Thanks to the ASSP project, mothers and children have access to affordable health care in the Democratic Republic of Congo. (Photo by IMA World Health staff)
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erched on the southern banks of the Ubangi and Uele rivers at the border of the Central African Republic lies the town of Yakoma. At the main general hospital, Hôpital Général de Référence de Yakoma, the Access to Primary Health Care project, known locally as ASSP, has made a difference that is reflective of the change that has occurred throughout the health zones where ASSP is working in the Democratic Republic of Congo.

“Before ASSP, the population could not afford to pay for health care,” said Alexis Vungbo, the general administrator at the Yakoma Hospital. “It was simply too expensive.”

A team of IMA analysts recently looked at the financial performance of the Yakoma Hospital in the Yakoma Health Zone in the province of Nord-Ubangi, which has one of the lowest rate of health indicators in all of the ASSP project’s provinces. At the beginning of the ASSP project in 2012, when a woman gave birth by cesarean section, she would expect to receive a hospital bill of 100,000 Congolese Francs (about $100). Very few people can afford to pay such a high price.

Families receive care in the pediatrics ward in January 2018. Hôpital Général de Référence de Yakoma is in a community of 102,244 people. (IMA World Health photo)

As a result, many women may have only one choice—to give birth at home without medical help. Many patients could not pay their hospital bills, running away in the middle of the night. Tragically, the cases of patients disappearing from the hospital were not the exception.

Before ASSP and Tosalisana, families couldn't afford primary health care. Today, the pediatrics ward at the Yakoma hospital is full of women and children.
Today, the price of health care services in Yakoma is more affordable and health workers are earning more.
By establishing the health cooperative to supplement support from ASSP, the community was able to manage its own funds and be in control of its own budget.

To supplement the support received from the ASSP project, the community of Yakoma created a health cooperative that they named Tosalisana, which means “let’s help ourselves” in Lingala, the local language. These two entities have given the community better access to health care. The price of medical services dropped and became more affordable. For instance, the cost of a C-section is now about $10 and a regular birth is about $3.30.

For a fee of 3,000 Congolese Francs (about $2) per person for an annual membership in the cooperative, patients saw their medical bills reduced by 40 percent of the original bill. The cooperative covers the balance of 60 percent.

“When I wasn’t in the cooperative, it was too expensive to pay the hospital bill. Now, if my child is sick, I go right to the health center without hesitating because the cooperative has reduced price of the hospital bill.”

— Angel Yatongba, a mother of four residing in Yakoma in the Democratic Republic of Congo

“With the establishment of Tosalisana, we have had a tremendous increase in the number of patients visiting the hospital,” Vungbo noted. “Before the health cooperative was established, the health center Cité received 158 new patients per month with a monthly revenue of $267,” Vungbo explained. “Now with the strength of the health cooperative combined with the support of ASSP, the health center currently welcomes about 500 new patients per month and makes about $485.”

The health cooperative has also benefited the medical staff. “Before ASSP, we were earning $82 per month. But now, a nurse can earn $182,” said an assistant head nurse at the health center Mission.

Tosalisana got off to a slow start due to Yakoma’s painful history with the previous organization that handled all of the hospital’s finances. That organization went bankrupt and suddenly disappeared in 2012. Many people in Yakoma lost the money they had contributed to that organization, which had partially functioned as a health cooperative. So, three years later when the new cooperative started its outreach activities in the health zone, the community was wary. Their reaction was, “What?! You’re back?!!”

Though, once the population began to see the benefits of the new cooperative, they again became interested in contributing. Patients began lining up for the consultations, medication and surgeries that they had not been able to afford in the past.

Located in an impoverished community of 102,244 inhabitants, the cooperative continues to gain membership. As of 2017, it had 5,151 members, already 50 percent of the necessary membership to operate at maximum efficiency.

In the past, all financial activities of the hospital were controlled by an external organization. Now, the hospital has taken charge of its operating expenses.

“This is an important aspect of the ASSP project,” said IMA Economist Alexandre Manunga. “It allows the health structure to manage its own funds and be in control of its own budget.” With an increase in patients, the steady income flow enables the hospital to plan for and efficiently manage their revenue and expenses accordingly. To further reinforce its financial health, an accounting system was recently installed at the hospital.

Overall, the financial performance of Yakoma’s hospital has been positive. Manunga concurred. “For a remote hospital in Northern Congo that has never managed its own finances,” he said. “These results are extremely encouraging.”

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