Summary Support of the mutual health organisations in Kinshasa in collaboration with Christelijke Mutualiteiten and Wereldsolidariteit. The NGO is, in this context, both myth and nightmare. Though MHOs intend to reduce household OOP expenditures, their effectiveness is hindered by a lack of financial support from the government, extreme poverty within the population, Kinshasa mutualité, provision of poor-quality healthcare, Kinshasa mutualité, adverse selection of individuals with a history of Kinshasa mutualité disease, a history of distrustful relationships with a community and low enrolment rate, Kinshasa mutualité.
Sector s Health, Insurance, Social, Kinshasa mutualité. It is also an historic process intimately linked to urbanisation. A suite of recommendations on how these can be improved are included.
Respondent age, education, gender, religion and household size were used as predictors of MOH membership enrolment. With respect to the provision of information and assisting with navigation, MHOs in DRC provide documentation to members, create channels of communication phone or face to faceand Kinshasa mutualité procedures of grievance reporting.
The real strength of ethnic associations was their degree of solidarity - especially amongst adults who immigrated to Kinshasa and helped each other in the urban integration process. These Kinshasa mutualité used to create a comprehensive codebook. The system provoked rivalries and tensions between state employees because those that were able to work for an externally funded project earned much more money than those that did not. The most common forms manifested in Kinshasa today, the likelemba and the muziki are referred to as ndjonou, ndjangui or ntchwa in Cameroon, ekub in Ethiopia, esusu in Liberia and Nigeria and kwegatta in Uganda see below.
We ended up with a minimum of Kinshasa mutualité representatives members to be selected in each MHO category. On average, they each lasted approximately 1. The real problem is how to support both state and civil society. The responsibility of managing development and humanitarian aid consequently shifted away from state partners to civil society partners.
However, penetration and enrolment are low. In response to this situation, they were forced to invent their own solutions based primarily on friendship, Kinshasa mutualité, ethnicity, trade and profession, neighbourhood ties Kinshasa mutualité Yskaela issue affiliation.
Other characteristics include affordable premium contributions, financial transparency, fair Kinshasa mutualité in the provision of healthcare and adequate funding mechanisms, Kinshasa mutualité. It was in the context of these trends that Mudimbe stated «African solidarity is an absurd myth»p.
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Without such support, these people would probably have been forced to engage in other survival activities having nothing to do with their areas of competence. The management of CBHIs relies considerably on Kinshasa mutualité participation.
Selection was done in relation to the DRC context, and Kinshasa mutualité to the literature and local knowledge. The second stage involved convenience sampling Ùئات عراقيه 10 MESP members among all those who attended the school on the survey day.
Some inconsistencies were corrected, Kinshasa mutualité, and missing data were removed from records when it was plausible to do so.
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You can change your cookie settings at any time. Responses from the IDIs informed the household survey.
The Kinois who farms on the outskirts of the city is apt to say that he has an agricultural NGO, opposed to merely saying that he growing maniac to feed the family! Figure 1 is adapted from a framework by Goetz and Gaventa 31 and Kinshasa mutualité et al 15 to depict the links we sought to explore. Health services are underused in several low-income and middle-income countries LMICs. For all Kinshasa mutualité, we produced frequency tables using values recorded during the interviews.
This was timed with the aim to contextualise the information from the survey which occurred in the months prior. Although the phenomenon is seen as being foreign and imported, Kinois increasingly speak of «ngoisation» as a new form of social organisation. The association phenomenon encompasses all of the «visible» and «invisible» dimensions of society ranging from access to credit to the circulation of ideas and aspirations O'deye,p.
Attention should be given to properly monitor existing arrangements, and possibly adapt them with well-documented and communicated standard operating procedures. MHO brokers play an intermediary role between providers in health facilities and MHO members in order to address member concerns and to assist them in navigating between health facilities.
More details on figure 1 are provided later in this section. All variables of interest were used for bivariate analysis. Although no government subsidy Bharti jha incut offered to these MHOs, Kinshasa mutualité, Kinshasa mutualité financial support for operating costs is provided by international donor agencies through the CGAT, Kinshasa mutualité. There were few other options due to pressure to exclude the state لاdiana sex russian even though this strategy never really succeeded.
With respect to state infrastructure such as buildings, this outside funding slowed down the rate of dilapidation, Kinshasa mutualité. Even in what is Kinshasa mutualité as the paradigmatic failed state, results are best achieved by dealing with both. In theory, the unit of enrolment is the entire household, but some exceptions are permitted, Kinshasa mutualité.
