Central African Countries Research Articles

Educational Migrants, ICTs and Socio-Spatial Relationships: Establishing Presence from a Distance

Previous research on transnational migration and information and communication technologies (ICTs) demonstrated how ICTs shape transnational social relationships. What remains less explored is how ICTs shape spatial dimensions of such relationships. Also, international educational migrants constitute a substantial part of transnational migration flow, yet their everyday lives are not well studied. Building upon material semiotic scholarship, we examine how ICTs shape socio-spatial dimensions of transnational relationships in the lives of educational migrants, and the impacts that such relationships have on their everyday lives. This research is based on the empirical exploration of 21 in-depth interviews with educational migrants who came from Central Asian and African countries to the Netherlands. We show that spatial relationships, such as co-presence and distance, are not naturally ‘given’ but are instead enacted in heterogeneous communication practices of educational migrants, and these relationships produce both enabling and constraining effects on their everyday lives.

Future drought risk in Africa: Integrating vulnerability, climate change, and population growth

Drought risk refers to the potential losses from hazard imposed by a drought event, and it is generally characterized as a function of vulnerability, hazard, and exposure. In this study, drought risk is assessed at a national level across Africa, and the impacts of climate change, population growth, and socioeconomic vulnerabilities on drought risk are investigated. A rigorous framework is implemented to quantify drought vulnerability considering various sectors including economy, energy and infrastructure, health, land use, society, and water resources. Multi-model and multi-scenario analyses are employed to quantify drought hazard using an ensemble of 10 regional climate models and a multi-scalar drought index. Drought risk is then assessed in each country for 2 climate emission pathways (RCP4.5 and RCP8.5), 3 population scenarios, and 3 vulnerability scenarios during three future periods between 2010 and 2100. Drought risk ratio is quantified, and the role of each component (i.e. hazard, vulnerability, and exposure) is identified, and the associated uncertainties are also characterized. Results show that drought risk is expected to increase in future across Africa with varied rates for different models and scenarios. Although northern African countries indicate aggravating drought hazard, drought risk ratio is found to be highest in central African countries as a consequent of vulnerability and population rise in that region. Results indicate that if no climate change adaptation is implemented, unprecedented drought hazard and risk will occur decades earlier. In addition, controlling population growth is found to be imperative for mitigating drought risk in Africa (even more effective than climate change mitigation), as it improves socioeconomic vulnerability and reduces potential exposure to drought.

Neglected Tropical Diseases in the Central African Region: A Review of their Mass Treatment Coverage

Background: The neglected tropical diseases (NTDs) are the most common conditions affecting the poorest 600 million people living in sub-Saharan Africa (SSA) of which the Central African region is part and parcel, and together produce a burden of disease that may be equivalent to one-half of SSA’s malaria disease burden and more than double that caused by tuberculosis. Establishing specific information on the mass treatment coverage would provide a basis for prioritizing control strategies as a means to address the Sustainable Development Goals (SDGs). The objective of this review was to determine the mass treatment coverage trend resulting from 5 NTDs amenable to mass treatment in the Central African region. Methods: A search on PubMed, ScienceDirect, Uniting to Combat NTDs, Cochrane Library, African Journals Online, MEDLINE, Scopus and Google Scholar with the following Keywords: “Neglected Tropical Diseases”, “Mass Treatment Coverage”, “Control”, “Elimination”, “Lymphatic filariasis”, “Onchocerciasis”, “Schistosomiasis”, “Soil-transmitted helminthiases”, “Trachoma was conducted, with the Medical Subject Headings (MeSH), with specific diseases listed as 5 NTDs amenable to mass treatment per Central Africa region country. Studies to assess the mass treatment coverage resulting from 5 NTDs amenable to treatment in Central Africa as the primary outcome variable, were included. Our search was limited to, articles published from the year 2013 to 2018 (A 5 years review) in English and French. The search identified a total of 140 articles amongst which 10 data-based reports and 5 original articles met the inclusion criteria to give a total of 15 papers that were considered. Results: Our review shows that, in the Central African region, Cameroon has the highest mass treatment coverage index (58/100) for 5 NTDs while Rwanda, Gabon, Equatorial Guinea, Sao Tome and Principe had mass treatment coverage indexes of 3/100, 1/100, 0/100, 0/100 respectively indicating the need for coordinated action in filling the missing gaps. Also, in the Central African region; over 66 million people received NTD treatment and those who didn’t receive NTD treatment were over 27 million. Conclusion: There is a need for more data on progress made in reaching people in need of NTD Mass treatment. The way forward paradigm in achieving the control and elimination of NTDs amenable to mass treatment in Central African countries will be to establish, and sustain a task force on NTDs at the African Union, set up a sustainable fund for neglected tropical diseases at the Africa Union, Regularly monitor and report on progress on neglected tropical diseases while recognizing and celebrating countries as they achieve elimination goals. Equally, operational studies on assessing the rate and impact of NTDs mass treatment coverage in the Central African region should be carried out.

