Authors : Kayungura Tasinzanzu Godefroid; Charles Wafula; Samuel Tororei

Volume/Issue : Volume 11 - 2026, Issue 3 - March

Google Scholar : https://tinyurl.com/3dpyff4v

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DOI : https://doi.org/10.38124/ijisrt/26mar1529

Note : A published paper may take 4-5 working days from the publication date to appear in PlumX Metrics, Semantic Scholar, and ResearchGate.

Abstract : Access to affordable and quality healthcare remains a major challenge in low- and middle-income countries, particularly in fragile and conflict-affected settings such as eastern Democratic Republic of Congo. Heavy reliance on out-ofpocket payments exposes households to catastrophic health expenditures and limits healthcare utilization. While Village Savings and Loan Associations (VSLAs) provide informal financial protection through solidarity mechanisms, their potential role in promoting health insurance uptake remains insufficiently understood. This study aimed to assess whether solidarity mechanisms within VSLAs can act as a catalyst for health insurance enrollment among members in Goma and surrounding areas. A quasi-experimental design was employed, involving 420 VSLA members equally divided into intervention and control groups. Baseline data were collected between November 2024 and January 2025, followed by an endline survey after a threemonth period of sensitization and training on health insurance integration. Data were gathered through structured interviews and analyzed using descriptive statistics, chi-square tests, and logistic regression to examine associations between solidarity participation and health insurance coverage. At baseline, no statistically significant association was found between solidarity fund participation and health insurance coverage in either group (p > .05). Endline results showed only modest increases in coverage (+1.9% in the intervention group versus +0.5% in the control group), which were not statistically significant. Logistic regression analysis identified mode of payment as the only significant predictor of insurance uptake (p < .001), while duration in the group and benefiting from solidarity funds remained non-significant. The findings suggest that although VSLA solidarity mechanisms strengthen financial resilience and social cohesion, they do not independently drive health insurance enrollment. Effective uptake requires stronger integration between communitybased financial systems and formal insurance schemes, alongside improved affordability, sustained awareness, and strengthened trust in healthcare services.

Keywords : Village Savings and Loan Associations (VSLAs); Solidarity Mechanisms; Health Insurance Uptake; Community-Based Health Insurance (CBHI); Financial Protection; Universal Health Coverage (UHC); Out-of-Pocket Payments; Health Financing; Crisis-Affected Settings; Democratic Republic of Congo (DRC); Social Protection; Microi-Nsurance; Health-Seeking Behavior.

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