Improving knowledge generation and capitalisation in health system strengthening projects: learning and documenting action research in the Democratic Republic of Congo
1
Enabel, Kisangani, Congo, Democratic Republic of the
2
Enabel, Kinshasa, Congo, Democratic Republic of the
3
Enabel, Brussels, Belgium
4
School of public health, University libre of Brussels, Bruxelles, Belgium
5
Centre des connaissances en santé, Kinshasa, Congo, Democratic Republic of the
Popul. Med. 2026;8(Supplement Supplement 1):A3721
ABSTRACT
INTRODUCTION:
To address challenges related to the financial accessibility of quality hospital care, Enabel (Belgian developpement agency) supports the Tshopo Provincial Health Division in the implementation of a subsidised flat-rate payment system at Isangi General Referral Hospital (GRH), while ensuring the financial sustainability of the facility. This approach aims to reduce out-of-pocket payments for patients referred to hospital care, including provisions for indigent patients.
METHODS:
A descriptive evaluative study was conducted at Isangi GRH from 1 October 2024 to 31 March 2025. The evaluation covered ten hospital services included in the subsidised flat-rate payment system. Only patients referred from primary health care centres to the GRH were eligible for the scheme. Three types of evaluation were carried out: (i) service volume assessment; (ii) technical quality assessment; and (iii) perceived quality of care assessment.
RESULTS:
A total of 1076 services were delivered compared to 642 planned for the study period, corresponding to an achievement rate of 167%. Among indigent patients, only 2 services were provided out of 32 planned (6.2%). Technical quality verification assessed seven health system pillars using the DQI framework, resulting in a quality score of 60.2%. Community verification combined with patient satisfaction surveys improved from 67% at baseline to 72% six months after implementation. Staff satisfaction increased from 49% at baseline to 70.1%. The overall quality score, integrating the DQI, patient satisfaction, and the complementary flat-rate assessment tool, was 60.6%. From a financial perspective, USD 29913 were spent against a projected budget of USD 21272, corresponding to an execution rate of 140.6%.
CONCLUSIONS:
The implementation of the subsidised flat-rate payment system was considered satisfactory in terms of service utilisation and quality improvement. However, several challenges were identified, particularly regarding coverage of indigent patients and financial forecasting, leading to recommendations to further strengthen and optimise the scheme.
To address challenges related to the financial accessibility of quality hospital care, Enabel (Belgian developpement agency) supports the Tshopo Provincial Health Division in the implementation of a subsidised flat-rate payment system at Isangi General Referral Hospital (GRH), while ensuring the financial sustainability of the facility. This approach aims to reduce out-of-pocket payments for patients referred to hospital care, including provisions for indigent patients.
METHODS:
A descriptive evaluative study was conducted at Isangi GRH from 1 October 2024 to 31 March 2025. The evaluation covered ten hospital services included in the subsidised flat-rate payment system. Only patients referred from primary health care centres to the GRH were eligible for the scheme. Three types of evaluation were carried out: (i) service volume assessment; (ii) technical quality assessment; and (iii) perceived quality of care assessment.
RESULTS:
A total of 1076 services were delivered compared to 642 planned for the study period, corresponding to an achievement rate of 167%. Among indigent patients, only 2 services were provided out of 32 planned (6.2%). Technical quality verification assessed seven health system pillars using the DQI framework, resulting in a quality score of 60.2%. Community verification combined with patient satisfaction surveys improved from 67% at baseline to 72% six months after implementation. Staff satisfaction increased from 49% at baseline to 70.1%. The overall quality score, integrating the DQI, patient satisfaction, and the complementary flat-rate assessment tool, was 60.6%. From a financial perspective, USD 29913 were spent against a projected budget of USD 21272, corresponding to an execution rate of 140.6%.
CONCLUSIONS:
The implementation of the subsidised flat-rate payment system was considered satisfactory in terms of service utilisation and quality improvement. However, several challenges were identified, particularly regarding coverage of indigent patients and financial forecasting, leading to recommendations to further strengthen and optimise the scheme.
| eISSN: | 2654-1459 |
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