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. 2018 Sep 11;7(1):136.
doi: 10.1186/s13643-018-0799-1.

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

Purity Njagi  1 , Jelena Arsenijevic  2   3 , Wim Groot  2
Affiliations

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

Purity Njagi et al. Syst Rev. .

Abstract

Background: To assess the financial burden due to out of pocket (OOP) payments, two mutually exclusive approaches have been used: catastrophic health expenditure (CHE) and impoverishment. Sub-Saharan African (SSA) countries primarily rely on OOP and are thus challenged with providing financial protection to the populations. To understand the variations in CHE and impoverishment in SSA, and the underlying determinants of CHE, a scoping review of the existing evidence was conducted.

Methods: This review is guided by Arksey and O'Malley scoping review framework. A search was conducted in several databases including PubMed, EBSCO (EconLit, PsychoInfo, CINAHL), Web of Science, Jstor and virtual libraries of the World Health Organizations (WHO) and the World Bank. The primary outcome of interest was catastrophic health expenditure/impoverishment, while the secondary outcome was the associated risk factors.

Results: Thirty-four (34) studies that met the inclusion criteria were fully assessed. CHE was higher amongst West African countries and amongst patients receiving treatment for HIV/ART, TB, malaria and chronic illnesses. Risk factors associated with CHE included household economic status, type of health provider, socio-demographic characteristics of household members, type of illness, social insurance schemes, geographical location and household size/composition. The proportion of households that are impoverished has increased over time across countries and also within the countries.

Conclusion: This review demonstrated that CHE/impoverishment is pervasive in SSA, and the magnitude varies across and within countries and over time. Socio-economic factors are seen to drive CHE with the poor being the most affected, and they vary across countries. This calls for intensifying health policies and financing structures in SSA, to provide equitable access to all populations especially the most poor and vulnerable. There is a need to innovate and draw lessons from the 'informal' social networks/schemes as they are reported to be more effective in cushioning the financial burden.

Keywords: Catastrophic health expenditure; Impoverishment; Out of pocket payments; Scoping review; Sub-Saharan Africa.

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Conflict of interest statement

Authors’ information

PN is a PhD Fellow/Researcher at the United Nations University–MERIT, School of Governance, Maastricht University, the Netherlands.

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Quality assessment of included studies. The figure represents a summary of the quality assessment scores as per the assessment criteria/checklist
Fig. 2
Fig. 2
PRISMA flow chart. The figure presents the flow of information through the different phases of studies selection. It maps out the number of records identified, included and excluded, and the reasons for exclusions
Fig. 3
Fig. 3
The level of CHE in SSA. The figure represents the level of CHE reported in the various studies/articles across countries over time. It plots the percentage of households with CHE at thresholds of 10% household income and 40% non-food expenditure, against the study period
Fig. 4
Fig. 4
Level of impoverishment. The figure represents the percentage of household impoverished after health payments against the poverty head count prior to health payments across countries
See this image and copyright information in PMC

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References

    1. Fortney JC, Burgess JF, Bosworth HB, Booth BM, Kaboli PJ. A re-conceptualization of access for 21st century healthcare. J Gen Intern Med. 2011;26:639–647. doi: 10.1007/s11606-011-1806-6. - DOI - PMC - PubMed
    1. Bright T, Felix L, Kuper H, Polack S. A systematic review of strategies to increase access to health services among children in low and middle income countries. BMC Health Serv Res. 2017;17 10.1186/s12913-017-2180-9. - PMC - PubMed
    1. J L Murray C, Xu K, Klavus J, Kawabata K, Hanvoravongchai P, Zeramdini R, et al. Assessing the distribution of household financial contributions to the health system: concepts and empirical application. Health systems performance assessment : debates, methods and empiricism. 2003;513–31.
    1. Xu K, Organization WH, et al. Distribution of health payments and catastrophic expenditures methodology. 2005. http://www.who.int/iris/handle/10665/69030. Accessed 28 Sep 2017.
    1. Ezat Wan Puteh S, Almualm Y. Catastrophic health expenditure among developing countries. Health Syst Policy Res. 2017;04 10.21767/2254-9137.100069.

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