frailty models to calculate incidence rates of EW, CS, arthralgia, pruritus and absence from work (AfW) and to analyses factors associated with increased incidence of each symptom. The population-attributable fractions (PAFs) associated with loiasis were also calculated for pruritus, AfW and arthralgia.
Among the studied manifestations, arthralgia had the highest incidence rate at 555.2 cases per 1000 Person-Year (PY), followed by pruritus (332.3 cases/1000 PY), AfW (298.6/1000 PY), EW (266.4/1000 PY), and CS (213.8/1000 PY). Notably, the incidence rates of CS, pruritus, arthralgia, and AfW were statistically significantly higher in the subgroup of individuals who experienced at least one episode of EW during the follow-up period. EW occurrence is more frequent when microfilaremia is present. The PAFs of AfW, pruritus and arthralgia, associated with loiasis was 18.0% [07.3-27.6], 20.8% [11.6-29.1] and 12.1% [3.1-20.1], respectively.
This is the first study to provide incidence rates for the clinical manifestations of loiasis. These estimates are crucial for assessing the burden of loiasis. The findings highlight the disease's impact on quality of life.
Journal Article
Variation of prevalence of malaria, parasite density and the multiplicity of Plasmodium falciparum infection throughout the year at three different health centers in Brazzaville, Republic of Congo
Background
In the Republic of Congo, hot temperature and seasons distortions observed may impact the development of malaria parasites. We investigate the variation of malaria cases, parasite density and the multiplicity of
Plasmodium falciparum
infection throughout the year in Brazzaville.
Methods
From May 2015 to May 2016, suspected patients with uncomplicated malaria were enrolled at the Hôpital de Mfilou, CSI « Maman Mboualé», and the Laboratoire National de Santé Publique. For each patient, thick blood was examined and parasite density was calculated. After DNA isolation, MSP1 and MSP2 genes were genotyped.
Results
A total of 416, 259 and 131 patients with suspected malaria were enrolled at the CSI «Maman Mboualé», Hôpital de Mfilou and the Laboratoire National de Santé Publique respectively. Proportion of malaria cases and geometric mean parasite density were higher at the CSI «Maman Mboualé» compared to over sites
(P-value
<0.001). However the multiplicity of infection was higher at the Hôpital de Mfilou (
P-value
<0.001).
At the Laboratoire National de Santé Publique, malaria cases and multiplicity of infection were not influenced by different seasons. However, variation of the mean parasite density was statistically significant (
P-value
<0.01).
Higher proportions of malaria cases were found at the end of main rainy season either the beginning of the main dry season at the Hôpital de Mfilou and the CSI «Maman Mboualé»; while, lowest proportions were observed in September and January and in September and March respectively. Higher mean parasite densities were found at the end of rainy seasons with persistence at the beginning of dry seasons. The lowest mean parasite densities were found during dry seasons, with persistence at the beginning of rainy seasons. Fluctuation of the multiplicity of infection throughout the year was observed without significance between seasons.
Conclusion
The current study suggests that malaria transmission is still variable between the north and south parts of Brazzaville. Seasonal fluctuations of malaria cases and mean parasite densities were observed with some extension to different seasons. Thus, both meteorological and entomological studies are needed to update the season’s periods as well as malaria transmission intensity in Brazzaville.
Journal Article
Meeting the demand of women affected by ongoing crisis: Increasing contraceptive prevalence in North and South Kivu, Democratic Republic of the Congo
Over 20 years of conflict in the DRC, North and South Kivu have experienced cycles of stability and conflict, resulting in a compromised health system and poor sexual and reproductive health outcomes. Modern contraceptive use is low (7.5%) and maternal mortality is high (846 deaths per 100,000 live births). Program partners have supported the Ministry of Health (MOH) in North and South Kivu to provide good quality contraceptive services in public health facilities since 2011.
Cross-sectional population-based surveys were conducted in the program areas using a two-stage cluster sampling design to ensure representation in each of six rural health zones. Using MOH population estimates for villages in the catchment areas of supported health facilities, 25 clusters in each zone were selected using probability proportional to size. Within each cluster, 22 households were systematically selected, and one woman of reproductive age (15-49 years) was randomly selected from all eligible women in each household.
