Determinants of health care utilization in an African urban environment: Results of a survey in Kinshasa (Congo)

This study analyses the choice determinants of the population for health ce ntres through a survey of the behaviour of families in a representative sam ple of 1000 households in the health districts of Kinshasa, Congo in 1997. For the most recent episode of illness, the respondents turned to seven typ es of care: the health centre (37%), private dispensaries (26.5%), self-med ication through a pharmacy (23.9%), traditional practitioner (21%), traditi onal self-medication (16.9%), private outpatients' clinic (16.7%) and a ref erence hospital (10.4%). Past logistics have shown that patients resort to a health centre rather than another type of care structure (P = 0.05) when looking for quality care, reasonable prices and the availability of varied services. On the other hand, concern about the geographical proximity in re lation to the family's residence calls for using the private dispensary. Wh en looking for a doctor or the existence of a 'convention', families are mo re inclined to choose a private officially recognized outpatients' clinic. Those who had been looking for a solution to a special type of illness opte d primarily for a traditional practitioner. In conclusion, the results of t his study show that if people choose the care offered by health centres, it is because they judge it to be of good quality. The integrated cars offere d by the same technician, with a required training, is a major asset in the acceptability of the first line of primary health care in Kinshasa. This s tudy suggests that it would no doubt be beneficial to integrate non-officia l private care structures into the primary health care system, as far as it is possible for them to achieve a level of quality comparable to that of t he health centres. In order that the traditional practitioner might play an important complementary role in the realization of primary health care, ev en in urban areas, the possibility of promoting sires of communication shou ld be studied. Moreover, considering the weak buying power of the city's in habitants and the previous existence of tontines out of solidarity, the 'co nventions' providing relief of health care costs, under the leadership of t he local communities. should be integrated into the organization of the urb an health system.