Our team has been very busy in the past few weeks. After deciding as a group that it would be more efficient for us to cut our challenge so we could address small pieces of it at a time, we had to decide on a solution strategy. That process itself was a great challenge. This is because of the following reasons: First of all, there are three different parties that need to be included in any solution we present. The first one is made of the international aid community. Included in it are the funding agencies (such as USAID), Non-governmental Organizations and Faith-based organizations. In theory, they should be motivated by a desire to see the government of DR Congo take a heavier responsibility in paying health workers salaries. In reality, the literature shows there is distrust coming from the international aid community regarding the capacity of the government to be able to take-on such a great managerial role. This can be observed in the plethora of micro-managed health projects in DR Congo which are led by individual organizations with no coordination between organizations and the government.
On the other side, is the government of the Democratic Republic of Congo. This government is motivated in theory by a desire to have agency in the development of health projects and infrastructure in the country. Making them capable to paying their own healthcare workers increases their legitimacy as a government. This also increases the popularity of the leaders within the population. Furthermore, capacity-building within the health sector will be another step towards development for DR Congo. In reality however, there does not appear to be a strong will from the government to take on this role. It can be argued that it is easier for administrative reasons to ignore this important problem, especially because a solution would be costly (time, financial and non-financial resources).
Lastly, but certainly not least are the healthcare provider themselves. They need to be paid for the work they do, and are motivated primarily by that pay. It can be argued that as long as they are paid well and in a timely manner, it does not really matter to them where the money is coming from (government vs international aid community).
Our proposed solution is to set up a website that would present information about the situation of the payroll system in DR Congo. Healthcare workers who receive payment will be asked to fill out forms- which will be collected by field workers using smartphone apps, making the collection faster and more easily transferable to the website. Once the healthcare workers are registered, they are sent codes on their cellphones that allow them to send information about the timely manner of their salary payment via SMS. If they have access to the website, they will also be able to consult job postings shared on the website by the community of international aid organizations. This additional service will serve as an incentive for them to get registered. The information provided will allow both the government and the international aid community to track efforts by the government to pay health care providers well. Based on observed progress, international aid organizations will decide to reward or “penalize” the government.
This is where we are currently. It is obvious that we need to work the specific of how this will happen. We welcome any comments/suggestions/ideas you may have!
Our team has quickly learned just how many angles this challenge (and solution!) can be viewed from. The health system in the DRC is complex and many years of civil conflict have had a significant impact not only on the infrastructure of health services, but also on the welfare of the population and capacity of the national government.
Through our research and team meetings up until now, our solution is developing around the idea of strengthening public-private partnerships to motivate government attention to the health sector. We are exploring different political and financial incentives for stakeholders to engage in necessary reforms in the DRC, before turning our attention to some of the more pragmatic challenges to public healthcare provision in the country. With one of the lowest GDPs per capita in the world, financing is already an important consideration.
In the DRC, most aid donors implement projects through NGOs rather than funding the government directly. Our approach is to work on how to bring these parties together in order to establish a collaborative and comprehensive strategy to tackling healthcare challenges. If some already allocated aid funding could be redirected through central channels, it’s possible that a more coordinated and effective health system could be implemented. In order to accomplish this, trust between the Ministry of Health, donors and NGOs needs to be well established; details of how the government could implement reforms, as well as desired outcomes and monitoring strategies will need to be outlined.
We’re confident that a centrally coordinated (and funded) health system would benefit all stakeholders. More specifically, updating the health services payroll could…
These are just a few of our thoughts. We’re excited to be meeting our mentor later this week and to continue researching, discussing and innovating! We’ll keep you posted!