Hermès Karemere^1,2*, Nadine Muhune¹, Rosine Bigirimana¹ and Samuel Makali¹

¹Catholic University of Bukavu, Democratic Republic of the Congo
²Université du Cinquantenaire de Lwiro, Democratic Republic of the Congo

*Corresponding Author: Hermès Karemere, Catholic University of Bukavu, Democratic Republic of the Congo.

Received: October 04, 2021; Published: March 09, 2022

Abstract

Synopsis

Introduction: The Katana Rural Health Zone has experienced several events, including looting of health centers, the stoppage of funding, or the instability of nursing staff, which could have hampered the functioning of its health structures. These structures continued to function in this unfavourable context, thus showing themselves to be resilient. The objective of this study is, on the one hand, to understand whether the various events that have occurred in the Katana Health Zone partly explain the sustainability of malaria and, on the other hand, to identify the different adaptation mechanisms put in place to facilitate the resilience of the Health Zone in the face of these events in the treatment of malaria. 

Methods: The methodology applied approach uses a case study using mixed methods (qualitative and quantitative) for data collection. The study covers the period from 2014 to 2018 and is based on the identification of events that have occurred in the Katana health zone, the analysis of the evolution of cases and deaths linked to malaria, and perceptions of key actors on the nature of the events and their link with the number of cases. The study used a document review and individual interviews targeting 8 key players. 

Results: The main destabilising events identified are linked to the management of human resources, the use of health services, the disruption of funding, the availability of curative or preventive inputs, community participation, and security and safety issues. infrastructure. The trend in the development of new cases of malaria is similar for all age groups. Death, on the other hand, evolves in a different way. The health services continued to provide care thanks to the coping mechanisms developed.

Conclusion: The study demonstrates the precariousness of a health system heavily dependent on humanitarian aid, the termination of which can generate dysfunction with effects on mortality, including infant mortality; the weak involvement of the government in supporting structures confronted with the effects of disasters such as the earthquake and looting; the poverty of the population, making it inaccessible to health care despite the drop in prices; and the resilience of health centres following the establishment of endogenous adaptation mechanisms.

Keywords: Resilience; Health System; Malaria; Katana; Democratic Republic of Congo

