Keywords
private healthcare facilities
urban environment
Bandalungwa
Democratic Republic of the Congo
How to Cite
Abstract
Introduction
The financial viability of healthcare facilities in the Democratic Republic of Congo (DRC) depends heavily on their ability to cover expenses through self-generated revenues. While the private sector plays a vital role in healthcare delivery in urban areas, it remains costly and largely inaccessible to poor households. Due to self-financing constraints, facilities struggle to meet operating costs, often driving price increases that further restrict access. Despite their growing market share, empirical data on their financial sustainability are sparse, highlighting the critical need to assess their profitability.
Purpose
To analyze the financial viability of private, for-profit health care establishments (HCEs) in the Bandalungwa health district.
Methods
This study used a mixed-methods case study design involving 11 HCEs in the Bandalungwa health district of Kinshasa. The study population comprised private, for-profit HCEs operating between January and December 2022. Data were gathered through semi-structured interviews, document reviews, and non-participant observations. Quantitative data were analyzed using descriptive statistics in SPSS 27. Qualitative data were analyzed using a thematic framework matrix in Microsoft Excel to identify primary and secondary operational patterns.
Results
Small enterprises dominated the private, for-profit healthcare landscape in the district (91%). Overall staff stability was low (27.3%), and the majority of HCEs (82%) were managed directly by their owners. Most facilities (82%) successfully covered their operational expenses through self-generated revenue and achieved positive net profits. Direct, out-of-pocket payments from households were the predominant source of funding.
Conclusion
While most private HCEs in Bandalungwa demonstrate financial viability, their reliance on direct fee-for-service payments leaves them highly vulnerable to local economic shocks. This fragile model severely restricts healthcare access for low-income populations, emphasizing the urgent need for universal risk-pooling and alternative financing mechanisms.
References
Adaskou, M., & Hssoune, A. (2021). Determinants of the financial viability of Moroccan microcredit associations: An analysis by panel data. Journal of Academic Research, Article 5642834. https://doi.org/10.5281/ZENODO.5642834
Bihin, J., De Longueville, F., & Linard, C. (2022). Spatial accessibility to health facilities in Sub-Saharan Africa: Comparing existing models with survey-based perceived accessibility. International Journal of Health Geographics, 21(1), Article 18. https://doi.org/10.1186/s12942-022-00318-z
Dijkzeul, D., & Lynch, C. (2006). Supporting local health care in a chronic crisis: Management and financing approaches in the Eastern Democratic Republic of the Congo. National Academies Press.
Fenny, A. P., Kusi, A., Arhinful, D. K., & Asante, F. A. (2016). Factors contributing to low uptake and renewal of health insurance: A qualitative study in Ghana. Global Health Research and Policy, 1(1), Article 18. https://doi.org/10.1186/s41256-016-0018-3
Fina-Lubaki, J.-P., Mudji E’kitiak, J., & Lukanu Ngwala, P. (2024). Primary healthcare training in the Democratic Republic of the Congo. African Journal of Primary Health Care & Family Medicine, 16(1), e1-e3. https://doi.org/10.4102/phcfm.v16i1.4508
Hussien, M., Azage, M., & Bayou, N. B. (2022). Financial viability of a community-based health insurance scheme in two districts of northeast Ethiopia: A mixed methods study. BMC Health Services Research, 22(1), Article 1072. https://doi.org/10.1186/s12913-022-08439-8
Kambamba, D. K. (2013). Formations médicales privées à Kinshasa: Qu’en est-il de leur émergence? (MPRA Paper No. 83169). Munich Personal RePEc Archive. https://mpra.ub.uni-muenchen.de/83169/
Kholi, J., & Wanjiru, R. (2013). Private sector opportunities in developing country healthcare. Proparco. https://www.proparco.fr/en/article/private-sector-opportunities-developing-country-healthcare
Macha, J., Kuwawenaruwa, A., Makawia, S., Mtei, G., & Borghi, J. (2014). Determinants of community health fund membership in Tanzania: A mixed methods analysis. BMC Health Services Research, 14(1), Article 538. https://doi.org/10.1186/s12913-014-0538-9
Nyamugira, A. B., Richter, A., Furaha, G., & Flessa, S. (2022). Towards the achievement of universal health coverage in the Democratic Republic of Congo: Does the country walk its talk? BMC Health Services Research, 22(1), Article 860. https://doi.org/10.1186/s12913-022-08228-3
Onder, O., Cook, W., & Kristal, M. (2022). Does quality help the financial viability of hospitals? A data envelopment analysis approach. Socio-Economic Planning Sciences, 79, Article 101105. https://doi.org/10.1016/j.seps.2021.101105
Organisation mondiale de la santé. (1994). Crise de la santé en milieu urbain: Les stratégies de la santé pour tous face à une urbanisation galopante (Rapport des discussions techniques de la quarante-quatrième Assemblée mondiale de la santé). OMS.
Pradhan, M., Waghmare, K. T., Alghabshi, R., Almahdouri, F., Al Sawafi, K. M., M, I., Alhadhramy, A. M., & AlYaqoubi, E. R. (2024). Exploring the economic aspects of hospitals: A comprehensive examination of relevant factors. Cureus, 16(2), e54867. https://doi.org/10.7759/cureus.54867
Ru Gan, C. C., & Kim, H. (2025). Bridging environmental impact and patient outcomes; Comment on "A review of the applicability of current green practices in healthcare facilities". International Journal of Health Policy and Management, 14(1), 1-3. https://doi.org/10.34172/ijhpm.9138
Shapira, G., Clarke-Deelder, E., Booto, B. M., Samaha, H., Fritsche, G. B., Muvudi, M., Baabo, D., Antwisi, D., Ramanana, D., Benami, S., & Fink, G. (2023). Impacts of performance-based financing on health system performance: Evidence from the Democratic Republic of Congo. BMC Medicine, 21(1), Article 381. https://doi.org/10.1186/s12916-023-03062-8
Traoré, S. (2024). Mesures d’accessibilité géographique aux soins de santé dans le district sanitaire de Bougouni au Mali. Revue Internationale de Géomatique, 33(1), 167-182. https://doi.org/10.32604/rig.2024.052696
World Health Organization. (2010). The world health report: Health systems financing: The path to universal coverage. World Health Organization.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright (c) 2026 Ngambue, I. S., Mafuta, M. E., Atila, M. N., Ndelela, N. S.