Area of Science:

• Public Health
• Health Systems Research
• Conflict and Health

Background:

• The Democratic Republic of the Congo has endured decades of conflict, leading to significant health burdens.
• Health centers in the Katana Health Zone have continued to function despite numerous disruptive events.

Purpose of the Study:

• To identify determinants enabling health centers to adapt to a dynamic and challenging context.
• To understand resilience factors in healthcare delivery during prolonged crises.

Main Methods:

• Cross-sectional study utilizing mixed methods (qualitative and quantitative data).
• Data collected through observation, document review, and interviews with 55 informants.
• Study period: 1990-2017 for qualitative data, 2013-2017 for quantitative data.

Main Results:

• Key disruptive events included rebellions, refugee influxes, humanitarian aid, earthquakes, and human resource instability.
• Adaptation mechanisms included developing new operational standards and fostering dynamic community participation.
• Healthcare service provision persisted due to these developed adaptation strategies.

Conclusions:

• Adapting financial aid management and operational procedures is crucial for health center functionality in changing contexts.
• Structured collaboration among stakeholders and community ownership enhance health center effectiveness.
• Selective, ad hoc interventions limit the sustainable development of health centers.