Performance of the 45001 Anti-Fraud Hotline System and Factors Associated with Alert Confirmation in Lomami Province (Democratic Republic of the Congo), 2021–2024

Abstract

In the Democratic Republic of Congo (DRC), abuse and fraud are the primary obstacles to achieving health objectives. They hinder the development of the health system. The objective of this article is to measure the performance of the 45001 anti-fraud green line system through alert management indicators and to identify the factors associated with their confirmation in Lomami Province (DRC), 2021-2024. A retrospective observational study, with descriptive and analytical aims, was conducted on secondary data from the 45001 hotline in Lomami Province, 2021-2024. The study also included an analysis of temporal trends in the hotline's performance indicators over the period considered. Of 966 viable alerts, 620 were investigated. Analyses were conducted using chi-square tests and binary logistic regression to identify factors associated with alert confirmation. The alert investigation rate was 64.1%, with a notable increase between 2021 (54.2%) and 2024 (73.9%). Of the alerts investigated, 467 (75.3%) were confirmed, and 153 (24.7%) were refuted on-site. Confirmed alerts led to a proposed sanction in 25.5% of cases (70.6% of which resulted in sanctions) and to remediation measures in 74.5% of cases, with a 100% success rate for these measures. In multivariate analysis, the confirmation of alerts was strongly associated with governance (ORa = 17.5; 95% CI: [6.3 – 48.4]; p < 0.001), service delivery (ORa = 3.8; 95% CI: [1.5 – 9.1]; p = 0.003), human resources (ORa = 3.3; 95% CI: [1.3 – 8.0]; p = 0.009), medicines (ORa = 2.5; 95% CI: [1.3 – 4.8]; p = 0.008) and financing (ORa = 2.2; 95% CI: [1.3 – 3.8]; p = 0.004). The model showed good discriminatory ability with the area under the ROC curve (AUC) of 0.739 (95% CI: 0.699 – 0.780; p < 0.001). The 45001 green line system demonstrates satisfactory performance, with an investigation rate of 64.1%, progressively improving (54.2% to 73.9% between 2021 and 2024), and a high and stable confirmation rate (75.3%). However, insufficient resources limit investigative capacity. Governance appears to be the primary determinant of alert confirmation. Strengthening financial and operational resources remains necessary to investigate all viable alerts and optimize the system's effectiveness.