The Governance of Nonprofits and Their Social Impact: Evidence from a Randomized Program in Healthcare in the Democratic Republic of Congo.

This article examines the effectiveness of bundling performance-based funding with auditing and feedback (A&F) to improve the governance and outcomes of nonprofit health centers in low-income countries, focusing on a randomized governance program in the Democratic Republic of Congo (DRC). The program, known as the Projet de Développement du Système de Santé (PDSS), randomly assigned about 1,000 health centers to receive either funding alone or funding combined with performance-based incentives and A&F. Results show that health centers receiving the bundled governance treatment significantly increased operating efficiency—measured by services provided per employee—and improved health outcomes, including reductions in stillbirths and neonatal deaths, compared to centers receiving funding only. Additional analyses indicate that funding alone expands service scale but does not enhance efficiency or quality, suggesting that funding and governance interventions complement each other rather than substitute. The study highlights the importance of tailored governance mechanisms that address knowledge gaps and information reliability challenges faced by nonprofits in low-income settings.