Routine Health Information System (RHIS) Assessment for Artemisinin-based combination Treatment outcomes for Malaria in Kisantu Health Zone, DRC

Abstract Background : Malaria treatment failure remains a significant challenge in the Democratic Republic of Congo (DRC) despite the adoption of Artemisinin-based Combination Therapies (ACTs) since 2005. While the World Health Organization (WHO) recommends periodic Therapeutic Efficacy Studies (TES) for high-transmission countries like the DRC, the practical effectiveness of using the existing Routine Health Information System (RHIS) to capture basic data on potential treatment failures remains unexamined. This study aimed to bridge this gap by evaluating the RHIS in the Kisantu Health Zone, assessing its structural capacity to capture treatment outcomes data, and identifying the challenges faced by health practitioners. The findings are intended to provide evidence-based recommendations to strengthen the RHIS for more timely surveillance of antimalarial treatment outcomes. Method : This qualitative study used a purposeful sampling approach to select seven primary health facilities and key health zone staff. Data was collected through semi-structured interviews on the documentation of therapeutic failures following ACT treatment and a structured document review to assess the system's capacity, existing processes, and associated challenges. Result: Interviews with health facility practitioners and health zone staff revealed a significant gap in the Routine Health Information System’s (RHIS) capacity for malaria surveillance. While facilities handle a high volume of malaria cases using standard RHIS tools, practitioners feel they lack the ability to formally document cases of treatment failure, despite observing them. This is largely due to a lack of a clear mandate from the national malaria control program, which has resulted in an absence of specific indicators and formal training on this issue. The findings indicate that RHIS is currently a passive system for general patient data rather than an active tool for surveillance drug outcomes. Both health facility and health zone staff have proposed feasible, low-cost solutions, including targeted training sessions, dedicated registers, and specific reporting forms, to improve the system's capacity to monitor treatment efficacy. These suggestions highlight that the primary barrier is not technical but a procedural and policy issue that can be addressed with targeted interventions. Conclusion. While the RHIS in the Kisantu Health Zone has the structural capacity to record basic patient data, it is still not an effective tool for the surveillance of anti-malarial drug effectiveness. The primary barriers are procedural and policy-based, stemming from a lack of clear mandate, specific indicators, and formal training for health workers. Implementing the proposed, low-cost interventions—such as targeted training and dedicated reporting tools—could significantly strengthen RHIS, transforming it into a more proactive surveillance tool to support timely and evidence-based public health decisions.