LE METROPOLIS SANTÉ+: Doctor, how would you describe today the state of the Congolese healthcare system? In your opinion, what are the priority challenges that the country must face?

DOCTOR ALPHONSE NZOMVUAMA: The Congolese healthcare system needs to be improved and, most likely, completely restructured in order to adapt it to the current advances in medicine. The main goal is to make healthcare accessible to everyone, or at least, in the first instance, to as many people as possible. Efforts in this direction are reportedly ongoing at the Ministry of Health.

The DRC still largely depends on external aid to finance its healthcare system. How can better health sovereignty be achieved?

 It is necessary for the country to free itself from this external dependence, particularly in the field of health. The authorities seem to be increasingly aware of this.Thus, a few weeks ago, I attended a conference in Brussels where the Minister of Health spoke to the Congolese community. He announced, in particular, the creation of a fund financed by a new tax. This is certainly a step forward, but it may not be sufficient. It is important not to lose sight of the fact that the quality of a healthcare system is closely linked to the economic situation of the country. The more people are employed, the more employee contributions will help strengthen healthcare financing. Needless to say, the management of these resources must be carried out with exemplary rigor.

What structural reforms do you consider essential to improve the governance of the sector? What concrete measures could be taken to strengthen universal health coverage in the DRC?

Measures need to be taken to combat disparities in care, both in quality and quantity, across the entire national territory. The example of Kinshasa is telling: depending on whether one lives in the affluent neighborhoods or in peripheral areas, the technical facilities range from very good to very poor. Added to this are financial difficulties that exclude a large part of our fellow citizens from access to quality care. Universal health coverage is an encouraging initiative that moves in the direction of improving this situation that we deplore. However, it will be a long-term effort for it to truly achieve universality. Wait and see!

The medical exodus remains a major problem. How can we retain doctors and caregivers in the DRC? What role should local training and international partnerships play?

Yes, this is a problem I know well, as I myself spent a large part of my career in France, whereas initially I only planned to stay there for seven years. Young doctors go abroad to train and master new medical tools. The realities they encounter in these host countries are diverse, and many of them end up staying there. This tendency is all the stronger because they find social and professional conditions there that are difficult to replicate in the DRC. I believe we should not oppose young people who leave: what they learn is also in the country's interest. Our responsibility is to make returning to the country attractive.

Which hospital infrastructure projects do you consider to be the most strategic for the future? In your opinion, what could the Congolese healthcare system look like in 10 or 20 years if the current reforms succeed?

If the ongoing reforms are not hindered, I think we could at least approach international standards. A minimum timeframe of about twenty years seems more realistic to me. As for hospital infrastructure, it seems to me that we should start by rehabilitating the existing facilities, some of which are in a state of advanced decay and disrepair. Of course, all of this will be accompanied by their equipment and the assignment of skilled personnel.

The Congolese healthcare system must be improved and, most likely, completely restructured in order to adapt it to the current advances in medicine.

As a specialist, what are today the main challenges of cardiac surgery in the Democratic Republic of Congo, and how can we address them to improve patient access to advanced care?

In cardiac surgery, whether for adults or children, the task is immense. One of my major concerns is inspiring vocations, as this mission is insurmountable for a single individual, or even for just a handful of people. One fact is well established: the development of cardiac surgery in a center always has a ripple effect on other disciplines. Indeed, the preparation and follow-up of heart surgery patients constitute a true interdisciplinary crossroads for the benefit of the patients.

▲Dr. Nzomvuama, at the back on the left, with a headlight: at the end of the removal of a heart tumor (September 2025, Cinquantenaire Hospital, Kinshasa)

Patient access remains, however, a major challenge. This is an expensive but vital surgery for patients whose purchasing power is particularly low. There are two solutions: either further reduce the cost of surgery, or obtain state support so that the out-of-pocket expenses for families remain manageable.

Today, the average cost of a procedure has already been brought down to between 10,000 and 15,000 dollars, but there is still room for further reduction without compromising either the quality of care or patient safety. Government assistance is therefore essential to relieve families and prevent a selection based on wealth.