Analysis of hospital performance from the point of view of sanitary standards: study of Bagira General Referral Hospital in DR Congo
Introduction
The hospital structure is part of a health system and as such it constitutes a system of care. It includes people and all activities and interventions whose primary purpose is to prevent, diagnose and treat health problems (1,2). The hospital will thus have to guarantee that each patient receives the combination of preventive, diagnostic and therapeutic acts which will assure him the best result in term of health, according to the current state of the medical science, at the best cost for the same result (efficiency), at the least iatrogenic risk (efficacy), and for its greater satisfaction in terms of procedures, results and human contacts within this system of care.
In the Democratic Republic of the Congo (DRC), a country that has adhered to the Alma Ata declaration on primary health care, the analysis of the provision of hospital care is generally only considered in the context of functionality of a health zone (HZ). The role of the hospital and in particular the General Referral Hospital (GRH) and its importance for the development of a HZ are reaffirmed (3-5). In addition to the provision of health care as a complementary package of activities (CPA) to the package of activities of the front line structures, the hospital in the DRC also has the mission to provide education and training, retraining of health professionals, operational research, quality control and supervision of first-level health structures namely health centers (HC) (6).
The DRC hospitalis no longer able to fulfill its mission for various reasons, the main ones being: poor governance, under-financing of the health system as a whole and the hospital in particular, weaknesses in the development of human resources, the living conditions of the patient in hospital, the deteriorated infrastructure, medical and non-medical equipment and materials, and inaccessibility to good quality drugs. These issues were carefully analyzed during the development of the strategic plan of the hospital reform in DR Congo initiated by the Ministry of Public Health in 2010 (7). The central problem identified for the entire hospital system of the Democratic Republic of Congo was the poor access of populations to quality health care. Four major direct causes were criminalized, namely: unsatisfactory governance in hospitals, unfair access of populations to health care, inadequate training of health personnel and health research to the needs of the sector, the poor quality of services and care provided to the population (7).
There seems to be a consensus on the importance of a hospital performing well and measuring its performance in order to improve it, but consensus on the approach to measure this performance does not seem to be established (8,9). The Bagira GRH organizes activities in a concrete context (South Kivu in eastern DRC), unstable (post-conflict armed situations) and changing (unstable human resources, casual partners). In such a context, measuring hospital performance in a conventional manner and then evaluating it can be difficult, costly and even controversial, mainly because of a lack of necessary, reliable and accurate data (1,10).
Through studies conducted in the context of developing countries, several concepts have been used in turn to designate hospital performance, including the operation of hospitals according to standards (6,11), patient satisfaction (12,13), quality of care (14), service delivery (10), service effectiveness (15) or profitability (16,17).
Taking into account all these concepts, dimensions and sub-dimensions that they entail, the performance of a hospital structure can be defined as its ability to establish and maintain a dynamic tension between the achievement of its mission (achievement of goals), the acquisition and control of resources, human resource development (well-being of workers and human development),integration and predictability of its production activities (18).
We have taken the perspective to analyze the Bagira GRH according to the standards set by the Ministry of Health of Congo.The operating standards of a hospital (6) are indeed a modality of regulation of a system of care and have constituted the main analytical framework of the Bagira GRH. The Ministry of Health of the DRC defines the operating standards of a GRH in relation to the organization of a hospital, its package of activities,the resources available, its structure and its environment. In this work, the performance of Bagira GRH is analyzed according to these five components of the standards, in a multidimensional approach. This model is closer to the normative model of Donabedian's rational action system (19). The objective of this study is to measure the hospital performance of Bagira GRH in terms of the operating standards established by the DRC Ministry of Health.
Methods
Presentation of the BAGIRA GRH
BAGIRA GRH serves an estimated population of 131,102 inhabitants (2016). The services it organizes are: Pediatrics, Surgery, Obstetrics of Gynecology, Internal Medicine, Laboratory, Ultrasound, Radiology, Reception, Pharmacy, Consultation, Voluntary Testing and Taking Center in charge of HIV patients, the family planning service, Maternal and Child care service, Administrative Services and Emergencies.
