Depreciation Allocations and Financial Resilience in Public Health Facilities in the DRC: An Underutilized Strategic Lever. A Qualitative Study and Reform Pathways for Sustainable Asset Management
DOI:
https://doi.org/10.47941/ijppa.3225Keywords:
Depreciation Allowances, Financial Resilience, Healthcare Facilities, Hospital Management, DRC.Abstract
Study Objective: This research examines the barriers to adopting depreciation allowances in public health facilities in the DRC, evaluates their potential as a strategic tool for financial resilience, and suggests pathways for reform to ensure sustainable integration.
Methodology: An exploratory qualitative study was conducted from January up to April 2025, with 296 professionals in the public health sector using semi-structured questionnaires. Inductive thematic analysis identified perceptions, obstacles, and opportunities related to depreciation.
Results: The results show that more than 74% of respondents have little or no familiarity with depreciation allowances; the majority of facilities do not integrate depreciation allowances into their financial management. Prioritizing urgent expenses is the main reason for the lack of applicability of depreciation allowances. Statistical tests (chi-squared and Spearman correlations) confirm that familiarity with and integration of depreciation allowances significantly improve the perception of financial resilience.
Contribution to theory, policy, and practice: On a theoretical level, this study fills a gap in the African literature on hospital asset management. On a practical level, it proposes concrete reforms to institutionalize depreciation, train managers, and align external financing with a sustainable approach. Finally, it offers policymakers ideas for reducing Congolese hospitals' dependence on international aid.
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References
Anessi-Pessina, E. Et al.(2020). Public Sector Accounting in Africa: Status and Reforms. Elsevier.
Asante, A., Wasike, W. S. K., & Ataguba, J. E. (2020). Health Financing in Sub-Saharan Africa: From Analytical Frameworks to Empirical Evaluation. Applied Health Economics and Health Policy, 18(6), 743–746. Https://doi.org/10.1007/S40258-020-00618-0
Brusca, I. Et al.(2015). IPSAS and Governmental Accounting in Europe. Springer.
Bumba Moaso Djongi, E. A. (2012). Déterminants socioéconomiques influençant l'accessibilité aux soins dans la zone de santé de Masa (Province Orientale/RDC) [Mémoire de licence, Université de Kisangani]. Mémoire Online. Https://www.memoireonline.com/12/12/6542/Determinants-socioeconomiques-influencant-laccessibilite-aux-soins-da.html
Chansa, C. Et al.(2018).Donor Dependency in African Health Systems. Health Policy and Planning.
Coccia, M. (2024). Country Risk to Face Global Emergencies: Negative Effects of High Public Debt on Health Expenditures and Fatality Rate in COVID-19 Pandemic Crisis. Igmin Research, 2(7), 537–545. Https://doi.org/10.61927/igmin214
Coccia, M., & Benati, I. (2023). Negative effects of high public debt for health planning: lessons from covid-19 pandemic crisis in europe. Https://doi.org/10.22541/au.169389726.67100280/v1
Collectivités locales. (2022). Plan de comptes M57. Https://www.collectivites-locales.gouv.fr/files/Finances%20locales/1.%20pr%C3%a9parer%20et%20ex%C3%a9cuter%20un%20budget/3.%20instruction%20bdgr/1.%20M57/2022/M57D_01012022.pdf
Cooray, A., & Özmen, İ. (2024). The role of institutions on public debt: A quantile regression approach. International Review of Economics & Finance, 93, 912–928. Https://doi.org/10.1016/j.iref.2024.03.065
Darimont, B. And Liu, D. (2013). Le système de santé de la république populaire de chine: entre privatisation et système public de santé. Revue Internationale De Sécurité Sociale, 66(1), 105-125. Https://doi.org/10.1111/issf.12005
Diallo, A. (2015). Évaluation de la gestion financière dans les structures hospitalières publiques du Mali. Mémoire de Master, Université de Bamako.
Foka Tagne, A. G., Tankeu, R. T., & Siewe, S. A. M. (2020). Appréciation de la performance hospitalière des hôpitaux publics au Cameroun. Journal of Academic Finance, 11(2), 69–87. Https://www.academia.edu/124585124/
Geoffroy, N., Daniel, N., Hervé, S., Romuald, T., & Ladifatou, G. (2020). Covid-19, capital humain et crise ã©conomique en afrique subsaharienne : une analyse prospective. European Scientific Journal Esj, 16(31), 162. Https://doi.org/10.19044/esj.2020.v16n31p162
Gupta, S. Et al.(2021).Fiscal Resilience in Developing Countries. World Bank Report.
