Hotchkiss David R, Blum Lauren S, Craig Leslie S, Yemweni Anicet, Wisniewski Janna, Lusamba-Dikassa Paul-Samson
Department of International Health & Sustainable Development, Celia Scott Weatherhead School of Public Health and Tropical Medicine, Tulane University, New Orleans, United States.
Consultant, Kinshasa, Democratic Republic of the Congo.
BMC Pregnancy Childbirth. 2025 Jun 7;25(1):665. doi: 10.1186/s12884-025-07470-x.
The maternal mortality ratio in the Democratic Republic of the Congo (DRC) remains among the highest globally. Despite ongoing investments in maternal health, there is only limited evidence on the effectiveness of health systems strengthening interventions in improving maternal health service quality and utilization in fragile settings. The study assesses the impact of a large, complex health systems strengthening program on maternal health care utilization in the DRC.
A difference-in-differences approach was applied using population-based household survey data at baseline (2014) and endline (2017) from treatment and matched comparison areas in three provinces. The dependent variables were antenatal care (ANC) utilization and facility-based delivery. Additionally, qualitative data were analyzed to assess perceptions of maternal health care offered and identify barriers and strategies to improve care delivery.
The health systems strengthening program significantly increased the probability of facility-based delivery, but had no significant impact on receiving at least four ANC visits. Qualitative findings suggest that uptake of ANC was constrained by travel distance, time burdens, limited community outreach, and cultural norms discouraging early ANC initiation.
Findings highlight the reliance on health centers and posts offering basic maternal services and limited accessibility of hospitals offering lifesaving comprehensive emergency obstetric care. This underscores the importance of formative research to inform interventions that align with social norms, address local barriers, and enhance the effectiveness of maternal health programs in fragile settings.
刚果民主共和国的孕产妇死亡率仍居全球最高之列。尽管一直在对孕产妇健康进行投资，但关于加强卫生系统干预措施在脆弱环境中改善孕产妇保健服务质量和利用率方面的有效性的证据有限。该研究评估了一项大型、复杂的卫生系统加强计划对刚果民主共和国孕产妇保健服务利用情况的影响。
采用双重差分法，利用2014年基线期和2017年终期来自三个省份治疗区和匹配对照区的基于人群的家庭调查数据。因变量为产前保健（ANC）利用率和设施分娩率。此外，对定性数据进行了分析，以评估对所提供的孕产妇保健的看法，并确定改善保健服务提供的障碍和策略。
卫生系统加强计划显著提高了设施分娩的概率，但对至少接受四次产前检查没有显著影响。定性研究结果表明，产前检查的接受受到旅行距离、时间负担、社区外展有限以及文化规范阻碍早期进行产前检查的限制。
研究结果突出了对提供基本孕产妇服务的保健中心和卫生站的依赖，以及提供挽救生命的综合紧急产科护理的医院可及性有限。这强调了开展形成性研究以指导符合社会规范并解决当地障碍的干预措施以及提高脆弱环境中孕产妇保健计划有效性的重要性。
