The Democratic Republic of Congo (DRC), once a regional leader in healthcare with a robust network of clinics and skilled physicians, has faced significant setbacks. Decades of political and economic instability have severely weakened its healthcare system. Today, hospitals and clinics across the DRC struggle with shortages of staff, equipment, and essential medicines. It’s estimated that a staggering 70% of the Congolese population has limited or no access to vital health services. Strengthening this fractured system is paramount to improving the well-being of the nation.
Despite these immense challenges, the DRC has demonstrated notable progress in recent years. Improved governance, better coordination among stakeholders, and increased investment in critical health areas by both the Congolese government and international partners are driving positive change. Between 2007 and 2013, child mortality rates for children under five saw a significant decrease, dropping from 148 to 104 deaths per 1,000 live births. Vaccination coverage also improved, with 45% of children aged 12 to 23 months receiving all recommended vaccines, up from 31% in 2007. Remarkably, the DRC has remained polio-free for over three years, a major public health victory considering the country’s vast size and infrastructural limitations.
However, significant hurdles persist. The DRC’s fertility rate remains high at 6.6 children per mother, placing it among the highest globally. Contraceptive prevalence, while increasing, remains low at just 8% in 2013, up from 6% in 2007. Maternal health indicators are also concerning, with nearly 39% of women of childbearing age suffering from anemia and 14% being underweight. Malnutrition rates remain alarmingly high, a persistent issue for two decades. Currently, 43% of children under five are stunted, indicating chronic malnutrition, and 8% suffer from wasting, a sign of acute malnutrition.
Malaria continues to be a major public health crisis in the DRC. The country bears the second-highest malaria burden worldwide, accounting for 11% of global cases in 2013. This disease is responsible for approximately one in five deaths among children under five and an estimated 40% of outpatient visits for this age group, placing immense strain on families and the healthcare system.
Tuberculosis (TB) is another significant concern. The DRC ranks sixth among the 22 countries that account for 80% of the world’s TB cases. While the prevalence of HIV/AIDS is lower in the DRC compared to many other sub-Saharan African nations, at 1.2% in the general population, it is notably higher in urban areas and among women, requiring targeted interventions.
Recognizing the critical need for investment, the Government of the DRC (GDRC) has steadily increased its health budget allocation from 3.4% of the national budget in 2011 to 8.6% in 2015. Significantly, 2015 marked the first year the GDRC specifically allocated funds for essential drugs and contraceptives, demonstrating a growing commitment to improving access to essential health commodities.
USAID’s Comprehensive Health Program in the DRC
The United States Agency for International Development (USAID) plays a leading role in supporting the DRC’s health sector. With a significant investment of $156 million in Fiscal Year 2015, USAID’s health program is its largest sector in the DRC, aligning with key U.S. government priorities. Around 32% of this funding supports the President’s Malaria Initiative (PMI), and 20% is allocated 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 initiatives, including PMI, PEPFAR, the Ending Preventable Maternal and Child Death initiative (EPMCD), the Global Financing Facility, and the Global Health Security Initiative, highlighting its importance in global health security and development efforts.
USAID’s programs provide primary health care services across a wide network, reaching over 12 million people in seven provinces – Kasai Oriental, Kasai Central, Sankuru, Lomami, South Kivu, Haut Lomami, and Lualaba – through 1,793 health facilities. Furthermore, USAID supports 103 stand-alone malaria-focused health zones in these same provinces, as well as in Orientale and Kinshasa provinces, demonstrating a broad geographical reach. HIV/AIDS support is concentrated in 21 health zones within Kinshasa and Katanga, targeting areas with higher prevalence. These robust programs are crucial for strengthening the DRC’s fragile health systems and ensuring sustainable improvements in health service delivery at all levels – national, provincial, and local.
USAID’s health program in the DRC focuses on five key interconnected areas:
Governance
USAID supports crucial 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 rigorous monitoring and evaluation of annual operational plans at both provincial and local levels. Crucially, USAID also empowers communities by providing training to identify and address their own health-related challenges, utilizing locally available resources to foster sustainable solutions and community ownership.
Supply Chain
A robust supply chain is essential for effective healthcare delivery. USAID works to improve the consistent availability of essential medicines and health commodities at all levels of the DRC’s health system. This involves strengthening national health commodity supply chain systems to ensure that vital medical supplies reach those in need, efficiently and reliably.
Human Resources
Recognizing that a skilled and motivated health workforce is the backbone of any health system, USAID invests in increasing the managerial and technical capacity of health workers and professionals at all levels. Career development initiatives are a key component, including providing scholarships and enhancing the academic and administrative capabilities of the Kinshasa School of Public Health. Furthermore, USAID advocates for the fair and timely payment of salaries for healthcare workers, recognizing the importance of decent working conditions in retaining and motivating essential health personnel.
Financing
Sustainable financing is critical for long-term health system strengthening. USAID actively advocates for increased financial commitment to health from the GDRC. This includes leveraging funds from other international donors and exploring innovative financing models to enhance service delivery and improve healthcare utilization across the DRC, ensuring the financial sustainability of health programs.
