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Catastrophic expenditure and impoverishment after caesarean section in Sierra Leone : An evaluation of the free health care initiative

van Duinen, Alex J. LU ; Westendorp, Josien ; Ashley, Thomas ; Hagander, Lars LU orcid ; Holmer, Hampus LU ; Koroma, Alimamy P. ; Leather, Andrew J.M. ; Shrime, Mark G. LU ; Wibe, Arne and Bolkan, Håkon A. (2021) In PLoS ONE 16(10 October).
Abstract

Background Utilizing surgical services, including caesarean sections, can result in catastrophic expenditure and impoverishment. In 2010, Sierra Leone introduced the Free Health Care Initiative (FHCI), a national financial risk protection program for the most vulnerable groups. Aim of this study was to investigate catastrophic expenditure and impoverishment related to caesarean section in Sierra Leone and evaluate the impact of the FHCI. Methods Women who delivered by caesarean section in nine hospitals were followed up with home visits one month after surgery, and data on medical and non-medical expenditures were collected. Individual income was estimated based on household characteristics and used to determine catastrophic expenditure... (More)

Background Utilizing surgical services, including caesarean sections, can result in catastrophic expenditure and impoverishment. In 2010, Sierra Leone introduced the Free Health Care Initiative (FHCI), a national financial risk protection program for the most vulnerable groups. Aim of this study was to investigate catastrophic expenditure and impoverishment related to caesarean section in Sierra Leone and evaluate the impact of the FHCI. Methods Women who delivered by caesarean section in nine hospitals were followed up with home visits one month after surgery, and data on medical and non-medical expenditures were collected. Individual income was estimated based on household characteristics and used to determine catastrophic expenditure and impoverishment for each patient. The impact of the FHCI was assessed by comparing actual expenditure with counterfactual expenditures had the initiative not existed. Results For the 1146 patients in the study, the median expenditure was 23 (IQR 4; 56) international dollars (Int$). Patients in the poorest quintile spent a median Int$ 59 (IQR 28; 76), which was significantly more than patients in the richest quintile, who spent a median Int$ 17 (IQR 2; 38, p<0.001). Travel (32.9%) and food (28.7%) were the two largest expenses. Catastrophic expenditure was encountered by 12.0% and 4.0% (10% and 25% threshold, respectively) of the women. Without the FHCI, 66.1% and 28.8% of the women would have encountered catastrophic expenditure. Conclusion Many women in Sierra Leone face catastrophic expenditure related to caesarean section, mainly through food and travel expenses, and the poor are disproportionally affected. The FHCI is effective in reducing the risk of catastrophic expenditure related to caesarean section, but many patients are still exposed to financial hardship, suggesting that additional support is needed for Sierra Leone's poorest patients.

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organization
publishing date
type
Contribution to journal
publication status
published
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in
PLoS ONE
volume
16
issue
10 October
article number
e0258532
publisher
Public Library of Science (PLoS)
external identifiers
  • pmid:34653191
  • scopus:85117345018
ISSN
1932-6203
DOI
10.1371/journal.pone.0258532
language
English
LU publication?
yes
id
1dac9c80-cd51-4895-bf95-16092e11e1b1
date added to LUP
2022-03-09 16:47:02
date last changed
2024-06-27 12:49:15
@article{1dac9c80-cd51-4895-bf95-16092e11e1b1,
  abstract     = {{<p>Background Utilizing surgical services, including caesarean sections, can result in catastrophic expenditure and impoverishment. In 2010, Sierra Leone introduced the Free Health Care Initiative (FHCI), a national financial risk protection program for the most vulnerable groups. Aim of this study was to investigate catastrophic expenditure and impoverishment related to caesarean section in Sierra Leone and evaluate the impact of the FHCI. Methods Women who delivered by caesarean section in nine hospitals were followed up with home visits one month after surgery, and data on medical and non-medical expenditures were collected. Individual income was estimated based on household characteristics and used to determine catastrophic expenditure and impoverishment for each patient. The impact of the FHCI was assessed by comparing actual expenditure with counterfactual expenditures had the initiative not existed. Results For the 1146 patients in the study, the median expenditure was 23 (IQR 4; 56) international dollars (Int$). Patients in the poorest quintile spent a median Int$ 59 (IQR 28; 76), which was significantly more than patients in the richest quintile, who spent a median Int$ 17 (IQR 2; 38, p&lt;0.001). Travel (32.9%) and food (28.7%) were the two largest expenses. Catastrophic expenditure was encountered by 12.0% and 4.0% (10% and 25% threshold, respectively) of the women. Without the FHCI, 66.1% and 28.8% of the women would have encountered catastrophic expenditure. Conclusion Many women in Sierra Leone face catastrophic expenditure related to caesarean section, mainly through food and travel expenses, and the poor are disproportionally affected. The FHCI is effective in reducing the risk of catastrophic expenditure related to caesarean section, but many patients are still exposed to financial hardship, suggesting that additional support is needed for Sierra Leone's poorest patients.</p>}},
  author       = {{van Duinen, Alex J. and Westendorp, Josien and Ashley, Thomas and Hagander, Lars and Holmer, Hampus and Koroma, Alimamy P. and Leather, Andrew J.M. and Shrime, Mark G. and Wibe, Arne and Bolkan, Håkon A.}},
  issn         = {{1932-6203}},
  language     = {{eng}},
  number       = {{10 October}},
  publisher    = {{Public Library of Science (PLoS)}},
  series       = {{PLoS ONE}},
  title        = {{Catastrophic expenditure and impoverishment after caesarean section in Sierra Leone : An evaluation of the free health care initiative}},
  url          = {{http://dx.doi.org/10.1371/journal.pone.0258532}},
  doi          = {{10.1371/journal.pone.0258532}},
  volume       = {{16}},
  year         = {{2021}},
}