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Public Disclosure AuthorizedPublic Disclosure AuthorizedPublic Disclosure AuthorizedPublic Disclosure Authorized

iTh Rol of th Privt Sctor in Improvin th Prformnc of th Hlth Sstm in th

Dmocrtic Rpublic of Cono

Tbl of Contnts

1.1

BACKGROUND 1

1.2

REGIONAL CONTEXT 2

1.3

ASSESSMENT PURPOSE, SCOPE, AND GEOGRAPHIC FOCUS 2

1.4

OVERVIEW OF THE REPORT 6

2.1

KEY REGIONAL THEMES 7

2.2

HEALTH SYSTEM STRUCTURE 7

3.1

INTRODUCTION 12

3.2

PRIVATE ENGAGEMENT AND PARTNERSHIPS 14

3.3

RECOMMENDATIONS 18

4.1

INTRODUCTION 22

4.2

FAMILY PLANNING 23

4.3

MATERNAL HEALTH 28

4.4

CHILD HEALTH 30

4.5

NUTRITION 32

4.6

OTHER HEALTH AREAS 33

4.7

SERVICE DEMAND 34

4.8

RECOMMENDATIONS 36

5.1

OVERVIEW OF THE SUPPLY CHAIN 38

5.2

PUBLIC/NGO SUPPLY CHAIN 39

5.3

COMMERCIAL SECTOR SUPPLY CHAIN 40

5.4

ACCESSIBILITY AND PRICING OF DRUGS 42

5.5

REGISTRATION AND PHARMACOVIGILANCE 43

5.6

RECOMMENDATIONS

44

6.Finncin 48

7.Hlth workforc 66

8.Hlth informtion sstms 74

9.Thr-r rod mp for ction 85

10.Conclusion 104

Appndixs 105

Rfrncs 112

mutuelles 52 ABEF Abt ACT ARCA ASF ASPS

ASRAMES

B&MGF BDOM CDR CLC CNMN

CNP-SS

CODESA

CPN CPR CTMP DCA DHIS2 DHS DPM DPS DRC FBO FDI

FEDECAME

FINCA FP GAHN GDP GSK HRH iHRIS IFC IHP IMNCI LMIS MCH mCPR MESP MFI MOCC MSME MSP NCIFP NGO OCC ORS PBF

PEPFAR

PMA2020

PMI PMTI PNAME PNDS PNLP PNPMS PNSR

POMUCO

PPP

PRONANUT

PSI SARA SBC SNIS TB TPA U5M UHC

UMUSAC

UNFPA

UNICEF

USAID UHC WB WHO xiii

Recommended Citation:

xv

Table 1

Tbl 1.

K ssssmnt ndins nd rcommndtions

Leadership and Governance

Service Delivery

Private Sector Supply Chain and Systems

Leadership and Governance

Service Delivery

xvii

Th DRC hs rcntl pssd lisltion (Loi Orniqu

no.17/002 du 8 févrir 2017) tht will nbl scl-up of covr in communit-bsd mutulls, s wll s othr nncin mchnisms, such s mndtor hlth insur- nc for civil srvnts.

Hlth nncin prorms vr, with d hoc mn-

mnt structurs, pmnt rrnmnts, nd dminis trtiv procsss. Prorms usull purchs srvics throuh f-for-srvic modls nd strul to mn risks of morl hrd nd frud. Th DRC hs pilotd prformnc-bsd nncin (PBF) schms to hlp improv hlth sstm prformnc. To dt, schms hv lrl xcludd privt providrs.

Humn rsourcs for hlth (HRH) dt in th privt

sctor r limitd bcus not ll stkholdrs rport to th MSP.

Privt providrs s tht FBOs nd NGOs r fvord b

th MSP bov for-prot hlth fcilitis for contrctin. Inititivs to incrs HRH motivtion r limitd b th MSP's inbilit to p th slris of its st in public fcilitis nd privt fcilitis th r contrctin with.

Trinin plns xist for ll lvls of HRH, but th qulit

nd ccssibilit of trinin vris bcus of indqut rsourcs nd trinrs, s wll s orphic/nncil constrints.