Differential Impacts of Institutional Matrix Dimensions on Structural Transformation in Sub-Saharan African Countries

Inégalités de revenu et croissance économique : vérification empirique sur un panel de pays de la Communauté Economique et Monétaire d’Afrique Centrale(CEMAC) Dr Nkouka Safoulanitou Léonard Abstract This study analyzed the link between economic growth and income inequality in Central African countries by integrating the geographic dimension (the contribution of the fixed exchange rate to the dynamics of economic growth and income inequality). Our results showed that economic growth in Central African and other developing countries in our sample is influenced by lagged GDP per capita, income inequality, political stability, infant mortality, public consumption. For its part, income inequalities are explained by the delayed gini index, GDP per capita. The membership of the Central African countries in the franc zone, also explains significantly and positively on the economic growth and negatively on the inequalities of income. This specificity for these countries allows us to point out that economic growth is a necessary condition but must be accompanied by the implementation of a policy to reduce inequalities. The promotion of good governance and the strategy of economic diversification also appear essential for making economic growth sustainable and inclusive. Full Text: PDF DOI: 10.15640/jeds.v7n2a9

African Countries in the Epoch of Information Globalization: New Challenges in the New Age

The article is devoted to the problem of ensuring security of North and Central African countries in the age of informational globalization. Today there is a new up-and-coming social and economic order based on telecommunications. The central place in this new system of public relations belongs to information and communication technologies. One can observe the situation when the creation of the knowledge-based economy is turning into the main strategic priority of the policy of every country, which considers ICT as an effective tool, which can ensure a sustainable social and economic growth. But at the same time, it is necessary to keep in mind that information technologies, when used effectively, are able to destroy existing orders, to overthrow political regimes that used to be rather stable and influential. Based on case studies of North African countries, authors show key instruments that have been used in those countries in order to manage public opinion. Among those instruments authors highlight: 1) aiming for bad expectations which entails the notion of an impending disaster and mass depression; 2) substitution of definitions which supposes that in order to create positive images of the opposition that resist the governmental forces, Western mass media calls militants and terrorists “rebels”; 3) implementation of mass dissatisfaction which means the situation when popular bloggers or representatives of opposition movements begin to promote the dissatisfaction of legal power; 4) use of biased materials. In this way, authors conclude that the effective resistance in the information warfare strictly depends on the presence of a national idea on the one hand and on the level of the informational culture of the society on the other. The last point seems to be the key element that can guarantee the survival of the State, especially if it pretends to pursue self-reliant political line based on its national interests and cultural values.

Institutions and the Economic Performance of Central African Countries

The purpose of this paper is to examine the combined effect of political and economic institutions on the economic performance of the countries of Central Africa. To do this, we use dynamic panel data over the period 1996-2013. Using Principal Component Analysis (PCA) to understand the multidimensionality of institutions through a composite indicator, and applying the estimation technique based on the Generalized Moment Method (GAM) to capture the impact of institutions on economic performance, we arrive at the following result: analyzed individually or in combination, institutions constitute a real obstacle to economic performance in Central Africa.

