EXECUTIVE SUMMARY
This study aims at sorting out the weak adhesion determiners
of households from the health association at Murhesa in the Rural of the
transversal descriptive sort has been carried out during the period from
January to October 2012 with a sample of 113 members from MUSAMU. Accurate
researches have been made about third study on the basis of the following
questionnaires:
What are determiners related to the weak adhesion of
households at the health mutual association of Murhesa?
- What are the sociocultural and demography determiners which
are the root causes of the weak adhesion of households to the health mutual
association?
- What are the economic determiners which influence the
household's weak adhesion to the health mutual association?
- What are the mutual and health institution which determine
the households weak and adhesion the health mutual association of Murhesa?
Our research hypotheses state the following:
ü The households' socio-cultural and demography
determiners such as, education level, ethnic ,religion, cultural beliefs , the
households irresponsible's profession, therapeutic uses, community health
leaders perception, matrimonial status, might determine the households' weak
adhesion to the health mutual association
ü The economic determiners such as households' financial
capacity, composition of the family, households' purchasing capacity, lack of
support, adhesion fees, contribution, and the involvement of the Government in
the organization of the health association might determine the health weak
adhesion to the health association.
ü The mutual and health institution determiners such as
the quality of the treatment , the population trust towards the competences of
the health treatment providers, the geographic proximity of the health care
centers which are agreed upon or partners the choice of the health structures ,
affiliation modalities and the services provided to the members ,the
contribution periodicity, internal rules ,trust in the association, association
principles information and comprehension might favor the households adhesion to
the health association.
The research objectives prior set up for this study have
been:
Entirely, this study focuses on the identification of
determiners the weak adhesion to the MUSAMU.
And specially;
· Determine the sociocultural and demography determiners
which lead to the households' weak adhesion to the health association of
Murhesa
· Determine the economic which hinder the capacity of
households' massive adhesion to the health association
· Be aware of the health mutual and health institution
determiners which influence the household's weak adhesion to the health
association of Murhesa
Closed questionnaire was submitted to 113 members from the
health association .This technique might help ask questions to interviewees who
freely answered them orally or written.
- Active observation
It has helped to observe the behavior of the health
association members (direct health treatments beneficiaries) on one land and on
the other hand the nursery staff (health services providers).
- Documentary analysis
The documentary riding has been carried out at the register
books from the members' adhesion to the association, protocols, follow up from
of the health association members, their affiliation cards, and Receipt pass-
books of members.
The registrars have allowed us exactly to have the picture of
the number of the health association members according to their origins, sex
and age, dependents, health centers which have signed agreements of
reimbursement of the health treatments bills with MUSAMU for the profit of its
members.
We have also read difference books, articles, report,
dissertation, internet webs etc dealing with the thematic aspects of our
study.
- Interaction
Has consisted in interaction with some members from Murhesa
community about the collaboration between the health association and FOSA
conventions one other hand. Our hypotheses have brought light on certain
result figures:
§ The results in relation to the sociocultural and
demography the low household membership to the mutual health Murhesa
The population from Murhesa hard appreciates the adhesion of
the table of the health association which has already lasted for 5 years. With
reference to the table 3 giving the progress the members' adhesion, we notice
directly that only 2451 members have been registered in 2012, form 350
households which give 8% of the population estimated of 27.777 inhabitants of
Murhesa health zone.
Self - health care is one of the causes of the weak adhesion ,
gives 27,9% before collecting the health treatment ticket, students are
represented by 8,8% whereas protestants constitute a portion of members with a
less score of 19,5%. The analysis of the table 2 indicate a low rate of the
health association penetration in the public selected area of 2008 was 3%, 2009
around 4%.In 2010, this rate was increased to 3,9% against 8,3% made of
members' in 2011.In April 2012,the health association of Murhesa had an
adhesion rate of around 8,4%( which gives a progress of 0,1%).It is noticed
that adhesion rate progresses very slowly comparatively to the population
number and in addition this adhesion progress is not support thought the health
services are regularly used by the health association members of Murhesa.
§ In view of the economic determinants of low
participation of households in the mutual health Murhesa
Firstly, a large consensus between the different researches is
sorted out concerning two major determinant adhesions. On one hand, it is clear
their contribution capacity and affects the households adhesion among 50% per
month whereas the household members of financial resources remains the major
reason given by the households to explain their non participation to the health
association (and this concerns alls the Ares under our study).In a known way
and priori contradiction, the amount of adhesion money and /or contribution is
exact and a bit easy to get at 28, 6% and 16,8%. The contraction, never the
less, is not apparent as the majority of members concerned with the
contribution amount are assessed exact and acceptable with regards to the
health services to which these contributions give right. For these issues, the
adherers and as well as non adherers think that general the contributions are
not very considerable, particular in terms of their knowledge about the cost
bills which might the imposed to them by the health care centers out of the
health association concerns .However, it is worth mention that in many
households members, or some members of the households, the effective payment of
the contributions is assessed hard to get.
