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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
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Director of memory:
Jury:
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MVUDI MATINGU Seraph, Professor and Senior of the
economic management and Faculty of Science, Professor at University KONGO, the
university William BOOTH
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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
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3.3.4. other aspects dregs with paludism 39
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3.3.4.1. place of the care
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39
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3.3.4.2. prescribed drugs
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39
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3.3.4.3. working days lost
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39
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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
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conclusion
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41
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bibliography
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43
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appendix
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50
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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$USD
by household.
3.3.3.2. Expenditure for the laboratory
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This table 24, indicates that 21,6% of the households spend a
sum ranging between 1 000 and 1 000FC for the test of laboratory, 27,0% to us
spent between 1 000 and 1 500FC, 24,3% spent between 1 500 and 2 000FC and
29,7% spent beyond 2 000FC.The average of this expenditure is 1594,59FC is
1,7$USD by household.
3.3.3.3.Expenditure of hospitalization
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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$USD by household.
3.3.3.4.Expenditure of nonhospitalization
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It is deduced from this table 25, 8,1% of the households spend
a sum ranging between 1000 and 1500FC in the event of nonthe hospitalization,
27,0% spent between 500 and 1 000FC, 10,8% spent between 1500 and 2 000FC and
32,4% spent more than 2 000FC.The average of this expenditure is 1560,3FC is
1,7$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$USD by household.These spend include the consultation and the
tests of laboratory.
3.3.3.6.Expenditure of the drugs
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It is deduced from this table 27, that 73,0% of the households
spend a sum between 300 - 1500FC for purchase of the drugs of paludism, 10,8%
spent between 1500 and 3000FC, 16,2% spent between 3000 and 4500 with an
average of 1508,1FC is 1,6$USD by household.
3.3.3.7.Other expenditure
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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$USD by
household.This expenditure includes the expenditure keeps sick, transport.
3.3.3.8.Total expenditure of the care of health for paludism
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The total expenditure of the households for the care of health
is
the sum of all the averages in particular:of consultation laboratory
, control
(the hospitalization , not hospitalization
.
, and the Other monthly expenditure
That is to say:
The total monthly expenditure of the households rises 28
674,27FC is 31,5$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
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II NOTES OF COURSE
1. KUZONDISA MBONGA, Notes of Political Course of Economy
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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.
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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
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September 2007, p.6
7. Problem Human: Health Teaching, EEC-Congo Mission,
booklet V, June 1963, p.3.
8. Annual report, District MBUKU, 2010
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10. Report/ratio on development in the World, To invest in
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11. Report/ratio on health in the World:For a real Change, 1999,
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12. Pressing Roland, Demographic Dictionary.>.>,
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>13. World round of the Funds against paludism, 2009
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