Understanding variations in catastrophic health expenditure, its underlying determinants and impoverishment in Sub-Saharan African countries: a scoping review

Summary Background In the Nigerian context, preconditions for financial catastrophe are operational as there is high out‐of‐pocket spending (OOPS) on health with low capacity to pay, presence of user fees, and poor prepayment insurance coverage. We reviewed the incidence and determinants of catastrophic health expenditure (CHE) in Nigeria. Methods Databases including PubMed, OVID, EMBASE, CINAHL, and Web of Science were searched for primary research studies on the incidence and determinants of CHE in Nigeria published between 2003 and 2018. Search terms used include household, out‐of‐pocket expenditure, catastrophic health expenditure, and Nigeria. Results Twenty studies that met the inclusion criteria were included in the review. At 10% of total household and nonfood expenditure, the incidence of CHE was 8.2% to 50%, while 3.2% to 100% households incurred CHE at 40% of nonfood expenditure. The incidence of CHE was higher among inpatients and studies with lower threshold definitions. Outpatient CHE was highest for type 2 diabetes and tuberculosis while human immunodeficiency virus (HIV) care incurred the most CHE among inpatients. Determinants of CHE include wealth status, age, gender, place of residence/geographical location, household size/composition, educational status, health insurance status, illness, and health provider types. Conclusion There is a high incidence of CHE across various common health conditions in Nigeria. CHE was more among the poor, elderly, rural dwellers, private facility utilization, female gender, and noninsured among others. We recommend expansion of the National Health Insurance Scheme via informal social and financing networks platforms. Increased budgetary allocation to health and intersectoral collaboration will also play a significant role in CHE reduction.

Section: Discussionmentioning

confidence: 87%

Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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

Okedo‐Alex

Akamike

Ezeanosike

et al. 2019

“…Evidence indicates that even in case of partial user fee removal, the very poor and ill often cannot afford to pay for their treatment due to uncovered costs or have to sell assets in order to be able to do so . High rates of OOPE have been shown to perpetuate and/or generate impoverishment across sub‐Saharan African (SSA) countries . Health financing in many LMICs still relies largely on direct user payments, leaving ill people exposed to potentially high OOPE on a large scale …”

Section: Introductionmentioning

confidence: 99%

“…High rates of OOPE have been shown to perpetuate and/or generate impoverishment across sub‐Saharan African (SSA) countries . Health financing in many LMICs still relies largely on direct user payments, leaving ill people exposed to potentially high OOPE on a large scale …”

Section: Introductionmentioning

confidence: 99%

Determinants of individual healthcare expenditure: A cross‐sectional analysis in rural Burkina Faso

Nakovics

Brenner

Robyn

et al. 2019

Summary Introduction Overwhelming evidence suggests that out‐of‐pocket expenditures (OOPEs) hamper access to care and impose a heavy economic burden across sub‐Saharan Africa (SSA). Still, current user fee reduction and removal policies often target specific groups and services, leaving large sections of the population exposed to OOPE. Methods To estimate the magnitude and the determinants of OOPE for curative services in Burkina Faso, we used data from a household survey conducted in 24 districts between October 2013 and March 2014 (n = 7844). Given a context of medical pluralism, we purposely focused on total OOPE irrespective of type of care sought. We used a two‐part regression model to estimate determinants of OOPE. Results Nearly 60% of those who reported an illness episode incurred a positive expenditure, with an average amount of 9362.52 FRS CFA per episode (1 USD = 577.94 FRS CFA). The first model revealed that the probability of incurring a positive OOPE was positively associated with perceived illness severity (P < .001), hospitalization (P < .001), and negatively associated with age (P = .026), distance (P = .060), and poorest wealth quintile (P = .054). The second model revealed that the magnitude of OOPE was positively associated with age (P = .087), education (P = .025), being household head (P = .015), having a chronic comorbidity (P = .025), perceived illness severity (P = .029), and hospitalization (P < .001) and negatively associated with symptoms unlikely to lead to adverse outcomes if not attended to in time (P = .056). Conclusion Our findings indicate that OOPEs remain a problem in Burkina Faso and that broader spectrum policy reforms are urgently needed to ensure adequate financial protection.

Drivers of healthcare expenditure growth in West Africa: A panel data investigation

Dauda,

Balogun

2023

Per capita health expenditure in West African countries appears to have assumed a growing trend over the years. This may not be unconnected with the critical role played by health in economic growth, sustainable development and human capital formation. This study analysed drivers of healthcare expenditure in West Africa, using panel data analysis. Random Effects estimating technique was preferred to pooled Ordinary Least Squares and Fixed Effects techniques based on Hausman and Breusch‐Pagan Lagrangian multiplier tests. Data employed were sourced from World Bank's world development indicators. The findings indicated that number of people using at least basic sanitation services, incidence of tuberculosis, malaria incidence, and per capita GDP, significantly increased healthcare expenditure in West Africa within the study period. Infant and under‐five mortality (UFM) rates raised healthcare expenditure but insignificantly in the sub‐region. The study recommends the need to reduce malaria and tuberculosis incidences as well as UFM rate in West Africa through appropriate policy enactment. Such policies should include adequate investment in education, increased per capita income, development of malaria vaccines, maintenance of hygienic environment and free treatment of tuberculosis patients.