Résumé : The authors analyze and present the position of stakeholders in the implementation of the Paris Declaration in the Democratic Republic of Congo. Five years after this Declaration concerning official development assistance (ODA), results are still uncertain and the road ahead remains long. Paradoxically resources provided through bilateral and multilateral cooperation have contributed to weakening the local health system. Principles such as alignment, harmonization and ownership are still rudimentary. Multiplication of project management frameworks and cutbacks in government healthcare spending have hindered efforts to rationalize healthcare sector funding. The effectiveness of ODA in the health sector is based mainly on pragmatic involvement on the part of regulatory officials and true commitment to the principles of the Paris Declaration on the part of donors. Efforts in this regard including the strategy to strengthen the health system and reform of health sector financing cannot succeed without improving governance at all levels.