**1. Introduction**

By way of introduction, the quotation below significantly translates the problem of sickle cell disease both in the Democratic Republic of the Congo and in most countries of sub-Saharan Africa:

*"Sickle cell disease is a genetic inherited disorder where hemoglobin (Hb) normal A (HbA) is replaced by another abnormal, HbS."*

Sickle cell anemia is a *serious disease* with manifestations and complications that directly affect the patient quality of life and his entourage. *This is not a shameful*

*disease* contrary; it is linked to a mutation that arose for us to defend against severe forms of malaria. It is due to the so-called *selective pressure* that has enabled AS carriers to resist severe forms of malaria. This advantage explains among other things why, although cosmopolitan, sickle cell disease predominates in Africa and its geographical distribution is superimposed on the malaria one.

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

*Contribution of Biomedical Equipment Management to Better Management of Sickle Cell Disease…*

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.

**2.2 Attempt to address the funding gap for the management of sickle cell**

In the specific case of the management of sickle cell disease, are there other ways

The first way already present in the field is that of the actions of charitable associations. The contribution of several nongovernmental organizations involved in the management of specific pathologies such as sickle cell disease is very significant and constitutes a major support, especially for the most deprived populations. The action is perceptible not only in the DR Congo but also in other countries of sub-Saharan Africa [8]. But these efforts remain insignificant compared to the magnitude of the disease, and a country's health policy cannot be based on impulses

The second way is the frequent use of donated second-hand equipment to reduce the costs they (the equipment) represent in the health-care chain. This resource can make a great contribution if best practices for donors and donors' applicants are rigorously observed [9]. Unfortunately, very often this is not the case. Many donations still arrive in Africa without observing the prerequisites, which very often makes them either ineffective or unusable. On the other hand, recourse to donations of second-hand equipment should remain ad hoc, without

The third way is that of optimizing the use of the means available to approach the objectives set. At the international level, donors have understood the challenge of structured and well-executed health financing. This obliges the partners to accompany for decades the countries receiving aid through specific national

In the DR Congo, it is through the national health development program that the

The partners in the health field remain practically the same for African countries, and their health problems are very similar: the fight against epidemics, malnutrition, and hereditary diseases. This probably explains why almost all countries in sub-Saharan Africa each develop a national health development plan, with virtually the same content except for a few differences. Examples include the DR Congo, Mali, Côte d'Ivoire, Burkina Faso, Benin, and Kenya. Therefore the methods applied by the partners for health support to the different countries will be very similar. In the national health development plans drawn up in many sub-Saharan African countries since 2000 to date, the improvement of infrastructures and the strengthening of the capacities of the medical technical platforms, including the expression of

government and its partners express their willingness to provide effective and realistic solutions to the health problems of the DR Congo's populations. This is

programs in order to reduce deficits and achieve the objectives.

generally applied for a period of 5 years, iteratively after evaluation.

state budget.

**disease**

that are difficult to predict.

becoming structural.

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of compensating for this financial situation?

*DOI: http://dx.doi.org/10.5772/intechopen.92546*

There are *four major outbreaks of sickle cell disease* based on genetic markers called haplotypes: Arabo-Indian, Beninese, Senegalese, and Central African or Bantu. Among Bantu haplotype carriers, the clinical expression of the sickle cell disease is more severe because of, among other things, the relatively low rate of the fetal hemoglobin (HbF) and other genetic factors.

According to WHO estimates, approximately 300–500,000 children are born each year with hemoglobinopathy; 80% of them are born in developing countries, particularly in Africa. The sickle cell anemia is a hemoglobin disorder most common in Africa, where every year about *200,000 newborns with sickle cell disease* are diagnosed and 80% will not reach the age of 5 years.

*In the Democratic Republic of the Congo (DRC)*, it is estimated that there are 25–30% heterozygous healthy carriers (AS) and about *50,000 homozygous newborns (SS) each year*, equating to 2% of newborns [1].

Sickle cell disease is particularly common among people from sub-Saharan Africa, India, Saudi Arabia, and Mediterranean countries. Migration has increased the frequency of the offending gene in the Americas. In parts of sub-Saharan Africa, sickle cell disease affects up to 2% of newborns. More broadly, the prevalence of sickle cell disease (healthy carriers that inherited the mutant gene from only one parent) in equatorial Africa is 10–40%, compared to only 1–2% on the coast of North Africa and less than 1% in South Africa. This distribution reflects the fact that the sickle cell trait confers an advantage in terms of survival against malaria and that the selection pressure due to malaria has made the mutant gene more frequent, especially in areas with high malaria transmission. In West African countries such as Ghana and Nigeria, the rate of trafficking is 15–30%, while in Uganda, where marked tribal variations are observed, it is 45% among the Bahamas of west of the country [2].