General methodological approach
Type of study
A descriptive, cross-sectional study using document review, participant observation and individual interviews.
Data collection
Document review
The study used the existing data at the hospital, collected as part of the national health information system (NHIS) between 2013 and 2016. Data collected relates to the patient's situation (rights, satisfaction), organization of the GRH (organized services, organized activities), the resources available at the hospital and the internal and external environment of the GRH. In order to extract this type of information, the documents consulted were: patient cards and various registers of services (consultations, laboratory, reception, transfer, presence, finance, accounting, personnel management, NHIS periodic templates, slip registration, input management sheets, etc.).
Participant observation
It focused on the organization of the hospital, the package of activities offered, the resources available, the structure and the environment. The principal investigator has meticulously reported all his observations weekly in a notebook. He was then medical director at Bagira GRH. The information has then been encoded using Word software by the secretary of the hospital initially formed on the study. The information mentioned in the reports of the services and validated during the meetings of the management committee of the hospital were compared to those collected by the principal investigator for their validation.
Interviews with key players
The interview consisted of oral questions to caregivers and patients during the study period about their perception of hospital benefits. Semi-closed questions were used during the interviews, addressed in particular to 200 patients who had been cared for in the BAGIRA GRH between 2013–2016 and 45 targeted care providers at random. They focused on the status of patients (rights and satisfaction especially), the organization (services and activities), the available resources and the environment of the GRH. A patient was considered to be satisfied with the care when he claimed to know his rights, that these rights were respected and that he could recommend relatives to this hospital.
Data analysis
Data on the status of patients’ rights were grouped and described according to the prevailing trend. The information about the activities, the resources and management tools, the architectural structure and the hospital environment were compared to the Health’s standards of functionality of a GRH in DR Congo to assess the level of Bagira GRH’ performance.
Ethical considerations
The study protocol was approved by the ethics committee of the Catholic University of Bukavu. Data collection was carried out in strict compliance with law and order and the moral integrity of the people interviewed. Informed, free and verbal consent was obtained prior to administering the questionnaire. Data was collected anonymously and confidentially, protecting the privacy of each respondent during encoding and data analysis.
Results
Situation of patients’ rights at Bagira Hospital
The proportion of patients satisfied with care is 69% during our study. The patient rights situation is summarized in Table 1.
Table 1
| Parameter | Result |
|---|---|
| Proportion of patients satisfied with the care (knowledge of their rights, respect of their rights and spontaneity to recommend their relatives to Bagira GRH) | 69% (n=200 patients interviewed) |
| Existence of a complaint committee at the GRH | No |
| Informed consent given by the users (surgical and invasive procedures, Anesthesia/moderate or deep sedation, transfusion, research, radiotherapy, chemotherapy apie...) | 50% (verbal consent, no specific text) |
| Existence of a process allowing patients to make oral or written complaints or suggestions anonymously if the patient wishes | Existence of a suggestion box but not used |
| Existence of a patient satisfaction questionnaire | No |
| Respect for others rights of patients (Right to care respecting the values and personal beliefs of the patient, Right to be informed and to participate in decision) | Respected religious beliefs |
| Right to security, privacy and confidentiality, right to have pain adequately treated, to file a complaint or suggestion without fear of reprisal, Right to know the price of services and procedures...) | Patients received and treated without any discrimination (sex, gender, race, religion, political affiliation, tribe or other) |
| Existence of a policy that defines its responsibilities for the patient’s property | No |
GRH, General Referral Hospital.
Organization of GRH Bagira
The organization and functioning of the Bagira GRH do not always meet the standards (Table 2).
