Factors associated with catastrophic health expenditure in sub-Saharan Africa: A systematic review

Abstract

Objective A non-negligible proportion of sub-Saharan African (SSA) households experience catastrophic costs accessing healthcare. This study aimed to systematically review the existing evidence to identify factors associated with catastrophic health expenditure (CHE) incidence in the region. Methods We searched PubMed, CINAHL, Scopus, CNKI, Africa Journal Online, SciELO, PsycINFO, and Web of Science, and supplemented these with search of grey literature, pre-publication server deposits, Google Scholar®, and citation tracking of included studies. We assessed methodological quality of included studies using the Appraisal tool for Cross-Sectional Studies for quantitative studies and the Critical Appraisal Skills Programme checklist for qualitative studies; and synthesized study findings according to the guidelines of the Economic and Social Research Council. Results We identified 82 quantitative, 3 qualitative, and 4 mixed-methods studies involving 3,112,322 individuals in 650,297 households in 29 SSA countries. Overall, we identified 29 population-level and 38 disease-specific factors associated with CHE incidence in the region. Significant population-level CHE-associated factors were rural residence, poor socioeconomic status, absent health insurance, large household size, unemployed household head, advanced age (elderly), hospitalization, chronic illness, utilization of specialist healthcare, and utilization of private healthcare providers. Significant distinct disease-specific factors were disability in a household member for NCDs; severe malaria, blood transfusion, neonatal intensive care, and distant facilities for maternal and child health services; emergency surgery for surgery/trauma patients; and low CD4-count, HIV and TB co-infection, and extra-pulmonary TB for HIV/TB patients. Conclusions Multiple household and health system level factors need to be addressed to improve financial risk protection and healthcare access and utilization in SSA. Protocol registration PROSPERO CRD42021274830

Out-of-pocket cost for medical care of injured patients presenting to emergency department of national hospital in Tanzania: a prospective cohort study

“…In SSA in general, factors that contribute to CHE are low socioeconomic status, lack of health insurance, rural residence, old age, chronic illness, hospitalisation, use of a private healthcare provider and use of specialist care 25. These factors are similar in comparable regions such as Iran,26 India27 and Chile 28.…”

Risk and determinants of catastrophic health expenditure among rural households in rivers state

“…34 Other reports have identified low socioeconomic status as a risk factor for incurring CHE. 29 The implication of this finding is that low-income earners residing in rural areas may not be able to access healthcare as at when desired. Community health insurance scheme could help reduced the out-of-pocket payment for health care in the rural areas.…”

“…[25][26][27][28] Some risk factors for incurring CHE from earlier studies include: living a rural residence, head of household being unemployed, advanced age (elderly) chronic illness and utilization of specialist healthcare. 29 Others includes number of unemployed households, hospitalization of a household member, 30 being of a low socioeconomic status, utilization of private health care providers, having a large household size, the presence of an elderly household member and absence of health insurance cover. 31 Determining the prevalence and determinants of CHE in rural area will provide evidence-based for intervention to achieved access and equity in health care delivery among the population.…”

A new approach to sustainable surgery: E-liability accounting for surgical health systems

“…The above point also highlights the fact that adoption of E-liability accounting will not have uniform implications across private and public healthcare systems. The former already exposes their patient population to a greater risk of high out-of-pocket expenses and thus potential catastrophic expenditure when accessing surgical care 17 18. The addition of an implicit responsibility for emissions reduction has the potential to further exacerbate high out-of-pocket expenditures.…”

“…The former already exposes their patient population to a greater risk of high out-of-pocket expenses and thus potential catastrophic expenditure when accessing surgical care. 17 18 The addition of an implicit responsibility for emissions reduction has the potential to further exacerbate high out-of-pocket expenditures.…”