title: Who can afford health care? Evaluating the socio-economic conditions and the ability to contribute to health care in a post-conflict area in DR Congo.
abstract: BACKGROUND
  The Democratic Republic of the Congo is today one of the poorest countries in the world; the health status of the population ranks among the worst in Sub-Saharan Africa. Public health services charge user fees and drug prices. Since 2008, north-eastern Congo is facing a guerrilla war. Malteser International is assisting with free health care for internally displaced persons as well as the general population. Before the incursion the health system was based on user fees. The aim of this study was to determine the socio-economic conditions of the population and to assess their ability to contribute to health care.
  
  
  METHODS
  Heads of 552 randomly selected households in 23 clusters in two health zones were interviewed using a standardised questionnaire.
  
  
  RESULTS
  The demographic description and socio-economic conditions of the study population were homogenous. Major source of income was agriculture (57%); 47% of the households earned less than US$ 5.5/week. Ninety-two percent of the interviewed households estimated that they would be able to contribute to consultation fees (maximum amount of US$ 0.27) and 79% to the drug prices (maximum amount of US$ 1.10). Six percent opted for free consultations and 19% for free drugs.
  
  
  CONCLUSIONS
  Living conditions were very basic; the estimated income of the study population was low. Almost half of the population perceived their current living situation as fairly good/good. More than 90% of the study population estimated to be able to contribute to consultation fees and 80% to drug prices. As a result Malteser International suggested introducing flat-rates for health care services. Once the project ends, the population will have to pay again for their health service. One solution would be the introduction of a health care financing system with the goal to reach universal coverage to health care.
authors.affiliation: Malteser International, Cologne, Germany.
authors.forename: Sibylle
authors.initials: S
authors.lastname: Gerstl
authors.forename: Justin
authors.initials: J
authors.lastname: Sauter
authors.forename: Joseph
authors.initials: J
authors.lastname: Kasanda
authors.forename: Alfred
authors.initials: A
authors.lastname: Kinzelbach
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000191:economics*; D015023:Democratic Republic of the Congo; D005191:Family Characteristics; D005251:Fees, Medical; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011203:Poverty / Q000191:economics*; D011795:Surveys and Questionnaires