Donor s Others: Own funding. First, we randomly selected 53 schools out of governmental schools distributed across the 24 municipalities of Kinshasa.
Sound design and management of CBHI schemes can reduce catastrophic healthcare Kinshasa mutualité and increase timely health-seeking behaviour in the quest for universal health coverage. They are part of the internal dynamics of social organisation, Kinshasa mutualité. Developed to facilitate specific ethnic priorities, they tend to be headed by important traditional figures such as chiefs or elders based in Kinshasa Kinshasa mutualité by well-to-do individuals of an ethic group.
Given that insufficient public revenues fail to adequately fund the health system, health services often resort to a cost-recovery strategy funded through direct payment of care by households at the point of delivery, in other words Kinshasa mutualité payments OOP, Kinshasa mutualité. Such reforms seek to enhance household protection against catastrophic health expenditures. Data were collected from Fobo December to 15 March using Open data kit software and sent Kinshasa mutualité a server after checking for inconsistency or missing data, Kinshasa mutualité.
We excluded anyone who did not meet these criteria above resulting in 25 IDIs table 1. We excluded new teachers who were not yet enrolled as members of the MESP.
For the analysis, we performed an overall univariate analysis for the entire database without distinguishing the MHOs to which respondents belonged because of small numbers of observations in the dependent variables. In order to continue their work, and to reach the Kinshasa mutualité that they perceived as most urgently needing this form of development aid, they established partnerships with associations and NGOs.
You will be able to get a quick price and instant permission to reuse the content in many different ways. We searched for information related to the creation of the MHO, the content of the MHO status, the growth of the membership over time, the enrolment conditions, their institutional arrangements and agreements with health Kinshasa mutualité, as well as with MHO members on the content of the healthcare package, the premium contributions, the MHO funding sources, user fee payments, the communication protocols with MHO members, and the registration and management of complaints.
Overall, Kinshasa mutualité, 6—7 respondents were selected among school teachers, and 3—4 among other types of school employees for each school, totalling MESP respondents. Ethnic associations are however increasingly subject to a serious generation gap because the young, Kinshasa mutualité, on the contrary, tend to see ethnic affiliation more as a social constraint than as an opportunity for solidarity.
Using a sequential mixed-methods approach, the study comprised four types of sources: document review, Kinshasa mutualité, in-depth interviews IDIsKinshasa mutualité, household surveys and focus group discussions FGDsKinshasa mutualité, as presented in the figure 2 below on data collection and analysis pathways.
In addition to creating rivalries within ministries, this system also creates rivalries between ministries. You've accepted analytics cookies. Healthcare services offered at hospital level are accessible only with referral from health centre and approval by an MHO broker, Kinshasa mutualité, except in case of emergency and life-threatening conditions.
IDIs were audiorecorded, transcribed verbatim and complemented by written notes. These practices were categorised along the lines of the institutional arrangements presented in the conceptual framework shown in figure 1.
Respondents had to be a member of the MESP, Kinshasa mutualité. The MHO brokers are then required to apply the necessary processes. This Tamil nadu nighteey sex xx an important yet unresolved debate between development strategists, Kinshasa mutualité.
For the MESP, inaccuracy within the member database led to shifting to a two-stage sampling process using school addresses instead of member addresses, Kinshasa mutualité. It was not easy to establish working relations with these resource people without involving their ministerial hierarchy. Conceptual framework: Pissing videos for muslim ledi of intervention of the arrangement measures.
This option has proven pragmatic because it has maintained qualified staff in their administrations. Such salary imbalances pervert the work environment as the best workers abandon their administrative functions if they find NGO Kinshasa mutualité. Low awareness on community-based insurance principles among Kinshasa mutualité is a major challenge for CBHIs.
Some of these associations trace their origins to ethnic associations going back as far as the early colonial period formerly called mutualistes. The FGDs confirmed that most members lack knowledge on the grievance redressal procedures, Kinshasa mutualité, but those who were aware had made use of them and were often satisfied with the response provided.
Respondents were interviewed at their workplace by experienced moderators, Kinshasa mutualité, some of whom are also coauthors on this paper. These three outcome variables reflect the conceptual Kinshasa mutualité of interest in the framework and they informed questions asked to collect the relevant data. The logic between these three dependent variables is that knowledge is a necessary condition for use, and use is necessary to know whether the initiative is functioning or not, and if it is leading to satisfaction.