Antimicrobial Resistance in the Central African Region: A Review

Background: The impact of antimicrobial resistance (AMR) has placed it among one of the top public health problems worldwide. AMR has increased the global infectious disease burden and put a greater strain on health systems. This review sought to contribute more evidence on this issue of AMR in the Central African Region, by determining the overall bacterial pathogens resistance rate and pathogen specific resistance rate with respect to antimicrobial agents common in the region. Methods: Pubmed and other relevant databases were searched using the Boolean strategy. We reviewed articles from 2008 to 2018 and in accordance with an adapted PRISMA guideline. Article retrieval and screening were done using a structured search inclusion/exclusion criteria. Median and interquartile ranges of percentage resistance were calculated for each antibiotic-bacterium combination. Results: Limited AMR data was available for Central African countries with no reported data for Burundi. A total of 30 articles were included in the final analysis. The most commonly reported bacterium was Salmonella spp that has been reported from 16 studies with median resistance rate of 45.5 (IQR 9.1-81.0). It was also observed that bacterium Staphylococcus aureus had the highest resistance rate with a median resistance of 90 (IQR 86.4-95.2). In general, median resistance rate higher above 50% were observed for the following bacteria; Staphylococcus aureus, Shigella spp, Klebsiella spp, Enterococci, E. Coli and Acinetobacter spp. Conclusion: The review highlights two important findings: first, there is a huge gap of data regarding Antimicrobial resistance in the Central African Region. Second, a high level of drug resistance exists for commonly prescribed Antimicrobial drugs in the Central African region. We recommend the standardization and quality of microbiological identification and susceptibility/resistance testing methods as well as surveillance of AMR to be improved to allow national and international organizations, to monitor the extent of the AMR problem. All of the identified areas of concern need urgent attention by the global health community in order to halt the public health threat associated with spreading AMR.

Evaluation and projected changes in daily rainfall characteristics over Central Africa based on a multi-model ensemble mean of CMIP5 simulations

This study uses daily rainfall data from 20 global climate models (GCMs) simulations, participating in the phase 5 of the Coupled Model Intercomparison Project (CMIP5) and eight daily rainfall indices defined by the Expert Team on Climate Change Detection and Indices (ETCCDI), to investigate the changes in extreme weather conditions over Central Africa under the representative concentration pathway 8.5. The performance of the multi-model ensemble (MME) mean which in fact refers to the best performing models selected through the Taylor diagram analysis was evaluated by comparing with two gridded daily observation datasets during the historical period (1998–2005). Results show that although some uncertainties may exist between the gridded observation datasets, MME consistently outperform individual models and reasonably reproduced the observed pattern of daily rainfall indices over the region, except in the case of consecutive wet day (CWD) where the high variability of individual members has resulted in the degradation of the overall skill of the MME. The assessment of the climate change signal in the eight daily rainfall indices was done for the mid and late twenty-first century (2026–2056 and 2066–2095 respectively), relative to the baseline historical time period (1976–2005). We found a significant increase in the total wet day rainfall amount (PRCPTOT) over southern (northern) Central Africa from December to February (from September to November). This is mainly due to the increase of high intense rainfall events rather than their frequency. The results also reveal that the increase in PRCPTOT was coupled with increase in the maximum consecutive 5-day rainfall amount (RX5DAY), the 95th percentile (R95), and the total wet day rainfall amount above the 95th percentile (R95PTOT), with more robust patterns of change at the late twenty-first century. The increase in extreme rainfall events (RX5DAY, R95, and R95PTOT) is likely to increase flood risks over Cameroon, Central African Republic, Gabon, Congo, Angola, Zambia, and Democratic Republic of Congo. On the other hand, changes in CWD and PRCPTOT are projected to significantly decrease over Angola, Zambia, and Democratic Republic of Congo from September to November. This is due to a substantial increase of zonal moisture divergence fluxes in upper atmospheric layers. The analysis has also shown that areas where CWD and PRCPTOT decreases coincides with those where consecutive dry days (CDD) increase. The decrease in CWD and PRCPTOT coupled with the increase in CDD could worsen drought risk and significantly disrupt priority socio-economic sectors for development such as rain-fed agriculture, hydroelectric power generation, and water resource availability. The results thus underline the importance for decision-makers to seriously consider adaptation and mitigation measures, in order to limit the risks of natural disasters such as severe droughts and floods that Central African countries may suffer in the future.

