From: Performance-based financing in three humanitarian settings: principles and pragmatism
 | South Kivu / DR Congo | Central African Republic | Adamawa State / Nigeria |
---|---|---|---|
National governance and leadership | • Conflict exacerbated pre-existing weaknesses related to lack of governance and underfunding | • MoH lost its leadership role to donors and NGOs | • Structured federal system with effective decentralisation • Federal and state governments’ efforts to strengthen primary health care delivery |
Consequences of conflict on service delivery | • Violent episodes have left infrastructure destroyed, equipment pillaged and led to lack of staff in some areas | • By 2016 27% of health facilities were partially or fully destroyed, and of all functioning facilities only 22% had a source of energy and 43% running water | • Insurgency left only 37% of facilities functional with limited staff, a break-down in governance and facing disease outbreaks |
Healthcare financing | • No fee exemption policies (except for some vertically-funded preventative services) • Reliance on user fees and external interventions | • Since 2014, externally funded free healthcare policy for women (covering perinatal services), children and ‘emergency’ services | • User fees in place generally, though lifted at the height of the crisis in 2014 |