Keywords
Hospital management
Resource allocation
Sustainability
Healthcare policy
How to Cite
Abstract
Introduction
Financing public hospitals in the Democratic Republic of the Congo, especially in Kisangani (Tshopo Province), remains a major challenge for the provision of quality health services. Although several funding sources exist, the specific contribution of self-financing to hospital budgets has not been well documented, leaving its role in financial sustainability unclear.
Purpose
This study evaluated the role of self-financing in the overall funding of the General Reference Hospitals of Makiso, Lubunga, and Tshopo between 2020 and 2022.
Methods
A quantitative research design was adopted, using an inductive and accounting approach. Nine annual financial reports (three per hospital) for the period 2020–2022 were analysed. The general trend analysis technique and Pearson’s linear correlation were used to determine the relationship between self-financing and total hospital funding.
Results
On average, self-financing accounted for 62.6% of total hospital funding. A strong positive correlation was found between self-financing and total funding (r = 0.95), indicating that self-financing significantly influenced the financial performance of the hospitals during the study period.
Conclusion
Although self-financing contributes substantially to hospital budgets, it does not guarantee financial autonomy, as public hospitals remain heavily dependent on households. This dependence places a financial burden on families and encourages overbilling. To address this, it is recommended that the government and its technical and financial partners diversify and strengthen funding mechanisms to reduce reliance on households and ensure more affordable and equitable hospital services in Kisangani. This study is one of the first empirical assessments of self-financing in Congolese public hospitals, quantifying its share in overall financing and outlining its implications for the sustainability of the health system.
References
Afouka, V. (2018). Knowledge, attitudes, and practices of managers on financial resource management. Journal of Manmohan Memorial Institute of Health Sciences, 1(4). https://doi.org/10.3126/jmmihs.v1i4.11994
Atake, E. H., & Amendah, D. (2023). Financial risk protection and universal health coverage in Togo: Evidence from household data. International Journal for Equity in Health, 22(1), 124. https://doi.org/10.1186/s12939-023-01993-y
Bazzoli, G. J., Chen, H. F., Zhao, M., & Lindrooth, R. C. (2008). Hospital financial condition and the quality of patient care. Health Economics, 17(8), 977–995. https://doi.org/10.1002/hec.1350
Courtejoie, N., & Richet, J. (2022). La situation économique et financière des établissements de santé en 2020 [The economic and financial situation of healthcare institutions in 2020]. Direction de la Recherche, des Études, de l’Évaluation et des Statistiques (DREES).
Direction de la Recherche, des Études, de l’Évaluation et des Statistiques. (2022). Les dossiers de la DREES (No. 100). DREES.
Levine, D. (2003). Éthique et allocation des ressources dans le système de santé [Ethics and resource allocation in the health system]. Revue Internationale d’Éthique Sociétale et de Gouvernance, 5(1).
Ly, M. B., Dia, A. T., Fall, C. A., & Faye, A. (2020). Health financing in Senegal: A case study of universal health coverage. Global Health Action, 13(1), 1729321. https://doi.org/10.1080/16549716.2020.1729321
Makamba, P., & Manunga, M. (2004). La problématique du financement de la santé en RDC [The problem of health financing in the DRC]. Ministère de la Santé – Table ronde des partenaires.
Maneckou, L. (2015). État des lieux de la gestion des ressources financières en Égypte [Financial resource management in Egypt]. [Journal name missing], 11, 1085–1089. https://www.ncbi.nlm.nih.gov/pubmed/21133629
Manzambi, K., Eloko, E., Bruyère, O., Gosset, C., Guillaume, M., & Reginster, J.-Y. (2015). Health financing and cost recovery: The heavy burden on Congolese households. Journal of Epidemiology and Public Health, 15, 15–27.
Maotela, K., Mulopo, M., & Mukalenge, C. (2019). Analyse des modalités de financement des soins de santé en République démocratique du Congo : une revue systématique [Analysis of healthcare financing methods in the Democratic Republic of Congo: A systematic review]. Annales Africaines de Médecine, 12(2), 3203–3219.
Ministère de l’Écologie, du Développement Durable et de l’Énergie. (2015). L’agenda 2030 et les objectifs de développement durable [Agenda 2030 and sustainable development goals]. Ministère de l’Écologie, du Développement Durable et de l’Énergie.
Ministère de la Santé & Ministère du Plan. (2006). Recueil des normes de la zone de santé [Health zone standards compilation]. République Démocratique du Congo.
Ministère de la Santé & Ministère du Plan. (2008). Enquête démographique et de santé, République Démocratique du Congo 2007 [Demographic and health survey, Democratic Republic of Congo 2007]. République Démocratique du Congo.
Ministère de la Santé Publique & Banque mondiale. (2019). Financement de la santé en République Démocratique du Congo : étude sur l’espace budgétaire du secteur de la santé en RDC [Health financing in the Democratic Republic of Congo: Study on fiscal space of the health sector]. République Démocratique du Congo.
Navarro, L., & Lievens, T. (2012). Financement de la santé, tendances en Afrique subsaharienne [Health financing trends in sub-Saharan Africa]. Oxford Policy Management.
Ndaya, K. (2022). La gestion des ressources financières dans la zone de santé de Kamina [Financial resource management in the Kamina health zone]. Éditions Universitaires Européennes.
Renmans, D., Holvoet, N., Criel, B., & Meessen, B. (2017). Performance-based financing: The same is different. Health Policy and Planning, 32(6), 860–868. https://doi.org/10.1093/heapol/czx030
Salah, E. (2013). Déterminants de la structure financière et réactions du marché boursier aux décisions de financement : Cas des sociétés cotées à la bourse des valeurs de Casablanca [Doctoral dissertation, Université Nice Sophia Antipolis & Université Cadi Ayyad].
Singh, S. R., Wheeler, J., & Rodwin, V. G. (2015). Hospital financial performance and quality of care: Evidence from hospital value-based purchasing. BMC Health Services Research, 15, 282. https://doi.org/10.1186/s12913-015-0690-x
UNICEF. (2021). The impact of COVID-19 on children and families. UNICEF. https://www.unicef.org/reports/impact-covid-19-children-and-families
USAID. (2023). Health financing landscape in the Democratic Republic of the Congo. Local Health System Sustainability Project (LHSS). https://www.lhssproject.org/sites/default/files/resource/202312/LHSS%20DRC_%20Health%20Financing%20Landscape%20Report_%20ENG_508C.pdf
Wery, O. (2015). Le projet Symphonie : la dématérialisation intégrale des factures des soins [The Symphonie project: Full digitalisation of healthcare invoices]. Finances Hospitalières, 93.
World Bank. (2017). Performance-based financing: A win-win system for patients and healthcare staff. World Bank. https://documents.worldbank.org/en/publication/documents-reports/documentdetail/708821511937526258/performance-based-financing-a-win-win-system-for-patients-and-healthcare-staff
World Bank. (2022). Two-thirds of households with children have lost income during the pandemic. World Bank. https://www.worldbank.org/en/news/press-release/2022/03/10/two-thirds-of-households-with-children-have-lost-income-during-pandemic
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