The Democratic Republic of Congo (DRC), once a leader in African healthcare with a robust network of clinics, skilled physicians, and a strong primary health care system, has faced significant challenges in recent decades. Political and economic instability has severely impacted its health infrastructure. Today, hospitals and clinics often suffer from shortages of staff, equipment, and essential medicines, leaving an estimated 70 percent of the Congolese population with limited or no access to necessary health services. Strengthening the health care system is therefore a crucial priority for improving the overall well-being of the nation.
Despite these considerable obstacles, the DRC has demonstrated notable progress in recent years. This positive shift is largely attributed to improved governance, enhanced coordination among stakeholders, and increased investments in critical health areas by both the Congolese government (GDRC) and international partners. Between 2007 and 2013, the mortality rate for children under five years of age saw a significant reduction, dropping from 148 to 104 deaths per 1,000 live births. Vaccination coverage also improved, with 45 percent of children aged 12 to 23 months receiving all recommended vaccines, up from 31 percent in 2007. A remarkable achievement has been the eradication of polio in the DRC for over three years, a testament to progress despite the country’s vast size and infrastructural limitations in delivering health services.
However, significant health challenges persist in the DRC. The fertility rate remains high at 6.6 children per mother, among the highest globally. Contraceptive prevalence, although increasing, remains low at just 8 percent in 2013, up from 6 percent in 2007. Nutritional deficiencies are widespread, with nearly 39 percent of women of childbearing age suffering from anemia and 14 percent being underweight. Malnutrition rates among children are alarmingly high and have remained stubbornly persistent for two decades: 43 percent of children under 5 are stunted (chronic malnutrition), and 8 percent are wasted (acute malnutrition).
Malaria continues to be a major public health crisis in the DRC. The country bears the second-highest burden of malaria cases worldwide, accounting for 11 percent of the global total in 2013. This disease is responsible for almost one in five deaths among children under five and an estimated 40 percent of outpatient visits for this age group.
The DRC is also among the countries most affected by tuberculosis (TB), ranking 6th out of the 22 nations that account for 80 percent of global TB cases. While the prevalence of HIV/AIDS is lower than in many other sub-Saharan African countries, at 1.2 percent in the general population, it is notably higher in urban centers and among women, indicating areas of concentrated risk.
Recognizing the critical need for improved healthcare, the GDRC has progressively increased its health budget allocation, from 3.4 percent of the national budget in 2011 to 8.6 percent in 2015. Significantly, 2015 marked the first year the GDRC specifically allocated funds for essential drugs and contraceptives, demonstrating a growing commitment to addressing key healthcare needs.
USAID’s Comprehensive Health Program in the DRC
The United States Agency for International Development (USAID) plays a leading role in supporting health initiatives in the DRC. USAID’s health program is the agency’s largest sector in the country, with a substantial investment of $156 million in assistance in Fiscal Year 2015. This program strongly aligns with key U.S. government priorities in global health. A significant portion of USAID’s health funding in the DRC is dedicated to specific global health initiatives, with approximately 32 percent supporting the President’s Malaria Initiative (PMI) and 20 percent contributing to the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). The DRC is designated as a focus country for several major global health programs, including PMI, PEPFAR, the Ending Preventable Maternal and Child Death initiative (EPMCD), the Global Financing Facility, and the Global Health Security Initiative.
USAID’s health program in the DRC is extensive, providing primary health care services across 1,793 health facilities located in 78 health zones. These services reach over 12 million people across seven provinces: Kasai Oriental, Kasai Central, Sankuru, Lomami, South Kivu, Haut Lomami, and Lualaba. In addition to broad primary care, USAID provides targeted support to 103 stand-alone malaria-supported health zones within these and additional provinces including Orientale and Kinshasa. USAID’s HIV/AIDS efforts are concentrated in 21 health zones within Kinshasa and Katanga, regions with higher prevalence rates. These comprehensive programs are vital for strengthening the DRC’s fragile health systems and ensuring sustained improvements in healthcare delivery at the national, provincial, and local levels.
USAID’s approach to strengthening the health system in the DRC is multi-faceted, focusing on key areas:
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Governance: USAID supports reforms within the Ministry of Health (MOH) aimed at streamlining and decentralizing the public health sector. This includes technical and financial assistance for the development, implementation, and monitoring of annual operational plans at both provincial and local levels. Furthermore, USAID empowers communities by training them to identify and address their own health challenges using locally available resources, fostering local ownership and sustainability.
