The Financial Burden of Non-Communicable Chronic Diseases in Rural Nigeria: Wealth and Gender Heterogeneity in Health Care Utilization and Health Expenditures

Abstract

ObjectivesBetter insights into health care utilization and out-of-pocket expenditures for non-communicable chronic diseases (NCCD) are needed to develop accessible health care and limit the increasing financial burden of NCCDs in Sub-Saharan Africa.MethodsA household survey was conducted in rural Kwara State, Nigeria, among 5,761 individuals. Data were obtained using biomedical and socio-economic questionnaires. Health care utilization, NCCD-related health expenditures and distances to health care providers were compared by sex and by wealth quintile, and a Heckman regression model was used to estimate health expenditures taking selection bias in health care utilization into account.ResultsThe prevalence of NCCDs in our sample was 6.2%. NCCD-affected individuals from the wealthiest quintile utilized formal health care nearly twice as often as those from the lowest quintile (87.8% vs 46.2%, p = 0.002). Women reported foregone formal care more often than men (43.5% vs. 27.0%, p = 0.058). Health expenditures relative to annual consumption of the poorest quintile exceeded those of the highest quintile 2.2-fold, and the poorest quintile exhibited a higher rate of catastrophic health spending (10.8% among NCCD-affected households) than the three upper quintiles (4.2% to 6.7%). Long travel distances to the nearest provider, highest for the poorest quintile, were a significant deterrent to seeking care. Using distance to the nearest facility as instrument to account for selection into health care utilization, we estimated out-of-pocket health care expenditures for NCCDs to be significantly higher in the lowest wealth quintile compared to the three upper quintiles.ConclusionsFacing potentially high health care costs and poor accessibility of health care facilities, many individuals suffering from NCCDs—particularly women and the poor—forego formal care, thereby increasing the risk of more severe illness in the future. When seeking care, the poor spend less on treatment than the rich, suggestive of lower quality care, while their expenditures represent a higher share of their annual household consumption. This calls for targeted interventions that enhance health care accessibility and provide financial protection from the consequences of NCCDs, especially for vulnerable populations.

Estimating the Incidence of Water Related Diseases: the case of Neglected Tropical Diseases in Rural Nigeria

“…Households in the middle wealth quintile were 24.29%, while those in the rich and richest wealth quintile were 9.03% and 2.11% respectively. This further corroborate studies that maintain rural households as low income group, with low access to health care [28].The results also shows that only 28% of the rural households use bed nets to sleep at night. This means that the majority of the rural households were predisposed to insect bites during the night.The implication of this is that the household members are susceptible to diseases caused by water-related insect vectors such as elephantiasis [29; 30].…”

A review of the incidence and determinants of catastrophic health expenditure in Nigeria: Implications for universal health coverage

“…Elements of the criteria that did not apply to a particular study were marked as not applicable. All the studies fulfilled most of the quality criteria except for five studies that did not provide a sample size justification and power description . Also, 13 of the studies did not measure key potential confounding variables measured nor adjust for them statistically …”

“…All the studies fulfilled most of the quality criteria except for five studies that did not provide a sample size justification and power description. 20,21,[29][30][31] Also, 13 of the studies did not measure key potential confounding variables measured nor adjust for them statistically. 6,20,23,24,[30][31][32][33][34][35][36][37][38]…”

“…Financial risk protection for health care should, therefore, be a priority for Nigeria. Varying incidence of CHE from spending on specific health conditions in Nigeria has been documented including noncommunicable chronic diseases, sickle cell disease, tuberculosis, outpatient and inpatient services, drugs for human immunodeficiency virus (HIV), and malaria treatment . The objective of this review is to systematically review scientific data from studies conducted in Nigeria that provide information on incidence and factors associated with CHE.…”

“…Varying incidence of CHE from spending on specific health conditions in Nigeria has been documented including noncommunicable chronic diseases, sickle cell disease, tuberculosis, outpatient and inpatient services, drugs for human immunodeficiency virus (HIV), and malaria treatment. 14,[20][21][22][23][24] The objective of this review is to systematically review scientific data from studies conducted in Nigeria that provide information on incidence and factors associated with CHE. The implications of these findings for the achievement of UHC with financial risk protection will also be discussed.…”