Overview

DRC’s National Health Strategy 2016-2020 calls for strengthened leadership and governance within the health sector.

The MOH specifically faces challenges at the provincial and health zone level in its ability to coordinate stakeholders and interventions, implement decentralization and healthcare reforms, and ensure care adheres to national standards. Weak leadership and functional steering bodies at the provincial and health zone level also results in a lack of evidence-based decision making and appropriate allocations of resources. Health Zone Management Teams and Health Development Committees (CODESAs), though present in almost all health zones, are much more responsive to routine administrative needs than to issues of management and good governance.

At the community level, villages often do not understand their rights and entitlements to health services and how to exercise them. Communities are often unaware of how governance institutions are structured, how power operates across them, and where decision-making power lies. Without this information or skills and resources to exercise them, they are unable to meaningfully hold health facilities and government accountable for health services.

Our Approach

ASSP improves leadership and governance by supporting the governance system at all levels. This includes support to administrative council meetings, planning meetings and documents and supervision. Using a leadership and governance lens, ASSP hopes to increase the understanding of social accountability both within and outside of government throughout all aspects of the project. Both the community and health service providers have roles to play. The project’s two supportive objectives under Leadership and Governance are therefore to:

  • Strengthen accountability at the provincial and health facility level for health service delivery.
  • Improve community participation and empowerment in the joint management of local health center activities.

Key Achievements

  • Nearly 786 health areas completed the Community Score Card process, developing improvement plans to improve a variety of factors that impact health uptake including the poor availability of quality drugs and supplies, poor cleanliness, poor infrastructure, poor customer service, and high fees in relation to service quality.
  • During Year 5, the number of operational CODESA (health development committees) has reached 894. This represents 113% of the annual target of 790 and 108% of the number of health facilities originally targeted. The frequency of meetings has also increased, resulting in greater dialogue on improving health service delivery and collaboration between the community and health facility management.
  • The Convention Cadre, an agreement between the government and the churches that deliver 40% of the healthcare in Congo, was signed off on by the Ministry of Health several years ago, but languished within the government for additional signatures prior to implementation. With the new reorganization of the MOH (i.e., new Minister of Health and new General Secretary), IMA has renewed those efforts. The new Minister of Health has signed off on the Convention Cadre. IMA will also be collaborating with the Integrated Governance Activity (IGA) to secure the remaining signatures and pilot implementation of the Convention Cadre in several provinces.
  • Since the launch of ASSP’s business abuse hotline in February of 2016, the Ministry of Health has resolved 678 issues reported by health centers and community.
  • The hotline has received 159 calls since January 2017. Half of the calls were related to medicines, with infrastructure, materials, tariffs, and theft each representing around 10% of calls. An analysis of data indicates that the number of calls per month (and calls per type of complaint) has remained relatively stable since January, (i.e., neither increasing or decreasing significantly).

A Hotline in DR Congo