improving access

For the vulnerable and needy.

barriers to accessing health care in the drc

User fees for health services are government policy in the Democratic Republic of the Congo. The Ministry of Health is clear that user fees are an essential feature of making health services feasible and sustainable. They believe that free health services create dependency and could put health care at risk should donor funding end. Additionally, since free health services generally have a high cost per capita, often they are accessible only to a limited population or geographic area.

While this policy is well-intended and grounded in studies, DRC presents high levels of vulnerable populations unable to afford these fees. In particular, the elderly, disabled and survivors of sexual or gender-based violence often lack the resources to obtain care.

assp saw an 82% increase in service utilization

assp saw an 102% increase in the number of births attended by a skilled professional.



Over 80% of children under five and pregnant women are using ASSP services

Our Approach to Improving Access to Health Care

ASSP strives to ensure the poorest and most vulnerable Congolese can access lifesaving primary health care. ASSP seeks to establish a system that decreases barriers to access to care, but also aligns with the national government’s policy for the individual to assume reasonable responsibility for health care costs. Specific objectives in line with the ASSP’s approach to universal access to health care are:

  • Improve mother, newborn and child health in all targeted health zones across all economic, geographic, age and gender cohorts
  • Provide treatment to survivors of sexual or gender-based violence, a large population currently without access to services and usually of more vulnerable classifications
  • Provide health care to survivors of emergencies, such as war, tribal conflicts and natural catastrophes
  • Ensure people with disabilities, orphans, widows, the elderly and anyone lacking social protection receives health care within their means; improve their health indicators, reducing disparities between the most vulnerable and average citizens

Key Achievements

Community Health Endowments

Enrolled CHE health cooperative groups have generated over $80,000 in subscription income for at least 141 health centers. Revenues grew nearly 370% from Y1 to Y2, improving health facilities’ ability to provide for all clients (including the indigent) and increasing the social safety net for health emergencies.

PEP Kits

ASSP provided 3,738 SGBV survivors with post-exposure prophylaxis (PEP) kits to help protect them from contracting HIV.

Fistula repair

3,418 women with fistula benefited from restorative surgery during ASSP with a general success rate of 93%.

Community Scorecards

ASSP began rolling out annual community scorecards at affiliated health facilities and 892 (98%) have submitted at least one scorecard, surpassing its goal of 80%. Findings showed that many communities felt their health center provided poor customer service and charged high fees compared to low-income levels of the client population. The scorecard program gives a voice to the communities and makes them feel engaged in health facility management. It is also an instrument for improving gender equity within communities and particularly in health care delivery, as sub groups of women and youth are established during the process to ensure their voices are heard and that these voices influence decisions on improvement measures to prioritize.



Real-time data sourced from the DHIS2 data management system on the number of people accessing primary health care in ASSP-assisted health areas from 2014 to 2018.


26 million consultations

Over 26 million people sought care at ASSP-assisted health centers over the course of the six-year project.


Learn more about how ASSP helped the MOH improve routine health data by implementing DHIS2 in its health zones and beyond.


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