Evaluation of the impact of the single contract and the provincial approach in the implementation of health system reform at intermediate level in Maniema, DR Congo

Angoyo Manvota Jacques 1, Akondji Bainakofota Dieudonné 2, *, Mukobya Wakyata Morgan 3, Ngamaneni Massi Raphael 4, Tokolombi Mokili Joseph 4, Wayele Ayomba Sathiel 4, Longomba inenu Pierre 4 and Longomba Kemetu Jean 4

1 Independent researcher affiliated to the Higher Institute of Medical Techniques of Isiro, Upper Uele Province. RD Congo.
2 University of Kisangani, Faculty of Law. RD Congo.
3 Department of Geology, Faculty of Sciences, University of Moyen Lualaba, Maniema Province, RD Congo.
4 Higher Institute of Medical techniques of Kisangani, DR Congo.
Research Article
World Journal of Advanced Research and Reviews, 2024, 22(03), 1231–1241
Article DOI: 10.30574/wjarr.2024.22.3.1301
Publication history: 
Received on 20 March 2024; revised on 25 May 2024; accepted on 28 May 2024
Introduction: The health system in the Democratic Republic of Congo lacks sufficient skills and funding. The decentralization of the health system, following the reform of the intermediate level initiated by the government of the Democratic Republic of Congo, has not yet succeeded in improving Human Resource Management in the health sector in Maniema.
Methodology: The inductive approach was used, with recourse to the survey method. This facilitated the collection of information on the knowledge, attitudes and practices of the strategies (effects/impacts) on health system reform, the single contract and the provincial approach. The qualitative survey used an active participatory method. Thus, the use of an attitude questionnaire or opinionnaire as an investigative tool seemed the logical way to gather information on the opinions, interests, values and attitudes of the interviewees. Documentary analysis enabled us to collect other information to complement that gathered by the survey.
Results: After analyzing the data, we arrived at the following results: 1. the single contract has provided a certain solution to the problem of planning the use of resources for certain actors and Technical and Financial Partners. However, most participants had reported that funding for specialized programs is still managed by the national authority; 2. some partners remain locked into the vertical programs of the Technical and Financial Partners, abandoning other programs that need funding to operate; 3. the single contract approach has not improved the remuneration of members of the Provincial Health Division, most of whom live on state bonuses.
Conclusion: Reform is one way of improving the performance of healthcare systems. In countries where health systems are heavily dependent on international aid, reform would make it possible to centralize aid and transparently finance the development or action plans of the health systems concerned.
Evaluation; Impact; Single contract; Provincial approach; Reform; Health system; Intermediate level; Maniema
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