Introduction: In line of the powerful concept of Universal health coverage (UHC) inspired to the Primary Health Care Renewal in 2008 and the Astana Declaration on Primary Health Care and the Sustainable Development Goals, this study analyzes the challenges of universal health coverage (UHC) in the Democratic Republic of Congo (DRC). Methods: The study used a reflective and interpretive synthesis of the literature. The search was conducted using keywords related to universal health coverage, health policies, systems and services and the DRC. Results: The study highlights a strong desire for progress in the DRC towards UHC that contrasts with the legal and organizational framework, governance practices, organization of health services and care delivery. Effects of this limited congruence are illustrated by the low level of integration and performance of health services, and the high level of catastrophic health expenditure and exclusion of the population in access to health care. Discussion and conclusion: In a context where nearly 75% of the population lives on less than USD 1.9 per day and the informal sector, the hybrid legal framework is an obstacle to the real progress towards UHC in the DRC. Changing the legal framework, by integrating a generalized mandatory system, and then structuring a greater raising of funds, including innovative financing, as well as establishing a more coherent and adaptive governance in favor of UHC, are priority avenues to explore to resolutely commit to the path of UHC in the DRC.