The impact of the single contract on health service delivery in the Democratic Republic of the Congo (DRC): findings from a quasi-experimental study.

The Democratic Republic of the Congo (DRC) initiated a contract (single contract) among the Provincial Ministry of Public Health, Provincial Health Divisions (PHDs), and development partners to strengthen the function of PHDs. Using a quasi-experimental research design, we assessed the impact of the single contract on primary health care (PHC) delivery in the country. We found that the single contract had a no direct impact on PHC services. When combined with the performance-based financing (PBF) program, the single contract demonstrated a more favorable impact on delivering PHC services. The single contract, though promising from a resource coordination and governance perspective, necessitates supplemental policies/interventions, such as PBF, to build an amiable health ecosystem to facilitate its effect on service delivery.