EASO
Democratic Republic ofCongo (DRC)

Medical Country of Origin Information
ReportAugust 2021

More information on the European Union is available on the Internet (http://europa.eu)

PDF

ISBN: 978-92-9485-769-9

doi: 10.2847/40625

BZ-06-20-137-EN-N© European Asylum Support Office, 2021
Cover photo, © iStock, photo from theme industry and accessed 29 July 2021.
Reproduction is authorised provided the source is acknowledged. For any use or reproduction of photos orother material that is not under the EASO copyright, permission must be sought directly from the copyrightholders.

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Acknowledgements
EASO acknowledges International SOS (Intl.SOS) as the drafter of this report.

The following departments and organisations have reviewed the report:•

EASO, MedCOI Sector, Third Country Research Unit, Asylum Knowledge Centre,•

Belgian Desk on Accessibility (BDA) at the Belgian Immigration Department,•

Department for Asylum and Migration Policy at the International and European Affairs Unit
within the Ministry of the Interior of the Czech Republic,•

Country of Origin Information (COI) Unit at the Ministry of Immigration and Integration within
the Danish Immigration Service, and•

COI Information Desk / Documentation of COI documents and case law at the German Federal
Office for Migration and Refugees.

It must be noted that the review carried out by the mentioned departments, experts or organisations
contributes to the overall quality of the report but does not necessarily imply their formal
endorsement of the final report, which is the full responsibility of EASO.

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Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Contents
Acknowledgements................................................................................................................................. 3Contents .................................................................................................................................................. 4
Disclaimer................................................................................................................................................ 8
Glossary and Abbreviations .................................................................................................................... 9
Introduction .......................................................................................................................................... 11
Methodology .................................................................................................................................... 11
Defining the terms of reference ................................................................................................... 11
Collecting information.................................................................................................................. 12
Quality control.............................................................................................................................. 13
Structure and use of the report ........................................................................................................ 13
Referencing ....................................................................................................................................... 13
Map ....................................................................................................................................................... 14
1. General information.......................................................................................................................... 15
1.1 Geography and demographics.................................................................................................... 15
1.2 Political context .......................................................................................................................... 16
1.3 Economic context ....................................................................................................................... 17
1.4 Historical background ................................................................................................................. 17
2 Health system organisation ............................................................................................................... 18
2.1 Impact of COVID-19 .................................................................................................................... 18
2.2 Overview ..................................................................................................................................... 18
2.3 Public healthcare ........................................................................................................................ 22
2.4 Private healthcare....................................................................................................................... 24
3 Healthcare human resources ............................................................................................................. 26
4 Pharmaceutical sector ....................................................................................................................... 28
5 National policy on blood transfusion and related services organisation .......................................... 30
6 Patient pathways ............................................................................................................................... 31
7 Risk-pooling mechanism .................................................................................................................... 32
7.1 Health services provided by the State / public authorities ........................................................ 32
7.2 Public health insurance............................................................................................................... 32
7.3 Community-based health insurance schemes............................................................................ 33
7.4 Private health insurance schemes .............................................................................................. 34
7.5 Other social security plans.......................................................................................................... 34

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Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

7.6 Work injury ................................................................................................................................. 35
7.7 Minimum wage ........................................................................................................................... 35
7.8 Poverty alleviation measures ..................................................................................................... 35
8 Out-of-pocket health expenditure ..................................................................................................... 36
8.1 Cost of consultations .................................................................................................................. 36
8.2 Treatment cost ........................................................................................................................... 37
8.3 Cost of medication ...................................................................................................................... 37
9 Cardiovascular diseases ..................................................................................................................... 38
9.1 General information ................................................................................................................... 38
9.1.1 Epidemiological context ...................................................................................................... 38
9.1.2 Strategies and policies for treatment and management of CVD ........................................ 38
9.1.3 Healthcare provisions for treatment and management of CVD ......................................... 39
9.2 Access to treatment.................................................................................................................... 40
9.3 Cost of treatment ....................................................................................................................... 41
9.4 Cost of medication ...................................................................................................................... 42
9.5 NGOs ........................................................................................................................................... 45
10 Diabetes ........................................................................................................................................... 46
10.1 General information ................................................................................................................. 46
10.1.1 Epidemiological context .................................................................................................... 46
10.1.2 Strategy and policies for treatment and management of diabetes .................................. 46
10.1.3 Healthcare provisions for treatment and management of diabetes ................................ 46
10.2 Access to treatment.................................................................................................................. 47
10.3 Cost of treatment ..................................................................................................................... 48
10.4 Cost of medication.................................................................................................................... 50
10.5 NGOs ......................................................................................................................................... 52
11 Haematology: anaemia and blood clotting disorders ...................................................................... 53
11.1 General information ................................................................................................................. 53
11.1.1 Epidemiological context .................................................................................................... 53
11.1.2 Strategy and policies for treatment and management of haematological disorders ....... 54
11.1.3 Healthcare provisions for treatment and management of haematological disorders ..... 55
11.1.4 Human resources .............................................................................................................. 55
11.2 Access to treatment.................................................................................................................. 55
11.3 Cost of treatment ..................................................................................................................... 57
11.4 Cost of medication.................................................................................................................... 59
11.5 NGOs ......................................................................................................................................... 59
12 Hepatitis B and C .............................................................................................................................. 60
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Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

12.1 General information ................................................................................................................. 60
12.1.1 Epidemiological context .................................................................................................... 60
12.1.2 Strategies and policies for treatment and management of hepatitis ............................... 60
12.1.3 Healthcare provisions for treatment and management of hepatitis ................................ 61
12.2 Access to treatment.................................................................................................................. 62
12.3 Cost of treatment ..................................................................................................................... 62
12.4 Cost of medication.................................................................................................................... 64
12.5 NGOs ......................................................................................................................................... 65
13 HIV/AIDS........................................................................................................................................... 65
13.1 General information ................................................................................................................. 65
13.1.1 Epidemiological context .................................................................................................... 65
13.1.2 Strategies and policies for treatment and management of HIVAIDS................................ 66
13.1.3 Healthcare provisions for treatment and management of HIV/AIDS ............................... 66
13.2 Access to treatment.................................................................................................................. 67
13.3 Cost of treatment ..................................................................................................................... 67
13.4 Cost of medication.................................................................................................................... 69
13.5 NGOs ......................................................................................................................................... 71
14 Nephrology....................................................................................................................................... 71
14.1 General information ................................................................................................................. 71
14.1.1 Epidemiological context .................................................................................................... 71
14.1.2 Strategies and policies for treatment and management of kidney disease ..................... 72
14.1.3 Healthcare provisions for treatment and management of kidney disease ...................... 72
14.2 Access to treatment.................................................................................................................. 74
14.3 Cost of treatment ..................................................................................................................... 74
14.4 Cost of medication.................................................................................................................... 76
14.5 NGOs ......................................................................................................................................... 76
15 Neurology: epilepsy and cerebrovascular accident (stroke) ........................................................... 77
15.1 General information ................................................................................................................. 77
15.1.1 Epidemiological context .................................................................................................... 77
15.1.2 Strategies and policies for treatment and management of CVD ...................................... 77
15.1.3 Healthcare provisions for neurology ................................................................................. 78
15.2 Access to treatment.................................................................................................................. 78
15.3 Cost of treatment ..................................................................................................................... 79
15.4 Cost of medication.................................................................................................................... 80
15.5 NGOs ......................................................................................................................................... 82
16 Psychiatry ......................................................................................................................................... 84
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Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

16.1 General Information ................................................................................................................. 84
16.1.1 Epidemiological context .................................................................................................... 84
16.1.2 Strategies and policies for psychiatry ............................................................................... 85
16.1.3 Healthcare provisions for psychiatry................................................................................. 85
16.1.4 Human resources .............................................................................................................. 86
16.2 Access to treatment.................................................................................................................. 86
16.3 Cost of treatment ..................................................................................................................... 87
16.4 Cost of medication.................................................................................................................... 88
16.5 NGOs ......................................................................................................................................... 90
17 Pulmonology: Asthma, Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnoea .. 92
17.1 General information ................................................................................................................. 92
17.1.1 Epidemiological context .................................................................................................... 92
17.1.2 Strategies and policies for treatment and management of respiratory illness ................ 93
17.1.3 Healthcare provisions for treatment and management of respiratory illness ................. 94
17.2 Access to treatment.................................................................................................................. 94
17.3 Cost of treatment ..................................................................................................................... 95
17.4 Cost of medication.................................................................................................................... 96
17.5 NGOs ......................................................................................................................................... 97
18 Tuberculosis ..................................................................................................................................... 98
18.1 General information ................................................................................................................. 98
18.1.1 Epidemiology ..................................................................................................................... 98
18.1.2 Policies and strategies ....................................................................................................... 98
18.1.3 The national response ....................................................................................................... 99
18.2 Access to treatment................................................................................................................ 100
18.3 Cost of treatment ................................................................................................................... 101
18.4 Cost of medication.................................................................................................................. 102
18.5 NGOs ....................................................................................................................................... 104
Annex 1: Core medicines price list ...................................................................................................... 105
Annex 2: Bibliography ......................................................................................................................... 109
Annex 3: Terms of reference for the MedCOI report on the Democratic Republic of Congo (DRC) .. 120
Topical reports: .......................................................................................................................... 120
Detailed content instructions topical reports: ............................................................................... 120
General information ................................................................................................................... 120
Access to treatment: .................................................................................................................. 120

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Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Disclaimer
This report was written according to the EASO COI Report Methodology (2019). 1 The report is basedon carefully selected sources of information. All sources used are referenced.
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The information contained in this report has been researched, evaluated and analysed with utmost
care. However, this document does not claim to be exhaustive. If a particular event, person ororganisation is not mentioned in the report, this does not mean that the event has not taken place orthat the person or organisation does not exist.
Furthermore, this report is not conclusive as to the determination or merit of any particularapplication for international protection. Terminology used should not be regarded as indicative of aparticular legal position.
‘Refugee’, ‘risk’ and similar terminology are used as generic terminology and not in the legal sense as
applied in the EU Asylum Acquis, the 1951 Refugee Convention and the 1967 Protocol relating to the
Status of Refugees.
Neither EASO nor any person acting on its behalf may be held responsible for the use which may bemade of the information contained in this report.
More information on the reference period for this report can be found in the methodology section of
the Introduction.

1 The 2019 EASO COI Report Methodology can be downloaded from the EASO COI Portal url

8Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Glossary and Abbreviations
Abbrev.

Explanation

ART

Antiretroviral Therapy

BDOM

Bureau Diocésain des Oeuvres Médicales

CHW

Community Health Worker

CT

Computerised Tomography

CKD

Chronic Kidney Disease

CNPP

Centre Neuro-Psycho-Pathologique

COPD

Chronic Obstructive Pulmonary Disease

CPLT

Coordinations Provinciales Lèpre et Tuberculose

CVD

Cardiovascular Disease

COI

Country of Origin

DHS

Demographic Health Survey

DOTS

Directly Observed Treatment Short Course

DRC

Democratic Republic of the Congo

EEG

Electroencephalography

GDF

Global Drug Facility

GDP

Gross Domestic Product

HRW

Human Rights Watch

IDP

Internally Displaced Population

INGO

International Non-Government Organisation

Intl.SOS

International SOS

MDR-TB

Multidrug-Resistant Tuberculosis

MESP

Mutuelle de Santé des Enseignants des Écoles Catholiques du Congo

MHO

Mutual Health Organisation

MSF

Médecins Sans FrontièresNGO

Non-Government Organisation

PEPFAR

President's Emergency Plan for AIDS Relief

PNDS

Plan National de Développement Sanitaire

PNLT

Plan Stratégique National de Lutte Contre La Tuberculose

PNSM

Programme National de Santé Mentale

POMUCO

Plateforme des Organisations Promotrices des Mutuelles de Santé duCongo

PSNHIV

Plan Stratégique National de Lutte contre le VIH

9Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

SCD

Sickle Cell Disease

TB

Tuberculosis

UN

United Nations

WHO

World Health Organization

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Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Introduction
This report is a minor update to the December 2020 MedCOI report on the Democratic Republic of
the Congo (DRC).

The purpose of the report is to provide information on access to healthcare in the Democratic Republicof the Congo (DRC). This information is relevant to the enforcement of EU+ countries’ immigration
legislation and to the international protection status determination (refugee status and subsidiary
protection).

Methodology
Defining the terms of reference
The terms of reference for this Medical Country of Origin Information Report are based on the Belgian
Desk of Accessibility’s ‘Researcher’s guide,’ developed in the framework of the MedCOI4 project. The
guide includes a list of questions to be addressed in the report. This was used to develop a‘Questionnaire on access to healthcare,’ which included a medication and consultation price list
containing common treatment and medication questions. This report is produced in line with the
EASO COI Report Methodology (2019) and the EASO COI Writing and Referencing Style Guide (2019).
For the specific terms of reference see Annex 3 of this report.

Minor version update
This report is an update to the December 2020 MedCOI report on DRC. It was updated in August 2021
for the following reasons:- to adjust some inconsistencies found and avoid confusion (about specific treatments and medicinesthat are available and unavailable) with the MedCOI availability service. The following was changed:
the term ‘available’ in the medication and treatment price tables has been eliminated. Availability oftreatment and medication is collected within the MedCOI service following a strict methodology. In
the context of this report, only the cost of the treatments and medication has been investigated. Whenno treatment price was found (for whatever reason), a dash marks the absence of data. When no
prices were found for a line of entry, the row was removed in order to improve the readability of thetables.
- to adjust and add extra information related to haemodialysis which was received after the
publication of the report (in April 2021).
On the first point, the adjustments related to the tables with treatment and medication prices are
mentioned in the separate chapters 9-18 about accessibility information on specific diseasegroups and in annex 1.
On the second point, the adjustments and extra information related to haemodialysis are mentioned
in separate chapter 14: Nephrology.
Besides a new cover photo and some minor editing there were no adjustments for other reasons. The
previous version of the report is still available in the EASO COI Portal, however this report should beconsidered with the most current and updated information available.

11Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Collecting information
The European Asylum Support Office (EASO) contracted Intl.SOS to manage the report delivery
including data collection. Intl.SOS recruited and managed a public health lead to author the reportand a local consultant to collect data. The public health lead was selected from Intl.SOS’ existing poolof consultants. The consultant was selected based on their experience in leading comparable projects
and on their experience working in DRC.
Key Informant Interviews
Key informant interviews were carried out by the local consultant in Kinshasa, during August and
September 2020. Interviews were conducted with five medical doctors who work in varied roles
related to healthcare delivery. This included individuals within the Ministry of Health, as well as Clinic
managers. An anonymised list of interviewees is given in table 1 which describes the core functions of
their roles.
Key Informant CodeRole Description

EASO1

Medical Doctor and local consultant responsible for in-country data collectionof the report.

EASO2

Director of a national programme within the Ministry of Health. Responsible
for national implementation of the strategy.
Medical Director and Head of Cardiology at prominent Kinshasa-based facility.

EASO3

Deputy Manager of a priority national programme. Responsible for national
implementation of the strategy.

EASO4

Medical Doctor and Monitoring and Evaluation officer in the Ministry of
Health.

EASO5Medical Director of a prominent Kinshasa-based clinic.

EASO6

Senior Medical Advisor of an international healthcare company.

Table 1: Anonymised key informants

Literature review
The local consultant collected documents and strategies to populate the questionnaire with additional
findings. Supplementary information was gathered from publicly available resources, by the reportauthor. Resources included national strategies, policies, grey literature and journal articles. Sourceswere carefully selected following the EASO Country of Origin Information (COI) Report Methodology(2019) and are referenced in footnotes on each page and included in the bibliography.
Medication and treatment prices
A comprehensive, although non-exhaustive, list of medication prices is given in the Annex I to thisreport and in each of the chapters on individual diseases. The data presented in these were collectedby the local consultant between August and November 2020. Price of medications was gathered fromeight pharmacies in Kinshasa. The prices of medicines in Kinshasa are comparable with other cities. 2
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The costs of treatments and medical examinations were drawn from price lists of the major public andprivate hospitals in Kinshasa (Clinique Ngaliema, Centre Médical de Kinshasa, Centre Médical Diamantand Hôpital Biamba Marie Mutombo). The cost of treatments in Kinshasa can be considered indicative

2 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email Correspondence,

August-November 202012

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)of the national prices, particularly as many specialised treatments are only available in Kinshasa-based
facilities. However, there may nonetheless be some regional variation in prices for some treatmentsthat has not been captured. 3
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Due to the variable value of the Congolese Francs, health facilities typically price medications andtreatments in United States dollar (USD). As such, all prices have been provided in USD. Of note,
community members can pay in either currency. 4
3FMore information on the working method can be found in the Standard Operating Procedures (SOP)and the Accessibility Guidelines published on the MedCOI website 5 and in the EASO COI Report
Methodology. 6
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Quality control
Quality control of the report was carried out both on content and form.
The accuracy of information included in the report was reviewed, to the extent possible, using
information provided by the local expert through other contacts, reports, scientific publications andarticles.
The form and content were reviewed by various partners (see Acknowledgements section).

Structure and use of the report
The report starts with a general introduction to the country and the healthcare system organisation.
Separate sections are dedicated to human resources in healthcare, the pharmaceutical sector, bloodtransfusion policies, patient pathways, insurance aspects and out-of-pocket expenditure. Lastly,
separate chapters contain accessibility information on specific disease groups: cardiovasculardiseases, diabetes, haematology, hepatitis, HIV/AIDS, nephrology, neurology, psychiatry,pulmonology, and finally tuberculosis.

Referencing
Recommended referencing for this report: ‘EASO MedCOI, Medical Country of Origin Information
Report: Democratic Republic of Congo (DRC), August 2021, [hyperlink].’

3 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email Correspondence,

August-November 2020
4 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email Correspondence,
August-November 2020
5 EASO MedCOI, url
6 EASO, European Asylum Support Office, Country of Origin Information (COI) Report Methodology, June 2019, url

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Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Map

Figure 1: Map of the Democratic Republic of Congo 7

7Central Intelligence Agency, The World Factbook, The Democratic Republic of Congo, 2021, https://www.cia.gov/theworld-factbook/countries/congo-democratic-republic-of-the/map

14Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

1. General information
1.1 Geography and Demographics
The Democratic Republic of the Congo (DRC) is situated in Central Africa. It is the second largest
country in Africa covering a total area of 2 344 858 square kilometres, equivalent to that of Western
Europe. 8 DRC has land borders with eight countries, the Republic of the Congo to the West, the Central
African Republic and South Sudan to the North, Uganda, Rwanda, Burundi and Tanzania to the Eastand Zambia, and Angola to the south.
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DRC is almost entirely landlocked except for a small area of coastline located in the West, measuring
37 kilometres. 9 In spite of this limited access to sea resources, DRC has vast sources of freshwater.
The Congo River is the second largest river in the world by discharge volume. The river and its
tributaries spread throughout the country. Eastern provinces form part of Africa’s Great Lakes region.
DRC is also rich in vegetation and natural resources; the Congo Rainforest is the second largest
rainforest in the world after the Amazon. 10
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The population of DRC is estimated to be around 101 million people. 11 DRC has a high fertility ratewith an average of 4.7 live births per woman. 12 Current projections estimate the total population will
have doubled by the year 2050. 13 The capital Kinshasa has a population of approximately 14 million
people and is located in the West along the Congo River. Other urban clusters are located in Eastern
provinces along the borders with Uganda and Rwanda. DRC is experiencing rapid rural-urban
migration. Although at present 55% of the population live in rural settings, it is estimated that by 2035
the urban population will have doubled and will surpass the proportion living in rural contexts. 14 The
life expectancy at birth in DRC is one of the lowest in the world. At 61.6 years, life expectancy is 14th
worst and significantly lower than the global average of 73.2 years. 15 There is a small variation in life
expectancy between men and women, which stand at 60.0 years and 63.2 years respectively. 16
Overall, DRC has a young population with an estimated 60% of the population aged under 25 years. 17
There is an equal ratio of men to women when the entire population is considered. 18 However, thisvaries by age categorisation with the greatest disparity in those aged over 65 years with a ratio of 0.74
males/female. 19
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In addition to life expectancy, DRC performs poorly across a range of other health indicators. Childmortality rates are high with DRC ranked 12th worst globally for number of deaths of children underfive. 20 However, child mortality rate has been consistently decreasing and currently stands at 85 per
1 000 live births relative to 115 per 1 000 live births in 2010. 21 DRC is one of the most linguisticallydiverse countries in the world, with over 200 languages spoken. 22 French is the official administrative
language widely used in education and government. The four most commonly spoken national
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8 World Bank, Country Overview, May 2020, url
9 CIA, Central Intelligence Agency, World Factbook, September 2020, url
10 CIA, Central Intelligence Agency, World Factbook, September 2020, url
11 CIA, Central Intelligence Agency, World Factbook, September 2020, url
12 IHME, Institute for Health Metrics, DRC dashboard, October 2020, url
13 IHME, Institute for Health Metrics, DRC dashboard, October 2020, url
14 World Bank, Directions in Development, Democratic Republic of Congo Urbanization Review, 2018, url, p.12
15 UNDP, United Nations development programme, Human Development Report, DRC Dashboard, 2019, url
16 UNDP, United Nations development programme, Human Development Report, DRC Dashboard, 2019, url
17 CIA, Central Intelligence Agency, World Factbook, September 2020, url
18 CIA, Central Intelligence Agency, World Factbook, September 2020, url
19 CIA, Central Intelligence Agency, World Factbook, September 2020, url
20 The World Bank, Mortality rate, under-5, 2019, url
21 The World Bank, Mortality rate, under-5 2019, url
22 Translators Without Borders, Language data for the Democratic Republic of Congo (DRC), 2016, url

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Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

languages are Lingala, Swahili, Tshiluba and Kikongo (Kituba). There are also more than 250 ethnic
groups identified in DRC. Ethnic tensions have also driven numerous periods of intercommunal
violence 23 as discussed below.
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1.2 Political Context
As outlined in the constitution promulgated in 2006, DRC is headed by a president that shares powerwith the prime minister. 24 Under the constitution, the president cannot run for more than two 5-year
terms. 25 DRC is decentralised with power and governance devolved to 26 administrative provinces. 26
Provinces are presided over by governors and up to 10 provincial ministers. 27
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Since 1990, DRC has had a multi-party system elected into office by the population. In 2018, Felix
Tshisekedi, leader of the Union for Democracy and Social Progress (Union pour la Démocratie et leProgrès Social, UDPS), was voted successor to Joseph Kabila. The 2018 was considered by several
independent groups to have been deeply flawed with several instances of voter fraud recorded. 28 The
leader of the main opposition party, Martin Fayulu, challenged the results in the constitutional
courts. 29 In spite of this, many foreign leaders endorsed and praised the election results with someclaiming that to reject the result could lead to more civil unrest. 30
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Due to what is considered to be a weak political system and broader insecurity, DRC is characterised
as a fragile state. 31 According to the Fragile States Index which compiles 12 indicators assessing social
cohesion, economic context, political context and social context, DRC is ranked as the fifth most fragile
country. 32
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According to the United Nations High Commissioner for Refugees (UNHCR), as of September 2019,
there were over 5.01 million internally displaced people across DRC. According to the same source, asof February 2020, there were over 918 000 DRC refugees and asylum seekers being hosted across
African countries. 33 Internally displaced populations are located across the country. In eastern
provinces, there are more than 100 armed groups active in the region, including the Allied Democratic
Forces, the Democratic Forces for the Liberation of Rwanda, and various Mai Mai militias. 34 In central
and southern provinces of the Kasai region, conflict between government troops and armed groups
in 2017 led to the displacement of 1.4 million people. 35 Both sides have been accused of war crimes
with an estimated 3 000 lives claimed. 36
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In south-eastern provinces, there was a long-standing conflict between Bantu and Twa ethnic
communities in the south eastern province of Tanganyika during which over 557 000 people weredisplaced. 37 In 2015, a peace accord was signed between leaders of the two community groups;
however, many remain displaced and episodes of violence have resurged, most recently in 2017. 38
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23 HRW, Human Rights Watch, DR Congo: Chronology, August 2009, url
24 Britannica, DRC government and society, 2020, url
25 Britannica, Democratic Republic of the Congo, 2020, url
26 The Guardian, Congo election runner-up rejects Tshisekedi victory as 'electoral coup, January 2019, url
27 Britannica, Democratic Republic of the Congo, 2020, url
28 FP, Foreign Policy, How Washington Got on Board With Congo’s Rigged Election, February 2019, url
29 CIA, Central Intelligence Agency, World Factbook, September 2020, url
30 FP, Foreign Policy, How Washington Got on Board With Congo’s Rigged Election, February 2019, url; BBC, DR Congoelection: African leaders congratulate Tshisekedi, January 2019, url
31 Fragile States Index, Measuring Fragility, 2020, url
32 Fragile states Index, Indicators, 2020, url
33 UNHCR, United Nations High Commissioner for Refugees, DR Congo emergency, March 2020, url
34 CIA, Central Intelligence Agency, World Factbook, September 2020, url
35 UNHCR, United Nation High Commissioner for Refugees, September 2020, url
36 BBC, DR Congo's Kasai crisis: War crimes committed by both sides, UN says, June 2018, url
37 IRC, International Rescue Committee, A Silent Crisis in Congo: The Bantu and the Twa in Tanganyika, n.d., url, p.2
38 IRC, International Rescue Committee, A Silent Crisis in Congo: The Bantu and the Twa in Tanganyika, n.d., url, p.8

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Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

DRC is also a host country for refugees from neighbouring countries. 39 The Rwandan genocide of 1994
led to a huge influx of Rwandan refugees into DRC. 40 In addition, thousands of refugees have fled to
DRC from neighbouring countries, including the Central African Republic and Burundi. 41
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The United Nations Organization Stabilization Mission in the Democratic Republic of the Congo(MONUSCO) has operated in the region since 1999 and is the largest and most expensive UN
peacekeeping mission in the world. 42
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1.3 Economic Context
DRC is classified as a low-income country. 43 While the proportion of the population living in poverty(defined as living on less than USD 1.90 a day) has been steadily decreasing since 2004, it still stands
at an estimated 77% of the total population. Per capita expenditure on healthcare, at USD 19.43, iswell below the Sub-Saharan Africa average, which stands at USD 83.78. 44
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In 2019, the Gross Domestic Product (GDP) of DRC was USD 47.32 billion and annual growth at 5.3%. 45
Domestic agriculture is the main source of food and income for the majority of the population andaccounts for 20% of GDP. 46 Mining and resource extraction also constitute an important industry. In
2018, although the extractive sector represented 98% of exports and 18% of GDP, it only employed
11% of the active population. 47 Mining is concentrated in southern and eastern provinces. 48 Except
for gold and copper, informal and small-scale mining account for a substantial portion of extracted
raw materials. 49
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1.4 Historical Background
DRC gained its independence from Belgium in 1960, but its early years were characterised by politicaland social instability. As outlined by the Central Intelligence Agency (CIA) World Factbook, the firstelected prime minister of the republic, Patrice Lumumba, was removed from office and executed by
Belgian-led troops in 1961. 50 Joseph Mobutu later claimed power and retained his position for 32
years through disputed elections and force. Mobutu’s government was guilty of severe human rights
violations, political repression and corruption. 51 A rebellion backed by Rwanda and Uganda, andfronted by Laurent Kabila ended the Mobutu rule in 1997. 52 In 2001, Laurent Kabila was assassinatedand was succeeded by his son, Joseph Kabila. Joseph Kabila’s re-election in 2006 met with the generalapproval of international monitors. His re-election in November 2011, however, was criticised anddisputed by the opposition. 53 In January 2019, after delayed elections, Felix Tshisekedi was sworn inas the new President of DRC. 54
48F

49F

50F

51F

52F

39 CIA, Central Intelligence Agency, World Factbook, September 2020, url
40 CIA, Central Intelligence Agency, World Factbook, September 2020, url
41 CIA, Central Intelligence Agency, World Factbook, September 2020, url
42 CIA, Central Intelligence Agency, World Factbook, September 2020, CIA, Central Intelligence Agency, World Factbook,

September 2020, url
43 World Bank, Data, 2019, url
44 World Bank Data, current health expenditure, 2017, url
45 World Bank, Data, 2019, url
46 World Bank, Data Bank, 2018, url
47 ITIE RDC, Initiative pour la Transparence des Industries Extractives République démocratique du Congo, June 2020, url
48 ITIE RDC, Initiative pour la Transparence des Industries Extractives République démocratique du Congo, June 2020, url
49 ITIE RDC, Initiative pour la Transparence des Industries Extractives République démocratique du Congo, June 2020, url
50 CIA, Central Intelligence Agency, World Factbook, September 2020, url
51 HRW, Human Rights Watch, Zaire Human Rights Developments, 1994, url
52 CIA, Central Intelligence Agency, World Factbook, September 2020, url
53 FP, Foreign Policy, How Washington Got on Board With Congo’s Rigged Election, February 2019, url
54 CIA, Central Intelligence Agency, World Factbook, September 2020, url

17

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

2 Health system organisation
2.1 Impact of COVID-19
DRC declared its first case of coronavirus disease 2019 (COVID-19) on March 10th, 2020. 55 Since then,
Kinshasa has been the epicentre of the outbreak with over 90% of confirmed cases. 56 The healthsystem of DRC, which is already described as a being fragile and weak, has been greatly strained by
the pandemic. A report by the WHO states that the number ventilators is limited and largely
unknown. 57
53F

