November 12th marked World Pneumonia Day. Save the Children has launched a global campaign to stop the disease in its tracks, with the publication of our flagship report Fighting for Breath.
In a series of blogs, we take a close look at the challenges and successes of countries around the world in beating pneumonia.
15% of all under-five deaths in the Democratic Republic of Congo are due to pneumonia, making it the single biggest killer of the country’s children. In 2000, the disease killed 41,587 under-fives, rising to 45,812 in 2015. DRC is one of seven African countries where the under-five mortality rate (U5MR) has risen over the last 15 years, largely due to pneumonia.
Big plans, not enough funding
The launch of the Global Action Plan for Prevention and Control of Pneumonia (GAPP) in 2009 encouraged DRC to address its high pneumonia rate – leading to a national policy against acute respiratory infections (ARI) that year. Unfortunately, there were no costed implementation plans and the policy was not put in place.
To encourage the implementation of this policy, Save the Children DRC, along with the National Programme for ARI, developed a fact sheet on ARI prevalence in 2014. But things have still not moved due to significant financial challenges.
A clear policy for pneumonia
DRC is one of the few countries with a clear pneumonia policy. It is supported by a strong emphasis on ICCM in addressing childhood illnesses at the community level, yet they have been unable to address the U5MR due to pneumonia.
This could be attributed to the low priority given to health, with public health expenditure made up of just 0.045% of the country’s GDP in 2000, rising to 1.6% in 2014. Per capita health expenditure was $18 in 2000, and fell to $7 in 2014. Out of pocket expenditure as a percentage of total health spending was 55% in 2000, but fell to 39% in 2014 (although given some of the challenges on the ground, one would have to question the validity of this data).
Different areas facing different challenges
Studies in 2009 showed that pneumonia is much less prevalent in western provinces (Kinshasa, Bas-Congo and Bandundu) compared with south-eastern provinces (Sud-Kivu and Katanga). However, the basic coverage rate for all eight vaccines is higher in Sud-Kivu (62.3%) compared with Bas-Congo (55%) and Bandundu (42%). Immunisation coverage is highest in Kinshasa (68%) with the lowest percentage of underweight children being just 5.5%. In Sud-Kivu, around 26% of children are underweight, compared with Katanga (20.3%), Bas-Congo (27.3%), and Bandundu (20.2%), which again, does not give a clear picture.
The wider cost of conflict
The conflict in DRC between 1998 and 2004 ravaged the country and its infrastructure. The death toll was estimated to be around 3.9 million. The last census, taken before the conflict in 1984, takes into account unreliable demographic data, which complicates health policy development, planning and budgeting.
It also raises questions about the validity and quality of the data sets that do exist. One of the most important health activities would be for donors to urgently support DRC to conduct a new census, although this activity would be highly contentious and political. One of the country’s basic needs has now become mired in politics. Birth registrations are also not recorded systematically, further compounding the problem.
Investing in DRC’s health
Health funding remains low, despite DRC having a more robust fiscal space than many other Africa nations. According to a recent Global Witness report, more than $750 million of mining revenues paid by companies to state bodies between 2013 and 2015 in DRC was lost to the treasury.
Lack of accountability, bad governance, mismanagement of mineral and natural wealth, continuing conflict in the eastern provinces, wide spread corruption, and a civil society greatly weakened by constant harassment, intimidation, and even extra judicial killings, leave DRC as the poorest rich country on earth.
Health programming in DRC needs to focus on strengthening democracy and ensuring that civil society is strong enough to advocate for improved health services, and to hold their parliamentarians and policy makers to account.
This is an important first step in ensuring that DRC can deliver on its health policies and pneumonia commitments, while progressing towards building strong health systems and achieving universal healthcare.
Read our featured pneumonia country briefings and our new report, Fighting for Breath.