Hermès Karemere¹*, Mireille Akonkwa¹, Aganze Kanozire¹, Alliance Mushi N’shobole¹, Joseph Balegamire², Florentin Asima Katumbi¹, Aladin Mahano Maombi¹ and Johanna Karemere³

¹Public Health Program, Health Sciences Department, Official University of Bukavu, Democratic Republic of the Congo
²University of the 50^th Anniversary of Lwiro, Democratic Republic of the Congo
³Independant Researcher, Democratic Republic of the Congo

*Corresponding Author: Hermès Karemere, Public Health Program, Health Sciences Department, Official University of Bukavu, Democratic Republic of the Congo.

Received: March 19, 2025; Published: May 21, 2025

Abstract

Introduction: Community participation plays a key role in the development of primary healthcare. This study aims to analyze the impact of community participation on the quality of health services in the Kadutu Health Zone, Bukavu, South Kivu, DR Congo.

Methodology: Analytical cross-sectional study conducted between June and October 2024 in the Kadutu Health Zone. Data collection involved individual interviews targeting 422 household heads, nine primary nurses from health centers, one chief medical officer of the health zone, and two community facilitators. It also conducted nine focus groups with community health workers. The data was entered into the Excel file. The quantitative data, exported to EPI-INFO version 7.1.1.3, underwent both univariate and bivariate analyses. The qualitative data underwent a thematic analysis determining the strengths, weaknesses, opportunities, and threats of community interventions and their effects on the quality of health services in the Kadutu Health Zone.

Results: All household heads (100%) attest to the implementation of community interventions in the Kadutu health zone. Community work aimed at hygiene and sanitation (according to 89.33% of household heads) and awareness and education (according to 95.02% of household heads) are the main community interventions carried out. The majority of Community health workers (CHWs) feel motivated (71.32%) to voluntarily carry out community-level interventions. Individuals who participate in community activities are 4.15 times more likely to observe an improvement in service quality compared to those who do not participate (OR = 4.15, 95%, CI [2.39-7.21], p < 0.001). Moreover, home visits appear as an important lever: individuals who have benefited from regular or occasional visits are 4.83 times more likely to observe an improvement in services than those who never or rarely receive them (OR = 4.83, 95% CI [2.80-8.34], p < 0.001). Another major determinant is the state of hygiene and sanitation of the environment, with a nearly 11 times higher probability of observing an improvement in services in a well-sanitized environment compared to an unsanitary environment (OR = 10.97, 95% CI [4.90-24.56], p < 0.001).

Discussion and Conclusion: This study highlights the importance of community participation in improving the quality of primary healthcare services in the Kadutu Health Zone. Several challenges persist, including data management issues, a lack of resources, cultural barriers, and insufficient coordination. By strengthening community participation and optimizing available resources, it would be possible to significantly improve access to quality care.

 Keywords: Community Participation; Quality of Services; Community Relay; Kadutu Health Zone; Bukavu; Democratic Republic of Congo

