Are people most in need utilising health facilities in post-conflict settings? A cross-sectional study from South Kivu, eastern DR Congo

Background: The disruptive effect of protracted socio-political instability and conflict on thehealth systems is likely to exacerbate inequities in health service utilisation in conflict-recovering contexts.Objective: To examine whether the level of healthcare need is associated with health facilityutilisation in post-conflict settings.Methods: We conducted a cross-sectional study among adults with diabetes, hypertension,mothers of infants with acute malnutrition, informal caregivers (of participants with diabetesand hypertension) and helpers of mothers of children acutely malnourished, and randomlyselected neighbours in South Kivu province, eastern DR Congo. Healthcare need levels werederived from a combination, summary and categorisation of the World Health OrganisationDisability Assessment Schedule 2.0. Health facility utilisation was defined as having utilised inthe first resort a health post, a health centre or a hospital as opposed to self-medication,traditional herbs or prayer homes during illness in the past 30 days. We used mixed-effectsPoisson regression models with robust variance to identify the factors associated with healthfacility utilisation.Results: Overall, 82% (n = 413) of the participants (N = 504) utilised modern health facilities.Health facility utilisation likelihood was higher by 27% [adjusted prevalence ratio (aPR): 1.27;95% CI: 1.13–1.43;p< 0.001] and 18% (aPR: 1.18; 95% CI: 1.06–1.30;p= 0.002) amongparticipants with middle and higher health needs, respectively, compared to those with lowhealthcare needs. Using the lowest health need cluster as a reference, participants in themiddle healthcare need cluster tended to have a higher hospital utilisation level.Conclusion: Greater reported healthcare need was significantly associated with health facilityutilisation. Primary healthcare facilities were the first resort for a vast majority of respondents.Improving the availability and quality of health service packages at the primary healthcarelevel is necessary to ensure the universal health coverage goal advocating quality health forall can be achieved in post-conflict settin