Utilizing provincial laws to garner resources for essential health services

The need

Despite progress over the past two decades to increase rates of routine immunization, over 176,000 children in the Democratic Republic of the Congo (DRC) missed out on a full course of vaccinations in 2018. As a result, the country continues to see outbreaks of vaccine-preventable disease and has one of the highest rates of child mortality worldwide.

Like many nations, DRC’s political system is decentralized, leaving provinces with many of the responsibilities for managing the health system that had, until recently, been held at the national level. In the case of immunization, DRC’s national government is responsible for acquiring vaccines and the provincial governments are responsible for delivering and distributing the vaccines to the communities. However, neither the national nor provincial Ministries of Health have enough dedicated funding to ensure these vaccines are properly stored and transported in a timely manner to health facilities around the country. Partially as a result of these funding gaps, vaccines in the DRC often fail to make it into the hands of those in need.

The policy solution

Reinforcing the capacity of provincial health leaders to sustain immunization funding in light of decentralization, two of DRC’s most vulnerable provinces—Tshopo and Bas-Uele—have passed edicts with the goal of ensuring funding and accountability for critical health services. While the edicts were originally meant to focus solely on immunization, advocates recognized a greater need and decided to broaden the edicts to cover health, but with a focus on immunization. These edicts not only set aside funding, but also outline the role of parliamentarians and provincial government as it pertains to health. Finally, and perhaps most importantly, the edicts outline methods for sustaining financial resources for the promotion of health services in each province in the face of the country’s changing political environment.

As the only organization currently working in the policy advocacy space in Tshopo and Bas-Uele, PATH assisted in the passing of the edicts through forming committees to draft the policy text and served as a technical advisor to the Ministries of Health throughout the process.

The impact

With the edicts now in place, when the central government distributes vaccines to DRC provinces, Tshopo and Bas-Uele have an agreed upon, written responsibility to channel provincial government funds for local distribution of the vaccines and proper cold chain maintenance.

Unlike other provinces, Tshopo and Bas-Uele have control of immunization funding and will therefore be impervious to future changes in political priorities as they relate to funding essential health services. The ultimate goal is that these edicts will lead to higher immunization rates, ultimately helping protect these provinces from major vaccine-preventable disease outbreaks and reducing child deaths.

The edicts also serve as an accountability tool for civil society who now have documentation by which to ensure the county health divisions execute on the edicts as outlined. During the budgetary process, these edicts will help ensure health needs of the provinces are put first.

Considerations for application

With increased devolution of political and economic power to local governments through decentralization, DRC—like many other developing countries—is having to adapt to ensure the health sector is run smoothly. One way of doing so is to pass provincial-level laws that will withstand any changes in national priorities. This approach could be applicable for other policy challenges in the DRC or another decentralized health system.

Policy text

• Edict for Mobilizing Financial Resources in Support of Health Promotion in Tshopo Province, 2018
• Edict of the Creation of a Fund for Health Promotion in the Province of Bas-Uele, 2017

Additional resources

• Driving Policy Change for Improved Health: A Technical Advocacy Approach