References

1. Fassin D and É Fassin. “Public health without the State? Community participation and health committees in Senegal”. Revue Tiers Monde (1989): 881-891.
2. Diallo B and Chapter IX. “Community participation and access to emergency obstetric care in Mali: funding challenges for the referral system, in Risking death to give life”. Presses de l’Université Laval (2017): 171-189.
3. Ridde V and JE Girard. “Twelve years after the Bamako initiative: findings and political implications for equitable access to health services for poor Africans”. Public Health 1 (2004): 037-051.
4. Hombanyi DB and H Karemere. “Community participation in the Sanitized Schools and Villages Program in the Bunyakiri health zone in South Kivu in the Democratic Republic of Congo: Issues of appropriation and perspectives”. International Journal of Innovation and Applied Studies3 (2022): 492-501.
5. Competed LFA and CA Mali. “The mali experience of community participation in health”. Community health in 4 acts: Benchmarks, actors, approaches and challenges (2016): 277.
6. Sombié I., et al. “Local perceptions of community participation in health in Burkina Faso”. Public Health4 (2015): 557-564.
7. Villanucci A., et al. “Public health, community participation and political mobilization in Ethiopia: the Women’s Development Army”. African Politics2 (2016): 77-99.
8. Sombié I., et al. “Understanding the influence of contextual factors on community participation in health: a case study in the health district of Tenkodogo, Burkina Faso”. Global Health Promotion (2016): 387-395.
9. Karemere H., et al. “An experience of implementing community care sites in the Democratic Republic of Congo [Integrated community case management: An experience from the Democratic Republic of Congo]”. International Journal of Innovation and Applied Studies1 (2017): 42-51.
10. Fournier and L Potvin. “Community participation and health programs: the foundations of the dogma”. Social Sciences and Health2 (1995): 39-59.
11. Lacouture A., et al. “Strengthening empowerment, participation and community ownership [Chapter 6]”. Health development in French-speaking Africa. Issues and perspectives post-2015 (2015): 11.
12. Tizio S and YA Flori. “THE BAMAKO INITIATIVE: “HEALTH FOR ALL” OR “ILLNESS FOR EVERYONE”?” Revue Tiers Monde (1997): 837-858.
13. Fassin D., et al. “The social issues of community participation: health committees in Pikine (Senegal)”. Social Sciences and Health3 (1986): 205-221.
14. Adom PVM., et al. “Model for integrating community health workers into the health system (Benin, Togo)”. Public Health2 (2019): 315-326.
15. Dunia GMB. “Implementation of community care sites in the Democratic Republic of Congo: establishment of a double standard in access to care”. The Pan African Medical Journal 14 (2013): 158.
16. Modeste GKB. “The problem of the involvement of Community Health Workers in the management of HIV/AIDS-Anthropological analysis of a story in the west of Côte d'Ivoire”. European Science Journal6 (2019): 1-13.
17. Kasongo B., et al. “Community perceptions of a biopsychosocial model of integrated care in the health center: the case of 4 health districts in South Kivu, Democratic Republic of Congo”. BMC Health Services Research1 (2023): 1431.
18. Diedhou, A., et al. “Community participation and health promotion: the experience of the hygiene and sanitation committees of the Touba district (Senegal)”. Cahiers Santé1 (2006): 43-47.
19. Ndiaye 1, P., et al. “Community participation in a latrine project in a rural Senegalese area”. Public Health 1 (2010): 147-154.
20. Haldane V., et al. “Community participation in health services development, implementation, and evaluation: A systematic review of empowerment, health, community, and process outcomes”. PloS one5 (2019): e0216112.
21. Rifkin SB. “Examining the links between community participation and health outcomes: a review of the literature”. Health Policy and Planning 29 (2014): ii98-ii106.
22. Bath J and J Wakerman. “Impact of community participation in primary health care: what is the evidence?” Australian Journal of Primary Health1 (2015): 2-8.
23. Boidin B. “Mutual societies in Africa: issues and perspectives”. Tropical Medicine and International Health1 (2021).
24. Munyanshongore C., et al. “Community participation in health in the urban health zone of Bukavu (Democratic Republic of Congo)”. Health Notebooks4 (2005).
25. Mudekereza N., et al. “Health policy, actors, strategies and content of interventions to combat cholera in the Uvira health zone in the Democratic Republic of Congo”. Revue de l’nurse congolais1 (2019): 1-9.
26. ZS-Kadutu. Annual Report (2023).
27. OKeeffe, J., et al. “Strengthening Community-Based Surveillance: Lessons Learned from the 2018 to 2020 Ebola Outbreak in the Democratic Republic of Congo (DRC)”. Doctors Without Borders (2023).
28. Sebbani M., et al. “Community mobilization for the improvement of pregnancy surveillance in rural areas in Morocco”. Pan African Medical Journal1 (2020).
29. de VILLEROCHE H and C Pot. “Achieving the Sustainable Development Goals: solutions proposed by the World Bank”. in Annales des Mines-Responsibility and environment. Cairn/Softwin (2017).
30. Kane H., et al. “Community health workers, link in biopower: from health norms to gender norms”. Biopolitics in West Africa. World of life, health, populations (2022).
31. Townsend E., et al. “Linking occupation and place in community health”. Journal of Occupational Science1 (2009): 50-55.
32. ACCESSIBILITY E and RAC HOUSEHOLDS. “COMMUNITY PRE-FINANCING. Development in the face of poverty: economic analysis and development network” (2006): 329.
33. Stone L. “Cultural influences in community participation in health”. Social Science and Medicine4 (1992): 409-417.
34. Organization WH. “Risk Communication and Community Participation (RCCE): Preparedness and Response to the 2019 Novel Coronavirus (2019-nCoV)”. Interim guidelines. 2020: World Health Organization (2020).
35. Tizio S. “Community participation and the role of the State in health policies. When one dogma drives out the other”. MOM Éditions1 (2005): 31-46.
36. Mbaye EM., et al. “Evolution of community involvement in the Ebola response”. Public Health4 (2017): 487-496.
37. Ghislain BB. “Prevention of Malnutrition in South Kivu (Democratic Republic of Congo): role and effectiveness of community-type interventions”.
38. Singaravelu S., et al. “Risk communication, community engagement and social mobilization during the outbreak of Ebola virus disease in Equateur Province, Democratic Republic of the Congo, in 2018”. Weekly Epidemiological Record3 (2019): 32-36.
39. Adama OZ. “Health by and for the community: socio-anthropological diagnosis of the Community Health Worker paradigm in Ivory Coast”. African Journal of Social Sciences and Public Health3 (2024): 33-51.
40. Sangho H., et al. “Training of mothers: strategy to improve the treatment of acute respiratory infections in Mali”. Public Health 24 (2012): 23-31.
41. Carillon S., et al. “The community response to the Covid-19 pandemic in Senegal: a missed opportunity?” Movements 1 (2021): 92-103.
42. PIEDBOEUF É. “Information and Communication Technologies (ICT) serving accessibility and quality of community-based rehabilitation care in Senegal: Establishment of a “tele-supervision” system among the Community-Based Relays for Cerebrally Paralyzed Children (RBC PC) of the SERFA IMC”. (2022).
43. Kayembe Ntumba HC. “Modalities, preferential trajectories and explanatory factors of the dynamics of spatio-temporal diffusion of cholera epidemics in the Democratic Republic of Congo (DRC)” (2023).

Citation

Citation: Hermès Karemere., et al. “From Community Participation to the Improvement of the Quality of Care Services in the Kadutu Health Zone: Challenges and Perspectives”.Acta Scientific Medical Sciences 9.6 (2025): 87-99.

Copyright

Copyright: © 2025 Hermès Karemere., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.