This case study explores proactive citizen engagement by the Integrated Health Project (IHP) implemented by Management Sciences for Health in the Democratic Republic of the Congo (DRC). It documents how IHP’s citizen engagement interventions influenced broader project implementation and outcomes.
Two factors in particular contributed to positive results in implementing citizen engagement approaches. The first was a Project design that made “people-centered” approaches integral to many of the Project’s components, with an emphasis on dialogue and personal empowerment to promote internally motivated behavior changes. The second was the inclusion of measures to strengthen both the supply of health services and the demand for health services. Results-based financing further incentivized both health service staff and citizen groups to improve services.
Major challenges to achieving the sustainability of citizen engagement initiatives and, more generally, project outcomes, relate to the weak capacity of citizen groups due to poverty and low human development levels; efforts are also hampered by the weak governance and limited financing that characterize the health sector in DRC. This results in a continuing need for both citizens and donors to finance the vast majority of health expenditures.
In this context, donor financing of citizen engagement in the health sector is likely to be most effective when it focuses on the following:
- Including citizen engagement measures that foster both consultation and participation to stimulate positive health practices, as well as (social) accountability to improve governance;
- Financing interventions to strengthen concurrently both citizen groups and health service infrastructure and capacity, including the use of results-based financing to incentivize both groups;
- Building into Project design instruments for monitoring and evaluation of citizen engagement measures; and
- Continuing dialogue with government to strengthen the governance framework for provision of health services.