In the room where you enter on tiptoe, it’s the same smell of milk. Women who have just given birth rest with their newborns. “This is my third child,” whispers Olga, who is nursing Elura, born in mid-April. This is the first time I didn’t have to pay anything to give birth. »
The eight other mothers who share the space agree. We are in the Luyindu Public Hospital Center, in the commune of Ngaliema, one of the twenty-four in the capital of the Democratic Republic of Congo (DRC). “It’s real social progress for Congolese women,” adds Annie Munungi, the nurse in charge of the maternity ward.
This “first package” of primary care desired by the government must ensure completely free monitoring of the birth, then of the mother and child during the first month. A small revolution in a country where under-5 mortality remains among the highest in the world, with a rate of 79 deaths per 1,000 births in 2021, according to the United Nations.
This system launched in September 2023 in the Congolese capital and three other provinces (South Kivu, Kasaï-Oriental and Kongo-Central) is presented as the beginning of the future universal health coverage (UHC), developed under the leadership of the Nations united under the Sustainable Development Goals (SDGs). A UHC intended, by 2030, to “ensure access for all to quality essential health services”. In mid-April, the “free maternity” program was expanded to seven new provinces and should be extended to the entire territory by the end of the year.
Huge task
But, while the implementation of UHC was declared a “national priority” in 2019 by President Félix Tshisekedi, it took five years for the Congolese authorities to build their strategy with the support of the American development agency, USAID, and the World Health Organization. A National Council of the CSU (CNCSU), directly attached to the presidency, was formed in 2021 with the primary mission of taking stock of the 519 health zones in this country four times the size of France. “At the time, the observation was that, unlike the rest of the continent, the life expectancy of the Congolese was falling,” recalls Doctor Polydore Kabila, coordinator of the CNCSU. The causes of mortality are multiple, the architecture of our ambitious National Strategic Plan must therefore be multi-sectoral in order to achieve UHC in 2025.”
The task is indeed immense for this country which invests on average only 4% of its gross domestic product in the health of its 103 million inhabitants and depends for 38% on external financing, according to the World Bank. While the average salary does not exceed 45 euros per month, the burden on households is overwhelming. This ambition is also complicated by the security situation in the east of the country, prey to violence by armed groups.
At the Celpa private maternity hospital in Luyindu, posters in French, Lingala and Swahili praising the free program are also posted on the walls. But establishments are struggling to get their advances reimbursed by the Congolese state. “The structures are doing their job, and we can be proud of not having lost any newborns,” says Pierre Buléli, the center’s administrator. But when we present the bill to the Health Solidarity Fund created especially for the system, the State only pays a third or half of it and with a lot of delay. »
“Fiasco announced”
“Our system is like that brand new ambulance you see in the yard. The State offered us magnificent vehicles with beautiful colors and a siren to help the population, quips Alphonse Mavanga, anesthetist and director of care at the Luyindu Hospital Center. But we can’t afford to buy gasoline. »
The National Council of the CSU argues for its part that it “carried out an uncompromising inspection” three months after the launch of the program “in order to correct what needs to be corrected. This is a very ambitious reform that we have undertaken.”
The National Union of Doctors (Synamed) had already warned in 2023 against a “fiasco announced” by the voice of its general secretary, the cardiologist John Senga, who denounced the lack of consultation, the undersizing of the budget but also the exclusion of certain procedures, such as ultrasound or biology, from the financing of the program. “In Kinshasa, the General Hospital, those of Ngaliema, Biamba Marie Mutombo, the Barumbu Mother-Child Hospital are booming,” he lists. In February, we raised these problems, duly argued, with the Ministry of Health and the Health Solidarity Fund. If the State does not correct the situation, we fear that establishments will be forced to backpedal and return to the old system. »
The CNCSU recalls that 42 million dollars (more than 38 million euros) have already been mobilized for the start of the program and that the Global Fund provided 78 million dollars for the expansion to the seven new provinces. Arguments which do not seem to calm doctors and midwives who do not rule out a strike movement so that this social progress can significantly reduce the mortality of Congolese mothers and their children.