Department of Nursing, Université du Québec en Outaouais, 5 Rue Saint-Joseph, J-2204, Saint-Jérôme, QC, J7Z 0B7, Canada.
Regional School of Public Health, Catholic University of Bukavu, Bukavu, Democratic Republic of the Congo.
J Epidemiol Glob Health. 2023 Dec;13(4):751-773. doi: 10.1007/s44197-023-00147-8. Epub 2023 Oct 7.
Access to universal health coverage is a fundamental right that ensures that even the most disadvantaged receive health services without financial hardship. The Democratic Republic of Congo is among the poorest countries in the world, yet healthcare is primarily made by direct payment which renders care inaccessible for most Congolese. Between 2017 and 2021 a purchasing of health services initiative (Le Programme de Renforcement de l'Offre et Développement de l'accès aux Soins de Santé or PRO DS), was implemented in Kongo Central and Ituri with the assistance of the non-governmental organization Memisa Belgium. The program provided funding for health system strengthening that included health service delivery, workforce development, improved infrastructure, access to medicines and support for leadership and governance. This study assessed the social and health impacts of the PRO DS Memisa program using a health impact assessment focus. A documentary review was performed to ascertain relevant indicators of program effect. Supervision and management of health zones and health centers, use of health and nutritional services, the population's nutritional health, immunization levels, reproductive and maternal health, and newborn and child health were measured using a controlled longitudinal model. Positive results were found in almost all indicators across both provinces, with a mean proportion of positive effect of 60.8% for Kongo Central, and 70.8% in Ituri. Barriers to the program's success included the arrival of COVID-19, internal displacement of the population and resistance to change from the community. The measurable positive impacts from the PRO DS Memisa program reveal that an adequately funded multi-faceted health system strengthening program can improve access to healthcare in a low-income country such as the Democratic Republic of Congo.
全民健康覆盖是一项基本权利，它确保即使是最弱势的群体也能获得医疗服务，而不会面临经济困难。刚果民主共和国是世界上最贫穷的国家之一，但医疗保健主要是通过直接支付来实现的，这使得大多数刚果人无法获得医疗保健。2017 年至 2021 年，在非政府组织比利时 Memisa 的协助下，在刚果中心和伊图里实施了一项购买医疗服务倡议（强化供应和扩大卫生保健获取方案，简称 PRO DS）。该方案为加强卫生系统提供了资金，其中包括提供医疗服务、发展劳动力、改善基础设施、获得药品以及支持领导和治理。本研究采用健康影响评估重点，评估了 PRO DS Memisa 方案的社会和健康影响。通过文件审查来确定方案效果的相关指标。使用对照纵向模型来衡量卫生区和卫生中心的监督和管理、卫生和营养服务的使用、人口营养健康、免疫水平、生殖和孕产妇健康、新生儿和儿童健康。结果在两个省的几乎所有指标中都发现了积极的结果，刚果中心的积极效果平均比例为 60.8%，伊图里的比例为 70.8%。方案成功的障碍包括 COVID-19 的到来、人口的内部流离失所以及社区对变革的抵制。PRO DS Memisa 方案产生的可衡量的积极影响表明，一个资金充足的、多方面的卫生系统强化方案可以改善像刚果民主共和国这样的低收入国家获得医疗保健的机会。
