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Impact of the cost of the care of health of menages in Kinshasa

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par Jérémy MESKIA MAVANGA
Université de Kinshasa RDC - Licence 2010
  

Disponible en mode multipage

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UNIVERSITY OF KINSHASA

FACULTE OF ECONOMIC SCIENCES AND MANAGEMENT
B.P 832 KINSHASA

Department of Economy
ECONOMY MATHEMATIQUE OPTION

MEMORY
To obtain the title of Lays off in Economic Sciences
Presented and supported publicly

MESKIA MAVANGA Jeremy- Ngankwey

2010, February

IMPACT OF THE COST OF THE CARE

OF HEALTH OF MENAGES A KINSHASA

Case of paludism

Director of memory:

Jury:

MVUDI MATINGU Seraph, Professor and Senior of the economic management and Faculty of Science, Professor at University KONGO, the university William BOOTH

MUKENDI MULUMBA KABAMBA: Professor with the Economic Management and Faculty of Science, Reader

SHIDI Hortense IHEMBA, Head of Work to the Economic Management and Faculty of Science, Rapporteur

(c) jeremymeskia@yahoo.fr, 2010 February

In memoriam

Lord, blessed all those which carried me, supported, and encouraged... parents, friends and benefactors.Eternal happiness with Rolyne MESKIA and Maguy MESA.

Dedication

With you my Very Powerful God, for your love, your grace and your assistance without end. I raise my eyes towards you and the help comes me oh Eternel which made the skies and the ground. Lord you are a shield for me, you are my glory, that which raises my head.

With my parents Roslin MES' KIA BUSULU and Rose LUZINGU MALELE and you my brothers and sisters, because it is impossible to find qualifiers and words with the height of the love and support that you always testified us.

With you Solange EMBALU; this affection and this perseverance that you ceases to testify to me encouraged me during this time of friendship.

Summary

Following the financial crisis of the Eighties, controlling them of the RDC was constrained to modify S are medical structures.This policy will entrainera the rise of many studies on the request for care of health in RDC. These studies were interested has the aspect cost monetary and nonmonetary of the request for care like to the household expenses to services of the care.However, they neglected the various stages or expenditure undertaken by the households to look after the malaria: it is the

impact of cost. The originality of this memory rises owing to the fact that it analyzes on the one hand, the recourse to the care and the expenditure of health and on the other hand, emphasizes the relations which exist between the household expenses and the care of the paludism of a sample representative of the population of district MBUKU in the commune of Lemba in town of Kinshasa in 2010, the analysis by software SPSS was use to study the impact of Co û T of the care of health. The results show that the expenditure of the care of health takes a significant share on the total monthly expenditure of the households.

Key words:Impact C oût of the care of health, households, paludism

Abstract

Since the financial crisis of the early 80s, controlling them of the RDC was constrained to modify medical are structures.This policy wills spirit the small channel of many studies one the request for care of health in RDC. These studies were interested has the aspect cost monetary and No monetary of the request for care like to the household expenses to services of the care.However, they neglected various training courses gold expenditure undertaken by the households to look after the malaria: it is the

impact of cost. The originality of this memory small channels owing to the fact that it analyzes one the one hand, the recourse to the care and the expenditure of health and one the other hand, emphasizes the relations which exist between the household expenses and the care of the paludism of has sample representative of the population of common district MBUKU in the of Lemba in town of Kinshasa in 2010, the analysis by software SPSS was uses to study the impact of Co S T of the care of health. The results show that the expenditure of the care of health takes has significant share one the total monthly expenditure of the households.

Keywords:Impact C ost of the care of health, households, paludism

THANKS

With the threshold of this work, we have the moral obligation to express our feelings of gratitude and of deep thanks to all those which brought to us their contest throughout our formation and during the realization of this work, it is in particular of Professor MVUDI MATINGU Séraphin and the Head of Work Mrs SHIDI Hortense IHEMBA, thanks to which, we raised the level of this essay.

With through the house Alma Divinatio, we present our sharp thanks as at all the personnel for their support as various as it is.

With the Kene-kene families, MULONGO Ruphin and Ruth MAFUTA, MUNZADI, OKANA, ODIO, BANITA, MUKIDI, NGANKWEY, MESIA and KILEBA, of which we will not be able to overlook the love and the affection that they do not cease making us proof.We theirs are grateful for their support and sacrifice during this period.

With our brothers and sisters:Rosine, Méroline, Valantine, Ndongo, Tshioka, Meski, Mukabaya, Matondo, Nsaniang, Laetitia, Ernest, Axel, Noëlla, Priscile, Emanuel, Grace, Ruphine, Plamédie, Taty, Mude, Alain, Jacques, Jackie, Reby, Valentia, Anderson, Armande, Irene Kilole, Niclette Mesa, Deyna, and Mulongo Grandpa, we their express our sincere gratirudes.

All friends:Renette KULONGA, Rossy Milwan, Mwaymba Elvis, Flory Mungobila, Tshibo Mayeye, Françi Soka, José Munkweme, Gedéon Milwan, Nseye, Yves Ibanga, Ntal Alpha, Guylain Sanga, Mariette Mane, Gisel Andaka, Ruth Olenu, Sabrina Okima, Yav Samushet, Bibi, Yalowando, Bopol, Digonda Christ, Landry Mavila, Cyril Forgiveness, David Mubwa, Hongerence Kitoko, Sandrine and Mama Munkweme, We have the deep joy of their expressed our sincerity.

They are many those which are entitled to our gratitude, their number plunges us in the embarrassment and we wonder by whom to start as long as it is difficult to estimate and evaluate the moral support and material which it did not cease to us bringing all to length this course which lasted so much.

The ones and the others of our readers, we ask not to hold us rigour for the imperfections and other material errors which would be, independently of our will, slipped into this work.That they take care well to excuse us.

CONTENTS

in memoriam 2

dedicace 3

thanks 6

contents 7

0. introduction 11

0. 1.problematic 11

0.2. aims of the study 13

0.3. working hypothesis 13

0.4. choice and interest of the subject 14 0.5. delimitation of the subject 14

chapter first:general information on paludism 15

1.1. definition of the concepts 15 1.1.1. paludism 15

1.1.2. cost 16

1.1.2.1. definition: 16

1.1.2.2. types of costs 16

1.1.3. menage 18

i.1.3.1. kind of menages 18

1.1.3.2. budget of the menage 18
1.2. situation of paludism in rdc 19

1.2.1. species plasmodiales 19

1.2.2. principal vectors 19

chapter second:policy and system of health in rdc 21

2.1. policy of health in rdc 21

2.2. structure of the medico-medical system 22

2.2.1. services of the government 22

2.2.2. medical departments of the companies privees 22

2.2.3. medical philanthropic organizations 23

2.3. mission and organization of the medical system medico 23

2.3.1. central level 23

ii.3.2. level intermediaire 24

2.3.3. level peripheric 24

2.4. role of the state in the sector of health 26

2.5. types of medical system medico 26

2.5.1. formal system 26 2.5.2. abstract system 27 2.6.1. personnel of health 27

2.6. 2.infrastructures 28

2.6.3. decentralisation and deconcentration 28

2.7. financing of the sector of health in rdc 29

2.8. problem of tariffings 30

chapter third:empirical checking of the cost of the care of health against paludism 32

3.1. presentation of the district mbuku 32

3.1.1. historical configuration 32

3.1.2. aspect geographic 32

3.1.3. administrative subdivisions 32
3.1.4. socio-economic aspect 33

3.1.5. population 33

3.2. methodology of the collection and processing of data 33

3.3. presentation of the results 34

3.3.1. caracteristic socio-demographic of the menages investigations 34

3.3.1.1. size of manage 34

3.3.1.2. educational level of the head of menage 34

3.3.1.3. occupation of the head of menage 34

3.3.2. monthly expenditure of the menages 34

3.3.2.1. expenditure food (dal) 34

3.3.2.2. expenditure schooling (dscol) 34 3.3.2.3. expenditure of the care of health (dss) 35 3.3.2.4. expenditure of the rents (dloy) 35

