Publication: Democratic Republic of the Congo Budget Execution in Health: From Bottlenecks to Solutions
Loading...
Published
2025-07-15
ISSN
Date
2025-07-15
Editor(s)
Abstract
The Democratic Republic of Congo is committed to achieving Universal Health Care by 2030. Progress toward this goal faces challenges due to limitations in the execution and allocation of the country's health budget. This contributes to health spending being predominantly financed by households and donors rather than the government. The only part of the government health budget that is consistently executed in line with allocations is for health worker payments. Execution rates for other spending categories are volatile and generally low. Many parts of the budget are not executed at all, while some activities are implemented without having been included in the budget. Budget execution within the Ministry of Health is influenced by both internal and external factors. Inconsistencies between strategic planning, budget preparation, and execution processes hinder effective financial management; inaccurate cost estimations; heavy reliance on exceptional procedures for spending and over-execution of specific budget lines to the detriment of otherwise planned activities. External challenges include a systematic over-estimation of national revenue; the highly centralized nature of budget execution processes; the dominance of health worker payments in budget allocations; the non-respect of budget management rules and cumbersome procurement and expenditure execution procedures.
Link to Data Set
Citation
“Cros, Marion Jane; El Kadiri El Yamani, Fatima; Muvudi, Michel; Nana, Aminata TOU. 2025. Democratic Republic of the Congo Budget Execution in Health: From Bottlenecks to Solutions. © World Bank. http://hdl.handle.net/10986/43458 License: CC BY-NC 3.0 IGO.”
Digital Object Identifier
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Related items
Showing items related by metadata.
Publication Ethiopia Budget Execution in Health(Washington, DC: World Bank, 2025-07-15)Ethiopia achieves a high overall rate of execution of its health budget. From 2016 to 2021 the health budget execution rate averaged 95 percent of the original budget allocation. The health budget execution rate was higher than the execution rates for overall government spending. The execution rate also increased each year. Nonetheless, the execution rate for regions was lower than for the federal government. The execution of the capital budget was also weaker, particularly at the regional and woreda levels. Data on execution rates for specific government programs are not available and may involve much more volatility than aggregated execution rates. Development partner spending managed outside of the federal Treasury also had much higher volatility in execution. Good practices that underpin Ethiopia's high execution rates include relatively low levels of arrears; reasonable turnaround times for payroll changes and high accuracy of payroll expenditures; timeliness and good communication of budgeting processes; and shortening of timeframes for transfers from federal to decentralized levels. Areas that hold back the quality of budget execution include limited transparency on execution data; capacity constraints at the facility and woreda levels; external resources being managed outside of government systems; limited flexibility of spending for health facilities; and overly simplified procurement processes that prioritise only the lowest price.Publication Budget Execution in Health(World Health Organization and the World Bank, 2025-03-11)This report builds on a joint WHO-World Bank initiative on budget execution challenges (described in more detail in Appendix 1). Following the introduction, section 2 provides an overview of core concepts from both a public financial management perspective and a health financing perspective and discusses how budget execution challenges can differ in countries with a separate purchasing agency, varying degrees of decentralization and significant donor funding. The trends and patterns in health budget execution data are analyzed and discussed in section 3. The analytical approach is detailed in Appendix 2. Section 4 identifies challenges that hinder good budget execution in health. These are drawn from an extensive literature review and a set of case studies. A summary of the case studies is provided in Appendix 3. Policy responses to these challenges are offered in section 5. This section lays out a pragmatic approach that Ministries of Finance, Ministries of Health and local governments can take to address six of the most frequently encountered budget execution challenges and points to examples from cases studies. Section 6 offers an engagement approach to address budget execution challenges. A four step diagnostic-to-solution model is proposed that guides an analyst through the process of identifying the right questions, data, and policy options in a structured manner. Section 7 concludes with a call to action for countries to embrace a more purposeful and collaborative budget implementation approach that involves finance, health and local government stakeholders. The compiled dataset used for the analysis is being released jointly with this report to support complementary analytical efforts.Publication Lao PDR Budget Execution in Health(Washington, DC: World Bank, 2025-07-15)The Lao People's Democratic Republic has a high execution rate for its overall health budget, ranging from 89 to 104 percent from 2015 to 2019. Aggregated execution rates are generally high across the main categories of spending - wage, non-wage recurrent and capital with only a couple of outliers during the period of analysis. Some of the public financial management practices employed that enable these high execution rates may, nonetheless, risk lowering the quality of spending. There is also greater variation in execution rates when