The Republic of Congo has been struggling with stagnant health outcomes in recent years, largely due to insufficient investments in primary health care that have 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 percent to 15.7 percent, while the rate of the first antenatal care (ANC) visits for pregnant mothers rose from 16 percent to 35 percent. Moreover, the rate of pregnant mothers who completed four visits increased from 8 percent in 2020 to 18 percent in 2021 [1-3]. Furthermore, with infrastructure, essential medicines, and infection prevention and control (IPC) materials available to patients, the districts were empowered to respond more strongly to the COVID-19 pandemic.
Key WHO Contributions
Procurement of technical services in the field for trainings and supportive supervision/p>
Leading technical trainings on clinical and health care facility management
Initiation of finance mechanisms to maintain operations in health care facilities
Establishment of new partnerships for wider community engagement
Development of indicators for performance monitoring and evaluation
How did Congo, with the support of the WHO Secretariat, achieve this?
WHO 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 centers 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 provided trainings to health care personnel. Trainings conducted included the 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 non-governmental organizations (NGOs): Médecins d’Afrique, Terre Sans Frontières, and Croix Rouge Congolaise. These NGOs conducted social mobilization activities that centred on the utilization of healthcare 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. This data has 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.
“Thanks to the support of the World Health Organization (WHO), the health center 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
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 using 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 better sustain results into the future.
References
- OMS Congo. Evaluation rapide de la fonctionnalité des districts sanitaires dans 11 départements : Rapport synthèse. Août 2019.
- OMS Congo. Rapport annuel du travail de l’OMS en République du Congo 2020. Décembre 2020.
- OMS Congo. Rapport annuel du travail de l’OMS en République du Congo 2021. Décembre 2021.
- ILO NATLEX: Congo - Old Age, Invalidity and Survivors Benefit Act
- UNESCO Planipolis: Plan National de Développement (PND) 2018-2022
- OMS Congo & MSP. Stratégie et plan opérationnels 2020 – 2021 : Mise en œuvre du treizième programme général de travail de l’OMS au Congo. Janvier 2020.
- World Health Organization. (2010). Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies. World Health Organization.
