title: Budget process bottlenecks for immunization financing in the Democratic Republic of the Congo (DRC).
abstract: BACKGROUND
  In Democratic Republic of the Congo (DRC), the availability of domestic resources for the immunization program is limited and relies mostly on external donor support. DRC has introduced a series of reforms to move the country toward performance-based management and program budgets.
  
  
  METHODS
  The objectives of the study were to: (i) describe the budget process norm, (ii) analyze the budget process in practice and associated bottlenecks at each of its phases, and (iii) collect suggestions made by the actors involved to improve the situation. Quantitative and qualitative data were collected through: a review of published and gray literature, and individual interviews.
  
  
  RESULTS
  Bottlenecks in the budget process and disbursement of funds for immunization are one of the causes of limited domestic resources for the program. Critical bottlenecks include: excessive use of off-budget procedures; limited human resources and capacity; lack of motivation; interference from ministries with the standard budget process; dependency toward the development partner's disbursements schedule; and lack of budget implementation tracking. Results show that the health sector's mobilization rate was 59% in 2011. For the credit line specific to immunization program activities, the mobilization rate for the national Expanded Program for Immunization (EPI) was 26% in 2011 and 43% for vaccines (2010). The main bottleneck for the EPI budget line (2011) and vaccine budget line (2011) occurs at the authorization phase.
  
  
  CONCLUSIONS
  Budget process bottlenecks identified in the analysis lead to a low mobilization rate for the immunization program. The bottlenecks identified show that a poor flow of funds causes an insufficient percentage of already allocated resources to reach various health system levels.
authors.affiliation: Agence de Médecine Préventive, Paris, France. Electronic address: jblegargasson@aamp.org.
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Le Gargasson
authors.affiliation: SANRU asbl, Kinshasa, The Democratic Republic of the Congo.
authors.forename: Benoît
authors.initials: B
authors.lastname: Mibulumukini
authors.affiliation: Agence de Médecine Préventive, Paris, France.
authors.forename: Bradford D
authors.initials: BD
authors.lastname: Gessner
authors.affiliation: Agence de Médecine Préventive, Paris, France.
authors.forename: Anaïs
authors.initials: A
authors.lastname: Colombini
mesh_terms: D002017:Budgets; D015023:Democratic Republic of the Congo; D005380:Financing, Government / Q000458:organization & administration*; D006078:Government Programs / Q000191:economics*; D017589:Immunization Programs / Q000191:economics*
keywords: Africa; Budget process; Democratic Republic of the Congo; Financing; National Immunization Programme; Performance-based budget