The Eastern Congo has been plagued by a cycle of conflict which has destabilized the country and region, destroyed social infrastructure and weakened state and civil society-run mechanisms of service provision, severely restricting the population’s already-limited access to basic services. Communities are often disengaged from decision-making processes around public service delivery, thus limiting their input into how these services function and address their needs.
Decades of neglect of the education system in the DRC has resulted in an adult literacy rate that was under 70 percent in 2006. Free education is a constitutional right, but in reality the education system is largely directly financed by parents through school fees and levies. Part of the fees are ostensibly dedicated to the construction and maintenance of buildings, yet most schools still do not meet minimum Congolese education standards. Schools are overcrowded and often lack equipment, water and sanitation facilities, and adequate teaching and learning materials.The low – and irregularly – paid staff are generally unmotivated. Few are officially registered on the government payroll, hence their reliance on locally collected school fees.
The health sector also faces dire challenges. Health services are often inaccessible and, even when within reach, essential inputs such as drugs and personnel are often unavailable. This in turn results in low utilization rates. Insufficient funding of the health sector and poor financial management results in a reliance on high user fees to cover staff salaries, operational costs and contributions to the health zone operations. In addition, patients are often required to purchase medicines and supplies for surgeries and other services. The high cost of health care also limits access, as a majority of households have difficulties paying for healthcare.
The poor health status of the Congolese population is evidence of weaknesses in the Congolese health system. Weak management and absent accountability relationships lead to corruption, lack of motivation, poor planning, and shoddy implementation of health services and policies. Mechanisms exist within the health system for users to give feedback and demand improvements, including the health development committee (CODESA), but these are often not functional. Even when functional, change is not necessarily happening because even when user voice is channeled appropriately, there is no incentive for service providers to improve their performance. In practice, the quality of, and access to, health services is variable and users’ voices have little impact on service provision.
It is this lack of citizen voice and influence over education and health services that prompted efforts to improve service delivery in these sectors by working on the relationships between service providers and service users. Also, the existence of clearly identified local level service providers in these sectors, operating within formal service delivery systems for which Congolese norms and standards exist, offers opportunities to bring the demand (citizens/users) and supply (State, faith-based organizations, doctors, nurses, school principals and teachers) sides together through a governance intervention that addresses the problems described above.