Summary

In the Democratic Republic of Congo (DRC), ThinkWell explored how the Bill & Melinda Gates Foundation could invest in improving the delivery of affordable family planning (FP) to vulnerable populations in Kinshasa. Through an assessment in 2018 and 2019, ThinkWell uncovered how the DRC’s ongoing strategic health purchasing reforms could be leveraged to improve access to FP services for women and girls in Kinshasa. Based on an extensive literature review and stakeholder interviews, we analyzed the FP financing landscape in DRC broadly and in the Kinshasa region specifically. Our final report recommends strategic purchasing arrangements for FP services that would be feasible in the short, medium, and long-term and presents a theory of change and a plan of action to help inform the foundation’s investment decisions.

Challenges

There are severe unaffordability and unavailability of FP services issues in Kinshasa, which poses a major barrier to the uptake and continuation of FP methods. Women mainly access family planning services in Kinshasa from private drug shops or private facilities, and since both public and private providers charge fees for FP services, poor women and girls face a significant financial barrier to access, especially for long acting reversible contraceptives (LARCs). In terms of policy, the DRC government recently launched its strategic purchasing strategy and is launching a performance-based financing (PBF) pilot in Kinshasa. Based on this, how can we leverage the current initiatives to develop a coherent approach to buying FP services in a way that strengthens women’s access to FP services?

Approach 

We anchored our assessment in examining how to strengthen the way that FP is positioned within government-owned strategic purchasing reform in Kinshasa. We strongly believe that partners should refrain from starting additional, parallel purchasing schemes and instead work to improve, strengthen, and harmonize ongoing strategic health purchasing reforms.

Results

Based on our report, the Bill & Melinda Gates Foundation is currently considering how to best implement our proposed solutions in Kinshasa.