Intra-Regional Exchanges and Economic Growth in Central African Economic and Monetary Community Countries (CAEMC)

Intra-Regional Exchanges and Economic Growth in Central African Economic and Monetary Community Countries (CAEMC)

Hepatitis C virus genotypes in hemodialysis patients in Angola.

To our knowledge, there are no published data on hepatitis C virus (HCV) genotypes in Angola. This study aimed at assessing the distribution of HCV genotypes in seropositive hemodialysis patients in Luanda. Among 51 HCV-positive subjects included, viremia was detected in 27 (53%). HCV genotyping was performed by bidirectional sequencing of the 5'-untranslated region by the Sanger method. HCV genotype 4 was largely predominant (20 cases; 74%), followed by genotypes 1b (5 cases; 18.5%), 1a and 2 (one case each; 3.7%). These results suggest that the distribution of HCV genotypes in Angola is similar to that reported from other Central African countries.

Response of Selected Maize Inbred Germplasm to Maize Lethal Necrosis Disease and Its Causative Viruses (Sugarcane Mosaic Virus and Maize Chlorotic Mottle Virus) in Kenya

Background: Maize lethal necrosis (MLN) disease continues to reduce the productivity of maize drastically threatening food security in the affected regions. It continues to cause yield loss of 30–100 percent in farmers’ fields, depending on the time of infestation which is valued at $198 million in Kenya. This has not only threatened regional trade, but also seed industry. It has been reported in the major maize belts of Uasin Gishu, Trans-Nzoia, Bomet, Narok and Nandi Counties. MLN is caused by the synergistic interaction between Sugarcane Mosaic Virus (SCMV) and Maize Chlorotic Mottle Virus (MCMV). The disease has then spread to other Eastern and Central African countries with devastating food security and economic consequences. Objectives: This study highlights result after screening selected maize inbred lines for resistance to MLN, SCMV and MCMV in identifying promising lines for integration into the breeding program for MLN resistance. Methods: Sixty-five (65) maize genotypes were artificially inoculated using virus strains collected from Bomet County in Kenya at 3-4 leaf stage. Data on disease severity and incidence, AUDPC and flowering were recorded. Results: From the result, the inbred lines had significant differences for SCMV, MCMV and MLN reactions. Based on Area Under Disease Progress Curve (AUDPC) score and ELISA analysis, genotypes MLN001 and MLN006 have the lowest score of 270, whereas OH28 had a maximum at 1259 under MCMV. Genotypes MLN042 and MLN041 were identified as the most promising sources of resistant against SCMV. However, no genotype was identified to have acceptable levels of tolerance to MLN, but MLN001 and MLN013 were identified as the best performers under MLN. This study also validated the presence of MLN tolerance in MLN013 (CKDHL120312) and MLN001 (CKDHL120918) as earlier reported by CIMMYT. These tolerant genotypes are now serving as donors in the introgression of the tolerance into the Kenyan adapted maize backgrounds and development of improved MLN tolerant varieties. This will go a long way in restoring and ensuring sustainable maize productivity in improving the livelihoods of the smallholder farmers who form 75% of the major maize producers in Kenya. Conclusion: The identified inbred lines would be recommended for use in varietal development, MLN management and to enhance maize productivity, in the MLN endemic regions and further research in understanding the mode of gene action for MLN tolerance.

