Determinants of private entrepreneurship in Kinshasa healthcare in the Democratic Republic of Congo: a structural equation modelling approach

Abstract

# Background Since the 1980s, the liberalisation of the healthcare sector, driven by structural adjustment policies promoted by the Bretton Woods Institutions, has resulted in a significant increase in private healthcare entrepreneurs. One of the primary goals of this shift was to enhance geographical access to healthcare. However, there have been no comprehensive studies analysing the determinants of local healthcare entrepreneurship development in the Democratic Republic of Congo (DRC). This study aims to evaluate the relationship between the health zone profile and the development of private healthcare service provision in the DRC. # Methods This research employs a cross-sectional and analytical approach, using a quantitative methodology based on the Partial Least Squares Path Modeling (PLS-PM) technique. The focus was on measuring the relationship between variables associated with the health zone profile and the growth of private healthcare services. An econometric analysis was used to test and validate this relationship. # Results The findings reveal a positive relationship between the profile of the health zone and the development of private health services in Kinshasa (coefficient of 0.720). The health zone profile is primarily influenced by the mortality rate (coefficient of 0.793), while the development of private healthcare entrepreneurship is most strongly reflected by the number of paramedical practices (coefficient of 0.293). # Conclusions The study suggests that continuous training initiatives and efforts to reduce mortality are crucial for improving health zone management. Moreover, managing healthcare infrastructure effectively in response to growing urbanization, rather than merely increasing the number of health areas, is recommended for better health zone management in the DRC.