Understanding variations in catastrophic health expenditure, its underlying determinants and impoverishment in Sub-Saharan African countries: a scoping review
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 financi...
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doaj-80111c14395b4043897cf796bbf9cd242020-11-25T02:04:18ZengBMCSystematic Reviews2046-40532018-09-017112310.1186/s13643-018-0799-1Understanding variations in catastrophic health expenditure, its underlying determinants and impoverishment in Sub-Saharan African countries: a scoping reviewPurity Njagi0Jelena Arsenijevic1Wim Groot2United Nations University - Maastricht Economic and social Research institute on Innovation and Technology(UNU-MERIT), Maastricht UniversityDepartment of Health Services Research, Faculty of Health Medicine and Life Sciences, Maastricht UniversityDepartment of Health Services Research, Faculty of Health Medicine and Life Sciences, Maastricht UniversityAbstract 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.http://link.springer.com/article/10.1186/s13643-018-0799-1Catastrophic health expenditureImpoverishmentOut of pocket paymentsSub-Saharan AfricaScoping review |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Purity Njagi Jelena Arsenijevic Wim Groot |
spellingShingle |
Purity Njagi Jelena Arsenijevic Wim Groot Understanding variations in catastrophic health expenditure, its underlying determinants and impoverishment in Sub-Saharan African countries: a scoping review Systematic Reviews Catastrophic health expenditure Impoverishment Out of pocket payments Sub-Saharan Africa Scoping review |
author_facet |
Purity Njagi Jelena Arsenijevic Wim Groot |
author_sort |
Purity Njagi |
title |
Understanding variations in catastrophic health expenditure, its underlying determinants and impoverishment in Sub-Saharan African countries: a scoping review |
title_short |
Understanding variations in catastrophic health expenditure, its underlying determinants and impoverishment in Sub-Saharan African countries: a scoping review |
title_full |
Understanding variations in catastrophic health expenditure, its underlying determinants and impoverishment in Sub-Saharan African countries: a scoping review |
title_fullStr |
Understanding variations in catastrophic health expenditure, its underlying determinants and impoverishment in Sub-Saharan African countries: a scoping review |
title_full_unstemmed |
Understanding variations in catastrophic health expenditure, its underlying determinants and impoverishment in Sub-Saharan African countries: a scoping review |
title_sort |
understanding variations in catastrophic health expenditure, its underlying determinants and impoverishment in sub-saharan african countries: a scoping review |
publisher |
BMC |
series |
Systematic Reviews |
issn |
2046-4053 |
publishDate |
2018-09-01 |
description |
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. |
topic |
Catastrophic health expenditure Impoverishment Out of pocket payments Sub-Saharan Africa Scoping review |
url |
http://link.springer.com/article/10.1186/s13643-018-0799-1 |
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