DR of Congo

Start: 2004

Phase: PBF started in 2004 in South Kivu province by Cordaid and the BDOM Bukavu. Followed in 2005 by a non-pure Euro 80 million European Commission financed phase 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 or RBF schemes of different sorts and designs across DRC, with differing 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 these non-pure PBF programs were in-conclusive.

The DRC government, aid agencies and (international) NGOs in DRC are reluctant to abandon the input approaches whereby the purchases of essential drugs, equipment, means of transport, school books, etc are centralised instead of left to health facilities. This, in practice but also according to economic theory, reduces significantly the effectiveness of those initiatives. Yet, since 2016 the government has agreed with the World Bank and some other aid agencies to start a more pure PBF program covering 25% of the country, although the issue of centralised purchasing is not yet fully settled.

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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