DRC Nears Historic 14.5% Abuja Target for Health Sovereignty

Why It Matters

Domestic resource mobilisation reduces dependence on donors and strengthens fiscal sovereignty, while improved public financial management promises more efficient, equitable health services for the DRC’s population.

Key Takeaways

• Health budget now ~14.5% of national budget.
• Health Promotion Fund levy could double revenue by 2026.
• Mandatory 2.5% salary contribution targets CDF 1.1 trillion.
• PFM reforms aim to cut 40% spending inefficiencies.
• DRC aims to meet or exceed Abuja 15% target.

Pulse Analysis

For decades the Democratic Republic of Congo has struggled with one of the lowest per‑capita health expenditures in sub‑Saharan Africa, hovering around $21.6 per person in 2021—roughly a quarter of the regional average. That shortfall forced households to shoulder more than a third of all health costs and left donors covering close to 40 percent of spending. The fiscal imbalance not only amplified poverty risks but also limited the government's capacity to respond to epidemics or build resilient primary‑care networks. Recognising that true health sovereignty begins with reliable financing, the DRC has embarked on a rapid fiscal turnaround.

The centerpiece of the turnaround is a new financing architecture that blends core budget allocations with two dedicated revenue streams. A 2 % levy on non‑essential imports fuels the Health Promotion Fund, which internal forecasts now expect to generate over twice the original CDF 599 billion projection by 2026. Simultaneously, a mandatory 2.5 % contribution on gross salaries—initially targeting the public sector—could raise CDF 1.1 trillion, with plans to extend coverage to the informal economy that employs 95 % of workers. Combined, these measures push health spending to nearly 14.5 % of the national budget, positioning the DRC on the cusp of the Abuja Declaration’s 15 % benchmark.

Financing alone, however, would be insufficient without robust public financial management. The DRC is overhauling procurement, payroll and budget execution processes, leveraging Africa CDC expertise and the Lusaka Agenda to eliminate the estimated 40 % loss from inefficiencies. Digital health insurance cards linked to Visa and Mastercard are being rolled out to improve transparency and bring informal workers into pooled schemes. If these reforms deliver, out‑of‑pocket expenses should fall, donor funds can be better aligned with national priorities, and the DRC could become a model for fiscal health sovereignty across the continent.