**2. Problems of financing of health systems and their corollary in the DR Congo**

#### **2.1 Deficit in sources of health-care funding**

A country's problem of access to health care depends on its ability to finance the required health systems. This presupposes that the country concerned can offer structures, viable infrastructures, and competent personnel. However, low-income countries are struggling to find adequate budget balances to effectively meet the ever-growing health needs of their populations [3], and this is the case of the DR Congo and many other countries in sub-Saharan Africa.

Indeed, the current sources of financing useful for universal health coverage are essentially public expenditure, donor funding, and compulsory contributions to social health insurance [4]. Since under current conditions household contributions to health care remain relatively low, with a few exceptions when community initiatives are organized [5] or when the state is effectively involved, only two sources are secure: public spending and donor funding.

With regard to public expenditure, the state budget is low, often well below Abuja's commitments (15%) [6]. In 2013, for example, the Congolese state allocated only 4.3% of its budget to health, while all projections for spending in 2020 are below 3%. Worse still, this state contribution has only decreased from 2013 to date. *Contribution of Biomedical Equipment Management to Better Management of Sickle Cell Disease… DOI: http://dx.doi.org/10.5772/intechopen.92546*

It just so happens that a large part of the financing of the health system relies heavily on donor funding. And in order to cover all needs, donors will theoretically have to continually increase their contribution in proportion to the decrease in the state budget.

But is such a hypothesis sustainable? Logically, the answer is negative, since donors cannot set themselves up as substitutes for failing health systems. Indeed, the study of the financing mechanism supported by the World Bank Group shows that "the health sector in the DRC suffers from several ills: low budget allocation; excessive household expenditure; dependence on external financing; available resources are poorly spent; budget execution is weak; governance problems; and the decentralization process is partly theoretical." [7] The same study shows that a decrease in external financing is observed from 2017, just as the projections predict that the deficit financing observed since 2019 will have to continue until 2030.