54F

55F

At present, a significant proportion of health facility human and financial resources have been directed
to COVID-19 related activities. 58 This reduces availability of services on an already strained healthservice. 59 In addition, Médecins Sans Frontières (MSF) reports that the number of consultations has
decreased which is likely to have downstream impacts on health outcomes and healthcare needs. 60
56F

57F

58F

2.2 Overview
Overall, the health system is described as suffering from substantial domestic underfunding with aheavy reliance on external donor funding. 61 A report by the World Health Organization (WHO)describes the health system as being dysfunctional due to decades of political instability. 62 A lack ofhealthcare financing by central government created a healthcare system dependent on out-of-pocket
payments and external aid financing. Importantly, international aid was often provided throughhumanitarian assistance programmes rather than development programmes. Humanitarianassistance is typically characterised by short funding cycles based on short-term goals. As suchorganisations would typically focus on their individual objectives and the resources required toachieved them. 63 This led to multiple and parallel coordination mechanisms, such as logistics, toaddress disease-specific challenges through vertical programmes. 64 The Government andinternational aid community began addressing these challenges through the adoption of the Health
System Strengthening Strategy in 2005. 65
59F

60F

61F

62F

63F

According to the World Bank, ‘the Government of the DRC has demonstrated progress in increasing
its domestic health funding: the 2019 national health accounts show that the share of the national

55 MSF, Médecins Sans Frontières, DRC: Covid-19 continues to spread, with potentially deadly secondary impacts, June 2020,

url
56 WHO, World Health Organization, Plan de Response Humanitaire Revise, June 2020, url, p.9
57 WHO, World Health Organization, Plan de Response Humanitaire Revise, June 2020, url, p.10
58 WHO, World Health Organization, Plan de Response Humanitaire Revise, June 2020, url, p.10
59 WHO, World Health Organization, Plan de Response Humanitaire Revise, June 2020, url, p.10
60 MSF, Médecins Sans Frontières, DRC: Covid-19 continues to spread, with potentially deadly secondary impacts, June 2020,
url
61 Kalambay, H., and Van Lerberghe,W., Improving Health System Efficiency, World Health Organization, September 2015,
url, p.9
62 Kalambay, H., and Van Lerberghe,W., Improving Health System Efficiency, World Health Organization, September 2015,
url, p.9
63 Kalambay, H., and Van Lerberghe,W., Improving Health System Efficiency, World Health Organization, September 2015,
url, p.7
64 Kalambay, H., and Van Lerberghe,W., Improving Health System Efficiency, World Health Organization, September 2015,
url, p.7
65 Kalambay, H., and Van Lerberghe,W., Improving Health System Efficiency, World Health Organization, September 2015,
url, p.7

18

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

budget allocated to health increased from 7.0% to 8.5% between 2016 and 2018.’ 66 However, thisaccounts for approximately only 10% of total healthcare funding. 67
64F

65F

The DRC health system is still supported by substantial international donor funding from multilateral,bilateral agencies and non-government organisations (NGOs). 68 This equates to approximately 40% of
total healthcare funding. 69 According to data from the Organisation for Economic Cooperation andDevelopment (OECD), in 2018 DRC was a recipient of a total of USD 2 509.8 million. 70 Of this, 23% wascategorised as supporting ‘health and population’ activities. 71 According to the same source, the fivemain donors are United States Aid, the World Bank, 72 United Kingdom Aid, the Global Fund andGerman Aid. 73 In 2016, it was estimated that there were over 25 donors contributing to the DRC
healthcare sector. 74
66F

67F

68F

69F

70F

71F

72F

The remaining portion of healthcare financing comes from out-of-pocket payments by patients at the
point of care. 75 Reducing the proportion of out-of-pocket payments is a key objective of the National
Health Development Plan 2019-2022 (Plan National de Développement Sanitaire (PNDS)). 76
73F

74F

The PNDS outlines national priorities and is used to allocate funding resources. 77 The overarchingstrategy is further elaborated by national programmes which provide further technical and financial
objectives to address specific disease areas. External funding is mostly directed to national
programmes for diseases considered a national priority. 78
75F

76F

The healthcare system in DRC is structured according to a three-level pyramid model; central,provincial and peripheral. 79 The roles and responsibilities at these different levels are as follows:
77F•

Central – also referred to as national. The functions and responsibilities at the Central level sit
within the authorities of the Ministry of Health. This level is primarily responsible for general
oversight and direction of the health system through the development of national policies,
strategies and directives. Other responsibilities include mobilising funds through national andinternational resources and overseeing health system monitoring data. These functions are
divided across two key directorates, the General Secretariat Office and the General HealthInspectorate. 80
78F

66 Global Financing Facility, Democratic Republic of Congo, 2019, url
67 IHME, Institute for Health Metrics, DRC dashboard, October 2020, url
68 IHME, Institute for Health Metrics, DRC dashboard, October 2020, url
69 IHME, Institute for Health Metrics, DRC dashboard, October 2020, url
70 OECD, Organisation for Economic Cooperation and Development, Recipient Country, 2018, url
71 OECD, Organisation for Economic Cooperation and Development, Recipient Country, 2018, url
72 Referred to in the source as International Development Association. Definition available in glossary of terms, url
73 OECD, Organisation for Economic Cooperation and Development, Recipient Country, 2018, url
74 Orbie, J., et al., The EU and the Emerging Global Order, 2018, url
75 IHME, Institute for Health Metrics, DRC dashboard, October 2020, url
76 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République

Démocratique du Congo, November 2018, url, p. 45
77 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url
78 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email Correspondence,
August-November 2020
79 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, SantéRépublique Démocratique du Congo, November 2018, url, pp. 10-12
80 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, SantéRépublique Démocratique du Congo, November 2018, url, pp. 10-12

19Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)o•At this level, the types of health facilities include: 81
79F▪

University hospitals▪

The National hospital (National hospital Kinshasa)Intermediate – also referred to as Provincial. Led by the Provincial Health Minister who is
responsible for the Provincial Health Office, the Provincial Health Inspectorate oversees theProvincial Hospital. 82 There is one provincial hospital per province. 83
80F

81F

The Provincial Health Office is a decentralised structure responsible for the technical training andthe contextualisation of national guidelines for provincial health facilities and monitoring of healthfacilities. A key objective is to support the implementation of guidelines and strategies at a healthfacility level. 84
82F

The Provincial Health Inspectorate is a decentralised structure primarily responsible for the quality
control of health facilities through auditing and inspection. A key objective is to register andmonitor the distribution of pharmaceutical interventions and specialist equipment. 85
83FoAt this level the types of health facilities include: 86
84F

▪
•

Provincial hospitals

Peripheral – also referred to as operational. This level is divided into 516 health zones serving a
population of 100 000 to 150 000 people. 87 Health zones are further subdivided into 8,504 healthareas. According to the PNDS, each health zone is managed and overseen by the Health Zone
Team and a Chief Medical Officer. It is at this level that the majority of health services are provided
to communities.
85Fo

The types of health facilities include: 88
86F▪

Health posts – basic facilities in rural contexts offering very limited services▪

Health centres – basic facilities offering a more comprehensive package of activities. 89
Health centres serve 5 000 to 10 000 community members. 90 According to the PNDS,
there are 8,266 health centres distributed across 8 504 health areas 91
87F

88F

89F

81

PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé,
SantéRépublique démocratique du Congo, November 2018, url, p. 48
82 PNLT, Plan Stratégique National de Lutte Contre La Tuberculose 2018-2020, Ministère de la Santé Publique, Secretariat
General, République Démocratique du Congo, 2017, pp.31-34
83 PNLT, Plan Stratégique National de Lutte Contre La Tuberculose 2018-2020, Ministère de la Santé Publique, Secretariat
General, République Démocratique du Congo, 2017, pp.31-34
84 PNLT, Plan Stratégique National de Lutte Contre La Tuberculose 2018-2020, Ministère de la Santé Publique, Secretariat
General, République Démocratique du Congo, 2017, pp. 31-34
85 PNLT, Plan Stratégique National de Lutte Contre La Tuberculose 2018-2020, Ministère de la Santé Publique, Secretariat
General, République Démocratique du Congo, 2017, pp. 31-34
86 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, pp. 10-12
87 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, Républiquedémocratique du Congo, November 2018, url, pp. 10-12
88 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé République
Démocratique du Congo, November 2018, url, p.10
89 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, p.10
90 PNLT, Plan Stratégique National de Lutte Contre La Tuberculose 2018-2020, Ministère de la Santé Publique, Secretariat
General, République Démocratique du Congo, 2017, p.32
91 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, p.1020

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)▪

General reference hospitals – according to the PNDS there are 393 of these distributed
across the country 92
90F

Health facilities are managed by a network of public and private organisations and structures. 93
Private facilities are sub-divided into for-profit and not-for-profit, the latter includes facilities those
operated by NGOs and faith-based organisations. 94 An absence of national health information systems
means that at present, there is an absence of national records on registered health facilities. 95
91F

92F

93F

The relative role of the public and private sector in managing health facilities varies according to thetype of facility. 96 A review of the health system carried out by the Demographic and Health Surveys
Programme in 2017 and 2018 categorised the different types of health facilities according to whether
they were publicly or privately run. 97 A total of 1 380 health facilities were purposively sampled to be
representative of the health system organisation. 98 As such, the following distributions can beconsidered to be representative across DRC. Of note, the study used a slightly different nomenclaturefor different types of health facilities than the PNDS, the following health facility names have been
included as written in the study. 99, 100 A total of 832 public facilities were reviewed, of these healthcentres accounted for the largest proportion (45%), followed by hospitals (35%), then reference
centres (17%) and lastly medical centres (3%). A total of 162 public facilities were reviewed, of these
health centres accounted for the largest proportion (50%), followed by medical centres (35%), thenhospitals (9%) and reference centres (6%). A total of 346 faith-based facilities were reviewed, of these
hospitals accounted for the largest proportion (50%), followed by health centres (22%), then reference
centres (18%) and medical centres (18%). Lastly, 40 not-for-profit facilities were reviewed, of these
medical centres accounted for the largest proportion (43%), followed by hospitals (33%), then healthcentres (9%) and reference centres (8%). 101
94F

95F

96F

97F

98F

99F

The same study also identified significant regional variation in the distribution of health facilities. 102
Most health facilities were located in the north eastern province of North Kivu (7%). This was closely
followed by the south western province of Kongo-Central, formerly part of greater Kinshasa, with 5.7%
of facilities, then Kinshasa with 5.2%. Provinces with the fewest health facilities were located acrossnorthern and central provinces. 103
100F

101F

With the exception of priority diseases, notably HIV/AIDS and TB, all consultations, diagnostic services
and treatments incur a fee in all types of health facilities. Fees are typically lower in public healthfacilities relative to private institutions. 104
102F

92 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République

Démocratique du Congo, November 2018, url, p.10
93 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé République
Démocratique du Congo, November 2018, url, p.11
94 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, p.11
95 World Bank, The role of the private sector in improving the performance of the Health System in the Democratic Republicof Congo, 2018, url, p. 74
96 EPSS, Evaluation des Prestations des Services de soins de Santé, April 2019, Ecole de Santé Publique de Kinshasa, url, p. 19
97 EPSS, Evaluation des Prestations des Services de soins de Santé, April 2019, Ecole de Santé Publique de Kinshasa, url, p. 19
98 EPSS, Evaluation des Prestations des Services de soins de Santé, April 2019, Ecole de Santé Publique de Kinshasa, url, p. 19
99 EPSS, Evaluation des Prestations des Services de soins de Santé, April 2019, Ecole de Santé Publique de Kinshasa, url, p.
330
100 The report does not include definitions for the different types of health facilities
101 EPSS, Evaluation des Prestations des Services de soins de Santé, April 2019, Ecole de Santé Publique de Kinshasa, url, p.
19102 EPSS, Evaluation des Prestations des Services de soins de Santé, April 2019, Ecole de Santé Publique de Kinshasa, url, p.
19
103 EPSS, Evaluation des Prestations des Services de soins de Santé, April 2019, Ecole de Santé Publique de Kinshasa, url, p.
19
104 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 202021

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

2.3 Public healthcare
The overall coverage of basic public services, including healthcare, is very limited. 105
103F

Public healthcare operates at three levels: primary, secondary and tertiary. The PNDS outlines a
Minimum Packet of Activities and a Complementary Packet of Activities which should be provided ateach level of the health system. 106 Of note, the services listed below include those which should be
provided and available at different types of healthcare facilities, in principle. However, irregular flowof finances, lack of trained personally and weak supply chains means many health services are often
not actually available at the point of care. 107
104F

105F

Primary Healthcare
Strengthening quality, availability and access to primary healthcare services is the principal goal of
PNDS. 108 At this level, healthcare is provided at health posts and health centres by non-physician
healthcare workers. This includes nurses, midwives, nutrition councillors and community healthworkers. 109
106F

107F

According to the PNDS, services available in health posts and health centres are: family planninginterventions including modern contraceptives (condoms and contraceptive pills); basic paediatricservices (treatment of moderate acute malnutrition, deworming, multi-nutrient supplements, oral
rehydration); basic malaria services (diagnosis, vector control through larvicides and mosquito nets);
basic tuberculosis services (treatment with first-line medications); basic HIV/AIDS services (onlytreatment of co-infections using cotrimoxazole medication); and nutritional supplementation for
pregnant women (folic acid, vitamin A and calcium). 110
108F

Health centres are also expected to offer: family planning (contraceptive injections); childhood
vaccinations (measles, diphtheria, tetanus toxoids and pertussis DTP, meningitis, hepatitis B, polio,
tuberculosis, yellow fever); and basic tuberculosis services (microscopy diagnosis, radiography
imaging). 111
109F

However, a lack of resources, including equipment and diagnostic tests, means health posts and healthcentres often lack the capacity to provide healthcare. 112 As a result, diagnosis are often made using
clinical presentation of symptoms reducing the extent to which different causes of ill health may be
distinguished from each other. 113 General symptoms such as fever are consequentially often assumed
to be malaria and treated accordingly. 114
110F

111F

112F

105

EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
106 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, pp. 87-94
107 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
108 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, p.4
109 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé République
Démocratique du Congo, November 2018, url
110 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, pp.87-94
111 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, pp. 87-94
112 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
113 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
114 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 202022

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Secondary Healthcare
At this level, patients can receive more specialised and complex care at general reference hospitals
and provincial hospitals, from general physicians, as well as other healthcare workers. 115
113F

In principle, services available in these facilities are: family planning interventions (long lasting
contraceptives, safe abortions, management of ectopic pregnancies); prenatal care (treatment ofsyphilis, management of hypertension, pre-eclampsia and other complications); delivery andpostpartum care (deliveries with skilled birth attendant, treatment of septicaemia including neonatal,
haemorrhage); treatment of sexually transmitted infections and other reproductive care (syphilis,
gonorrhoea, chlamydia, urinary tract infections, inflammatory pelvic disease); paediatric care(treatment of dysentery, diarrhoea, malaria, measles, antiretroviral for HIV, treatment of severe
malnutrition); childhood vaccinations (same as primary care); malaria treatment; tuberculosis (TB)
services (same as primary care); HIV/AIDS services (treatment with first-line medications, nutritional
supplementation for pregnant women (same as primary care); and non-communicable diseases
services (screening, monitoring and treatment of heart disease, and diabetes). 116
114F

Emergency services are included in the PNDS under tertiary care facilities. However, most hospitals,
including reference and provincial, provide at least basic general emergency care. 117 Emergency careservices are extremely limited. 118 A study carried out in 2015 on a representative sample of provincial
hospitals, found that only 2 of the 12 hospitals were able to provide all essential surgery andanaesthetic services, as defined by the WHO’s Emergency and Essential Surgical Care Situation
Analysis Tool. 119 Factors which contributed to an inability to provide services included no orinterrupted water supply (9 of 12 hospitals), as well as no, or interrupted electricity supply (7 of 12
hospitals). 120
115F

116F

117F

118F

In addition, pain relief in DRC, including in emergency care is very limited. 121 The International
Narcotics Control Board (INCB) defines less than 200 daily doses per million, per day as inadequate fora population’s pain management. 122 According to the latest data from INCB, in 2013 DRC had 2 daily
doses per million, per day. 123
119F

120F

121F

Tertiary Healthcare
At this level, patients can receive specialised care from specialist physicians at university hospitals andthe national hospital. 124
122F

All services available in secondary healthcare centres are available at tertiary care centres. Additional
services include: delivery and post-partum care (obstructed deliveries, corticosteroids to delay
premature deliveries, induced pregnancies and treatment of neonatal septicaemia); paediatric

115 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République

Démocratique du Congo, November 2018, url
116 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, pp. 87-94
117 Kalisya, L. et al., The state of emergency care in Democratic Republic of Congo, December 2015 url, pp. 156
118 Sion, M. et al., Global Health: Science and practice, A Resource Planning Analysis of District Hospital Surgical Services inthe Democratic Republic of the Congo, 2015, url, p. 1
119 Sion, M. et al., Global Health: Science and practice, A Resource Planning Analysis of District Hospital Surgical Services inthe Democratic Republic of the Congo, 2015, url, p. 1
120 Sion, M. et al., Global Health: Science and practice, A Resource Planning Analysis of District Hospital Surgical Services inthe Democratic Republic of the Congo, 2015, url, p. 1
121 INCB, International Narcotic Control Board, Availability of Internationally Controlled Drugs, 2015, url, p. 16
122 INCB, International Narcotic Control Board, Availability of Internationally Controlled Drugs, 2015, url, p. 7
123 INCB, International Narcotic Control Board, Availability of Internationally Controlled Drugs, 2015, url, p. 16
124 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url

23

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

services (treatment of severe: diarrhoea, pneumonia, malaria and measles); TB services (diagnosis ofmultidrug resistance); and emergency services, including basic emergency surgery. 125
123F

2.4 Private healthcare
As previously described, private facilities are divided into for-profit and not-for-profit, with the latterincluding facilities operated by NGOs and faith-based organisations. 126 Traditional medicine has also
been included under private healthcare to align with the PNDS. 127
124F

125F

For-profit facilities
According to the PNDS, the for-profit health sector operates primarily in urban centres and economic
hubs. 128 The scope of services available in private facilities are not standardised and varysignificantly. 129 Generally, private facilities are more likely to have basic resources and infrastructure,including electricity, and offer a greater scope of services. As such, there is a consensus that private
facilities provide higher quality care and are the preferred provider for those with the necessaryfinancial resources. 130
126F

127F

128F

There are a number of private hospitals mostly located in Kinshasa, Lubumbashi and Goma. 131
129FFaith-based facilities
Faith-based health facilities are an important provider of health services representing approximately
40% of health facilities. 132 As such, faith-based facilities are integrated into the public sector withreferral pathways between facilities. 133 Some estimates suggest that faith-based organisations
manage 34% of General Reference Hospitals. 134
130F

131F

132F

Non-government organisations (NGOs)
There is a significant presence of national and international Non-Government Organisations (INGOs)
integrated into the health sector. The Health Cluster, led by the WHO, coordinates agencies involvedin providing health services in DRC. There are 24 international NGOs and 31 national NGOs involvedin the DRC health cluster. 135 The majority of organisations operate in Eastern provinces andKinshasa. 136
133F

134F

125 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République

Démocratique du Congo, November 2018, url, pp. 87-94
126 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, p. 11
127 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, p. 11
128 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé République
Démocratique du Congo, November 2018, url, p.11
129 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
130 Sion, M. et al., Global Health: Science and practice, A Resource Planning Analysis of District Hospital Surgical Services inthe Democratic Republic of the Congo, 2015, url, p.1
131 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
132 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, p.11 ; Wodon et., Market share of faith-inspired healthcare providers in Africa,
The review of faith and international affairs, 12 March 2017, url
133 Severe Malaria, DRC health system for malaria, 2017, url
134 Severe Malaria, DRC health system for malaria, 2017, url
135 WHO, World Health Organisation, Health Cluster Democratic Republic of Congo, June 2020, url
136 WHO, World Health Organisation, Health Cluster Democratic Republic of Congo, June 2020, url

24

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

The role of different organisations depends on cooperation agreements, as well as on their resources
and technical capacities. 137
135F

For instance, MSF has a significant presence in DRC and manages a number of clinics. 138 This includes
a specialist HIV/AIDS clinic in Kinshasa, as well as numerous Ebola Treatment Centres in Eastern
provinces. 139 Similarly, International Medical Corps manages several Ebola Treatment Centres andsupports with provisions of essential drugs and medical supplied across the Eastern provinces of NorthKivu, South Kivu and Tanganyika. 140
136F

137F

138F

Traditional medicine
Traditional medicine has an important role in the healthcare system. 141 In regions with particularly
scarce resources and formal health structures, such as provinces located in the centre of the DRC,
traditional medicines are the first treatment source. There has been a national programme in placesince 2001 that provides guidance and regulation for the traditional medicines sector. 142
139F

140F

137

EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
138 MSF, Doctors Without Borders, 2018, url
139 MSF, Doctors Without Borders, 2018, url
140 IMC, International Medical Coprs, Democratic Republic of the Congo, n.d, url
141 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, p. 11
142 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé République
Démocratique du Congo, November 2018, url, p. 11

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Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

3 Healthcare human resources
It is widely agreed that the DRC is faced with a critical shortage of healthcare professionals. 143
However, current and reliable data is limited. According to latest figures from the World Bank, in 2016,
there were 0.074 physicians per 1 000 population, placing it 14th worst of the 264 countries
included. 144 With regard to nurses and midwives, in 2018 there were 1.11 per 1 000 people, which isranked as 14th worst. 145 The health sector is particularly lacking in specialists, including pharmacists,
dentists and specialist physicians. 146
141 F

142F

143F

144F

Healthcare professionals are unequally distributed with most concentrated in large urban areas,
notably Kinshasa. According to the PNDS, the Kinshasa has the highest number of physicians at 13
851, while Bas-Uele has the fewest with 2 117. 147
145F

Training of medical personnel is provided through a combination of public and private institutions
known as Medical Technical Institutes and Medical Education Institutes. According to the PNDS, theannual human resources audit carried out in 2017 identified a total of 478 training institutions. 148 Of
these, approximately 30% were state institutions, 34% were private faith-based institutions and 35%
were private for-profit. 149
146F

147F

Nursing training is provided in all the provinces. In contrast, midwifery is only available at 19 training
schools (of the aforementioned 478) and laboratory technicians in only 13. 150 Emergency Medicine is
not yet established as a medical speciality in DRC. 151 There are no postgraduate training programmes
for nurses or physicians. 152
148F

149F

150F

The PNDS describes professional training of medical professionals as being of poor quality. It describes
a proliferation of institutions which do not meet expected standards due to a general lack of resources,
equipment and high quality teachers and supervisors. The PNDS also states there is low workforce
motivation and retention, in part due to regular non-payment of salaries and low wages. 153
151F

143 ONRHSC, Observatoire National Des Ressources Humaines de La Santé En RD. Congo, 2020, url
144 World Bank, Data, 2016, url
145 World Bank, Data, 2018, url
146 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République

Démocratique du Congo November 2018, url, pp. 25-27
147 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, p. 25
148 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, p. 25
149 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url
150
PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé,
République Démocratique du Congo, November 2018, url, p. 25
151 Kalisya, L. et al., The state of emergency care in Democratic Republic of Congo, December 2015, url, p. 153
152 Kalisya, L. et al., The state of emergency care in Democratic Republic of Congo, December 2015, url, p. 154
153 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, pp. 25-26

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Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

The health sector is also supported by a network of Community Health Workers (CHWs, known locallyas relais communautaires). 154 CHWs are typically existing members of the communities within which
they operate. 155 They function as an important intermediary between formal health structures andcommunities. Their key responsibilities include providing health information to encourage positive
hygiene practices and healthy behaviours, as well as increase healthcare seeking behaviours forcommunicable and non-communicable diseases. 156 CHWs are typically volunteers mobilised by NGOs
and so are most active in areas with a large presence of organisations. 157
152F

153F

154F

155F

154 PNLT, Plan Stratégique National de Lutte Contre La Tuberculose 2018-2020, Ministère de la Santé Publique, Secretariat

General, République Démocratique du Congo, 2017, p. 64
155 Millington, K, Effectiveness of Community Health Workers, , Knowledge, evidence and learning for development,
November 2018, url, p. 2
156 Millington, K, Effectiveness of Community Health Workers, Knowledge, evidence and learning for development,
November 2018, url, p. 3
157 Millington, K, Effectiveness of Community Health Workers, Knowledge, evidence and learning for development,
November 2018, url, p. 7

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Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

4 Pharmaceutical sector
A National List of Essential Medicines is published periodically. 158 The list was last updated in 2018
although the 2010 list is most commonly used by physicians and pharmacists. 159 Medications included
are selected by a committee to meet the priority needs of the majority of the population. Those
included on the list are prioritised by national purchasing programmes. 160
156F

157F

158F

The supply and provision of medications is achieved through the National System for Supply of
Essential Medicines. This is based on centralised purchases by the Federation of Essential Drugs
Purchasing Centres and decentralised distribution through Centres of Regional Distribution of
Essential Medicines. There are 19 Regional Medical Distribution Centres that are responsible forproviding stock to registered distribution sites. Provincial inspectorates carry out quality assurance toensure that the medicines are of sufficient quality and prevent circulation of counterfeit medicines.
There are four laboratories approved by the Ministry of Health which conduct quality screening.
Registered medical centres which receive stock through these central purchasing mechanisms include
public and private (including not-for-profit) health facilities, as well as pharmacies. The centralised
management and distribution to provinces aims to ensure that supply of essential medicines matchesdemand. 161
159FHowever, an assessment of Regional Distribution Centres revealed that they lack operational capacity
to meet demands from registered health facilities. The amount of stock provided to medical facilities
often falls below their requirements. 162 As described in the PNDS, Regional Distribution Centres havebecome weaker, particularly with regard to their role as a central purchasing unit. 163 Factors identified
as undermining central purchasing and regional distribution include a lack of reliable financing, weak
information management systems, lack of human resources for supervision and management andabsence of local production of medicines. 164
160F

161F

162F

As a result, some healthcare implementing partners choose to circumvent the national supply chainsand operate parallel logistics chains, creating fragmentation and duplication. 165 In 2017, it wasestimated that there were over 170 registered and unregistered wholesalers supplying 109 registeredpharmacies. 166 The numerous registered wholesalers reduce the scope for economies of scale andefficiencies in supply chains. 167
163F

164F

165F

The weak central purchasing and regional distribution mechanisms, as well as weak registration andinspection processes, have contributed to the proliferation of a parallel, informal market of medicines.

