Table 8 Examples of RMNCAH+N services that proved particularly challenging to be implemented in North and South Kivu, as reported by study informants
Factors | Challenging service | Efforts to overcome the challenge |
|---|---|---|
Socio-cultural factors | • Family Planning • Abortion and post-abortion care • Care for survivors of sexual violence • Child health (services beyond vaccination such as growth monitoring or regular checks for early detection of conditions) | • Increase demand through awareness activities and build trust in the provider • Using family planning counselling as entry point for other sexual, reproductive or maternal services • Engage with difference audiences (youth, men, women, religious groups, midwives, teachers, etc) and work with champions • In communication messages, focus on the health risks for women and children (for example: the four “Too”: too many/ too early/ too close/ too late pregnancies) • Free care or input distribution |
Health Service Delivery | ||
Lack of equipment/ ambulance | • Neonatal resuscitation • Referral | • Strengthen providers skills for early detection of complications • Anticipate delivery complications by admitting pregnant women weeks before due date in maternity waiting homes (binyola) |
Lack of trained human resources | • Mental health for GBV victims • Maternal mortality surveillance | • Strengthen providers’ skills |
Essential Medicines | • STIs, HIV • Undernutrition • General child and maternal health | • Improving procurement capacity to prevent stockouts • International procurement (by INGOs) • Resort to local pharmacies |
Emergency context | • Adolescent health • Reproductive health | • Ensuring that MISP is included in all emergency programs |