[ Analyse des coûts des soins de santé chez les enfants de moins de 5 ans dans la Zone de santé de Bagira et implications pour la couverture sanitaire universelle ]
Volume 43, Issue 1, July 2024, Pages 14–27
Bertin Mulume Baganda1, Samuel Lwamushi Makali2, and Hermès Karemere3
1 Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Sud-Kivu, RD Congo
2 Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Sud-Kivu, RD Congo
3 Ecole régionale de Santé Publique, Université catholique de Bukavu, Bukavu, Sud-Kivu, RD Congo
Original language: French
Copyright © 2024 ISSR Journals. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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.
Author Keywords: Direct cost of care, children under 5 years old, financial access to care, Bagira health zone, South Kivu, Democratic Republic of Congo.
Volume 43, Issue 1, July 2024, Pages 14–27
Bertin Mulume Baganda1, Samuel Lwamushi Makali2, and Hermès Karemere3
1 Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Sud-Kivu, RD Congo
2 Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Sud-Kivu, RD Congo
3 Ecole régionale de Santé Publique, Université catholique de Bukavu, Bukavu, Sud-Kivu, RD Congo
Original language: French
Copyright © 2024 ISSR Journals. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
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.
Author Keywords: Direct cost of care, children under 5 years old, financial access to care, Bagira health zone, South Kivu, Democratic Republic of Congo.
Abstract: (french)
Introduction: Dans près de la moitié des pays africains, 40% ou plus des dépenses totales de santé sont constituées par les paiements directs des ménages, ce qui crée des obstacles financiers à l’accès aux services de santé et expose la population à l’appauvrissement. La présente étude vise à analyser les coûts de soins de santé des enfants de moins de cinq (5) ans et d’en identifier les enjeux et perspectives d’amélioration de l’accès financière aux soins de santé dans la Zone de Santé de Bagira. Méthodologie: L’étude est transversale populationnelle, menée dans la Zone de santé de Bagira, auprès des 314 parents d’enfants de moins de 5 ans pour une période de Juin à Novembre 2023. Les données ont été recueillies à l’aide d’un questionnaire préalablement élaboré et enregistré dans KoboCollecte. Les variables quantitatives ont été synthétisées en moyenne ± DS et en médiane avec intervalle interquartile (P25, P75) tandis que celles catégorielles ont été encodées et décrites en fréquences et proportions pour chaque catégorie. Un modèle de régression logistique binaire testant les associations a été appliqué. Les analyses ont été réalisée à l’aide des logiciels MS Excel 2016 et SPSS (version 29). Résultats: Le tiers (31,2%) des parents ont fait la consultation dans un établissement des soins de 1ère ligne (32,2%). Pour la majorité de ménages, les coûts moyens de consultation ont été de 2,7 ± 2,0 USD; de 7,7 ± 5,8 USD pour les tests de laboratoire et de 12,0 ± 9,5 USD pour la facture des médicaments; de 70,7 ± 58,2 USD pour la facture des examens d’imagerie et d’hospitalisation. 38,2% de factures ont été couvert par une assurance santé locale qui n’est payée qu’à 56,1% par AVEC (Association Villageoise d’Epargne et de Crédit) à une contribution de moins d’1/3 des coûts de soins, ce qui a conduit à 6% des ménages à vendre leurs biens pour payer les restes de la facture. Le fait que l’enfant a été transféré dans une structure d’échelon supérieur (p=0,021), le fait que l’assurance n’a pas aidé à payer les frais des soins (p=0,000) et le décès de l’enfant qui était malade (p=0,004) ont été les facteurs associés au coût élevé de soins de santé des enfants de moins de 5 ans. Conclusion: Ces résultats prouvent à suffisance que les faibles revenus des ménages, les coûts élevés des soins et la contribution insuffisante d’assurance santé ne permettent pas aux ménages de couvrir les coûts de soins de leurs enfants et recourent souvent à l’automédication et la vente des biens, d’où la nécessité de mettre en place des programmes de protection sociale tel que la couverture sanitaire universelle pour atténuer l’impact des chocs sanitaires sur les ménages vulnérables dans les communautés congolaises.
Author Keywords: Coût direct de soins, enfants de moins de 5 ans, accès financier aux soins, Sud-Kivu, République Démocratique du Congo.
How to Cite this Article
Bertin Mulume Baganda, Samuel Lwamushi Makali, and Hermès Karemere, “Analysis of health care costs among children under 5 years of age in the Bagira Health Zone and implications for universal health coverage,” International Journal of Innovation and Applied Studies, vol. 43, no. 1, pp. 14–27, July 2024.
