CSU is not an option but a duty

Approximately 50 million Congolese, representing 60% of the population, do not have access to the healthcare system. The courage and bravery of our healthcare workers merits the strengthening of adequate human and material resources. We will call on the government to take swift action to rehabilitate referral hospitals, build healthcare platforms, and establish a healthcare coverage system through mutual health insurance companies. We cannot accept a failing healthcare system at the risk of the lives of our fellow citizens.

The government's mission will be to increase the population's coverage rate through an affordable and effective health insurance system by 10% per year until universal health coverage is achieved. To this end, we will reform the National Social Security Fund and promote the establishment of a suitable health coverage ecosystem that covers all social categories.

(Excerpt from Félix Tshisekedi's speech on January 24, 2019)

The son of Étienne Tshisekedi, a historic figure in the Congolese opposition, and having spent a large part of his life in Europe, Félix Tshisekedi, from the moment he took office, displayed his desire to place public health at the heart of his actions. His ambition: to guarantee every Congolese equitable access to healthcare. This orientation is in line with the ideological line of his party, the UDPS, whose credo remains unchanged: "The people first," against the backdrop of the quest for social well-being for all.

Which government to lead the reform?

The choice of Sylvestre Ilunga Ilukamba as Prime Minister had sparked debate from the moment it was announced. At over 70 years old, some saw him as a seasoned veteran of the political scene, capable of steadying the ship of government. Others, however, doubted his ability to embody the renewal promised by Félix Tshisekedi.

Once appointed, Ilukamba nevertheless placed health at the heart of his program. Before the National Assembly in September 2019, he hammered home his priorities: "improving social conditions with the main focuses: education as the key to change and the main social elevator, access to health care for all and ensuring universal health coverage."

Ambitious commitments, certainly, but difficult to achieve in a constrained budgetary context and weakened institutions.

100 Day Program

In his speech on March 2, 2019, Félix Antoine Tshisekedi launched his emergency program for the first 100 days with great fanfare. Health was among the priorities. The president promised the rehabilitation of emblematic hospitals such as Maman Yemo and the University Clinics of Kinshasa, the completion of Sendwe Hospital in Lubumbashi, the inauguration of new health centers, and even the construction of a specialized Ebola hospital in Ituri. On paper, the ambition was clear: to upgrade a dilapidated hospital system.

While awaiting the appointment of a Prime Minister, the presidential cabinet took charge of the matter and set the pace. But the momentum would not live up to its promises. While the construction of an ultramodern military hospital at Camp Tshatshi was noted, the program would not be completed. In August 2019, a thunderbolt came: the Minister of Health, Oly Ilunga, was arrested for embezzlement. Sentenced to five years of forced labor, his case alone illustrates the fragility of the sector.

Because health, far from being a poor relation, attracts significant funding intended to improve the daily lives of the Congolese people... But it is too often diverted to the benefit of particular interests. Meanwhile, promulgated in December 2018, Law 018/035 establishing the general principles relating to the organization of public health came into effect in April 2019, six months later. It enshrines the rebirth of a modern health sector. An architecture of four major institutions that are piloting Félix Tshisekedi's major reform: universal health coverage.

WHAT ABOUT THE BLANKET HEALTH UNIVERSAL (CSU) ?

A right, not a privilege, according to the WHO. For the World Health Organization (WHO), Universal Health Coverage (UHC) is not a convenience, but a fundamental right. In concrete terms, it guarantees that every individual can receive the care they need, at the right time, without the risk of falling into poverty.

UHC is not limited to curative care; it supports every stage of life, from prevention to health promotion, including treatment, rehabilitation, and even palliative care. Behind this objective lie two major challenges: protecting the health of populations and securing their economic future.

Because in many countries with fragile health systems, a simple hospitalization or heavy treatment can be enough to ruin a family. Asset sales, unsustainable debt, and shattered savings: the cost of illness then becomes a collective burden, weighing on the sick, but also on their children and grandchildren.

A barometer of sustainable development

For the United Nations, health is not just a matter of well-being: it is at once a prerequisite, a tangible outcome and a true barometer of sustainable development. It is with this in mind that Universal Health Coverage (UHC) has been included at the heart of Sustainable Development Goal No. 3 (SDG 3) for 2030: “Ensure healthy lives and promote well-being for all at all ages”.

