Orapuh Journal | Journal of Oral & Public Health
Effects of free maternity care on beneficiary satisfaction: Multicentre study conducted in the Binza Météo Health Zone, Kinshasa, Democratic Republic of the Congo
PDF

Keywords

Effects
free care
maternity care
satisfaction
beneficiaries

How to Cite

KAFUMBI, J., Mumvudi, M. F., Lufwa, M. N., & Mabakutuvangilanga, N. S. D. (2025). Effects of free maternity care on beneficiary satisfaction: Multicentre study conducted in the Binza Météo Health Zone, Kinshasa, Democratic Republic of the Congo. Orapuh Journal, 6(7), e1263. https://doi.org/10.4314/orapj.v6i7.63

Abstract

Introduction

The Democratic Republic of Congo (DRC) ranks among the nations with the highest maternal mortality rates in the world, with 846 deaths per 100,000 live births.

Purpose

This study aimed to assess the effects of free maternal health care on access, service quality, and beneficiary satisfaction, while also examining the socio-economic and psychological impact of this policy on women in the field of maternal health.

Methods

The survey employed a phenomenological qualitative approach to data collection and utilised the Donabedian model in the Binza Météo health zone. Data were collected through semi-structured interviews with 43 women who had given birth in selected maternity units. A thematic approach was used to analyse the interview content.

Results

The results show that access to care improved with the elimination of financial barriers. Women expressed overall satisfaction with free antenatal consultations and childbirth. However, many difficulties remain, including indirect costs (e.g., transportation, drugs, and ultrasound scans), overloaded infrastructure and healthcare staff, and challenges related to hygiene and resource availability. Participants also emphasised the importance of healthcare staff's commitment, despite a few reported cases of negligence.

Conclusion

Free maternity care in the DRC has positively impacted both access and satisfaction; however, significant structural improvements are still required, particularly regarding funding, infrastructure, and medical staff working conditions.

https://doi.org/10.4314/orapj.v6i7.63
PDF

References

Agbré-Yacé, M. L., Kourouma, K. R., Doukouré, D., Ndia, F. A., Kpébo, D., Koumi-Mélèdje, M. D., Yaya Bocoum, F., Bousso Senghor, D., & Aké-Tano, O. (2023). Barrières et facilitateurs de l’utilisation des services de santé de la reproduction en Côte d’Ivoire : Une étude qualitative auprès de la communauté. Santé publique, 35(3), 297‑306.

Ameyaw, E. K., Baatiema, L., Naawa, A., Odame, F., Koramah, D., Arthur-Holmes, F., Frimpong, S. O., & Hategeka, C. (2024). Quality of antenatal care in 13 sub-Saharan African countries in the SDG era : Evidence from Demographic and Health Surveys. BMC Pregnancy and Childbirth, 24(1), 303. https://doi.org/10.1186/s12884-024-06459-2

Amponsah-Tabi, S., Dassah, E. T., Asubonteng, G. O., Ankobea, F., Annan, J. J. K., Senu, E., Opoku, S., Opoku, E., & Opare-Addo, H. S. (2022). An assessment of the quality of antenatal care and pregnancy outcomes in a tertiary hospital in Ghana. PLOS ONE, 17(10), e0275933. https://doi.org/10.1371/journal.pone.0275933

Ansu-Mensah, M., Danquah, F. I., Bawontuo, V., Ansu-Mensah, P., & Kuupiel, D. (2020). Maternal perceptions of the quality of Care in the Free Maternal Care Policy in sub-Sahara Africa : A systematic scoping review. BMC Health Services Research, 20(1), 911. https://doi.org/10.1186/s12913-020-05755-9

Ansu-Mensah, M., Danquah, F. I., Bawontuo, V., Ansu-Mensah, P., Mohammed, T., Udoh, R. H., & Kuupiel, D. (2021). Quality of care in the free maternal healthcare era in sub-Saharan Africa : A scoping review of providers’ and managers’ perceptions. BMC Pregnancy and Childbirth, 21, 220. https://doi.org/10.1186/s12884-021-03701-z

