Good healthcare data improves the quality of care: the DRC experience

The focus of international health care data has long been on communicable disease (HIV, TB, malaria) and on maternal and child health,¹ with little attention paid to indicators related to emergency, critical and operative care (ECO).

This conversation is beginning to shift. The Lancet Commission on Global Surgery² brought attention to the unmet need for surgery globally, and emphasized the importance of good data in its call to action. Recent resolutions of the World Health Assembly have confirmed the place of Surgical, Obstetric, Trauma and Anaesthetic (SOTA) care as an essential component of Universal Health Coverage (UHC)³ and this year the resolution on ECO was adopted.⁴ 

Improving surgical data in the Democratic Republic of the Congo

King’s Global Health Partnerships has worked in the Democratic Republic of the Congo (DRC) in partnership with the Kongo Central Provincial Ministry of Health and Division of Health to improve the quality of care in the Kongo Central province since 2018. The Kongo Central province is in the southwest of the DRC, and serves a population of close to six million people. The work has a particular focus on improving trauma and emergency care, an expressed need of health care leaders and the community. As part of this work, there is a focus on improved data collection, management and use. 

Our existing Safe Surgery programme has implemented changes in relation to surgical indicators and a new programme will work to implement the WHO Clinical Registry in Kongo Central.

The current Safe Surgery programme, funded by the EKFS Foundation, has implemented the WHO Safe Surgery Saves Lives initiative⁵ which seeks to improve the safety of surgical care around the world, by defining a core set of safety standards outlined in ten pillars, including patient monitoring with oxygen saturation probes; infection, prevention and control; and implementation of the WHO Safe surgery checklist.

As part of this programme, an evaluation has been carried out to understand the current health data collection and processing system, and to improve the surgical indicators. A mixed methods approach was used to understand and evaluate the flow of health care data in 10 healthcare facilities in Kongo Central, and at provincial level. The key findings of the situational analysis demonstrate that there is: 

• A lack of awareness amongst healthcare workers, administrators and policy makers of recommended surgical indicators. 
• A heterogenous process for data collection, analysis and use across healthcare facilities, health zones and provincial leadership
• Disconcordance between different data sets used to monitor surgical activity and indicators.  

We are working directly with the provincial health division to introduce an improved system for data collection, analysis and reporting at these 10 target facilities. These surgical indicators help monitor geographical access to surgery, surgical volume and mortality rates. This expanded data set monitors the quality of SOTA care and will help inform healthcare policy, and now aligns better with international norms.

Implementing a Trauma Registry in Kongo Central

A new programme, funded by the Sir Halley Stewart Trust, will work with the provincial Ministry of Health, the Programme National des Urgences et Action Humanitaire (PNUAH) and community groups (including road users, drivers and the police) to better understand information related to road traffic collisions, how information is shared and how this impacts decision making.

As part of a two year programme, the World Health Organisation Clinical Registry will be implemented at the Hopital Provincial de Reference Kinkanda in Matadi. Implementation of this registry will collect data that is vital to understanding and improving patient care. Lessons learnt from its implementation will be relevant for many other low resource settings.

We are looking for volunteers to support this work over the next two years. In this first phase, we are looking for three clinicians with experience in emergency medicine and global health to support the development of a feasibility study and situational analysis. Please visit our volunteering page to learn more about the available roles.

References

¹ 2018 Global reference list of 100 core health indicators (‎plus health-related SDGs)‎ https://iris.who.int/handle/10665/259951

² Lancet Commission on Global Surgery 2015 https://www.thelancet.com/commissions/global-surgery

³ Manon Pigeolet,1,2,3 Selam Degu,1 Isabella Faria,1 Matthew T. Hey,1 Tayana Jean-Pierre,1 Don E. Lucerno-Prisno,1 Ali Jafarian,4 Natalia Kanem,5 John G. Meara,1 Lia Tadesse Gebremedhin,6 Cherian Varghese,7 Tarsicio Uribe-Leitz,1 and Kee B. Park1 Universal health coverage: a commitment to essential surgical, obstetric, and anesthesia care, World Health Summit 2021 (PD 20) BMC Proc. 2023; 17(Suppl 6): 4.

⁴ The World Health Assembly resolution on integrated emergency, critical and operative care for universal health coverage and protection from health emergencies: a golden opportunity to attenuate the global burden of acute and critical illness https://link.springer.com/article/10.1007/s00134-023-07176-8

⁵ World Health Organisation Safe Surgery saves lives 2009  https://www.who.int/teams/integrated-health-services/patient-safety/research/safe-surgery