A major ambition for theRDC

Health Coverage Universal Health Coverage (UHC) embodies a major ambition for the DRC: to offer every citizen access to quality healthcare, without discrimination and without the risk of impoverishment linked to the cost of treatment. “Health can no longer be a luxury reserved for a few. Universal Health Coverage is an imperative and a right for every Congolese. Our commitment is clear: to transform our healthcare system so that it meets the needs of all, regardless of income or social status. This requires investment in our infrastructure, the training and effective deployment of healthcare professionals, and ensuring equitable access to healthcare throughout the country,” says Dr. Samuel Roger Kamba, Minister of DRC Health

Major reforms in the DRC

On June 1, 2021, Félix Tshisekedi established, by decree, the National Council for Universal Health Coverage (CNCSU). Placed under his direct chairmanship, this leading body includes at least ten ministers. Its mission: to design, guide, and monitor all interventions related to Universal Health Coverage (UHC) in the DRC. Alongside him, Roger Kamba, his special advisor in charge of UHC, ensures the coordination of the technical committee responsible for turning ambitions into concrete actions. In December 2021, the government unveiled a national strategic plan designed to chart the roadmap. The objectives are ambitious: to increase Congolese life expectancy by 30%, halve maternal mortality, and reduce child and youth mortality by 50%. In the short term, the aim is to increase coverage of essential health services to 60% and end direct payment for care, one of the main barriers to accessing health services.

In the background, this strategic plan emphasizes universal access not only to healthcare but also to essential services such as drinking water, electricity, sanitation, and a health-promoting environment. All of these are levers without which UHC would remain a slogan.

The pillars of the CSU

Three pillars structure this vision: improving the quality of care, equity in access to it and financial protection for households.

• The FSS health solidarity fund

The creation of the Health Solidarity Fund (FSS) is a central pillar. Established by Law No. 18/035 and reinforced by Decree No. 22/13 of April 9, 2022, the FSS is a public institution designed to finance the CSU. It draws on various sources: the state budget, contributions from health insurance schemes, as well as donations and legacies.

▲ Félix Tshisekedi inaugurates the CMTT of Lubumbashi

For the first time in the DRC, this fund covers several insurance schemes:

·        Mandatory health insurance for active and retired civil servants in the State public services: Since May 8, 2025, military personnel and police officers have benefited from coverage for occupational risks and illnesses. This system is financed by contributions: a 3% share of the agents' salary and a 12% share from the State.

·        Mandatory health insurance for workers governed by the Labor Code, active and retired: it started in certain bodies such as the judiciary

·        School and student health insurance : in progress

·        Informal sector health insurance : in progress

·        State medical assistance for vulnerable people This has already been effective since the launch of free maternity care for all pregnant women.

“UHC is not an option but a duty,” said Félix Tshisekedi during the launch in 2023 of the program for free maternity and newborn care.

The National Institute of Public Health (INSP): health sentinel

The National Institute of Public Health (INSP) is responsible for centralizing information, mobilizing expertise, and implementing an effective response framework. Its mission is to prevent, detect, and respond effectively to epidemics and other health emergencies, thereby protecting the Congolese population from health threats.

Key agencies for a high-performing health system

Several agencies support Universal Health Coverage (UHC) in the DRC, each with a specific role:

·        National Agency for Clinical Engineering, Information and Health IT (ANICNS): a pillar of the digital transformation of the health system, it aims to modernize data management and improve patient monitoring.

·        National Agency for Essential Medicines and Health Products (ANAMED): guarantor of the availability, quality and distribution of medicines throughout the country.

·        Congolese Pharmaceutical Regulatory Authority (ACOREP): ensures the quality, safety and efficacy of medicines, thus protecting the population against defective or dangerous products.

The Local Development Program (PDL-145T): bringing care closer to rural populations

After the 100-day program, President Félix Tshisekedi launched the Development Program

Local 145 Territories (PDL145T), which focuses on local health. By the end of October 2024, 276 health centers had already been built out of the 786 planned across the country, including 181 fully equipped and handed over to communities.

The ambition is simple: to prevent rural populations from having to travel dozens of kilometers to access a hospital, and to guarantee everyone a minimum level of quality care, wherever they live. This is a way to reduce health inequalities between the capital and the hinterland, while laying the foundations for a more equitable system.

