RIPSEC Democratic Republic of Congo - Analysis of financing arrangements for health care in the Democratic Republic of Congo: a systematic review

Analysis of financing arrangements for health care in the Democratic Republic of Congo: a systematic review

Summary

Context and objective.

The universal health coverage (UHC) requires an urgent rethinking of the health financing system in low-income countries as DRCongo. This study aimed to provide an overview of the current methods of funding health care to help implement an adapted UHC policy. Methods. A systematic analysis of published papers on health care financing in the DRC, between 1980 and 2018 was conducted, according to PRISMA guidelines, using the Medline/PubMed and Google Scholar search.

Results.

Twenty-seven articles were selected out of 1,429 consulted, for the thematic analysis. Direct payment is the most common mode either in the form of a fee-for-service payment or a flat rate fee generally subsidized. Whatever its form, direct payment excludes a great amount of people, constituting a real barrier to care accessibility. People consider the prepayment as a pass or travel order giving access to cheaper health care. Adhesion to mutual health insurance remains low because of the precarity of the population and the marginal quality of health services provided. The care payment subsidy policy is available as a free healthcare form or as financial incentives including cash transfer and results-based financing. Whatever the form of subsidy, there is an improvement in the use of services. But this performance is not sustainable.

Conclusion.

Despite the current large use of direct payment, the prepayment could better improve the care accessibility. This needs to be evidenced in further larger studies.