Improving financial access to health care in the Kisantu District in Congo: acting upon complexity

The reforms in Kisantu have led to more transparency in the payment system, better availability of drugs, higher predictability of the costs to the patient, and better financial access to health services. The results also indicate a more rational use of resources, with improved gate-keeping by the first health service level and more efficient use of the hospital.

›Shifting from a fee-for-service payment to a subsidized flat rate payment as a policy option for poor countries creates the necessary conditions for other health sector reforms. Such a financing system guarantees better access to health care for the poor population and increases equity in the health financing system. However, the implementation of flat fees cannot be an isolated measure or a goal in itself. It must be part of a more comprehensive package of efforts, including rational human resources management (with correct wages) and professional diagnostic and therapeutic behaviour.

Health workers will change their behaviour if they earn a correct salary for quality work. The people will change their behaviour and use public health services if these services are functional and if they are provided at a fair, affordable and predictable cost.

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