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Abstract

RÉSUMÉ
Introduction. En Afrique subsaharienne, les mutuelles de santé sont promues pour améliorer l’accès financier aux soins. Cependant, la couverture formelle n’équivaut pas à une utilisation effective, et les déterminants du recours aux services chez les membres restent mal compris, en particulier dans des contextes de crise comme l’est de la République Démocratique du Congo. Cette étude visait à identifier les facteurs associés à l’utilisation des services de santé par les bénéficiaires des mutuelles dans la ville de Goma. Méthodologie. Il s’agissait d’une enquête transversale analytique menée en mai 2024 auprès de 577 membres de mutuelles de santé, sélectionnés selon un échantillonnage aléatoire stratifié. La collecte des données s’est appuyée sur un questionnaire administré aux participants. L’analyse statistique a été réalisée à l’aide du logiciel SPSS (version 23), et une régression logistique a permis d’identifier les variables associées au recours aux services de santé. Résultats. Le recours aux services de santé concernait 72,8 % des bénéficiaires interrogés. Les facteurs négativement associés à l’utilisation des soins incluent : célibat (OR=0,3), appartenance à une tribu du Sud (OR=0,5), représentation surnaturelle de la maladie (OR=0,4), chômage (OR=0,2), personnel perçu comme non compétent (OR=0,3), expériences de soins négatives (OR=0,3), médicaments disponibles mais de mauvaise qualité (OR=0,2), et paquet de prestations incomplet (OR=0,3). Les facteurs positivement associés sont : temps d’attente court (OR=2), qualité globale jugée satisfaisante (OR=2,3) et ticket modérateur abordable (OR=2,1). Conclusion. L’adhésion à une mutuelle ne garantit pas l’accès aux soins. Notre étude révèle que l’utilisation est fortement modulée par des facteurs socio-culturels, économiques et, surtout, par la perception de la qualité des services. Pour être efficaces, les politiques de couverture santé universelle dans des contextes similaires doivent simultanément renforcer la qualité des soins et mener des actions ciblées pour lever les barrières spécifiques à certains groupes.
ABSTRACT
Introduction. In sub-Saharan Africa, community health insurance schemes are promoted to improve financial access to care. However, formal coverage does not equate to effective utilization, and the determinants of service use among members remain poorly understood, particularly in crisis settings like eastern Democratic Republic of Congo (DRC). This study aimed to identify factors associated with healthcare utilization by insurance beneficiaries in Goma city. Methodology. This was a cross-sectional analytical survey conducted in May 2024 among 577 members of mutual health organisations, selected using stratified random sampling. Data collection was based on a questionnaire administered to participants. Statistical analysis was performed using SPSS software (version 23), and logistic regression was used to identify variables associated with the use of health services. Results. Use of health services concerned 72.8% of beneficiaries surveyed. Factors negatively associated with healthcare use included: being single (OR=0.3), belonging to a southern tribe (OR=0.5), supernatural beliefs about illness (OR=0.4), unemployment (OR=0.2), staff perceived as incompetent (OR=0.3), negative experiences of care (OR=0.3), medicines available but of poor quality (OR=0.2), and incomplete service packages (OR=0.3). The positively associated factors are: short waiting times (OR=2), overall quality deemed satisfactory (OR=2.3) and affordable co-payments (OR=2.1). Conclusion. Enrollment in a health insurance scheme does not guarantee access to care. Our study reveals that utilization is strongly influenced by socio-cultural and economic factors, and most critically, by the perceived quality of services. To be effective, universal health coverage policies in similar settings must simultaneously strengthen the quality of care and implement targeted actions to overcome specific barriers faced by certain groups.

Keywords

Mutual health organisations healthcare utilisation Access to care Associated factors Goma Mutuelles utilisation des services de santé Accès aux soins Facteurs associés Goma

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Justin Murhabazi Ntabiruba, Célestin Kimanuka Ruriho, Zacharie Tsongo Kibendelwa, Amani Kabesha Théophile, John Inipavudu Baelani, Wenceslas Barijoro birikunjira, … Stanis Wembonyama okitosho. (2025). Factors Associated with the Use of Health Services by Beneficiaries of Mutual Health Organisations in Goma, Democratic Republic of Congo : Facteurs Associés à l’Utilisation des Services de Santé par les Bénéficiaires des Mutuelles de Santé à Goma, République Démocratique du Congo . HEALTH SCIENCES AND DISEASE, 27(1). https://doi.org/10.5281/zenodo.18000703
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