Pregnant women across the Democratic Republic of the Congo are to be offered free healthcare in an effort to cut the country’s high rates of maternal and neonatal deaths.
Women in 13 out of 26 regions in the country will, by the end of the year, be entitled to free services during pregnancy and for one month after childbirth. Babies will receive free healthcare for their first 28 days under the scheme, which the government plans to extend to the rest of DRC – although there is no timetable for that yet.
However, health workers have raised concerns that hospitals and medical centres are ill-equipped to cope with any increased demand on services. Some told the Guardian there were not enough staff, facilities or equipment to successfully introduce the $113m (£93m) programme, which is supported by the World Bank.
The rollout of the programme comes amid nationwide strikes by nurses, midwives, technicians and hospital administrative staff, who are calling for higher pay and better conditions.
Congo has one of the highest number of maternal and neonatal deaths in the world. Latest figures record the maternal morality ratio at 547 deaths for every 100,000 live births, and its neonatal rate – the number of babies dying before 28 days of life – at 27 per 1,000 live births. The numbers are a long way from UN targets to reduce maternal and neonatal deaths to fewer than 70 deaths per 100,000 and 12 per 1,000, respectively, by 2030.
The minister of public health, Roger Kamba Mulamba, said the programme would free women from a “prison sentence”.
He said: “Mothers today get healthcare without fear when they are pregnant. Babies today do not die because they have no access to antibiotics. Mothers today do not die because they cannot afford to pay for a caesarean delivery.”
General examinations in public health centres can cost about 27,000 Congolese francs (£8), while ultrasounds can cost 60,000 francs. C-sections cost about 524,000 francs. According to the World Bank, more than 60% of Congolese live on less than $2.15 (5,600 francs) a day.
DRC has no universal health coverage, and most people cannot afford what limited care there is. Hospitals are known to detain patients until they have paid medical bills in full. Some new mothers have been forced to stay for weeks in overstretched facilities while relatives search for solutions.
The scheme was initially launched in the capital, Kinshasa, in September, but is now being rolled out to more of the country, including in eastern DRC, which has been blighted by years of conflict. The health ministry said it is spending $42m on the scheme, which is the first part of a $200m programme for prenatal, maternal and neonatal care. It said it was using radio, television to inform women about the free services.
Dr Simplice Kibatatu, from Kinkole general hospital on the outskirts ofKinshasa, said he welcomed the programme, but added that his health centre had been overwhelmed by the number of women seeking care.
“We moved from 30 women to about 65 women delivering each month,” he said. “Pregnant women were arriving at around 10am. Now that it [care] is free, they are turning up early, at around 8am, waiting for a consultation.”
Claudel Diakileke, a technician at the maternity centre in Barumbu, a district of Kinshasa, called the pilot scheme a fiasco. He said there were not enough doctors or trained midwives to meet the demand, and that the government had not provided health centres with more equipment or medicines.
The country has an estimated 9,500 doctors and 73,000 nurses to serve a population of about 95 million. It has one midwife for every 20,000 people.
He added that some women were concerned about the quality of care they would receive. “They say, ‘we always see that anything free is not good’,” he said.
Diakileke criticised the government for not consulting the healthcare workforce or community liaison workers, “who play the role to sensitise the population” before introducing the scheme. Community workers are “the ones who build trust with pregnant women, that tell them if you join the scheme you’ll get good care”.
Nenete Asuka, who owns a restaurant in Kinshasa, said she had yet to benefit from the scheme. She had to pay for a recent ultrasound and examinations at the Barumbu centre. “They said free delivery, but, when I come here I [had to] pay,” said Asuka, who is six months pregnant.
Filo Biancumpa, a dressmaker, who is also six months pregnant, is happy about the scheme, but said: “I never knew the free birth delivery was under way. Whenever I’m coming here [to the health centre], I find they [health workers] are on strike. There is no way to speak to female health workers who counsel pregnant women.”
