Perceptions of the rape crisis in the Eastern Democratic Republic of Congo: A community-based approach using an opportunistic design

For almost three decades, the Democratic Republic of Congo (DRC) has experienced cycles of armed conflict, particularly in the east. During these conflicts, systematic rape has been used as a weapon of war to break women and communities. Knowledge produced about this phenomenon to date relates to the epidemiology, etiology and the consequences of these rapes, particularly on survivors in care institutions, thus ignoring the impact this phenomenon has on the communities. Our survey aims to investigate the extent to which women from the Orientale, North Kivu and South Kivu provinces experienced rape, as well as their perceptions regarding its frequency, characteristics, and repercussions for/on victims in their communities. From a sample of 1483 women, more than 99% had directly or indirectly experienced rape, on at least five occasions in three-quarters of cases. In their experience, a large proportion of the rapes took place at the victims' homes in the presence of family members and were perpetrated by members of military or paramilitary groups. Frequent health problems (several possibilities) reported include: bleeding (40.8%), pain (23.9%); unwanted pregnancies/abortions (23.4%), urogenital problems including STD (12.0%). Concerning mental health, they reported fear and anxiety (56.3%), depression and suicidal thoughts (16.8 %), insomnia (5.3%); 94.7% reported feelings of humiliation and shame and 6.9% social exclusion and stigmatization. Support for victims comes largely from NGOs (47.6%), families (27.1%) and Churches (14.3%). This is a major cultural, economic, political, human rights, and public health problem, which the authorities and international community must commit to tackling. (Afr J Reprod Health 2022; 26[4]: 42-56).

Analyse du financement du systeme de sante au Congo

En 1993; la Banque Mondiale a consacre son desormais traditionnel Rapport sur le developpement dans le monde au theme de la sante et plus particulierement a investir dans la sante. C'est dire l'importance de ce probleme; de la sante bien sur en tant que facteur essentiel de developpemnt mais aussi de son financement: on sait que le manque croissant de ressources financieres est une des causes essentielles de la deterioration de la qualite des soins en Afrique sub saharienne et le Congo n'y echappe malheureusement pas

Health Sector Strategic Plan 2000/01 - 2004/05

The Health Sector Strategic Plan (HSSP - 2000/1 - 2004/5) has been developed as a collaborative undertaking of the Minsitry of Health; related ministries; the development partners and other stakeholders. The plan has been prepared within the framework of the Poverty Eradication Action Plan and health sector policy. It described the major technical helath programmes and support services and their outputs. The technical health programmes arise from the minimum health care package described in the policy; while the support services include HUman Resources; Policy and Planning; quality assurance; information management system; research and development; health infrastructure; procurement of drugs; equipment; supplies and logistics; health care financing and legal and regulatory framework. The overall purpose of the Plan is to reduce morbidity and mortality from major causes of ill health in Uganda and the disparities therein; as a contribution to poverty eradication and economic and social development of the people. Health sector reforms; including decentralisation; have led to administrative and structural changes in the health care delivery system. The district health system will be used to deliver a package of health services to the population of Uganda; while the Minsitry of Health will be responsible for policy formulation; standards and guidelines; overall and other national level health care institutions will provide the necessary back up support to the district health services. The objectives of the plan are to:. Relate the ongoing health sector reforms to health development . Provide a framework for three year rolling planns at all levels. Involve all stakeholders in health development. Exhibit a health sector strategic framework; with coherent goals; objectives and targets for the next five years. Indicate the level of investment in terms of costs required for achieving the policy objectives agreed upon by Government of Uganda and its development partners. Articulate the essential linkages between the various levels of the national health care delivery system. The Strategic plan is presented in a Logical Framework Matrix in figures I and II. The overall programme Goal and the Programme Purpose are presented at the top of the matrix. There are five major outputs of the health Sector Strategic Plan. Below are the Outputs: Output 1 defines the minimum package of health services . Output 2 describes the health organisation and management system. Output 3 to 5 describe important support services that are necessary for the successful delivery and implementation of the minimum health package. Each of these outputs consists of a number of major elements which when considered together will allow the output to be produced. Figure I presents an overview of the plan; which outlines the elements that make up each output. Each of these elements is fully described in narrative form and supported by a Logical Framework Matrix in subsequent chapters. The elements have outputs and represent a broad guide for operational activities. Within the extensively decentralised service delivery system in the country; and the nature of the Budget Framework and the Medium Term Expenditure Framework (MTEF) formulation process; it is considered inappropriate to develop a detailed costed five year operational plan for the HSSP. Cost estimates for the five year plan are presented in chapter five. Detailed operational plans and budgets will be developed annually by the central implementating proggrammess and implementation processes to ensure optimal use of resources within the framework of the minimum health care package. The indicative cost analysis for the Health Sector Stragetic Plan shows a total cost figure of US$954 million. The annual total costs are US$159 million in Year 1; US$179 million in Year 2; US$207 million in Year 3; US$ 209 million in Year 4; and US$ 201 million in Year 5. The costs for delivering the Uganda Minimum Health Care Package are US$ 110 million in Year 1; US$117 million in Year 2; 138 million in Year 3; US$ 140 million in Year 4; and US$ 144 million in Year 5. They represent between 65and 73 of annual total costs. The Health Sector Strategic Planning financing framework anticipates an indicative resource envelope of US$ 956 million and government allocation totalling US$344 million over the five-year period. Government of Uganda (GOU) resource as a percentage of recurrent cost will range from 42in Year 1 to 55 in sector. The process of financial planning; programming and management requires commitement of all the stakeholders in the health delivery system namely; the government; the donoros; the private sector and the communities. It is envisaged that government will seek support from development partners to redirect spending through a flexible budgetary sudgetary support procedure. Furthermore; it would explore options for improving efficiency within the public health sector. The implementation of the Health Sector Stragetic Plan will be a dynamic process with constant refinement of the defined needs; modification of the minimum package; cost estimates and provision of financial resources for the health service needs. Following the initial plan design; the next step will include further preliminary technical analysis and preparation of operational plans at all levels. In subsequent years; it is envisaged that the performance of the Health Sector Strategic Plan will be monitored twice yearly through the Joint Missions and will be subjected to mid-term review and re-appraisal