Congo is still struggling to pay people fighting the Ebola epidemic

(Bloomberg) — Six Ebola control posts in northeastern Democratic Republic of Congo stopped reporting last month because the people manning them were not paid.

Elsewhere, officials checking a list of 240 people said to be working at an Ebola center found only 40 workers.

The contradiction captures a problem that has dogged Congo’s public health system for decades and is now complicating its fight against the world’s fastest-growing Ebola epidemic. The government is trying to remove bogus workers from payrolls using biometric registration and centralized payments after officials found payrolls filled out by people who may not actually be working.

However, verifying these lists slows down payments to genuine responders, contributes to strikes, and disrupts screening, treatment, and infection control as the disease spreads.

“The Ministry of Health does not have an accurate idea of who works where and what they do,” said Stylianos Moshonas, a researcher at the University of Antwerp who has studied Congolese public administration for years.

Public Health Minister Roger Kamba estimates that 15 to 20% of people who claimed some of the recent Ebola payments were bogus. He said money was available to pay respondents and blamed many of the delays on manipulation of staff lists.

The stakes are rising: Congo reported 6,186 confirmed infections and 3,007 deaths on Monday, and disputes over payments are disrupting some of the essential work needed to contain the epidemic.

Six checkpoints in Haut-Uélé province stopped reporting during a strike by unpaid workers in mid-August. Almost two weeks later, five still hadn’t reported. Since Sunday, three checkpoints in neighboring Ituri, the epicenter of the epidemic, have also been on strike over unpaid wages.

By August 19, only five of the 18 responders manning the Ebola checkpoint in North Kivu province had been paid. Community workers there and in neighboring Tshopo have been without pay for three months, government reports show.

Disputes over payments have also disrupted treatment and infection control. Hygienists demanding unpaid allowances went on strike at the Bunia Ebola Treatment Center in early August, interrupting the admission of patients. A later strike by decontamination workers left some infection control work unfinished in Ituri.

“Bugs and Problems”

Congo’s difficulties in paying health workers long predated the current outbreak.

The Ministry of Public Health devoted 93% of its public spending to personnel in 2022, the World Bank said in a report last year. However, among the nearly 256,000 healthcare workers on the payrolls, less than 20% received basic pay, 41% received occupational hazard allowance and 56% received neither.

The workforce has expanded far faster than the government’s ability to pay it, Moshonas said. Workers are often appointed without a funded position or are formally registered as civil servants, particularly at the provincial level.

“You have staff inflation without the budget being able to keep up with paying all those people,” he said.

Formal registration is important, even if government salaries are modest, because it gives workers more job security and entitlement to benefits, including a pension, Moshonas said.

Staff lists are compiled at the health facilities and forwarded to the capital city of Kinshasa, where various ministries handle salaries and occupational hazard allowances. Not everyone who is presented for payment ends up on the payroll.

“To this day, it’s literally managed on Excel lists with all the errors and problems that come with it,” Moshonas said. Connections may matter. Nurses seeking payment sometimes travel to Kinshasa or approach unions to have their cases resolved, he added.

The further away people are from Kinshasa, the less likely they are to receive a government reward, the World Bank found.

This led to some side hustles. Health workers have long supplemented government salaries or made up for their absence with patient fees, local contributions and aid-funded payments. Epidemics create another source of income: temporary payments to those who trace contacts, screen travelers, disinfect facilities and even bury the dead.

During the 2018-2020 Ebola epidemic in Congo, the audit found 1,813 respondents with discrepancies in their records, including duplicates and people who could not be physically identified, according to a Congo Research Group report.

A separate review by the World Bank found parallel payment lists, fraudulent records and the same names submitted to different agencies. Verification of who actually worked delayed payments, and the bank recommended a single database of respondents and tighter HR controls.

Similar problems arose during Covid. Health workers went on strike over unpaid allowances, while officials complained that response teams were bloated. A government review found that irregular payments contributed to failures to investigate alerts and detect suspected infections, delayed lab results and sometimes delayed treatment.

Now, authorities are again trying to reconcile payroll records and beneficiary lists to resolve payment disputes, the World Health Organization’s office in Congo said in an email.

Biometric registration should make it harder to fill out payment lists, Public Health Minister Kamba told reporters in August. “We’re always trying to cheat, add,” he said.

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