DR of Congo

History: PBF started in 2004 in South Kivu province by an alliance between Cordaid and the BDOM Bukavu, later the provincial purchasing agency. In 2006, the European Commission started financing a PBF project of Euro 80 million in 4 provinces. From 2016 onwards, the government with World Bank support and other donors started a large PBF programme covering 25% of the country.

Coverage Estimate: 25%
Feasibility: High
Supported by: Government, World Bank, Global Fund, GAVI, others’

Description: A PBF health pilot started in South Kivu by Cordaid in 2004 later followed in 2006 by a multi-sectoral PBF program also in Education, Road Maintenance and Public Administration. An impact study covering the period 2006-2008-2010 in South Kivu was published in Health Affairs and showed encouraging results in particular concerning the improvement in access to essential drugs, improved quality of care and the cost-effectiveness of aid agency interventions.

Since the last 15 years, there were various PBF, RBF or P4P schemes of different sorts and designs across DRC, with different budgets and implementation characteristics. Most of these schemes would not be considered pure PBF designs according to the PBF best practices such as presented in the SINA Health course manual (module 9). The results of the non-pure PBF programs were inconclusive such as the Katanga impact study implemented by two INGOs.

The main problem during about 10 years was that the DRC government, the aid agencies and (international) NGOs in DRC were reluctant to abandon their input approaches. Yet, due to several evaluations showing the importance of the more pure approach, the government in 2016 agreed with the World Bank to start a pure PBF program covering 25% of the country.

The current national PBF unit in DRC recruited recently several PBF experts trained in the “pure” approach and upscaling is underway.

Reference:
Soeters, R., P.-B. Peerenboom, et al. (2011). “Performance-Based Health Financing Experiment Improves Care in a Failed State.” Health Affairs 30(8): 1518-1527.

Fox, S., S. Witter, et al. (2013). “Paying health workers for performance in a fragmented, fragile state: reflections from Katanga Province, Democratic Republic of Congo.” Health Policy and Planning.

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