reduction of life expectancy at birth from year to year, average infant and maternal mortality rate as well as the average incidence of diseases are higher than what obtains in other segments of the population. They suffer from diseases like tuberculosis which mainly affect young adults in the most productive period of their lives, while the risk is even higher for persons living with HIV. 209. Furthermore, in addition to the fact that women account for the majority of the population of the DRC (52%), they also constitute one of the most vulnerable groups, particularly in the rural areas where the lack of money or low household incomes, cost of health care, selfmedication among households in case of illness and the long distance between the households and the health centres are the main causes or determining factors which explain why poor households cannot access health care in the DRC. 210. Ultimately, all social segments pay money to access health care. That is why the percentage of access to health care by the population varies according to the level of economic well-being, level of education and place of abode. In fact, studies have shown that among women in the poorest fifth, 80.8% have difficulty in accessing health care, against 50% among richer women. This money problem affects more women in the rural areas (74.9%) than those in the urban areas (58.4%). Similarly, uneducated women (79.9%) a r e more frequently confronted with this problem than those who have had secondary education (61.4%) and those who have had higher education (40.1%) (DRC-DHS, 2013-2014). Differences are also observed at the provincial level – more than 72% of women in the Equateur, the Orientale Province, the two Kasais and Bandundu, against only 45.1% in Kinshasa. The seriousness of this problem worsens significantly with the number of living children. In addition, for 38.9% of women, it is the distance they have to travel to reach the health care centres which hinders access to health care. As is to be expected, these problems are much more frequent in the rural areas than in the urban centres. They are also more frequent among women living in households classified under the poorest two fifths. They vary from province to province. In Equateur and the Orientale Province, one out of two women faced problems of distance in order to reach health facilities (DRC-DHS, 2013 -2014). 211. The current structuring of the Ministry of Health into 13 Central Departments and 52 Specialized Programmes meets the needs of universal health care coverage to address the problems raised above, particularly the poor income of the head of household, high cost of health care, self-medication and the long distance to be covered by the people before they reach health centres. In this regard, the DRC is divided into 11 provinces (now 26), which are themselves sub-divided into administrative districts, which are in turn distributed into health zones. A health zone corresponds to the internationally-used concept of a health district: a network of primary healthcare centres supervised by a district hospital for treatment of all ailments which go beyond the resources and capacity of the health centres. Health infrastructure may be the property of the State or private non-profit stakeholders. As a general rule, the latter often enter into a contractual agreement with the State which clarifies the rights and responsibilities of the two parties, but they retain significant autonomy in the area of management. The organization of health services in the Democratic Republic of Congo follows this three-stage pyramid: health zone (ZS), general referral hospital (HGR) and health centre (CS). On the whole, the country has 515 health zones distributed in all the provinces. 212. As part of the “five-project” policy of the Republic initiated by the Head of State, several projects have been carried out by the Government in order to address the various problems raised concerning access to health care by the people. Health centres have been built in the country, general referral hospitals have been rehabilitated, and medical training institutions have been refurbished and equipped, while several health centres and hospitals have been provided with subvented pharmaceutical products. 213. By way of illustration, the free distribution of insecticide-treated mosquito nets (two per household) has been embarked upon throughout the country. This measure is contributing to the fight against malaria and the promotion of the right to health. Substantial funding has been provided for projects aimed at combating certain diseases (AIDS, tuberculosis, 45

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