Arcury, T., Preisser, J. S., Gesler, W. M., & Powers, J. M. (2024). Access to Transportation and Health Care Utilization in a Rural Region. ResearchGate. https://www.researchgate.net/publication/8064705_Access_to_Transportation_and_Health_Care_Utilization_in_a_Rural_Region

Asmamaw, M., G., Tewuhibo, B., D., & Ayenew, W. (2024). Availability of Essential Medicines in Ethiopia : A Systematic Review. ResearchGate. https://doi.org/10.26420/jcommunitymedhealthcare.2021.1049

Benjamin, A. M. J., Bob, S. N., Odon, M. M., Déclerck, M. H., Arlette, L. L., Celestin, N. W. M., Joseph, L. E., & Gérard, E. E. M. (2023). Financial accessibility of households to primary health services and care in the era of universal health coverage in the DRC through public financing mechanisms in the province of South Ubangi, DRC. International Journal of Social Sciences and Scientific Studies, 3(6), 3357‑3374.

Binyaruka, P., Andreoni, A., Balabanova, D., McKee, M., Hutchinson, E., & Angell, B. (2022). Re-aligning Incentives to Address Informal Payments in Tanzania Public Health Facilities : A Discrete Choice Experiment. International Journal of Health Policy and Management, 12, 6877. https://doi.org/10.34172/ijhpm.2022.6877

Braimah, A., Aninanya, G. A., & Senu, E. (2023). Proportion and factors influencing client satisfaction with delivery services in health facilities in the Sissala East Municipality, Ghana : A cross-sectional study. Health Science Reports, 6(4), e1166. https://doi.org/10.1002/hsr2.1166

Chakrabarti, S., & Tatavarthy, A. D. (2019). The geography of medical travel in India : Differences across states, and the urban-rural divide. Applied Geography, 107, 12‑25. https://doi.org/10.1016/j.apgeog.2019.04.003

Chimhutu, V., Tjomsland, M., & Mrisho, M. (2019). Experiences of care in the context of payment for performance (P4P) in Tanzania. Globalization and Health, 15(1), 59. https://doi.org/10.1186/s12992-019-0503-9

Cronk, R., Guo, A., Folz, C., Hynes, P., Labat, A., Liang, K., & Bartram, J. (2021). Environmental conditions in maternity wards : Evidence from rural healthcare facilities in 14 low- and middle-income countries. International Journal of Hygiene and Environmental Health, 232, 113681. https://doi.org/10.1016/j.ijheh.2020.113681

Dahab, R., & Sakellariou, D. (2020). Barriers to Accessing Maternal Care in Low Income Countries in Africa : A Systematic Review. International Journal of Environmental Research and Public Health, 17(12), 4292. https://doi.org/10.3390/ijerph17124292

Dinkashe, F. T., Haile, K., & Adem, F. M. (2022). Availability and affordability of priority lifesaving maternal health medicines in Addis Ababa, Ethiopia. BMC Health Services Research, 22, 524. https://doi.org/10.1186/s12913-022-07793-x

Eke, P. C., Ossai, E. N., Eze, I. I., & Ogbonnaya, L. U. (2021). Exploring providers’ perceived barriers to utilization of antenatal and delivery services in urban and rural communities of Ebonyi state, Nigeria : A qualitative study. PLoS ONE, 16(5), e0252024. https://doi.org/10.1371/journal.pone.0252024

Esan, D. T., Sokan-Adeaga, A. A., & Rasaq, N. O. (2022). Assessment of satisfaction with delivery care among mothers in selected health care facilities in Ekiti state, Nigeria. Journal of Public Health Research, 11(4), 22799036221127572. https://doi.org/10.1177/22799036221127572

Gitobu, C. M., Gichangi, P. B., & Mwanda, W. O. (2018). Satisfaction with Delivery Services Offered under the Free Maternal Healthcare Policy in Kenyan Public Health Facilities. Journal of Environmental and Public Health, 2018(1), 4902864. https://doi.org/10.1155/2018/4902864

Gnanasekaran, S., Jayaraj, V., V.b., Y., Mohanraj, P. S., Babu, C., Rajendran, N., & Rajendran, V. (2024). A comprehensive evaluation of water, sanitation and hygiene (WASH) in health facilities : A systematic review and meta-analysis. Journal of Hospital Infection, 151, 116‑130. https://doi.org/10.1016/j.jhin.2024.06.018