3.3.2.5. expenditure of transport (dtrans) 35

3.3.2.6. capital expenditures (dequi) 35
3.3.2.7. expenditure of clothing (dhab) 35

3.3.2.8. expenditure the transfer (dtrans) 36
3.3.2.9. consumer expenditure of water (deau) 36

3.3.2.10. consumer expenditure of electricity (delect) 36
3.3.2.11. expenditure for wood (dbois) 36

3.3.2.13. expenditure for the communication (dcom) 36
3.3.2.14. expenditure of leisure and drink (adlb) 37

3.3.2.15. total monthly expenditure of the menages (dmtm) in FC 37
3.3.3.1. expenditure for the consultation (dcon) 37

3.3.3.2. expenditure for the laboratory 37

3.3.3.3. expenditure of hospitalization 38

3.3.3.4. expenditure of nonhospitalization 38

3.3.3.5. expenditure for control 38

3.3.3.6. expenditure of the drugs 38

3.3.3.7. other expenditure 38

3.3.3.8. total expenditure of the care of health for paludism 39

3.3.4. other aspects dregs with paludism 39

3.3.4.1. place of the care

39

3.3.4.2. prescribed drugs

39

3.3.4.3. working days lost

39

3.3.4.4. knowledge of the mode of transmission of paludism 40

3.3.4.5. knowledge of the means of fight against paludism 40

3.3.5. impact of the economic cost of the care of paludism 40

conclusion

41

bibliography

43

appendix

 

50

 

LIST ABBREVIATIONS

HAVE :Surface of Health

BCZS :Central office of Zone of Health

CS :Center Health

FC :Honest Congolais

STI :Infection Sexually Transmissible

K :Capital

L :Work

OMD :Objectives of the Millenia for the Development

WHO :World organization of Health

ONG :Nongovernmental Organization

PEV :Program Elargie Vaccination

GDP :Gross domestic product

PNLP :Program National of fight against Paludism

RDC :Democratic republic of Congo

SPSS :Statistical Pactkage for the social Science

SSP :Care of Primary Health

ZS :Zone of Health

0. INTRODUCTION

0. 1.PROBLEMATIQUE

The socio-economic development of a country depends on several factors of which health. This last is a fundamental sector which occupies a place of choice in the development of the nations, insofar as health directly affects the economic growth while acting on the factor work (L) and capital (K).

For that, the countries of the whole world are invested to improve health of their populations by improving their living conditions and while fighting against the diseases likely to prevent the economic growth and the durable development in general. Among these diseases, we can quote: the tuberculosis, the VIH/SIDA and the paludism which are the great diseases to be fought within the framework of the objectives of the millennium of the development from here 2015, (4th OMD).

In connection with paludism, of any is not unaware of that this disease belonged to the tropical and subtropical landscape of the terrestrial sphere, in particular those of sub-Saharan Africa as well as few Mediterranean moderate areas. It is the most fatal disease of the world more than the VIH/SIDA. It permanently threatens 40% of humanity, that is to say two billion individuals.

According to estimates' of WHO made on 30 countries of Africa, paludism tackles 96 million people each year and causes 1 to 3 million died in the children of less than 5 years. Always according to WHO, paludism would be responsible for 59% of the external reasons for consultation in the children of less than 5 years, 41% of the reasons for consultation among pregnant women, 54% of the reasons for hospitalization among pregnant women. It would be one great causes also depopulation and deterioration of the quality of life as well in urban environment as in rural medium of the RDC and country sub-Saharan in general.

However the vectors of paludism are known as well as the drugs to look after this disease.

In RDC, paludism belongs to the three great causes of morbidity and mortality. Its impact on the reduction in the capacity to work (invalidation or absenteeism) and on the economy in general is not yet well evaluated.

In absence of this disease, the request for care of health in the households will be less. Moreover, we know that in RDC, the cares of health are primarily financed by the households.

In addition, the RDC, country of the Third World whose income per capita of inhabitant is difficult to determine because of the natural character of its economy and the not yet developed monetary reports/ratios; the yearly consumption by household is estimated at 1735$ in the cities. This figure hides great disparities according to the types of the households: it is against 1450$ for the "abstract private households" 2360$ for the "public households" which are the best affluent ones. The yearly consumption of the households (including the charged subsistence farming and rents) is 2055 $, that proves that the population congolaise lives below the poverty line. Nevertheless the monthly average income could amount to 97,5 USD by household in 2006, that is to say an income spent per day and anybody of 0,85$ US.

In these incomes, it is not impossible that the expenditure of care of health related to paludism is an unbearable burden by the households.

The town of Kinshasa know a rate of paludism very high, related generally to insalubrity, with the presence of water of tides, stagnant water everywhere in the city. Many existing medical structures, practise a discrimination of price to look after this disease, with an unquestionable incidence on the household expenses in this city. But this incidence was not the subject yet of an evaluation in the studies which we read. For this reason we wanted tempted to evaluate some.

Our concern is to analyze or study the impact of the cost of the care of health relating to paludism in the households kinois of district MBUKU of the commune of KISENSO.

0.2. AIMS OF THE STUDY

0.1.1. General objective

The general objective of this study is to evaluate the weight of the expenditure related to the care of health of paludism in the monthly expenditure of the households in order to propose certain strategies of the fights against paludism.

0.1.2.Specific objectives

This study proposes like specific objectives to evaluate:

The cost of the care of health relating to paludism for the households of the known as district; and

Its share in the household expenses.

0.3. WORKING HYPOTHESIS

On the basis of the our specific objectives, our assumption is stated are as follows:The expenditure of health for the treatment of

paludism takes a significant share in the monthly expenditure of the households.

0.4. METHODOLOGY OF WORK

0.3.1. Methods

Being methods, we estimate to resort to the statistical and analytical methods.

The analytical method enables us to analyze the results obtained in order to make the forecasts if possible;

The statistical method helps us to gather the data of households with an aim of working out calculations of the economic costs of the malaria and the tables of synthesis.

0.3.2. Techniques

GRAWITZ and PINTO support that the techniques are tools at the disposal of research, they are limited of numbers and are known with the majority of sciences. To work out this work, we made use of following techniques:

- Documentary techniques: these techniques give access research

former thanks to the documents (newspapers, annual reports etc.);

- Interview: it comes to supplement information which the qualitative

techniques did not provide us;

- Techniques of samplings: we proceeded to a simple random sampling near a sample of the households and people alive with paludism in order to analyze the results of the variables selected.

0.4. CHOICE AND INTEREST OF THE SUBJECT

The justification of this study lies primarily in the comparative analysis of the economic costs relating to the care of paludism on the effective expenditure of the households against this disease.

The choice of the subject of research is judicious, insofar as the variation of the household expenses, due to the income per capita of inhabitant who is difficult to determine, can negatively influence the quality of care of health.Moreover, nonthe urbanization, erosions, the holes, water stagnated, the localization on the hill of the district where our choice is carried are projecting facts of our study.

0.5. DELIMITATION OF THE SUBJECT

December 2010;period of reproduction of the anophèles because large rains.

Compared to space, our study relates to only households which suffered from paludism which lives with district MBUKU in the commune of KISENSO.

0.6. GROUNDWORK OF WORK

Except, the introduction and the conclusion, work is divided into three chapters. The first door on the general information; the second speaks about the policy and of the system of health in RDC and third is devoted to the empirical checking of the cost of the care of health against paludism.

