COVID-19: A need to revalue the first line of care: notes from the Tshamilemba Health Centre , Congo

 

COVID-19 : Une nécessité de revaloriser la première ligne des soins Entre détection et protection au Centre de Santé Tshamilemba, Lubumbashi, République Démocratique du Congo

 

The government has been working on biological control measures such as laboratory research into viruses and vaccines. Their focus lies first and foremost on measures to change people’s socio-economic behaviour such as a lockdown, the mobilisation of political actors, a call to respect barrier gestures and restrictions including a ban on religious worship, the closure of bars and terraces, an awareness campaign about the pandemic and the need for preventive measures.

They introduced also wider sanitation measures such as the disinfection of political public spaces (parliament, presidential palace, senate, etc.), but overlooked the public spaces where citizens mingle. On the health system level, stakeholders quarrel about the functioning of a multi-sector national and provincial response committee, the design of a few wards at the Ngaliema Hospital, in Kinshasa and the construction of new hospitals (Lubumbashi) that can handle COVID-19 cases. Long-standing health facilities are ignored in the response to Covid-19.

Between 10 March, date of the first confirmed COVID-19 case, and 7 June almost 89 days later, the DRC registered 4,106 COVID-19 cases of which 3,481 active cases, 537 cured and 88 deaths, i.e. an average of 46 new cases, 6 cured and 1 death per day. Mass screening of the Congolese police force, and voluntary screening is planned at the Martyrs stadium in the capital Kinshasa. The fact that such a mass event could facilitate the (air) transmission of Covid-19 is somehow not considered. 11, out of a total of 26 provinces, have now been affected, an increase of 4 since our previous blog.

The Haut-Katanga province alone has 33 COVID-19 cases and 2 deaths, all recorded in Lubumbashi, the provincial capital. We note a gradual increase over the past week.

The provincial governor, through the provincial Ministry of health, continues to support the ‘standard’ approach: educating the public to respect the universal barrier gestures (frequent hand washing, wearing a face mask, social distancing, etc.), but with little regard for the local context and dynamics. However, in contrast to the beginning of the epidemic, the population seems to have lowered their guard. The provincial government has received laboratory and diagnostic equipment for on-site case confirmation in Lubumbashi.

The management teams of the Congolese health districts received awareness posters for training purposes showing barrier gestures. However, triage, notification, decision trees, therapeutic protocols, referral advice, and death toll statistics on Covid-19 cases are not available at health training level. As planning is centralised, health districts and their senior teams are not involved, read excluded, from all COVID response activities.

The Tshamilemba health district, one of the 11 Lubumbashi health districts, has 11 Covid-19 cases, or 1/3 of all cases in Lubumbashi. The district’s management health team, including the Chief Medical Officer, is not involved, consulted, or informed on case detection and management. De facto, the Congolese health system’s response to Covid-19 is largely designed and managed in a top-down manner, often bypassing local health systems.

But the epidemic is still there and persists!

And what about front-line health facilities, that are meant to have a broad responsibility for the health of well-defined populations of the Lubumbashi health districts?

The Tshamilemba Learning and Research Health Centre (in French Centre de Santé d’Apprentissage et de Recherche Tshamilemba, with acronym CSART) in the Tshamilemba Health District in Lubumbashi city is a good illustration of the situation of front-line health facilities. The CSART is a health training scheme set up in 2012 in collaboration with the Institute of Tropical Medicine in Antwerp, the School of Public Health of the University of Lubumbashi, and the Provincial Health Division of Haut-Katanga to organise front-line health services in the Congolese urban context.

As everywhere else, CSART has received the means to detect and protect health personnel. In the last week, the international NGO World Vision provided the centre with a thermometer to measure the body temperature of all visitors (thermometry) entering the facility, hand washing devices, gloves, gels and masks for staff protection, from the international NGO World Vision. However, CSART has no triage, notification, decision-making tree, or case referral scheme. CSART thus oscillates between the challenge of detection and treatment of COVID-19 cases and the personal protection of health personnel in the city of Lubumbashi. The centre has 10 doctors, 15 nurses and 3 administrative staff, all of them untrained and unprepared to deal with COVID-19 cases.

According to the population, the organisation of the COVID-19 response is not clear, leading to a lack of trust and a perception of the disease as this “COVID-BUSINESS”. There is an urgent need to align the perception of the population, and the accountability and transparency of the authorities in the response to COVID-19 in the city of Lubumbashi.

About the author

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.

Bart Criel is a medical doctor and currently professor at the Public Health Department of the Institute of Tropical Medicine Antwerp, Belgium.

Competing interests:

None declared

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