DRC SURVEY: An Overview of Demographics, Infrastructure, Health, - PowerPoint PPT Presentation

3/14/17 DRC SURVEY: An Overview of Demographics, Infrastructure, Health, and Financial Services in the Democratic Republic of Congo Naughton B, Abramson R, Wang A, Kwan-Gett T Work Order Name |

Agenda Agenda  Introduction  Methodology  Findings  Demographics & Infrastructure  Health System & Outcomes  Financial Wellbeing  Conclusion Work Order Name 03/14/17 2 |

Introduction Work Order Name 3 03/14/17 |

Introduction Contextual Review ฀ Challenges:  Violence and instability  Nearly collapsed & overburdened health system  Crippled infrastructure  Humanitarian crises  Persistent conflict particularly in Eastern region ฀ There are promising trends however, and further targeted investments could have a large and lasting impact Work Order Name 03/14/17 | 4

Introduction Contextual Review – Data Concerns ฀ Data quality has been questioned in the literature ฀ Concerns anecdotally corroborated by experts at UW, PATH, and IHME ฀ Particular skepticism of government-produced statistics on health sector outcomes ฀ In 2015, World Bank granted $45 million to strengthen National Statistical System to support accurate and accessible data Work Order Name 03/14/17 | 5

Introduction Added Complication: New Province Boundaries Work Order Name 03/14/17 6 |

Work Order START Team Work Order & Deliverables  Identify trends and indicators across DRC including demographics, infrastructure, health outcomes, and financial well-being  Deliverables:  Summary report  Presentation  All sources used  Editable database that can be updated Work Order Name 03/14/17 7 |

Methodology Work Order Name 03/14/17 8 |

Methodology Project Overview Work Order Name 03/14/17 9 |

Methodology Sources & Database ฀ All sources are stored and organized according to theme with a common naming system for easy access ฀ The editable database can be updated over time, and identifies both referenced and un-referenced sources for each theme Screenshot DRC Documents Database Work Order Name 03/14/17 10 |

Primary Findings Work Order Name 03/14/17 11 |

Primary Findings Thematic Areas Demographics & Trends and indicators will be Infrastructure highlighted across the three main thematic areas Health System Financial & Outcomes Well-Being Work Order Name 03/14/17 12 |

Primary Findings: Demographics & Infrastructure Work Order Name 13 03/14/17 |

Demographics & Infrastructure Demographics Figure Source: CIA Factbook Work Order Name 14 03/14/17 |

Demographics & Infrastructure Demographics: Education of Girls Overall, an estimated 52% of girls in DRC have less than a complete primary education, however the figure ranges dramatically among provinces (28.4%-75.4%). 1 28.4% 75.4% % girls with incomplete primary education Data source: DRC-DHS Survey 2013-2014, 1: Statistics associated with prior provincial boundaries. Work Order Name 03/14/17 15 |

Demographics & Infrastructure Demographics: Modern Contraception Overall, 8% of married women in DRC report use of modern contraception method, ranging from a low of 4-5% in central areas compared to 19% in Kinshasa. 1 3.9% 19.0% % married women using modern contraception Data source: DRC-DHS Survey 2013-2014, 1: Statistics associated with prior provincial boundaries. Work Order Name 03/14/17 16 |

Demographics & Infrastructure Demographics: Fertility Rate DRC has an overall fertility rate of 6.6 children per woman, however the rate varies through the country. (range: 4.2-8.2 children/woman) 1 4.2 8.2 Average children/woman Data source: DRC-DHS Survey 2013-2014, 1: Statistics associated with prior provincial boundaries. Work Order Name 03/14/17 17 |

Demographics & Infrastructure Infrastructure: Electricity, Water, & Sanitation UTILITIES Urban Households Rural Households 85% 90% 80% 70% 60% 50% 42% 40% 32% 30% 21% 17% 20% 10% 0.40% 0% Electricity Improved Water Source Improved Sanitation Facilities Data source: DRC-DHS Survey 2013-2014 Work Order Name 18 03/14/17 |

Demographics & Infrastructure Infrastructure: Information & Communication Technology MOBILE PHONE & INTERNET ACCESS 60 Mobile phone subscriptions 50 53 (2015) Per 100 people 40 30 20 10 Internet Users 3.8 (2015) 0 Data source: World Bank World Development Indicators Work Order Name 19 03/14/17 |

