Profile of Chief Medical Officers and performance of health zones in crisis contexts: a cross-sectional study in three provinces of the Eastern Democratic Republic of Congo
Abstract Context In crisis-affected health systems, the performance of health zones (also known as health districts) is challenged by recurrent armed conflicts and state fragility. The profiles of health zone managers and contextual factors can significantly influence the zones' ability to effe...
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BMC
2025-03-01
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| Series: | Human Resources for Health |
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| Online Access: | https://doi.org/10.1186/s12960-025-00982-9 |
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| author | Rosine Bigirinama Jean-Corneille Lembebu Christian Chiribagula Pacifique Mwene-Batu Denis Porignon Abdon Mukalay Albert Mwembo Ghislain Bisimwa |
| author_facet | Rosine Bigirinama Jean-Corneille Lembebu Christian Chiribagula Pacifique Mwene-Batu Denis Porignon Abdon Mukalay Albert Mwembo Ghislain Bisimwa |
| author_sort | Rosine Bigirinama |
| collection | DOAJ |
| description | Abstract Context In crisis-affected health systems, the performance of health zones (also known as health districts) is challenged by recurrent armed conflicts and state fragility. The profiles of health zone managers and contextual factors can significantly influence the zones' ability to effectively respond to population health needs. This study explores these interactions to identify key factors associated with health zones performances in three provinces of Eastern Democratic Republic of Congo (DRC), a region that has endured over three decades of conflict. Methods This mixed-methods study was conducted between October 2022 and April 2024, using data covering the period from 2017 to 2022. In the DRC, health zones are managed by Chief Medical Officers (CMOs). We assessed the functionality and performance of health zones using key indicators related to primary healthcare delivery and management. Data on CMO profiles and the operational contexts of their health zones were analyzed to identify factors influencing functionality and performance, through multivariate regressions (p < 0.05). In addition, 17 individual interviews with key health system actors were analyzed thematically to capture perceptions on CMO performance and stability. Results CMOs with training in primary healthcare management and extensive professional experience were statistically associated with higher health zone performance. Conversely, instability among CMOs, due to frequent rotations driven by political influences and weak collaboration between decision-making bodies, negatively impacted performance. However, support from international and faith-based partners was associated with improved health zone performance. Conclusions This study highlights the importance of investing in capacity-building for health managers to strengthen health systems and improve resilience in crisis settings. Establishing robust governance frameworks that promotes transparency in the recruitment and management of health managers, and ensure stability in human resources, is critical for maintaining and improving health system performance. |
| format | Article |
| id | doaj-art-278d82d8b2fc4a52866b3fa1efefba45 |
| institution | DOAJ |
| issn | 1478-4491 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Human Resources for Health |
| spelling | doaj-art-278d82d8b2fc4a52866b3fa1efefba452025-08-20T02:56:09ZengBMCHuman Resources for Health1478-44912025-03-0123111910.1186/s12960-025-00982-9Profile of Chief Medical Officers and performance of health zones in crisis contexts: a cross-sectional study in three provinces of the Eastern Democratic Republic of CongoRosine Bigirinama0Jean-Corneille Lembebu1Christian Chiribagula2Pacifique Mwene-Batu3Denis Porignon4Abdon Mukalay5Albert Mwembo6Ghislain Bisimwa7Ecole Régionale de Santé Publique, Université Catholique de BukavuEcole Régionale de Santé Publique, Université Catholique de BukavuEcole Régionale de Santé Publique, Université Catholique de BukavuEcole Régionale de Santé Publique, Université Catholique de BukavuDépartement des Sciences de la Santé Publique, School of Medicine, Université de LiègeEcole de Santé Publique, University of LubumbashiEcole de Santé Publique, University of LubumbashiEcole Régionale de Santé Publique, Université Catholique de BukavuAbstract Context In crisis-affected health systems, the performance of health zones (also known as health districts) is challenged by recurrent armed conflicts and state fragility. The profiles of health zone managers and contextual factors can significantly influence the zones' ability to effectively respond to population health needs. This study explores these interactions to identify key factors associated with health zones performances in three provinces of Eastern Democratic Republic of Congo (DRC), a region that has endured over three decades of conflict. Methods This mixed-methods study was conducted between October 2022 and April 2024, using data covering the period from 2017 to 2022. In the DRC, health zones are managed by Chief Medical Officers (CMOs). We assessed the functionality and performance of health zones using key indicators related to primary healthcare delivery and management. Data on CMO profiles and the operational contexts of their health zones were analyzed to identify factors influencing functionality and performance, through multivariate regressions (p < 0.05). In addition, 17 individual interviews with key health system actors were analyzed thematically to capture perceptions on CMO performance and stability. Results CMOs with training in primary healthcare management and extensive professional experience were statistically associated with higher health zone performance. Conversely, instability among CMOs, due to frequent rotations driven by political influences and weak collaboration between decision-making bodies, negatively impacted performance. However, support from international and faith-based partners was associated with improved health zone performance. Conclusions This study highlights the importance of investing in capacity-building for health managers to strengthen health systems and improve resilience in crisis settings. Establishing robust governance frameworks that promotes transparency in the recruitment and management of health managers, and ensure stability in human resources, is critical for maintaining and improving health system performance.https://doi.org/10.1186/s12960-025-00982-9Health system managementConflictsHealth human resourcesDRC |
| spellingShingle | Rosine Bigirinama Jean-Corneille Lembebu Christian Chiribagula Pacifique Mwene-Batu Denis Porignon Abdon Mukalay Albert Mwembo Ghislain Bisimwa Profile of Chief Medical Officers and performance of health zones in crisis contexts: a cross-sectional study in three provinces of the Eastern Democratic Republic of Congo Human Resources for Health Health system management Conflicts Health human resources DRC |
| title | Profile of Chief Medical Officers and performance of health zones in crisis contexts: a cross-sectional study in three provinces of the Eastern Democratic Republic of Congo |
| title_full | Profile of Chief Medical Officers and performance of health zones in crisis contexts: a cross-sectional study in three provinces of the Eastern Democratic Republic of Congo |
| title_fullStr | Profile of Chief Medical Officers and performance of health zones in crisis contexts: a cross-sectional study in three provinces of the Eastern Democratic Republic of Congo |
| title_full_unstemmed | Profile of Chief Medical Officers and performance of health zones in crisis contexts: a cross-sectional study in three provinces of the Eastern Democratic Republic of Congo |
| title_short | Profile of Chief Medical Officers and performance of health zones in crisis contexts: a cross-sectional study in three provinces of the Eastern Democratic Republic of Congo |
| title_sort | profile of chief medical officers and performance of health zones in crisis contexts a cross sectional study in three provinces of the eastern democratic republic of congo |
| topic | Health system management Conflicts Health human resources DRC |
| url | https://doi.org/10.1186/s12960-025-00982-9 |
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