In the Democratic Republic of the Congo (DRC), the public healthcare system is based on a 4-level pyramid model. The first level comprises of community health centers where nurses provide basic care. Reference health centers with generalist physicians are the second level. The third level comprises provincial hospitals, which offer specialist care. The forth level comprises university hospitals. The government, in collaboration with many NGOs, controls the public health care sector. Access to care in certain area has been reduced because of many years of war that the country faced.
Next to the public health sector, there is a private sector which has earned a reputation for providing better quality health services and specialized care. People decide where to seek medical care but most people choose the public sector because of its affordability. In terms of diabetes, the majority seek certain public hospitals that cooperate with NGOs that support diabetes care. Two centers, in Kinshasa and Goma, have support from Life for a Child.
What happens if you need to see a doctor?
Patients have to make an appointment with their doctors to be assessed. Generally doctors have certain days in the week on which they see patients. Patients wait for long times to be seen, likely because of the small number of health centers with physicians. To see a doctor patients have to pay around 10 dollars.
Who decides what doctors can prescribe?
The government provides a list of drugs suitable for use in DR Congo together with essential information about their use.
What about getting admitted to hospital?
There are no hospitals that provide care for free, so every patient has to pay. For those with type 1 who cannot afford to pay, if they are lucky they might be seen for free but this is not a rule.
When admitted to the hospital for a diagnosis of diabetes, patients receive insulin injections and treatment. Family members must seek and pay for insulin after that. Patients spend around ten days in the hospital, which can cost anything from 50 to 100 dollars. This amount is very expensive when you consider that the average annual income in the Democratic Republic of the Congo is just 400 dollars (as of 2013). About 71 percent of people living in the DRC live below the global poverty line.
Practically, what is it like to live with type 1 diabetes in DR Congo?
The majority of Congolese people live in remote and inaccessible villages. Living with type 1 diabetes is very difficult. Access to medications like insulin and consumables still remains very low. Most take only NPH twice daily and nothing else. The financial burden coupled with poor knowledge, distance to hospitals and social stigmatization means children living with diabetes mostly present at the hospital with complications.
The prevalence of kidney disease is around 15%. The mortality rate for people with diabetes is very high. Most people only survive five years after the discovery of diabetes. There is no insurance scheme yet that covers insulin for children living with diabetes, so it must be paid out of pocket. Data on living with type 1 diabetes is low in comparison to type 2 diabetes. However it is clear that DR Congo is seeing a growing number of cases of children living with diabetes.
How does diabetes care vary throughout in DR Congo?
Diabetes care varies a lot across the different regions in DR Congo. This can be attributed to varying factors such as distance to healthcare facilities and the inaccessibility of certain areas. Most of the diabetes specialists settle in large cites rather than rural areas.
A big thank you to Dr. Cirhuza Justin Cikomola, an endocrinologist at the Université catholique de Bukavu, for providing this information.