Chapter First: GENERAL INFORMATION ON PALUDISM

This chapter presents the general information on the paludism, analyzes how the RDC can control paludism and studies then the way in which one can make move back paludism.

1.1. DEFINITION OF THE CONCEPTS

1.1.1.Paludism

1.1.1.1. Definition of paludism

According to the dictionary of Flammarion medicine, paludism comes from the Latin word palus, which means marsh and in English malaria; feverish, parasitic, endemic disease and cosmopolitan due to a protozoon, sporozoaire of the plasmodium kind transmitted by the puncture of the hematophagous female of a mosquito of the anophèle kind.

Paludism according to the encyclopaedia is a parasitic disease produced by a protozoon parasitic of blood and transmitted by a mosquito of the hot and marshy areas.

The medical dictionary stipulates that paludism is an endemic infectious disease caused by parasites of the plasmodium kind and transmitted to the man by the puncture of the females of mosquitos of the anophèles kind.

1.1.1.2. History of paludism

Empirical knowledge of the alchemists to the Middle Ages had allowed the establishment of the bonds of causality between the frightening feverish affection and proximity of the marshes from where the expression "fever of the marshes" on the one hand, badly aria or bad air, on the other hand, whose the terms synonymous with paludism derive respectively.

In 1650, the bark of a wild shrub, quinquina, imported of Peru where the autochtones used it since immémoriaux times, made it possible to Europeans to finally reach the treatment of the malaria.

In 1820, two chemists, Furriers and Caventou, isolated from the bark of quinquina about thirty alkaloids of which famous quinines and quinidines.In 1880, a biologist, Laveran, discover in the red globules of the patients reached of the malaria the protozoon responsible for this inffection which it baptized of the name Plasmodium and obtained for this discovery the Nobel Prize of medicine.

In 1898, Bignama, then Grassi in 1899, describe the complete cycle of plasmodiums at the anophèle.The hepatic development of plasmodiums in the human being is shown in 1948 by Shortt and Garnham.

1820 to 1940 surroundings, no therapeutic progress had been carried out, but little before the Second World War, chloroquine, first antipaludic of synthesis, is prepared and opens the way with a whole series of derivative.

In 1957, research is undertaken in the world by WHO. After fast successes especially in zone subtropical and moderated, in the developed countries, the islands, and progress becomes slow, in particular in the disinherited countries.

In 1961 at the time of discovered P. Facifarum resistant to amino-4-quinolines, antipaludic of synthesis largely used, and their extension to the world and currently worrying;whereas in 1968 a campaign east redefines in order to éradiquer the effects of the disease (mortality and morbididté).A present, research is directed towards the vectorial anti fight, the treatment curative and prophylactic (resistance to insecticides) are of a technical but so economic nature, the treatment requires again produced effective against the stocks of P. Falciparum resistant to amino-4- quinolines, and of the antipaludic aimings exoérythrocytaire.

I.1.1.3.Cause paludism

The causes of paludism are on the one hand natural and on the other hand anthropic.The natural causes are:the dryness and the flood;and the anthropic causes are:stoppings, ponds, the irrigation, deforestation, and improvement of the dwelling.

1.1.2. Cost

1.1.2.1. Definition:

With the illustrated direction, the cost is a value, an estimated price of the goods and services; based on the comparison of the incomes, for one period given. According to economists', the cost indicates an
expenditure of the company necessary to the realization of its production.

1.1.2.2. Types of costs

Generally the cost of a disease includes/understands:

A. Direct costs

It is generally impossible to calculate the sum of the real costs of case of disease; this is why we will use the explicit cost by patient i.e. the cost which refers to the expenditure indeed related to the payment of an episode of disease. This cost is also variable according to case's, and includes/understands: costs of consultation, drug, the hospitalization, transport, etc.

- Cost of treatment: this cost includes the expenditure devoted to the purchase of drug prescribes by the doctor after the confirmation of a diagnosis;

- Cost of consultation: they are the expenditure carried out by the patient before being received by a doctor;

- Cost of laboratory: by cost of laboratory, it is necessary to consider the expenditure engaged by the test of laboratory in order to male nurse or to confirm the diagnosis posed;

- Cost of transport: they are expenses paid by the patient to go to the hospital;

- Cost of hospitalization:they are the expenses engaged by the

patient when it is interned at the hospital for a permanent follow-up;
- Cost of treatment:this cost includes the expenditure devoted to the

purchase of drug prescribes by the doctor after the confirmation of a

diagnosis;

B Indirect costs

The indirect cost is the sum expressed in monetary unit of work. That is composed of ancillary costs. This cost can be regarded as implicit and fixed in the case of the patients dealt with by the company, and these costs relate to the categories of population having a productive function for the company, because a sick patient will be always constrained to suspend his occupation for one period, which is prejudicial for the employer and indirectly for the company.

For the economists, these costs are regarded as true social cost by the potential losses of production. In other words, the disease has a cost which takes into account not only the medical expenses but also potentially lost work.

Within this framework, these costs can also enter in account what the Anglo-Saxon authors call the intangible effects. It is a question here of evaluating the effects of paludism on the quality of the life (the morals of patient or his entourage, the anguish, the losses effective, sufferings, etc....).The effects related to the loss of wellbeing are real but difficult to evaluate in monetarists term, this is why they are often forgotten in different the studies on the cost from a disease in a company and consequently to guide the medical doctors of the policy.

C Total Cost

It represents the sum of the direct costs or Cost fixed or implicit and the cost indirect of an episode of paludism. It is possible to calculate by patient or disease in a unity of place like the area or a country. To know the cost of each disease makes it possible to carry out comparisons between pathologies, or for pathology, between countries.

1.1.3. Spare

A household is consisted of the people belonging to certain categories of supplemented population with share, in particular the soldiers placed in barracks, the boarders, who have their residence nobody in this housing.

In addition, a household is defined as being a connected unit or not which only recognizes the authority of one and even nobody live in housing and often take their joint meal and take part in the recurring expenses.

Moreover, a household or cell of consumption is the whole of the people living of the same incomes and sharing the same meals (it is the unit of analysis).

I.1.3.1. Left households

One distinguishes two types of households below:

Spare nuclear; where all the members resulting from a family, i.e. are composed of couple and their children;

Spare nuclear widened; where we find the members who are around a family core (couple with child) and the members of the relationships at least remote.

1.1.3.2. Household budget

It is necessary to understand by household budget a description with posteriori of the expenditure and average incomes of households.

· The income of a household is compared to the total expenditure of the household (consumer expenditure and transfer).It has several origins: wages, the modern or traditional company remunerating capital or invested work.

· The expenditure of household is the expenditure carried out by the household for the acquisition of the goods and services of consumption, expenditure caused with the purchase of real estate.

1.2. SITUATION OF PALUDISM IN RDC

Research on paludism in RDC, began at the beginning of the XXème century. Initially directed towards the protection of expatriés, they extended quickly to all the layers from the population.One counts more than 300 devoted publications on this subject.

1.2.1. Species plasmodiales

Three species plasmodiales are met in RDC, namely: Plasmodium Falciparum, person in charge for the serious forms of the paludism and which remains the most frequent species (95%), Plasmodium Ovale and Plasmodium Malariæ. These two last species can be separately or in mixed infections with Plasmodium Falciparum.

1.2.2. Principal vectors

The vectors most met are Anophèles gambiae (92%), Anophèles funestus (principal vector for the area of the high plateaus of the East), Anophèles nili, Anophèles moucheti, Anophèles brunnipes, and Anophèles paludis.

