Revolutionizing Health Management in the D.R. Congo

The statistics make for stark reading: with only seven years to go, most African nations face a gargantuan uphill struggle to reach the UN SDG targets. As a result, almost 500 million Africans could be living in extreme poverty by 2030 - at least 70% of whom could still be there in 2050.

This is the main reason we devoted our academic research to finding practical solutions that integrate our training in engineering and strategy. Our work on 1,000 health clinics in the Democratic Republic of Congo could have wide-ranging consequences on health management across the continent.

In the HEC podcast Breakthroughs, we describe what we uncovered and how our findings could be applied more broadly. We also reflect on the positive impact that women leaders are having in these health centers.

I was born in Cameroon, and the DRC has always represented, for me a huge country full of untapped potential - but also one marked by crisis, civil war, and instability.

Studying the DRC was a way to understand Africa more broadly. We saw it as a miniature version of the continent, and we hoped that if new solutions could work there, they might work elsewhere too.

Healthcare in the DRC operates through a pyramid structure that is shaped by both government oversight and the interventions of NGOs and non-profit organizations. Our research focused on how the managerial practices within this system affect the outcomes of the aid it receives. We approached the topic through the lens of strategic governance and looked at how behavior - not just economic inputs - determines results.

Every year, billions of dollars are invested in development, but results are often limited. We wanted to understand why. We believed the answer could lie in how those resources are managed and implemented.

Rather than simply examining how much money is delivered to clinics, we studied the routines and practices in place: how organizations audit, provide feedback, train staff, and interact with beneficiaries. In short, we looked at the difference management makes.

One of our key findings is that funding alone increases the volume of healthcare activity - but not necessarily its quality. Without proper governance, more money simply leads to more distributed drugs and more patients seen, without improving patient outcomes.

But when we introduced sound governance practices - including supervision, feedback loops, and accountability structures - both quality and volume increased. To measure quality, we focused on infant mortality. In clinics where governance mechanisms were implemented, we observed a nearly 50% drop in mortality over a four-year period.

This is significant given that the DRC is one of the most dangerous countries in the world to be born in, with an infant mortality rate of 70 deaths per 1,000 births (Unicef, 2020). In contrast, the U.S. reports 6 deaths per 1,000, and France reports 4.

Crucially, improving governance did not require new medical personnel or expensive technology. It simply required training existing staff to follow WHO protocols rigorously and creating systems of oversight that supported consistent care.

In my second paper, I investigated how gender dynamics affect healthcare leadership in the DRC, a highly patriarchal society. I found that health centers with female leaders tend to deliver higher quality care. But contrary to some Western literature, the mechanisms were not based on collaboration or consensus-building.

Instead, I found that women leaders in the DRC were more effective because they used more top-down management. They held fewer meetings, delegated less, and made more autonomous decisions. I interpreted this as a strategic adaptation to the gendered dynamics of the region. By avoiding conflict and asserting control, these leaders were able to work around structural bias and improve organizational performance.

While my data doesn’t yet allow me to assess the full impact of these leadership styles in areas of communal conflict or ethnic tension, I suspect that women leaders may also be more inclined to treat patients with equity - a topic we plan to explore further.

Methodology

We conducted a multi-year field study of 1,000 rural health centers across the Democratic Republic of Congo. Our dataset included leadership composition, governance structures, funding levels, medical routines, and outcome indicators such as infant mortality. We used a mixed-methods approach that combined quantitative analysis with field interviews and organizational observations. We then developed a governance-performance framework to analyze how different management approaches affect outcomes in fragile healthcare environments.

Applications

Our research offers evidence-based tools for NGOs, public agencies, and global health donors seeking to maximize the effectiveness of development funding. By integrating behavioral governance into aid strategy, organizations can ensure that funds translate into real-world impact. Our findings also support greater inclusion of women in leadership roles within healthcare and beyond, especially in post-conflict settings where traditional hierarchies may constrain collaboration.