The Healthcare System in Congo: What a French National Should Know

The Ministry of Health and Population, based in Brazzaville, is the supervisory authority of the health system. France Diplomatie describes the hospital network as generally weak and reminds us that, outside the towns, emergency services are non-existent. The World Health Organization reports a very modest health expenditure per capita.

On insurance, CLEISS (the French liaison centre for international social security) describes a compulsory health insurance scheme, the RAMU, established by Law No. 37-2014 and amended by Law No. 12-2023 of 10 May 2023, which covers sickness, accident, maternity and rehabilitation (excluding occupational accidents and diseases) and whose management has fallen to the CAMU since 1 July 2023. The CNSS continues to manage pensions, occupational accidents and family benefits for employees pending the setting up of the new funds.

For an expatriate, the practical reading is to rely on the medical and social centre of the French embassy in Brazzaville for guidance, on insurance that organises evacuation for serious conditions, and on a comparison of the options with the guide healthcare systems of the world.

France and Congo are bound by a social security agreement in force since 1 June 1988. According to CLEISS, it covers maternity, invalidity, old age and survivors, occupational accidents and diseases and family benefits, but contains no coordination provision for the sickness branch or for death insurance. Protocol No. 1 nonetheless provides for the maintenance of certain health insurance benefits, in kind and in cash, for insured persons who go to Congo; on a transfer of residence, this maintenance is limited to six months.

In practice, the Carte Vitale does not serve as cover in Congo and care is billed to the patient. The conditions of access for a foreigner to the RAMU should be confirmed with the CAMU and the employer. Seconded employees remain subject to an exception to the liability rule provided for by the agreement; the extent of sickness cover in that case should be checked with CLEISS and the Urssaf (the French social security contributions collector).

See healthcare reimbursement in Congo to compare situations.

France Diplomatie names no facility in particular on its health pages, but indicates that the medical and social centre of the French embassy in Brazzaville can be accessed. It mentions the number 117 (emergency police) for accidents, without publishing a medical emergency number. Before departure, save the numbers of your assistance provider, those of the French embassy in Brazzaville and of the consulate general in Pointe-Noire.

The number of road accidents is very high and continually rising; the handling of personal injury accidents is very limited and almost non-existent outside the towns. In the event of an accident, you must not move the vehicle and should promptly notify the police or gendarmerie. For intercity travel, France Diplomatie recommends travelling in a convoy of at least two vehicles, not driving at night, having working means of communication (a satellite phone is advised) and taking first-aid equipment, water and food, which also matters for quick access to care.

Registering with Fil d’Ariane (the ministry’s alert service) is recommended for a stay of under six months; beyond that, registration on the register of French nationals living abroad is strongly recommended. For hospitalisation, direct payment by the insurer avoids advancing the costs; see direct payment and medical evacuation.

France Diplomatie recommends taking only the strictly necessary medicines, in their original packaging, with a prescription giving the names in international non-proprietary names, checking that they are authorised in Congo and never buying medicines on the street because of the risk of counterfeits. A visit to the dentist before departure is suggested.

For a chronic treatment, building up a stock before departure and asking a doctor about the available equivalents limit the risk of running out. Dental and optical care fall under insurance contracts and the CFE (Caisse des Français de l’étranger, the French social security fund for expatriates); see expat health insurance.

The French vaccination schedule must be up to date (diphtheria, tetanus, poliomyelitis, whooping cough, measles). Yellow fever vaccination is mandatory for people over 9 months of age, to be done at least 10 days before departure at an approved centre; the record is checked on entry. Depending on the stay, hepatitis A, typhoid fever, hepatitis B, rabies, chikungunya, dengue, mpox, and tuberculosis for children under 15 on frequent or long stays are also recommended.

Malaria carries a year-round risk across the whole territory: protection against mosquitoes and preventive treatment after medical advice; any fever during the stay or in the weeks following return calls for a consultation. Dengue is present, chikungunya has caused many cases in Pointe-Noire, Kouilou and Brazzaville, rabies is regularly reported, notably in Pointe-Noire, and cholera, typhoid fever and hepatitis A are transmitted by contaminated water and food.

To these are added Zika (consultation before travel for pregnant women), mpox, poliomyelitis, trypanosomiasis (low risk, mainly in rural areas) and tuberculosis. France Diplomatie reminds us that a country not requiring a vaccine does not mean there is no risk: yellow fever is potentially fatal in 20 to 60% of cases, with no curative treatment.

Drink only bottled water, sealed drinks or water made drinkable (filtration, boiling or disinfectant). Wash your hands often, cook food thoroughly, peel or wash fruit and vegetables well, and avoid raw vegetables, shellfish, reheated dishes and cold buffets.

Against mosquitoes: covering clothing, repellents on the skin, treated mosquito nets, removal of stagnant water. Other risks: caution on the road and on two wheels, swimming only in supervised areas (to be avoided in the rapids of the Congo River and its tributaries), walking in shoes, not touching or feeding animals, immediately washing any bite or scratch with soap and water.

For pregnant women or those planning a pregnancy, France Diplomatie recommends consulting before departure because of the risk of serious complications linked to Zika. Mpox is more serious in children, pregnant women and immunocompromised people. For children, vaccinations and malaria prevention should be prepared with a doctor; for a chronic illness, check the continuity of treatments, the insurer’s coverage and the declaration of medical history; see medical questionnaire and history.

France Diplomatie describes an insurance or assistance contract covering care, surgery, hospitalisation and medical repatriation as essential. Three routes exist: the CFE, with membership before departure or within three months of settling in for immediate cover; international first-euro insurance, with direct payment and evacuation; the protection of a secondment.

The comparison is made on the coverage area, hospitalisation ceilings, maternity, evacuation and the medical questionnaire; see coverage area.