1.2.3.Dynamics of transmission

At least 97% of the population lives in the zones with stable paludism characterized by the equatorial and tropical facies. The central Basin has a permanent transmission.It is an endemic zone of hyper (50 to 75% of the infected people) and of holoendemy (more than 75% of the infected people).The 3% remainder live in the mountainous areas of the East of the RDC where paludism is unstable with probability of persistence of the epidemic.

The transmission is sporadic and seasonal on the high plateaus of the East (Katanga), the provinces of the South, Kivu North, and in Ituri (Eastern Province).The rate of average inoculation varies ente 2,8 and 620,5 punctures per anybody per annum in Kinshasa and the index sporozoïtic goes up to 7,2% in urban environment.The transmission of paludism is less low in urban, but higher zone in peripheral zone.

Chapter Second: POLICY AND SYSTEM OF HEALTH IN RDC

2.1. POLICY OF HEALTH IN RDC

The historical evolution of the system of health of the RDC, like that of other African States, is marked by the institutional character and the initiative of the authorities. The medical situation of the RDC knew variable levels since the colonial period so far. With the paddle of independence, the medical policy was primarily centered on the remedial medicine, through medico-surgical centers and satellite dispensaries.

With the changes socio-policies of the years 1960 and 1970, the system of health knew deep disturbances. The population could reach the rare care of health only thanks to the efforts of several speakers who started respectively to try out policies of Community health in Bwamanda (Province of Ecuador), in Kisantu (Province of Low-Congo), in Kasongo (Province of Maniema) and Vanga (Province of Bandundu).

These experiments will be determining and will influence the policy of health of the RDC and whose evolution led to the adhesion of the RDC to the African charter of development aiming at Health for all by 2015 and adopted the strategy of the Primary Care of Health (SSP) like basic strategy. In order to support geographical accessibility with the SSP, the country was subdivided in 306 Zones of Health (ZS) in 1985 then in 515 in 2004.

The ZS serve each one on average 100.000 inhabitants in rural medium and 150.000 in urban environment. Each ZS includes/understands a central Office of ZS (BCZS), a general Hospital of reference (HGR) and 15 to 20 Centers of Health (CS) serving each one a Surface of Health (ACE), emanation of the local community.

The policy which to date governs the sector of the Health of the years 1978 has as a fundamental option "the satisfaction of the needs for health of all the population that it is in urban environment or rural medium". It aims:

- Education concerning the problems of health and the methods of fight;

- The promotion of good nutritional conditions;

- Material and infantile protection including family planning;

- The fight counters the epidemics and great endemics;

- Vaccination counters the infectious diseases;

- Treatment of the diseases and the current lesions;

- supply healthy water and measurements of basic cleansing; - Supply of the essential drugs;

- Mental health;

- The administrative Process;

- The formation continues.

2.2. STRUCTURE OF THE MEDICO-MEDICAL SYSTEM

At June 30, 1960, the RDC had a significant and sophisticated medical organization. At that time the medical system congolais was very well structured with academic installations which made the pride of the country the shortly after independence.

For proof, the population of certain African countries like Zambia, the African Southern Republic, Kenya not to quote that these came to be made look after in hospitals of the place. Since, we note an opposite movement. It is now congolais them which will be made look after in these countries and lend services in this field. What proves with sufficiency that there is a problem in the organization of our medical system?

Before 1960, the medical departments of the territory congolais were ensured by triple organization:

- Medical departments of the government;

- Private companies;

- Medical philanthropic works.

2.2.1. Services of the government

They were directed by the Doctor as a head and included/understood five great subdivisions:

- Services of Medical care

- Services of the medical Laboratories;

- Service of Supply drugs, products and materials of all the governmental formations and to approve were ensured by the pharmaceutical medico- central Deposit (DCMP);

- Service of medical Teaching;

- Service of Public health.

2.2.2.Medical departments of the private companies

They dealt with curative and prophylactic medical care their employees and their families and some times of all the population residing in their operating range. It is necessary to announce on this subject that the university private clinics of Kinshasa (CUK) belonged to the ONATRA, before being bought by MGR Gillon.

2.2.3.Medical philanthropic organizations

They were created on the initiative of the religious missions and/or other private institutions, which ensured a great part of the load of medical care. Their activities were coordinated by the government, because

of the voluntary share taken by these organizations in the care with the population.

2.3.MISSION AND ORGANIZATION OF MEDICAL SYSTEM MEDICO

In RDC, the medical system is organized by the Ministry for the Public health, assisted by the Secretariat-general in administrative management. This Ministry is represented in each province by a provincial Ministry of health which acts instead of the central medical authority. The Ministry for Health has the role of ensuring the supply the whole of the population of the care of health of quality at better cost. These various functions are primarily:

· Administration of the care of health, the drug and the technical equipment;

· The management of the environment for health;

· The management of the partnership for health;

· Human inheritance and finance, stock management;

· Studies, planning and standardization;

· The organization of the teaching of sciences of health.

Until 1978, the RDC had medical system inherited colonization. Since then, the base of our policy is based on the strategy of the care of primary health (SSP), following the adhesion of the country to the charter of Alma ATA (1978) and to the Charter of Development in Africa (1980).Concretizing this adhesion in 1981, the RDC had worked out a national medical policy founded on the primary care of health whose objective was to make available the care from health to all the population congolaise.

For fulfilling its functions well, the Ministry for the Public health is structured in medical pyramid which includes/understands: the central level; the intermediate level; and the peripheral level.

2.3.1. Central level

It has primarily a normative, strategic role and of regulation. It includes/understands the Cabinet of the Minister, the Secretariat-general, 13 central directions and 52 directions of programmers/services specialized such as the campaigns against paludism, the onchocercose, tuberculosis, the VIH/SIDA and STI, the National Program of the Nutrition, the National Programmed of Health of the Reproduction and the Widened Program of Vaccination (PEV).The campaigns against the disease are placed under the

coordination of the Management of the fight against the disease (4th Direction).

II.3.2. Intermediate level

This level plays the technical role of support, accompaniment, framing and logistics at the zones of health. In its current configuration, it consists of 11 provincial divisions and 48 districts of health. Each provincial division includes/understands offices corresponding to the normative directions of the central level, a hospital and a laboratory of the provincial level of reference. Each district of health includes/understands three cells charged with:

· general services and studies;

· inspection of the medical departments and pharmaceutical; and

· service of hygiene.

These cells are supervised by the Doctor Head of District. A district supervises approximately ten zones of health.

2.3.3. Peripheral level

The ZS is the operational level. It includes/understands BCZS, a HGR and a network of CS. The ZS is directed by the Doctor Head of Zone supported by the members of the team tallies of the ZS. On recommendation of the States Généraux of Health held in February 2000, the Ministry for Health initiated the process of revision of the medical chart of the country, in order to bring closer the health services the population and to avoid the overlapping of a ZS between two decentralized administrative entities. Thus, the number of ZS passed from 306 to 515 in 2005.

2.4. ROLE OF THE STATE IN THE SECTOR OF HEALTH

Generally, the expenditure of health amounts between 13 and 15% of the world income. In 2005, they amounted with more than 1.700 billion dollars, which represents at least 13 % of world income. Only extent of the expenditure which the State devotes to health made that it is absolutely essential to include/understand the effect of the policy of the governments on pubic health. The role of the State varies from one country to another. Three reason of an economic nature justify and direct the action of the State, namely:

1. The poor always do not have the means of obtaining the clean care of health to improve their productivity and their good - to be. The

authorities can make move back poverty while investing for pubic health.

2. Certain interventions of health of authentic public goods or create importance positive externalities. The market private would produce only little of it.

3. As the operation of the markets of health and the sickness insurance has weaknesses, the State can improve the good - to be by improving operation of these markets.

