Papers by Christian Molima
Research Square (Research Square), Mar 17, 2023
International Journal of Integrated Care, Oct 23, 2018
Background: The concept of biopsychosocial care is one of the approaches recommended in the healt... more Background: The concept of biopsychosocial care is one of the approaches recommended in the health system by the WHO. Although efforts are being made on the provider side to implement it, community involvement is needed to enable its integration into the health sector. For this to happen, the community must first have an understanding of the approach, as a stakeholder and direct beneficiary. The objective of this study is to understand the community's views on the concept of integrated health care according to the biopsychosocial approach (BPS) at the Health Center of a Health District. Methods: We conducted a qualitative study based on individual semi-directive interviews with members of the Health Development Committees of six Health Areas belonging to four Health Districts as well as with some patients met in health facilities. A total of 15 interviews were conducted. The adapted NoMAD tool, derived from the Theory of the Normalization Process of Complex Interventions, allowe...
African Journal of Primary Health Care & Family Medicine, 2021
Basket fund, an innovative approach for intermediate health system level financing in the Democra... more Basket fund, an innovative approach for intermediate health system level financing in the Democratic Republic of Congo: Implementation process and challenges. Background: Universal health coverage should allow countries to establish a financing strategy in order to guarantee the health of the population. Aim: Our objective was to describe the process and preliminary results of the implementation of the basket fund approach as a mode of financing the intermediate level (provincial health divisions) of the Congolese health system. Setting: The study was conducted in the provincial health divisions (PHDs), representing the intermediate level of the health system in the Democratic Republic of Congo, where the basket fund approach has been implemented Methods: We conducted a mixed-methods convergent study as part of the evaluation of the basket fund approach in the Democratic Republic of Congo, five years after its introduction (2014-2019). Data was collected through a document review and individual interviews by telephone. A descriptive analysis of the quantitative data was conducted using Statistical Package for Social Sciences (SPSS) version 24 software. The qualitative data were analysed by thematic analysis using a pre-established thematic framework. Results: The implementation of the basket fund approach was effective in some (PHDs) (53.8% in 2016). The operating costs of the PHDs varied according to the size, density and number of health zones covered. In the PHDs where the basket fund was operational, this approach appeared to contribute to improved planning and management in the use of resources, the partnership between technical and financial partners (TFPs and PHDs) and incentives for the performance of PHD agents. Conclusion: In the DRC, the basket fund approach has contributed to improved collaboration between donors in the health sector and facilitated the decentralisation of funding planning to the provincial level.
International Journal of Innovation and Applied Studies, 2020
Introduction: The present study aims to be carried out in the Bagira health zone in the Democrati... more Introduction: The present study aims to be carried out in the Bagira health zone in the Democratic Republic of Congo and aims to determine the factors that influence access to health services for children under 5 years of age suffering from malaria in this zone. Specifically, the study will describe the therapeutic route for children under 5 with malaria, identify the specific determinants of the use of health services in the Health Zone by these children and will suggest prospects for improving the access to health care and services. Methodology: The study will be cross-sectional, consisting of a household survey of children who had a fever episode during 2019 in the Bagira Health Zone. The data collected will be mainly analyzed using the Logit multinomial model in order to identify the specific determinants of access to health services by the study population.
Background Health system, in Democratic Republic of Congo, is expected to move towards a more peo... more Background Health system, in Democratic Republic of Congo, is expected to move towards a more people-centered form of healthcare provision by implementing biopsychosocial (BPS) approach. It’s then important to examine how change are possible in providing healthcare at first line of care.
African Journal of Primary Health Care & Family Medicine, 2021
Background In the Democratic Republic of Congo (DRC), healthcare services are still focused on di... more Background In the Democratic Republic of Congo (DRC), healthcare services are still focused on disease control and mortality reduction in specific groups. The need to broaden the scope from biomedical criteria to bio-psychosocial (BPS) dimensions has been increasingly recognized. Aim The objective of this study was to identify the barriers and facilitators to providing healthcare at the health centre (HC) level to enable BPS care. Settings This qualitative study was conducted in six HCs (two urban and four rural) in South-Kivu (eastern DRC) which were selected based on their accessibility and their level of primary healthcare organization. Methods Seven focus group discussions (FGDs) involving 29 healthcare workers were organized. A data synthesis matrix was created based on the Rainbow Model framework. We identified themes related to plausible barriers and facilitators for BPS approach. Results Our study reports barriers common to a majority of HCs: misunderstanding of BPS care by ...
