A Resource Planning Analysis of District Hospital Surgical Services in the Democratic Republic of the Congo

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An ill-equipped operating room at a district hospital in the DRC (top) compared with a fully equipped one in another district (bottom).

Table 1. Hospitals Included in the Situational Analysis and Their Locations, Democratic Republic of the Congo

Table 2. Costs Included and Not Included in the DRC Hospital Resource Planning Exercise

Costs	Examples
Included
Clinical interventions	• General anesthesia
	• Applying a cast
	• X-ray
Referral costs as defined by country	• Ambulance
	• Medical services during transport
Health facility administration	• Hospital manager salary
	• Office equipment
District health administration	• District health manager salary
	• Supervisory visits
Not Included
Capital investments to rehabilitate health facilities	• Building repairs or construction of new building
Preservice human resource training	• University education for medical officers
Infrastructure outside the health care facility	• Paved roads for better access

Table 3. Source of Price Data in the DRC Resource Planning Exercise by Resource Type

Resource Type	Source of Price Data
Human	• Mbudi agreement + NGO salary top-up (Demba and Kabare)
Pharmaceuticals	• Price list from 3 medicine distribution centers^a + IDA list price
Medical equipment	• MOH and donors (per unit purchase price)
Health facility infrastructure	• Building: Ministry of Infrastructure, Public Works, and Reconstruction (per m²)
	• Cleaning: 2.5% of building per year
	• Utility management: 1.5% of building per month
	• Maintenance: 2.5% of building per year
Consumable/disposable items	• MOH and district hospitals (per unit purchase price)

Abbreviations: DRC, Democratic Republic of the Congo; IDA, International Development Assistance; MOH, Ministry of Health; NGO, nongovernmental organization.
↵a Association Régionale D'Approvisionnement en Médicaments Essentiels (ASRAMES), Centrale de Distribution de Médicaments Essentiels du Kasaï Occidental (CADIMEK), and La Centrale d'Achat et de Distribution de Médicaments Essentiels de Kinshasa (CAMESKIN).

Table 4. Calculated Operating Budget and Utilization Rate^a for Selected DRC Hospitals by Type of Hospital Service

Hospital	Surgery (including obstetrics)	Total (for all hospital services)	Surgery Component of Total
Normative Hospital
Costs	$2.17	$11.86	18.30%
Utilization rate	0.05	0.15	33.30%
Demba Hospital
Costs	$0.08	$0.31	24.20%
Utilization rate	0.003	0.03	9.00%
Kabare Hospital
Costs	$0.69	$3.40	20.20%
Utilization rate	0.01	0.15	3.33%

Abbreviation: DRC, Democratic Republic of the Congo.
↵a Costs are per inhabitant per year in US$. Utilization rate is the number of cases per inhabitant per year.

Table 5. Basic Infrastructure Capacity of Selected DRC District Hospitals

Equipment/Supplies	Abuzi	Bwamanda	Demba	Goma	Kabare	Kinkanda	Kirotshe	Lubumbashi	Mulongo	Panzi	Wapinda	Yakoma
Catchment area	80,000	200,000	252,000	100,000	155,000	165,000	280,000	200,000	100,000	150,000	70,000	100,000
No. of beds	65	242	65	245	150	150	150	200	150	350	90	65
No. of admissions/year	850	5,000	1,500	5,000	5,000	4,000	5,000	4,032	3,500	5,000	600	1,500
No. of surgical cases/year	250	3,500	600	1,000	1,500	850	850	2,345	850	3,500	150	250
No. of operating rooms	1	2	1	2	4	4	1	3	3	5	1	1
Running water, frequency of availability	X	O	X	✓	O	✓	O	O	O	✓	X	X
Electricity, frequency of availability	O	✓	O	✓	O	✓	✓	O	X	✓	X	O

Abbreviations: DRC, Democratic Republic of the Congo; ✓, Always; X, Never; O, Sometimes.

Table 6. Frequency of Availability of Essential Equipment and Supplies at Selected DRC Hospitals

Equipment/Supplies	Abuzi	Bwamanda	Demba	Goma	Kabare	Kinkanda	Kirotshe	Lubumbashi	Mulongo	Panzi	Wapinda	Yakoma
Gloves, sterile, sizes 6–8	O	✓	✓	✓	✓	✓	✓	✓	✓	✓	O	✓
Oropharyngeal airway, adult	X	✓	X	✓	✓	✓	X	O	✓	✓	X	X
Resuscitator bag valve and mask, adult	X	✓	X	O	✓	O	✓	✓	✓	✓	X	O
Mask and tubing to connect oxygen supply	X	✓	X	✓	X	O	✓	O	O	✓	X	X
Oxygen source (cylinder/concentrator)	X	✓	X	✓	X	O	✓	✓	X	✓	X	X
Chest tubes insertion equipment	X	✓	X	✓	X	✓	X	O	O	✓	X	X

Abbreviations: DRC, Democratic Republic of the Congo; ✓, Always; X, Never; O, Sometimes.

