Inactive 8(a) Set-Aside (FAR 19.8)

The Government of the Democratic Republic of the Congo (GDRC) and its partners are working closely to strengthen the DRC health system. Although the country budget allocated to health remains below th... The Government of the Democratic Republic of the Congo (GDRC) and its partners are working closely to strengthen the DRC health system. Although the country budget allocated to health remains below the international target of 15 percent, the GDRC has slowly increased its allocation each year. Additionally, the GDRC, in 2019 became a first-time donor to the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM) through a pledge of $6 million. In order to optimize the effort of the GDRC and its partners to improve the DRC health system, effective coordination and communication among all donors is critical. A Global Fund Liaison (GFL) position is key to ensuring coordination and optimal communication between U.S. Government (USG) programs and the GFATM as well as other stakeholders. This will ensure that all stakeholders capitalize on opportunities to leverage collaboration and identify critical technical assistance needs. HIV/AIDS, Malaria and TB Profile The USG activities in each of the disease areas are aligned with the National Health Development Plan. The National Malaria Control Program (NMCP) reports that malaria accounts for 19 percent of child under-five mortality contributing to approximately 21,601 deaths a year. The DRC is the 10th largest contributor to the world’s tuberculosis (TB) burden and has an estimated incidence rate of 392 cases per 100,000 people. HIV/TB co-infection rates are estimated at 16 percent and multi-drug resistant (MDR) TB cases represent two percent of the TB infected population. The DRC’s HIV epidemic is generalized, with a prevalence of 1 percent to 1.2 percent (ages 15-49) based on 2012 UNAIDS estimates. President’s Emergency Plan for AIDS Relief (PEPFAR) The U.S. Government (USG) through PEPFAR is one of two primary donors addressing the HIV/AIDS epidemic in the DRC, the other being the GFATM. The GDRC began receiving PEPFAR funding in 2004 at $3 million per year. Funding has increased over time to $117 million in fiscal year (FY) 2023. The success of the PEPFAR program and the ultimate management and control of the HIV/AIDS epidemic in the DRC is linked to the successful implementation of GFATM programming. In the DRC, PEPFAR is implemented by the U.S. Department of State (DOS), the U.S. Agency for International Development (USAID), the Department of Health and Human Services (Centers for Disease Control and Prevention - CDC), and the Department of Defense (DOD). PEPFAR supports the three highest burden geographical provinces of Kinshasa, Haut-Katanga, and Lualaba. The generalized HIV epidemic in the DRC has resulted in an estimated 515,385 people living with HIV out of an estimated population of 117 million (calculated based on UNAIDS estimates [version 6.26]). Prevalence is higher in urban areas (1.6 percent) versus rural areas (0.9 percent) and the burden of HIV is higher among women than men 25 years and older (268,896 female PLHIV v. 97,979 male PLHIV). According to UNAIDS, a majority of HIV transmission in DRC is through heterosexual contact, exacerbated by high-risk sexual practices (such as having multiple concurrent partners) and low or inconsistent condom use. The President’s Malaria Initiative (PMI) Malaria prevention and control are major foreign assistance objectives of the USG. The President’s Malaria Initiative (PMI) was launched in June 2005 to rapidly scale up malaria prevention and treatment interventions and reduce malaria-related mortality by 50 percent in 15 high-burden countries in sub-Saharan Africa. On Nov. 16, 2010, the DRC became the 16th PMI country and funding has more than tripled in five years from $18 million to $54.5 million in FY 2022. Malaria continues to be the leading cause of morbidity and mortality in the DRC, with more than 27 million malaria cases and 24,368 malaria deaths reported in 2022. Globally, the DRC accounts for an estimated 12 percent of all malaria cases and 13 percent of all malaria deaths. Approximately 97 percent of the population lives in zones with stable malaria transmission lasting 8 to 12 months per year. PMI focuses on targeted technical assistance to the National Malaria Control Program (NMCP) and field implementation of activities in nine out of twenty-six provinces covering approximately 33.4 million people. Since 2010, the mortality rate for children under five years of age has fallen by 34 percent, and the incidence rate has fallen by 40 percent. USG Tuberculosis Program in DRC The DRC is a high burden TB country and ranked third in Africa. Data from 2022 showed that the country has notified 81% of estimated TB cases, notified only 25% of estimated drug resistant TB cases, and achieved a treatment success rate of 84% drug resistant TB cases. USAID/DRC support to the GDRC for TB prevention, diagnosis and treatment is at the national, provincial and health zone levels with a portfolio of more than $16 million, including for TB/HIV activities. USAID supports TB activities in nine provinces, strategically leveraging other USAID investments. USAID is the national lead on MDR and XDR activities. Additional activities include DOTS expansion (including community-based DOTS and pediatric TB treatment), TB drugs management, TB/HIV infection detection and treatment, MDR TB management and new diagnostic tools introduction. A threat to the progress made in TB activities has been the development of MDR-TB and HIV/TB co-infection, both of which are priorities for the GDRC. Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) The GFATM is an international financing institution that funds countries to implement programs aimed at reducing the morbidity and mortality related to these three infectious diseases: AIDS, tuberculosis and malaria. It was created in 2002 to dramatically increase resources for the fight against the three pandemics. GFATM does not manage or implement programs on the ground; it relies instead on local implementing partners (Principal Recipients (PRs)) with expertise in program management and/or the three diseases. GFATM works with partners to ensure that funding serves the men, women and children affected by these diseases in the most effective way. The USG is the largest contributor to the GFATM’s annual budget (30%), hence there is a large responsibility on in-country USG teams to ensure the success of GFATM programming. In the DRC, the government, civil society, the private sector, and affected communities partner to implement programs and work in close collaboration with other bilateral and multilateral organizations to supplement existing efforts dealing with the three diseases. The GFATM is providing up to $659 million between 2021 and 2023 across six active investments. Grants of up to $17 million for HIV, $19 million for TB and $198 million for HIV and TB have been signed for DRC for 2021-2023. Two malaria grants of up to a combined $378 million for 2021-2023 will support DRC’s malaria control goals. A grant of up to $45 million will play a pivotal role in supporting the Ministry of Health to build a resilient and sustainable health system. The following results were achieved in 2021: 444,000 people living with HIV (PLHIV) are receiving antiretroviral treatment, 231,000 tuberculosis cases have been treated, 18.5 million patients diagnosed and treated for malaria and 8.4 million insecticide-treated mosquito nets were distributed. Health donors in the DRC, including WHO, UNAIDS, UNICEF and the European Union, are keenly interested in the success of the GFATM. The Global Fund Liaison plays a critical role in ensuring that GFATM programs are implemented effectively to provide the Congolese population with the needed drugs and services financed through the GFATM.