Overview

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.

Our Approach

ASSP seeks to improve access to primary health care through the implementation of a Community Health Endowment (CHE) strategy. CHEs reduce the out-of-pocket costs that households have to pay at the time of health service through a cooperative-type model. ASSP forms simple locally-managed health care cooperatives that give member households access to basic health center services at preferential rates in exchange for modest pre-paid subscriptions. Specific objectives of this strategy for ASSP include:

  • Increasing demand for and access to routine health center services by reducing out-of-pocket costs for member households.
  • Increasing net revenue for local health centers.
  • Strengthening the sense of ownership of and loyalty to the local health center in community groups.
  • Reinforcing the health zone’s ability to build strong, sustainable partnerships between health service clinics and the communities they serve.

Key Achievements

  • Health centers with the highest participation rates are currently adding $800 to $950 per year to local revenues.
  • Where individuals have been reluctant to pass subscriptions through a cooperative group, health center workers and subscribers have adapted the program to allow individual households to join the plan by subscribing directly at the health center.