158 EASO1, Medical doctor and local consultant responsible for in-country data collection, Email Correspondence, August –November 2020
159 EASO6, Senior Medical Advisor of an international healthcare company, Email Correspondence, August 2020.
160 EASO1, Medical doctor and local consultant responsible for in-country data collection, Email Correspondence, August –November 2020
161 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url - 29
162 World Bank, The role of the private sector in improving the performance of the Health System in the Democratic Republicof Congo, 2018, url, pp. 38-48
163 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url - 29
164 World Bank, The role of the private sector in improving the performance of the Health System in the Democratic Republicof Congo, 2018, url, pp. 38-48
165 World Bank, The role of the private sector in improving the performance of the Health System in the Democratic Republicof Congo, 2018, url, pp. 38-48
166 World Bank, The role of the private sector in improving the performance of the Health System in the Democratic Republicof Congo, 2018, url, p. 10
167 World Bank, The role of the private sector in improving the performance of the Health System in the Democratic Republicof Congo, 2018, url, pp. 38-48

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Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

There are numerous sources which contribute to the informal medicines market which vary in sizeand degree of organisation. These include large-scale organised purchasing and import ofunregistered medicines from international sellers. On a smaller scale, there are individuals who travelinternationally to South Africa or further, with the objective of buying medicines to sell in DRC. 168
Lastly, there is the opportunistic import of medicines which results from individuals, particularly thediaspora community, who import often small amounts of medicine for private/family consumption orfor sale to local vendors. 169
166F

167F

These unregistered medicines are often integrated into the formal healthcare system. Private medical
facilities, registered to receive stock through the central purchasing system, often supplement theirstock through the informal market. In contrast, public medical facilities experiencing stockouts, arelikely to direct individuals to source medicines from the informal market. For example, a doctor in a
public hospital will direct family members to source a named medicine from the informal market inorder to treat a patient in the hospital. 170
168F

The informal market operates through individuals as well as through pharmacies. A study by the WHO
in 2015 estimated that there were over 5 000 medical dispensaries operating in Kinshasa without alicence or trained pharmacist. 171 While stakeholders critique the scale of unregistered andunregulated medical dispensaries, they also recognise that these currently play a critical role widening
access to medications given the lack of trained pharmacists. 172
169F

170F

The scale of the informal medicines market has resulted in the proliferation of poor quality medicines
which are either counterfeit or lack sufficient active ingredient to be effective. 173 According tonational records, approximately 0.5% of medicines entering DRC did not meet data quality
standards. 174 However, these statistics only represent cases identified at borders where medicines
which were registered were submitted for inspection during approval processes. 175 When the entire
medicines market is considered, the proportion of poor quality medicines is much higher. For instance,a study of medicines available in the private market in 2018 found that almost 30% of medicines were
defined as being of poor quality and almost 60% were underdosed. 176 Addressing poor medicines
quality is included as a key objective of the PNDS. 177
171F

172F

173F

174F

175F

168 Amwanga Z, Illegal pharmacies provide a convenient option – but not necessarily a safe one, June 2019, url
169 EASO1, Medical doctor and local consultant responsible for in-country data collection, Email Correspondence, August –November 2020
170 EASO1, Medical doctor and local consultant responsible for in-country data collection, Email Correspondence, August –November 2020
171 Berne-Waberm, Le System Sanitaire a Kinshasa: Medicaments et Soins Du VIH-Sida, de l’hypertension Arterielle, Dur
Diabète de Type II et Des Troubles Mentaux, December 2014, url, p. 9
172 World Bank, The role of the private sector in improving the performance of the Health System in the Democratic Republicof Congo, 2018, url, p. 39
173 Amwanga Z, Illegal pharmacies provide a convenient option – but not necessarily a safe one, June 2019, url
174 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url
175 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé République
Démocratique du Congo, November 2018, url, p.28
176 Schiavetti, B. et al., The American Journal of Tropical Medecine and Hygiene, January 2018, url, p. 894
177 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, p. 28

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Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

5 National policy on blood transfusion andrelated services organisation
National blood transfusions are coordinated by a technical unit that sits within the Ministry of Health.
The national blood transfusion policy was promulgated in 1999 and implemented in 2002. The policy
aims to make quality blood products of sufficient quantity available and accessible throughout thecountry. 178 To achieve this, the policy aims to create a national network of autonomous bloodtransfusion structures, headed by the National Centre for Blood Transfusion located in Kinshasa. 179
The centre is responsible for managing 10 provincial transfusion centres managed by respective
provincial medical coordinators. 180
176F

177 F

178F

Blood donations are received through a network of mobile and stationary facilities as well as in
hospitals. The majority of blood donations are from family members of those requiring transfusions(61%), followed by community volunteers (34%) and lastly those receiving some form of remuneration(5%). In most health facilities providing blood transfusions, immunohaematological classification islimited to A-B-O. The phenotype of other characteristics, such as Rhesus antigens, is not systematicallycarried out. Rapid antigen tests are typically used to screen for antibodies to HIV, hepatitis B andhepatitis C, as well as screening for syphilis. 181 Some central provinces conduct additional screening
for trypanosomiasis. 182
179F

180F

In spite of these efforts to strengthen the blood supply system, DRC is characterised by a severe blood
shortage and many hospitals lack resources and facilities for blood transfusions. 183 An article
published in 2018 describes the story of a mother who was seeking a blood transfusion for her
daughter. As the clinic located in central DRC did not have any blood in stock, she was required tosource her own donor. As a result, she was required to pay the clinic and the individual which meant
she could not afford the total amount that her daughter required. The provincial health minister isquoted as saying ‘32 people in the province died in 2017 because they didn’t get bloodtransfusions’. 184
181F

182F

178 Kabinda, J. et al, Transfusion sanguine en République Démocratique du Congo: efforts réalisés et défis à relever, 2015,

url, p. 342
179 EASO6, Senior Medical Advisor of an international healthcare company, Email Correspondence, August 2020.
180 Kabinda, J. et al, Transfusion sanguine en République Démocratique du Congo: efforts réalisés et défis à relever, 2015,
url, p. 342
181 Kabinda, J. et al, Transfusion sanguine en République Démocratique du Congo: efforts réalisés et défis à relever, 2015,
url, p. 345
182 EASO6, Senior Medical Advisor of an international healthcare company, Email Correspondence, August 2020.
183 Global Press Journal, A Blood Transfusion in Africa ? It’s Free in Rwanda, Unaffordable in Zimbabwe, October 2017, url;
Global Press Journal, Critical Shortage at DRC Blood Bank Has Fatal Consequences, August 2018, url
184 Amwanga, Z, Global Press Journal, Critical Shortage at DRC Blood Bank Has Fatal Consequences, August 2018, url

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Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

6 Patient pathways
The healthcare system is centred on primary healthcare. From initial consultations at a primary
healthcare facility, patients may receive onward referrals to specialist care. However, the fragmented
nature of DRC’s healthcare system has created an absence of clear patient pathways. For mostdiseases, there are no national treatment guidelines and protocols leading to a weak standardisationof care. Patients move frequently between different types of health facilities, from public to private
for-profit and private not-for-profit, which further compounds the complexity of referral pathways. 185
183F

Direct self-referral to specialist physicians or treatment centres is possible through informal referralroutes. These informal pathways are particularly common in urban centres. Private facilities inparticular operate through informal pathways whereby individuals may self-refer. 186
184F

For complex care, those with necessary financial resources almost exclusively choose to travel toneighbouring countries for treatment. Key medical destinations include Rwanda, South Africa andIndia. 187
185F

185

EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
186 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
187 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 202031

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

7 Risk-pooling mechanism
DRC has weak risk-sharing mechanisms across the health system. As described in the PNDS, ‘the poor
allocation of public resources for health and insufficient mechanisms to share risks, constitute one of
the major challenges to achieving Universal Health Coverage’. 188 There are a small number of public
and private risk sharing mechanisms. According to a report by the World Bank based on data from2014, ‘private health insurance and other health benefit programmes are concentrated among
formally employed people in wealthier income quintiles and reach no more than 3% to 4% of the
population’. 189 As a result, the majority of healthcare costs are paid at the point of care, placing large
proportions of the population at risk of healthcare-related catastrophic cost. 190 At present, access tohealth insurance is largely a marker of notable wealth. 191
186F

187F

188F

189F

7.1 Health services provided by the State / public authorities
A comprehensive outline of health services is given in chapter 2.3, state provision of health services
are centred on primary care. 192 The Ministry of Health, through provincial structures, is responsible
for the payment of salaries, organisational training and replenishment of medication stocks. However,as discussed, frequent delays in salary payments as well as stock shortages are reported in publichealth facilities, particularly in rural districts. 193
190F

191F

7.2 Public health insurance
A National Programme for Promotion of Health Insurance was established in 2001 as part of the Health
System Strategic Plan. However, public health insurance remains distinctly under-developed. 194
192F

The only health insurance scheme supported by public financing is reserved for teachers and called
the Mutual Health Insurance for Primary, Secondary and Professional Education (Mutuelle de santédes enseignants des écoles catholiques du Congo, MESP). 195 The insurance scheme receives cofinancing from public funds equivalent to USD 1.20 per person, per month, the equivalent of 40% of
the total monthly premium. 196 In spite of receiving support from public financing, the insurance
cannot be considered a public health insurance scheme as it was established by a not-for-profit
193F

194F

188 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République

Démocratique du Congo, November 2018, url, p.32
189 World Bank, The role of the private sector in improving the performance of the Health System in the Democratic Republicof Congo, 2018, url, p. 10
190 Wagstaff, A, et al, Progress on catastrophic health spending in 133 countries: a retrospective observational study, theLancet, February 2018, url, p.176
191 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
192 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, p.4
193 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url
194 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
195 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
196 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 202032

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

organisation in 2001 to support teachers and their families. 197 There are no other national insurance
schemes for health in DRC. 198
195F

196F

7.3 Community-based health insurance schemes
The government of DRC has, in its health development strategy, identified Mutual-health insurance
schemes as playing an important role to achieve Universal Health Coverage. 199 A report assessing therole of Mutual Health Organisations in DRC states, ‘to move towards strengthening the role andregulation of Mutual Health Organisations (MHOs), the government defined in law the fundamental
principles of MHOs’. 200, 201 The same source further states, ‘MHOs are a non-profit association ofmembers that seek, via member contributions, to conduct interventions of protection, solidarity, andmutual assistance for its members and their dependants, offering the opportunity to access quality
healthcare at decent prices. The law provides two options: (1) compulsory affiliation for anyone whose
premium can be deducted at the source in enterprise-based, corporate, school, and student MHOs;
and (2) voluntary enrolment in community-based MHOs for informal sector workers ‘. 202
197F

198F

199F

200F

The study further describes that there are two coordinating bodies which aim to strengthen
governance and management of these mutual health schemes. The first, the National Programme for
the Promotion of Mutuals (Programme National de Promotion des Mutuelles de Santé) wasestablished under the health system strategic plan in 2001. It aims to take control of a number of small
fractured mutual health schemes. The second, the Platform of Organisations for the Promotion of
Mutual in Health of Congo (Plateforme des organisations promotrices des mutuelles de santé duCongo, POMUCO) was established in 2015. This aims to strengthen governance and advocacy toaccelerate the achievement of universal health coverage. 203
201F

Despite of this commitment to strengthen mutual health schemes, at present they remain
underdeveloped and fragmented. 204
202F

By far the most well-established mutual health insurance scheme is the aforementioned Mutual
Health Insurance for Primary, Secondary and Professional Education (Mutuelle de santé desenseignants des écoles catholiques du Congo, MESP). Membership of MESP is large enough so as tobe able to leverage terms and conditions from providers to strengthen the quality healthcare provided
at clinics. 205
203F

197

EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
198 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
199 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé République
Démocratique du Congo, November 2018, url, p.57
200 The law determining the fundamental principles of MHOs (Loi organique N˚ 17/002) was proclaimed on 8 February 2017
201 Criel, B, et al., Can mutual health organisations influence the quality of healthcare provision? The case of the Democratic
Republic of Congo, April 2020, url, p.3
202 Criel, B, et al., Can mutual health organisations influence the quality of healthcare provision? The case of the Democratic
Republic of Congo, April 2020, url, p.3
203 Criel, B, et al., Can mutual health organisations influence the quality of healthcare provision? The case of the Democratic
Republic of Congo, April 2020, url, p.3
204 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, p. 57
205 Criel, B, et al., Can mutual health organisations influence the quality of healthcare provision? The case of the Democratic
Republic of Congo, April 2020, url, p. 1

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Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

7.4 Private health insurance schemes
At present, private health insurance schemes have a limited role in DRC and cover only small portionsof the population. Employers are required by law to contribute to access to healthcare of theiremployees and their families. However, contributing to healthcare through insurance schemes is notmandatory. Instead, companies can choose to pay medical fees, provide on-site services or contributeto insurance premiums. The law is not rigorously enforced across all sectors and so is largely applied
to government employees, or those working for large international organisations. 206
204F

The coverage and types of services included in employer-sponsored health insurance vary greatly.
These are often limited to coverage of primary care services but with many excluding maternal careand family planning services. 207 Employer sponsored insurance plans account for the majority of theprivate sector market. As such, the private insurance market largely covers those employed in theformal sector often in relatively lucrative positions. It is estimated that only 4% of the population iscovered by a private insurance plan. 208
205F

206F

In 2015, the government of DRC voted to expand the private health insurance sector. The Regulation
and Control of Insurance Bureau was established and charged with providing operating licences tohealth insurance providers. However, at present there are a few private insurance companies
operating in DRC. 209
207F

Companies based in remote locations, such as the mining industry, often choose to provide on-site
primary health services rather operating through health insurance schemes. 210
208F

7.5 Other social security plans
The 2011 social security law defined a number of social protection measures. On the whole, these
apply to those employed in the formal sector, including public sector employees, and are dependent
on employee and employer contributions. 211 Payments expected are typically 5% employee
contribution and 5% employer contribution. Plans usually include old age pensions from the age of60, disability pension due to permanent loss of earning capacity and survivor pensions whereby adependent is entitled to a proportion of a deceased person’s pension. 212 These measures are notsystematically enforced, and employee and employer contributions vary significantly. 213
209F

210F

211F

There are no laws related to mandatory maternity or paternity cover.

206

EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
207 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
208 World Bank, The role of the private sector in improving the performance of the Health System in the Democratic Republicof Congo, 2018, url, p. 10
209 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
210 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
211 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
212 Social Security Administration, Office of Retirement and Disability Policy, Social Security Programs Throughout the World:
Africa, 2019, url
213 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 202034

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

7.6 Work injury
Those employed in the formal sector are required to contribute 2.25% of income, to a ‘social insurance
system’ to cover work injury. 214 This is matched by equal employer contributions. 215 As with pensions,this is not systematically enforced and payments are often not received for work-related injuries. 216
212F

213F

214F

7.7 Minimum wage
The legal minimum wage in DRC is Congolese Francs 7 075 (equivalent to USD 3.61). 217 However, as
the majority of the population work in the informal sector, the national minimum wage is often notapplied. 218
215F

216F

7.8 Poverty alleviation measures
There are no social security systems in place for unemployed persons. 219
217F

214 Social Security Administration, Office of Retirement and Disability Policy, Social Security Programs Throughout the World:

Africa, 2019, url
215 Social Security Administration, Office of Retirement and Disability Policy, Social Security Programs Throughout the World:
Africa, 2019, url
216 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
217 Wage indicator, Minimum Wage – Congo, September 2020, url
218 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
219 Social Security Administration, Office of Retirement and Disability Policy, Social Security Programs Throughout the World:
Africa, 2019, url

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Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

8 Out-of-pocket health expenditure
The vast majority of healthcare in DRC is accessed through out-of-pocket expenditures, at the pointof care. 220 Out-of-pocket healthcare spending accounts for 40% of all healthcare financing in DRC. 221
In primary care facilities, the ratio of expenditures from out-of-pocket healthcare is approximately
32% on health centre consultations, 64% on medications and 2% on non-medical items like food. 222
Those who are unable to pay are at times held in the medical facility until fees are paid. An
observational study in Lubumbashi found that over half of the 85 women unable to pay were held in
the hospital for 1 to 30 days. 223
218F

21 9 F

220F

221F

In private facilities including faith-based organisations, user fees are the main source of income forhealthcare providers, covering healthcare activities and staff remuneration. In public facilities,
government financing is often unreliable and insufficient, making user fees a vital source ofrevenue. 224 Not-for-profit institutions have more variable application of user fees depending on theorganisation leading the facility. 225
222F

223F

National programmes for priority diseases aim to remove all healthcare-related fees. 226 Priority
diseases include HIV/AIDS and TB. As such, consultations, diagnostic tests, medications and key
treatments are free, in principle. However, it is relatively common that fees are applied prior to a
positive confirmation of disease. Those with suspected HIV or TB will be expected to pay for
consultations and diagnostic tests in many health facilities. These fees are often prohibitive and a limit
to the access to healthcare. 227
224F

225F

8.1 Cost of consultations
The cost of consultations depends on the type of facility. 228
226F

Cost of consultations

Publicoutpatient
treatment price

Public inpatient
treatment pricePrivateoutpatient
treatment pricePrivate inpatient
treatment priceSpecialist consultation

USD 10

USD 10

USD 40

USD 40Inpatient treatment costs include the consultation and bed. Additional costs such as medications andimaging are not included and are supplementary. 229
227F

220 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République

Démocratique du Congo, November 2018, url, p. 41
221 IHME, Institute for Health Metrics, DRC dashboard, October 2020, url
222 Laokri, S., et, al, Assessing out-of-pocket expenditures for primary health care, BMC Health Services Research, June 2018,url pp.8
223 Cowgill, K and Mukengeshayi, Hospital detention of mothers and their infants at a large provincial hospital, Reproductive
Health, 2019, url
224 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
225 For instance, MSF facilities typically do not have any user fees
226 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url
227 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
228 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
229 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 202036

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

8.2 Treatment cost
There is some evidence of overcharging and oversubscribing of medicines, diagnostic tests, andmedical procedures by health facilities, due to the reliance on user fees. 230 For example, the largest
community health scheme, the MESP, has medical advisors and administrative staff who review
invoices relative to treatments received. Medical advisors estimate that 95% of invoices are revised
down after review by up to 25%. 231 For the majority of the population, the cost of treatments act asa significant, and often insurmountable, barrier to healthcare. 232 As a result, the majority of the
population does not have access to care outside of primary care services. 233
228F

229F

230F

231F

8.3 Cost of medication
The government of DRC registers and controls the distribution of pharmaceuticals throughout theprovinces, through provincial health inspectors. This mechanism aims to regulate drug prices andquality. 234
232F

Medications for key priority diseases are provided for free. Notably these include, anti-retrovirals,
treatment of opportunistic infections, and TB treatments, including multidrug-resistant tuberculosis(MDR-TB). 235
233F

Resourcing and supply chain challenges has resulted in a prominent informal pharmaceuticals market.
Prices of medicines from these sources are variable, with instances of medications being both higher
and lower than in registered facilities. 236
234F

230 Stéphanie Stasse et al., “Improving Financial Access to Health Care in the Kisantu District in the Democratic Republic ofCongo: Acting upon Complexity”, Global Health Action 8, no. 1 (2015), url, p.1
231 Criel, B, et al., “Can Mutual Health Organisations Influence the Quality and the Affordability of Healthcare Provision? The
Case of the Democratic Republic of Congo”, url, p.2
232 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url
233 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
234 World Bank, The role of the private sector in improving the performance of the Health System in the Democratic Republicof Congo, 2018, url, pp. 38-48
235 World Bank, The role of the private sector in improving the performance of the Health System in the Democratic Republicof Congo, 2018, url, pp. 38-48
236 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 202037

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

9 Cardiovascular diseases
9.1 General information
9.1.1 Epidemiological context
Cardiovascular Disease (CVD) is a general term for conditions affecting the heart and blood vessels.
There is a significant lack of CVD prevalence data on CVD in DRC, although it is estimated that theprevalence is relatively high and increasing. 237 Stroke is ranked as the sixth leading cause of death andfirst among non-communicable diseases. 238 Coronary heart disease is the seventh leading cause ofdeath. 239 According to the latest WHO data published in 2018, coronary heart disease deaths in DRC
stood at 28 410, or 4.27%. 240 Hypertension is a key risk factor for CVD that increases morbidity andmortality. A screening campaign carried out in 2018 estimated the prevalence of arterial hypertension
to be 26% of the adult population in Kinshasa. 241 According to the PNDS, it is likely that the prevalence
is comparable in other urban areas. 242
235F

236F

237F

238F

239F

240F

9.1.2 Strategies and policies for treatment and management of CVD
To date, the health system in DRC has largely been oriented towards addressing communicablediseases. In spite of this, in 2014 a National Programme against Cardiovascular Diseases (Programme
National des Maladies Cardiovasculaires) was adopted by the Ministry of Health. 243 This raised theprioritisation given to addressing the management of CVD, particularly in public facilities. The
programme, however, has not been updated and has been underfinanced. This has therefore
prevented realisation of the key objectives of the programme. 244
241F

242F

Addressing CVD is nonetheless outlined in the National Strategic Health Plan (Plan National deDéveloppement Sanitaire 2016-2020, PNDS) as a priority health area for the Government of DRC andthe Ministry of Health of DRC. 245 As part of this, the PNDS includes hypertension management amongits key indicators for monitoring success of the strategy implementation. 246 In addition, managementof hypertension is included among the minimum packet of activities for health centres and hospitals,
while screening of risk factors and treatment of cardiovascular disease is included in the packet of
activities for hospitals. 247
243F

244F

245F

237 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République

Démocratique du Congo, Nov 2018, url, p. 21
238 Institute of Health Metrics, “DRC Dashboard,” 2017, url
239 Institute of Health Metrics, “DRC Dashboard,” 2017, url
240 World Life Expectancy, DRC, 2018, url
241 Buila, N., et al., Analysis of blood pressure and selected cardiovascular risk factors in the Democratic Republic of theCongo: the May Measurement Month 2018 results, European Heart Journal Supplements, 28 August 2018, url, pp. 50-53
242 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, Nov 2018, url, p. 21
243 EASO2, Director of a national programme within the Ministry of Health and Medical Director and Head of Cardiology atprominent Kinshasa based facility, Email Correspondence, August 2020. Strategy document was not made available for thereport.
244 EASO2, Director of a national programme within the Ministry of Health and Medical Director and Head of Cardiology atprominent Kinshasa based facility, Email Correspondence, August 2020.
245 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, Nov 2018, url, p. 21
246 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, Novemeber 2018, url, pp. 87-94
247 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, pp. 87-94

38

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

9.1.3 Healthcare provisions for treatment and management of CVD
CVD treatments available at primary care facilities include lifestyle consultations, risk factor
monitoring and dispensing of medications, such as diuretics. 248 However, many primary care facilities
lack guidelines on the treatment of CVD, while a lack of continual professional development training
for nurses leads to a poor standardisation of care. 249 This often results in the poor management ofrisk factors and increased burden of ill health attributable to CVD. 250
246F

247F

248F

There are very limited specialised care services available in provincial secondary or tertiary
facilities. 251 Provincial hospitals often face significant infrastructure challenges and lack a continuous
supply of electricity and water. 252 As a result, elective surgeries are only performed in a few specialist
hospitals. 253 However, limited resources means patients have poor health outcomes and mortality
rates are relatively high. 254 For instance, an observational study of heart disease treatment in a private
and a university hospital between 2014 and 2016, recorded a hospital mortality rate of 19%, and a
35% death rate within one year of presentation. 255
249F

250F

251F

252F

253F

Most seek specialised care from a select number of medical facilities located in Kinshasa. 256 The
medical facilities include: 257
254F

255F

•

•

Public sector:oKinshasa University Clinic (Clinique Universitaire de Kinshasa)oKinshasa General Hospital (Hôpital Général de Kinshasa)oNgaliema Clinic

Private sector (for profit):o

HJ Hospital Kinshasa (HJ Hôpitaux Kinshasa) 258. The HJ Hospitals also have facilities in
Lubumbashi and Goma 259
256F

257F

o

Diamant Medical Centre (Centre Médical Diamant 260)oMedical Centre Kinshasa (Centre Médical de Kinshasa 261)

258F

259F

248 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République

Démocratique du Congo, November 2018, url, pp. 87-94
249 Lulebo,A. et al., Assessment of hypertenstion management in primary health settings in Kinshasa, Democratic Republicof Congo, BMC Health Service Research, December 2015, url, p. 3
250 Lulebo,A,. et al., Assessment of hypertenstion management in primary health settings in Kinshasa, Democratic Republicof Congo, BMC Health Service Research, December 2015, url, pp. 5-8
251 EASO2, Director of a national programme within the Ministry of Health and Medical Director and Head of Cardiology atprominent Kinshasa based facility, Email Correspondence, August 2020.
252 GSHP, Global Health science and practice, A Resource Planning Analysis of District Hospital Surgical Services in the
Democratic Republic of the Congo, October 2018, url, p. 1
253 EASO2, Director of a national programme within the Ministry of Health and Medical Director and Head of Cardiology atprominent Kinshasa based facility, Email Correspondence, August 2020.
254 Malamba-Lez, D. et al, Heart failure etiologies and challenges to care in the developing world: an observational study in
Democratic Republic of Congo, Cardiac Failure, October 2018, pp. 854-859, url, p.1
255 Malamba-Lez, D. et al, Heart failure etiologies and challenges to care in the developing world: an observational study in
Democratic Republic of Congo, Cardiac Failure, October 2018, pp. 854-859, url, p.1
256 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
257 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
258 HJ Hospital, n.d, url
259 HJ Hospital, n.d, url
260 Centre medical Diamant, n.d, url
261 CMK, Centre Medical de Kinshasa, n.d, url

39

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)o

Monkole Medical Centre (Centre Hospitalier Monkole) 262
260F

With regard to Ngaliema Clinic, a specialist children’s cardiac ward was built in 2017. 263 However,according to one source writing for Global Cardiac Surgery, by late 2018 only two surgeries had been
performed. 264
261F

262F

Due to a lack of specialist cardiologists, healthcare services available at these health centres is often
limited. 265 Specialist surgeries in particular are offered on an intermittent and often unreliable basis.
The medical centres rely on international cardiologists to visit in order to perform a limited numberof scheduled services. 266 As a result, those with the required financial resources typically seek
treatment in other countries, usually South Africa. 267
263F

264F

265F

9.2 Access to treatment
Access to healthcare in DRC is limited, particularly for specialised care. Medicines, alongside lifestyleconsultations, are the main treatment options for patients with CVD in DRC. 268 A representative
sample of health centres were reviewed in 2017 and 2018 to assess availability of different diagnostic
and treatment services in health facilities. 269 This found that diuretics, used to treat high bloodpressure, were relatively widely available, being present in 63% of facilities. 270 Other medicines weremuch less readily available. For example, statins, used to treat high cholesterol, were in stock in fewer
than 1% of the health facilities reviewed. Finally, only 22% of hospitals assessed had oxygen available
for use during emergency care. 271
266F

267F

268F

269F

Lack of community awareness regarding CVD and related risk factors reduces health-seeking
behaviours and contributes to late presentation at clinics. As a result, patients tend to require more
complex care. 272
270F

Other factors limiting access to treatment include the cost of care (see below) and lack of affordable
transport. A lack of transport facilities particularly affects access to emergency care during heart
failure. 273
271F

Health services, including those for CVD, are available to all citizens with access to healthcare only
dependent on ability to pay.

262 CEFA, Centre Hospitalier Monkole, n.d, url
263 Clinique Ngaliema, n.d, url
264 Kanmounye,U, Global Cardiac Surgery, Auscultating cardiac surgery in the DR Congo, September 2018, url
265 EASO2, Director of a national programme within the Ministry of Health and Medical Director and Head of Cardiology atprominent Kinshasa based facility, Email Correspondence, August 2020.
266 EASO2, Director of a national programme within the Ministry of Health and Medical Director and Head of Cardiology atprominent Kinshasa based facility, Email Correspondence, August 2020.
267 EASO2, Director of a national programme within the Ministry of Health and Medical Director and Head of Cardiology atprominent Kinshasa based facility, Email Correspondence, August 2020.
268 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020.
269 Study reviewed availability of services in a total of 1,380 Health Facilities proportionally distributed across provinces. Thiswas carried out between November 2017 and April 2018.
270 EPSS, Evaluation des Prestations des Services de soins de Santé, Ecole de Santé Publique de Kinshasa, April 2019, url, p.
251
271 EPSS, Evaluation des Prestations des Services de soins de Santé, Ecole de Santé Publique de Kinshasa, April 2019, url, p.
43
272 Malamba-Lez, D. et al, Heart failure etiologies and challenges to care in the developing world: an observational study in
Democratic Republic of Congo, Cardiac Failure, October 2018, pp. 854-859, url, p. 1
273 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 202040

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

9.3 Cost of treatment
There are no financial support programmes for the treatment of CVD. 274 The vast majority ofhousehold healthcare spending is through out-of-pocket payments at the point of care. 275 Out-ofpocket payments at the point of care are a significant barrier to healthcare. For the majority of the
population, treatment beyond primary care consultations are not economically accessible. 276 For
example, according to the aforementioned study on cardiac care outcomes in Lubumbashi, theaverage cost of a 10-day inpatient hospitalisation for heart failure is USD 1 000. 277 This is almost equal
to the average annual income of USD 1 080. 278
272F

273F

274F

275F

276F

The cost of inpatient care is more expensive in private hospitals when compared to public facilities.
The increased price relates primarily to the cost of the room, rather than consultations and tests. The
prices below were gathered from a range of clinics based in Kinshasa and provide an indication of thecost of healthcare services. The total costs incurred by patients can be approximated by summing all
relevant services. For instance, outpatient cardiac consultation would cost as a minimum USD 17 foradmission and USD 10 for a consultation with a cardiologist. All medications incur supplementarycharges. Of note, inpatient costs are not inclusive of food. 279
277F

Publicoutpatient
treatment
price

Publicinpatienttreatment
price

Privateoutpatient
treatment
price

Privateinpatienttreatment
price

Reimbursement/ specialprogramme /free

Cardiology
department (dailyrates)USD 17

USD 17

USD 50-100

USD 100300

None

Cardiac surgery
department (dailyrates)

-

-

-

-

None

USD 10

USD 10

USD 40

USD 40

None

-

--

USD 40

USD 40

None

--

--

USD 50-100*

USD 50-100*

None

Cost
treatment 280

of

278F

Clinical admissions

Specialist
Cardiologist
Cardiac surgeon
Medical imaging
Angiogram(available in only
one private hospital

274 EASO2, Director of a national programme within the Ministry of Health and Medical Director and Head of Cardiology atprominent Kinshasa based facility, Email Correspondence, August 2020
275 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, p. 41
276 EASO2, Director of a national programme within the Ministry of Health and Medical Director and Head of Cardiology atprominent Kinshasa based facility, Email Correspondence, August 2020
277 Malamba-Lez, D. et al, Heart failure aetiologies and challenges to care in the developing world: an observational study in
Democratic Republic of Congo, Cardiac Failure, October 2018, 24:12 pp. 854-859, url, p. 1
278 World Bank, Data Bank, GNI per capita, PPP (current international $) 2018, url
279 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
280 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 202041

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Publicoutpatient
treatment
price

Publicinpatienttreatment
price

Privateoutpatient
treatment
price

Privateinpatienttreatment
price

Reimbursement/ specialprogramme /freeElectrocardiogram(ECG)

USD 10-30

USD 10-30

USD 30-150

USD 30-150

None

Ultrasoundof the heart(= echocardiography = echocardiogram= TTE)USD 50-100

USD 50-100

USD 50-100

USD 70-100

None

Holter monitor/
ambulatory ECG
device (cardiology)

USD 100-200

USD 100-200

USD 100-200

USD 100400

None

None

Cost
treatment 280

of

278F

but without
permanent
specialists in DRC)

Treatment in case of severe heart rhythm disorder
Placement ofpacemaker*

Service by
periodically
visiting
international
doctorService by
periodically
visiting
international
doctorService by
periodically
visiting
international
doctorService by
periodically
visiting
international
doctorPriceunknownPrice
unknown

USD 2 500

USD 2 500

* There are not currently any specialists based in DRC able to perform these procedures. Treatment
can only be provided by visiting international doctors. 281
279F

9.4 Cost of medication
Patients often have poor adherence to treatments, particularly for chronic conditions like thoserelated to CVD. 282 This is due to prohibitive costs and lack of availability of key medications. 283
280F

281F

The price of medications was collected from eight registered pharmacies based in Kinshasa. 284
Medicines from the informal market have not been included.
282F

Drug name

Form

Price per box

Is the drug included onnational essential drugs
lists?

