DRC offers free maternity care to cut death rate among mothers and babies

Pregnant women in the Democratic Republic of Congo should be offered free healthcare in an effort to reduce the country’s high maternal and newborn mortality rate.

Women in 13 of the country’s 26 regions will be entitled to free services during pregnancy and for a month after childbirth by the end of the year. Babies will receive free healthcare for the first 28 days under the programme, which the government plans to expand to the rest of the DRC – although there is no timetable yet for that.

However, health professionals have expressed concern that hospitals and medical centers are ill-equipped to meet the increased demand for services. Some told the Guardian there were not enough staff, facilities or equipment to successfully introduce the $113 million (£93 million) programme, which is supported by the World Bank.

The rollout of the program comes amid nationwide strikes by nurses, midwives, technicians and hospital administrative staff, calling for higher wages and better conditions.

Congo has one of the highest rates of maternal and newborn deaths in the world. The last numbers mention the maternal morality relationship with 547 deaths per 100,000 live births, and the neonatal rate – the number of babies who die before the age of 28 days – 27 per 1,000 live births. The numbers are still a long way off UN goals reducing maternal and neonatal deaths to less than 70 deaths per 100,000 and 12 per 1,000, respectively, by 2030.

Health Minister Roger Kamba Mulamba said the program would free women from “imprisonment”.

He said: “Nowadays mothers can get healthcare without fear when they are pregnant. Babies today don’t die because they don’t have access to antibiotics. Mothers these days don’t die because they can’t afford a C-section delivery.”

General examinations in public health centers can cost around 27,000 Congolese francs (£8), while ultrasounds can cost 60,000 francs. A caesarean section costs approximately 524,000 francs. According to the World Bank more than 60% of Congolese living on less than $2.15 (5,600 francs) a day.

The DRC does not have universal healthcare coverage, and most people cannot afford the limited care that is available. Hospitals They have been known to detain patients until they have paid their medical bills in full. Some new mothers have been forced to stay in overloaded facilities for weeks while family members search for solutions.

The plan was initially launched in the capital Kinshasa in September, but is now being rolled out to a wider part of the country, including eastern DRC, which has been ravaged by years of conflict. The Health Ministry said it is spending $42 million on the program, which is the first part of a $200 million program for prenatal, maternal and neonatal care. It said it used radio and television to inform women about the free services.

Dr. Simplice Kibatatu, from Kinkole General Hospital on the outskirts of Kinshasa, said he welcomed the program but added that his health center was overwhelmed by the number of women seeking care.

“We went from 30 women to about 65 women giving birth every month,” he said. “Pregnant women arrived around 10am. Now that (care) is free, they are waiting early, around 8 a.m., for a consultation.”

Claudel Diakileke, a technician at the maternity center in Barumbu, a district of Kinshasa, called the pilot project a fiasco. He said there were not enough doctors or trained midwives to meet demand, and that the government had not provided health centers with more equipment or medicines.

The country has an estimated 9,500 doctors and 73,000 nurses to serve a population of approximately 95 million people. It has one midwife for every 20,000 people.

He added that some women were concerned about the quality of care they would receive. “They say, ‘we always see that everything that is free is not good,’” he said.

Diakileke criticized the government for not consulting health care workers and community liaison officers, “who play the role of sensitizing the population,” before implementing the plan. Community workers are “the ones who build trust with pregnant women, telling them that if you participate in the program, you will get good care.”

Nenete Asuka, a restaurant owner in Kinshasa, said she has not yet benefited from the scheme. She had to pay for a recent ultrasound and examinations at the Barumbu centre. “They said delivery was free, but when I came here I (had) to pay,” said Asuka, who is six months pregnant.

Filo Biancumpa, a seamstress, who is also six months pregnant, is happy with the plan, but said: “I never knew there was a free birth going on. Every time I come here (to the health center), I find that they (health workers) are on strike. There is no way to talk to female health care workers who attend to pregnant women.”