Complications in Implementing a Health System Development Project in Équateur Province (DRC): A Qualitative Analysis of Blocking Factors and Potential Solutions
Abstract
Objective
The Health System Development Project (PDSS), supported by the World Bank, was suspended in January 2020 in Équateur Province (Democratic Republic of the Congo) for official governance reasons. This study analyzes the complications that led to this breakdown and their impact on the local health system.
Methods
A descriptive qualitative study was carried out with 50 staff members directly involved in the PDSS across six health zones (Mbandaka, Wangata, Bolenge, Bikoro, Ingende, and Lotumbe). Semi-structured interviews were conducted, transcribed, and subjected to thematic analysis.
Results
The main complications identified were: an unclear action plan (42% of respondents), lack of prior training (58%), financial delays (32%) and logistical delays (26%), difficulties in paying staff (40%), conflicts between stakeholders (66%), lack of coordination (70%), and supervision problems (72%). Weak local governance, lack of community involvement, and opacity in resource management emerged as root causes.
Conclusion
The suspension of the PDSS in Équateur resulted from a combination of structural, organizational, and human failures. Recommendations for future projects include capacity building, role clarification, financial transparency, and intersectoral coordination.
Keywords
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How to cite
Bakombo Mbuki, F. (2026). Complications in Implementing a Health System Development Project in Équateur Province (DRC): A Qualitative Analysis of Blocking Factors and Potential Solutions. SDF Journal of Public Health. https://sfoundation.one/articles/sdf-2026-0010-complications-in-implementing-a-health-system-development-project-in-e