Anti-hypertensive:
Perindopril

TabletUSD 15 (5 mg, 30 units per box)
USD 32 (10 mg, 30 units per box)

No

281

EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020.
282 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020.
283 Please refer to chapter 4 for further details on the pharmaceutical sector
284 Please refer to the Introduction for further details on the methodology of price data collection

42Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Drug nameForm

Enalapril

TabletLisinopril

TabletBisoprolol

TabletPrice per box
USD 8 (5 mg 30 units per box)
USD 11 (20 mg, 28 units per box)
USD 18 (20 mg, 28 units per box)
USD 9 (5 mg, 28 units per box)
USD 5 (2.5 mg, 30 units per box)
USD 12 (10 mg, 30 units per box)

Is the drug included onnational essential drugs
lists?
YesNo

No

USD 37.5 (160 mg, 28 units per box)
Propranolol

TabletUSD 19 (80 mg, 28 units per box)

No

USD 9 (40 mg, 28 units per box)
Carvedilol

TabletAtenolol

TabletIndapamide

TabletFurosemide

TabletTorasemide

TabletEplerenone

TabletUSD 9.5 (6.25 mg, 56 units per box).
USD 32(25 mg, 30 units per box)
USD 12.5 (100 mg, 30 units per box)
USD 7(50 mg, 30 units per box)
USD 11(1.5 mg, 20 units per box)
USD 9 (2.5 mg, 30 units per box)
USD 9 (40 mg, 30 units per box)
USD 28.5 (10 mg, 30 units per box)
USD 13 (10 mg, 30 units per box)
USD 11 (5 mg, 30 units per box)
USD 26 (25 mg, 30 units per box)

No

Yes

No

Yes

No
No

USD 11 (25 mg, 30 units per box)
Spironolactone

TabletUSD 15(50 mg, 30 units per box)

Yes

USD 19 (100 mg, 30 units per box)
USD 14 (25 mg, 30 units per box)
Hydrochlorothiazide

TabletUSD 19 (50 mg, 30 units per box)

Yes

USD 20 (100 mg, 30 units per box)
Lisinopril +Hydrochlorothiazide(combination)

TabletUSD 20 (20 mg Lisnopril/12.5 hydro,
30 units per box)

No

Enalapril +Hydrochlorothiazide(combination)

TabletUSD 12.5 (20 mg/12.5 mg, 30 units
per box)No

Nifedipine

TabletUSD 21 (30 mg, 30 units per box)

No

Losartan

TabletUSD 11 (50 mg, 30 units per box)

No43

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Drug name

Form

Price per box

Is the drug included onnational essential drugs
lists?

USD 15 (100 mg, 30 units per box)

Valsartan

TabletUSD 37.5 (160 mg, 30 units per box)
USD 30.5 (80 mg, 30unis per box)

No

USD 10.5 (40 mg, 28 units per box)
USD 16.5 (80 mg, 28 units per box)
Olmesartan

TabletUSD 26 (12.5 mg, 28 units per box)
USD 32 (12.5 mg, 28 units per box)

No

USD 40 (25 mg, 28 units per box)
USD 45 (25 mg, 28 units per box)
Telmisartan

TabletUSD 23 (4 0mg, 30 units per box)
USD 25 (80 mg, 30 units per box)

No

USD 28 (160 mg, 28 units per box)
Candesartan

TabletUSD 30 (80 mg, 28 units per box)

No

USD 24 (40 mg, 28 units per box)
Irbesartan

TabletAmlodipine

TabletLercanidipine

TabletAmlodipine +Valsartan +Hydrochlorothiazide

TabletUrapidilTabletUSD 15 (150 mg, 30 units per box)
USD 17 (300 mg, 30 units per box)
USD 16.5 (10 mg, 30 units per box)
USD 25 (5 mg, 30 units per box)
USD 47 (20 mg, 28 units per box)
USD 24.5 (10 mg, 28 units per box)
USD 45 (160 mg, 5 units per box)
USD 65 (160 mg, 10 units per box)
USD 27 (30 mg, 30 units per box).
USD 38 (60 mg, 30 units per box)

No

Yes

No

No

No

USD 50 (4 mg, 28 units per box)
Doxazosin

TabletUSD 23 (4 mg, 20 units per box)

No

USD 15 (2 mg, 28 units per box)
Antiplatelet
aggregation:
Aspirin

TabletUSD 12 (500 mg, 100 units per box)

Yes

44

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

9.5 NGOs
There is a significant presence of national and international NGOs integrated into the health sector
across DRC. 285 However, most of these do not focus specifically on CVD. 286
283F

284F

The Belgian NGO Chaîne de l'Espoir, is one of particular importance for CVD service provision. 287 The
NGO supports capacity strengthening by bringing international cardiac surgeons to provide specialised
services and training to Kinshasa University Clinic (Clinique Universitaire de Kinshasa) and Ngaliema
Clinic. 288 The organisation focuses specifically on providing treatments to children. 289
285F

286F

287F

285 Barbelet, V. et al., Local Humanitarian Action in the Democratic Republic of Congo, March 2019, url pp.7
286

EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
287 Chaîne de l espoir- Belgique, n.d, url
288 Chaîne de l’espoir- Belgique, n.d, url
289 Chaîne de l’espoir- Belgique, n.d, url

45Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

10 Diabetes
10.1 General information
10.1.1 Epidemiological context
Epidemiological data on diabetes in DRC is very limited as there is absence of a national monitoring
system or protocols. The International Diabetes Federation estimates that the population prevalenceof combined type 1 and type 2 diabetes in DRC is 4.8%. These estimates are based on small-scalestudies and comparative countries from which data has been extrapolated and modelled. 290 Based on
this, the prevalence of diabetes in DRC is almost half of the estimated global prevalence, which stands
at 8.5%. 291 However, there is evidence that the prevalence in cities may be notably higher. A screening
campaign in Kinshasa in 2018 estimated the prevalence to be 15.5% of the adult population. 292
288F

289F

290F

The proportion of undiagnosed cases in DRC is very high. In 2019, it was estimated that there were 1
230 000 undiagnosed cases of diabetes with 28 382 diabetes-related deaths. 293 The mortality rate forpeople with diabetes is high; most people only survive five years after the diagnosis of diabetes. 294
291F

292F

10.1.2 Strategy and policies for treatment and management of diabetes
The National Health Development Plan 2019-2022 (Plan National de Développement Sanitaire, PNDS)
includes the screening and treatment of diabetes among the Essential Package of Activities for
Hospitals. 295, 296 According to the PNDS, primary care facilities, such as health posts and health centres,
should, subject to supply chain capacity, be able to conduct diagnostic tests using a glucometer tomeasure blood-glucose levels and reactive strips for urine analysis. 297
293F

294F

295F

There is evidence that a more detailed strategy or national programme to address diabetes has beendeveloped (known as the Programme National de Lutte Contre le diabète). 298 However, a copy of thenational programme was not made available for review.
296F

10.1.3 Healthcare provisions for treatment and management of diabetes
Diabetes treatments available from health centres and provincial hospital include lifestyleconsultations, risk factor monitoring and dispensing of medications such as insulin. 299 In principle,
these services are available at health centres and provincial hospitals across the country; however,this is dependent on the availability of diagnostic tests and medicines as described below. There arevery limited specialised care services available in provincial secondary or tertiary facilities. Provincial
297F

290 International Diabetes Federation, IDF Atlas 9th edition, 2019, url, p. 136
291 WHO, World Health Organization, Diabetes Key Facts, June 2020, url
292 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République

Démocratique du Congo, November 2018, url, p. 21
293 International Diabetes Federation, IDF Atlas 9th edition, 2019, url, pp.136 -137
294 T1 International, Global Type 1 Map Democratic Republic of Congo, n.d, url
295 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, pp. 87-94
296 Further details on the Essential Package of Activities included in chapter 2
297 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, pp. 87-94
298 Actualite.CD, RDC/Covid-19 : une campagne de dépistage massif du diabète et de l’hypertension prévue à Kinshasa pourréduire le risque de décès, September 2020, url
299 EPSS, Evaluation des Prestations des Services de soins de Santé, Ecole de Sante Publique de Kinshasa, April 2019, url, pp.
252-255

46

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

hospitals often face significant infrastructure challenges and lack a continuous supply of electricity
and water. 300
298F

Specialised services, such as consultations with trained specialists or specialised surgeries, are almost
exclusively provided in Kinshasa. 301 Hospitals which provide specialised services for diabetes include:
299F

•

•

Public sector: 302
300FoKinshasa University Clinic (Clinique Universitaire de Kinshasa)oKinshasa General Hospital (Hôpital Général de Kinshasa)

Private sector (for profit): 303
301Fo

HJ Hospital Kinshasa (HJ Hôpitaux Kinshasa). The HJ Hospitals also have facilities in
Lubumbashi and Goma. 304
302FoDiamant Medical Centre (Centre Médical Diamant) 305
303F

Medical facilities which offer specialised eye care for diabetic retinopathy include: 306
304F•

Public:o•

St Joseph’s Hospital Kinshasa (Hôpital St Joseph)

Private:oVi-zion Opthamology Clinic (Vi-zion Clinique D’Opthalmologie) 307
305F

10.2 Access to treatment
Access to healthcare in DRC is very limited, particularly for specialised care. With regards to diabetes,
there is a significant treatment gap, particularly for patients with type 1 diabetes. 308 Factors which
contribute to low coverage of healthcare include poor availability of diagnostic and treatment
interventions in health facilities. A representative sample of health centres was reviewed in 2017 and2018 to determine the availability of medicines and diagnostic tests. 309 The study found that only 6 in
10 health facilities had diagnostic tests to conduct glycaemic testing at the time of the assessment. 310
This varied by type of health facility, with only 47% of health centres able to test for diabetes
compared to 78% of hospitals. A substantial regional variation was also recorded. The lowest
availability of diagnostic services (6% of health facilities) was recorded in the central-south western
306F

307F

308F

300 Sion, M. et al., Global Health: Science and practice, A Resource Planning Analysis of District Hospital Surgical Services inthe Democratic Republic of the Congo, 2015, url, pp.56
301 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
302 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
303 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
304 HJ Hospital, n.d, url
305 Centre Medical Diamant, n.d, url
306 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
307 Vi-Zion MD, Clinique d’ophtalmologie, n.d, url
308 Muyer, et al., Mortality of young patients with diabetes in Kinshasa, DR Congo, Diabetic Medicine, April 2010, url, p. 405
309 EPSS, Evaluation des Prestations des Services de soins de Santé, April 2019, Ecole de Santé Publique de Kinshasa, url, pp.
252-255
310 Availability of diagnostic services varied provincially and ranged from 6% in Lomami to 95% in Bas-Uele

47

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

province of Lomami. In contrast, 95% of health facilities in the northern province of Bas-Uele haddiagnostic tests available. 311
309F

Essential medicines for diabetes, including insulin, were available in approximately 10% of healthcentres. As with diagnostic test, the availability of insulin varied by type of health facility and province.
Insulin was available in only 9% of health centres assessed compared to 55% of hospitals. A similar
provincial variation in insulin availability was reported. Health facilities in the provinces of Lomami
and Kasai Oriental had the lowest availability of insulin at only 5% of health facilities. In contrast, 69%
of facilities in Nord-Ubangi had insulin in stock. 312
310F

As a result of poor availability of diagnostic and treatment resources, patients are required to travel
to provincial hospitals where diagnostic and treatment resources are more readily available. 313 As the
majority of the population lives in rural settings, the distance to these health facilities can besignificant. 314
311F

312F

The variation in stock availability in rural health facilities compared to urban is significant; 77% of
health facilities in urban areas were equipped to provide diabetes services, compared to 40% of healthfacilities in rural areas. 315 Most specialist services are provided in university hospitals located in urban
centres. 316
313F

314F

Lack of community awareness regarding diabetes and related risk factors reduces health-seeking
behaviours and contributes to late presentation at clinics. 317 Other factors limiting access totreatment include the cost of care (discussed below) and lack of affordable transport. A lack oftransport facilities particularly affects access to emergency care during diabetes ketoacidosis, aserious complication associated with poorly managed blood-glucose levels. 318
315F

316F

10.3 Cost of treatment
There are no financial support programmes for the treatment of diabetes. 319 The vast majority ofhousehold healthcare spending is through out-of-pocket payments at the point of care, which createsa significant barrier. 320 For the majority of the population, treatments beyond primary careconsultations are not economically accessible. 321
317F

318F

319F

Late presentation at a health facility means that patients are often diagnosed during periods ofextreme ill health resulting from unmanaged blood sugar levels. 322 As a result, during diagnosis
320F

311 EPSS, Evaluation des Prestations des Services de soins de Santé, Ecole de Santé Publique de Kinshasa, April 2019, url, pp.

252-255
312 EPSS, Evaluation des Prestations des Services de soins de Santé, Ecole de Santé Publique de Kinshasa, April 2019, url, pp.
252-255
313 T1 International, Global Type 1 Map Democratic Republic of Congo, n.d, url
314 CIA, Central Intelligence Agency, World Factbook, September 2020, url
315 EPSS, Evaluation des Prestations des Services de soins de Santé, Ecole de Santé Publique de Kinshasa, April 2019, url, pp.
252-255
316 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
317 Katchunga, P, et al., Connaissances de la population générale sur l’hypertension artérielle et le diabète sucré au Sud-Kivu,
République Démocratique du Congo, Revue d'epidémiologie et de santé publique, March 2012, url, p. 141
318 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
319 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
320 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, Nov 2018, url, p. 41
321 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
322 Katchunga, P, et al., Connaissances de la population générale sur l’hypertension artérielle et le diabète sucré au Sud-Kivu,
République Démocratique du Congo, Revue d'epidémiologie et de santé publique, March 2012, url, p. 141

48

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

patients are typically admitted to hospital for approximately 10 days. The cost of admission ranges
from USD 50-100. 323 The average annual income of USD 1 080 equates to USD 90 per month, making
hospital healthcare prohibitively expensive for the majority of the population. 324
321F

322F

The cost of inpatient care is more expensive in private hospitals when compared to public facilities.
The increased price relates primarily to the cost of the room, rather than consultations and tests. The
prices below were gathered from a range of clinics based in Kinshasa and provide an indication of thecost of healthcare services. The total costs incurred by patients can be approximated by summing all
relevant services. All medications incur supplementary charges. Of note, inpatient costs are notinclusive of food. 325
323F

Publicoutpatient
treatment
price

Publicinpatienttreatment
price

Privateoutpatient
treatment
price

Privateinpatienttreatment
price

Reimbursement/ specialprogramme /free

USD 10-20

USD 20-30

USD 30

USD 30

None

Internal specialist(internist)

USD 10

USD 10

USD 50

USD 50None

Ophthalmologist

USD 10

USD 10

USD 30

USD 30None

Endocrinologist

USD 10

USD 10

USD 60

USD 60

None

General practitioner

USD 5

USD 5

USD 20

USD 20None

USD 15-25

USD 15-25

USD 50

USD 50None

Blood glucose meterfor self-use by patient

USD 4

USD 6

USD 15

USD 15None

Blood glucose self-test
strips for use by
patient

USD 2.5

USD 4

USD 15

USD 15None

USD 16

USD 24

USD 35

USD 35

None

Cost of treatment

Clinical admission
Admittance in internalor endocrinology
department (dailyrates)
Specialist
consultations

Neurologist
Devices for measuring
blood glucose

Laboratory researchBlood glucose(including
HbA1C/ glyc.Hb)

323 T1 International, Global Type 1 Map Democratic Republic of Congo, n.d, url
324 World Bank, Data Bank, GNI per capita, PPP (current international $) 2018, url; United Nations Development Programme,

Human Development Report 2016, 2016, url
325 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 202049

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Cost of treatment

Renal/ kidney function(creatinine, urea,
proteinuria, sodium,
potassium levels)

Publicoutpatient
treatment
price

Publicinpatienttreatment
price

Privateoutpatient
treatment
price

Privateinpatienttreatment
price

Reimbursement/ specialprogramme /free

USD 27

USD 41

USD 170

USD 170

None

-

-

USD 200

USD 200-

Treatment
Laser treatment ofdiabetic retinopathy

10.4 Cost of medication
Patients often have poor adherence to treatments, particularly for chronic conditions like diabetes. 326
This is due to prohibitive costs and lack of availability of key medications. 327
324F

325F

The price of medications was collected from eight registered pharmacies based in Kinshasa. 328
Medicines from the informal market have not been included.
326F

Drug name

Form

Price per box

Is the drug typically included on national
essential drugs medicines lists?

Oral Antidiabetics

Metformin

TabletGlibenclamide

TabletUSD 1 (850 mg,
10 tablets perbox)
USD 1.5 (500 mg,
10 tablets perbox)
USD 15 (5 mg, 20
tablets per box)

Yes

Yes

USD 6 (40 mg, 30
tablets per box)
Gliclazide

TabletUSD 10 (80 mg,
30 tablets per
box)

No

USD 5 (1 mg, 30
tablets per box)
Glimepiride

TabletUSD 10 (2 mg, 30
tablets per box)

No

USD 19.5 (4 mg,
30 tablets per
box)

326

EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
327 Please refer to chapter 4 for further details on the pharmaceutical sector
328 Please refer to the Introduction for further details on the methodology of price data collection50Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Drug name

Repaglinide

Form

TabletPrice per box
USD 8 (1 mg, 30
units per box)
USD 15 (2 mg, 30
tablets per box)

Is the drug typically included on national
essential drugs medicines lists?

No

Insulins
USD 4 (each box
contains 100
pens of 5 ml,
100U/mL)

Intermediate
acting[12-24 hours]; insulin
NPH/isophane like Insu
latard ®

InjectionLong acting [24 hours];
insulin detemir

Injection(insulin pens)

USD 12 (eachbox contains 5pens of 5 ml,
100U/mL)

No

Injection

USD 12 (eachbox contains 5pens of 5 ml,
100U/mL)

No

Long acting [24 hours];
insulin glargine like
Lantus®

Premixed: combinationof regular (short acting)andinsulin isophane (intermediate acting) like
Mixtard®
Premixed: aspart (rapid
acting) and aspart
protamine(intermediate acting)like ®Novomix
Premixed: combinationof lispro (rapid acting)andinsulinlisproprotamine(intermediate acting)
Premixed: NPH 70/30
combination of rapid
andintermediate
acting insulin
Combinationofinsulin degludec (extralong acting) and insulin
aspart (rapid acting)51

Injection

USD 7 (each box
contains 100
pens of 5 ml,
400U/mL)

USD 4 (each box
contains 100
pens of 5 ml,
100U/mL)
USD 7 (each box
contains 100
pens of 5 ml,
400U/mL)Yes

Yes

Injection

USD 12 (eachbox contains 5pens of 5 ml,
100U/mL)

No

Injection

USD 12 (eachbox contains 5pens of 5 ml,
100U/mL)

No

Injection

USD 12 (eachbox contains 5pens of 5 ml,
100U/mL)

No

Injection

USD 15 (eachbox contains 5pens of 5 ml,
100U/mL)No

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Drug nameRapid
acting[2-5hours];
insulin aspart like
®Novorapid
Rapid
acting[2-5hours]; insulin lispro

Short
acting[7-8hours]; bovine, porcine
or human regularinsulin like ®Actrapid

Form

Price per box

Is the drug typically included on national
essential drugs medicines lists?

Injection

USD 12 (eachbox contains 5pens of 5 ml,
100U/mL)

No

Injection

USD 12 (eachbox contains 5pens of 5 ml,
100U/mL)

No

Injection

USD 3.75 (eachbox contains 5pens of 5 ml,
100U/mL)Yes

USD 7 (each box
contains 5 pensof 5 ml,
400U/mL)

OthersGlucagon

Injection

USD 35.85 (1mg/ml, 1 unit per
box)

Yes

10.5 NGOs
There are some examples of diabetes projects supported by NGOs in DRC. 329 However, these projects
are localised and not integrated into the health system. For instance, programme and research reports
indicate that in 2017, Médecins Sans Frontières (MSF) was supporting an integrated diabetes clinic in
Mweso Hospital in eastern Democratic Republic of Congo. 330 However, there is an absence of data on
whether the hospital continues to be supported by MSF for diabetes care.
327F

328F

The World Diabetes Foundation has delivered a variety of health system capacity strengthening andcommunity outreach programmes mostly in Kinshasa and Eastern provinces. 331 These programmes
have varied in length from five years of programme implementation to one year of implementation. 332
329F

330 F

329 World Diabetes Foundation, Improving diabetes care WDF05-128, n.d,url; MSF, Médecins Sans Frontières, Evaluating
the effectiveness and burden of diabetes care in a complex humanitarian emergency setting in Mweso, North Kivu,
Democratic Republic of the Congo (DRC), 2015, url
330 Murphy, A., et al., Diabetes care in a complex humanitarian emergency setting: a qualitative evaluation, Health services
Research, June 2017, url, p. 2; MSF, Médecins Sans Frontières, Evaluating the effectiveness and burden of diabetes care in
a complex humanitarian emergency setting in Mweso, North Kivu, Democratic Republic of the Congo (DRC), 2015, url
331 World diabetes Foundation, n.d, url
332 World diabetes Foundation, Integrated diabetes care, project timeline 2010 – 2015, n.d, url; World diabetes Foundation,
Sensitisation and Education Campaign on Diabetes in the Bukavu Health Care District, project timeline 2013 – 2014, n.d, url

52

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

11 Haematology: anaemia and blood clotting
disorders
11.1 General information
11.1.1 Epidemiological context
Haematological disorders are diseases which affect the blood or blood production. 333 This chapter will
focus on sickle cell disease, anaemia and haemophilia.
331F

Sickle cell disease
Global prevalence data shows that DRC has one of the highest burdens of sickle cell disease in theworld. 334 Population prevalence data is limited; however, studies estimate that approximately 30% of
the population carries the sickle cell trait. 335 There is evidence that the sickle cell trait is protective
against malaria and therefore particularly common in regions with a high prevalence of malaria. 336
However, inheriting two copies of the sickle cell trait is associated with severe ill health andmortality. 337 This form of sickle cell diseases is known as sickle cell anaemia. At present, DRC does notconduct routine childhood screening for sickle cell anaemia, as a result national prevalence data islimited. 338 However, regional estimates have shown the prevalence of new-borns born with sickle cellanaemia ranges from 0.96 % 339 to 1.4 %. 340 This equates to approximately 30 000 to 40 000 newborns each year. 341 No data was found on the outcomes of children born with sickle cell disease in
DRC. Regional studies on outcomes from across sub-Saharan Africa suggest that sickle cell anaemia isassociated with very high rates of childhood mortality with estimates stating that between 50% and
90% of children die before the age of five. 342
332F

333F

334F

335F

336F

337F

338F

339F

340F

Iron deficient anaemia
The prevalence of iron deficient anaemia is high. 343 Overall, approximately 60% of children under 5
and 40% of women aged between 15 and 49 are affected by anaemia. 344 Iron deficient anaemia isparticularly harmful to these groups given its association with impaired brain development, increased
341F

342F

333 Nature Research, Haematological diseases definition, n.d url
334 Piel, F. et al., Global burden of sickle cell anaemia in children under five, 2010-2050: modelling based on demographics,

excess mortality, and interventions, Plos Med, July 2013, url, p. 4
335 Aloni, M. et al., Acute Crises and Complications of Sickle Cell Anaemia Among Patients Attending a Paediatric Tertiary Unit
in Kinshasa, Democratic Republic Of Congo, Haematology reports, June 2017, url, p. 1
336 Piel, F. et al., Global distribution of the sickle cell gene and geographical confirmation of the malaria hypothesis, Nature
Commnications, November 2010, url, p. 1
337 Wastnedge, E. et al., The global burden of sickle cell disease in children under five years of age: a systematic review andmeta-analysis, December 2017, url, pp. 5-7
338 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
339 Agasa, B. et al., Prevalence of sickle cell disease in a north-eastern region of the Democratic Republic of Congo: what
impact on transfusion policy?, Feburary 2010, url, p. 1
340 Tshiolo, L. et al., Neonatal screening for sickle cell anaemia in the Democratic Republic of the Congo: experience from apioneer project on 31 204 new-borns, Journal of Clinical Pathology, January 2009 url, p. 1
341 Aloni, M. et al., Acute Crises and Complications of Sickle Cell Anaemia Among Patients Attending a Paediatric Tertiary Unit
in Kinshasa, Democratic Republic Of Congo, Haematology reports, June 2017, url, p. 1
342 Grosse, S. et al., Sickle Cell Disease in Africa, American Journal of Preventative Medicine, December 2011, url, p. 1
343 DHA, Demographic and Health Survey 2013 – 2014 Democratic Republic of Congo, 2014 url, p. 12
344 DRC National Anaemia Profile, 2014, url, p. 1

53

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)risk of pre-term delivery and low birth weight delivery. 345 Lack of iron consumption from food themain cause of iron deficient anaemia in DRC. 346 DRC is faced with the second largest hunger crisis in
the world with over 70% of the population experiencing chronic food insecurity and poor dietary
diversity. 347
343F

344F

345F

Haemophilia
Haemophilia is a condition which impairs the body’s ability to create blood clots to stop bleeding.
There are two types of haemophilia known as haemophilia A and B. These differ with respect to themissing blood clotting factors. Data on the prevalence of haemophilia A and B in DRC is extremely
limited. 348 The World Federation of Haemophilia (WFH), an international not-for-profit organisation,
estimates that haemophilia is rare, with 1 child in 10 000 born with haemophilia A and 1 in 50 000
born with haemophilia B. 349 When applied to population demographic data for DRC, these estimatessuggest that there are approximately 8 400 people living with haemophilia A and 1 600 withhaemophilia B. 350
346F

347F

348F

11.1.2 Strategy and policies for treatment and management of haematologicaldisorders
There is no overarching national strategy for the management of haematological disorders. 351 Thereis mention of sickle cell disease within the National Health Development Plan (Plan National deDevelopment Sanitaire 2019-2022, PNDS); however, this only extends to saying that the treatment ofsickle cell anaemia is not yet integrated into essential primary care services. 352 There is evidence thata national programme specifically aimed at addressing sickle cell anaemia (Programme National deLutte contre la Drepanoctyose), has been developed by the Ministry of Health. 353 However, a copy ofthe national programme was not made available for review.
349F

350F

351F

The PNDS does not comment on the other haematological disorders included in this report. 354
However, there is a significant focus given to addressing malnutrition which, as described, is the mainunderlying cause of iron deficient anaemia in DRC. 355 A national strategy to strengthen nutritional
security is likely to have a positive impact on iron deficient anaemia. 356
352F

353F

354F

Broadly, there is an absence of national guidelines for the treatment of haematological diseases. As
such, treatment and care pathways are not standardised and as a result, quality of care is highlyvariable. 357
355F

345 DRC National Anaemia Profile, 2014, url, p. 2
346 Messina, J. et a., Spatial and social factors drive anaemia in Congolese women, November 2013, url, p. 2
347 World Food Programme, Democratic Republic of Congo, 2019, url
348 EASO3, Deputy Manager of a priority national programme. Responsible for national implementation of the strategy, Email

Correspondence, August 2020
349 World Federation of Haemophilia, Annual Global Survey 2018, October 2019, url
350 Based on population estimates from CIA, Central Intelligence Agency, World Factbook, July 2020, url
351 EASO3, Deputy Manager of a priority national programme. Responsible for national implementation of the strategy, Email
Correspondence, August 2020
352 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé République
Démocratique du Congo, November 2018, url pp. 22
353 Foundation Pierre Fabre, n.d, url
354 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url
355 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url pp. 15-16
356 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
357 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020

54

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

11.1.3 Healthcare provisions
haematological disordersfortreatmentandmanagementof

The availability of treatments for haematological disorders is very limited. 358
356F

The PNDS places an emphasis on strengthening primary care services. Treatments for haematologicaldisorders available at a primary care level includes nutritional consultations for those suffering fromnutritional anaemia and dispensing of basic medication. 359
357FSpecialist treatments for SCD, including blood transfusions, are available in a small number of hospitals
in large urban areas, notably Lubumbashi 360 and Kinshasa. 361 This includes a specialist sickle cell
treatment centre in Monkole Hospital (Centre Hospitalier Monkole) 362 in Kinshasa. 363 There are no
specialist treatment centres for haemophilia but some treatments, such as blood transfusions, can betreated in the same centres as sickle cell disease. 364 More details on the blood transfusion system canbe found in0.
358F

359F

360F

361F

362F

11.1.4 Human resources
There is a notable lack of medical specialists trained on the management of haematological disorders.
In a study of 460 physicians treating patients with SCD, fewer than 1% had ever received specifictraining. 365 Formal medical training on management of blood clotting diseases is even more
limited. 366 WFH delivers important capacity training for physicians to improve treatment of those withhaemophilia. Physicians from DRC are not yet well integrated into the training programme, as noneof the 42 healthcare professionals from 18 African countries trained between 2016 and 2018 werefrom DRC. 367
363F

364F

365F

11.2 Access to treatment
Access to healthcare in DRC is limited, particularly for specialised care such as the treatment of
haematological disorders. 368 New-born screening programmes are poorly integrated into maternity
366F

358

EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
359 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
360 Lubumbashi is DRC’s second largest city, located in the South East
361 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
362 Foundation Pierre Fabre, Support for the sickle cell treatment unit at the Centre Hospitalier Monkole, n.d, url
363 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
364 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
365 Mbiya, B. et al., Sickle cell disease in the Democratic Republic of Congo: Assessing Physicians’ Knowledge and Practices,
Tropical Medicine and Infectious Disease, July 2020, url, p. 1
366 EASO3, Deputy Manager of a priority national programme. Responsible for national implementation of the strategy, Email
Correspondence, August 2020
367 Diop, S., et.al., Improving access to haemophilia care in sub-Saharan Africa by capacity building, Blood advances,
December 2019 url, p. 3
368 EASO3, Deputy Manager of a priority national programme. Responsible for national implementation of the strategy, Email
Correspondence, August 202055

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

services. 369 As a result, haematological diseases are characterised by late presentation to healthfacilities and a notable treatment gap. 370
367F

368F

Sickle cell disease
A cause of the treatment gap arises from a lack of diagnostic and treatment availability at healthfacilities. 371 A representative sample of health facilities were reviewed in 2017 and 2018 to assess theavailability of different essential services. 372 This review, by the USAID funded Demographic and
Health Surveys (DHS) Program and Kinshasa School of Public Health, found that nationally, only 1% of
health facilities offer diagnostic services for sickle cell anaemia. Disaggregation by type of healthfacility found that no health centres and only 4% of hospitals were equipped for diagnostic testing. 373
Attempts to scale-up testing of new-borns have mostly been delivered through pilot programmes inselected maternities. 374 Although these programmes have demonstrated a positive impact, theyremain fragmented and lack national reach. 375
369F

370F

371F

372F

373F

Key treatments of sickle cell anaemia include prevention and prompt treatment of infections, pain
relief, treatment with hydroxyurea to prevent sickle formation, blood transfusions and general regularmonitoring by physicians.

