Democratic Republic of the Congo

{Photo credit: Warren Zelman}Photo credit: Warren Zelman

There are no magic bullets in life. For fixing a healthcare system, though, there is one approach that comes close: results-based financing. Management Sciences for Health (MSH) pioneered results-based financing in Haiti in 1999, and has been adapting and improving it ever since in sub-Saharan Africa, Latin America, and South-East Asia, including in fragile states.

In my 20-plus years in global health, I’ve seen what happens without results-based financing: A major donor sends millions of dollars’ worth of equipment and supplies to a developing country—and the quality of health services delivered doesn’t improve—or worse, it declines. Why?

Health providers are human, like all of us—sensitive to incentives, motivation, and demotivation. Say a hospital improves and now is well stocked: the community realizes this and the utilization rate doubles. Suddenly, a nurse may be facing 40 patients a day instead of 20, but without any added pay or assistance. It’s only natural he or she might work less under the crushing workload.

{Photo credit: Warren Zelman, Democratic Republic of the Congo}Photo credit: Warren Zelman, Democratic Republic of the Congo

This post originally appeared on the Frontline Health Workers Coalition blog.

I grew up in a village in northwestern Democratic Republic of the Congo (DRC), and although I’m now a doctor and live in Kinshasa, I remember those days well.

I know what it’s like to live 23 kilometers from the nearest health center and to navigate forests and floods to get there. I know how a lack of something simple like antibiotics can cause a quick death. I’ve lost many peers from the village over the years and a lot of family members.

In fact, that’s why I became a physician.

Meet Sophie.

I'd like to introduce you to a special mother. Her name is Mama Sophie (meet her in this video). Seven months pregnant and experiencing pain, Sophie went to the Dipeta Health Facility in Democratic Republic of the Congo (DRC):

I thought maybe the baby was changing position in the womb, but…[they told me the baby was coming].

Sophie was frightened: she had lost two babies before. She wasn’t the only person concerned. Dipeta Health Facility has an incubator, but doesn't have a reliable source of electricity to use it.

When I delivered... I could see people were worried… But, Mama Esther, the birth attendant said: ‘Mardochée will grow up in the Kangaroo Mother style.'

Trained by the birth attendant on Kangaroo Mother Care, Sophie held Mardochée skin-to-skin close against her chest -- wrapped in a cloth like a kangaroo protecting a newborn in its pouch -- for days and days.

{Photo credit: Rui Pires.}Photo credit: Rui Pires.

This special January 2014 edition of the Global Health Impact Newsletter (subscribe) features 12 stories from 2013 highlighting how MSH is saving lives by strengthening health systems at all levels--from the household to the community to the health facility to national authorities. The stories were selected through an internal storytelling contest (available in print soon).

We are also pleased to share a post from President and CEO Jonathan D. Quick outlining our vision for 2014.

A Note from Dr. Jonathan D. Quick

Vision 2014: UHC and the Opportunity for a Healthy Life

 {Photo credit: MSH.}USAID Administrator Rajiv Shah (right) is welcomed to Democratic Republic of the Congo (DRC) by Minister of Health Dr. Felix Kabange.Photo credit: MSH.

Last month, I had the honor of welcoming United States Agency for International Development (USAID) Administrator Rajiv Shah to Democratic Republic of the Congo (DRC) during a visit that took place December 15-18, 2013.

{Photo credit: Warren Zelman. DRC}Photo credit: Warren Zelman. DRC

MSH's current newsletter (November/December 2013) features stories about the people on the frontlines improving health and saving lives: health workers.

A Note from Dr. Jonathan D. Quick

My MSH colleagues Mary O'Neil and Jonathan Jay blog about what we can learn from the Third Global Forum on Human Resources for Health, held this November in Recife, Brazil:

Recife Top Ten: Together Toward Health for All

Mukabaha Ntakwigere (at right) at the General Reference Hospital in Nyangezi, DRC. {Photo credit: MSH staff.}Photo credit: MSH staff.

Tuberculosis (TB) is a leading cause of death in Democratic Republic of the Congo (DRC), partly due to a low case detection rate within the health system, compounded by little knowledge or awareness among patients of the disease’s symptoms. In the province of Sud Kivu, where people have relied on traditional healers for generations, those who were suffering from the persistent, painful coughing that is one symptom of TB were advised by traditional healers that they had been poisoned, and they were not referred to health centers.

In Sud Kivu province, in the health zone of Nyangezi, with a population of roughly 129,000 people, case detection was below 12%, which is the minimum "acceptable" threshold for TB detection.

Medical professionals in Nyangezi realized that they were never going to identify and treat those suffering from TB until they could educate the community about the symptoms and the treatment methods.

A group of young men in Mwene Ditu discuss using a cell phone to access health information. {Photo credit: Overseas Strategic Consulting, Ltd.}Photo credit: Overseas Strategic Consulting, Ltd.

Mobile phones are being used increasingly throughout Africa to improve health. The USAID-funded Democratic Republic of Congo-Integrated Health Project (DRC-IHP) is using mobile phone technology to increase the number of people referred to health centers in the project’s 80 targeted health zones. In Mwene Ditu, project staff observed that low numbers of referrals to health centers would be improved by increasing communication—within the community, between the community and health service providers, and among provincial health officials.

Immaculée, seated, holding her twin boys. Thanks to the intervention of the center’s midwife, at left, both of these babies are now in good health. {Photo credit: IRC.}Photo credit: IRC.

Thirteen newborns die every hour in Democratic Republic of the Congo (DRC). So on July 23, when 25-year old Immaculée went into labor with twins at the Monvu Reference Health Center in the Idjwi Health Zone, and her first twin was born without signs of life, the chances of survival were not in his favor.

The odds are stacked against newborns in the DRC: neonatal mortality hovers around 97 deaths for every 1,000 live births, and has done so for years, explaining the acute need for intervention in this area.

Recognizing this need, the USAID-funded DRC-Integrated Health Project (DRC-IHP), in conjunction with the Church of Latter Day Saints and the Ministry of Public Health, organized a “Helping Babies Breathe” training in Kinshasa in April 2012, to build the capacity of health providers who oversee labor and delivery.

Helping Babies Breathe is an evidence-based neonatal resuscitation approach designed for resource-limited areas, which teaches health workers how to handle newborns’ breathing in their first minute of life, a critical period known as the “Golden Minute.”

A community-based distribution agent discusses family planning options with a family in the DRC health zone of Ndekesha. {Photo credit: MSH.}Photo credit: MSH.

Cross-posted from Frontline Health Workers Coalition.

Evidence of the need to scale up the number of frontline health workers in developing countries abounds throughout sub-Saharan Africa, as described in a recent post on the Frontline Health Workers Coalition blog by Avril Ogrodnick of Abt Associates. Yet training new health workers is not sufficient, in itself, to sustainably address the crisis: governments must also invest in providing management support to harvest the full value of these trainings.

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