Table 2
| Component | Standard | Reality |
|---|---|---|
| Accommodation capacity | 1 bed per 1,000 inhabitants | 1 bed for 2017 inhabitants |
| Services | Administrative Services: reception, secretariat, accounting, archiving and library | No library, no office for the administrator manager, the reception service is incorporated in the external consultation box for lack of space; secretarial and accounting work in tight spaces, archiving is not well maintained for lack of space |
| Basic Medical Services: Pediatric, Gynecology & Obstetric, Internal Medicine and Surgery | Services exist and are functional | |
| Emergency and resuscitation service | No existing resuscitation room | |
| The emergency room is narrow and not equipped | ||
| Medical services: blood bank, dentistry, physiotherapy and orthopedic equipment, nutrition, ophthalmology, Otorhinolaryngology, pharmacy, laboratory, medical imaging (radiology, ultrasound)... | Functional blood bank thanks to a solar fridge, Physiotherapy, orthopedic, ophthalmology and non-organized Otorhinolaryngology services; there are no inputs for nutrition, the pharmacy does not have a qualified pharmacist, the laboratory does not perform several examinations (biochemistry) for lack of inputs, permanent electrical power and some devices, only X-rays of long bones and skull are performed by lack of qualified agent, obstetric ultrasounds are most done for lack of training of Doctors | |
| General services: laundry, maintenance, carpentry, electrification, logistic, morgue... | All these services are non-existent | |
| Management bodies | Executive Committee (CODIR) composed of the Medical Director, the Medical Chief of Medical Staff, the Managing Director(AG), the Director of Nursing (ND), the Pharmacist and a representative of the medical services of the Hospital | CODIR meets once a week. It includes the managing director, the managing director, the nursing director, the chief medical officer, the pharmacist and the laboratory manager. In 2016, 40 of the 48 planned meetings were held, representing an achievement rate of 83% |
| Management Committee (COGES): chaired by the Medical Director of the GRH. It has as members: the Head of HZ, all the doctors of the GRH, the AG, the ND, the representative of the owner (if the structure is private), a representative of the local authority (administrator of the territory or burgomaster), representatives of partners who work at the Hospital and a staff representative | The COGES is organized by the HZ Office and is held once a month, in which the MD, the AG and the ND participate. During the course of 2016, out of 12 COGES planned, 10 were made to which the Hospital team actively participated. The recommendations made by the latter concerning the hospital are developed at CODIR which is held every Friday in the presence of all the members | |
| Interaction with other elements of the HZ | Executive team of HZ (ECZ) | The ECZ meetings are regular and the hospital is actively represented by the MD and the ND |
| Zonal pharmacy | The hospital buys the drugs available at the zonal pharmacy a priori | |
| HC | MD and ND oversees HC of hospital health area | |
| Population | Meetings with the population do not take place | |
| Partners | The relations with the partners are those of complementarity, except for the hierarchy which does not take into account the suggestions of the hospital |
GRH, General Referral Hospital.
Activities of CPA
Degree of achievement of activities of the CPA at GRH Bagira (Table 3).
