Landscape of maternal and neonatal care provision in Lubumbashi, Democratic Republic of Congo: Results from a 2023 health facility census

Sixty million births are expected in urban sub-Saharan Africa in 2030. To address maternal and perinatal mortality, reliable data on facilities providing urban childbirth care is essential. We describe a census of all health facilities in Lubumbashi, the second largest conurbation in the Democratic Republic of Congo, where such information was outdated. We systematically identified existing health facilities and collected data using a questionnaire on childbirth care provision and use. We analysed facility distribution across the 11 health zones, their level, capability and birth volumes. Out of 1,455 facilities identified, 971 reported providing childbirth care. Facility numbers exceeded the list available to health authorities and were five-fold greater compared to a previous census in 2006. There was a predominance of the private sector (97% of facilities). Private facilities were mainly primary level with very low birth volumes. One third of facilities reported performing caesarean sections, and they were not limited to hospitals. A dense network of primary level, low volume, for-profit facilities provided most childbirth care in Lubumbashi. Regulation of the private sector is necessary to improve quality and financial accessibility of childbirth care, in view of the planned rollout of the free childbirth care program in all provinces. Biographical noteThe authors of this study work together under the UrbanBirth Collective umbrella to examine maternal health in cities. We are a group of academic researchers based in the DRC and Belgium and provincial health decision-makers. Jointly, we developed this study, collected the data, analysed the results and presented them to the stakeholders in Lubumbashi. The main concern bring us together is the health of women, their babies and families in large cities in Africa, and how health systems can be designed or adapted to better meet their needs.