Nurses & midwives

Physicians

Nurses & midwives / physicians (per 1,000 people)

Source: World Bank

Years of fighting in DRC have crippled the health system, leaving up to 80% of people with little or no access to health care, according to Anatole Mangala, who works on a team of special advisers to the office of the presidency that focuses on universal health coverage.


In North Kivu and South Kivu, there is less than 1 doctor per 10,000 citizens, according to government statistics from 2015 — far below the World Health Organization’s minimum threshold of 23 doctors, nurses, and midwives per 10,000 people. The shortage is due to a lack of trained health care workers, staff members not being paid, and universities being unequipped to train health professionals.

While the Ministry of Public Health is supposed to receive 15% of the national budget under the Abuja Declaration, approximately 10% is given, Mangala said. The country’s resources are overstretched after battling back-to-back Ebola epidemics for two years. The outbreak in the East was the world’s second-deadliest, killing more than 2,000 people before officially ending in June, and the current one in the northwestern province of Équateur is spreading quickly.


The coronavirus, with more than 10,000 cases and 260 deaths domestically, is exacerbating a system already struggling to cope.

Dr. Immaculée Mulamba Amisi discusses the challenges of getting the community, and health service providers, to accept the arrival of the coronavirus and why the country needs to implement universal health coverage to deal with future epidemics.

“When the pandemic arrived, no one was expecting it, and no one knew how to manage it,” Amisi said.


Not only are the hospitals overwhelmed, but people are reluctant to seek care. At the onset of the outbreak, the majority of admitted patients died because hospitals did not have access to ventilators, and communities thought staff members were intentionally killing people, Amisi said. This fueled negative perceptions of health clinics and deterred people from going.


The absence of universal health coverage in DRC is another obstacle. Sick patients who cannot afford treatment are waiting too long before going to the hospital and then dying upon arrival, or they are self-medicating with herbs, Amisi said. Those who cannot pay but still seek treatment are forced to stay in the hospital until their families can cover their expenses.


Before the pandemic, DRC was slowly inching toward implementing UHC, but even though a law providing health insurance was passed in 2017, little had been put into action, said Fabien Mayani, lobby and advocacy coordinator for Cordaid in DRC. The government planned to establish the basics for coverage this year, but the coronavirus put everything on hold.

“When the pandemic arrived, no one was expecting it, and no one knew how to manage it,” Amisi said.


Not only are the hospitals overwhelmed, but people are reluctant to seek care. At the onset of the outbreak, the majority of admitted patients died because hospitals did not have access to ventilators, and communities thought staff members were intentionally killing people, Amisi said. This fueled negative perceptions of health clinics and deterred people from going.


The absence of universal health coverage in DRC is another obstacle. Sick patients who cannot afford treatment are waiting too long before going to the hospital and then dying upon arrival, or they are self-medicating with herbs, Amisi said. Those who cannot pay but still seek treatment are forced to stay in the hospital until their families can cover their expenses.


Before the pandemic, DRC was slowly inching toward implementing UHC, but even though a law providing health insurance was passed in 2017, little had been put into action, said Fabien Mayani, lobby and advocacy coordinator for Cordaid in DRC. The government planned to establish the basics for coverage this year, but the coronavirus put everything on hold.