Determinants of hardship financing in coping with out of pocket payment for care seeking of under five children in selected rural areas of Bangladesh

Tahsina, Tazeen; Ali, Nazia Binte; Siddique, Abu Bakkar; Ahmed, Sameera; Rahman, M. Mokhlesur; Islam, Sajia; Rahman, M.M. Hafizur; Amena, Bushra; Hoque, Dewan Md Emdadul; Huda, Tanvir; Arifeen, Shams El

doi:10.1371/journal.pone.0196237

Cited by 17 publications

(19 citation statements)

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“…Heavy reliance on OOP healthcare payments posed a financial burden on households and lead to different types of coping strategies to be adopted to cover healthcare payments for maternal and neonatal illness. In our study, coping strategies adopted to meet OOP healthcare payments are consistent with a study from rural Bangladesh [45].…”

Section: Discussionsupporting

confidence: 80%

Financial risk of seeking maternal and neonatal healthcare in southern Ethiopia: a cohort study of rural households

Borde

Loha

Johansson

et al. 2020

Int J Equity Health

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Introduction: Ethiopian households' out-of-pocket healthcare payments constitute one-third of the national healthcare budget and are higher than the global and low-income countries average, and even the global target. Such out-of-pocket payments pose severe financial risks, can be catastrophic, impoverishing, and one of the causal barriers for low utilisation of healthcare services in Ethiopia. This study aimed to assess the financial risk of seeking maternal and neonatal healthcare in southern Ethiopia. Methods: A population-based cohort study was conducted among 794 pregnant women, 784 postpartum women, and their 772 neonates from 794 households in rural kebeles of the Wonago district, southern Ethiopia. The financial risk was estimated using the incidence of catastrophic healthcare expenditure, impoverishment, and depth of poverty. Annual catastrophic healthcare expenditure was determined if out-of-pocket payments exceeding 10% of total household or 40% of non-food expenditure. Impoverishment was analysed based on total household expenditure and the international poverty line of ≈ $1.9 per capita per day. Results: Approximately 93% (735) of pregnant women, 31% (244) of postpartum women, and 48% (369) of their neonates experienced illness. However, only 56 households utilised healthcare services. The median total household expenditure was $527 per year (IQR = 390: 370,760). The median out-of-pocket healthcare payment was $46 per year (IQR = 46: 46, 92) with two episodes per household, and shared 19% of the household's budget. The poorer households paid more than did the richer for healthcare, during pregnancy-related and neonatal illness. However, the richer paid more than did the poorer during postpartum illness. Forty-six percent of households faced catastrophic healthcare expenditure at the threshold of 10% of total household expenditure, or 74% at a 40% nonfood expenditure, and associated with neonatal illness (aRR: 2.56, 95%CI: 1.02, 6.44). Moreover, 92% of households were pushed further into extreme poverty and the poverty gap among households was 45 Ethiopian Birr per day. The average household size among study households was 4.7 persons per household.

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Section: Discussionsupporting

confidence: 80%

Financial risk of seeking maternal and neonatal healthcare in southern Ethiopia: a cohort study of rural households

Borde

Loha

Johansson

et al. 2020

Int J Equity Health

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“…Hardship financing was exemplified by borrowing money, asking someone else to pay for them, or selling personal or household items, and CHE, which entails that OOPs displaces basic household consumption. This level of hardship financing is much lower than what was reported in a study by Tahsina et al [35], mainly because of the removal of user fees, though similar to a study in Bangladesh.…”

Section: Discussionsupporting

confidence: 76%

Hardship financing of out-of-pocket payments in the context of free healthcare in Zambia

2019

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Despite the removal of user fees on public primary healthcare in Zambia, prior studies suggest that out-of-pocket payments are still significant. However, we have little understanding of the extent to which out-of-pocket payments lead patients to hardship methods of financing out-of-pocket costs. This study analyses the prevalence and determinants of hardship financing arising from out-of-pocket payments in healthcare, using data from a nationally-representative household health expenditure survey conducted in 2014. We employ a sequential logistic regression model to examine the factors associated with the risk of hardship financing conditional on reporting an illness and an out-of-pocket expenditure. The results show that up to 11% of households who reported an illness had borrowed money, or sold items or asked a friend for help, or displaced other household consumption in order to pay for health care. The risk of hardship financing was higher among the poorest households, female headed-households and households who reside further from health facilities. Improvements in physical access and quality of public health services have the potential to reduce the incidence of hardship financing especially among the poorest.

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“…Overall, 8,679 households were surveyed and the response rate was 99.9%. Details of the baseline survey has been published elsewhere [26, 27].…”

Section: Methodsmentioning

confidence: 99%

Association of food security and other socio-economic factors with dietary diversity and nutritional statuses of children aged 6-59 months in rural Bangladesh

et al. 2019

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Introduction Dietary diversity score (DDS) is a proxy indicator for measuring nutrient adequacy. In this study, we aimed to identify the nutritional statuses and current patterns of DDS among children between 6–59 months old and their associations with different individual and household level factors in rural Bangladesh. Methods The Nobokoli programme of World Vision Bangladesh was implemented in Mymensingh, Sherpur, Rangpur, Dinajpur, Thakurgaon, Panchagar, and Nilphamari districts of Bangladesh between 2014 and 2017. A cross-sectional community household survey was administered between July and October 2014 to collect baseline data to evaluate the Nobokoli programme. A total of 6,468 children between 6–59 months old were included in the final analysis. Anthropometric data was collected following WHO guidelines on using wooden height and digital weight scales. We collected food intake information for the past 24 hours of the survey. The WHO’s child growth standard medians were used to identify the nutritional indices of stunting, wasting, and underweight. Food items consumed were categorized into nine food groups and the DDS was constructed by counting the consumption of food items across these groups during the preceding 24 hour period. The association of DDS and nutritional status (stunting, wasting and underweight) with sociodemographic factors and household food security status were examined using multivariable models; linear regression and logistics regression respectively. Results The prevalence of stunting, wasting and underweight among children aged 6-59months were 36.8%, 18.2% and 37.7% respectively. Our findings revealed that almost all children ate any form of starch followed by consumption of milk or milk products (76%) and fleshy meat /fish (61%) respectively. The mean DDS among children was 3.93(sd 1.47). Forty percent of the children obtained a DDS score less than 4. Multivariable analysis suggested that children whose mothers had higher educational attainment and are skilled workers had higher DDS (15% and 48% respectively) compared to their counterparts. The DDS showed strong positive association with household wealth status. Children from food secure households had 26% higher DDS compared to children from food insecure households. Similarly, increasing maternal education and household wealth were found to be protective against childhood stunting and undernutrition. Discussion Our findings reiterate the need for improving household socioeconomic factors and household food security status for improving dietary diversity practices and nutritional status of children. Evidence-based solutions are needed to be implemented and expanded at scale to ensure appropriate dietary practices and improve nutritional status of the children in local context.

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Determinants of hardship financing in coping with out of pocket payment for care seeking of under five children in selected rural areas of Bangladesh

Cited by 17 publications

References 50 publications

Financial risk of seeking maternal and neonatal healthcare in southern Ethiopia: a cohort study of rural households

Financial risk of seeking maternal and neonatal healthcare in southern Ethiopia: a cohort study of rural households

Hardship financing of out-of-pocket payments in the context of free healthcare in Zambia

Association of food security and other socio-economic factors with dietary diversity and nutritional statuses of children aged 6-59 months in rural Bangladesh

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