High Poverty and Hardship Financing Among Patients with Noncommunicable Diseases in Rural Haiti

Abstract

Background: Poverty is a major barrier to healthcare access in low-income countries. The degree of equitable access for noncommunicable disease (NCD) patients is not known in rural Haiti. Objectives: We evaluated the poverty distribution among patients receiving care in an NCD clinic in rural Haiti compared with the community and assessed associations of poverty with sex and distance from the health facility. Methods: We performed a cross-sectional study of patients with NCDs attending a public-sector health center in rural Haiti 2013-2016, and compared poverty among patients with poverty among a weighted community sample from the Haiti 2012 Demographic and Health Survey. We adapted the multidimensional poverty index: people deprived ≥44% of indicators are among the poorest billion people worldwide. We assessed hardship financing: borrowing money or selling belongings to pay for healthcare. We examined the association between facility distance and poverty adjusted for age and sex using linear regression. Results: Of 379 adults, 72% were women and the mean age was 52.5 years. 17.7% had hypertension, 19.3% had diabetes, 3.1% had heart failure, and 33.8% had multiple conditions. Among patients with available data, 197/296 (66.6%) experienced hardship financing. The proportions of people who are among the poorest billion people for women and men were similar (23.3% vs. 20.3%, p > 0.05). Fewer of the clinic patients were among the poorest billion people compared with the community (22.4% vs. 63.1%, p < 0.001). Patients who were most poor were more likely to live closer to the clinic (p = 0.002). Conclusion: Among patients with NCD conditions in rural Haiti, poverty and hardship financing are highly prevalent. However, clinic patients were less poor compared with the community population. These data suggest barriers to care access particularly affect the poorest. Socioeconomic data must be collected at health facilities and during community-level surveillance studies to monitor equitable healthcare access. Highlights:• Poverty and hardship financing are highly prevalent among NCD patients in rural Haiti.• Patients attending clinic are less poor than expected from the community. • People travelling farther to clinic are less poor. • Socioeconomic data should be collected to monitor healthcare access equity.

Does distance from a clinic and poverty impact visit adherence for noncommunicable diseases? A retrospective cohort study using electronic medical records in rural Haiti

“…The lack of association between poverty and visit adherence in our NCD sample could be explained by a number of factors. We have reported that patients presenting to the NCD clinic were not as poor as the surrounding community, perhaps leading to a narrower distribution of poverty among patients in the NCD clinic that limits statistical power [25]. Patients who presented to the NCD Clinic were also self-selected and engaged in care.…”

“…To define poverty, we used a two-step process. First, we calculated the intensity of individual multidimensional poverty [ 25 ], and second we categorized people as poor if their intensity of multidimensional poverty was greater than the median value for the entire NCD Clinic (poor compared to their peers).…”

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