Last June, 19 Belgian experts launched a call to make Public Health a priority of the bilateral Cooperation with DRC. This initiative echoes the effort sustained by the Congolese government in this sector.
Three Challenges to Tackle
The first challenge of Congois about territorial management. With a territory equivalent to Western Europe and a population of 65 million, DRC is the second most populated country in sub-Saharan Africa. 69% of people are living in rural areas, most of the time in scattered housing since there is a low human density (24 per km2). Some landlocked and remote regions endure a difficult access.
The second challenge of Congo is about demography management. On this issue, statistics are close to the continent average. The demographic growth is 2.7% (African average is 2.4%). 46% of the population is below 15 (African average is 45%) and the
average age is 17. The fertility rate is still high at 5.8 (African average is 4.6) and Congolese have a shorter life expectancy of 50 (African average is 56).
The third challenge ofCongois about Development management. DRC is still in a reconstruction era after 7 years of wars that caused the death of 5 million victims. The Congolese population endured massive displacements, recurrent epidemics and a complete collapse of the Health system. Facing a 70% poverty rate, the Development strategy is focused on protecting vulnerable groups.
For the government, the main issue is to mobilize enough resources to finance the development of Public Health. In the next budget, the share for Health will increase from 3.5% up to 6.8%. However, the government contribution only represents 24% of the total spending in this sector. Private contributions (donors, NGOs) remain vital since they cover 76% of Health costs.
The access to medical care reached a 50% rate in 2009 but more needs to be done. The government has launched a major decentralization process to develop the health map efficiently. The National Plan for Health Development 2011-2015 arranges the progressive setting of Health Provincial Divisions. Rural health services are at the core of this strategy. The purpose is to achieve a generalization of basic health care and to reduce disparities between provinces.
The attention is also focused on building a medical capacity. In 2011, the government decided to increase the number of physicians by 50% before 2015. But with a 1/9,000 ratio, DRC still lags behind the WHO recommendations of 1/650. However, once again, the country positions in the average of sub-SaharanAfrica(1/10,000). To address such a low medical density, the government develops alternative solutions such as rural health centres staffed by health workers and mobile clinics.
The Millennium Development Goals (MDGs) are the main guideline in the efforts dedicated to Public Health. In this regard, some encouraging results can be noted.
Maternal mortality has significantly receded with a 40% drop since 2006. Congo has a 540/100,000 ratio. This figure is close to the African average and 14 sub-Saharan countries score worse. It is unlikely that DRC will reach the MDG rate of 322 by 2015 but there is a sustained endeavour to improve maternal conditions. Today 90% of pregnancies receive medical attention and 74% of births benefit a medical environment.
In addition, child mortality (from 0 to 5 years) is also improving. Since the beginning of this decade, it has been reduced by 22% and DRC ranks33 inthe 48 sub-Saharan countries. WHO notes a significant progress in vaccination rates with 85% for BCG and 72% for polio. However, death in the neonatal phase still represent 1/3 of infant mortality. A better awareness is required in post-natal supervision.
Lastly, fighting pandemics is also a priority in this overexposed country. Congo strives to develop a coordinated strategy to stem the spread of three main threats: malaria, HIV/AIDS and tuberculosis. Due to a better case detection, prevalence figures are high. Regarding malaria, DRC is among the most affected countries globally but WHO projections hold out some hope for a curve in trend by 2015.
The support from European countries remains therefore essential to achieve efficiency in Public Health. While DRC has engaged unprecedented efforts, the commitment of partners sends out a very positive signal ■