In recent years, the Democratic Republic of Congo has made considerable progress in reducing the under-five mortality rate from 148 deaths per 1,000 live births in 2007 to 104 deaths in 2013. Despite this reduction, the maternal mortality ratio remains high at 846 deaths per 100,000 live births, and other RMNCAH indicators continue to perform poorly with, for example, a contraceptive prevalence rate stagnating at 20 percent since 2008 and chronic malnutrition among children under five persisting at 43 percent. On the supply-side, this poor performance is directly correlated with low quality of care, inadequate preparedness for obstetric emergencies, and the limited availability of effective referral systems. On the demand-side, RMNCAH results are adversely affected by poor access to facilities, socio-cultural impediments, and financial barriers. RMNCAH performance is further compounded by economic and geographic disparities. For example, only 36 percent of children in the poorest wealth quintile are immunized compared to 65 percent in the richest wealth quintile (DHS, 2013–2014).
The government of the Democratic Republic of Congo draws on an existing multi-stakeholder platform to carry out a broad consultative process involving civil society and the private sector as well as bilateral and multilateral organizations. Providing the foundation for in-country and government-led coordination, this platform is supported by a GFF technical team presided by the Prime Minister’s office.
Drawing on existing evidence and on the national Health Development Plan, the Democratic Republic of Congo’s Investment Case proposes a two-pronged approach, simultaneously prioritizing: (1) system-wide interventions to strengthen human resources, civil registration and vital statistics, medical drug and commodity supply chains, as well as public finance management; and (2) focused interventions to expand essential RMNCAH services and address underfunded RMNCAH areas, particularly family planning and nutrition. The Democratic Republic of Congo’s Investment Case is being prepared to both address national level needs and the specific needs of select provinces.
As part of the GFF Country Platform, the Bill & Melinda Gates Foundation, the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF), the U.S. Agency for International Development (USAID), the World Bank and the World Health Organization (WHO) are supporting the development of the Investment Case. In addition, the governments of Canada, Japan (i.e., the Japanese International Cooperation Agency), Norway, and the United States (i.e., USAID), as well as Gavi, the Vaccine Alliance, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the World Bank, with financing from both the International Development Association (IDA) and the GFF Trust Fund, are contributing complementary resources to the partnership platform to support the achievement of RMNCAH results.
Health financing strategy
The government of the Democratic Republic of Congo is also spearheading the preparation of a health financing strategy to target and harmonize sustained financing. It particularly focuses on increasing domestic resource mobilization, enhancing the alignment of domestic and external resources, and attracting additional and complementary funding, including bilateral funding such as that provided by Norway's International Climate and Forest Initiative for improved family planning.