Barriers and facilitators in the implementation of bio-psychosocial care at the primary healthcare level in South Kivu, Democratic Republic of Congo.

Christian E.N Molima,Hermès Karemere,Pacifique Mwene-Batu,Jean Macq,Espoir B Malembaka,Ghislain Bisimwa,Samuel Makali

doi:10.4102/phcfm.v13i1.2608

Abstract

BackgroundIn the Democratic Republic of Congo (DRC), healthcare services are still focused on disease control and mortality reduction in specific groups. The need to broaden the scope from biomedical criteria to bio-psychosocial (BPS) dimensions has been increasingly recognized.AimThe objective of this study was to identify the barriers and facilitators to providing healthcare at the health centre (HC) level to enable BPS care.SettingsThis qualitative study was conducted in six HCs (two urban and four rural) in South-Kivu (eastern DRC) which were selected based on their accessibility and their level of primary healthcare organization.MethodsSeven focus group discussions (FGDs) involving 29 healthcare workers were organized. A data synthesis matrix was created based on the Rainbow Model framework. We identified themes related to plausible barriers and facilitators for BPS approach.ResultsOur study reports barriers common to a majority of HCs: misunderstanding of BPS care by healthcare workers, home visits mainly used for disease control, solidarity initiatives not locally promoted, new resources and financial incentives expected, accountability summed up in specific indicators reporting. Availability of care teams and accessibility to patient information were reported as facilitators to change.ConclusionThis analysis highlighted major barriers that condition providers’ mindset and healthcare provision at the primary care level in South-Kivu. Accessibility to the information regarding BPS status of individuals within the community, leadership of HC authorities, dynamics of HC teams and local social support initiatives should be considered in order to develop an effective BPS approach in this region.

Highlights

In the Democratic Republic of Congo (DRC), healthcare services are still focused on disease control and mortality reduction in specific groups
They are described as barriers found in most or all the health centres (HCs) and specific facilitators found in some of the HCs
The perception that HC workers have of a BPS approach and the current way in which the same agents carry out community activities constitute barriers to the implementation of a BPS approach

Summary

Introduction

In the Democratic Republic of Congo (DRC), healthcare services are still focused on disease control and mortality reduction in specific groups. Person-centred healthcare is defined as individual care that considers needs, values and choices of people. A person-centred approach ensures, amongst others, that an individual is actively involved in therapeutic decisions.[1,2] An important condition for person-centred care (PCC) is the communication and mutual trust between healthcare providers and people. Person-centred care could cover the spectrum of bio-psychosocial (BPS) health.[3,4]. Enlarging the perspective of individual healthcare beyond diagnosis and treatment of disease implies looking at one’s psychological, social, somatic and spiritual capacities.[5] They are potential resources to help people to cope with environmental stress or diseases.[6] In the BPS approach, interaction between individuals, within families and community groups is important.[7]

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Conclusion