Towards the achievement of universal health coverage in the Democratic Republic of Congo: does the Country walk its talk?

Abstract

In 2009, the Democratic Republic of Congo (DRC) started its journey towards achieving Universal Health Coverage (UHC). This study examines the evolution of financial risk protection and health outcomes indicators in the context of the commitment of DRC to UHC. To measure the effects of such a commitment on financial risk protection and health outcomes indicators, we analyse whether changes have occurred over the last two decades and, if applicable, when these changes happened. Using five variables as indicators for the measurement of the financial risk protection component, there as well retained three indicators to measure health outcomes. To identify time-related effects, we applied the parametric approach of breakpoint regression to detect whether the UHC journey has brought change and when exactly the change has occurred.Although there is a slight improvement in the financial risk protection indicators, we found that the adopted strategies have fostered access to healthcare for the wealthiest quantile of the population while neglecting the majority of the poorest. The government did not thrive persistently over the past decade to meet its commitment to allocate adequate funds to health expenditures. In addition, the support from donors appears to be unstable, unpredictable and unsustainable. We found a slight improvement in health outcomes attributable to direct investment in building health centres by the private sector and international organizations. Overall, our findings reveal that the prevention of catastrophic health expenditure is still not sufficiently prioritized by the country, and mostly for the majority of the poorest. Therefore, our work suggests that DRC’s UHC journey has slightly contributed to improve the financial risk protection and health outcomes indicators but much effort should be undertaken.

Facilitators and barriers to supply-side maternal, newborn, and child health service availability in DRC: a systematic review and narrative synthesis

“…ASSESSMENT OF STUDY QUALITY Of the 26 studies, none were assessed as "weak," 13 as "moderate" 15,23,[30][31][32][33][34][35][36][37][38][39][40] and 13 as "strong". 36,[41][42][43][44][45][46][47][48][49][50][51][52] STUDY LOCATION All documents included the DRC. Six had a multi-country scope.…”

“…49,54 Per capita health expenditure in the DRC is less than 10% of the average for the rest of sub-Saharan Africa. 51 Less than 10% of per capita health expenditure originates from government, while external aid accounts for about 39% of total health expenditure. 49 Estimates of out-of-pocket or household spending range from 40% to 50% of total health expenditure.…”

“…14 A key goal of UHC is reducing financial barriers to care so the whole population can access affordable preventative, curative, and rehabilitative care. 51 Following the DRC's adoption of UHC policies, there were slight improvements in financial risk protection indicators. 51 However, adopted policies increased healthcare access for the wealthiest quantile without meaningful progress for the rest of the population.…”

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

“…Health insurance serves as a protective mechanism in pooling financial resources of participants to reduce the burden of out-of-pockets expenditures, which usually result in massive financial barriers and impoverished life in the households 1 2. Previous studies pinpointed the financial hardship of individuals and households resulting from a suboptimal health insurance coverage.…”

“…Evidence suggests that political involvement, good governance and specifically strong and dynamic leadership are crucial to ensure the expansion of health insurance in SSA countries, and especially in the Democratic Republic of the Congo (DRC) where health insurance coverage is extremely low at 5% among women of reproductive ages 7 23. There is currently no publicly owned insurer,2 24 25 making it more difficult to own health insurance given the high unemployment rates in the country since most health insurance schemes are offered through the employer’s plan.…”