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.

Introduction: Financial inaccessibility to health services is aggravated in some health zones by armed conflicts. This study analyzes the direct costs of care for children under 5 years old based on the Integrated Management of Childhood Illness approach (PCIME). It compares the direct costs of care with the solvency of the care bill issued according to the pricing applied in hospitals in three health zones (Ibanda, Walungu and Lemera) in South Kivu, in the Democratic Republic of Congo. This province has been experiencing recurrent armed conflicts for thirty years. Methodology: The study is comparative cross-sectional, conducted from January to December 2018 in hospitals and health centers in the health zones of Ibanda, Walungu and Lemera in South Kivu. Data collection mainly relied on documentary review (patient files, hospital registers, laboratory registers, cash books and issued invoices). Data analysis was performed using Excel 2016 and SPPS software. The frequencies, the proportions and the median were identified. The comparison of the proportions was carried out. A logistic regression model testing the associations was applied and one-way analyzes of variance or Pearson’s correlation test were performed for the observed variations. Results: The direct cost of health care for children under 5 years old remains high, although the cost of care for the majority of pathologies is less than or equal to $US50 (p<0.001). The cost of hospitalization per episode of care (≤ $US78) represents the highest cost in the Ibanda Health Zone (ZS) for a non-flat rate. The cost of drugs remains higher (≤ $US20) in the HZ of Lemera, which is more unstable for a flat rate (p<0.001). Households pay 82% of bills. The insolvency of healthcare bills is predominant (89.9% in the rural Health Zone of Lemera with a flat rate (p<0.001)). Certain socio-demographic factors (age of the patients, level of education and socio-professional situation of the parents) explain 48% of the directly proportional increase in the cost of care (p<0.001); while the evolution of the cost is inversely proportional from the rather stable urban Health Zone of Ibanda with non-flat rate to the rural Health Zones of Walungu and Lemera respectively stable and unstable all applying a flat rate (p=0.018). Discussion and Conclusion: Crisis situations have a negative impact on health care costs for children in South Kivu, especially those who are vulnerable. There are, however, differences in the cost of care observed according to the Health Zones in crisis. We recommend a further study including several health zones and dealing with quantitative and qualitative aspects in order to analyze and adapt primary health care financing strategies.

Introduction: The performance-based financing approach was deployed in the Health Zone (ZS) of Miti-Murhesa between 2009 and 2014 by the « Agence d’Achat des Performances » (AAP) South Kivu. This study analyzes whether such an approach can really influence the use of health services. Methods: This is a quasi-experimental evaluation («before-after» study), adapted to the program intervention evaluation framework, using a documentary review and individual interviews that targeted 345 people, including 246 users care services and 99 health care workers. Thematic analysis of the data was applied and concerned the socio-demographic characteristics of the respondents, their perceptions of the program impact, the use of services before and during the program and the use of therapeutic alternatives before and during the program. Results: The proportion of people declaring use of health services in the Health Zone increased from 59% before the program to 93% at the end of the program (n=246). During the program implementation, the number of people who resorted to self-medication, the prayer room or witch doctors decreased, respectively from 126 (i.e. 51.2%) to 55 (i.e. 21.9%); from 9 (i.e. 3.6%) to 6 (i.e. 2.4%) and from 6 (i.e. 2.4%) to 2 (i.e. 0.8%) while that of people who had recourse to traditional healers increased significantly by 24 (9.7%) to 114 (46.3%). The population recognized the positive effects of the performance-based financing (PBF) program of AAP Sud-Kivu. Concerning the perception of the facilitators of the Health Zone, 94% (n=99) attest that the program has motivated the staff, has favored the improvement of the quality of services and has favored the realization of home visits. The lack of care for certain pathologies, including chronic ones such as tuberculosis, is deplored. Conclusion: Performance-based financing can actually improve the use of frontline care services by reducing care costs and improving the quality of services. However, recourse to traditional healers remains the most competitive therapeutic alternative to the care offered by the integrated health structures of the ZS of Miti-Murhesa. This study recommends a sustainability plan for each performance-based financing program and effective regulation of the practice of traditional healers.

