Experiences of Healthcare Providers and Households Facing Healthcare Costs in Eastern Kasai/DR Congo: A Qualitative Analysis

Abstract

Introduction: Access to healthcare in the DRC remains limited, not only due to high costs and low health insurance coverage, but also because of out-of-pocket payments, which expose households to catastrophic health expenditure. This study aimed to analyze the perceptions and strategies of both healthcare providers and the population when faced with payment difficulties in Kasaï Oriental. Methodology: This is a qualitative study that was conducted from June to July 2024 through 13 focus groups and 9 semi-structured interviews. Participants included healthcare providers (doctors, nurses, midwives), small merchants and motorcycle taxi drivers in urban and rural areas. Thematic analysis was performed using ATLAS.ti 6 after transcription and translation of the interviews. Results: Healthcare providers highlight limited technical equipment, sometimes leading to transferring patients outside the province, increasing their cost of care, making medicine shortages more frequent and developing a dependence on vertical programmes. High costs force households to delay seeking care, go into debt, sell family assets, or resort to self-medication, traditional healers, and sometimes churches. This can even lead to the loss of patients, even those who were already in contact with the health system. Various solidarity mechanisms (instalment payments, community funds, rebates, assistance from benefactors) make it possible to partially overcome financial barriers. Nevertheless, the population perceives healthcare as generally unaffordable, sometimes leading to the escape from healthcare centres of patients unable to pay and even their abduction. Conclusion: Financial barriers remain a major obstacle to equitable access to healthcare. Strengthening public funding and promoting mutual health insurance schemes are essential for progress towards universal health coverage in Democratic Republic of Congo.