Table 3
| Degree of organization/availability | |
|---|---|
| Healing | |
| Curative consultations, hospitalization of patients, intensive care and emergencies, reference surgical care, management of deliveries, therapeutic nutritional rehabilitation, sterilization of equipment, transfusion safety and rehabilitation activities | - Rooms cramped and poorly equipped for consultations |
| - All referred cases are seen by the doctor, even if the reference conditions are inappropriate (no ambulance) | |
| - Inexistence of intensive care or emergency for lack of intensive care unit | |
| - The operating room is poorly equipped | |
| - Partograph is poorly maintained at the maternity ward | |
| - All blood donors are volunteers | |
| - Rehabilitation activities are not organized (Physiotherapy, Kinesiology, Equipment) | |
| Preventive | |
| Consultations referrals, preventive care to pregnant women in the ANC, antenatal-risk pregnancies to mothers, preventive care to new-nés in immediate postpartum vaccination motherhood, promotion of exclusive breastfeeding, family planning, prenuptial consultations | - The whole package of these activities is offered |
| - Vasectomy and IUD are too unacceptable | |
| - Breast consultation counseling is only required by 50% of youth who consult, no reference for screening for syphilis or HIV has been done | |
| Promotionals | |
| Communication for behavior change (CCC) to patients and their families, psychosocial support (mental health, AIDS); e limination and destruction of contaminated equipment at the hospital | - Ineffective CCC |
| - Psychosocial support not performed for lack of psychologist | |
| - Presence of a sorting area and waste disposal | |
| Management | |
| Management of hospital health information, human resources, material resources and finances | - Staff not trained in NHIS, all operations of the NHIS are done by hand |
| - Action research is not carried out | |
| - Staff assignments do not take into account standards, the GRH is not consulted | |
| - Nearly 40% of required equipment is not available | |
| - Unfinished budget, unplanned executed budget | |
| Support of the activity package | |
| Laboratory exams (parasitology, hematology, bacteriology, biochemistry) and medical imaging (radiography, ultrasound, ECG, EEG) | - 25% of the planned laboratory examinations are not carried out due to lack of material |
| - Biochemical examinations are not performed | |
| - X-ray workers are poorly trained | |
| - Obstetric ultrasounds are the most performed (70% of ultrasounds) | |
| - ECG and EEG are not performed | |
| Management tools | - Incomplete |
GRH, General Referral Hospital.
Resources
Human resources
Human resources at Bagira GRH (Table 4).
Table 4
| No. | Professional category | Number according to the standards | Number observed at Bagira Hospital |
|---|---|---|---|
| 1 | Doctor | 6 | 6 |
| 2 | Dentist | 1 | 0 |
| 3 | Pharmacist | 2 | 1 |
| 4 | A1 or L2 nurses | 4 | 6 |
| 5 | Nurse A2 | 10 | 16 |
| 6 | Nurse A3 | 10 | 6 |
| 7 | Nurse attendant A1, A2, A3 | 7 | 8 |
| 8 | Medical biologist | 2 | 0 |
| 9 | Lab technician A1, A2 | 4 | 2 |
| 10 | Physiotherapist A1 | 5 | 0 |
| 11 | Nutritionist A1 | 2 | 1 |
| 12 | Radio technician A1 | 2 | 2 |
| 13 | A1 anesthetist | 2 | 1 |
| 14 | Pharmacy assistant A2 | 4 | 2 |
| 15 | L2 manager administrator | 2 | 1 |
| 16 | Manager manager A1 | 4 | 1 |
| 17 | A2 sanitation technician | 4 | 1 |
| 18 | Secretary | 1 | 1 |
| 19 | Accounting | 1 | 1 |
| 20 | Cashier | 1 | 2 |
| 21 | Statistician and archiving | 1 | 1 |
| 22 | Billing agent | 1 | 1 |
| 23 | Receptionist | 2 | 2 |
| 24 | Driver and DRIVER MEchanic | 2 | 0 |
| 25 | Laundry staff | 3 | 1 |
| 26 | Morgue staff | 1 | 1 |
| 27 | Security agents | 2 | 0 |
| 28 | Cook | 1 | 0 |
| 29 | Clerk/bailiff | 1 | 1 |
| 30 | Maneuver | 5 | 7 |
| 31 | Surface technicians/Garçosn and maids | 6 | 8 |
| 32 | Electrician | 1 | 1 |
| 33 | Carpenter | 1 | 0 |
| 34 | Plumber | 2 | 0 |
GRH, General Referral Hospital.
Financial resources
Elements of financial resources (Table 5).
