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Zaire Health Care System
In a regional context, the health care system
established to
meet these challenges appears impressive, at least on
paper,
although the UN estimates that only 50 percent of the
population
had access to health care in the early 1990s (see
table 9,
Appendix). The ratio of physicians to population in the
early 1990s
was claimed to be approximately one per 14,000, markedly
higher
than in neighboring countries such as Rwanda (one to
35,000) or
Burundi (one to 45,000), for example. The ratio of nurses
to
population was estimated as approximately one to 1,900,
spectacularly higher than the sub-Saharan African average
of one to
45,000. Average population per hospital bed was
approximately 700,
a better rate than neighboring Burundi's 850, for example.
In theory, the nation is divided into health zones,
each
covering a population of 100,000 to 150,000 and containing
on
average one referral hospital, between one and three
reference
health centers, and fifteen to twenty-five standard health
centers.
Each standard health center is staffed with at least one
certified
nurse and provides basic preventive and simple curative
services to
the five to ten villages in its area. Serious medical
cases are
referred upward to the health zone's reference health
centers and
referral hospital.
The health care system is considerably less impressive
in
practice, however. The relatively high physician- and
paramedic-to-
population ratio masks the fact that the quality of
medical
education has seriously deteriorated. Moreover, salaries
of medical
personnel are too low to permit staff the luxury of
full-time
attention to their professional duties. Virtually all
people
employed in the public sector must seek outside income in
order to
survive. It is not uncommon for state hospital nurses, for
example,
to demand private payment from a hospitalized patient or
the
patient's family before changing a dressing, or before
administering a medication prescribed by the patient's
physician.
In fact, according to Janet MacGaffey, doctors, nurses,
and other
medical personnel routinely require payment of a personal
fee
before they will care for a patient. Even emergency cases
are not
admitted to a hospital until payment has been made.
The large number of health centers and health zones
cited in
statistics is similarly misleading. Many government health
centers
are dysfunctional, completely lacking in medications or in
basic
medical equipment and personnel. In the early 1990s, the
publichealth system had deteriorated further as a result of
civil and
political unrest and severe economic disruptions. Indeed,
the
government's health services have in essence collapsed.
What health
care Zairians find comes more often private sources. The
elite
continue to seek quality health care abroad.
Religious organizations, notably the Roman Catholic,
Protestant, and Kimbanguist churches, and international
relief
organizations provide the bulk of health care in Zaire,
particularly in rural areas, as happened in the
preindependence era
as well. The Catholic medical service network is the
largest and
involves primary responsibility for some ninety health
zones. The
Protestant network participates in the development of
fifty health
zones; as the implementing agent of an AID-supported rural
health
project, it plans to develop fifty more health zones over
a sevenyear period. Kimbanguist medical work centers on the
rehabilitation
of two urban hospitals and on management of 180 health
centers
scattered all over the country. Private enterprises also
manage
large health care facilities where they provide
high-quality care.
The large parastatal General Quarries and Mines (Générale
des
Carrières et des Mines--Gécamines), for example, owns
seven
hospitals and six clinics with about 2,264 beds.
Data as of December 1993
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