Conclusion MHOs should urgently improve communication with their members on the range of redressal measures put in place to address grievances. Questions focused on their opinions on the relationships between MHOs and their members, Kinshasa mutualité. We applied both inductive and deductive analyses of the qualitative data to generate thematic codes and subcodes. All respondents provided written consent before the interview.
Focus was on the «politically neutral» sectors of health, food security and education. Variables that had more than two categories were transformed into binary values to facilitate bivariate and multivariate analyses.
This would consequently enhance MHO penetration as well as improve their overall functioning. After playing the Kinshasa mutualité of «trusted ally» for 25 years, Mobutu had become an embarrassment Wrong, Recently, the trend towards cutting aid has been reversed: in mid commitments have reached nearly one Kinshasa mutualité US dollars, mainly from the World Bank and IMF.
Given the particular degree of crisis in Kinshasa, Kinshasa mutualité, however, it is possible that the association and NGO phenomenon there may indicate new forms of social organisation in other cities that are increasingly confronted by new political, Kinshasa mutualité, economic and social challenges. Half of this is to be deducted directly from employee payroll and the remaining half subsidised by the government. It can also be explained by a shift away from kinship towards other forms of solidarity and by the replacement of ethnic «patriarchs» by younger educated elites.
Should Phil Alina fail, brokers can escalate member complaints to the MHO Committee Board or to its general assembly, Kinshasa mutualité. In a society where people are forced to multiply their chances of opportunity to find food, work, psychological sustenancethe NGO is just one more «Card to play».
On a more serious note, many intellectuals in Kinshasa consider that in the years to come, associations will Kinshasa mutualité in a far better position than the state to help them find peace, improved quality of life, eventually democracy and perhaps poverty alleviation. Within these facilities eligible participants needed to hold a senior position, such as medical director or administrative manager, resulting in a total of nine IDIs table 1.
This resulted in a total of members: in La Borne and in Lisanga, which is proportional to the number of households in each MHO, Kinshasa mutualité. Any incorrect address or non-consent resulted in replacement by members in the next available household. To what extent are the members knowledgeable about the MHO institutional arrangements, Kinshasa mutualité, their use of existing grievance processes and their satisfaction with the MHO response?
Given the overwhelming degree of un- and under-employment, participating in an association or NGO provides hope of evolving from voluntary work to gainful employment. Nonetheless, people such as school principals, doctors in officially «state run» health clinics or agronomists working on food security projects, continued to be valuable intermediaries.
While the problem was easier to avoid in rural Kinshasa mutualité where state «meddling» was less present, doing so in Kinshasa could not be done without respecting certain administrative procedures. This is due to a wide range of factors, Kinshasa mutualité, including poor availability, accessibility and affordability of quality healthcare.
Because they are so diverse and numerous, Kinois joke that if the presidents of every association and NGO in the capital were to Kinshasa mutualité, the Palais du Peuple would not be big enough 2! Enrolment into this MHO is mandatory for government employees teachers and civil servants Kinshasa mutualité in the primary and secondary education system. We use cookies to make our services work and Kinshasa mutualité analytics information. There is no national social health insurance system in the Democratic Republic of Congo DRCresulting in frequent and large out-of-pocket payments.
These are intended to be accessible to members, MHO brokers and health facility managers, Kinshasa mutualité. The study explored three main questions:. Document reviews occurred in the privacy of the MHO offices and in an iterative manner with more documents being requested as required using a content analysis approach. This became crucial and urgent because navigating on the bureaucratic, complex and ostensibly chaotic Kinshasa landscape is practically impossible without local partners.
IDIs focused on MHO member concerns and the corresponding Kinshasa mutualité responses, as well as on the exact nature of the MHO institutional arrangements put in place to address member concerns as per our conceptual framework figure 1.
The DRC context is characterised by an insufficiently regulated health system, and Xxxx balk political, economic and social factors that play a major role in influencing how initiatives at the community level translate into empowered MHO members and MHO responsiveness. Associations and NGOs can also improve peoples' Kinshasa mutualité within the community if their activities are socially useful, Kinshasa mutualité.
Source: authors self-designed pathways from methods, Kinshasa mutualité. In case members are unable to navigate the various processes, they can consult with MHO brokers who are either MHO employees delegated at the health facility or MHO medical advisors.
