Journal article

Introduction: In the Democratic Republic of Congo (DRC), health intervention funding relies heavily on international partners. Securing a "notice of no-objection" requires drafting rigorous Terms of Reference (TOR). This study analyzes operational pitfalls in TOR development within the Ministry of Public Health, Hygiene and Prevention during 2021–2022 to improve funding efficiency. Methods: We used a mixed-methods design reviewing 461 TORs across 52 national programs and 12 central directorates. Concurrently, semi-structured interviews were conducted with 1,710 key actors, split into developers ($n = 770$; 45.05%), supervisors ($n = 500$; 29.24%), and funders ($n = 440$; 25.71%). Results: Out of 440 TORs formally submitted to funding bodies, 71.4% were rejected. Key drivers of rejection were a shortage of technical drafting skills (40.6%), inadequate stakeholder profiling (32.2%), and out-of-deadline submissions (27.2%). Technical methodologies (19.0%) and designated stakeholder frameworks (15.2%) were the worst-performing sections. Conclusion: The high proposal rejection rate is an administrative bottleneck that slows down health service delivery. Addressing it requires standardized templates, digital project management tools, and continuous peer-mentorship channels.