§ As determinants related to mutual health and health
institutions of the poor adhesion of households to mutual health Murhesa
Determiners related to the health treatments and collaboration
with the health treatment providers constitutes as well important determiners
to the health association adhesion. First of all bad health treatments
provided( with regards the patients' can gives 34,2%, prescription and
availability of medicine 16,2% ,and the treatment efficiency and in timely
manner influence weakly the adhesion).In addition, the population's skepticism
towards the health staff's skills increases their lack of trust in the latter
and therefore scores 86,7%. Furthermore, the doubts related to the
organization capacity improvement of the treatment quality also contribute to
the non affiliation. The reasons for the lack of trust of 31% in the
association may also originate from the previous negative backgrounds, or
misstatement suspicion, embezzling of the members, funds by their
representatives.
Secondly, other determiners ,through not offer noticed ,also
to play a signification role in the adhesion dynamics, First of all, the
obligation to give all the fees once leads to the discouragement of the
households, gives 50%.In the contrary, the fact of taking into consideration
income bills stimulate adhere very considerable number of the population to
adhere at ( 41,6%) which given forth the harvest season and the students
holidays generally in the months of July and September in Murhesa DR Congo.
Moreover , it often happens that only few households members
adhere effectively .This seems to incite that the entire and obligatory adhere
of the whole family is considerate as non reasonable as per the financial
aspect .In the contrary ,households generally prefer individuals payment with
differents costs for children and adults . As for the services provided by the
association, generally they are fixed in accordance with the concerned
population of 58, 9% with regard to the amount of money they are able to give
.Therefore, and they are generally satisfied of it.
The adhesion decision may also be linked to characteristics
which are very individual: education influence, a high level guaranteeing a
high open mind to the innovation that make the medical assurance and an
outstanding understanding of the association system and as well as advantages
it offers, which is contrary at Murhesa for the teachers (14%) and students
could be expected to use their intellectual abilities to help illiterate people
understand the system quit well. Likewise, ethnic origin and religion may also
have influence .But, it is possible that these parameters may truly be minor
and may be associated to high decisive factors such as the income level or
religious relation/affiliation of the health association initiative
organizations. It is the reason why catholic Christians represent 78% for this
study.
§ In terms of suggestions and recommendations :
- We solicits the involvement of all stakeholders those
responsibility. Find the involvement of community leaders for the development
of mutual health and create a Mobil team to regularize the sensitive for the
community
- Install relay bases under the Mutual Health ZSR
Miti-Murhesa, develop and strengthen the awareness of students in their
academic to join the Musamu Spread the message of membership in all schools and
churches Miti-Murhesa without discrimination.
- Advocacy for funding and construction of the community
center. If the inclusion of a new service can attract new members, the
exclusion of a benefit may exclude certain members of the mutual
- Managers of households, better then use the services of
their availability by joining heavily and acquire the services offered by the
health insurance scheme, get involved in the collaboration between Musamu
responsible for health and well-being of the community, and unite in mutual
solidarity. The gaps are enormous to fill in the health sector in RDC. Les
results of this work is not to frustrate the people and not be limited to
simple scientific publication, intersectional coordination and interpersonal
are a few things to arriving to implement good experiences elsewhere in recues
who solicit countries that the Honorable elected by the people to vote a law
admitting subvention and accompanying measures of mutual health in the DRC
- The mutual Murhesa showing greater flexibility in sampling
and frequency of contributions and the terms of membership would create more
government participation by reducing the dues in the form of taxes or taxes and
value added taxes or VAT.
- Partners: Expected by partners of bilateral and multilateral
agencies, NGOs and other stakeholders. Their role is to complement the
government's vision of ensuring the implementation of policies, mobilize
resources and develop local capacity.
Monitor the performance indicators
Musamu with FOSA. The BCZ Miti-Murhesa BDOM managers of the mutual
Murhesa, implement collaborative consortium agreements with community leaders
and managers of health facilities
- As support BDOM integrates this
activity in the program for the operationalization BCZS and develop a mechanism
for monitoring and verification of the treatment based on Murhesa mutual.
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