1. Abt Associates Inc. In collaboration with: I Aga Khan Foundation I Bitrán y Asociados I BRAC University I Broad Branch Associates I Deloitte Consulting, LLP I Forum One Communications I RTI International I Training Resources Group I Tulane University’s School of Public Health better systems, better health Better Health Systems: Strategies that Work Presentation Series at the Global Health Council Fred Rosensweig February 7, 2012 Health Systems Strengthening in the DRC

2. Overview of Health Systems 20/20’s Activities in DRC Program facts: 4 years and $7.3m Goals 1) Strengthen policymaking and inform strategies in health financing aimed at increasing access to services 2) Build sustainable institutional capacity of key national entities in management and coordination to enhance their effectiveness

3. Health Systems 20/20 Program Health financing - National Health Accounts – including WASH subaccount - Development of performance-based financing policy (PBF) and initial support for roll-out - Evaluation of Mutual Health Organization experience - Sub-recipient assessment for Global Fund grant

4. Health Systems 20/20 Program Capacity-building - Institutional Strengthening of Kinshasa School of Public Health (KSPH) - Strengthening of management and coordination capacity of HIV/AIDS Office (PNLS), Nutrition and Family Planning Offices in MOH

7. Challenges ChallengeConsequences Weak institutional capacityNo accountability Limited follow through Poorly paid staff Poor working conditions Dependency on donor fundingLimited government resources Strongly influenced by donor priorities Lack of qualified local consultantsBest people leave to work for development partners Personal economic securityEveryone is in survival or rent- seeking mode Lack of concern for the greater good

8. Coping with these Challenges Weak institutional capacity - Identify and work in partnership with strong leadership - Build management capacity over time (no short- term fix) - Make tangible improvements in working conditions - Find ways to motivate staff

9. Coping (cont.) Dependency on donor funding - Leverage other donors’ funding - Plan based on available resources - Develop capacity to attract and mobilize resources Finding qualified local consultants - Use a mix of local staff and resident expats

10. Coping (cont.) Personal economic security - Create incentives so all benefit - Use existing incentives (e.g, per diems for residential meetings) - Reward performance (PBF)

11. How these HSS Interventions Reduce Fragility KSPH is an enabling institution that trains public health leaders and carries out the analyses that inform HSS and health policy decisions PNLS has a stewardship role in development and oversight of HIV/AIDS programs By highlighting lack of resources, poor government commitments, and lack of support at provincial level, NHA provides information for improving state legitimacy

12. Reducing Fragility Strengthening NHA unit in MOH has attracted other donors and enhanced its role Large-scale PBF system provides incentives to achieve results a n d improve service delivery

13. Abt Associates Inc. In collaboration with: I Aga Khan Foundation I Bitrán y Asociados I BRAC University I Broad Branch Associates I Deloitte Consulting, LLP I Forum One Communications I RTI International I Training Resources Group I Tulane University’s School of Public Health better systems, better health www.HealthSystems2020.org Thank you