Lwamushi Samuel Makali, Karemere Hermès, Banywesize Robert, Eboma Christian Molima, Mwene-Batu Pacifique, Lembebu Corneille, Ferrari Giovanfrancesco, Paul Elisabeth, Balaluka Ghislain Bisimwa, Donnen Philippe
Ecole Régionale de Santé Publique, Faculté de Médecine, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo.
Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium.
Int J Health Policy Manag. 2023;12:8001. doi: 10.34172/ijhpm.2023.8001. Epub 2023 Oct 17.
The Eastern part of the Democratic Republic of Congo (DRC) has been affected by armed conflict for several years. Despite the growing interest in the impact of these conflicts on health service utilisation, few studies have addressed the coping mechanisms of the health system. The purpose of this study is to describe the traumatic events and coping mechanisms used by the health zones (HZs) in conflict settings to maintain good performance.
This multiple case study took place from July to October 2022 in four HZs in the South Kivu Province of DRC. HZs were classified into "cases" according to their conflict profile: accessible and stable (Case 1), accessible but remote (Case 2), unstable (Case 3), and intermediate (Case 4). Eight performance indicators and the amount of funding provided to the HZs by non-governmental organizations (NGOs) were recorded. A graph was created to compare their evolution from 2013 to 2018. A thematic analysis of qualitative data from individual interviews with selected health workers was conducted.
Both battle-related events (war and its effects) and non-battle-related events (epidemics, disasters, strikes) were recorded according to the case conflict-profile. Although the cases (3 and 4) most affected by armed conflicts occasionally performed better than the stable ones (1 and 2), their operational action plan was poorly carried out. The coping mechanisms developed in cases 3 and 4 were the deployment of military nurses in preventive and supervisory activities, the solicitations of subsidies from NGOs, the relocation of health care facilities and the implementation of negotiation strategies with the belligerents.
Armed conflict results in traumatic events that disrupt the execution of the operational action plan of HZs. The HZs' management team expertise, its strong leadership, and substantial financial support would enable this system to develop reliable and sustainable adaptive mechanisms.
刚果民主共和国（DRC）东部多年来一直受到武装冲突的影响。尽管人们越来越关注这些冲突对卫生服务利用的影响，但很少有研究涉及卫生系统的应对机制。本研究的目的是描述冲突环境下卫生区（HZs）为保持良好绩效而经历的创伤性事件和采用的应对机制。
本多案例研究于2022年7月至10月在刚果民主共和国南基伍省的四个卫生区进行。根据冲突情况，卫生区被分为“案例”：可进入且稳定（案例1）、可进入但偏远（案例2）、不稳定（案例3）和中等（案例4）。记录了八项绩效指标以及非政府组织（NGO）向卫生区提供的资金数额。绘制了一张图表以比较它们在2013年至2018年期间的演变情况。对从选定卫生工作者的个人访谈中获取的定性数据进行了主题分析。
根据案例冲突情况记录了与战斗相关的事件（战争及其影响）和与非战斗相关的事件（流行病、灾害、罢工）。尽管受武装冲突影响最严重的案例（3和4）偶尔表现得比稳定案例（1和2）更好，但其运营行动计划执行不力。案例3和4中制定的应对机制包括在预防和监督活动中部署军事护士、向非政府组织申请补贴、搬迁医疗设施以及与交战方实施谈判策略。
武装冲突导致创伤性事件，扰乱了卫生区运营行动计划的执行。卫生区的管理团队专业知识、强有力的领导以及大量的财政支持将使该系统能够建立可靠且可持续的适应机制。
