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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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The health district as a complex system.
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Figure 0002: The health district as a complex system.

Mentions: The method used was action research, an iterative process of problem analysis, hypotheses generation, identification of solutions, implementation, and evaluation of the action(s) taken (30–33). Action research is appropriate for studying complex problems (such as health care access) in complex systems (such as the Kisantu local health system) as it takes into account the various interrelations with various actors in the system, the context specificities, the connections between actors, context and the system itself, and unexpected results. Lessons learned during the action-research implementation, models, and frameworks used are source of inspiration to other wanting to develop or scale-up similar experiences. From the start, the Kisantu intervention considered the health system as an open complex system with interlinked components interacting with the context in which the health system is located. Understanding this interconnectedness and complexity is at the core of a systems thinking approach that views the system as a whole, with properties beyond the component parts (34). In this perspective, which is represented in Fig. 2, the application of an action to one component of the system can upset the balance of the whole system.


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)

The health district as a complex system.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0002: The health district as a complex system.
Mentions: The method used was action research, an iterative process of problem analysis, hypotheses generation, identification of solutions, implementation, and evaluation of the action(s) taken (30–33). Action research is appropriate for studying complex problems (such as health care access) in complex systems (such as the Kisantu local health system) as it takes into account the various interrelations with various actors in the system, the context specificities, the connections between actors, context and the system itself, and unexpected results. Lessons learned during the action-research implementation, models, and frameworks used are source of inspiration to other wanting to develop or scale-up similar experiences. From the start, the Kisantu intervention considered the health system as an open complex system with interlinked components interacting with the context in which the health system is located. Understanding this interconnectedness and complexity is at the core of a systems thinking approach that views the system as a whole, with properties beyond the component parts (34). In this perspective, which is represented in Fig. 2, the application of an action to one component of the system can upset the balance of the whole system.

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