Journal of Geoscience and Eco Agricultural Studies

Abstract

This study examines the economic, organizational, and geographical factors that determine households’ access to health services in the Butembo Health Zone. Equitable access remains limited due to direct payment, the high cost of medical care, and the unequal distribution of health resources. Households, faced with financial and logistical constraints, see their use of health services strongly affected by these barriers.

The cross-sectional survey conducted among households and health facilities made it possible to assess costs, service availability, service utilization, and the obstacles encountered. The sample was predominantly female (77.5%), with 72% married, and half of the respondents had a secondary level of education (50%), indicating a population capable of understanding and adopting health financing mechanisms. Households had an average of six members, often including children under five, which increases the demand for maternal and pediatric care. Geographical accessibility was generally good: 83% of households reached health centers on foot, with a median distance of one kilometer.

However, despite this proximity, the low median income—about 100 USD per month—exposes households to a high risk of catastrophic health expenditures. The weaknesses of existing financing mechanisms and disparities in service provision remain major obstacles. Strengthening solidarity mechanisms and harmonizing service delivery are essential to improve equity and the effectiveness of the local health system.