Introduction: Faced with the growing phenomenon of urbanization and the need to adapt health services to the urban context, this article describes the catchment area and the profile of the patient who attended the two urban medical health centers (CSMU) set up, as part of an action research, in the city of Goma, Eastern Democratic Republic of (DRC). Methods: This is a retrospective observational study based on registry and patient record data from April 2019 to December 2021. Data collected on tablets were analyzed using statistical software STATA 14.1. Results: 14.433 patients attended both CSMUs during the period. Both CSMUs experienced attraction beyond the health areas of implantation (26.7%). The profile of the patient is predominantly female (62.3%), educated (70.5% graduated at least in the humanities), adult (44.9% aged 18 to 49), registered with the CSMU in 19.6% of cases. The reason for consultations is dominated by infectious (55.2%) and parasitic (10.6%) diseases, followed by chronic diseases (26.9%) and trauma (2.6%) (p <0.001). In more than 90% of cases, the care involves 3 different skills (medical, nurses and social worker) of the multidisciplinary team. Discussion and Conclusion: The catchment area and patient profile found show the interest of rethinking the way urban health services are organized in order to better meet the expectations of urban populations.

Introduction: This study aims to describe the perceptions of stakeholders involved in the management of the twelfth Ebola virus disease outbreak in North Kivu; in order to identify the contributing factors of its containment and management in less than 3 months. Methods: This descriptive and cross-sectional study used interviews guided by comprehensive questionnaire among all the stakeholders involved in the management of the twelfth Ebola virus disease, including health managers, healthcare providers, community leaders, heath partners and any other actors involved in the emergency response to outbreaks. Data analysis was performed using IBM SPSS version 23.0 for both coding and statistical analyses of collected data. Results: Based on the perceptions of different stakeholders who compared the tenth and twelfth outbreaks, the management of the latter was characterized by fewer funding and training of staff; a better understanding of local socio-cultural variations and needs (97.2%, versus 9.1%; p<0,001), a clear tracking and follow-up of contacted and/or suspected cases (91.5% versus 66.7%; p<0,001), a greater community involvement and application of standard operating measures implemented by the emergency team (80.3% versus 66.7%; p<0,001); and a proper management of cases of Ebola virus disease (both confirmed, suspected or contacted) (94.1% versus 66.7%; p<0,001). Conclusions: Our findings reveal that the integrative approach response into the local health system, which strengthened community engagement and trust in the emergency response ‘teams, enabled the rapid containment of the twelfth Ebola virus disease outbreak in North Kivu, in Democratic Republic of Congo. This approach is part of a new paradigm compatible with the health system resilience.

Introduction: In connection with the reform of the intermediate level of the health system in the DRC, this article describes the perceptions of health district teams, regarding to intermediate health level support, in North Kivu province. Methodology: This descriptive cross-sectional study conducted a self-administered questionnaire survey of senior staff in 34 health districts in North Kivu. The collected data was encoded and analyzed using SPSS version 26 software. Results: More than 85% of health district managers (29/34 districts) view positively the support and coaching at the intermediate level, in terms of the adequacy of the accompanying object, the gradient of the competences of the supervisors, the capacity building, the support for problem-solving and the progress on the path of revitalization of health districts. On the other hand, these perceptions are nuanced about the availability of framers, the frequency of accompanying visits, the juxtaposition of these visits on other activities and the effects on the use of services and the protection of users from financial risks. These perceptions do not vary by gender, age, occupational categories, and seniority in function and within the health district (p>0.05). Discussion and conclusion: These results show the value of more coherence, proactivity and responsiveness in support and reform of the intermediate level, to strengthen its impact on the performance of health district teams.

Introduction: As part of a process to reorganize urban health services, this article analyzes the profile of health services in the eastern DRC city of Goma; the aim is to identify their distribution and level of medicalization. Methods: This descriptive and cross-sectional study conducted a comprehensive survey of health care facilities in the city of Goma in January 2018. Geographical and health data (infrastructure, equipment, human resources, care provided) were collected by professionals. They were encoded and analyzed using SPSS version 20 software. Results: The urban supply of care in Goma is too bloated with one facility for 8,794 inhabitants, one hospital bed for 326 inhabitants, one nurse for 586 inhabitants and one doctor for 2567 inhabitants. On the other hand, a lack of midwives, sub-equipment and infrastructure that does not meet hospital standards are observed. This health facilities, mainly privately lucrative (79%) with 56% of establishments created in the last 6 years, are variously distributed. The first-line care offer represents 34% and incorporates a medical practice in 43% of cases. Discussion and Conclusion: This provision of care requires strong regulation from the perspective of a better governed, streamlined and staggered urban health system, which better meets the quality standards and user’s expectations in urban contexts.

Introduction: This study analyzes hospital maternal death factors in six heath zones in the East of the Democratic Republic of Congo. The objective of this study is to identify the determinants and the circumstances of the maternal deaths. Methodology: This study is descriptive and analyzes the content of the medical files and death review of the mother deaths occurred between 2009 and June 2014 in 22 referral hospitals of 6 zones of health of the province of the North Kivu in the East of the RDC. The data collected by binomials of well experimented nurses and physician about 74 mother deaths were analyzed by SPSS software. Results: The hospital maternal mortality is high (106,9 deaths for 100.000 living Births). 87, 5% cases of maternal deaths arrived in time to the referral hospitals and 69,2% of cases were well taken in charge to the primary health level centers. On the other hand, the hospital care has been judged inadequate in 83,1 % of the cases, notably because of non-suitable medical and nursing care and limited availability either of the medicines and transfusion blood. The hemorrhage was the first reason of maternal death (63,4 % of the cases) and also the eclampsia (8,5%) and infections (7%). The indirect reasons were incriminated in less than 6% of the cases. Conclusion: The high level of hospital maternal deaths, the importance of the hemorrhages and limited medical and nurse competencies in maternal deaths, put in evidence the interest to reinforce the nurse and medical competencies and the clinical governance in reference hospitals.