Impact of external funding reductions on anti-malarial availability and treatment access in Haut-Lomami and Haut-Katanga Provinces, DRC, 2024-2026
Design
Mixed-methods study (sequential explanatory design): secondary analysis of routine surveillance and stock data, cross-sectional health facility and vendor stock assessment, household survey with verbal and social autopsy, and qualitative interviews and focus group discussions.
Context
Since early 2025, MSF teams in Haut-Lomami and Haut-Katanga Provinces have reported more frequent and longer stockouts of anti-malarial medicines and rapid diagnostic tests in public health facilities. These reports coincided with reductions in external malaria funding, including USAID-supported supply mechanisms. In Bukama health zone, Epicentre's annual mortality surveys showed under-five mortality rising from 0.70 (95% CI 0.58–0.84) to 1.24 (95% CI 1.08–1.43) deaths per 10,000 per day between 2024 and 2025.
Malaria is suspected to contribute to this rise, but several questions remain open: whether malaria-specific mortality has increased, whether trends in routine surveillance reflect true incidence or changes in reporting, how long and how widespread stockouts have been, how care-seeking has changed, and whether private or informal vendors have compensated for public sector shortages. Routine systems in DRC capture malaria mortality and stock availability incompletely. A structured investigation is therefore needed to inform the Ministry of Public Health, provincial health authorities, and MSF operational planning and advocacy.
Our role
Epicentre designed the study, are principal investigators, and carry out the data analysis, in collaboration with MSF Operational Centre Paris (OCP), which supports fieldwork logistics in Lubumbashi and Bukama.
Partners
- Programme national de lutte contre le paludisme (PNLP), including the provincial malaria coordinators of Haut-Lomami and Haut-Katanga
- Médecins Sans Frontières, Centre opérationnel de Paris (MSF-OCP).
Objectives
The overall objective is to assess the extent to which recent reductions in external malaria funding have been associated with changes in anti-malarial availability, malaria incidence, treatment-seeking behaviour, and malaria-attributable mortality in Haut-Lomami and Haut-Katanga Provinces. The specific objectives are to:
• describe trends in reported malaria incidence and malaria-related mortality from routine surveillance data between 2024 and 2026;
• assess the frequency, duration, and distribution of anti-malarial stockouts in public health facilities and private providers;
• quantify the current availability of artemisinin-based combination therapies, rapid diagnostic tests, and injectable artesunate in a random sample of facilities and vendors;
• explore the experiences of patients and healthcare workers with stockouts, barriers to treatment, and perceived changes over time.
Methodology
The study combines four components across five health zones selected to contrast urban and rural settings and priority and non-priority contexts: Bukama, Kitenge, and Mulongo (Haut-Lomami), and Ruashi and Kafubu (Haut-Katanga).
• Routine malaria case, death, and stock data (IDS, DHIS2, and the PNLP dashboard) are analysed with interrupted time series models across three periods (before, during, and after the funding transition).
• A cross-sectional survey audits anti-malarial stocks in a stratified random sample of health facilities and medicine vendors.
• A malaria module and a verbal and social autopsy are added to Epicentre's multi-indicator household survey in Bukama to estimate malaria-related mortality, suspected malaria incidence, and access to care.
• Semi-structured interviews and focus group discussions with healthcare workers and community informants in Bukama are used to interpret the quantitative findings.
All components are integrated in the final analysis.
Impact
The findings are intended to support the Ministry of Public Health, the PNLP, and provincial authorities in understanding the scope and distribution of treatment access failures, and to inform decisions on resource allocation and supply chain reinforcement. They will also inform MSF's operational response and advocacy. Results will be added to this page as they become available. à mesure de leur disponibilité.