Introduction: The Katana Rural Health Zone has experienced several events including looting of health centers, the cessation of funding or the instability of nursing staff, which could have hindered the functioning of its health structures. These structures have continued to operate in this unfavorable context, thus showing themselves to be resilient. This study aims to identify the adaptive mechanisms put in place by the Katana health zone in the face of adverse events. Methodology: The study is a mixed cross-sectional study covering the period from 2014 to 2018. It is based on the identification of events that occurred in the Katana Health Zone, the analysis of the evolution of cases and deaths linked to malaria and the perceptions of key players on the nature of the events, their link with the number of cases. The study used a documentary review and individual interviews targeting 8 key players. Results: The main destabilizing events identified are related to the management of human resources, the use of health services, the breakdown of funding, the availability of curative or preventive inputs, community participation and security and safety issues. Infrastructure. The trend of the evolution of new cases with malaria is similar for all age categories. On the other hand, the evolution of deaths is different. Health services continued to provide care thanks to the coping mechanisms developed. Conclusions: The study demonstrates the precariousness of a health system heavily dependent on humanitarian aid, the interruption of which can generate dysfunction with effects on mortality, including infant mortality; the weak involvement of the government in supporting structures facing the misdeeds of disasters such as the earthquake and looting; the poverty of the population making it inaccessible to health care despite the reduction in prices and the resilience of health centers following the establishment of endogenous adaptation mechanisms..

Background: The National Healthy Schools and Villages Program aims to provide and maintain water, hygiene and sanitation facilities in rural and peri-urban villages and schools in the Democratic Republic of Congo (DRC). In South Kivu, at least 75% of projects fail when the involvement of the population is not taken into account. This is the case of the Bunyakiri Health Zone where a weak appropriation of the achievements of the Healthy Schools and Villages Program in the post-certification phase is observed, resulting in the loosening of the community. The aim of the study was to determine the factors associated with low ownership of the post-certification phase of Healthy Schools and Villages Program. Methodology: The study was descriptive cross-section using a semi-structured questionnaire. It involved 383 households located in healthy villages and 69 certified schools. Data processing and analysis was done using Stata v14 software. We used the Chi-square test to compare categorical variables at the level of statistical significance set at p <0.05. Results: The level of ownership of the Heathy Schools and Villages Program in the post-certification phase is low and associated with the negative perceptions of the community towards the Healthy Schools and Villages Program (p = 0.0294); insufficient and / or lack of financial resources (p = 0.0327); the absence / non-existence of community-based committees in some villages and schools (p = 0.0000); the lack of motivation of the members of the existing committees and the effectiveness of these committees (p = 0.0134); the insufficiency / absence of supervision of permanent monitoring of activities by the BCZ and the technical and financial partners (p = 0.0024 and 0.0286) and the low or not community mobilization in the village (p = 0.0000).Discussion and Conclusion: The low ownership of Healthy Schools and Villages Program remains a major problem in communities and the involvement of all stakeholders in the process is of great importance. Intervention projects should set up dynamic committees and motivate them, a monitoring plan and financial support while building community support in order to sustain interventions.

Introduction: As part of a process to reorganize urban health services, this article analyzes the profile of health services in the eastern DRC city of Goma; the aim is to identify their distribution and level of medicalization. Methods: This descriptive and cross-sectional study conducted a comprehensive survey of health care facilities in the city of Goma in January 2018. Geographical and health data (infrastructure, equipment, human resources, care provided) were collected by professionals. They were encoded and analyzed using SPSS version 20 software. Results: The urban supply of care in Goma is too bloated with one facility for 8,794 inhabitants, one hospital bed for 326 inhabitants, one nurse for 586 inhabitants and one doctor for 2567 inhabitants. On the other hand, a lack of midwives, sub-equipment and infrastructure that does not meet hospital standards are observed. This health facilities, mainly privately lucrative (79%) with 56% of establishments created in the last 6 years, are variously distributed. The first-line care offer represents 34% and incorporates a medical practice in 43% of cases. Discussion and Conclusion: This provision of care requires strong regulation from the perspective of a better governed, streamlined and staggered urban health system, which better meets the quality standards and user’s expectations in urban contexts.

Introduction: The present study aims to be carried out in the Bagira health zone in the Democratic Republic of Congo and aims to determine the factors that influence access to health services for children under 5 years of age suffering from malaria in this zone. Specifically, the study will describe the therapeutic route for children under 5 with malaria, identify the specific determinants of the use of health services in the Health Zone by these children and will suggest prospects for improving the access to health care and services. Methodology: The study will be cross-sectional, consisting of a household survey of children who had a fever episode during 2019 in the Bagira Health Zone. The data collected will be mainly analyzed using the Logit multinomial model in order to identify the specific determinants of access to health services by the study population.

