How COVID-19 restrictive measures were not implemented in Bukavu, DR Congo: a participatory qualitative case study

Background Health systems in study setting were inadequately prepared for the COVID-19. Our research aimed to contribute to describe, through a socio-anthropological study, the different dynamics in the non-compliance to COVID-19 response measures, in Bukavu city, Democratic Republic of the Congo. We argue that, continuous application of the COVID-19 restrictive measures required relevant resources and competencies in a transparent management of the response pillars such as risk communication, epidemiological surveillance, prevention and control, laboratory organization, medical and psycho-social care and logistics. Methods: A qualitative study with a socio-anthropological survey was conducted in Bukavu Town, South Kivu Province, in Democratic Republic of the Congo. An exploratory survey aiming at co-producing the study objectives with key stakeholders was conducted with 17 participants including academics, health professionals including technical agents of the COVID-19 response and community members. In- depth 86 semi-structured interviews and 5 FG each of 7 to 11 actors were organized. The interviewed actors were selected through convenience sampling and the saturation of data indicated the it size. The theme explored during the individual interview and focus group discussion was the community perception on restrictive COVID-19 measures and behaviors risks; and the factors that represent obstacles to the adoption of the response measure. We have triangulated the opinions collected in order to verify their veracity. The interview recordings were translated and transcribed. We used the thematic analysis method to progressively present and discuss the survey results by identifying recurring themes in the data sources. Results: The study present a timeline of dynamics in the non-compliance to first wave COVID-19 measures in Bukavu, Democratic Republic of Congo. The analysis begins with the echo of the emergence of COVID-19 internationally on social media and it influence on the population's understanding. Following by, the sporadic compliance with the response measures from the experience of the first cases of COVID-19. Next, the determinants of the COVID-19 alert full down and the breakdown in the application of preventive measures are presented. These determinants are argued around (i) the inadequacies in coordination illustrated with the case of resignation of Noble Prize winner Mr. Dr. Mukwege from the COVID-19 response committee. (ii) Then, the community socio-financial disability as barrier to response adoption. (iii) Following, the lake in public order services to monitor the completion of response measures. (iv) And the gaps in the health system structure and the negative legacies of the management of the previous Ebola epidemics waves in DR Congo. Conclusion Establishing strategies to respond to emerging diseases is a complex challenge in fragile system contexts with inadequate health security schemes, surveillance and preparedness. As to achieve community engagement in such context, the COVID-19 response explored should benefit from an integrated complementary strategies such as the accompaniment of the most disadvantaged people, concetualized sensitization, and the application of incentives to motive the compliance.