The Healthcare System in the Democratic Republic of the Congo: Getting Treated, Insured and Vaccinated

The Ministry of Public Health, Hygiene and Social Welfare draws up health policies, plans and strategies and oversees the regulation of hospitals, pharmacies, laboratories and medical training. Its website presents several specialised bodies: the National Institute of Public Health (research, training and epidemiological surveillance), the Authority for the Regulation and Control of Universal Health Coverage (ARC-CSU), the Health Solidarity Fund (support for vulnerable populations), the Health Promotion Fund (prevention) and two agencies devoted to essential medicines and pharmaceutical regulation (ANAMED and ACOREP).

This organisation is part of a broader reform, which aims at financing, access to care, households’ financial protection, the quality of medicines and digitalisation. For households, the burden remains heavy: the World Bank puts at about 38% the share of current health expenditure paid directly by households, and at about 0.2 doctors per 1,000 inhabitants the medical density.

The CNSS general scheme (the National Social Security Fund) pays occupational risk benefits, family benefits (including maternity) and pensions; its pages mention no sickness branch. No compulsory health insurance scheme appears on the official sources read: the conditions of access for a foreigner to any future mechanism are not published.

No mechanism for a non-employed foreign resident to join a public cover was read on the official sources. An employee on a local contract is affiliated to the CNSS by their employer, but the fund’s pages describe no reimbursement of routine care. In practice, an expatriate’s health protection comes through an expat health insurance contract, through the CFE (Caisse des Français de l’Étranger, the French expatriate social security fund) or through the employer’s group contract; no social security agreement links France and the DRC (CLEISS list; CLEISS is the French liaison centre for social security abroad).

France Diplomatie describes public hospitals, in Kinshasa as in the provinces, that are dilapidated, with obsolete equipment, often lacking medicines and rarely capable of quality care. Good-quality general practitioners and specialists work in the private sector, mainly in Kinshasa and Lubumbashi, in clinics some of which approach European standards; the capital also has laboratories, dental practices and pharmacies judged reliable. All services are payable in advance.

An expatriate’s first-contact doctor is therefore a private general practitioner, chosen if possible from the embassy’s useful contacts, which mentions a private facility in Kinshasa whose director is the embassy’s reference doctor, as well as a private emergency service operating on subscription. A contract that provides for direct payment with these facilities avoids paying up front: see the guide to healthcare reimbursement in the DRC.

The France Diplomatie records give no national emergency number. The contacts published are those of the French embassy in Kinshasa (+33 5 16 44 00 67), the consular agency in Lubumbashi (+243 99 7012167 or +243 99 7041800) and the consular agency in Bukavu (+243 81 7374820 or +243 99 3506665). The embassy pays no medical costs: assistance must be taken out before departure and its number kept on you.

For serious conditions, local technical facilities are not always sufficient: evacuation abroad then becomes a matter of contract. The cover features to check are the hospitalisation ceiling, medical repatriation, medically equipped transport and evacuation from a province. See repatriation and assistance and the glossary entry on medical repatriation.

France Diplomatie advises taking only the strictly necessary medicines, in their original packaging with the labels, accompanied by a prescription giving the names by international nonproprietary name, and checking that they are authorised in the DRC. Medicines must never be bought on the street, because of the risk of counterfeits. Pharmacies in Kinshasa judged reliable are the normal source of supply, whereas public hospitals are often out of medicines.

The Ministry of Health website mentions two agencies, one for essential medicines (ANAMED) and the other for pharmaceutical regulation (ACOREP), to be consulted to learn the rules in force. Chronic treatments are planned with a doctor before departure.

According to France Diplomatie, quality private care is concentrated in Kinshasa and Lubumbashi. Outside these two cities, public hospitals remain the only local provision, with the limits described above: obsolete equipment, shortages of medicines, care rarely of good quality. The French embassy has consular agencies in Lubumbashi and Bukavu, useful for reaching the French administration in the provinces.

Travel in the provinces is prepared with the assistance provider: check that the contract covers evacuation from the region visited, inform the assistance provider of the itinerary and consult the vigilance map. The east of the country, where several provinces affected by the Ebola epidemic are located, includes many red zones formally advised against by France Diplomatie; evacuation there depends on the local situation. The guide on living in the DRC details the classification of zones.

The France Diplomatie health record gives simple rules: drink only bottled water, capped drinks or water made safe (filtration, boiling or, failing that, disinfectant); wash your hands frequently; cook meat, fish and eggs thoroughly; avoid raw vegetables, shellfish, reheated dishes and cold buffets; peel or carefully wash fruit and vegetables with safe water. These steps reduce the risk of cholera, typhoid fever and hepatitis A.

Against mosquitoes, vectors of malaria, dengue and chikungunya, the recommendations are long clothing, skin repellents, impregnated mosquito nets, diffusers or air conditioning, and removal of standing water. In the event of fever during the stay or in the weeks after returning, a quick consultation is advised; dengue is not treated with anti-inflammatory drugs.

Yellow fever is the only mandatory vaccination, preferably at least ten days before departure. France Diplomatie also recommends being up to date with the French vaccination schedule and, depending on the stay, vaccines against hepatitis A and B, typhoid fever, meningitis ACWY, tuberculosis in children under 15, rabies, chikungunya, dengue and mpox in the event of risk exposure. A consultation at an international vaccination centre should be planned well before departure.

Health alerts regularly report Ebola epidemics in several provinces of the east and north, with strict hygiene and advice to consult quickly in the event of symptoms for up to three weeks after leaving a risk area, as well as cholera epidemics, including in Kinshasa: bottled or boiled water, consultation of a vaccination centre before departure. Added to these are typhoid fever, whose incidence is notable in the Kinshasa suburbs, plague in Ituri, anthrax in North Kivu and cases of mpox. For a pregnant woman, the risk linked to the Zika virus calls for medical advice before the trip.