Democratic Republic of Congo (DRC) has some of the highest maternal and child mortality ratios in the world; women have an average of 6.6 children; and 42 percent of women aged 15-19 years are mothers or pregnant with their first child. For every 1,000 children born, 58 die before their first birthday and 104 die within the first five years of life. Chronic malnutrition affects 43 percent of children under five. These poor health outcomes are linked to low coverage of high-impact services for reproductive, maternal, newborn, child, and adolescent health (RMNCAH), such as antenatal and delivery care, and weak capacity for emergency obstetric care. To add to this, chronic political instability and armed conflict have made it difficult for DRC to increase domestic spending on health care.
The GFF Partnership Response
The government of the DRC, in partnership with the GFF and key stakeholders prioritized funding for the expansion of an integrated package of services, as described in the country’s investment case, National Health Development Plan (NHDP) for 2019–2022. It focuses on the critical but underfunded areas of family planning, nutrition, adolescent health, and civil and vital statistical reporting. Government leadership and partner support have made it possible for the GFF to help prioritize high-impact interventions in provinces with the lowest health indicators. Each partner played a role – for example, the Ministry of Health and civil society organizations defined RMNCAH-N priorities; UNICEF conducted a health system bottleneck analysis; WHO provided support in costing the investment case; and the GFF Secretariat supported resource mapping. The GFF also helped pool funds around the investment case from the World Bank (IDA), the GFF, USAID, GAVI, and the Global Fund, among others. The GFF is also providing US$10 million in co-financing to support a $30 million World Bank project for the Human Development Systems Strengthening Project in DRC.
Improving the allocation and efficient use of health financing in the DRC has already reduced costs of care for patients, strengthened service quality, and increased the uptake of services. For example, about 50,000 additional women had assisted deliveries, and 60,000 additional women sought postnatal care from 2017 to 2018. DRC’s investment case was successful in guiding policy makers through difficult budget allocation choices to select which health services to expand and which groups to target first. The investment case was then used to update the NHDP and ensure that these health priorities are adequately financed—not only by development partners but also by government resources. The alignment of the government's health budget with the new NHDP will make it possible to monitor increases in domestic and external spending on priority areas.
The GFF aims to provide technical support on public financial management in order to address the low budget execution rate: below 60 percent nationally and below 20 percent in several provinces. The GFF continues to provide technical assistance to link the investment case to the government planning and budgeting cycle, and aims to undertake a comprehensive assessment of civil registration and vital statistics (CRVS), develop a costed national CRVS strategy and implementation plan, and support catch-up registration campaigns through schools.
To learn how the DRC has achieved results, view the latest GFF Annual Report.