Health in fragile states. Country case study: Democratic Republic of the Congo.

Abstract

Since 1994 conflict in the eastern part of the Democratic Republic of Congo (DRC) has created a major humanitarian crisis that significantly colors the way in which donor programs are conceived developed and implemented. Although a peace accord was signed a transitional government put into place and a constitution ratified the central governments stability remains tenuous. Violence continues to have a major impact on mortality rates in the eastern part of the country creating a mixed scenario in which humanitarian interventions and development programs must coexist. In addition to political instability which has been driven at various times by neighboring states and even rogue militias other important drivers of fragility will have to be addressed if short-term gains in the social sector are to be sustained. Above all these include abject poverty-it is estimated that up to 80 percent of the Congolese population lives on less than $1 per day and parts of the country are essentially demonetized. Attention to jobs creation and income generation is essential. Moreover the education system is in greater disrepair than the health system creating a real risk that the next generation of Congolese will be illiterate. Finally a culture of predation and corruption prevails in the public and private commercial sectors. Progress in social sectors will be seriously impeded unless steps can be taken to heighten the level of confidence of both foreign investors and the Congolese population. Establishing the governments legitimacy first and then its effectiveness depend on demonstrating commitment and resolve to overcome these cultural factors. (excerpt)