Exploring social accountability and responsiveness procedures of Community-based Health Insurance in Kinshasa, Democratic Republic of Congo, using qualitative approach research

Background For community health insurance (CHI), building a trustful relationship with affiliates is a major challenge. In the absence of national health insurance, mutual health organizations (MHOs) are functioning as community-based health insurance (CBHIs). MHOs have been considered as one of the building blocks of the financial mechanisms to access quality health care. This study intended to explore procedures used by MHOs to enhance their social accountability and responsiveness. Methods We conducted a qualitative case study to investigate institutional arrangements and its implementing measures. Data were collected through a documentary review of more than 50 local related documents, 34 in-depth interviews with MHO and health facility managers, and 15 focus group discussions with MHO members. We focused on identifying and analyzing the existing institutional arrangements, their implementation, and their perceived effectiveness. Results We distinguished five institutional arrangements with 35 related measures for implementing these arrangements. MHO managers perceived them to be successful, while their members disagreed, and most of them did not have good knowledge of these implementing measures. For MHO managers, potential contributing factors to this perceived success were the coaching from MHO platforms, the 2017 law regulating MHOs, the inclusion of MHOs in the national UHC strategy, the nature of membership affiliation, and MHO managerial capacities. Conclusion To build trustful relationships and to engage into an effective dialogue between MHO managers and members, MHOs should build their internal capacities in implementing key institutional arrangements and related measures to improve their social accountability and responsiveness.