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Supply Chain: A critical component of USAID’s program is improving the availability of essential medicines and health commodities throughout the DRC’s health system. This involves strengthening the national supply chain systems to ensure reliable and efficient distribution from national to local levels, addressing shortages and stockouts that frequently plague health facilities.
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Human Resources: Recognizing that a strong health workforce is fundamental, USAID invests in increasing the managerial and technical capacity of health workers and professionals at all levels. Career development initiatives include providing scholarships and enhancing the academic and administrative capabilities of the Kinshasa School of Public Health, a key institution for training future health leaders. USAID also advocates for the consistent and timely payment of salaries for healthcare workers, a crucial factor in workforce motivation and retention.
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Financing: To ensure long-term sustainability and effectiveness, USAID actively advocates for increased financial investment in health from the GDRC. This includes leveraging funds from other international donors and exploring innovative financing models to improve both service delivery and utilization, ensuring that resources are used efficiently and effectively to reach those in need.
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Service Delivery: USAID supports the GDRC’s delivery of a comprehensive package of essential health services in selected regions. A key focus is promoting the health of vulnerable populations, including women, girls, newborns, and children under 5. Simultaneously, the program actively works to reduce the prevalence of major diseases such as malaria, TB, and HIV/AIDS through targeted interventions and prevention strategies.
Key Achievements of the Health Program in FY 2015
USAID’s health program, along with the contributions of other partners, has yielded significant positive outcomes in the DRC. Select achievements from Fiscal Year 2015 highlight the program’s impact:
- An estimated 150,000 child deaths were averted in 78 USAID-supported health zones that received comprehensive assistance over the preceding three years, demonstrating the profound impact of sustained support.
- Due to the increased efforts of USAID and other partners in malaria control, all 516 health zones across the nation received malaria program coverage for the first time, a landmark achievement in reaching the entire population at risk.
- Over 9 million anti-malarial combination therapy treatments were distributed, ensuring prompt and effective treatment for those affected by malaria.
- More than 250,000 pregnant women received at least two doses of sulfadoxine-pyrimethamine (IPTp) for intermittent preventive treatment of malaria during pregnancy, protecting both mothers and their unborn children.
- Family planning and reproductive health interventions supported by USAID resulted in 1,107,160 couple years of protection, empowering individuals to make informed choices about family size and spacing.
- In USAID-served areas, an estimated 92 percent of women delivered babies with a skilled birth attendant, significantly higher than the national rate of 80 percent, improving maternal and newborn survival rates.
- Nearly 460,000 newborns received essential newborn care, crucial interventions in the immediate postnatal period to ensure healthy development.
- The DRC remained polio-free, a continued success attributed to ongoing immunization and surveillance efforts.
- Over 3 million children under age 5 received Vitamin A supplements in USAID-assisted health zones, a simple yet highly effective intervention reducing the risk of under-5 deaths by approximately 25 percent among children deficient in this vital micronutrient.
- More than 150,000 people accessed HIV testing and counseling services and received their test results, a critical step in HIV prevention and care.
- Over 10,000 people were on HIV treatment, receiving life-saving antiretroviral therapy and ongoing care.
These achievements demonstrate the tangible impact of the health program in improving the lives of Congolese citizens and strengthening the nation’s health system.
Current Activities and Continued Commitment
USAID continues to support a wide range of activities in the DRC health sector through various implementing partners. These activities are categorized broadly across cross-cutting initiatives and disease-specific programs, showcasing a comprehensive approach to addressing the diverse health needs of the country. Current activities encompass critical areas such as integrated health projects, pharmaceutical and service systems strengthening, disease control and reproductive health support, health financing and governance, maternal and child health, family planning and reproductive health, malaria prevention and treatment, HIV/AIDS care and prevention, tuberculosis control, polio eradication, and water supply and sanitation improvements. This ongoing commitment reflects the sustained need for health program support in the DRC and the dedication of USAID and its partners to working collaboratively with the Congolese government and people to build a healthier future.
In conclusion, the health care program in the Democratic Republic of Congo is a multifaceted and evolving effort aimed at overcoming significant historical and ongoing challenges. Through strategic partnerships, targeted interventions, and a commitment to strengthening all aspects of the health system, substantial progress has been made. However, continued investment and focused programs are essential to further improve the health and well-being of the Congolese population and ensure a more resilient and equitable health system for the future.
