ROLE ET RESPONSABILITES DES AUTORITES LOCALES DANS LA MISE ŒUVRE DE LA DECENTRALISATION DU SYSTEME DE SANTE DANS LA PROVINCE DU MANIEMA EN REPUBLIQUE DEMOCRATIQUE DU CONGO
DOI:
https://doi.org/10.61841/70zccm16Keywords:
Health decentralization, local authorities, governance, health system, responsibilities, Maniema.Abstract
This study aimed to evaluate the role and responsibilities of local authorities in implementing the decentralization of the health system in Maniema Province by identifying key functions performed, shortcomings encountered, and factors associated with effective implementation.
A quantitative cross-sectional study was conducted involving 84 participants engaged in the governance and operation of the health system in Maniema Province. Data were analyzed using descriptive statistics (frequencies, percentages, means, and standard deviations) and statistical tests (Pearson’s chi-square, Fisher’s exact test, Student’s t-test, ANOVA) with 95% confidence intervals and a significance threshold set at p < 0.05.
The results show that local authorities are relatively involved in health planning (86.9%), the development of operational plans (90.5%), and coordination with health zones (83.3%). Conversely, their involvement remains low regarding resource allocation (35.7%), resource mobilization (41.7%), supervision of health facilities (45.2%), and monitoring and evaluation (50.0%). The mean score for responsibilities exercised was 5.65 ± 3.15 out of 9, while the mean scores for planning/autonomy/coordination and resources/institutional capacities were 2.45 ± 0.92 and 2.17 ± 0.90 out of 5, respectively. Only 21.4% of participants demonstrated implementation classified as effective, compared to 78.6% classified as ineffective. Statistically significant associations were observed between effective implementation and age, education level, length of service, position held, and the affiliated institution (p < 0.001).
It requires an effective transfer of competencies accompanied by sufficient financial, human, and material resources, as well as capacity building for local authorities in planning, management, supervision, and monitoring and evaluation.
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