Working conditions and environment of maternal and neonatal healthcare providers in the context of armed conflicts and humanitarian crises of Eastern DR Congo

Healthcare workers (HCW) play a crucial role in reducing maternal and infant mortality. However, in contexts of endemic armed conflicts, such as in the Democratic Republic of Congo (DRC), these professionals must operate under extreme working conditions, which can affect the quality of care. This study aims to assess the working environment and challenges faced by maternal and neonatal HCW in the DRC to better understand their ability to deliver quality care in a prolonged war context. We conducted a cross-sectional study in the North and South Kivu provinces in Eastern DRC. The study primarily targeted healthcare facilities in eight health zones. An evaluation aligned with the structure/process dimensions (profile and perception of the work environment of HCW) according to Donabedian was conducted. A descriptive and comparative analysis of the health zones (HZs) using the Chi-square test and T test was performed. Informed consent was obtained for participation in the study. A total of 200 HCW were enrolled in the study, 71% of whom were women, with an average age of 37.5 years. Nurses were the majority, followed by midwives, while general practitioners represented 10.67%. On average, HCW worked approximately 67 h per week. A third of HCW do not feel well-prepared and are dissatisfied with their work environment, reporting gaps in discussions about interpersonal skills, promotion opportunities, and professional development. Disparities in treatment were observed, with notable inequalities in training, time off, work hours, function, and promotions, often exacerbated by gender. Less than 30% received bonuses, and 90% did not receive non-monetary incentives. Verbal threats and assaults, humiliations, and physical assaults from colleagues and patients were common, with a higher incidence in women and from North Kivu. Finally, nearly a quarter of HCW felt exposed to insecurity in and around their facilities, a perception more pronounced in North Kivu than in South Kivu. This study shows that HCW in the DRC, particularly in conflict zones, work under extremely difficult conditions, characterized by intensive hours, lack of training, professional inequalities, and high insecurity. These challenges may compromise quality of care and the well-being of providers, underscoring the urgency of strengthening their protection and support to maintain the resilience of the healthcare system.