Iron deficient anaemia
Programmes to address iron deficient anaemia mostly focus on improving food security andnutritional diversity. Many of these programmes fall outside of the scope of the health system. From
health facilities, community members may receive lifestyle consultations to increase ironconsumption. 376
374F

Haemophilia
First-line treatments for haemophilia include a number of medications. 377 In addition, poorly
managed blood clotting disorders often require elective surgeries due to musculoskeletal
complications. 378 These medications and surgeries are largely unavailable in DRC. 379
375F

376F

377F

Poor resourcing of health facilities affects access to healthcare for all the aforementioned
haematological disorders. Other factors which limit access to treatment include the cost of care

369

EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
370 Tshiolo, L , National Development of SCD Programmes in Congo DR, Conference Presentation, October 2016 url
371 EPSS, Evaluation des Prestations des Services de soins de Santé, Ecole de Santé Publique de Kinshasa, April 2019, url, pp.
42-43
372 Study reviewed availability of services in a total of 1,380 Health Facilities proportionally distributed across provinces. Thiswas carried out between November 2017 and April 2018.
373 EPSS, Evaluation des Prestations des Services de soins de Santé, Ecole de Santé Publique de Kinshasa, April 2019, url, pp.
42-43
374 Tshiolo, L, Neonatal screening for sickle cell anaemia in the Democratic Republic of the Congo: experience from a pioneer
project on 31 204 new-borns, Journal of Clinical Pathology, January 2009, url, p. 1
375 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
376 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
377 World Federation of Haemophilia, Guidelines for the Management of Haemophilia, 2020, url, pp. 12-14
378 World Federation of Haemophilia, Guidelines for the Management of Haemophilia, 2020, url, p. 14
379 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020

56

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)(discussed below) and lack of affordable transport. A lack of transport facilities particularly affects
access to emergency care during sickle cell crisis. 380
378F

Health services are available to all community members and there are no restrictions according tomigration status. The only condition to access treatment is ability to pay. 381
379F

11.3 Cost of treatment
There is no national risk-sharing mechanisms or national health insurance for haematologicaldisorders. 382 As a result, the majority of households use out-of-pocket payments at the point of care.
Specialist treatments are expensive and costs are prohibitive for the majority of the population. 383 As
a result, most patients receive only basic interventions available from primary care facilities or
pharmacies. These include simple pain relief and broad-spectrum antibacterial and antiviral
medications. 384
380F

381F

382F

The cost of inpatient care is more expensive in private hospitals when compared to public facilities.
The increased price relates primarily to the cost of the room, rather than consultations and tests. The
prices below were gathered from a range of clinics based in Kinshasa and provide an indication of thecost of healthcare services. The total costs incurred by patients can be approximated by summing all
relevant services. For instance, outpatient cardiac consultation would costs as a minimum USD 17 foradmission as well as USD 10 for a consultation with a cardiologist. All medications incur supplementarycharges. Of note, inpatient costs are not inclusive of food. 385
383F

Publicoutpatient
treatment
price

Publicinpatienttreatment
price

Privateoutpatient
treatment
price

Privateinpatienttreatment
price

Reimburse
ment /
specialprogramme/ freeUSD 25-30

USD 30-40

USD 50

USD 50None

Paediatric department(daily rates)

USD 10-20

USD 20-30

USD 50-100

USD 50-100

None

Intensive caretreatment (daily rate)

USD 15-25

USD 25-40

USD 100-300

USD 100-300

None

USD 10-15

USD 10-15

USD 40

USD 40None

Cost of treatment

Clinical admission
Haematology
department(daily rates)

Specialist Consultation
Haematologist

380

EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
381 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
382 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
383 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, p. 41
384 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
385 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 202057

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Cost of treatment

Paediatrician

Publicoutpatient
treatment
price

Publicinpatienttreatment
price

Privateoutpatient
treatment
price

Privateinpatienttreatment
price

Reimburse
ment /
specialprogramme/ freeUSD 10

USD 10

USD 40

USD 40

None

Laboratory tests and diagnostics
Complete BloodCount: e.g. Hb, WBC &platelets

USD 10

USD 15

USD 40

USD 40None

Coagulation tests:
e.g. prothrombin time(PT)

USD 55

USD 82

USD 60-90

USD 60-90

None

Serologic testing ofblood types (A, B,
O, rhesus, +/-)USD 19USD 29USD 15

USD 15

None

Measuring blood oxyg
en/ arterial blood gas(Astrup)

USD 35

USD 35

USD 60

USD 60

None

Transfusion oferythrocytes/red
blood cells

USD 20

USD 20

USD 75

USD 75None

Bloodtransfusion (safe; e.g.
checked for HIV andhepatitis B/C)

USD 18

USD 26

USD 75

USD 75

None--

Priceunknown*

Priceunknown*

None

Platelets / thrombocyt
es transfusion

USD 100

USD 100

USD 225

USD 225

None

Clinical treatment incase of sickle cell
crisisUSD 100150/10 days

USD 200300/10 days

USD 400500/10 days

USD 400500/10 days

None

Oxygen therapy with
devicelike nasal catheter-

USD 15-20/day

USD 30

USD 30None--

Treatments

Plasmapheresis

Diagnostic imaging
Transcranial Doppler(TCD) to measure blood flow through brain's
blood vessels.

USD 210

USD 210

None*Information from one hospital: plasmapheresis machine is currently being repaired out of thecountry.

58

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

11.4 Cost of medication
Patients often have poor adherence to treatments, particularly for chronic conditions like thoserelated to CVD. 386 This is due to prohibitive costs and lack of availability of key medications. 387
384F

385F

The price of medications was collected from eight registered pharmacies based in Kinshasa. 388
Medicines from the informal market have not been included.
386F

Drug name

Form

Price per box

Is the drug included on lists like national
essential drugs list?

Hemostatics

TabletTranexamic acid

USD 25 (250 mg, 50
units per box)
USD 23 (500 mg, 20
units per box)

Yes

Injection

USD 15 (16 (500 g/2
ml)

TabletUSD 45 (0.2 mg, 30
units per box)

No

Folic acid

TabletUSD 5 (5 mg, 100
units per box)

Yes

Hydroxycarbamide orhydroxyurea (Hydrea)

TabletUSD 13 (500 mg, 30
units per box)

No

Ferrous sulphate +folic acid (vit B9)TabletUSD 9 (50 mg/350
mcg, 30 units per
box)

No

CapsuleUSD 5 (200 mg, 10
units per box)

Desmopressin
Against anaemia

Iron injection
Ferrioxidesaccharate(ferric saccharateintravenous iron)- Venofer®

Injection

No

30 USD (20 mg/ml)

11.5 NGOs
Of the haematological disorders, SCD has received relatively significant support from the NGO
community. For example, the Pierre Fabre Foundation financed the specialist sickle cell unit inMonkole Hospital for a two-year period during 2011 and 2012. 389 More recently, the country’s firstlady Denise Nyakeru Tshisekedi, has been advocating for improved community sensitisation andhealth services for SCD. This has included making SCD a priority area for financial support from her
foundation. 390
387F

388F

386

EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
387 Please refer to chapter 4 for further details on the pharmaceutical sector
388 Please refer to the Introduction for further details on the methodology of price data collection
389 Foundation Pierre Fabre, Support for the sickle cell treatment unit at the Centre Hospitalier Monkole, n.d., url
390 Denise Nyakeru Tshisekedi Foundation, Projet de Lutte contre la Drepanocytose, n.d., url

59

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

12 Hepatitis B and C
12.1 General information
12.1.1 Epidemiological context
Hepatitis is an inflammation of the liver which causes numerous health problems. Hepatitis B and C
refer to the virus which causes the inflammation. Hepatitis B and C are chronic conditions which, if
left untreated, can lead to liver cirrhosis or cancer. 391 Data on the prevalence of hepatitis B and C in
DRC varies significantly as it is not routinely monitored. 392
389F

390F

Hepatitis B is relatively widespread throughout the country and population age groups. 393 The
Coalition for Global Hepatitis Elimination estimates that prevalence in DRC is approximately 4.25%,
corresponding to 3 727 890 people living with this chronic infection. 394 This is below the regional
prevalence estimates which stands at 6.2% of the adult population. 395 In 2019, there were an
estimated 4,460 hepatitis B related deaths in DRC. 396 Key transmission routes include sexualtransmission, vertical transmission from mother to child and infected blood transfusions. 397
391F

392F

393F

394F

395F

Hepatitis C is also relatively widespread in DRC. The prevalence is ranked as high/moderate andestimated at 3.26% of the population. In 2019, there were approximately 5 000 hepatitis C related
deaths. 398 Key transmission routes for hepatitis C include inadequately sterilised medical equipment
particularly syringes and infected blood transfusions. Key at risk population groups include people
with diabetes, people with HIV and postpartum women. 399
396F

397F

12.1.2 Strategies and policies for treatment and management of hepatitis
The Ministry of Health have not developed specific programmes to outline key priorities to address
the burden of hepatitis B and C. 400 However, within the National Strategic Plan against HIV/AIDS(PSNHIV, Plan Stratégique National de Lutte Contre le VIH/SIDA 2018-2021), focus is given on hepatitis
co-infection. 401 The PSNHIV includes among its key objectives the strengthening of screening and oftreatment capacities for hepatitis in patients who are HIV positive. 402 In addition, the national
cooperation strategy with the World Health Organization (Stratégie de Coopération de l’OMS avec lepays République Démocratique du Congo 2017–2021) sets hepatitis B and C prevention and
398F

399F

400F

391 WHO, World Health Organization, Hepatitis, n.d, url
392

EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
393 Shindano, T. et al., Hepatitis B virus infection in the Democratic Republic of Congo: a systematic review of prevalence
studies (2000-2016), Journal of Public Health, January 2018, url, p. 1
394 Coalition for Global Hepatitis Elimination, Data Dashboards Democratic Republic of Congo, 2019, url
395 World Health Organization, Fact Sheet Hepatitis B, July 2020, url
396 Coalition for Global Hepatitis Elimination, Data Dashboards Democratic Republic of Congo, 2019, url
397 Shindano, T. et al., Hepatitis B virus infection in the Democratic Republic of Congo: a systematic review of prevalence
studies (2000-2016), Journal of Public Health, January 2018, url, p. 1
398 Coalition for Global Hepatitis Elimination, Data Dashboards Democratic Republic of Congo, 2019 url
399 WHO, World Health Organization, Hepatitis C, n.d, url
400 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020.
401 PSNHIV, Plan stratégique sectoriel santé de La lutte contre le vih/sida 2018-2021, Ministère de la Santé République
Démocratique du Congo, April 2018 [no url], p. 7
402 PSNHIV, Plan stratégique sectoriel santé de La lutte contre le vih/sida 2018-2021, Ministère de la Santé, République
Démocratique du Congo, April 2018 [no url], p. 8

60

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

management as strategic priorities. 403 Lastly, the National Health Development Plan 2019-2022 (Plan
National de Développement Sanitaire, PNDS) includes hepatitis B vaccinations among recommended
routine childhood vaccinations. 404 However, there is no further reference to hepatitis B or C in the
PNDS. 405
401F

402F

403F

12.1.3 Healthcare provisions for treatment and management of hepatitis
The PSNHIV is relatively well financed which has enabled some resource mobilisation for hepatitis
healthcare activities. Beyond the PSNHIV, there has been little financing of hepatitis-related
healthcare. 406
404F

The PNDS places an emphasis on strengthening primary care services. 407 In principle, basic services
for hepatitis B and C, including diagnostic testing and medicines, can be received at primary carestructures. However, accessibility and supply chain challenges, discussed below, reduce the extent towhich these services are available. 408
405F

406F

There are very limited specialised care services available in secondary or tertiary facilities. Elective
surgeries are performed only in few specialist hospitals. With respect to complex care for liver
damage, these are only available in a few specialist private facilities in Kinshasa. 409 The medical
facilities include: 410
407F

408F

•

Public sector:o•Kinshasa University Clinic (Clinique Universitaire de Kinshasa)

Private sector (for profit):o

HJ Hospitals Kinshasa (HJ Hôpitaux Kinshasa). The HJ Hospitals also have facilities in
Lubumbashi and Goma. 411
409FoDiamant Medical Centre (Centre Médical Diamant) 412

oMedical Centre Kinshasa (Centre Médical de Kinshasa) 413

410F

411F

o
o

Monkole Medical Centre (Centre Hospitalier Monkole) 414
412F

Clinique Marie Yvette

415
413F

403 WHO, World Health Organization, Stratégie de Coopération de l’oms avec le pays République Démocratique du Congo

2017–2021, url, p. 17
404 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo November 2018, url, p. 91
405 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url
406 EASO4, Medical Doctor and Monitoring and Evaluation officer in the Ministry of Health, Email Correspondence, August2020.
407 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, p. 4
408 EPSS, Evaluation des Prestations des Services de soins de Santé, Ecole de Santé Publique de Kinshasa, April 2019, url, p.42
409 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
410 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
411 HJ Hospitals, n.d, url
412 Centre Medical Diamant, n.d, url
413 CMK, Centre Medical de Kinshasa, n.d, url
414 Centre Hospitalier Monkole, n.d, url
415 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 202061

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

In general, those with the required financial resources travel internationally for all specialised care. 416
414F

12.2 Access to treatment
It is estimated that the majority of those affected by hepatitis B and C are unaware of their infection
status and are not receiving treatment. 417 As such, many of those infected develop liver cirrhosis andother complications. 418 Factors contributing to this treatment gap are many and include challenges toproviding and accessing care.419
415F

416F

Challenges to providing services include limited health facility resources to carry out diagnostic andmonitoring tests and provide treatment interventions.420 Systematic screening for hepatitis is not
performed within the population or at-risk groups, such as pregnant women. Primary healthcare
workers are not adequately trained and equipped to diagnose and treat patients with chronic hepatitis
B and C.421
Similarly, low access to healthcare for the population is rooted in numerous factors including lack offinancial resources to pay for services and inaccessibility of clinics due to geographical spread of healthcentres.422
In the absence of a national programme to control hepatitis, there are no targeted programmes toreduce barriers to accessing care.423 However, there are small localised trials which aim to pilot
approaches to determine their effect and scalability.424 Examples of these include reducing motherchild transmission of hepatitis B by integrating screening, treatment and immunisation programmes
into existing vertical transmission programmes.425

12.3 Cost of treatment
There are no financial support programmes for the treatment of hepatitis.426 The vast majority ofhousehold healthcare spending is through out-of-pocket payments at the point of care. Out-of-pocket
payments at the point of care are significant barrier to accessing healthcare. For the majority of the
population, treatment beyond primary care consultations are not economically accessible.427

416

EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
417 Coalition for Global Hepatitis Elimination, Data Dashboards Democratic Republic of Congo, 2019, url
418 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
419 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
420 EPSS, Evaluation des Prestations des Services de soins de Santé, Ecole de Santé Publique de Kinshasa, April 2019, p. 42
421 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
422 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
423 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
424 Clinical Trials, Arresting vertical transmission of Hepatitis B Virus, University of North Carolina and University of Kinshasa,
August 2020, url
425 Clinical Trials, Arresting vertical transmission of Hepatitis B Virus, Clinical Trials, University of North Carolina and Universityof Kinshasa, August 2020, url
426 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
427 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url pp. 41

62

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

The principal treatments options for hepatitis B and C are lengthy medications.428 The availability ofthese medications is very low and the costs of treatment is extremely high (discussed further
below).429
Other healthcare costs such as consultations and inpatient treatment depend on the type of healthfacility. The prices below were gathered from a range of clinics based in Kinshasa and provide anindication of the cost of healthcare services. The total costs incurred by patients can be approximatedby summing all relevant services. All medications incur supplementary charges. Of note, in-patient
costs are not inclusive of food.430
Publicoutpatient
treatment
price

Publicinpatienttreatment
price

Privateoutpatient
treatment
price

Privateinpatienttreatment
price

Reimbursement/ specialprogramme /free

USD 10-25

USD 25-40

Over USD
200

Over USD 30

None

Internist or Infectious
disease specialist

USD 20

USD 20

USD 40

USD 40None

Hepatologist

USD 20

USD 20

USD 40

USD 40None

Gastroenterologist

USD 20

USD 20

USD 40

USD 40

None

Internal medicine(Internist)

USD 20

USD 20

USD 40

USD 40

None

Laboratory research ofliver function (PT,albumin, bilirubin,transaminases:
ASAT(=SGOT),
ALAT(=SGPT)

USD 25

USD 35

USD 90

USD 90

None

Laboratory research of
HBV antibody in case ofhepatitis B

USD 10

USD 15

USD 40

USD 40

None

Laboratory research of
HCV antibody in case ofhepatitis C

USD 10

USD 15

USD 40

USD 40None

USD 40

USD 40

USD 105

USD 105

None

Cost of treatment

Clinical admission
Infectious diseasedepartment (daily rate)
Specialist

Clinical biology

Diagnostics for hepatitis
Diagnostic imaging bymeans of ultrasound (ofthe liver)

428 WHO, World Health Organization, Hepatitis, n.d, url
429

EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
430 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 202063

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Publicoutpatient
treatment
price

Publicinpatienttreatment
price

Privateoutpatient
treatment
price

Privateinpatienttreatment
price

Reimbursement/ specialprogramme /freeDiagnostic research, inthe form of liver biopsy

USD 90

USD 90

USD 150205

USD 150-205

None

Diagnostic research:transient elastography;
test for liver fibrosis(e.g. FibroScan)

USD 280

USD 280

USD 360

USD 360

None

Cost of treatment

12.4 Cost of medication
For most patients with hepatitis B, antiviral medications help to reduce the impact of infection but
they do not provide a cure. As such, patients require life-long treatment.431 In DRC, patients withchronic conditions usually often have poor adherence to treatments due to prohibitive costs and lackof availability of key medications.432
Direct Acting Antivirals can cure a patient of hepatitis C in 12 weeks with a success rate of over 90%.433
Licensing agreements allow for the use of some generic medicines in DRC reducing the cost oftreatment to increase access.434 Under generic pricing structures, a 12-week course of direct-acting
antiviral medications such as sofosbuvir for hepatitis C can be procured at USD 750 per patient.435
However, a weak central purchasing system for medications means that in spite of these vastly
reduced treatments costs, these medications are mostly unavailable in DRC.436
The price of medications was collected from eight registered pharmacies based in Kinshasa.437
Medicines from the informal market have not been included.
Form

Price per box

Is the drug included onnational essential drugs list?

Ledipasvir + sofosbuvir(combination)

TabletUSD 980 (90 mg/400 mg,
30 units per box)

No

Ribavirin

TabletUSD 360 (200 mg, 30 units
per box)

No

Drug nameHepatitis C medication

Both Hepatitis B and C(classic medication)

431 WHO, World Health Organization, Guidelines on hepatitis B and C testing, February 2017, url, p. 24
432

EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
433 WHO, World Health Organization, Guidelines on hepatitis B and C testing, February 2017, url, p. 28-29
434 WHO, World Health Organization, Technology and market landscape hepatitis C medicines, August 2017, url, p. 54
435 WHO, World Health Organization, Technology and market landscape hepatitis C medicines, August 2017, url, p. 59
436 Medical Xpress, Researchers define the burden of Hepatitis in Democratic Republic of the Congo, October 2017, url
437 Please refer to the Introduction for further details on the methodology of price data collection

64Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Drug name

Form

Price per box

Is the drug included onnational essential drugs list?

Interferon alfa 2aTabletUSD 350 (600 mg, 30 units
per box)

No

Interferon alfa 2b

TabletUSD 125 (20 0 mg, 30 units
per box)No12.5 NGOs
The national NGO called Association d’encadrement des personnes infectées par l'hépatite (alsoknown as SOS Hépatites), is a member of the World Hepatitis Alliance.438 The organisation advocatesto strengthen health services for those with hepatitis.439
Research for the report did not identify any other NGOs supporting health services for hepatitis.

13 HIV/AIDS
13.1 General information
13.1.1 Epidemiological context
Since 2010, the prevalence of HIV has been steadily decreasing.440 However, it remains among theleading causes of death in DRC.441 There are approximately 520,000 people living with HIV/AIDs in DRC
representing 1.2% of the population.442
Prevalence data on opportunistic infections is very limited.443 A study on patient data from a hospitalin Kinshasa identified TB as the main opportunistic infection, affecting 43%444 of patients being treatedfor HIV. This was followed by fungal infections, such as candidiasis (21% co-infected), pneumonia(11%), and other viral and bacterial infections, such as herpes zoster (10%) and salmonella (4%).445

438 World Hepatitis Alliance, Our Members, n.d, url
439 SOS Hépatites, August 2019, url
440 UN AIDS, Democratic Republic of Congo Fact Sheet, 2019, url
441 Institute of Health Metrics, DRC Dashboard, 2017, url
442 UN AIDS, Democratic Republic of Congo Fact Sheet, 2019, url
443

EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
444 The study methodology does not include the total number of patients included.
445 Kamangu, NE. et al., Profiles of opportunistic infections in people living with HIV followed at the Military Hospital of
Kinshasa Reference (camoKokolo), DRC, Retrovirology, May 2012, doi:10.1186/1742-4690-9-S1-P146

65

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

13.1.2 Strategies and policies for treatment and management of HIVAIDS
Addressing the burden of HIV/AIDS is a key priority for the Government. Two current strategy
documents outline the Ministry of Health446 and the multisectoral447 approach to control and prevent
HIV/AIDS. In particular, these aim to reduce transmission rates, particularly from mother to child, andincrease access to quality healthcare. The strategy documents aim to reduce the number of new
infections by 80% by 2021.448
The national HIV/AIDS programme received 90% of financing through external resources.449 Key
donors to the HIV/AIDS response are PEPFAR (the U.S. President's Emergency Plan for AIDS Relief) and
the Global Fund.450 PEPFAR focuses its activities on the three key provinces Haut-Katanga, Lualaba andKinshasa, which account for 50% of the total number of people living with HIV/AIDS in DRC.451 The
financial contribution from the government primarily funds health worker salaries and someinfrastructure.452

13.1.3 Healthcare provisions for treatment and management of HIV/AIDS
In general, the care and treatment of people living with HIV/AIDS consists of three components:
medical, nutritional and psychosocial. This includes promotion of prevention, testing, care, treatment(including for opportunistic infections), and viral load detection.453 According to the National Strategy
for the Fight Against HIV/AIDS, these services should be integrated into the broader health system.454
This means that the diagnosis and treatment of HIV/AIDS should be provided by all health facilities.
However, as described below, weak supply chains limit the extent to which health facilities are able
to provide a comprehensive package of HIV/AIDS services.455 At a community level, networks ofCommunity Health Workers (CHWs) act as an intermediary between health facilities and theircommunities. With regard to HIV, CHWs aim to increase coverage of treatment by encouraging
healthcare-seeking behaviours and promote prevention messaging. Importantly, this includes
addressing HIV-related stigma.456
In addition to integrated health services, a specialist HIV/AIDS medical facility known as Kabinda Day
Hospital is managed by Medicins Sans Frontières in Kinshasa. The hospital provides treatment forpeople at all stages of HIV/AIDS infection including those with advanced AIDS.457

446 Plan Strateguque Multisectoriel Santé de la Lutte Contre le VIH/SIDA 2018-2021, Programme National de la Lutte Contre

le VIH/SIDA, Ministère de la Santé, République Démocratique du Congo
447 PSNHIV, Plan Stratégique National de la Riposte au VIH/SIDA 2018-2021, Programme National Multisectoriel de Lutte
contre le Sida, Secretariat Executif National, pp. 26-27
448 PSNHIV, Plan stratégique sectoriel santé de La lutte contre le vih/sida 2018-2021, Ministère de la Santé, République
Démocratique du Congo, April 2018, pp. 26-27
449 Plan Stratégique Multisectoriel Santé de la Lutte Contre le VIH/SIDA 2018-2021, Programme National de la Lutte Contre
le VIH/SIDA, Ministère de la Santé, République Démocratique du Congo [no url], pp. 9450 Plan Stratégique Multisectoriel Santé de la Lutte Contre le VIH/SIDA 2018-2021, Programme National de la Lutte Contre
le VIH/SIDA, Ministère de la Santé, République Démocratique du Congo [no url], pp. 24-29
451 PEPFAR, Democratic Republic of the Congo Country Operational Plan (COP) 2019 Strategic Direction Summary, April 2019,url, p. 3
452 PEPFAR, Democratic Republic of the Congo Country Operational Plan (COP) 2019 Strategic Direction Summary, April 2019,url, pp. 55
453 EPSS, Evaluation des Prestations des Services de soins de Santé, Ecole de Santé Publique de Kinshasa, April 2019, url, p.
228
454 PSNHIV, Plan stratégique sectoriel santé de La lutte contre le vih/sida 2018-2021, Ministère de la Santé, République
Démocratique du Congo, April 2018 [no url], pp. 26-27
455 EPSS, Evaluation des Prestations des Services de soins de Santé, Ecole de Santé Publique de Kinshasa, April 2019, url, pp.
228-230456 DFID, Department for International Development, Effectiveness of Community Health Workers, November 2018, url, p. 8457 MSF, Médecins Sans Frontières, In Kinshasa, HIV-positive people wait until death’s door before coming to receive
treatment, November 2019, url

66

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

13.2 Access to treatment
In spite of being a priority disease for the Ministry of Health, UNAIDS estimates that the coverage of
HIV/AIDS services is low. Approximately 53% of adults and children living with HIV receive
antiretroviral therapy (ARTs), leaving a coverage gap of over 40%. This varies across different
segments of the population with highest coverage in men aged over 15 at 72%, and lowest in children
aged from 0 to 14, at 28% coverage. The coverage of treatments to prevent mother to childtransmission is estimated at 45%.458 Details on the treatment coverage of opportunistic infections isvery limited. Factors which contribute to low coverage include poor availability of diagnostics andtreatment interventions in health facilities.459
A representative sample of health centres were reviewed in 2017 and 2018 to determine the extent
of stock shortages in medical facilities. The assessment found that approximately 4 out of 10 healthfacilities did not have resources to conduct HIV screening, including rapid testing kits and ARTs whichwere only available in 37% of health facilities. The availability of medicines and diagnostic kits varied
by type of health facility. Hospitals recorded the greatest availability of products at the point ofassessment, while conversely, these were least available in Health Centres. Significant provincial
variation was also recorded with treatments least available in Central and North-western provinces.460
The lack of availability of diagnostic and treatment products in community-level health facilities,
creates a notable barrier to accessing HIV/AIDS services. Community members are required to travel
greater distances to find facilities with medicines in stock.461 Other factors limiting access to treatment
include lack of affordable transport, stigma, and prohibitive cost of initial consultations.462

13.3 Cost of treatment
In principle, there should not be any user fees for HIV treatment services, including biologicalmonitoring and distribution of ARTs.463 However, it is not uncommon for patients to be charged
consultation and testing fees prior to knowing their HIV status. The price of these vary according to
the type of health facility (health centre or hospital) and whether they are public or private facilities.464
Costs of treatment of associated healthcare, such as co-infections, are not systematically free ofcharge.465 User fees are often prohibitive and limit access to treatment for large portions of the
population.466
Some targeted programmes, such as conditional cash and voucher programmes, have been
implemented to reduce financial burdens and encourage use of HIV/AIDS services.467 For example, arandomised control trial conducted at an antenatal clinic gave participants USD 5 for enrolling on a

458 UNAIDS, Democratic Republic of Congo Fact Sheet, 2019, url
459 EPSS, Evaluation des Prestations des Services de soins de Santé, Ecole de Santé Publique de Kinshasa, April 2019, url, pp.