Table 5
| Standards | Reality at grh bagira |
|---|---|
| Funding sources | |
| Budget allocation of the state | Non-existent |
| External financing (donors) | Non-existent |
| Community contributions | Main source of financing |
| Private Sector Resources | Rare, sporadic |
| Recovery of care costs | Realized |
| Free healthcare | Not applied |
| Flat rate | Flat rate applied |
| Management tools | Ledger and financial accounting software not available |
| Cash book, receipt book, biller, voucher book, expense book, cash register, check book if applicable, tariff, receivables register, accounting software and ledger |
Material ressouces and equipment
Material resources and equipment are insufficient. In each service as shown in Table 6, equipment and materials planned areincomplete.
Table 6
| Basic equipment for | Observation |
|---|---|
| Consultation | Incomplete |
| Sterilization | Incomplete |
| Care, dressing | Incomplete |
| Surgery | Incomplete |
| Medicine | Incomplete |
| Gynecology | Incomplete |
| Maternity | Incomplete |
| Ophthalmology, otorhinolaryngoly, dentistry | Incomplete |
| Laboratory | Incomplete |
| Medical imaging | Incomplete |
Among the material resources management tools, the hospital does not have title deeds or cadastral documents (Table 7).
Table 7
| Management tools | Observation |
|---|---|
| Inventory sheet | Existing |
| Requisition/billing sheet | Existing |
| Movement sheet | Existing |
| Medication Management Tools | Existing |
| Entry register | Existing |
| Delivery slip | Existing |
| Purchase order | Existing |
| Property titles | Non-existent |
| Cadastral documents | Non-existent |
Drug management
Essential drugs are often available even though there have been some ruptures as shown in Table 8 in 2016.
Table 8
| Sentinel drugs | Number of days out of essential drug (s) sentinel (s) in 2016 |
|---|---|
| Other medicines | 0 |
| Quinine inj | 6 |
| Ampicillin inj | 12 |
| Gentamycin inj | 0 |
| Glucose serum | 10 |
| Physiological serum | 12 |
| Dexamethasone inj | 0 |
| Methergine inj | 8 |
GRH, General Referral Hospital.
Architectural structure of Bagira GRH
The dimensions of the buildings proposed by the Ministry of Health to a hospital with the capacity of 100 beds per 100,000 inhabitants are not satisfied. The hospital had originally been designed as a health post before to be transformed into a hospital center and then a GRH in the Bagira HZ without the possibility of compliance with standards. The hospital has kept the old laboratory, maternity, laundry and other services that do not currently meet the standards in every respect.
These dimensions concern the administrative department, the outpatient department, the internal medicine department, the pediatric service, the surgery department, the operating theater, the gynecological obstetric department, the maternity ward, the laboratory, the central office of the health area (if included in the GRH), pharmacy, radiology, laundry room, central kitchen, both incinerators and garage.
The radiology room is not far enough away from busy areas. The electrical installation does not allow to have a three-phase electric current of 240–380 V + neutral + earth 30 to minimum. A 20 KVA breakdown generator and a solar panel are available but often out of order or not functional.
The site where the hospital is located is not polluted, but is close to traffic. The terrain is not spacious enough to allow for possible extension. The site is well connected to the existing road network, the terrain is slightly hilly. Aseptic areas are separated from septic areas.
Hospital environment
Situation of the environment within GRH Bagira (Table 9).