Gon, G., de Barra, M., Dansero, L., Nash, S., & Campbell, O. M. R. (2020). Birth attendants’ hand hygiene compliance in healthcare facilities in low and middle-income countries : A systematic review. BMC Health Services Research, 20, 1116. https://doi.org/10.1186/s12913-020-05925-9

Guo, A., Bowling, J. M., Bartram, J., & Kayser, G. (2017). Water, Sanitation, and Hygiene in Rural Health-Care Facilities : A Cross-Sectional Study in Ethiopia, Kenya, Mozambique, Rwanda, Uganda, and Zambia. The American Journal of Tropical Medicine and Hygiene, 97(4), 1033‑1042. https://doi.org/10.4269/ajtmh.17-0208

Hailu, A. D., & Mohammed, S. A. (2020). Availability, price, and affordability of WHO priority maternal and child health medicine in public health facilities of Dessie, north-East Ethiopia. BMC Medical Informatics and Decision Making, 20, 221. https://doi.org/10.1186/s12911-020-01247-2

Hill, C. M., Fantasia, H. C., & Burnette, S. (2024). Implementing a Respectful Maternity Care Guideline During Childbirth Experiences. Nursing for Women’s Health, 28(1), 50‑57. https://doi.org/10.1016/j.nwh.2023.09.006

Ilboudo, P. G., & Siri, A. (2023). Effects of the free healthcare policy on maternal and child health in Burkina Faso : A nationwide evaluation using interrupted time-series analysis. Health Economics Review, 13(1), 27. https://doi.org/10.1186/s13561-023-00443-w

Ilboudo, P., & Siri, A. (2022). La Politique de Gratuité des Soins de Santé Maternelle et Infantile au Burkina Faso : Effets et Pérennité de l’Intervention.

Imo, C. K. (2022). Influence of women’s decision-making autonomy on antenatal care utilisation and institutional delivery services in Nigeria : Evidence from the Nigeria Demographic and Health Survey 2018. BMC Pregnancy and Childbirth, 22, 141. https://doi.org/10.1186/s12884-022-04478-5

Jang, S., Lee, S., & Sohn, A. (2024). Assessing Maternal Satisfaction : Patient-Centered Care, Hospital Environment, and Information-Seeking in Chanika Hospital in Tanzania. Journal of Personalized Medicine, 14(5), Article 5. https://doi.org/10.3390/jpm14050455

Kafumbi, J., Mayituka, N. M., Mundele, M. T., Tsangu, P. J.-C., Mandefo, K. J., & Kikobo, K. A. (n.d.). La communication soignant-soigné en milieu hospitalier: Étude menée à l’Hôpital Général de Référence de Kenge, Kwango, Rép. Dém. Congo. International Journal for Multidisciplinary Research (IJFMR), 6(2), 1–13.

Kafumbi, K. J., Mayituka, N., Malu, M., Mandefo, K. J., Mundele, L. T., Tangu, P. J., & Kikobo, K. A. (2024). La communication soignant-soigné en milieu hospitalier: Étude menée à l’Hôpital Général de Référence de Kenge, Kwango, Rép. Dém. Congo. IJMRE, 6(2), 1–13. https://doi.org/10.2139/ssrn.5054029

Kafumbi, K., Mitondo, M., E., Nsimba, M., P., Ilenda, M., H., & Muwawa, K., J.-J. (2024). Sources of health funding in households in the Barrière health area, Kenge Health Zone, Kwango, Democratic Republic of Congo. International Journal of Multidisciplinary Research and Explorer, 4(2), Article 2.