Service Delivery
USAID supports the GDRC’s delivery of a comprehensive package of essential health services in targeted regions. A core focus is on promoting the health of vulnerable populations, including women, girls, newborns, and children under 5, who are disproportionately affected by health challenges. Simultaneously, the program actively works to reduce the prevalence of major diseases such as malaria, TB, and HIV/AIDS through prevention, treatment, and care interventions.
Key Achievements in FY 2015
The impact of USAID’s health program is evident in several significant achievements in Fiscal Year 2015:
- Child Mortality Reduction: An estimated 150,000 child deaths were averted in the 78 USAID-supported health zones that received comprehensive assistance over the preceding three years, demonstrating the tangible impact of sustained health interventions.
- Expanded Malaria Control: For the first time, due to increased efforts by USAID and other partners in malaria control, all 516 health zones across the nation received malaria program coverage, marking a significant expansion in malaria prevention and treatment efforts.
- Malaria Treatment Distribution: Over 9 million anti-malarial combination therapy treatments were distributed, ensuring access to effective treatment for those affected by malaria.
- Malaria Prevention in Pregnancy: More than 250,000 pregnant women received at least two doses of sulfadoxine-pyrimethamine for intermittent preventive treatment of malaria in pregnancy (IPTp), protecting both mothers and their unborn children from the risks of malaria.
- Family Planning and Reproductive Health: Family planning and reproductive health interventions supported by USAID resulted in an impressive 1,107,160 couple years of protection, empowering individuals to make informed choices about family size and spacing.
- Skilled Birth Attendance: In USAID-served areas, an estimated 92% of women delivered babies with the assistance of a skilled birth attendant, significantly higher than the national rate of 80%, contributing to safer deliveries and improved maternal and newborn health outcomes.
- Essential Newborn Care: Nearly 460,000 newborns received essential newborn care, crucial for ensuring a healthy start to life and reducing newborn mortality.
- Polio-Free Status Maintained: The DRC continued to maintain its polio-free status, a testament to ongoing immunization efforts and disease surveillance.
- Vitamin A Supplementation: Over 3 million children under age 5 received Vitamin A supplements in USAID-assisted health zones. This supplementation is estimated to reduce the risk of under-5 deaths by approximately 25% among children deficient in this vital micronutrient.
- HIV Testing and Counseling: More than 150,000 people accessed HIV testing and counseling services and received their test results, a critical step in HIV prevention and care.
- HIV Treatment Expansion: More than 10,000 people were receiving life-saving HIV treatment, expanding access to care and improving the lives of those living with HIV.
Current Activities and Implementing Partners
USAID’s ongoing health program in the DRC is implemented through a range of activities and partnerships with experienced organizations. These activities are categorized by health area and implementing partner:
Cross-cutting
- Integrated Health Project plus – Management Sciences for Health, Inc. (MSH)
- Systems for Improved Access to Pharmaceuticals and Services (SIAPS) – Management Sciences for Health, Inc. (MSH)
- World Health Organization/Africa Regional Office (WHO/AFRO) Support for Disease Control and Reproductive Health in Africa – World Health Organization
- Health Financing and Governance (HFG) – Abt Associates, Inc.
Maternal and child health
- Fistula Care Plus – Engender Health
- Project Cure – Project Cure
- Maternal and Child Survival Program – Jhpiego
Family planning and reproductive health
- Central Contraceptive Procurement (CCP) – John Snow, Inc.
- Evidence to Action (E2A) – Pathfinder
- Support to International Family Planning Organizations (SIFPO) – Population Services International (PSI)
Malaria
- UNICEF Maternal and Child Health Umbrella Grant – United Nations Children Funds (UNICEF)
- President’s Malaria Initiative Expansion Project (PMI-EP) – Population Services International (PSI)
- MalariaCare Project – Program for Appropriate Technologies in Health (PATH)
- DELIVER Project Task Order – John Snow, Inc.
- Indoor Residual Spraying 2 Task Order – Abt Associates, Inc.
- MEASURE EVALUATION PHASE IV – University of North Carolina
HIV/AIDS
- Supply Chain Management System (SCMS) – Partnership for Supply Chain Management
- Integrated HIV/AIDS Project (ProVIC+) – PATH and the Elizabeth Glaser Pediatric AIDS Foundation
- Applying Science to Strengthen and Improve Systems (ASSIST) – University Research Co., LLC
- Livelihoods and Food Security Technical Assistance II (LIFT) – FHI 360
- Food and Nutrition Technical Assistance III (FANTA) – FHI 360
- Coordinating Comprehensive Care for Children Affected by HIV/AIDS (4Children) – Catholic Relief Services
- Linkages Across the Continuum of HIV Services for Key Populations Affected by HIV (LINKAGES) – FHI 360
Tuberculosis
- TB Challenge – International Union Against Tuberculosis and Lung Disease
- Stop TB Partnership – World Health Organization
Polio
- World Health Organization Consolidated Grant (Polio Commodities) – World Health Organization
- Health and Immunization Response Support – UNICEF
Water supply and sanitation
- UNICEF Maternal and Child Health Umbrella Grant – UNICEF
Through these comprehensive programs and dedicated partnerships, USAID continues to play a vital role in strengthening the health care system in the Democratic Republic of Congo, working towards a healthier future for all Congolese citizens.