Table 9
| Standard | Reality at the hospital |
|---|---|
| Internal environment | |
| Environmental sanitation | |
| 1. Practice of weeding, cleaning of sewers | Realized |
| 2. Availability of an incinerator, hygienic sanitary facilities, sewage and run-off drainage system and drinking water supply system | Realized |
| 3. Existence of accompanying lodges, erection of barriers at dangerous places | Partially realized |
| 4. Location of the healthy hospital (unpolluted environment), spacious and connected to the existing road network | Realized |
| Protection against harmful insects (flies and mosquitoes) | |
| 5. Installation of an anti-mosquito screen on the windows and other openings of the GRH building | Realized |
| 6. Use of ITNs by hospitalized patients and women who have given birth in hospitals | Partially realized |
| 7. Self-closing doors and fly trap traps in the rooms | Partially realized |
| Running water | |
| 8. Running water permanently | Non permanent water |
| Lighting and energy | |
| 9. Connection to the public or private electricity supply network, generator and/or adapted solar device | Partially realized |
| Solid waste treatment | |
| 10. Existence of an incinerator, a garbage pit (canopy), a placenta hole (canopy) and garbage cans with lids in all rooms and in the yard | Partial existence |
| Liquid waste treatment | |
| 11. Collection of wastewater in developed canals leading to a lost well | Realized |
| 12. Runoff water channeled to collectors of the public network | Realized |
| 13. Hospital terrain not too rugged, with gradient greater than 10% to facilitate good sewage and runoff drainage | Realized |
| Protection against sound noises | |
| 14. GRH implanted in a calm zone, protected from heavy traffic and far from sources of vibration | Realized |
| Fire prevention and power supply | |
| 15. Provide a perimeter of at least 25 m around buildings in rural areas to prevent fire | Realized |
| 16. Place fire extinguishers in strategic places, place emergency exits, provide fire resistant woodwork, electrical circuits must be protected with suitable fuses in urban areas | Realized |
| 17. Properly insulate electrical wires | Realized |
| 18. The electrical cables must be sections conforming to the loads | Partially realized |
| External environment | |
| Main actions | |
| 19. Weeding the price of GRH | Realized |
| 20. Drying puddles | Realized |
| 21. Erection of an enclosure/fence to prevent straying of animals and animals in the yard | Realized |
GRH, General Referral Hospital.
Only 14 out of 21 standards of the environment within GRH Bagira are fully met.
Discussion
This chapter is devoted mainly to the discussion of the main results concerning the characteristic of the hospital, the organization of the services, the activities of the CPA, the resources, the structures of the hospital, the internal and external environment of the hospital and the evolution of hospital indicators. Standards are not reached at Bagira GRH.
Patient Satisfaction at Bagira GRH
The proportion of satisfied patients care offered at the GRH Bagira is 69% in our study. The measure of satisfaction is generally based on multiple means, complaints, exit questionnaires, but also specific or general surveys (20,21). One of the limitations of our study is the impossibility of determining the aspects of care on which patient dissatisfaction is observed due to the absence of a complaint committee at the GRH or a specific satisfaction questionnaire. The suggestion box is not used by patients and misses the hospital’s innovative ideas (22) that patients would bring to improve the quality of care.
Regarding the rights of patients, they are welcomed and treated without any discrimination related to sex (gender), race, religion, membership of a political group, tribal or other specific. Patients consider that their right to information is respected, albeit to varying degrees. The right to confidentiality has not been analyzed. However, patients can not protest when their rights are violated because they do not know them. The most effective way to protect the rights of patients is either the existence of a person with specialized knowledge of patients’ rights or the creation of an internal committee of the hospital (23). The GRH has not developed a policy to strengthen respect for patients’ rights. In fact, 50% of the interventions are based on verbal consent and in 50% of the other cases, the consent of the patients is not formalized before surgery.
Organization of services
Standards are not reached in the organization of hospital services. The capacity is 1 bed for 2007 inhabitants but in reality it would be 1 bed per 1,004 inhabitants in view of the low use of the hospital by the inhabitants of Bagira (56% in 2016). The standard defined by the Ministry of Health is disconnected from the reality of hospitals in urban areas and thus requires a revision due to the creation of new structures providing hospital care in the Bagira HZ but also the facility for patients to go to nearby areas seeking non-existent care at Bagira Hospital. Several services planned and useful to the population are not organized; this is the case of the emergency and resuscitation service, as well as so-called specialized services (including ophthalmology, otorhinolaryngology, orthopedic or physiotherapy). General services are also lacking (laundry, maintenance, carpentry, electrification, logistic, morgue...). The use of an hospital can thus be influenced by the organized services and the care offered (24)
CPA activities
The analysis of activities of the supplementary package of activities (CPA) at GRH Bagira demonstrates some deficiencies that would hinder the quality of care and ultimately the performance of the hospital (2). Among these shortcomings are noted, the low equipment (almost 46% of the required equipment is not available), the lack of intensive care and emergency for lack of resuscitation service, the partograph badly held at the maternity, the non-organization of rehabilitation activities (kinesiology, physiotherapy, equipment) or lack of psychosocial support for lack of psychologist.
