Support decentralization - HIV activities - Kinshasa

The main health problems in the Democratic Republic of Congo (DRC) are related to reproductive health, maternal health, malnutrition, malaria, road traffic injuries, tuberculosis and HIV/AIDS. HIV/AIDS is still a widespread epidemic, where the DRC has an average adult HIV prevalence of 1.2%, with an HIV prevalence of 1.6% in Kinshasa. 

MSF OCB works to care for people living with HIV, with activities in Kinshasa since 1993. Since 2002, to address the problem of access to HIV services, MSF launched an HIV project at Kabinda Hospital, a referral hospital southwest of Kinshasa (AIDS project), in collaboration with the Ministry of Health. The centralized nature of care led to overcrowding and long wait times became common, while access was difficult for some patients (travel time). To address this problem, the project began to support the decentralization of services to other health facilities in 2005. The AIDS project includes two major operational components: the Kabinda Hospital Center (CHK) and support for decentralization. 

An evaluation of the decentralization component was already carried out in 2019 and finalized in 2020 that focused on the evolution of the decentralization strategy from 2005 to 2017, as well as the results achieved. In 2022, MSF commissioned a second evaluation of the decentralization component of the project, covering the period 2017 to 2022. It was conducted by a group of external evaluators. The scope of the evaluation focused on (1) the relevance and coherence of decentralization objectives; (2) coherence between the objective of decentralization, the strategy deployed and the implementation on the ground; and (3) identification of lessons learned in relation to decentralization in general and the types of organization of the decentralization intervention in the city of Kinshasa (integrated and non-integrated). 

The evaluators recommend MSF to (1) extend support for decentralization to other health facilities in non-integrated areas, (2) strengthen support for health structures through long-term technical support, (3) improve project data and information management, (4) improve the preparation of MSF's disengagement and to (5) advocate for the inclusion of quality improvement aspects in the process to decentralize HIV care in the DRC.