considering more disaggregated levels of budget spending, including between the central and provincial level of government. Good practices that have helped budget execution include the ringfencing of spending on health and flexibility in budget laws enabling high execution of capital budgets. Key bottlenecks holding back budget execution performance include the lack of a mechanism linking spending to the delivery of outputs; weaknesses in how budget allocations are set for health worker payments; delays in payments reaching health facilities; a lack of transparency in disaggregated spending data, no publication of audits and no reporting on the stock of arrears; inefficiencies in the availability of resources for health facilities; and the widespread use of manual reporting which delays reporting processes and is prone to errors and inconsistencies.Publication Pakistan Budget Execution in Health(Washington, DC: World Bank, 2025-07-15)Pakistan’s overall national health budget had a high rate of execution from 2016 to 2019, averaging 95 percent. However, execution rates between provinces as well as between categories of spending varied significantly. At the health facility level, execution of spending is notably challenging, particularly for non-wage expenditure. Good practices that facilitated better budget execution included strong integration of payroll and personnel records in most provinces as well as the contracting out of the provision of primary healthcare services to the private sector in Sindh, Baluchistan, and Punjab Provinces. This approach has facilitated more consistent budget execution rates and evidence of resources reaching the facility level. There remain challenges, however, with ensuring the accountability of how these resources are used. The main bottlenecks holding back the quality of budget execution include an inability to track primary, secondary, and tertiary healthcare budgets and their execution; systematic over-estimation of resources by the provinces; weaknesses in budget preparation processes; inefficiency in spending control processes; lack of autonomy for primary healthcare facilities; insufficient integration of vertical programs in local health systems; and lack of a process for capturing spending arrears.Publication Solomon Islands Budget Execution in Health(Washington, DC: World Bank, 2025-07-15)The Solomon Islands government plays key roles in the health sector, as a funder, regulator, and provider of nearly all health services. Health services are funded, managed, and delivered by the Ministry of Health and Medical Services (MHMS). The MHMS also allocates resources (such as funding, staff, and supplies) to its provincial health services, which are part of the MHMS rather than the provincial governments, to deliver health services in the provinces on behalf of the MHMS. Most health facilities are government-owned, with a few operated by churches. However, church-owned facilities receive annual budget allocations, human resources, medical supplies, and capital investments from the government. There are privately owned outpatient facilities, but these are mainly found in urban areas. There is no social health insurance or separate agency for buying healthcare services.
Users also downloaded
Showing related downloaded files
Publication Western Balkans 6 Country Climate and Development Report(Washington, DC: World Bank Group, 2024-07-16)This Regional Western Balkans Countries Climate and Development Report (CCDR) stands out in several ways. In a region that often lacks cohesive regional alliances, this report emphasizes how the challenges faced across countries are often common and interconnected, and, importantly, that climate action requires coordination on multiple fronts. Simultaneously, it illustrates the differences across countries, places, and people that require targeted strategies and interventions. This report demonstrates how shocks and stressors re intensifying and how investments in adaptation could bring significant benefits in the form of avoided losses, accelerated economic potential, and amplified social and economic spillovers. Given the region’s high emission and energy intensity and the limitations of its current fossil fuel-based development model, the report articulates a path to greener and more resilient growth, a path that is more consistent with the aspiration of accession to the EU. The report finds that the net zero transition can be undertaken without compromising the economic potential of the Western Balkans and that it could lead to higher growth than under the Reference Scenario (RS) with appropriate structural reforms.Publication Poverty, Prosperity, and Planet Report 2024(Washington, DC: World Bank, 2024-10-15)The Poverty, Prosperity, and Planet Report 2024 is the latest edition of the series formerly known as Poverty and Shared Prosperity. The report emphasizes that reducing poverty and increasing shared prosperity must be achieved in ways that do not come at unacceptably high costs to the environment. The current “polycrisis”—where the multiple crises of slow economic growth, increased fragility, climate risks, and heightened uncertainty have come together at the same time—makes national development strategies and international cooperation difficult. Offering the first post-Coronavirus (COVID)-19 pandemic assessment of global progress on this interlinked agenda, the report finds that global poverty reduction has resumed but at a pace slower than before the COVID-19 crisis. Nearly 700 million people worldwide live in extreme poverty with less than US$2.15 per person per day. Progress has essentially plateaued amid lower economic growth and the impacts of COVID-19 and other crises. Today, extreme poverty is concentrated mostly in Sub-Saharan Africa and fragile settings. At a higher standard more typical of upper-middle-income countries—US$6.85 per person per day—almost one-half of the world is living in