Multilevel Governance and Control of the COVID-19 Pandemic in the Democratic Republic of Congo: Learning from the Four First Waves
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Organisation of the Response to COVID-19
“The Technical Secretariat is the technical body of the multisectoral committee for information sharing and decision-making. It meets weekly and every Monday. There are also periodic meetings of coordination mechanisms between the Technical Secretariat, the Multisectoral Committee and the task force of the President to enable major decisions to be made, such as the application and release of curfews or the provision of strategic data to conduct the response.”(KI, GDDC)
“So, in terms of governance, it is a strategy that needs to be reviewed, especially in the mechanisms of collaboration among the different components. So, in a very complicated context, sometimes we do not know how to identify the limits of each other’s prerogatives and that can contribute to a blockage.”(KVIII, TS)
“It was very difficult because at the beginning, we were left out of the management of the epidemic. They said it is the Technical Secretariat, it is the taskforce, it is... I do not know, it is happening at that level. They met. It is difficult at my level to tell you if they talk about what, what is the chain of transmission for decisions.”(KII, DES)
“At the provincial level, the advantage is that it is the provincial Minister of Health comes to chair these meetings and we are with all these partners who support us; we discuss with them. If there are options to be considered, we do it together with them, and if there is information to share, we share it together. At the level of our coordination team, almost permanently, irregularly, we are with colleagues from communication, education, the Ministry of Planning, and Nonstate actors. We have a number of organisations that support the health system.”(KIII, PHD 1)
“We were sitting at the zonal level. We had local district committee meetings chaired by the municipality mayor. We had weekly meetings, and decisions were made during these meetings. When we meet, we see the priorities in relation to the activities to be carried out, we decide, we draw up a list of the decisions made, then we follow up under the aegis of the municipality mayor.”(KIV, HZM 1)
“... Nonstate actors, we have a number of organisations that support the health system; in any case they are there, the list is so long and it depends on the level. However, at the level of the PHD we have, I can mention UNICEF, the WHO, FHI 360, MSF, and so forth. In any case, there are many partners who come to support the provincial health division.”(KIII, PHD1)
“.... It is only with time that we finally thought of a kind of decentralization where the trainings were organized. We started to train the health zone management teams (HZMTs), which is the way the members of the HZMTs were trained. Then, we started to train the other providers (Titular Nurses and other professional categories). In addition, at our level of the zone, with the support of other partners such as MSF, PATH, and so forth, we started to train the community health workers (approximately 30 people). We trained the community relay agents (approximately 200), so that they in turn could pass on the information to the community so that it could adhere to the observance of the preventive measures (barrier gestures).”(KVI, HZM 5)
3.2. Decisions at the Central and Provincial Levels (Responses) and the Analytical Process
“There were also major measures such as the closure of all the country’s borders with the outside world; over time, we wanted to confine the whole city, but it was not possible, and we ended up confining the commune of Gombe alone.”(KVII, PHD3)
“We truly have irresponsible authorities who do not measure the consequences of their decisions.”[39]
A key informant said, “For example, we refused to do a global lockdown; that was a decision that had been made, and then we had to postpone it, and that is why we had only contained Gombe. This means that now, we do not do lockdowns like we did in Gombe anymore because we had feedback; we changed the lockdown to a curfew, and that was by having feedback from the community.”(KVIII, TS)
A key informant said: “Well, at the level of the city of Kinshasa, given that at the first moment (March, April, May), we realized that the city of Kinshasa (the capital) was recording a greater number of cases and the municipality of Gombe recorded more cases at the beginning of the pandemic. Decisions were made, notably for lockdowns, which essentially concerned the city of Kinshasa in general, and especially the municipality of Gombe, where there were no more entries or exits and other measures were taken: the banning of gatherings, the closures of schools and churches, the closures of all cultural, commercial and sporting activities, and so forth. In short, all mass activities were banned. These are the measures that were taken.”(KI, GDDC)
3.3. Interventions at the Operational Level