227-238460 EPSS, Evaluation des Prestations des Services de soins de Santé, Ecole de Santé Publique de Kinshasa, April 2019, url, pp.
227-238
461 Motomoke, E Village reach, On Road and River: Distributions begin in DRC, August 2017, url
462 The conversation, HIV is still taboo in the DRC: chronicles from Kinshasa, August 2017, url
463 Plan Stratégique Multisectoriel Santé de la Lutte Contre le VIH/SIDA 2018-2021, Programme National de la Lutte Contre
le VIH/SIDA, Ministère de la Santé, République Démocratique du Congo [no url], p. 24
464 Democratic Republic of the Congo Country Operational Plan (COP) April 2019, President's Emergency Plan For AIDS Relief,
PEPFAR, url, p. 43
465 EASO3, Deputy Manager of a priority national programme. Responsible for national implementation of the strategy, Email
Correspondence, August 2020
466 MSF, Medecins Sand Frontieres, Left Behind by the HIV Response, December 2017, url, p. 26
467 Yotebieng, M. et al., Lancet HIV, February 2016, Conditional cash transfers increase uptake of and retention in PMTCT
care: A randomized controlled trial url

67Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

programme to prevent mother-to-child HIV transmission.468 Those who enrolled were given an
additional dollar for each consultation visit. The study found the conditional cash programmeincreased the number of women who attended antenatal visits. However, these types of programmes
are often localised and not integrated into the health system.469
The cost of inpatient care is more expensive in private hospitals when compared to public facilities.
The increased price relates primarily to the cost of the room, rather than consultations and tests. The
prices below were gathered from a range of clinics based in Kinshasa and provide an indication of thecost of healthcare services. The total costs incurred by patients can be approximated by summing all
relevant services. Of note, in-patient costs are not inclusive of food.470

Cost of treatment

Publicoutpatient
treatment
price

Publicinpatienttreatment
price

Privateoutpatient
treatment
price

Privateinpatienttreatment
price

Reimbursement /specialprogramme / free

Free

Free

USD 95

USD 300

Free in all public
facilities supportedby the PSNHIV

Free

Free

USD 40

USD 40Free in all public
facilities supportedby the PSNHIV

Free

Free

USD 40

USD 40Free in all public
facilities supportedby the PSNHIV

Free

Free

USD 40

USD 40Free in all public
facilities supportedby the PSNHIV-Free incertain notfor-profit
clinics

Clinical admission
Infectious
diseasedepartment (daily rate)
Consultation cost by
specialist
Internist

Infectious
specialist

HIV specialist

diseaseClinical biology

CD4 count*

Viral Load

-

Free

Free

Free incertain notfor-profit
clinics

USD 100-112
in private
clinics

USD 100112 inprivateclinics

USD 10

USD 10Free in certain notfor-profit clinics

Free in all public
facilities supportedby the PSNHIV

468 Yotebieng, M. et al., Lancet HIV, Feburary 2016, Conditional cash transfers increase uptake of and retention in PMTCT

care: A randomized controlled trial url
469 Tull, K, Social Protection Measures for Increasing Access to Health Services, 2018, University of Leeds Nuffield Centre forInternational Health and Development, November 2018, url
470 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 202068Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)* The government has not been able to mobilise resources for CD4 counts in public health facilities.
These are for example covered and carried out in clinics managed by the NGO Médecins Sans
Frontières.471

13.4 Cost of medication
Antiretroviral treatments for HIV are free of charge at all health facilities and registered pharmacies.472
The price of medications was collected from eight registered pharmacies based in Kinshasa.473
Medicines from the informal market have not been included.

471 EASO3, Deputy Manager of a priority national programme. Responsible for national implementation of the strategy, Email

Correspondence, August 2020
472 Plan Stratégique Multisectoriel Santé de la Lutte Contre le VIH/SIDA 2018-2021, Programme National de la Lutte Contre
le VIH/SIDA, Ministère de la Santé, République Démocratique du Congo [no url], p. 24
473 Please refer to the Introduction for further details on the methodology of price data collection

69Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Form

Price per box

Is the drug included onnational essential drugs
list?

Ritonavir

TabletFree (100 mg, 120 units per
box)

Yes

Darunavir

TabletFree (600 mg, 60 units per
box)

Yes

Dolutegravir

TabletFree (50 mg, 30 units per
box)

Yes

Drug nameSingle antiretroviral/ARVs:

Nevirapine

TabletEfavirenz

TabletLamivudine (both for hepatitis B
and HIV)

TabletAbacavir

TabletZidovudine

TabletFree (50 mg, 60 units perbox)
Free (200 mg, 60 units perbox)
Free (200 mg, 30 units perbox)
Free (600 mg, 30 units perbox)
Free (150 mg, 30/60/90/120
units per box)
Free (300 mg, 30/60/90/120
units per box)
Free (300 mg, 60 units perbox)
Free (150 mg, 30/60/90/120
units per box)
Free (300 mg, 30/60/90/120
units per box)

Yes

Yes

Yes

Yes

Yes

Combination with 2, 3, or 4
antiretrovirals:
Truvada®
(combinationofemtricitabine/tenofovir
disoproxil)

Combivir®
(combination
zidovudine / lamivudine)ofTabletTabletFree (200 mg, 30 units perbox)
Free (300 mg, 30 units perbox)
Free (150 mg, 30 units perbox)
Free (300 mg, 30 units per
box).

Yes

Yes

Epzicom® Kivexa® (combination of
abacavir and lamivudine)

TabletFree (300 mg, 60 units per
box)

Yes

Kaletra® (combination of lopinavir/ ritonavir)

TabletFree (100 mg, 60 units per
box)

Yes

70

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

13.5 NGOs
Providing and strengthening HIV/AIDS services is a priority for the Ministry of Health and the broader
global health community.474 As such, the role of national and international NGOs is extensive.475 The
literature review did not elucidate existing resources providing a comprehensive overview of the roleof NGOs in HIV/AIDS service provision. The role of NGOs can be understood through project
documents and resources published on NGO websites.
Examples of international NGOs delivering HIV/AIDS health services include MSF,476 IMC,477 andCordaid.478 These NGOs often work with local NGOs and civil societies to implement projects. For
instance, in 2018, Cordaid worked with 28 civil society organisations to deliver HIV/AIDs services in
413 health zones across the country.479 The type of services provided by international NGOs varies
from managing clinics, training medical staff to integrating specific activities, such as psychosocial
support.480
MSF and IMC in particular manage a number of clinics across Eastern provinces which provide HIV
services among other things. In addition, MSF manages a large specialist HIVAIDS clinic in Kinshasa
known as the Centre Hospitalier de Kabinda. In 2018, the clinic provided treatment to over 2 000
patients.481

14 Nephrology
14.1 General information
14.1.1 Epidemiological context
Nephrology relates to the study of kidneys and kidney disease. Prevalence data for kidney disease in
DRC is very limited.482 Estimates for the prevalence of Chronic Kidney Disease (CKD) range from 7% to12%483 of the population and end-stage renal disease is estimated to affect 0.2% of the population.484
In line with global trends as the burden of noncommunicable diseases and risk factors increase, theoverall prevalence is estimated to be increasing.485 Key risk factors for CKD include hypertension anddiabetes.486

474 WHO, World Health Organization, WHO Cooperation Strategy with Democratic Republic of Congo 2017-2021, 2017475 Plan Stratégique Multisectoriel Santé de la Lutte Contre le VIH/SIDA 2018-2021, Programme National de la Lutte Contre

le VIH/SIDA, Ministère de la Santé, République Démocratique du Congo [no url], p. 50
476 MSF, Doctors Without Borders, 2018, url
477 IMC, International Medical Corps, Democratic Republic of the Congo, n.d, url
478 Cordaid, Global Fund Partnership, 2018 url
479 Cordaid, Global Fund Partnership, 2018 url
480 WHO, World Health Organisation, Health Cluster Democratic Republic of Congo, June 2020, url
481 MSF, Doctors Without Borders, 2018, url
482 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
483 Mannix, M. et al., Prevalence and risk factors of chronic kidney disease (CKD) in South Kivu, Democratic Republic of Congo(DRC): a population-based study, nephrology dialysis transplantation, May 2018, url, p. 1; Sumaili, E. et al, Epidemiology ofchronic kidney disease in the Democratic Republic of Congo: Review of cross-sectional studies from Kinshasa, the capital July
2010, url, p. 1
484 Sumaili, E. et.al, Prevalence of chronic kidney disease in Kinshasa: results of a pilot study from the Democratic Republicof Congo, January 2009, url, p. 1
485 Sumaili, E. et.al, Prevalence of chronic kidney disease in Kinshasa: results of a pilot study from the Democratic Republicof Congo, January 2009, url, p. 1
486 Please refer to chapters on cardiovascular disease and diabetes for further information

71Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

14.1.2 Strategies and policies for treatment and management of kidneydiseaseA national programme or strategy specifically aimed at addressing the burden of CKD has not beendeveloped.487 CKD is also not mentioned in the National Health Development Plan 2019-2022 (Plan
National de Développement Sanitaire, PNDS).488 However, key risk factors, notably hypertension anddiabetes are referred to in the PNDS and national programmes to address them have beendeveloped.489,490

14.1.3 Healthcare provisions for treatment and management of kidney disease
Primary care facilities offer basic services.491 These include medications and lifestyle consultations toaddress risk factors, such as hypertension.492 Specialist care for nephrology is very limited due to alack of trained physicians and specialised equipment.493 With regard to human resources specialisedin the treatment of kidney disease, data suggests that there are very few specialised nephrologists in
DRC. A study from 2007 estimated that there were seven nephrologists (0.11/million inhabitants) forthe entire population.494 While it is possible that the number of nephrologists has increased, it isprobable that these are still relatively few in number.495
The local consultant provided this information in April 2021: 496•••

Haemodialysis centres exist both in the public and private sector.
In general, most of the haemodialysis centres in the country are owned by the private sector.
Although there has been significant progress, the haemodialysis centres are still unevenly
distributed across the country. Haemodialysis centres are located in various regions, provinces
and cities in the following way: 497•

The North-western provinces (former Equateur province and former Orientale province) as
well as in the central provinces (former Kasai-Oriental province, former Kasai- Occidental andformer Bandudu province) appear not to have haemodialysis centres. 498

487

EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
488 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, pp. 21 and 93
489 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
490 Please refer to chapters on cardiovascular disease and diabetes for further information
491 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, p. 9492 EPSS, Evaluation des Prestations des Services de soins de Santé, , Ecole de Santé Publique de Kinshasa, April 2019, url, pp.
251-259493 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
494 Krzesinski, JM., How to tackle the avalanche of chronic kidney disease in sub-Saharan Africa: the situation in the
Democratic Republic of Congo as an example, nephrology dialysis transplantation, February 2007, url, p. 334
495 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
496 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, April 2021
497 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, April 2021
498 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, April 2021

72Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)•

In the South East of the country, 16 haemodialysis centres are located in Lubumbashi in thefollowing way: 499
10 at Medical Centre du Centre Ville ( Centre Médical du Centre Ville = CMDC)500
2 at Medical Centre Beniker (Centre Medical Beniker)
1 at MedPark Clinic 501
2 at Medical Centre Baraka (Centre Medical Baraka) and1 at Hospital Gecamines Sud (Hôpital Gecamines Sud)502 with the additional note that due
to technical problems, the dialysis machines in Hôpital Gecamines Sud and Centre Medical
Baraka may not be operational for 4 to 5 months per year. 503•

In the mid-North eastern part of the country haemodialysis centres are located in Bukavu
and Goma. 504•

In Kinshasa, these numbers of haemodialysis machines were located in the following way: 505
10 at Kinshasa University Clinic (Clinique Universitaire de Kinshasa):
0 at Kinshasa General Hospital (Hôpital Général de Kinshasa/ Hôpital Général Provincial deReference de Kinshasa): no haemodialysis machines are currently operational
13 at HJ Hospital Kinshasa (HJ Hôpitaux Kinshasa) 506
5
0
9
5
8

at Medical Centre Kinshasa (Centre Médical de Kinshasa)
at Ngaliema Clinic (Clinique Ngaliema): no haemodialysis machines are currently
operational
at Medical Centre AFIA (Centre Medical AFIAat Military Medical Centre Camp Lufungula (Centre Médical Militaire Camp Lufungula)at Ngaliema ( Medical) Centre 507: 8 operational haemodialysis machines 508

The local consultant provided this information in August- November 2020:
Kidney transplants are not currently available in DRC. Kidney donor candidates are referred abroad by
Congolese nephrologists. Complications upon return to DRC often cannot be adequately managed byin-country facilities, requiring the patient to travel abroad for follow-up care.509

499

EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, April 2021
500
CMDC, Centre Médicale du Centre Ville, n.d., url
501
MedPark Clinic, n.d., url502
Hôpital Gecamines Sud, n.d., url
503 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, April 2021
504 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, April 2021
505 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, April 2021
506
HJ Hospitals, n.d., url
507
Ngaliema Medical Center, n.d.; url
508 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, April 2021
509 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 202073

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

14.2 Access to treatment
Access to treatment for CKD and end-stage kidney disease is very limited.510 There is limited
information on the national treatment gap; however, a study from 2012 in Kinshasa estimates that
only 12% of those requiring dialysis are on treatment.511 As a result, according to a review on accessto dialysis in Kinshasa, most patients with end-stage renal disease in DRC die without receiving
appropriate treatment.512
Treatment for kidney disease incudes lifestyle consultations and pharmacological interventions tomanage high blood pressure and high cholesterol.513 These are similar to treatments required for
cardiovascular disease.514 These are accessible in primary care facilities, such as health centres.515
Specialist care includes dialysis. As there are only two dialysis centres, this creates a significant
geographical barrier for the majority of the population who lives in rural settings.516 Other factors
contributing to poor access to treatment include the prohibitive cost of healthcare (discussed below)
and lack of affordable transport.517

14.3 Cost of treatment
There is no national risk-sharing mechanisms or national health insurance for the treatment of kidneydisease.518 As a result, the majority of households use out-of-pocket payments at the point of care.519
The treatment of kidney disease is prohibitively expensive for the majority of the population. Dialysis
in particular requires financial resources which far exceed the average income in DRC.520 The total
estimated cost of regular haemodialysis, including dialysis and medications, is approximately USD 28
000 per year.521 The average annual income is USD 1 080.522
The prices below were gathered from a range of clinics based in Kinshasa and provide an indication of
the cost of healthcare services. The total costs incurred by patients can be approximated by summing

510

EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
511 Mukendi, S. et al., Accessibilité à la dialyse péritonéale continue en ambulatoire à Kinshasa, Journal of Nephrology,
September 2012, url
512 Izeidi, P. et al., Cost estimate of chronic hemodialysis in Kinshasa, the Democratic Republic of the Congo: A prospective
study in two centres, Hemodialysis International, 2020, url, p. 122
513 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
514 Please refer to report on cardiovascular disease for further details.
515 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
516 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
517 Kalisya, L. et al., The state of emergency care in Democratic Republic of Congo, African Journal of Emergency Medicine,
August 2015, url, p. 156
518 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
519 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, p. 41
520 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
521 Izeidi, P. et al., Cost estimate of chronic haemodialysis in Kinshasa, the Democratic Republic of the Congo: A prospective
study in two centres, Haemodialysis International, 2020, url, p. 124
522 World Bank, Data Bank, GNI per capita, PPP (current international $) 2018, url

74

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

all relevant services. All medications incur supplementary charges. Of note, inpatient costs are notinclusive of food.523
Publicoutpatient
treatment
price

Publicinpatienttreatment
price

Privateoutpatient
treatment
price

Privateinpatienttreatment
price

Reimbursement/ specialprogramme /free

USD 25-50

USD 50

USD 30

USD 30No

Consultation by aninternist

USD 10

USD 10

USD 40

USD 40No

Consultation by anephrologist

USD 10

USD 10

USD 50

USD 50No

Research forelectrolytes; potassium,
sodium, calcium andmagnesium

USD 40

USD 55

USD 65-100

USD 65-100

No

Research / acid-basebalance in blood andurine; e.g. serum andurine pH, electrolyte
levelsUSD 25

USD 35

USD 40-100

USD 40-100

No

Research of bacterial
cultures

USD 10

USD 15

USD 30-100

USD 30-100

No

Research of renal/
kidney function(creatinine, urea,
proteinuria, sodium,
potassium levels)

USD 30

USD 45

USD 65-300

USD 65-300

No

Research: PTH, calcium,
phosphate

USD 40

USD 60

USD 50-70

USD 50-70

No

USD 30-35

USD 30-35

USD 45-100

USD 45-100

No

Haemodialysis (cost of
one session)-

USD 60-195
per session

USD 340-490
per session

USD 340-490
per session

No

Acute haemodialysis-

USD190 per
sessionUSD 250 per
sessionUSD 250 per
sessionNo

Cost of treatment

Clinical admission
Nephrology department(daily rates)
Specialist Consultation

Laboratory tests

Medical imaging
Ultrasound of kidney
Treatment

523

EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 202075

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

14.4 Cost of medication
Patients often have poor adherence to treatments, particularly for chronic conditions like thoserelated to kidney disease.524 This is due to prohibitive costs and lack of availability of key
medications.525 The estimated quarterly costs of medications for a patient with end-stage renal
disease is USD 802.526
The price of medications was collected from eight registered pharmacies based in Kinshasa.527
Medicines from the informal market have not been included.

Form

Price per box

Is the drug typically
included on the national
essential drugs medicines
list?

Injection

USD 30-50 (4 000 mg, 6units per box)

Yes

calcium carbonate

Tablets

USD 10 (500 mg, 60 units
per box)Yesmagnesium hydroxide +aluminium hydroxide(combination)

SachetUSD 20 (400 mg 30 units
per box)

TabletUSD 5 (400 mg, 40 units
per box)sevelamer

TabletUSD 100 (800 mg, 180
units per box)

Drug name

Haematopoietic growth factor;
for anaemia due to renal
problems
Erythropoietin
Phosphate binders

Yes

Yes

Medication to treat metabolic
acidosis
sodium bicarbonate(= sodium hydrogen carbonate)

Suspension

USD 10 (250 ml 1 unit perbox)
USD 20 (500 ml, 1 unit per
box)

Yes

14.5 NGOs
The key informant interviews and literature review did not identify any national or international NGOs
who focus specifically on kidney disease.

524 EASO2, Director of a national programme within the Ministry of Health and Medical Director and Head of Cardiology atprominent Kinshasa based facility, Email Correspondence, August 2020
525 Please refer to chapter 4 for further details on the pharmaceutical sector
526 Izeidi, P. et al., Cost estimate of chronic haemodialysis in Kinshasa, the Democratic Republic of the Congo: A prospective
study in two centres, Haemodialysis International, 2020, url, p. 125
527 Please refer to the Introduction for further details on the methodology of price data collection76Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

15 Neurology: epilepsy and cerebrovascular
accident (stroke)
15.1 General information
15.1.1 Epidemiological context
Neurological disorder includes a range of disorders; the focus here is on epilepsy and stroke.
Availability of prevalence data on neurological disease in DRC varies by type of disease.528
WHO publishes estimates of stroke529 prevalence and burden of disease. According to these, in 2018
stroke accounted for 29 821 or 4.48% of total deaths in DRC and has been ranked among the top 10
causes of death throughout the last decade.530
The prevalence of epilepsy is significantly less well documented. Globally, epilepsy is believed to affect
4 to 10 people in every 1,000.531 In DRC, a study carried out in Lubumbashi suggests that theprevalence is approximately 6 per 1 000 (500 000 individuals).532 However, there is little data to
generalise this to the wider population.533 Relative proportions of neurological disorders can beinferred from health facility patient records. Among 3 540 patients who presented to aneuropsychiatric clinic over a 1-year period, 423 (11.9%) were identified as having epilepsy.534 For the
majority of people with epilepsy, the underlying cause is unknown. However, global estimates suggestthat approximately 25% of cases result from traumatic brain injury and are therefore considered
preventable.535 Road traffic accidents are a key driver of brain injury and the incidence of accidents ishigh in DRC.536

15.1.2 Strategies and policies for treatment and management of CVD
The National Health Development Plan 2019-2022 (Plan National de Développement Sanitaire, PNDS)
does not include any reference to epilepsy or stroke.537 In addition a, targeted national programme
has not been developed by the Ministry of Health for either of these diseases.538 However, the PNDS

528

EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
529 Stroke results either from a blood clot blocking blood flow to the brain (ischaemic) or bleeding around the brain(haemorrhagic).
530 Institute of Health Metrics, DRC Dashboard, 2017, url
531 WHO, World Health Organization, Epilepsy, June 2019, url
532 Koba Bora, B. et al., Living with epilepsy in Lubumbashi: epidemiology, risk factors and treatment gap, Pan Africa Medical
Journal, August 2015 url pp.1
533 Mukuku, O. et al., Epidemiology of Epilepsy in Lubumbashi, Hindawi Neurology Research International, June 2019, url
pp.2
534 Koba Bora, B. et al., Living with epilepsy in Lubumbashi: epidemiology, risk factors and treatment gap, Pan Africa Medical
Journal, 26 August2015 doi: url
535 WHO, World Health Organization, Epilepsy, June 2019, url
536 Institute of Health Metrics, “DRC Dashboard,” 2017, url
537 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url
538 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 202077Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

does include addressing hypertension under its key performance indicators.539 Hypertension is a key
risk factor for stroke.

15.1.3 Healthcare provisions for neurology
The PNDS places an emphasis on strengthening primary care services.540 Neurological treatments
available from primary care services are extremely limited. Services include dispensing medications
when these are in stock.541
Specialist treatments are available in hospitals of large urban areas notably Lubumbashi542 andKinshasa.543 There is one specialist neuropsychiatric institution located in each of these cities, theseare: Centre Neuro-Psychiatrique Joseph Guislain, Lubumbashi,544 and Centre Neuro-PsychoPathologique, in Kinshasa University Hospital.545 Epilepsy services available in these hospitals include
diagnostic tests (electroencephalography (EEG) and computerised tomography (CT) scan, as well as
treatment using anti-epileptic medications.546
The treatments for stroke aim to reduce the impact of the stroke and decrease the likelihood ofreoccurrence. An important risk factor for stroke is cardiovascular disease.547 Treatments for stroke
include pharmacological interventions immediately after the episode of stroke, followed by longer
term physiotherapy to manage impairments. The latter is available in both of the specialist
neurological centres in Kinshasa and Lubumbashi.548

15.2 Access to treatment
General access to healthcare in DRC is extremely limited. This is even more true for specialist services
such as neurology.549
An observational study of patients diagnosed with epilepsy in Lubumbashi, estimated a treatment gap
of 67%.550 As the estimate is based on those presenting at the hospital, the actual treatment gap islikely to be significantly greater.551 Epilepsy was also characterised by late presentation to physicianswith the mean duration between the onset of seizures and first consultation at 83.5 months.552 This

539 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République

Démocratique du Congo, November 2018, url, p. 79
540 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, p. 4
541 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
542 DRC’s second largest city located in the South East
543 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
544 Fracarita International, n.d, url
545 Univeristy de Kinshasa, Centre Neuro Pyscho Pathologique, n.d, url
546 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
547 For further details on healthcare services for CVD, please refer to the CVD report.
548 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
549 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
550 Koba Bora, B. et al., Living with epilepsy in Lubumbashi: epidemiology, risk factors and treatment gap, Pan Africa Medical
Journal, August 2015 url, p. 3
551 Koba Bora, B. et al., Living with epilepsy in Lubumbashi: epidemiology, risk factors and treatment gap, Pan Africa Medical
Journal, August 2015 url, p. 2
552 Mukuku, O. et al., Epidemiology of Epilepsy in Lubumbashi, Hindawi Neurology Research International, 29 June 2019, url,
p. 3

78

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

increases the likelihood of long-term impairments from unmanaged seizures.553 The treatment gap forstroke is unknown, as many patients and their families do not seek formal care.554
Traditional healers have an important role in epilepsy. In rural districts where formal healthcare
structures are limited, traditional medicine is often the first healthcare sought for children withepilepsy.555 In the aforementioned observational study in Lubumbashi, 30% of patients with epilepsy
had visited traditional healers prior to presentation at the hospital.556
Factors contributing to poor access to treatment include the prohibitive cost of healthcare (discussed
below), poor availability of specialist services nationally and lack of affordable transport.557 A lack oftransport facilities particularly affects access to emergency care during a stroke.558
Globally, epilepsy has a long history of association with witchcraft and evil spirits, leading to stigma
that affects health-seeking behaviours. A study on perceptions of epilepsy from a rural community in
Ituri, a North eastern province, found that epilepsy related stigma was common.559 Although thesefindings cannot be generalised to the entire population, they do demonstrate additional factors that
impact health-seeking behaviours of families and access to anti-epileptic drugs.560

15.3 Cost of treatment
There are no financial support programmes for the treatment of neurological disorders.561 The vast
majority of household healthcare spending is through out-of-pocket payments at the point of care. 562
Out-of-pocket payments are significant barrier to healthcare. For the majority of the population,
treatments beyond primary care consultations are not economically accessible.563 For example, theaverage cost of hospitalisation in a public neurology ward is USD 17.5 - 25 per day. Diagnostic imaging,such as an EEG, is supplementary and costs on average 33.5 USD. The average annual income isapproximately USD 1 080, equating to USD 90 per month.564
The prices below were gathered from a range of clinics based in Kinshasa and provide an indication of
the cost of healthcare services. The total costs incurred by patients can be approximated by summing
all relevant services.565

553 Epilepsy Foundation, Thinking, Memory and Epilepsy, February 2014, url
554

EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
555 Mukuku, O, et al., Epidemiology of Epilepsy in Lubumbashi, Hindawi Neurology Research International, June 2019, url, p.
3
556 Mukuku, O. et al., Epidemiology of Epilepsy in Lubumbashi, Hindawi Neurology Research International, June 2019, url, p.
4557 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
558 Kalisya, L. et al., The state of emergency care in Democratic Republic of Congo, African Journal of Emergency Medicine,
August 2015, url, p. 156
559 Dolo, H. et al.,Community perceptions of epilepsy and its treatment in onchocerciasis endemic region in Ituri, Infectious
diseases of poverty, December 2018 url, pp. 3-6
560 Mukuku, O. et al., Epidemiology of Epilepsy in Lubumbashi, Hindawi Neurology Research International, 29 June 2019, url,
p. 3
561 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
562 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, Nov 2018, url, p. 41
563 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
564 World Bank, Data Bank, GNI per capita, PPP (current international $) 2018, url
565 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 202079Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Publicoutpatient
treatment
price

Publicinpatienttreatment
price

Privateoutpatient
treatment
price

Privateinpatienttreatment
price

Reimburse
ment /
specialprogramme/ freeUSD 10-20

USD 20-25

USD 50

USD 50No

Neurologist

USD 15-25

USD 15-25

USD 30-50

USD 30-50

No

Rehabilitation specialist

USD 10

USD 10

USD 30

USD 30No

Neurosurgeon

USD 15-25

USD 15-25

USD 50

USD 50No

Internist

USD 10

USD 10

USD 40

USD 40No

Physical therapist

USD 10

USD 10

USD 20-30

USD 20-30

No

USD 30

USD 30

USD 50250

USD 50250

No

CT scan

USD 100-180

USD 100-180

USD 280450

USD 280450

No

MRI scanUSD 190

USD 190

USD 200500

USD 200 500

No

Cost of treatment

Clinical admission
Clinical admittance in neurology
department (daily rates)
Specialist consultation

Laboratory research and diagnostics
EEG (Electroencephalogram)

15.4 Cost of medication
Patients often have poor adherence to treatments, particularly for chronic conditions like neurologicaldisorders.566 This is due to prohibitive costs and lack of availability of key medications.567
The price of medications was collected from eight registered pharmacies based in Kinshasa.568
Medicines fromthe informal market have not been included.

566

EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
567 Please refer to chapter 4 for further details on the pharmaceutical sector
568 Please refer to the Introduction for further details on the methodology of price data collection80Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Drug name

Form

Price per box

Is the drug included on the national
essential drugs list?

