title: [Impact of mid-level management and support on the performance of a district health system in the Democratic Republic of the Congo].
abstract: BACKGROUND
  The aim of this study was to assess the contribution of mid-level management and support practices to the overall performance of a district healthcare system.
  
  
  METHODS
  This case study was carried out in the North Kivu Province of the Democratic Republic of the Congo. It was based on analysis of (i) preventive and curative healthcare services and (ii) management and support practices provided from 2000 to 2008.
  
  
  RESULTS
  In response to recurring sociopolitical unrest since 1992, the mid-level health system (provincial level) in North Kivu has strengthened management and support practices. The main goals have been to optimize allocation of interventions by external emergency organizations and integration of specialized program activities, to harmonize intervention techniques implemented by external partners, to standardize supervision of sanitary districts with regard to care provider skills, and to adapt strategic options defined by the Ministry of Health to the provincial level. Using this comprehensive approach, the performance of the North Kivu Province in terms of curative and preventive care has exceeded the national average since 2001. Between 2001 and 2008, use of curative services progressed from 0.36 to 0.50 new cases/capita/year. Positive results have also been recorded for infrastructure coverage, essential medicine stock, health information system, and emergency preparedness.
  
  
  CONCLUSIONS
  Stronger mid-level management and support practices have improved care activities in the health district while protecting the population from unstructured interventions by emergency organizations or specialized programs. A comprehensive management approach has also improved the resilience of the district and increased its contribution to Millennium Development Goals.
authors.affiliation: Centre Scientifique et Médical de l'Université Libre de Bruxelles, Belgique. jbkahindom@gmail.com
authors.forename: M J B
authors.initials: MJ
authors.lastname: Kahindo
authors.forename: C
authors.initials: C
authors.lastname: Schirvel
authors.forename: H
authors.initials: H
authors.lastname: Karemere
authors.forename: P
authors.initials: P
authors.lastname: Mitangala
authors.forename: A
authors.initials: A
authors.lastname: Wodon
authors.forename: D
authors.initials: D
authors.lastname: Porignon
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards*; D015023:Democratic Republic of the Congo; D006078:Government Programs / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D008483:Medical Assistance / Q000592:standards; D012189:Retrospective Studies; D012931:Social Environment