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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1 Introduction
1 Introduction
Pages 1-12
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In particular, the topic of cost recovery, or more modestly, cost sharing, in these crises has rarely been studied, and there are no standard responses for simultaneously recovering costs and increasing a population's access to health care in war zones. Higher quality data on the management of cost recovery can lead to a better understanding of the interaction of price, quality, access, and 1
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2. To determine how these financing approaches affect utilization rates in the health zones supported by the four NGOs.
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The key to health care financing is to establish a health management system that provides the right incentives for the staff and organizations involved to improve the quality of health care and keep it cost-efficient. Health facility utilization shows the current level of the population using the health facility, as well as the difference in health facility usage with different payment schemes by different organizations.
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Only then can a higher degree of cost recovery be reintroduced. BACKGROUND For more than 30 years, the people of the DRC suffered under President Mobutu's unchecked corruption and mismanagement, which "left public services in disrepair, creating desperate poverty, chronic poor health," and ethnic conflicts (see Van Herp, Parque, Rackley, and Ford, 2003:141; Wrong, 2001)
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. The eastern DRC has become an "unchecked incubation zone for diseases," with the highest rates of excess mortality known to have occurred in the world (Roberts, 2000:3)
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Simultaneously, the fees obtained cannot adequately cover all operating costs of the health centers. At the national political level, the death of President Laurent Kabila in January 2001 and subsequent replacement by his son, Joseph Kabila, led to renewed diplomatic interventions to achieve peace.
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THE PROBLEM The topic of cost recovery or cost sharing in today's chronic crises has rarely been studied, and cost sharing has become a contentious issue inside and outside war zones and can be a key barrier to overcoming health inequities. In addition, there are no commonly acknowledged standard responses for simultaneously recovering costs and increasing attendance in war zones (Poletti, 2003, 2004)
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4) .4 In sum, raising revenue and increasing efficiency and equity constitute the main arguments in favor of introducing fees.5 The assumptions behind the rationale for cost recovery center on the role of the state and its accountability to its population, in particular on the idea that a willing and able government takes the interests of its population seriously, and that despite economic problems sound macroeconomic policy will help improve the lives of its citizens.
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For this reason, the interaction between the local population, the local health system, and the international organizations becomes a crucial topic for further study. Since there are no commonly accepted approaches to health financing in chronic crises in general or to cost recovery in particular, many international organizations -- and their donors -- promote their own approaches to support health care, and concomitantly, cost recovery.
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internal documents of the four organizations with quantitative data on attendance and management of the health care system; (2) a literature study on cost recovery/cost sharing; and (3)
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ECC Église du Christ au Congo ECHO Humanitarian Aid Office of the European Union EPI Extended Program on Immunization EU European Union FrC Franc Congolais FLC Front de Libération du Congo FOMULAC Fondation Médicale de l'Université de Louvain en Afrique Centrale FSKI Fondation Sud Kivu HC health center HMIS health management information system ID internal document continued
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12 SUPPORTING LOCAL HEALTH CARE IN A CHRONIC CRISIS BOX 1-1 Continued IDA International Dispensary Association IDP internally displaced person IMF International Monetary Fund IRC International Rescue Committee KAP knowledge, attitudes, and practices MDM Médicins du Monde Merlin Medical Emergency Relief International MONUC Mission Observatrice des Nations Unies pour le Congo MOU memorandum of understanding MRND Mouvement Républicain Nationale Démocratique MSF Médecins Sans Frontières MSF-H Médecins Sans FrontièresHollande NGO nongovernmental organization OCHA United Nations Office for the Coordination of Humanitarian Affairs OFDA Office of U.S. Foreign Disaster Assistance ORS oral rehydration salt PATS Programme d'Appui Transitoire au Secteur de la Santé PHC primary health care RCD Rassemblement Congolais pour la Démocratie RHC reference health center SANRU Projet de Développement de la Santé Rurale SNIS Système National d'Information Sanitaire UN United Nations UNDP United Nations Development Programme UNICEF United Nations Children's Fund WHO World Health Organization
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