Determinants of Household Participation in Healthcare Prepayment Schemes in the City of Goma, in the Eastern Democratic Republic of the Congo: A Cross-Sectional Study

Background Out-of-pocket health expenditures are often difficult for households to manage and can lead to financial hardship and poverty. Prepayment mechanisms, including community-based health insurance, offer a pathway toward financial protection, yet uptake remains low in many low-income settings. This study aimed to identify the determinants of household participation in healthcare prepayment schemes in Goma, Democratic Republic of Congo. Methods We conducted an analytical cross-sectional study using multistage cluster random sampling among 807 households in Goma in November 2023. Data were collected using a structured questionnaire, encoded, and analyzed in SPSS version 23. Logistic regression models were used to assess factors associated with participation in healthcare prepayment. Results Overall, 13.1% of households participated in a prepayment scheme. Factors negatively associated with participation included: male household head (OR = 0.5), being unmarried (OR = 0.3), no prior membership in associations (OR = 0.09), primary-level or lower education (OR = 0.3), poor knowledge of mutual health schemes (OR = 0.04), unemployment (OR = 0.4), low socioeconomic status (OR = 0.3), poor reception at health facilities (OR = 0.9), perceived incompetence of health staff (OR = 0.6), unavailability of medicines (OR = 0.5), care-related adverse events (OR = 0.3), lack of explanations during care (OR = 0.5), high contribution fees (OR = 0.9), incomplete benefit package (OR = 0.2), and lack of trust in scheme management (OR = 0.2). Age below 30 years among household heads was positively associated with participation (OR = 1.8). Conclusion Household enrollment in healthcare prepayment schemes in Goma remains low. Multiple socioeconomic, cultural, and healthcare quality-related factors negatively influence participation. Targeted strategies are needed to strengthen trust, accessibility, and the perceived value of community-based health insurance.