Demographics & Infrastructure Infrastructure: Transportation Source: Map No. 4007 Rev. 11 United Nations, May 2016 Work Order Name 20 03/14/17 |

Primary Findings: Health System & Outcomes Work Order Name 21 03/14/17 |

Health System & Outcomes Health Service Delivery Source: Muyembe et al. 2013. Work Order Name 22 03/14/17 |

Health System & Outcomes Key Health System Challenges Little Accountability Leads to poor planning, implementation, corruption Fragmentation of Health Services Disparate and disconnected providers Weak Supply Chain Parallel systems and stock outs Health Workforce Inconsistent salaries, poor training User Fees Unpredictable and unregulated End-User Challenges Patients presenting with advanced disease Work Order Name 23 03/14/17 |

Health System & Outcomes Health Challenges: Outbreaks & Non-Communicable Diseases (NCDs) ฀ I nfectious disease outbreaks are recurring and detrimental  In particular: malaria, TB, measles, yellow fever, and cholera  Weak/non-existent surveillance systems  Poor laboratory capability  Fragmented and inconsistent roll-out of systematic vaccinations ฀ NCDs are rising with epidemiological transition  Increasing rates of NCDs are being identified  Increasing reports of complications related to hypertension, including stroke and chronic kidney disease Work Order Name 03/14/17 24 |

Health System & Outcomes Mortality Trends 1990-2015: The Rise of NCDs NTDs and Malaria Neonatal Disorders Nutritional Deficiencies Cardiovascular Diseases Neoplasms Diabetes Chronic Respiratory Diseases Maternal Disorders Work Order Name 25 Source: IHME 2015 03/14/17 |

Health System & Outcomes Under-Five Mortality: Indicative of Health System Challenges U5M in Central Africa and Great Lakes Countries  Almost half of the deaths in the country are children under age 5  Diarrhea, acute lower respiratory infections and malaria account for more than 50% of the deaths of children under five in the country  Stark differences rural to urban  Children from urban areas 2x as likely to be immunized than those in rural areas Work Order Name 26 03/14/17 |

Health System & Outcomes Nutrition Challenges – Particularly for Women & Children DRC Urban Rural Children under age five who are stunted (%) 43 33 47 Children under age five who are wasted (%) 8 5 9 Children under age five who are underweight (%) 23 14 26 Children age 6-59 months who are anemic (%) 60 59 60 Women age 15-49 who are anemic (%) 38 41 37 Men age 15-49 who are anemic (%) 23 21 24 Source: 2013 DHS Work Order Name 27 03/14/17 |

Financial Wellbeing Work Order Name 28 03/14/17 |

Financial Wellbeing Focus Areas Microfinance Economic Credit Services Banking System Overview Mobile Money Work Order Name 29 03/14/17 |

Financial Wellbeing Banking System Low infrastructure ● Microfinance coverage Lack of regulation ● Economic Credit Services Banking System Overview Mobile Money Work Order Name 30 03/14/17 |

Financial Wellbeing Banking System: Remains Small and Underdeveloped Sources: IMF, World Bank, Central Banks, European Investment Bank, 2013 Work Order Name 31 03/14/17 |

Financial Wellbeing Mobile Money Microfinance Economic Credit Services Banking System Overview Lagging adoption ● Mobile Money despite rising mobile phone subscription Work Order Name 32 03/14/17 |

Financial Wellbeing Mobile Money: Increasing Usage but with Bottlenecks Work Order Name 33 03/14/17 |

Financial Wellbeing Credit Services Microfinance Economic Credit Services Banking System Overview High growth ● Remains a scarce, ● Mobile Money expensive, and highly concentrated resource Work Order Name 34 03/14/17 |

Financial Wellbeing Credit Services: Less Reliance on Formal Institutions Sources of Credit in the DRC 35 Percentage of those who reported using credit 30 25 20 15 10 5 0 A financial A private lender An employer A family or friend Store credit institution Source: Demirguc-Kunt and Klapper 2012 Work Order Name 35 03/14/17 |

Financial Wellbeing Microfinance Lack of regulation ● and supervision Microfinance Not profitable or ● sustainable Economic Credit Services Banking System Overview Mobile Money Work Order Name 36 03/14/17 |

Financial Wellbeing Microfinance: Rapid Recent Growth 1 million 143 Institutions 208 Branches Source: IMF, as of end 2012 Source: World Bank Work Order Name 37 03/14/17 |

Financial Wellbeing Microfinance: Risk Mitigation Work Order Name 38 03/14/17 |