Kenanewabo Nicolas, Molima Christian, Karemere Hermès
Sante Publique. 2020 July-August;32(4):359-370. doi: 10.3917/spub.204.0359.
For three decades, the Democratic Republic of the Congo has faced recurrent wars. These have caused a significant burden of morbidity and mortality. In this context, the Katana Health Zone experienced several events that could have hampered the functioning of its health centers, which nevertheless continued to operate.Purpose of research: This study aims to identify specific determinants that have enabled health centers to adapt to a changing context. This is a cross-sectional study using mixed data, carried out in the Mugeri, Ihimbi and Ciranga health centers during the period 1990-2017 for qualitative data and from 2013 to 2017 for the quantitative data. It is based on observation, documentary review and individual interviews with 55 informants.
The main events identified are the recurring rebellions, the massive arrival of refugees, the arrival of humanitarian aid, the earthquakes and the instability of human resources. The supply of services and care has continued thanks to the adaptation mechanisms developed, including the development and application of new directives and standards and dynamic community participation.
On the one hand, the study demonstrates the value of adapting the procedures for managing financial aid and the operation of a health center in the event of a change in context; the effectiveness of a more structured and regular collaboration between different actors and the appropriation of the activities of the health center by the community. On the other hand, the study identifies the limits of selective and ad hoc interventions, which do not favor the effective development of health centers.
三十年来，刚果民主共和国一直面临反复的战争。这些战争造成了巨大的发病和死亡负担。在此背景下，卡塔纳卫生区经历了几次可能阻碍其卫生中心运作的事件，但其卫生中心仍继续运营。
本研究旨在确定使卫生中心能够适应不断变化的环境的具体决定因素。这是一项采用混合数据的横断面研究，于1990年至2017年期间在穆盖里、伊欣比和西朗加卫生中心收集定性数据，2013年至2017年收集定量数据。该研究基于观察、文献回顾以及对55名受访者的个人访谈。
确定的主要事件包括反复发生的叛乱、大量难民的涌入、人道主义援助的到来、地震以及人力资源的不稳定。由于制定了适应机制，包括制定和应用新的指令和标准以及社区的积极参与，服务和护理的提供得以持续。
一方面，该研究证明了在环境变化时调整管理财政援助和卫生中心运营程序的价值；不同行为者之间更有组织、定期的合作以及社区对卫生中心活动的认同的有效性。另一方面，该研究确定了选择性和临时干预的局限性，这些干预不利于卫生中心的有效发展。
