A paradigm shift is underway in the Democratic Republic of the Congo (DRC). Technological innovation is transforming the old health system model into a partnership between patients and professionals, aided and augmented by digitally enabled technologies and better data.
This transformation will now be accelerated by political buy-in, thanks to the formal adoption and appropriation of the costed Digital Health Investment Roadmap for the DRC by the Ministry of Public Health, Hygiene and Prevention (MOH) and the National Universal Health Coverage Council.
The roadmap, supported by the US Agency for International Development (USAID) and Digital Square at PATH—and adopted following a March 9, 2022, roundtable discussion that included more than 90 participants from the DRC government, donor organizations, and the private sector—will help to plot a course for standardizing the DRC’s different digital platforms, training thousands of health workers, and computerizing thousands of health centers by 2024.
During her opening remarks, Emma Din, USAID’s Maternal & Child Health Team Lead in the DRC, said, “The COVID pandemic has shown the importance and need to migrate to strong digital communication and data systems. These digital solutions allow us to share information, integrate and visualize the data we all need to make decisions and direct our resources to real priorities.”
USAID and PATH
PATH’s Digital Square project, funded by USAID, is providing technical assistance and expertise to help close the health equity gap in a country where access to affordable, quality care is at stake. According to the Mo Ibrahim Foundation’s 2021 Report, the DRC ranks 39th in Africa on the Access to Health Care indicator—a decline since 2010.
Specifically, Digital Square is focused on two main objectives:
- Strengthen institutional capacities of the MOH Digital Health Agency, ANICNS. Beginning with current MOH staff to create a knowledge base, and then supporting ANICNS so that it can fully fulfill its mandate of coordinating and promoting digital health interventions, this increase in capacity will provide a starting point for a sustainability agenda for the country.
- Support the MOH through the next stage of development of the investment roadmap. Through this process, the government will undertake a highly transparent process of prioritization and budgeting of digital investments and present these funding opportunities to donors to ensure a coordinated approach to funding and implementing the roadmap.
“Many examples of projects and activities currently being implemented have been shared today,” Dr. Body Ilonga, MOH General Director for Organization and Management of Health Services and Care, told the roundtable assembly. “The roadmap we have discussed becomes ours. Its implementation depends on all of us. The challenges are enormous, but if you see where we have come from and where we are today, we cannot afford to lose hope.”
“The challenges are enormous, but if you see where we have come from and where we are today, we cannot afford to lose hope.”— Dr. Body Ilonga, DRC Ministry of Health
A decisive stage
The DRC is now at a decisive stage: under the government’s leadership, the roadmap will require sustained commitment from all development partners to adhere to this process, contribute to the investment roadmap, and align future digital health investments with national priorities.
More specifically, it will require overall capacity strengthening of the digital health agency, ANICNS, as the DRC government recently embarked on a journey to implement universal health coverage (UHC) for all, culminating in a national strategic plan for UHC. The country has set five key strategic objectives, including establishment of UHC governance and management. Under this objective, ANICNS will drive initiatives related to digital health transformation as a key UHC pillar. Without adequate resources, ANICNS will have difficulty fulfilling its mission of ensuring digital governance of the UHC and supporting the development of digital health and clinical engineering in the DRC.
“USAID is still willing to support the government in a concrete way and will continue to work with our partner PATH to ensure that ANICNS is empowered and equipped with an eHealth architecture,” Din said.
Building interoperable digital health systems will require the use of a systematic architectural approach to outline health information services, processes, components, activities, and policies, and guide best practice business requirements and principles for health authorities and their partners.
“There is a huge need for coordination to bring together initiatives around digital health.”— Edna Harimenshi, Director of Programs, PATH DRC
“There is a huge need for coordination to bring together initiatives around digital health,” explained Edna Harimenshi, Director of Programs at PATH DRC. “Thanks to the remarkable work of USAID through Digital Square, we are able to support ANICNS, and propose a ministry-driven enterprise architecture for DRC’s digital health ecosystem.”
Improving the efficiency and sustainability of the Congolese health system
Digital Square will work with the MOH to develop an enterprise architecture for the entire health system. This tool will enable a connection between business functions within the health care system and information technology, software, hardware, process flows (between care and case management, logistics, and diagnostics), and human resources needs. The model will need implementation support in standardizing digital health tools used across the health system and rolling out trainings for health care providers at various levels. The MOH envisions training 20,000 more health personnel and computerizing 3,400 health centers by 2024. This investment will integrate the different data collection tools to make them interoperable and strengthen digital health at the community level.
“Many solutions exist that must be thought of in a single system. All these experiences need to speak to each other, or they will remain disparate experiences. Maybe successful, but not systemic,” warned Dr. Jacques Kokolomami, cabinet member of the President’s Special Advisor in charge of UHC in the DRC.
In the DRC, the health management information system and the integrated disease surveillance and response system each routinely report data. Though the health information system has an established data collection and analysis mechanism at all levels, data use and feedback remain low and vary across health zones. The country does not systematically use these data to compile health statistics. Health decisions are based on data from various sources that are sometimes unreliable or generalized, and therefore do not reflect the real needs and realities of the country.
“Many solutions exist that must be thought of in a single system. All these experiences need to speak to each other, or they will remain disparate…. Maybe successful, but not systemic.”— Dr. Jacques Kokolomami, a DRC special advisor on UHC
Establishing a robust health management information system capable of integrating various data collection tools into a platform—and so allowing effective interoperability—is an ambitious goal. In this new architecture, community health workers will remain the key players in transitioning from paper-based data collection to digital.
The best use of data will need to be through the development of written standards and mechanisms for organizational guidance promoting the use of data, increased funding at all levels (especially at the community level), and development of operational support, while providing training in the use of data at all levels of the health pyramid. In addition, the MOH will need to increase funding for internet access in all 516 health zones, train additional health care personnel in the use of digital tools, and implement standardized data quality assurance protocols at all levels.
“Now there is clear consensus that connected health workers are necessary to achieve our ambitious goals such as universal health coverage,” Dr. Kokolomami said. “Our challenge for the years ahead is to ensure technology is reaching its promise to accelerate health equity in the DRC.”