Congo Keeps Struggling To Pay The People Fighting Its Ebola Outbreaks

(MENAFN- Live Mint) (Bloomberg) -- Six Ebola checkpoints in northeastern Democratic Republic of Congo stopped reporting last month because the people staffing them hadn't been paid.

Elsewhere, officials checking a list of 240 people supposedly working at an Ebola center could find only 40 of the workers.

The discrepancy 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 purge fictitious workers from payment lists using biometric registration and centralized payments, after officials found payrolls padded with people who may not actually be working.

But verifying those lists is slowing payments to genuine responders, contributing to strikes and disrupting screening, treatment and infection-control work as the disease spreads.

“The Ministry of Health doesn't have an accurate image of who works where and does what,” said Stylianos Moshonas, a University of Antwerp researcher who has studied Congo's public administration for years.

Public Health Minister Roger Kamba has estimated that 15% to 20% of people submitted for some recent Ebola payments were fictitious. He said money was available to pay responders and blamed many of the delays on manipulation of personnel lists.

The stakes are rising: Congo had recorded 6,186 confirmed infections and 3,007 deaths as of Monday, and payment disputes are interfering with some of the basic work needed to contain the outbreak.

Six checkpoints in Haut-Uélé province stopped reporting during a strike over unpaid workers in mid-August. Almost two weeks later, five were still failing to report. As of Sunday, three checkpoints in neighboring Ituri, the outbreak's epicenter, were also on strike over unpaid wages.

By Aug. 19, only five of 18 responders staffing Ebola checkpoints in North Kivu province had been paid. Community-engagement workers there and in neighboring Tshopo had gone unpaid for three months, government reports show.

Payment disputes have also disrupted treatment and infection control. Hygiene workers demanding unpaid allowances went on strike at a Bunia Ebola treatment center in early August, disrupting admissions. A later strike by decontamination workers left some infection-control work unfinished in Ituri.

'Errors and Problems'

Congo's difficulties paying its healthcare workforce long predate the current outbreak.

The Public Health Ministry devoted 93% of its public spending to personnel in 2022, the World Bank said in a report last year. Yet among almost 256,000 health workers on personnel lists, fewer than 20% received a base salary, 41% received an occupational-risk allowance and 56% received neither.

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

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

Formal registration matters even when government salaries are modest because it gives workers greater job security and entitlement to benefits including a pension, Moshonas said.

Personnel lists are assembled at health facilities and passed up to the capital, Kinshasa, where different ministries handle salaries and occupational-risk allowances. Not everyone submitted for payment ultimately makes it onto the payroll.

“It's literally managed on Excel lists to this day with all the errors and problems this carries,” Moshonas said. Connections can matter. Nurses seeking payment sometimes travel to Kinshasa or turn to trade unions to pursue their cases, he added.

The farther people are located from Kinshasa, the less likely they are to receive government remuneration, the World Bank found.

That's led to side hustles, of sorts. Health workers have long supplemented government pay, or made up for its absence, with patient fees, local allowances and aid-funded payments. Epidemics create another source of income: temporary payments for those tracing contacts, screening travelers, disinfecting facilities and even burying the dead.

During Congo's 2018-2020 Ebola epidemic, an audit found 1,813 responders with irregularities in their records, including duplicates and people who couldn't be physically identified, according to a Congo Research Group report.

A separate World Bank review found parallel payment lists, fraudulent entries and the same names submitted to different agencies. Verifying who had actually worked delayed payments, and the Bank recommended a single database of responders and stronger personnel checks.

Similar problems emerged during Covid. Health workers went on strike over unpaid allowances while officials complained that response teams had been inflated. A government review found irregular payments contributed to failures to investigate alerts and detect suspected infections, delayed laboratory 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 Congo office said in an email.

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

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