Evaluation of the Impact of Revitalizing Community Mobilization Units on the Performance of Health Services in the Province of South Kivu (DRC)
Abstract:
Community participation is a key pillar of primary healthcare and a major lever for improving health indicators (Haldane et al., 2019). In the Democratic Republic of Congo, Community Action Units (CACs) have been established to strengthen this engagement, although their effectiveness remains insufficiently documented. This study aimed to evaluate the effect of revitalizing community health centers (CHCs) on the use of health services in the province of South Kivu. A cross-sectional analytical study was conducted with 408 CHCs distributed across six health zones. The data were analyzed using statistical methods including paired t-tests, correlation analyses and multivariate regression, with a significance threshold set at p < 0.05. The results show that the CACs were, on average, composed of 7.6 members, with a male predominance (71%). A statistically significant improvement was observed for some indicators, notably family planning (+109.6%, p < 0.001) and prenatal consultations (+47.78%, p = 0.003), while no significant effect was observed on vaccination coverage (p = 0.906). The main determinants identified include awareness-raising activities and members' education levels. These results suggest that community health workers contribute to improving behaviour-sensitive indicators, but that their impact remains limited by the structural constraints of the healthcare system.References:
[1]. World Health Organization.
Declaration of Alma-Ata. Geneva: WHO; 1978.
[2]. World Health Organization.
Astana Declaration on Primary Health Care. Geneva: WHO; 2018.
[3]. Haldane V, et al. Community
participation in health services: a systematic review. PLoS One. 2019.
[4]. Rifkin SB. Examining the links
between community participation and health outcomes. Health Policy Plan. 2014.
[5]. George AS, et al. Community
participation in health systems research. Health Policy Plan. 2015.
[6]. Erku DA, et al. Community
engagement initiatives in primary health care. PLoS One. 2023.
[7]. Altare C, et al. Health
services in conflict-affected settings. Confl Health. 2020.
[8]. Behl R, et al. Rebuilding
child health in South Kivu. Confl Health. 2022.
[9]. Cleland J, et al.
Contraception and health. Lancet. 2012.
[10]. Lassi ZS, Bhutta ZA.
Community-based interventions. Cochrane Database Syst Rev. 2015.
[11]. Ministry of Health, Democratic
Republic of Congo. CAC Manual. Kinshasa: Ministry of Health; 2016.
[12]. Falisse JB, et al. Community
governance in fragile settings. PLoS Glob Public Health. 2023.
[13]. Ngongo N, et al. Community
health worker programs in Africa. PLoS Glob Public Health. 2024.
[14]. Kasongo B, et al. Community
engagement in South Kivu. Research Square. 2024.
[15]. South J, Phillips G.
Evaluating community engagement. J Epidemiol Community Health. 2014.
[16]. World Health Organization.
Immunization Agenda 2030. Geneva: WHO; 2019.
[17]. Ubillos-Landa S, et al. Community animation programs.
Appl Psychol Health Well Being. 2020.
[18]. Arghittu A, Castiglia P,
Dettori M. Family medicine and primary healthcare: the past, present and
future. Healthcare (Basel). 2023;11. https://doi.org/10.3390/healthcare11152128
[19]. Gholipour K, Shokri A, Tabrizi
JS, Iezadi S, Naghibi D, Bidarpoor F. Barriers to community participation in
primary health care of district health: a qualitative study. BMC Prim Care.
2023;24(1). https://doi.org/10.1186/s12875-023-02062-0
[20]. Kafflouman KS, Soulama F,
Kalumendo R, Ouoba B, Songa JA, Kinda M, et al. Evaluation of post-training monitoring of CHWs.
Texila Int J Public Health. 2023;11(3):294-304.
[21]. Mabetha D, Ojewola T, Van Der Merwe M, Mabeka R, Goosen G, Sigudla J, Hove J, Witter S, D'Ambruoso L. Realising radical potential: building community power in primary health care through Participatory Action Research. Int J Equity Health. 2023;22(1). https://doi.org/10.1186/s12939-023-01894-7
