Improving Demand for Health Services with the Involvement of Community Health Workers: A Case Study of Community Dynamics at Mosango Rural Health Zone in the Democratic Republic of Congo

John Etshumba Mukulukulu¹, Dosithee Ngo-Bebe², Norbert Kimbamfu Mabanza³, Fulbert Nappa Kwilu⁴

¹Kinshasa School of Public Health, Management Department, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
²Kinshasa School of Public Health, Chief of Management Department, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
³Kinshasa Superior Technical and Medical Institute, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
⁴Kinshasa School of Public Health, Management Department, University of Kinshasa, Kinshasa, Democratic Republic of Congo.

Introduction: DRC is one of Sub-Saharan Africa country with high infant and maternal mortality. The major problem is the underuse of health services because of inaccessibility on all fronts and also the population under-information to the health and development problems. Community participation is one of the basic requirements and basic principles of the Primary Health Care to solve this problem. That is why we choose Mosango RHZ to assess the improvement of demand for health services with the involvement of community health workers. Methods: We conduct a cross-sectional study carried out in Mosango RHZ in 2019. The study combined a mixed method (quantitative and qualitative) based on the realist evaluation approach which takes into account the Context-Mechanisms-Effects explained in the conceptual framework model. Results: Four predictive factors determine the improvement of health indicators with the involvement of CHWS in activities of the Mosango RHZ: Having attended school (p = 0.000; OR = 0.150); Having sufficient theoretical knowledge on malaria, diarrhoea, pneumonia, malnutrition, availability of inputs to treat these diseases (p = 0.004; OR = 0.192); Having taken the training as CHWS and Having undergone more than one training as CHW (p = 0.013; OR = 0.074). This result corroborated with other studies carried in low- and middle-income countries like DRC. Conclusion: The involvement of CHWs on improving demand for health services is effective in Mosango RHZ. The improvement of health service indicators and the effectiveness of this community intervention were conditioned by capacity building of the CHWs, the availability of inputs and the involvement of the community in the activities of the health zone through the Community Action Cells.

CHWS Health Services Utilization, Mosango Rural Health Zone, Realist Evaluation, Democratic Republic of Congo