The burden of household out-of-pocket health expenditures in Ethiopia: estimates from a nationally representative survey (2015–16)

Abstract

In Ethiopia, little is known about the extent of out-of-pocket health expenditures and the associated financial hardships at national and regional levels. We estimated the incidence of both catastrophic and impoverishing health expenditures using data from the 2015/16 Ethiopian household consumption and expenditure and welfare monitoring surveys. We computed incidence of catastrophic health expenditures (CHE) at 10% and 25% thresholds of total household consumption and 40% threshold of household capacity to pay, and impoverishing health expenditures (IHE) using Ethiopia's national poverty line (ETB 7184 per adult per year). Around 2.1% (SE: 0.2, P < 0.001) of households would face CHE with a 10% threshold of total consumption, and 0.9% (SE: 0.1, P < 0.001) of households would encounter IHE, annually in Ethiopia. CHE rates were high in the regions of Afar (5.8%, SE: 1.0, P < 0.001) and Benshangul-Gumuz (4.0%, SE: 0.8, P < 0.001). Oromia (n = 902 000), Amhara (n = 275 000) and Southern Nations Nationalities and Peoples (SNNP) (n = 268 000) regions would have the largest numbers of affected households, due to large population size. The IHE rates would also show similar patterns: high rates in Afar (5.0%, SE: 0.96, P < 0.001), Oromia (1.1%, SE: 0.22, P < 0.001) and Benshangul-Gumuz (0.9%, SE: 0.4, P = 0.02); a large number of households would be impoverished in Oromia (n = 356 000) and Amhara (n = 202 000) regions. In summary, a large number of households is facing financial hardship in Ethiopia, particularly in Afar, Benshangul-Gumuz, Oromia, Amhara and SNNP regions and this number would likely increase with greater health services utilization. We recommend regional-level analyses on services coverage to be conducted as some of the estimated low CHE/IHE regional values might be due to low services coverage. Periodic analyses on the financial hardship status of households could also be monitored to infer progress towards universal health coverage.

The Magnitude of Perceived Professionalism and Its Associated Factors Among Nurses in Public Referral Hospitals of West Amhara, Ethiopia

“…The regional state has a population of 28 million (mid-2018), 14 zones, three city administrations, and 180 sub-city administrations (139 rural and 41 urban). 15 It also has 80 hospitals (8 referrals, 2 general, and 73 primary hospitals), 847 health centers, and 3342 health posts. 16 Despite the increased number of health facilities, shortages of skilled health personnel, medical equipment, drugs, and medical supplies, inefficient and inequitable use of health resources are the challenges of the region.…”

The burden of household out-of-pocket healthcare expenditures in Ethiopia: a systematic review and meta-analysis

“…In Ethiopia, studies indicated that the burden of household Out-Of-Pocket healthcare expenditures was high and has shown a significant increment, indicating 2% of households are facing financial hardship, and this per cent would likely increase with greater health services utilization [ 13 ]. In recent years, 46% of rural households in Ethiopia, that sought healthcare faced catastrophic healthcare expenditure at the threshold of 10% of total household expenditure, or 74% at a 40% non-food expenditure, and 92% of households that sought healthcare were pushed further into extreme poverty due to household out-of-pocket healthcare expenditures [ 14 ].…”

Perceptions of Inequity in the Provision and Utilization of Maternal, Newborn, and Child Health Services in Tigray, Ethiopia. A Qualitative Explorative Study

“…Economic status was linked to inequities in the utilization of maternal and child health services, despite the provision of free maternal health services to all women across all socioeconomic levels (13). The countries' socioeconomic level (22) is also associated with maternal and child health services utilization (11). The respondents in our study highlighted that lack of money for transportation and buying drugs was a major discouraging factor for poor women to utilize these services (23,24).…”

“…The respondents in our study highlighted that lack of money for transportation and buying drugs was a major discouraging factor for poor women to utilize these services (23,24). Such accumulated costs may create a nancial catastrophe to the household (22) and push them into poverty (25). Striving to reach the health-related SDG 3 targets for maternal and child health outcomes depends on progress in eliminating poverty de ned in SDG 1 (3).…”