CTDGH researcher

Prof. Dr. SAMUEL LWAMUSHI MAKALI

Vice-Director

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My name is Samuel Lwamushi Makali, and I am a medical doctor who graduated from the Catholic University of Bukavu (UCB), DRCongo, in 2016. At the end of my medical training, I began a clinical career at the Hôpital Provincial Général de Référence de Bukavu in the emergency and intensive care unit. In parallel with my clinical work, I completed a master's degree in community health at the same university in 2018. I then focused on my clinical career from 2019 to 2021 before starting a PhD in public health at the Université Libre de Bruxelles in the health policy and systems research centre, in 2021. During my PhD, I explored the theme of the resilience of my country's health system in the context of the complex crisis facing its eastern region. I finished my PhD in September 2024. I am currently Associate Professor at the UCB Regional School of Public Health and a researcher in health policies and systems.

Expertise

The research I carried out on resilience focused on the operational level of the Congolese health system (the health district). The main question of my research was to understand how health districts, which have been facing chronic (for more than two decades) and complex crises consisting of acute shocks (epidemics, natural disasters, etc.) and chronic stresses, both intrinsic (linked to failures in the health system, such as lack of funding or medicines) and extrinsic (mainly linked to armed conflicts and population displacements), continue to be operational and provide basic care to the population. I found that these health districts had developed a minimally adaptive resilience that had a number of weaknesses, such as forgetting to emphasize the quality of care and the lack of multi-sectoral involvement in crisis management. The research led to recommendations aimed at strengthening the health system at strategic areas in order to move from this minimum adaptive resilience to a more complete organizational resilience.
I conducted an extreme case study comparing a health district that had never been affected by armed conflict to another health district that had been severely affected (find it here). To classify these health districts, I used two objective indicators: the number of deaths directly linked to armed conflicts and the number of internally displaced people due to these conflicts. The aim of the comparison was to explore the level of resilience of these two health districts. I used Kruk's resilience index for this exploration, using mixed methods (qualitative and quantitative). As results, > 98% of participants agreed that the essential components of a resilient HDs were prior knowledge of the strengths and weaknesses as well as the public health risk posed by the crisis (awareness), together with community and non-health actors’ involvement during the crisis (Integration). Common resilience mechanisms (e.g. epidemic management plan, crisis management committee) were identified, and the more affected health district implemented additional mechanisms, including DRCongo armed forces involvement, community healthcare sites and mobile clinics, specific warning system, and regular socio-demographic monitoring of displaced persons alongside promotion of activities for social cohesion strengthening.

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