Child Health—Economic Impact
The Democratic Republic of Congo (DRC) is the second largest country in the African continent. The total population is about 85 million according to the National Institute of Statistics (1), of which 56% are children. Despite being the richest in natural resources and holding a lot of potential for economic development, it is one of the poorest countries in the world, and neonatal mortality (death of a live-born baby within the first 28 days of life) remains very high, according to the latest statistics (2).
Beyond the challenges of long-term development, the country faces one of the world’s largest and most complex humanitarian crises, and deals frequently with conflicts, violence, natural disasters and epidemics. This includes Ebola in the east of the country at the present moment, which has a devastating effect on children. Children are directly attacked and deprived of their basic human (health) rights (2). The number of newborn deaths globally remains alarming, especially in some of the world’s poorest countries. In the DRC, one in 35 newborns dies before they make it to one month; this accumulates to an estimated 96,000 neonatal deaths a year (2).
Although the DRC has made considerable progress in reducing newborn and child mortality rate from 148 per 1,000 live births in 2007 to 104 in 2017, the number of newborn deaths remains high. According to Dr. Tajudeen Oyewale, the UNICEF Representative in the DRC, the situation is exacerbated by, among other things, the conflicts and crises that prevent pregnant women from receiving proper health care throughout pregnancy until childbirth (1).
In addition, the prevalence of stunting remains alarming. According to recent data, about 42.6% or 5.6 million children under five are stunted (DRC, DHS 2014). In fact, the DRC has the third largest population of stunted children in sub-Saharan Africa, after Nigeria and Ethiopia. The prevalence of treatable common childhood diseases is high and the use of preventive and curative services for pregnant women and children is very low. The rate of routine health services used for children is even lower: 90.3% of newborns receive no postnatal care; only 22% to 45% of children age 12 to 23 months are fully vaccinated (3).
These are some reasons why disease and death rates seen among newborns and women in the DRC remain precariously high, and the country did not achieve any of the Millennium Development Goals (2015). Children and adolescents are rarely targeted as health service recipients, therefore, they are often forgotten in healthcare intervention programs. This is unfortunate because children and teens could be great advocates to speak on health care access and gaps that impact them the most, since they are the future of our country.
The health budget for the 2019 financial year is $1,045 billion (Congolese Franc), or USD $598 million (4). With an estimated population of 85 million, the cost of health per capita is CF 12,303 (USD $7) per year, while the average per capita forecast in the National Health Development Program (PNDS) 2020-2022 is US $13 per capita (4). However, access to health care and services is problematic because of the low purchasing power by the general population. Direct payment of household health is the main way of financing services and health care. It accounted for $634,199,232 out of $692,243,689 of the current expenditure on household health, or 91.62%. This direct health payment in relation to total health expenditure (USD $1,620,619,406) represents 39% (1). To minimize the risk of financial exclusion at the expense of the poorest, all public health services will need to be subsidized by the government while encouraging charitable activities in these areas. That is why local health actors in the DRC should pay close attention to the health of children starting from birth, so that they can make a firm commitment to funding neonatal services.
It is with this in mind that the government, with the support of its financial partners, has had to launch campaigns for social and behavioural change, along with other forms of community mobilization through national media campaigns. A set of interventions delivered through the health system targeting pregnant, breastfeeding and under-5 pregnant women will also be very effective in improving the health and nutrition status of children and sustainably reducing morbidity, the infant mortality rate, and the risk of stunting. There is a need to increase the financial potential and purchasing power of households through cash transfers and have a way to encourage income-generating activities: co-operatives, those in peasant communities, micro-credits and investments in agriculture and trades, the main sources of household income, will facilitate their access to quality neonatal health care. This way, every child will have the chance to reach full health.
It is important to stress that investing in human capital and early childhood is an important part of a country’s economic development trajectory; it is not enough to invest in infrastructure. Especially in a country like the Democratic Republic of Congo, there is a need to properly manage natural resources, so that the country can invest in its human capital. When we say capital, it means that it is an investment, it is not an expense. What we know today, from several studies, is that a dollar invested in improving nutrition produces $11 in profit.