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Over the past 50 years, the Democratic Republic of Congo (DRC) significantly reduced its infant mortality rates, thanks in part to donations from international organisations like USAID and the World Bank.
But how can the DRC maximize the impact of this funding? For Anicet Fangwa, the answer lies in management. He is an Assistant Professor of Strategy and Organization at the Desautels Faculty of Management.
“Sometimes very simple, common-sense practices can have a significant effect, even on the most complex of systems,” he said on the McGill Delve podcast.
In a research paper, he and his colleagues identified three management practices that improved health outcomes at a DRC hospital: performance-based financing, auditing, and providing feedback. Fangwa found that these tactics reduced the probability of infant mortality by as much as 25 per cent over just two years.
Managing for maximum impact
Fangwa’s proposed approach to health governance in the DRC combines three management tactics.
First: performance-based financing. This involves distributing money based on the recipients’ accomplishments, measured in terms of quantity or quality of services delivered.
This isn’t an entirely new idea. Performance-based financing has been commonly used in foreign aid since its first implementation in Southeast Asia in the early 2000s. It marked a shift from past approaches to aid distribution, where money often came with few conditions or in the form of debt, said Fangwa.
But now, Fangwa takes this approach further by bundling it with two other components: auditing and feedback.
Auditing, he explains, involves fostering transparency by keeping records. This is useful for medical staff to help track their work. It’s also useful for funders, who can use these records to measure performance. Then, based on this information, funders can provide feedback to staff on how to improve.
In one example from the DRC, hospital staff started writing down the names of their patients, said Fangwa. This allowed them and their supervisors to better track the flow of patients and the care they received, among other important metrics. Evaluators could then use these findings to deploy Anicet’s third management tactic: offer feedback to staff to help improve their performance.
Feedback, in this case, has nothing to do with medical training, explained Fangwa. It’s really about helping staff improve their management abilities. Simple skills like budgeting can help them organize needs into priorities, which can be transformative in organisations with few administrative supports.
But this kind of learning takes time.
“It’s not just memorizing something,” said Fangwa. “It’s a change in behaviour.”
Medical staff must adapt to new systems and workflows. These kinds of habits take time to develop. But once they’re established, they can have a tremendous impact.
On the McGill Delve podcast, Professors Anicet Fangwa and Sabine Dhir further explore the impact of these practices in the DRC. Listen on our website or search “McGill Delve” wherever you listen to podcasts.
Anicet Fangwa
This article was written by Eric Dicaire.
This episode of the Delve podcast was hosted by Sabine Dhir and edited and mixed by Eric Dicaire. Saku Mantere is McGill Delve’s editor-in-chief.
Based on the paper “The Governance of Non-Profits and their Social Impact: Evidence from a Randomized Program in Healthcare in the Democratic Republic of Congo” by Anicet Fangwa et al.