Improving reproductive health care for conflict-affected communities in DRC
The Democratic Republic of the Congo has been in civil war for years. The war has been officially over for a decade, but violence and conflict remain, especially in the eastern part of the nation, where it has already claimed millions of lives.
International Medical Corps began working in DRC in 1999, supporting over 2 million people, over 80% of whom have been displaced by the conflict.
This includes reproductive health and family planning services – essential in a country where over 98% of complications during pregnancy are directly caused by a lack of appropriate medical care.
International Medical Corps, along with the Centre for Disease Control (CDC), the University Research Co., LLC (URC), the United Nations Fund for Population Assistance (UNFPA) and the Ministry of Health in North Kivu Province, has been conducting a research project to develop and implement an approach to improve the quality of reproductive care in DRC.
The project aims to bridge the gap between evidence and practice, by integrating a quality improvement approach in implementing the maternal and newborn health (MNH) components of the Minimum Initial Service Package – a set of crucial activities established by the Inter-Agency Working Group for Reproductive Health in Crises that must occur in a coordinated and timely manner at the start of a humanitarian crisis.
In order for the research project to have both an experimental and a control group, MNH training and improvement programs were planned for two groups of ten health facilities. The first ten would receive training and support immediately and after a year, data would be collected from health providers there to assess the level of improvement. Then, starting the second year, training and improvement programmes would be implemented in the other ten facilities.
The ultimate goal, based upon the results of the research and the differences in the two groups of health facilities after the first year, would be twofold: 1) to come up with recommendations for new policies and guidelines for MISP, improving priorities in humanitarian crises around the world and 2) to improve the quality of health in DRC itself.
Throughout the past two years, International Medical Corps has provided training in basic emergency obstetric and neonatal care in all twenty health facilities. Joel Ambebila, International Medical Corps’ Programme Director in DRC, says that while the project aim was rather straightforward, there were many logistical challenges to overcome.
“For instance, the routes we must take to carry out the research and training are dangerous and difficult… when our team were on their way to the Itebero Health zone, the road they were travelling was literally broken in two. At one point, the team had to get out of the car and trek by foot to get a new car and continue the journey.
“Additionally, the project uses community health workers (CHWs) to carry drugs on their head to remote and inaccessible health facilities – the CHWs sometimes walking for up to three days to do this.”
With International Medical Corps’ training and improvement programmes, the staff of the health centres of Chambucha and Hombo Nord in North Kivu - the epicentre of war - were able to learn how to improve the quality of reproductive health services that their patients would receive. Regular coaching sessions were held after training as well, to ensure that the staff were implementing what they have learned.
Mapenzi Isava, 25-years-old, a mother of three and a midwife at CS Hombo Nord, says: “Thanks to the training I received, I now know how to identify and best treat cases of postpartum haemorrhage.
“During the training we were taught about the importance of the quality of our work. We were told that it is not only important to look at what we do, but how we do it… I am very happy because in our community, the cases of postpartum haemorrhage has decreased.”
Esther Nkesina, a midwife at CS Ndofia in another community in North Kivu, adds: “Several years of seniority does not mean several years of good practice. I did not think I could learn again, but thanks to this project I have learned new things about Active Management of Third Stage Labour (AMTSL) and the filling of partographs."
While this project is almost complete, International Medical Corps’ work in DRC is by no means finished. International Medical Corps has had ongoing programmes in many areas other than reproductive health for years – in terms of primary health care, International Medical Corps supports 70 clinics and hospitals in North and South Kivu and has mobile medical units in other areas, where it also provides essential medical supplies, training and transfer of patients who need specialised care. Gender-based violence prevention, water and sanitation programs and nutrition and food security are also among International Medical Corps’ priorities.
This project is funded by Elrha’s Research for Health in Humanitarian Crises (R2HC) Programme, which aims to improve health outcomes by strengthening the evidence base for public health interventions in humanitarian crises. The R2HC programme is funded equally by the Welcome Trust and DFID. Visit www.elrha.org/r2hc for more information.