Social Opportunity versus Urban Bias Pre-financing Community Health-care in Rural Congo
Background paper to the ERD 2010
Hervé Mamboueni-Mboumba, University of Florence, Italy
Paper prepared in the framework of the European Report on Development 2010.
Purpose: this paper studies the feasibility of a participatory approach in providing health-care services. It focuses on a concrete case study in rural Congo – Brazzaville (the village Moubangou, district of Kimongo). It assesses the real possibilities for rural households to participate in this scheme by analysing what determines whether, and, if so, how, they become eligible for (pre-) financing health-care. The scheme can be figured as a triangle in which government, local populations and NGOs are involved in improving the local/national health conditions of the population.
Methodology: data are from the Recensement Général de la Population et de l’Habitat (2007), Enquête Congolaise auprès des Ménages (2005) and from other fonts to describe the health situation in the country. Original data are from a recent questionnaire in an empirical perspective. The questionnaire is completed and qualitatively supported by different focus groups. An experimental approach is applied in order to estimate formally the key determinants on the probability of acting collectively to solve questions related to health-care in the rural context.
Findings: By considering social opportunities as arrangements that society makes in terms of education, health-care, etc., which greatly affect an individual’s ability to improve his or her condition (Sen: 2004), the variations (rural versus urban) in sub-Saharan Africa (SSA) emphasise the gap between social and economic achievements. In this way, the paper tries to capitalise on the recent findings concerning the debate in order to elaborate a conceptual framework. The latter is needed to set an appropriate strategy for improving the health-care system, in which externalities, such as external shocks, are particularly important. With colonialism, in particular after 1987, Health Management in Congo developed a system in which medical expenses are supported individually. This approach is not always favourable to vulnerable rural populations because it does not facilitate access to basic health. It does not allow the risks to be shared between ill and healthy people. The high costs for hospitalisation or for the treatment of a serious illness, the nature of diseases in correlation with their social and economic background, the instability of income in rural area and many other reasons suggest a collective coverage of health expenditures. The advantages of this approach are the followings: a risk-sharing approach and a preventive approach (by pre- financing). Both aspects imply an improvement in terms of equality in access to health-care, encouragement to the providers to improve the quality and efficiency of care services, the involvement of the local population in the strategic management of the structure without excluding the government in its principal directives. The result is similar to a triangle in which local populations, NGOs and government play together for the same purpose.
Social implications: findings bear implications on how rural communities should convey their energies in order to face the crucial question of health. They also imply, for international donors, the question of how to assist both local and disadvantaged communities best.
Originality: papers concerning the determinants of health in rural areas generally consider the actual role, but not the potential building capacities of the farmers. The original view in this paper is the personal author experience.