A Continental Health Agency Confronts the Gap Between Donor Pledges and Spending on the Ground
Where are the remaining 700 million dollars? Dr Jean Kaseya, Director-General of the Africa Centers for Disease Control and Prevention, put that question to journalists in Kinshasa on Wednesday, 14 October, and called it “the real question we must ask ourselves” (translated from French). His figures were simple. Donors say they have disbursed $962 million to the organizations implementing the Ebola response in the Democratic Republic of Congo. A verification exercise with Congolese health authorities could trace only a little over $200 million to the structures actually carrying out the response. The difference is more than $700 million.
The wording matters. Kaseya did not say the money had been stolen, and the exercise behind his numbers was partial. At a meeting convened by officials of the National Institute of Public Health, fewer than 30 percent of implementing partners turned up to account for what they had received. The $200 million figure reflects only those who attended, and about $100 million of it was reported as still unspent. The $700 million is therefore money that has not yet been accounted for, not money proven to be missing. That is still a serious gap, and Kaseya made clear that he intends to close it: “We are not going to let go.”
From Pledges to Payments
Kaseya traced how the money grew. The regional response plan launched with the World Health Organization sought $512 million, about $242 million of it for the DRC, and the Congolese government itself disbursed $50 million. A heads-of-state meeting on 16 June, chaired by Burundi’s president, raised commitments to $1.2 billion and then $1.6 billion. After a meeting hosted by the United States, which holds the G20 presidency, and an appeal by Prime Minister Judith Suminwa in New York, total commitments reached about $3 billion: $3.045 billion in Kaseya’s account, and $2.9 billion in an Africa CDC statement from 4 October. Among the larger contributors, the United States raised its pledge from $462 million to $887 million, the World Bank provided about $420 million and the European Union about $500 million.
Of the $1.6 billion announced earlier, $962 million, about 58 percent, has actually been paid out. Crucially, it did not go to the Congolese government. It went to implementing partners, including non-governmental organizations. That is the core of Kaseya’s argument. “From the moment the donor says it sent the money and can show that the money arrived, the implementer has the obligation to show and justify, even to the one who sent the money, what it did with it,” he said.
A Government Ready to Act
Kinshasa now says it will follow up closely with every partner. Any organization that received funds must state how much it received and how it was used, in line with the government’s response plan. Partners that fail to do so could have their accreditation suspended and their activities in the country ended. Africa CDC backed this approach in its 4 October statement, supporting national accountability mechanisms including, where appropriate, administrative measures against organizations that do not meet transparency and reporting requirements. It also said it would strengthen its own Financial Tracking Mechanism to identify gaps and reduce duplication.
Kaseya presented the consolidated figures as a first. “For the first time, we have a consolidated view of the resources mobilized for an epidemic in Africa,” he said, adding that partners had followed their own practices and that methods were now being harmonized. He also praised the Congolese government’s own mobilization of funds, saying he had never seen a government do it this way in 30 years in public health.
The Outbreak Has Not Waited
The financial dispute comes as the epidemic changes shape. Kaseya said the epidemic curve had been declining for two weeks, but that the main hotspots were moving north, to Beni and Butembo in North Kivu, which worried Africa CDC and prompted calls for stronger surveillance and contact tracing. The wider toll on health is already visible: he said maternal mortality had risen by 75 percent in the Bunia and Nizi health zones and that fewer children were being vaccinated. Africa CDC declared the outbreak a regional concern once it reached both the DRC and Uganda, and a fatal case imported from the DRC has since been recorded in Kenya. The agency says it has recruited more than 200 staff in the DRC.
This is why money that cannot be traced matters. In an outbreak, every unaccounted dollar is a contact tracer not paid, a clinic not supplied or a vaccination round delayed. The DRC has lived through repeated Ebola epidemics, and the management of international emergency funding there has long raised concerns about transparency. Past responses in eastern Congo were also hampered by community mistrust, and unanswered questions about money only deepen it.
Who Holds the Ledger
For decades, the money for Africa’s health emergencies has traveled from foreign donors to international and non-governmental partners, with African governments often the last to know how it was spent. Kaseya’s challenge reverses that order: an African institution and an African government asking the implementers to open their books. The demand would be stronger with a complete audit rather than a meeting most partners skipped, and the partners deserve the chance to show their accounts before conclusions are drawn. But the principle is sound. A response run in Congo, for Congolese patients, should be accountable to Congolese authorities, and a continent that wants to lead its own health security must first be able to see where its health money goes.
