Democratic Republic of the Congo: Project to Support the Integrated Development of the Healthcare System in North Kivu (PADISS)

 

PADISS (Support Project for the Integrated Development of the Healthcare System) is an interdisciplinary project, carried out by authorities from the provincial area and with the participation of numerous actors, including the population. The project has a simultaneous effect on different key elements of the healthcare system in North Kivu in order to offer sustainable, good quality, coherent and appropriate treatments.

 

Context

In 2020, with an estimated population of 9,000,000 inhabitants, the quality of the healthcare system in the region of North-Kivu still represents a big challenge. Healthcare provision and services face recurring high-priority issues:

  1. Poor healthcare coverage.
  2. Poor quality of services and treatments, due to an inadequate quality assurance process (clinical audits, supervision, coaching, mentoring, hospital hygiene, etc.).
  3. Low availability of healthcare supply      and poor financial, geographical and cultural accessibility of healthcare services for the population.
  4. Low resiliency of healthcare structures against possible epidemics, emergencies, and disasters.

Poor public accountability of healthcare services before the community.

Problems linked to HR in the healthcare system:

 In regard to HR training, there is an imbalance between how courses are organised and the even distribution of healthcare professionals, not only between rural and urban environments, but also between healthcare structures in the same provinces. Some categories (general practitioners, nurses) are in overproduction while others are in underproduction (obstetricians, intensivists, pharmaceutical assistants). There is a plethora in urban areas and a deficit in rural areas. Moreover, low wages and the high proportion of healthcare professionals who do not receive either wages or bonuses lead to a lack of motivation and loyalty among professionals.

The proliferation of secondary schools, high schools and universities that do not meet the required standards, along with the lack of an operational education system, are the main causes of the insufficient quality of healthcare professional’s education and service provider’s skills.

Problems linked to medicine, vaccines, and specific inputs:

  1. Low availability of medicine and specific inputs in health training (called “FOSA”);
  2. Circulation of low quality medicine;
  3. Few inspections of pharmaceutical establishments and services;

A blatant lack of data to support the quantification of needs, the lack of information about storage, and the poorly organised and inefficient distribution network.

Objectives

The Project to Support the Integrated Development of the Healthcare System in North Kivu (PADISS) started in March 2017, and was formulated in collaboration with the local authorities and Erasme-Coopération. The main objective is to improve the quality of healthcare and its accessibility in the North Kivu province. The project ensures that the available healthcare supply is organised in a sensible way, and that treatments in hospitals and health centres comply with the quality and management standards in order to be eligible for the Purchase Funds for Healthcare Services in North Kivu (FASS, Fonds d’Achat de Services de Santé du Nord–Kivu) subsidies.

The strengthening of the DPS’ (Provincial Health Division) expertise and means is one of the main objectives of the project. This will be achieved by:

  • Organising the DPS’ work and resource management in order to allow the executives to be operational in the health zones (ZS);
  • Securing the system supplying health services with essential medicines to guarantee their efficiency and continuity;
  • Securing blood transfusions;
  • Reactivating and optimizing the provincial health information system;
  • Establishing an efficient dialogue between health authorities, service providers, and the population.

Actions

  1. Renovating and equipping healthcare facilities and Watsan projects based on previously defined priorities ;
  2. Supporting the Provincial Health Division in its coordination and development functions for health zones;
  3. Supporting the HPNK (Provincial Health Hospital) so that they may offer good-quality, secondary health treatments. In particular, the main focuses of the project are governance (especially the clinical one), reorganising services, ensuring quality of healthcare, managing the pricing system and testing a new computerised system of patient’s files;
  4. Organising the continuing education of the health staff, thanks to the introduction of a provincial continuing education centre;
  5. Adapting the organisation of primary healthcare in the urban areas;
  6. Starting an accreditation process for the healthcare structures in North Kivu in collaboration with the FASS, on the basis of clinical expertise, budget balance, management, supply of essential medicine, infrastructures and equipment, in order to improve the affordability of quality healthcare for the population;
  7. Analysing the feasibility of a health insurance system for North Kivu that fits in with the RDC’s procedure towards universal health coverage (UHC);
  8. Supporting the implementation of a provincial policy to fight against malnutrition;
  9. Adopting an iterative way of thinking for each action that is put in place, in order to accumulate experience.

