Mentorship to strengthen health system leadership: A case study of the Walungu rural health zone in the eastern Democratic Republic of Congo.

PLOS global public health Pub Date : 2024-12-12 eCollection Date: 2024-01-01 DOI:10.1371/journal.pgph.0003354
Rosine Bigirinama, Ghislain Bisimwa, Samuel Makali, Aimé Cikomola, Janvier Barhobagayana, Jean-Corneille Lembebu, Christian Chiribagula, Pacifique Mwene-Batu, Abdon Mukalay, Denis Porignon, Albert Tambwe
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Abstract

From 2015 to 2019, the "RIPSEC" program launched a mentorship program, transforming the Walungu health zone, in eastern crisis-affected Democratic Republic of Congo, into a "Learning and Research Zone" (LRZ). As part of the program, a local university was tasked with strengthening the LRZ manager's leadership capacities, including efforts to troubleshoot challenges related to the proliferation of informal healthcare facilities (IHFs). IHFs are unregulated healthcare structures operating on the fringes of the law, and claiming to offer cheaper, higher-quality care to the local population. This study evaluates the impact of RIPSEC mentorship on leadership development and the performance in the Walungu LRZ, particularly concerning the utilization of integrated curative health services in competition with IHFs. We used a mixed method approach, combining retrospective analysis of some key health indicators before (2014) and during RIPSEC program (2014 vs. 2015-2019), and in-depth qualitative interviews with members of the LRZ management team. Quantitative data were presented as frequencies and proportions. Simple linear regression (p<0.05) measured the influence of IHFs on service use. The LRZ's functionality and performance were assessed using an internal benchmarking approach, with results presented as trend curves. Deductive analysis of interviews allowed for a deeper exploration of quantitative trends. Despite efforts by the LRZ managers to regulate IHFs, these structures negatively impact the use of curative services by diverting patients away from integrated healthcare options. RIPSEC mentorship notably enhanced manager's leadership skills, leading to more effective management. While the use of curative health services slightly increased during the program, rates remained below 50%, and gains were not sustained post-program. RIPSEC mentorship has positively impacted leadership and performance in Walungu. However, financial challenges and the persistent influence of IHFs continue to impede the sustainability of these gains. Comprehensive strategies beyond enhancing managerial leadership solely, are necessary.

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加强卫生系统领导的指导:刚果民主共和国东部瓦隆古农村卫生区的案例研究。
2015年至2019年,“RIPSEC”项目启动了一项指导计划,将受危机影响的刚果民主共和国东部的瓦伦古卫生区改造为“学习与研究区”。作为该计划的一部分,当地一所大学的任务是加强LRZ经理的领导能力,包括努力解决与非正规医疗设施(IHFs)激增相关的挑战。IHFs是不受监管的医疗机构,在法律的边缘运作,并声称为当地居民提供更便宜、更高质量的医疗服务。本研究评估了RIPSEC指导对Walungu LRZ的领导力发展和绩效的影响,特别是在与IHFs竞争的综合治疗卫生服务的利用方面。我们采用了混合方法,结合了对RIPSEC计划之前(2014年)和期间(2014年与2015-2019年)的一些关键健康指标的回顾性分析,以及对LRZ管理团队成员的深入定性访谈。定量数据以频率和比例表示。简单线性回归(p
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