Kare, A. P., Gujo, A. B., & Yote, N. Y. (2021). Quality of antenatal care and associated factors among pregnant women attending government hospitals in Sidama Region, Southern Ethiopia. SAGE Open Medicine, 9, 20503121211058055. https://doi.org/10.1177/20503121211058055

Kareem, Y. O., Morhason-Bello, I. O., OlaOlorun, F. M., & Yaya, S. (2021). Temporal relationship between Women’s empowerment and utilization of antenatal care services : Lessons from four National Surveys in sub-Saharan Africa. BMC Pregnancy and Childbirth, 21(1), 198. https://doi.org/10.1186/s12884-021-03679-8

Kasongo, S. E., Remo, I. J.-C., Ndongo, A. D., Matengelo, G. E. E., & Kunzi, B. N. (2024). Opinions des femmes bénéficiaires de la gratuité de la maternité dans le cadre de la couverture santé universelle en République Démocratique du Congo : Cas du Centre Hospitalier du Mont-Amba dans la Zone de Santé de Lemba, Kinshasa. Revue Congolaise des Sciences et Technologies, 3(4), Article 4. https://doi.org/10.59228/rcst.024.v3.i4.103

Keshtkar, L., Madigan, C. D., Ward, A., Ahmed, S., Tanna, V., Rahman, I., Bostock, J., Nockels, K., Wang, W., Gillies, C. L., & Howick, J. (2024). The Effect of Practitioner Empathy on Patient Satisfaction : A Systematic Review of Randomized Trials. Annals of Internal Medicine, 177(2), 196‑209. https://doi.org/10.7326/M23-2168

Khalfan, S. S., & Albert, à l’arrière. (2023). Women’s Satisfaction with Maternal Delivery Care at Health Facilities. ResearchGate. https://www.researchgate.net/publication/374570714_Women's_Satisfaction_with_Maternal_Delivery_Care_at_Health_Facilities

Kwasi, A. (2024). Transportation : Barrier to Maternal and Child Healthcare Service in Rural sub-Saharan Africa. ResearchGate. https://doi.org/10.31191/afrijcmr.v2i2.30

Lagarde, M., Lépine, A., & Chansa, C. (2022). The long-term effects of free care on birth outcomes : Evidence from a national policy reform in Zambia. SSM - Population Health, 17, 101051. https://doi.org/10.1016/j.ssmph.2022.101051

Laurenzi, C. A., Rabie, S., Mamutse, S., Skeen, S., van Vuuren, N. J., Neethling, R., Field, S., & Honikman, S. (2024). Exploring Empathic Communication Among Community Health Workers : Applying the ENACT Tool in Two South African Sites. Health Promotion Practice, 15248399241285888. https://doi.org/10.1177/15248399241285888

Liu, Y., Li, T., Guo, N., Jiang, H., Li, Y., Xu, C., & Yao, X. (2021). Women’s experience and satisfaction with midwife-led maternity care : A cross-sectional survey in China. BMC Pregnancy and Childbirth, 21(1), 151. https://doi.org/10.1186/s12884-021-03638-3

Mannava, P., Durrant, K., Fisher, J., Chersich, M., & Luchters, S. (2015). Attitudes and behaviours of maternal health care providers in interactions with clients : A systematic review. Globalization and Health, 11, 36. https://doi.org/10.1186/s12992-015-0117-9

Mao, W., Watkins, D., Sabin, M. L., Huang, K., Langlois, E., Ogundeji, Y., Fogstad, H., Schäferhoff, M., Yamey, G., & Ogbuoji, O. (2023). Effects of public financing of essential maternal and child health interventions across wealth quintiles in Nigeria : An extended cost-effectiveness analysis. The Lancet Global Health, 11(4), e597‑e605. https://doi.org/10.1016/S2214-109X(23)00056-6

Mbidi, T., Downing, C., & Temane. (2024). Midwives’ and women’s experiences with respectful maternity care around the globe : A meta-synthesis. ResearchGate. https://doi.org/10.1016/j.wombi.2023.04.002

Mbongi, G. (2021). Ma loi sur la gratuité des soins de la maternité : Lutte contre la mortalité maternelle et infantile en RD Congo. l’Harmattan.