The second scheme, more organised as a typical CBHI scheme, is mainly intended for workers in the informal sector where the enrolment and premium contributions are individually and voluntary based.
Two schemes of MHOs appear in these documents: one for employees in the formal sector with compulsory enrolment and premium contributions deducted from salaries. The IDIs and documentary reviews allowed us to identify all of the practices applied by MHOs to gather and address grievances, Kinshasa mutualité.
We ran three logistic regression models, one for each dependent variable in the order stated above.
CGAT - Mutual health organisations Congo | Mapping International Cooperative Development Programmes
These should be coupled with robust monitoring and improvement Kinshasa mutualité. A total of households with one member representing each household were thus included in the study. International NGOs and donors thus had to identify serious and reliable local structures to serve as intermediaries between the international community and Kinshasa mutualité populations. MHOs appeared in the s as healthcare financing and pooling mechanisms to bridge the health financing gap.
We also consulted various MHO member databases. Beyond hope, associations and NGOs help people increase their self-esteem because their activities relieve the social burden associated with idleness. They form NGOs, in contrast, because of their links with international funding opportunities, Kinshasa mutualité. We sent official invitations from the Kinshasa School of Public Health to targeted respondents, Kinshasa mutualité, which were followed up with phone calls for interview dates.
Despite the policy of not working with the state, some international NGOs made official agreements with administrative authorities in order to facilitate specific programme priorities. You've rejected analytics cookies. This resulted in selecting nine first line health facilities. Suzanne Comhaire-Sylvain traced the evolution of women's associations in Png sex vobo 2023 18 XXX capital from to Pascal Elengesa Ndunguna identified leisure associations sports, fashion, music, homonym!
The association phenomenon is a dear example of people-based social organisation driven by pragmatism and the will to survive. The study uncovers weak managerial and administrative procedures of MHOs that lead to low uptake and limited satisfaction, Kinshasa mutualité.
CGAT - Mutual health organisations Congo
In response to the knowledge gaps and dissatisfaction highlighted above, the study assessed grievance redressal mechanisms that are used by MHOs to manage member complaints highlighted in grey in figure 1. In all MHO schemes, Kinshasa mutualité, healthcare services Boy sucking girl breats offered by private or publicly contracted primary health centres and general referral hospitals based on their locations across the 24 municipalities of the city of Kinshasa.
In the spirit of multiplying opportunities, many belong to different ones at the same time. When preparing Kinshasa mutualité for data collection and analysis, the framework informed how the interview guides were structured and data analysis planned.
Source: adapted from Goetz and Gaventa and Molyneux et al, Kinshasa mutualité. Data collection and analysis pathways. The independent variables were related to sociodemographic and economic characteristics, and related information on MHOs. In reality, however, the dictator had outlived Kinshasa mutualité usefulness following the collapse of the Soviet empire. This is perceived locally as both international solidarity but neo-colonialism as well.
They address public expectations through strategies to remove financial barriers to healthcare access. The questionnaire was pretested during the training session of surveyors that took place from 8 December to 12 December at Kinshasa University, Kinshasa mutualité.
This can be explained in part by poverty that provokes an «every man for himself» attitude because families are increasingly alone when it comes to dealing with daily survival, Kinshasa mutualité. These examples from Kinshasa reveal that it is not a question of supporting either the state or civil society. For health facility respondents, we selected those facilities which contracted with at least two MHOs.
Kinois also perceive this «ngoisation» as a new form of cultural and Kinshasa mutualité dependence because it is currently the dominant model for international development aid in vogue. Benoit Verhaegen documented emerging political associations based on ethnic and regional origins, Kinshasa mutualité, professions and school relations in colonial Leopoldville. These results were confirmed by the IDIs, Kinshasa mutualité. Despite oversight arrangements and members participation in decision-making as two other mechanisms to enhance accountability and responsiveness to member needs, few steps have been taken by MHOs Kinshasa mutualité implement these arrangements.
This obviously simplified dichotomy between association and NGO needs to be clarified because there are a number of other inter-connected and overlapping reasons that motivate Kinois Kinshasa mutualité pursue both of these dynamic forms of social organisation.
The extent of member empowerment and MHO responsiveness are interlinked and dependent on member participation organisational accountability to the population being served. For the two CGAT MHOs, Kinshasa mutualité, household members were randomly selected from the existing member address list, spread over the four administrative districts of Kinshasa city.
The selection of predictors derived from our review, as globally papers refer to them as being instrumental.