Introduction: This study analyzes hospital maternal death factors in six heath zones in the East of the Democratic Republic of Congo. The objective of this study is to identify the determinants and the circumstances of the maternal deaths. Methodology: This study is descriptive and analyzes the content of the medical files and death review of the mother deaths occurred between 2009 and June 2014 in 22 referral hospitals of 6 zones of health of the province of the North Kivu in the East of the RDC. The data collected by binomials of well experimented nurses and physician about 74 mother deaths were analyzed by SPSS software. Results: The hospital maternal mortality is high (106,9 deaths for 100.000 living Births). 87, 5% cases of maternal deaths arrived in time to the referral hospitals and 69,2% of cases were well taken in charge to the primary health level centers. On the other hand, the hospital care has been judged inadequate in 83,1 % of the cases, notably because of non-suitable medical and nursing care and limited availability either of the medicines and transfusion blood. The hemorrhage was the first reason of maternal death (63,4 % of the cases) and also the eclampsia (8,5%) and infections (7%). The indirect reasons were incriminated in less than 6% of the cases. Conclusion: The high level of hospital maternal deaths, the importance of the hemorrhages and limited medical and nurse competencies in maternal deaths, put in evidence the interest to reinforce the nurse and medical competencies and the clinical governance in reference hospitals.

Background: HIV infection continues to wreak havoc around the world. Women are not spared, especially pregnant women, with low levels of education or information, transmitting HIV to their children. This study aims to assess the level of knowledge of women in reproductive age on the prevention of mother-to-child transmission of HIV / AIDS in the AFIA-Sake health area in the Democratic Republic of Congo. Method: This study is descriptive, involving 315 women aged 15-49 years from the AFIA-SAKE health area. The data collected by questionnaire were checked, captured and analyzed. The frequency of observations was calculated and the proportions were compared for accuracy when the CI was 95%. Results: The study shows that only 10% of women are aware of the prevention of mother-to-child transmission of HIV. Antenatal consultation is the excellent channel of communication. Among the women interviewed on antiretrovirals, 56% do not know when they will be given to pregnant women diagnosed with HIV; 63% do not know the value of administering antiretrovirals and 78% do not know when antiretrovirals will be given to the newborn. Conclusion: Achieving the goal of sustainable development for an HIV-free generation, with zero new infections in children and no HIV-related deaths, involves informing women of reproductive age about the prevention of mother-to-child transmission. HIV child through increased enrollment of girls, introduction of sex education as well as information on HIV in schools and antenatal clinics.

Background: Mortality under 5 in sub-Saharan Africa remains very high. Interventions implemented including community support through the establishment of community care sites aim to improve access to care. The study evaluates the implementation of community care management in the Kabare health zone that be fully supported by International Rescue Committee. Methodology: The study followed a framework based on standards of the DR Congo Health Ministry about the functioning of community care sites. It has used review literature, data analysis from the health information system and mothers interviews. Results: Community care management through care sites improves access to health care. Strict compliance with the Ministry of Health guidance during the implementation of the community care sites is observed. Two constraints facing these directions are identified: the abandonment of some health community workers with closure of their sites as a consequence and the limited funding of the sites; the process didn’t meet all the input requirements. Conclusion: The study identifies the health community worker as a key player in the implementation of community care and advocates strengthening the mechanism of his recruitment, his formation, his supervision, his estate and the maintenance of motivation. The study proposes actions to improve the operation and sustainability of community care sites.

Introduction: Road traffic accidents constitute a major public health problem because of death, disability and trauma with medical, surgical, psychological, mental, economic, social and sometimes legal formidable complications resulting from them. Socio-professional reintegration of the survivors of accidents can become complex. This study identifies the main determinants of road security in Goma in the Democratic Republic of Congo and offers prevention strategies adapted to the context. Methodology: The study is descriptive cross and analysis data collected from police oral trials about traffic accidents occurred during 2015. Resultats: The study essentially shows that 36% of the accidents occurred on weekends (Saturday and Sunday); 25.5% of the accidents took place between 18 and 21 hours; the main cause of accidents was the bad driver behavior, including speeding and drunk steering wheel. Serious injuries (24.5%) and death (11.9%) were dreadful consequences. Discussion and conclusion: Accidents can be avoided. The study proposes strategies to reduce road traffic accidents by securing users the road, the vehicle and the road infrastructure. The implementation of these strategies is heavily dependent on the political will of the authorities of the DR Congo.

Introduction: The present study aims to analyze the waiting time before the general and specialized medical consultation, to identify the causes and consequences of prolonged waiting and propose ways to reduce the waiting time. Methodology: The study will be descriptive and will use the literature review to determine the long waiting time before the medical specialist consultation for patients referred, the participant observation to measure wait times in general medical consultation and interviews to determine the causes and consequences of a prolonged wait times.

Introduction: This study analyzes supervisions in 8 health zones in Haut-U