Micro assurance santé comme levier financier à L’accès aux services de santé de qualité En RD Congo: Défis, Pistes des Solutions et Perspectives
Pages : 618-633Download PDF
Introduction: The Democratic Republic of Congo (DRC) has been trying for some years to develop social protection mechanisms with the aim of reducing financial barriers to access to health services.
While the country has made real progress in achieving health infrastructure over the past two decades of implementation of the program approach, it remains true that indices of health service utilization remain very high Weak and confronted with the vicious cycle of poverty and health problems. Aware of the heavy burden of health care costs borne by subsistence households, the authorities have initiated a number of reforms (health micro insurance, medical assistance for indigents, etc.) to lay the foundations for a universal health coverage. It is true that these systems have recently entered an extension phase. Visu, this propensity generally remains slow, insufficient, real and seems irreversible.
Aim: The aim of this study was to assess the existing propensity experience and their potential by attempting to answer the following questions: (i) What is the potential of these micro insurances to make a greater contribution to their development, (ii) What constraints, challenges or conditions prevent the realization of such potential? (iii) How can this potential be realized? (iv)What are the possible solutions and perspectives? Its specific objectives were to: (1) Identify and describe existing “micro-health” (or similar) systems (situation diagnosis); (2) Investigate the potential of health micro insurance in the context of the DRC health system in universal health coverage (3) Identify the obstacles, challenges and constraints of non-realization of potential and (4) Effectiveness of universal health coverage.
Methods and Materials: It was a cross-sectional descriptive standard study spanning a 12 month period (January 2013 -2014). Twenty five (25) eligible SMEs across the country were collated and recruited in relation to the inclusion criteria. Managers, promoters, providers, support structures and households were subjected to questionnaires developed on the basis of the qualitative and quantitative variables studied and indexed. The non-directive interviews were guided by semi-structured interviews from the outset to the use of care in the form of group focus. Results:It appears that the role of the state in the overall propensity of health micro insurance (HMI ) in the DRC has so far been very limited mainly by the absence of a legal framework and seems to constitute an obstacle . The low adhesion rate and penetration and their determinants had been documented. The following recommendations and suggestions were proposed: (1) Adoption of draft laws governing the operation; (2) Greater government involvement in granting subsidies; (3) Adoption of an incentive for caregivers; (4) development of income-generating activities to cover operating costs of HMI ; (5) partnerships known as “linkages” between health micro insurance and microfinance enterprises (incentive for massive membership). Conclusion: This study offers a fascinating insight into the contribution of state support in the pursuit of the propensity of health mutuals, which will be long and arduous. It will cover better financial protection of the population better access to health care. Self-financing seems to be a utopia in every case.
Keywords: Health micro insurance; Access; Primary Health Care; Institutional support; DRC