Q2 2026
West African Wastewater Surveillance
Country profile · Q2 2026

DR Congo

Active polio, mpox, and cholera surveillance led by INRB. Outbreak burden drives political attention; financing access constrained by low GDP.

At a glance · today
28
Active sites
3%
Population coverage
3%
Sewered coverage
$145
Cost / sample
6
Pathogens tracked
50
5-yr target sites
Trajectory

Today vs the 5-year target

Today
Active sites
28
Provinces covered
8 / 26
Population coverage
3%
Cost / sample
$145
5-year target
Active sites
50
Provinces covered
26 / 26
Population coverage
30%
Cost / sample
—

~3% nationally

Pathogens monitored

What is being tracked today

  • Poliovirus integrated
  • Mpox integrated
  • Cholera integrated
  • E. coli researched
  • Salmonella Typhi researched
  • Klebsiella researched
Cost economics · per sample

What it costs to monitor

$145
cost per sample, today
Panel A · By cost type
$124 Total $145
  • Direct recurrent$124 · 86%
  • Direct capital$8 · 6%
  • Indirect$13 · 9%
Panel B · By activity
Sample collection: $5 (4%)Sample transport: $41 (31%)Sample processing: $23 (17%)Sample analysis: $59 (44%)Outreach & communication: $5 (4%)Activity$133
  • Sample collection4%$5
  • Sample transport31%$41
  • Sample processing17%$23
  • Sample analysis44%$59
  • Outreach & communication4%$5
Panel C · Cost drivers
  • Staff (low-skilled)$4330%
  • Staff (high-skilled)$3625%
  • Reagents$2215%
  • Consumable supplies$139%
  • Utilities & overheads$139%
  • Transport (private)$96%
  • Lab equipment & other$53%
  • Transport (government)$32%
Capability

Strengths and challenges

Capability scorecard
  • Sewer coverage
    High
  • Logistics
    Moderate
  • Testing capacity
    Moderate
  • Use of information
    Moderate
  • Cost & value
    High
Inside the system
Operational and institutional factors
Strengths
Policy & Governance
  • Growing interest in WES among health authorities and researchers, particularly following the COVID-19 pandemic, which demonstrated the value of environmental surveillance as an early warning tool.
Financial Resources
  • Existing domestic contributions to WES by government through the provision of staff salaries and use of gov-owned lab equipment. This existing domestic financial commitment could be built upon to expand programme through the INRB.
Infrastructure & Capacity
  • Well-established environmental surveillance programme that spans across 8 provinces for polio since 2017. Operational foundation where broader WES can be built upon.
Challenges
Policy & Governance
  • WES remains a novel concept that is not well internalised or understood by provincial health officials or wider health sector decision-makers.
  • No formal or legal policy framework to anchor WES implementation in DRC outside of the polio programme. WES activities remain vulnerable to funding disruptions.
Coordination & Integration
  • Overlapping mandates that creates confusion and duplication between MoPH, MEDD, and MRHE disrupts efforts to establish a coherent One Health approach.
Data & Methodology
  • Without a clear cost-effectiveness study showing the value of early warning it is difficult to make the case for sustained resource allocation.
External environment
Political, economic and ecosystem factors
Strengths
Infrastructure & Capacity
  • Sustained investments in polio-related infrastructure from the government, WHO, GAVI, and UNICEF. INRB has strong pathogen genomic capabilities and lab capacities that can be leveraged to expand WES to additional pathogens beyond polio.
Coordination & Integration
  • A strong institutional entry point exists to integrate cholera into a more comprehensive WES framwork using the GTMLC cholera coordination platform and WASH programmes.
  • There are several initiatives that are exploring the integration of WES into National Action Plans for AMR. The ODIN project actively isolated and sequences bacterial pathogens from wastewater to detect AMR genes, paving the way for a unified national AMR surveillance system.
  • ODIN project bridges academia and government-owned surveillance, with joint funding proposals between INRB and Univ. Kinshasa submitted.
Policy & Governance
  • Outbreak surveillance in the DRC is of high international importance, a strong case for sustained international donor funding.
Challenges
Financial Resources
  • There is a lack of reliable financial data and low budget transparency across the health sector, making it difficult to map existing funding landscape for WES.
  • Outside of WHO-coordinated polio funding stream, WES funding is highly fragmented across multiple donors and partners. All other pathogens stay in pilot or conceptualisation phases.
  • The cost and availability of extraction and PCR kits is a challenge, especially during periods of market tension or global supply chain disruption
Infrastructure & Capacity
  • There is a limited number of laboratories with the capacities to process WES samples. INRB in Kinshasa holds the country's only genomic sequencnig capacity. There is a high cost and inefficiency of shiping water samples to Kinshasa.
Financing landscape