Hepworth, N.(2017).Accrual Accounting in the Public Sector: A Systematic Review. IMF Working Paper.
Houston, M., Day, M., de Lago, M., & Zarocostas, J. (2011). Health services across Europe face cuts as debt crisis begins to bite. BMJ, 343. Https://doi.org/10.1136/BMJ.D5266
Kabey, M.(2022). La Gestion Financière Publique en RDC : Enjeux et Perspectives. PU Kinshasa.5
Kirigia, J.(2016).Health Financing in Africa: Challenges and Opportunities. WHO Bulletin.
Lebedeva, L., & Shkuropadska, D. (2024). Resilience of eu healthcare systems. Зовнішня Торгівля: Економіка, Фінанси, Право. Https://doi.org/10.31617/3.2024(133)07
M. Workshop: Rethinking health system resilience for Europe: Health System Functions in a time of Permacrisis. (2023). European Journal of Public Health, 33. Https://doi.org/10.1093/eurpub/ckad160.476
Mbelwa, L.(2018). Public Financial Management in Sub-Saharan Africa. Routledge.
Ministère de la Santé Publique, Hygiène et Prévention de la République Démocratique du Congo. (2016). Plan National de Développement Sanitaire 2016-2020. Https://www.prb.org/wp-content/uploads/2020/06/RDC-Plan-National-de-Developpement-Sanitaire-2016-2020.pdf
Ministère de la Santé Publique, Hygiène et Prévention de la République Démocratique du Congo. (2019). Plan National de Développement Sanitaire recadré pour la période 2019-2022. Https://platform.who.int/docs/default-source/mca-documents/policy-documents/plan-strategy/COD-CC-10-010-PLAN-STRATEGY-2012-fra-National-Health-Development-Plan-2019-2022.pdf
Mouto Nsia, C. (2014). Contribution du contrôle de gestion à la performance des hôpitaux publics au Cameroun. Mémoire en ligne.
Mushi, H. Et al.(2020).Health Infrastructure Financing in the DRC. The Lancet Global Health.
Nguena, C. (2017). Comprendre les systèmes budgétaires hospitaliers dans les pays en développement : une analyse critique des pratiques en Afrique subsaharienne francophone. Revue Africaine de Finances Publiques, 4(2), 101–119.
Organisation mondiale de la Santé. (2019). Plan National de Développement Sanitaire recadré pour la période 2019-2022. Https://platform.who.int/docs/default-source/mca-documents/policy-documents/plan-strategy/COD-CC-10-010-PLAN-STRATEGY-2012-fra-National-Health-Development-Plan-2019-2022.pdf
Piscopo, J. A., Groot, W., & Pavlova, M. (2024). Determinants of public health expenditure in the EU. PLOS ONE, 19. Https://doi.org/10.1371/journal.pone.0299359
Pradhan, N. A., Ali Samnani, A. A. B., Abbas, K., & Rizvi, N. (2023). Resilience of primary healthcare system across low- and middle-income countries during COVID-19 pandemic: a scoping review. Health Research Policy and Systems, 21. Https://doi.org/10.1186/s12961-023-01031-4
République Démocratique du Congo. (2011). Décret n° 011/05 du 21 janvier 2011 fixant des directives visant l'assainissement des états financiers des entreprises publiques transformées en sociétés commerciales. Https://www.leganet.cd/Legislation/Droit%20Public/epub/D.11.05.21.01.2011.htm
République Démocratique du Congo. (2017). *Arrêté ministériel n° 004/1250/CAB/ MINIS/ GMC/
République Démocratique du Congo. (2017). Arrêté ministériel n° 004/1250/CAB/ MINIS/ GMC/CAJ/OWE/2017 du 15 septembre 2017. Https://www.leganet.cd/Legislation/Droit%20Public/SANTE/AM.004.15.09.2017.html
République Démocratique du Congo. (2022). Évaluation de la gestion des investissements publics – PIMA et PIMA Changements climatiques. Https://infrastructuregovern.imf.org/content/dam/PIMA/Countries/DRC/documents/DRC%20PIMA%20-%20French%20version.pdf
République Démocratique du Congo. (2022). Ministère de la Santé Publique, Hygiène et Prévention: Accueil. Https://sante.gouv.cd/
