Current conditions in the DRC are the result of more than a century of corrupt and unstable governments. During the 1880s, King Leopold II of Belgium gained control over what was then known as the Congo Free State, holding it as his pri- vate property. Although Belgian administrators helped develop basic infrastructure such as roads and hospitals, they also exploited natural resources for Belgium’s benefit, used brutal force when it suited their purposes, kept virtually all power in Belgian hands, and inflamed ethnic conflict among Congolese ethnic groups to keep them from uniting against Belgian control.
Belgium relinquished control over the DRC in 1960. Since then, the country has been governed primarily by a series of corrupt, ruthless dictators (often funded by the United States for its own purposes). To make matters worse, beginning in 1998, the country was torn by a ferocious civil war fueled by interethnic conflict and competition over valuable minerals. The numbers of dead from that war ap- proach those from World War II, and the widespread use of mass rape as a weapon stunned the world.
Although the civil war officially ended in 2003, the violence continues, and the central government’s control over the military, paramilitary groups, and the public remains fragile. Moreover, years of warfare led to environmental destruc- tion, the abandonment or destruction of agricultural lands, and large-scale movement of citizens away from rural war zones into substandard, temporary housing in cities. All these factors have fed malnutrition and disease, including preventable outbreaks of cholera, measles, and malaria—and, most ominously, Zika and Ebola viral diseases. The DRC remains one of the world’s poorest nations, with a GNI per capita of only $730.
Structure of the Health Care System On paper, the health care system in the DRC consists of a network of hospitals, primary care clinics, and public health workers distributed around the country’s numerous health districts. These days, however, it is difficult to even talk about a health care system in the DRC. During the civil war, many doctors fled rural areas or fled the nation altogether, many hospitals were damaged or destroyed, and many pharmacists lost access to basic medications. Although conditions have improved since then in urban areas (primarily because of disease-specific health programs sponsored by the World Bank, World Health Organization, and other international nonprofit Purchasing Care Although treatment in state-run clinics and hospitals is supposed to be offered at low prices, in reality patients and their families are often expected to pay for everything, including medicines, bandages, and other supplies. Moreover, even the lowest of fees are too high for many Congolese to pay. Others may decide against going to a doctor because they know they can’t afford any medicines that the doctor might prescribe.