DR Congo

Last Updated: October 26, 2011

Senior Program Officer:

Hélène Mambu-ma-Disu, MD

Program Activities
Health Sector Architecture
Health Financing
Budgeting
Budget Flows and Reporting
Budget Performance
Parliamentary Notes
Immunization Performance Indicators
Disease Burden
Useful Links

Program Activities:

June 2009: Program Director Michael McQuestion and Senior Program Officer Hélène Mambu-Ma-Disu conducted introductory meetings in Kinshasa.
September 2009: The first Sabin-sponsored parliamentary briefing was held in Kinshasa.
November-December2009: Senior Programme Officer participated in the macroplanning of EPI Program for 2010
January 2010: Senior Program Officer Helene Mambu-Ma-Disu attended the National Health Coordinating Committee meeting, met several times with parliamentarians.
March 2010: SIF Senior Program Officer Helene Mambu-Ma-Disu joined a co-hosted Global Fund-GAVI mission to discuss innovative immunization financing arrangements for DR Congo.
June 2010: Sabin and WHO co-sponsored a second parliamentary briefing at the Palais du Congres. Among the participants were governors, parliamentarians and ministers of health from four of the country's 11 provinces.
June 2010: Senior Program Officer Helene Mambu-Ma-Disu participated in a GAVI Regional Working Group mission to DRC.
June 2010: Senior Officer Mambu-Ma-Disu participated in a cMYP update (2011-1015) workshop which was also attended by MPs and representatives from finance, budget and planning ministries.
July 2010: SIF Program Director Mike McQuestion, Senior Program Officer Helene Mambu-Ma-Disu and DR Congo's National EPI Manager met with immunization teams, governors and parliamentarians in Katanga and Bas Congo Provinces.
September 2010: Government and parliamentary representatives from Democratic Republic of Congo visit Cameroon as Sabin peer exchangers to discuss national immunization trust funds for both countries. Read the resulting "Call from Yaounde" here.
December 2010: Mr. Andre BONA KABAMBA, Ministry of Finance, and MP Hon. Gregoire LUSENGE KAKULE traveled as Sabin peer exchangers and presented DRC's proposed immunization trust fund to colleagues at the 2nd African Regional Immunization Conference in Ouagadougou, Burkina Faso.
August 2011: Senior Program Officer Helene Mambu-Ma-Disu attended a semi-annual immunization review and met with the Socio Cultural Affairs Committee of the Bas Congo Parliament.

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Health Sector Architecture:

There are 515 health zones in the country's eleven provinces. Of these, 508 had functional EPI programs in 2009.
DR Congo is an International Health Partnership country; it signed a Global IHP+ Compact in May 2010. Read more here.
Provincial elections in 2006-07 formed subnational governments. Under the decentralization plan, the federal government will transfer 40% of revenues to the provinces and the provinces are responsible for health delivery including immunizations.
WHO and UNICEF maintain field offices in ten of the country's eleven provinces. The field offices currently administer EPI funding in coordination with multisectoral Committes Provincaux de Pilotage and with Provincial EPI Program managers.

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Health Financing:

In 2007, DR Congo spent US$17 per capita on health. Health accounted for 6% of recurrent government expenditures. (Source: Countdown to 2015 Report, 2010)
In 2008, DR Congo received US$203.4m in Official Development Assistance for health, up from US$138.3m in 2007. (Source: OECD Creditor Reporting System)
Highly Indebted Poor Countries (HIPC) / Multilateral Debt Relief (MDR) Initiatives: DR Congo began receiving interim HIPC debt relief credits in July 2003. As of mid-2008, the country had received credits totaling US$454.5m (of a total commitment of $10.4b). As per the Poverty Reduction Strategy Paper (PRSP), the government has used these savings to invest more in poverty-reducing programs, including PHC delivery (from $26.2m in 2002 to $279.5m in 2006). DR Congo's pro-poor expenditures have increased 10-fold since reaching Decision Point in 2003. (Source: IDA/IMF. HIPC and MDRI-- Status of Implementation: September 15, 2009.)
In July 2010, DR Congo was awarded an additional US$12.3b in HIPC and MDRI debt relief, signaling that the country had reached the HIPC Completion Point. An as yet unknown proportion of these funds will be allocated for health.
National Immunization Program:
According to WHO figures, government financing for routine immunization totaled US$445,249 in 2002, $404,341 in 2003 and $1.4m in 2004. The GAVI grants to the DRC began in 2003. In 2005, the Government invested $3.2m in the routine EPI. In 2009, the figure was $1.9m.
According to the 2008-2012 cMYP, $32.3m were spent in 2005 specifically on the routine EPI program ($12 per infant born that year). Adding in shared health services expenditures to support EPI increases this to $36.1m ($14 per infant). The government financed $1.6m of the specific routine EPI expenditures (4 percent), less than $1 per infant . Elsewhere the document states the government spent $ 678,236 on routine EPI in 2004 and $ 308,170 in 2005.
In 2009, a routine EPI budget of US$500,000 was approved but never disbursed. In FY2010, the government submitted, and parliament approved, an increased health budget. The budget includes $6.5m for immunization, representing about 7% of the US$91m 2010 EPI budget.
The discrepant government expenditure figures are noteworthy. The overall pattern suggests a substitution effect whereby the government investment has decreased as external partner investments have increased.
In 2010, six of eleven provinces inserted EPI line items into their provincial budgets. EPI line items also appear in the 2011 federal health budget.