A good policy of health takes account of the differences in attention of the diseases. It is effective if it accroit the good - to be population by an improvement of its health, by a greater consumer satisfaction or by a reduction of the total cost of the services compared to what it would be if the State did not intervene.

2.5. TYPES OF MEDICAL SYSTEM MEDICO

In RDC we have two types of system, where on with dimensions formal system representing the official organization and other side the abstract system which moreover appears better organized that the formal system.

2.5.1. Formal system

As mentioned above, it is the official structure which organizes the system of care of health according to the desire of the public authority. It is made that for a certain time, this official structure is not any more with measurement to ensure with effectiveness the objectives which are assigned to him by the public authority. Today, this structure is characterized by a advanced dilapidation of the infrastructures, equipment and systematic leakage of the executives towards the sectors abstract.

The buildings which shelter the central services of the Ministry for the Public health are in general in bad state not maintained. On the level of Kinshasa, the Capital of the RDC, one can record some installations which resist such as the University Private clinics of Kinshasa, the General Hospital; of reference of Kinshasa, the Private clinic Ngaliema, the Pediatry of Kalembelembe... there are also others which die under the obliging eye of the authority.

We quote the hospital of Kitambo, the Private clinic Kinoise, the hospital complex King Baudouin 1st.If in Kinshasa, there are installations which have a degree of advanced dilapidation, that in is it on the level of the interior of the country? Indeed, inside the country certain Centers of Health are very dilapidated and make care almost ineffective. These hospitals

which had an initially social objective became truths districts business where doctors and the whole of the personnel do not have decent fees.

2.5.2. Abstract system

Since the structure known as formal became ineffective, it occurred in the middle of the Eighties a passion of the nationals to invest in the medical sector to face the inefficiency of the public system in order to avoid. It is thanks to this system called abstract, but which became component essential framework of the medical system congolais, the offer of care of health widened to the most stripped layers. It is thanks to the abstract sector that we find in Kinshasa at least a Medical centre in each district with a presence noticed inside the country.

2.6. DIFFICULTIES RENCONTREES BY THE MEDICAL SYSTEM IN RDC

The shortly after independence, the medical authorities of Congo had to face the great difficulties of a technical nature which persist mainly still at the present time.

2.6.1. Personnel of health

The data of the table 1montrent that human resources for health constitute a serious problem for the sector as a whole in RDC.

With through this table 1, we notice that the number of doctors passed certainly from 2.000 in 1998 to 3116 in 2006 and that of the male nurses from 27.000 to 43.021 for the same period, but this number remains insufficient in comparison with the weight of the population and especially of the bad distribution of these personnel.

In RDC indeed, there is 1 doctor for 20.143 inhabitants whereas the standard requires 1 doctor for 10.000 inhabitants and 1 graduate male nurse for 8.000 inhabitants whereas the standard is 1 graduate male nurse for 5000 inhabitants. Also, almost 60% of the doctors who work in the public sector are based in Kinshasa or one count only 10% of the population. This situation has as consequence the deficiency of the personnel in certain provinces in particular the Provinces of Maniema and Ecuador. They have respectively only 13 and 31 doctors. It is generally the graduate male nurse who is titular center of health in these provinces.

Table 2, indicates to us that more than 70% of the personnel of health congolais are installed in urban environment. Moreover, this table shows that about half of the doctors whom account the country resides at Kinshasa.

The personnel of health are very often overpowered under the weight of postponed fees in addition insufficient. Moreover, the personnel is obstinate with several problems in particular:

- The scales are established according to the seniority rather than according to the qualifications and of the responsibilities;

- The problems of transport contribute to the delay and the absenteeism with the service;

- Miss autonomy of staff management of the majority of the programs and services entrainment a bad manpower deployment and a plethora in certain services.

2.6. 2.Infrastructures

The RDC currently counts 401 hospitals including 176 pertaining to the State, 179 with the religious confessions, 46 with the companies of the public and private sector;7725 other establishments of care include/understand the centers of health of reference, the centers of health, maternities, the dispensaries and the polyclinics also belonging to the State, the companies, the religious confessions, the ONG and to the physical private people and morals.

2.6.3.Decentralization and devolution

With an aim of consolidating the national unit and of creating centers of impulse and development at the base, the new constitution voted by referendum in 2006 structured the administration congolaise in 26 provinces equipped with the legal personality and exerting competences of proximity. The ZS are located in the territorial entities called "territory or commune" and for this reason will be directly financed by the decentralized budgets. Since 2004, the Surfaces of Health (ACE) work out micro integrated plans which are consolidated on the level of the BCZS to make a plan of the ZS of it. This plan of the ZS is transmitted to the provincial level, which has the capacity to mobilize other potential partners.

Mechanisms of footbridges are installed, in particular by the opening of the credit limits for the ZS in order to facilitate the follow-up of financial flows and the expenditure on all the levels of the system of health.

2.7. FINANCING OF THE SECTOR OF HEALTH IN RDC

The country has passed through a dimensional crisis multi for several decades. This crisis started during the Seventies continued at the Nineties and worsened with the international financial crisis of 2007, transformed into economic crisis, and social crisis.

From the economic point of view, there is to it quasi paralysis of the basic essential economic activity, with like consequence, a budget deficit growing, a capital flight, a devalorization of the national currency, an imbalance of the balance of payments, a high rate of unemployment, a fall of the production, insufficiency of income, an excessive debt, a growing loss of the purchasing power of the population.

As regards the social aspects the basic public services such as housing, the education and the care of health are not ensured any more in a satisfactory way. At present, serious indices indicate that health in RDC did not profit from the adequate strategies of financing and is today at the base of cératines against performance justifying the installation of reforms an exhaustive list of these against-performance could arise in these term:

The share of the budget allocated with the health, which was 4,7% average between 2003 and 2006 and very weak. Certain countries make already an effort to increase this share. In Mozambique, for example, the public expenditure of health increased in 1992 and 1993, within the framework of a program of reform economic vaster and Mauritania committed itself appreciably increasing the envelope of health in 1992 and 1996. It is not the case in RDC, the expenditure of health decreased throughout these quoted crises Ci-high.

It is deduced from this table 3, that from 2003 to the 2006, budgetary share allocated with health varies from 4.90% to 4.03%, which is lower than the standard suggested by the WHO which is about 10 to 15%.Following this situation, we notice that they are the consumers of care of health which supports them even this load.

The RDC endorsed the objectives of Millennium for the Development which to consist with:

- To reduce by 3/4 maternal mortality from here 2015;

- To reduce by 2/3 the mortality of the children by less than 5 years from here 2015;

- To stop and reverse the tendencies of the propagation of the VIH/SIDA from here 2015.

The engagement of the Government in this field resulted in the allowance of the significant resources to the sector of Health. Thus, within the framework of the budget arranged 2004 and 2005, it gave the priority to the expenditure of the social sector. The appropriations relating to the expenditure of fight against poverty in the social sector accounted for 31% of the total Budget evaluated to 528 billion Congolais Francs. On this amount, 5,6% are 29,7 billion Congolais Francs were assigned to the sector health, which accounts for 1,2% of the nominal GDP of 2004.The budget

appropriations referring to the fight against paludism are difficult to determine.

As regards financing, the medical history of the RDC appoints 4 times to know:

- The colonial period, characterized by budgets of health sufficient financed primarily by the Treasury with the support of the private sector and the religious confessions;

- The period of after independence, (1960-1979) during the which political disturbances and the socio-economic crisis causing an increasingly drastic thinning down of contribution of the government;

- The period known as of "the golden age" of primary care of health (1982-1988) during which country received a flood of external resources against balancing the negative effects of the nuisance of the State;

- The period of return of darkness (1990-1997)) characterized by a quasi complete absence of contribution of the public sector to the financing of health and the suspension of the bilateral co-operations.It is as from this period that the sector of health began its self-financing.