PLOS ONE
Introduction Little is known about the outcomes of subjects with a history of severe acute malnut... more Introduction Little is known about the outcomes of subjects with a history of severe acute malnutrition (SAM). We therefore sought to explore the long-term effects of SAM during childhood on human capital in adulthood in terms of education, cognition, self-esteem and health-related disabilities in daily living. Methodology We traced 524 adults (median age of 22) in the eastern Democratic Republic of the Congo, who were treated for SAM during childhood at Lwiro hospital between 1988 and 2007 (median age 41 months). We compared them with 407 community controls of comparable age and sex. Our outcomes of interest were education, cognitive function [assessed using the Mini Mental State Examination (MMSE) for literate participants, or its modified version created by Ertan et al. (MMSE-I) for uneducated participants], self-esteem (measured using the Rosenberg Self-Esteem Scale) and health-related social and functional disabilities measured using the World Health Organization Disability Ass...
Acta Scientific Medical Sciences
BMC Emergency Medicine
Introduction Penetrating craniocerebral injuries (PCCI) are types of open head injuries caused by... more Introduction Penetrating craniocerebral injuries (PCCI) are types of open head injuries caused by sharp objects or missiles, resulting in communication between the cranial cavity and the external environment. This condition is deemed to be more prevalent in armed conflict regions where both civilians and military are frequently assaulted on the head, but paradoxically their hospital outcomes are under-reported. We aimed to identify factors associated with poor hospital outcomes of patients with PCCI. Methods This was a retrospective series of patients admitted at the Regional Hospital of Bukavu, DRC, from 2010 to 2020. We retrieved medical records of patients with PCCI operated in the surgical departments. A multivariate logistic regression model was performed to find associations between patients’ admission clinico-radiological parameters and hospital outcomes. Poor outcome was defined as a Glasgow Outcomes Score below 4. Results The prevalence of PCCI was 9.1% (91/858 cases) among...
Journal of Hospital Management and Health Policy
Background: This study determines hospital performance in terms of the operating standards of a G... more Background: This study determines hospital performance in terms of the operating standards of a General Referral Hospital (GRH) established by the Democratic Republic of the Congo (DRC) Ministry of Health in relation to the organization of a hospital, its package of activities, the resources available, its architectural structure and its environment. Methods: A descriptive, cross-sectional study conducted in 2017 at Bagira Reference General Hospital in the city of Bukavu, in DRC. Data collection used the literature review, observation and interviews. The data were compiled using Excel spreadsheets, analyzed using Word and Excel, and presented as proportions and qualitative observations. All results were compared to the standards of the Ministry of Health of the DRC for the GRH functioning. Results: Based on the 5 components analyzed relating to the operating standards of an GRH, the level of performance is variable depending on each component. Standards are sometimes completely achieved, sometimes partially, sometimes not reached. Gaps hampering the operation of the hospital were identified using this standards-based performance assessment model. Conclusions: Measuring hospital performance according to standards is one of the perspectives that can guide managers to improve the quality of the care provided. The operating standards of the Bagira GRH are on average reached partially, jeopardizing the quality of patient care. While local efforts can be made to raise the hospital's organizational level, improving the quality of the hospital activity package requires significant funding from the government.
African Journal of Primary Health Care & Family Medicine
Reform and Performance of the Provincial Health Inspectorate and the Provincial Division of Healt... more Reform and Performance of the Provincial Health Inspectorate and the Provincial Division of Health of South Kivu in the Democratic Republic of Congo. Background: The intermediate level incorporated both the Provincial Health Inspectorate (IPS) and the Provincial Health Division (DPS) of Health. The new constitution of 2006 gave impetus to decentralisation, which became effective in 2015. The reform introduced at the intermediate level clearly separated the IPS and the DPS. This article assesses the effect of this reform on the performance of IPS and DPS in South Kivu, Democratic Republic of Congo. Methodology: The study is evaluative before and after and covers the period from 2012 to 2017. It uses mixed methods: three techniques were used to collect data including observation, document review and individual interviews. The analysis of the quantitative data concerned the evolution of the indicators; that of qualitative data was carried out by themes from two theoretical models: the ministerial functional framework and the 'Strengths, Weaknesses, Opportunities and Threats' analysis framework (SWOT analysis). Scores were assigned to each managerial function according to their level of performance for better comparison. Results: After the reform, a decline in the performance score of activities devolved to IPS is noted, mainly due to the low funding of activities. On the other hand, in the DPS, the evolution of the score is favorable, because of the strong support given to the reform at this level by the partners and the government. The alignment of partners to a single contract for funding DPS activities is observed. The weak financing of the health sector by the government remains a weak point, however, and the brain drain a threat to institutional sustainability. The introduction of the single financing contract constitutes an opportunity to improve the performance of the provincial management team. Discussion and Conclusion: The study shows the improvement in the performance of managerial functions of the DPS and the regression to the IPS. The low funding of IPS by the Congolese government could jeopardise the reform.
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Papers by Christian Molima