Supporting Local Health Care in a Chronic Crisis Management and Financing Approaches in the Eastern Democratic Republic of the Congo (2006) / Chapter Skim
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3 Main Findings
3 Main Findings
Pages 36-66
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From page 36... ...
. The objective of the qualitative analysis is to find possible reasons for the variations in utilization rates with regard to security and the management approaches by the different agencies.
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From page 37... ...
The health nurse also checks their status; in this way, the local health committee and the health nurse can control each other's work. The IRC reimburses the health centers for the coupons that they receive.
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From page 38... ...
and limited (primary and secondary support to hospitals for health care) indigent treatment in Kabare Health Zone.
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From page 39... ...
1999 functioned well enough to abolished) revenues spent on limit or withdraw incentives for zone international support bureau, health centers and health committee Health centers, reference Health centers, reference Humanitarian organizations health centers, and health centers, and traditionally focus on primary hospitals (primary and hospitals (primary and health care, more secondary health care)
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From page 40... ...
Reimbursement health committee and health to health centers by IRC staff. Indigent are treated for free, no reimbursement to health centers by Merlin.
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From page 41... ...
Important to provide together with health incentives to health center staff committee, but no in order to promote treatment reimbursement to of the indigent. Claims of free health centers by indigent treatment hard to ASRAMES verify without control and indigent care system Before January 2001 Since September 1999 Regular adjustment necessary $2.00 Urban/rural maximum for optimization of use due to $1.00 Adult $1.0/$0.5 insecurity and economic After Child $1.0/$0.5 decline.
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From page 42... ...
42 SUPPORTING LOCAL HEALTH CARE IN A CHRONIC CRISIS TABLE 3-1 Continued Finance IRC Merlin Allocation of revenues 30% drugs and supplies Old (to savings account) 45% incentives 40% incentives 10% running costs 30% running cost 25% zone bureau subsidy 20% community fund Proposed 70% incentives 20% running cost/community fund 10% zone bureau subsidy Adopted 65% incentives 20% running cost/community fund 15% zone bureau subsidy Debt of health center Growing, especially at No information reference health centers with more complex treatments Utilization rates Strong growth, especially Strong growth of indigent attendance
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From page 43... ...
If revenues are not of the costs of the drugs high enough the 4 to the zone bureau. Of organizations attempt to the remaining revenues: provide direct subsidies, e.g., 40% running costs for preventive services 60% incentives No information Growing debt led to Important topic requires humanitarian cost-sharing further research in terms of policy.
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From page 44... ...
President including finances, signs the contracts. indigent status and guarding drugs and supplies
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From page 45... ...
An health center. Security 17 health zone visited adaptable middle ground problems may obstruct every 2 months (in 2002 would be either a visits every month decentralized supervision system or a shadowing exercise in which health authorities are required to undertake a certain amount of supervisory visits in order to receive continued support Does not cooperate closely One for each health Well-functioning health with health committees center.
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From page 46... ...
plus $100 a 44% goes to the zone month as incentive for bureau. And 250 liters medical doctors and $150 as of petrol, 5 liters of incentive for other zone motor oil a month for bureau staff supervisory visits and field trips Kabare bureau zone salaries: Of 30% running costs, 60% goes to the zone bureau.
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From page 47... ...
Problem of parallel reporting systems. Doubts of capacity and corruption linger Health center pays 15% 10% zone bureau The four NGOs support the of the costs of the drugs running costs (see zone bureaus in very different to the zone bureau Table 3-1)
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From page 48... ...
Health staff receives refresher training in treatment protocols, vaccination techniques, epidemiological surveillance, cholera treatment and other topics as deemed necessary. Occasional finance training for health center Donor OFDA, perhaps USAID ECHO in the future Utilization Access has improved, Access has improved, but but more work to analysis needs to be carried out.
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From page 49... ...
Rational prescription Judgment on quality of Management of primary training is not possible health care Financial management and accountancy Training in drugs management Training on the spot of BCZ supervisors Health information systems and management models Training for supervisors and trainers Consulting techniques ECHO ECHO for several years, OFDA and ECHO have and now PATS different policies for cost sharing and hospital support. This contributes indirectly to fragmentation of health system Unclear whether access Access has improved, but Access has improved.
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From page 50... ...
With heavy supervision and regular stock-ups, the presence of drugs in a health facility boosts patient confidence. IRC-supported clinics are in a single health zone.
