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

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Université de Kinshasa RDC - Licence 2010

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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.

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