DRC nears historic 14.5% Abuja target for health sovereignty

For years, the story of health financing in the Democratic Republic of Congo, or DRC, has been told as one of shortfall: too little public funding, leading to overreliance on households and partners —and heightened vulnerability when crises hit.

In 2021, the DRC’s health expenditure was just $21.59 per person — barely one-fourth of the $92 average across sub-Saharan Africa. The financial burden of health care was distributed unevenly: More than a third fell on households through out-of-pocket payments, while external donors covered nearly 40%. Domestic government financing, in contrast, accounted for less than a fifth (about 18%) of the total spend. This high, direct, out-of-pocket burden often turns illness into an economic shock, making health a key driver of poverty.

The DRC acknowledges this reality — but refuses to be defined by it. Instead, it is choosing a different trajectory: increasing domestic resources for health, creating more predictable health-dedicated revenues by reducing inefficiencies, and tightening the public financial management and governance systems that ensure every dollar buys services, medicines, and readiness — and delivers results and trust.

A new health financing architecture

In 2001, African Union members signed the Abuja Declaration, pledging to allocate at least 15% of annual government budgets to health. However, more than two decades later, only three countries — Rwanda, Botswana, and Cabo Verde — have consistently met or exceeded this target. While the DRC has yet to cross this line, the direction and speed of its progress are unmistakable.

This year, the DRC is redefining its fiscal sovereignty in health. Although core health allocation has surpassed 5.5 trillion Congolese francs (approximately $2.5 billion), the real transformation lies beyond this baseline. Through bold political decisions, the government has operationalized a dedicated health financing architecture anchored in domestic resource mobilization.

The Health Promotion Fund, financed by a 2% levy on imported products (excluding food and agricultural goods), was initially projected by the Africa Centres for Disease Control and Prevention to generate up to CDF 599 billion in 2026. Internal updates from the Ministry of Health and Ministry of Finance now estimate it will generate more than double — a clear signal of political will. With a national peace agreement poised to revitalize economic activity and trade flows, this fund is expected to expand significantly beyond 2026, turning post-conflict recovery into sustained health investment.

Simultaneously, the rollout of mandatory health insurance introduces a structural 2.5% health contribution on gross salaries across public and private sectors. Even with conservative modeling done internally, this reform would generate CDF 787 billion in 2026. With broader public sector coverage and gradual private sector integration, internal projections indicate revenues could exceed CDF 1.1 trillion. Future expansion will include full formal sector coverage and progressive inclusion of the informal economy, which currently accounts for over 95% of employment. By extending protection to those traditionally excluded from formal systems, this is more than just fiscal reform — it’s social transformation.

A shift toward domestic ownership

Taken together, these strategic funding pillars — core budgetary allocations, the Health Promotion Fund, and the new insurance contributions — propel total health financing to nearly 14.5% of the national budget. For a country long portrayed as aid-dependent, this marks a strategic shift toward domestic ownership.

The trajectory does not stop there. By systematically capturing private sector expenditures in national health accounts and scaling provincial cofinancing models — such as the Mashako immunization approach, which demonstrated that clear targets, real-time data, and strong accountability can rapidly improve immunization coverage even in complex health systems — the state can create a stronger platform for expanding primary health care, vaccination, and emergency readiness. In so doing, the DRC would not merely approach the 15% Abuja target — it would surpass it.

Public financial management is the new health frontier

Financing is only half of sovereignty; stewardship is the other half. Globally, up to 40% of health spending is lost every year due to inefficiencies: fragmented plans, parallel reporting systems, weak procurement, poor payroll management, and even ghost workers. To improve equity, financial protection, efficiency, and overall health outcomes, the DRC needs a larger share of health spending to come through public and pooled channels. It also needs budgets to translate into drugs, salaries, referrals, surveillance, and primary care that people can actually use.

This is where public financial management, or PFM — how a government manages its resources — stops being an accounting exercise and becomes frontline health protection. Better PFM means one national plan, budget, and results framework; more credible procurement; cleaner payrolls; more predictable cash releases; and routine publication of execution data that citizens and partners can trust. It reduces fragmentation between central and provincial levels, improves budget credibility, and helps partner funds reinforce national priorities instead of bypassing them.  

In this vein, Africa CDC is supporting the DRC’s PFM transformation by embedding a senior subject matter expert and other experienced public health reform staff within its country office. The goal is to provide the technical assistance needed to strengthen PFM systems, enhance budget execution, and ensure more effective allocation and use of health resources.

Initial efficiency gains are already emerging through key reforms underway in the DRC:

• The establishment of a delivery unit to accelerate implementation and accountability.

• Participation in the African pooled procurement mechanism to secure affordable, quality health products.

• The digitization of systems to strengthen program management, emergency response, and national data ownership.

• The introduction of Visa- and Mastercard-linked health insurance cards to better integrate the informal sector into the formal economy and advance universal health coverage, enabling transparent contributions while ensuring continuity of care.

The expected outcome is greater financial inclusion, reduced leakage, and a more accountable and sustainable health financing system

What stronger PFM and the Lusaka Agenda can unlock

External financing will remain important to the DRC’s health journey — the country will continue to work with bilateral and multilateral partners and philanthropies. But the nature of these partnerships is shifting; the era of imposed agendas has ended. That is the core promise of the Lusaka Agenda, a global framework to unify fragmented donor-led health projects: stronger country leadership, fewer parallel systems and inefficiencies, improved execution, and better value for money.

By institutionalizing PFM reforms alongside the Lusaka Agenda, the DRC is committing to  strengthening health funding. This commitment will ultimately protect households from high out-of-pocket costs by working toward the goal of implementing health insurance.

A commitment anchored in pride and accountability

The DRC stands with confidence and resolve behind its 2026 health framework, which signals a sovereign nation investing boldly in the well-being of its people; a nation ready to mobilize its own resources and rebuild a health system grounded in discipline, transparency, and measurable results. But pride is not a substitute for performance.

We call on the DRC Parliament and every citizen, province, and partner to hold us to the highest standard of delivery and impact. In partnership with Africa CDC, the president of the DRC will convene a biannual review with ministers, governors, provincial leaders, and partners to assess progress, confront bottlenecks, and publish clear corrective actions and timelines. We invite citizens and partners to witness this effort.

This is no longer a story of aspiration; it is a story of political choice. The DRC is demonstrating that health financing reform is not about waiting for donors — it is about mobilizing national will, aligning fiscal instruments with sovereignty, and transforming recovery into resilience.