Antiepileptics (e.g. toreduce frequency of
attacks)
USD 30 (250 mg, units
per box)
Levetiracetam

TabletUSD 35 (500 mg, 50 units
per box)

No

USD 39 (1 000 mg, 30
units per box)

Carbamazepine

TabletValproic acid OR
Valproate OR
Depakine®

TabletUSD 20 (100 mg, 20 units
per box)
USD 40 (200 mg, 20 units
per box)
USD 15 (500 mg, 40 units
per box)Yes

Yes

USD 55 (150 mg, 56 units
per box)Pregabaline

TabletUSD 45 (75 mg, 56 units
per box)
USD 20 (50 mg, 30 units
per box)

No

USD 15 (25 mg, 30 units
per box)Gabapentine

TabletUSD 75 (300 mg, 90 units
per box)No

Phenytoin*

TabletUSD 15 (100 mg, 100
units per box)

Yes

Phenobarbital

TabletUSD 13.5 (100 mg, 15
units per box)

Suspension

USD 10, (5 ml, 1 unit perbox)

CapsulesUSD 240 (250 mg, 100
units per box)

Injection

USD 40 USD (1 mg, 6units per box)

Ethosuximide*

Clonazepam
Tablet81

USD 10 (50 mg, 15 units
per box)

USD 25 (0.5 mg, 100
units per box)
USD 20 (2.5 mg, 40 units
per box)

Yes

Yes

Yes

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Drug name

Form

Price per box

Is the drug included on the national
essential drugs list?

Clobazam

TabletUSD 35 (10 mg, 30 units
per box)No

Diazepam (rectiole /rectal suppository for
epileptic attacks)*

TabletUSD 3.50 (10 mg, 10
units per box)

No

Diazepam (i.v.
Injection for epileptic
attacks)

Injection

USD 10 (5 mg, 10 units
per box)Yes

Midazolam (i.m.
Injection for epileptic
attacks)*

Injection

USD 4 (5 mg, 5 units per
box)

No

Antiepileptics to treat
acute attacks/statusepilepticus:

phenytoin (i.v.
injection for epileptic
attacks)

Solution

USD 13 (25 mg/ml, 10
units per box)
USD 25 (50 mg/ml, 10
units per box)

Yes

Anti-blood-clotting
medicines:

Warfarin*

TabletUSD 3 (2 mg, 20 units perbox)
USD 6 (5 mg, 20 units perbox)
USD 2.5 (100 mg, 100
units per box)

Yes

Acetylsalicylic acid
(Aspirin®)

TabletHeparinCapsuleUSD 12 (200 mg, 10 units
per box)Yes

Clopidogrel

TabletUSD 35 (75 mg, 30 units
per box)

No

USD 3 (500 mg, 30 units
per packet)

Yes*The medication is typically very difficult to find.

15.5 NGOs
Fracarita International is a faith-based non-profit organisation that has an important role in thetreatment of Neurological Disorders in DRC. Fracarita International supports the specialist centre of
Lubumbashi, Centre Neuro-Psychiatrique Dr Joseph Guislain, with resources and capacity
strengthening.569

569 Fracarita International, n.d, url

82

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

The international NGO, Humanity and Inclusion also is also active regarding disability inclusion andadvocacy.570 Humanity and Inclusion aims to address the needs of all disabilities which includes, but
is not exclusive to, neurological disorders. Humanity and inclusion operates primarily in the eastern
province of North Kivu and central province of Kasai.571

570 Humanity and Inclusion, Democratic Republic of Congo, n.d, url
571 Humanity and Inclusion, Democratic Republic of Congo, n.d, url

83

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

16 Psychiatry16.1 General information
16.1.1 Epidemiological context
Psychiatry is a medical field that addresses a range of mental health conditions. The focus here will be
on depression, anxiety disorders like post-traumatic stress disorder, and psychotic disorders likeschizophrenia and bipolar disorder. There is very limited reliable prevalence data on mental healthdisorders in DRC as data is not routinely collected and reported in clinics.572 According to the 2019
Global Burden of Disease study, 4.21% of the population suffers from depressive disorders, equal toover 3.6 million people. This is greater than the estimated global prevalence which stands at 3.76%.573
Other studies and reports suggest that the prevalence is much higher at 15 million people.574 Of note,however, these studies reference the National Mental Health Programme (Programme National deSanté Mentale, PNSM), published in 2006 and so cannot be considered up to date.575
Displaced populations, including internally displaced, refugees, and returnees, are disproportionately
affected by mental ill health.576 As outlined in chapter 1, there are over 5 million internally displaced
people and over 524 000 refugees living in DRC.577 This suggest that there is a high level of need formental health services.

572

EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
573 IHME, Institute for Health Metrics, Global Health Development Report, 2019, url
574 WHO, World Health Organization, Democratic Republic of Congo, Mental Health Atlas 2011, url, p. 1; Le Potentiel, Au
moins 15 millions de personnes atteintes des troubles mentaux en RDC, 14 October 2008. Referenced in: Immigration andRefugee Board of Canada, Democratic Republic of the Congo: The treatment of people with mental health disorders;protection and services provided by the state, June 2012, url
575 The PSNM was not made available for review
576 Morina, N., et al., Psychiatric Disorders in Refugees and Internally Displaced Persons After Forces DisplacementL A
Systematic Review, September 2018, url, p. 1
577 UNHCR, United Nations High Commissioner for Refugees, DR Congo emergency dashboard, September 2019, url

84

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

16.1.2 Strategies and policies for psychiatry
The burden of mental health disorder is described in detail in the National Health Development Plan
(Plan National de Development Sanitaire 2016-2020, PNDS). Although the PNDS details the estimatedburden of disease, it does not go on to propose a health system response to address it.578 In addition,
the lists of essential services for health centres and hospitals do not include any psychiatric services.579
Previously, a number of national strategies, referred to as programmes, were developed to strengthen
the provision of mental health service. Importantly, the 1999 strategy aimed to move treatment
services out of medical facilities towards a care in the community approach, by increasing service
provision through primary care structures.580 This model is considered to be a fundamental step toaddress stigma and strengthen dignity in care for those with mental health disorders. However, themost recent national programme for mental health has not been updated since 2006.581 The absenceof a renewed strategy suggests that targeted health system strengthening for mental health provisions
has not continued.
The WHO provides important technical support to the Ministry of Health. Key priorities of the support
provided are outlined in the Strategic Cooperation of WHO with DRC 2017-2021 (Stratégie deCoopération de l’OMS avec le pays République Démocratique du Congo 2017-2021).582 The country
cooperation strategy includes the strengthening of mental health services among the key priorities.583
In particular, the strategy aims to focus on strengthening mental health services for women at a
primary care level.584

16.1.3 Healthcare provisions for psychiatry
The health facility from which patients can receive treatment depends on the psychiatric services
which they require. In principle, primary care facilities can dispense medications; however, supply
chains greatly limit the availability of medications. Secondary and tertiary facilities, such as hospitals,
can provide more complex treatments, including inpatient facilities during mental health crisis.585
An article from 2010 identified six hospital institutions with services for mental health disorders.586
This includes four specialised mental health facilities which are, the Neuro-Psycho-Pathology Centre(Centre Neuro-Psycho-Pathologique, CNPP) at the University of Kinshasa, the CNPP at the Katwambi
Centre (Centre de Katwambi) in the province of Western Kasai and Doctor Joseph Guillain of
Lubumbashi Neuropsychiatric Centre (centre neuropsychiatrique Docteur Joseph Guillain de
Lubumbashi) in Katanga province, and the Karhale Psychiatric Mental Health Care Centre (centre
psychiatrique Soins de santé mentale de Karhale) in South Kivu. In addition to facilities identified in

578 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République

Démocratique du Congo, November 2018, url, p. 21
579 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, pp. 87-93
580 On’okoko, M., Mental health in the Democratic Republic of Congo: a post-crisis country challenge, April 2010, url, p. 41
581 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondance, August-November 2020
582 WHO, World Health Organization, Stratégie de Coopération de l’oms avec le pays République Démocratique du Congo
2017–2021, url
583 WHO, World Health Organization, Stratégie de Coopération de l’oms avec le pays République Démocratique du Congo
2017–2021, url, p. 17
584 WHO, World Health Organization, Stratégie de Coopération de l’oms avec le pays République Démocratique du Congo o2017–2021, url, p. 57
585 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
586 Xinhua News Agency, RDC: un malade mental viole et tue sa mère à Kananga, 16 November 2010, url

85

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)the source, Telema Hospital in Kinshasa is an important provider of psychiatric health services.587 In
2014, it was estimated that there were 500 inpatient beds nationally.588
Psychotherapy and other forms of talking therapies, such as cognitive behavioural therapy, are almost
non-existent.589 However, local women's organisations often provide support services for victims ofrape.590 In addition, mental health and psychosocial support is a growing specialism withininternational humanitarian and development organisations.591 Through these, psychologists andpsychiatrists provide supplementary specialist services in conflict and post-conflict provinces.592

16.1.4 Human resources
There is a significant lack of trained mental health medical professionals in DRC.593 A more recent
needs assessment conducted in 2019 in Eastern DRC suggests that significant human resource
challenges persist.594 This assessment reviewed mental health service provision in six private healthcentres in the north eastern province of South Kivu. This found that although 6% of centres had staff
with at least some mental health training, the extent of training varied from five days to one month.595

16.2 Access to treatment
Access to healthcare generally in DRC is extremely limited.596 The PNDS estimates that the treatment
coverage of psychiatric services is just 5%, meaning the vast majority of those who require services do
not have access.597 A contributing factor to low coverage is the poor availability of specialist services
in health facilities, the PNDS states that only 3% of primary care facilities have integrated mental
health services.598
Lack of availability of treatment options in clinics increases the distance communities are required totravel for healthcare.599 While there is some geographic distribution of specialist mental centres, the587

EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
588 Ikanga, J, Psychology in the Democratic Republic of the Congo: Its struggles for birth and growth, American Psychological
Association, December 2014, url
589 Organisation suisse d’aide aux réfugiés OSAR, RD Congo: Soins psychiatriques, 10 June 2009. Referenced in: Organisation
suisse d'aide aux réfugiés (OSAR), République démocratique du Congo : développements actuels, 6 October 2011, url, p. 21
590 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
591 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
592 Bedford, J. et al., Key considerations: mental health and psychosocial support, North Kivu, Anthrologica, October 2019url, p. 1-2
593 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
594 Thulin, E. et al., Mental Health Care and Gender Based Violence in Eastern DRC: Needs Assessment and Report of
Activities, January 2020, url, p. 7
595 Thulin, E., et.al., Mental Health Care and Gender Based Violence in Eastern DRC: Needs Assessment and Report of
Activities, January 2020, url, p. 7
596 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
597 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, p. 21
598 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url
599 Motomoke,E, Village reach, On Road and River: Distributions begin in DRC, August 2017, url

86

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

majority are located in Kinshasa. Patients from rural areas who received prescriptions from urban
providers have difficulty refilling them near home.600
Other factors limiting access to psychiatric treatment include the cost of care (discussed below), lackof affordable transport, and stigma. Mental health stigma has an important role in affecting
healthcare-seeking behaviours of individuals and their families.601 As described ‘the shame of having
a mental disorder extends to the family because each person is an integral part of a larger familial andsocial fabric’.602 Children with mental health disorders are particularly affected by stigma, with somebeing called ‘child witches‘ or cursed.603
Stigma associated with key risk factors of mental ill health further reduces healthcare-seeking
behaviour. In particular, experiences of sexual violence and human rights abuses are associated withmajor depressive disorder and post-traumatic stress disorder.604 Related stigma increases thediagnostic and treatment gap.605

16.3 Cost of treatment
There are no financial support programmes for the treatment of mental health disorders.606 The vast
majority of household healthcare spending is through out-of-pocket payments at the point of care.607
Out-of-pocket payments at the point of care are a significant barrier to healthcare. For the majority ofthe population, treatment beyond primary care consultations are not economically accessible.608
The cost of psychiatric treatment is considered high compared to average earnings. Additional hospital
expenses, such as food, typically also have to be covered by patients.609
The prices below were gathered from a range of clinics based in Kinshasa and provide an indication of
the cost of healthcare services. The total costs incurred by patients can be approximated by summing
all relevant services.610

600

EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
601 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
602 Ikanga, J, Psychology in the Democratic Republic of the Congo: Its struggles for birth and growth, in: Psychology
International, December 2014, url
603 UNICEF, Les enfants accusés de sorcellerie, April 2010, url, p. 22
604 Johnson, K. et al., Association of Sexual Violence and Human Rights Violations With Physical and Mental Health inTerritories in the Eastern Democratic Republic of the Congo, American Medical Association, August 2010, url, p. 553
605 Espinoza, S, Barriers to Mental Health Treatment Within the Congolese Population, October 2016, url
606 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
607 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, p. 41
608 EASO2, Director of a national programme within the Ministry of Health and Medical Director and Head of Cardiology atprominent Kinshasa based facility, Email Correspondence, August 2020
609 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
610 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 202087

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Publicoutpatient
treatment
price

Publicinpatienttreatment
price

Privateoutpatient
treatment
price

Privateinpatienttreatment
price

Reimbursement/ specialprogramme /free

USD 10-20

USD 20-25

USD 50

USD 50No

Psychiatrist

USD 15-25

USD 15-25

USD 30-50

USD 30-50

NoPsychologist

USD 10

USD 10

USD 20-30

USD 20-30

NoPsychiatric nurse
at home (per visit)

USD 10

USD 10

USD 20

USD 20No

Cost of treatment

Clinical admission
Psychiatric clinic(daily rates)
Specialist Consultation

Psychotherapy session treatments
Cognitive
behaviouraltherapy

USD 10 per
sessionUSD 10 per
sessionUSD 15 persessionUSD 15 persessionNo

Eye Movement
Desensitisation
and Reprocessing

USD 25 persessionUSD 25 persessionUSD 25 persessionUSD 25 persessionNo

16.4 Cost of medication
Patients often have poor adherence to treatments, particularly for chronic conditions like thoserelated to CVD.611 This is due to prohibitive costs and lack of availability of key medications.612
The price of medications was collected from eight registered pharmacies based in Kinshasa.613
Medicines fromthe informal market have not been included.
Drug name

Form

Price per box

Is the drug typically includedon national essential drugs
medicines list?

Paroxetine

TabletUSD 20 (20 mg, 30 units per box)

No

Citalopram

TabletUSD 30 (10 mg, 28 units per box)

No

Escitalopram

TabletUSD 30 (10 mg, 28 units per box)

No

Fluoxetine

TabletUSD 10 (20 mg, 14 units per box)

Yes

Imipramine*

TabletUSD 2 (25 mg, 30 units per box)

No

Trazodone

TabletUSD 20 (50 mg, 30 units per box)

No

Antidepressants

611 EASO2, Director of a national programme within the Ministry of Health and Medical Director and Head of Cardiology atprominent Kinshasa based facility, Email Correspondence, August 2020
612 Please refer to chapter 4 for further details on the pharmaceutical sector
613 Please refer to the Introduction for further details on the methodology of price data collection88Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Drug name

Form

Price per box

Is the drug typically includedon national essential drugs
medicines list?

Amitriptyline

TabletUSD 15 (25 mg, 30 units per box)

Yes

USD 12.95 (10 mg, 30 units perbox)
Medication off-label
use PTSD
Alfuzosin (also withprostate complaints)

TabletUSD 30 (10 mg, 30 units per box)

No

Lamotrigine (alsoantiepileptic)

TabletUSD 70 (200 mg, 30 units per box)

No

USD 37 (100 mg, 30 units per box)
USD 22 (50 mg, 30 units per box)
USD 15 (25 mg, 30 units per box)

Topiramate

TabletUSD 150 (100 mg, 28 units per
box)

No

Injection

USD 20 (5 mg, 5 units per box)

Yes

Antipsychotics; classic
Haloperidol

USD 10 (5 mg, 20 units per box)
Capsules
Chlorpromazine

TabletUSD 15 (25 mg, 100 units per box)

Yes

Fluphenazine

TabletUSD 160 (25 mg, 30 units per box)

Yes

Injection

USD 3.2 (25 mg/ml, 3 units perbox)

Antipsychotics; modern
atypicalOlanzapine

TabletUSD 40 (5 mg, 30 units per box)

No

USD 60 (10 mg, 30 units per box)
Risperidone

TabletUSD 35 (1 mg, 30 units per box)

Yes

USD 70 (2 mg, 30 units per box)
Quetiapine

TabletUSD 100 (300 mg, 30 units per
box)

No

USD110 (300 mg, 60 units perbox)
Anxiolytics
Diazepam (e.g. Valium)

TabletUSD 10 (10 mg, 30 units per box)

Yes

Bromazepam

TabletUSD 30 (6 mg, 30 units per box)

Yes

USD 15 (3 mg, 30 units per box)
Clonazepam*

89

TabletUSD 5 (0.5 mg, 50 units per box)

NoMedical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Drug name

Form

Price per box

Is the drug typically includedon national essential drugs
medicines list?

Clorazepate

TabletUSD 30 (5mg, 30 units per box)

No

Lorazepam

TabletUSD 30 (1 mg, 30 units per box)

No

USD 30 (2.5 mg, 30 units per box)

Medication for bipolar
disorder/manic
depression
Carbamazepine (alsoantiepileptic)

TabletUSD 15 (200 mg, 50 units per box)

Yes

Zopiclone

TabletUSD 45 (7.5 mg, 14 units per box)

No

Zolpidem

TabletUSD 30 (10 mg, 14 units per box)

No

Melatonin

TabletUSD 35 (2 mg, 30 units per box)

No

TabletUSD 3 (5 mg, 20 units per box)

No

Medication for sleeping
disorder; sedatives

Medication to treat side
effectsofantipsychotics/antiParkinsonism
Trihexyphenidyl**The medication is typically difficult to find.

16.5 NGOs
National and international NGOs have an important role in community level provision of mental healthservices. Many of the NGOs focus their mental health programmes on supporting victims of sexualand gender-based violence. For instance, Médecins Sans Frontières (MSF),614 International Rescue
Committee,615 Care International616 and International Medical Corps617 all provide programmes
related to mental health. The activities of these NGOs are focused on Eastern provinces and the Kasai
region in central DRC.
Mental health and psychosocial support programmes also target victims of the Ebola epidemic andtheir families. A report by UNICEF states that in 2019, there were 1 100 psychologists trained tosupport patients and their families.618 Other organisations supporting mental health interventions
include the Danish Refugee Council.619

614 MSF, Médecins Sans Frontières, n.d, url
615 IRC, International Rescue Committee, Democratic Republic of the Congo: Strategy Action Plan, 2020, url, p. 3
616 Care International, Democratic Republic of Congo, n.d, url
617 IMC, International Medical Corps, Democratic Republic of the Congo, n.d, url
618 UNICEF, Supporting Ebola patients and their families, December 2019, url
619 WHO, World Health Organization, Psychological support for life after Ebola, June 2019, url

90

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Of note, there are over 50 national and international NGOs operating in DRC.620 Supporting victims ofviolence in all its forms is a core objective of many of these organisations. The above list of NGOs andtheir operations should not be considered an exhaustive depiction of all community-based mental
health services.

620 WHO, World Health Organization, Health Cluster, September 2020, url

91

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

17 Pulmonology: asthma, chronic obstructive
pulmonary disease and obstructive sleep
apnoea17.1 General information
17.1.1 Epidemiological context
Respiratory illnesses include a number of diseases which affect the lungs and other parts of therespiratory system. Respiratory illnesses, in particular asthma and chronic obstructive pulmonary
disease (COPD), are a significant burden in the DRC.621 The 2019 Global Burden of Disease (GBD) study
estimates that the prevalence of chronic respiratory illnesses stands at 4.01%, equivalent to over 3.4
million people. This includes asthma and COPD for which their disaggregated prevalence is estimatedat 3.09% and 1.01%, respectively.622 Other studies suggest that the prevalence of different types of
respiratory illnesses are significantly higher.623 A study carried out in 2017 estimated the prevalenceof asthma among adults in Kinshasa to be 6.9%.624 In line with global trends whereby asthma is moreprevalent in urban areas, the general population prevalence is likely to be slightly lower.625
Data on COPD in DRC is very limited. Systematic reviews estimate that the prevalence in sub-SaharanAfrican countries is between 4% and 25% of the population.626 Globally, COPD is the third mostcommon cause of death and an estimated 90% of deaths are believed to occur in low- and middleincome countries.627
Key risk factors for COPD and asthma in DRC are household air pollution, occupational exposures andsmoking. With regard to occupational exposures, construction workers and mine workers are among
key at-risk groups.628 In addition, asthma and COPD are important risk factors for lower respiratory
tract infections and increase the likelihood and severity of a disease.629 In DRC, lower respiratory tract
infections are the third leading cause of death.630
With regard to obstructive sleep apnoea, globally there is a lack of reliable prevalence data and mostinformation is derived from studies in high-income countries. A recent estimate suggests that over
900 million people across the globe have obstructive sleep apnoea.631 Key risk factors for obstructive
sleep apnoea relate to cardiovascular diseases and include obesity.632 Although the number of people

621

EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
622 IHME, Institute of Health Metrics, GBD Results Tool, 2019, url
623 Kabengele, B, et al., Prevalence and determinants of asthma in adults in Kinshasa, Plos One, May 2019, url, p. 1
624 Kabengele, B, et al., Prevalence and determinants of asthma in adults in Kinshasa, Plos One, May 2019, url, p. 1
625 The majority of the population of DRC live in rural settings.
626 Finney, L, et al., Chronic obstructive pulmonary disease in sub-Saharan Africa: a systematic review, Int. Journal of
Tuberculosis and Lung Disease, January 2013 url, p. 1
627 WHO, World Health Organization, Chronic obstructive pulmonary disease (COPD) Key Facts, December 2017, url
628 Mbelambel, E. et al., Prevalence of chronic obstructive pulmonary disease among Congolese cement workers exposed to
cement dust, 16 October 2018, url, p. 1
629 WHO, World Health Organization, The Global Impact of Respiratory Disease, 2017, url
630 IHME, Institue for Health Metrics, DRC Dashboard, 2019, url
631 Benjadield, A. et al., Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based
analysis, The Lancet, August 2019, DOI: url, p. 1
632 Gulotta, G. et al., Risk Factors for Obstructive Sleep Apnoea Syndrome in Children: State of the Art, September 2019, url,
p. 3

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Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

who are obese in DRC is increasing, the national prevalence of 3.7% is significantly lower than the
global average of 13%.633 It is therefore probable that the prevalence of sleep apnoea is increasing but
nonetheless lower than the global average.634

17.1.2 Strategies and policies for treatment and management of respiratory
illness
The National Health Development Plan (Plan National de Development Sanitaire 2016-2020, PNDS)
makes some reference to respiratory infections.635 The list of essential health centre and hospital
services includes the treatment of pneumonia.636 However, there is no reference to other respiratory
infections or diseases.637
In addition to the PNDS, strategic priorities of the ministry of health are detailed in documents known
as programmes.638 There is evidence that a national programme against acute respiratory tract
infections (Programme National de Lutte Contre les Infections Respiratoires Aigues) has beendeveloped.639 However, the programme was not made available for review. Similarly, a targetednational programme to address the prevalence of smoking has also been developed but was not madeavailable.640
The PNDS does not refer to obstructive sleep apnoea, nor do the other national level documents
reviewed.641
The WHO provides important technical support to the Ministry of Health. The key priorities of the
support provided are outlined in the Strategic Cooperation of WHO with DRC 2017-2021 (Stratégie deCoopération de l’OMS avec le pays de la République Démocratique du Congo 2017-2021).642 Although
the cooperation agreement includes the strengthening of health services for noncommunicablediseases (NCDs), details are not provided on the NCDs which will be prioritised.643 As a result, it is notclear whether respiratory tract illnesses, such as asthma and COPD, would be included.644 The
cooperation also does not include reference to respiratory tract infections, such as pneumonia.645

633 World Health Organization, Country Profile Democratic Republic of Congo, 2016, url
634

EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
635 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, p. 49
636 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, pp. 87-94
637 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
638 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
639 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondance, August-November 2020
640 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
641 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url
642 WHO, World Health Organization, Stratégie de Coopération de l’oms avec le pays République Démocratique du Congo
2017–2021, url
643 WHO, World Health Organization, Stratégie de Coopération de l’oms avec le pays République Démocratique du Congo o2017–2021, url pp.57
644 WHO, World Health Organization, Stratégie de Coopération de l’oms avec le pays République Démocratique du Congo o2017–2021, url
645 WHO, World Health Organization, Stratégie de Coopération de l’oms avec le pays République Démocratique du Congo
2017–2021, url

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Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

17.1.3 Healthcare provisions for treatment and management of respiratory
illness
Treatments available for respiratory illnesses from primary care facilities include consultations with
non-specialist medical staff and access to basic medications. At a community level, health centres
should be able to treat acute respiratory illnesses, depending on the availability of medicines.646 For
treatments related to chronic conditions, such as asthma, patients can access more specialist
consultations at provincial level hospitals. However, provincial hospitals often face significant
infrastructure challenges and lack a continuous supply of electricity and water.647 For specialist
consultations, patients must visit Kinshasa where health facilities are better resourced. Healthfacilities able to treat chronic respiratory conditions include ‘the principle large medical centres ofKinshasa’.648 These are:649••

Public sector:oKinshasa University Clinic (Clinique Universitaire de Kinshasa)oKinshasa General Hospital (Hôpital Général de Kinshasa)

Private sector (For Profit):o

HJ Hospital Kinshasa (HJ Hôpitaux Kinshasa).650 The HJ Hospitals also have facilities in
Lubumbashi and Goma651

oDiamant Medical Centre (Centre Médical Diamant)652

oMedical Centre Kinshasa (Centre Médical de Kinshasa)653

17.2 Access to treatment
Access to healthcare in DRC is limited, particularly for specialised care. A factor contributing to low
access to healthcare includes poor availability of medicines at health facilities.654 A representative
sample of health centres were reviewed in 2017 and 2018 to assess availability of different diagnostic
and treatment services in health facilities.655 This found that fewer than 20% of health facilities offeredtreatment options for asthma or COPD.656
As outlined in chapter 1, DRC suffers from significant supply chain challenges which greatly limit theavailability of medicines. The central and the southern province are particularly affected by the weak646

EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
647 Sion, M. et al., A resource planning analysis of district hospital surgical services in the Democratic Republic of the Congo,
Global Health: Science and Practice, 2015 url, p. 1
648 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
649 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
650 HJ Hospitals, n.d, url
651 HJ Hospitals, n.d, url
652 Centre Medical Diamant, n.d, url
653 CMK, Centre Medical de Kinshasa, n.d, url
654 EPSS, Evaluation des Prestations des Services de soins de Santé, Ecole de Santé Publique de Kinshasa, April 2019, url, pp.
60-61 and 82-83
655 Study reviewed availability of services in a total of 1,380 health facilities proportionately distributed across provinces.
This was carried out between November 2017 and April 2018.
656 EPSS, Evaluation des Prestations des Services de soins de Santé, Ecole de Santé Publique de Kinshasa, April 2019, url, pp.
251-260

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Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

supply chains and often experience the greatest duration of stock interruptions.657 Medications used
to treat respiratory diseases are exposed to the same weak supply chains. As a result, individuals areoften required to travel significant distances in order to find medicines or specialist care.658 Other
factors which limit access to treatment include the cost of care (discussed below) and lack ofaffordable transport. A lack of transport facilities particularly affects access to emergency care forexample during asthma attacks and pulmonology crisis.659

17.3 Cost of treatment
There are no financial support programmes for the treatment of patients with chronic lungconditions.660 The vast majority of household healthcare spending is through out-of-pocket payments
at the point of care.661 Out-of-pocket payments at the point of care are a significant barrier tohealthcare. For the majority of the population, treatment beyond primary care consultations are noteconomically accessible.662
The prices below were gathered from a range of clinics based in Kinshasa and provide an indication of
the cost of healthcare services. The total costs incurred by patients can be approximated by summing
all relevant services.663

Cost of treatment

Publicoutpatient
treatment
price

Publicinpatienttreatment
price

Privateoutpatient
treatment
price

Privateinpatienttreatment
price

Reimbursement/ specialprogramme /free

USD 10-20

USD 20-30

USD 30

USD 30No

Clinical admission
Pulmonology
department (dailyrates)

Specialist consultation
Generalpractitioner

USD 5

USD 5

USD 20

USD 20No

Pulmonologist

USD 10

USD 10

USD 30

USD 30No

USD 50

USD 50

USD 100-110

USD 100-110

No

Diagnostic research
Lung function
tests
Medical devices

657

EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
658 Motomoke, E, Village reach, On Road and River: Distributions begin in DRC, August 2017, url
659 Kalisya, L. et al., The state of emergency care in Democratic Republic of Congo, African Journal of Emergency Medicine,
August 2015, url, p. 156
660 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
661 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé, République
Démocratique du Congo, November 2018, url, p. 41
662 EASO2, Director of a national programme within the Ministry of Health and Medical Director and Head of Cardiology atprominent Kinshasa based facility, Email Correspondence, August 2020
663 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 202095

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Cost of treatment

Publicoutpatient
treatment
price

Publicinpatienttreatment
price

Privateoutpatient
treatment
price

Privateinpatienttreatment
price

Reimbursement/ specialprogramme /freeSpacer (withmask) for inhaler
with asthma
medication

USD 20

USD 20

USD 20

USD 20No

Nebulizer

USD 15

USD 15

USD 15

USD 15No-

USD 900

USD 900

USD 900

No

-

USD 5

USD 5

USD 5

No

Breathingmachines(ventilator,
respirator, etc.)
CPAP therapy

17.4 Cost of medication
Many of the medicines used to treat respiratory illnesses are not available in DRC. The availability andprice of medications was collected from eight registered pharmacies based in Kinshasa.664 Medicinesfrom the informal market have not been included.
Drug name

Form

Price per box

Is the drug typically included on national
essential medicines list?

