Two provinces in the Democratic Republic of Congo (DRC) are trying to bridge the yawning gap between potential wealth and the nation’s critical health needs. Haut-Katanga and Lualaba provinces are doing it through their approach to localization—too often a platitude, not a practice. How? By making wise use of tax money from the controversial mining industry, which faces pressure from DRC collaboration with donors, civil society, and the private sector to improve its practices.
“No matter if we are here or not, these communities are finding solutions for their own problems.” says Dr. Diarra Houleymata, Abt Global’s chief of party for the U.S. Agency for International Development (USAID)-funded Integrated Health Project (IHP) in the DRC. “We need to really build on the systems they have already, not bring something external, which is not working for them at all.”
The country has always possessed two major reservoirs of potential: a diverse and vibrant population, which now totals nearly 105 million people, with deep cultural legacies, entrepreneurial spirit, and resilience; and vast mineral wealth, including significant deposits of cobalt, copper, diamonds, gold, tantalum, and tin. The DRC recently has seen a surge in mining investment. “Local revenues are not very considerable compared to the revenues from our mineral resources,” says Sebastien Mwape Kabinda, chief of the Bukanda sector in the Haut-Katanga province.
Mining company taxes provided funding in both Haut-Katanga and Lualaba, mostly for local development projects such as infrastructure, schools, and other local projects. Everything but health, it seemed. Yet “health is the priority of priorities for us,” Kabinda notes.
So, the Abt-led IHP program developed advocacy partnerships with provincial health divisions to persuade local governing bodies called Decentralized Territorial Entities to shift a larger chunk of spending to healthcare. The initial commitment in 2020 came to $684,500. Then the momentum picked up. Between late 2022 and 2023, a series of 18 advocacy meetings with local officials aimed to convince them of the pressing needs of the health zones and to rally even more support for addressing health coverage gaps. At the end of the meetings, the officials invited the chief medical officers of the health zones to take part in drawing up annual investment plans for each zone.
“This advocacy was of paramount importance,” says Dr. Claude Ngoikitenge, chief medical officer for the Kipushi health zone.
The IHP-supported advocacy partnership brought together local development committees for Kaponda and Bukanda to plan together. These efforts set in motion a plan to support health priorities in 2023 and 2024 and helped the funding for health in those health zones surge to $22.5 million in 2023. “USAID has helped us a lot by playing the role of facilitation,” Ngoikitenge says.
The money financed health infrastructure, drilling of water points for access to potable water, delivery of medicine, and provision of fuel to support mass campaigns in remote areas. The investments spanned 29 health centers and three health posts. Local officials bought medical equipment, medicine, five ambulances, two mortuary refrigerators, and 19 motorcycles for supervision and vaccine transportation. The funding also goes to helping people internally displaced by mining and DRC’s civil strife. In the last quarter of 2023, the Abt team and its local partner, Ambassadors for the Fight Against Tuberculosis, reached more than 15,000 people living in camps with health campaigns that raised awareness of communicable disease symptoms.
This approach for domestic resource mobilization may be replicable in other areas with large mining sectors. But mining revenue doesn’t exist everywhere, of course. There may be other sources like agriculture, fishing, or textiles that can enable a locality to replicate and scale a similar approach. And that’s the point. Strategies should be tailored to the local context. What should be the focus of strengthening local systems is local control of the revenue and decisions on how to spend it based on local needs.
Over the past six years, Abt and its partners have worked with the Ministry of Health to strengthen local health planning in several districts and foster coordination between health and other local officials. The goal is to expand access to and use of local funds to address local health needs.
Our integrated approach helps strengthen the capacity of local partners covering a broad spectrum of the DRC’s health needs: nutrition; malaria; family planning; reproductive, maternal, newborn, and child health; tuberculosis (TB); COVID-19; and water, sanitation, and hygiene (WASH) — all with a focus on health system sustainability. “We have strengthened their capacity to enable them to provide quality care even in remote places and places of insecurity,” says USAID IHP Deputy Director Narcisse Embeke. “Even after the program, they will be able to continue to provide care to the vulnerable population at all levels.”
Malaria, the DRC’s leading cause of maternal and child morbidity and mortality, is a particular challenge. Nearly all of the population lives in high malaria transmission zones. That’s why USAID IHP has made a big push on malaria treatment, including awareness campaigns that included screening and referrals for free care. From October 2022 to September 2023, the project supported local partners who provided care to nearly 4 million children under five in nine provinces, a 38 percent increase since 2017.
It’s impossible to overstate the importance of local community, person-to-person touches. Consider how Lomami Province dealt with COVID-19. Like most of the DRC, the province faced stubbornly persistent COVID-19 infections. Vaccination campaigns, which are relatively short, were relatively ineffective. What Lomami needed was a system of routine, ongoing vaccinations.
That’s what USAID IHP and its partners help provide. We supported the Lomami’s Macici Health Center by transporting vaccines, advanced vaccine strategies, management and awareness-raising tools, and materials and equipment for infection prevention and control. What made the difference, though, was strengthening grass roots community involvement in the vaccination effort. We regularly shared vaccination updates with health zone officials and providers while strengthening capacity in scores of facilities. As a result, 51,928 people achieved complete COVID-19 vaccination status, with 175 vaccination sites in seven provinces participating.
Local eyes and ears play a critical role in combatting TB, too. In the DRC, the stigma attached to TB makes people reluctant to seek care. It’s associated with HIV and poverty, and the risk of transmission is high. This makes it hard to detect, diagnose, and treat the disease.
But this is changing, even as cases of drug-resistant TB increase. The reason: our focus on communities through our collaboration with the National Tuberculosis Control Program. We focus on influencers such as pastors, teachers, traditional chiefs, and women’s and youth groups, who encourage people to get screening and treatment. We also provide integrated services such as nutrition kits to promote community engagement. In addition, the project awarded nearly $5 million in grants to nine local non-governmental organizations (NGOs) to identify potential TB patients and ensure follow-up treatment. The money has enabled NGO Batwa Bemba Oluwamie, for example, to expand its community connections. “The more you spend time with the community and understand the problem, the more you can find solutions,” says Biguette Bountouki-Lombouchi, national coordinator and founder of Batwa Bemba.
That’s the essence of locally driven solutions. Not every country or province has minerals to mine. But all of them can invest in another resource: their people—those with the local knowledge to design, tailor, and implement workable ways to address challenges—and will reap the benefits of the solutions.