Key Messages

• The Democratic Republic of the Congo has no Global Hunger Index (GHI) score because data are incomplete, but its hunger level is provisionally designated as alarming. In 2019 the country experienced the second-worst food crisis in the world in terms of the number of people affected. Child mortality and child stunting are high. On the positive side, child wasting has fallen significantly since 2001.

• Poverty in DRC is extraordinarily high: Recent projections suggest that 72 percent of the population is living in poverty.

• Ongoing violence and insecurity, particularly in the east of the country, are contributing to persistent instability and high levels of displacement and undermining livelihoods and food security.

• Multiple public health crises — including serious outbreaks of Ebola, measles, and cholera, and now the global COVID-19 pandemic — undermine people’s health, food and nutrition security, and economic well-being. Access to clean water, sanitation, and hygiene facilities is extremely low.

• Effective interventions have included farmer field schools; care groups providing nutrition education, skill building, and food rations for women and children; and nutrition supplementation.

• Real progress and successes in food and nutrition security will depend on improving the security situation, building up government institutions and capacity, raising agricultural production and productivity, reforming the water, sanitation, and hygiene (WASH) sector, and strengthening nutrition education and family planning and reproductive health services.

Country Context

With a vast landmass, large population, and extensive natural resources, DRC has great economic potential, but its development has been hampered by war and recurring conflict in recent years. The country is the largest in Africa South of the Sahara, and its population of 84 million people is the third highest in that region (World Bank 2020a). It has considerable mineral resources, including cobalt, tantalum, tin, gold, and diamonds, particularly in the south and east of the country (Geenen and Marysse 2016). However, the country’s history of brutal exploitation during colonialism and its later authoritarianism, political crises, and war have left the government extremely fragile, with a limited ability to provide social and economic services.

Furthermore, the effectiveness of government services and investments is being hampered by widespread corruption (Bak et al. 2019). Although DRC experienced its first peaceful transition of presidential power in 2019, it still faces steep challenges in the path to development (IFAD 2019). More than 100 armed groups perpetuate violence, particularly in the east of the country, including in Nord-Kivu, Sud-Kivu, and Ituri (ICG 2019). This violence has led to high levels of displacement: at the end of 2019, 5.5 million people were displaced within the country itself — the highest level in Africa — and as of February 2020 nearly 1 million refugees and asylum seekers had fled to neighboring countries. Furthermore, as of January 2020 more than half a million refugees and asylum seekers had been displaced to DRC from other countries (IDMC 2020; UNHCR 2020a).

Poverty is rampant. The most recent official poverty statistics show that as of 2012, 76.6 percent of the population lived in poverty, down from 94.1 percent in 2004 (World Bank 2020a). World Bank projections suggest that by 2018 this rate had declined slightly to 72 percent — still extraordinarily high (World Bank 2019b). In 2018 GDP per capita was just $562 in current US dollars. This is the 10th-lowest GDP per capita of all countries in the world with available data. Poverty is more pronounced in the country’s northwest and central provinces (World Bank 2017). Since 2010 GDP per capita has grown at an average annual rate of 3 percent (World Bank 2020a), although the COVID-19 pandemic and resulting economic fallout are likely to threaten this progress. According to the Human Development Index, DRC ranks 179th out of 189 countries (UNDP 2019).

Agriculture employs the majority of the population, but industry — led by mining — contributes the most to GDP. Agriculture accounted for 68 percent of employment in 2019, compared with 21 percent in services and 11 percent in industry. However, agriculture represents just 19 percent of GDP, whereas services contribute 33 percent and industry contributes 44 percent (World Bank 2020a). Conflict and instability pose challenges to the agriculture sector by displacing farming families from their land and reducing the financial resources available to invest in seeds, fertilizer, and other inputs. Flooding, landslides, and soil erosion also hamper agricultural production and are likely to increase owing to climate change and increased climate variability (FAO 2018a; USAID 2018b). Given farmers’ limited access to modern techniques and inputs, agricultural productivity is low compared with the average for Africa South of the Sahara (World Bank 2019a). Availability of banking services is extremely limited, particularly in rural areas, and farmers rarely have land titles that can be used as collateral for loans (Marivoet et al. 2018).

