The Democratic Republic of Congo (the DRC) has rapidly improved the quality of social services and infrastructure in general, and the health sector in particular in recent years. It is not always easy to know if the changes generated by the many initiatives that are taking place now will meet the needs of future generations of Congolese. However, uninterrupted access to vaccines and other essential medicines is among the changes certain to have a lasting and positive impact on the health of the population. That is why the DRC is committed to reforming its supply chains. Assuring delivery of health products to the entire population without distinction will require significant planning, coordination and resources. The DRC constitutes an enormous logistical challenge simply by its geographic, demographic and cultural diversity. It is the largest country in sub-Saharan Africa with 2.3 million km2 mainly covered by a humid tropical forest. The DRC is also one of the most populous countries in Africa with 77 million inhabitants who predominantly live in rural, geographically dispersed areas. Vaccines and health commodities are delivered from Kinshasa, often by air, which is extremely expensive. Besides the costs, it can take weeks to deliver health products to nearly 9000 active health centers, and sometimes deliveries are not made at all. As a result, many health facilities lack the products to ensure positive health outcomes.

A second challenge is that there are dozens of supply chains in the DRC managed by many different programs. Coordination between these various programs is limited, increasing the burden on health workers while rendering the management of supply chains very difficult.

Finally, there are program-specific challenges. For example, the immunization program lacks adequate and sufficient chain equipment to meet vaccine storage requirements. Even with the recent acquisition of 1600 refrigerators through Gavi funds, only 50% of health facilities have functioning cold chains, leaving a major gap to address. These reasons are why the health supply chain in DRC has been described as a “casse-tête,” literally, a “head-breaker.”

The immunization supply chain in the DRC has not changed much in several decades. While an excellent fit for distributing the first available vaccines, the supply chain has become outdated. It is simply unreasonable to expect the original design to meet the latest requirements to reach every child in the country, especially with the addition of many new vaccines. And the volume and value of vaccines will continue to grow – quadrupling or quintupling by the end of this decade according to recent estimates.