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From page 51... ...
· Supervisors and zone bureau staff generally examine the orders for medicines for correctness. · The IRC, Malteser, Merlin, and ASRAMES all have conditions that the health centers must fulfill in order to ensure delivery.
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From page 52... ...
In addition, supervision can help prevent health staff from raising prices, increase respect for opening hours, and contribute to more professional and efficient, even friendlier, care. 2 In 2001, survey teams working in the Walungu health zone had to gain consent from both rebel factions in Walungu, while trying to avoid letting either side know that they had had contact with the other.
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From page 53... ...
The health zone with the highest average utilization rates between 1999 and 2001 is Katana (average 42 percent) , supported by the IRC.
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From page 54... ...
54 SUPPORTING LOCAL HEALTH CARE IN A CHRONIC CRISIS 90 A C A C C B B B B x D s 80 tieli ci fa 70 thla heta 60 1 cenadn 50 ttea 2 noita 40 3 pul 30 po egatnecr 20 Pe 10 0 r y l pt v r v r y l pt v n-99 Ju pt Ma Jul Ju Ma Se No n-00 Ma May Se No n-01Ma Ma Se No Ja Ja Ja Time period IRC ASRAMES Malteser Walungu Malteser Nyangezi FIGURE 3-1 Utilization of health facilities supported by NGOs in eastern DRC. NOTE: Fee A: $1.5 urban; $1 rural Fee B: $2 Adults; $1 children Fee C: $1 urban; 0.5 rural Fee D: $1 adults; $0.5 children Arrow 1: Start of IRC indigent coupon scheme Arrow 2: Reported influx of IDPs into Katana Health zone Arrow 3: Closure of several health facilities in Walungu and Nyangezi due to insecurity 1999, a peak in utilization is evident late in each year.
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From page 55... ...
NOTE: Arrow 1: Reported influx of IDPs into Katana health zone
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From page 56... ...
No simultaneous rise or security reports are recorded from the ASRAMES health zones. We can suggest that the first steep rise in utilization rates was a result of internally displaced persons moving into the Katana health zone.
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From page 57... ...
Yet for the IRC there is a decline in indigent utilization from August 2000 onward, indicating that many internally displaced persons were leaving the area and nonindigent groups were using health facilities. The trend in ASRAMES utilization rates around this time is similar to those of the IRC, with a peak in November and December 2000 in the utilization of health facilities.
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From page 58... ...
Notably, these differences relate to the IRC's intensive system of supervision to improve health care quality and local capacities, including the classification of indigent, the reclassification of those under age 15 as children, and the accessibility of the agency to the health zones it supports. From the data under Objective 1, it seems that indigent support as well as intensive supervision and regular drug supplies lead to higher utilization rates.
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From page 59... ...
Merlin works with variable rates that can differ by health zone based on (60 percent of) local private pharmacy prices.
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From page 60... ...
Some of the waivers include free drugs; for example, Mer lin provides folic acid for pregnant women. Table 3-3 shows revenues that would be gained as a result of utilization rates of half, 1.0, and 3.0 times per year and the percentage of all operational costs of the health facility that these revenues would make up.
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From page 61... ...
Applying this figure to Katana data means that health facility running costs would total $326,400 per year for all health facilities. Based on the ideal minimum standard goal of three visits per person per year, IRC revenues would result in revenues amounting to $1,061,820, taking into account free health care for indigent populations.
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From page 62... ...
Utilization, at its highest in Kabare health zone, is 1.15 per year, and in Katana, at its highest point, 0.8 per year -- leading to the revenues described in Table 3-4. The revenues gained through the IRC system would make up 46 percent of those needed to run health facilities alone on a month to month basis.
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From page 63... ...
. TABLE 3-6 Estimated Revenues from Health Facilities in JanuaryDecember 2001 Under Age 5 Over Age 5 Total Estimated Revenues Raised ($)
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From page 64... ...
-- Running costs vary from 10 to 30 percent for health centers and from 10 to 25 percent for zone bureaus. -- Savings should contribute to running costs or buying medicine once the NGO terminates its support.
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From page 65... ...
The international organizations are divided on this, but most local health staff do not want to lose these resources. They will promote cost recovery as long as there is no functioning state.
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From page 66... ...
It is clear that the zone bureaus and local health staff require technical and management support. The control mechanisms for the contract approach should be established clearly in advance (goals, reporting procedures, supervision, evaluation, and so on)
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