Poverty, education and health insurance coverage among women of reproductive ages in the Democratic Republic of the Congo: a cross-sectional and multilevel analysis

Abstract

ObjectiveTo investigate inequalities of health insurance coverage (outcome) at subnational level, and the effects of education and poverty on the outcome.DesignSecondary analysis of Demographic and Health Surveys. The outcome variable was health insurance ownership.SettingThe Democratic Republic of the Congo.SubjectsWomen aged 15–49 years (n=18 827).ResultsFindings indicated significant spatial variations of the health insurance ownership which ranged from 1.2% in Bandundu and Kasaï Oriental to 15.5% in Kinshasa the Capital City. Furthermore, findings showed that an additional year of women education increased by 10% the chance of health insurance ownership (adjusted OR, AOR 1.098; 95% CI 1.065 to 1.132). Finally, living in better-off households increased by 150% the chance of owing a health insurance (AOR 2.501; 95% CI 1.620 to 3.860) compared with women living in poor households.ConclusionsGiven the low levels of health insurance coverage, the Democratic Republic of the Congo will not reach the Sustainable Development Goal 3, aimed at improving maternal and child health unless a serious programmatic health shift is undertaken in the country to tackle inequalities among poor and uneducated women via universal health coverage.

Health insurance uptake, poverty and financial inclusion in the Democratic Republic of Congo

“…The results showed that approximately 4% of male and female respondents had health insurance coverage in the DRC with hardly any difference between the genders which is a very low rate even for African standards. This result is consistent with the findings of Dimbuene et al (2022) who reported a low HI uptake of 5% for women of reproductive age in the DRC. Shao et al (2022) also confirmed a low HI coverage in the DRC of 2.8%.…”

“…Our results corroborate the findings of Adebayo et al (2015) who found that wealthier households and individuals were more likely to own HI than poor individuals in countries such as Cameroon, Burkina Faso, and Nigeria. In the same context as the DRC, Dimbuene et al (2022) found similar results demonstrating that women of reproductive ages living in better‐off households had higher chances of being covered by an HI compared to those from poor households. In their study, Doris et al (2022) revealed that households in the lowest income quintile were 19% less likely to own HI than those in the wealthier group.…”

“…Our results align with several studies conducted in other SSA contexts, whose findings support the idea that educational status is among the highest contributors to inequality in health insurance coverage (Adebayo et al, 2015; Barasa et al, 2021; Doris et al, 2022; Shao et al, 2022). A similar study conducted in the DRC using a different dataset found that one year of completed education increased by 10% the likelihood of owning HI among Congolese women of reproductive age (Dimbuene et al, 2022).…”

Association between sexual violence and multiple high-risk fertility behaviours among women of reproductive age in sub-Saharan Africa

“…Similarly, Seidu et al [10] found that being in a polygamous relationship exacerbated the risk of MHRFB in SSA. Also, studies have identified poverty, substance use, marital status, post-traumatic stress disorder, and conventional gender role belief as factors associated with MHRFB [11][12][13].…”