Quantitative Evaluation of Health Service Utilization in the Kenge Health Zone, Kwango Province, Democratic Republic of the Congo

Introduction The Democratic Republic of the Congo (DRC) continues to face protracted socio-economic instability that adversely impacts population well-being and impedes access to essential medical care. Equitable access to healthcare services remains a critical challenge in rural settings such as the Kenge Health Zone, resulting in consistently low service utilization. Improving service availability and economic accessibility is crucial to ensuring effective healthcare delivery. Purpose This study evaluated the quantitative utilization of healthcare services within the Kenge Health Zone across the 2024–2025 evaluation periods. Methods A retrospective, quantitative, descriptive empirical design was conducted across 20 health areas randomly selected from the 29 total health areas comprising the Kenge Health Zone. Secondary performance data collected via the quantitative assessment framework developed by the Health System Development Project (Programme de Développement des Services de Santé [PDSS]) were extracted in collaboration with evaluators from the Performance-Based Financing Public Utility Establishment (Établissement d'Utilité Publique - Financement Basé sur les Résultats [EUP-FBP]). Service utilization rates were calculated against PDSS targets and evaluated using standard validation thresholds (≥ 80% indicating effective utilization). Results Overall healthcare service utilization remained low across both years, recording overall coverage rates of 30.8% in 2024 and 36.5% in 2025. Although specific indicators exceeded operational targets—such as contraceptive renewal (198.2% in 2024) and cesarean deliveries (119.4% in 2024; 154.0% in 2025)—most basic preventive and curative primary health services operated well below optimal thresholds. Conclusion Healthcare services in the Kenge Health Zone are severely underutilized by the local population. Heavy reliance on direct, out-of-pocket household expenditure serves as the main barrier to access. Given that subsistence agriculture forms the economic foundation of the zone, health policymakers should consider flexible mechanisms, including in-kind payments and fixed sliding-scale fee structures, to reduce financial barriers and enhance service utilization.