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RÉSUMÉ
Introduction. The Republic of Congo, facing shortage and unequal distribution of the health workforce, is increasingly relying on community health workers (CHWs) to strengthen primary care. This research aims to analyze the organization, dynamics, and challenges of collaboration between CHWs and healthcare professionals in Congo. Methodology. A qualitative approach was adopted based on in-depth, semi-structured interviews and focus groups with community health workers (CHWs), health professionals, community leaders, and health authorities in the Dolisie health district. Results. A total of 22 interviews and three focus groups were conducted with CHWs, health professionals, community leaders, and health authorities. The most represented age group was the under 35 years of age with a feminine predominance (57%). Most of them were trained in the community's Minimum Package of Activities (MAP) and intervened within their own community. Almost all participants recognized the importance of community health workers (CHWs) in primary care. The results showed that CHWs provide a critical link between communities and health services, including awareness, prevention, and case referral. Collaboration, although hierarchically organized, is also based on informal and community dynamics. It is facilitated by proximity, shared goals, and local trust but is hampered by limited supervision, lack of continuous training, insufficient institutional recognition, and irregular financial incentives. Conclusion. Community health workers play a crucial role in linking communities with health services. However, their impact is hampered by precarious status, a lack of recognition, and resources.
ABSTRACT
Introduction. La République du Congo, confrontée à une pénurie et à une répartition inégale du personnel de santé, s'appuie de plus en plus sur les agents de santé communautaires (ASC) pour renforcer les soins primaires. Cette recherche vise à analyser l'organisation, la dynamique et les défis de la collaboration entre les ASC et les professionnels de santé au Congo. Méthodologie. Une approche qualitative a été adoptée, basée sur des entretiens approfondis, semi-structurés et des groupes de discussion avec des agents de santé communautaires (ASC), des professionnels de santé, des leaders communautaires et des autorités sanitaires dans le district de santé de Dolisie. Résultats. Au total, 22 entretiens et trois groupes de discussion ont été menés avec des ASC, des professionnels de la santé, des leaders communautaires et des autorités sanitaires. Le groupe d'âge le plus représenté était celui des moins de 35 ans avec une prédominance féminine (57%). La plupart d'entre eux ont été formés au Paquet Minimum d'Activités (PMA) de la communauté et sont intervenus au sein de leur propre communauté. Presque tous les participants ont reconnu l'importance des agents de santé communautaires (ASC) dans les soins primaires. Les résultats ont montré que les ASC constituent un lien essentiel entre les communautés et les services de santé, notamment en matière de sensibilisation, de prévention et d'orientation des patients. La collaboration, bien que hiérarchiquement organisée, est également basée sur des dynamiques informelles et communautaires. Elle est facilitée par la proximité, les objectifs communs et la confiance locale, mais elle est entravée par une supervision limitée, un manque de formation continue, une reconnaissance institutionnelle insuffisante et des incitations financières irrégulières. Conclusion. Les agents de santé communautaire jouent un rôle crucial dans l'établissement de liens entre les communautés et les services de santé. Cependant, leur impact est entravé par un statut précaire, un manque de reconnaissance et de ressources.

Keywords

Community health health professionals collaboration qualitative study Congo Primary health care Agents de santé communautaires professionnels Collaboration étude qualitative Congo Soins de santé primaires

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How to Cite
Reiche Diauvani Massengo Nsongola, Gilbert Ndziessi, Martin Yaba, Joseph Axel Ngatse, Ange Clauvel Niama, Gerard Eloko Matangelo, … Elisabeth Paul. (2025). Function, Collaboration and Challenges of Community Health Workers in the Congolese Health System: A Qualitative Multi-Stakeholder Study in the Health District of Dolisie: Fonction, Collaboration et Défis des Agents de Santé Communautaire dans le Système de Santé Congolais : Une Étude Qualitative Multi-Acteurs dans le District Sanitaire de Dolisie. HEALTH SCIENCES AND DISEASE, 26(9). https://doi.org/10.5281/hsd.v26i9.7011
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References