Reference hospitals to strengthen the health system

Several reference hospitals have been inaugurated in recent years in order to modernize the health system and bring care closer to the population:

·        The Camp Colonel Tshatshi Hospital Center, inaugurated on April 8, 2023 in Kinshasa, fulfills a dual essential mission: to offer high-level care to members of the Republican Guard and their families, while opening up to neighboring civilian populations;

·        Muya Reference Hospital: inaugurated in December 2024 by President Félix Tshisekedi, it is the first modern hospital in the center of the country, fully equipped with the latest generation of equipment;

·        Mwangeji General Referral Hospital: Located in Lualaba province, this tertiary-level hospital complex was opened in June 2025. It meets a crucial need: to provide quality care locally to the population;

·        Tshisekedi Tshilombo Hospital Centre (CHTT): inaugurated in Lubumbashi in April 2025, this hospital centre, which bears the name of the president, marks an important milestone for the health sector, benefiting social security beneficiaries, local populations and even the sub-region;

·        La Renaissance University Hospital Center (formerly Mama Yemo): long abandoned, this vast hospital establishment has been completely modernized and returned to the public in December 2023, once again offering cutting-edge infrastructure to the capital; The modernization of the university clinics of Kinshasa (PRECUK).

Concrete advances for pediatric nephrology

"Our priority is to provide every Congolese with access to quality healthcare," explains Roger Kamba, Minister of Health. This requires innovation, strengthening infrastructure, and equipping hospitals with modern equipment. In May 2025, this ambition will be realized with the official launch of acute peritoneal dialysis activities for children. The first insertion of a peritoneal dialysis catheter (PD catheter) was performed directly at the patient's bedside, using locally prepared dialysate fluids. This represents a major advancement in pediatric nephrology care, which now makes it possible to treat cases that were previously difficult to manage in the DRC on-site. Conversely, some facilities continue to suffer. Rehabilitation work is underway for the Kintambo maternity ward, while the Kinshasa referral hospital, known as the Sanatorium, remains in a dilapidated state. The same is true of the Kinshasa clinic located in Gombe. This contrast illustrates the persistent challenges of the Congolese hospital system, between modernized infrastructures and abandoned establishments.

•A breeding ground for epidemics

Six years after the launch of reforms, and despite the emergence of new hospital infrastructure, health crises remain commonplace in the DRC. In addition to the COVID-19 pandemic that marked 2019, the country continues to face recurring outbreaks of cholera, Ebola virus disease, and, more recently, Mpox (monkey pox). These epidemics, which resurface regularly, put a strain on a still fragile health system and mobilize significant human and financial resources, often in an emergency.

Cholera

In May 2025, Health Minister Samuel Roger Kamba officially declared a new cholera outbreak affecting six provinces: Haut-Katanga, Tanganyika, South Kivu, North Kivu, Tshopo, and Kongo Central. According to the WHO, the situation quickly reached alarming proportions: between January and August 2025, the DRC recorded more than 44,000 suspected cases and 1,238 deaths, more than double the figures recorded during the same period in 2024. Kinshasa, particularly hard hit, is experiencing an epidemic of rare intensity. Twenty-seven of its 35 health zones are now affected, with a case fatality rate of 8%, well above the national average of 2.7%. Faced with the emergency, a vaccination campaign was launched at the end of August in the capital and several provinces, in the hope of containing the spread of the virus.

Mpox: a persistent and underestimated epidemic

Declared a national epidemic at the end of 2022, Mpox (monkey pox) continues to weigh heavily on the Congolese health system.

Between January 1 and May 31, 2025, the DRC recorded 12,208 suspected cases and 22 deaths, more than half of the cases reported in Africa during the period, according to the WHO.

In Kinshasa, the Kinoise Clinic has become the primary referral center for severe cases. With 42 beds and an average of around twenty patients, it has only a handful of caregivers specifically trained in the treatment of MPOX. The teams work in precarious conditions, marked by chronic shortages of gloves, medications, and protective equipment. The result: a mortality rate close to 10%, far higher than what is observed elsewhere.

In an attempt to stem the spread, a targeted vaccination campaign has been launched, with the support of partners such as UNICEF. But the challenges remain considerable: weak epidemiological surveillance capacity, a lack of laboratory tests, and limited access to antiviral treatments. The response is further complicated by the fact that the country is simultaneously managing other health emergencies such as cholera and measles, not to mention the persistent insecurity in the east.

