Submission ID 132013
| Issue/Objective | The Democratic Republic of Congo continues to face one of the world's most neglected displacement crises, compounded by recurrent febrile disease outbreaks within a malaria endemic setting. In the Province of Kinshasa, flooding and ongoing civil instability have driven surges of Internally Displaced Persons (IDPs) seeking care in local health facilities, while recurring respiratory illnesses and emerging infections have further strained an already fragile health system. Within this context, health workers (HWs) operate at a critical interface between systemic constraints and the lived realities of displacement. This study aimed to explore how HWs perceive and navigate health system barriers and facilitators, alongside displacement related social and economic challenges faced by IDPs, when managing febrile diseases. |
|---|---|
| Methodology/Approach | Semi structured interviews were conducted with 18 HWs across five health zones in Kinshasa Province between June 9 and 16, 2025. Participants were recruited using purposive and snowball sampling based on relevant experience providing care for IDPs. Data was analyzed using inductive reflexive thematic analysis. The qualitative software NVivo 15 was used to organise and code the data. |
| Results | Five main themes identified, including (1) displacement as a structurally produced clinical context of inequality; (2) systemic and economic constraints as drivers of access and preparedness failures ; (3) health workers at the fault line; (4) adaptive practices and informal innovation under constraint; and (5) fractured knowledge, culture, and perception across health system levels. |
| Discussion/Conclusion | Displacement didn't simply add new patients for HWs, it changed the condition of care as IDPs brought displacement-produced deprivation into facilities constrained by financing and supply shortages. When IDPs and host communities converged, the overlap zone became a stress point where HW confronted cost-driven trade-offs and a tension between protocol and judgement, generating moral distress, and avoidance for some, but also human-first ethics, sacrifice, improvisation, and solidarity mechanisms for others. The balance of HWs responses shaped the quality and equity of febrile disease management, while their overlap further amplified health system dysfunction. These results offer a lens for understanding how HW behavior in complex contexts reflects both health system resilience and constraint amid the increasing frequency of both forced displacement and febrile illnesses. |
| Presenters and Affiliations | Landry Kalembo Mary Heersink School of Global Health & Social Medicine, McMaster University Deborah DiLiberto Mary Heersink School of Global Health & Social Medicine, McMaster University Mwandagalirwa Kashamuka Kinshasa School of Public Health, University of Kinshasa Jean Claude Kalenga Kinshasa School of Public Health, University of Kinshasa antoinette Tshefu Kinshasa School of Public Health, University of Kinshasa Lawrence Mbuagbaw Department of Health Research Methods, Evidence and Impact, McMaster University Kristin Banek Celia Scott Weatherhead School of Public Health and Tropical Medicine, Tulane University |
