better systems, better health
Health Systems Strengthening
in the DRC
Better Health Systems: Strategies that Work
Presentation Series at the Global Health Council
Fred Rosensweig
February 7, 2012
Abt Associates Inc.
In collaboration with:
I Aga Khan Foundation I Bitrán y Asociados
I BRAC University I Broad Branch Associates
I Deloitte Consulting, LLP I Forum One Communications
I RTI International I Training Resources Group
I Tulane University’s School of Public Health
Overview of Health Systems 20/20’s
Activities in DRC
 Program facts: 4 years and $7.3m
 Goals
1) Strengthen policymaking and inform strategies in
health financing aimed at increasing access to
services
2) Build sustainable institutional capacity of key
national entities in management and coordination
to enhance their effectiveness
Health Systems 20/20 Program
 Health financing
- National Health Accounts – including WASH
subaccount
- Development of performance-based financing
policy (PBF) and initial support for roll-out
- Evaluation of Mutual Health Organization
experience
- Sub-recipient assessment for Global Fund grant
Health Systems 20/20 Program
 Capacity-building
- Institutional Strengthening of Kinshasa School of
Public Health (KSPH)
- Strengthening of management and coordination
capacity of HIV/AIDS Office (PNLS), Nutrition
and Family Planning Offices in MOH
Challenges
Challenge
Consequences
Weak institutional capacity
•
•
•
•
Dependency on donor funding
• Limited government resources
• Strongly influenced by donor
priorities
Lack of qualified local consultants
• Best people leave to work for
development partners
Personal economic security
• Everyone is in survival or rentseeking mode
• Lack of concern for the greater
good
No accountability
Limited follow through
Poorly paid staff
Poor working conditions
Coping with these Challenges
 Weak institutional capacity
- Identify and work in partnership with strong
leadership
- Build management capacity over time (no shortterm fix)
- Make tangible improvements in working conditions
- Find ways to motivate staff
Coping (cont.)
 Dependency on donor funding
- Leverage other donors’ funding
- Plan based on available resources
- Develop capacity to attract and mobilize resources
 Finding qualified local consultants
- Use a mix of local staff and resident expats
Coping (cont.)
 Personal economic security
- Create incentives so all benefit
- Use existing incentives (e.g, per diems for
residential meetings)
- Reward performance (PBF)
How these HSS Interventions
Reduce Fragility
 KSPH is an enabling institution that trains public
health leaders and carries out the analyses that
inform HSS and health policy decisions
 PNLS has a stewardship role in development and
oversight of HIV/AIDS programs
 By highlighting lack of resources, poor government
commitments, and lack of support at provincial level,
NHA provides information for improving state
legitimacy
Reducing Fragility
 Strengthening NHA unit in MOH has attracted other
donors and enhanced its role
 Large-scale PBF system provides incentives to
achieve results and improve service delivery
better systems, better health
Thank you
www.HealthSystems2020.org
Abt Associates Inc.
In collaboration with:
I Aga Khan Foundation I Bitrán y Asociados
I BRAC University I Broad Branch Associates
I Deloitte Consulting, LLP I Forum One Communications
I RTI International I Training Resources Group
I Tulane University’s School of Public Health