Comprendre l'accompagnement du changement dans les interventions d'assistance technique long-terme en appui à l'administration de la santé : cas de l'appui à la mise en œuvre de la stratégie de renforcement du système de santé au niveau provincial en République Démocratique du Congo

Health is a major issue in development. The health sector of developing countries is frequently supported by international cooperation. Long term technical assistance (LT-TA) is a common cooperation instrument. Our research aims to understand ‘‘how’’ long-term technical assistance interventions contribute or can contribute effectively to the strengthening of the counterpart organization. Our case study is based on the support to the “Health System Strengthening Strategy” implementation at provincial level of the health administration in the Democratic Republic of Congo. Our methodological framework is complex systems theories. The research consist of an in-depth literature review and three field studies, namely a study about actors’ perceptions and two studies of technical assistance’s interventions in two provinces. LT-TA interventions are relevant, but their potential is not sufficiently used. Key-elements are the demand of the local counterpart, “process” skills which empower LT-TA to implement change process, interactions based on responsibility. Complexity is a relevant theoretical methodological framework for health systems research and should be developed further.