Neonatal Health in the Democratic Republic of Congo

Introduction: Every year an estimated 2.4 million babies die during the neonatal period, the first
four weeks of life. Almost all neonatal deaths occur in low-income and middle-income countries, yet most research focuses on the 1% of deaths that occur in high-income countries. This case study focuses on the Democratic Republic of Congo (DRC), a country with particularly high rates of neonatal death. DRC has made significant efforts to improve neonatal health; however, much work remains for the country to meet its main 2020 Every Newborn Action Plan (ENAP) goals to end preventable neonatal death. In order to accelerate progress of their 2030 ENAP goals, understanding the surrounding factors that impact high neonatal mortality is vital.

Objectives: To identify barriers and opportunities for improving neonatal health and decreasing rates of neonatal death in DRC. Following this, to present recommendations for accelerating progress towards reducing the national neonatal mortality rate.

Background: In 2014, the World Health Organization proposed ENAP as a step towards achieving Sustainable Development Goal (SDG) 3.2, which includes reducing preventable neonatal deaths. SDG 3.2 is particularly relevant in DRC, where several issues remain a threat to neonatal health including ongoing conflicts, internally displaced populations, spread of infectious diseases (such as Ebola, measles, and now COVID-19), and a weak healthcare system.

Methods: A thematic review of recent grey and academic literature regarding key themes, questions, tensions, and emerging lessons associated with DRC and neonatal health was conducted. Informed by the literature review, a qualitative case study approach was then utilized. This included 12 Key-informant interviews (KIIs) conducted with healthcare providers and professional associations, humanitarian and healthcare-implementing partners, and government and local authorities. Interviews were conducted virtually in French and translated and transcribed to English for a thematic analysis.

Results: Key factors supporting neonatal health included national commitment to neonatal health, external partnerships, training and mentoring, as well as home services and cost-effective practices. Key challenges for neonatal health included limited financial resources, ongoing conflict, lack of infrastructure and equipment, unfavorable external partnerships that serve as a crutch for the government and lack of motivation from health providers and clinical health workers due to difficult working conditions and lack of pay.

Conclusions: To attain the SDG targets for neonatal health, DRC must prioritize neonatal health, especially in its regions experiencing humanitarian challenges, by continuing to work on effective conflict resolution methods, attaining better coordination with humanitarian organizations, emphasizing neonatal plans in emergency preparedness, focusing on incentives that motivate health care workers, and investing in low-technology efforts that improve health services.