  1. [1] WHO. Global strategy on human resources for health: workforce 2030. World Health Organization, 2016.
  2. [2] WHO. Health workforce requirements for universal health coverage and the Sustainable Development Goals. (Human Resources for Health Observer, 17). World Health Organization, https://iris.who.int/handle/10665/250330 (2016, accessed 6 August 2025).
  3. [3] WHO. WHO guideline on health policy and system support to optimize community health worker programmes, https://www.who.int/publications/i/item/9789241550369 (accessed 6 August 2025).
  4. [4] D’Amour D, Ferrada-Videla M, San Martin Rodriguez L, et al. The conceptual basis for interprofessional collaboration: Core concepts and theoretical frameworks. Journal of Interprofessional Care 2005; 19: 116–131.
  5. [5] Kok MC, Broerse JEW, Theobald S, et al. Performance of community health workers: situating their intermediary position within complex adaptive health systems. Hum Resour Health 2017; 15: 59.
  6. [6] Musabyimana A RP Thomson DR. Evaluation of Rwanda’s Community Health Worker Program: Impact on maternal and child health indicators. Glob Health Sci Pract 2021; 478-489.
  7. [7] Binagwaho A, Scott KW. Improving the world’s health through the post-2015 development agenda: perspectives from Rwanda. Int J Health Policy Manag 2015; 4: 203–205.
  8. [8] LeBan K, Kok M, Perry HB. Community health workers at the dawn of a new era: 9. CHWs’ relationships with the health system and communities. Health Res Policy Sys 2021; 19: 116.
  9. [9] Etshumba L, others. Community Care Sites in the DRC: Analysis of Implementation and Challenges. Health Policy and Planning 2018; 33: 458–467.
  10. [10] Raven J, Wurie H, Witter S. Health workers’ experiences of coping with the Ebola epidemic in Sierra Leone’s health system: a qualitative study. BMC Health Services Research 2018; 18: 251.
  11. [11] Diaconu K, Witter S, Dakessian A, et al. Fragile, handle with care: refining a key concept for global health and development. BMJ Glob Health 2023; 8: e012956.
  12. [12] Bitongwa Masumbuko Jacques1 2. Déterminants de la résilience des systèmes de santé: Cas des zones de santé post conflit de Bunyakiri et de Kalehe en province du Sud-Kivu, Est de la RDC. Humanities & Natural Sciences Journal 2025; 6: 329–339.
  13. [13] Ministère de la santé et de la population. Plan national de developpement sanitaire (PNDS) 2023-2026, https://sante.gouv.cg/plan-national-de-developpement-sanitaire-2023-2026/ (2024).
  14. [14] Patton MQ. Qualitative Research & Evaluation Methods: Integrating Theory and Practice. SAGE Publications, 2014.
  15. [15] Maes K, Closser S, Tesfaye Y, et al. Volunteers in Ethiopia’s women’s development army are more deprived and distressed than their neighbors: cross-sectional survey data from rural Ethiopia. BMC Public Health 2018; 18: 258.
  16. [16] Perry HB, Zulliger R, Rogers MM. Community Health Workers in Low-, Middle-, and High-Income Countries: An Overview of Their History, Recent Evolution, and Current Effectiveness. Annu Rev Public Health 2014; 35: 399–421.
  17. [17] WHO. Framework for action on interprofessional education and collaborative practice. World Health Organization, https://apps.who.int/iris/bitstream/handle/10665/70185/WH?sequence=1 (2010, accessed 17 June 2024).
  18. [18] Gilson L, Lehmann U, Schneider H. Practicing governance towards equity in health systems: LMIC perspectives and experience. Int J Equity Health 2017; 16: 171.
  19. [19] Agarwal S, Sripad P, Johnson C, et al. A conceptual framework for measuring community health workforce performance within primary health care systems. Hum Resour Health 2019; 17: 86.
  20. [20] Uta Lehmann DS. Community health workers: What do we know about them? The state of the evidence on programmes, activities, costs and impact on health outcomes of using community health workers. CHW Central, https://chwcentral.org/resources/community-health-workers-what-do-we-know-about-them-the-state-of-the-evidence-on-programmes-activities-costs-and-impact-on-health-outcomes-of-using-community-health-workers/ (2013, accessed 12 March 2023).
  21. [21] WHO. Community health worker assessment and improvement matrix (CHW AIM), https://www.unicef.org/media/58176/file (2021).
  22. [22] Ballard M, Westgate C, Alban R, et al. Compensation models for community health workers: Comparison of legal frameworks across five countries. J Glob Health 2021; 11: 04010.
  23. [23] UNICEF. mTrac: Uganda’s mobile health reporting system, https://www.data4sdgs.org/sites/default/files/2018-09/mTRAC%20CaseStudy_FINAL.pdf (2019).

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