Background The rapid spread of COVID-19 worldwide has confined millions of people to their homes and has caused a substantial degree of psychological distress. This study aims to investigate the psychological distress impact of the COVID-19 pandemic among the Saudi population. Methods This is a cross-sectional study, using data collected from 3036 participants via an online self-reported questionnaire. The psychological distress was constructed using the COVID-19 Peritraumatic Distress Index to classify individuals in the sample as having normal, mild or severe distress levels. The study used descriptive analysis and multinomial logistic regressions to examine the sociodemographic factors associated with psychological distress levels during the COVID-19 pandemic. Results The evidence showed that 40% of the Saudi population are distressed due to COVID-19, of whom approximately 33% are mildly distressed, while 7% are severely distressed. The distress levels are particularly high amongst the young, females, private sector employees and health workers, especially those working on the frontline. Conclusion The COVID-19 pandemic is associated with increased distress amongst people living in Saudi Arabia. In support of evidence found in other countries, the study has established that the distress levels vary across different sociodemographic characteristics. Therefore, limiting people’s psychological damage demands both medium- and long-term policy strategies, which include mapping the rates of stress and anxiety for effective psychological treatment allocation and establishing innovative online methods of heightening people’s mental wellbeing.

Background: Achieving universal health coverage is an important objective enshrined in the 2015 global Sustainable Development Goals. However, the rising cost of healthcare remains an obstacle to the attainment of the universal health coverage. Health insurance is considered an option to reduce out-of-pocket (OOP) expenditure on health and medicine. Nevertheless, the relationship between insurance and the OOP along welfare distributions is not well understood. This study investigates the heterogeneous association between health insurance and OOP expenditure on health and medicine, along income, using data from the Kingdom of Saudi Arabia.Methods: This study used data of 8655 individuals drawn from the Saudi Family Health Survey conducted in 2018. The study adopts Tobit models to account for possible corner solution due to individuals with zero expenditure on health. We minimize the confounding effects of non-random selection into the insurance program by estimating the Tobit equations on a sample weighted by inverse propensity scores of insurance participation. In addition, we test whether the health insurance differently relates to OOP on health and medicine amongst people with access to free medical care as opposed to those without this privilege. The study estimates separate models for OOP expenditure on health and on medicines.Results: Health insurance reduces OOP expenditure on health by 2.0% and OOP expenditure on medicine by 2.4% amongst the general population while increasing the OOP expenditure on health by 0.2% and OOP expenditure on medicine by 0.2%, once income of the insured rises. The relationship between the insurance and OOP expenditure is robust only amongst the citizens, a sub-sample that also has access to free public healthcare. Specifically, the insurance reduces OOP expenditure on health by 3.6% and OOP on medicine by 5.2% and increases OOP expenditure on health by 0.4% and OOP expenditure on medicine by 0.5% once income of the insured increases amongst Saudi citizens. In addition, targeting medicines can lead to greater changes in OOP. The relationship between insurance and OOP is stronger for medicine relative to that observed on health expenditure.Conclusion: Our findings suggest that insurance induces different effects along the income spectrum. Hence, policy needs to be aware of the possible welfare distribution impacts of upscaling or downscaling the coverage of insurance amongst the populations, while pursuing universal healthcare coverage.

Background: Saudi Arabia's healthcare sector is growing at a hasty stride; nevertheless, the quality of healthcare consumption remains challenged by the growing caseload in free public health facilities. Insurance could ease this pressure by moving some healthcare demand to private facilities conditional on its ability to enact health-seeking behaviour. These potential effects remain under-investigated. Therefore, the aim of this study was to investigate whether health insurance nudges health-seeking behaviour using data from Saudi Arabia. Materials and Methods: The study used nationally representative secondary data, obtained from the Family Health Survey, conducted in 2018, in Saudi Arabia. Health-seeking behaviour was measured by individual attendance of medical check-up. To account for endogeneity due to non-random selection of individuals into insurance, the analysis employed the inverse propensity weighting and the instrumental variables methods. Results: The results revealed that health insurance leads to increased chances of going for medical check-up. The effects are higher amongst non-Saudi nationals relative to citizens. Furthermore, people who purchase personal health insurance schemes are more likely to go for checks-ups, followed by individuals provided by the private sector and government sector. Finally, the study found that insurance positively nudges hypertension, diabetes, and cholesterol specific medical check-ups. Conclusion:The findings indicated the need for health policy to increase access to health insurance in Saudi Arabia. A notable policy response is the introduction of national health insurance coverage, which has already proven in other countries as an effective measure to attain universal access to improved health. Nevertheless, results from this study highlighted variations in demand for health seeking based on type of insurance with highest returns in personal insurance. Policy should leverage on this behaviour response by introducing insurance packages that share premiums with citizens to incentivise utilisation. The results can also be used to design policy responses to demand for insurance, in the entire Arabian Gulf region, since these countries have similar health financing mechanism with Saudi Arabia.

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Out-of-pocket (OOP) expenditures on health remain high in many low- and middle-income countries despite policy efforts aiming to reduce these health costs by targeting their hotspots. Hotspot targeting remains inadequate, particularly where the OOP expenditures are related across geographic regions due to unequal demand, supply and prices of healthcare services. In this paper, we investigate the existence of geographical correlations in OOP health expenditures by employing a spatial Durbin model on data from 778 clusters obtained from the 2016 Malawi’s Integrated Household Survey. Results reveal that Malawian communities face geographical spillovers of OOP health expenditures. Furthermore, we find that factors including household size, education and geographical location are important drivers of the OOP health expenditure’s spatial dependency. The paper calls for policy in low-income countries to improve the quality and quantity of healthcare services in both OOP hotspots and their neighbouring communities.

The paper investigates whether cultural lineage mediates gender gaps in child nutrition. It captures nutrition using height-for-age and stunting. The analysis uses the 2014 Malawi Millennium Development Goals Endline Survey data. We find evidence of male child nutrition deprivation in matrilineal cultural lineage. The gender of the household head does not relate to the mediating role of lineage on gendered nutrition gaps. As such, the analysis of gendered nutrition should account for the potential impact of culture to produce policy relevant estimates. Furthermore, deficiencies in male nutrition remains a strong health problem, particularly in cultures that benefit most from returns on female children. In these cultures, lineage dominates personal parental preferences. Therefore, there is a need to revisit received wisdom that providing more resources to female heads eliminates gender gaps by provision of culture-tailored nutritional interventions.

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The Malawi Farm Input Subsidy Program (FISP) was praised for turning the country's food deficit into a surplus immediately after its inception in 2005. It is, however, not clear whether these food security gains spillover to equity in distribution of welfare. In this study we examine the effects of the FISP on per-capita consumption convergence, using a sample of 2251 households interviewed in the 2010 to 2013 Malawi Integrated Household Panel Survey. The analysis employs a Lewbel method of instrumental variables (IV) to account for the potential non-random selection into the FISP. The results reveal that FISP helps relatively poor farmers increase household percapita consumption towards converging to that of the relatively rich. This convergence is robust only amongst small but not large farmers. Past studies that evaluated the FISP while not paying attention to the welfare equity gains in household per-capita consumption, may have underestimated its benefits. Policy, should, therefore, support the FISP with an additional objective of reducing inequality, beyond the primary aim of enhanced food security. Considering that the effects of FISP are limited to small farmers, alternative interventions such as inputs for credit should be made available to large farmers. This will allow the FISP induce widespread welfare gains.