To be viable, the system of financing of health must be

conceived so as to meet the need for the population.

2.8. PROBLEM OF TARIFFINGS

The problem of tariffing with which the households faces are confronted with the medical formations related on the one hand to the quality of the care of health, with the labour are employed, on the other hand, with the socio- categories professional. These medical formations are confronted with the dilemma of tariffing according to social categories'.

The development of a tariffing as regards health offers several advantages to us:

· it makes it possible to make a comparison of the services between them;

· by fixing the price, it makes it possible to homogenize the quality of the rendered services. As regards health, the prices do not balance them even according to mechanisms' of supply and demand, because this field is rich in situation of monopoly.

Nevertheless, the practice of a tariffing poses a serious problem and imposes frequent revisions. These last make it possible to prevent that the prices do not become too much and influence way significant quality of the care. In addition, Signalons that, tariffing depends on the socioprofessional categories.

Chapter Third: EMPIRICAL CHECKING OF THE COST OF THE CARE OF HEALTH AGAINST PALUDISM

This chapter is subdivided in three sections:

- Presentation of district MBUKU;

- Methodology of the collection and data processing;

- Interpretation of the results;

- Knowledge of mode of transmission of paludism;

- Impact of the economic cost of the care of paludism.

3.1. PRESENTATION OF DISTRICT MBUKU 3.1.1.Historical configuration

District MBUKU is a decentralized administrative entity deprived of the legal personality and which counts among the 17 districts which form the Commune of Kisenso.

Formerly, it was controlled by the Commune of Lemba.But following the ministerial stop n69/012 of 23 January 1969 fixing the limits of 24 Communes of the Town of Kinshasa, the Police chief Sous-Régionale of Amba Mount will transmit this ground portion to the Commune of KISENSO.

3.1.2. Geographical aspect

The district MBUKU which with 3Km2 of surface is limited:

in North :by the Congo-extremely avenue which separates it from the

District Release;

in the East in the South in the West

by the Kinduku avenue which separates it from the Amba District;

by the Kwambila river, bordering on the Mandela District of Common the Ngafula Mount;

by the Congo-extremely avenue which separates it from the Mbanza-Lemba District of the commune of Lemba.

3.1.3. Administrative subdivisions

The District is subdivided in following grouping:Kwambila, Bandundu, Dibaya, Kahundu, Kimpese, Mangombo, Nzau-Lemba, Fwala, Nzenga, Sindiki.

The district has 26 avenues which are:Congo-extremely, Kuigola, Home 30 Mbinza, Mbandaka, Kianza, Akadi, Kivuvula, Kitambala, Mozengo 1 And 2 Malomba, Kasanza, Mpangu, Pelende, Mandungu,

Tungu, Nsele, Kingudi, Kiboko, Yumbi 1 And 2, Kinzulu, Kwambila, Kinzumbi, Mafwa, Yasa Bomenge, Niwa, Bent.

Moreover, the District at an office which functions with 7 Agents and Heads of district.

3.1.4.Socio-economic aspect

In District MBUKU one finds there the activity in social matter such as: Community organizations Nongovernmental, schools, organizations, centers of public health, dispensaries and private maternities.

The carried on commercial activities are small the retail trade in particular:25 shops, 10 pharmacies, 1 hotel bar, 3 undertaking, 11 houses of communications, 5 couture houses, 1 provided bakery, 1 photo studio, 3 joineries, 2 deposits of cements, and 2 shoe manufactures.

3.1.5. Population

According to the report/ratio of 2010, the population of the District amounts to 18 890 including 18 861 nationals and 29 foreigners.Let us note that the District in majority is inhabited by the students and workers of the University of Kinshasa.

3.2. METHODOLOGY OF THE COLLECTION AND PROCESSING OF DATA

To collect the data of this study, we started by collecting information only on District MBUKU in order to constitute our base of survey. Having at our disposal the number of avenues, we proceeded by the reconstitution of our sample by calling upon the systematic sampling which constitutes an alternative of the random sampling.

Initially, starting from the total number of the avenues, we chose 15 avenues randomly like targets because of 4 households by avenues. We organized interviews near 4 households out of 15 avenues. What gives us a sample of 60 households?

After the examination and the coding of the questionnaires, the data of the investigation were checked before being treated with the computer with software EPIDATA. Then, the data were analyzed thanks to software SPSS.

3.3. PRESENTATION OF THE RESULTS

3.3.1. Socio-demographic characteristics of the surveyed households

3.3.1.1. Size of manage

In District MBUKU, the average face of the households is of 5, 75 people. One observes very few households made up of more than 13 people is 3,4%;46,6% households have a size ranging between 4 and 6 people.

3.3.1.2.Marital status of the head of household

He appears after the reading of this table 5, that 53,3% of the heads of household are grooms, 35% are single people, the veuf(ve)s account for 8,3% and 1,7 % of surveyed are divorced and 1,7% are the polygamous ones.

3.3.1.2. Educational level of the head of household

He is deduced from this table 6, that 43,3% of the heads of households are bachelors, 35,5% gradué(e)s, 13,3% reached the secondary level and 8,3% stopped at the primary school.

3.3.1.3.Occupation of the head of household

Table 7, informs us that on 60 heads of surveyed households, 56,6% are civils servant, 16,8% are workers in the private sector, 3,0% are inter alia tradesmen and housewives.

3.3.2.Monthly expenditure of the households 3.3.2.1. Expenditure food (Dal)

It arises from the table 8, that 35,0% of the households spend a sum ranging between 15000 and 45000FC for the food, 3,3% spent between 45000 and 75000FC, 11,7% spent between 75000 and 105000FC, 5,0% spent a sum ranging between 105000 and 135000FC, 23,3% of households spent between 135000 and 165000 FC, 6,7% spent between 165000 and 225000FC and 8,3% of household spent beyond 225000FC.We notice that the average of this expenditure is 114000FC is 126,6$USD by household.

3.3.2.2.Expenditure schooling (Dscol)

Table 8, indicates that 31,7% of the households spend a sum ranging between 5000 and 15000FC for schooling, 48,3% to us spent between 15000 and 25000FC, 15,0% spent between 25000 and 35000FC, 5,0% spent beyond 35000FC.We notice that the average of this expenditure is 19333,3FC is 21,2 $$USD>by household.

3.3.2.3. Expenditure of the care of health (Dss)

Table 9, shows us that 62,2% of the households spend a sum ranging between 100 and 1500FC for the care of health, 10,8% spent between 1500 and 3000FC, more than 27,0% spent beyond 4500FC.The average of this expenditure is 2159,45FC is 2,ÚSDpar household.

3.3.2.4. Expenditure of the rents (Dloy)

It arises from the table 10, that 40,4% of the households spend a sum ranging between 10000 and 20000FC for the rent, 48,9% spent between 20000 and 40000FC, 10,0% spent beyond 40000FC.We notice moreover that the average of this expenditure is 26063,8FC is equivalent 28,6$USD by household.

3.3.2.5. Expenditure of transport (Dtrans)

Table 11, shows us that 57,8% of the households spend a sum ranging between 500 and 1000FC for transport, 11,1% spent between 1000 and 2000FC, 15,6% spent between 2000 and 3000FC, 15, 7% spent beyond 3000FC.The average of this expenditure is 1533,3FC is 1,6$USD by household.

3.3.2.6. Capital expenditures (Déqui)

It arises from the table 12, that 42,9% of the households spend less 4500FC to get the equipment, 35,7% spent between 45000 and 9000FC, 21,4% spent beyond 9000FC.The average of this expenditure is 5785,7FC is 6,3$USD by household.

