The effect of mentorship as a means of strengthening leadership in the health system at the operational level: a case study of the Walungu rural health zone in the eastern Democratic Republic of Congo

Context In the rural Health Zone (HZ) of Walungu, eastern Democratic Republic of Congo, major constraints impede health outcomes. From 2015 to 2019, the “RIPSEC” program transformed Walungu into a Learning and Research Zone (LRZ) under the mentorship of a local university to enhance the leadership capabilities of HZ managers, focusing on managing challenges including the proliferation of Informal Healthcare Facilities (IHFs). Objective This study evaluates the impact of RIPSEC mentorship on leadership development and the performance of the Walungu LRZ, particularly concerning the utilization of integrated curative health services in competition with IHFs. Methods We used a mixed method approach, combining retrospective analysis of some key health indicators before (2014) and during RIPSEC program (2015-2019), and in-depth qualitative interviews with members of the HZ management team. Quantitative data were presented as frequencies and proportions. Simple linear regression (p<0.05) measured the influence of IHFs on service use. The functionality and performance of the HZ were assessed using an internal benchmarking approach, with results presented as trend curves. Deductive analysis of interviews allowed for a deeper exploration of quantitative trends. Results Despite efforts to manage them, IHFs negatively influenced the use of curative services. RIPSEC mentorship notably enhanced the leadership skills of managers, leading to improved management effectiveness. While the use of curative health services slightly increased during the program, rates remained below 50%, and gains were not sustained post-program. Conclusion RIPSEC mentorship has positively impacted leadership and performance in Walungu. However, challenges related to sustainability and financing persist, necessitating comprehensive interventions beyond enhancing managerial leadership solely. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement No specific funding was received to support the creation of this manuscript or the research presented herein. The data utilized in this study were collected during the execution of the RIPSEC program, which was initially funded by the European Union. However, the RIPSEC program itself did not provide direct financial support for the post-program qualitative data collection, the analysis or the writing of this study's findings. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The research of this study protocol was approved by the ethics committee of the Université Catholique de Bukavu under reference number UCB/CIES/NC/019/2021. Informed consent was obtained from each respondent prior to the interview. All stages of the study complied with the relevant guidelines and regulations. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as [ClinicalTrials.gov][1]. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable The datasets analyzed during the current study are available from the corresponding author on reasonable request. [1]: http://ClinicalTrials.gov