The effect of mentorship as a means of strengthening leadership in the health system at the operational level: a case study of the Walungu rural health zone in the eastern Democratic Republic of Congo

ContextIn the rural Health Zone (HZ) of Walungu, eastern Democratic Republic of Congo, major constraints impede health outcomes. From 2015 to 2019, the "RIPSEC" program transformed Walungu into a Learning and Research Zone (LRZ) under the mentorship of a local university to enhance the leadership capabilities of HZ managers, focusing on managing challenges including the proliferation of Informal Healthcare Facilities (IHFs). ObjectiveThis study evaluates the impact of RIPSEC mentorship on leadership development and the performance of the Walungu LRZ, particularly concerning the utilization of integrated curative health services in competition with IHFs. MethodsWe used a mixed method approach, combining retrospective analysis of some key health indicators before (2014) and during RIPSEC program (2015-2019), and in-depth qualitative interviews with members of the HZ management team. Quantitative data were presented as frequencies and proportions. Simple linear regression (p<0.05) measured the influence of IHFs on service use. The functionality and performance of the HZ were assessed using an internal benchmarking approach, with results presented as trend curves. Deductive analysis of interviews allowed for a deeper exploration of quantitative trends. ResultsDespite efforts to manage them, IHFs negatively influenced the use of curative services. RIPSEC mentorship notably enhanced the leadership skills of managers, leading to improved management effectiveness. While the use of curative health services slightly increased during the program, rates remained below 50%, and gains were not sustained post-program. ConclusionRIPSEC mentorship has positively impacted leadership and performance in Walungu. However, challenges related to sustainability and financing persist, necessitating comprehensive interventions beyond enhancing managerial leadership solely.