Modern contraceptive prevalence among women in union ranged from 8.4% to 26.7% in the six health zones; current use of long-acting or permanent method (LAPM) ranged from 2.5% to 19.8%. The majority of women (58.9% to 90.2%) reported receiving their current method for the first time at a health facility supported by the program partners. Over half of women in four health zones reported wanting to continue their method for five years or longer.
Current modern contraceptive use and LAPM use were high in these six health zones compared to DRC Demographic and Health Survey data nationally and provincially. These results were accomplished across all six health zones despite their varied socio-demographic characteristics and different experiences of conflict and displacement. These findings demonstrate that women in these conflict-affected areas want contraception and will choose to use it when good quality services are available to them.
Journal Article
Interval follow up of a 4-day pilot program to implement the WHO surgical safety checklist at a Congolese hospital
Background
The World Health Organisation Surgical Safety Checklist (SSC) improves surgical outcomes and the research question is no longer ‘does the SSC work?’ but, ‘how to make the SSC work?’ Evidence for implementation strategies in low-income countries is sparse and existing strategies are heavily based on long-term external support. Short but effective implementation programs are required if widespread scale up is to be achieved. We designed and delivered a four-day pilot SSC training course at a single hospital centre in the Republic of Congo, and evaluated the implementation after one year. We hypothesised that participants would still be using the checklist over 50% of the time.
Method
We taught the four-day SSC training course at Dolisie hospital in February 2014, and undertook a mixed methods impact evaluation based on the Kirkpatrick model in May 2015. SSC implementation was evaluated using self-reported questionnaire with a 3 point Likert scale to assess six key process measures. Learning, behaviour, organisational change and facilitators and inhibitors to change were evaluated with questionnaires, interviews and focus group discussion.
Results
Seventeen individuals participated in the training and seven (40%) were available for impact evaluation at 15 months. No participant had used the SSC prior to training. Over half the participants were following the six processes measures always or most of the time: confirmation of patient identity and the surgical procedure (57%), assessment of difficult intubation risk (72%), assessment of the risk of major blood loss (86%), antibiotic prophylaxis given before skin incision (86%), use of a pulse oximeter (86%), and counting sponges and instruments (71%). All participants reported positive improvements in teamwork, organisation and safe anesthesia. Most participants reported they worked in helpful, supportive and respectful atmosphere; and could speak up if they saw something that might harm a patient. However, less than half felt able to challenge those in authority.
Conclusion
Our study demonstrates that a 4-day pilot course for SSC implementation resulted in over 50% of participants using the SSC at 15 months, positive changes in learning, behaviour and organisational change, but less impact on hierarchical culture. The next step is to test our novel implementation strategy in a larger hospital setting.
Journal Article
A qualitative analysis of decision-making among women with sexual violence-related pregnancies in conflict-affected eastern Democratic Republic of the Congo
Background
Sexual violence is prevalent in conflict-affected settings and may result in sexual violence-related pregnancies (SVRPs). There are limited data on how women with SVRPs make decisions about pregnancy continuation or termination, especially in contexts with limited or restricted access to comprehensive reproductive health services.
Methods
A qualitative study was conducted in Bukavu, Democratic Republic of the Congo (DRC) as part of a larger mixed methods study in 2012. Utilizing respondent-driven sampling (RDS), adult women who self-reported sexual violence and a resultant SVRP were enrolled into two study subgroups: 1) women currently raising a child from an SVRP (parenting group) and 2) women who terminated an SVRP (termination group). Trained female research assistants conducted semi-structured interviews with a subset of women in a private setting and responses were manually recorded. Interview notes were translated and uploaded to a qualitative software program, coded, and thematic content analysis was conducted.
Results
A total of 55 women were interviewed: 38 in the parenting group and 17 in the termination group. There were a myriad of expressed attitudes, beliefs, and emotional responses toward SVRPs and the termination of SVRPs with three predominant influences on decision-making, including: 1) the biologic, ethnic, and social identities of the fetus and/or future child; 2) social reactions, including fear of social stigmatization and/or rejection; and 3) the power of religious beliefs and moral considerations on women’s autonomy in the decision-making process.
Conclusion
Findings from women who continued and women who terminated SVRPs reveal the complexities of decision-making related to SVRPs, including the emotional reasoning and responses, and the social, moral, and religious dimensions of the decision-making processes. It is important to consider these multi-faceted influences on decision-making for women with SVRPs in conflict-affected settings in order to improve provision of health services and to offer useful insights for subsequent programmatic and policy decisions.
Journal Article