How Does the Context Shape the Technical Support from the Provincial Health Administration to District Health Management Teams in the Democratic Republic of Congo? A Realist Evaluation

Samuel Bosongo (), Zakaria Belrhiti, Faustin Chenge, Bart Criel, Bruno Marchal and Yves Coppieters
Additional contact information
Samuel Bosongo: Faculté de Médecine et Pharmacie, Université de Kisangani, Kisangani 2012, Democratic Republic of the Congo
Zakaria Belrhiti: Département de Santé Publique and Management, École Internationale de Santé Publique, Université Mohammed VI des Sciences de la Santé, Casablanca 82403, Morocco
Faustin Chenge: Faculté de Médecine et Pharmacie, Université de Kisangani, Kisangani 2012, Democratic Republic of the Congo
Bart Criel: Institute of Tropical Medicine Antwerp, 2000 Antwerp, Belgium
Bruno Marchal: Institute of Tropical Medicine Antwerp, 2000 Antwerp, Belgium
Yves Coppieters: École de Santé Publique, Université Libre de Bruxelles, 1070 Bruxelles, Belgium

IJERPH, 2024, vol. 21, issue 12, 1-24

Abstract: Since 2014, the health sector in the Democratic Republic of the Congo has been undergoing reforms aimed at strengthening the Provincial Health Administration (PHA) to better support health district development through technical support to district health management teams (DHMTs). However, there is limited understanding of how, for whom, and under what conditions this support works. Using a realist evaluation approach, this study aimed to test an initial program theory of technical support to DHMTs by PHA staff in Kasai Central Province. Data were collected from document reviews, interviews, questionnaires, and routine health information systems. After thematically analysing the implementation, context, actors, mechanisms, and outcomes, we applied retroductive reasoning to connect these elements using the Intervention–Context–Actors–Mechanisms–Outcomes configurations (ICAMOcs) heuristic. We identified nine ICAMOcs showing how resource constraints and political and organisational challenges hindered the effective delivery of technical support. These challenges triggered disabling mechanisms, such as low motivation, self-efficacy, a sense of accountability, psychological safety, reflexivity, the perceived relevance of support, the perceived credibility of PHA staff, and perceived autonomy, resulting in mixed outcomes. The performance-based financing scheme helped mitigate some issues by providing resources and boosting extrinsic motivation, but concerns persist about its sustainability due to reliance on external funding. These findings highlight the need for strong political commitment and coordinated efforts to address these challenges.

Keywords: technical support; district health management teams; provincial health administration; Democratic Republic of Congo; realist evaluation (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2024
References: View references in EconPapers View complete reference list from CitEc
Citations:

Downloads: (external link)
https://www.mdpi.com/1660-4601/21/12/1646/pdf (application/pdf)
https://www.mdpi.com/1660-4601/21/12/1646/ (text/html)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:gam:jijerp:v:21:y:2024:i:12:p:1646-:d:1540630

Access Statistics for this article

IJERPH is currently edited by Ms. Jenna Liu

More articles in IJERPH from MDPI
Bibliographic data for series maintained by MDPI Indexing Manager ().