Limitd informtion is vilbl bout wht drus nd

commoditis r ristrd. Privt sctor dt r routinl collctd nd includ hih lvls of privt sctor rportin for thos ris- trd, n chivmnt tht nds to b continuousl rin forcd nd incntivid.

District Hlth Informtion Sstm 2 (DHIS2) FP nd

child hlth dt r limitd nd do not provid com plt pictur of commodit s uppl or dmnd.

Th loistics mnmnt informtion sstm (LMIS) is insucint to monitor nd strnthn th suppl chin. Lvr nd strnthn xistin providr ntworks nd

frnchiss to rinforc privt providr trinin on FP counslin nd srvic provision.

Encour collbortion mon donors, intrntionl

nonovrnmntl ornitions (NGOs), nd FEDECAME to i mprov th ntionl sstm for commodit forcst- in nd procurmnt.

Estblish n dvocc forum for mutulls to n ov-

rnmnt nd othr k stkholdrs to implmnt nd monitor dhrnc to common prformnc stndrds focusd on clinicl cr, srvic mix, pricin nd billin prctics, rportin, nd ptint srvic stndrds.

Support xpnsion of strtic purchsin for hlth nncin prorms, includin contrctin, which includs nw modls for qulit ssurnc of contrctd privt providrs.

Vlidt succsss nd chllns of PBF nd th xtnt to which th hv nd privt providrs. Tst whthr nd how PBF cn promot qulit nd cinc in th privt sctor.

Support MSP to collbort with public nd privt sc-tor stkholdrs to bttr mp th HRH vilbl in th privt sctor cross k hlth rs to idntif nd ddrss HRH ps.

Dvlop nd implmnt with th MSP's Dirctort of Humn Rsourcs sstmtic pproch to improv HRH motivtion in both th public nd privt sctor in collbortion with prtnrs.

Support MSP to work with prtnrs, includin ordrs nd providr ssocitions, to improv trinin prorms cross public nd privt trinin institutions, includin prorms for trinrs.

Estblish comprhnsiv wb-bsd dtbs of r-

istrd drus nd pprovd lots for frquntl usd mdicins.

Tbl 1.

K ssssmnt ndins nd rcommndtions

Tbl 1.

K ssssmnt ndins nd rcommndtions

Leadership and Governance

Private Sector Supply Chain and Systems

Health Workforce in the Private Sector

Leadership and Governance

Private Sector Supply Chain and Systems

Health Workforce in the Private Sector

xix

Gnrll, lisltion currntl inhibits ccss to privt

hlth srvics nd products. Th currnt customs nd txtion rims ris th costs of locl production of mdicins nd th costs tht consumrs p for importd commoditis. Cost is mjor brrir to th us of FP srvics in th pri-vt sctor.

Private Sector Supply Chain and Systems

Th dcntrlid rionl suppl chin ntwork, FEDE-

CAME, hs limitd cpcit nd rquirs nw nncin

strtis to mn bd dbt risk.

Rionl distribution cntrs nd to improv dbt mn-

mnt to row oprtions.

Th privt sctor suppl chin is hvil frmntd

nd in nd of mjor ovrhul, s wll s cpcit strnthnin to dlivr nd hndl mdicins ccordin to phrmcuticl norms.

Th mjor brrir for locl mnufcturrs is thir filur

to chiv th qulit stndrds tht would llow thm to prticipt in FEDECAME nd intrntionl orni tion tndrs. Th DRC lcks cultur of insurnc mon citins, lim-itin dmnd for insurnc.

Th mjorit of hlth nncin prorms focus on thr-

putic cr rthr thn prvntiv srvics, such s FP.

Privt providrs hv limitd xprinc with or know-

how to work with hlth nncin prorms, nd thir clinicl nd srvic stndrds vr widl.

Access to Finance

Th ASPS could b vlubl prtnr to xpnd nncin for th privt hlth sctor.

Hlth providrs oftn hv wk businss nd nncil mnmnt cpcit nd r unbl to provid nn-cil sttmnts or ccounts histor to prov thir rp-

mnt cpcit to nncil institut ions.

