High Poverty and Hardship Financing Among Patients with Noncommunicable Diseases in Rural Haiti

Abstract

Background: Poverty is a major barrier to healthcare access in low-income countries. The degree of equitable access for noncommunicable disease (NCD) patients is not known in rural Haiti.

Objectives: We evaluated the poverty distribution among patients receiving care in an NCD clinic in rural Haiti compared with the community and assessed associations of poverty with sex and distance from the health facility.

Methods: We performed a cross-sectional study of patients with NCDs attending a public-sector health center in rural Haiti 2013-2016, and compared poverty among patients with poverty among a weighted community sample from the Haiti 2012 Demographic and Health Survey. We adapted the multidimensional poverty index: people deprived ≥44% of indicators are among the poorest billion people worldwide. We assessed hardship financing: borrowing money or selling belongings to pay for healthcare. We examined the association between facility distance and poverty adjusted for age and sex using linear regression.

Results: Of 379 adults, 72% were women and the mean age was 52.5 years. 17.7% had hypertension, 19.3% had diabetes, 3.1% had heart failure, and 33.8% had multiple conditions. Among patients with available data, 197/296 (66.6%) experienced hardship financing. The proportions of people who are among the poorest billion people for women and men were similar (23.3% vs. 20.3%, p > 0.05). Fewer of the clinic patients were among the poorest billion people compared with the community (22.4% vs. 63.1%, p < 0.001). Patients who were most poor were more likely to live closer to the clinic (p = 0.002).

Conclusion: Among patients with NCD conditions in rural Haiti, poverty and hardship financing are highly prevalent. However, clinic patients were less poor compared with the community population. These data suggest barriers to care access particularly affect the poorest. Socioeconomic data must be collected at health facilities and during community-level surveillance studies to monitor equitable healthcare access.

Highlights: Poverty and hardship financing are highly prevalent among NCD patients in rural Haiti.Patients attending clinic are less poor than expected from the community.People travelling farther to clinic are less poor.Socioeconomic data should be collected to monitor healthcare access equity.

Keywords: diabetes; equity; global health; hypertension; noncommunicable disease; poverty.

Figure 1

Percent of NCD Clinic patients deprived in each indicator for women and men, unadjusted. 95% Confidence intervals shown.

Figure 2A

Proportion by deprivation status by sex among people in NCD Clinic, unadjusted. The proportion of people across deprivation levels is different between sexes (p = .002).

Figure 2B

Poverty distribution among NCD Clinic vs. Community. Proportion of people by deprivation status, NCD Clinic (n = 378, 1 patient with missing address) vs weighted community sample, unadjusted. Poverty distribution is different between the NCD Clinic and Community groups (p < 0.001).

Figure 3

Number of people by wealth quintile in the NCD Clinic and Community nationally, and by geographic region. Wealth quintiles are defined using 2012 Haiti DHS data nationally, and individually for the major departments where NCD Clinic patients live.

Figure 4

Map of number of NCD Clinic patients and poverty by communal section. The average percent deprivations for patients is shown in red shades. The number of patients is shown by the size of the circles.