In the Democratic Republic of Congo (DRC), bridging the gap between under-reached communities and essential health care services remains a pressing challenge. Up to two-thirds of Congolese people (50 million people) face barriers when accessing health care, including long distances to health facilities, high out-of-pocket expenses, and a shortage of primary health care (PHC) options. Despite ongoing efforts by government to enhance the quality and coverage of the health system, high costs and lack of accessible care still drive many to lower cost by choosing traditional healers, prayer rooms, or private facilities as their first choice when faced with illness.
At VillageReach, we have a bias towards transformational over incremental change. As noted by President Emily Bancroft, “We believe creativity and fearless exploration are essential to developing sustainable solutions that improve health services and foster lasting change.” This approach means using data to identify problems and seeking powerful solutions. We start by routinely learning what people need from the health system, particularly the most under-reached. From there we co-develop and evaluate solutions, and we build upon what works.
The Community Insights to Action (CITA) Framework is a data-driven framework that empowers governments and communities to co-identify their health care needs, prioritize interventions, and monitor progress toward achieving better health outcomes. Here is how we can operationalize the CITA framework in DRC to improve the responsiveness of the country’s PHC system.
Harnessing CITA in the DRC
The DRC, with its vast geography, diverse cultural contexts, and complex health system, presents a unique opportunity to operationalize CITA. The Ministry of Health’s (MoH) ambitious National Health Development Plan (2020-2022), Strategic Area 1, focuses on improving health service delivery and continuity of care, with the aim of enhancing the availability, accessibility, and utilization of quality health services for all. Implementing a routine feedback mechanism with under-reached Congolese at scale is essential to address the dynamic preventative, diagnostic and therapeutic needs of the DRC’s under-reached communities, providing strong strategic alignment with the government’s health care objectives.
As I highlighted during a panel on Advancing UHC: Communty Insights into Action at the 3rd International Conference on Public Health in Africa (CPHIA 2023), work is already underway. VillageReach has started to integrate CITA principles into its Next Generation Supply Chain Plus (NGCA+) solution, which has demonstrated significant success in improving health care access and health product availability in communities at the last mile across the DRC. The “plus” represents an evolved approach that involves various components, including an enhanced role for the country’s Community Health Worker (CHW) network in the identification and vaccination of zero dose children.
The extensive presence of CHWs provides a valuable platform for community engagement, data collection and, importantly, action. CHWs are seeking to understand reasons and barriers for non-vaccination, and ultimately, the health needs and preferences of families with zero-dose and under-vaccinated children, to protect them from life-threatening, vaccine-preventable diseases. Through this approach, the country was able to recover a total of 1700 zero dose children from April to September 2023 across two hard-to-reach health districts (Mimia and Oshwe) in the Maindombe province.
Opportunities to Improve Feedback Data Aggregation and Prioritization
The CITA Framework comprises a feedback loop composed of five key steps, which we call petals, in the process of translating community insights into action. We see significant opportunity to improve on petals 2 and 3 in the DRC, those related to the aggregation of data and the prioritization of insights.
Improving how data is aggregated will entail bringing together disparate data sources that describe or gather insights on under-reached communities’ needs and preferences, including health data, demographic information, and data from other sectors such as agriculture and education. This data can shed light on the underlying factors contributing to health inequities and inform evidence-based decisions.
Prioritization will involve working with MoH stakeholders and representatives from under-reached community groups to identify the most pressing health needs and selecting interventions that are most likely to make a significant impact on improving health outcomes. This process requires careful consideration of community preferences, available resources, and the feasibility of implementing interventions.
Leveraging Existing Data Sources to Meet the Needs and Preferences of Under-Reached Communities
DRC is a large country that possesses a wealth of data sources that can be harnessed for CITA implementation. Existing health data, such as routine service delivery data and household surveys, can provide valuable insights into health service utilization, coverage and barriers to access. Additionally, data from other sectors, such as agriculture and education, can offer complementary perspectives on the factors influencing health outcomes.
By effectively aggregating and prioritizing community insights, VillageReach and its partners can expect to achieve several positive outcomes, including:
- Improved targeting of health care interventions to address the most pressing community needs
- Enhanced coordination and collaboration among stakeholders to maximize impact
- Greater transparency and accountability in resource allocation
- Strengthened community participation in decision-making related to health
Next Steps: Institutionalizing CITA for Long-Term Impact
As the DRC develops its National Health Development Plan (2024-2030), there is an opportunity to embed CITA principles into the planning process, reaffirm the government’s commitment to community involvement, and to create mechanisms for integrating community insights into national planning and decision-making.
VillageReach is working to harmonize and institutionalize CITA across its programs and partnerships in DRC by co-developing standardized data collection tools, training staff on CITA methodologies and establishing platforms for sharing and exchanging data and insights in partnership with best-placed local and national social impact organizations.
A Transformative Approach for Sustainable Change
VillageReach’s commitment to transforming health care in DRC is founded on the awareness that community insights hold the key to unlocking sustainable solutions. By integrating routine feedback mechanisms at scale, VillageReach and its partners can empower communities to drive positive change, bridging the gap between health needs and access. This data-driven approach has the potential to save lives, improve health outcomes, and create a healthier DRC.