“... For the management of COVID-19 patients, there were structures that were identified here in Kinshasa and that we gave a lot of materials and equipment in terms of COVID-19 treatment centers in hospitals, and we trained the staff of these hospitals to be able to take care of simple cases, moderate cases and severe cases of COVID-19. We also had to train the teams in the health zones because at a certain point we saw that the hospitals were saturated, so we had to rely on the structures in the health zones to take care of patients in the community. Not all patients should always go to hospitals.”(KI, GDDC)
“.... after receiving this alert, they carry out investigations in the field, that is to say, correctly identifying the person and collecting the signs that he or she presents in relation to a table of signs that we provided that are consistent with COVID-19. Thus, after having collected the signs, interviewed or talked to the patient, when we find that this patient needs to be collected, i.e., when the alert is validated, the person goes to the lab to collect the sample and from there, the sample is taken to the NIBR...”(KIX, HZM 3)
“... There is also an intervention through the IPC (Infection Prevention and Control) subcommittee, which is in charge of household decontamination. If a patient is already positive and has already been treated, they quarantine at home, and the house must be decontaminated to protect the family members with whom the patient lives so that they cannot catch the disease. Even in the offices where we work, if there is already a positive case, in any case, we have to close the offices and decontaminate them.”(KX, HZM 2)
As one key informant said, “Communication in general is done through sensitization by the community facilitators and community relay agents. That is, there is a program in place that each community relay agent follows, as there are many of them; those who have been trained by the zone, they share the avenues or health areas to cover. In addition, every day, they go to the places where there are a lot of people, places that are more frequented, for example, markets, shops, and avenues; they do the sensitization with megaphones and they insist a lot in the hot spots where there are crowds of people. All they say is to observe the barrier gestures.”(KX, HZM 2)
The statement of a key informant is as follows: “...We have seen in the past that the introduction of vaccines related to other diseases was beneficial. In addition, we even think that this time, this vaccine could be the solution to this pandemic, especially since we have even fewer cases in the country and the case fatality rate in relation to the pandemic or disease is even lower. So it is time. It is a decision that allows us to anticipate the danger...”(KIX, HZM 3)
A key informant said, “As always! Even the disease itself has not been easily accepted, let alone the vaccine. To date, if you just look at the numbers of people vaccinated, it is not truly too great. Since we started the COVID-19 vaccination activity on May 12 in our zone, we have not yet reached 20 people vaccinated.”(KX, HZM 2)
4. Discussion
5. Limitations of the Study
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Category of Documents | Themes Used | ||
---|---|---|---|
Organisation of the Response | Decisions by State Authorities | Interventions Implemented | |
Gray literature documents | 12 | 21 | 13 |
Scientific publications | 3 | 4 | 11 |
Total | 15 | 25 | 24 |
Structures | Composition | Role |
---|---|---|
State actors at the central level | ||
Presidential Task Force (PTF) | President of the Republic Advisors | ✓ Acts as an interface between the Technical Secretariat and the Presidency |
COVID-19 Multisectoral Response Committee (MRC) | ✓ Prime Minister ✓ Minister of Health ✓ Other related ministers | ✓ To provide the government’s policy direction ✓ Mobilizing resources and managing funds |
Technical Secretariat (TS) | ✓ Coordinator ✓ General Secretary of Health ✓ General Inspector of Health ✓ Representatives of technical and financial partners ✓ Civil society representatives | ✓ Provide strategic management of all response and preparedness commissions. |
State actors at the provincial and peripheral levels | ||
Provincial Coordination Committee (PCC) | ✓ Governor ✓ Ministry (health, communication) ✓ Provincial Division Manager ✓ NGOs | ✓ Implementation of interventions decided by the TS ✓ Coordination of the response at the provincial level |
Operational structure | ✓ Health Zone Management Team ✓ Local political and administrative authorities | ✓ Establishment of rapid response teams ✓ Raising public awareness ✓ Decentralized management of the epidemic through a local approach |
Non-state actors | ||
Technical and financial partners | ✓ WHO, World Bank, Doctor Without Borders, UNICEF, Alima, ICRC… | ✓ Technical support for the government ✓ Supply of materials ✓ Strengthening the capacity of providers ✓ Case management ✓ Raising public awareness |
Other actors | ✓ NGOs and NPOs ✓ Private companies ✓ Religious organisations | ✓ Raising public awareness ✓ Supply of materials ✓ Strengthening the capacity of providers |
Taken Measures | Year 2020 | Year 2021 | 2022 | Acceptability | ||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
