Facility-Based Assessment of Emergency Obstetric and Neonatal Care in Vanga Health Zone, Kwilu Province, Democratic Republic of Congo

TL;DR

This study assesses the quality of emergency obstetric and neonatal care in 63 health facilities in Vanga, DRC, revealing severe shortages in infrastructure, staff, and supplies, which endanger maternal and newborn health.

Contribution

The study provides the first detailed empirical assessment of EmONC facility capacity and performance in the Vanga Health Zone, highlighting critical gaps and unsafe practices.

Findings

Most facilities lacked basic infrastructure like water and beds, and had poor availability of essential equipment and medicines.

Unsafe practices were common, including caesarean sections and blood transfusions performed without trained doctors or proper support.

Caseload data was likely falsified for financial incentives, undermining the reliability of performance assessments.

Abstract

Maternal and neonatal morbidity and mortality rates in the Democratic Republic of Congo (DRC) remain unacceptably high. The lack of empirical evidence on the capacity and performance of health facilities offering emergency obstetric and neonatal care (EmONC) is a central problem. With more real-world facility data, policymakers can make informed decisions on resource allocation, investment and harm-reduction strategies. This study collected data from 63 healthcare facilities in the Vanga Health Zone, Kwilu province, DRC to assess the quality of EmONC provision.

a cross-sectional survey of all EmONC healthcare facilities excluding Vanga referral hospital in the Vanga Health Zone from September - December 2023. “Type A” facilities were defined as those employing doctors, “Type B” facilities did not employ doctors. Quality indicators measured were: infrastructure, equipment, supplies and medicines, human resources, EmONC signal functions and EmONC patient outcomes (caseload data was collected from two 3-month periods (Jan-March 2021 and Jan-March 2022)).

We identified widespread infrastructural deficiencies, including no water sources in 61/63 facilities, a complete lack of emergency transfer capability, and limited bed capacity. Stock inventories showed that 39/50 categories in type B facilities and 38/52 categories in type A facilities had “Poor” availability of basic EmONC equipment, supplies, and medications. The median number of nurses providing 24/7 care across all specialities in type B facilities was four. Doctors were employed at 5/63 health facilities (13 doctors total), none had received post-graduate training. Signal function data showed inadequate basic EmONC, plus widespread unsafe practices: caesarean-sections and blood transfusions performed without doctors, support or essential equipment. There were concerns over the validity of caseload data.

Health facilities in Vanga Health Zone show inadequacies in all quality domains assessed and are unable to provide acceptable EmONC. We also present evidence of unsafe practices risking patient harm.

Facility-based Assessment of Emergency Obstetric and Neonatal Care in Vanga Health Zone, Kwilu Province, Democratic Republic of Congo.

The DRC has one of the highest rates of mortality for mothers and newborn babies despite many efforts to improve access and quality to healthcare. A key problem is that there is very little accurate data on the resources and facilities available at health centres in the country, particularly in more rural and remote areas.

We visited all 63 health facilities within one health district, Vanga, located within Kwilu province, South-Western DRC. At each facility, we collected data to assess the quality of healthcare in several areas, including case registers from two three-month periods, infrastructure, staff, equipment, supplies and medicines, and key emergency obstetric and neonatal services offered.

The data showed widespread shortages of the most basic infrastructure, such as beds, toilets and running water. Facilities were greatly short-staffed and not properly trained to handle the cases they were performing. Facilities lacked the most basic supplies and medicines. Some facilities did not provide core emergency services such as delivering antibiotics to pregnant and post-parum women, whereas others reported performing caesarian sections and blood transfusions without adequate training or doctors. There was evidence that cases being recorded in registers were falsified for financial incentives, which cast doubt on the validity of the caseload data.

These findings underscore the failings of obstetric and neonatal care provided in rural areas of the DRC, and suggest patients are being harmed. Policymakers and researchers should work closely with local health managers to identify and implement strategies to improve the validity of caseload data and address critical shortages in resource allocation.

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