Where the funding could come from

Domestic public
  • Domestic government expenditure
    unlikely

    Staff salaries only. Very low GDP/capita; no dedicated WES budget line.

Multilateral development banks
  • World Bank IDA
    possible

    $250M outbreak preparedness project (2024–29). Reallocation to WES possible via NDoH/Finance decision.

  • European Investment Bank
    possible

    If govt interest in domestic commodity production or supply chain strengthening exists.

Global health funds
  • Pandemic Fund
    possible

    Currently is recipient of a single country grant (SOPRAP) = $25m value with extra $6.5m co-financed/invested, and a multi-country grant shared between DRC, Rwanda, Uganda (for Mpox). However, not eligible for additional funding under 4th CfP.

  • IPSN (WHO Pathogen Surveillance Network)
    possible

    DRC's high outbreak burden (Mpox, cholera, polio) aligns closely with IPSN's genomic surveillance mission. INRB already engaged in pathogen genomics work with Gates/ODIN.

  • The Global Fund
    likely

    DRC best-placed of 5 countries to attract GF given outbreak profile and low income status.

Bilateral & philanthropic
  • Gates Foundation
    likely

    Currently funding INRB multi-pathogen pilot. Strategic interest in DRC given outbreak importance.

  • Rotary Foundation
    possible

    Possible for polio-linked WES. DRC's polio burden makes WES a natural Rotary interest.

  • Bilateral GHS donors
    likely

    DRC best-placed of 5 countries given low GDP/capita and significant international externalities from outbreak control.

Strategic pathway

What to do next

Phase 1 · 0–2 years
Immediate
Phase 2 · 2–4 years
Medium term
Phase 3 · 4–6 years
Long term
Immediate · 0–2 years
  1. Finalise and publish standardised WES SOPs for sample collection, concentration, PCR, and sequencing for all actively surveyed pathogens (polio, Mpox, cholera).
    Cost: low Timeline: immediate
  2. Conduct cost-effectiveness analysis of WES and prepare an investment case brief for MoPH leadership ('the only speech politicians understand').
    Cost: low Timeline: immediate
  3. Develop financial SOPs for Gates Foundation grant compliance and reporting — a prerequisite for continued and expanded funding.
    Cost: low Timeline: immediate
  4. Resolve import tax shortfall (~$34k/yr): engage MoPH for a formal exemption letter for WES reagents; submit to Customs as public health infrastructure.
    Cost: low Timeline: immediate
Medium term · 2–4 years
  1. Align WES data with the national DSE (epidemiological surveillance) dashboard — integrate Mpox and cholera WES signals into MoPH weekly reporting.
    Cost: medium Timeline: short
  2. Decentralise sample concentration infrastructure to 3 provincial labs (Kisangani, Lubumbashi, Goma) to reduce costly 1-litre sample transport to Kinshasa.
    Cost: high Timeline: medium
  3. Draft a formal inter-ministerial coordination MOU between MoPH, MEDD, and MRHE establishing clear WES roles and data-sharing obligations.
    Cost: medium Timeline: short
  4. Expand to 52 sites (+2/region) covering all 26 provinces — beginning with regions where INRB already has outbreak response capacity.
    Cost: high Timeline: medium
Long term · 4–6 years
  1. Draft and pass a national WES policy — present to National Assembly with cost-effectiveness evidence, WHO endorsement, and INRB technical validation.
    Cost: medium Timeline: long
  2. Develop a One Health communication strategy — formally engage Ministry of Environment (MEDD) and Animal Health ministry to co-fund zoonotic WES sites.
    Cost: medium Timeline: long
  3. Expand to 70 sites (2× current urban + ~10% unsewered population coverage) using adapted open-sewer and river-catchment sampling methods.
    Cost: high Timeline: long
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