Abstract
BackgroundProlonged exposure to war has severely impacted the provision of health services in the Democratic Republic of the Congo (DRC). Health infrastructure has been destroyed, health workers have fled and government support to health care services has been made difficult by ongoing conflict. Poor reproductive health (RH) indicators illustrate the effect that the prolonged crisis in DRC has had on the on the reproductive health (RH) of Congolese women. In 2007, with support from the RAISE Initiative, the International Rescue Committee (IRC) and CARE conducted baseline assessments of public hospitals to evaluate their capacities to meet the RH needs of the local populations and to determine availability, utilization and quality of RH services including emergency obstetric care (EmOC) and family planning (FP).MethodsData were collected from facility assessments at nine general referral hospitals in five provinces in the DRC during March, April and November 2007. Interviews, observation and clinical record review were used to assess the general infrastructure, EmOC and FP services provided, and the infection prevention environment in each of the facilities.ResultsNone of the nine hospitals met the criteria for classification as an EmOC facility (either basic or comprehensive). Most facilities lacked any FP services. Shortage of trained staff, essential supplies and medicines and poor infection prevention practices were consistently documented. All facilities had poor systems for routine monitoring of RH services, especially with regard to EmOC.ConclusionsWomen's lives can be saved and their well-being improved with functioning RH services. As the DRC stabilizes, IRC and CARE in partnership with the local Ministry of Health and other service provision partners are improving RH services by: 1) providing necessary equipment and renovations to health facilities; 2) improving supply management systems; 3) providing comprehensive competency-based training for health providers in RH and infection prevention; 4) improving referral systems to the hospitals; 5) advocating for changes in national RH policies and protocols; and 6) providing technical assistance for monitoring and evaluation of key RH indicators. Together, these initiatives will improve the quality and accessibility of RH services in the DRC - services which are urgently needed and to which Congolese women are entitled by international human rights law.
Highlights
Prolonged exposure to war has severely impacted the provision of health services in the Democratic Republic of the Congo (DRC)
Implementation of the Minimum Initial Services Package (MISP) is a standard in the Sphere Project's Humanitarian Charter and Minimum Standards in Disaster Response [4], emergency obstetric care (EmOC) and family planning (FP) services are still rarely available to populations affected by armed conflict [2,5]
Access to reproductive health (RH) care is a basic human right, yet integrated and fully comprehensive RH services based on sound facility assessment data are not the norm in most emergency and post-emergency settings
Summary
Prolonged exposure to war has severely impacted the provision of health services in the Democratic Republic of the Congo (DRC). Reproductive Health among Conflict-Affected Populations Complex humanitarian emergencies caused by armed conflict are characterized by social disruption, population displacement and collapse of public health infrastructure [1]. Women and men affected by armed conflict have the right to RHrelated information and access to safe, effective, affordable and acceptable FP methods as well as appropriate and effective health care services that will enable women to experience safe pregnancies and childbirth [3]. Implementation of the MISP is a standard in the Sphere Project's Humanitarian Charter and Minimum Standards in Disaster Response [4], emergency obstetric care (EmOC) and FP services are still rarely available to populations affected by armed conflict [2,5]
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