Introduction: In almost half of African countries, 40% or more of total health expenditure is made up of out-of-pocket payments from households, which creates financial barriers to accessing health services and exposes the population to impoverishment. This study aims to analyze the health care costs of children under five (5) years old and to identify the issues and prospects for improving financial access to health care in the Health Zone of Bagira. Methodology: The study is cross-sectional population, carried out in the health zone of Bagira, among 314 parents of children under 5 years old for a period from June to November 2023. The data were collected using a questionnaire previously developed and saved in KoboCollecte. Quantitative variables were summarized as mean ± SD and median with interquartile range (P25, P75) while categorical ones were encoded and described in frequencies and proportions for each category. A binary logistic regression model testing associations was applied. The analyzes were carried out using MS Excel 2016 and SPSS (version 29) software. Results: A third (31.2%) of parents had the consultation in a primary care establishment (32.2%). For the majority of households, the average consultation costs were 2.7 ± 2.0 USD; 7.7 ± 5.8 USD for laboratory tests and 12.0 ± 9.5 USD for medication bill; of 70.7 ± 58.2 USD for the bill for imaging examinations and hospitalization. 38.2% of bills were covered by local health insurance which is only 56.1% paid by WITH (Village Savings and Credit Association) at a contribution of less than 1/3 of the costs care, which led 6% of households to sell their belongings to pay the remainder of the bill. The fact that the child was transferred to a higher-level structure (p=0.021), the fact that the insurance did not help pay the costs of care (p=0.000) and the death of the child who was sick (p=0.004) were the factors associated with the high cost of health care for children under 5 years old. Conclusion: These results sufficiently prove that low household incomes, high healthcare costs and insufficient health insurance contributions do not allow households to cover the costs of healthcare for their children and often resort to self-medication and sale of goods, hence the need to put in place social protection programs such as universal health coverage to mitigate the impact of health shocks on vulnerable households in Congolese communities.