HOW ROBUST ARE DISTRICT HEALTH SYSTEMS - COPING WITH CRISIS AND DISASTERS IN RUTSHURU, DEMOCRATIC-REPUBLIC OF CONGO

BACKGROUND Since the eighties, the North Kivu Province socio-economic environment has been deteriorating. This province also faced an influx of Rwandan refugees in July 1994. The paper is to show how a rural he alth objective of the district has been able to adjust and maintain it s medical activities under unfavourable conditions. METHOD Performance s of the local health system were assessed through the analysis of rou tine medical data collected in the Rutshuru Health District (RHD) betw een 1985 and 1995. Specific data collected during the Rwandan refugee crisis measured the workload of RHD due co the refugees. RESULTS For 1 1 years, health infrastructures have remained accessible and functiona l in RHD. The curative utilization and preventive coverage rates incre ased. Obstetrical activities were intensified from a quantitative as w ell as from a qualitative point of view. Between July and October 1994 , the RHD treated 65 000 cases of various pathological conditions in R wandan refugees settled outside the camps. This corresponds to 9.3% of consultations for Rwandan refugees settled on RHD's territory and rep resents a 400% increase in the curative workload for the RHD health se rvices. Human and financial resources remained at a very low level, es pecially when compared with those available in the camps through relie f agencies. CONCLUSION The RHD was severely affected by various stress es but its services managed to provide significant and efficient respo nse to these crises. Health district systems may constitute an effecti ve tool to provide health care under adverse conditions.