Table 7. Range of Surgical Interventions Performed at Selected DRC Hospitals

Procedure	Abuzi	Bwamanda	Demba	Goma	Kabare	Kinkanda	Kirotshe	Lubumbashi	Mulongo	Panzi	Wapinda	Yakoma
General and Pediatric Surgery
Resuscitation	+	+	+	+	+	+	+	+	+	+	−	−
Abscess incision and drainage	+	+	+	+	+	+	+	+	+	+	+	+
Biopsy	−	+	−	−	+	+	−	+	+	+	−	−
Hydrocele	+	+	+	+	+	+	+	+	+	+	+	+
Hernia	+	+	+	+	+	+	+	+	+	+	+	+
Appendectomy	+	+	+	+	+	+	+	+	+	+	+	+
Laparotomy	+	+	+	+	+	+	+	+	+	+	+	+
Contracture release/skin graft	−	+	−	+	+	+	−	+	+	+	−	−
Tracheostomy/Cricothyroidotomy	−	+	−	+	−	+	+	+	+	+	−	−
Congenital hernia	+	+	+	+	+	+	+	+	+	+	+	−
Neonatal surgery	−	+	−	+	−	+	+	+	+	+	+	+
Male circumcision	+	+	+	+	+	+	+	+	+	+	+	+
Orthopedics and Trauma
Suturing	+	+	+	+	+	+	+	+	+	+	+	+
Wound debridement	+	+	+	+	+	+	+	+	+	+	+	+
Burn	+	+	+	+	+	+	+	+	+	+	−	−
Foreign body removal	−	+	−	+	+	+	+	+	+	+	−	−
Joint dislocation	−	+	−	+	−	−	−	+	+	+	−	−
Closed fracture repair	−	+	−	+	−	+	+	+	+	+	−	−
Open fracture repair	−	+	−	+	−	+	−	+	+	+	−	−
Osteomyelitis/septic arthritis drainage	−	+	−	+	+	+	−	+	+	+	+	−
Amputation	−	+	−	+	+	+	+	+	+	+	−	−
Chest tube insertion	−	+	+	+	−	+	−	+	+	+	−	−
Obstetrics/Gynecology and Other
Dilation and curettage	+	+	+	+	+	+	+	+	+	+	+	+
Tubal ligation	+	+	−	+	+	−	+	+	+	+	−	+
Cesarean delivery	+	+	+	+	+	+	+	+	+	+	+	+
Obstetric fistula	−	+	−	−	−	+	−	+	+	+	−	−
Cystostomy	+	+	−	+	+	+	+	+	+	+	+	+
Urethral stricture dilation	−	+	+	+	+	+	+	+	+	+	−	−
Anesthesia Care
Ketamine	+	+	+	+	+	+	+	+	+	+	+	+
Regional	−	+	−	+	+	+	+	+	+	+	−	−
Spinal	+	+	+	+	+	+	+	+	+	+	+	+
General anesthesia	−	−	−	+	−	+	−	+	−	+	−	−

Table 8. Summary of Surgical Deficiencies at Selected DRC Hospitals Compared With Benchmark of DRC Model Normative Hospital

	Normative	Abuzi	Bwamanda	Demba	Goma	Kabare	Kinkanda	Kirotshe	Lubumbashi	Mulongo	Panzi	Wapinda	Yakoma
Catchment area, thousands	100	80	200	252	100	155	165	280	1,000	100	1,000	70	100
Maximum distance to next facility, km	NA	65	2,000	90	300	65	250	15	8	–	10	65	65
EESC capacity (of total 32 interventions)	32	17	31	17	30	24	30	23	32	31	32	15	14
Surgical intervention deficiencies^a	0%	47%	3%	47%	6%	25%	6%	28%	0%	3%	0%	53%	56%
Cost per inhabitant per year, US$	2.17	NA	NA	0.08	NA	0.69	NA	NA	NA	NA	NA	NA	NA

Abbreviations: DRC, Democratic Republic of the Congo; EESC, emergency essential and surgical care; NA, not applicable.
↵a Calculated as 100 – (EESC capacity/32).