DRC Presentation

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Information about DRC Presentation

Published on January 7, 2008

Author: abdullah

Source: authorstream.com

Health Reform in DRC: Steering harmonisation and alignment There's more to health politics than expertise and tools :  Health Reform in DRC: Steering harmonisation and alignment There's more to health politics than expertise and tools Dr Miaka, Secretary General, MOH DRC Dr Kalambay, Director, Studies and Planning, MOH DRC hppt:www//minisanterdc.cd Slide2:  Where we come from 2005: a strategy for reforming the sector and for dealing with donors Conditions of success & lessons learned The way forward A robust health system…:  A robust health system… Pioneer of district health model ("zones de santé") Rather dense network 400 hospitals (1 / 180,000 inhabitants), 5078 health centres (1 / 10,000 inhabitants). Programme indicators seem to be green, but the system is falling to pieces State absent since 1980s (budget = MONUC); Health budget 2005: 1.2 $/inh; Salary DMO: < 50 $ / month Sliding:  Sliding The world's deadliest crisis:  The world's deadliest crisis 60 M inhabitants: : 24 million affected 1,6 million IDPs Around 500,000 refugees in neighbouring countries Conflict related excess mortality: 4,000,000 Slide7:  A wide spectrum of situations Slide8:  A wide spectrum of situations Slide9:  A series of programmes, in parallel, in contradiction, with gaps, and wasting of resources The language of districts is still there, but only bits and pieces work Health “care” for sale: unregulated commercialisation of health care delivery Institutional inflation and distortion:  Institutional inflation and distortion Service delivery Individual coping strategies + the pump → Commercialisation, Exclusion Dangerous "care" Institutional memory disappears Inflation of facilities: From 306 to 515 districts Lukula (150,000 inh): norm: 18 HC; 2004: 75 facilities; 2005: 92 facilities Two-track donor funding → Fragmentation and conflicts in the field Institutional inflation and distortion:  Institutional inflation and distortion 2. HRH One of the few professions perceived as attractive Schools are profitable businesses 17 → 58 university faculties and training centres: 2004: 5 extra drs per hospital. 2006: 10? 219 → 362 nursing schools 1+/district; produce > 7000 per year: > 1 / HC Dangerous: Social time-bomb Harmful for health Overproduction of HRH:  Overproduction of HRH 2005: 1500 in 2 universities, + ??? In 15 other medical faculties Institutional inflation and distortion:  Institutional inflation and distortion 3. Leadership and Governance Institutional inflation following donor money & pressure: from 7 to 13 directorates, from 17 to 52 programmes This absorbs large part of donor money and energy, but with little visible results MOH largely absent in strategic discussions within donors Donor reactions:  Donor reactions "It's corrupt and it doesn't work" Create parallel systems for rapid results Create parallel systems to gather data and indicators Focus on programs and on implementation, not on support and capacity building Conflictual relation with the structures they're supposed to support A multitude of donor coordination mechanisms (per programme!) and discussion clubs, a/o GIBS, most without MOH. The multiplication of coordination mechanisms further contributed to fragmentation. Slide16:  2005: MOH formulates a strategy for reform Political context:  Political context War winds down; Political transition, New constitution, Perspective of elections, Decentralisation Signs of improvement (budget, governance…) More international confidence, aid flows tend to grow Conjunction of various agendas: Civil service reform Reconstructing the State / but without financial teeth Performance of programmes constrained by weakness of health system: ex EPI / Polio 2005: Who?:  2005: Who? Initiative MOH Open Steering group, with co-optation of internal diaspora: DEP-WHO-WB-BTC-EU-Canada… An endogenous strategy as first step of reform, Taking into consideration political evolution constitutional changes civil service reform Scope :  Scope District development as priority Redefine roles of central and intermediary levels Rationalise financing Develop Human Resources for Health policy Health systems research Strengthen intra- and intersectoral coordination Manage donors and stakeholders Specificity of the strategy:  Specificity of the strategy Central/cross-cutting: Prevent further harm: "mesures conservatoires" to halt inflation and distortion System: Start from operational problems in the field: progressive district development Address donor fragmentation: shift locus of negotiation Address programme fragmentation: shift from programme to system funding Surprisingly Rapid Effects:  Surprisingly Rapid Effects Became health component of PRS Donor adhesion: "déclaration commune" Influence on other ministries: Plan, Public administration; adhesion of Ministry of Finance Readjustment existing projects FED, USAID, WB, ADB Reorientation of new initiatives Belgium, Canada Control of donor fragmentation GIBS, MOH-GIBS incentives & salary supplements… GIBS becomes pressure group (e.g. GFAMT, politicians) Single steering committees, single TA Control of programme fragmentation Annual review (S, not P), "mesures conservatoires" Common products: norms, minimum package GIBS channels programme funds through district plans from funding programmes to funding systems: the shift for 6 major donors:  from funding programmes to funding systems: the shift for 6 major donors Slide23:  Lessons learned: Conditions of success Conditions of success / lessons learned:  Conditions of success / lessons learned 1. People Diaspora, memory Complicity, team 2. A double strategy: substance and management of partners 3. Start from problems in the field Rather than from central or from tools Because it's where the problems are Because coping strategies there are vulnerable Progressively but with FULL package (VISIBLE) 4. Manage resistance, tensions and ambitions 5. Conditioned by overall development otherwise tensions & distortions (e.g. HRH!!!) Slide25:  Way forward On substance:  On substance Rebuilding the health sector is necessary to rebuild the State and secure peace Accept that it is a long term and complex endeavour: no magic bullets Accept that responsibility for health is more than controlling a sum of diseases – and that this will cost money Build alliances beyond the health sector On relations with partners:  On relations with partners State is still fragile, partners have to anticipate Situations change, partners have to be flexible Declarations of good will are not enough, partners have to align their internal incentives It will take time, partners need to make long term and predictable commitments It means building systems, partners have to look at HRH (salaries!) and institutions (capacities!), not just at programmes and technical issues

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