This blog is a part of # COVID19Africa Series. Click for French version.
The first line of health care is not only the primary level of care, it also ensures coordination of care and of patient information. However, in the DRC, its role seems to be in tatters due to the Congolese government’s ill-coordinated and ineffectively integrated response to the COVID-19 epidemic. The political authorities seem to have ignored the first line of the health care delivery system and have put themselves at the forefront of the health response to the epidemic.
The national containment measures including social distancing and other precautions, the closure of borders, the set-up of a medical response team and a national awareness raising campaign are enforced by the military and police. Mobile response teams screen on a case-by-case basis, quarantine people and treat confirmed COVID-19 patients.
On May 3rd, the country had 674 confirmed cases, 33 deaths and 75 cured patients. That amounts to an average of 12.5 confirmed cases/day, 0.6 deaths/day, 1.4 cured/day, since 10 March (54 days), when the first case was reported.
The World Bank and the International Monetary Fund have donated US$410 million to support the fight against COVID-19, or US$4.56 per capita in a country with a population of 90 million people and six provinces affected, the city-province Kinshasa and 5 other provinces, including the Haut-Katanga (with Lubumbashi as capital).
The epidemiological situation in the Haut-Katanga province has also changed and the provincial government has responded by setting up a COVID-19 intake hospital near Lubumbashi International Airport, preparing the Haut-Katanga and Governorate reference hospitals, and establishing a multi-sector task force that includes monitoring, communication, management, logistics and WASH sub-committees. To our knowledge, no health facility in the health districts (the operational level par excellence of the health system) has received any guidance on how to prepare for a possible COVID-19 outbreak.
On 24 April, the Haut-Katanga officials confirmed their first COVID-19 case, imported from Nairobi via Zambia. The provincial authority announced the news via local television and urged the public to be vigilant, to not underestimate the seriousness and real risk of COVID-19 and to observe social distancing and other precautionary measures. The Governor of the province decreed an unexpected lockdown on 28 April in Lubumbashi to enable contact tracing of the first case.
As described in our previous blog, there is no guidance on confinement and health workers are sometimes not even able to reach their workstation because the majority of them live quite far away
Those on duty the evening before the lockdown were thus left to their own devices and had to leave their wards unattended because they had not anticipated this situation. The military and the police sent everyone home and even stopped public transport; hence, health staff could not get to work and relieve their colleagues. The community pays the price because the authorities do not manage the COVID-19 situation in a responsible and reliable manner (their stewardship role) and have become in fact an administrative-police force.
On 30 April 2002, 6 days after the first case was confirmed, four new cases were recorded in Lubumbashi. The provincial authorities said that these were contact cases associated to the first case. A company security guard thought he had detected a possible case after discovering someone whose temperature was 38°C. He called an ambulance and alerted the entire neighborhood. The suspected patient was taken to a nearby health facility and complained about being treated harshly by his company, but also thanked the health staff for the welcome he received and for having informed him, after examination, that there was nothing serious to worry about .
The mayor of Lubumbashi subsequently made wearing a mask mandatory in public spaces, with anyone caught without a mask, facing a fine of 5,000 Congolese francs (US$ 2.5). These restrictive measures benefit law enforcement officers who hold poor citizens to ransom, and the latter no longer know to which saint to turn to for daily survival and COVID-19.
So, who is responsible for the well-being of the population?
Alcohol-based and hand sanitizing gels, masks, and gloves can be bought. Those who distribute them for free are doing so only for political and socio-cultural visibility, not out of solidarity. Who will then provide protective items for the poor who have no connections?
If the health zones and their hospitals have barely been considered in the response to the crisis, then what about primary health care services?
Currently, the city has 5 confirmed and stable cases, detected in the Tshamilemba Health District, 0 deaths and 76 cases under investigation. This district is one of the eleven districts of the city and the Tshamilemba Health Centre is the only public facility. Of the 10 doctors in this health centre, only 2 received a one-day training on the resuscitation of COVID-19 patients, just before the first case was reported in Lubumbashi. The health centre received posters with awareness messages from the Provincial health division, gloves, alcohol-based gels, masks and toilet paper from CHEMAF, the mining company, and two hand-washing devices from two NGOs.
Interventions at the Tshamilemba Health Centre are uncoordinated, inefficient, and faltering and raise doubts as to whether the political authorities can implement national health policies. What about the involvement of primary health care services, and what about the many other health issues people face, like malaria, tuberculosis, measles, malnutrition, etc.? The Lubumbashi situation illustrates the relevance of collective and concerted action to deal with COVID-19. We believe that the first line of health care should play a key role in this endeavor. Haut-Katanga.
Didier Chuy Kalombola is a doctor with a Master Public Health from the Institute of Tropical Medicine Antwerp. He is currently conducting research on the stewardship of urban health systems.
Charles Kaya Mulumbati is a public health physician and a researcher in the Unit of Health services organization of the Department of Public Health, Faculty of Medicine, University of Lubumbashi, DR Congo.
Bart Criel is a medical doctor, public health expert and currently Professor at the Public Health Department of the Institute of Tropical Medicine Antwerp, Belgium.
Competing interests: None