Achieving sustainable financing in a fragile context

The Democratic Republic of the Congo has faced repeated conflicts over the past two decades that have weakened institutions and led to millions of deaths (particularly among women and children), largely as a result of preventable diseases and malnutrition. Health expenditure in the country is low, at only half the average of low-income countries. A recent public expenditure review revealed that addressing this low expenditure does not require complicated new revenue generation measures, which are likely to be challenging to implement in a context in which institutions are still recovering from prolonged conflict. Instead, a combination of straightforward interventions could more than double the domestic resources currently available for health.

Increasing general tax revenues through better enforcement and administration of existing taxes and new levies from the natural resources sector could increase government health spending by 0.4% of gross domestic product (GDP). Increasing the share of the government budget that is allocated to health could increase spending by 0.3% of GDP. Better execution of budgets –from making appropriate allocations, to establishing controls to assure proper use of funds as well as monitoring and reviewing funds to ensure that limits are not exceeded –could increase spending by 0.6% of GDP. Recent economic growth in the country has exceeded 7% per year, which creates an important opportunity to increase resource mobilization for health.

At the same time, partners in the country such as GAVI, the Global Fund, UNICEF and the World Bank, are harmonizing their approaches and aligning their work to support the Ministry of Public Health’s objective of reducing fragmentation among partners. The partners are jointly supporting a large-scale program that aims to improve the delivery of an essential integrated package of RMNCAH services through performance-based financing and by addressing key bottlenecks in the health system.