References

1. Ahoua L., et al. “High mortality in an internally displaced population in Ituri, Democratic Republic of Congo, 2005: results of a rapid assessment under difficult conditions”. Global Public Health3 (2006): 195-204.
2. Control CfD, Prevention. “Elevated mortality associated with armed conflict - Democratic Republic of Congo, 2002”. MMWR Morbidity and Mortality Weekly Report20 (2003): 469-471.
3. Depoortere E and Checchi F. “Pre-emptive war epidemiology: lessons from the Democratic Republic of Congo”. The Lancet9504 (2006): 7-9.
4. Mukengere Mukwege D and Nangini C. “Rape with extreme violence: the new pathology in South Kivu, Democratic Republic of Congo”. PLoS Medicine12 (2009): e1000204.
5. Fenton G. “Coordination in the great lakes”. Forced Migration Review18 (2003): 23-24.
6. Karemere Bimana H. Adaptive hospital governance in a changing context: study of Bunia, Logo and Katana hospitals in the Democratic Republic of Congo: UCL-Université Catholique de Louvain (2013).
7. Makali SL., et al. “Comparative analysis of the health status of the population in six health zones in South Kivu: a cross-sectional population study using the WHODAS”. Conflict and Health1 (2021): 1-11.
8. Karemere H., et al. “Analyzing Katana referral hospital as a complex adaptive system: agents, interactions and adaptation to a changing environment”. Conflict and Health1 (2015): 1-10.
9. Kenanewabo N., et al. “Adaptive management of health centers in a changing environment in the Democratic Republic of the Congo”. Public Health4 (2020): 359-370.
10. Kruk ME., et al. “What is a resilient health system? Lessons from Ebola”. The Lancet9980 (2015): 1910-1912.
11. Amat-Roze JM. “Health in sub-Saharan Africa, between progress, setbacks and renewal”. Bulletin of the Association of French Geographers1 (2010): 105-118.
12. Bigirinama R., et al. “Environmental and anthropogenic factors associated with increased malaria incidence in South ‐ Kivu Province, Democratic Republic of the Congo”. Tropical Medicine and International Health 5 (2020): 600-611.
13. Ren M. “Greater political commitment needed to eliminate malaria”. Infectious Diseases of Poverty1 (2019): 1-4.
14. “Health pyramid 2019: Health mapping of the province of South Kivu”. Provincial Health Division, South Kivu, DR Congo (2019).
15. Guével MR and Pommier J. “Research using mixed methods in public health: issues and illustration”. Public Health1 (2012): 23-38.
16. Pinard R., et al. “The choice of a mixed methodological approach to educational research”. Qualitative Research 1 (2004): 58-80.
17. Karemere H. “Analysis of attitudes and behaviors of doctors and nurses as a strategic lever in the management of hospital resources”. Pan African Medical Journal1 (2015).
18. “Human resources for health: global strategy for 2030”. Geneva: World Health Organization (2016).
19. Stovall JG., et al. “The impact of an employees' strike on a community mental health center”. Psychiatric Services 2 (2004): 188-191.
20. Munyamahoro M and Ntaganira J. “Determinants of household health service use in Rubavu district” (2012).
21. Philippe CM., et al. “Factors determining the low household use of the curative service in the health zone of Pweto, Katanga province, Democratic Republic of Congo in 2013”. Pan African Medical Journal1 (2015).
22. Wilkinson D., et al. “Effect of removing user fees on attendance for curative and preventive primary health care services in rural South Africa”. Bulletin of the World Health organization 79 (2001): 665-671.
23. Konate MK., et al. “Community health policy and economic and social viability of community health centers in Mali: Case study in urban and rural areas” (Draft).
24. Bashi J., et al. “Mutuelles de santé in Bukavu in the Democratic Republic of Congo: factors favorable to the use of health services by members”. The Pan African Medical Journal 35 (2020).
25. Doumbouya ML. “Accessibility of health services in West Africa: the case of Guinea” (2008).
26. Nkemba B., et al. “Coverage and cost of care for an episode of malaria in the health zone of Miti-Murhesa, Democratic Republic of Congo [Taking in charge and cost of malaria treatment in Miti-Murhesa health zone, Democratic Republic of Congo]”. International Journal of Innovation and Applied Studies 3 (2014): 920.
27. Karemere H., et al. “An experience of setting up community care sites in the Democratic Republic of Congo [Integrated community case management: An experience from the Democratic Republic of Congo]”. International Journal of Innovation and Applied Studies1 (2017): 42-51.
28. Faye SL. “Empowering community relays for seasonal intermittent preventive treatment of malaria (IPT) in Senegal: issues, modalities, challenges”. Somewhere Else 1 (2012): 129-146.
29. André AMCM and Adolphe KC. “Involvement of “community relays” in a clinical trial project: example of the development of a vaccine against placental malaria in pregnant women in Sô-Ava (South Benin)”.
30. Stearns J and Vogel C. “The landscape of armed groups in Eastern Congo: fragmented, politicized networks”. Kivu Security Tracker (2017).
31. Namakula J and Witter S. “Living through conflict and post-conflict: experiences of health workers in northern Uganda and lessons for people-centered health systems”. Health Policy and Planning 29 (2014): ii6-ii14.
32. Chirwa Y., et al. “Deployment of human resources for health in Zimbabwe: synthesis report”. Liverpool: ReBUILD (2016).
33. Cometto G., et al. “Health sector recovery in early post ‐ conflict environments: experience from southern Sudan”. Disasters 4 (2010): 885-909.
34. Highlights: overview of the situation: needs and humanitarian response: South Kivu and Maniema 2 (2015): 1-6.
35. Mitangala Ndeba P., et al. “Protein-energy malnutrition and malaria-related morbidity in children 0-59 months in the Kivu region, Democratic Republic of Congo”. Med too 1 (2008): 51-57.
36. Baxerres C., et al. “What family resources finance children's health?” Third World Review 2 (2010): 149-165.
37. Ridde V., et al. “Improving the affordability of health care in Burkina Faso: A research strategy potentially favorable to the use of evidence”. Global Health Promotion1 (2011): 110-113.
38. Soors W., et al. “Health microinsurance in sub-Saharan Africa: an opportunity to improve access to emergency obstetric care?” Reduce financial barriers to obstetric care in low-resource countries (2008).
39. Porignon D. “Adequacy of district health systems in critical situations: experiences in the African Great Lakes Region: Free University of Brussels, Brussels, Belgium” (2003).
40. Ager AK., et al. “Health service resilience in Yobe state, Nigeria in the context of the Boko Haram insurgency: a systems dynamics analysis using group model building”. Conflict and Health1 (2015): 1-14.

Citation

Citation: Hermès Karemere., et al. “Vulnerability of the Katana Health Zone in the Democratic Republic of the Congo: A Resilience Strategy to Malaria Treatment in Healthcare Facilities from 2014 to 2018”.Acta Scientific Medical Sciences 6.4 (2022): 46-56.

Copyright

Copyright: © 2022 Hermès Karemere., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.