Financement de la santé et recouvrement des coûts : le lourd fardeau des ménages congolais. Résultats des comptes nationaux de la santé.

This study examines the share and allocation of household expenditure in health financing, as presented by the National Health Account figures. These figures are based on a national survey carried out in 2010 among 11,000 households, 2,200 people living with HIV/AIDS, 183 institutions, 42 mutual funds, 18 companies and using the balance sheets of 1,300 companies. Total household health expenditure per capita per year amounted to U.S. $ 4.50. Routine health expenditure is covered by the households (40%) and international cooperation (45%) through direct payment without cost sharing (93.7%). A hospital stay is warranted in case of nutritional deficiencies (34%), malaria (12%) and mental disorders (10%). 82% of outpatient care is related to malaria (71%) and mental disorders (12.5 %). In conclusion, the observation that 71.58% of hospitals expenditure, 96.49% of ambulatory care centres expenditure, 98.48% of medical and diagnosis laboratories expenditure, 72.42% of pharmacies expenditures come from households’ out of pocket expenses calls for the establishment of solidarity mechanisms in the health sector. Outpatient malaria care consumes as much as 71% of household expenditure, and we therefore need to strengthen prevention, treatment and focus on monitoring progress. The fact that nutritional deficiencies are the leading cause of people seeking hospital care suggests that efforts are needed to improve their living conditions of households. Mental disorders are the third leading cause of hospital recourse and this pathology should therefore be included in the minimum and supplementary package of activities.