Challenges in healthcare financing for surgery in Sub-Saharan Africa

Abstract

One-third of the global burden of disease is attributed to surgical conditions yet, 5 billion people globally, lack access to surgery. The Lancet Commission on Global Surgery, Obstetrics, and Anesthesia (LCOGS) published guidelines for improving access by reducing catastrophic health expenditures (CHEs) by 2030. This is especially important in sub-Saharan Africa (SSA) where 90% of the extreme poor reside. In this paper, we provide a narrative review of four studies on CHEs for surgical care in SSA published since 2015. We discuss healthcare financing in the countries and summarize the authors’ key findings of out-of-pocket payments (OOP) and CHEs. Briefly, the studies enrolled 130 to 300 patients and collected direct OOPs via chart review of health costs or patient interviews. Indirect costs were calculated from lost wages and transportation costs. CHEs were defined as health costs exceeding 10% of the GDP per capita or the household income. Despite healthcare being reported as free in all studies, 60%-90% of surgical patients had CHEs with all costs considered. OOPs persists for medicines and anesthesia that should be covered under any health insurance scheme. In some cases, indirect costs associated with transportation and wages were major drivers of CHEs for surgery. Without addressing these gaps in coverage, more people will risk impoverishment in seeking surgical care in SSA.

Discharge instructions given to women following delivery by cesarean section in Sub-Saharan Africa: A scoping review

“…Furthermore, for the provision of discharge instructions to become an effective practice, they need to account for several limiting factors unique to the sub-Saharan setting. One of these is the financial burden to follow-up, where hospital fees and cost of transport often risk pushing patients and their families into financial catastrophe [29,58,62]. Another limiting factor is the lack of access to physical materials such as bandages, clean water, and feminine hygiene products, all of which can limit individual capacity to follow through on instructions provided [18,63].…”

Recommendations for developing effective and safe paediatric and congenital heart disease services in low-income and middle-income countries: a public health framework

“…Unfortunatley, out-of-pocket payment for surgical services is still common in LMICs, which is a major barrier to accessing care and many programmes seek alternative forms of financing to support their patient population. 28 29 …”

Challenges and solutions to providing surgery in Sierra Leone hospitals: a qualitative analysis of surgical provider perspectives

“…Providers emphasise national healthcare financing for surgical care as a solution to these cost-related barriers and delays. Community-based health insurance schemes and government sponsored insurance plans have been successfully used to increase surgical access and reduce catastrophic expenditure in countries like Rwanda and Ghana 42…”

“…Community-based health insurance schemes and government sponsored insurance plans have been successfully used to increase surgical access and reduce catastrophic expenditure in countries like Rwanda and Ghana. 42 Another pathway through which challenges were found to affect patients in this analysis is the limitation of potential surgical capacity, particularly at the district hospital level. 43 44 Challenges related to infrastructure and the availability of surgical and anaesthetic equipment were heavily emphasised as limitations to performing more complex procedures.…”