Public health crises directly threaten the population’s well-being, undermine economic growth, and in some cases exacerbate food and nutrition insecurity. DRC has experienced 11 Ebola virus disease outbreaks since 1976. In June 2020 a new outbreak in Équateur province was detected, and its largest outbreak to date, centered in Nord-Kivu province, was declared over. Since May 2018 over 3,400 cases and more than 2,200 deaths have occurred in Nord-Kivu, Sud-Kivu, and Ituri provinces (WHO 2020a; MSF 2020). Fighting the Ebola outbreak has required considerable public health resources and created significant disruption to livelihoods and food security in the affected areas. The global COVID-19 pandemic has the potential to have more widespread effects on food security, either through the direct effects of the disease in the country or as a result of the ensuing economic contraction. A massive and ongoing measles outbreak that began in 2018 has infected more than 300,000 people and killed 6,045 in 2019, with children particularly hard hit. Measles puts children at increased risk of acute malnutrition, which, in turn, increases the severity and duration of measles (Ducomble and Gignoux 2020; Holzmann et al. 2016). Moreover, DRC faces a cholera epidemic across 23 of its 26 provinces, with over 30,000 cases and 500 deaths in 2019 alone (Solidarités International 2020).

Although DRC has no 2020 Global Hunger Index score owing to a lack of data, its hunger level is provisionally designated as alarming (see Box 1.3). Data for one of the four indicators used to calculate GHI scores — the prevalence of undernourishment—are unavailable. However, according to the 2020 Global Report on Food Crises, DRC experienced the second-worst food crisis in the world in 2019 in terms of the number of people affected, with 15.6 million people facing crisis or emergency levels of acute food insecurity. Factors driving food insecurity include conflict and insecurity, which trigger displacement and loss of livelihoods; weather extremes; crop pests; and economic shocks such as high maize flour prices (FSIN 2020).

Child stunting—an indicator of chronic undernutrition—remains high. At 41.8 percent in 2017–2018, child stunting at the national level has not declined substantially since 2001, when it was 44.4 percent (see Figure 3.2) (INS, USAID, and UNICEF 2019; UNICEF, WHO, and World Bank 2020a). At the provincial level the highest stunting rates are in Kwango, Kasaï-Central, and Sankuru, with more than half of children stunted in each province, compared with just 15.6 percent in Kinshasa (Table 3.1) (INS, USAID, and UNICEF 2019). Children in DRC with access to health services and adequate food and care have lower levels of stunting than other children, whereas lack of rainfall during the growing season increases the probability of child stunting (Skoufias, Vinha, and Sato 2019). Furthermore, children who are breastfed within the first hour of birth and children whose mothers were 20 years of age or older at the time of delivery are less likely to be stunted (Kismul et al. 2018).

Child wasting—an indicator of acute undernutrition—has fallen significantly. The child wasting rate was 6.5 percent in 2017–2018, a considerable decline from 15.9 percent in 2001 (INS, USAID, and UNICEF 2019; UNICEF, WHO, and World Bank 2020a). The provinces with the highest wasting rates are Nord-Ubangi, at 13.5 percent, and Ituri, at 11.2 percent. Sud-Kivu has the lowest child wasting rate of any province, at 2.6 percent, and Nord-Kivu’s rate is also relatively low, at 4.6 percent (INS, USAID, and UNICEF 2019).

