ARTICLE | doi:10.20944/preprints202309.0411.v1
Subject: Public Health And Healthcare, Health Policy And Services Keywords: community participatory asset mapping; asset-based approaches to health; health inequalities; basic healthcare services; community-based healthcare; democratic republic of congo
Online: 6 September 2023 (10:32:40 CEST)
Populations with healthcare needs often reside in post-conflict settings where basic services needed to maintain good health may be non-existent or hard to access. Therefore, there is a need for better identification and reallocation of resources as part of the post-conflict health rehabilitation effort. This study applies an asset-based approach to explore the more optimal design of health services and to identify the resource constraints for basic health service delivery to the most vulnerable communities in eastern Congo. We implemented the asset mapping in two phases. Firstly, we combined a qualitative survey with community walks to identify the assets already present in the communities. Secondly, we conducted group discussions to map out assets that are the core of Asset-Based Community Development (ABCD) practice. We finally documented all assets in a Community Asset Spreadsheet. Overall, 209 assets were identified as available and potentially valuable resources for the communities in eastern Congo. Among them, 60 were local associations, 24 were land and physical environment, 43 were local institutions, 46 were individuals, 32 to economy and exchange, and only 6 were related to culture, history, and stories. Drawing upon the findings from the qualitative survey, community walks, and group discussions, we conclude that an important number of resources were in place for basic health service delivery. By activating the existing and potential resources, the most vulnerable populations in eastern Congo might have the required resources for basic health service delivery. Our findings support the use of an asset-mapping research method as appropriate to identify existing and potential resources for basic health services in a post-conflict setting.
ARTICLE | doi:10.20944/preprints202308.1768.v1
Subject: Public Health And Healthcare, Public Health And Health Services Keywords: Maternal health care services utilization; Trends; Health inequalities; Inequality measurement; Post-conflict; Democratic Republic of Congo (DRC)
Online: 25 August 2023 (07:10:01 CEST)
This study assessed health inequality trends and the degree of maternal healthcare services utilization in the DRC, using two consecutive Demographic and Health Surveys, 2007 and 2013-2014. First, we assessed the changes in the magnitude of inequality in the utilization of MHCS using logistics and regressions. Second, we analyzed the distribution of inequality in each MHCS utilization variable using the Gini coefficient and the Lorenz curve. Third, we used the Wagstaff two groups concentration indices comparison method to assess health inequality trends. Finally, we fitted the concentration curves to estimate the inequality in the utilization of MHCS to the economic condition of women. Women were less likely to have their first ANC visit within the first trimester, less likely to receive checkups during ANC visits, and less likely to attend more ANC visits when living in eastern DRC compared to western DRC. Women in rural areas were less likely to have their last birth by C-section, and less likely to receive PNC than women in urban areas. Women with middle, richer, and richest wealth indexes were more likely to complete more ANC visits, more likely to deliver by C-section, most likely to receive PNC, and more likely to receive ANC than those with lower wealth indexes. Over time, inequality in the utilization of MHCS decreased for ANC and PNC but increased for the delivery by C-sections. These findings suggest that innovative strategies are still needed to improve the utilization of MHC services among poorer, rural, and underserved women in post-conflict DRC.