DRC Session 3D3

Dr. Marie Louise Mbo, M.P.H Director of National Reproductive Health Program - Democratic Republic of congo

Trends in institutional deliveries :

Institutional deliveries increased from 69,7% in 1998 to 74% in 2007 Maternal Mortality (MMR) decreased from 1837/100000 live births in 1998 to 549/100000 in 2007 Neonatal Mortality (NMR) increased from 39/1000 live births in 2001 to 42/1000 LB in 2007 Institutional deliveries take place in health facilities, both public and private, and are assisted mostly by Nurses, Midwifes, and less frequently by General Practitioners and Specialists
Sources: MICS2 2001; Strategic Povert Reduction Document 2006-2008. DHS (Demographic and Health Survey) 2007; Situation analysis of National Reproductive Health Programme 2007-2010

 Reasons of high rates of institutional delivery:

Behavior acquired since colonial time Financial accessibility facilitated by family solidarity (birth is a happy event) Good availability of staff -even if not qualified-

Impacts of the increase of institutional delivery on the quality of service:

Offer has increased but insufficiently so that some women go to facilities not compliant with standards or even quack doctors Service isnt up to Maternal and Newborn Health standards and procedures

Current post delivery discharge practices

Average duration of stay is 3 days Discharge procedures : opinion of medical staff then administrative authorization (payment of expenses), discharge with an appointment for a follow-up visit at health facility after 6 days However the Strategy of " Three 6 " is not followed (1st visit after 6th hour, 2nd visit after 6th day, 3rd after 6th week]

Challenges: Postnatal follow-up remains the big challenge.

Even if Postnatal visits increased from 23,8 % to 64 % between 2001 and 2010, risk of mortality remains. Furthermore, followup visit at home are not part of DRC strategies.

Solutions : National Strategic Plan 2011-2015

Building technical capacities Increasing financial resources Strengthening information system Increasing number of maternity hospitals by both construction & rehabilitation [6000 in 1990 & more than 8000 in 2006] Quality Insurance Plan of reproductive health products Strengthening communication on reproductive Health

Perspectives : Increase coverage / universal access; Improve

quality of service ; Increase use of key services of Maternal and Newborn Health.