How to Develop a Realist Evaluation to Evaluate the Effectiveness of Integrated Management of Childhood Illness Strategy in Community Care Sites in the Democratic Republic of Congo

Etshumba, John Mukulukulu; Bebe, Dosithée Ngo; Kalambay, Patrick Kayembe; Nappa, Fulbert Kwilu

doi:10.4236/ojepi.2019.93019

Cited by 2 publications

(4 citation statements)

References 16 publications

(15 reference statements)

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“…This study follows the rst 2 during which we laid the foundations for using the realist approach to assess the effectiveness of IMCI-C at the CCS level. (12) (13). It allowed us to analyze the pro les of CCSs and the human resources working there (provider CHWs) on the basis of the results obtained through a mixed approach (qualitative and quantitative).…”

Section: Discussionmentioning

confidence: 99%

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Profiles of Community Care Sites and provider Community Health Workers: A Case study at Gombe Matadi, Kenge and Kisantu Rural Health Zones in the Democratic Republic of Congo

Etshumba,

Bebe,

Emina

et al. 2023

Preprint

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Background: In sub-Saharan Africa, the DRC is ones of countries with high infant and child mortality. To solve this problem, the Ministry of Public Health has set up a new program: IMCI-C at the level of Community Care Sites managed by non-health professionals who are provider CHWs. Since its implementation, there have not yet been many studies that concretely describe the operation of CCS. It’s why we have chosen the Realist Evaluation Approach to analyze CCS functionality in the DRC. Methods: To carry out this study which is a mixed method case study (qualitative and quantitative); we applied the fundamental principles of a realist evaluation which come down to Context – Mechanisms – Effects in the conceptual framework model that we developed with an emphasis on Mechanisms. Provider CHWs profile and CCSs functionality were defined after data collection through documentary review, CCS direct observation, in-depth interview with registered nurses and health zone team members using an interview guide with semi-structured questionnaire and a survey using a quantitative questionnaire with provider CHWs. Results: CCS functionality was measured through the standards enacted for the implantation of CCS as well as the profile of provider CHWs which manage them. At the significance level (p=0.039) has been in place for 3 years or more increases by 7 times chance that it is functional (OR = 6.7; p = 0.000), has household is located less than 5 km from the CCS increases by 4 times chance that the CCS is functional (OR = 7.04; p = 0.034), has provider CHW is regularly trained and supervised increases by 10 times chance that the CCS is functional (OR = 10.01; p = 0.031), provider CHW participation in CAC meetings (OR = 4.34; p = 0.009) and CCS Management Team leads the management of CCS increase by 4 times chance that this CCS is functional (OR = 3.6; p = 0.002). Finally, if there is an initiative for funding CCS increases by 8 times CCS functionality (OR = 8.69; p = 0.009). Conclusion: CCS are functional in the three RHZs. Their organization, establishment and operation are directly linked to the provision of services to populations living mainly in health areas with difficult access, the availability of inputs of three IMCI-C diseases management, namely uncomplicated malaria, diarrhea and pneumonia as well as building provider community health workers capacity to ensure their management. This study shows an effective contribution of provider CHWs on CCS functionality in health areas with difficult access.

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Section: Discussionmentioning

confidence: 99%

“…By looking at CCS pro les, we focus on the main Mechanisms that make up our conceptual framework model. (13)…”

Section: Introductionmentioning

confidence: 99%

Profiles of Community Care Sites and provider Community Health Workers: A Case study at Gombe Matadi, Kenge and Kisantu Rural Health Zones in the Democratic Republic of Congo

Etshumba,

Bebe,

Emina

et al. 2023

Preprint

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“…This is why the DRC health policy has integrated the CMAP managed by CHWS into the MAP of the HZs. It has the consequence before its implementation, the identification and choice of CHWS, capacity building and the provision of inputs to organize case management according to the 5 interventions of the CMAP CHWS [8]. Once all these conditions have been met, taking into account individuals and household's characteristics, the implementation of CMAP activities with the support of Technical and Financial Partners in the HZ, through awareness rising of the community by CHWS has led to behavior change in the community through communication for social and behavioral change.…”

Section: Context Mechanisms Effectsmentioning

confidence: 99%

“…Community health workers receive information and benefit from trainings by the health center or Health zone management team (HZMT) on the management and prophylaxis of these diseases: malaria, diarrhoea, acute respiratory infections, malnutrition. CHWs also receive information on health, education and development and Communication for Social and Behavioral Change (CSBC) [8]. The minimum CHW activities package (MCAP) is mainly composed of the following 5 interventions: 1) Management of simple malaria, diarrhoea, acute respiratory infections, malnutrition; 2) Family planning through community distribution of contraceptive methods; 3) Participation in micro-planning of the EPI, Malaria Programme and Reproductive Health Programme; 4) Strengthening of routine vaccination through the recovery of children lost to follow-up and 5) Strengthening the Water, Hygiene and Environmental Sanitation program.…”

Section: Introductionmentioning

confidence: 99%

Improving Demand for Health Services with the Involvement of Community Health Workers: A Case Study of Community Dynamics at Mosango Rural Health Zone in the Democratic Republic of Congo

Mukulukulu¹,

Ngo-Bebe²,

Mabanza³

et al. 2020

OJEpi

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Introduction: DRC is one of Sub-Saharan Africa country with high infant and maternal mortality. The major problem is the underuse of health services because of inaccessibility on all fronts and also the population under-information to the health and development problems. Community participation is one of the basic requirements and basic principles of the Primary Health Care to solve this problem. That is why we choose Mosango RHZ to assess the improvement of demand for health services with the involvement of community health workers. Methods: We conduct a cross-sectional study carried out in Mosango RHZ in 2019. The study combined a mixed method (quantitative and qualitative) based on the realist evaluation approach which takes into account the Context-Mechanisms-Effects explained in the conceptual framework model. Results: Four predictive factors determine the improvement of health indicators with the involvement of CHWS in activities of the Mosango RHZ: Having attended school (p = 0.000; OR = 0.150); Having sufficient theoretical knowledge on malaria, diarrhoea, pneumonia, malnutrition, availability of inputs to treat these diseases (p = 0.004; OR = 0.192); Having taken the training as CHWS and Having undergone more than one training as CHW (p = 0.013; OR = 0.074). This result corroborated with other studies carried in low-and middle-income countries like DRC. Conclusion:

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How to Develop a Realist Evaluation to Evaluate the Effectiveness of Integrated Management of Childhood Illness Strategy in Community Care Sites in the Democratic Republic of Congo

Cited by 2 publications

References 16 publications

Profiles of Community Care Sites and provider Community Health Workers: A Case study at Gombe Matadi, Kenge and Kisantu Rural Health Zones in the Democratic Republic of Congo

Profiles of Community Care Sites and provider Community Health Workers: A Case study at Gombe Matadi, Kenge and Kisantu Rural Health Zones in the Democratic Republic of Congo

Improving Demand for Health Services with the Involvement of Community Health Workers: A Case Study of Community Dynamics at Mosango Rural Health Zone in the Democratic Republic of Congo

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