Climate change, famine, and low-income communities challenge Sustainable Development Goals

Climate change, famine, and low-income communities challenge Sustainable Development Goals

Evaluation of nutrients and anti- nutrient properties of traditionally prepared treculia africana decne (bread fruit diet and toasted seeds)

Protein deficiency affects more than 170 million pre-school children and nursing mothers in developing countries creating a need for a strategy to improve the nutritional status of their diet through supplementation with plant proteins. The nutritional value of Treculia africana (African Breadfruit) has been extensively studied under laboratory conditions. Although the Breadfruit tree grows wildly in some West and Central African countries, and its seeds eaten in various forms by the populace, there has not been an attempt to evaluate its nutritive value as prepared at the home level. The goal of this study was, therefore, to evaluate the nutritive value of the seeds as indigenously prepared by the general populace in order to determine the suitability of its use as a good complementary diet. The raw seeds purchased in the Ikenne local government area (LGA) of Ogun State, Nigeria were subjected to cooking and toasting methods (using firewood) as practiced in the area. A proximate analysis was performed on the three samples (Raw, Cooked and Toasted) in order to evaluate the composition and some anti-nutritional factors of the Breadfruit seeds. Results showed that the cooked and toasted samples had better nutritive values as compared with the raw seeds; the mean % protein content of the raw, cooked and toasted samples were 16.32±0.09, 18.25 ±0.00 and 17.22±0.04, respectively. Ash content was 1.36±0.057, 1.86±0.042 and 1.83±0.007, respectively, fat was 10.98±0.071, 11.50±0.134 and 13.74±0.233, respectively and crude fiber was 1.25±0.007, 2.13±0.014 and 2.39±0.064, respectively. The tannin level was higher in cooked and toasted seeds than in the raw seeds but was not in toxic amounts (1.19gm, 3.50 and 2.32 in the raw, cooked and toasted seeds, respectively). Phytate levels were generally lower in the cooked and toasted seeds; at 2.85%, 1.99%, and 2.24% for raw, cooked and toasted seeds, respectively. This study showed that the two major modes of preparation of the African Breadfruit seeds retained high levels of nutrients with lower levels of anti-nutrients. The resulting meal/snack will be useful as a good complementary diet for the African child, especially in areas where it grows wildly as it will provide a more viable alternative to the currently known and consumed weaning diets among the rural population. Toasting the African Breadfruit seed will be particularly helpful for working mothers who require ready to eat food as the moisture content was lowered (and by extension the shelf life increased) by this method of processing. Keywords: Toasting, Proximate composition, Anti-nutritional factors, African Breadfruit, Complementary diet

Biomass resources assessment and bioenergy generation for a clean and sustainable development in Cameroon

Cameroon is a central African country located at the bottom of the Gulf of Guinea. It has huge forest resources and over 70% of active population is employed in agriculture, fishery and livestock. Therefore, a lot of residues are generated from activities and most of them are not used for energy purpose. The goal of this paper is threefold: first, quantifying and assessing the energy potential of these residues; second, investigating the corresponding conversion systems; and third, analyzing the importance of biomass as a source of energy and its potential contribution to sustainable development of the country. Four biomass sources are considered in the study: forest residues, agricultural crop residues, animal manure and Municipal Solid Wastes (MSW). The potential of each source is estimated for the base year 2012. Our estimation shows that animal manure and organic fraction of MSW can produce almost 1 km3 of biogas annually. Also, the total potential of electricity generation from all the sources is estimated to be about 67.5 TWh.y−1, representing approximately twelve times the Cameroon's total electric production of 2010; implying that biomass sources could significantly contribute towards meeting the future energy requirement of the country. Depending on the type and quantity of biomass source, desired final energy, environmental impact and economic conditions, the conversion of biomass into energy can be achieved by thermo-chemical and biological conversion systems that are currently at different stages of research, development, demonstration and commercialization.

