Reinforcing social accountability in health services in Sud Kivu and Kongo Central provinces
Final evaluation of the GPSA/CODESA project
This report looks at the GPSA-funded project implemented by the Dutch NGO Cordaid to reinforce the CODESAs in the Democratic Republic of the Congo (DRC). The Comité de Développement Sanitaire (Sanitary Development Committee), or CODESA, is a committee made of community members who co-manage their primary health-care facilities (HF) and lead the sanitary development of their area. The GPSA/CODESA project took place in two provinces, Sud Kivu and Congo Central, which are located 1,800 km apart and differ in terms of their socio-economic situation and political stability. The Congolese health system is largely decentralised (with core regulations and some vertical programmes still managed by the national Ministry of Health) and benefits from substantial international aid, especially in the eastern part of the country, including Sud Kivu. This aid is provided in the form of technical assistance, material, and also input-based and output-based (performance-based financing, PBF) financing. Substantial power resides with health provinces, which have their own Provincial Ministries of Health and may be at times relatively cut off from Kinshasa given the poor transportation in a huge territory and important security in some areas. They are allocated a budget and distribute resources to health zones (HZ) and primary health facilities (HF). HFs have some degree of autonomy in management, which has been extending by or due to decentralisation, insecurity, and PBF.