Effective responses: Protestants, Catholics and the provision of health care in the post-war Kivus

Abstract

In extremely weak states, why are some civil society organisations better at providing health care than others? The case of health-care provision in the Kivu provinces of the eastern DRC provides a useful context in which to examine this question. Faced with the negative effects of more than 15 years of conflict, civil society organisations are the only institutions capable of providing social services. This article uses a series of case studies of local, faith-based health-care providers to argue that a number of historical, demographic and institutional factors cause some groups to develop stronger social capital networks than others. This in turn affects the degree of effectiveness that an organisation will have in providing social services in the state's absence. In doing so, they effectively substitute for the state in its role as a provider and regulator of public goods.

[Réponses efficaces : les Protestants, les Catholiques et la prévention des soins sanitaires dans le Kivu d'après-guerre]. Dans les états extrêmement faibles, pourquoi certaines organisations de la société civile sont plus efficaces pour fournir les soins sanitaires que d'autres? Le cas de prévention des soins sanitaires dans les provinces du Kivu à l'est de la RDC fournit un contexte pertinent pour examiner cette question. Faisant face aux effets négatifs de plus de 15 ans de conflits, les organisations de la société civile sont les seules institutions capables de fournir des services sociaux. Cet article utilise une série d'études de cas de fournisseurs de soins de santé confessionnels opérant au niveau local, pour soutenir qu'un certain nombre de facteurs historiques, démographiques et institutionnels permettent à certains groupes de développer de plus forts réseaux sociaux que d'autres. Ceci affecte à son tour le degré d'efficacité d'une organisation dans la fourniture de services sociaux en l'absence de l'État. De cette manière, ils se substituent effectivement à l'État dans son rôle de fournisseur et régulateur de biens publics.

Mots-clés : RDC ; soins de santé, religion ; les Protestants, les Catholiques ; Kivu

Keywords:

• DRC
• health care
• religion
• Protestant
• Catholic
• Kivu

Notes

This article is based on interviews with more than 210 subjects, including Congolese elites, primarily hospital and school administrators and staff, church officials who oversee social-service programmes, government officials, and civil society leaders in each city, and international peacekeepers, observers, and representatives of international non-governmental organisations (NGOs) and agencies that are involved in health care. Although there are a number of other civil society organisations engaged in social-service provision in each city, the CSOs represented in this study represent those who have organisational headquarters in either North Kivu or South Kivu. Five of the six organisations have headquarters in Bukavu or Goma. The exception is the CEBCE church, which is headquartered in northern North Kivu. Interviews were also conducted in Kinshasa, Kampala, Kigali, Nairobi, and in Austin and Washington, DC, USA.

Scholars disagree on the extent to which the Congolese state holds regulatory power in its relationship with religious institutions providing educational services in DRC. See Seay 2011, Poncelet et al. 2010, Leinweber 2011, De Herdt, Titeca and Wagemakers, 2010a, Titeca and De Herdt, 2011, and Herdt, Titeca and Wagemakers, 2010b.

Most Protestant churches in the DRC are members of an overarching organisation called the Église du Christ au Congo (Church of Christ in Congo – ECC). Each distinct church is technically a member community of the ECC, and each community is assigned a number. ECC communities are usually referred to by their number and acronym.