M3 | M4 | M5 | M6 | M7 | M8 | M9 | M10 | M11 | M12 | M1 | M2 | M3 | M4 | M5 | M6 | M7 | M8 | M9 | M10 | M11 | M12 | M1 | M2 | M3 | ||
1st Wave | 2nd Wave | 3rd Wave | 4th Wave | |||||||||||||||||||||||
Permanent measures | ||||||||||||||||||||||||||
Correct wearing of mandatory masks | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | Very acceptable by 53% of people |
Systematic hand washing | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | Very acceptable |
Physical or social distancing | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | Weakly acceptable |
Discouragement of greeting by hand when meeting | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | Moderately acceptable |
Avoid touching the face (eyes, nose, mouth) without disinfecting the hands | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | Although very acceptable, impossible to achieve |
Cough or sneeze into the elbow with a disposable tissue | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | Very acceptable by 53% of people |
No hug as a greeting when meeting | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | Moderately acceptable |
Border screening | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | Very acceptable |
Intermittent measures | ||||||||||||||||||||||||||
Prohibition of gatherings of more than 20 people | X | X | X | X | X | X | X | X | X | X | Moderately acceptable | |||||||||||||||
Closure of schools | X | X | X | X | X | X | X | X | X | X | Acceptable by 37% of people | |||||||||||||||
Closure of Universities and Higher Institutes | X | X | X | X | X | X | X | X | X | X | Acceptable by 37% of people | |||||||||||||||
Suspension of services, funerals, and sports activities | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | Acceptable by 34.2% of people | ||||||||
Suspension of sports activities and non-essential shops | X | X | X | X | X | X | X | X | X | Unacceptable | ||||||||||||||||
Closing of discos and nightclubs | X | X | X | X | X | X | X | X | X | |||||||||||||||||
One-time measures | ||||||||||||||||||||||||||
Suspension of all flights from countries at risk | X | X | X | X | X | X | Weakly acceptable | |||||||||||||||||||
Border closure | X | X | X | X | X | X | Weakly acceptable | |||||||||||||||||||
Restriction of provincial movements | X | X | X | X | X | X | X | X | Weakly acceptable | |||||||||||||||||
Prohibition of all migratory movements | X | X | X | Weakly acceptable | ||||||||||||||||||||||
Prohibition of river transport between provinces | X | X | X | Weakly acceptable | ||||||||||||||||||||||
Quarantine of travellers, suspected and positive cases | X | X | X | X | X | X | X | X | Moderately acceptable | |||||||||||||||||
State of health emergency | X | X | X | X | ||||||||||||||||||||||
Confinement | X | X | X | X | X | Unacceptable by 80% of Congolese in Kinshasa | ||||||||||||||||||||
Closure of public establishments | X | X | X | Unacceptable by 67% of people | ||||||||||||||||||||||
Value Added Tax exemption for two months | X | X | X | Very acceptable | ||||||||||||||||||||||
Suspension of payment of electricity and water bills for two months | X | X | X | Very acceptable | ||||||||||||||||||||||
Postponement of the rent payment by tenants | X | X | X | Very acceptable | ||||||||||||||||||||||
Curfew from 9 p.m. to 5 a.m. | X | X | X | X | X | X | X | X | X | X | X | X | X | |||||||||||||
Vaccination against COVID-19 | X | X | X | X | X | X | X | X | X | X | X | X | Very acceptable |
Taken Measures | Year 2020 | Year 2021 | Year 2022 | ||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
M3 | M4 | M5 | M6 | M7 | M8 | M9 | M10 | M11 | M12 | M1 | M2 | M3 | M4 | M5 | M6 | M7 | M8 | M9 | M10 | M11 | M12 | M1 | M2 | M3 | |
1st Wave | 2nd Wave | 3rd Wave | 4th Wave | ||||||||||||||||||||||
Active case finding | X | X | X | X | X | X | X | X | |||||||||||||||||
Case detection (rapid test and PCR) | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X |
Mass screening | X | X | X | ||||||||||||||||||||||
Vaccination against COVID-19 | X | X | X | X | X | X | X | X | X | X | X | X |
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Kashiya, Y.; Ekofo, J.; Kabanga, C.; Agyepong, I.; Van Damme, W.; Van Belle, S.; Mukinda, F.; Chenge, F. Multilevel Governance and Control of the COVID-19 Pandemic in the Democratic Republic of Congo: Learning from the Four First Waves. Int. J. Environ. Res. Public Health 2023, 20, 1980. https://doi.org/10.3390/ijerph20031980
Kashiya Y, Ekofo J, Kabanga C, Agyepong I, Van Damme W, Van Belle S, Mukinda F, Chenge F. Multilevel Governance and Control of the COVID-19 Pandemic in the Democratic Republic of Congo: Learning from the Four First Waves. International Journal of Environmental Research and Public Health. 2023; 20(3):1980. https://doi.org/10.3390/ijerph20031980
Chicago/Turabian StyleKashiya, Yves, Joel Ekofo, Chrispin Kabanga, Irene Agyepong, Wim Van Damme, Sara Van Belle, Fidele Mukinda, and Faustin Chenge. 2023. "Multilevel Governance and Control of the COVID-19 Pandemic in the Democratic Republic of Congo: Learning from the Four First Waves" International Journal of Environmental Research and Public Health 20, no. 3: 1980. https://doi.org/10.3390/ijerph20031980