Democratic Republic of Congo NHA Policy Impact
Actual Policy Use
Estimation Type: General
Year of Policy Impact: 2010, 2011, 2012
Type of Policy Impact: Institutionalization; Policy Dialogue; Advocacy
Country: DRC
Region: Sub-Saharan Africa
Topic: National Health Accounts
Democratic Republic of Congo NHA Policy Impact
Through the experience of conducting the 2008/09 National Health Accounts (NHA), the Democratic Republic of Congo (DRC) has taken important steps towards institutionalizing NHA by increasing demand and ownership over the NHA process, building local capacity, and successfully implementing cost-saving institutionalization strategies in data collection. Also, after wide dissemination in both French and English, the 2008/09 DRC NHA results substantiated policy dialogue in the broader stakeholder community in DRC, where results have informed national health policy development and health sector management.
With technical support from the Health Systems 20/20 Project, the DRC Ministry of Health (MOH) conducted the 2008/09 NHA, producing a picture of overall financial flows in the DRC health system as well as in specific health areas, including HIV, reproductive health, and child health through the completion of a general NHA and three subaccount analyses. This effort included a representative household survey, a targeted survey of people living with HIV, review of government expenditure reports, and institutional surveys for donors, NGOs, public and private employers, and mutual health insurance schemes.
This work has not only provided evidence to inform policy-makers taking steps to strengthen the health system in the DRC, but has also taken the DRC forward in improving the quality, consistency, and policy relevance of NHA data (i.e. NHA institutionalization).
The official release of the NHA results in October 2011 signaled a significant increase in awareness of, demand for, and ownership over NHA among national stakeholders in the DRC, as evidenced by the MOH’s decision to provide a dedicated budget and human resources for the National NHA Program (PNCNS). Most immediately, the funds will be used to update the NHA estimates for 2010, with additional data collection at the provincial level in order to provide more detailed information on MOH’s progress toward health system decentralization, which is a key country priority.
The increase in capacity at local institutions resulting from this experience conducting an NHA has also contributed to the DRC’s success in moving forward with institutionalization. During the 2008/09 NHA production process conducted in collaboration with Health Systems 20/20, PNCNS staff were trained and participated in all aspects of the NHA. The decision to allocate domestic funds to produce the next round of NHA reveals the strengthened national capacity and confidence in the PNCNS to produce NHA.
Experience planning surveys for the 2008/09 NHA also facilitated collaboration between the Ministry of Planning, responsible for conducting surveys, and the PNCNS team, responsible for producing and disseminating NHA. The head of the PNCNS team stated that the two agencies are now discussing future opportunities for continued collaboration on another household survey to be conducted in a few years.
Building capacity at the Kinshasa School of Public Health (KSPH) by sub-contracting the data collection for the targeted household survey of people living with HIV (PLHIV) also represents a significant step towards institutionalization. USAID and the World Bank, among other international stakeholders, have both articulated the importance of building the capacity at local institutions to conduct NHA because of high turnover of technical staff within government ministries.
In contrast, local institutions such as KSPH are less likely to lose this capability. This experience collecting out-of-pocket expenditure data from PLHIV will make HSPH an important resource for the MOH in future iterations of NHA. Successful collaboration with a major population-based survey to collect household-level data on health expenditure for use in the NHA reduced overall cost of the NHA significantly, signifying a step forward in the development of more efficient methods for conducting NHA in the DRC and in the international community.
Through the addition of a health expenditure module to the Multiple Indicator Cluster Survey (MICS), a major household survey implemented by UNICEF, the NHA team gathered the needed national-representative data on household out-of-pocket expenditure while saving an estimated US$1 million relative to what an independent NHA household survey would have cost. Also, the expenditure questions and training materials developed for this survey, as well as the experience implementing the expenditure module, can be used as a model to repeat similar collaborative efforts, in the DRC and in other countries.
