Paying the price: Pandemic puts DRC’s fragile health system at risk

In eastern DRC, the pandemic is making it hard for youth and women to access sexual and reproductive health services. Health workers are doing their best to provide care despite challenges.

Every morning at 5 a.m., Pacifique Mugisho Mukaba starts his day shouting into a megaphone. The 21-year-old youth ambassador is trying to help communities in the Democratic Republic of the Congo protect themselves against COVID-19 by promoting hand-washing and social distancing.

But cautioning people via a loudspeaker is a far cry from the intimate community gatherings Mukaba held in the Katana Health Zone in South Kivu before the pandemic hit the country in March, when he would facilitate conversations about sexual and reproductive health and advocate against issues such as child marriage and youth pregnancy.

Mukaba also goes from door to door informing youths how they can access sexual health services. As one of 16 ambassadors working in North Kivu and South Kivu provinces for Cordaid’s Jeune S3 program in DRC, Mukaba has had to adapt his messages and approach.

Yet he worries all the added work might not be enough.

“You have to go … to more than 1 million households. … It can be hard,” Mukaba said, adding that community involvement is needed for young people to prosper. “As there is no school, there are no jobs, and there are no businesses, we are concerned that the youth might contract sexually transmitted diseases and HIV/AIDS. We will no longer have time to sensitize the whole community,” he said.

As a youth ambassador for Cordaid’s Jeune S3 program in Congo, 21-year-old Pacifique Mugisho Mukaba’s role is to raise awareness among young people about how they can access sexual health services. He worries the COVID-19 pandemic will lead to a rise in unwanted pregnancies and sexually transmitted diseases, as young people stop visiting health centers and community meetings no longer take place.

Since the community meetings stopped, some villages that had a decline in unwanted pregnancies before the pandemic are now seeing them spike, Mukaba said. He also noticed that young people, in fear of contracting the coronavirus, did not want to go to hospitals to get condoms or be tested for sexually transmitted diseases.

Access to sexual and reproductive health services during the pandemic has become a global problem.

According to family planning NGO Marie Stopes International, almost 2 million women and girls across 37 countries lost access to its contraception and safe abortion services during the first half of the year due to the pandemic. The group estimates that this will cause an additional 900,000 unplanned pregnancies, 1.5 million unsafe abortions, and 3,000 pregnancy-related deaths.

In war-weakened countries with fragile health systems — like DRC, which has the third-highest fertility rate in the world — accessing health services during an emergency can be even harder.

Mukaba now starts his day shouting into a megaphone, promoting hand-washing and social distancing in his hometown.

When the virus arrived in DRC, sexual and reproductive services stopped for several weeks because hospitals were overwhelmed, local health care workers told Devex. Once they restarted, hospitals were often ill-equipped. When 22-year-old Pascaline Mapenzi Wasso tried to get condoms in May and June at a clinic in Bukavu, the provincial capital of South Kivu, it had run out, she said.

Doctors and nurses in North Kivu and South Kivu say the lack of trained personnel and government assistance, as well as endemic distrust in the health system, has led to more babies dying, more unwanted pregnancies, and a decrease in access to sexual education and family planning. Pregnant women are afraid to go to the hospital for fear of getting sick, and many arrive too late for care. Others can no longer afford regular checkups due to the economic fallout from coronavirus restrictions.