Expected impacts

At the end of the project, the certified healthcare structures will offer financially accessible, first and second quality level healthcare to the inhabitants of Goma. Many mechanisms will be put in place to guarantee that this quality level is maintained:

  • The certification of health structures will bring quality to subsidised healthcare;
  • A new, coherent and sensible organisation of subsidised healthcare that will respond to urban specificities;
  • The implementation of a continuing education programme for health staff;
  • Recognition of the population’s role as an analytical viewpoint on the organisation of medical treatments;
  • The establishment of new relationships between the population and the health staff that defines roles and duties for each actor.

The offer of secondary and tertiary treatments will be redesigned depending on restrictions and available resources.

The provincial hospital, which will be reorganised and fully equipped, will ensure coordination with the support of partner hospitals and will play an important role in the continuing education programme.

 

The province will have a strategy to fight malnutrition adapted to each context. There will be an authorization mechanism for the corresponding health system.

The province will also have a centre of continuing education for the medical and paramedical staff. The training units will be linked to a staff certification system. If

If possible, the partners will be encouraged to incorporate their “traditional” training within the framework of the education centre and to participate in its financing.

The DPS will have better control of the training organisation and of the resulting staff absences.

The main healthcare structures in the Rutshuru zone will integrate the certification and subsidy system.

The DPS’ existing measures will be reinforced (support to the different zones, health information…). The DPS will have new measures to improve the organisation and coordination of treatments at the province level (including a certification system and education centres).

Operational partners

  • DPS NK is a decentralised structure of the Ministry of Public Health of the DRC. It has the duty to (i) support the provincial government, especially the Minister, in achieving constitutional prerogatives; (ii) to manage the provincial health administration; (iii) to give technical, logistic and management support to health zones and structures; (iv) to organise the supply and use of health services by implementing the provincial health development plan; (v) to coordinate services, interventions and health partners in the province; (vi) to guarantee the monitoring and evaluation of the health interventions in North Kivu.

The NK DPS has a crucial role in implementing the PADISS project, particularly in the strategic aspect of the development of a universal health coverage system. The first step towards the UHC system is certifying medical training and staff, to guarantee access to quality healthcare for the whole population.

  • ZS Goma and Rutshuru. The health zone is a geographical entity delimited by the DRC’s Ministry of Public Health. The health services are organised in two interdependent levels under the supervision of a Health Zone Management Team who reports to the Health Zone Management Committee. The Committee has three main functions: (i) managing and coordinating health measures; (ii) organising the healthcare supply in the general referral hospital; (iii) providing support regarding the organisation of medical services in health centres.

Management teams from Goma and Rutshuru’s health centres guide the implementation of the PADISS project in these two zones, particularly by supervising the activities planned in health centres and general hospitals, including community mobilisation.

  • HPNK (North Kivu provincial hospital): its mission is to ensure the continuity of medical care to the patients that require a technical facility that is not available in the general referral For this purpose, it develops secondary health services, it serves as an internship location for clinical training, it participates in field training of the medical staff and in operational research activities.

Since May 2019 the HPNK has received a subsidy from the European Development Fund (EDF 11) to carry out this mission. This helps them to work towards a flat rate pricing system where the patient benefits from co-payments, and the European Union is the third-party payer.

Within the PADISS framework, the HPNK agreed to improve the healthcare supply, both in terms of the quality of medical care provided and its functions in the provincial healthcare system.

Complete Project Project to support the integrated development of the North Kivu health system (PADISS)
“Accreditation” axis Support for the establishment of an accreditation system in North Kivu
“Health Insurance” axis Support for the establishment of an appropriate health insurance system
“DPS” axis Support for the provincial health division of North Kivu 
“Education” axis Support for the establishment of an autonomous continuing training system in clinical practice and in the management of health services
“Urban Health” axis Construction and rehabilitaion of health structures 
“Nutrition” axis Support for the establishment of a viable organization of health services in urban areas
“Gender and Participation” axis Support for strengthening gender and community participation

 

Financial partners

The project is funded by the European Union (EU) and the Belgian Cooperation. It is a part of the Reinforcement Programme for the Supply and Development of Medical Care Access (PRO-DS) funded by the European Union within the 11th European Fund for Development.

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belgique partenaire du développement

Budget

€16,500,000

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