Health goals are achieved only when strong systems are in place to support them. Whether a government hopes to reduce HIV incidence or increase access to modern family planning methods, it must examine health outcome achievements through a health systems strengthening (HSS) lens. The overall health system, with its many layers and players, creates (or prevents) an enabling environment for improving coverage, quality, and scale of health interventions. Unfortunately, health systems in the Democratic Republic of Congo (DRC) have suffered from years of conflict and limited funding resulting in the need to address various issues in order to achieve improved health outcomes.
As a health systems-driven project, ASSP works within 52 health zones to improve the health needs of populations in 5 provinces. During the baseline assessment, ASSP measured all health zones using a 12-indicator scorecard. The indicators examined the health system across a variety of building blocks and measured indicators such as human resource availability, coverage of vaccinations, and reporting promptness. More than 80% of health zones (44) were rated as having low functionality. Findings verified the degree of health systems challenges such as high levels of absenteeism and pharmaceutical stock-outs. .
ASSP represents an important transition in the DRC, from humanitarian to developmental assistance. Having a framework to plan and measure that developmental progress is, therefore, an important and strategic element for ASSP. The primary objective of the framework is to transition each health zone through the three project developmental phases ensuring each graduates to the maintenance phase. Graduation helps facilitate greater sustainability in ensuring DRCs health system is more prepared to meet health needs. In order to support this objective ASSP has:
- Built effective health care service delivery systems through infrastructure development and capacity building in financial management, facility management, supply chain, health management information systems (HMIS) and service delivery
- Improved leadership and governance at the health facility, health zone, and provincial levels
- Strengthened systems integration and advocacy, creating greater efficiency and economies of scale and advocating for greater resources from the Congolese government
- Ensured each health zone achieved at least seven of eight maintenance phase indicators for maximum sustainability by the project’s end
- All health zones have undergone baseline assessments and have completed capacity strengthening plans (with ASSP support) based upon findings.
- Currently, 202 health facilities have been rehabilitated or newly constructed and another 87 construction projects are underway, including 51 new facilities and 36 renovations. Evidence shows improvements to service utilization and skilled birth attendance rates following the completion of construction and renovation works.
- Health development committees (CODESAs) are meeting more frequently and reporting their achievements, forging stronger bonds between community and facility and increasing health facility accountability. In fact, 823 CODESAs (and growing) are functional and reporting regularly. Virtually all CODESAs have submitted reports on time about health activities, a significant increase from the 75.4% baseline.
- A range of ASSP project indicators demonstrate strong service delivery and HSS progress, serving as a proxy for the maintenance level indicators. For example, ASSP reached 100% of its Year 4 target for health zones using DHIS2 to submit and complete their reports on time. Improved timely reporting is critical to making service delivery improvements.