title: Perceptions of health, health care and community-oriented health interventions in poor urban communities of Kinshasa, Democratic Republic of Congo.
abstract: In Democratic Republic of Congo access to health care is limited because of many geographical and financial barriers, while quality of care is often low. Global health donors assist the country with a number of community-oriented interventions such as free distribution of bednets, antihelminthic drugs, vitamin A supplementation and vaccination campaigns, but uptake of these interventions is not always optimal. The aim of this study was to explore the perceptions of poor urban communities of the capital Kinshasa with regard to health issues in general as well as their experiences and expectations concerning facility-based health services and community-oriented health interventions. Applying an approach rooted in the grounded theory framework, focus group discussions were conducted in eight neighborhoods of poor urban areas in the city of Kinshasa in July 2011. Study participants were easily able to evoke the city's major health problems, with the notable exceptions of malnutrition and HIV/AIDS. They perceive the high out-of-pocket cost of health services as the major obstacle when seeking access to quality care. Knowledge of ongoing community-oriented health interventions seems good. Still, while the study participants agree that those interventions are beneficial; their acceptability seems to be problematic. This is chiefly put down to a lack of information and government communication about the programs and their interventions. Furthermore, the study participants referred to rumors and the deterring effect of stories about alleged harmful consequences of those interventions. Along with improving the provision and quality of general health care, the government and international actors must improve their efforts in informing the communities about disease control programs, their rationale and benefit/risk ratio. Directly engaging community members in a dialogue might be beneficial in terms of improving acceptability and overall access to health services and interventions. Novel ways of reducing the high out-of-pocket expenditure should also be explored.
authors.affiliation: Department of Tropical Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: Vivi
authors.initials: V
authors.lastname: Maketa
authors.affiliation: Epidemiology unit, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo.
authors.forename: Mimy
authors.initials: M
authors.lastname: Vuna
authors.affiliation: Epidemiology unit, Institut Supérieur de Techniques Médicales, Kinshasa, Democratic Republic of Congo.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Baloji
authors.affiliation: Department of Social Science, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: Symphorien
authors.initials: S
authors.lastname: Lubanza
authors.affiliation: Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium ; Telethon Institute for Child Health Research, The University of Western Australia, West Perth, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Hendrickx
authors.affiliation: International Health Unit, Faculty of Medicine, University of Antwerp, Antwerp, Belgium.
authors.forename: Raquel Andrea
authors.initials: RA
authors.lastname: Inocêncio da Luz
authors.affiliation: Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Marleen
authors.initials: M
authors.lastname: Boelaert
authors.affiliation: Department of Tropical Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo ; Epidemiology unit, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo ; Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Pascal
authors.initials: P
authors.lastname: Lutumba
mesh_terms: D002947:Cities / Q000706:statistics & numerical data*; D003153:Community Health Services / Q000706:statistics & numerical data*; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D015023:Democratic Republic of the Congo; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006292:Health Priorities; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D010465:Perception; D011203:Poverty; D011640:Public Policy