poverty. The report also provides evidence that the number of countries that have high levels of income inequality has declined considerably during the past two decades, but the pace of improvements in shared prosperity has slowed, and that inequality remains high in Latin America and the Caribbean and Sub-Saharan Africa. Worldwide, people’s incomes today would need to increase fivefold on average to reach a minimum prosperity threshold of US$25 per person per day. Where there has been progress in poverty reduction and shared prosperity, there is evidence of an increasing ability of countries to manage natural hazards, but climate risks are significantly higher in the poorest settings. Nearly one in five people globally is at risk of experiencing welfare losses due to an extreme weather event from which they will struggle to recover. The interconnected issues of climate change and poverty call for a united and inclusive effort from the global community. Development cooperation stakeholders—from governments, nongovernmental organizations, and the private sector to communities and citizens acting locally in every corner of the globe—hold pivotal roles in promoting fair and sustainable transitions. By emphasizing strategies that yield multiple benefits and diligently monitoring and addressing trade-offs, we can strive toward a future that is prosperous, equitable, and resilient.Publication Global Economic Prospects, June 2025(Washington, DC: World Bank, 2025-06-10)The global economy is facing another substantial headwind, emanating largely from an increase in trade tensions and heightened global policy uncertainty. For emerging market and developing economies (EMDEs), the ability to boost job creation and reduce extreme poverty has declined. Key downside risks include a further escalation of trade barriers and continued policy uncertainty. These challenges are exacerbated by subdued foreign direct investment into EMDEs. Global cooperation is needed to restore a more stable international trade environment and scale up support for vulnerable countries grappling with conflict, debt burdens, and climate change. Domestic policy action is also critical to contain inflation risks and strengthen fiscal resilience. To accelerate job creation and long-term growth, structural reforms must focus on raising institutional quality, attracting private investment, and strengthening human capital and labor markets. Countries in fragile and conflict situations face daunting development challenges that will require tailored domestic policy reforms and well-coordinated multilateral support.Publication Expanding Opportunities: Toward Inclusive Growth(World Bank, Washington, DC, 2023-04-04)South Asia’s outlook is shaped by both good and bad news in the global economy. Lower commodity prices, a strong recovery in the services sector, and reduced disruptions in value chains are aiding South Asia’s recovery but rising interest rates and uncertainty in financial markets are putting downward pressure on the region’s economies. Countries in South Asia, especially those with large external debt, face difficult tradeoffs as they respond to these pressures. Growth prospects have weakened, with large downside risks in most countries given limited fiscal space and depleting foreign reserves. Going forward, broad reform programs, including a sustainable fiscal outlook, are needed to put South Asia on a more robust and inclusive growth path. Inequality of opportunity, which is higher in South Asia than in other regions of the world, is both unfair and inefficient. Reducing inequality of opportunity and increasing economic mobility will help broaden countries’ tax base and boost support from the population for the critical reforms.Publication Working Without Borders(Washington, DC: World Bank, 2023-07-24)Online gig work poses both opportunities and challenges for governments and workers. On the upside, it offers prospects for income generation, especially in developing countries, where most people work in low-productivity, low-quality, often informal jobs. The virtual and often temporary nature of gig work also provides flexibility for often neglected groups such as women, youth, migrants, and people with disabilities. These jobs could be a stepping-stone to bet¬ter-quality jobs for low-skilled workers by helping them learn critical digital skills and close the digital divide. But most gig jobs offer little to no protection for workers, with uncertain income streams and no clear career pathways. Depending on local labor regulations, many gig workers are not protected against unfair practices, abuse or injuries while working. Gig work also raises challenges for managing data security and privacy. The report examines how countries can navigate the promise and perils of online gig work. It reveals that the online gig workforce is much larger than previously assumed with an estimated 154 million to 435 million Online gig workers around the globe. For the first time ever, the report mapped and tracked regional platforms and gig workers who work in languages other than English. Key messages are: • Online gig work is expanding, accounting for up to 12% of the global labor force and is a growing source of income for millions. • Demand for online gig workers is rising faster in developing countries than in industrialized countries. • Local gig platforms play a vital role in the local labor market, but they face challenges in establishing a viable business model, and opportunities for long-term growth. • Online gig work can support inclusion by providing work opportunities for youth, women, and low-skilled workers. • Gig workers, like most other informal sector workers in developing countries, are often outside the purview of labor regulations. • The gig economy can offer opportunities locally to build digital skills, increase income-earning opportunities, and facilitate social protection coverage of informal workers.