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Improving financial access to health care in the Kisantu district in the Democratic Republic of Congo: acting upon complexity.

Stasse S, Vita D, Kimfuta J, da Silveira VC, Bossyns P, Criel B - Glob Health Action (2015)

Bottom Line: A financial subsidy from BTC allowed to reduce the height of the flat fees.The results in terms of enhancing people access to quality health care were immediate and substantial.It provides useful lessons for other districts in the country.

View Article: PubMed Central - PubMed

Affiliation: Belgian Aid Agency, Kisantu, DR Congo; stephaniestasse@yahoo.co.uk.

ABSTRACT

Background: Comzmercialization of health care has contributed to widen inequities between the rich and the poor, especially in settings with suboptimal regulatory frameworks of the health sector. Poorly regulated fee-for-service payment systems generate inequity and initiate a vicious circle in which access to quality health care gradually deteriorates. Although the abolition of user fees is high on the international health policy agenda, the sudden removal of user fees may have disrupting effects on the health system and may not be affordable or sustainable in resource-constrained countries, such as the Democratic Republic of Congo.

Methods and results: Between 2008 and 2011, the Belgian development aid agency (BTC) launched a set of reforms in the Kisantu district, in the province of Bas Congo, through an action-research process deemed appropriate for the implementation of change within open complex systems such as the Kisantu local health system. Moreover, the entire process contributed to strengthen the stewardship capacity of the Kisantu district management team. The reforms mainly comprised the rationalization of resources and the regulation of health services financing. Flat fees per episode of disease were introduced as an alternative to fee-for-service payments by patients. A financial subsidy from BTC allowed to reduce the height of the flat fees. The provision of the subsidy was made conditional upon a range of measures to rationalize the use of resources.

Conclusions: The results in terms of enhancing people access to quality health care were immediate and substantial. The Kisantu experience demonstrates that a systems approach is essential in addressing complex problems. It provides useful lessons for other districts in the country.

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A map of Kisantu district (health zone), Bas Congo, DRC.
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Figure 0001: A map of Kisantu district (health zone), Bas Congo, DRC.

Mentions: Kisantu district is located in the province of Bas Congo in the extreme southwest of the DRC and counts 144,395 inhabitants, among which approximately 45% live in the town of Kisantu and its surroundings (Fig. 1). It has one GH located in the semi-urban zone, as well as 16 IHCs. The GH belongs to the Diocese of Kisantu; however, it has signed an agreement with the State and operates as a district-designated hospital, assisting the government in providing healthcare for its population. Four of its seven resident medical doctors are also priests, and each year the hospital welcomes approximately eight freshly graduated doctors who will train at the GH during a stay of 6–24 months. Four IHCs are located in the vicinity of the GH (i.e. less than five km distant). Kisantu has a long history of cooperation with Belgium. In the 1970s and 1980s, it cooperated with other health zones to feed and influence health policies throughout the DRC (26, 27).


Improving financial access to health care in the Kisantu district in the Democratic Republic of Congo: acting upon complexity.

Stasse S, Vita D, Kimfuta J, da Silveira VC, Bossyns P, Criel B - Glob Health Action (2015)

A map of Kisantu district (health zone), Bas Congo, DRC.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4307026&req=5

Figure 0001: A map of Kisantu district (health zone), Bas Congo, DRC.
Mentions: Kisantu district is located in the province of Bas Congo in the extreme southwest of the DRC and counts 144,395 inhabitants, among which approximately 45% live in the town of Kisantu and its surroundings (Fig. 1). It has one GH located in the semi-urban zone, as well as 16 IHCs. The GH belongs to the Diocese of Kisantu; however, it has signed an agreement with the State and operates as a district-designated hospital, assisting the government in providing healthcare for its population. Four of its seven resident medical doctors are also priests, and each year the hospital welcomes approximately eight freshly graduated doctors who will train at the GH during a stay of 6–24 months. Four IHCs are located in the vicinity of the GH (i.e. less than five km distant). Kisantu has a long history of cooperation with Belgium. In the 1970s and 1980s, it cooperated with other health zones to feed and influence health policies throughout the DRC (26, 27).

Bottom Line: A financial subsidy from BTC allowed to reduce the height of the flat fees.The results in terms of enhancing people access to quality health care were immediate and substantial.It provides useful lessons for other districts in the country.

View Article: PubMed Central - PubMed

Affiliation: Belgian Aid Agency, Kisantu, DR Congo; stephaniestasse@yahoo.co.uk.

ABSTRACT

Background: Comzmercialization of health care has contributed to widen inequities between the rich and the poor, especially in settings with suboptimal regulatory frameworks of the health sector. Poorly regulated fee-for-service payment systems generate inequity and initiate a vicious circle in which access to quality health care gradually deteriorates. Although the abolition of user fees is high on the international health policy agenda, the sudden removal of user fees may have disrupting effects on the health system and may not be affordable or sustainable in resource-constrained countries, such as the Democratic Republic of Congo.

Methods and results: Between 2008 and 2011, the Belgian development aid agency (BTC) launched a set of reforms in the Kisantu district, in the province of Bas Congo, through an action-research process deemed appropriate for the implementation of change within open complex systems such as the Kisantu local health system. Moreover, the entire process contributed to strengthen the stewardship capacity of the Kisantu district management team. The reforms mainly comprised the rationalization of resources and the regulation of health services financing. Flat fees per episode of disease were introduced as an alternative to fee-for-service payments by patients. A financial subsidy from BTC allowed to reduce the height of the flat fees. The provision of the subsidy was made conditional upon a range of measures to rationalize the use of resources.

Conclusions: The results in terms of enhancing people access to quality health care were immediate and substantial. The Kisantu experience demonstrates that a systems approach is essential in addressing complex problems. It provides useful lessons for other districts in the country.

Show MeSH