Impact of Universal Health Coverage on Quality of Care in Public Health Facilities in Mbandaka, Democratic Republic of the Congo: A Mixed-Methods Study (2024–2025)
Abstract
Introduction
Universal Health Coverage (UHC) has been adopted as a national priority in the Democratic Republic of the Congo (DRC) since 2023, aiming to ensure equitable access to quality essential health services without financial hardship. However, the impact of UHC on actual care quality in resource-limited settings such as Mbandaka remains poorly documented. This study evaluated the impact of UHC implementation on the quality of care in public health facilities in Mbandaka, Équateur Province.
Methods
A mixed-methods cross-sectional study was conducted from September 2024 to July 2025 in Mbandaka city. Participants included 220 health service users, 50 healthcare providers, 30 health facility managers, and 10 provincial authorities selected through stratified random and purposive sampling. Data were collected using structured questionnaires, semi-structured interviews, and direct observation. Quantitative data were analyzed using descriptive statistics and chi-square tests (SPSS version 25). Qualitative data were analyzed thematically.
Results
Among users, 62% were aged <30 years (OR=2.5, p<0.001), and 60% were female. While 49% waited <30 minutes, 24% waited >60 minutes. Despite UHC, 65% reported paying for services (OR=3.2, p<0.001). Satisfaction was low: only 12% were very satisfied, and 40% were poorly satisfied. Major problems included lack of reception (39%), high costs (29%), and medicine shortages (18%). Among providers, 72% lacked training on UHC (OR=0.2, p<0.001), and 60% were dissatisfied with working conditions (OR=0.4, p=0.03), primarily due to unpaid salaries (67%). Medicine stockouts were reported by 73% of managers (OR=6.8, p<0.001). Provincial authorities reported no specific UHC policy (80%) and no concrete support (100%). Significant associations were found between education level and satisfaction (OR=0.2, p<0.001) and between economic status and UHC awareness (OR=1.5, p=0.04).
Discussion
UHC has improved financial accessibility, but significant gaps remain in service quality, medicine availability, provider motivation, and governance. User satisfaction is low despite reported respect from staff. Provider training on UHC is virtually absent, and stockouts are endemic. Provincial support is lacking. These findings highlight that financial protection alone is insufficient; systemic strengthening is required.
Conclusion
UHC in Mbandaka has partially improved access but has not yet translated into sustained quality of care. Addressing human resource deficits, ensuring medicine availability, providing provider training, and strengthening provincial governance are urgently needed to realize UHC's full potential.
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How to cite
Soko Bosobe, J. (2026). Impact of Universal Health Coverage on Quality of Care in Public Health Facilities in Mbandaka, Democratic Republic of the Congo: A Mixed-Methods Study (2024–2025). SDF Journal of Public Health. https://sfoundation.one/articles/sdf-2026-0029-impact-of-universal-health-coverage-on-quality-of-care-in-public-healt