Amount spent by the government of DR Congo on routine immunization per infant (USD) (2000-2010)

Source:
1. WHO Vaccine Preventable Disease Monitoring System, 2008. Immunization Profile: DR Congo. All data derived from the WHO/UNICEF Joint Reporting Form as follows:
a: C_6450. This % excludes any external financing from donors.
b: C_6490. This % includes all recurrent, immunization-specific spending financed solely with government funds. This includes vaccines, injection supplies, salaries, and per diems of health staff working full-time on immunization, transport, vehicles, and cold chain maintenance, training, social mobilization, and monitoring and surveillance. "NA" indicates data not available.

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Budgeting:

The Executive Branch delivers the annual proposed budget (la loi de finances) to the Assembly no later than 15 September.
The 2010 budget included approximately US$95m for public health, representing 5.85% of the total budget. This compares to $64m in 2009.

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Budget Flows and Reporting:

a Joint WHO/UNICEF/GAVI/Sabin mission in June 2010 documented widespread disbursement problems in the government's public finance management system. Funds approved for EPI and other health programs were not being disbursed. As part of its HIPC Completion Point agreement, the Ministry of Finance did not release the funds until after July 2010.

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Budget Performance:

In 2007, DR Congo's routine EPI Program immunized 463,909 children with DTP3 and spent US$15,264,664 (around US$33 per DTP3 child). (Source: GAVI Annual Progress Report, 2007)
Country Policy and Institutional Assessment:
The World Bank 2007 CPIA gave DR Congo's budget and financial management systems (Indicator #13) a score of 2.5, equal to its 2005 score. (mean 2007 score for all IDA countries: 3.2) Read more here.
Open Budget Index: DR Congo scored 0% out of a possible 100% on the Open Budget Index 2008. This indicates that the government provides no budgetary information to the public. Read more here.
The government produces in-year budget execution reports for each sector, however, these reports are not published. A performance-based budgeting system will be introduced in 2011.
The National Health Sector budget did increase from less than 4.5% [of the total government budget] in 2009 to 6.3% in 2010

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Parliamentary Notes:

DR Congo has both a federal and eleven provincial parliaments.
DR Congo has a bicameral Parliament. It consists of a Senate (108 seats) and National Assembly. The National Assembly has 500 deputies representing 169 circonscriptions across the country's 11 provinces.
The National Assembly meets from 15 March-15 June and 15 September-15 December.
Of particular interest for the national immunization program is the Permanent Commission Economique et Financiere and the Special Commission Socio-Culturelle. In September 2009, following the first SVI parliamentary briefing, this Commission asked for and received a detailed government report on the 2009 national immunization budget. It is advocating a larger immunization budget for 2010.

During 2010, the Vice-President of the Parliament's Economic and Finance Committee (ECOFIN) worked with the national EPI team to review and clarify the proposed 2011 EPI budget.
The next parliamentary and presidential elections will be held on 27 November 2011. Subnational legislative elections will follow in November 2012 (Source: ElectionGuide).
Section I, Articles 42 and 47 of the Constitution (2006) obliges the State to guarantee the health of every Congolais child. Section VII, Article 204 empowers provinces to organize basic health services, including immunization campaigns.
In 2010 the MoF began drafting a law to create a national immunization trust fund.

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Immunization Performance Indicators:^*

Percent of districts reporting at least 80% coverage (DPT3), 2008^*: 54%
^*Source:
WHO Vaccine Preventable Disease Monitoring System, 2008. Immunization Profile: DR Congo. Data derived from the WHO/UNICEF Joint Reporting Form, Indicator GSA17ap. "NA" indicates data not available.

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Disease Burden:

Population (2008): 64,257,000
Births (2008): 2,886,000
U5 Deaths (2008):
- total 554,000
- preventable by routine EPI: 77,560¹
- preventable by routine EPI and new vaccines: 138,500²

(Source: UNICEF "State of the World's Children" 2009 )

¹ Assumes use of BCG, DPT, polio, and measles vaccines prevent 14% of U5 deaths.
² Assumes use of BCG, DPT, polio, measles, HepB, Hib, yellow fever, and pneumococcal antigen-containing vaccines prevent 25% of U5 deaths.

Note: Vaccine preventable death estimates assume that force of infections, individual susceptibility, and probability of exposure are constant at all mortality levels.

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Senior Program Officer:

Program Activities:

Health Sector Architecture:

Health Financing:

Budgeting:

Budget Flows and Reporting:

Budget Performance:

Parliamentary Notes:

Immunization Performance Indicators:^*

Disease Burden:

Useful Links:

Interactive map

DR Congo

Senior Program Officer:

Program Activities:

Health Sector Architecture:

Health Financing:

Budgeting:

Budget Flows and Reporting:

Budget Performance:

Parliamentary Notes:

Immunization Performance Indicators:*

Disease Burden:

Useful Links:

Interactive map

Immunization Performance Indicators:^*