Health seeking behavior, and financial access in Yemen

This paper presents the findings of a small health seeking behavior survey in two Governorates in Yemen, and provides guidelines for conducting larger surveys. The average per capita income in the sample was $ 485, while out-of-pocket health expenditure is $ 37. For 74% of the reported disease episodes the patients visited government health facilities, while 26% visited private clinics or hospitals. However, 71% of the respondents prefer attending private health facilities if they had the free choice. The main reason for this preference is the good perceived quality in the private sector. Further analysis showed that 73% of the visits to government health facilities were followed by visits to private pharmacies to buy drugs or private clinics to seek additional diagnostic and therapeutic care. Drug availability was considered problematic in all types of health facilities. Average waiting time was the longest in government hospitals with 5.3 hours and the shortest in private clinics with 3.1 hours. The average expenditure for the purchase of drugs in health facilities was $ 2.2 and $ 7.8 in private pharmacies. 54% of total out-of-pocket health expenditure was for buying drugs. Based on these data drug sales in Yemen would total $ 370 million per year. There is a need to further study the other elements of the minimum health care package such as birth spacing, malnutrition and chronic diseases. As far as the methodology for future health seeking behavior surveys is concerned much effort must be made to identify non-medical and female interviewers. After the selection of the interviewers good training is required to reduce interviewer bias. Such training can at the same time also be used to test the questionnaire to avoid bias due to its poor design. The surveys should be practically oriented in providing baseline data for future new programs for example in the context of the health reforms and reproductive health

Health seeking behavior and financial access in Yemen: a study in two governorates

This paper presents the findings of a small health seeking behavior survey in two Govemorates in Yemen, and provides guidelines for conducting larger surveys.The average per capita income in the sample was $ 48.5, while out-of-pocket health expenditure is $ 37. For 74% of the reported disease episodes the patients visited government health facilities, while 26% visited private clinics or hospitals. However, 71% of the respondents prefer attending private health facilities if they had the free choice. The main reason for this preference is the good perceived quality in the private sector. Further analysis showed that 73% of the visits to government health facilities were followed by visits to private pharmacies to buy drugs or private clinics to seek additional diagnostic and therapeutic care. Drug availability was considered problematic in all types of health facilities. Average waiting time was the longest in government hospitals with 5.3 hours and the shortest in private clinics with 3.1 hours. The average expenditure for the purchase of drugs in health facilities was $ 2.2 and $ 7.8 in private pharmacies. 54% of total out-of-pocket health expenditure was for buying drugs. Based on these data drug sales in Yemen would total $ 370 million per year. 41% of the respondents said they needed to take a loan or that they needed to sell some assets to pay the health care bill. The "very poor" spent with $19.8 more on health care bills than the average of the other socio-economic groups, but they needed to take more often a loan or to sell something than the other groups in the study. In how far these expenses are catastrophic for the "very poor" remains to be studied. In conclusion it seems that the health services in Yemen suffer more from quality problems than from financial access problems. However, the $37 out-of-pocket expenditure such as found by a World Bank study in 1998 seems unnecessarily high - a figure, which is largely confirmed by this study. The issue seems to be how the informal out-of-pocket expenditure can better be utilized for the public benefit, and how the government can better regulate the informal private sector. There is a need to further study the other elements of the minimum health care package such as birth spacing, malnutrition and chronic diseases. As far as the methodology for future health seeking behavior surveys is concerned much efforts must be made to identify non-medical and female interviewers. after the selection of the interviewers good training is required to reduce interviewer bias. Such training can at the same time also be used to test the questionnaire to avoid bias due to its