Exploring cost drivers for improving disease management: the case of type 2 diabetes at a tertiary hospital in Burundi, Africa

Globally, the covid-19 pandemic has seriously impacted access to healthcare facilities across the world, although there is little evidence on how the pandemic affects the use of essential healthcare in the world. This study sought to evaluate the impact of the covid-19 pandemic on antenatal indicators in the region of Guelmim Oued Noun, Morocco using the interrupted time-series analysis. The aggregated data was delivered by regional health authorities covering the period from January 2017 to December 2020. The descriptive results revealed a steady decline after the Covid-19 pandemic in Antenatal indicators. The results of the regression model showed a negative impact of the pandemic on the antenatal recruitment rate (ß2 = - 16.14; p < 0.01), recruitment rate of women in antenatal visits the 1st quarter of pregnancy (ß2 = -2.09; p < 0.01), antenatal visit completion rate (ß2= -18.10, p>0.05), average number of visits/pregnancies (ß2 = -15.65, p<0,05). The effect of thecovid-19 pandemic on antenatal rates was significant for almost the indicators studied. Future studies should be focused on the impact of the pandemic on postnatal and immunization services on the national scale.

Catastrophic health expenditure in sub-Saharan Africa: systematic review and meta-analysis

Objective To estimate the incidence of, and trends in, catastrophic health expenditure in sub-Saharan Africa. Methods :We systematically reviewed the scientific and grey literature to identify population-based studies on catastrophic health expenditure in sub-Saharan Africa published between 2000 and 2021. We performed a meta-analysis using two definitions of catastrophic health expenditure: 10% of total household expenditure and 40% of household non-food expenditure. The results of individual studies were pooled by pairwise meta-analysis using the random-effects model. Findings : We identified 111 publications covering a total of 1 040 620 households across 31 sub-Saharan African countries. Overall, the pooled annual incidence of catastrophic health expenditure was 16.5% (95% confidence interval, CI: 12.9­20.4; 50 datapoints; 462 151 households; I2 = 99.9%) for a threshold of 10% of total household expenditure and 8.7% (95% CI: 7.2­10.3; 84 datapoints; 795 355 households; I2 = 99.8%) for a threshold of 40% of household non-food expenditure. Countries in central and southern sub-Saharan Africa had the highest and lowest incidence, respectively. A trend analysis found that, after initially declining in the 2000s, the incidence of catastrophic health expenditure in sub-Saharan Africa increased between 2010 and 2020. The incidence among people affected by specific diseases, such as noncommunicable diseases, HIV/AIDS and tuberculosis, was generally higher. Conclusion :Although data on catastrophic health expenditure for some countries were sparse, the data available suggest that a non-negligible share of households in sub-Saharan Africa experienced catastrophic expenditure when accessing health-care services. Stronger financial protection measures are needed.

Tuberculosis out-of-pocket expenditure study Lesotho: Final study report

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Socioeconomic status and health shocks; analysis of coping strategies in rural households of Enugu State, Nigeria

Background: Health burden in rural areas of developing countries is worsened by the limited coverage of health insurance. With constrained access to quality healthcare and constituting two thirds of Nigeria's poor, this study investigates how rural households cope with health shocks consequent on their socioeconomic status. Method: Data was collected from 600 households in Enugu using a questionnaire. Cross-tabulation, chi square and multiple regression statistical techniques were employed for data analysis. Findings: About 53% of the respondents were male household-heads while borrowing (47.65%), sales of assets (43.85%), diversion of funds (2.00%) and reduced expenditure (6.48%) were the main coping strategies. Education, occupation, and income statistically influenced the coping strategies (P < 0.005) and jointly accounted for 26.5% (R2 = 0.265, P < 0.001) of the variations in coping strategies. Conclusion: Having a rural healthcare policy and mainstreaming the informal sector into the national health insurance scheme will am

Coût financier de la prise en charge des hépatites virales chroniques B et C au CHU de Brazzaville (Congo)

Introduction. Les dépenses de santé ont considérablement augmenté dans le monde lors de la dernière décennie. Les hépatites virales chroniques B et C sont des affections chroniques nécessitant un traitement prolongé et qui est encore coûteux, le Congo ne disposant pas encore d'assistance maladie universelle. Le but de cette étude était d'évaluer le coût de la prise en charge des hépatites virales B et C au Congo. Matériels et Méthodes. Il s'agit d'une étude transversale rétrospective et descriptive, réalisée du 1er juin au 31 Décembre 2016 dans le service de Gastro-entérologie et médecine interne du CHU de Brazzaville. Nous avons colligé les dossiers des patients suivis pour hépatite B et C. Les variables d'étude ont été les coûts des examens paracliniques et les coûts des traitements. Résultats. les coûts des examens paracliniques étaient de 296 000 FCFA (451€) pour le coût maximum de l'hépatite B, celui de l'hépatite C était de 596 500 FCFA (910,6 €). Les coûts du traitement de l'hépatite virale C étaient de 1 050 000 FCFA (1603,05 €) pour trois mois. Pour l'hépatite B, ils étaient de 389 987 (595,4€) par semestre. Le coût global de la prise de l'hépatite virale C était de 1 345 313 FCFA (2053,9€) et de 535 569 (817,662 €) pour l'hépatite B. Conclusion. Les coûts de la prise en charge des hépatites B et C sont encore trop élevés au Congo. Une prise en charge globale s'avère nécessaire, similaire à celle de l'infection à VIH

