DRC: the quality of health centers is not just a question of funding

Research in the Democratic Republic of Congo highlights the essential role of management practices in the quality of care provided to the most disadvantaged populations.

The statistics are clear: in just seven years, most African countries will face a gargantuan struggle to achieve the United Nations Sustainable Development Goals (SDGs). Consequently, more than 500 million Africans could live in extreme poverty by 2030 – of which at least 70% could still be in 2050.

Yet every year billions and billions of dollars are invested in developing countries low income. However, improvement and progress in terms of impact remain quite limited. How to explain such an incomplete impact?

In a recent research work, we studied the practices implemented in 1000 health centers in Democratic Republic of Congo (DRC) and how these practices can enable them to effectively benefit from the funds they receive. One of the main lessons is that financing is complementary to good governance.

A decline in infant mortality

We have observed that if only funds are poured into the health centers, they improve the volume of activity, they are able to treat more patients and provide a lot more medicines. But the quality of their services is not improving. However, when these funds are combined with good management practices (audit, feedback and commitment to really change the behavior of the beneficiary of the fund), we see an improvement in both quality and quantity.

In particular, we measure this quality of service by studying the infant mortality rate. In our study, we find that we are able to reduce the number of deaths by almost 50% over a period of four years! Keep in mind that the DRC is one of the worst countries to be born in, with an infant mortality rate of 70 per 1 births. Compare this to USA or France which have 0,4 deaths per 1 births…

An important dimension for good care is the need for staff and pregnant women to follow the process formalized by the World Health Organization (WHO) to achieve a healthy term of pregnancy. Infant mortality is often the result of inappropriate behavior and not in accordance with the WHO protocol in its entirety.

Good managerial practices can reduce this. Indeed, there is no need for additional medical training or change of employees: with good managerial skills, the teams give the best of themselves and provide high quality services.

The positive role of women

Our research also shows a very positive correlation between higher representation high women in the management and quality of the services provided. The literature generally suggests that women tend to be more collaborative and to generate much more interaction between the different groups.

However, in the DRC, a highly patriarchal society, women leaders tend to reduce interaction with the group, they call fewer meetings and decide alone on matters such as finances. In other words, they rely more on top-down management than on collaborative management in this specific area.

They also tend to avoid internal conflict because they are aware that the surrounding communities will take the man's side rather than the woman's.

While our findings relate to health centers in the DRC, they may also have broader resonance. Indeed, studying the DRC is a way of studying Africa in general. The idea is to find solutions to its problems, because what works there must be able to work elsewhere on the continent.

Anicet Fangwa, Ph.D. Student, Strategy and Business Policy, HEC Paris Business School; Bertrand Quelin, Professor of Strategy and member of the SnO Center (Society and Organizations), HEC Paris Business School; Caroline Flamer, Professor of International and Public Affairs, Columbia Universityand Marieke Huysentruyt, Associate Professor, Strategy and Business Policy, HEC Paris Business School

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