The Democratic Republic of the Congo (DRC) is the 2nd largest country in Africa by area and the 4th by population with over 89 million people. It is home to over 200 ethnic groups and languages. It’s also one of the poorest countries in the world. DRC has experienced recurrent political and social instability since its civil war that lasted from 1997–2003. Active conflict remains today, mostly in the east despite the signing of multiple peace accords.
The conflict in DRC has resulted in a health-system collapse and created a humanitarian disaster. An estimated 5.4 million excess deaths occurred during the civil war, with fewer than 10% attributed to violence and the rest to preventable and treatable medical conditions such as malaria, diarrhea, pneumonia and malnutrition. The last few decades of unrest have left its once lauded healthcare system in shambles. Now, around 70% of Congolese people have little to no access to basic healthcare and most live in extreme poverty.
DRC has some of the highest infant and maternal mortality rates. Although life expectancy and birth has gone up, it is still rather low. About 70% of the population lacks access to adequate food, and one in four children is malnourished. Causes of food insecurity include population displacements, lack of access to basic social services, low agricultural productivity, lack of road infrastructure and chronic poverty. In 2012, the main causes of morbidity and mortality were malaria, HIV/AIDS, tuberculosis, parasitic infections, respiratory infections, malnutrition and reproductive health issues.
Epidemics are a part of life for the majority of people in the DRC. Most notably measles, cholera and meningitis. Infected patients often present in extremis due to lack of vaccination programs, poor healthcare access and fee-for-service barriers. Only 12% of HIV-positive patients receive antiretroviral drugs and 95% of women living with AIDS do not have access to treatment.
Before the civil war, DRC had a well-organized healthcare system. Now, it has severely deteriorated over the last 20 years and faces poor infrastructure, security risks and a growing burden of non-communicable diseases. Government expenditure is among the lowest in the world despite raising it in the last few years. Most healthcare services in DRC charges a fee. Unregulated, fee-for-service payments are widespread and have resulted in a completely unpredictable cost of care for the patient. Direct payment is usually requested for every single intervention.
As of 2016, there were 401 hospitals in the DRC. Access to medical care remains sparse in rural areas though. In fact, it is still difficult for many citizens to obtain necessary medical aid. Additionally, these hospitals often lack proper equipment and staff to meet some of the needs of the patients. Hospitals often run out of essential medicines and supplies required for various treatments. In 2018, The Emergency Plan for the Revitalization of Immunization was implemented with the goal of increasing vaccinations for children. Under this plan many children were protected against life threatening diseases.
The number of health care workers in the DRC averages out to .09 physicians to 1,000 individuals. This is drastically less than most other countries. One-third of health care workers are over 60 years old. These numbers are odd and surprising, considering the country produces up to 9,000 new health care workers each year. Despite this, there is a severe shortage of health care workers in many areas and facilities in the DRC. Many NGOs provide aid to the DRC. USAID provides more than 12 million people with basic primary health services. In the last few years, the government in the DRC has started to focus a little on healthcare but there is a long way to go before progress is made.