Social protection in health: the need for a transformative dimension

Michielsen, Joris; Meulemans, Herman; Soors, Werner; Ndiaye, Pascal; Devadasan, Narayanan; Herdt, Tom De; Verbist, Gerlinde; Criel, Bart

doi:10.1111/j.1365-3156.2010.02529.x

Cited by 11 publications

(8 citation statements)

References 10 publications

(10 reference statements)

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“…Direct payment for care by users compensates for shortfalls in state funding since the supply of health care generally involves financial costs to be recovered [ 10 , 21 , 23 – 28 ]. In the absence of a financial protection system, these costs become high relative to household income, reducing households’ access to care [ 10 , 21 , 23 – 30 ] and/or becoming catastrophic or impoverishing expenses [ 22 , 31 – 33 ].…”

Section: Discussionmentioning

confidence: 99%

Social and economic consequences of the cost of obstetric and neonatal care in Lubumbashi, Democratic Republic of Congo: a mixed methods study

Musau

Abel

Jacques

et al. 2021

BMC Pregnancy Childbirth

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Background The aim of this study was to explore and measure the social and economic consequences of the costs of obstetric and neonatal care in Lubumbashi, the Democratic Republic of Congo. Methods We conducted a mixed qualitative and quantitative study in the maternity departments of health facilities in Lubumbashi. The qualitative results were based on a case study conducted in 2018 that included 14 respondents (8 mothers of newborns, 2 accompanying family members and 4 health care providers). A quantitative cross-sectional analytical study was carried out in 2019 with 411 women who gave birth at 10 referral hospitals. Data were collected for one month at each hospital, and selected mothers of newborns were included in the study only if they paid out-of-pocket and at the point of care for costs related to obstetric and neonatal care. Results Costs for obstetric and neonatal care averaged US $77, US $207 and US $338 for simple, complicated vaginal and caesarean deliveries, respectively. These health expenditures were greater than or equal to 40% of the ability to pay for 58.4% of households. At the time of delivery, 14.1% of women giving birth did not have enough money to pay for care. Of those who did, 76.5% spent their savings. When households did not pay for care, mothers and their babies were held for a long time at the place of care. This resulted in the prolonged absence of the mother from the household, reduced household income, family conflicts, and the abandonment of the home by the spouse. At the health facility level, the increase in length of stay did not generate any additional financial benefits. Mothers no longer had confidence in nurses; they were sometimes separated from their babies, and they could not access certain prescribed medications or treatments. Conclusion The government of the DRC should implement a mechanism for subsidizing care and associate it with a cost-sharing system. This would place the country on the path to achieving universal health coverage in improving the physical, mental and social health of mothers, their babies and their households.

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Section: Discussionmentioning

confidence: 99%

Social and economic consequences of the cost of obstetric and neonatal care in Lubumbashi, Democratic Republic of Congo: a mixed methods study

Musau

Abel

Jacques

et al. 2021

BMC Pregnancy Childbirth

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“…Such road necessarily includes what Michielsen and colleagues term ‘the dimension of transformation’ of social protection in health: “transforming the social and institutional context (…) to counteract exclusion and deprivation of the right to health and quality care” [ 85 ]. To be substantive, transformation needs realisation of citizenship and political action at state level.…”

Section: Resultsmentioning

confidence: 99%

Lack of access to health care for African indigents: a social exclusion perspective

