The Participatory Institutional Capacity Assessment and Learning (PICAL) Index, Its Adaptation in the Democratic Republic of the Congo, and Lessons Learned.

The purpose of this study is to share lessons learned and recommendations from the adaptation of Participatory Institutional Capacity Assessment and Learning (PICAL) tool used by the United States Agency for International Development's (USAID) Integrated Health Program (IHP) in the Democratic Republic of the Congo (DRC). The PICAL tool assesses, monitors, and evaluates institutional capacity building across four categories: Demand for Institutional Performance, Organizational Learning Capacity, Administrative Capacity, and Systems Strengthening Capacity. Each category of PICAL is subdivided into sub-categories, and all sub-categories are evaluated using a six-point scale. Through USAID IHP, PICAL has been field-tested and used in nine provinces and 45 health zones in the DRC. Qualitative findings from key informant interviews suggest that use of PICAL contributed to institutional capacity strengthening. Lessons learned from this study underscore the importance of sustaining regular and long-term follow-ups, adapting the tool to an institution's context, engaging with health leaders, and providing financial support to ensure long-term improvement and sustainability. This study is crucial in informing other projects and program implementers about PICAL and its potential to enhance institutional capacity.