Conduct ll nd rultor rviw to idntif rul-

tor rticls rltd to th privt hlth sctor ndin rform. Encour locl dru mnufcturin throuh polic rform, tchnicl support, ccss to nncin, nd rvis- in customs nd txtion rims.

Explor opportunitis to xpnd currnt PPP orts for

vccins to includ FP commoditis. Throuh xistin prorms from th World Bnk nd othr prtnrs, provid tchnicl support to FEDECAME bond procurmnt, stor, nd loisticl issus to includ cost controls, mrktin, nd risk mnmnt. Assist th ntir FEDECAME ntwork (includin rionl cntrs) to ccss nw nncin opportunitis nd mn- bd dbt. Strnthn th privt suppl chin b buildin cpc-it of rionl distributors to hndl mdicins; buildin public-sctor cpcit to suprvis nd nforc dru rultions nd inspct phrmcis; risin th qulit stndrds of dru wholslrs; nd dnin nw scop of prctic for scond-tir dru shops tht cn sll lim itd rn of ssntil mdicins. Provid tchnicl support throuh th WHO to mnufc-turrs to improv qulit. Collbort with th Autorité d Réultion t d Con- trôl ds Assurncs (ARCA; nw insurnc rultor), insurnc compnis, mutulls, hlth providrs, nd othr ctors to duct consumrs bout insurnc, nd pilot n insurnc prorm trtd t informl, vulnr- bl roups.

Collbort with mutulls nd corport sponsors to

covr FP nd prvntiv hlth srvics nd products. Strnthn rdinss of privt providrs to prtici-pt in mutulls nd othr hlth nncin inititivs b dvlopin sclbl providr ntwork with common qulit, pricin, nd trtmnt stndrds.

Tbl 1.

K ssssmnt ndins nd rcommndtions

Tbl 1.

K ssssmnt ndins nd rcommndtions

Leadership and Governance

Service Delivery

Private Sector Supply Chain and Systems

Leadership and Governance

Service Delivery

Private Sector Supply Chain and Systems

xxi

Hlth nncin prorms run b third prt dminis-

trtors or privt sctor mplors oftn fc chlln s rltd to providr pmnts, costs, or frud, mon othrs.

It is dicult for privt providrs to obtin nncin to

build or xpnd thir prctic.

Thr r fw ornitions in th DRC positiond to provid tchnicl ssistnc to hlth ntrpriss tht would nbl thm to b invstor rd.

Althouh mn implmntin prtnrs r risin wr-

nss bout k hlth rs, thr is no coordintd pproch to prtnrin with tlcommunictions ncis, such s Orn, Vodcom, Airtl, nd Africll, which hv lr phsicl, virtul, nd humn ntworks cross th

DRC nd cn b lvrd to improv ntionl communi

ction infrstructur.

Support third-prt dministrtor (TPA) or mplor to dvlop nd scl up n improvd modl to dministr n mplo bnt prorm.

Prtnrships btwn quipmnt supplirs nd bnks

cn dvlop (for th bnk) piplin of clints ndin lons to purchs quipmnt nd (for th supplir) sourc of nncin. Work with nncil institutions to xpnd lndin to th hlth sctor, potntill throuh risk-shrin mchnism (such s USAID Dvlopmnt

Crdit Authorit portfolio urnt), idntif mdium or

lonr-trm fundin, nd provid tchnicl ssistnc to bnks to rduc th cost of lndin to th hlth sctor.

Assss th lndscp for hlth ntrpriss nd dtr-

min th most promisin ctivitis to jump-strt hlth compnis.

Assss, hrmoni, nd rt dmnd for diitl

hlth srvics in th hlth sctor.

Convn implmntin prtnrs, tlcommunictions

ncis, nd th MSP to stblish diitl hlth nt- work coordintin bod tht hrmonis pprochs to diitl communiction nd outrch strtis for k hlth prioritis. This includs xplorin PPP opportunitis for communiction nd dt collction nd trnsmission.

Tbl 1.

