# A Readiness Level Assessment of Healthcare Facilities in the Democratic Republic of Congo for the Management of Cardiovascular Disease and Diabetes

## TL;DR

Healthcare facilities in the Democratic Republic of Congo are poorly equipped to manage cardiovascular disease and diabetes, especially in rural and primary-level facilities.

## Contribution

The study provides the first comprehensive assessment of healthcare facility readiness for managing cardiovascular disease and diabetes in the DRC.

## Key findings

- Average readiness scores for managing CVD and diabetes in DRC healthcare facilities are below 50%.
- Only four provinces have over 50% of facilities equipped to manage diabetes, and none for CVD.
- Primary-level and rural facilities show the lowest readiness scores for both diseases.

## Abstract

Introduction: Sub-Saharan Africa in general, and the Democratic Republic of the Congo (DRC) in particular, is undergoing an epidemiological transition characterized by a more rapid increase in the number of non-communicable diseases (NCDs). However, the level of readiness of the DRC’s healthcare facilities (HFs) to manage these diseases is unknown. Thus, our study aimed to assess these HFs’ level of readiness to manage cardiovascular disease (CVD) and diabetes. Methodology: This cross-sectional study involved 1412 HFs in the DRC, selected by stratified random sampling. They are representative of the country’s 26 provinces. The World Health Organization (WHO) Service Availability and Readiness Survey (SARA) was used. The “readiness” outcome was a composite measure of the capacity of HFs to manage CVD and diabetes. The readiness indicator comprised four domains, and a score of ≥70% indicated “readiness” to manage CVD and diabetes. Informed consent was obtained from the stakeholders, and the ethics committee held a positive opinion. Statistical analyses were performed using STATA 17 software. Results: The average readiness scores of the DRC’s HFs to manage CVD and diabetes are less than 50%, being 38.3% (37.3–39.3) and 39.8% (38.7–40.9), respectively. These scores were less than 40% for CVD and diabetes in rural HFs. They were less than 30% for CVD and diabetes in primary-level HF. No province possesses over 50% of health facilities equipped to address cardiovascular illnesses, and only four provinces (Haut Uele, Kinshasa, Nord Kivu, and Sud Kivu) possess over 50% of health facilities equipped to address diabetes. The provinces with health facilities exhibiting the least preparedness in managing cardiovascular illnesses and diabetes are Nord Ubangi and Sankuru. Only 0.07% (0.01–0.5) of HFs obtained a score ≥ 70% for CVD management, and 5.9% (4.8–7.3) obtained this score for diabetes management. Conclusions: Significant deficiencies must be rectified to enhance service delivery in the management of cardiovascular disease (CVD) and diabetes. Most primary-level and rural facilities demonstrated inadequate preparedness for CVD and diabetes screening and management, exhibiting low readiness scores and limited-service availability in the assessed domains. While secondary-level services are relatively accessible, critical gaps persist that must be addressed to improve readiness for CVD and diabetes care. Healthcare facilities should possess the capacity to deliver recommended services across various tiers, ensuring both service readiness and availability.