Health insurance and user fees: a survey of health service utilization and payment method in Mushin lga, Lagos, Nigeria

Background: Studies have documented how out-of-pocket payments (OOP) and user fees result in catastrophic health expenditures, providing evidence that health systems are better financed through prepayment mechanisms such as health insurance. Aim: This study sought to determine the perception of community residents to health insurance, their pattern of health service utilization and method and amount of payment. Methods: This descriptive cross-sectional study among 422 household members in Mushin LGA obtained data on sociodemographic characteristics, perception of health insurance, enrollment status and willingness to enroll; last use of health services and method of payment for health care services. Data analysis was done with Epi-info (ver 7) and results were presented as frequencies, percentages, means and standard deviations. Statistically significant associations were determined using the Chi-square test at significance level of p < 0.05. Results: Over half the respondents (56.6%) had not heard about health insurance. Very few (19.7%) were enrolled. Of those not enrolled, 57.1% were willing to consider buying health insurance. The method of payment for health services reported by respondents was OOP (98.3%). Those in younger age groups, with higher levels of education and higher household incomes reported having heard of health insurance. Higher educational level and household incomes were positively associated with willingness to enroll in a health insurance scheme. Conclusion: Awareness was insufficient, health services were paid for mostly from OOP. The authors recommend taking the opportunity to encourage uptake of health insurance for young adults and those in low- and middle-income households

Compliance to HIV Treatment Monitoring Guidelines can Reduce Laboratory Costs

Background: Panel tests are a predetermined group of tests commonly requested together to provide a comprehensive and conclusive diagnosis; for example; liver function test (LFT). South African HIV antiretroviral treatment (ART) guidelines recommend individual tests for toxicity monitoring over panel tests. In 2008; the National Health Laboratory Services (NHLS) request form was redesigned to list individual tests instead of panel tests and removed the 'other tests' box option to facilitate efficient ART laboratory monitoring.Objectives: This study aimed to demonstrate changes in laboratory expenditure; for individual and panel tests; for ART toxicity monitoring.Method: NHLS Corporate Data Warehouse (CDW) data were extracted for HIV conditional grant accounts to assess ART toxicity monitoring laboratory expenditure between 2010/2011 and 2014/2015. Data were classified based on the tests requested; as either panel (LFT or urea and electrolytes) or individual (alanine transaminase or creatinine) tests.Results: Expenditure on panel tests reduced from R340 million in 2010/2011 to R140m by 2014/2015 (reduction of R204m) and individual test expenditure increased from R34m to R76m (twofold increase). A significant reduction in LFT panel expenditure was noted; reducing from R322m in 2010/2011 to R130m in 2014/2015 (60% reduction).Conclusion: Changes in toxicity monitoring guidelines and the re-engineering of the NHLS request form successfully reduced expenditure on panel tests relative to individual tests. The introduction of order entry systems could further reduce unnecessary laboratory expenditure

Expenditures on health research in sub-Saharan African countries: results of a questionnaire-based survey

Objective To estimate the sources of funds for health research (revenue) and the uses of these funds (expenditure). Design A structured questionnaire was used to solicit financial information from health research institutions. Setting Forty-two sub-Saharan African countries. Participants Key informants in 847 health research institutions in the 42 sub-Saharan African countries. Main outcome measures Expenditure on health research by institutions; funders and subject areas. Results An estimated total of US$ 302 million was spent on health research by institutions that responded to the survey in the World Health Organization (WHO) African Region for the biennium 2005-2006. The most notable funders for health research activities were external funding; ministries of health; other government ministries; own funds and non-profit institutions. Most types of health research performers spent significant portions of their resources on in-house research; with medical schools spending 82 and government agencies 62. Hospitals spent 38 of their resources on management; and other institutions (universities; firms; etc.) spent 87 of their resources on capital investment. Research on human immunodeficiency virus/tuberculosis and malaria accounted for 30 of funds; followed by research on other communicable diseases and maternal; perinatal and nutritional conditions (23). Conclusions Research on major health problems of the Region; such as communicable diseases; accounts for most of the research expenditures. However; the total expenditure is very low compared with other WHO regions

The Double-Edged Sword: Financial Source of Household Healthcare Expenditure in Ghana

In many regions; some of the most formidable enemies of health are joining forces with the allies of poverty to impose a double burden of disease; disability and premature death. This paper looks at the main financial sources households use to finance healthcare in Ghana. It examines the spatial and socio-economic dynamics and the challenges these pose to health and development. Analysis of the 2003 Ghana World Health Survey data indicates that approximately 41of households depend on more than one financial source with 88 depending on household income to finance healthcare expenditure. The high dependency on household income will erode gains in the economic and health sector in the midst of the recent global economic recession. Comprehensive national health insurance programs that cover emerging disease conditions will mitigate the double burden of disease on households in emerging economies

Is Health Care Financing in Uganda Equitable?

