1. Accessing health services in the Democratic Republic of Congo: Perspectives of the elderly Ganzamungu Zihindula Pranitha Maharaj Maharajp7@ukzn.ac.za

2. Background The Democratic Republic of the Congo (DRC) is situated in central Africa and is the third largest country in Africa. The country is vast and rich in natural resources but the majority of the population lives in poverty. Poverty is a major problem in the country with 71.3% of the Congolese surviving below the income poverty line (UNDP 2010). Hunger is a major problem for a large sector of the population. The life expectancy remains low at 48 years but there are a substantial number of older people in the country given the massive population (UNDP 2010).

3. Background For the past several decades the DRC has been characterized by severe conflict and political upheavals. This has had serious implications for the health sector, and also has negatively impacted on the health of thousands of civilians. The health of older population in the country has also suffered as a result of decades of armed conflict.

4. Background Given the situation in the country it is difficult to come across reliable data on the health situation of the population, particularly the older sector.

5. Aim of the study The aim of the study is to shed some insights into the health and health seeking behaviour of the elderly.

6. Methodology The study relies on qualitative data that comes from in-depth interviews. 20 in-depth interviews

7. Perception of Health Almost all the respondents reported poor health, stating that they suffered from a range of health ailments. Men and women associate old age with poor health and they expect to experience ill-health. Some argue that poverty was exacerbating their health situation.

8. Health Seeking Behaviour Interviews revealed the desperate situation of men and women who are suffering from ill-health in the DRC. Their precarious financial situation places them at a great disadvantage. In most cases, access to treatment in the DRC is limited by financial barriers. Without money they will not receive health services.

9. Health Seeking Behaviour Accessing health facilities in the rural areas is a huge challenge. The long distance to the health centre is a major barrier to utilization of health care services. Many of the rural areas in particular do not have proper roads and it is difficult to get around these areas. In addition, the trip to the health facility is long and exhausting for them, especially for the sick and frail. Some fear visiting health facilities because of the fear of physical and sexual violence. It was not uncommon for women who were on their way to markets, churches and hospitals to be become victims of rape.

10. Health Seeking Behaviour The lack of government support was perceived as a major barrier to accessing health care. They were not aware of any social grants for the elderly.

11. Conclusion Health services are out of reach for many of the elderly. There is limited coverage of health services in the DRC. In the DRC the rural areas have been most severely affected by war. The war destroyed roads and bridges that ensured easy access to health centers. An important issue to emerge is how the economic situation of the elderly impacted on their health seeking behaviour. Cost is a major barrier to health care utilization. In addition, because of their frailty they cannot access health care services without the support of family and friends.