A comprehensive clinical and genetic study in 127 patients with ID in Kinshasa, DR Congo

Pathogenic variants account for 4 to 41% of patients with intellectual disability (ID) or developmental delay (DD). In Sub-Saharan Africa, the prevalence of ID is thought to be higher, but data in Central Africa are limited to some case reports. In addition, clinical descriptions of some syndromes are not available for this population. This study aimed at providing an estimate for the fraction of ID/DD for which an underlying etiological genetic cause may be elucidated and provide insights into their clinical presentation in special institutions in a Central African country. A total of 127 patients (33 females and 94 males, mean age 10.03 ± 4.68 years), were recruited from six institutions across Kinshasa. A clinical diagnosis was achieved in 44 but molecular confirmation was achieved in 21 of the 22 patients with expected genetic defect (95% clinical sensitivity). Identified diseases included Down syndrome (15%), submicroscopic copy number variants (9%), aminoacylase deficiency (0.8%), Partington syndrome in one patient (0.8%) and his similarly affected brother, X-linked syndromic Mental Retardation type 33 (0.8%), and two conditions without clear underlying molecular genetic etiologies (Oculo-Auriculo-Vertebral and Amniotic Bands Sequence). We have shown that genetic etiologies, similar to those reported in Caucasian subjects, are a common etiologic cause of ID in African patients from Africa. We have confirmed the diagnostic utility of clinical characterization prior to genetic testing. Finally, our clinical descriptions provide insights into the presentation of these genetic diseases in African patients.

Multi-dimensional assessment of drought vulnerability in Africa: 1960–2100

Drought vulnerability is a complex concept that identifies the capacity to cope with drought, and reveals the susceptibility of a system to the adverse impacts of drought. In this study, a multi-dimensional modeling framework is carried out to investigate drought vulnerability at a national level across the African continent. Data from 28 factors in six different components (i.e. economy, energy and infrastructure, health, land use, society, and water resources) are collected for 46 African countries during 1960–2015, and a composite Drought Vulnerability Index (DVI) is calculated for each country. Various analyses are conducted to assess the reliability and accuracy of the proposed DVI, and the index is evaluated against historical observed drought impacts. Then, regression models are fitted to the historical time-series of DVI for each country, and the models are extrapolated for the period of 2020–2100 to provide three future scenarios of DVI projection (low, medium, and high) based on historical variations and trends. Results show that Egypt, Tunisia, and Algeria are the least drought vulnerable countries, and Chad, Niger, and Malawi are the most drought vulnerable countries in Africa. Future DVI projections indicate that the difference between low- and high-vulnerable countries will increase in future, with most of the southern and northern African countries becoming less vulnerable to drought, whereas the majority of central African countries indicate increasing drought vulnerability. The projected DVIs can be utilized for long-term drought risk analysis as well as strategic adaptation planning purposes.

The Government-led initiative for LPG scale-up in Cameroon: Programme development and initial evaluation

In 2016, the government of Cameroon, a central African country heavily reliant on wood fuel for cooking, published a Masterplan for increasing primary use of LPG from 20% to 58% of households by 2035. Developed via a multi-sectoral committee with support from the Global LPG Partnership, the plan envisages a 400 million Euro investment program to 2030, focused on increasing LPG cylinder numbers, key infrastructure, and enhanced regulation. This case study describes the Masterplan process and investment proposals and draws on community studies and stakeholder interviews to identify factors likely to impact on the planned expansion of LPG use.

Spatial assessment of maize physical drought vulnerability in sub-Saharan Africa: Linking drought exposure with crop failure