Ipratropium +fenoterol(combination)

TabletUSD 25 (50 mcg/20 mcg,
5 units per box)

No

Montelukast
sodiumTabletUSD 22 (10 mg, 30 units
per box)

No

USD 10 (2.5 mg /2.5 ml,
60 units per box) (Spray)
USD 60 (5 mg /2.5 ml, 10
units per box) (vial)
Salbutamol

USD 3 (5 mg /2.5ml, 1
unit per box) (syrup)

Yes

USD 7.125 (1 mg, 10
units per box)
(Suppository)
USD 30 (400 mg, 50 units
per box)

Theophylline

Beclometasone

Spray

USD 40 (250 mcg, 1unit
per box)
USD 20 (125 mcg, 1 unit
per box)Yes

Yes

664 Please refer to the Introduction for further details on the methodology of price data collection

96Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Drug name

Form

Price per box

Is the drug typically included on national
essential medicines list?

Budesonide

Suspension

USD 100 (1 mg /2ml, 20
units per box)

No

Fluticasone

Spray

USD 20 (12 mcg, 1 unit
per box)No

Ipratropium
bromidemonohydrate

TabletUSD 15 (10 mcg, 10 units
per box)No17.5 NGOs
Chronic respiratory illnesses are not cited among the priority healthcare interventions supported by
the large international NGOs which operate in DRC (such as MSF and IMC). There are number of
advocacy organisations which aim to raise awareness of the respiratory illnesses faced by those whowork in the informal mining sector.665 However to date, there has not been a large NGO response to
implementing healthcare interventions.
Treatments for acute respiratory tract infections are supported by some NGOs. The medical
international NGO, International Medical Corps (IMC), supports 64 clinics and hospitals. These arelocated in the Eastern provinces of North Kivu, South Kivu and Tanganyika. These facilities areequipped to treat lower respiratory tract infections, such as pneumonia.666

665 Amnesty, DRC: Alarming research shows long lasting harm from cobalt mine abuses, May 2020, url
666 IMC, International Medical Corps, Democratic Republic of Congo, n.d, url

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Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

18 Tuberculosis
18.1 General information
18.1.1 Epidemiology
DRC has a high burden of tuberculosis (TB) infections. DRC is ranked nineth in the world and secondin Africa for total number of TB infections.667 The Global TB report publishes 3 lists of the 30 countries
with highest burden of TB, TB/HIV coinfection and multidrug-resistant TB (MDR-TB). DRC is 1 of 14
countries to appear on all 3 lists. 668
In 2018, approximately 270 000 people fell ill with TB, representing 321 cases per 100 000. Of these,
approximately 11% were coinfected with HIV.669 MDR-TB is a growing concern. Of new TB infectionsin 2018, approximately 1.7% of cases were MDR-TB cases rising to 9.5% for previously treated cases.670
In spite of these challenges, there have been notable improvements across key indicators. Since 2010,
the rate of new cases has steadily declined from 327 to 321 cases per 100 000 people. Similarly, thenumber of deaths attributable to TB in those not co-infected with HIV has steadily decreased from 57
to 51 per 100 000 people.671

18.1.2 Policies and strategies
Addressing TB is a key priority for the Ministry of Health and the Government of DRC.672 The national
response to TB is coordinated by the National Programme for the Fight Against Tuberculosis (PNLT,
Plan stratégique National de Lutte Contre La Tuberculose).673 This coordinating body is part of the
Ministry of Health and responsible for drafting and overseeing the National Strategy for the Fight
Against Tuberculosis 2018-2020.674 The current strategy builds on previous strategies, the first ofwhich was published in 1980.675 The general objective of the Strategy is to contribute to a reduction
in mortality and morbidity, as well as catastrophic costs676 linked to TB. Specifically, this aims to reduce
the number of deaths attributable to TB by 20% in 2020 compared to 2015.677 To do this, the strategy
comprises 10 objectives which focus on different dimensions of TB diagnosis and treatment, including
scaling up screening services, strengthening service provisions for treatment of HIV co-infection and
MDR-TB, as well as strengthening the broader healthcare systems and structures.678

667 PNLT, Plan Stratégique National de Lutte Contre La Tuberculose 2018-2020, Ministère de la Santé Publique, Sécretariat

General, République Démocratique du Congo, 2017 [no url], p. 15
668 WHO, World Health Organisation, Global Tuberculosis Report, 2019, url, p. 23
669 WHO, World Health Organization, Tuberculosis Country Profile, 2020, url, p. 37
670 WHO, World Health Organisation, Tuberculosis Country Profile, 2020, url, p. 58
671 WHO, World Health Organisation, Tuberculosis Country Profile, 2020, url
672 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
673 PNLT, Plan Stratégique National de Lutte Contre La Tuberculose 2018-2020, Ministère de la Santé Publique, Sécretariat
General, République Démocratique du Congo, 2017 [no url]
674 PNLT, Plan Stratégique National de Lutte Contre La Tuberculose 2018-2020, Ministère de la Santé Publique, Sécretariat
General, République Démocratique du Congo, 2017 [no url], pp. 35 - 58
675 PNLT, Plan Stratégique National de Lutte Contre La Tuberculose 2018-2020, Ministère de la Santé Publique, Sécretariat
General, République Démocratique du Congo, 2017 [no url], p. 35
676 Defined as costs totalling ≥ 20% of annual household income.
677 PNLT, Plan Stratégique National de Lutte Contre La Tuberculose 2018-2020, Ministère de la Santé Publique, Secretariat
General, République Démocratique du Congo, 2017, p. 110
678 PNLT, Plan Stratégique National de Lutte Contre La Tuberculose 2018-2020, Ministère de la Santé Publique, Secretariat
General, République Démocratique du Congo, 2017, pp. 110-111

98Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

The implementation of the TB strategy receives significant technical and financial support fromnumerous international agencies.679 This includes multilateral agencies, notably the World Bank andWHO, bilateral funders and international NGOs.680 Latest figures from 2018 show that the TB services
were largely financed through international funds. The principal financing agency was the Global Fundwhich dispersed USD 46.995 million.681 Domestic funding stood at USD 0.55 million.682 Total financing
needs stood at USD 74.372 million indicating a significant financing gap of USD 26.78 million.683 The
scale of under financing has been relatively consistent since 2015 while the value of domestic
contributions has varied from a peak of USD 2.75 million in 2015 and to the lowest at USD 0.188 million
in 2017.684
Financial resources from State contributions are used primarily for salary and workforce costs.685

18.1.3 The national response
The PNLT strategy states that healthcare implementation and governance for TB should be as
follows:686
Central Level – This includes the directorate for the PNLT situated within the Ministry of Health. The
directorate is responsible for the overall coordination of tuberculosis programme activities. Centrallevel functions also include a National Reference Laboratory, a central warehouse for anti-tuberculosis
drugs and a specialist hospital in Kinshasa, ‘Centre d’Excellence Damien’. The hospital is responsible
for providing specialist services for multi-drug resistant MDR- TB.687
Intermediate Level – This includes provincial health officers who form the Provincial Coordination for
the fight against Leprosy and Tuberculosis (CPLT, Coordinations Provinciales Lèpre et Tuberculose).
Each CPLT oversees a reference laboratory and provides technical support to their respective HealthZones.688
Peripheral Level –689 This level constitutes the main point of contact between community members
and activities outlined in the PNLT. Within each health zone, all health centres are expected to be able
to screen for TB and provide first-line treatment and monitoring services. At least three health centres
should offer diagnostic and treatment services delivered by at least one nurse trained specifically in
TB screening and treatment. These centres are consequentially called Health Centres for Diagnosis
and Treatment. The principal diagnostic approach uses microscopes with 100x immersion forassessment of sputum samples. GeneXpert machines are used for the diagnosis of TB and to
determine whether an individual is infected with MDR-TB. In 2016, there were 84 GeneXpert machines

679 PNLT, Plan Stratégique National de Lutte Contre La Tuberculose 2018-2020, Ministère de la Santé Publique, Secretariat

General République Démocratique du Congo, 2017, pp. 118-146
680 PNLT, Plan Stratégique National de Lutte Contre La Tuberculose 2018-2020, Ministère de la Santé Publique, Secretariat
General, République Démocratique du Congo, 2017, p. 61
681 Stop TB Partnership, Country Dashboards, 2018, url
682 WHO, World Health Organization, Global Tuberculosis Report 2020 url, p. 137
683 Stop TB Partnership, Country Dashboards, 2018, url
684 Stop TB Partnership, Country Dashboards, 2018, url
685 PNLT, Plan Stratégique National de Lutte Contre La Tuberculose 2018-2020, Ministère de la Santé Publique, Secretariat
General, République Démocratique du Congo, 2017, [no url], pp. 36-38
686 PNLT, Plan Stratégique National de Lutte Contre La Tuberculose 2018-2020, Ministère de la Santé Publique, Secretariat
General, République Démocratique du Congo, 2017, p. 35
687 PNLT, Plan Stratégique National de Lutte Contre La Tuberculose 2018-2020, Ministère de la Santé Publique, Secretariat
General, République Démocratique du Congo, 2017, p. 35
688 PNLT, Plan Stratégique National de Lutte Contre La Tuberculose 2018-2020, Ministère de la Santé Publique, Secretariat
General, République Démocratique du Congo, 2017, p. 35
689 PNLT, Plan Stratégique National de Lutte Contre La Tuberculose 2018-2020, Ministère de la Santé Publique, Secretariat
General, République Démocratique du Congo, 2017, pp. 35-40

99

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

located across the country.690 The PNLT aims to have 252 machines in place by the end of 2020.
Diagnosis services are also provided using magnetic resonance imaging (MRI) scanners. DRC has a lackof MRI scanners; a study by WHO in 2014 stated that there were no scanners available across thecountry.691 Some well-resourced hospitals, such as HJ Hospital Kinshasa,692 now have MRI scanners;
however, nationally, these remain few in number.693
Health centres which do not have on-site diagnostic facilities are expected to transfer samples todiagnostic centres and offer treatment services. First-line treatment for drug-susceptible TB, directly
observed treatment short-course (DOTS) course should be available in all health facilities.694
A network of Community Health Workers (CHWs) act as an intermediary between health facilities andtheir local communities.695 With regards to TB, CHWs aim to increase coverage of treatment byencouraging healthcare seeking behaviours and promote prevention messaging.696

18.2 Access to treatment
It is estimated that 63% of those requiring treatment received services, resulting in a coverage gap of
approximately 40%.697
A key driver of low coverage rates is lack of availability of treatment and diagnostic services at healthfacilities.698 A representative sample of health centres were reviewed in 2017 and 2018 to assess
availability of services.699 Of these, only half were able to provide diagnostic services either directly or
through referral. This includes sputum microscopy, rapid diagnostic kits and lung radiography. Of
these only 60% offered HIV testing for TB patients. Of health centres offering treatment, only half had
first-line medications available at the point of the assessment. Services were least available in healthcentres and conversely most readily available in hospitals.700
The lack of availability of diagnostic and treatment products in community level health facilities,
creates a large barrier to accessing TB services.701 Community members are required to travel greater
distances to find facilities with medicines in stock.702 Other factors limiting access to treatment
include, lack of affordable transport, stigma and prohibitive cost of initial consultations.703

690 PNLT, Plan Stratégique National de Lutte Contre La Tuberculose 2018-2020, Ministère de la Santé Publique, Secretariat

General, République Démocratique du Congo o, 2017, pp. 37
691 WHO, World Health Organization, Global Health Observatory data repository , September 2016, url
692 HJ Hospitals, n.d, url
693 PNLT, Plan Stratégique National de Lutte Contre La Tuberculose 2018-2020, Ministère de la Santé Publique, Secretariat
General, République Démocratique du Congo, 2017, pp. 35-40
694 PNLT, Plan Stratégique National de Lutte Contre La Tuberculose 2018-2020, Ministère de la Santé Publique, Secretariat
General, République Démocratique du Congo, 2017, pp. 35-40
695 DFID, Department for International Development, Effectiveness of community health workers, November 2018, url, p. 2
696 PNLT, Plan Stratégique National de Lutte Contre La Tuberculose 2018-2020, Ministère de la Santé Publique, Secretariat
General, République Démocratique du Congo, 2017, p. 64
697 WHO, World Health Organisation, Tuberculosis Country Profile, 2020, url
698 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
699 Study reviewed availability of services in a total of 1,380 Health Facilities proportionately distributed across provinces.
This was carried out between November 2017 and April 2018.
700 EPSS, Evaluation des Prestations des Services de soins de Santé, Ecole de Santé Publique de Kinshasa, April 2019, url, pp.
277-286
701 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
702 Motomoke,E, Village reach, On Road and River: Distributions begin in DRC, August 2017, url
703 Stop TB Partnership, TB Community, Right and Gender Assessment in Democratic Republic of the Congo 2018 Report,
2018, url, p. 19

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Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

According to a report by Stop TB, key at risk populations include those who are people living with HIV,close contacts of a known case, prison populations, people who work in mines and internally displaced
populations. Aside from HIV, active case finding from these other target populations remains low.704

18.3 Cost of treatment
There are few health insurance schemes in DRC. The system largely operates through point-of-carepayments. These are typically out-of-pocket payments that are often be prohibitive for the poorest.705
However, many treatment and care services for TB, particularly medications, are provided free ofcharge to all patients.706
According to treatment protocols, diagnostic tests and medications for TB, including MDR-TB, are freeat the point of care.707 The main costs incurred by patients are related to consultations and inpatientfees. It is estimated that 57% of patients faced catastrophic healthcare costs708 in 2019 as a result of
their TB treatment.709 Costs vary significantly according to the type of facility in which treatment isreceived. 710
In 2018, the average cost of treating patients with drug-susceptible TB was USD 200.711 For patientswith MDR-TB this rises to USD 4 500.712
The Government of DRC, along with WHO, is in the process of carrying out a survey on costs faced by
TB patients and their households. This aims to understand the key drivers of catastrophic costs inorder to standardise the cost of care for patients.713
The prices below were gathered from a range of clinics based in Kinshasa and provide an indication of
the cost of healthcare services. The total costs incurred by patients can be approximated by summing
all relevant services.714

Cost oftreatment

Publicoutpatient
treatment
price

Publicinpatienttreatment
price

Privateoutpatient
treatment
price

Privateinpatienttreatment
price

Reimbursement /special programme /free

USD 12.5

USD 40

USD 40Free in all public
facilities supported by
the PNLT

Specialist consultation
Pulmonologist

USD 12.5

704 Stop TB Partnership, TB Community, Right and Gender Assessment in Democratic Republic of the Congo 2018 Report,

2018, url, p. 49
705 PNDS, Plan National de Développement Sanitaire recadré pour la période 2019-2022, Ministère de la Santé République
Démocratique du Congo, November 2018, url, p. 41
706 PNLT, “Plan Stratégique National de Lutte Contre La Tuberculose 2018-2020,” Minstry of Public Health, 2017, pp. 149
707 PNLT, “Plan Stratégique National de Lutte Contre La Tuberculose 2018-2020,” Minstry of Public Health, 2017
708 Defined by WHO as “expenditure is catastrophic if a household’s financial contributions to the health system exceed 40%
of income remaining after subsistence needs have been met”, n.d, url
709 WHO, World Health Organization, Tuberculosis Country Profile, 2020, url
710 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
711 WHO, World Health Organization, Global Tuberculosis Report 2020 url, p. 141
712 WHO, World Health Organization, Global Tuberculosis Report 2020 url, p. 142
713 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
714 EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020101Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Cost oftreatment

Publicoutpatient
treatment
price

Publicinpatienttreatment
price

Privateoutpatient
treatment
price

Privateinpatienttreatment
price

Reimbursement /special programme /free

TB specialist

USD 12.5

USD 12.5

USD 40

USD 40Free in all public
facilities supported by
the PNLTUSD 25-40

USD 25-40

USD 40-45

USD 40-45

No

USD 7.5(Colourationgram)

USD 7.5(Coloration
gram)

Medical imaging
Radiography
Laboratory tests

Resistancetest fortuberculosisdrugs

USD 5-10

USD 5-10

USD 25 – 40
(standard
culture andLowensteinculture)USD 25 – 40
(standard
culture andLowensteinculture)Sputumsmear
microscopy--

USD 7.5

USD 7.5

NoFree in all public
facilities supported by
the PNLT

18.4 Cost of medication
National procurement of TB medications is supported by the Global Drug Facility (GDF) of the Stop TB
partnership.715 The GDF facilitates pooled procurement of medications to decrease drugs prices anddirectly procures medications for some countries including DRC.716
TB medications are closely controlled and governed by the Ministry of Health. They are stored in acentral warehouse in Kinshasa and dispersed to registered health centres according to need. In orderto reduce the number of cases of MDR-TB, medications are only administered from facilities
supported by the PNLT through directly observed treatment protocols.717 However, drug shortages
are relatively common, particularly in rural Health Centres, which in turn increases the likelihood thatpatients develop MDR-TB.718

715 The Global Development Facility, Stop TB Partnership, n.d, url
716 The Global Development Facility, Stop TB Partnership, n.d, url
717

EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020
718 EASO4, Medical Doctor and Monitoring and Evaluation officer in the Ministry of Health, Email Correspondence, August
2020

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Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Drug name

Form

Price per box

Is the drug included on lists like national
essential drugs list?

First line TB medicines
Combination of Isoniazid+ Rifampicin +Ethambutol+ Pyrazinamide (e.g. withbrand name Forecox)

Combination of Isoniazid+ Rifampicin

TabletTabletFree (500 mg,
30/60/120/240 units
per box)Free (1 g,
30/60/120/240 units
per box)Free (300 mg/600
mg, 75 mg/150 mg
840/1 000 units perbox)
Free (400 mg, 1 000
units per box)

Free in all public facilities supported by
the PNLTFree in all public facilities supported by
the PNLTFree in all public facilities supported by
the PNLT

Pyrazinamide

TabletRifampicin

TabletFree (150 mg, 100
units per box)

Free in all public facilities supported by
the PNLT

Ethambutol

TabletFree (400 mg, 100/units per box)

Free in all public facilities supported by
the PNLT

Isoniazid

TabletFree (500 mg, 1 000
units per box)

Free (100 mg, 1 000
units per box); forchildrenFree (300 mg, 1 000
units per box); foradultsFree in all public facilities supported by
the PNLT

Second/third line TB
medicines (e.g. with MRD
and XDR TB and/or
HIV+TB)
Moxifloxacin

TabletFree (400 mg, 20
units per box)

Free in all public facilities supported by
the PNLT

Amikacine

CapsuleFree (1 g, 10 units
per box)Free in all public facilities supported by
the PNLT

Bedaquiline

TabletFree (100 mg, 28
units per box)

Free in all public facilities supported by
the PNLT

Linezolid

TabletFree (600 mg, 30
units per box)

Free in all public facilities supported by
the PNLT

Terizidone

TabletFree (250 mg, 1 unit
per box)Free in all public facilities supported by
the PNLT

Clofazimine

TabletFree (100 mg, 100
units per box)

Free in all public facilities supported by
the PNLT

Cycloserine

TabletFree (250 mg, 100
units per box)

Free in all public facilities supported by
the PNLT

103

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Drug name

Form

Price per box

Is the drug included on lists like national
essential drugs list?

Delamanid

TabletFree (100 mg, 48
units per box)

Free in all public facilities supported by
the PNLT

Para aminosalicylic acid (=PAS, or 4-aminosalicylic
acid)

TabletFree (50 mg, 16 units
per box)Free (100 mg, 16
units per box)

Free in all public facilities supported by
the PNLT

18.5 NGOs
There is a significant presence of national and international non-government organisations (NGOs)
integrated into the health sector. The Health Cluster, led by the World Health Organization,
coordinates agencies involved in providing health services in DRC. There are 24 international NGOs
and 31 national NGOs involved in the DRC health cluster.719 The majority of organisations operate inEastern provinces and Kinshasa. As TB is a priority disease for the Ministry of Health, there is relatively
significant NGO investment and cooperation relative to other disease areas.720

719 WHO, World Health Organization, Health Cluster Democratic Republic of Congo, June 2020, url
720

EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report, Email
Correspondence, August-November 2020104Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Annex 1: Core medicines price list
The price of medications was collected from eight registered pharmacies based in Kinshasa.721
Medicines fromthe informal market have not been included.
Drug name

Form

Price per box

Injections

USD 7.5 (10 mg, 10 units
per box)

Is the drug included on thenational essential drugs
medicines list?

Painkillers

Morphine
TabletInjections
TramadolTablets

Diclofenac

USD 27 (10 mg, 14 units
per box)Yes

USD 30 (20 mg, 14 units
per box)
USD 10 (50 mg, 5 vials
per box).
USD 55 (50 mg, 100
tablets per box)

Yes

USD 18 (100 mg, 100
units per box)

TabletUSD 11 (100mg, 100
units per box).

Gel

USD 4 (50 g of Gel 1%)

Suppository

USD 6.5 (100 mg, 10
units per box)

Injections

USD 0.5 (500 mg 1 unit
per box)Yes

Antibiotics andvaccinations

Amoxicillin
Tablets

USD 3 (500 mg, 50 units
per box);
USD 6.5 (1 000 mg, 20
units per box)

Injections

Mostly used in combinedform i.e.: Bactrim(Sulftamethoxazine+Trim
ethoprim)

Tablets

Mostly used in combinedform i.e.: Bactrim(Sulftamethoxazine+Trim
ethoprim)

Trimethoprim

721 Please refer to the Introduction for further details on the methodology of price data collection

105

Yes

Yes

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Drug name

Form

Injections
Cefuroxime
Tablets

Price per box
USD 6 (75 mg, 20 units
per box)
USD 15 (500 mg, 10 units
per box)

USD 50 (500 mg, 1 unit
per box)

Tablets

USD 25 (500 mg, 20 units
per box)Injections

USD 7 (500 mg, 10 units)

Ciprofloxacin
Tablets

Injections

USD 5 (500 mg, 20 units
per box)

Tablets

Yes

Yes

USD 9 (750 mg, 20 units
per box)
USD 19 (200 mg, 10 units
per box)
USD 41 (500 mg, 10 units
per box)

Levofloxacin

Yes

USD 11 (250 mg, 10 units
per box)Injections
Ampicillin

Is the drug included on thenational essential drugs
medicines list?

Yes

USD 33 (500 mg, 5 units
per box)
USD 17.5 (500 mg, 10
units per box)

Penicillamine

Amoxicillin +Clavulanic acid(combination)

Tablets

USD 35 (500 mg, 30 units
per box)Injections

USD 10 (1.2g, per
injection)

Tablets

USD 9 (500mg, 16 units
per box)

SachetPhenoxymethylpenicill
inTrimethoprim AND
Sulfamethoxazole(Cotrimoxazole)Yes

USD 11 (1000 mg, 10
sachets per box)
USD 13.5 (1g, 16 sachets
per box)Injections

USD 19. 2 (1 g, 50 units
per box

Tablets

USD 17.5 (1 g, 12 units
per box)

TabletsYes

USD 5 (960, 10 units perbox)
USD 3 (480 mg, 20 units
per box)

Yes

Yes

106

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Drug name

Form

Price per box

Is the drug included on thenational essential drugs
medicines list?

Nitrofurantoin

Tablets

USD 24 (100 mg, 50 units
per box)Yes

Tetracycline

Tablets

USD 4.5 (250 mg, 10
units per box)

Yes

Metronidazole

Tablets

Injections
Clindamycin
CapsulesUSD 5 (250 mg, 20 units
per box)
USD 5 (500 mg, 14 units
per box)Yes

USD 12. (600 mg, 10
units per box).
USD 15 (300 mg, 16 units
per box)Yes

USD 8 (150 mg, 12 units
per box).
USD 17.5 (250 mg, 6units per box)

Azithromycin

Tablets

USD 34 (500 mg, 6 units
per box).

Yes

USD 23 (500 mg, 3 units
per box).
USD 24 (500 mg, 10 units
per box).

Clarithromycin

Tablets

Diphtheria, Tetanus,
Pertussis (acellular)
Hib vaccine

Injection

USD 60 (0.5 mg, 10 units
per box).

Yes

Poliomyelitis(inactivated) vaccine

Injection

Free 0.5 mg, (20 units
per box)Yes

Influenza vaccine

Injection

USD 45 (90.5mg, 20 units
per box).

No

Measles vaccine

Injection

USD 123 (0.5 mg, 500
units per box (10 vials of
50 doses)

Yes

Mumps vaccine

Injection

USD 123 (0.5 mg, 10
units per box)

No

Pneumococcal vaccine

Injection

USD 65 (0.5 mg, 10 units
per box)No

Rubella vaccine

Injection

USD 50 (0.5 mg, 10 units
per box)

No

107

USD 10 (500 mg, 10 units
per box).

YesMedical Country of Origin Information Report | Democratic Republic of Congo (DRC)108

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Annex 2: Bibliography
Oral sources, including anonymous sources
EASO1, Medical Doctor and local consultant responsible for in-country data collection of the report,
Email Correspondence, August-November 2020 and April 2021.
EASO2, Director of a national programme within the Ministry of Health. Responsible for national
implementation of the strategy. Medical Director and Head of Cardiology at prominent Kinshasabased facility, Email Correspondence, August 2020.
EASO3, Deputy Manager of a priority national programme. Responsible for national implementationof the strategy, Email Correspondence, August 2020.
EASO4, Medical Doctor and Monitoring and Evaluation officer in the Ministry of Health, Email
Correspondence, August 2020.
EASO5, Medical Director of a prominent Kinshasa-based clinic. Email Correspondence, August 2020.
EASO6, Senior Medical Advisor of an international healthcare company, Email Correspondence,
August 2020.
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110Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

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119Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Annex 3: Terms of reference for the MedCOI
report on the Democratic Republic of Congo(DRC)
Topical reports:
•
•
•
•
•
•
•
•
•
•

HIV
TB
Hepatitis B/C
Psychiatry (depression, anxiety disorders like PTSD, psychotic disorders like schizophrenia,
bipolar disorder, sleeping disorders)
Neurology (epilepsy, CVA)
Diabetes
Cardiovascular diseases (hypertension, myocardial infarction, heart failure, heart rhythm
disorders)
Nephrology (kidney diseases; renal failure)
Pulmonology (asthma, COPD, sleep apnoea)
Haematology (anaemia; like iron deficiency anaemia and sickle cell anaemia, + blood clotting
disorders)

Detailed content instructions topical reports:
General information--

Prevalence and incidence of diseases (epidemiologic data)
How is the health care organized for this disease?
o How is the disease treated – at specific centres, in primary health care centres,
secondary care / hospitals, tertiary care etc.?
o Which kinds of facilities can treat the disease (public, private not for profit (e.g.
hospitals run by the church), private for profit sector)?
How are the resources organized in general to treat patients with this disease? Are there
sufficient resources available to treat all patients?
Is treatment of this disease possible in public hospitals?
Are there any national plans or programmes for this disease?
Are there any international plans or (donor) programmes for this disease?

Access to treatment:--

Specific treatment programmes?
Specific state (eg insurance or tax) covered programmes? Are there any factors limiting theaccess to healthcare for patients? If so, are they economic, cultural, geographical, etc.? Are
there any policies to improve access to healthcare and/or to reduce the cost of treatments
and/or medication? What is the number of people having access to treatment?
Is the treatment geographically accessible in all regions?

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Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

-

-

-

What is the ‘typical route’ for a patient with this disease (after being diagnosed with thedisease)? In other words: for any necessary treatment, where can the patient find help
and/or specific information? Where can he receive follow-up treatment?
What must the patient pay and when?
Is it the same scenario for a citizen returning to the country after having spent a number ofyears abroad?
What financial support can a patient expect from the government, social security or a public
or private institution? Is treatment covered by social protection or an additional/communal
health insurance? If not, how can the patient gain access to a treatment?
Any occurrences of discrimination for people with this disease?

Insurance and national programmes:-

National coverage (state insurance)
Programmes funded by international donor programmes, e.g. Global Fund, UNAIDS, Unicef,
Gates foundation, Clinton foundation etc
Include any insurance information that is specific for patients of this disease

Cost and coverage of treatments:-

In the table, indicate the price for inpatient and outpatient treatment in public and private
facility and if the treatments are covered by any insurance.
For inpatient, indicate what is included in the cost (bed/daily rate for admittance,
investigations, consultations…).
Is there a difference with respect to prices between the private and public facilities?
Are there any geographical disparities?
Are the official prices adhered to in practice?

Medication costs:-

Are medicines in general accessible in the whole country or are there limitations?
Are the medicines registered in DRC? If yes, what are the implications of it being registered?
Indicate in the table:o generic name, brand name, dosage, form, pills per package, official prices, source,
insurance coverage:▪ Are (some of the) medicines mentioned on any drug lists like national lists,
insurance lists, essential drug lists, hospital lists, pharmacy lists etc.?
• If so, what does such a list mean specifically in relation to coverage?
▪ Are there other kinds of coverage, e.g. from national donor programmes orother actors?

NGOs
-

121

Are any NGOs or international organisations active for patients of this disease? What are theconditions to obtain help from these organisations? What help or support can they offer?

Medical Country of Origin Information Report | Democratic Republic of Congo (DRC)

Doi: 10.2847/40625

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