Health seeking behavior, and financial access in Yemen

ABSTRACT

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