Abstract

Facility-Based Assessment of Emergency Obstetric and Neonatal Care in Vanga Health Zone, Kwilu Province, Democratic Republic of Congo

Junior, M. Desmond, K. Sabwa, B. English, M.
Wellcome Open Res. 2026; 111

Permanent descriptor

https://doi.org/10.12688/wellcomeopenres.25137.2

BACKGROUND: Maternal and neonatal morbidity and mortality rates in the Democratic Republic of Congo (DRC) remain unacceptably high. The lack of empirical evidence on the capacity and performance of health facilities offering emergency obstetric and neonatal care (EmONC) is a central problem. METHODS: This study assessed the quality of EmONC provision across 63 healthcare facilities in Vanga Health Zone, Kwilu province, DRC. RESULTS: We identified widespread infrastructural deficiencies, including no water sources in 61/63 facilities, no emergency transfer capability, and critically low bed capacity. Stock inventories showed that 38/52 categories assessed in facilities had poor availability of basic EmONC equipment, supplies and medications. The median number of nurses providing 24/7 care across all specialties in nurse-led facilities was four. Doctors were employed at 5/63 facilities (13 doctors total), none with postgraduate training. Signal function data revealed widespread failure to provide basic EmONC alongside dangerous practices including caesarean sections and blood transfusions performed without doctors, trained staff or essential equipment. Caseload data was near-identical across both collection periods in all 58 nurse-led facilities, possibly suggesting falsification linked to performance-based financing. CONCLUSION: Health facilities in Vanga Health Zone show inadequacies in all quality domains assessed and are unable to provide safe or acceptable EmONC. Women and newborns are suffering unnecessary harm due to system-level failings in resource allocation and governance. Facility-based Assessment of Emergency Obstetric and Neonatal Care in Vanga Health Zone, Kwilu Province, Democratic Republic of Congo. The DRC has one of the highest rates of mortality for mothers and newborn babies despite many efforts to improve access and quality to healthcare. A key problem is that there is very little accurate data on the resources and facilities available at health centres in the country, particularly in more rural and remote areas. We visited all 63 health facilities within one health district, Vanga, located within Kwilu province, South-Western DRC. At each facility, we collected data to assess the quality of healthcare in several areas, including case registers from two three-month periods, infrastructure, staff, equipment, supplies and medicines, and key emergency obstetric and neonatal services offered. The data showed widespread shortages of the most basic infrastructure, such as beds, toilets and running water. Facilities were greatly short-staffed and not properly trained to handle the cases they were performing. Facilities lacked the most basic supplies and medicines. Some facilities did not provide core emergency services such as delivering antibiotics to pregnant and post-parum women, whereas others reported performing caesarian sections and blood transfusions without adequate training or doctors. There was evidence that cases being recorded in registers were falsified for financial incentives, which cast doubt on the validity of the caseload data. These findings underscore the failings of obstetric and neonatal care provided in rural areas of the DRC, and suggest patients are being harmed. Policymakers and researchers should work closely with local health managers to identify and implement strategies to improve the validity of caseload data and address critical shortages in resource allocation. eng