3.3.2.7. Expenditure of clothing (Dhab)

Table 13, shows us that 51,5% of the households spend below 4500FC for clothing, 15,2% spent between 4500 and 9000FC, 33,3% spent beyond 9000FC.The average of this expenditure rises with 9812,5FC is 10,7$USD by household.

3.3.2.8. Expenditure the transfer (Dtrans)

It arises dutableau 14, that 42,9% of the households spend a sum ranging between 1000 and 10000FC for the transfer in favour of the others, 28,6% spent between 20000 and 30000FC, 28,6% spent beyond 30000FC.The average of this expenditure is 20928,57FC is 22,9$USD by household.

3.3.2.9. Consumer expenditure of water (Deau)

Table 15, shows us that 33,3% of the households spend a sum ranging between 1000 and 3000FC for water, 25,0% spent between 3000 and 6000FC, 16,7% spent between 6000 and 9000FC, 25, 0% spent beyond 9000FC.The average of this expenditure is 5666,67FC by household.

3.3.2.10. Consumer expenditure of electricity (Délect)

Table 16, shows us that 12,5% of the households spend a sum ranging between 1000 and 3000FC for electricity, 25,0% spent between 3000 and 6000FC, 16,7% spent between 6000 and 9000FC, 12,5% spent between 12000 and 15000FC and 33,3% spent beyond 15000;with an average of 9812,5FC is 10,7$USD by household.

3.3.2.11. Expenditure for wood (Dbois)

It is deduced from this table 17, that 11,1% of the households spend a sum ranging between 1000 and 3000FC for wood, 3,7% spent between 6000 and 9000FC, 22,2% spent between 9000 and 12 000FC, 33,3% spent between 12000 and 15000 and 29,6% spent beyond 15000FC.The average of this expenditure is 8722,2FC is 9,5$USD by household.

3.3.2.12.Expenditure for the embers (Dbr)

This table 18, shows us that 14,8% of the households spend a sum ranging between 1 000 and 3 000FC for ember, 11,1% spent between

3 000 and 6 000FC, 74,1% spent beyond 9 000FC.The average of this expenditure is 8574,0FC is 9,4$USD by household.

3.3.2.13.Expenditure for the communication (Dcom)

This table 19, indicates to us that 45,3% of the households spend less than 4500 for the communication and 54,7% spent beyond 9000FC.The average of this expenditure is 16344,3FC is 17,9$USD by household.

3.3.2.14.Expenditure of leisure and drink (ADlb)

This table 20, shows us that 41,8% of the households spend a sum ranging between 500 and 4500FC for transport, 21,8% spent between

4 500 and 9 000FC, 14,5% spent between 9 000 and 13 500FC, 1,8% spent between 13500 and 18 000 20,0% spent beyond 18 000FC.The average of this expenditure is 8490,9FC is 9,3$USD by household. 3.3.2.15.Total monthly expenditure of the households (DMtm) in FC

The monthly expenditure is the sums of all expenditure Ci-high. That is to say:

Fromwhere

3.3.3.Monthly expenditure of the care of health for paludism

Table 21, shows us that 38,3% of the surveyed households did not suffer from paludism against 61,7% which suffered from it.

3.3.3.1.Expenditure for the consultation (Dcon)

It is deduced from this table 22, 67,5% of the households spend a sum ranging between 2500 and 4500FC for the consultation, 32,4% spent between 4500 and 9000FC.The average of this expenditure is 4554,04FC is 5,0$USD by household.

3.3.3.2. Expenditure for the laboratory

 

This table 24, indicates that 21,6% of the households spend a sum ranging between 1 000 and 1 000FC for the test of laboratory, 27,0% to us spent between 1 000 and 1 500FC, 24,3% spent between 1 500 and 2 000FC and 29,7% spent beyond 2 000FC.The average of this expenditure is 1594,59FC is 1,7$USD by household.

3.3.3.3.Expenditure of hospitalization

 

It is deduced from this table that 50,0% of the households spend a sum between 5 000 and 10 000FC in the event of hospitalization, 12,5% spent between 10 000 and 15 000FC, 37,5% spent between 3 000 and 4500 with an average of 11 875FC is 13,0$USD by household.

3.3.3.4.Expenditure of nonhospitalization

 

It is deduced from this table 25, 8,1% of the households spend a sum ranging between 1000 and 1500FC in the event of nonthe hospitalization, 27,0% spent between 500 and 1 000FC, 10,8% spent between 1500 and 2 000FC and 32,4% spent more than 2 000FC.The average of this expenditure is 1560,3FC is 1,7$USD by household.

3.3.3.5.Expenditure for control

This table 26, shows us that 78,3% of the households spend less than 10 000 for control, 21,6% spent beyond 10 000FC, with an average of 7162,16FC is 7,8$USD by household.These spend include the consultation and the tests of laboratory.

3.3.3.6.Expenditure of the drugs

 

It is deduced from this table 27, that 73,0% of the households spend a sum between 300 - 1500FC for purchase of the drugs of paludism, 10,8% spent between 1500 and 3000FC, 16,2% spent between 3000 and 4500 with an average of 1508,1FC is 1,6$USD by household.

3.3.3.7.Other expenditure

 

This table 28, shows us that 41,8% of the households spend between 1000 and 3000 for other expenditure, 21,8% spent between 6 000 and 9 000FC, 14,5% spent between 9 000 and 12 000 and 20,0% spent beyond 12 000FC.The average of this expenditure is 5472,9FC is equivalent to 6,0$USD by household.This expenditure includes the expenditure keeps sick, transport.

3.3.3.8.Total expenditure of the care of health for paludism

 

The total expenditure of the households for the care of health is
the sum of all the averages in particular:of consultation laboratory

, control

(the hospitalization , not hospitalization

.

, and the Other monthly expenditure

That is to say:

The total monthly expenditure of the households rises 28 674,27FC is 31,5$USD i.e., a household spends close to 31,5$USD to look after a member of family which suffers from paludism.

3.3.4.Other aspects related to paludism 3.3.4.1. Place of the care

It rises from this table 29 that 44,8% of the households were looked after in centers of health against 55,2% which takes the direction of the hospital.

3.3.4.2.Prescribed drugs

It is deduced from this table 30 that 70,2% of the patients were looked after by quinine compressed and perfusion, 13,5% underwent the injection of arthemether, 16,2% patients were looked after by the fancidare. 3.3.4.3.Lost working days

It is deduced from this table 31 that 16,3% of patients lost 2 to 4 working days, 24,3% lost some between 5 and 7 days and 13,5% lost more than 7 working days;with a 5 working days average lost.

3.3.4.4.Knowledge of the mode of transmission of paludism

This table shows 32 us that 72,9% of the patients know how to catch paludism 27,0% against who are ignoramuses.

3.3.4.5.Knowledge of the means of fight against paludism

This table 33 informs us that 79,6% of patients know how to fight paludism 20,4% against who declared the opposite.

3.3.5.Impact of the economic cost of the care of paludism

The economic impact of cost on the budget of household is released by the report/ratio of the total expenditure of the care on

the total expenditure of the households .

A household devotes nearly 13% of its budget to look after a member of family which suffers from paludism.

By comparing the total average expenditure of the care of health which rises with 2159,45FC is 2,4$USD and the average expenditure of

care against paludism which are of 33 727,7FC, is we notice what

follows in this table 34 informs us that the monthly expenditure of the care

against is 94,0% against the total monthly expenditure of health of households which are 6,0%.

Let us note that the expenditure of care of health for the households having known a case of paludism is enormous.Considering the importance of this amount, there is a need for recommending the fight against paludism in RDC;because the impact of this expenditure in the total expenditure of the care of health of households are significant.