Introduction: Health care financing provides the resources and economic incentives for operating health systems and is a key determinant of health system performance. Equitable financing is based on: financial protection; progressive financing and cross-subsidies. This paper describes Uganda's health care financing landscape and documents the key equity issues associated with the current financing mechanisms. Methods: We extensively reviewed government documents and relevant literature and conducted key informant interviews; with the aim of assessing whether Uganda's health care financing mechanisms exhibited the key principles of fair financing. Results: Uganda's health sector remains significantly under-funded; mainly relying on private sources of financing; especially out-of-pocket spending. At 9.6of total government expenditure; public spending on health is far below the Abuja target of 15that GoU committed to. Prepayments form a small proportion of funding for Uganda's health sector. There is limited cross-subsidisation and high fragmentation within and between health financing mechanisms; mainly due to high reliance on out-of-pocket payments and limited prepayment mechanisms. Without compulsory health insurance and low coverage of private health insurance; Uganda has limited pooling of resources; and hence minimal cross-subsidisation. Although tax revenue is equitable; the remaining financing mechanisms for Uganda are inequitable due to their regressive nature; their lack of financial protection and limited cross-subsidisation. Conclusion: Overall; Uganda's current health financing is inequitable and fragmented. The government should take explicit action to promote equitable health care financing by establishing pre-payment schemes; enhancing cross-subsidisation mechanisms and through appropriate integration of financing mechanisms

Financial Risks Associated with Healthcare Consumption in Jinja; Uganda

Introduction: Financial access to promotive; preventive; curative and rehabilitative healthcare by every one remains a challenge globally. The requirement to make direct payments at the time of consuming health services is one of the reasons why it persists. In this paper; we present findings on the financial risks households bear as a result of healthcare consumption in one district in Uganda. Methodology: Using simple random sampling; we selected 384 household heads in 3 health sub districts. A structured questionnaire was to conduct the survey. Focus group discussions and Key Informant interviews were also conducted. Results: Up to 77(297/384) of households reported making direct payments for healthcare when a household member fell ill; 45(174/384) did so each time a household member fell ill. Payment for healthcare was associated with employment of the household head in the informal sector (OR 1.6; 951.2-2.1); presence of children OR 1.5; 951.3-1.9 or someone with chronic illness OR 3; 951.5-6 respectively and history of hospitalization (OR 3; 951.7-6.5). Conclusion: A high burden of healthcare needs; disproportionately affect children and women among households in Jinja. Direct payments for healthcare still occur in spite of the abolishment of user fees at public health facilities and tax based financing of health services in Uganda

An Overview of Health Financing Patterns and the Way Forward in the WHO African Region

The way a health system is financed affects the performance of its other functions of stewardship; input (or resource) creation and services provision; and ultimately; the achievement of health system goals of health improvement (or maintenance); responsiveness to people's non-medical expectations and fair financial contributions. To analyse the changes between 1998 and 2002;in health financing from various sources; and to propose ways of improving the performance of health financing function in the WHO African Region. A retrospective analysis of data obtained from the World Health Report; 2005. The analysis reported in this paper is based on the National Health Accounts (NHA) data for the 46 WHO Member States in the African Region. The data were obtained from the World Health Report 2005. It consisted of information on: levels of per capita expenditure on health; total expenditure on health as a percentage of gross domestic product (GDP); general government expenditure on health as a percentage of total expenditure on health; private expenditure on health as a percentage of total expenditure on health; general government expenditure on health as a percentage of total government expenditure; external expenditure as a percentage of total expenditure on health; social security expenditure on health as a percentage of general government expenditure on health; out-of-pocket expenditure as a percentage of private expenditure on health; and private prepaid plans as a percentage of private expenditure on health. The analysis was done using Lotus SmartSuite software. Results: The analysis revealed that: fifteen countries spent less than 4.5of their GDP on health; forty four countries spent less than 15 of their national annual budget on health; sixty three percent of the governments in the Region spent less than US$10 per person per year; fifty per cent of the total expenditure on health in 24 countries came from government sources; prepaid health financing mechanisms cover only a small proportion of populations in the Region; private spending constituted over 40 of the total expenditure on health in 31; direct out-of-pocket expenditures constituted over 50of the private health expenditure in 38 countries. Every country needs to develop clear pro-poor health financing policy and a comprehensive health financing strategic plan with a clear roadmap of how it plans to transit from the current health financing state dominated by inequitable; catastrophic and impoverishing direct out-of-pocket payments to a visionary scenario of universal coverage. The strategic plan should strengthening of health sector advocacy and health financing capacities; health economics evidence generation and utilisation in decision-making; making better use of available and expected resources; monitoring of equity in financing; strengthening of the exemption mechanisms; managed removal of direct out-of-pocket payments (for countries that choose to); and improving country-led sectoral coordination mechanisms (e.g. Sector Wide Approaches)