Health services for women, children and adolescents in conflict affected settings: experience from North and South Kivu, Democratic Republic of Congo
Health services for women, children and adolescents in conflict affected settings: experience from North and South Kivu, Democratic Republic of Congo
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DOI：
10.1186/s13031-020-00265-1
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发表时间：
2020-05-27
影响因子：
3.6
通讯作者：
Spiegel, Paul
中科院分区：
文献类型：
--
作者：
Altare, Chiara;Malembaka, Espoir Bwenge;Spiegel, Paul
背景几十年来，不安全一直是刚果民主共和国东部地区的特点。在旷日持久的冲突中提供保健服务以维持妇女和儿童的健康是一项挑战。这种混合方法的案例研究，旨在描述如何生殖，孕产妇，新生儿，儿童，青少年健康和营养（RMNCAH+N）服务已在北基伍省和南基伍省提供自2000年以来，他们是如何成功were.MethodsWe进行了一项案例研究，使用案头审查公开文献，二次分析的调查和卫生信息系统的数据，和主要的定性访谈。定性部分提供了对影响RMNCAH+N设计和实施的因素的见解。我们与政府官员、人道主义机构工作人员和设施内的医疗保健提供者进行了49次访谈，并与四个卫生区（Minova、Walungu、Ruanguba、Mweso）的社区卫生工作者进行了焦点小组讨论。我们应用框架分析来调查被调查者的关键主题。定量部分使用全国调查和国家卫生设施信息系统的二级数据来估计省级和省级以下的RMNCAH+N干预措施的覆盖率。不安全的服务提供之间的关联进行了研究与随机效应广义最小二乘模型，使用卫生设施的数据从南基伍省。ResultsCoverage选定的预防RMNCAH+N干预措施似乎高在北基伍省和南基伍省，往往高于全国水平。卫生设施数据显示，各省的不安全状况与预防服务覆盖率之间存在小的负相关。然而，受冲突影响地区的健康状况比稳定地区差。调查答复者指出，提供服务方面的主要挑战是熟练人员的可用性和保留、缺乏基本材料和设备以及财政资源不足，无法确保卫生工作者的定期付款、药品的可用性和设施的运行成本。不安全加剧了预先存在的挑战，但似乎并不代表在北基伍和南基伍提供服务的主要障碍。ConclusionsProvision of preventionable RMNCAH+N services has continued during intermittent conflict in North and South Kivu.非政府组织和联合国机构为应对人道主义需求而作出的长期努力可能是在冲突中维持干预覆盖面的关键。卫生行为体和社区似乎已适应不断变化的不安全程度和性质，并制定了确保提供和获得预防服务的战略。然而，紧急不可重复的RMNCAH+N干预似乎并不容易获得。实现可持续发展目标将需要增加获得拯救生命干预措施的机会，特别是对新生儿和孕妇。
BackgroundInsecurity has characterized the Eastern regions of the Democratic Republic of Congo for decades. Providing health services to sustain women's and children's health during protracted conflict is challenging. This mixed-methods case study aimed to describe how reproductive, maternal, newborn, child, adolescent health and nutrition (RMNCAH+N) services have been offered in North and South Kivu since 2000 and how successful they were.MethodsWe conducted a case study using a desk review of publicly available literature, secondary analysis of survey and health information system data, and primary qualitative interviews. The qualitative component provides insights on factors shaping RMNCAH+N design and implementation. We conducted 49 interviews with government officials, humanitarian agency staff and facility-based healthcare providers, and focus group discussions with community health workers in four health zones (Minova, Walungu, Ruanguba, Mweso). We applied framework analysis to investigate key themes across informants.The quantitative component used secondary data from nationwide surveys and the national health facility information system to estimate coverage of RMNCAH+N interventions at provincial and sub-provincial level. The association between insecurity on service provision was examined with random effects generalized least square models using health facility data from South Kivu.ResultsCoverage of selected preventive RMNCAH+N interventions seems high in North and South Kivu, often higher than the national level. Health facility data show a small negative association of insecurity and preventive service coverage within provinces. However, health outcomes are poorer in conflict-affected territories than in stable ones. The main challenges to service provisions identified by study respondents are the availability and retention of skilled personnel, the lack of basic materials and equipment as well as the insufficient financial resources to ensure health workers' regular payment, medicaments' availability and facilities' running costs. Insecurity exacerbates pre-existing challenges, but do not seem to represent the main barrier to service provision in North and South Kivu.ConclusionsProvision of preventive schedulable RMNCAH+N services has continued during intermittent conflict in North and South Kivu. The prolonged effort by non-governmental organizations and UN agencies to respond to humanitarian needs was likely key in maintaining intervention coverage despite conflict. Health actors and communities appear to have adapted to changing levels and nature of insecurity and developed strategies to ensure preventive services are provided and accessed. However, emergency non-schedulable RMNCAH+N interventions do not appear to be readily accessible. Achieving the Sustainable Development Goals will require increased access to life-saving interventions, especially for newborn and pregnant women.