Expanding Health Care Provision in a Low-Income Country

Chansa, Collins; Pattnaik, Anooj

doi:10.1596/29185

Cited by 11 publications

(10 citation statements)

References 2 publications

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“…Despite other studies showing that service level agreements improved utilization of health services [ 45 ] our finding may suggest that it has not achieved one of its intended purpose of protecting households from the financial burden of health expenditures. This is because many of the mission facilities and needed services are not part of the agreements and the poor who access services at these facilities still incur higher out-of-pocket payments [ 46 ]. There is need for government to expand these Service Level Agreements to include more facilities and services needed by households.…”

Section: Discussionmentioning

confidence: 99%

Examining the incidence of catastrophic health expenditures and its determinants using multilevel logistic regression in Malawi

2021

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Background Despite a free access to public health services policy in most sub-Saharan African countries, households still contribute to total health expenditures through out-of-pocket expenditures. This reliance on out-of-pocket expenditures places households at a risk of catastrophic health expenditures and impoverishment. This study examined the incidence of catastrophic health expenditures, impoverishing effects of out-of-pocket expenditures on households and factors associated with catastrophic expenditures in Malawi. Methods We conducted a secondary analysis of the most recent nationally representative integrated household survey conducted by the National Statistical Office between April 2016 to 2017 in Malawi with a sample size of 12447 households. Catastrophic health expenditures were estimated based on household annual nonfood expenditures and total household annual expenditures. We estimated incidence of catastrophic health expenditures as the proportion of households whose out-of-pocket expenditures exceed 40% threshold level of non-food expenditures and 10% of total annual expenditures. Impoverishing effect of out-of-pocket health expenditures on households was estimated as the difference between poverty head count before and after accounting for household health payments. We used a multilevel binary logistic regression model to assess factors associated with catastrophic health expenditures. Results A total of 167 households (1.37%) incurred catastrophic health expenditures. These households on average spend over 52% of household nonfood expenditures on health care. 1.6% of Malawians are impoverished due to out-of-pocket health expenditures. Visiting a religious health facility (AOR = 2.27,95% CI:1.24–4.15), hospitalization (AOR = 6.03,95% CI:4.08–8.90), larger household size (AOR = 1.20,95% CI:1.24–1.34), higher socioeconomic status (AOR = 2.94,95% CI:1.39–6.19), living in central region (AOR = 3.54,95% CI:1.79–6.97) and rural areas (AOR = 5.13,95% CI:2.14–12.29) increased the odds of incurring catastrophic expenditures. Conclusion The risk of catastrophic health expenditures and impoverishment persists in Malawi. This calls for government to improve the challenges faced by the free public health services and design better prepayment mechanisms to protect more vulnerable groups of the population from the burden of out-of-pocket payments.

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Section: Discussionmentioning

confidence: 99%

Examining the incidence of catastrophic health expenditures and its determinants using multilevel logistic regression in Malawi

2021

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“…On the contrary, a study conducted in Malawi found that the odds of HIV-positive status were 0.72 times lower in people from poorer households as compared to those from richest households (AOR = 0.72, 95% CI = 0.54-0.95) [40] . Malawi has reported HIV prevalences of between 6.4 and 10% which are much lower than in KZN [41] and is classi ed as a low income country [42] . The contradictory ndings may be caused by multi-factors which explain different contexts at which HIV evolve in these two settings.…”

Section: Discussionmentioning

confidence: 99%

Geo-Analysis: The Distribution of Community Health Workers in Relation to the HIV Prevalence in Kwazulu-Natal Province, South Africa

Khumalo

Ntuli

Lutge

et al. 2021

Preprint

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Background: The Ward Based Primary Health Care Outreach Team (WBPHCOT) policy framework states that community health workers (CHW)s should be distributed mainly according to poverty lines for each catchment population. We aimed to describe the spatial distribution of CHWs in relation to the HIV prevalence which has been associated with poverty in previous studies.Methods: We utilized geographic information system (GIS) method to visualize the distribution of CHWs in relation to HIV prevalence in KwaZulu-Natal (KZN) districts. Dot density mapping, was used to visualize the random distribution of CHWs in relation to HIV prevalence in the districts. The districts’ HIV prevalence, number of PLWH, CHW: PLWH ratio and poverty scores were mapped using choropleth mapping. MapInfo 17, a GIS software was used to map geospatial presentation of the data.Results: Ten out of 11 KZN districts had more than a required CHW:PLWH ratio of 1:160-267, which indicates a significant shortage of CHWs regardless of the HIV prevalence or poverty scores. Furthermore, our findings showed extensive geospatial heterogeneity with no clear pattern in the distribution CHWs in relation to the HIV prevalence and poverty scores in the districts Conclusion: This finding represents inequalities in the provision of HIV services by the CHWs. It is critical to strengthen response to the HIV epidemic through the well informed and justified distribution of CHWs especially to the poor districts.

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“…Malawi is one of the world’s poorest countries. With more than 60% of its total health expenditure financed by donor aid (Chansa & Pattnaik, 2018) and a high presence of international NGOs, it has been called a “donor darling” (Koch, 2007, p. 1) and has experienced “NGO-mania” (Kloster, 2015). These organizations contextualize and display global development policies such as the SDG5 through campaigns, conferences, interventions, and the mass media.…”

Section: The Malawian Contextmentioning

confidence: 99%

“Nowadays there isgender”: “Doing” global gender equality in rural Malawi

Adolfsson

Madsen

2019

Theory & Psychology

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This article analyzes the intersection of psychology with global development policy and practice, reviewing how gender as a concept is negotiated and understood amongst men and women in rural Malawi. We argue that gender, considered from a psychological perspective, has been narrowed down to meet the standards of global policy actors. By empowering individuals to “self-actualize,” policy implementers expect social and economic spin-off effects such as lower birth rates, higher education levels, and poverty reduction. The focus on individuals acts to obscure the broader structural power inequities, is especially prevalent in rural Malawi. To explain this, we use Haslam’s idea of “concept creep,” on how psychological concepts tend to affect other institutional traditions. The everyday understandings of gendered life described here show how gender is a fluid concept that shifts according to cultural, social, and ideological norms.

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Expanding Health Care Provision in a Low-Income Country

Cited by 11 publications

References 2 publications

Examining the incidence of catastrophic health expenditures and its determinants using multilevel logistic regression in Malawi

Examining the incidence of catastrophic health expenditures and its determinants using multilevel logistic regression in Malawi

Geo-Analysis: The Distribution of Community Health Workers in Relation to the HIV Prevalence in Kwazulu-Natal Province, South Africa

“Nowadays there isgender”: “Doing” global gender equality in rural Malawi

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