Crop yields exhibit known responses to droughts. However, quantifying crop drought vulnerability is often not straightforward, because components of vulnerability are not defined in a standardized and spatially comparable quantity in most cases and it must be defined on a fine spatial resolution. This study aims to develop a physical crop drought vulnerability index through linking the drought exposure index (DEI) with the crop sensitivity index (CSI) in sub-Saharan Africa. Two different DEIs were compared. One was derived from the cumulative distribution functions fitted to precipitation and the other from the difference between precipitation and potential evapotranspiration. DEIs were calculated for one, three, six, nine, and twelve-month time scales. Similarly, CSI was calculated by fitting a cumulative distribution function to maize yield simulated using the Environmental Policy Integrated Climate model. Using a power function, curves were fitted to CSI and DEI relations resulting in different shapes explaining the severity of vulnerability. The results indicated that the highest correlation was found between CSI and DEI obtained from the difference between precipitation and potential evapotranspiration in one, three, and six-month time scales. Our findings show that southern African countries and some regions of the Sahelian strip are highly vulnerable to drought due to experiencing more water stress, whereas vulnerability in Central African countries pertains to temperature stresses. The proposed methodology provides complementary information on quantifying different degrees of vulnerabilities and the underlying reasons. The methodology can be applied to different regions and spatial scales.

Study of Ebola Virus Outbreak Dynamics, Impact of Vaccination and Other Preventive Measures on Transmission Control

Ebola virus disease (EVD) is an emerging and remerging zoonosis associated with high fatality rate, mainly caused by the Zaire Ebola virus (ZEBOV) and Sudan Ebola virus (SEBOV) strains. Approximately 20 epidemics of EVD have been documented mainly in Central African countries since 1976. Currently, there are no therapeutics agents and vaccines yet approved for EVD. However, several promising therapeutics and vaccines candidates are actively undergoing various phase of clinical development. This study aims to study the EVD dynamics and evaluate the potential impacts of vaccines and other preventive measures on EVD transmission control and significance of medical intervention on outcome of the disease. An initial branch chain model of EVD dynamics was built based on data obtained from previous study. Different epidemiological scenarios for EVD with impacts of intervention were simulated using Berkeley-Madonna Version 8.3.18 software. Every reduction in the exposure rate of EBV infection by 10% produces two- to five-fold improvement in protection against EVD. Transmission control is optimum when the rate of exposure to EBV infection is reduced below 1%. Optimal control of EVD transmission can be achieved through strategic implementation of successful vaccination programme, and other preventive measures as well as rapid delivery of supportive medical care.

Assessing out-of-pocket expenditures for primary health care: how responsive is the Democratic Republic of Congo health system to providing financial risk protection?

BackgroundThe goal of universal health coverage is challenging for chronically under-resourced health systems. Although household out-of-pocket payments are the most important source of health financing in low-income countries, relatively little is known about the drivers of primary health care expenditure and the predictability of the burden associated with high fee-for-service payments. This study describes out-of-pocket health expenditure and investigates demand- and supply-side drivers of excessive costs in the Democratic Republic of Congo (DRC), a central African country in the midst of a process of reforming its health financing system towards universal health coverage.MethodsA population-based household survey was conducted in four provinces of the DRC in 2014. Data included type, level and utilization of health care services, accessibility to care, patient satisfaction and disaggregated health care expenditure. Multivariate logistic regressions of excessive expenditure for outpatient care using alternative thresholds were performed to explore the incidence and predictors of atypically high expenditure incurred by individuals.ResultsOver 17% (17.5%) of individuals living in sample households reported an illness or injury without being hospitalized. Of 3341 individuals reporting an event in the four-week period prior to the survey, 65.6% sought outpatient care with an average of one visit (SD = 0.0). The overall mean expenditure per visit was US$ 6.7 (SD = 10.4) with 29.4% incurring excessive expenditure. The main predictors of a financial risk burden included utilizing public services offering the complementary benefit package, dissatisfaction with care received, being a member of a large household, expenditure composition, severity of illness, residence and wealth (p < .05). The insured status influenced the expenditure level, with no association with catastrophe. Those who did not seek care when needed reported financial constraints as the major reason for postponing or foregoing care. Wealth-related inequities were found in service and population coverage and in out-of-pocket payment for outpatient care.ConclusionBurdensome expenditure for primary care and its key drivers are of utmost importance. Forthcoming health financing reform agendas must incorporate a strategy for getting data used in the design of financial risk protection. Realizing equitable and efficient access to outpatient care is a vital ingredient for sustainable health systems.