Factors associated with loyalty in the mutual health of Kisantu in Democratic Republic of the Congo

Introduction: Some African countries have initiated mutual health insurance to improve access to health care, However, most of these initiatives have not succeeded in covering the majority of the population, nor in securing long-term loyalty. Considering that very few studies, if not none, allude to the Democratic Republic of Congo (DRC), this study aims to determine the explanatory factors for both loyalty and non-loyalty within the Kisantu health mutual insurance in DRC and to identify any specific factors in the urban rural Congolese context. Purpose of research: We conducted a five-year prospective study, starting in 2013, among 320 households, selected among a cohort of 2202 households. Using the SPSS (R) 21.0 software, the association between loyalty and socio-demographic, socioeconomic variables and the degree of satisfaction with insurance products, as well as the motivations with respect to targeted loyalty, was sought. Results: Thus, we found that the sociodemographic characteristics were not associated with loyalty of payments. In contrast, statistically significant relations were found between loyalty and socioeconomic characteristics, including occupation, estimated income, as the motivations expressed with regard to loyalty (P <= 0.001). In a logistic regression model, occupation, estimated household income of $100 or above were twice more likely to be loyal than those with an income below $100. Protection by income has not been identified as a predictor in the studies included in our survey of the literature, but it proved to be significantly associated with loyalty in the present study. On the other hand, beyond the fidelity factors observed in this study, aspects relating to the management of mutual health insurance, which have appeared as predictors in other contexts, are not identified as such in our community. Conclusions: In an urban rural context in DR Congo where the majority of the population has a low and unstable income, and considering the low amount of contribution to the Kisantu health mutual, 4.2% of the median household income, it will be necessary therefore rethink the place of health spending in households and the extension of solidarity in the form of uniform or income-based contributions.