Democratic Republic of the Congo: improving access to health care in North Kivu
On 20 November 2009, the ICRC handed over the newly rebuilt Vuhoyo health centre to the health authorities in Kayna. Health delegate Marcelle Baltzinger highlights the struggles and inadequacies of health-care facilities in North Kivu. She describes ICRC efforts to improve access to care in this part of the country scarred by devastating armed conflict and marked by persistently poor security conditions.
What are the main problems encountered by health-care providers in North Kivu?
The armed conflict has severely weakened the already vulnerable health-care facilities in North Kivu, and they continue to struggle amid the ongoing lack of security. Needs are great and far exceed the support and aid provided by the ICRC and othe r humanitarian organizations.
Facilities are generally lacking in equipment, basic supplies and medicines. It is virtually impossible for emergency cases to be taken to hospital, as the necessary infrastructure either doesn't exist or has been damaged.
In some villages, vaccination and prenatal clinics are no longer functioning, which means that children and pregnant women are left without access to these services.
Another problem is that with the economic situation so dire, patients often do not have the means to pay for care. As a result, the cost-recovery rate is no higher than 30%, and yet these facilities rely on payments from patients as their principal source of funding.
Many of the problems are caused by crumbling facilities and dilapidated medical equipment. A long-term approach is therefore needed. Likewise, the population's economic problems need solutions in order to improve people's nutrition and thus reduce their susceptibility to illness.
What is the impact of poor security on civilian access to care?
A lot of the people who had been displaced by the conflict have recently returned home. Health services nevertheless remain far out of reach for many. A violence-prone environment restricts movement and hinders access to health care. It can even prove fatal when it slows or prevents medical evacuation.
Poor security conditions aggravate malnutrition, as harvests are regularly pillaged and access to fields restricted. This has a direct impact on the health of the population, and on children in particular.
Health-care professionals feel the impact of a violence-prone environment just as keenly, since their role is not always respected by the parties to the conflict. Care centres are attacked or pillaged, and personnel are sometimes forced to work under extremely difficult circumstances.
The Vuhoyo health centre, in the Lubero territory, was fully rebuilt by the ICRC.
Can you explain the background to this project?
The ICRC has been working with the Vuhoyo centre for several years and has been giving it ad hoc support since 2005. It was built in 2001 by the members of the Vuhoyo community, at the initiative of the local leaders.
This village is in a province not directly affected by the conflict. In November 2008, however, it became host to huge numbers of displaced people from Rutshuru, Kibirizi and Mirangi. The health centre had to cope with a sudden influx of new patients. Housed in a dark, damp building with a thatched roof, and with very limited resources, the centre could clearly no longer meet the demands being placed on it.
The ICRC's reconstruction project has improved access to primary health-care for about 8,000 people living in the area. The residents of Vuhoyo, and the thousands of people displaced by the chronic instability, now benefit from a newly renovated health-care facility, fully furnished with all the essential supplies, equipment and medicines.
What else is the ICRC doing in this area to improve access to care?
Since November 2008, the ICRC has been offering regular support to four other facilities in southern Lubero: the referral hospitals in Kitsombiro and Bwatsinge, the Kaseghe health centre and Mat anda hospital in Butembo. Matanda hospital is southern Lubero's referral hospital for war injuries, in particular gunshot wounds.
The ICRC supplies these facilities with vital medicines, equipment and hygiene items, augmenting their ability to provide treatment. In Beni, for example, the ICRC has set up a physiotherapy unit and built a sterilization unit and laundry.
In addition, the ICRC offers the facilities substantial financial support, helping to cover their running costs and reimbursing them for the expense of treating displaced people.
High-quality health care also depends on having attentive, well-trained and motivated staff. The ICRC contributes towards salary bonuses for health-care personnel – in order to encourage them to continue working there – and supports their ongoing training. For instance, a series of seminars on treating war wounds was run by the ICRC in October 2009, in North and South Kivu. In addition, an ICRC surgical team was sent to work with the staff at the Beni general referral hospital in April and May 2009.