Abstract for: Tracking events to inform a system dynamics model of maternal and newborn healthcare services in urban settings: Insights from Lubumbashi City, DRC.

In urban settings, maternal and newborn healthcare (MNH) services are affected by complex dynamics and events, such as natural disasters and health system disruptions, including medicine shortages. To understand how these events affect MNH services and outcomes, we propose development of a system dynamics model (SDM) to inform strategies that anticipate system shocks and surges. This study presents first phase of model development, describing events tracked in Lubumbashi city, DRC. Primary data collection was carried out at health facility (n=206), health zone (n=11), city, regional and national levels, from various sources including media, government announcements, and healthcare providers by 26 trained investigators for 15 months. Entries were recorded using KoboToolbox, with weekly meetings organised for validation. Preliminary analysis to structure data for the model was performed, providing an overview of events and their effect on maternal healthcare provision and use. We documented 2,674 events in 206 healthcare facilities, (an average of 38 events per week). Public facilities reported more events than private, with higher counts at tertiary levels. Lubumbashi health zone had the most events. Common events included vaccination campaigns, staff absences, and medicine stock-outs. At city, regional and national levels, 156 events were identified, mainly policy changes and infectious disease outbreaks. All events will be captured in SDM to inform strategies that anticipate system shocks. In conclusion, different events occur frequently across health facilities and national levels. These events are expected to have measurable impacts on MNH access and outcomes. Incorporating them into a systems dynamic model will improve understanding of their interactions and enable predictions on MNH indicators, supporting more resilient planning and targeted interventions.