Depreciation Allocations and Financial Resilience in Public Health Facilities in the DRC: An Underutilized Strategic Lever. A Qualitative Study and Reform Pathways for Sustainable Asset Management

Study Objective: This research examines the barriers to adopting depreciation allowances in public health facilities in the DRC, evaluates their potential as a strategic tool for financial resilience, and suggests pathways for reform to ensure sustainable integration. Methodology: An exploratory qualitative study was conducted from January up to April 2025, with 296 professionals in the public health sector using semi-structured questionnaires. Inductive thematic analysis identified perceptions, obstacles, and opportunities related to depreciation. Results: The results show that more than 74% of respondents have little or no familiarity with depreciation allowances; the majority of facilities do not integrate depreciation allowances into their financial management. Prioritizing urgent expenses is the main reason for the lack of applicability of depreciation allowances. Statistical tests (chi-squared and Spearman correlations) confirm that familiarity with and integration of depreciation allowances significantly improve the perception of financial resilience. Contribution to theory, policy, and practice: On a theoretical level, this study fills a gap in the African literature on hospital asset management. On a practical level, it proposes concrete reforms to institutionalize depreciation, train managers, and align external financing with a sustainable approach. Finally, it offers policymakers ideas for reducing Congolese hospitals' dependence on international aid.