In cash-poor households, even modest out-of-pocket costs for health consultations may constitute a barrier to promptly accessing primary health care in the DRC. Local communities are often alienated from the health system and increasingly assume that organizing health care services is solely the responsibility of the ministry of health or international NGOs. However, quality universal primary health care cannot be achieved in Congo without healthcare consumers taking more ownership of the financing and accountability of their health care system.
Health care cooperatives or community health endowments (CHEs) address some of these difficulties. Prepayment options allow members to pay when cash is available and access health care as needed. Group plans balance risks among many members of the community. Fee reductions for cooperative members make it easier for households to get the necessary cash together when an illness occurs.