Economic burden of out-of-pocket expenditure, productivity cost during pregnancy and COVID-19 impact on household economy in a cohort of pregnant women in Anuradhapura District, Sri Lanka; A study protocol

Abstract

Background: Investigating the out-of-pocket expenditure (OOPE) associated with maternal health is important since OOPE directly affects the affordability of health services. Global evidence suggests the importance of capturing the productivity cost during pregnancy in terms of absenteeism and presenteeism. Furthermore, the impact of the ongoing COVID-19 pandemic on the household economy needs to be further evaluated as pregnant women are one of the most vulnerable groups. This study aims at determining the economic burden of OOPE, productivity cost, and COVID-19 impact on pregnant women's household economy in a cohort of pregnant women in Anuradhapura District, Sri Lanka. Methods: The study setting is all 22 Medical Officer of Health (MOH) areas in Anuradhapura district, Sri Lanka. The study has three components; a follow-up study of a cohort of pregnant women to assess the magnitude and associated factors of OOPE and to assess the productivity cost (Component 1), a qualitative case study to explore the impact and causes of the OOPE under free health services (Component 2) and a cross-sectional study to describe the effects of COVID-19 outbreak on household economy (Component 3). The study samples consist of 1,393 and 1,460 participants for components one and three, respectively, and 25 pregnant women will be recruited for component two. The data will be analyzed using descriptive, parametric, and non-parametric statistics for the first and third components and thematic analysis for the second component. Discussion: With the lack of evidence on OOPE, productivity loss/cost in terms of maternal health, and COVID-19 impact on household economy in Sri Lanka, the evidence generated from this study would be valuable for policymakers, health care administrators, and health care practitioners globally, regionally, and locally to plan for future measures for reducing the OOPE, productivity loss/cost, and minimizing the economic hardship of the COVID-19 outbreak during pregnancy.

How costly is the first prenatal clinic visit? Analysis of out-of-pocket expenditure in rural Sri Lanka - a country with free maternal health care

“…The RaPCo study is a prospective cohort study, mainly conducted to identify the implications of socio-economic, demographic characteristics, and maternal mental health status on pregnancy and newborn outcomes [44]. An economic evaluation under the RaPCo study has been conducted to examine the economic burden of OOPE, productivity loss/cost of pregnant women, and the impact of the COVID-19 pandemic on the household economy of pregnant women in rural Sri Lanka [7]. The complete economic evaluation was a follow-up study that was carried out throughout the pregnancy period.…”

“…The complete economic evaluation was a follow-up study that was carried out throughout the pregnancy period. The present study is a part of the sub-component (economic burden of OOPE) of the economic evaluation of the RaPCo study [7,44].…”

“…The concept of out-of-pocket expenditure (OOPE) on health care refers to the payments made by individuals and families for medical services [1] which is widely defined as 'direct payment for the cost of care' [2][3][4]. The World Bank defines OOPE as 'any direct payout by households, including gratuities and in-kind payments, to health care providers of pharmaceuticals, therapeutic appliances, and other goods and services whose primary intent is to contribute to the restoration or enhancement of the health status of individuals or population groups' [5][6][7][8]. OOPE is considered a vital issue in the global health agenda, as it impedes enhancing the population health most effectively under the society's available resources and competing needs [9].…”

Impact of COVID-19 pandemic on health service utilisation and household economy of pregnant and postpartum women: a cross-sectional study from rural Sri Lanka

“…We conducted a cross-sectional study via telephone interviews. The participants were the women in the economic component of the largest pregnancy cohort in Sri Lanka, the Rajarata Pregnancy Cohort (RaPCo) 29 30. Anuradhapura district is the largest district in Sri Lanka (7179 km 2 ), with a current population of about 900 000, and most of the population (92.7%) belongs to the district’s rural population.…”

Out-of-Pocket Expenditure for Antenatal Care Amid Free Health Care Provision: Evidence From a Large Pregnancy Cohort in Rural Sri Lanka

“… 49 The study setting, period, population, and sample details are presented in relevant sections of this article and published elsewhere. 49 , 50 …”