K ssssmnt ndins nd rcommndtions

1. Bckround nd Mthodolo

1.1

BACKGROUND

With a population of 78.7 million, the DRC is Africa's fourth most populous country (World Bank 2016). The country is experiencing rapid population growth, espe cially among youth ages 15 to 30 years (USAID 2014), with an expected increase of 10 million by 2050. Most of the population lives in poverty and is not active in the formal economy. The National Institute of Statistics found that the DRC's informal sector represented 89 percent of total economic activity in 2012 (export.gov 2017b). investment, the DRC has experienced limited improve ments in its economic and development outcomes. Declines in the global price of minerals and petroleum have led to slower economic growth in recent years. Gross domestic product (GDP) grew only slightly between 2015 and 2016, from $37 billion to $38.5 billion (2.4 percent, increased from 1 percent to 12 percent between 2015 and

2016. Ongoing political instability discourages investment,

diverts attention from economic issues, and increases the cost of doing business (export.gov 2017b). Foreign direct investment (FDI) statistical data are unavailable ( Box 1 The United Nations has an ongoing, large-scale peace keeping operation in the east of the DRC, where violence persists because of the presence of several militias and foreign armed groups (U.S. Department of State 2016).Es of doin businss In recent years, the DRC has made it easier to start a business, including in health, by combining multiple registration procedures, reducing the time required to obtain a building permit, and eliminating the require ment for a woman to obtain her husband's permission to start a business (World Bank 2017a; 2017d). The DRC has also established a one-stop shop for opening a busi

ness and accessing credit information by establishing a credit registry known as the "centrale des risques" in the

Banque Centrale. In addition, the government has created the National Agency for Investment Promotion, which uses provisions of the new Investment Code to simplify investments and make the procedures more transparent. Probusiness incentives range from tax breaks to duty dependent upon the location and type of enterprise, the number of jobs created, the extent of training and pro motion of local staff, and the export-producing potential of the operation.

Table 2

lists the DRC's "Doing Business" rankings by topic. The DRC ranked 182 of 190 countries in 2017 - although reforms have made it easier to start a business, there

2017d). On a scale of 0 to 100, the Millennium Challenge

policy (94) and business start-up (76) but low marks in regulatory quality (18), access to credit (24), control of corruption (18), and government effectiveness (20) (MCC 2017).Hlth outcoms Despite gradual improvements in some key health indica

Obtinin rlibl sttisticl dt on FDI in th DRC

rmins chlln. Th lrst forin invstors in th DRC r Chvron Oil, with its Cono Gulf Oil subsidir,

Citibnk, Tlcl, Mobil, Group Dmsux conlomrt,

Brlim brwr, UNIBRA brwr, Tbcono/Rothmn

Corp., Hsson Group, nd BAT Cono.

Mi n.d.

countries that collectively accounts for half of all deaths are not covered by basic treatment services for diarrhea, fever, and respiratory infections (Barroy et al. 2014). Use of oral rehydration solution (ORS) and zinc remains low, even in provinces with large urban areas, such as Katanga, where use of ORS and zinc is at 38.3 percent and 0.9 percent, respectively (MPSMRM, MSP, and ICF International. 2014). The DRC also has high rates of mal amounting to 4.5 percent of GDP lost annually (World

Food Programme 2017).

1.2

REGIONAL CONTEXT

tion in culture, economy, language, and health indicators. Many locations can be accessed only by plane or boat, adding to regional differences. Kinshasa province, home to the capital city, generally outperforms the rest of the country for most health indicators. North and South Kivu, where instability has been concentrated in recent years, have the highest rate of infant mortality. The for mer Katanga province has the highest fertility rate at

7.8 children per woman and the lowest use of contracep

tives at 3.9 percent.

Table 3

summarizes general health characteristics for the key regions of this report. 1.3

ASSESSMENT PURPOSE, SCOPE,

AND GEOGRAPHIC FOCUS

To guide the MSP and development partners in their strat egies and health investments, the World Bank and IFC, in partnership with the B&MGF and USAID, are implement ing a private health sector assessment. This assessment supports ongoing and future government and donor efforts by providing:

An estimate of the size, scope, and scale of the private health sector, with an emphasis on key stakeholders

and their roles; An overview of the types of health services and prod- ucts offered by the private sector, with particular focus on FP and MCH;quotesdbs_dbs1.pdfusesText_1

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