刚果民主共和国卫生预算执行：从瓶颈到解决方案（英）2025

Marion Jane CrosFatima El Kadiri El YamaniMichel MuvudiAminata TOU Nana BUDGET EXECUTION IN HEALTH:FROM BOTTLENECKS TO SOLUTIONSDEMOCRATIC REPUBLIC OF CONGOABSTRACT:The Democratic Republic of Congo is committed to achieving Universal Health Care by 2030. Progresstoward this goal faces challenges due to limitations in the execution and allocation of the country’s healthbudget. This contributes to health spending being predominantly financed by households and donorsrather than the government. The only part of the government health budget that is consistently executedin line with allocations is for health worker payments. Execution rates for other spending categories arevolatile and generally low. Many parts of the budget are not executed at all, while some activities areimplemented without having been included in the budget. Budget execution within the Ministry of Healthis influenced by both internal and external factors. Inconsistencies between strategic planning, budgetpreparation, and execution processes hinder effective financial management; inaccurate costestimations; heavy reliance on exceptional procedures for spending and over-execution of specificbudget lines to the detriment of otherwise planned activities. External challenges include a systematicover-estimation of national revenue; the highly centralized nature of budget execution processes; thedominance of health worker payments in budget allocations; the non-respect of budget managementrules and cumbersome procurement and expenditure execution procedures.Disclaimer:The findings, interpretations, and conclusions expressed in the paper are entirely those ofthe authors, and do not represent the views of the World Bank, its Executive Directors, or the countriesthey represent.Correspondence Details:Marion Cros mcros@worldbank.orgMarion Jane CrosSenior Health Specialist, Health, Nutrition and PopulationGlobal Practice, World Bank, New Delhi, IndiaMichel MuvudiSenior Health Specialist, Health, Nutrition and PopulationGlobal Practice, World Bank, Kinshasa,Democratic Republic of CongoFatima El Kadiri El YamaniSenior Health Economist, Health, Nutrition and PopulationGlobal Practice, World Bank, Kinshasa,Democratic Republic of CongoAminata TOU NanaConsultant, Democratic Republic of CongoCASE STUDY SERIES Budget execution in health: from bottlenecks to solutions© The International Bank for Reconstruction and Development / The World Bank, 20251818 H Street NWWashington DC 20433Telephone: 202-473-1000Internet: www.worldbank.orgThis work is a product of the staff of The World Bank with external contributions. The findings,interpretations, and conclusions expressed in this work do not necessarily reflect the views of The WorldBank, its Board of Executive Directors, or the governments they represent.The World Bank does not guarantee the accuracy, completeness, or currency of the data included in thiswork and does not assume responsibility for any errors, omissions, or discrepancies in the information,or liability with respect to the use of or failure to use the information, methods, processes, orconclusions set forth. The boundaries, colors, denominations, and other information shown on any mapin this work do not imply any judgment on the part of The World Bank concerning the legal status of anyterritory or the endorsement or acceptance of such boundaries.Nothing herein shall constitute or be construed or considered to be a limitation upon or waiver of theprivileges and immunities of The World Bank, all of which are specifically reserved.Rights and PermissionsThe material in this work is subject to copyright. Because The World Bank encourages disseminationof its knowledge, this work may be reproduced, in whole or in part, for noncommercial purposes aslong as full attribution to this work is given.Any queries on rights and licenses, including subsidiary rights, should be addressed to World BankPublications, The World Bank, 1818 H Street NW, Washington, DC 20433, USA; fax: 202-522-2625;e-mail: pubrights@worldbank.org.Graphic design.David Lloyd Design (DLD). Unless otherwise credited, all images used in this report were created in part withMidjourney AI and overlayed with graphics created by DLD. Any resemblence to a real individual is accidental.This interactive document has been optimised for use on computers and tablets in portrait orientation.Click on this section to return to the beginning of the sectionClick on this square to return to the contents page BUDGET EXECUTION IN HEALTH:FROM BOTTLENECKS TO SOLUTIONS - CASE STUDY SERIES -DEMOCRATIC REPUBLIC OF CONGOACKNOWLEDGMENTS1. HEALTH FINANCING CONTEXT2. BUDGET EXECUTION IN HEALTH3.PUBLIC FINANCIAL MANAGEMENT CONTROLSFOR HEALTH SPENDING4. GOOD PRACTICES AND BOTTLENECKSREFERENCESCONTENTSLIST OF FIGURESFIGURE 1:DEMOCRATIC REPUBLIC OF CONGO HEALTH FINANCING SOURCES, 2016-21FIGURE 2:HEALTH SECTOR FINANCIAL FLOWS IN DEMOCRATIC REPUBLIC OF CONGOFIGURE 3:HEALTH BUDGET EXECUTION RATE, 2016-20FIGURE 4:EXECUTION BY HEAL