The study we undertook is part of an evaluative research aimed at improving the quality of health sciences teaching at I. S.T.M.-Gemena in the South Ubangi Province in the South Ubangi Republic in the Democratic Republic of Congo. Indeed, for several years of existence of the I.S.T.M.- Gemena, teaching has been done according to the objective approach which is based more on the behaviors to be adopted by the learners but practical skills have always been the business of the areas of professional life (hospitals, health centers) through advanced training courses, contrary to the expectations of the population at the end of higher education. This situation has never been the subject of any study and we believe that the non-integration of the Competency-based Approach in the teaching of health sciences at the higher level can be classified among the causes of the drop in performance. academic that the community deplores today in this school of higher education.

This study is the result of a survey of 344 people in the Bwamanda Health Zone specifically in 8 health areas on the determinants of low affiliation to the Bondeko Health Mutual in the Provincial Division of Southern Ubangi Health. In the Democratic Republic of Congo. We conducted a descriptive retrospective study aimed at improving the conditions for universal access to health care by identifying the factors that may affect affiliation to the health insurance system of developing countries. Considering the contribution and the importance of a mutual health in the accessibility of care in health facilities, this research is based on the observation that Bondeko Health Mutual is one of the oldest in the DRC but also constituted for certain country a model to follow for others including Rwanda. Despite its seniority it turns out that the annual affiliation rate does not believe in relation to the expected population. The results of this research revealed that poverty, discouragement of providers, number of people in the household and high affiliation fees are the determinants of weak community affiliation in this research.