Republic of the Congo 2024. Community Health System Maturity Assessment and Reframed Operational Plan
With ICHESS technical assistance under the Global Fund–funded BIRCH project (Building Integrated Readiness for Community Health), the Ministry of Health and Population of the Republic of the Congo carried out the 2024 community health system maturity assessment at a national workshop in Brazzaville (31 July – 1 August 2024), then used its findings to reframe the 2024 community health operational action plan.
Why it matters. The assessment follows the June 2022 situational analysis and measures progress since then. The number of community health workers (CHWs) trained and deployed rose from 828 in 2022 (8.9% coverage) to 2,390 CHWs in 52 health districts in 2024, which is still only 25.7% of the 9,289 CHWs planned in the 2021–2024 national strategic plan.
Method. Document review of policies, strategies, program and HMIS data, combined with key-informant work at the workshop. The maturity matrix, inspired by the CHW Assessment and Improvement Matrix (CHW AIM), covered 7 domains and 32 program components, with bottleneck and root-cause analysis and mitigation strategies.
Key findings
| Domain | 2024 status | Key finding |
|---|---|---|
| Leadership, governance and planning | Functional | National policy on community-based health interventions, 2021–2024 strategic plan, 2024 operational plan, CHW training manuals and supervision guide |
| Service delivery | Functional (improved since 2022) | Defined package; in 8 districts, 250 CHWs treat malaria, pneumonia and diarrhoea with ACT, amoxicillin DT, zinc and ORS (iCCM) |
| Financing | Partially functional | Funding mostly from partners; difficulties in disbursing state budget allocations |
| Human resources | Partially functional | 2,390 of 9,289 planned CHWs trained and deployed |
| Information systems | Partially functional | Community information system still paper-based; digitization started with the Mangwélé and Mavimpi mobile apps (DTIC, UNICEF funding, ICHESS technical support) |
| Supply chain | Partially functional (regressed) | Irregular involvement in forecasting and procurement; frequent stock-outs for CHWs |
| Community engagement | Partially functional | Weak and inactive health committees; civil society involvement at an early stage |
Overall, the community health system is rated partially functional, with clear gains in governance and service delivery.
Reframed 2024 operational action plan. Building on the assessment, the plan sets five objectives: stronger coordination by the Primary Health Care Directorate, community accountability, wider coverage of RMNCAH-Nutrition, HIV, TB and malaria interventions, documentation of lessons learned, and advocacy for domestic funding and CHW remuneration. Its eight strategies are costed at about XAF 1.05 billion (≈ €1.6 million), including:
- 87 training sessions for 2,623 CHWs on the integrated community package
- CHW training in event-based surveillance using a One Health approach
- 45 general assemblies of health committees (COSA) and training of 378 members of non-functional COSA
- Evaluation of the 2021–2024 national community health strategic plan and quarterly coordination meetings
Recommendations. Address every bottleneck with targeted mitigation strategies, fund priority actions through sustainable domestic resources, and pool efforts between government, health-related sectors and international partners.