République du Congo. (2017). Mettre en œuvre des réformes de la gestion des finances publiques pour stimuler la croissance et assurer le partage de la prospérité. Https://documents.worldbank.org/curated/pt/762331495565571819/pdf/ACS14289-FRENCH-OUO-9-22-5-2017-11-54-0-congopemfarfrnmainreportweb.pdf
République Française. (2022). Décret n° 2022-608 du 21 avril 2022 fixant les règles nationales d'amortissement. Https://www.legifrance.gouv.fr/jorf/id/JORFTEXT000045638719
République Française. (2022). Document d’appui méthodologique- Europe en France. Https://www.europe-en france.gouv.fr/sites/default/files/20212027_dame_eligibilite_0.pdf
République Française. (2022). Document d’appui méthodologique. Https://www.europe-en-france.gouv.fr/sites/default/files/20212027_dame_eligibilite_0.pdf
République Française. (2022). Guide des imputations budgétaires et comptables. Https://www.collectivites-locales.gouv.fr/files/finances-locales/Documentation/Guide%20des%20imputations%20budgetaires%20et%20comptables.pdf
République Française. (2022). Guide des imputations budgétaires et comptables. Https://www.collectivites-locales.gouv.fr/files/finances-locales/Documentation/Guide%20des%20imputations%20budgetaires%20et%20comptables.pdf
République Française. (2022). Plan de comptes M57 - Collectivités locales. Https://www.collectivites-locales.gouv.fr/files/Finances%20locales/1.%20pr%C3%a9parer%20et%20ex%C3%a9cuter%20un%20budget/3.%20instruction%20bdgr/1.%20M57/2022/M57D_01012022.pdf
République Française. (2022). Régime de l'amortissement dégressif spécifique à certains biens. Https://bofip.impots.gouv.fr/bofip/4744-PGP.html/identifiant%3DBOI-BIC-AMT-20-20-50-20150902
République Française. (2022). Revue de dépenses : les dispositifs médicaux. Https://www.igf.finances.gouv.fr/files/live/sites/igf/files/contributed/Rapports%20de%20mission/2024/2023-M-106-03%20Rapport%20RDD-Dispositifs%20m%C3%a9dicaux.pdf
Tangcharoensathien, V., Panichkriangkrai, W., Witthyapipopsakul, W., & Patcharanarumol, W. (2022). COVID-19 Aftermath: Direction Towards Universal Health Coverage in Low-Income Countries. International Journal of Health Policy and Management, 12. Https://doi.org/10.34172/ijhpm.2022.7519
Tapsoba, Y., Ndokabilya, E., Wema, J., Engels, T., & Paul, É. (2023). Cartographie et analyse du financement de la santé dans la province du sud-kivu (rdc). Santé Publique, Vol. 35(3), 315-328. Https://doi.org/10.3917/spub.233.0315
Tsani, S., Riza, E., Tsiamagka, P., & Nassi, M. (2021). Public financing and management for a sustainable healthcare sector: some lessons from the covid-19 pandemic (pp. 233–254). Springer, Cham. Https://doi.org/10.1007/978-3-030-69284-1_12
Van Damme, W. (2007). World social health insurance: strengthening health systems in low-income countries. PLOS Medicine, 4(3), 596–597. Https://doi.org/10.1371/JOURNAL.PMED.0040137
Van Wyk, J.(2019).Challenges in Implementing Accrual Accounting in the Public Sector. OECD Journal.
Widhiyoga, G., & Ikawati, N. (2022). Health System Resilience and Community Participation amidst the Covid 19 Pandemic: A Case Study of SONJO (Sambatan Jogja) in the Special Region of Yogyakarta, Indonesia. JSP : Jurnal Ilmu Sosial Dan Ilmu Politik, 26(1), 17. Https://doi.org/10.22146/jsp.68825
Wiysonge, C. S., Paulsen, E. J., Lewin, S., Ciapponi, A., Herrera, C. A., Opiyo, N., Pantoja, T., Rada, G., & Oxman, A. D. (2017). Financial arrangements for health systems in low‐income countries: an overview of systematic reviews. Cochrane Database of Systematic Reviews, 2017(9), 0. Https://doi.org/10.1002/14651858.CD011084.PUB2
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