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.

Background: The emergence of several healthcare structures that comply with the health policy has been observed in many health zones in DR Congo, particularly urban ones. The aim of this study is to describe the proliferation of hospital structures in the Ibanda health zone (HZ) and to analyze the determinants of their creation, as well as stakeholders’ perceptions of the care offered by these structures. Methodology: A convergent mixed-methods study was conducted in the Ibanda Health Zone from June 2021 to February 2022. Data were collected through documentary review and interviews. A descriptive analysis of the characteristics of health facilities was carried out; but also an inductive thematic analysis was performed after the qualitative data had been transcribed and then coded through a tree of sub-themes grouped into themes. Results: The study revealed that the Ibanda HZ, has a total of 40 hospital facilities. Not only are these inequitably distributed within the health areas, but 45% of them are outside the administrative and technical control of the provincial authority. Many specialized services are absent from most facilities. The study suggests that the quality of care in the Ibanda HZ has improved over time, but that this quality is not the same in all facilities. Study participants report that the cost of care is high in relation compared to the financial capacity of households. For them, this explains this population’s recourse to alternative solutions such as self-medication or traditional medicine. Conclusion: The study recommends tighter control of the conditions under wich care structures are set up and run, and improved quality of service for the benefit of the community.

Introduction: In DR Congo, healthcare provision is characterized by the anarchic emergence of medical facilities and the medicalization of front-line healthcare structures. In urban areas, healthcare services are still poorly organized, despite the establishment of Health Zone organization and operating standards. In Bukavu, as elsewhere in the country, this situation arises against a backdrop of urbanization and galloping demographics, creating new healthcare needs for the population. The aim of this study was to analyze the organization of hospital care provision in the city of Bukavu. Methodology: The study conducted is of an exploratory cross-sectional type using documentary review, key informant interviews and geolocation of hospital structures from August 05, 2021 to October 30, 2021 in the city of Bukavu in DR Congo. Data from the complementary package of activities (PCA) and the geolocation of hospital facilities were collected to produce the mapping. Geolocation information was processed in QGIS software version 3.28 to produce a current health map of hospital structures. Results: We observed an anarchic proliferation of hospital structures and a medicalization of front-line health facilities, nearly half of which offer an incomplete package of complementary activities that do not meet the standards established in the Democratic Republic of Congo. 39% have been set up over the last 5 years (2016-2021) in a context of weak regulation and control by Congolese government services. The majority of hospitals in Bukavu offer the same type of services. They are essentially privately owned (50.3%), denominational/church-owned (21.1%), 13.6% are managed by non-governmental organizations and only 12.6% are under the direct management of the Congolese state. Conclusion: The supply of hospital care in Bukavu is plethoric and seems to pursue profit-making goals without necessarily meeting the real needs of the population. Re-regulating the organization of hospital care and providing technical and financial support to the health system could help to improve it in Bukavu.