Ebola: the return of the virus to Kasai

In early September 2025, the Ministry of Health announced the resurgence of the Ebola virus in Kasai province. Within days, 28 cases were confirmed, including 15 deaths. Among the victims were two healthcare workers, a stark reminder of the danger facing those on the front lines. According to UN News, analyses carried out at the National Institute for Biomedical Research (INRB) in Kinshasa confirmed the presence of the most feared strain: the Zaire Ebola virus, first identified in the DRC in the 1970s. This is not a first for Kasai, which was already hit by epidemics in 2007 and 2008. Since its discovery in 1976, the DRC has experienced 15 Ebola outbreaks. The last, which occurred in Équateur province in 2022, was brought under control in less than three months. But each resurgence is a reminder of how vulnerable the country remains: in the east as in the center, the shadow of Ebola continues to hover over a health system already weakened by other crises.

Healthcare workers, the pillar of health reform

At the heart of Félix Tshisekedi's health policy lies one conviction: without trained and motivated healthcare workers, universal access to care will remain a pipe dream. Upon taking office, the president tackled an explosive issue: the hazard allowance, long demanded by doctors.

Of the 7,723 practitioners listed in the so-called "Bibwa" file, 6,017 were finally aligned with this bonus. In 2022, a memorandum of understanding, now known as the Bibwa Agreement, made it possible to settle this dispute by expanding the system: nearly 3,000 nurses obtained the same recognition, accompanied by the signing of a new salary scale.

The measure didn't stop there. In the same vein, 100 pharmacists, 20 surgeons, 18 physicians, 1,000 administrative staff, and 800 other healthcare workers were also included in the bonus in the fourth quarter of 2022. This progress was hailed as a decisive step towards revaluing a long-underestimated medical profession, even if the challenges of motivation and working conditions remain.

Progress in figures between 2019 and 2025

The figures show the progress made between 2019 and 2025. However, despite undeniable progress, challenges remain:

1.     ACCESS TO CARE

Only 28%of the population had regular access to first-level health structures;against 41%,thanks to the opening of community health centers and the rehabilitation of urban hospitals (Ngaliema, University Clinics, Camp Tshatshi Hospital).

2.     HUMAN RESOURCES IN HEALTH

Per 100,000 inhabitants, on note environ 0.9 doctorAnd 4 nurses ; against 1.3 doctor And 6 nurses.This statistic is still far from the WHO standard (10 doctors And 30 nurses For 10 000).

TENDENCY: slow but significant progression: +13 points in 6 years

3.     HEALTH BUDGET

The national health budget represented6,8 %of the state budget. It reaches9,4 %, with a gradual increase in investment in hospital infrastructure and staff remuneration.

TREND: +2.6 points, but still lower than the Abuja commitment(15 %).

4.     MATERNAL AND INFANT MORTALITY

Maternal mortality:

473 deathsFor every 100,000 live births, we note473 deaths against 392.

Infant mortality (less than5 years) :

For 1 000 live births, we note85 deaths against 68. TENDENCY: Decrease of15 to 20%, but the DRC remains one of the most affected countries in Africa.

5.     VACCINATION

DTP3 (diphtheria-tetanus-pertussis) vaccination coverage has increased from56 has 71%,thanks to the Gavi Initiative and national campaigns.

TREND: +15 points,but coverage remains heterogeneous depending on the province.

6.     MALARIA, TUBERCULOSIS AND HIV

Malaria:

Reported cases24 millionscompared to 19 million cases estimated in 2025, or(−20 %) HIV/AIDS:

Adult prevalence 1,2 % against 0,9 %in 2025

Tuberculosis:

An incidence of324case for100 000inhabitants against210 case for100 000 residents.

TENDENCY :Visible progress but still insufficient in the face of epidemiological challenges.

7.     HOSPITAL INFRASTRUCTURE

Approximately 430 hospitalsfunctional throughout the territory against more than520 hospitalsoperational, including several modernized in Kinshasa, Lubumbashi and Goma.

TREND: +20%, with a persistent urban-rural gap.

Tangible progress but persistent challenges

In six years, the Democratic Republic of Congo (DRC) has undoubtedly made progress in the health sector. Figures show an increase in vaccination coverage, a relative reduction in maternal and infant mortality, and better access to primary care, particularly in certain urban areas.

But this real progress remains fragile. With a population expected to reach 90 million by 2025, the pressure on already overstretched hospital infrastructure continues to grow. In the east, armed conflicts continue to paralyze healthcare provision and are hitting displaced populations hard, often deprived of basic health services.

However, the World Bank estimates that if this momentum is maintained—and supported by more rigorous governance and sustainable financing—the DRC could, by 2030, have a more robust health system. A system capable not only of managing health emergencies but also of meeting the needs of a young and growing population.