Facility-Based Assessment of Emergency Obstetric and Neonatal Care in Vanga Health Zone, Kwilu Province, Democratic Republic of Congo

Background Maternal and neonatal morbidity and mortality rates in the Democratic Republic of Congo (DRC) remain unacceptably high. The lack of empirical evidence on the capacity and performance of health facilities offering emergency obstetric and neonatal care (EmONC) is a central problem. With more real-world facility data, policymakers can make informed decisions on resource allocation, investment and harm-reduction strategies. This study collected data from 63 healthcare facilities in the Vanga Health Zone, Kwilu province, DRC to assess the quality of EmONC provision. Methods a cross-sectional survey of all EmONC healthcare facilities excluding Vanga referral hospital in the Vanga Health Zone from September - December 2023. “Type A” facilities were defined as those employing doctors, “Type B” facilities did not employ doctors. Quality indicators measured were: infrastructure, equipment, supplies and medicines, human resources, EmONC signal functions and EmONC patient outcomes (caseload data was collected from two 3-month periods (Jan-March 2021 and Jan-March 2022)). Results We identified widespread infrastructural deficiencies, including no water sources in 61/63 facilities, a complete lack of emergency transfer capability, and limited bed capacity. Stock inventories showed that 39/50 categories in type B facilities and 38/52 categories in type A facilities had “Poor” availability of basic EmONC equipment, supplies, and medications. The median number of nurses providing 24/7 care across all specialities in type B facilities was four. Doctors were employed at 5/63 health facilities (13 doctors total), none had received post-graduate training. Signal function data showed inadequate basic EmONC, plus widespread unsafe practices: caesarean-sections and blood transfusions performed without doctors, support or essential equipment. There were concerns over the validity of caseload data. Conclusion Health facilities in Vanga Health Zone show inadequacies in all quality domains assessed and are unable to provide acceptable EmONC. We also present evidence of unsafe practices risking patient harm.