Mehreen Bhorat, hasseur, Peters, S., Khumalo, N., & Davies. (2024). Analysis of patient flow and barriers to timely discharge from general medical wards at a tertiary academic hospital in Cape Town, South Africa. ResearchGate. https://doi.org/10.1186/s12913-024-10806-6

Mekie, M., Belachew, Y. Y., Chanie, E. S., Bayih, W. A., Fenta, S. M., Masresha, G. A., Ferede, W. Y., & Addisu, D. (2024). Perceived quality of maternal care and its barriers based on women’s perspective in hospitals of Northwest Ethiopia : A qualitative study. Frontiers in Medicine, 11. https://doi.org/10.3389/fmed.2024.1387710

Mollel, D., Kagashe, G. A., Asingizwe, D., Banzimana, S., Maru, S. M., & Niragire, F. (2024). Barriers to access of maternal health commodities among pregnant women in public health facilities in Ubungo Municipal Council, Tanzania. Journal of Pharmaceutical Policy and Practice, 17(1), 2300457. https://doi.org/10.1080/20523211.2023.2300457

Mwana-wabene, A. C., Lwamushi, S. M., Eboma, C. M., Lyab, P. M.-B., Cheruga, B., Karemere, H., Mwembo, A. T., Balaluka, G. B., & Mukalenge, F. C. (2022). Choix thérapeutiques des hypertendus et diabétiques en milieu rural : Une étude mixte dans deux zones de santé de l’Est de la République Démocratique du Congo. African Journal of Primary Health Care & Family Medicine, 14(1), 3004. https://doi.org/10.4102/phcfm.v14i1.3004

Navas, R., Peteiro Mahía, L., Blanco López, S., López Castiñeira, N., Seoane Pillado, T., & Pertega Díaz, S. (2021). Women’s satisfaction with childbirth and postpartum care and associated variables. Revista Da Escola de Enfermagem Da USP, 55, e03720. https://doi.org/10.1590/S1980-220X2020006603720

Njeri, S. (2020). Utilization of Antenatal Care Services, Nutrition status and Dietary diversity in pregnancy : A case study of Pumwani Maternity Hospital [Thesis, University of Nairobi]. http://erepository.uonbi.ac.ke/handle/11295/153222

Nkoumou, N., Gaston. (2020). Gratuité des soins et utilisation des services de santé maternelle – une analyse d’impact au Sénégal. L’Actualité économique, 96(2), 159‑193. https://doi.org/10.7202/1076510ar

Nwagbara, U. I., Hlongwana, K. W., & Chima, S. C. (2024). Mapping evidence on the factors contributing to long waiting times and interventions to reduce waiting times within primary health care facilities in South Africa : A scoping review. PLOS ONE, 19(8), e0299253. https://doi.org/10.1371/journal.pone.0299253

Odiwuor, F. O., Kimiywe, J., & Waudo, J. (2020). Influence of Nutrition Knowledge on Dietary Practices and Attitudes of Pregnant Women in Migori, Kenya.

Okoli, C., Hajizadeh, M., Rahman, M. M., & Khanam, R. (2020). Geographical and socioeconomic inequalities in the utilization of maternal healthcare services in Nigeria : 2003–2017. BMC Health Services Research, 20(1), 849. https://doi.org/10.1186/s12913-020-05700-w

Olwanda, E., Opondo, K., Oluoch, D., Croke, K., Maluni, J., Jepkosgei, J., & Nzinga, J. (2024). Women’s autonomy and maternal health decision making in Kenya : Implications for service delivery reform - a qualitative study. BMC Women’s Health, 24(1), 181. https://doi.org/10.1186/s12905-024-02965-9

Onambele, L., Guillen-Aguinaga, S., Guillen-Aguinaga, L., Ortega-Leon, W., Montejo, R., Alas-Brun, R., Aguinaga-Ontoso, E., Aguinaga-Ontoso, I., & Guillen-Grima, F. (2023). Trends, Projections, and Regional Disparities of Maternal Mortality in Africa (1990–2030) : An ARIMA Forecasting Approach. Epidemiologia, 4(3), 322‑351. https://doi.org/10.3390/epidemiologia4030032

Onwujekwe, O., Obi, F., Ichoku, H., Ezumah, N., Okeke, C., Ezenwaka, U., Uzochukwu, B., & Wang, H. (2019). Assessment of a free maternal and child health program and the prospects for program re-activation and scale-up using a new health fund in Nigeria. Nigerian Journal of Clinical Practice, 22(11), 1516‑1529. https://doi.org/10.4103/njcp.njcp_503_18

Organisation mondiale de la Santé. (2023). Tendances de la mortalité maternelle de 2000 à 2020 Estimations de l’OMS, de l’UNICEF, du FNUAP, du Groupe de la Banque mondiale et de la Division de la population de l’UNDESA.

