The DRC’s Health System is based on the 1978 Alma Ata Declaration based on the Primary Health Care Strategy, and the 1987 Bamako Initiative that committed people to the management of the health system. health and in cost-sharing. In this system, the operational unit is the Health Zone.
The health system forms a pyramid at three levels: The peripheral or operational level, The intermediate level, The central level
Peripheral or operational level.
It consists of 515 Health Zones (ZS). The Health Zone is the basic unit for health planning and the implementation of primary health care. At this level, the health structures are organized into two levels linked together by a system of reference and against reference.
The first level is a network of more or less 7,868 Health Centers (HCs) that provide the population with the Minimum Activity Package (MAP). The PMA includes curative, preventive, promotional and support activities, whose tasks are delegated to a multi-purpose team of nurses from the Health Center by the Health Zone Executive Team (ECZS). The health centers include the health centers themselves, the reference health centers, the maternities, the dispensaries and the polyclinics also belonging to the State, to the companies, to the religious confessions, to the NGOs and to the private individuals physical and moral.
The second level consists of approximately 434 General Reference Hospitals (HGRs) which offer the Complementary Activity Package (PCA). The PCA includes health activities organized within the framework of internal medicine, surgery, gynecology – obstetrics and pediatrics within a HGR. It also carries out activities related to management (hospital health information, human, material and financial resources as well as the management of personnel in the ZS). It is at the HZ level that all interventions are integrated into the basic structures of primary and community health care. With an average of between 100,000 and 200,000 inhabitants, each ZS is subdivided into health areas of about 5,000 to 10,000 inhabitants depending on the area, served by a health center.
Since 2004, the Health Zones (AS) have been developing integrated micro-plans that are consolidated at the BCZS level into a Health Zone (ZS) plan. This HZ plan is transmitted to the provincial level, which has the power to mobilize other potential partners.
Bridging mechanisms are in place, including the opening of credit lines for HZs to facilitate monitoring of financial flows and expenditures at all levels of the health system.
The intermediate level
It consists of 11 Provincial Divisions of Health and 65 District Health Offices. There are also 2 Provincial Reference Hospitals and similar provincial structures. The intermediate level provides technical support to the HZs with coordination, training, supervision, monitoring, evaluation, inspection and control functions. It translates the standards issued by the central level into operational guidelines and ensures their application.
The recent economic history of the DRC is marked by several attempts at reorganization and recovery of the economy. Faced with financial imbalances, rising indebtedness and stagnant production, the country was forced in the 1970s and 1980s to adopt the stabilization and structural adjustment policies recommended by the International Monetary Fund. (IMF) and the World Bank (1)
In the context of the administrative division stipulated in the current Constitution, the country will be subdivided into 26 provinces. It will follow the establishment of made of 26 Provincial Divisions of Health.
The central level
It is made up of the Minister of Health supported by his cabinet, the General Secretariat with central directorates, health programs and other specialized services. The central level also includes 57 national hospitals, 4 university hospitals, 32 specialized hospitals and assimilated structures. This level plays the normative and regulatory role with coordination and strategic orientation functions.
In June 2006, the DRC changed its National Health Policy based on a new orientation defined by the Strategy for Strengthening the Health System (SRSS). This strategy has received favorable opinions from most of the technical partners (bilateral and multilateral cooperation) of the Ministry of Public Health and has since succeeded in bringing together the support of the main health donors in the DRC. Above all, it helped to develop, in a concerted manner, drawing on a common vision, programs designed to strengthen the health system. It is now the common thread that must support the development of any health sector support program and inspire the evolution of programs already in place.
This strategy represents a new beginning for the health sector in the DRC, after two decades of fragmentation and progressive degradation. It also represents the re-emergence of the previously marginalized MSP, not only as an actor of the system, but also as unifying the efforts of the various partners who are still acting in a dispersed order. Lastly, it represents a new collective way of working for the different actors of the health sector who will thus be able to coordinate their support.
SRSS is redefining the rules of the game for collaboration between MSP and partners in a framework of harmonization and alignment. It specifies a series of precautionary measures to stop the gradual deterioration of the Congolese health system. It fixes, above all, the strategic axes to rebuild and restart it. These strategic axes revolve around the revitalization of the Health Zones, under the direction of the Ministry of Public Health, in collaboration with its partners, and implementation mainly through NGOs.
This strategy of recovery and revival of the health sector involves: the rehabilitation and implementation of local health facilities (hospitals, health centers, pharmacies, etc.), the development of human resources through basic training and development in the course of employment, the improvement of the working conditions of health personnel, the supply of basic pharmaceutical products and the equipment of hospitals, medical centers and university clinics.
The number of doctors has increased from about 2,000 in 1998 to 5,967 in 2008, the number of pharmacists is now 1,300 and the number of nurses has increased from 27,000 to 43,021 over the same period. These numbers are still insufficient given the demographic weight. In the DRC, in fact, there is a doctor for 11,274 inhabitants (when the norm is one doctor per 10,000 inhabitants), a pharmacist for 51,748 (when the norm is for a pharmacist for 20,000 inhabitants) and a nurse. graduated for 8000 inhabitants (when the norm is of a qualified nurse for 5.000 inhabitants). This shortage of staff is coupled with unequal spatial distribution: 60% of public sector doctors are based in Kinshasa, where only 10% of the population is counted. Some provinces (notably Maniema and Ecuador) suffer from a strong lack of medical staff. They only have 13 and 31 doctors respectively.
The Constitution of the Third Republic enshrines the right of all Congolese to health and food security (Article 47 of the Constitution of the Republic). To realize this right, the Ministry of Public Health has formulated strategies to improve its health policy. For the drug, the PPN of the Democratic Republic of Congo was adopted in 1997 and revised in 2005. Discussions are currently under way at the level of the government to propose it to parliament in the form of a bill. This new law will replace two obsolete laws that currently serve as a legal framework for pharmaceutical regulation (Ordinance No. 27 bis / Hygiene of March 15, 1933 on the practice of pharmacy, and Royal Decree of March 15, 1952 on the healing in the DRC).