Resources of the Bagira Hospital
Overall, the resources at Bagira Hospital do not support the standards. The total number of staff is 61 in 2017 instead of 43, which is 42% more. Some human resources are missing (anesthesiologist, physiotherapist), others are more numerous (nurses). Caregivers represent 75% of all staff compared to 25% of administrative and support staff. The levels of competence and motivation of staff can influence the performance of a hospital (25); they do not were measured in this study.
The payment of care by the population is the main source of funding for the hospital (78% in 2016). The State budget allocation is non-existent, cost recovery is 63% mainly due to the poverty of the population in DR Congo (26,27). The flat rate is applied to the Bagira hospital offering an advantage of access to care for the poorest and a disadvantage for the managers to measure the real cost of the acts of care.
Material resources and equipment are insufficient. In each service, equipment and materials planned are incomplete.
This negatively interferes with the quality of care provided and the use of the hospital (2). The availability of drugs is an important factor in the quality of care. Despite a few days of stock-outs observed at Bagira Hospital, the latter has worked well in recent years.
Hospital structures at the architectural level
The building does not meet the standards in terms of dimensions. The Hospital was before designed as a health post and has become a GRH with the same facilities that do not meet the structuring standards. In such buildings and premises, some services are difficult to operate with an impact on the quality of patient reception and care. The hospital architecture must be the factor and the instrument of the hospital cure (28).
Environment (Water-Hygiene and Sanitation) at Bagira Hospital
At the Bagira hospital, 67% of hygiene standards are fully respected, 29% partially respected and 4% not respected. The non-permanence of water in the hospital is the most crucial problem. The analysis of knowledge of healthy practices in relation to hygiene was not carried out as part of this study.
Limitations of the study
The main limitations of this study primarily concern the methodological approach based on standards. Indeed, the study could not explore the other dimensions of performance (29,30) due to limited data collection from the start. Secondly, the tools used to measure patient satisfaction (23) as well as those used to assess their rights could not be representative of all aspects.
Conclusions
The objective of the study was to contribute to the performance and the good functioning of the BAGIRA GRH by identifying the information on the current operation of the BAGIRA GRH against the standards; the main factors that can reduce performance and to identify interventions adapted to the context may improve performance.
The study shows that the standards are not met and describes the limitations of the study, essentially from a methodological point of view. The study also questions the relevance of certain standards such as hospital capacity or the number of employees by occupational category, particularly in urban areas.
Efforts should be made at different levels to improve the performance of the Bagira Hospital in relation to the organization of services, the organization of activities of the CPA, the availability of resources, the development of structures at the architectural level and the internal and external environment of the hospital. The approach used can be improved in another hospital to produce a hospital performance assessment tool.
Acknowledgments
Funding: None.
Footnote
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jhmhp.2020.03.02). The authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study protocol was approved by the ethics committee of the Catholic University of Bukavu. Data collection was carried out in strict compliance with law and order and the moral integrity of the people interviewed. Informed, free and verbal consent was obtained prior to administering the questionnaire. Data was collected anonymously and confidentially, protecting the privacy of each respondent during encoding and data analysis.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
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Cite this article as: Karemere H, Mukwege J, Molima C, Makali S. Analysis of hospital performance from the point of view of sanitary standards: study of Bagira General Referral Hospital in DR Congo. J Hosp Manag Health Policy 2020;4:5.
