District health system strengthening to improve access to quality primary health care services in the Congo

The Congo has been struggling with stagnant health outcomes in recent years, largely due to insufficient investment in primary health care that has led to the underutilization of health services by the population. In an effort to address this issue, the World Health Organization (WHO) Congo collaborated with the Ministry of Health (MoH) to develop a decentralized strategy to provide technical assistance, mobilize resources and support implementation of activities at the peripheral level of the health system. After two years of implementation (January 2020–December 2021), the programme has achieved remarkable results. Health care service utilization increased from 8.1 to 15.7 percent, while the rate of the first antenatal care (ANC) visits for pregnant mothers rose from 16 to 35 percent. Moreover, the rate of pregnant mothers who completed four visits increased from 8 percent in 2020 to 18 percent in 20211–3. Furthermore, with infrastructure, essential medicines and infection prevention and control (IPC) materials available to patients, districts were empowered to respond more strongly to the COVID-19 pandemic.

How did Congo, with the support of the WHO Secretariat, achieve this?

The WHO country office in Congo provided technical expertise to the MoH to introduce the Enhanced District Approach (EDA) into Congo’s 2018 national health policy, the National Health Development Plan 2018–2022, and established a joint operational strategy. The EDA focuses on strengthening the capacity of district health systems to deliver quality health services, while also addressing the underlying social and economic determinants of health. The strategy aimed to first revitalize 12 of the 52 health districts in the country before progressively expanding to the remaining 40 districts.

Thanks to the support of the World Health Organization (WHO) and the Ministry of Health and Population, our people can receive the medical care they need without having to travel to Brazzaville or Kinshasa for treatment, eliminating the need for long-distance journeys. - Mr Joel Ngatsongo, Chief Administrative Officer of Mbamou Island

To strengthen local governance so that operational health zones and their subdistrict level health centres could deliver the minimum health care package to the local population, WHO Congo assigned two national consultants and a driver to each health directorate. These personnel provided day-to-day support to the regional director, district health management team and also trained health care personnel. Training sessions included Integrated Management of Childhood Illnesses (IMCI), family planning, using a partograph when assisting birth at health facilities and the management of health institutions. Joint WHO Congo and MoH teams then conducted enhanced supportive supervision missions to improve governance, using a set of WHO tools to assess existing gaps and challenges, and provided technical assistance and advice to improve the functionality of the health committees in each district. WHO Congo also provided technical assistance and guidance to mobilize, establish and manage local cost-sharing funds, which were used to finance operational gaps such as payment of health volunteers, purchase medicines, equipment, and fuel for outreach and vaccinations.

To raise community awareness of the importance of having access to health care, WHO Congo partnered with three nongovernmental organizations (NGOs): Médecins d’Afrique, Terre Sans Frontières and Croix Rouge Congolaise. These NGOs conducted social mobilization activities that centred on the utilization of health care facilities, maternal health, antenatal care visits, immunization and COVID-19 prevention.

Furthermore, WHO Congo worked with the MoH on designing a comprehensive set of 18 performance indicators for health facilities in 12 districts. These data have been instrumental in monitoring health outcomes based on WHO standards. Over the two-year implementation of the programme, data indicated that restoring the community’s trust in the health care facilities and improvements in district functioning had resulted in increased service utilization.

The initiative’s success stands as a testament to the effectiveness of WHO Congo and the MoH’s comprehensive operational approach which encompassed local governance, supportive supervision, financial seed funds to cover operational deficits and NGO-orchestrated promotion activities. The presence of strong national-level MOH support for decentralization and WHO Congo’s direct support at the district level was crucial, as was accessing a common pool of funds. This enabled resources from a variety of programmes to be amalgamated for district-strengthening, allowing numerous gaps in the health workforce, health financing and accountability to be addressed efficiently. Taking a district strengthening approach is also expected to sustain results more effectively into the future.

Thanks to the support of the World Health Organization (WHO), the health centre now has access to a variety of essential health products, equipment, and materials that we previously lacked. These resources, including solar panels, will help us provide better care and improve the health of our community  - Mr Olivier Kitsoki, Head of Mbamou Village

Knowledge

WHO country stories: delivering for all

“This impact story was published as part of the WHO country stories: delivering for all report, which presents a snapshot of how WHO has delivered on its mission in countries and contributed to health outcomes across a wide range of issues during 2022-2023.”