CONCLUSION

At the end of this study devoted to the impact of the economic cost of care of health of the households with Kinshasa "case of paludism", the objective is that to evaluate the weight of expenditure related to the care of health against paludism in the total expenditure of the households by the application of the statistical tools.

Answer to this question, we carried out an empirical analysis in order to release the average total expenditure of the households and its characteristics and the average total expenditure of care of health against paludism in households.The following question should find a response in this work:which is the impact of the cost of the care of health relating to paludism in the households kinois of District MBUKU of the Commune of KISENSO?

To direct this investigation, we left the following assumption:

The expenditure of health for paludism takes a very significant share in the monthly expenditure of households.

For the checking, we used and resorted to the documentary techniques, of samplings and interviews more precisely on the statistical analysis with software SPSS. We noted what follows:

- the average size of the surveyed households is of 5,75 people;

- the monthly average total expenditure of the households rises to 247 414,69FC is 271,8$USD;

- The average total expenditure for the care of paludism is amount to 33 727,1 FC is equivalent to 37,0$USD;

- the households having known a case of paludism were neat to 70,2% in centers of health against 29,7% which were done looked after in the hospitals;

- the prescribed drugs are to 16,2% the fancidare, 70,3% compressed and injectable quinine, and 13,5% of artermether;

- 16,3% of the patients lost 2 to 4 working days, 24,3% lost some between 5 and 7 days and 13,5% lost more than 7 working days, the average being 5 days lost of work.

With regard to the knowledge of the mode of transmission, 72,9% of the households know how one catches the paludism against 27,0% which do not know;79,6% know how to fight the paludism against 20,4% which ignoramus,

By comparing the monthly expenditure for the care of paludism which is 33727,1 FC is 37,0$USD and the monthly expenditure of

households which rise to 247 414,69FC, we notice that this expenditure takes a significant share is 13% on the total monthly expenditure of the households. This amount could be well used for another thing if one managed to stop the propagation of this disease

Moreover, by comparing the monthly expenditure of the care of total health of the households which rise with 2159,45FC (or 2,4$USD) is 6,0% of the total expenditure and spend them of the care against paludism which is of 33 727,7FC is 94,0% of total expenditure. We notice that the expenditure of the care of health for the households having known a case of paludism is enormous.

By what precedes, we can conclude that the impact of paludism is enormous in the household expenses.

Vis-a-vis this situation we suggest with the households setting

up the strategies stated by WHO to fight against paludism in particular:

- the cleansing will intra and perished domestic which is the whole of action carried out around and in the house having for goal to fight against the reproduction of the mosquitos, (example:limp of sardines, puddle pools of water).With regard to this point, installation will take into account, the vents air, to cover the windows, the septic tanks and the slits which constitute the hiding-places of the mosquitos;

- the use of the impregnated mosquito nets they are fabrics of synthetic fibre cotton fibres of variable form and various dimensions of which one entour of bed and which one soaks in an insecticide bath called "déltanethrine" which protects from the mosquitos and other insects;

- the brigade of hygiene in particular gives some councils to the heads of the households:

to cover the dustbins;

to clean the gutters;

to manage waste by incineration well;

the hiding and the recourse to a service for waste;

to clear of undergrowth the piece and the environment.

BIBLIOGRAPHY

I WORKS

1. ARON R., the class struggle, Gallimard, Paris, 1964, p.72

2. BERSNIAK and G DURU, Economy of Health, Masson, 1997, p.69

3. BAGALWA MASHEKA Joseph, Analyse cost of requests in medical load of PVVIH, school of public health, 2007-2008, 51 p.

4. BAKAFWA WASHIKONA, Saving in Developing country, G2, UNIKIN, FASEG, 2005, p. 33

5. Bernard and Genevieve Pierre, medical Dictionary:for the tropical areas, Kinshasa, BERPS, 1989, p.450

6. Brigitte LAISHE and Mr. Jean-Paul GAYILONI, Bring back caritasdev.cd, 3rd World Round of the Funds against paludism, 2009

7. C PRESVELOU, Sociology of family consumption, Brussels, Working edition, 1968, p.73

8. CHIMANUKA B, BAHWERE P., BISIMWA B, NINNY N, Plaziervercammen JA, DONNEN P., Envolving altitude malaria has poor rural area surrounding the paediatric hospital of Lwiro in Kivu, The American Society of Tropical Medicine and Hygiène, 2001.

9. HOUYOU, Budget Domestic, Nutrition and Way of life to Kinshasa, Kinshasa, PUZ, 1973, p. 96

10. Jean IVE CAPUL and Olivier Garnier., Dictionary of Economy and social Sciences, Paris, Hatier, p.100

11. KAZADI W et al., Urbain Malaria in Kinshasa, The American Society of Tropical Medicine and Hygiene, 2000, Poster presentation, N.602

12. Madeleine G, and Roberto P., Method in Social Sciences, 8th edition, Dalloz, Paris, 1990, p.2

13. MULUMBA MADISHALA M.D. Paul, Medical Elements of Protozoologie, Kinshasa, Médiaspaul, Collection University Publications, 2006, p.17-45

14. PRESVELOU C, Sociology of family consumption, Brussels, Working edition, 1968, p.73

15. Pressing Roland, Demographic Dictionary.>.>, p.11

II NOTES OF COURSE

1. KUZONDISA MBONGA, Notes of Political Course of Economy I, G1 FASEG, UNIKIN, p.67

2. BAKAFWA WASHIKONA, Saving in Developing country, G2, UNIKIN, FASEG, 2005, p. 33

3. LOKOTA Materne Claude, Economy of Health, Run L2 EAR, 1999, p.49

4. LUKUSA DIA BONDO., Notes of Political Course of Economy II, G2, UNIKIN, FASEG, p. 67

5. LUTUTALA., Introduction to demography, L1 Démographie, UNIKIN, Notes new, 1993-1994

6. NGIMBI N.P., and alii, Notes on the anophèles with Kinshasa, RDC, Service of Parasitology, Faculty of Medicine of the university of Kinshasa, pp 377-378

7. NGOBEBE, Notes of Course of Public health, G2 Hospital management, ISTM, p.35

8. NYEMBO SHABANI, Notes of course of saving in development, L1, UNIKIN, FASEG, 2008-2009, 215 pages

III REVIEWS, ARTICLES, NEWSPAPERS, REPORTS/RATIOS

1. Project CRY (Country of Return Information information on the country of return).Drive country:RDC, May 2007.Address by electronic mail:return@vluchtelingenwerk.be

2. BAGALWA MASHEKA Joseph, Analyse cost of requests in medical load of PVVIH, school of public health, 2007-2008, 51 p.

3. Strategic document of Growth and Reduction of Poverty, June 2006,

38 pages

4. The IMF, OECD, UNO, the World Bank, Report/ratio on the Objectives of the findable millenium of development on www.paris21.org/betteworld < http://WWW.paris21.org/betteworld >

5. Ministry for the Public health: Policy and master line of financing of the health services, 1999, p.5-6

6. WHO, Entomological Profile of paludism in RDC, September 2007, p.6

7. Problem Human: Health Teaching, EEC-Congo Mission, booklet V, June 1963, p.3.

8. Annual report, District MBUKU, 2010

9. Report/ratio of the Ministry of health: State of places of the Health sector, May 1999, p.86

10. Report/ratio on development in the World, To invest in health, 1993, p.164

11. Report/ratio on health in the World:For a real Change, 1999, p.19

12. Pressing Roland, Demographic Dictionary.>.>, p.11 .

>13. World round of the Funds against paludism, 2009






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"La première panacée d'une nation mal gouvernée est l'inflation monétaire, la seconde, c'est la guerre. Tous deux apportent une prospérité temporaire, tous deux apportent une ruine permanente. Mais tous deux sont le refuge des opportunistes politiques et économiques"   Hemingway