The mortality rate for children under age five has fallen but still lags behind the average rate for the region. As of 2018 child mortality in DRC was 8.8 percent, down from 16.1 percent in 2000 but still worse than the 7.8 percent average for Africa South of the Sahara. In 2018, about 296,000 children under the age of five died in DRC (UN IGME 2019b). One of the main causes of child mortality in DRC is malnutrition, along with malaria, acute respiratory infections, and diarrheal diseases (Kavle et al. 2019; MPSMRM, MSP, and ICF International 2014). The Congolese wars (1996–1997 and 1997–2003) increased infant mortality, mainly through higher death rates in the post-neonatal period (1 through 11 months of age) (Lindskog 2016). The provinces with the highest under-five mortality rates are Kasaï at 16.9 percent, Haut-Lomami at 13.1 percent, and Sankuru at 12.7 percent. Interestingly, several provinces with high levels of ongoing conflict have relatively low child mortality rates, such as Nord-Kivu, at 2.6 percent, Sud-Kivu, at 3.8 percent, and Ituri, at 4.4 percent. A 2007 analysis also observed a low child mortality rate in Nord-Kivu, the center of ongoing conflict, and surmised that this low rate may have been due to the presence of several nongovernmental organizations working to reduce child mortality as well as the large proportion of children living in humanitarian camps (Kandala et al. 2014).

The diversity of people’s diets and the frequency of their meals are insufficient. Cassava and maize are the most commonly consumed staple crops in DRC, followed by rice. Beans are also an important part of the diet, as is palm oil (FEWS NET 2019). Meat, fish, eggs, fruits, and vegetables are consumed occasionally, and dairy is rarely consumed (Kismul, Mapatano, and Banea 2017). Among children aged 6–23 months, just 8.0 percent receive a minimum acceptable diet according to the most recent data (INS, USAID, and UNICEF 2019). It is important to note that up-to-date data on diets at the national level are limited (IPC 2016).

Water, sanitation, and hygiene (WASH) are inadequate, contributing to malnutrition and poor health. In households without clean running water, children are more likely to be stunted. Poor access to WASH is associated with higher rates of anemia (World Bank 2017). Just 33 percent of Congolese have access to improved sanitation, 59 percent have access to improved sources of drinking water, and 22 percent have handwashing facilities with water and soap in the home, which poses a challenge to effectively preventing the spread of COVID-19 (INS, USAID, and UNICEF 2019; UN Water 2020). Even water facilities considered to be improved have been found to be contaminated with harmful bacteria, including more than a third of piped water in Kinshasa, making clear that improved water quality is needed (World Bank 2017).

Various types of interventions have the potential to improve food and nutrition security in low- and lower-middle-income countries. Research has shown, however, that the effectiveness of a given approach depends on the context in which it is implemented, which can vary from country to country and even within country borders. A selection of the impact evaluation literature presents some of the available evidence on what has been effective in DRC.

Farmer field schools and a care group program for women and children have been particularly effective. The Jenga Jamaa II program a US Agency for International Development program implemented by an NGO in Sud-Kivu, included a variety of measures to address food insecurity and child undernutrition, including farmer field schools, farmer-to-farmer training, and women’s empowerment groups. It also included a care group program for pregnant women and children under two years of age that provided child health and nutrition education, promoted homestead gardens, and supplied monthly rations (cornsoya blend and vitamin A–fortified oil). The care groups, women’s empowerment groups, and farmer field school programs significantly improved household dietary diversity and household food security, with the farmer field schools having the greatest impact (Doocy et al. 2018). The care group and farmer field school programs improved children’s diets, with the care group program seeming to be most effective, suggesting that the nutrition education component may have been an important element for improving child nutrition (Doocy et al. 2019).

Supplements provided to pregnant women improve newborn nutrition. In the Women First study, women in Équateur province were given a lipid-based micronutrient supplement at least three months before conception, as well as a protein-energy supplement if they had a low body mass index (BMI) or experienced suboptimal weight gain during pregnancy. Compared with the control group that did not receive a supplement, children born to women in the intervention group had greater length-for-age at birth (Hambidge et al. 2019).

Cash transfers and food vouchers have comparable impacts on recipients’ food consumption, but cash transfers may be the less costly option. To determine whether cash transfers or vouchers are more effective at assisting households in humanitarian contexts, Concern Worldwide conducted a randomized experiment at an informal camp in Masisi Territory in eastern DRC. The results showed no significant differences in terms of food consumption or other measures between the recipients of vouchers and cash transfers. However, the cash transfer program was less costly to administer on an ongoing basis and provided more flexibility and perhaps better safety for recipients, who were able to choose when and where to redeem their transfers (Aker 2017).