Oyugi, B., Audi-Poquillon, Z., Kendall, S., & Peckham, S. (2024). Examining the quality of care across the continuum of maternal care (antenatal, perinatal and postnatal care) under the expanded free maternity policy (Linda Mama Policy) in Kenya : A mixed-methods study. BMJ Open, 14(5), e082011. https://doi.org/10.1136/bmjopen-2023-082011

Oyugi, B., Kendall, S., & Peckham, S. (2021). Effects of free maternal policies on quality and cost of care and outcomes : An integrative review. Primary Health Care Research & Development, 22, e43. https://doi.org/10.1017/S1463423621000529

Ridde, V., & Mbow, N. B. (2021). Vers une couverture sanitaire universelle en 2030 ? : Réformes en Afrique subsaharienne. Ed. Science et Bien Commun. https://doi.org/10.5281/zenodo.5166925

Sahoo, K. C., Negi, S., Patel, K., Mishra, B. K., Palo, S. K., & Pati, S. (2021). Challenges in Maternal and Child Health Services Delivery and Access during Pandemics or Public Health Disasters in Low-and Middle-Income Countries : A Systematic Review. Healthcare, 9(7), 828. https://doi.org/10.3390/healthcare9070828

Samb, O. M., & Ridde, V. (2018). The impact of free healthcare on women’s capability : A qualitative study in rural Burkina Faso. Social Science & Medicine, 197, 9‑16. https://doi.org/10.1016/j.socscimed.2017.11.045

Solene. (2021, décembre 3). Accouchement : Combien ça coûte, quelle prise en charge ? Neufmois.fr. https://www.neufmois.fr/ma-grossesse/accouchement-combien-ca-coute-quelle-prise-en-charge

SOWC2021_Full_Report_FR_WEB_copy .pdf. (s. d.). Consulté 9 septembre 2024, à l’adresse https://www.unicef.org/media/115496/file/SOWC2021_Full_Report_FR_WEB_copy%20.pdf

Strong, J., Lattof, S. R., Maliqi, B., & Yaqub, N. (2021). Experiences of private sector quality care amongst mothers, newborns, and children in low- and middle-income countries : A systematic review. BMC Health Services Research, 21, 1311. https://doi.org/10.1186/s12913-021-06905-3

Tankeng, C. A., Halle-Ekane, G., Mokom, A. A., Ngunyi, Y. L., Wambo, A. G. S., Ngouakam, H., & Yenshu, E. V. (2021). Parturients Perception of Care Providers Attitude Towards Women During Labour And Delivery In Southwest Cameroon. https://doi.org/10.21203/rs.3.rs-635053/v1

Tekelab, T., Chojenta, C., Smith, R., & Loxton, D. (2019). The impact of antenatal care on neonatal mortality in sub-Saharan Africa : A systematic review and meta-analysis. PloS One, 14(9), e0222566. https://doi.org/10.1371/journal.pone.0222566

UNFPA. (2021, septembre 17). UNFPA engagé à sauver des vies de femmes et nouveau-nés en RDC. UNFPA République Démocratique Du Congo. https://drc.unfpa.org/fr/news/unfpa-engag%C3%A9-%C3%A0-sauver-des-vies-de-femmes-et-nouveau-n%C3%A9s-en-rdc

Vyas, H., & Bhardwaj. (2024). Maternal satisfaction with childbirth services among postnatal mothers at a primary health center. ResearchGate. https://www.researchgate.net/publication/369238209_Maternal_satisfaction_with_childbirth_services_among_postnatal_mothers_at_a_primary_health_center

Wallace, C., Watt, S., Mulawa, Z., & Pommells, M. (2019). WaSH as a maternal health issue : Three perspectives from rural Uganda. Development in Practice, 29(2), 183‑195.

Wang, X., Wang, R., Sheng, F., & Chen, L. (2022). The effects of empathy by caregivers on healthcare service satisfaction. Frontiers in Psychology, 13. https://doi.org/10.3389/fpsyg.2022.912076

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.