Financial Viability of Private Health Care Facilities in Urban Areas: Case Study of the Bandalungwa Health District, Kinshasa, Democratic Republic of the Congo

Abstract

Introduction

The financial viability of healthcare facilities in the Democratic Republic of Congo (DRC) depends heavily on their ability to cover expenses through self-generated revenues. While the private sector plays a vital role in healthcare delivery in urban areas, it remains costly and largely inaccessible to poor households. Due to self-financing constraints, facilities struggle to meet operating costs, often driving price increases that further restrict access. Despite their growing market share, empirical data on their financial sustainability are sparse, highlighting the critical need to assess their profitability.

Purpose

To analyze the financial viability of private, for-profit health care establishments (HCEs) in the Bandalungwa health district.

Methods

This study used a mixed-methods case study design involving 11 HCEs in the Bandalungwa health district of Kinshasa. The study population comprised private, for-profit HCEs operating between January and December 2022. Data were gathered through semi-structured interviews, document reviews, and non-participant observations. Quantitative data were analyzed using descriptive statistics in SPSS 27. Qualitative data were analyzed using a thematic framework matrix in Microsoft Excel to identify primary and secondary operational patterns.

Results

Small enterprises dominated the private, for-profit healthcare landscape in the district (91%). Overall staff stability was low (27.3%), and the majority of HCEs (82%) were managed directly by their owners. Most facilities (82%) successfully covered their operational expenses through self-generated revenue and achieved positive net profits. Direct, out-of-pocket payments from households were the predominant source of funding.

Conclusion

While most private HCEs in Bandalungwa demonstrate financial viability, their reliance on direct fee-for-service payments leaves them highly vulnerable to local economic shocks. This fragile model severely restricts healthcare access for low-income populations, emphasizing the urgent need for universal risk-pooling and alternative financing mechanisms.