Soors

Dkhimi

Criel

2013

International Journal for Equity in Health

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BackgroundLack of access to health care is a persistent condition for most African indigents, to which the common technical approach of targeting initiatives is an insufficient antidote. To overcome the standstill, an integrated technical and political approach is needed. Such policy shift is dependent on political support, and on alignment of international and national actors. We explore if the analytical framework of social exclusion can contribute to the latter.MethodsWe produce a critical and evaluative account of the literature on three themes: social exclusion, development policy, and indigence in Africa–and their interface. First, we trace the concept of social exclusion as it evolved over time and space in policy circles. We then discuss the relevance of a social exclusion perspective in developing countries. Finally, we apply this perspective to Africa, its indigents, and their lack of access to health care.ResultsThe concept of social exclusion as an underlying process of structural inequalities has needed two decades to find acceptance in international policy circles. Initial scepticism about the relevance of the concept in developing countries is now giving way to recognition of its universality. For a variety of reasons however, the uptake of a social exclusion perspective in Africa has been limited. Nevertheless, social exclusion as a driver of poverty and inequity in Africa is evident, and manifestly so in the case of the African indigents.ConclusionThe concept of social exclusion provides a useful framework for improved understanding of origins and persistence of the access problem that African indigents face, and for generating political space for an integrated approach.

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Section: Discussionmentioning

confidence: 99%

“…Direct payment for care by users compensates for shortfalls in state funding since the supply of health care generally involves nancial costs to be recovered [9,[21][22][23][24][25][26][27]. In the absence of a nancial protection system, these costs become high relative to household income, reducing households' access to care [9,[21][22][23][25][26][27][28][29][30] and/or becoming catastrophic or impoverishing expenses [20,[31][32][33]. Several surveys around the world have shown that this method of payment constitutes a barrier to access to quality health care [19,[34][35][36][37][38][39] and leads to a lack of equity and universal health coverage [2,6,10,14,[19][20][21][22].The same is true for interventions that reduce the case fatality rate among women with obstetric complications, which in this case cause high, unaffordable, catastrophic and impoverishing costs for households in resource-poor countries.…”

Section: Discussionmentioning

confidence: 99%

Social and Economic Consequences of the Cost of Obstetric and Neonatal Care in Lubumbashi, in the Democratic Republic of Congo: Mixed Study

Musau¹,

Ntambue²,

Omewatu³

et al. 2020

Preprint

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Background: The aim of this study was to explore and measure the social and economic consequences of the cost of obstetric and neonatal care in Lubumbashi, the Democratic Republic of Congo.Methods: We conducted a mixed qualitative and quantitative study in the maternity departments of health facilities in Lubumbashi. The qualitative results were based on a case study conducted in 2018 that included 14 respondents (8 parturients, 2 accompanying family members and 4 health care providers). A quantitative cross-sectional analytical study was carried out in 2019 with 411 women who gave birth at 10 referral hospitals. Data were collected for one month at each hospital, and selected parturients were included in the study only if they paid out-of-pocket and at the point of care for costs related to obstetric and neonatal care.Results: Costs for obstetric and neonatal care averaged US $77, US $207 and US $338 for simple, complicated vaginal and cesarean deliveries, respectively. These health expenditures were greater than or equal to 40% of the ability to pay for 58.4% of households. At the time of delivery, 14.1% of women in childbirth did not have enough money to pay for care. Of those who did, 76.5% spent their savings. When households did not pay for care, mothers and their babies were held for a long time at the place of care. This resulted in prolonged absence of the mother from the household, reduced household income, family conflicts, and the abandonment of the home by the spouse. At the health facility level, the length of stay increased without generating any additional financial benefits. Disrespectful care and the deterioration of the relationships between caregivers and parturients were also recorded.Conclusion: To reduce the social and economic consequences of care, the government of the DRC should implement a mechanism for subsidizing care and should associate it with a cost-sharing system. This would result in achieving universal health coverage and improving the physical, mental and social health of mothers, their babies and their households.

show abstract

Social protection in health: the need for a transformative dimension

Cited by 11 publications

References 10 publications

Social and economic consequences of the cost of obstetric and neonatal care in Lubumbashi, Democratic Republic of Congo: a mixed methods study

Social and economic consequences of the cost of obstetric and neonatal care in Lubumbashi, Democratic Republic of Congo: a mixed methods study

Lack of access to health care for African indigents: a social exclusion perspective

Social and Economic Consequences of the Cost of Obstetric and Neonatal Care in Lubumbashi, in the Democratic Republic of Congo: Mixed Study

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